California Voters Say Rich Should Help Fund MH Care

California voters agreed to tax the rich to support public mental health services.

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 homeless.”

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 said.

How Did They Win?

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 (Original article: 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 proven model.”

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 program.

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 treatment.

An organized opposition developed after a poll found support for Proposition 63 at 64 percent. Gov. Arnold Schwarzenegger (R) came out against the proposition.

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.

Implementation Will Be Key

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 observed.

More information on Proposition 63 is posted at the CMH's Web site at<www.campaignformentalhealth.org>.▪