Psychiatric News June 17, 2005
Volume 40 Number 12
© 2005 American Psychiatric Association
p. 9
Complex Strategy Leads To Success of MH Initiative
Kate Mulligan
"We knew we had a winner," says a California Psychiatric
Association spokesperson about landmark mental health legislation.
California voters passed Proposition 63 in November 2004, a ballot
initiative that authorizes a 1 percent tax on annual adjusted gross income
over $1 million to support county-operated mental health systems.
The tax will result in an estimated $1.8 billion in new revenues over the
first three years.
What lessons does this legislation hold for mental health advocates who are
struggling with erosion in financial support for services in other sections of
the country?
Health policy analysts Richard Scheffler and Neal Adams tackled that
question in "Millionaires and Mental Health: Proposition 63 in
California" in the May 3 Health Affairs. They noted that
California's history of allowing voters to bypass the legislative process and
place initiatives on the ballot dates back to 1911. Since then, voters
approved 104 of the 303 initiatives that qualified for the ballot.
Only 12 initiatives affecting taxes passed. Of those, only three, including
Proposition 63, increased taxes.
Proposition 63 passed with a majority of 53.8 percent. In the same
election, Proposition 72, which would have expanded employer responsibility
for health care coverage, failed by a small margin.
Passage had "much visible support and little visible
opposition," according to the authors.
Randall Hagar, director of government affairs for the California
Psychiatric Association (CPA), shares that opinion and worked to develop that
support.
The CPA was a member of the group that drafted the ballot initiative, he
said, and later was represented on the steering committee of the Campaign for
Mental Health, which led the effort (Psychiatric News, December 3,
2004).
The campaign commissioned polls and focus groups to help with its
planning.
"We knew we had a winner when the results came back," said
Hagar. "Respondents overwhelmingly replied affirmatively to the
question, `Have you or someone you know suffered from a serious mental
illness?'"
He believes the strong positive response represents a major change in
public perception that signals a decrease in stigma in the last 10 years.
The phrase "everyone knows someone with mental illness" became
a key theme of the campaign.
Supporters raised $4.3 million, and opponents raised $17,500. Top
contributors to passage included the California Council of Community Mental
Health Agencies, California Healthcare Association, California State Council
of Service Employees Issues Committee and other unions, and Mental Health
Association of Los Angeles County.
APA, which gave $25,000 to the campaign, was the only national organization
to make a contribution. Hagar said, "Members of the steering committee
were duly impressed."
The CPA assisted its five district branches to raise money and secured the
support of the California Medical Association. Donations from California
physicians reportedly exceeded $100,000, according to Hagar.
Scheffler and Adams noted, "The pitch that mental health treatment
works was credible and easy to deliver."
Proposition 63 built on the success of legislative initiatives sponsored by
Assemblyman Darrell Steinberg (D). The resulting program, which targeted
mental health services to people who were homeless, was cited as a model in
the 2003 report of the New Freedom Commission on Mental Health.
Hagar also credits earlier work by Assemblywoman Helen Thomas (D), who
introduced a bill to make mental health services an entitlement. That bill
"served as an inspiration and template for Proposition 63," he
said.
Scheffler and Adams listed six primary arguments in favor of passage of
Proposition 63 (see
box).
To determine the sources of voter support for Proposition 63, the authors
examined the independent effect of a number of variables at the county
level.
Scheffler and Adams found the percentage of registered Democrats to be
highly significant and positively correlated to a "yes" vote.
The percentage of Hispanic population was highly significant but negatively
correlated to a "yes" vote. The authors speculate that the reasons
could be differences in the perceived need for mental health services as
compared with other voters and the lack of cultural competence in the service
delivery system.
The rate of homelessness was positively correlated with a "yes"
vote but was statistically weak. The authors substituted statewide average
data on homelessness for county data when the latter was unavailable.
The authors called Proposition 63 "a landmark piece of mental health
and fiscal legislation" and noted that the mental health community in
California and the nation will be watching carefully to see what happens.
Hagar said, "We convened a task force that is working on such issues
as the development of state guidelines for the expenditure of
funds."
He expects that funds from Proposition 63 could become available to county
governments as early as September, although the amounts have yet to be
determined.
"Millionaires and Mental Health: Proposition 63 in
California" is posted at
<http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.212v1>.
Related Article:
-
Why Help Mentally Ill People?
Psychiatr News 2005 40: 9.
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