Budget Woes Threaten Progress In Mental Health Care
At a Taco Bell outside the Didi Hirsch Mental Health Care headquarters in Culver City, a man named Glynn is taking a lunch break. He wears a backwards baseball cap and orange and gold Fubu sweatpants. He was diagnosed with a mental disorder 20 years ago. He works at the center’s adult day care center, where he helps put out utensils and chops food for clients’ meals. He used to make money by gathering cans in the neighborhood and recycling them.
“It was freeing, in a way,” he said. “You don’t have a boss over you all the time.”
With Didi Hirsch, though, he’s much better off. He talks about the classes Didi Hirsch offers to people dealing with severe and persistent mental illnesses. “They have classes to teach you how to get a job. How to present yourself.”
Over the last decade or so, mental health programs have begun to convert from the medical model to a system in which the clients are given more of an equal, empowered voice in their treatment. Rather than simply manage the symptoms of mental illness, more and more programs are focused on the recovery of the client so that they can become fully functioning, productive members of society.
Agencies such as Didi Hirsch, The Village in downtown Long Beach and Lamp Community in Skid Row have programs that focus on the whole person through housing, money management, education and job training, along with the more typical therapeutic care.
Now those advances are in jeopardy because of severe budget cuts signed into weeks ago by Gov. Jerry Brown. In an effort to close the state’s $26 billion budget deficit, the governor has gutted a variety of social services, among them mental health.
Brown has so far taken $861 million out of the Mental Health Services Act, a 2004 voter-approved memorandum, called Proposition 63, to use a tax on millionaires to fund county mental health services. The law was hailed as an advancement not only because of the extra funding it provided, but also because its language encouraged a more recovery-based system statewide. Now many are worried that the cuts, along with the economy, will further marginalize the clients. Some call the cuts blatantly illegal.
“The mental health services that have saved so many lives and have begun to transform ours into a more progressive system are in jeopardy,” said Delphine Brody, an advocate with the California Network of Mental Health Clients. “And exactly how much in jeopardy depends on what happens next with the budget.”
When Brown proposed his budget last year, he said that the money taken out of the Mental Health Services Act would be replaced by other funds in the next fiscal year. The Legislative Analyst Office points out that raiding the act without voter approval may be illegal. Brown is calling it realignment. Brody and other advocates call it a “swindle.”
Now the cuts are a done deal, though the state has no clear plan to repay. And with the current stall in discussions between legislators to extend 2009 tax extensions, it is looking less and less likely that the money will come back.
Initially, the Los Angeles County Department of Mental Health and some advocates saw promise in the model because it would give counties more control over revenue streams. That assessment now appears to have been overly optimistic, Brody said.
“Those who were most jubilant about the governor’s proposal, I think, greatly underestimated Republican opposition to any sort of tax proposal.”
Rusty Selix of the Mental Health Association in California, one of the advocates who, with reservation, expressed initial support for the governor’s plan, now sounds more cautious. Still, he said, the outcome remains to be seen. “If you had called me two months from now and there was still nothing worked out, then I think there would be more panic,” he said.
“One of those things that is the big unknown is, are those funds going to be replaced, and is it still going to be tied to those taxes.”
The Smaller They Are, the Quicker They Fall
The economy is already taking its toll on mental health services. Verdugo Mental Health Care, an agency that serves lower-income communities in Glendale and Pasadena, declared bankruptcy on March 28. It will be sold to Didi Hirsch and will become that agency’s 11th site in the Los Angeles area.
A drop in private and county funding coupled with a recent construction project caused the agency to go under, Verdugo’s lawyers in the bankruptcy said.
Small agencies like Verdugo are most vulnerable to changes in the economy and county funding because they often lack the cushion of private donations that larger agencies like Didi Hirsch and Lamp have, said Didi Hirsch’s CEO Kita Curry.
“Smaller agencies have a harder time weathering the inevitable loss of revenue.”
Verdugo and Didi Hirsch are moving full-throttle to make sure the services in the area don’t disappear because of Verdugo’s financial troubles.
“[Verdugo] believes that if the assets are not sold to another nonprofit mental health provider under contract with DMH (like Didi Hirsch), the purchase price would be lower and services would cease to be rendered,” said Andrew Parlen, the Verdugo’s bankruptcy lawyer, in an email.
The L.A. department has fared better than most because it had set aside reserve funding before the recession and it used Mental Health Services Act dollars to make up for cuts. But now even those funds are in peril. “There are counties that basically shut down their systems,” Curry said.
Still, with a state raid on Prop. 63, there would not be the same safety net in place and agencies would be less able to provide services. “But we will fight it very hard,” Curry said, speaking about the various advocacy groups. The clients themselves, she said, often don’t have much time for public advocacy because they spend so much time looking for housing and dealing with their own issues. But some do speak out.
“They’re frightened when they read about this stuff, wondering, are these services going to go away?”
A Changing System
The change in the system of mental health care from the clinical model to a more recovery-focused model is something for which advocates like David Gonzalez and Ron Schraiber have fought for years. The programs funded by Prop 63 are supposed to do more than give treatment; they’re also supposed to empower clients. Current fiscal plans threaten to put this progress on hold.
Gonzalez visited his psychiatrist in New York City after being diagnosed with his mental illness. The psychiatrist asked him, Where do you see yourself in five years? “I had never really given it much thought,” Gonzalez told me. “Because I was so used to decisions being made on my behalf.”
“So I thought about it a little while, and I told the doctor, ‘I could see myself being the director of a psychosocial clubhouse.’” The doctor asked him if he had been taking his medication. When Gonzalez said that he had, the doctor said, “Well maybe we need to increase your dose.”
Now Gonzalez is a nationally known advocate for change in mental health services and is part of a movement to give mental health clients a greater voice in their care. Two years ago, he came to California, which had begun to transform its own mental health services. But that progress may soon be set back by severe reductions in funding.
The system is changing, but many take the promises of change with a grain of salt.
Schraiber, a client representative for the Los Angeles Department of Mental Health, has the zeal of a 1970s radical activist and a sense of humor to match. He says he “cracked up” at UC Irvine during graduate school. He’s been hospitalized “eight times at Camarillo, three at Metropolitan, one at Napa and several other hospitals.” He’s been arrested 15 times, including once during a demonstration at Cal State Northridge during his undergrad years. As he puts it, that was “B.C.” (Before Crazy)
The era of institutionalization and the medical model, he says, was a dark one for mental health services. The fear and the stigma made clients not want to seek help. “Many of us have preferred the chill of the night air to the cold reality of our psychiatric treatment,” he said.
Lamp, The Village and Didi Hirsch are outstanding programs, but they are not necessarily indicative of the entire system, advocates say. “They’re the exception that proves the rule that the mainstream service,” says Catherine Bond, a client advocate. She sees the system is attempting to transform. “But the problem is, they’re very entrenched in the medical model and all of the funding demands that the billing show medical necessity.”
“We’re stuck in a system that gives lip service to the concept of transformation.”
This report is part of our special series, California in Crisis, which explores the personal, local ramifications of the state budget debacle. Please click here for more.