“California’s teacher-librarians under pressure just when they’re needed most” (November 15) reveals one of the most serious problems in California education. Not mentioned, however, is the consistent finding that library quality has been shown to be related to reading scores. Studies done by Keith Curry Lance, Jeff McQuillan and others have shown that better libraries, with more holdings, more staffing and a credentialed librarian, mean better reading.
California’s reading scores have been among the worst in the United States since our national reading test scores (the NAEP) have been analyzed by state, in 1992. California at that time also ranked last in the country in school library quality. Neither reading scores nor library quality have changed much since then.
The problem is not restricted to school libraries: In last year’s “America’s Most Literate Cities” report, in the category “Library Support, Holdings, and Utilization,” six California cities were in the bottom seven (out of 75), including Los Angeles.
University of Southern California
Sigrid Bathen’s excellent article, “Changes in mental health care system spur new optimism,” outlines the governor’s consolidation of Mental Health and Addictions Departments with Health Services. While the sense of opportunity is palpable, it is tempered by healthy skepticism among stakeholders. Yet to emerge are the factors that can help or hinder this bold move. What is the opportunity? Where are the pitfalls?
Integration of health and behavioral health has become a major force in health reform and a necessary ingredient for the improved quality, consumer (and family) satisfaction and reduced costs that are core to the newly evolving reimbursement methodologies – a light year from our current procedure and volume-driven reimbursement.
However, consolidation does not assure integration. This fact is best reflected in the continued siloing and fragmentation in many systems that have joined mental health and substance use services elsewhere albeit in name only. While the planned stakeholder process and public hearings can clarify sentiment and garner input, they cannot substitute for a clinically grounded framework of how these three spheres fit together along a continuum of care within local communities. That continuum must move from preventive and primary to more complex specialty care, including specialty care for the more serious behavioral conditions. It must become the driver in structuring the regulatory functions necessary to hold providers and localities accountable in this new paradigm. Integration requires a different mind-set, culture and processing of data (integrated data) within the regulatory system itself if it is to become real and thrive.
Surely, with so much resting on getting this right, we can insist on threading the needle to achieve more than window-dressing.
Dr. Johanna Ferman, Martinez
Ed’s Note: Dr. Ferman, a public psychiatrist with 35 years’ experience, served as Director of Behavioral Health in Ambulatory Care within Contra Costa County, as the Deputy Commissioner for Clinical Programs for the New York State Office of Mental Health and as Chief Executive Officer and Medical Director for the Center for Mental Health in Washington, D.C.
The recent response to our commentary (“In California’s system of care for the mentally ill, leadership is lacking”) misrepresented our views.
We agree that Proposition 63, now known as the Mental Health Services Act, was an excellent and badly-needed initiative, specifically intended to address “severe mental illness”. Further, we agree that the bulk of the MHSA monies have been well spent. All the more reason to decry statewide squandering of millions for programs that MHSA did not authorize, and the voters did not intend.
Our focus was not on the well-spent dollars but on the waste of badly-needed prevention funds, which constitute 20 percent of MHSA tax revenues. MHSA is very specific about the use of these funds, for programs “similar to those provided under other programs effective in preventing mental illnesses from becoming severe” with “components similar to programs that have been successful in reducing the duration of untreated severe mental illness and assisting people in quickly regaining productive lives.” While good prevention programs are certainly being funded, hip-hop car washes, yoga, therapeutic horseback riding and the like were not even targeted to persons with “severe mental illness.” Further, these programs bear no similarity to the “effective” and “successful” programs the voters intended to fund.
We pointed out two programs that have been “successful in reducing the duration of untreated severe mental illness.” One is assisted outpatient treatment, known in California as Laura’s Law and funded in only two counties to date. It should be made mandatory using MHSA funds. The other is inpatient psychiatric beds for the mentally ill, in short supply throughout California because of low federal reimbursement rates.
When oversight (e.g. Laura’s Law) and crisis beds are unavailable, the severely mentally ill end up dead or on the streets. These are the people the voters intended to help. They got short shrift when funds were allocated because no one speaks for them, and they cannot speak for themselves.
Counties are free to fund other “successful” prevention strategies, assuming they exist—but not to spend monies earmarked for the “severely” mentally ill on making the entire population happier, which seems to be the premise of many county grants. The recently-passed AB 100 exacerbates this problem by reducing oversight of MHSA expenditures. Legislation recouping misallocated funds and narrowing county discretion would solve it.
Mary Ann Bernard, DJ Jaffe,New York