California has raised nearly $9 billion to fund services for the mentally ill since Proposition 63, an income tax on millionaires, passed in 2004. But a recent State Auditor’s report found that state agencies have failed to adequately monitor how mental health tax dollars are spent. Critics say money was used on questionable preventative programs like yoga classes, gardening, and buying iPads. We’ll discuss the audit and whether the money benefited those most in need.

State Audit Raises Questions Over Mental Health Spending 21 August,2013forum

Rusty Selix, executive director and legislative advocate at Mental Health Association in California
Dan Logue, assemblyman for California's 3rd District and vice chair of the Assembly Health Committee
Rose King, policy consultant and co-author of Proposition 63, the "Mental Health Services Act"
Debbie Innes-Gomberg, District Chief, Los Angeles County Department of Mental Health

  • pinky

    Rusty Selix is one who is grubbing for funds. He and his organization are part of the problem. Rose King is the co author and the MHSA money was not ever intended to be spent on funding organizations who do not do direct care and services for seriously mentally ill people who need help.

  • Robert Thomas

    I thought I heard Ms.Innes-Gomberg refer to a “262 percent decrease….” in something. Did I mis-hear? I can’t run the audio back yet. Maybe she said “sixty-two percent decrease”.

  • tcpasquini

    Please stick with the data and the facts AND THE LAW! Mr. Selix twists the facts to suit PR talking points. The full service partnerships are not doing whatever it takes. There is no evidence of quality or continuity of care. There is no compliance. Contra Costa MH Commission has called for a county audit.

    • tcpasquini

      Laura’s Law is evidence based on has not been allowed based on the states misdirection to counties. It can save lives and money.

  • Bernadette

    It disappoints me to hear that alternative preventative therapies are being questioned here. As a licensed massage therapist I see every day the effect massage has on individual’s mental states. I personally have struggled with depression my entire adult life and have found that yoga and gardening have incredible power to keep my depression at bay. Please continue to consider and embrace these “alternative” therapies as a part of a holistic healthcare system.

    • Peter Mantas

      Bernadette – I don’t believe that anyone apposes alternative therapies. The issue is that the funding is designed to get people with Severe Mental Illness (SMI) to seek help and receive treatment. The funds were not allocated for those with depression or less severe forms of mental illness. The money was to be allocated to prevent people with SMI from becoming in danger to self and/or others. This would take the form of improving the continuum of care so once a person is stabilized he/she will remain stable. We all need to keep in mind that by and large most people with SMI don’t even believe that they have an illness so how would we even get them to participate in yoga, massage therapy and the like? This is the context that most of the listeners didn’t have going into the show. Hopefully this program and others will help educate the general public that has not been effected by mental illness.

  • Bernadette

    I would also love for these alternative therapies to be taken seriously enough so that they can eventually be covered by insurance and therefore available to individuals who can’t easily afford these types of services.

  • DJ Jaffe

    Since Selix says Oversight was negilgent does he favor replacing the commissioners who failed to exercise oversight?

  • DJ Jaffe

    Selix failed to disclose that FSPs are only for people well enough to volunteer for services. Those who are currently psychotic and refuse treatment are not eligible. HE fails to understand it was for severe mental illness, not to ‘improve mental health”

  • DJ Jaffe

    Why doesn’t MHSA fund Lauras law?

  • Johanna Ferman MD

    There are some remarkable programs designed to improve care of the seriously mentally ill coming out of Prop 63 — but the bottom line comes at the community level, where vulnerable individuals remain without access, where families are still suffering untold stress, and where the BASE system, in spite of its retrenchment post-2008, has not been significantly improved.

    HOW to use seed funds to transform the base of a rapidly retrenching system remains a major challenge both within California and beyond.

  • Johanna Ferman MD

    With the largest component of funding the 80% of mental health funds that go to the base of the system; the MHSA funds, as acknowledged, represent some 20%. When the BASE is broken, as it is in much of California — infusing 20% does not often correct this. The analogy is building new rooms onto a house with a cracked foundation — one after another, while never fixing the basic foundation. The ‘foundation’ of care for people with serious mental illness, as with ANY serious illness, must be high quality medical care (health and behavioral health), HOUSING, EMPLOYMENT, resources for navigation and assuring that stigma does not shunt people to the periphery of our communities.

  • Peter Mantas

    Mr. Selix and other insiders communicate to the general public that the stakeholder process included the County Statutory Mental Health Commissions/Boards, consumers, family members and Mental Health professionals. Those that participated in the processes can tell you that it was as dysfunctional and disorganized as could be. Furthermore smoke and mirrors dominated the process which most knowledgeable stakeholders found objectionable and demanded improved transparency and accountability. The audit report verifies what the local stakeholders have been complaining for years. Had administrators at the state and county levels listened to their own stakeholders the story would have been different today.

    Most people forget that there are two levels of oversight and accountability. The first is at the county level with the statutory local county Mental Health Commissions/Boards (MHC). The second is at the state level with the Oversight and Accountability Commission (OAC). In Contra Costa County we found our MHC requests to the AOC for assistance in system accountability fell on deaf ears.

    It is unfortunate that our efforts encountered smoke and mirrors and circling of the wagons to protect their own. I reiterate the results are very visible in today’s audit.

  • Peter Mantas

    In order for the general public to understand the complexity of the public Mental Health System it needs appropriate context. Furthermore questions for the experts need do be framed in a way as to mitigate smoke and mirrors (talking points). In other words:
    1. Name the target group for the yoga therapy program.
    2. Please explain why this group was selected?
    3. Present the metrics which display need for such a program.
    4. How are you measuring quality of performance and outcomes before the program is authorized.
    5. Today what are the qualitative and quantitative performance results.

    If one was to ask such questions… The questions would be treated by a look of deer in headlights. By and large most MHSA programs were developed without these metrics. So the way that the system measures performance is by counting the number of people served by the program. You tell me if this is an appropriate way to measure performance.

  • Peter Mantas

    To the question of whom was the Prop 63 funding allocated to? A quick look at Section 3 of the law one finds the purpose is 100% for Severe Mental Illness (SMI) not depression not ADHD not drugs and alcohol. ( Funds were also allocated to the prevention and early intervention of SMI not all kinds of mental or behavioral illness.

    Section 3 also communicates that NONE of the Prop 63 funds are to be used to fund services already in place in 2004 or federally mandated services. However, as Mr. Selix communicated… In his opinion the reason MHSA programs are not as successful as could be is because counties have cut Mental Health System (County General Fund) funding by 70% requiring Prop 63 funds to back-fill the funding gap. If his assertion is correct than the counties are improperly using 70% of the funds they are receiving. (I believe that this assertion is incorrect.)

  • FACTS in Mental Illness

    Dear Governor, no piece-meal, quick fix by the very perpetrators of corruption, organized waste, and systematic raid on mental health money will satisfy me — or millions of other Californians who will not be deceived by the modern snake-oil entrepreneurs. Nothing can compensate for the life-long injuries, lost lives, and pain inflicted upon people with a mental illness and their families and friends. But advocates are clear the state must apply its best expertise and ethics to overhaul state administration of public mental health systems.
    The California State Auditor reported that at least four state departments responsible for oversight cannot provide evidence that Prop 63 expenditures–now $10 Billion–are of any benefit to California’s mental heath systems and its clients. The Auditor reported that the state has little assurance that taxpayer funds were used effectively and appropriately, and the public cannot be sure that MHSA programs are achieving their intended purposes. A Mental Health Directors Association could not provide any reassurances to the State Auditor.
    Is this an EMERGENCY?? This evidence alone should set off alarms in the offices of Governor Brown and his appointees to the Health and Human Services Agency, Dept of Finance, Dept of Health Care Services and a MHSA Oversight Commission–but the Brown Administration appears willing to gamble more billions in tax dollars in the hope that bureaucrats and Commission appointees will be rehabilitated.
    AND the CA State Auditor did not look into whether counties actually complied with the law in MHSA spending and programs, or misused tax revenue for unauthorized purposes–this report is yet to come. The Auditor cannot tell the public how much of this money was spent for actual mental illness treatment–and how much continues to be squandered on useless reports, needless conferences, studies, planning, reporting, and evaluating.

    Rusty Selix, Lobbyist for Mental health providers and Mental Health Associations, does not dispute that only FIVE PERCENT of consumers are “fully served” after nine years and $10 Billion expenditures. Selix and proponent Senator Darrell Steinberg have no comments about the conditions endured by the other 95%. That 95% has a caring constituency — and we expect action. Rose King

  • Peter Mantas

    The law was passed and landed in the hands of the Department of Mental Health (DMH). The law was interpreted incorrectly (by design or in error). This interpretation was used to establish plan development and roll-out to the counties. County mental health directors were given limited time to establish their local organization which would develop plans for implementation. The county (local) Mental Health Commissions/Boards that provide oversight were not trained on the Prop 63/MHSA law. At the state level the MHSA Oversight and Accountability Commission (MHSAOAC) was staffed primarily by insiders taking guidance from the same system the Commission was to oversee. (Does anyone have a problem with this?)

    From the beginning to the present; there was no plan that would ensure accountability. continuity and conformity of plans. So today the system can’t roll-up performance/outcomes from program to county system to state level performance. DMH started with a poor roll-out design and that continued down the line and across the system. Today the majority of the system operates with NO qualitative performance metrics. Quantitative (people served) is not a performance metric.

    The whistle blowers such as King/Pesquini and the like that understand the law were the few that recognized the problems from the unset. However, the system circled the wagons and vilified those us that recognized the problems and spoke up.

    So what was the goal of Prop 63/MHSA. It was not to create a bunch of disparate feel good programs. It was to improve outcomes for a specific part of the community. That is those with Severe Mental Illness (SMI) and those that have the potential of developing SMI. This is clearly the purpose articulated in Section 3 of the law.

    Given this goal how should have DMH and local county Mental Health Directors addressed this need? One would think that these professionals would have started by answering the question: “what are the current outcomes and how can we improve the continuum of care to improve these outcomes for SMI’s?” Had these profession done this the current outcomes would be exponentially more improved.

    As far as I’m concerned we need to stop wasting time and precious funds on audits and start over. The system is screwed up. Money is wasted; people are in pain; people are committing suicide; people are killing others; people are languishing in jails/prisons. Again money is wasted. We can do so much more with the funds that are available.

    Time for solutions not smoke and mirrors.

  • erictremont

    Darrell Steinberg has received a lot of good press over the past few years for leading the battle to raise additional taxes to fund treatment for the mentally ill, and whenever he is interviewed by the press he never hesitates to take a victory lap. Yet the scathing comments about the dysfunctional aspects of the program that are posted on this site makes me wonder if he or anybody else in the state legislature could care less about how the program is actually implemented.

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