Sen. Darryl Steinberg authored the Mental Health Services Act (MHSA), or Proposition 63, and in November 2004, mental health treatment was dramatically improved throughout California. The bill created a 1 percent state tax on adjusted gross income in excess of $1 million in order to improve and expand the mental health system, including treatment services, prevention and early intervention, capital facilities, housing, technology, training and education and innovative programs.
Having experienced a terrible tragedy in 2001 that involved a person with an untreated mental illness shooting and killing three people, Nevada County eagerly embraced the MHSA funding as a part of a community solution. An overarching priority identified in Nevada County was to create Full Service Partnerships (FSP). FSPs invite the consumers and their families to a broad array of traditional and rehabilitative mental health services delivered by a single provider in one location. In addition to treatment, FSP may assist individuals with food, clothing, shelter and whatever it takes to help them achieve their goals and improve the quality of their lives.
Up until this system transformation, Nevada County had no programs of this type to offer to the neediest mentally ill individuals. Nevada County contracts with Turning Point Providence Center (TPPC), a division of Turning Point Community Programs, to provide this service.
The focus of services delivered by TPPC is for individuals over the age of 18 who are seriously mentally ill. Many have schizophrenia, schizoaffective disorder, bipolar disorder and major depression. These high-risk individuals also have a history of multiple psychiatric hospitalizations and frequent incarcerations in the local jail. They are often dangerous to themselves or others and unable to provide for or utilize basic living essentials such as food, clothing and shelter.
The TPPC program serves 90 individuals, including patients participating in Mental Health Court and Lanterman-Petris-Short Conservatees, and 10 individuals mandated into outpatient treatment by Welfare and Institutions Code 5345, or Laura’s Law, named after Laura Wilcox, one of the victims who died in the 2001 shooting.
All 90 individuals receive assertive community treatment, an evidence-based FSP practice. This model requires multidisciplinary staffing with psychiatrists, psychotherapists, case managers, nurses, substance abuse counselors and peer counselors. There is one staff person available for every 12 people in the program, and services are available 24 hours per day, seven days per week. Each person helps to develop a unique and customized individualized service plan and has a designated personal service coordinator. Most services are provided in homes and the community, rather than in an office.
Together with the personal service coordinator, support and involvement from friends and family, the team strives to build upon and utilize the individual’s strengths and preferences in order to achieve the goals. Services include mental health treatment, substance abuse treatment, housing, employment and training and facilitate access to primary care. These services are offered in the context of a “recovery” philosophy. Staff embrace and believe that recovery from mental disorders and/or substance-use disorders is a hopeful process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential.
TPPC carefully tracks and reports individual and system outcomes and performance measures. Overall satisfaction of those receiving services was 82 percent (November 2012 through April 2013). The most recent data, from May 2012 to April 2013 comparing pre-treatment and post-treatment episodes, indicated a 64-percent decrease in the number of days of psychiatric hospitalization, a 21-percent decrease in the number of days in jail, a 94-percent decrease in homelessness and an 87-percent decrease in emergency interventions. Finally, the experience in Nevada County also highlights a net cost savings, primarily due to reduced hospitalizations and incarceration.
Clearly, the implementation of the Mental Health Services Act in Nevada County has fulfilled the expectations of our residents and improved the quality of life for individuals afflicted with mental illness. Persons with mental illness are living more at home, have fewer symptoms and spend less time in hospitals or jails.
The community is safer, and sick people are less likely to hurt themselves or others because of their illness. None of these benefits would be realized without the Mental Health Services Act. Nevada County — indeed, all of California — owes an enormous debt to Sen. Steinberg for his efforts to provide for healthier and safer state.
Michael Heggarty, MFT, is the Nevada County director of health.