Top

Administration and Policy in Mental Health and Mental Health Services Research

Published in:

01-09-2015 | Original Paper

Linking the Legislative Process to the Consequences of Realigning California’s Public Mental Health System

Authors: Megan E. Vanneman, Lonnie R. Snowden

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 5/2015

Abstract

In 1991, California transferred significant responsibility, resources, and accountability for public mental health from the state to its 58 counties. Using purposeful sampling, we conducted in-depth interviews with ten senior state and county leaders to gain insights into the relatively uncharted area of their understanding of this legislation’s intent, development, and long-term consequences. While realignment secured funding for the system and provided incentives and flexibility for counties to move toward providing more community-based care, the decision to base realignment allocations on counties’ historical spending along with minimal payments to address differences helped to institutionalize spending disparities. Results of this study can inform how we develop and implement decentralization policies.

Available only for authorised users

Through Realignment, counties receive revenues equal to the previous year’s total. Growth funds from a sales tax account are first given to caseload-driven social service programs (Legislative Analyst’s Office, 2001). Any remaining growth from the sales tax account and all vehicle license fees (the funding mechanisms for Realignment) are distributed to counties. The balance was given to “under-equity” counties, which received a state mental health financing supplement. To determine under-equity status, a population-poverty measure for each county was calculated by taking the average of two metrics—(1) the county’s portion of the statewide population and (2) the county’s portion of the State’s Supplemental Security Income (SSI) and Aid to Families with Dependent Children (AFDC) recipients (Masland 1997, p. 33). If a county’s population-poverty portion was greater than the portion of the statewide Realignment base it received, it was considered an under-equity county (Department of Mental Health 2003, p. 6).

Aberbach, J. D., & Rockman, A. (2002). Conducting and coding elite interviews. Political Science and Politics, 35(4), 673–676. doi:10.1017/S1049096502001142.CrossRef

Aday, L. A., Begley, C. E., Lairson, D. R., & Balkrishnan, R. (2004). Evaluating the health care system: Effectiveness, efficiency, and equity. Chicago, IL: Health Administration Press.

Berry, J. M. (2002). Validity and reliability issues in elite interviewing. Political Science and Politics, 35(4), 679–682. doi:10.1017/S1049096502001166.CrossRef

Bronzan-McCorquodale Act, Ch. 89, 1991 Cal. Stat. 303.

Brown, E.G., Jr. (2011). 2011–2012 governor’s budget summary. Retrieved from http://www.dof.ca.gov/budget/historical/2011-12/governors/summary/documents/2011-12_Budget_Summary-State_of_California.pdf. Accessed 26 Aug 2014.

Center on Budget and Policy Priorities. (2011). Medicaid block grant would produce disparate and inequitable results across states. Retrieved from http://www.cbpp.org/cms/index.cfm?fa=view&id=3422.

Community Mental Health Service Act (1957) (Short-Doyle Act), Ch. 1989, Cal. Stat. 3535.

Department of Health Care Services. (2014). Performance outcomes system implementation plan for Medi-Cal specialty mental health services for children & youth. Retrieved from http://www.dhcs.ca.gov/formsandpubs/Documents/Legislative%20Reports/Mental%20Health/SMHSPerf_Outcomes_System-Jan2014.pdf.

Department of Mental Health. (2003). AB 328 Realignment data report as required by AB 328 and AB 2044. Sacramento, CA: State of California Department of Mental Health.

Dey, I. (1999). Grounding grounded theory: Guidelines for qualitative inquiry. San Diego, CA: Academic Press.CrossRef

Frank, R., & Gaynor, M. (1994). Fiscal decentralization of public mental health and the Robert Wood Johnson Foundation Program on chronic mental illness. The Milbank Quarterly, 72(1), 81–104. doi:10.2307/3350339.CrossRefPubMed

Harvey, W. S. (2011). Strategies for conducting elite interviews. Qualitative Research, 11(4), 431–441. doi:10.1177/1468794111404329.CrossRef

Hesse-Biber, S. N., & Leavy, P. (2006). The practice of qualitative research. Thousand Oaks, CA: Sage Publications Inc.

Holahan, J., Weil, A., & Wiener, J. M. (Eds.). (2003). Federalism and health policy. Washington, DC: The Urban Institute Press.

HyperRESEARCH. (Version 3.5.2) [Computer Software]. Randolph, MA: ResearchWare, Inc.

Initiative Measure (Prop. 63, approved Nov. 2, 2004), Mental Health Services Act of 2004. Lanterman-Petris-Short Act, Ch. 1667, 1967 Cal. Stat. 4074.

Leech, B. L. (2002a). Asking questions: Techniques for semistructured interviews. Political Science and Politics, 35(4), 665–668. doi:10.1017/S1049096502001129.CrossRef

Leech, B. L. (2002b). Interview methods in political science. Political Science and Politics, 35(4), 663–664. doi:10.1017/S1049096502001117.CrossRef

Legislative Analyst’s Office. (2001). Realignment revisited: an evaluation of the 1991 experiment in state-county relations. Retrieved from http://www.lao.ca.gov/2001/realignment/020601_realignment.html.

Lehman, A. F., Postrado, L. T., Roth, D., McNary, S. W., & Goldman, H. H. (1994). Continuity of care and client outcomes in the Robert Wood Johnson Foundation Program on Chronic Mental Illness. The Milbank Quarterly, 72(1), 105–122. doi:10.2307/3350340.CrossRefPubMed

Masland, M. C. (1997). Local variation in response to decentralization of authority in California’s public mental health system (Doctoral dissertation). Retrieved from ProQuest Dissertations & Theses database (Order No. 9827030).

Morrissey, J. P., Calloway, M., Bartko, W. T., Ridgely, M. S., Goldman, H. H., & Paulson, R. I. (1994). Local mental health authorities and service system change: Evidence from the Robert Wood Johnson Foundation Program on Chronic Mental Illness. The Milbank Quarterly, 72(1), 49–80. doi:10.2307/3350338.CrossRefPubMed

Oates, W. E. (1999). An essay on fiscal federalism. American Economic Association, 37(3), 1120–1149. Retrieved from: http://www.jstor.org/stable/2564874.

Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N. & Hoagwood, K. (2013). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research. Advance online publication. doi:10.1007/s10488-013-0528-y.

Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Act of 2010, Pub. L. No. 111–152, 124 Stat. 1029 (2010).

Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage.

Roy, A. (2012). Why block-granting Medicaid will result in better health care for the poor. Forbes. Retrieved September 30, 2012 from http://www.forbes.com/sites/aroy/2012/09/30/why-block-granting-medicaid-will-result-in-better-health-care-for-the-poor/.

Ryan, P. (n.d.). California mental health financing 101: The Mental Health Services Act in the context of overall county mental health financing pressures [PowerPoint presentation]. Retrieved from http://www.mhsoac.ca.gov/Meetings/docs/Meetings/2006/CalifMHFinancing101.pdf.

Scheffler, R., & Smith, R. B. (2006). The impact of government decentralization on county health spending for the uninsured in California. International Journal of Health Care Finance and Economics, 6(3), 237–258. doi:10.1007/s10754-006-9003-6.CrossRefPubMed

Scheffler, R. M., Wallace, N. T., Hu, T. W., Garrett, A. B., & Bloom, J. R. (2000). The impact of risk shifting and contracting on mental health service costs in California. Inquiry 37(2), 121–133. Retrieved from http://www.jstor.org/stable/29772885.

Scheffler, R., Zhang, A., & Snowden, L. (2001). The impact of realignment on utilization and cost of community-based mental health services in California. Administration and Policy in Mental Health, 29(2), 129–143. doi:10.1023/A:1014336530490.CrossRefPubMed

Shapiro, D. L. (1995). Federalism: A dialogue. Evanston, IL: Northwestern University.

Snowden, L., Scheffler, R., & Zhang, A. (2002). The impact of realignment on the client population in California’s public mental health system. Administration and Policy in Mental Health, 29(30), 229–241. doi:10.1023/A:1015191425834.CrossRefPubMed

Sosin, M. R. (1990). Decentralizing the social service system: A reassessment. Social Service Review, 64(4), 617–636. Retrieved from http://www.jstor.org/stable/30000977.

Soss, J., Fording, R. C., & Schram, S. F. (2011). Disciplining the poor: Neoliberal paternalism and the persistent power of race. Chicago: The University of Chicago Press.CrossRef

Stone, D. (2002). Policy paradox: The art of political decision making, revised edition. New York, NY: W. W. Norton & Company.

Scheffler R., Wallace, N., Hu, T. W., Bloom, J. & Garrett, B. (1998). The effects of decentralisation on mental health costs in California. Mental Health Research Review, 5, 31–32. Retrieved from http://www.pssru.ac.uk/archive/pdf/mhrr5.pdf.

The Kaiser Family Foundation, The Kaiser Commission on Medicaid and the Uninsured. (2011). Mental health financing in the United States: A primer. Retrieved from http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8182.pdf.

Weiss, R. S. (1994). Learning from strangers: The art and method of qualitative interview studies. New York: The Free Press.

Zhang, A., Scheffler, R., & Snowden, L. (2000). State health care reform: The effects of program realignment on severely mentally ill persons in California’s community-based mental health system. Psychiatric Services, 51(9), 1103–1106. doi:10.1176/appi.ps.51.9.1103.CrossRefPubMed

Title: Linking the Legislative Process to the Consequences of Realigning California’s Public Mental Health System
Authors: Megan E. Vanneman
Lonnie R. Snowden
Publication date: 01-09-2015
Publisher: Springer US
Published in: Administration and Policy in Mental Health and Mental Health Services Research / Issue 5/2015
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-014-0591-z

At a glance: The STEP trials

Springer Medicine

Linking the Legislative Process to the Consequences of Realigning California’s Public Mental Health System

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2015

Measures for Predictors of Innovation Adoption

Sharing State Mental Health Data for Research: Building Toward Ongoing Learning in Mental Health Care Systems

Integrating Science and Engineering to Implement Evidence-Based Practices in Health Care Settings

Long-Term Clinical Outcomes from a Randomized Controlled Trial of Two Implementation Strategies to Promote Collaborative Care Attendance in Community Practices

Clinicians’ Attitudes Towards Outcome and Process Monitoring: A Validation of the Outcome Measurement Questionnaire

Co-responding Police-Mental Health Programs: A Review