Involuntary civil commitments after the implementation of California's mental health services act

Objective: As of fiscal year 2008-2009, California's Mental Health Services Act (MHSA) has distributed $3.2 billion in new tax revenues to county mental health systems. This voter-approved act attempts to address the needs of unserved and underserved consumers with severe mental illness by implementing a "whatever it takes" approach. The research literature indicates that the incidence of involuntary treatment may gauge the overall functioning of the public mental health system. Consistent with the notion that the MHSA may facilitate effective treatment of severe mental illness, the authors tested the hypothesis that the incidence of two types of involuntary treatment - 72-hour holds and 14-day psychiatric civil commitments - declines as the enhancement of service access and quality is supported by MHSA funds. Methods: The investigators obtained quarterly counts of involuntary 72-hour holds (N=593,751) and 14-day psychiatric hospitalizations (N=202,554) for 28 counties, with over 22 million inhabitants, from July 2000 to June 2007. A fixed-effects regression approach adjusted for temporal patterns in treatment. Results: The petitions for involuntary 14-day hospitalizations, but not involuntary 72-hour holds, fell below expected values after disbursement of MHSA funds. In these counties, 3,073 fewer involuntary 14-day treatments - approximately 10% below expected levels - could be attributed to disbursement of MHSA funds. Results remained robust to alternative regression specifications. Conclusions: Fewer than expected involuntary 14-day holds for continued hospitalization may indicate an important shift in service delivery. MHSA funds may have facilitated the discharge of clients from the hospital by providing enhanced resources and access to a range of less-restrictive community-based treatment alternatives.