Capitol Alert

Report rips California’s oversight of mental health initiative

In 2012, children and adults exercise as part of a wellness program run jointly by the La Familia Counseling Center and the YMCA in Sacramento.
In 2012, children and adults exercise as part of a wellness program run jointly by the La Familia Counseling Center and the YMCA in Sacramento. Associated Press file

Ten years after California voters passed Proposition 63’s tax on millionaires to fund programs for the mentally ill, the state cannot document whether billions of dollars in funding have improved residents’ lives, according to a new report by the Little Hoover Commission.

The report, released by the oversight body on Tuesday, is the second in two years faulting the state for inadequately accounting for a program that has raised more than $13 billion.

Bureaucratic and technological shortcomings, the Little Hoover Commission said, make it difficult, if not impossible, to analyze the measure’s effect.

In a letter accompanying the report, commission Chairman Pedro Nava pointed to “overlapping and sometimes unaccountable bureaucracies” and to a panel – the Mental Health Services Oversight and Accountability Commission – that “still lacks teeth.”

While Proposition 63 has by “many accounts … demonstrated successes in improving lives throughout the state,” Nava wrote, “for oversight, the record is not so notable. After 10 years, the state cannot provide basic answers to basic questions: Has homelessness declined? Are programs helping Californians stay at work or in school? Who is being served and who is falling through the cracks?”

Proposition 63, written by former Senate President Pro Tem Darrell Steinberg and approved by voters in 2004, created the Mental Health Services Act and imposed a 1 percent income tax on Californians earning $1 million or more per year to pay for mental health programs.

Funding from the proposition now accounts for about one-quarter of California’s total spending on mental health, according to the report.

Though hailed by advocates as a necessary source of money for county programs, the Little Hoover Commission said authorities cannot “clearly show, much less measure, what more than $13.2 billion has accomplished in terms of improving services” for people with mental health needs.

The commission’s findings are in line with a report by state Auditor Elaine Howle in 2013 that found inadequate oversight and monitoring of county programs funded by Proposition 63 money. She said that because of minimal oversight, California has “little current assurance” that funds directed to counties have been used effectively.

Critics have pointed to Proposition 63 spending on yoga, horseback riding and other activities as evidence of questionable oversight.

In its report Tuesday, the Little Hoover Commission recommended expanding the authority of the Mental Health Services Oversight and Accountability Commission to review some mental health programs before funding them. It also urged the commission and Department of Health Care Services to develop a data system to better monitor outcomes of programs funded by Proposition 63.

Jennifer Whitney, a spokeswoman for the Mental Health Services Oversight and Accountability Commission, said her panel and the Department of Health Care Services are currently working on improving data collection to track outcomes for people who receive services. But the state relies on information from counties, she said.

“We feel that we’ve had no teeth,” Whitney said. “We have not been able to insist that the data gets sent to us, basically.”

Steinberg, a Sacramento Democrat who is now setting up a mental health policy institute, said county officials are improving data collection efforts and that the first thing the institute does – likely within four to six weeks – will be to produce a “comprehensive evaluation” of programs funded by Proposition 63.

“I have been harping for years on the need for a comprehensive, outcome-based evaluation for the Mental Health Services Act,” he said. “Because I know this … It is making profound and positive change in the mental health system. There are tens of thousands of people whose lives are transformed because of the services under the act.”

Robert Oakes, executive director of the County Behavioral Health Directors Association of California, said it is the state – not counties – that has held up data collection.

“We provide lots of data to lots of different entities,” he said. “The biggest problem is the lack of coordination among all the state agencies that get data … Even departments within agencies don’t work as well together as they could.”

Oakes also argued against giving the Mental Health Services Oversight and Accountability Commission authority to review programs up front, saying “the last thing Californians need is additional state bureaucracy to be put on counties” providing mental health programs.

Jon Coupal, president of the Howard Jarvis Taxpayers Association, which opposed Proposition 63, said the report is “unfortunately reflective of how some of these special funds escape scrutiny over the long term.”

He added, “Merely the creation of a commission does not mean good management. In fact, sometimes it means just the opposite.”

Call David Siders, Bee Capitol Bureau, (916) 321-1215. Follow him on Twitter @davidsiders.

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