OT - Proposition 63 - Tax the Rich | Arthritis Information
http://www.latimes.com/news/science/la-me-mental16sep16,1,39 37015,full.story?ctrack=5&cset=true
Please remove any extra spaces and try again if the link doesn't work.
This article is about a novel mental health bill, Proposition 63, which is just getting under way. It 'taxed the rich' to pay for rebuilding the mental health system that was dismantled under Reagan.
Pip
To the top.
Pip
I couldn't read the story because you have to be registered and I'm not.
I was able to get to it fine and im not registered. Have to register to see the article
By Scott Gold and Lee Romney, Los Angeles Times Staff Writers
September 16, 2007
For two years after Alfredo Ruiz was diagnosed with schizophrenia, his family tried -- and failed -- to find him help.
His mother knocked without success on the doors of shelters and medical
clinics throughout the San Fernando Valley. Meanwhile, her son's
illness sent him deeper into psychosis and paranoia. Unemployed and
homeless, without access to treatment, he began sleeping under a bridge
-- a knife under his body, just in case.
Today, Ruiz, 31, is stable and lucid --
and in the vanguard of a novel experiment in healthcare: Proposition
63, California's 1% surtax on incomes above million that will
generate .5 billion this fiscal year for treatment of the mentally
ill.
Approved by voters in 2004, Proposition 63 aims to reform the
long-troubled mental health system by finding and helping sick people
who have historically had little access to care -- youths on the verge
of homelessness, the elderly, poor minorities -- and severely ill
adults who have fallen through the cracks. Proposition 63's authors
hope the initiative will transform California's public mental health
system, eventually creating a culture in which illness is no longer a
patient's defining characteristic.
Ruiz is an early beneficiary of one of Proposition 63's main efforts, a
style of therapy known as "whatever it takes" -- based on the notion
that mental illness is rarely an isolated problem but is typically
accompanied by physical illness, social isolation, educational
deficiencies, poverty and other problems.
Now, instead of care that was patchwork at best, Ruiz is receiving
comprehensive help from a team of more than a dozen clinicians.
In the past, if he had been lucky enough to score a spot in a shelter,
Ruiz would have been handed an address and a bus token. Instead, his
new caseworkers found him a place to live, drove him there -- and
stopped to buy him a sleeping bag and toothbrush on the way. No longer
overburdened by massive caseloads, they ferry him to appointments to
ensure that he receives disability benefits. Not only do his case
managers stop in weekly at his shelter to check on him, his
psychiatrist visits too, to ensure that his pills are working -- a
level of care that would have been a preposterous extravagance not long
ago.
"They saved our lives," said Ruiz's mother, Maria Orduņo.
But even as some have begun receiving platinum-level services
unimaginable before Proposition 63 -- officials hope that 17,000 people
statewide will be receiving "whatever it takes" therapy by next summer
-- other kinds of care have deteriorated.
Some cash-strapped counties have slashed traditional funding for mental
health services, and the state has made cuts too. In almost every
corner of California, which has an estimated 1 million people with
serious mental illness or emotional disturbance, core mental health
budgets are stagnant at best while demand for services balloons.
Although mental health advocates in the state are thrilled about a
guaranteed funding source that isn't subject to budgetary whims, they
worry that innovative programs created with the new money are being
layered on top of a disintegrating mental health system that
Proposition 63 does nothing to correct.
And the new law forbids counties from using Proposition 63 money to
backfill -- to pay for programs that existed prior to its passage. That
provision was written to protect the new money, to keep counties from
making cuts elsewhere that would undermine the promise of the new
program. But it has also added to the sense among some healthcare
administrators that their hands are tied.
"Proposition 63 was a huge policy mistake," said Jeff Smith, executive
director of the Contra Costa Regional Medical Center, which cares for
scores of poor, uninsured residents. "It took a good amount of money
and dedicated it to new services at the same time that old services
have been just ravaged. Instead of solving a problem, it just covered
it over -- with a nice, fluffy frosting."
Early signs suggest that many counties -- as well as the state -- are
cutting with one hand even as they are providing new, top-of-the line
services with the other:
* Los Angeles County, which runs the nation's largest public mental
health system, will receive more than 5 million in Proposition 63
money this year to fund an array of innovative programs. But at the
same time, a -million shortfall in the county's core mental health
budget has resulted in long waiting lists at many clinics. Some
patients have had their number of visits with therapists cut in half;
others no longer receive counseling at all.
* As part of a budget crisis, Santa Clara County recently ordered its
Department of Mental Health to cut million from its budget --
almost as much as the million it will receive through Proposition
63 in 2007-08.
* Fresno County will use its .6 million in Proposition 63 funds to
provide exhaustive care to 540 severely ill residents and for rural
outreach, among other programs. But the county is simultaneously
cutting about million from the rest of its mental health budget.
More than 140 of the county's 636 mental health staff positions have
been eliminated, and the county will curtail services for about 650
clients with less severe conditions, such as depression and anxiety.
* Shasta County will receive .7 million in Proposition 63 money. But
the new funding comes as the county has been forced to devote an
increasing chunk of its mental health budget to expensive Medi-Cal
cases -- leaving about million less for standard patient care than
before Proposition 63 began. The Health and Human Services Agency has
laid off six of its nine psychologists. And the county now serves 500
fewer patients than before Proposition 63.
* In August, Gov. Arnold Schwarzenegger eliminated funding for a
successful -million program for the homeless mentally ill -- the
program that served as the model for Proposition 63. Advocates say the
cut violates the new law, which specifically forbids the state from
dropping below the funding commitment it had made to mental health
before Proposition 63. Mental health advocates express conflicting
feelings about the new law.
"The acknowledgment that mental health care is broader than
medication and psychotherapy is brilliant. It's wonderful," said Marta
McKenzie, director of the Shasta County Health and Human Services
Agency. "But how do you build this new set of programs for a small
population when you have this overwhelming set of responsibilities for
this larger group of clients?"
An attempt to fill gapsProposition 63 was written amid a growing
perception among advocates, lawmakers and the mentally ill themselves
that there were huge gaps in mental health care -- particularly at the
community level, which had been stressed to the breaking point by the
closure of large, outdated mental hospitals starting in the 1960s. It
was a national problem but particularly acute in California.
"Forty years is long enough to wait," said state Sen. Darrell Steinberg
(D-Sacramento), a Proposition 63 author. "This is the unspoken issue of
our time."
About half the measure's funds are aimed at the style of "wraparound"
care being received by Alfredo Ruiz. Addressing all the needs of
someone with severe mental illness is expensive: The state estimates
the cost at an average of ,000 per client per year.
But this type of intensive case management made possible by Proposition
63 can interrupt an even costlier cycle of crises, studies have shown.
And partly because it expects consumers to be involved in their own
care, it can help severely mentally ill men, women and children
function and even thrive.
Across the state, mental health officials say, they are also seeing the benefits of other programs funded by Proposition 63.
In San Luis Obispo County, for example, a new free counseling service
for poor Spanish-speaking residents is at capacity. In Monterey County,
parents are learning how to help their adopted children recover from
trauma and abuse.
And in Tulare County, a severely mentally ill man in his early 20s is
in stable housing -- along with his siblings and parents -- after a
caseworker found them living in tents. Before Proposition 63,
regulations would have forbidden the county from helping the young
man's family members, without whom he would falter.
"He invited us to his bedroom, which was two pieces of canvas," said
Walt Lunsford, chief operating officer of Turning Point of Central
California, which is running Proposition 63 programs in several
counties. "Now he's getting mental health treatment. And, not
surprisingly, he's getting better."
Los Angeles County is the largest beneficiary of the tax; the county
could receive more than billion in the next five years, and dozens
of new programs are underway. Downtown, trained professionals have
started accompanying police on 911 calls involving people with mental
illness to defuse situations before they become violent. In Van Nuys, a
clubhouse will target the social isolation that plagues many people
with mental illness. And hundreds of patients will be treated through
"whatever it takes" therapy.
The new programs are already showing results. At a recent morning
meeting at a county clinic in Granada Hills, a social worker's
announcement was met with cheers: "Eric and I went for a walk."
Eric, diagnosed with schizophrenia, had not left his house for nine
years. His Proposition 63-funded social worker had worked for nearly
three months to lure him out -- time she could never have devoted under
her previous caseload. Social workers operating in Proposition 63
programs often average fewer than 15 clients each; under the old system
they might have carried 90 at a time. "We've been given a gift," said
Wendi Tovey, director of the Granada Hills program.
But some county residents -- those who don't need the kind of intensive
treatment offered in the new programs -- are receiving less care today
than before California launched its ambitious reform effort.
For 10 years, Vernon Hemingway, 52, relied on free group counseling
sessions in his skid row neighborhood to stave off the debilitating
bipolar cycles that had cost him a stable, middle-class life. But as
part of L.A. County's push to close a budget shortfall, the program was
recently pared back severely.
Sessions once run by professionals are now run by patients themselves.
Hemingway says the meetings are no longer useful, that they have become
dominated by disruptive, unmedicated patients. Several months ago, he
quit. Now he spends most of his time alone, watching TV in a
9-a-month hotel room.
"I don't put my business out on the street. That was one place you
could talk," he said. "It was the one place you felt safe -- physically
and mentally. It meant a lot."
Stories like Hemingway's are increasingly common across the state,
leading some advocates for the mentally ill to question whether
Proposition 63 can transform care in the way its backers envisioned.
"It's the same old song," Hemingway said. "They raise your hopes. And then they let you down."
Core services sufferingThe new law expressly forbids counties
from using Proposition 63 money to replace funding for existing
programs and requires the state to at least maintain its 2004 level of
mental health funding.
But the provisions have not stopped the erosion of the bread-and-butter
mental health system -- leaving Proposition 63's architect deeply
concerned.
"My worst nightmare," Steinberg said at a recent rally against planned
cuts to mental health care, "is to wake up 10 years from now and find
out that. . . we didn't increase mental health services."
The measure, Steinberg emphasized, was never intended as a "cure-all
for mental health in California. It's intended to begin -- emphasis on
begin
-- to make up for 40 years of neglect." Still, Steinberg has noted with
growing alarm the false perception that "mental health is now being
taken care of."
Indeed, across the state, some counties wrestling with budget pressures
seem to view the influx of Proposition 63 cash as license to cut
elsewhere.
State officials who oversee Proposition 63 have threatened legal action
if it can be shown that counties are relying on the new program to
cushion the blow of budget cuts in the mental health system.
In the meantime, old services are sometimes being cut before new ones are up and running.
"We are kind of jumping between two precipices," said Santa Clara
County Supervisor Liz Kniss. "We are jumping off one because we can't
continue to fund what we've funded. And we are waiting to jump to the
other side. What I worry about is the canyon in between."
Proposition 63 came along at a time when many county mental health
departments were in crisis. In recent years, caseloads -- and the cost
of care -- have soared while the patchwork of funds that flow to
counties for mental health services has failed to keep pace.
In Fresno County, current cuts are just the latest in a crisis that has
eliminated two-thirds of the adult mental health department staff in
three years. Giang Nguyen, director of the Department of Behavioral
Health, still calls Proposition 63 "a blessing." In the meantime, she
acknowledges, the waits at outpatient clinics will be longer and
caseloads in non-Proposition 63 programs will climb.
The lament can be heard in county after county.
"We're being strangled," said Glenn County Mental Health Director Maureen Hernandez.
Hernandez called her small county's Proposition 63 infusion -- about
0,000 for the coming year -- "pitifully small" compared with strains
in the overall .6-million budget. Proposition 63 will provide a new
drop-in center and "whatever it takes" services for five to 10 clients.
But families who rely on the county's core services face years of
belt-tightening.
Said Hernandez: "You don't bring the neighborhood over and feed them when your own children are starving."
Left out in the middleNowhere, perhaps, is the dichotomy as
stark as in Los Angeles County, which has a .2-billion mental health
budget and serves 200,000 clients each year.
Patients who are stable -- well enough to function in society and, in
many cases, work and live on their own -- are thriving in new "wellness
centers" funded by the new law. There, they have access to what many
clinicians believe is the last piece in making a patient's life whole
again: a group of friends, an art class, an outing to a bowling alley.
At the other end of the spectrum, patients who are completely
debilitated by illness are receiving what many say is the best public
mental health care ever offered in California -- the "whatever it
takes" therapy that is helping Alfredo Ruiz.
But it's the thousands of patients in the middle -- who suffer from
illnesses that are serious but not disabling, and about half of whom
are indigent and uninsured -- who have been left in the lurch.
"We have people coming in and we have to say: 'I'm sorry, you're not
sick enough. But when you get really sick, come back and see us,' "
said Marvin J. Southard, director of the Los Angeles County Department
of Mental Health. "It's ridiculous. But that's the situation we find
ourselves in."
Trying to close its -million shortfall, the county curtailed
services in its mental health clinics partly by eliminating or
transferring to Proposition 63 programs 154 staff positions out of
about 3,200.
Meanwhile, some of the new programs have signed up only about a third
of the clients they are expected to care for by the end of the year. At
the same time, at the old-fashioned outpatient clinics, many new
patients are now added to a waiting list and told to return in a week
or two -- a very long time, officials acknowledge, for someone with a
mental illness.
The Downtown Mental Health Center on skid row treats about 2,500 of the county's most challenging patients.
Within a couple of years, Proposition 63 is expected to offer a
one-stop care center there where patients would not only be treated for
mental illness but could receive medical and dental care, housing and
educational assistance, and other services.
For now, however, the center is in a bind. Ten of its 60 employees,
including half of its caseworkers, have been transferred to new
Proposition 63 programs amid the budget crunch. Others are likely to
follow in their footsteps. The result, said Larry Hurst, acting
district chief for the county Department of Mental Health's Skid Row
Management Team, is "triage."
"Now we ask: 'Are Individual A's needs more urgent than Individual B's?
What would be the risk of delaying services to Individual B? And for
how long can we do it?' " Hurst said.
"That's the reality at this time," he said. "It's swallowing that
reality that is challenging to our staff. They want to be able to do
more. But it's like emptying the Pacific Ocean with a toy pail."
scott.gold@latimes.com
leora.romney@latimes.com
I read that the US ranks pretty far down on the
list of nations with good health care for all of it's citizens. Pretty
sad commentary for the most wealthy country in the world! It seems that
the rich get what they need while the rest of us frequently make do with mediocrity
or without. Ever fight with an insurance company to get a certain drug or
medical procedure done? Until people in the US wake up to the fact that
they are being snowed, controlled, and manipulated by the strong medical, drug
and insurance lobbyists, nothing will change. In fact, medical costs are
one of the driving forces for many of us retirees that have moved to other
countries where we can continue to live at the pre-retirement level. It's
one of the main reasons we are in Panama! For example, health care in
Panama is excellent and we are finding in many ways better, more personalized
and thorough than we got in TX with Teachers Retirement insurance. Our
medications and dr apts here frequently are costing us only what we paid in the states
for co-pays -- while in TX we were paying the big bucks just for the privilege
of having insurance in the first place.
We're probably the worst in terms of mental health. What I found so fasinating is the money for this comes from 1% surtax on the income above 1M.
Most social programs are funded by 'sin taxes'. Smoking. Drinking. etc. which, of course, hits the smaller guy much harder.
It's also interesting watching the Governements trying to get around the intent of the law by cutting services elsewhere. Seems they're about to be sued. Good.
Pip
We have a huge and very beautiful mental health residential hospital
here, but when the conservative government came into the province 8
years ago they shut most of it down and there was a sudden influx of
mentally ill people living on the street. The idea was that these
people had access to other social programs, but it didn't pan out
because they are too mentally challenged to access them. 8 years later
we now have a HUGE and SHAMEFUL homeless problem we didn't used to
have, that's going to take way more resources to address than keeping
the hospital operating would have. It's an embarrassment. I
applaud the idea behind Proposition 63.
Copyright ArthritisInsight.com