FIG1 An historical event took
place in California on April 22 when it was announced that the supporters of
Mental Health Initiative (Proposition 63) had turned in nearly double the
required 373,819 signatures needed to qualify the Initiative for the November
ballot—they had gatherered more than 600,000.
Proposition 63 will pay for a broad range of mental health services for
children and adults, including prevention and training and if passed will
result in the most extensive mental health system in the state's history.
It is well known that across the country, with the 1963 passage of the
Kennedy Mental Health Act, a promise was made to the mentally ill. In exchange
for state-hospital closings they were promised treatment and housing in their
own communities. Unfortunately only the first half was accomplished: hospitals
Community mental health systems were started, but state budget allocations
over the years have not kept up with costs, resulting in the promise being
increasingly broken. By putting Proposition 63 on the ballot, Californians
believe it is now time to fulfill this 40-year-old promise.
Proposition 63 will be financed with a new 1 percent tax on an individual's
gross annual income over $1 million, which would generate an estimated $700
million a year. 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
According to a California legislative analyst, every taxpayer will
eventually save money. She points out that savings would be 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 homeless. Doing nothing is not
As we know, without treatment many mentally ill end up in jails, prisons,
and on the streets—the last place to expect help. There are more than
50,000 people homeless in California, and estimates are that up to 30 percent
of them are seriously mentally ill and not being treated. Fifty years ago they
would mostly be treated in hospitals.
There are more than 200,000 people in California prisons and jails, and it
is estimated that up to 20 percent are mentally ill. If they had received
treatment most of them would not be there.
The reduction in hospital beds for the mentally ill and the diversion of
those persons to prisons and jails confirms Penrose's extensive studies from
as early as 1939 in England. He showed that as you reduce spending for
treatment and hospital care for the severely mentally ill, you have a
corresponding increase in the number of mentally ill people in the criminal
One example of mental hospital bed cuts made over 50 years is startling:
Richard Lamb, M.D., a professor of psychiatry at the University of Southern
California, reports that in l955 the national average for state mental
hospital beds was 339 per 100,000 people. By 2000 the number of such beds had
dropped to 22 per 100,000. For California the figures are even more
dramatic—as of May there were fewer than two beds per 100,000.
A poll taken last spring found support for Proposition 63 at 64 percent.
Californians know that something must be done. But this was before an
organized opposition developed and flooded the media. Certainly state and
national groups will try to defeat Proposition 63, including the Howard Jarvis
Taxpayers Association and Americans for Tax Reform. In addition we expect the
Church of Scientology and related organizations, such as the Citizens
Commission on Human Rights, will mount a vigorous effort to defeat Proposition
63, as will other groups.
This is a battle with national implications: if this approach is successful
in California, it could spread to other states. However, just as President
Kennedy's 1963 act influenced treatment of the mentally ill for nearly a
generation, Proposition 63 could well influence how California and perhaps the
nation will be treating the mentally ill for the next generation.
The California Psychiatric Association (CPA) is one-third of the way toward
its goal of raising $50,000 to support the initiative. APA quickly recognized
the importance of Proposition 63 and has generously given CPA $25,000 to
enhance the chances for success. California psychiatrists would be grateful
for financial support from colleagues throughout the country who see the
importance of Proposition 63. There will be 14 other propositions on the
ballot, so money to increase visibility will be essential.
Checks made out to the Campaign for Mental Health can be sent to 1121 L St.
#908, Sacramento, Calif. 95814. Please identify your contribution as from a