Mental Health Services Act (MHSA):
Waste and Fraud, 3 articles
Myriad problems with Mental Health Services Act funding
Dr. Larry Poaster, the chair of the Mental Health Services Oversight and Accountability Commission (MHSOAC) wrote an op-ed criticizing families of people with severe mental illness who criticize how Mental Health Services Act (MHSA) funds are being spent. He claims the program is working well. But it's not.
For one thing, the oversight committee itself is diverting MHSA funds meant to help people with severe mental illness to other causes. In their case, it's to hire a PR firm to further the oversight committee's claim that all is well.
How does hiring a PR firm help people with severe mental illness? Is that why taxpayers voted to tax themselves? They felt a dearth of PR firms? To cite another example, the California Mental Health Services Authority made a multi-year commitment to fund a "Center for Dignity, Social Inclusion and Stigma Elimination." Instead of providing treatment and services to people with severe mental illness, it will provide ads and brochures to the public.
When the myriad of examples like this are documented, Dr. Poaster claims that critics are "use(ing) single anecdotes out of context and ignore overwhelming facts." But it is Dr. Poaster who fails to present the big picture.
As part of his claim that MHSA is working well, he points to a report that shows MHSA Full Service Partnerships (FSP) reduced hospitalizations, arrests and incarcerations. Those claims are probably true. It's a good and important program. But he fails to disclose that these programs are exclusively for voluntary patients. The homeless psychotic people on the streets who 'know', they are Jesus or the FBI planted a transmitter in their head—the most severely ill who refuse treatment can not get access to these programs. They are being turned over to police and law enforcement in record numbers. As a result of realignment, many may soon to be discharged back into the communities where service providers will again refuse to serve them.
Dr. Poaster correctly notes that 20% of total MHSA funding goes to "Prevention and Early Intervention" programs. The law requires those programs to be "designed to prevent mental illnesses from becoming severe and disabling." But the oversight committees guidelines to counties say, "(P) revention programs are expected to focus on individuals prior to diagnosis of a mental illness. (emphasis in original)". Twenty percent of MHSA funds meant to help people with mental illness are not being diverted from their proper destination. The mentally ill are specifically excluded. Dr. Poaster claims these programs are effective but MHSOAC minutes show their evaluation "is based on what counties said they were going to do, rather than actual on-the-ground assessment."
In defense of the status-quo, the Oversight Commission chair claims that counties, not the committee set priorities and that millions were spent on a process that included "the diverse segments that are affected by mental health: schools, law enforcement, homeless programs, social services, faith communities and countless others."
Prop 63 was not passed to improve mental health (make people happier) it was passed to " reduce the long-term adverse impact… resulting from untreated serious mental illness." Including these 'countless others' led to a money grab free-for-all and counties developing amorphous something-for-everyone plans that focused primarily on 'social services' rather than treatment and services for those with severe mental illness. Lack of housing, education and employment were defined as 'risk factors' for poor mental health, and therefore housing, education and employment programs were showered with money that should have been spent help ing people with severe mental illness. Except in the case of Nevada County (and more recently Los Angeles county) none of the county plans included implementation of Laura's Law, and making services available to those enrolled. Services for Laura's Law recipients is the exact type of "new and innovative" services MHSA should be funding.
Millions continue to be spent on process, committees, consultants, PR firms, publishers, art directors, and writer instead of programs for people with severe mental illness. Orange County just published an expensive, glowing report on its use of MHSA funds, but no useful financial data that would help the public see where the money was going. And the report was fifty pages long.
As Rusty Selix, executive director of the California Council of Community Mental Health Agencies stated in reviewing where we are "In many ways, conditions are horrendous and difficult, but we're kind of used to that."
As the family member of someone with severe mental illness, I am not used to that. The problems with MHSA are not 'isolated incidents'.
What's the answer?
1. The legislature should require distributors of MHSA funding to follow the language and clear intent of the law and only distribute MHSA funds to programs that focus on "severe mental illness." They can accomplish that by adopting the National Institute of Mental Health's definition of 'serious mental illness', which covers no more than 8 percent of the population and require all or the majority of MHSA funding to be spent on this targeted population. By using this definition, California can avoid the wrangling that would result from trying to create it's own definition.
2. The state should use its "clarification" power under Section 18 of MHSA to eliminate regulations that are contrary to law and direct desperately needed MHSA funds towards uses consistent with MHSA.
3. Rose King, a veteran California political consultant who was involved in writing MHSA legislation makes a good case for the legislature to reexamine the maintenance of effort provision, which created a two-tier system: those with serious illness who received minimal and substandard services prior to MHSA are now routinely and intentionally denied any MHSA funded services, while those who are barely ill, or not ill, get comprehensive services.
4. Carla Jacobs of the Treatment Advocacy Center says the legislature should remove the sunset provision from Laura's Law because it discourages counties from making the long-term plans needed to correctly implement it. Once Laura's Law is implemented, MHSA funds could be used to serve those enrolled in Laura's Law in programs already serving others.
The critics of MHSA do not have an MHSA-funded PR firm on their side. But they do have the facts.
Legislative Fix Needed To Stop Waste of Millions Earmarked For Severe Mental Illness
California continues to ignore the dangerous mentally ill, while squandering millions in mental health dollars earmarked for "severe mental illness" on the worried well, whose voices are much louder in local politics.
Despite the rash of assaults and homicides committed by dangerous patients at Napa State Hospital—the most recent just last month—the current proposed budget will produce more murders and assaults by lowering state hospital staff ratios to save money. Meanwhile, the misnamed Mental Health Services Oversight and Accountability Commission ("MHSOAC") soldiers on, apparently unaffected by the impending demise of Department of Mental Health ("DMH"), or the state budget crunch.
In fact, MHSOAC is now wasting even more taxpayer money on a PR campaign, amassing stories of how Proposition 63 has been successfully used. But MHSOAC success stories, which certainly exist, cannot hide the waste of millions of dollars in Proposition 63 prevention/early intervention funds.
Here is the background: in 2004, California voters passed Proposition 63, now the Mental Health Services Act ("MHSA"), to help those with "severe mental illness." MHSA earmarks 20% of its funds for programs "effective in preventing mental illnesses from becoming severe" and "successful in reducing the duration of untreated severe mental illness." Note the statutory emphasis here: "effective" and "successful" programs for "severe mental illness" and for "mental illness" that may become "severe."
DMH, however, ignored the voters' intentions by issuing regulations that exempt prevention funds from the general regulatory requirement that Proposition 63 funds be used for "severe mental illness/emotional disturbance." It's tracking system for prevention/early intervention funds don't even require a diagnosis code. Plus, it gave counties "flexibility" to do whatever they wanted with Proposition 63 funds, as long as DMH decided the use "meets the intent" of Proposition 63.
Not surprisingly, though contrary to the law they were supposed to be enforcing, DMH/MHSOAC approved plenty of programs that had nothing to do with "mental illness," much less "severe mental illness." $133,571,200.00 in Proposition 63/MHSA prevention/early intervention funds were budgeted for allocation last summer. What got funded? elementary school programs about bullying, therapeutic gardening for unhappy Hmong refugees, horse therapy for troubled teens who are not mentally ill, a support group for gay and lesbian teens, parenting skills programs, a support program for unwed mothers, a hip hop car wash, a homework help programs for non-mentally ill students, yoga and "Soul Chi," for the stressed, among other things. These may be fine programs, but they are hardly "effective" and "successful" at preventing or shortening the duration of "severe mental illness," as required by law.
Don't blame worthy organizations for applying for these grants. Blame the regulation and regulators who invited them to do it. The potential for further abuse has become greater after AB100 sent many DMH functions to the counties. They submitted these grants for approval, and have now learned some very bad spending habits.
The legislature should stop this abuse by using its "clarification" power under Section 18 of MHSA to eliminate regulations that are contrary to law and direct desperately-needed MHSA funds towards uses consistent with MHSA. First and foremost, Laura's Law, which is presently optional by county, should be made mandatory, and funded through Proposition 63. Laura's Law meets prevention/early intervention funding criteria by "reducing the duration of severe mental illness" through assisted outpatient treatment. And as MHSA requires, it works. Its New York analogue, "Kendra's Law," has an excellent track record of preventing violence and keeping the mentally ill out of jails and prisons by safely maintaining them in the community. Nevada County has found that Laura's Law saves $1.81 for every $1 invested by reducing hospitalizations, 911 calls, arrests, trials and incarcerations.
With a little imagination, the legislature could also direct MHSA funds towards care of the thousands of mentally ill inmates who will be leaving state prisons as the result of the U.S. Supreme Court's Plata order. While MHSA states that its funding cannot be used for state parolees, mentally ill inmates who are Laura's Law eligible could be released subject to a Laura's Law order, rather than parole. MHSA funding can even be used to build facilities with restrictive settings, so long as he needs of the people to be served cannot be met in a less restrictive or more integrated setting. So how about directing funds towards local psychiatric facilities that will house people who will otherwise end up in state hospitals, which are dangerously overcrowded and understaffed?
Legislators, please use your "clarification" power in Section 18 of MHSA to stop DMH from funding "mental illness lite" in contravention of voter intention. The safety of the public and the needs of the severely mentally ill are too dire for such waste. The voters gave you the power to fix this. You owe it to them and the thousands of very sick people who need these funds to do it.
In California's system of care for the mentally ill, leadership is lacking
California is killing people with mental illness. Not for lack of money, but for lack of leadership. Earlier this month in Fullerton, police fatally beat mentally ill Kelly Thomas after he was abandoned by the mental health system. In January, Los Angeles police shot mentally ill Earl Rhodes; in February San Mateo police shot mentally ill Robert Caron. In June, Bakersfield police shot mentally ill Adam Horttor.
But don't blame the police. They are being forced to tread where the mental health system refuses to go to the aid of people with the most serious mental illnesses. These are often homeless, delusional, psychotic, and yes, sometimes dangerous individuals. Almost all could be helped with treatment. Almost all were abandoned by the California mental health system so they could fund 'services' to everyone else. On almost every occasion police take these severely ill individuals to hospitals without incident to see they get care. But they rarely get it. The mental health system releases them and they inevitably deteriorate to become a police responsibility again.
In California you are almost four times more likely to be incarcerated for severe mental illness than treated for it. Thousands of these severely mentally ill prisoners may be released because of the U.S. Supreme Court's order in Brown v Plata, which decided that the treatment of the mentally ill in California prisons amounts to "cruel and unusual punishment."
Pre-2004, California counties could claim they didn't have enough money to treat people with "severe" mental illness. But in 2004, voters chipped in to raise over $800 million annually via Proposition 63, now the Mental Health Services Act (MHSA) for the repeatedly stated purpose of addressing "severe mental illness." Legal restrictions on use of MHSA prevention funds were particularly specific: such programs must be effective in "preventing mental illnesses from becoming severe" or "successful in reducing the duration of untreated severe mental illness."
County mental health commissioners have accepted the funding, but not the requirement to spend it on the "severely" mentally ill. With the acquiescence of the almost-defunct Department of Mental Health in Sacramento, they have intentionally diverted funds away from severe mental illness.
San Francisco County is spending money earmarked for prevention of "severe" mental illness - for yoga, line dancing, drumming and Soul Chi (soulful movement), for individuals with 'sub-clinical' depression.
King County spends MHSA funds on "equine [horse]-facilitated psychotherapy" and "drumming" for Indian youth reading below grade level or merely "exhibiting ... problems."
Butte County is funding a "Therapeutic Wilderness Experience."
Contra Costa County is using MHSA funding for a hip-hop carwash, family activity nights, creative learning circles, school programs to reduce dating violence bullying and sexual harassment, outings for the isolated elderly, and a homework club.
Orange County is using MHSA funding for programs specifically limited to those "who have achieved a high level of recovery" and programs that intentionally "focus on the person rather than the disease." They run groups to improve "personalized socialization," relationship building, and exploring educational opportunities.
Los Angeles County is funding "emotional recovery" centers, 'stigma' campaigns, tuition reimbursement programs, market research, employment offices and a host of other services that arguably benefit the least "severely" ill but inarguably don't benefit the most "severely" ill. Los Angeles is eliminating a proposal to use MHSA funds to start a Safe Haven Program that would provide a safe environment for chronically homeless individuals with "severe" mental illness because it "has been unable to find a qualified contractor." But Los Angeles County is still expanding hotlines, warm lines, suicide lines, and referral lines leading to more and more organizations referring to fewer and fewer services. It's a shell game that's not helping people with "severe" mental illness and is creating a danger for all of us. Not what voters wanted.
And then there are the enormous amounts of public money being spent on administration. Counties are hiring expensive consultants, enlarging their bureaucracies and even awarding themselves grants, like the $83,000 Contra Costa County gave itself for "stigma reduction and awareness education."
The reorganization of the California mental health system should not be allowed to proceed without taking into consideration the impact on the most severely mentally ill. By simple majority vote, the Legislature has the power to enact a "clarifying" amendment to get Proposition 63 funds back on track. Laws and regulations should be put in place to insure services that help the severely ill like Laura's Law, crisis beds, and outreach services go to the front of the funding line, rather than the back.
In some states it is criminal to misallocate earmarked funds. In California, it's standard operating procedure.