Audit: Mental health spending not properly tracked

SACRAMENTO, Calif. (AP) — The state has failed to properly monitor more than $7 billion in voter-approved money for mental health programs from California’s extra tax on millionaires and cannot reassure the public that it is going to help those most in need, the state auditor reported Thursday.

California can offer “little assurance that the counties have effectively and appropriately used the almost $7.4 billion,” Auditor Elaine Howle reported.

Howle’s review came in response to an investigation last year by The Associated Press that found tens of millions of dollars raised under Proposition 63 have gone to programs designed to help those who have not been diagnosed with any mental illness. Those so-called innovation programs include yoga, gardening, art classes and horseback riding.

“Media reports have reflected skepticism about counties’ Innovation programs, some of which include acupuncture and yoga,” the audit said. “Assessing and reporting on program effectiveness is therefore critical to ensure that only effective programs are continued and that the taxpayers and the public are assured that MHSA funds are put to the best use.”

Voters approved Proposition 63 in 2004, creating a 1 percent tax on incomes of more than $1 million to fund mental health programs. The money raised through the Mental Health Services Act has created some 1,500 programs so far.

Nearly $1.2 billion went to prevention and early intervention programs. They were being created at the same time that mental health spending from the state’s traditional sources was falling dramatically during the recession.

Assemblymen Dan Logue, R-Linda, and Brian Nestande, R-Palm Desert, requested the audit last summer after the AP’s report. Senate President Pro Tem Darrell Steinberg, a Sacramento Democrat who co-authored Proposition 63, also later signed the request.

Howle found that the state Department of Mental Health failed to conduct any broad evaluation of how counties spent the money or ask counties to report on the effectiveness of their programs as the law established.

“When the responsible state entities do not provide guidance to counties for effective program evaluation, the public cannot be sure that MHSA programs are achieving their intended purposes,” the auditor’s report said.

A separate accountability commission established as part of the ballot initiative did not adopt a plan for evaluating the programs until March 2013, more than eight years after voters approved the tax and just months after AP’s report.

Steinberg said the auditor found no evidence that Proposition 63 funds were misused or that programs were ineffective.

“But if we are to build consensus for mental health care funding, the state must demonstrate the effectiveness of existing programs in an objective and consistent way,” Steinberg said in a written statement. “It’s not good enough just to do the work. We must tell the story to help break the stigma surrounding mental illness and encourage those suffering in silence to seek help.”

A new agency, Health Care Services, took oversight of the state mental health funding last year. Howle recommended it set up on-site reviews of counties and write performance contracts with counties that set program goals, including measurable performance data.

Health Care Services said it has already adopted some of Howle’s recommendations and is in the process of implementing others.

As part of the audit, Howle reviewed county mental health programs in Los Angeles, Sacramento, San Bernardino and Santa Clara, finding wide discrepancies in how they assessed and reported on mental health spending. All of them had set general goals for their programs, but some counties did not communicate those goals to the contractors who were actually providing services. Howle said.

The auditor recommended revisions to the mental health services contracts in all the counties except Los Angeles.

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