Report shows MHSA funds having positive impact on LA County mental health services

A new report conducted by RAND Health shows that Los Angeles County’s mental health programs have benefited from the Mental Health Services Act (MHSA) funds. Los Angeles County is the largest local mental health agency in the state.

In 2004 MHSA was passed, which levied a 1 percent tax on incomes over $1 million to fund mental health services. LA County used MHSA funds to expand access to Full-Service Partnerships (FSP)  and offer new Prevention and Early Intervention (PEI) services.

Under the MHSA, 20 percent of funds must be allocated to PEI programs and 45 percent of funds must be allocated to community services and supports, with the majority allocated to FSP.

LA County Department of Mental Health commissioned an evaluation of these programs to “understand who is being reached by key MHSA-funded services and what the impact of services has been.” The evaluation, conducted by UCLA and RAND research, examined data from 2012 to 2016.

The evaluation focused on PEI services for children and transition-age youth (ages 16-25) and FSP programs.

The report offered five key findings in its analysis of PEI programs for children and transition-age youth.

  1. LAC DMH provided PEI services to almost 130,000 youth, the vast majority of whom were members of ethnic minority groups. Furthermore, the intent of PEI is to reach youth who have not previously gotten care. In this aspect, PEI is working as intended. Almost 65 percent of the unique clients receiving PEI care between 2013 and 2016, corresponding to more than 60,000 children and youth, were new clients.
  2. Utilization of treatments, such as therapy and case management, increased with use of PEI services. However, psychiatric care decreased, perhaps indicating that youth who receive PEI services were more likely to receive a trial of a psychosocial treatment before assessment for medications.
  3. PEI is associated with staying well and getting better. Of those receiving care preventively (i.e., those who scored below a widely used threshold for psychological distress at entry into care), 88 percent of this high-risk group remained below the threshold for clinically significant symptoms over time. Of those who had symptom levels above a clinical cut-off for psychological distress at the start of their PEI services, 51 percent no longer had clinically significant symptoms at the conclusion of care. After benchmarking the clinical care to randomized trials, we found that most practices fell within the same range of clinical response as did the trials, suggesting that the evidence-based care offered by PEI services is effective among this population.
  4. Hispanic and Asian youth responded particularly well to PEI services, in comparison with non-Hispanic white and black youth. However, all racial/ethnic groups experienced significant improvements in symptoms.
  5. PEI services have significant impacts on children and families beyond symptomatic relief. The qualitative interviews suggested that youth receiving PEI services have multiple impairments that the programs address. Future evaluations should capture the broad range of potential outcomes resulting from PEI services, including functioning, school, and impact on families.

The report offered four key findings in its analysis of FSP programs.

  1. FSP enrollment increased over the five years evaluated for children, TAY, and adults. Further, the majority of those enrolled actively engaged in the program.
  2. FSP programs provide services to vulnerable and diverse populations. The programs are located throughout the county, but they are primarily in areas with more households in poverty, where LAC DMH services are likely to be needed the most. The individuals served by the programs tend to have severe diagnoses (e.g., psychotic disorders) and relatively high rates of homelessness. Qualitative interviews also revealed that FSP clients were simultaneously experiencing problems with mental health, physical health, and social issues. The programs predominately serve racial/ethnic minorities.
  3. FSP clients experienced improvements in their life circumstances and functioning. FSP clients experienced decreased rates of homelessness, decreased rates of detention or incarceration within the justice system, and decreased utilization of inpatient hospitalization for mental health. Adults in particular had increased rates of having a primary care provider, suggesting a better connection to physical health care.
  4. FSP programs simultaneously and synergistically address mental health needs and social needs (e.g., housing, benefits, social support, food, transportation), according to participants in qualitative interviews. Clients also reported developing close relationships with FSP providers, which facilitated their recovery.

However, the report does not reveal how much funding LA County has received under the MHSA. In FY 2014-15, LA County received $737,610,000. Of that, approximately $233 million went to community support and $140.5 million went to prevention.

The report recommends in the future, LA County Department of Mental Health should conduct cost-effectiveness and cost-benefit analyses for the programs. It also recommends that LA County Department of Mental Health facilitates “future outcome-monitoring and quality-improvement efforts by retooling the approach to measuring outcomes.”

This report was released just a few weeks after an audit released by the California State Auditor revealed “excessive reserves” of MHSA funds at the county level and a lack of oversight by the Department of Health Care Services.