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Administration and Policy in Mental Health and Mental Health Services Research

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01.09.2015 | Original Paper

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

verfasst von: Megan E. Vanneman, Lonnie R. Snowden

Erschienen in: Administration and Policy in Mental Health and Mental Health Services Research | Ausgabe 5/2015

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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.

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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).

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Titel: Linking the Legislative Process to the Consequences of Realigning California’s Public Mental Health System
verfasst von: Megan E. Vanneman
Lonnie R. Snowden
Publikationsdatum: 01.09.2015
Verlag: Springer US
Erschienen in: Administration and Policy in Mental Health and Mental Health Services Research / Ausgabe 5/2015
Print ISSN: 0894-587X
Elektronische ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-014-0591-z

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