Prop 63 Mental Health Law Not Implemented Five Years After Passage

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By Rose King

The California Department of Mental Health (DMH) has spent five years and hundreds of millions in Prop 63 tax revenue on conferring, planning, reporting, and papering itself and legions of contract consultants, with little progress to show for it. The product is process, and the matter of committees, meetings, reports, and personnel to manage it. Improvements in direct services are yet to be seen.

I filed a Whistleblower Complaint Report with the California State Auditor because DMH has failed to implement Prop 63, the Mental Health Services Act (MHSA), and cannot get the money out the door to provide better services for more people. The central complaint is that the law requires expansion of “county mental health Systems of Care,” but DMH decided to invent a new system, with a new bureaucracy, requiring counties to recruit new clients and create new programs.

•    With $5.4 Billion added revenue since enactment, DMH has not funded Systems of Care;
•    Five years after passage by voters in November 2004,, DMH has not produced an implementation plan;
•    With almost $50 million state administrative costs this year, DMH still cannot produce county guidelines for integrating infrastructure and program funding;
•    No shortage of requirements, regulations, forms, letters, studies, and “visions” —but no context or parameters to direct program or funding priorities.

Defying logic and the law, DMH did not take the prepared path to implementation, which was exhaustively vetted by every stakeholder organization and the California Mental Health Planning Council, and which is described in details dealing with pre-existing Systems of Care, Welfare and Institutions Codes, with Service Standards, Philosophy, and Treatment Options. 

DMH took the path of creating a “Two-Tier” system, with comprehensive services in the new programs for new clients—a system independent of today’s struggling county programs, suffering budget cuts, with declining access and quality of services.

DMH Director Dr. Stephen Mayberg wanted to start anew, and that’s how DMH is spending MHSA monies. DMH is virtually ignoring the current system, and about 700,000 current clients who are poorly served, according to county mental health directors.

Did DMH decide it was too hard to expand services?  The authors, donors, volunteers and voters who passed Prop 63 supported a plan to build upon model programs, tested and proven, but never adequately funded. Prop 63 would serve those now denied treatment for lack of funding.    

Somewhat more complicated are provisions of the law adding new preventive and innovative programs, and providing start-up funds. The state is supposed to tell counties how to integrate all components into a single plan. Dr. Mayberg did not comply with this requirement either. He said the law was too complex, so DMH would implement one provision at a time, and counties would write six different plans. To date, one of the six DMH-designed plans is partly funded and that one does not comply with the law.  

My formal Whistleblower Complaint runs 39 pages, with 21 attachments, and everyone involved with the process knows this is the abridged version. I asked the State Auditor to consider: (1) Misuse of tax revenue for unnecessary, complicated, new programs and state and local bureaucracies; (2) Creation of a dysfunctional, fragmented, inefficient, and wasteful process, employing an industry of planners; (3) Programs and priorities developed independent of an overall plan—stand-alone projects which do not have to demonstrate relevancy or efficacy toward known objectives.

I got involved with Prop 63 implementation because I was involved with writing the ballot measure, and went to work for then-Attorney General Bill Lockyer to launch the Oversight and Accountability Commission (OAC) created by MHSA. The Attorney General is a designated member of the OAC because those in law enforcement have had to become experts in mental health systems and the poverty of resources. 

I also got involved with Prop 63 because, like many others, my acquired policy expertise in serious mental illness and service systems started at home. My husband died by suicide in Sacramento County as a result of untreated bipolar disorder. Over the years, children, and then grandchildren, have sought treatment in private and public systems. I still intend to see progress.

Here are the unanswered questions for Proposition 63: bottom line here. What is the starting point and where is the finish line?  What are system strengths and weaknesses? Where is the roadmap to victory and what resources do we need to get there?  

A couple of years ago, a woman in San Mateo County told me the popular pronunciation of the MHSA is “Messa.” Can we fix this mess? The California State Auditor can help a great deal by stating how Prop 63 money should be spent, investigating whether current expenditures and legislated delays are appropriate, and requiring the state to operate within a documented implementation plan. 

I believe many implementation partners will work for results the clients, families, and communities can see.

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 Lockyer's tenure on the OAC in 2005-07.