Making the Most of State Mental Health Efforts

It would be tough to call it integrated medicine. According to public health experts, the state of mental health care in California is more like a crazy quilt of mixed treatments, limited funding and uncertain outcomes.

That’s precisely what the Mental Health Services Oversight and Accountability Commission hopes to change. The board was created by the Mental Health Services Act, passed by California voters in 2004. It convened Wednesday in Sacramento to iron out the details of how it hopes to evaluate the sprawling mental health system in California.

“This is a critical meeting for this commission,” said Larry Poaster, vice chair of commission.

California policymakers want to spend mental health money on programs that work. The trick is figuring out what those programs are, based on hard data.

Available data, Poaster said, is not always so reliable.

“We know very little with regard to what is happening with data and outcomes and statistical information,” he said. The data supplied by counties is often incomplete or unusable, he said, because you need to compare outcomes, for instance, based on standards that all counties have. And that equanimity of data just doesn’t exist.

The first step is to clean up the mental health data from counties, so that comparisons — and determinations — can be made. “It will be an ongoing process,” he said. “Right now it’s like the first phase of a 10-phase project. But it’s a start.”

And that start needs to happen quickly. “We have a million dollars left, but unless we get liftoff quickly, we risk losing that money,” Poaster said.

Stephanie Welsh,  associate director at the California Mental Health Directors Association, said the commission has to walk a fine line because the directive of the commission is huge and broad, and the financing for that effort is relatively modest.

“No way all these deliverables can be achieved,” Welsh said. “Our job today is to pare down the deliverables while still having a good product.”

In other words, given the short time frame of needing to clean up data from the counties, evaluate that data and make recommendations about which programs might work better than others, the number of success markers may need to be trimmed back.

“The first piece is documenting what’s wrong. Then how to fix it,” Denise Hunt, also from the CMHDA, said.

Hunt raised an interesting point, given the ongoing budget crunch being debated just down the street. “We have a (mental health) service system that’s suffering (from budget cuts) at the same time as we have a million dollars to evaluate that system.”

But, she said, “I still think we should start somewhere.”

Stephanie Oprendek of the California Institute for Mental Health summed it up nicely:  “One of the problems with mental health evaluation — it is by its nature unknown and amorphous.”

That’s what makes this job so important, Poaster said. “We started on this journey and we’re in our third year now, it’s been a time-consuming process, with starts and stops because of the budget, but now we’ve finally arrived.”

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