Proposition 63: How Did It Happen?
Proposition 63 is, of course, landmark legislation drawing attention not just in California's mental health community, but to other interests in California, as well as mental health interests across the nation and, in fact, around the world.
It is often stated that if we can see farther than others it is only because we stand on the shoulders of giants. There have been many giants advancing the cause of mental health in California and we need to acknowledge their efforts without which Proposition 63 would not have been possible.
We start with the Lanterman Petris Short Act in the 1960's, which started the process of converting California's hospital-based mental health system to community care. Two key legislative staffers, Art Bolton and the late Stephen Thompson, worked diligently to make that legislation possible and also to make sure it included a promise that the money would follow the clients into an adequately funded community care system, finally fulfilled by Proposition 63.
Steve Thompson was especially important and served as a great leader in state health and mental health policy. In addition to the Lanterman Petris Short Act, he was a consultant to many local mental health organizations and helped develop community mental health programs throughout the 70's and into the 1980's.
In 1979, Assemblyman Tom Bates and CASRA authored the bill to establish the community residential treatment system. In the 1980's we developed the children's and adult/older adult systems of care. These efforts were led, of course, by two great legislators, Assemblymember (and then later Senator) Cathie Wright and Assemblymember Bruce Bronzan - who also teamed with Senator Dan McCorquodale, to give us realignment in 1991, at least stabilizing our funding. Children's system of care was the brainchild of then Ventura County Mental Health Director Randy Feltman. The adult/older adult system of care was developed by a task force established by Lt. Governor Leo McCarthy. It was the brainchild of a staff member, Rose King, and chaired by a leading NAMI member, who also published the NAMI journal for decades, Dan Wiseburd. It led to the establishment of the Village Integrated Service Agency led by Richard Van Horn and Martha Long of the National Mental Health Association of Los Angeles. A MHAC member, its success encouraged LA, Stanislaus, and Sacramento to extend similar programs based upon outcomes developed by the late Vince Mandella and David Pilon. These efforts in turn formed the basis for Darrell Steinberg's AB 34.
Rose King was also a family member who has lost a husband and a son to suicide caused by their severe mental illnesses and is now assisting her daughter in caring for her grandson. However, beyond her personal experience was her political wisdom, as it was Rose King who first told me back in the late 1980's that the mental health community could do an initiative to get its needs met. She showed me polling studies, which indicated that when asked the question, would you rather have government money spent to increase funding for a particular subject or given back to the taxpayers. Mental health came in second only to the frail elderly and ahead of education, public safety, transportation and other subjects usually listed at the top of the public's priorities.
While we abandoned our initial effort in 1990, to be part of the unsuccessful nickel-a-drink alcohol tax, it was Rose again in 2001, who was working as a staff member for Assemblymember Helen Thomson, who concurred with me that an initiative would be the way to accomplish the full funding of the mental health system, as had been proposed in Assemblymember Thomson's AB 1422 - (which, of course, was going nowhere in the Legislature). Without Rose King's wisdom and inspiration, it is doubtful there would have been a Proposition 63, and we all have her to thank.
We also need to thank Assemblymember Thomson and her co-author Senator Don Perata, as well as Senator Richard Polanco (who had gotten an even stronger bill out of the State Senate), for their leadership in mental health parity legislation, which is a necessary part of our foundation, assuring that private health insurers must provide mental health insurance coverage comparable to other diseases.
Around the same time in the 1990's, as mental health parity was passing, counties and community agencies were implementing the first significant funding for children's mental health services - the so-called EPSDT (Early and Periodic Screening Diagnosis and Treatment) program, which is a federal Medicaid requirement California had been ignoring until a lawsuit settlement, brought by Mental Health Advocacy Services Attorney Jim Preis with support and guidance from CCCMHA board member Steve Elson (then of the Sycamores in Los Angeles, now of Casa Pacifica). That funding program now exceeding $1 billion in state and federal funds remains the only strong entitlement to mental health services in California and is protected by Proposition 63.
We also need to thank the California Council of Community Mental Health Agencies. It was not an easy decision for CCCMHA's board to commit such substantial resources to this effort back in 2002, when hardly anyone thought that something like this had a chance. For that, we must thank all of CCCMHA's board members, particularly President John Buck.
Richard Van Horn of the Mental Health Association of Los Angeles, whose Village Integrated Services Program - one of the original adult system of care pilots, formed the basis for Darrell Steinberg's AB 34 program, which Prop 63 funds. Jerry Doyle, now an Oversight and Accountability Commission Member, began wrap-around programs in California and led efforts in drafting and building support among children's agencies.
Support came from many stakeholders that are on the "margins" of the traditional mental health community, such as educators, law enforcement, and older adult and children's advocacy groups. Almost 7,000 people made donations to the campaign. Thousands came to rallies and other Prop. 63-related events. We reached millions of Californians through newspaper articles about mental health issues and television advertisements. In addition, we have thousands of interested individuals on our email list, building an organized mental health constituency that we have never had in this state. Now we have laid the foundation for a true grassroots movement. NAMI California, the California Healthcare Association and Service Employees International Union all helped build credibility for this effort. Their CEOs Duane Dauner and Dean Tipps co-chaired our campaign steering committee, with participation from all of the other leading mental health organizations representing consumers, family members, providers and county mental health interests - all working together.
All of our efforts to build this model system are now placed in the hands of our State Department of Mental Health led by Dr. Stephen Mayberg, who has served three governors and led all of our positive developments of model services. While Dr. Mayberg could not be directly involved in the campaign, his department, as well as all of the local public and private organizations involved in implementation and systems of care, was responsible for making sure that people would believe that the funding would go to proven successful programs.
Dr. Mayberg believes that, "Proposition 63 presents a once-in-a-lifetime opportunity to transform our mental health system to one that is based on principles of recovery, programs that work and involvement of all of our stakeholders, especially the consumers and family members. California can lead the way by developing a system that keeps individuals in their communities with treatment and supports from a variety of sources, rather than in institutions or on the street. A satisfying quality of life in the community is possible with integration, proven programs, accountability and, most of all, better and earlier access."
Finally, of course, we thank former Assemblymember (and hopefully future Senator) Darrell Steinberg, whose vision and leadership made this campaign a reality, who single-handedly helped raise much of the money, built the support and minimized the opposition. There has never been another individual elected to state or federal legislative office who made mental health a higher priority than has Assemblymember Darrell Steinberg. Clearly, with the passage of Proposition 63, there is no one else who has done as much for the cause of mental health as Darrell Steinberg. He will always be our greatest "mental health hero" and we will always be indebted to him.
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