Status of California's County Mental Health Programs

In November 2004 California voters passed the Mental Health Services Act (MHSA), which increased funding for the public mental health system by imposing a 1% tax on individual incomes over $1 million. The legislation's goal is to transform California's system by ensuring that funds are used for new or expanded innovative programs based on the recovery model. Over the past three years, many have expressed concerns about how to determine whether the new funding would spark the intended transformation because of the lack of baseline measurement in many of the areas expected to change.

A new report released by the Petris Center on Health Care Markets and Consumer Welfare at the University of California, Berkeley, attempts to address these concerns by providing data on the structure, organization, and financing of county mental health departments in the 2004 fiscal year, just before voters passed MHSA. According to the report, departments spent most of their budgets on outpatient services, with low overhead and low spending on hospitalization.

Forty-four counties representing 98% of California's population responded to the Petris Center survey. In 2004 counties spent an average of $5,011 per client per year on services, and services represented an average of 90 percent of budgets. An average of 2% of budgets was spent on state hospital beds, and 4% on institution for mental disease (IMD) beds. One-third of the budgets was spent on child and family services. Nearly 40% of mental health department employees were bilingual. Most counties had experience with at least one program to provide innovative models of care.

The survey also looked at the amount of consumer involvement in county mental health departments before passage of MHSA. Sixteen percent of counties included a consumer as part of the management team, and one-third had a program for hiring consumers as county employees. The average spending on peer and family services was $34 per client for adults and $54 per client for children and families.

The survey is part of a three-year study by the Petris Center, funded by the California HealthCare Foundation, to evaluate MHSA's impact. The 79-page report, California on the Eve of Mental Health Reform, is available on the Petris Center Web site at www.petris.org.