Audit: ‘Little Oversight? Over California’s $7.4 Billion Mental Health Spending

The California State Auditor issued a report on Friday blasting the lack of oversight and lack or absence of performance measures related to the California Department of Mental Health and the Mental Health Services Oversight and Accountability Commission’s implementation and oversight of the Mental Health Services Act (MHSA). Voters approved the MHSA in 2004 as Proposition 62. The MHSA was sold to voters as a means of addressing widespread mental health problems; the premise, summarized by the Auditor is that “mental illnesses are extremely common, affecting almost every family in California, and that the failure to provide timely treatment can destroy individuals and families.”

In order to combat this widespread problem, Proposition 62 was passed to enable a 1% income tax on all individuals earning in excess of one million dollars. Between fiscal years 2006-07 through 2011-12, $7.4 billion was raised and dispersed to counties to implement mental health programs.

The findings of the auditor are quite revealing:

  • We found no evidence that Mental Health performed on-site reviews to ensure that county assertions about their compliance with MHSA requirements and use of funds were accurate and proper.
  • None of the entities charged with evaluating the effectiveness of MHSA programs-Mental Health, the Accountability Commission, or a third entity-have undertaken serious efforts to do so.
  • Mental Health either did not always obtain certain data or did not ensure counties reported the required data.
  • The Accountability Commission did not adopt a framework for evaluation until recently-more than eight years after the passage of the MHSA.
  • It is too soon to tell whether the California Department of Health Care Services’ efforts will address all of our concerns about the oversight of MHSA programs.
  • Each of the four county departments we reviewed used different and inconsistent approaches in assessing and reporting on their MHSA programs, and the county departments rarely developed specific objectives to assess the effectiveness of the programs.

A full 16 counties had yet to even provide cost reports for fiscal year 2010-11, which were due last October. There have also been inconsistent administrations and submissions of client and service information, which would help a competent oversight commission track what kinds of services are being provided and thereby are in most demand; counties have also been inconsistent in their administration of consumer perception surveys and required quarterly progress reports. There have also yet to be a required annual expense and revenue reports on the implementation of the MHSA.

A former research analyst is quoted as saying that the Department of Mental Health “never monitored whether counties submitted the required data or verified the data’s accuracy.”

According to the Los Angeles Times, the audit was prompted by a Times article that revealed MHSA funding was going towards martial arts and yoga classes as part of “Innovation program” funding. On this point, the audit notes counties “have been advised that Innovation programs are efforts to learn about promising approaches to treating and preventing mental illness and that the programs are similar to pilot or demonstration projects, are time limited, and should be assessed for effectiveness.” However, the counties examined simply failed to do this.

The audit looked into San Bernardino County, Los Angeles County, Santa Clara, and Sacramento County and their implementation of the MHSA. In examining the counties’ implementation of the MHSA, the audit found widely differing program contracts, often with few goals or measures for effectiveness. According to the report, counties “generally lacked specific targeted objectives that were well defined and measurable and that quantified what program success is.”

Considering the noble intentions of the MHSA and the billions of tax dollars entrusted to governments to effectively and efficiently use to combat a challenging problem, one would think that governments could at least get this one right. Apparently not.