After 10 Years, Fine Tuning is Needed for the Mental Health Services Act

After about ten years of implementation some fine tuning is needed for the Mental Health Services Act to better achieve its goals

This Thursday May 26th the Little Hoover Commission will hold its Prop-63-Logosecond hearing on the Mental Health Services Act (MHSA). At issue is its conclusion that state officials have not implemented the recommendations they made in January 2015.

At the same time legislators are taking unprecedented steps to earmark funds (Senate No Place Like Home budget proposal; AB 2017 McCarty – College Students; AB 2279 – Fiscal Reporting). CCCBHA and I support these efforts and join other stakeholders in recognizing the need for some fine tuning of this act.

When we wrote the Mental Health Services Act we had two simple goals:
  1. Get the “whatever it takes” model of comprehensive services from the children’s and adults’ systems of care to every child with a serious emotional disturbance and every adult and older adult with a severe mental illness
  2. Make prevention and early intervention the norm and not the exception so that people do not suffer for years without treatment – moving from a “fail first” system to one that gets people help at the first signs of mental illness.

When measured by these goals it is not clear we have made very much progress. However, that does not mean that the counties, the state or the Act can be significantly faulted for that failure. Instead, the results are primarily due to lack of adequate funds for community services and supports and lack of adequate knowledge of what would work best to achieve our prevention and early intervention goals – that mostly require action from other systems (primarily health care and education).

We can’t do much to change the two sources that will help us have enough funds – the economy and federal funds (which were increased significantly by the Affordable Care Act and could be increased even more by the Certified Community Behavioral Health Centers program). But we can do better to improve the focus, decision making process, and accountability to get more out of the available dollars.

Of critical importance is that we simply don’t have the reports we need to know which full service partnership programs are the most effective or efficient at serving each important population- by age, race ethnicity, sexual orientation or other variable.

In addition, the legislature is rightly concerned about the small numbers of people who had been homeless among those currently being served.

And stakeholders are rightly concerned that since state approval of county plans was eliminated most counties do not seem to have a process that their stakeholders consider adequate.

State officials join stakeholders in expressing concerns regarding lack of fiscal transparency regarding how much money the county spent in the past year and has available from each source for its budget year.

It is also appropriate for legislators to seek to earmark funds for college students, school mental health, crisis care, and triage as priority areas of focus that seem not to be getting adequate attention.

It is equally appropriate for children’s advocates to say “What about us?” in light of concerns related to the realignment of the two main funding sources- special education mental health (used to be AB 3632 and is now AB 114) and EPSDT.

When we wrote the act we had three goals for children with serious emotional disturbances:

  • To protect the entitlements
  • To fill in the gaps and use MHSA funds to pay for whatever the two entitlements (or private insurance) could not pay for
  • To require every county to implement wrap around care as an alternative to residential placement when feasible
We really don’t know how well we are doing, even though the entitlements are essentially federal and can’t be (and have not been) weakened. There is a growing sense that we are not making progress in addressing unmet needs. There is legislative, stakeholder and state agency interest in putting a better accountability system in place to measure 1) the effectiveness of current services are; 2) the number of people being served; and 3) how many could be served with existing funds.
This, of course, is not just an issue for children’s services; it applies to all services.
The MHSA will continue to be the fastest growing state revenue source – more than doubling over the past eleven years and projected to grow even faster over the next ten years.
Accordingly, my testimony to the Little Hoover Commission focuses on the need to have all counties develop a strategic plan regarding unmet needs and how much more money they think they will need to reach everyone needing intensive services (and to have the workforce to provide it).

At the state level we need a more strategic approach to prevention and early intervention to guide counties, so that within a few years we can see some standardization around a set of best practices.

After all this is health care – and you should get the same care no matter where you live. As both the Mental Health Services Act and Affordable Care act promise – everyone should get the right care at the right place at the right time.

We are not there – nor are we likely to get there any time soon – but as Yogi Berra famously said, “If you don’t know where you want to go you will probably end up somewhere else.”

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