Funding uncertainties force mental health services to change approach
For Mental Health Client Action Network’s Matt Davis, overcoming the way the world viewed his schizophrenia diagnosis was just the first step of recovery. Now, helping others face similar challenges is his cure and life’s work.
“The world tells you if you have a mental illness, you’re weird, damaged, or flawed,” says Davis during a brief break from assisting clients at MHCAN’s front desk. “I don’t feel like that [since] I started coming here.”
At MHCAN, the stigma of mental illness is nonexistent. The organization was founded in 1992 by a group of Santa Cruz residents who were involved in the mental health consumer rights movement, some as ex-patients and others as survivors of mental health abuse. MHCAN became a nonprofit in 1995.
MHCAN has always been run, as Davis puts it, “By us, for us.”
MHCAN’s unique offering of weekly activities boasts a lineup that sounds more like a holistic mind/body spa than a mental health program partially funded by the county. The wellness and self help center offers art therapy, gentle yoga, acupuncture, creative writing, healing through art, open art studio, poetry and knitting, along with support groups called Wellness and Empowerment and Mood Matters. In all, there are 26 weekly support groups. Other resources include a computer lab, stocked kitchen, clothing donations and transportation to and from doctor appointments.
At the core of it all is peer support—the crux of MHCAN’s philosophy.
“Many mental health clients tend to isolate,” says Linda Kiva, executive director at MHCAN, “so socialization is a very important aspect of the groups, as well as the healing that takes place as part of a peer-to-peer interaction, as in ‘I’ve been there and can understand what you’re going through, and I know you will come out of this.’ The simple act of being there for another is healing in itself.”
Davis first came to MHCAN 15 years ago as a client referred by a doctor. Since then, he has held several jobs at MHCAN.
“I was very empowered by recovery so I try to empower others,” Davis says. Today, he leads two weekly support groups—Smoking Cessation and Peer Support.
Housed in an A-frame building on Cayuga Street, MHCAN serves 600 clients in Santa Cruz County. The self-help and wellness center is a contract agency with County Mental Health, which provides about 60 percent of funding for MHCAN. The remainder comes from private donations. Like the rest of county mental health services, MHCAN has been feeling the pinch of decreased funding. Three years ago there were 14 staff members. Today, there are only seven part time staffers.
“Our county funding has been reduced by 43 percent over the past three years, as the general economy has declined and the state revenues to the county has declined,” says Kiva. “MHCAN is not exempt at all to past and future state funding cuts. We have accommodated the cuts mainly by reducing staff, and cutting all other expenses to the bone.”
State of Mind
Gov. Jerry Brown’s proposed 2011 state budget, aimed at narrowing the state’s $25 billion deficit, includes eliminating redevelopment agency (RDA) funding in order to “realign” those funds, shifting control of some services—like public safety and mental health services—from the state to local governments. Brown’s plan banks on voters to approve a five-year extension on temporary taxes (which have filled the RDA coffers), which were levied in 2009.
“The potential exists for some future greater flexibility and responsiveness to local needs in running these programs if realigned, but the details matter as to whether that flexibility would be made real and at what cost,” says Leslie Tremain, director of Santa Cruz County Health Services Agency.
Tremain characterizes Gov. Brown’s realignment proposal as “a very, very big outline without the details filled in.” Overall, realignment has been met with mixed reviews within the City and County of Santa Cruz.
Faced with the possibility of the state handing over its control of certain mental health services, local providers are turning to the mental health clients themselves to drive Santa Cruz County’s mental health programs in a new direction.
“I think what we are trying to do is find ways through [peer-run programs] that really engage the community’s natural resources and support to help us add to what we can offer to serve the people in the community,” says Tremain. For mental health consumers, peer-run programs offer increased control and the benefits of receiving counseling from someone who has overcome similar challenges.
Outside of MHCAN, there is a group of mental health consumers that meet weekly and call themselves the Client Core. The Client Core is responsible for establishing the mission and guidelines of a new peer-run project called The Respite House. With the assistance of $3.6 million in federal grant money, the eight-bed Peer-Run Crisis Respite house will function as a stopgap in a time of mental health crisis. Those who visit the house will be more likely to be homeless or living in poverty than the general population of Santa Cruz.
The Respite House, says Tremain, will “provide respite for people that might be entering a really rough time in their lives.” Backed by federal money, programs such as The Respite House are changing the way providers approach mental healthcare.
Angie Savage knows peer-run mental health programs. She also likes to multitask. At MHCAN, Savage is a time-share program manager, a position she worked her way up to after starting at MHCAN in 2007 as a client. Savage, who has been diagnosed with schizoaffective disorder, also leads the Client Core, the group that represents mental health consumers in Santa Cruz County. Savage’s peer counseling skills also earned her a position at the new Respite House, where she will be working as a counselor.
“I view MHCAN as a place for peers and consumers to come that’s welcoming, so they don’t have to stay out in the cold, so they can have someplace to relax and someplace to support personal growth,” says Savage.
For MHCAN clients facing the extra challenge of homelessness, MHCAN does what it can to provide resources and connect their clients with housing services, but lack of funding has made this increasingly difficult. In the corner of Savage’s MHCAN office, a lone green sleeping bag waits for a client in need. It’s the last remnant of a de-funded program that used to provide sleeping bags for homeless clients.
“I worry about people when I go home,” says Savage. “I wonder where so and so is going to be sleeping tonight. It’s hard not to.”
In 2009, 55 percent of Santa Cruz County homeless were experiencing at least one mental health issue, while 26 percent identified as mentally ill, according to the Health Services Agency Public Health Report.
County mental health providers say that preventative services are key to keeping mental health consumers off the streets. Unfortunately, these same services will also be the most vulnerable to budget cuts.
“It just whittles down every year more to the bone,” says Christine Sippl, senior health services manager for the Homeless Person’s Health Project. “And so the services that are available and covered are only for the people who are most severely affected by their mental illness. Often there just aren’t the services to get up stream and provide preventative service. The most valuable thing is when we can assist a homeless person with mental illness to get into housing, and ideally there’s enough human resources to help people sustain their housing.”
But for local mental health programs, what’s “ideal” is far from reality. State funding for mental health services may continue to wither, another casualty of an unbalanced budget. Or, Gov. Brown’s realignment plan may change the future and send uncertain financial resources back to their local origins, to serve the people however the people see fit.
As the success of MHCAN’s peer staffed programs has proven, survival is often
about a community coming together in mutual support.
“We need to do more to really use the natural community resources that are available to us,” Tremain says. “We’ve got to pull together when times get tough.”
