Mental Health Services Act Needs to Focus on Mental Illness


Posted on 12 March 2012

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By DJ Jaffe

The chair of the California Mental Health Services Oversight and Accountability Commission (MHSOAC) wrote an op-ed in Capital Weekly criticizing families of people with severe mental illness who criticize how Mental Health Services Act (MHSA) funds are spent. He claims the program is working well. But it's not.

For one, the oversight committee itself is diverting MHSA funds meant to help people with severe mental illness to other causes. In their case, it's to hire a PR firm to further the oversight committee's claim that all is well. How does hiring a PR firm help people with severe mental illness? Is that why taxpayers voted to tax themselves? They felt a dearth of PR firms?

To cite another example, the California Mental Health Services Authority made a multi-year commitment to fund a "Center for Dignity, Social Inclusion and Stigma Elimination." Instead of providing treatment and services to people with severe mental illness, it will provide ads and brochures to the public.

When the myriad of examples like this are documented, the chair of the committee, Dr. Larry Poaster wrote that critics are "use(ing) single anecdotes out of context and ignore overwhelming facts." But it is Dr. Poaster who fails to present the big picture.

As part of the committee chair's claim that MHSA is working well, he points to a report that shows MHSA Full Service Partnerships (FSP) reduced hospitalizations, arrests and incarcerations. Those claims are probably true. It's a good and important program. But he fails to disclose that these programs are exclusively for voluntary patients. The homeless psychotic people on the streets who 'know' they are Jesus or the FBI planted a transmitter in their head -- the most severely ill who refuse treatment can not get access to these programs. They are turned over to police and law enforcement in record numbers. As a result of realignment, many may soon to be discharged back into the communities where service providers will again refuse to serve them.

Dr. Poaster correctly notes that 20% of total MHSA funding goes to "Prevention and Early Intervention" programs. The law requires those programs to be "designed to prevent mental illnesses from becoming severe and disabling." But the oversight committee's guidelines to counties say, "(P)revention programs are expected to focus on individuals prior to diagnosis of a mental illness. (emphasis in original)." 20% of MHSA funds meant to help people with mental illness are now being diverted from their proper destination. The mentally ill are specifically excluded. Dr. Poaster claims these programs are effective but MHSOAC minutes show their evaluation "is based on what counties said they were going to do, rather than actual on-the-ground assessment."

In defense of the status quo, the Oversight Commission chair claims that counties, not the committee, set priorities and that millions were spent on a process that included "the diverse segments that are affected by mental health: schools, law enforcement, homeless programs, social services, faith communities and countless others." Prop 63 was not passed to improve mental health (make people happier) it was passed to "reduce the long-term adverse impact... resulting from untreated serious mental illness." Including these 'countless others' led to a money-grab free-for-all and counties developing amorphous something-for-everyone plans that focused primarily on 'social services' rather than treatment and services for those with severe mental illness.

Lack of housing, education and employment were defined as 'risk factors' for poor mental health, and therefore housing, education and employment programs were showered with money that should have been spent helping people with severe mental illness. Except in the case of Nevada County (and more recently Los Angeles county) none of the county plans included implementation of Laura's Law, and making services available to those enrolled. Services for Laura's Law recipients is the exact type of "new and innovative" services MHSA should be funding.

Millions continue to be spent on process, committees, consultants, PR firms, publishers, art directors, and writers instead of programs for people with severe mental illness. Orange County just published an expensive glowing report on their use of MHSA funds, but no useful financial data that would help the public see where the money was going. And the report was fifty pages long.

As Rusty Selix, executive director of the California Council of Community Mental Health Agencies stated in reviewing where we are, "In many ways, conditions are horrendous and difficult, but we're kind of used to that."

As the family member of someone with severe mental illness, I am not used to that. The problems with MHSA are not 'isolated incidents'.

What's the answer?

1. The legislature should require distributors of MHSA funding to follow the language and clear intent of the law and only distribute MHSA funds to programs that focus on "severe mental illness." They can accomplish that by adopting the National Institute of Mental Health's definition of 'serious mental illness,' which covers no more than 8% of the population and require all or the majority of MHSA funding to be spent on this targeted population. By using this definition, California can avoid the wrangling that would result from trying to create its own definition.

2. The state should use 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.

3. Rose King, a veteran California political consultant who was involved in writing MHSA legislation makes a good case for the legislature to reexamine the maintenance of effort provision, which created a two-tier system: those with serious illness who received minimal and substandard services prior to MHSA are now routinely and intentionally denied any MHSA-funded services, while those who are barely ill, or not ill, get comprehensive services.

4. Carla Jacobs of the Treatment Advocacy Center says the legislature should remove the sunset provision from Laura's Law because it discourages counties from making the long-term plans needed to correctly implement it. Once Laura's Law is implemented, MHSA funds could be used to serve those enrolled in Laura's Law in programs already serving others.

5. MHSA boards should be independent of the organizations they fund. End the conflict of interest caused by board members, employees, former board members and former employees of MHSA recipients serving on the oversight committees.

The critics of MHSA do not have an MHSA-funded PR firm on their side. But they do have the facts.

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DJ Jaffe is the founder of Mental Illness Policy Org which provides the media and public officials with unbiased information about "serious" mental illness from a pro-treatment perspective. It covers issues of violence, deinstitutionalization, not guilty by reason of insanity, assisted outpatient treatment, involuntary commitment, involuntary treatment and other issues. This article originally published on the Huffington Post.

"Dr. Poaster claims these programs are effective but MHSOAC minutes show their evaluation "is based on what counties said they were going to do, rather than actual on-the-ground assessment."

THESE ARE TYPICAL RESPONSES, OUR GOVERNMENT OFFICIALS WANT US TO BELIEVE. TIME AND TIME AGAIN SHOWS THAT THESE SOCIAL SERVICES ARE NOT MEANT TO BE A FOR PROFIT PROGRAM. BUT EVIDENCE SHOWS THAT MUCH OF THE FUNDING ARE GOING TO SUPPORT ADMINISTRATIVE, OVERHEAD, CAPITAL ACQUISITIONS, AND BLOATED PENSION AND SALARIES OF ADMINISTRATORS AND STAFFS THAT OFTEN FAIL TO DELIVER ANY MEANINGFUL RESULTS. I AM SO GLAD THAT THERE SOME OF US THAT ARE PAYING CLOSE ATTENTION. IF THIS WAS A "NON-PROFIT ORGANIZATION" THEY WOULD HAVE ALREADY FAILED THEIR NON-PROFIT STATUS. (JUST ON THE TESTING OF THE percent (%) of administrative cost over revenue and actual delivery of services to these class of social service beneficiaries.

IT IS HIGH TIME WE HOLD THESE PUBLIC OFFICERS TO ACCOUNT FOR MISMANAGING OUR TAX DOLLARS. ITS HIGH TIME THAT WE MAKE SURE THAT 95% OF THE REVENUES ALLOCATED FOR THIS SERVICE GOES TO CARING FOR THESE PEOPLE AND CAP A 5% ON ADMINISTRATION. THE BUREACRATS HAS GOTTEN OUT-OF-HAND AND CITIZENS NEED TO TAKE CONTROL OF THESE OFFICERS.

GOVERNMENT IS GETTING TOO BIG AND TOO COSTLY WITHOUT ANYTHING "GOOD" FOR THE PUBLIC TO SHOW FOR.

In addition to excluding people with serious mental illness from 20% of the funds (PEI Programs), Larry Poaster and the oversight committee just gave almost $3 million to Disability Rights California (DRC) for the ostensible purpose of fighting 'stigma'. DRC is a publicly financed law firm that has made their main mission preventing counties from using MHSA funds to help people with mental illness who are 'likely to become gravely disabled or danger to self or others'. (i.e, are eligible for Laura's Law).

It is bad enough that Dr. Poaster and the Mental Health Services Oversight and Accountability Commission are excluding mentally ill from benefitting from MHSA funds; but it is unconscionable that they use those funds to fund law firms fighting treatment of mental illness.

BTW, the publicly funded PR firm they hired started a Facebook page on Proposition 63 and have posted their concerns about MHSA on the page. That means California tax dollars are being used to suppress freedom of speech.

When will the madness end. Please ask the legislature to investigate why MHSA funds are being diverted from serious mental illness. Thank you.

I appreciate it when authors of articles come back to defend and/or elaborate. So thanks.

I happily voted for Prop 63, and would do so again...as i think its not only good public policy, but its had a substantial positive impact. With that said, you bring up some disturbing points...and, as with all public policy, it can be distorted, and its full potential can go unrealized due to corruption, incompetence, and our crony capitalist system.

There was an article recently published on this site by Patricia Ryan of the California Mental Health Directors Association that details Prop 63's successes. She writes, "One year after joining the program, participants found that they used costly emergency psychiatric services 28% less than before, went to inpatient hospitals 65% less, and utilized long term care facilities 82% less than before.

In Los Angeles County, FSP programs are currently serving 6,256 individuals of all ages, and the results speak for themselves. Recent data shows severely mentally ill adults enrolled in an FSP program have experienced the following:

68% reduction in days spent homeless

53% increase in days living independently

46% reduction in days incarcerated

23% decrease in days psychiatrically hospitalized"

The article can be found here: http://www.californiaprogressreport.com/site/prop-63-improving-lives-and...

So, I guess I would argue that what you are saying is critical, and it demonstrates that this measure is being kept from having the impact it could and should have, but, that doesn't in any way detract from the successes either, and the need for it...

Would you concur with this assessment? Or are you saying that this should not have passed and should be repealed? I hope that's not the case, because without that funding, thanks to a small tax on the top one half of one percent of wage earners in the state, we, and the mentally ill, would be in a world of hurt...esp. in these times of austerity and the continued dismantling of our safety net at a time its needed most.

I'd be interested to here your take. And thanks again for exposing these shortcomings...because good public policy DEPENDS on such transparency and public outcry.

Do some MHSA funds do good? Sure. No denying it.

Are they doing good for those taxpayers intended to help? A lot are not. Perhaps most. I can't tell you how much because counties and MHSAOC refuse to publish useful financial data. The issue is how much waste are you willing to accept? For example, their stats you cite show homelessness was reduced. Did those people have a serious mental illness? Don't know.

In my opinion...(Scratch that. According to the findings of Proposition voters), they wanted the money spent on the most seriously ill, not the worried-well. The homeless, the psychotic, those who often refuse treatment. There is no argument that can be made that treatment-refusers are getting helped by MHSA or that the oversight committee is trying to correct that. The opposite is true.

The MHSAOC has worked pro-actively to exclude treatment-refusers (those so psychotic they don't know they need treatment) from being helped by MHSA funding.
1. MHSAOC issued a policy that specifically said PEI funds should not be used for anyone who is mentally ill (treatment refuser or not). That alone affected 20% of funds.
2. MHSAOC gave at least $3 million to fight efforts to implement Laura's Law, the only program targeted to treatment refusers.
3. MHSAOC is giving much more than that to other groups (who have connections to MHSAOC) under the guise of 'reducing stigma' or 'empowerment', but are being used to fight Laura's Law and not being used for the most severely ill.
4. MHSAOC justifies a two-tier system, whereby anyone who ever received a mental health service before MHSA was enacted is made ineligible for MHSA funded help under the guise of "non-supplantation' (maintenance of effort provisions).

Those who refuse treatment and are living under lice-infected clothing, screaming at voices only they can hear are those voters wanted helped. They are very clearly not getting help and are being turned over to police. As I wrote in an earlier Capital Weekly piece: ( http://www.capitolweekly.net/article.php?_c=10f76c4jrxstji7&xid=zy1wphqx... )

County mental health commissioners have accepted the funding, but not the requirement to spend it on the “severely” mentally ill. With the acquiescence of the almost-defunct Department of Mental Health in Sacramento, they have intentionally diverted funds away from severe mental illness.

San Francisco County is spending money earmarked for prevention of “severe” mental illness - for yoga, line dancing, drumming and Soul Chi (soulful movement), for individuals with ‘sub-clinical’ depression.

King County spends MHSA funds on “equine [horse]-facilitated psychotherapy” and “drumming” for Indian youth reading below grade level or merely “exhibiting ... problems.”
Butte County is funding a “Therapeutic Wilderness Experience.”

Contra Costa County is using MHSA funding for a hip-hop carwash, family activity nights, creative learning circles, school programs to reduce dating violence bullying and sexual harassment, outings for the isolated elderly, and a homework club.

Orange County is using MHSA funding for programs specifically limited to those “who have achieved a high level of recovery” and programs that intentionally “focus on the person rather than the disease.” They run groups to improve “personalized socialization,” relationship building, and exploring educational opportunities.

Los Angeles County is funding “emotional recovery” centers, ‘stigma’ campaigns, tuition reimbursement programs, market research, employment offices and a host of other services that arguably benefit the least “severely” ill but inarguably don’t benefit the most “severely” ill. Los Angeles is eliminating a proposal to use MHSA funds to start a Safe Haven Program that would provide a safe environment for chronically homeless individuals with “severe” mental illness because it “has been unable to find a qualified contractor.” But Los Angeles County is still expanding hotlines, warm lines, suicide lines, and referral lines leading to more and more organizations referring to fewer and fewer services. It’s a shell game that’s not helping people with “severe” mental illness and is creating a danger for all of us. Not what voters wanted.

What's the solution? I proposed some in the article. Certainly using MHSA funds for Laura's Law implementation would help. MHSAOC is actively supporting opposition to doing that and these MHSA supported groups are spreading pseudo-legal arguments that MHSA can't be used for Laura's Law implementation. I would argue that is exactly what voters intended.

I'm on a roll now (Grin)

The core issue is that before MHSA, county mental health departments did not want or accept responsibility for the most seriously ill. Through neglect they were able to turn the seriously ill over to the police.

In California, you are 3.8X more likely to be incarcerated for mental illness than hospitalized ( http://mentalillnesspolicy.org/imd/shortage-hosp-beds.pdf )

The abandonment of those with the most serious mental illness by the mental health departments has created an unsustainable drain on California law enforcement officers (See survey of CA LEOs: http://lauras-law.org/states/california/biasotticastats.html ).

Just look at the incidents in a single county (San Mateo: http://lauras-law.org/states/california/sanmateotragedies.html )

If California had perfect community based services they would still need over 10K more beds to serve the needs of the most seriously ill ( Page 2: http://mentalillnesspolicy.org/imd/shortage-hosp-beds.pdf )

Now that the mental health directors have MHSA funds, they are still not using them for the most seriously ill. They still prefer to treat the worried-well. They are easier. If two people show up for treatment-one who needs marriage counseling and one who is homeless, psychotic and has schizophrenia-the former will get services and the later sent to the end of the line. MHSA was supposed to change that. It hasn't.

Thanks again for all the info. I have asked the other author I cited to comment here as well. I always like to get to the root of the problem...it sounds like in this case you're saying, as you do here at the end, that the reason they aren't spending more of their resources on the seriously mentally ill is because its easier and cheaper to help people without such deep problems.

Are there other motives involved here? I know there's always intense pressure in programs like this (due to fear of being axed) to spend as little resources as possible while claiming as big as successes as possible (which might be why they don't want to take on the hardest cases).

It sounds like they don't want to take that challenge on out of fear they may "fail" to meet certain demands placed upon them...and might feel it could cost too much resources to tackle those hard cases as well. Is this at the core of the problem do you think? And if not, what are some of the other reasons? Are there financial interests/lobbies that could be influencing such decisions too? (like the typical power lobbies in the health industry complex)

I know there's a lot of dedicated public servants and mental health professionals that would much rather address the real crisis, not lesser ones...so I'd like to know all the reasons why this isn't happening. Thanks again!

I am not surprised that the Exec Dir. of CA Assoc. of Mental Health Directors thinks the California Mental Health Directors are doing an excellent job. I just differ. And so do many families of people with serious mental illness.

I am a little less able to comment on motivation than results. The results are that the seriously mentally ill are not getting care. Many are homeless and 3X as many are winding up incarcerated than hospitalized. Money is no longer the issue. Thanks to Mental Health Services Act, mental health departments have plenty. Yet in spite of the infusion of Prop 63 cash, Mental health departments (with few exceptions) have not made delivering services to the most seriously mentally ill a priority. As long as the psychotic don't show up for services (something they are often incapable of doing on their own) the mental health departments let them go unserved. They conduct "outreach" but when someone is so psychotic they think you are approaching them to put a transmitter in their head, they are not likely to accept your outreach. So the outreach workers (great people at heart) move on to someone not as disturbed.

Put another way: Except for conservatorships (which take away massive rights and require dangerous behavior) no county (other than NV and LA) has a community program for people so sick they refuse treatment. ALL community programs are voluntary. But up to 50% of people with serious untreated mental illness have anosognosia: the inabililty to recognize they are ill. The organ charged with regulating behavior and figuring this out, the brain, is the one that is not functioning properly. They are left to fend for themselves until police step in, in spite of fact Mental Health directors could use Laura's Law to stop that.

I don't know how to say it any other way: the most seriously ill are ignored. If you're not well enough to accepttreatment, no one is going to help you get it. (Except the police after you become dangerous).

Now, as a result of Brown v. Plata, many mentally ill individuals who were victims of this policy and incarcerated will now be released back into the community and mental health directors are not preparing for that by implementing Laura's Law which could help see these people get the humane treatment they are entitled to. (Nevada County and LA County being exceptions) (See article on using Laura's Law to help address Brown v. Plata: http://www.huffingtonpost.com/dj-jaffe/brown-v-plata-compliance-_b_85741... ) Funding is not the issue.

Why are mental health directors not preparing for Brown v. Plata results? Why do they continue to "reverse prioritize", fund new programs for less ill while letting the most seriously ill go untreated? (See this criticism by someone involved in writing MHSA about how the county directors are avoiding the most seriously ill: http://www.newsreview.com/sacramento/two-tiered-mental-health-system/con... ) Helping the most seriously ill should be the number one priority of MHSA funds, not the last.

As for motivation, here is my guess. MH Directors are well meaning, but It is easier to treat the worried well. And spreading funds among the worried well, as opposed to focusing on the seriously ill allows you to serve more people. MH directors can brag, 'Look how many people we serve" and ignore the fact the most seriously ill are not included. The supervisors don't have enough professional expertise to see through the sham and the mental health complex (MHA, NAMI, APA, professional patients, etc.) will all cheer MH directors for funding "mental anything". (This is a big problem now: these orgs are making the definition of mental illness so broad (bad grades? Give me a break) and MHSA is giving away so much money that no one is left who can stand up to them and say this is not what voters intended).

I agree with you 100%: MH directors are not bad people. But perhaps because they work within a political process, they have to spread the money as broadly as possible so they can buy off the largest numbers. The squeaky wheel gets the oil, and at this point, those who get MHSA funds can squeak the loudest and they are saying "Bravo, Give me more!" Facts simply don't matter anymore.

Meanwhile, the homeless mentally ill, the psychotic mentally ill are left to deteriorate until they become dangerous enough for the police step in. It's really cruel.

Yeah, that was one of the theories I put forth in my question to you...that its easier not to deal with the hardest cases...I'm guessing in the cases of the most mentally ill, we're talking about an especially difficult job...and yeah, that could hurt your "success numbers", and probably a daunting task to many of these workers. I wonder how much good the work they have accomplished has done...even if it hasn't been dealing enough with the psychotic mentally ill that you're talking about?

Hopefully that other author will come here and offer some of her thoughts and data. God knows, we have a problem with a variety of mental illnesses in this country, and a lack of treatment for them (and coverage) that goes beyond just the psychotic...but as you say, that wasn't what was promised.

years ago they called it force treatment to state hospitals today they force us to become criminals and we do time not treatment
i am writing this since i have been part of a clients which were force into state hospitals in the 70's-early 90's which when state hospitals where closed due to being forced to stay for years . with a stigma that we would never amount to anything or be able to accomplish recovery and live normal lives . since 2000 we have come a long way although what they did is forced us to become criminals and sit in prisons and jails for long lengths of time instead of hospitalization and outpatient treatment . in 2004 a bill was passed prop 63 which gave money to help get new programs to develop our skills and abilities However due to recent budget cuts and facilities closing many are now in limbo or cannot be served due to getting legal documents to not being critical enough until they have been criminalized. then and only then are they forced to do jail prison or end up in our new offenders programs. which with Laura's law would keep your rights and you would have a say in what you want and expect as well as if you have medications or not. however in jails and prison they give you some or more then you need to medicate your behavior remember when there was an access of 30-50 racial on seraqil which due to the high number of deaths from this drug being administrated in our prisons and jails it is now banned and now they are limited to how a client is sedated so they have control. I also have seen many whom due to refusal of voluntary services due to miss treatment and or bad reactions . I am a walking example of how and what works. i got it explained to me this way when we are young we are forced to attend school then forced as an adult to get a job and pay bills and follow laws which are enforced" meaning Forced treatment of society" or serve the consequences however, due to a mental illness we are sometime not capable or willing to comply yet they give us a choice which takes all our rights and dignity including

I don't know how to say it any other way: the most seriously ill are ignored. If you're not well enough to accept treatment, no one is going to help you get it. (Except the police after you become dangerous).OR the family members that love the person and is committed to their well being even tho they are mentally ill. I support Laura's Law, It would work for our family. It starts with FAMILY you have to have just a little compassion and when getting the help you need be relentless. Never give up hope, one day 10 years from now maybe sooner, they will be safe.

Here is a typical letter I get all the time. This one posted today and is in Merced County. The family had been trying to get Juan treatment. Juan refused treatment. Mental Health authorities refused to help.

Just wanted to ask everyone for prayers right now for my husband Juan who just got arrested for stealing. He believed his "mom" (susan b. anthony) told him it was ok that he take some stuff from "her" stores. He is living in a delusion that I dont know if he can ever get out of, just praying that this happened for a reason and that this will finally get him the help he needs. He has been calling bail bonds men to get a hold of me to get him out but I just cant because I feel if i do he will never get any help. If theres anyone thats gone through something like this with their loved ones can you please give me some advice? I dont know what to do, my heart hurts so much for him. Thank you.
(end)
(She is willing to speak publicly if you are interested).

Here' the truth
-there is no accountability that MHSA money is used only for patients with severe mental illness-no medical/psychiatric diagnosis is required on the patients chart, so many programs are created that having nothing to do with SMI (ie: gang violence, crime survivor support, parenting programs, pregnant teen programs, etc)
-all mental health care is 100% voluntary
-there are no involuntary assistance/programs for those patients who are unable to seek voluntary care and unable to cognitively understand their need for treatment with a disorder that functions from the brain; the primary source of their disease
-obtaining a conservatorship can take years of deterioration, then only to now have a patient with a severely damaged brain; making them more difficult to treat and treatment resistant
-CalMHSA's agenda is to maintain a 100% voluntary treatment system; they have formed a powerhouse of Behavioral Health care directors, who have now aligned themselves with Disability Rights California who lobbys against AOT statewide, signing a 3 year contract with tax payer money to maintain their philosophy and agenda for a 100% voluntary system, and AOT only coming from the criminal justice system, which maintains the criminalization of the mentally ill
-the behavorial health care depts dont want the responsibility for caring for the sickest patients-they dont have facilites to place them-they dont mind them falling into the criminal justice system; its not on their dime, and they rather the patient be followed by the court system
-the BHCD's dont have a moral obligation to protect the patient under the LPS law, the community, or law enforcement, they instead contract superficial programs with no identifiable program outcomes maintaining employment for social workers
-there is no help for the severely psychotic and delusional patient who is unable to seek voluntary services-its not "illegal" to be psychotic although they end up homeless, incarcerated (with the incarceration rates in all counties rising to prove it) have a higher risk for suicide statistically, suffer needlessly, and have permanent brain damage
-MHSA programs discriminate against those patients who are unable to seek treatment, who dont have medi-cal, and service only a small percentage of citizens who qualify for their program criteria.
-MHSA funds are managed by non-medical employees who have no understanding of brain disease; its as barbaric as having a social worker manage heart disease
-why we allow people, who have no interest in truly helping the severely mentally ill, who are beurocrats employing their friends, continue having control of MHSA funds is uncongiable and inhumane.

The mental health Industry of "training, conferencing, reporting, evaluating, planning and conducting stakeholder meetings" among themselves is puling off the Heist of the Century. One Billion $$$ a year since 2005 has been pumped out toward illegal, immoral, and irresponsible ends. The state Department of Mental Health took the lead, but many political actors are complicit in operating a mental health system that can only be described as criminally negligent. The medieval conditions are a product of willful ignorance, political ambition, and greed.

As a co-author of Prop 63, and a consultant to the Attorney General during his term on the Oversight and Accountability Commission in the first two years of implementation--I can tell you firt-hand that principal parties set out to generate those success story statistics by serving only FIVE PERCENT of public mental health clients--and ONLY NEW CLIENTS in NEW PROGRAMS. The calculated purpose of excluding all underserved clients in the existing system was to generate those deceptive statistics. They are irrelevant and a cruel insult to consumers and their families and friends suffering the tragedy of untreated serious mental illnesses, and the despair leading to increased suicides and incarceration.

State employees, lobbyists, oversight commissioners agreed that they would get better "performance data" by serving new clients in new programs. The strategy also produced a bonanza of new grants for Rusty Selix clients such as the Mental Health Associations and contract providers, and the California Institute of Mental Health, the premier grant consumer and producer of conferences, trainings, reports of unknown utility, and employer of legions of consultants with the proper special interest connections. "Stakeholders" who claim to represent major constituencies such as mental health consumers, family members, and children shared in the largesse with major grants to conduct programs for which there is minimal audience or questionable benefit. Entrepreneurs in every conceivable service for "stakeholders" and unwanted and unknown products got aboard the same gravy train.

I agree with all of the critics above and Mr Jaffe's analysis. They are absolutely accurate -- but only lack appropriate emphasis on the 500,000 people diagnosed with serious mental illnesses and in the public mental health system who are not "treatment-refusers" but demeaned "treatment-seekers." No one gets into the system -- and past the ACCESS gatekeepers--without a diagnosis. But that is about all they get if they are lucky--no authentic evaluation, no respectable standard of medicine, no ethical health treatment for their serious illnesses. If they have a warm body related to them, who may be identified by the mental health staff, they get even less service. My teenage family members have been prescribed first-time, heavy-duty psychotropic medications, with potentially lethal side effects, and then scheduled for a return visit four months later.

After eight years and $8 Billion, clinics in Senator Steinberg's district serve thousands of people who are seriously mentally ill and seeking treatment, trying desperately to maintain some dignity and independence, hopelessly unable to access recovery services, and under treated/misdiagnosed/inappropriately treated by case workers with a caseload of 150 consumers, psychiatrists with a caseload of 600 clients, and service personnel with minimal training and capacity for relating to their clients.

This is the standard of care in Senator Steinberg's district, where one would expect a model service system after $220 million + in Prop 63 allocations.

The money is stolen, critically ill people are cheated and left to die, and there is no limit to the tolerance for inhumanity by the shameless thieves, some of whom attempt to deceive themselves as well as the public. I filed a whistleblower complaint on the anniversary of the fifth year of passage. California Progress Report carried the related story. Nothing has changed except the magnitude of waste and compounding conflicts of interest. Rose King

Governor Jerry Brown's State of the State Address promised implementation of laws that are "..efficient, honest, and in the people's interest." Note to governor: MHSA law fails this test.

Why should voters enact another tax increase for state-funded programs, when your management of Prop 63 tax money does not meet your own standard? When your administration is preparing to hand over the mismanaged, corrupt, wasteful system to counties with no strings attached?

Ms. King:
I just found your previous article for California Progress Report. Wow! It really lays out what is going on. http://www.californiaprogressreport.com/site/node/7072

It sounds like we can all agree on the need for REAL help and funding for the truly mentally ill...so, the question then becomes how best to advocate for some of the reforms the author (both here) has laid out? The other option is the continuing dismantling of desperately needed services at a time they're needed most (which would have been devastating without Prop 63 funding)...so that can't be the solution...but it sounds like you've got a number of good ideas to move us forward.

Thanks to both of you for bringing this to light...