Promises Still to Keep: A Second Look at the Mental Health Services Act

Report #233, September 2016
Promises Still to Keep: A Second Look at the Mental Health Services Act

Full Report

Executive Summary

Press Release

FOR IMMEDIATE RELEASE
September 8, 2016

For Additional Information Contact:
Carole D’Elia, Executive Director
(916) 445-2125

Commission Issues Second Call to Strengthen Oversight of $2 Billion Annual Millionaire’s Tax – Proposition 63

The Little Hoover Commission, in a report sent Thursday to Governor Brown and the Legislature, again advised more vigorous accounting for $2 billion in annual revenues and outcomes for Proposition 63, the Mental Health Services Act (also known as the Millionaire’s Tax). Nineteen months ago the Commission cited weak financial reporting and limited oversight of Proposition 63 revenue as a threat to this critical funding source – and finds only partial improvement since. The Act, approved by voters in 2004, promised to develop and expand mental health care services statewide through a 1 percent surtax on millionaire incomes.

Twelve years and $17 billion later the state still can’t handily show the impacts of this funding, how it is spent or who is helped. As the Commission warned in its 2015 report, Promises Still to Keep: A Decade of the Mental Health Services Act, lawmakers have begun diverting this lucrative revenue source.

“This unique source of money is clearly at risk and so are the people it is intended to serve. If counties and the state can’t demonstrate the difference it makes for individuals, their families and California as whole, it may not survive,” said Commission Chair Pedro Nava. “The Commission heard many moving stories of success that attest to the transformative power of Proposition-63 funded programs. But too many of these real-life anecdotes lack hard proof of statewide data to back them up,” Chair Nava said.

In its January 2015 report, the Commission stated that more than a decade after voters enacted the measure, the state lacked data to tell the story of its accomplishments. Leadership has been absent to adequately address these concerns and to enforce the Act.

The Commission’s follow-up report, Promises Still to Keep: A Second Look at the Mental Health Services Act, also acknowledges progress since January 2015 to better account for Proposition 63 spending. Additional Commission recommendations:

  • Untangle a muddled state bureaucracy to clarify which agency should best administer, oversee and enforce the Mental Health Services Act.
     
  • Take bolder steps to improve transparency of state and local spending.
     
  • Rapidly develop a state-owned data system to monitor and measure outcomes of Mental Health Services Act funding.
     
  • Create more meaningful ways for the public to guide and participate in spending decisions and raise concerns about spending priorities.
     
  • Encourage replication of successful programs statewide by sharing model programs and ideas beyond county borders.
     

The Little Hoover Commission is a bipartisan and independent state agency charged with recommending ways to improve the efficiency and effectiveness of state programs. The Commission’s recommendations are submitted to the Governor and the Legislature for their consideration and action. For a copy of the report or documents from the Commission’s May 2016 public hearing, visit the Commission’s website: www.lhc.ca.gov.

Fact Sheet

Study Description

For this study, the Commission revisited its January 2015 review of the Mental Health Services Act, Promises Still to Keep: A Decade of the Mental Health Services Act. The Commission’s report, citing a decade of bureaucratic stumbles and data challenges, called for the state to address critical shortcomings in its implementation of 2004’s Proposition 63 ballot measure, known as the Mental Health Services Act. The measure created a 1 percent tax on personal income in excess of $1 million and dedicated the revenue to fund mental health services. The tax has raised more than $13 billion since 2004.

In its 2015 report, the Commission called on the state to better validate how money generated by Proposition 63 has been used to help Californians with mental illness recover and thrive, and how it has prevented others from developing a serious mental illness. The Commission urged the Governor, Legislature and state agencies responsible for overseeing implementation to take several actions, including expanding the authority of the Mental Health Services Oversight and Accountability Commission – an independent board created by the initiative to oversee and evaluate spending plans. The Commission also called for improving financial reporting to ensure progress toward outcomes such as expanded services and new innovative programs that Proposition 63 backers promised to voters in 2004.

The Commission scheduled a public hearing on Thursday, May 26, 2016, to follow up on the concerns raised in its 2015 report and to assess the progress implementing its recommendations for effective use of the state’s significant investment in mental health services. 


Previous Studies

Agenda

Overview

In this report, the Commission renews its January 2015 call to strengthen the oversight of Proposition 63, the Mental Health Services Act (MHSA) of 2004. This report updates and builds on recommendations the Commission made in a 2015 report, Promises Still to Keep: A Decade of the Mental Health Services Act

During its review, the Commission found weak financial reporting and limited oversight of Proposition 63 expenditures.

The Commission recommends the state further clarify the roles and responsibilities of the state agencies that administer, oversee and enforce the MHSA, and increase transparency of state and local spending of MHSA funds.

Print 
			Agenda
  • September 8
    2016
    Mental Health Services Act Check-Up
    10:00 a.m., 925 L Street, Suite 805, Sacramento, CA
    Public Meeting
    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    August 26, 2016

    For Additional Information Contact:
    Carole D’Elia, Executive Director
    (916) 445-2125

    Notice of Meeting

    On Thursday, September 8, 2016, the Little Hoover Commission will conduct a meeting to discuss and consider a draft report on the Mental Health Services Act. The meeting will begin at 10 a.m. in Suite 805 at 925 L Street in Sacramento.

    Additional teleconference locations accessible to the public during the meeting will be:

    750 Battery Street, Suite 400, San Francisco, CA 94111

    15 W. Carrillo, Santa Barbara, CA 93101

    3750 University Avenue, 6th Floor, Riverside, CA 92501

    12456 Ventura Blvd., Suite 1, Studio City, CA 91604

    425 South Palos Verdes Street, San Pedro, CA 90731

    634 South Spring Street, Suite 920, Los Angeles, CA 90014

    All public notices for meetings are on the Commission’s website, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Friday, September 2, 2016.

  • May 26
    2016
    Mental Health Services Act Check-Up
    9:30 a.m., State Capitol, Room 437, Sacramento, CA
    Public Hearing
    Agenda

    AGENDA

    Public Hearing on the Mental Health Services Act (MHSA)
    Thursday, May 26, 2016, at 9:30 a.m. 
    State Capitol, Room 437
    Sacramento, CA 


    Opening Remarks

    Reflections from MHSA Co-Author

    1. Darrell Steinberg, Former Senate Pro Tem and Founder, Steinberg Institute (Written Testimony)
       

    State Oversight of the Mental Health Services Act

    1. Toby Ewing, Executive Director, Mental Health Services Oversight & Accountability Commission (Written Testimony)
       
    2. Karen Baylor, Deputy Executive Director of Mental Health and Substance Use Disorder Services, California Department of Health Care Services (Written Testimony)
       
    3. Jane Adcock, Executive Officer, California Mental Health Planning Council (Written Testimony)
       
    4. Daphne Shaw, Councilmember, California Mental Health Planning Council 
       

    Local Implementation of the Mental Health Services Act

    1. Kirsten Barlow, Executive Director, County Behavioral Health Directors Association (Written Testimony)
       
    2. Phillip Deming, Chair, San Diego County Behavioral Health Advisory Board
       
    3. Debbie Innes-Gomberg, District Chief, Los Angeles County MHSA Implementation and Outcomes Division (Written Testimony


    Mental Health Stakeholder Groups

    1. Rusty Selix, MHSA Co-Author and Executive Director of Policy and Advocacy, Mental Health America of California (Written Testimony)
       
    2. Stacie Hiramoto, Director, Racial and Ethnic Mental Health Disparities Coalition (Written Testimony)

    Comments Submitted by Members of the Public

    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    May 12, 2016

    For Additional Information Contact:
    Carole D’Elia, Executive Director
    (916) 445-2125

    Notice of Meeting

    On Thursday, May 26, 2016, the Little Hoover Commission will conduct a public hearing to revisit the progress made to address concerns raised in its 2015 report, Promises Still to Keep: A Decade of the Mental Health Services Act. The hearing will begin at 9:30 a.m. in Room 437 of the State Capitol in Sacramento.

    At this hearing, the Commission will hear updates on the advances made to implement its recommendations and seek feedback about the obstacles that might be limiting progress and the strategies to overcome them.

    The Commission will first hear from former state Senate President pro Tempore Darrell Steinberg, the founder of the Steinberg Institute and the co-author of the Mental Health Services Act (MHSA). Next, the Commission will hear from a panel representing the state’s role in oversight of the Act, including the executive director of the Mental Health Services Oversight and Accountability Commission, the deputy executive director of the Mental Health and Substance Use Disorder Services within the Department of Health Care Services and the executive officer and a councilmember of the California Mental Health Planning Council. The next panel features those involved in local implementation of the Act, including the executive director of the County Behavioral Health Directors Association, the chair of the San Diego County Behavioral Health Advisory Board and the district chief for the Los Angeles MHSA Implementation and Outcomes Division. Finally, the Commission will hear from several stakeholder groups, including executive director of policy and advocacy for Mental Health America of California and the director of the Racial and Ethnic Mental Health Disparities Coalition.

    There will be an opportunity for public comment at the end of the hearing. The Commission also encourages written comments. Immediately following the hearing, the Commission will hold a business meeting in Room 175 at 925 L Street in Sacramento. An additional location for the business meeting only is UCSF Benioff Children’s Hospital Outpatient Center Boardroom, 744 52nd Street, Basement, Oakland, CA 94609.

    All public notices for meetings are on the Commission’s website, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, May 19, 2016.

    Video
Print 
		Agenda
  • September 8
    2016
    Mental Health Services Act Check-Up
    10:00 a.m., 925 L Street, Suite 805, Sacramento, CA
    Public Meeting
    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    August 26, 2016

    For Additional Information Contact:
    Carole D’Elia, Executive Director
    (916) 445-2125

    Notice of Meeting

    On Thursday, September 8, 2016, the Little Hoover Commission will conduct a meeting to discuss and consider a draft report on the Mental Health Services Act. The meeting will begin at 10 a.m. in Suite 805 at 925 L Street in Sacramento.

    Additional teleconference locations accessible to the public during the meeting will be:

    750 Battery Street, Suite 400, San Francisco, CA 94111

    15 W. Carrillo, Santa Barbara, CA 93101

    3750 University Avenue, 6th Floor, Riverside, CA 92501

    12456 Ventura Blvd., Suite 1, Studio City, CA 91604

    425 South Palos Verdes Street, San Pedro, CA 90731

    634 South Spring Street, Suite 920, Los Angeles, CA 90014

    All public notices for meetings are on the Commission’s website, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Friday, September 2, 2016.

  • May 26
    2016
    Mental Health Services Act Check-Up
    9:30 a.m., State Capitol, Room 437, Sacramento, CA
    Public Hearing
    Agenda

    AGENDA

    Public Hearing on the Mental Health Services Act (MHSA)
    Thursday, May 26, 2016, at 9:30 a.m. 
    State Capitol, Room 437
    Sacramento, CA 


    Opening Remarks

    Reflections from MHSA Co-Author

    1. Darrell Steinberg, Former Senate Pro Tem and Founder, Steinberg Institute (Written Testimony)
       

    State Oversight of the Mental Health Services Act

    1. Toby Ewing, Executive Director, Mental Health Services Oversight & Accountability Commission (Written Testimony)
       
    2. Karen Baylor, Deputy Executive Director of Mental Health and Substance Use Disorder Services, California Department of Health Care Services (Written Testimony)
       
    3. Jane Adcock, Executive Officer, California Mental Health Planning Council (Written Testimony)
       
    4. Daphne Shaw, Councilmember, California Mental Health Planning Council 
       

    Local Implementation of the Mental Health Services Act

    1. Kirsten Barlow, Executive Director, County Behavioral Health Directors Association (Written Testimony)
       
    2. Phillip Deming, Chair, San Diego County Behavioral Health Advisory Board
       
    3. Debbie Innes-Gomberg, District Chief, Los Angeles County MHSA Implementation and Outcomes Division (Written Testimony


    Mental Health Stakeholder Groups

    1. Rusty Selix, MHSA Co-Author and Executive Director of Policy and Advocacy, Mental Health America of California (Written Testimony)
       
    2. Stacie Hiramoto, Director, Racial and Ethnic Mental Health Disparities Coalition (Written Testimony)

    Comments Submitted by Members of the Public

    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    May 12, 2016

    For Additional Information Contact:
    Carole D’Elia, Executive Director
    (916) 445-2125

    Notice of Meeting

    On Thursday, May 26, 2016, the Little Hoover Commission will conduct a public hearing to revisit the progress made to address concerns raised in its 2015 report, Promises Still to Keep: A Decade of the Mental Health Services Act. The hearing will begin at 9:30 a.m. in Room 437 of the State Capitol in Sacramento.

    At this hearing, the Commission will hear updates on the advances made to implement its recommendations and seek feedback about the obstacles that might be limiting progress and the strategies to overcome them.

    The Commission will first hear from former state Senate President pro Tempore Darrell Steinberg, the founder of the Steinberg Institute and the co-author of the Mental Health Services Act (MHSA). Next, the Commission will hear from a panel representing the state’s role in oversight of the Act, including the executive director of the Mental Health Services Oversight and Accountability Commission, the deputy executive director of the Mental Health and Substance Use Disorder Services within the Department of Health Care Services and the executive officer and a councilmember of the California Mental Health Planning Council. The next panel features those involved in local implementation of the Act, including the executive director of the County Behavioral Health Directors Association, the chair of the San Diego County Behavioral Health Advisory Board and the district chief for the Los Angeles MHSA Implementation and Outcomes Division. Finally, the Commission will hear from several stakeholder groups, including executive director of policy and advocacy for Mental Health America of California and the director of the Racial and Ethnic Mental Health Disparities Coalition.

    There will be an opportunity for public comment at the end of the hearing. The Commission also encourages written comments. Immediately following the hearing, the Commission will hold a business meeting in Room 175 at 925 L Street in Sacramento. An additional location for the business meeting only is UCSF Benioff Children’s Hospital Outpatient Center Boardroom, 744 52nd Street, Basement, Oakland, CA 94609.

    All public notices for meetings are on the Commission’s website, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, May 19, 2016.

    Video