The Impact of Realignment on the Client Population in California's Public Mental Health System

This study examined whether decentralization of California's public mental health system under program realignment has changed the composition of the client population, with greater attention toward inclusion of persons with a severe mental illness. Clients' demographic and clinical status were compared before and after realignment. The study sample consisted of 75,951 clients, representing 1.5 million adults who accessed the public mental health services in California during a 6-year study period. The post-realignment client population had lower functional status, more unemployment, and lower levels of education—all indicating greater functional impairment. They were more likely to suffer from an affective disorder, but they were less likely to have either a non-psychotic disorder or schizophrenia. The study found no evidence suggesting that realignment jeopardized access to the public mental health system in California, and it indicated at least the possibility that it promoted greater access by clients with greater functional impairment.