This week, the Little Hoover Commission convened to take a close look at the mental health system in California — in particular, how successful the 2004 Mental Health Services Act has been, and where it has been lacking.
California voters in 2004 passed Proposition 63, which established the Mental Health Services Act and set a 1% income tax on personal income in excess of $1 million. Over 10 years, that tax raised about $13.2 billion, and is due to deliver an estimated $1.58 billion in the 2014-15 fiscal year.
On Tuesday, the Little Hoover Commission looked into the details of the good and the bad delivered with that money, sparked by a state auditor report last year that found the program suffering from a lack of oversight of how counties implement state mental health programs, and how the counties gauge those programs’ effectiveness.
Rusty Selix, executive director of the California Council of Community Mental Health and one of the people who helped draft Prop. 63 a decade ago, testified at Tuesday’s hearing.
“We had three goals for it,” Selix said. “One was to fully fund the model program, the adult system of care. The [second] thing was protecting entitlements for children.” Those first two objectives were accomplished fairly well, Selix said.
“The third thing was doing something which had not been done anywhere in the United States — which is prevention and early intervention,” Selix said.
It’s much harder to measure success with that last objective, Selix said.
“You’re basically measuring the absence of an event,” he said. “Are there fewer people showing up in the ER?” Also, he said, there has been a concern about more people coming into a system where care is good and skewing the results. “For instance we’ve seen that 40% of the homeless in San Francisco came from somewhere else,” he said, “so there’s a concern that the need is going to always keep growing as we become a magnet for people in other states.”
Overall, he said, the new model of care has worked. But some issues have remained problems.
“Another major feature of the act was to do something about the racial and ethnic disparities [in use of mental health services], to reduce those disparities,” he said.
That hasn’t really happened. The percentage of people who access mental health services should be at about 15%, Selix said, and it’s at about 10% for whites and African Americans — but it’s much lower for Latinos and Asians, he said.
“With Latinos and Asians, we were at 3% [in 2004] and now we’re up to 4%,” Selix said.
Stronger state oversight is vital for better implementation of programs at the county level, said Jessica Cruz, executive director of the National Alliance on Mental Illness California.
“There should be some sort of state consistency within the act,” Cruz said. “The counties should be adhering to what the state put in place. But because there’s not an oversight, or one that has enforcement or teeth to do anything if there is an issue, then as advocates we don’t have anywhere to go. We believe there should be statewide oversight that has teeth for enforcement.”
The other big missing piece, she said, is consistency of evaluation. Counties need to assess success in similar ways, and data needs to be shared between counties and the state, she said.
“But we don’t have the data,” she said.