By Alison Monroe. February 24, 2024,
https://www.eastbaytimes.com/2024/02/24/opinion-prop-1-is-the-best-chance-in-decades-to-change-the-system/
For nine years, I begged Alameda County agencies to give my intermittently homeless and schizophrenic ward the care she needed to stay alive and well. Last September, some 12 years after I became her legal guardian, she fatally overdosed on meth and fentanyl.
The mental health system operating in California counties like mine could not save my daughter, and Proposition 1, the mental health funding reform and bond measure on the March ballot, is our best chance in many years to change it.
The Mental Health Services Act, the “millionaire’s tax” of 2004, has generated tens of billions of dollars for California’s counties to help people suffering from the most “serious, disabling and persistent” forms of mental illness. But unfortunately today’s system fails to keep people with serious mental illness alive, well and out of jail.
Repeated audits, such as the Mental Illness Policy Org’s 2013 report “Bait and Switch,” showed how mission creep and waste were undermining the implementation of the MHSA. Money has been made available for health fairs, speakers’ bureaus, support groups and advertising campaigns to “be aware of mental health,” but not adequately for beds and homes — outside jail — for the seriously mentally ill.
Without actual places to live, stay and be treated, there is no continuum of care and no recovery for our family members, many of whom do not even know they are ill.
We don’t want them institutionalized — we want them to be treated right away when the illness appears, and before their brains are damaged by sustained psychosis and street drug use.
Early on in my nine-year struggle for my daughter, public facilities kept discharging her despite knowing she would immediately use meth and run away. I could not understand why so much MHSA money was being spent so freely while the county rationed hospital beds and supportive residences so strictly.
At one point, I didn’t even want to eat the (excellent) ham sandwiches served at public meetings for Alameda County’s behavioral health department simply because MHSA money paid for them. I eat them now because, well, people have to eat — and because I dare to ask for so much more from the system.
At first, my group, FASMI, wasn’t sure what to make of Prop. 1. We initially opposed Senate Bill 326, one of the legislative parents of Prop. 1, as not going far enough to reform the system.
It doesn’t include a right to treatment — something families have been asking for and which ought to be a human right for everyone with a no-fault illness.
But the Prop. 1 package provides many good things, including state oversight and evaluations of county outcomes, which the MHSA sufficiently lacked. It includes treatment of substance abuse so our dual-diagnosis family members don’t fall between stools. It also moves population-based
prevention programs (5% of the MHSA budget) to the state, where oversight officials can decide free of local lobbying what it might mean to prevent mental illness.
Furthermore, Prop. 1 retains local funding that can prevent relapse and deterioration of people already diagnosed with serious illness, which was the original meaning of “prevention” in the MHSA.
The $6.4 billion bond measure included with Prop. 1 designates $2 billion for supportive housing and $4.4 billion for mental health treatment beds — 10,000 of them. I was overjoyed that the bill was amended late to make clear that at least some of the bond money could be used to build secure beds, locked or unlocked, temporary or longer-term — not only hospitals but crisis residentials, residential drug-treatment and dual-diagnosis programs, and peer respites.
Prop. 1 is not intended to solve homelessness. It’s about the mentally ill, treating conditions that affect 82% of the homeless population at some point, according to a UCSF study. To solve the kind of homelessness that is due to rising rents and stagnant income, we need totally different measures.
Prop. 1 will not “hide” anyone, either. Many of our loved ones are already being hidden in jails and prisons, and — for a day or two at a time — in psychiatric emergency rooms. We will not allow them to drop out of sight or out of mind.
A vote against Prop. 1 is a vote to preserve a failed system. This measure will give the state more control over spending and provide new money for actual countable facilities that will give the system a footprint.
Rest assured, this is not blind optimism. When money is thrown at the powerless, it doesn’t necessarily stick, and it can create an increasingly entitled and entrenched bureaucracy wherever it goes. But California has a chance to steer change under Prop. 1 and move in the direction that saves lives.
The state is finally beginning to force counties to evolve and give the public a unified, responsible system. FASMI and others will watch the implementation of Prop. 1 closely, and we will help the state watch over that implementation.
We won’t be fooled by ham sandwiches.
— Alison Monroe is a retired editor in Oakland and co-founder of Families Advocating for the Seriously Mentally Ill. Monroe wrote this column for CalMatters
Proposition 1 would raise over $6 Billion to build the infrastructure needed to provide a full continuum of care for those with serious mental illnesses, and institute reforms to the way counties use the revenue they receive from the Mental Health Services Act, approved by California voters in 2004.
The promise of MHSA was that it would enable counties to deliver comprehensive care for children, adults and seniors living with the most serious and disabling mental illnesses, generally understood to include brain-based disorders like Schizophrenia, Bipolar Disorder, Schizoaffective Disorder, and Serious Depression. But despite the billions of dollars awarded to counties over the past two decades, those struggling with these illnesses continue to suffer, denied access to life-saving medical treatment and the supports needed to live in recovery in our communities.
Reform of MHSA is long overdue. If, as opponents to Proposition 1 claim, the existing programs being funded by MHSA are working so well, why are those with serious mental illness languishing on our streets visibly deteriorating, dying premature and preventable deaths, likelier to wind up in our jails and prisons than to find a treatment bed? The status quo is not working, especially for those who because of their ethnicity or the color of their skin have historically been the most marginalized and who suffer the harshest punishment for being ill, being the most likely to be incarcerated and the least likely to receive sustained care in our hospitals and communities.
Implementation of the original MHSA law left it to counties and their local mental health departments to determine their own rules for MHSA spending and programs. Unfortunately, this revenue stream has too often been diverted into social service programs unrelated to Serious Mental Illnesses (SMI). Some of these programs may benefit the wellness of the general public or special segments of the public, but unless they are helping those with SMI, they should find their funding elsewhere. They should not be hijacking the funding that was dedicated for this very specific and very neglected population.
Those with these brain disorders need the same supports as those with any other medical illness: access to hospitals when warranted, the stability of a home to return to, and services in the community. But since it’s enactment two decades ago, MHSA has only funded community-based services. It has failed to provide for hospitals and sufficient housing, without which there is no continuum of care, there is no recovery. Brain disorders are some of the most complex illnesses to treat and sometimes the only way to monitor the effects of life-saving medications and other therapies is in an inpatient facility.
This is not a call for re-institutionalization, as some opponents wrongly claim. On the contrary, treatment in a secure therapeutic setting at the right time and for the right length of time can stabilize a person with SMI, preventing dozens of returns trips through the revolving doors of emergency rooms for traumatic and costly ‘crisis stabilization’ that doesn’t stabilize anyone and only leads to more crises. It also delays treatment, leaving people in untreated psychosis, which is known to cause irreversible damage to the brain and dim the chances for recovery. When people receive sustained treatment in therapeutic settings, they can more successfully transition back into the community and live safely in housing that provides an appropriate level of support and continuing access to treatment and services.
Proposition 1 also fixes the gap in service for those with the related problem of substance use disorder. The majority of those with untreated mental illness wind up self-medicating with street drugs; substance abusers often have underlying mental disorders or develop them as a result of their addictions. The Modernization Act requires that treatment providers and facilities prepare to deal with these intertwined disabilities.
And most importantly, Proposition 1 imposes stricter accountability by requiring that outcomes are measured and spending audited, with penalties for failure to comply with the intent of the law. These reforms are needed to prevent the kinds of mission creep that has been occurring under the existing MHSA implementation.
Proposition 1 will not end all homelessness, nor is that it’s intent. But properly implemented, it can help the most vulnerable segment of this population: those with treatable but untreated mental illnesses. In the long run, it will reduce the burden on society; the billions that we currently pour into policing, emergency services, and incarceration. Most importantly, it will reduce human suffering and enable many to regain lives of dignity and hope.
— Patricia Fontana, 1/24/2024
At this time, FASMI is NOT a 501(c)(3) nonprofit entity and donations are not tax-deductible.
