Voluntary psychiatric emergencies in Los Angeles County after funding of California's Mental Health Services Act.
OBJECTIVE
Since 2006, California's Mental Health Services Act (MHSA) has distributed an estimated $6 billion in new tax revenues to county mental health systems. Although evaluations of MHSA's effectiveness find favorable outcomes among high-risk individuals that represent 6% of all mental health clients, scant research has tested whether MHSA funds improve the overall functioning of the public mental health system. The authors analyzed whether the incidence of voluntary emergency psychiatric visits, a key gauge of the functioning of the mental health system, fell below expected levels after the disbursement of MHSA funds. Los Angeles County, the most populous county in California, was examined.


METHODS
The authors obtained the monthly incidence of emergency psychiatric visits among Medi-Cal patients for 96 months spanning July 2000 to June 2008 (5.9 million overall admissions, of which 47,328 were emergency visits). Time-series methods controlled for temporal patterns in emergency visits as well as other potential confounders (unemployment, for example) that could induce spurious associations.


RESULTS
The incidence of voluntary psychiatric emergencies fell below expected levels eight to 12 months after the disbursement of MHSA funds. After one year, emergency visits returned to their long-term mean level. Results remained robust after analyses controlled for outliers and potential confounders.


CONCLUSIONS
In the short term, an infusion of public funds devoted to mental health services appeared to reduce psychiatric emergency visits. Explanations for the transient nature of the decline in emergency visits in Los Angeles County are discussed.
Department of Planning, Policy, and Design, University of California, Irvine, 202 Social Ecology I, Irvine, CA 92697-7075, USA. tim.bruckner@uci.edu
Tim A
TA
Bruckner
Kim
K
Yonsu
Bharath
B
Chakravarthy
Timothy Tyler
TT
Brown
D000293:Adolescent; D000328:Adult; D002140:California; D003156:Community Mental Health Services / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000534:rehabilitation; D008605:Mental Health Services / Q000191:economics / Q000331:legislation & jurisprudence; D008875:Middle Aged