California mental health tax providing services to needy in L.A. County, study finds

March 13, 2018

Funding from California's special tax for mental health services has allowed Los Angeles County to reach the seriously mentally ill and those at risk for mental illness with services and prevention efforts, lowering both homelessness and the need for psychiatric hospitalizations, while improving employment and wellbeing, according to a new RAND Corporation study.

The analysis found that from 2012 through 2016, the Los Angeles County Department of Mental Health provided prevention and early intervention services to almost 130,000 youth, and intensive clinical and social services designed to stabilize those who have serious psychiatric illnesses to almost 25,000 youth and adults.

"We found evidence that the services created in Los Angeles County under the Mental Health Services Act are reaching the people they intend to help, and those people are benefitting from the services provided," said Scott Ashwood, lead author of the report and a policy researcher at RAND, a nonprofit research organization.

California voters in 2004 approved Proposition 63, which created a 1 percent tax on all personal income over $1 million to provide expanded mental health services statewide.

Researchers from RAND and UCLA analyzed administrative data to evaluate two types of programs in Los Angeles County supported by the tax. The first is prevention and early intervention programs that aim to prevent the onset of mental illness and the related negative consequences. The second area evaluated was the county's full-service partnership program, which takes a "housing first" approach to improve residential stability and mental health outcomes for people with serious mental illness.

Funding from the Mental Health Services Act allowed the county Department of Mental Health to significantly expand both types of services to reach more people from a wider array of age groups.

The evaluation found that the prevention program provided services to about 130,000 youths, with 65 percent of those served being new clients. Hispanic and Asian youth served by the program had particularly good outcomes in comparison to other groups, although all racial/ethnic groups saw improvements.

"Helping young people can change the trajectory of their lives and potentially put them on a path where they experience less suffering, better relationships and more success in life," Ashwood said.

Researchers found that the number of people receiving services under the full-service partnership program rose over the study period, providing intensive housing support and other social services to about 25,000 adults and children during the period. Participants tended to have a severe diagnosis, such as suffering from schizophrenia or another psychotic disorder, and had a high likelihood of being homeless.

The rate of homelessness dropped sharply among those served by the program and participants also experienced less inpatient hospitalization for their mental health problems. The employment rate also increased among those receiving services, although the overall jobless rate among the group remained high.

Researchers recommend that the county Department of Mental Health revise some of its data collection methods to better document whether program participants are improving and whether best practices are being followed as services are delivered.

The evaluation did not include other county services supported by the Mental Health Services Act, such as primary prevention programs or outreach services, because those efforts do not have data readily available for review.
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Support for the study was provided by the Los Angeles County Department of Mental Health and the California Mental Health Services Authority.

The study, "Evaluation of the Mental Health Services Act in Los Angeles County Implementation and Outcomes for Key Programs," is available at http://www.rand.org. Other authors of the study are Nicole Eberhart, Lesley Baseman, Aaron Kofner, Gulrez Azhar, Margaret Chamberlin, Jeanne Miranda and M. Audrey Burnam, all of RAND, and Elizabeth Bromley, Sheryl Kataoka, Bonnie Zima, Alethea Marti, Lingqi Tang, Blake Erikson, Kristen Choi and Lily Zhang, all of the UCLA Center for Health Services and Society.

RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.

RAND Corporation

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