Legislative Fix Needed To Stop Waste of Millions Earmarked For Severe Mental Illness
By Mary Ann Bernard
California continues to ignore the dangerous mentally ill, while squandering millions in mental health dollars earmarked for “severe mental illness” on the worried well, whose voices are much louder in local politics.
Despite the rash of assaults and homicides committed by dangerous patients at Napa State Hospital—the most recent just last month—the current proposed budget will produce more murders and assaults by lowering state hospital staff ratios to save money. Meanwhile, the misnamed Mental Health Services Oversight and Accountability Commission (“MHSOAC”) soldiers on, apparently unaffected by the impending demise of Department of Mental Health (“DMH”), or the state budget crunch.
In fact, MHSOAC is now wasting even more taxpayer money on a PR campaign, amassing stories of how Proposition 63 has been successfully used. But MHSOAC success stories, which certainly exist, cannot hide the waste of millions of dollars in Proposition 63 prevention/early intervention funds.
Here is the background: in 2004, California voters passed Proposition 63, now the Mental Health Services Act (“MHSA”), to help those with “severe mental illness.” MHSA earmarks 20% of its funds for programs “effective in preventing mental illnesses from becoming severe” and “successful in reducing the duration of untreated severe mental illness.” Note the statutory emphasis here: “effective” and “successful” programs for “severe mental illness” and for “mental illness” that may become “severe.”
DMH, however, ignored the voters’ intentions by issuing regulations that exempt prevention funds from the general regulatory requirement that Proposition 63 funds be used for “severe mental illness/emotional disturbance.” It’s tracking system for prevention/early intervention funds don’t even require a diagnosis code. Plus, it gave counties “flexibility” to do whatever they wanted with Proposition 63 funds, as long as DMH decided the use “meets the intent” of Proposition 63.
Not surprisingly, though contrary to the law they were supposed to be enforcing, DMH/MHSOAC approved plenty of programs that had nothing to do with “mental illness,” much less “severe mental illness.” $133,571,200.00 in Proposition 63/MHSA prevention/early intervention funds were budgeted for allocation last summer. What got funded? elementary school programs about bullying, therapeutic gardening for unhappy Hmong refugees, horse therapy for troubled teens who are not mentally ill, a support group for gay and lesbian teens, parenting skills programs, a support program for unwed mothers, a hip hop car wash, a homework help programs for non-mentally ill students, yoga and “Soul Chi,” for the stressed, among other things. These may be fine programs, but they are hardly “effective” and “successful” at preventing or shortening the duration of “severe mental illness,” as required by law.
Don’t blame worthy organizations for applying for these grants. Blame the regulation and regulators who invited them to do it. The potential for further abuse has become greater after AB100 sent many DMH functions to the counties. They submitted these grants for approval, and have now learned some very bad spending habits.
The legislature should stop this abuse by using its “clarification” power under Section 18 of MHSA to eliminate regulations that are contrary to law and direct desperately-needed MHSA funds towards uses consistent with MHSA. First and foremost, Laura's Law, which is presently optional by county, should be made mandatory, and funded through Proposition 63. Laura’s Law meets prevention/early intervention funding criteria by “reducing the duration of severe mental illness” through assisted outpatient treatment. And as MHSA requires, it works. Its New York analogue, “Kendra's Law,” has an excellent track record of preventing violence and keeping the mentally ill out of jails and prisons by safely maintaining them in the community. Nevada County has found that Laura's Law saves $1.81 for every $1 invested by reducing hospitalizations, 911 calls, arrests, trials and incarcerations.
With a little imagination, the legislature could also direct MHSA funds towards care of the thousands of mentally ill inmates who will be leaving state prisons as the result of the U.S. Supreme Court’s Plata order. While MHSA states that its funding cannot be used for state parolees, mentally ill inmates who are Laura’s Law eligible could be released subject to a Laura’s Law order, rather than parole. MHSA funding can even be used to build facilities with restrictive settings, so long as he needs of the people to be served cannot be met in a less restrictive or more integrated setting. So how about directing funds towards local psychiatric facilities that will house people who will otherwise end up in state hospitals, which are dangerously overcrowded and understaffed?
Legislators, please use your “clarification” power in Section 18 of MHSA to stop DMH from funding “mental illness lite" in contravention of voter intention. The safety of the public and the needs of the severely mentally ill are too dire for such waste. The voters gave you the power to fix this. You owe it to them and the thousands of very sick people who need these funds to do it.
Mary Bernard writes for mentalillnesspolicy.org and is a Stanford honors/University of Chicago Law graduate that spent eighteen years as an Assistant Attorney General in Minnesota, including several as counsel to its state mental hospitals.