Background and Objective:
Proposition 63, the Mental Health Services Act (MHSA) passed in 2004 in the state of California, offers a singular opportunity to reduce racial and ethnic disparities in mental health through major changes in the state’s approach to mental health service delivery. The initiative proposed a 1% tax to be levied on all individuals earning at least one million dollars. The revenues generated as a result of this taxation are to be spent on the expansion and improvement of mental health services in the state of California. The current study is an initial effort to evaluate the extent to which programs and plans developed in response to the Mental Health Services Act address disparities in mental health for Latino children and youth.
California counties were required to submit three-year program and expenditure plans to obtain MHSA funding. From those counties that had submitted proposals at the time of this study, ten were selected for review. A literature review and key informant interviews were conducted to develop a tool with which to evaluate county proposals for funding. The results of this process yielded criteria that fell into four categories: assessment, access, quality, and evaluation. Each county proposal was then evaluated using the review tool.
Results and Recommendations:
Overall, counties provided an adequate assessment of their population, proposed strategies to improve workforce diversity and language access, and identified several general approaches for improving physical access to care for Latino children and youth. However, there was a lack of specificity in the plans. Most of the counties did not identify specific treatments and outreach efforts.
To increase the likelihood that counties will implement culturally responsive treatments and outreach efforts specifically tailored for their communities, it is recommended that counties partner with the state Department of Mental Health and academic institutions. This collaboration will facilitate the development, identification, and dissemination of evidence- and community- based strategies to improve access and quality of care to Latino children and youth. Continuous monitoring and evaluation of the effectiveness of strategies employed in reducing disparities will be an essential component of this process.
The MHSA has brought the problem of racial and ethnic disparities in mental health to the fore by issuing a mandate that cultural competence be embedded in all aspects of the implementation of this law. Despite the challenges inherent in reducing disparities in mental health care, this mandate ensures that the reduction of disparities will be a prominent goal for mental health service systems. To ensure that this goal is attained, a continuous process of evaluation and collaboration between counties and the state Department of Mental Health must be established.
Rachel Guerrero, MSW, Office of Multicultural Services, California Department of Mental Health
Mentor: Francis Lu, MD, Professor of Clinical Psychiatry, University of California, San Francisco