California's Prop 63/Mental Health Services Act Fails Seriously Mentally Ill

In 2004, Californians altruistically passed a 1% tax on millionaires specifically to fund services for people with serious mental illness. As a result of reports that the funds were not reaching people with serious mental illness Mental Illness Policy Org. conducted a study and found many of the complaints to be true. Below is a summary of our report released August 15, 2013. The full report is here Our op-ed in San Diego Union Tribune is here. We shared our concerns with the California State Auditor.

California’s Mental Health Service Act:   A Ten Year $10 Billion Bait and Switch 

An investigation by Mental Illness Policy Org and Individual Californians

August 15, 2013 

Background

In November, 2004 California voters enacted a 1% tax on millionaires (Prop 63) to establish the Mental Health Services Act (MHSA) fund solely to help people with serious mental illnesses.[1] $10 billion has been raised since inception. Voters also created a Mental Health Services Oversight and Accountability Commission (MHSOAC a/k/a “Oversight Commission”) to see the program stuck to its purpose of helping people with serious mental illness.

Primary Findings

Many people with serious mental illness are receiving critical treatment as a result of Prop 63 but billions are being diverted to other purposes:

•  $1-2 Billion of Prevention and Early Intervention (PEI) Funds was intentionally diverted to social service programs masquerading as mental illness programs or falsely claim they prevent serious mental illness.
• ·$2.5 billion of the “Full Service Partnership (FSP) funds were spent without oversight of whether the recipients had schizophrenia, bipolar disorder, or the other serious mental illnesses that made them eligible for MHSA funds.
•  $23 million went to organizations directly associated with Oversight Commissioners.
• $11 million is going to PR firms that make the Oversight Commissioners look good and hide the failure of MHSA to accomplish its mission
• $9 million is going to organizations working prevent the seriously ill from receiving treatment until after they become violent.
• ·Up to $32 million was diverted to TV shows, radio shows, PSAs and other initiatives designed to reach the public without mental illness. Some feature the Senate President Pro Tem Darrell Steinberg

Additional Findings

• County Behavioral Health Directors chaired meetings that allowed “stakeholder input” to trump the legislative language and voter intent to spend the funds on those with serious mental illness.
• No attempt is made to ensure programs receiving MHSA funds serve people with serious mental illness.[2]
• MHSA funds are being lavished on studies, reports, and consultants that generate jobs for those who get the contracts, but not services for people with serious mental illness.[3]
• Millions were diverted to programs intended to ‘improve the wellness’ of all Californians, rather than provide treatment to Californians with serious mental illnesses.[4]
• Funds failed to expand the capacity of proven existing programs as the legislation required.
• The most important programs to help the most seriously ill (like Laura’s Law) are going unfunded.
• The Oversight Commission evaluated counties based on what they said they were going to do rather than on what they did.
• A series of amendments and related legislation introduced by legislators made it less likely MHSA funds will ever reach people with serious mental illness.[5]

The full report documents each of these findings.

Who is responsible for the failure:

The Oversight Commission

The problems with MHSA are not ‘under the radar,’ they are caused by the radar operators. The MHSOAC Oversight Commissioners have become cheerleaders for mission creep and cronyism rather than careful stewards of public funds. The Oversight Commissioners receive funds for their programs, approve distribution of the funds, hire outside evaluators to prove they are doing a good job and PR firms to convince the public all is well.

County Behavioral Health Directors

County behavioral directors--thirty-four of whom recently voted themselves MHSA-funded IPads[6]—have allowed the stakeholder process to circumvent legislative intent. Rather than following the letter or intent of the voters, they are funding anything brought to them by stakeholders and refuse to focus their resources on the most seriously mentally ill.

California’s non-profit mental ‘health’ and social service industries

California’s non-profit mental health and social service industries provide an important safety net for many Californians. But in a gold-rush like attempt to garner funds for their own programs, they threw those with serious mental illness under the bus. Non-profits and associations like Disability Rights California, NAMI California, Mental Health America of California, each of which receive over $3 million in MHSA funds and have representation on the Oversight Commission put their own parochial needs ahead of those of people with serious mental illness.

Senate President Pro-Tem Darrell Steinberg and the Legislature

Many of the citizens who contributed information to this report told us the Senate leader’s heart is in the right place and he can be part of the solution. Unfortunately, when we look at the facts, we are forced to conclude that since passage, Senator Darrell Steinberg has been part of the problem.  He introduced and the legislature passed numerous bills that subverted the intent of voters to use the funds to help the most seriously ill.SB 1467 ensured fewer Innovation Funds reached persons with mental illness.[7]His opposition to SB 664 made it harder for counties to implement Laura’s Law. His opposition to AB-1265 guaranteed mentally ill prisoners would go untreated upon end of their sentence.  SB-364 as proposed made it more dangerous for parents to call authorities to help mentally ill loved ones. AB 100 included provisions he proposed that diverted $836 million of MHSA funds to existing obligations that state had, in spite of provisions in MHSA that the funds should not supplant other funds. We would love to see the Senator resume a leadership role in improving services for people with serious mental illnesses. That would require him to break with community based program directors who are committed to diverting funds to their own programs.  Recommendations on how to do so are in the report..

Conclusion: It is undeniable that some people with serious mental Illness are being helped by MHSA, but unmitigated mission creep has left many of the most seriously mentally ill seriously underserved. There is an unregulated feeding frenzy going on and Prop 63 is on its way to becoming a “Ten Year, $10 Billion Bait and Switch.”

Read California's Proposition 63: A 10 Year, $10 Billion Bait and Switch

[1] The purpose was to “To define serious mental illness among children, adults and seniors as a condition deserving priority attention. ”See the bill as originally passed http://mentalillnesspolicy.org/states/california/prop63text.pdfand as amended in 2012 http://mentalillnesspolicy.org//states/california/mhsa/MHSA_Amend-AB1467_July2012.pdf

[2] Many of the outcome reports are at http://www.mhsoac.ca.gov/Evaluations/CSS-Outcomes.aspx . They do not include any info on the diagnosis of people served.

[3] Ex. The Oversight Commission put out an RFP for an evaluation to evaluate the evaluations. Neither the original evaluations or the evaluation of the evaluations require evaluation of whether the people being served were seriously mentally ill individuals eligible for services. http://mhsoac.ca.gov/Evaluations/docs/Contracts/RFP_MHSOAC012-015.pdf

[4] The Oversight Commission itself created an eight page glossy insert for papers throughout the state headlined, “Mental Illness: It Affects Everyone, even though the legislation is not intended to affect everyone. See http://issuu.com/news_review/docs/2013-01-03_mentalillness (accessed 6/23/12).

[5] Most notably, AB-100 took $863 million out of the MHSA fund and directed it to fund programs courts had mandated the state to fund. AB 1467 (July 2012) essentially disconnected Innovative Funds (5% of total MHSA funds) from a connection with serious mental illness.  

[6]Through CalMHSA, a Joint Power Authority funded with MHSA Prevention funds.

[7] See Appendix C. How Senate President Pro-Tem Exempted an additional 5% of MHSA funds (Innovative Services Funds) from helping persons with serious mental illness.

[1] Many of the outcome reports are at http://www.mhsoac.ca.gov/Evaluations/CSS-Outcomes.aspx . They do not include any info on the diagnosis of people served.

[2] Ex. The Oversight Commission put out an RFP for an evaluation to evaluate the evaluations. Neither the original evaluations or the evaluation of the evaluations require evaluation of whether the people being served were seriously mentally ill individuals eligible for services. http://mhsoac.ca.gov/Evaluations/docs/Contracts/RFP_MHSOAC012-015.pdf

[3] The Oversight Commission itself created an eight page glossy insert for papers throughout the state headlined, “Mental Illness: It Affects Everyone, even though the legislation is not intended to affect everyone. See http://issuu.com/news_review/docs/2013-01-03_mentalillness (accessed 6/23/12).