On behalf of the Mental Health Services Oversight and Accountability Commission (MHSOAC or Commission) we are pleased to present our first report to the Governor and Legislature. This report provides a detailed summary of the Commission’s oversight and evaluation of the effective use of California’s investment in improving quality and access to mental health services through the Mental Health Services Act (MHSA). In addition this report identifies some of the vast achievements being made in the implementation of new public MHSA mental health programs aimed at preventing mental illnesses from becoming severe and disabling, with an emphasis on improving timely access to services for unserved and underserved populations. These many accomplishments have been achieved through ongoing collaborative efforts at the State and local levels among the Commission, the Department of Mental Health, the California Mental Health Planning Council, the California Mental Health Director’s Association, county mental health departments, and significant contributions throughout California from diverse citizens, including people struggling with mental illness and their family members.
The year of 2010 marked the five-year anniversary of the MHSA implementation, approved by voters in November 2004. We are pleased to note the accomplishment of several milestones:
All California counties are receiving funding from the MHSA for programs developed through robust community stakeholder participation.
All California counties have approved Prevention and Early Intervention plans and are in the process of implementing programs that will lead to early identification, diagnosis, and treatment of mental illness, with goals of wellness, recovery, and reduction of disability, suffering, and economic costs associated with untreated mental illness.
Prevention and Early Intervention Statewide programs are being developed for suicide prevention, stigma and discrimination reduction, and mental health services for students; county-based prevention and early intervention programs are being implemented in all of these areas.
As of November 2010, approximately $5.1 billion of MHSA funds have been distributed to counties. This includes the $734.9 million distributed for Prevention and Early Intervention and $175.5 million distributed for Innovation programs.
Clients and taxpayers are seeing results. One evaluation by the UC Berkeley, Nicolas C. Petris Center, May 2010, demonstrated that after 12 months of participation in Full-Service Partnership (FSP) Programs, a key strategy of the MHSA, the proportion of mental health consumers living independently increases by approximately 20 percent, mental health-related emergency services are 67 percent lower, probability of being arrested drops by 56 percent, and employment outcomes are improved by 25 percent.
With five years of program experience now behind us, MHSOAC will be expanding its current evaluation efforts to ensure all funds are expended in the most cost-effective manner and services are provided in accordance with recommended best practices subject to local and state oversight to ensure accountability to taxpayers and the public.
Areas of measurement will include:
Reduction rates in suicide, incarcerations, school failure or drop out, unemployment, prolonged suffering, homelessness, and removal of children from their homes.
The impact programs are making through new approaches to increase access to unserved and underserved groups, increase the quality of services, including better outcomes, promote interagency collaboration, and increase access to services.
Per-person costs and financial analysis of outcomes and benefits of FSP Programs and the impact of selected services/strategies on outcomes specified in the MHSA.
Ongoing evaluations in these areas will be critically important in learning what is working at the county level and what can be modified to increase the positive impact these programs have on the public mental health system. In addition to evaluating Prevention and Early Intervention and Innovative programs, the Commission intends to utilize past evaluation efforts to build upon what has already been done and expand the scope to incorporate additional areas. This approach is an incremental process to learn from current research and identify additional components that could lead to a greater understanding of impact of the MHSA on the public mental health system. As referenced earlier, such past evaluations include the Petris Center, May 2010 evaluation titled “Evidence on the Effectiveness of FSP Programs in California’s Public Mental Health System”.
The Commission will face a variety of challenges in the upcoming years including the volatility of the MHSA revenues and the impending changes to the mental health system with the passage of Federal Healthcare Reform, the Federal Mental Health Parity and Addiction Equity Act and the approval of the new Medicaid 1115 Waiver. The Commission is eager to be a collaborative partner and leader during these times and as such will continue to meet its statutory role to provide oversight, review and evaluation of projects and programs supported with MHSA funds, review and/or approve local MHSA funding requests, and ensure oversight and accountability of the public community mental health system.