MHSA Update, February 2012

From NAMI California by Kathleen Derby, March 1, 2012

Two legislative hearings on mental health reorganization and three MHSOAC committee meetings were held last month. What follows is a brief summary of the legislative hearings and key discussion that occurred in the Mental Health Funding and Policy, Services, and Evaluation Committees.

Joint Legislative Hearing on Mental Health Reorganization – 2/21/12

Testimony was provided at this hearing by the Departments of Health and Human Services, Health Care Services, Mental Health and Public Health. The restructure was discussed, with some of the newer elements being that the functions of the Office of Multicultural Services’ functions will be split between the Department of Health Care Services (County Cultural Competence Plans) and the Department of Public Health, Health Equity Division (CA Reducing Disparities Project). Other key testimony was given by the Department of Mental Health in which they indicated that Annual Performance Contracts will no longer be necessary for counties moving forward. In light of the removal of state oversight of county plans, this is concerning, particularly because the County Mental Health Directors have previously commented that it was precisely through these contracts that much statewide accountability would lie. Many stakeholders, including Bettie Reinhardt for NAMI California, stepped forward to testify on the need for statewide accountability of counties to stakeholders.

Assembly Select Committee on Disabilities – 2/23/12

Testimony was provided by the following organizations on the topic of “Bridging the Gap – What Have We Missed?”: CA Network of Mental Health Clients, Disability Rights CA, Southern Caregiver Resource Center, and Mental Health Oversight and Accountability Commission. On the topic of “Dollars, Cents and Sensibility – Keeping Budget Cuts Away from Consumers”, Jessica Cruz of NAMI California testified along with County Mental Health Directors Association, NAMI member, Keris Myrick, and the Department of Mental Health. Among other things, Jessica Cruz’ testimony emphasized that due to the changes in statewide oversight and mental health realignment, local advocacy will need to be strengthened to help ensure that politics at the local level does not put mental health funding at further risk.

Funding and Policy Committee – 2/15/12

At February Mental Health Funding and Policy Committee meeting, committee members went over various financial reports the MHSOAC uses to display total amounts of funds distributed to counties, by funding stream, etc., to determine which reports were still necessary in the reorganized mental health environment and what may need to be amended. There are various types of reports the OAC generates most of which will continue. However, one report displayed funding by MHSA component. We were informed that due to the new way counties are receiving funds (i.e. directly from the State Controller rather than having to request funds by component), it will be impossible to show the amounts allocated to each component.

To review, the state has done away with state review and approval of county plans. In the old system, plans were approved and funds were distributed according to what was requested for each component. In this new system, funds go directly to counties from the state controller, and it is left up to counties to distribute among components according to the formulas in the MHSA. I asked if accountability of distribution is something that should concern the Funding and Policy Committee. I followed up by asking whose responsibility it will be to make sure that distributions are made according to law. I was not given any answers during the meeting, but was told that these and other questions raised by MHSOAC staff will be relayed to the Evaluation Committee. I made the point that this type of information is needed more in “real time,” while the Evaluation will be compiling and analyzing data from a longitudinal perspective. We should continue to follow this and seek answers on ensuring financial accountability. While we are being told that much of this will fall to local responsibility, we still don’t know to what extent politics may complicate at the Board of Supervisors level. Client and family advocates care deeply about this but are not set up to do this type of oversight. In this new environment, the necessity of transparent local funding reports is essential for stakeholders at the local level.

Services Committee – 2/22/12

During a report out of implementation on the county level, the Chair commented that he was hearing a consensus that local community planning processes have slowed.

There were reports given by the Strategic Planning Workgroups of the CA Reducing Disparities Project (African American, Asian Pacific Islander, Latino, Native American, GLBTQ). Their strategic plans are due from March through June. They are tasked with coming up with promising practices for each community which will then be implemented with one time funding geared toward creating sustainability in our system for reducing disparities. The MHSOAC is tasked with creating guidelines, now referred to as “guidance,” for this implementation.

The MHSOAC is also tasked with overseeing Training and Technical Assistance. They have interpreted this as not actually performing the training and TA, but as an oversight duty. CiMH has been authorized by the state to be the main provider of Training and TA to the public mental health system. Their contract, formerly held by DMH, will now move to the Department of Healthcare Services (DHCS). CiMH has conducted a needs assessment survey of where more training and TA is needed. NAMI California was interviewed as part of this survey. One major area we felt was lacking was the inclusion of clients and family members as part of their training, both to inform it, attend, and also serve as trainers.

CalMHSA is in the beginning stages of the rollout of the Prevention and Early Intervention Statewide Programs. NAMI California’s piece of the project – Reducing Stigma and Discrimination in Mental Health and System Partners – is also in its beginning stages, with local affiliates preparing to be trained and build capacity in the programs that are part of this project: In Our Own Voice, Provider Education, Parents and Teachers as Allies, and Breaking the Silence. We are involved in these projects as a contractor, but the avenues for public stakeholder input at this point seem limited for statewide projects of this size. There are 6 stakeholders from around the state that serve on a Program Advisory Committee to CalMHSA. Stakeholder participation is invited at their meetings, which are held 6 times per year, and at the meetings of the CalMHSA Board of Directors, which are also held 6 times per year. The CalMHSA Board of Directors includes Mental Health Directors only, no stakeholders. CalMHSA is also hosting calls with county liaisons to provide communication at a localized level regarding the implementation of the programs. Though client and family stakeholders have not yet been invited to participate on these calls, we have requested this.

Evaluation Committee

The MHSOAC is monitoring multiple contracts for Evaluation. A summary of these contracts is attached. One of the larger evaluation contracts goes by the term “Phase II” and “Phase III”. Phase II of the Evaluation includes the following deliverables: 1) Report of activities and costs of local MHSA Funds; 2) Reports on Prioritized Indicators (these are indicators based on the negative outcomes outlined by the MHSA); and 3) Summary and synthesis of existing evaluations re a) consumer outcomes, and b) MHSA values. Phase III of the Evaluation includes the following deliverables: 1) Full Service Partnership analysis – re costs and cost benefit; 2) Impact of the MHSA on client outcomes using participatory research re a) general system development and b) involvement of clients/families/caregivers in the public mental health system; and 3) a report on a) data elements needed for comprehensive evaluation and b) process for integrating services process variable with client outcomes.

In the midst of their contracting out evaluations, it became clear to the MHSOAC that there were issues with the data systems being used. They contracted with CSUS to assist with the state DCR system which would then let counties see their own data to determine where cleanup was necessary. This is still in process. Questions arose as to how to evaluate if system is improving and that there needs to be built in feedback loops from the counties to report on this progress.

In terms of future priorities, the MHSOAC recognizes they need to build a Master Plan for Evaluation. They are in the process of hiring a full-time evaluator to advise them. Meanwhile, the following priorities have been outlined by the committee for approval by the Commission: 1) outcomes of Early Intervention; 2) reducing disparities; 3) continuing improvement of the DCR system; and 4) developing a framework for evaluating PEI. – On this note, since CalMHSA has contracted with RAND to evaluate PEI, CalMHSA has agreed to share this resource with the MHSOAC and allow the MHSOAC to weigh in on the direction of this project.

One thing that is concerning in terms of the future of oversight and accountability is that we have been told that this will now be enforced through evaluation of outcomes. We know, however, that the state of the current evaluation will probably not drill down to the level of detail that used to be required on the front end. Until a system is in place that will be able to provide that level of accountability, there needs to be frequent and transparent reporting that will hold counties accountable, both in terms of funding, programming and community involvement.

Announcement of Statewide Stakeholder Process meeting:

Finally, I want to remind you of a statewide meeting that is being convened by community partners to move forward on establishing statewide standards for stakeholder engagement on local and state levels. Since oversight (plan review and approval) of county plans is moving to the local level and there are indications that the state may not even keep Annual Performance Contracts in place, there needs to be a mechanism to ensure and increase meaningful stakeholder input at all levels. There is the need for agreed upon standards and ways to ensure accountability to those standards – through regulation or other binding direction.

The first meeting will be this Wednesday, February 29, in Sacramento from 10:00 a.m. – 3:00 p.m. Please see the notice that was sent out 2/13/12 and the one that will be sent out Tuesday, February 28 for more detail, or contact kathleen.derby@namicalifornia.org.


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