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Little Hoover Commission Issues Report on State’s Mental Health Services

The state’s Little Hoover Commission this week released a report analyzing the efficacy of the Mental Health Services Act a decade after it was approved by California voters.

The commission report noted some improvements and successes in the state’s mental health system but it also said it’s difficult to evaluate quality and access to services because there’s no mechanism in place to track where the money goes and how it’s spent.

“The thing that has the most weight for me is the idea that there are families in California whose children or loved ones should be receiving services, and we can’t tell whether they’re getting them or not,” said Pedro Nava, chair of the commission.

“That’s the human element of a study printed on paper that has to be emphasized,” Nava said. “The state of California cannot say with any assurance that that’s happening. And that alarms me.”

The Little Hoover Commission is a nonpartisan agency established in 1962 to provide independent oversight to the state. California voters passed Proposition 63 in November 2004 and it set up the Mental Health Services Act, which has raised $13.2 billion for mental health services in the past decade.

It is expected to deliver an estimated $1.58 billion in the 2014-15 fiscal year.

The Little Hoover Commission report had two main criticisms of the act’s implementation:

  • Weak oversight. The system needs “prompt and dramatic review,” the report said, with little monitoring or oversight of county programs, including the potential mishandling of state funds; and
  • Poor transparency and no fiscal accountability. The state needs better data to evaluate the strengths and weaknesses of the act’s implementation, the report said. That includes a better data system and a stronger effort to make information it does collect available online.

The commission also had several recommendations:

  • Expand the authority of the Mental Health Services Oversight and Accountability Commission to include up-front reviews of some plans before funds are budgeted;
  • Allow the oversight commission to levy sanctions and withhold funds from counties;
  • Improve the data system in a collaborative effort between the Department of Health Care Services and the oversight commission; and
  • Update the oversight commission website to make it easier to see how money is spent and who benefits from services.

“We need to be more rigorous in tracking down the money and seeing how it’s spent,” Nava said. “You can’t ignore the fact that it’s the counties, and they all have different ways of doing things, so there’s no single metric that you can apply across all the counties that can measure success.”

If you can’t compare access and quality between counties, he said, you can’t know what’s working and what isn’t.

“I’m sure if you asked them, every county will say it’s working,” Nava said. “The thing that jumped out at me is just how opaque the programs are from county to county. You can’t drill in to see what’s right or wrong. Every county does it their way, and that’s the root basis for the inability to identify programs that work and those that should be shut down.”

Nava, former state Assembly member and former member of the California Coastal Commission, had an interesting take on why the counties might want to consent to more-uniform metrics and benchmarks between counties:

“I don’t think counties realize how vulnerable they are,” he said. “In the past the Legislature has wanted to move some of that money around.” The one way to ensure continued Mental Health Services Act funding is to show tangible results from the spending. Otherwise, legislators may try to earmark some of that funding for pet projects, he said.

The next step is up to the Legislature, Nava said, since it oversees the act’s implementation.

“One of the benefits of working from a report from the Little Hoover Commission is that it’s nonpartisan and vetted,” Nava said. “It’s a good starting point for the conversation. We need to make sure this money is spent in the best possible way, so it has the most impact and positive consequences.”  

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