California voters agreed to tax the rich to support public mental health
More than half of them (53.3 percent) voted last month in favor of
Proposition 63, which will impose a tax surcharge of 1 percent on the taxable
personal income above $1 million to pay for services offered through the
state's existing mental health system. The initiative will generate an
estimated $700 million a year.
"We're ecstatic," said Randall Hager, legislative director for
the California Psychiatric Association (CPA). "It's hard to come up with
words to describe the importance of what happened. This could be the beginning
of a whole new era for the public mental health system. We hope to make good
on broken promises to people with mental illness."
The effort was led by a coalition, the Campaign for Mental Health (CMH).
CPA was one of the early supporters. "It's been a high priority for
us," said Hager. "We helped develop the concept and have been
rallying our members."
Richard A. Shadoan, M.D., a past president of the CPA, wrote in Viewpoints
in the September 3 issue of Psychiatric News, "The scope of the
program and its tax-the-rich source will provoke a debate. But it's an
argument worth having to make California face the neglect of not providing
treatment to more than 1 million people with mental illness."
He pointed out that a California legislative analyst estimated"
savings of hundreds of millions of dollars annually on a statewide
basis from reduced costs for state prison and county jail operations and
medical care, police activities, shelters, and social service programs for the
Shadoan told Psychiatric News, "We are very grateful for
APA's early endorsement of Proposition 63, its contribution of $25,000 to
support the initiative, and to psychiatrists around the country who made
contributions in response to the Viewpoints article."
The five district branches in California together raised about $50,000, he
State Assemblyman Darrel Steinberg (D) showed tireless and effective
leadership in the battle to pass Proposition 63, according to CPA members. He
has a long-standing commitment to funding for mental health care (see facing page).
The CMH turned to well-known tools of successful political strategists and
also adopted innovations, such as use of the Internet, to create support.
Early in 2003, organizers hired an opinion research and public policy
analysis firm to conduct focus groups to gauge reaction to the initiative
(Psychiatric News, January 2, May 7).
Among the conclusions of the firm, Fairbank, Maslin, Maullin, and
Associates, was that the "severely mentally ill evoke the most sympathy
and compassion from voters.... Even more cynical voters who doubted the
measure's means, merits, and objectives did not question the need to provide
seriously emotionally disturbed children with [treatment].... Voters want a
Organizers emphasized the idea that the new effort was modeled on
California AB 34, a pilot program approved in 1999 that funds services to
mentally ill adults who are homeless or at risk of becoming homeless or
incarcerated. The New Freedom Commission on Mental Health cited it as a model
The CMH formed a broad coalition of organizations that together represent a
number of different constituencies.
In addition to state and national medical and mental health associations,
the CMH includes six major California unions and organizations such as the
California Teachers Association, AARP-California, and the California Police
Chiefs Association (CPCA).
CPCA President Cam Sanchez wrote in a letter to the San Diego
Union-Tribune, "Police chiefs like me face an awful reality: 20
percent of our officers' time is spent dealing with untreated mental illness.
Too often, we must take people with mental illness to jail, not because they
have done anything wrong, but because there is nowhere else to go....
Proposition 63 will finally make mental health care a priority and free law
enforcement to spend more of their time and resources on public safety rather
than our failed mental health system."
City councils in Los Angeles, Oakland, Santa Barbara, and Santa Monica
supported the initiative, as did the San Francisco Board of Supervisors.
The CMH gathered more than 600,000 signatures, nearly double the number
required to qualify the initiative for the ballot.
Advocates could turn to the Web site<www.campaignformentalhealth.org>
for updates on progress, as well as for an extensive array of information to
help the organizing process. There were suggestions on hosting events and
targeting groups, an opportunity to donate online, and facts and analyses that
could be used in advocacy. Steinberg even hosted a daily blog in which
advocates shared ideas.
Sympathetic stories in major newspapers portrayed the impact of the failed
mental health system and described lives that had been reclaimed by
An organized opposition developed after a poll found support for
Proposition 63 at 64 percent. Gov. Arnold Schwarzenegger (R) came out against
David Yow, a spokesperson for a campaign against the measure, argued,"
While there is a great idea behind it, this measure is a desperate
substitution for an actual solution. It takes an important social program and
ties it to a funding source that is really a narrow slice of taxpayers,"
according to the October 22 San Francisco Chronicle.
Proposition 13, passed in California in 1978, restricted increases in
property taxes and required that all state tax increases be approved by a
two-thirds vote of the state legislature. Because of the difficulty of
securing that vote, advocates for various causes have turned to the use of
propositions or "ballot-box budgeting" to raise revenue.
Advocates of Proposition 63 argued that although such a strategy is not an
ideal method, the importance of the initiative took precedence.
Shadoan believes that the "job is only half done" with the
initiative's passage. He said, "Psychiatrists and other mental health
practitioners now must work to make certain that the funds are expended in a
cost-effective manner on high-quality treatment."
He will chair the Proposition 63 Implementation Task Force of the CPA.
Maintaining quality in implementation will be important to ensure public
trust and establish accountability, Shadoan continued. In addition, advocates
in other states will look to California for evidence that can be used to
support similar initiatives.
"The impact of this initiative goes far beyond California," he
More information on Proposition 63 is posted at the CMH's Web site