Background 

Health and mental health are inextricably intertwined, and the health safety net should be supported by a range of other services, including mental health and substance abuse services.  However, services for people with mental illness, addiction, or co-occurring disorders have been fragmented and inadequately funded.  Stigma surrounding mental illness and addictions is another powerful barrier against help-seeking, community acceptance, and public policies supporting access to high quality services and reduction of disparities. The California Endowment has invested nearly 10 percent of its grant funds since 1997 into direct services, research and advocacy activities to increase access, improve cultural competency in mental health systems and reduce disparities. 

Since 2001, The Endowment has launched mental health strategic initiatives with the goal of improving mental health and well-being for populations at high risk of acute or chronic mental illness through increased access to culturally competent, age-appropriate services, and increased size and quality of the mental health work force. Priority populations for these initiatives are ethnic minority or linguistically isolated populations, low-income groups, and adolescents in the child welfare and probation systems, because they are the most underserved or poorly served by fragmented systems. 

Activities

• Integrated Behavioral Health Project: The goal of this four-year, $3.35 million partnership with the Tides Center is to accelerate the integration of behavioral health services, such as substance abuse treatment and mental health counseling, into primary health care settings for California’s low-income and minority health care consumers who historically have had no or limited access to these services. In addition, IBHP seeks to reduce the stigma of accessing these services by making them available through their trusted health care providers with whom they are comfortable seeking care.
• Healthy Returns Initiative: The California Endowment in 2005 launched its four-year, $6.5 million Healthy Returns Initiative designed to strengthen the capacity of probation departments to improve access to mental health and health services for adolescents in detention facilities and to ensure continuity of care upon their release; and address access policy barriers for this population. Probation departments in Los Angeles, Ventura, Santa Cruz, Santa Clara and Humboldt counties are engaged in the initiative.
• Mental Health Initiative (2001 – 2005): Through the Special Opportunity in Mental Health Funding, grants totaling $24 million were awarded to 46 organizations across the state to work independently or collaboratively in underserved communities to provide direct services, training, community education or other services. 

Support for Policy Implementation

The Endowment has played a leading role in supporting the implementation of two groundbreaking ballot initiatives passed by California voters.  The Substance Abuse Crime Prevention Act (Prop. 36), enacted in 2001, requires that under specific circumstances, non-violent offenders with addictions be provided with treatment services in lieu of incarceration.  Through grants to UC San Diego’s California Center for Criminality and Addiction Research, Training, and Application, county teams of law enforcement, judicial services, and treatment providers received extensive training and technical assistance to work together to implement the act.  In 2005, voters passed the Mental Health Services Act (Prop. 63), raising new funds to expand access to state-of-the-art recovery-oriented mental health services, create cutting-edge prevention and early intervention services, and increase the size and capabilities of the mental health workforce.  The Endowment has convened stakeholders to identify early implementation strategies and issues, and grants have strengthened technical assistance for counties to undertake large-scale systems change activities and increase their capacity to work effectively with diverse populations.