State Auditor Faults Mental Health Oversight

     (CN) - California's State Auditor found "little assurance" that the state's Department of Mental Health is effectively monitoring operations in four counties.
     California voters passed the Mental Health Services Act in 2004, designating more than $7 billion to expand mental health programs in the state. Taxpayers who earned more than $1 million were taxed an additional 10 percent to fund the program.
     After media reports that tax dollars were spent on yoga and acupuncture, the California State Auditor last week published a performance review, which found "little assurance of the Act's effectiveness" and problems with oversight in some counties.
     "We expected that Mental Health would base its monitoring of county MHSA programs on the provisions of the performance contract that the MHSA required Mental Health to enter into with each county," the report said. "However, in fiscal year 2008-09, Mental Health stopped using the performance contract and began using an agreement that offered little specificity as to the steps a county should take to assure compliance with the MHSA.
     "Functionally, it appears Mental Health treated the agreement as simply a means of providing MHSA funding to counties. Although the assurances within the agreement may have satisfied the minimal requirements set forth in state law, had Mental Health made better use of the agreement as a tool for holding counties accountable for their use of MHSA funds, it would have significantly bolstered the State's oversight role."
     The auditor found no evidence that the department comprehensively monitored counties to ensure they implemented their state-approved plans for improving mental health services.
     "We expected that Mental Health would have taken steps to ensure that counties received the guidance necessary to effectively evaluate and report on the performance of their MHSA programs. However, Mental Health did not provide explicit direction to the counties on how to evaluate their programs effectively, including directions for setting reasonable goals, establishing specific objectives, and gathering the data necessary to meaningfully measure program performance," the auditor wrote.
     "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."
     In its review of Mental Health Departments in Los Angeles, Sacramento, San Bernardino and Santa Clara counties, the auditor found those counties "rarely developed specific objectives to assess the effectiveness of program services."
     Among other things, the auditor recommended that the state Health Care Services Department enter into performance contracts with the counties so the counties can show that their programs are being used as intended.