Audit finds lack of oversight of Mental Health Services Act spending

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SACRAMENTO — Nearly a decade after California voters approved a multibillion-dollar tax increase to improve mental health services, the state has failed to provide proper oversight of county programs funded by the measure, a state audit concluded Thursday.

State Auditor Elaine Howle looked at the last six years, during which almost $7.4 billion from the Mental Health Services Act was directed to counties for mental health programs.

The state Department of Mental Health and a state accountability commission “have provided little oversight of counties’ implementation of MHSA programs,” particularly regarding their effectiveness, Howle wrote to Gov. Jerry Brown and the Legislature.


She added that reviewers expected to find a process in place to guide and evaluate implementation of the law according to best practices, “but that is not what we found.”

The audit was requested by lawmakers after reports by The Times that some counties were using the funds to provide yoga and martial arts classes.

The money comes from Proposition 63, which placed a 1% income tax on individual income above $1 million a year to help people severely affected by mental illness.

Auditors found no evidence that the state performed on-site reviews to check that counties were complying with the requirements of the measure and that “use of funds were accurate and proper,” the report said. None of the agencies responsible for evaluating the effectiveness of programs funded by Proposition 63 has “undertaken serious efforts to do so,” it said.

The lack of oversight means many people still fall through the cracks, according to D.J. Jaffe, executive director of Mental Illness Policy Org, a group that advocates for the mentally ill.

“It means people who are seriously mentally ill are still being left to forage in Dumpsters for food and stay imprisoned in their own hallucinations,” he said.


Toby Douglas, director of the state Department of Health Care Services, which has taken over mental health programs, agreed with the recommendation that oversight be improved.

A state framework for evaluation was established only recently — more than eight years after the passage of the initiative, the audit concluded. Los Angeles, San Bernardino, Sacramento and Santa Clara counties “rarely developed specific objectives to assess the effectiveness of program services,” it said.

However, the audit said Los Angeles County was “generally effective” in collecting and analyzing data to determine whether goals were being met.

Rusty Selix, a coauthor of Proposition 63, said he agreed with the call for more oversight. “Most important is that it did not find that any of these counties were expending funds in violation of the act,” said Selix, executive director of the California Council of Community Mental Health Agencies.

Howle’s report noted that Proposition 63 called for innovative approaches to treating the mentally ill, and auditors did not judge the merit of controversial spending on yoga, acupuncture and martial arts classes. Better evaluation is needed to show the outcomes of such approaches and address the controversy over money spent that way, the report said.

Yoga and other similar programs are only a small part of treatment programs and help with socialization, according to Kathleen Piché, a spokeswoman for the Los Angeles County mental health agency.


Jaffe complained that millions of dollars had been spent on public relations services and radio and television spots on mental illness issues, when the money could have gone directly to helping those seriously in need.

Selix said the broadcast spots and other public outreach efforts are a legitimate part of eliminating the stigma attached to mental illness so more people will seek treatment.