California Proposition 63 (2004)

Proposition 63 was a California ballot proposition on the November 2, 2004 ballot. Its official name and title on the ballot was the Mental Health Services Act. It passed with 6,191,691 (53.8%) votes in favor and 5,337,216 (46.2%) against.

Background of Proposition 63

The initiative was written by then-Assemblyman Darrell Steinberg (who later became a State Senator) and mental health lobbyist Sherman "Rusty" Selix.^[1] In California, only thirteen initiatives affecting taxes have passed. Of these thirteen, only four have increased taxes: Proposition 99 passed in 1988, Proposition 10 passed in 1998, Proposition 63 passed in 2004, and Proposition 30 passed in 2012.^[2] The details of the initiative were:

• The new tax is to affect the wealthiest 0.1 percent of California’s taxpayers, which amounts to approximately 30,000 taxpayers. With the passage of Proposition 63, this group earning more than $1 million would experience a change in tax rate from 9.3 percent to 10.3 percent on every dollar they made over $1 million. This would result in approximately a 31 percent increase to the previous to Proposition 63's annual mental health budget of $2.6 billion.^[2] These funds are to be used to transform the State’s public mental health system, expand it, and revolutionize the existing system with a focus on promoting recovery-oriented programs.^[3]
• The Mental Health Services Act (MHSA) is projected to generate approximately $254 million in the 2004-2005 fiscal year, $683 million in 2005-06 fiscal year, and then increasing amounts subsequently. Much of the funding will provide county mental health programs funds for programs consistent with their local plans. Furthermore, uncommitted funds during FY 2005-06 will be used to establish county reserve accounts as required by the MHSA.^[4]

Overall, since the 2004-05 fiscal year, $7.4 billion has been collected and placed into the Mental Health Services Fund.^[5]

A later ballot measure, Proposition 1E appeared on the May 19, 2009 special election ballot. This measure would have authorized a fund-shift of approximately $230 million annually in income tax surcharge revenue currently earmarked for Proposition 63. However, the measure was defeated.

Purpose and Intent of the Proposition

• To address serious mental illness among children, adults, and seniors involving prevention and early intervention services and supportive medical care ^[6]
• To reduce the adverse impact from untreated serious mental illness from individuals, families, and state and local budgets ^[6]
• To expand innovative and successful service delivery programs for children, adults, and seniors, including culturally and linguistically competent approaches for underserved populations ^[6]
• To provide the state and local governments with funds adequate to meet the needs of all children and adults. State funds are available to provide services that are not already covered by individuals’ or families’ insurance programs or by federally sponsored programs.^[6]
• To ensure that all funds are spent in the most cost effective manner and services are provided following best recommended practices, with local and state oversight to ensure accountability ^[6]

Official summary

• Provides funds to counties to expand services and develop innovative programs and integrated service plans for mentally ill children, adults and seniors.
• Requires state to develop mental health service programs including prevention, early intervention, education and training programs.
• Creates commission to approve certain county mental health programs and expenditures.
• Imposes additional 1% tax on taxpayers' taxable personal income above $1 million to provide dedicated funding for expansion of mental health services and programs.
• Prohibits state from decreasing funding levels for mental health services below current levels.

Summary of Legislative Analyst's Estimate of Net State and Local Government Fiscal Impact

• Additional state revenues of about $275 million in 2004-05 (partial year), $750 million in 2005-06, $800 million in 2006-07, and probably increasing amounts annually thereafter, with comparable annual increases in expenditures by the state and counties for the expansion of mental health programs.
• Projected savings on state prison and county jail operations, on medical care expended, homeless shelters, and social services programs.^[7]
• The magnitude of these potential savings to the state and local agencies is unknown, but is projected to be as high as the low hundreds of millions of dollars annually on a statewide basis.^[7]

5 Components of the MHSA

• Community Services and Supports (CSS)–provides funds for direct services to individuals with severe mental illness^[8] jksdjn
• Capital Facilities and Technological Needs (CFTN)–provides funding for building projects and increasing technological capacity to improve mental illness service delivery^[8]
• Workforce, Education and Training (WET)–provides funding to improve the capacity of the mental health workforce^[8]
• Prevention and Early Intervention (PEI)–provides investment of 20% of the MHSA funding for outreach programs for families, providers, and others to recognize early signs of mental illness. The overall goal is to improve early access to services and programs, to reduce stigma, and discrimination experienced by individuals with mental illness. MHSA Prevention and Early Intervention Programs serve Californians of all ages.^[8]
• Innovation (INN)–funds and evaluates new approaches increasing access to the underserved and unserved communities, promote interagency collaboration, and increase the overall quality of mental health services ^[8]

Prevention and Early Intervention (PEI) Programs

• Counties, with the exception of small counties, are required to spend 51% of PEI funds on individuals between ages 0 and 25. The rationale is that half of all mental disorders start by age 14 and three fourths of mental disorders start by age 24.^[9]

Mental Health Services Oversight and Accountability Commission (MHSOAC)

• As of January 2011, the Mental Health Services and Oversight and Accountability Commission (MHSOAC) appropriated more than $742.5 million of PEI funds for all 58 counties.^[9]
• An additional $129 was appropriated for statewide PEI efforts for suicide prevention, improving student mental health, and to reduce the stigma and discrimination associated with mental health.^[9]
• Approximately at least three quarters of the California counties include one or more programs to address the MHSA objectives such as reducing school failure, incarcerations, and mental health-related stigma and discrimination.^[9]
• As of November 2010, the MHSOAC approved 28 Innovation plans for 26 counties, a total of $108,357,624.^[10]

Results of the Community Services and Supports (CSS) Programs

• Community Services and Supports (CSS) programs are strongly associated with reductions in homelessness. Transition age youth (TAY) and adults have been found to have reduction in number of days spent homeless. Furthermore, these reductions have complemented by additional improvements in residential outcomes. The number of days spent in restrictive settings and overall consumers of these setting such as residential treatment and emergency shelters has decreased form consumers in all age groups. The number of consumers and days spent in residential or independent living settings increased.^[11]
• There is a strong association between Community Services and Supports (CSS) programs’ participation and reductions in acute psychiatric hospitalizations.^[11]
• The number of mental health emergencies at hospitals has decreased across all age groups, especially for TAY and older adults.^[11]
• There has been an association with reductions in arrests with participation in CSS programs, especially for TAY, adults, and older adults. There is a wide range in variance in the reductions for time spent in criminal justice settings for children and TAY.^[11]
• Due to limited supporting evidence, the association between CSS program participation and reduced physical health emergencies and improvements in education cannot be made.^[11]
• Currently, there appears to be slight to no difference in employment outcomes for TAY, adults, and older adults participating in CSS programs, for a year of more. These finds are tentative pending more evidence.^[11]

Human Resources, Education, and Training Program

• Each county mental health program has to submit a needs assessment identifying its shortages in each professional and other occupational category. The objective is to increase the supply of professional staff and other staff that county mental health programs anticipate they will require in order to provide the increase in services projected to serve additional individuals and families.^[6]
• There will be expansion plans in forgiveness and scholarship programs offered in return for a commitment to employment in California’s public mental health system. These programs will also be available to current employees of the mental health system who want to further their education and obtain Associate of Arts, Bachelor of Arts, master's degrees, or doctoral degrees.^[6]
• There will also be a creation of a stipend program for persons enrolled in academic institutions who want to be employed in the mental health system.^[6]
• Regional partnerships among the mental health system and the educational system will be established to outreach to multicultural communities and therefore increase the diversity of the mental health workforce.^[6]

Revisions to Mental Health Services Act (MHSA)

• On March 24, 2011, Governor Brown signed Assembly Bill 100 (AB 100) into law, which made several changes the MHSA. These changes included the elimination of review and approval of county MHSA plans by the Department of Mental Health (DMH) and the MHSOAC. AB 100 specified the Legislature’s intent to ensure continued state oversight and accountability of the MHSA. The objective of AB 100’s was to assure the state in consultation with the MHSOAC, establish a more effective means of ensuring county performance complies with the MHSA.^[10]

At Present

The initiative’s objective was to expand mental health programs, expand the availability of services, and reduce state spending on mental health.^[12][13]

Regrettably, since the proposition's passage, chronic homelessness in California has increased, and the state has not seen an increase in psychiatric beds.^[14] An important fix to the proposition was introduced in 2015 allowing counties to use proposition 63 funding to implement Laura's Law; however, implementation has been haphazard at best.^[15] Moreover, the proposition's funded projects were not integrated with state efforts to reduce criminal justice sentences. This led to a high number of prison releases of mentally ill former inmates who did not receive services or guidance from proposition 63 funded programs. According to the county of Los Angeles, "The reforms may have had the "unintended consequence" of ending post-release support services and court-mandated drug and alcohol treatment for many offenders with mental health and substance abuse issues"^[14] The proposition also pre-dated the expansion of Medi-Cal made possible through the Affordable Care Act, which made substance use treatment and mental health services part of the "essential health benefits" of both Medi-Cal and private health insurance plans.

References

1. ↑ http://www.sos.ca.gov/admin/press-releases/prior/2003/03_094.pdf
2. 1 2 Richard M. Scheffler and Neal Adams Millionaires And Mental Health: Proposition 63 In California. Health Affairs, no. (2005) http://content.healthaffairs.org/content/early/2005/05/03/hlthaff.w5.212.full.pdf
3. ↑ Brown TT, Mahoney CB, Adams N, Felton M, Pareja C. What Predicts Recovery Orientation in County Departments of Mental Health? A Pilot Study Adm Policy Ment Health (2010) 37:388–398
4. ↑ Mental Health Services Act (Proposition 63). (2009). California Department of Mental Health. http://www.dmh.ca.gov/Prop_63/mhsa/
5. ↑ Mental Health Services Act Expenditure Report: Fiscal Year 2010-11. Mental Health Services Oversight and Accountability Commission. http://www.mhsoac.ca.gov/About_MHSOAC/docs/FactSheet6_3-18-11.pdf
6. 1 2 3 4 5 6 7 8 9 Mental Health Services Act (Proposition 63). (2009). California Department of Mental Health. 1-18
7. 1 2 Proposition 63: Mental Health Services Expansion and Funding. Legislative Analyst Office. http://www.lao.ca.gov/ballot/2004/63_11_2004.htm
8. 1 2 3 4 5 5 Components of the MHSA-Overview. Mental Health Services Oversight and Accountability Commission. http://www.mhsoac.ca.gov/About_MHSOAC/docs/5Components_030311.pdf
9. 1 2 3 4 Mental Health Services Act (MHSA) – Prevention and Early Intervention (PEI) Fact Sheet. Mental Health Services Oversight and Accountability Commission. http://www.mhsoac.ca.gov/About_MHSOAC/docs/FactSheet7_3-18-11.pdf
10. 1 2 Highlights. Mental Health Services Oversight and Accountability Commission. http://www.mhsoac.ca.gov/
11. 1 2 3 4 5 6 Mental Health Service Act Community Services and Supports (CSS) Evaluation Brief. Summary and Synthesis of Findings on CSS Consumer Outcomes. UCLA Center for Healthier Children, Youth and Families. May 11, 2011. http://mhsoac.ca.gov/Meetings/docs/Meetings/2011/May/OAC_052611_Tab8_UCLAEvalBrief.pdf
12. ↑ Proposition 63: California's Mental Health Miracle. Behavioral Health Management. www.behavioral.net
13. ↑ Prop. 63 Improving Lives and Communities. San Bernardino County Department of Behavioral Health http://www.sbcounty.gov/dbh/Announcments/2011/Press_Release_Prop63_Improving_Lives_and_Communities.pdf
14. 1 2 http://www.latimes.com/local/lanow/la-me-ln-competency-cases-report-20160908-snap-story.html.  Missing or empty |title= (help)
15. ↑ https://johnmoorlach.wordpress.com/2016/01/06/moorlach-update-more-prop-63-repurposing-january-6-2016/.  Missing or empty |title= (help)

External links

• HealthVote.org: Neutral information & analysis about the progress of Prop. 63 after the Nov. 2004 election
• vote2004.sos.ca.gov/voterguide/ - 2004 Voter Information Guide (with text of Proposition 63)