It’s unlikely that anyone would say it is “frivolous” to exercise and eat well to guard against heart disease and diabetes. Both of those preventive measures have been proven to be highly beneficial in avoiding more serious health problems.
The same is true for mental illness. Studies have demonstrated that preventive strategies and intervening when early signs or symptoms appear offer the most effective ways to help people with mental health issues manage their symptoms and behavior.
The alternative approach — directing resources only to those who’ve already experienced a mental health crisis — is akin to ignoring a person with high cholesterol until he or she has had a heart attack. In California, our mental health system has been funded in this fashion for decades, and we see the unfortunate evidence of this failed approach in the homelessness on our streets, in crowded emergency rooms and through costly incarceration and institutionalization of people with mental illness.
The San Francisco Examiner’s recent editorial, “Funds meant for mental illness,” relies on an Associated Press report that cherry-picks from hundreds of mental health programs across the state to paint a misleading picture. The assertions made by The AP and The S.F. Examiner that prevention and early intervention programs don’t improve mental health outcomes are narrow-minded and short-sighted.
Untreated mental illness affects us all — causing more days of work loss and work impairment than many other chronic conditions such as diabetes, asthma and arthritis. We need to invest in prevention and early intervention so that more people don’t have to reach a crisis point before they get help.
Expanding services to those in need was one goal of the Mental Health Services Act (Proposition 63) approved by voters in 2004. California counties are meeting that goal through a range of Prop. 63-funded services, including “full service partnerships” that offer community-based, around-the-clock support individuals need to recover from their mental illnesses. But Prop. 63 also looks ahead — targeting funds for preventive programs that provide services earlier, when outcomes are better and costs lower. Absent this approach, California’s mental health system will always strain to play catch-up, without the money to meet the needs of a growing, aging and diverse population.
Prop. 63 is responsible for a major shift in the way California provides mental health services. As passed by voters, it actually mandates that a portion of funding be spent on prevention and early intervention programs that target high-risk populations, including culturally underserved populations and individuals who have experienced trauma.
Because the majority of adult mental illness begins early in life, intervening early is a critically important and powerful strategy, with significant potential long-term impacts. Even for one of the most severe mental health disorders such as schizophrenia, there are now effective, evidence-based strategies to diagnose the disorder as early as possible, provide rigorous treatment and change the course of the illness. Meanwhile, children with unaddressed mental health problems are much more likely to drop out of school, go to jail as adults and suffer other negative outcomes.
It should be noted, too, that these new, effective mental health programs are not created in a vacuum by government officials. Rather, as prescribed by law, there is a robust process of community involvement and local decision-making that governs the use of Prop. 63 funds. Communities in each county determine the best approaches to meet the unique needs of their populations.
Prop. 63 programs conscientiously address the human toll and high costs of untreated mental illnesses. As Prop. 63 author state Senate President Pro Tem Darrell Steinberg has said: “Prevention and early intervention is the only way that we are going to change attitudes and make sure people get help before they become a statistic.”
Patricia Ryan is executive director of the California Mental Health Directors Association, a nonprofit advocacy association representing the mental health directors from each of California’s 58 counties.