Commentary

roseking.JPGBy Rose King*

In 2004, California approved Proposition 63, a historic victory expected to transform the state's ailing mental health system. Voters made good on a 40-year old promise to fund community services, when their elected officials could not do the job. As a coauthor of the measure, I believed the clear language of the law guaranteed expansion of proven programs. We could finally afford a system that works.

The magnitude of need was well known in California's fragmented and crisis-driven system, where counties reported in 2005 that virtually all mental health clients were poorly served. (California is a county-controlled service system.) Prop 63, known as the Mental Health Services Act (MHSA), was supposed to change this picture.

But today, five years after passage, billions in new taxes have had minimal impact on local systems, access is rationed, and consumers are still denied services essential to recovery. Counties do not report advances in program standards for those 700,00 clients who were not fully served when Prop 63 passed.

In Sacramento County where I live, 4,500 consumers were told in August not to return to see their clinic doctor or get medications; news media report that budget cuts are crowding emergency rooms. Volunteer stakeholders on county committees throughout the state filed grievances with every agent of recourse, and appealed to an Oversight and Accountability Commission (OAC) created by the MHSA. Comments from diverse areas of the state were similar in a 2008 survey by the National Alliance for Mental Illness (NAMI) California. They said: "It seems that more $$ are spent on planning, meetings, than are actually being spent in service...None of our family members were receiving adequate services before Prop 63 and now they are receiving even less...It is definitely unfair and discriminating"

The discrimination and diversion of funds became apparent as the state rolled out its implementation plans. The Department of Mental Health (DMH) required counties to budget the majority of funds for new programs to serve new clients, launching a "Two-Tier" system in which poorly served clients in existing programs could expect little benefit from the MHSA. As a consultant to California's Attorney General, a member of the OAC, I witnessed and reported on the state's performance.

Whistleblower Complaint
Last November, on the fifth anniversary of passage of Prop 63, I filed a Whistleblower Complaint with the California State Auditor. My complaint makes the following allegations:


    1. Tax revenues intended to expand community mental health programs and raise standards of service were diverted to create a separate system for unknown and unexplained purposes;

    2. Waste of time and money resulted from mismanagement, incompetence, and state policies that created a fragmented, inefficient, and unnecessary new bureaucracy, and an industry of unnecessary planning;

    3. Officials failed to establish a functional structure and process to implement the law, operating without known standards and objectives, and inviting potential conflicts of interest and special interest influences.


Grievances, attached to a press release, include the following:

    •More than $6 billion has been collected in taxes, but very little is allocated to county improvements, and at least a billion of last year's revenue idles in a state fund. In May 2008, Governor Schwarzenegger's own Department of Finance issued a scathing evaluation of MHSA implementation in a DMH audit. Three years after passage, only one quarter of the taxes collected were distributed to the counties, and the process was inefficient, delayed, insufficiently documented, and not compliant with the law.

    • Funding is stalled because the state required new programs and rejected the proven service systems. Auditors called for a total of 19 "corrective actions," and said the state needed "a strategic development and implementation plan...and one set of comprehensive, integrated guidelines for all components." Despite state administrative costs approaching $50 million a year, the DMH has not published an official plan explaining policies or expenditures.

    •The state's "Two-Tier" system and disjointed implementation generates needless state and local bureaucracies, along with county planning now in its sixth year of working on six separate proposals to obtain MHSA funds. The total in county administrative costs is unexplored and unreported, but replicates state operations.

    •MHSA state and county money supports legions of paid consultants and stakeholders, for conferences, committees, focus groups, and studies to "reinvent the wheel" and explore problems with known solutions. DMH reported that more than half of its budget was devoted to private contracts in the first years of implementation, but reports no longer include this detail. County advocates cannot easily determine how much money goes to overhead and how much is spent on direct services.

    •The OAC approves county spending plans with no knowledge base of local conditions, and supports a public relations campaign to promote a celebration of MHSA "success," despite having no knowledge of MHSA benefits, and no comment on the critical MHSA implementation audit.


Consequences for Community Mental Health
Now, in 2010, implementation faces a double threat. To help plug the deficit, Governor Schwarzenegger's budget calls for shifting as much as $847 million from MHSA funds. Voters rejected a raid on Prop 63 funds in 2009, but the governor will try again in a June election, exploiting the incompetence or willful mismanagement of his own agents who have allowed county funds to pile up in a state account. He would eliminate system improvements because his administration lacks the capacity to efficiently fund them. After violating the original contract with voters, the governor will ask them to completely reverse the intent of the law. Strong voter support for community mental health has been consistent over decades--and underestimated by politicians. In July 2001, a professional survey showed a solid majority were aware of inadequate funding and in favor of an initiative; 67 percent said they had personal experience with people with a mental illness.

In an exchange of correspondence and newspaper opinion articles with DMH Director Dr. Stephen W. Mayberg, I challenged state policies calling for creation of new programs instead of higher standards for existing programs. Director Mayberg said the rationale for his plan is to prioritize services to "those most in need," and implied that this meant new clients identified through "outreach." He did not cite any research that determined a criteria for "most in need," did not explain why his purpose required new programs, nor why his private preferences should be honored above the provisions of the MHSA. There is no evidence to support DMH assertions that stakeholder participation influenced deviations from law.

Like many others who work for progress in mental health, my own perspective and acquired policy expertise started at home. When our three children were still in school, my husband died by suicide in Sacramento County as a result of untreated bipolar disorder. Since then, a second and third generation of my family members has sought treatment in public and private systems, and I have continued to advocate for promised services.

The waste of state revenue is inexcusable after decades of waiting for community mental health funding, and the magnitude of mismanagement, incompetence, and questionable expenditures is nothing less than scandalous. The numbers deprived of recovery are incalculable, and the numbers who despair and lose their lives are invisible.

My whistleblower complaint represents many in the mental health community who are opposing further waste of resources, and fighting to change the course of local funding. Thousands worked to pass the law and millions need its benefits. I believe a public demand for the integrity of the law--not the pretense of benefits marketed by some advocates--will ensure its success and the continued support of the electorate.


*Rose King is a political and policy consultant, and a family member of individuals with serious mental illness. As Chief of Staff to Lieutenant Governor Leo McCarthy, she initiated a state Task Force on Serious Mental Illness that developed landmark legislation in 1988. She worked with a drafting committee for Prop 63, and served as Principal Consultant to then-Attorney General Bill Lockyer to launch the MHSA Oversight and Accountability Commission during his tenure on the OAC in 2005-07. Rose has developed policy and communication strategies for state and national organizations and candidates, served California State Assembly and Senate leaders and Constitutional Officers, and the U.S. Congressional leadership since 1975. She has served numerous advocacy and civic organizations in her community and state.

Comments (18)
Teresa Pasquini:

The California Mental Health Directors Association has joined with California Institute of Mental Health to spend millions planning a 5 year celebration of Prop 63 data. What are they celebrating? The failure to implement the law, as written and approved by the voters. Are they celebrating the endless planning and chit chatting about wellness and recovery when so few are actually receiving direct services?

The OAC Evaluation Committee held a meeting on January 20, 2010 and heard a report by a consulting firm on how it will write a report to evaluate data. They will provide a report on a lot of reports gathered from a lot of counties. How accurate are those reports? Are they going to show the truth? Are thy going to show the facts? Or will it be another PR spin of what the paid consultants hired by the paid community stakeholders and the paid administrators want you to think are facts.

We have been receiving data that skews the reality of the mental health system for years. We need to challenge the data with facts.

Rose King has broken down the issues in this posted article along with filing a Whistle blower Complaint with the State Auditor. I hope the California Legislature will consider exploring her concerns. While some believe it will shine a light on the failure of the initiative and risk the funds, the funds are already at risk with the Governor's proposed budget. We need to highlight the waste and the illegal implementation that violated the law and has left countless California clients and families without services, treatment, or dignity.

As a family member of two consumers living in Contra Costa County, I have served as a stakeholder for the past four years and personally witnessed the implementation chaos of Prop 63. The broken promises to expand the system of care, in accordance with the law, vs the creation of politically correct boutique programs that are untested. It has been a wasteful and bureaucratic nightmare.

Contra Costa County has received 52 million dollars in MHSA funding over the past 5 years. How much of that money has gone to direct services? Have the funds been used as promised and contracted? Have the contracts been monitored and productivity scrutinized? Have services been maintained, as originally contracted? Have county staff been paid from Prop 63 funding legally? How would we know? Has a supported housing program for the mentally ill been developed? Do we have measurable, factual savings on jail mental health services, hospital mental health services, reduced homelessness of those with serious mental health issues, or demonstrated measurable preventative programs? How much has been spent on consultants or endless planning meetings?

Rose King has done a community service by unveiling some of the wasteful, illegal, unethical practices. The public needs an independent overseer of the billions of dollars that Proposition 63 created to expand care and fix existing gaps in service. So far, too few have benefited from a fragmented, discriminatory, two tiered implementation. Rose speaks for all the disenfranchised and voiceless mental health clients who are still living without the hope that Prop 63 promised.

While many stakeholders hold on to the idealistic goals of transforming the mental health system, many consumers and families are living without support, medications, medical care, food and clothing. Shame on California's DMH for breaking the promise of community recovery again.

Posted by Teresa Pasquini | January 28, 2010 1:41 AM
Marilyn Hawes:

It is shameful and disgusting that this Prop 63 funding is not being properly allocated to mental health clients who so badly need it. We must do all in our power to stop the Governor and the Legislature from diverting these funds to other programs and to pressure the Department of Mental Health to protect the community they represent. The voters spoke loud and clear when they voted for this initiative to expand and improve mental health services. Thank you, Rose King, for your work and dedication in bringing this to our attention. Now, we the public need to act immediately to change the course of this funding.

Posted by Marilyn Hawes | January 31, 2010 7:28 PM
Diana Hankins/El Dorado Co:

So disappointed in the way that Prop 63 has been used. I agree it is not working, We can not get help for those in most need. We have had deaths,people lost, taken advantage of, put in jail people let go from MH because of the new belief they no longer require mental health services. We can not even get the newly diagnosed mentally ill help. We have no housing in S.L. Tahoe,no local doc,no hospital, not even a 23 hr holding facility.No one to send a mentally ill person to for care that may need it. Looks like we are going backward instead of forward. It was bad before but now it is worse.
Meetings on Prop. 63, no one in the communtiy wants to attend because MH has changed the programs that were put into affect in the past. A good example with the new program that counties can put togeather called Innovation. MH can use 1/2 of the funding to do planning. What a waste. We need help with the basic needs. Why can't each county fill in the gaps that they have??? The funding could help with the basic services needed in each county instead of this designed programs which have not helped clients.I do not want to see the Prop. defeated just used for what it was intended, that has not happend.

Posted by Diana Hankins/El Dorado Co | February 1, 2010 4:13 PM
Chuck Alderete:

It is just shocking to think that the state has had a means of funding effective programs-- ones that can help people-- and has wasted the Prop 63 money away on meaningless bureaucratic nonsense. It seems like there ought to be some kind of public audit of this whole thing, and this article really points out that need. If the governor gets away with stealing the funds for another purpose that would certainly be a crime. I hope the people responsible for implementation will come to their senses, starting with a sense of decency.

Posted by Chuck Alderete | February 2, 2010 2:04 PM
Frank Woodard, Esq.:

Pollster Frank Luntz has a great saying, “It’s not what you say, it’s what people hear.”

In my opinion Rose’s timing could not have been worse. The part of the public that is not connected with mental illness isn’t going to hear Rose’s desire to redirect the MHSA, all they are going to hear is that “Its not working and even the experts agree”. It just adds fuel to the recent criticism from the University of San Diego Law School about prop 63.

Right now most of our elected officials are drooling at all that money for the taking and with the publics support derived from all these negative articles you better believe they are going to take it. RIP MHSA.

Posted by Frank Woodard, Esq. | February 4, 2010 6:58 PM
Chuck Alderete:

But that money is legally NOT "for the taking."
Ms King's article points out the need to increase and empower the public's intent to fund proven effective services. We voted for this!
If we really, honestly think about it, MOST of us are "connected with mental illness," whether we like it or not. Think about people's family members and friends with mental health needs.
Read the article again, carefully, and call or write to the governor or your local newspaper editor to call for the proper implementation of Prop. 63.

Posted by Chuck Alderete | February 5, 2010 10:10 PM
Marcus Martel:

Rose King clearly states and reinforces the fact that the state has not used the funding of Proposition 63 to support and improve mental health issues. It is imperative that we acknowledge and question why this money is not being used more effectively for services for clients with specific mental health needs. The misdirecting and misuse of specific funds in all areas needs to stop now. We need to know how this money is being used and be assured that it is in fact being used to meet its purpose and original objectives. I commend Rose King for her involvement and for speaking out.

Posted by Marcus Martel | February 5, 2010 11:30 PM
Frank Woodard, Esq.:

Chuck,

I guess you are right - the proposal is to divert the funds, not take the funds. But what is the difference?

The State Legislature is considering whether to put a ballot measure before voters to divert funding away from the Mental Health Services Act (Prop. 63) in order to help address the state's budget deficit in 2010-11.

This year, the Governor proposes to redirect $452 million for two years, and to put another initiative in front of voters in the June statewide election.

Additionally, if California doesn't receive nearly $7 billion in new federal funds, the Governor proposes to divert another $847 million away from the Mental Health Services Act. These two proposals together, total $1.75 billion over two years that will be taken away from mental health services.

The Assembly Budget Committee will discuss this proposal on February 11 and the decision to put this issue on the ballot could be made by the entire legislature as early as February 22.

Posted by Frank Woodard, Esq. | February 6, 2010 10:30 AM
barbara dellamarie:

Mr. Woodward

Your argument is misdirected. The governor is looking to raid any source of funding he can find to avoid raising taxes and to close the budget gap. He would be eyeing this fund whether there was proof of wrongdoing or not. What you are saying amounts to this: Fraud and waste should not be exposed for fear that the money will be taken away. Using this logic the funds would still not be used to help those in need but no one would be the wiser that the funds are not being spent as intended. In other words, no one wins except the contractors, the hotels hosting "planning conferences," and the Department of Mental Health.

This expose will place pressure on those responsible for implementing Prop 63 as intended and will at least give the MHSA a fighting chance to really do some good.

Posted by barbara dellamarie | February 8, 2010 1:39 AM
Rose King:

The $847 million jackpot for the drooling politicians is available only because of the incompetence of Schwarzenegger’s Department of Mental Health. Those lusting for the money have not even asked why all that revenue from last fiscal year is still sitting in a state fund. Does anyone really think county supervisors could not figure out how to improve mental health treatment, consistent with the intent of Prop 63?

Well into this fiscal year, the state cannot get the money from 2008-09 out the door because of the cockamammy process invented by DMH. Bureaucracy and corruption block funds for direct services, while the delays are a boon to grant-seekers, consultants, conference planners, and professional stakeholders, among the vast industry devoted to studying problems with known solutions. The real stakeholders are tired of the “input” theatrics and want some “output.”

Phony success stories did not persuade legislators last time and won’t fool the voters this time. The discussion here about preserving Prop 63 funding and purpose, is the central debate that really needs to take place today. Perhaps the governor's new threat is an opportunity to tell the real stories and get Prop 63 on track to deliver for consumers and communities.

Posted by Rose King | February 8, 2010 3:52 AM
Frank Woodard, Esq.:

Rose,

I believe that some of your statements are very broad and somewhat of a glittering generality, specifically your allegations of phony success stories and corruption inherent in this cockamamie process. If you do have proof of corruption within these processes, that information should immediately go to the Attorney General. If the success stories are phony then that information needs broader public awareness.

I cannot speak for the entire state or the entire MHSA program as you can. I can only speak for one transitional age youth, in one county (Orange), in one MHSA program. Prior to this MHSA program, he had seven psychiatric hospitalizations over the span of four years. Some of these hospitalizations lasted as long as 5 months. After his enrollment in the MHSA program, he has had no psychiatric hospitalizations, lives independently and is compliant with his medication. Something he could not do prior to this program. I would be the first to admit that he still has a very long way to go, but at least he is generally stable. Prior to the MHSA program, he was in a county program that was not working I believe because there was no “youth” element. It was hard for him to sit in a group with 40-year-old men and identify with them. He was 18 to 20 when he was in those county programs.

I currently sit on the steering committee for transitional age youth in Orange County and while I am frustrated with all the budget problems and slow process, I sincerely think that we are making some progress.

In my opinion, I feel that much of your criticism of these MHSA programs in not warranted, at least in Orange County and I only hope all of your criticism does not result in throwing the baby out with the bath water.

Frank Woodard, Esq.
Orange County, CA.

Posted by Frank Woodard, Esq. | February 8, 2010 12:19 PM
Jean Arnold:


With the voters supporting Proposition 63, how did California's bold experiment come to such an impasse? I always thought the public's misconceptions and prejudice were at the root of our problems, but the support of California voters doesn't fit that scenario.

Maybe the California stalemate holds some missed clues to the nation's 30-year resistance community services. I (in New York) doubt there's an advocate in the country that hasn't struggled against endless roadblocks to progress. Prop. 63 may hold lessons for us all. Thanks to MIWatch for airing this valuable exchange of views.

Jean Arnold

Posted by Jean Arnold | February 9, 2010 9:42 AM
Frank Woodard, Esq.:

Barbara,

What the voters give the voters can take away.

The fact that we have the MHSA is one issue; the fact that it is allegedly full of corruption (Rose King’s words), fraud (your words) and waste is another.

As far as waste goes, I have never known a government program that does not have waste. It is part of the deal. One parties waste is another’s intelligent use of resources. Get use to it, waste is a part of the government process, and yes Barbara I know this should not be this way, but bumble bees are not suppose to be able to fly either.

As far as corruption or fraud goes, that is not acceptable. Those charges should go directly to the AG. As I am sure Rose knows, Jerry is big on prosecuting these types of crimes and will take immediate action if the evidence warrants that action.

My concern is that I want the MHSA to survive. I do not want to destroy it; I want to make it work, and at least in Orange County I believe it is working, but like any program could work better. However, if all the voters hear is that it is corrupt, full of fraud and is not working then with the voter’s approval, the MHSA programs would be gutted into oblivion.

With 1E, they tried it once, but failed. Now it may be round two and the sound bite is “It’s not working, full of corruption and waste, we need the money for Medi-Cal”.

Posted by Frank Woodard, Esq. | February 9, 2010 12:14 PM
Barbara Dellamarie:

Mr. Woodward,

You are certainly trying to dominate this discussion. But you are viewing the issue with tunnel vision. I am truly happy to hear that you have had a positive experience with the MHSA. However, it is but one example. Surely as an attorney you must know that one instance of anecdotal evidence does not justify the stifling of a pattern of government waste in a program that is generating billions of dollars. Rose King is in a position to see the broader issues in the waste that has been documented and this affects so many individuals in a negative way. Again this is not to lessen or invalidate your experience. You obviously care very much for the individual of which you speak. And you also give Ms. King her due by stating that she is in a better position to speak to the issue of the entire MHSA. Please read her bio, particularly this portion: "She worked with a drafting committee for Prop 63, and served as Principal Consultant to then-Attorney General Bill Lockyer to launch the MHSA Oversight and Accountability Commission during his tenure on the OAC in 2005-07." Ms. King tried to help make the MHSA work, sir. She has a stake in its success.

I am aware that there is waste in all of government. That does not mean we have to tolerate it, nor do I need the lesson in "how government works." I work in government and do see waste firsthand, but not on the scale of the MHSA. That does not mean I have to "get used to it." People like Ms. King have the courage to challenge that waste and like it or not (You state, "It is part of the deal.") it is the right thing to do.

As far as taking matters directly to the AG, if the State Auditor deems that the evidence warrants it, they will send it on to the AG. This is stated on their site. And here is a quote from them: "The purpose of the California State Auditor's office is to improve California government by assuring the performance, accountability, and transparency that its citizens deserve." As I understand it this is Ms. King's primary goal - performance, transparency and accountability, not prosecution. This goal will do more to assure the success of the MHSA than continued waste resulting in far fewer individuals in need getting help. You, perhaps subconsciously, agree that these issues should be brought to light by this statement: "If the success stories are phony then that information needs broader public awareness." That is exactly what Ms. King has done and will, I hope, continue to do.

Barbara Dellamarie


Posted by Barbara Dellamarie | February 9, 2010 8:12 PM
Frank Woodard, Esq.:

Barbara,

If you feel that I am trying to dominate this discussion, for the record as of 2/10/2010 there are 14 postings of which only 4 (mine) could be considered in support of MHSA. As I calculate it that is about 28% of the postings, hardly a domination. I do feel that opposing views have a right to be heard no matter how repugnant they may be to others. “If everybody is thinking the same, then nobody is thinking” is a famous General Patton quote to which I agree.

You state that my evidence is anecdotal, which simply means you doubt its veracity, or in other words, my statements are considered by you as untrustworthy. It is a nice way of calling me a liar. As I state that I am only talking about one individual, in one county (Orange), in one program I am clearly not trying to use this experience to deduce a conclusion to the overall program.

You clearly state Ms. Kings involvement and qualifications, which I agree are outstanding and prove a massive amount of dedication to helping those suffering from this disease. She has done much more work in this area than I have, has an outstanding record to which mine is pale in comparison. She does have a major stake in this process, but being a family member don’t I also have a stake in this process?

You have stated that Ms. King's primary goals are performance, transparency and accountability, not prosecution. But you can’t do a goal, only those things that lead up to achieving that goal. I don’t believe that publicly trashing MHSA will lead to the accomplishment of her goals. And this is where I disagree with her. I believe at this time such actions will only lead to the gutting of resources for MHSA.

Additionally, as you state if you have evidence of fraud in the MHSA programs I would not wait for an audit report, I would recommend that you immediately report this fraud to the AG.

Peace Barbara!

P.S. the last name is spelled Woodard, not Woodward.

Posted by Frank Woodard, Esq. | February 11, 2010 10:48 AM
Jose D.:

I am one of the homeless persons who should be served. I have psychiatric disabilities. Groups in the Alameda County like the South County Homeless Project receive these funds. But they play a shell game where the SCHP will not let a person in "unless they have a referral from the 'County' mental health system." I found there is no county governmental mental health system. The entire system has been privatized. So, when I called "North" county mental health they provided the nonsense reason as to why they would not provide the referral, "you have to be in the county mental health system to be in the county mental health system." After being told by SCHP to contact Berkeley Mental Health, BMH said, "we do not provide referrals or treatment for persons with PTSD."

Similarly, I was kept on the treadmill for over a year by the Shelter + Care program.

Now, a new rental project is opening but it requires special forms and procedures to screen based on mental illness contrary to the Joint HUD/DOJ statement:
http://www.acbhcs.org/housing/.

I see a lot of big salaries and no services. We need mental health advocates. Thank you for your good work!

Posted by Jose D. | July 29, 2010 8:08 PM
Wynship Hillier:

I am coming to this discussion rather late, and I apologize. I have two observations:

1. A key part of the MHSA legislation was the non-supplant provision. This provision is there because if it weren't, the state would hack the other mental health service systems to death in a minute to raid their budgets, with the excuse that MHSA funds could pick up the slack and no one would know the difference. The authors of the MHSA put non-supplant in because MHSA is supposed to *expand* the mental health system in California. Note the emphasis in the MHSA on Prevention and Early Intervention programs. The intent is to get to patients sooner, where they can be helped quicker, *before* they go into the very expensive criminal justice and other systems. The other programs are not working very well right now because they have different funding sources, sources that are taking a big hit. This is not to say that the criticisms of the MHSA are without merit, nor that the system could not be improved. However, about that, please see my next point.

2. Last time I looked, less than a month ago, there were two (2) open positions on the MHSA Oversight and Accountability Commission. The two vacant positions were for one MH consumer and one family member of an MH consumer. The complaints about MHSA sound a little bit hollow while these positions are open. Moreover, anyone can write to their county mental health director and ask to be included on dicussions of draft county plans and updates. MHSA has excellent provisions for community involvement that people are not taking full advantage of. According to the DMH's Community Mental Health Block Grant Application to SAMHSA, counties have not submitted all of the plans to the DMH about how to spend MHSA funds that they could. That could be an explanation for why so little funds have been allocated. People need to get in touch with their local mental health directors, find out whether plans have been submitted or approved, and if they haven't been submitted, why not, and should take part in discussing and shaping them. It doesn't sound from the discussion above that anyone is taking part in the process, although people sound very knowledgable about the system.

Posted by Wynship Hillier | October 25, 2010 7:20 PM
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