Oversight Commissioners proposed and enacted regulations and guidelines that diverted funds to people without serious mental illness and refuse to correct it. (FN1)

Proposed and enacted CCR Title 9 Regulations that
diverted funds from seriously mentally ill

How the regulation diverts funds
3400(b) Programs and/or services provided with MHSA funds shall:
(1) Offer mental health services and/or supports to individuals/clients with serious mental illness and/or serious emotional disturbance, and when appropriate their families.
(A) The Prevention and Early Intervention component is exempt from this requirement.
…
(d) The County is not obligated to use MHSA funding to fund court mandates.		 This exemptedPrevention and Early Intervention (PEI) programs from having a tie to serious mental illness.

 

Nothing in MHSA precludes the use of MHSA funds for Laura’s Law recipients, yet 3400(d) suggests they don’t have to.
3610 (f)  The County shall not provide MHSA funded services to individuals incarcerated in state/federal prisons or for parolees from state/federal prisons. The legislation precludes support for those paroled from state prisons. This reg goes further and prevents funds from helping parolees from federal prisons.

Following regulations diverted PEI funds away from the intended purpose of the funds.

Section 3930.  (d) PEI funds may not be used for the following:
(1) Individualized treatment, recovery, and support services for those who have been diagnosed with a serious mental illness or serious emotional disturbance, unless the client or individual has been identified by a provider as experiencing first onset of serious mental illness/emotional disturbance.		 This reg specifically prevents funds from reaching those “who have been diagnosed with a serious mental illness”. Yet the PEI legislation requires funds to be used to “prevent mental illness from becoming severe and disabling”. The effect of this legislation is to prevent people with mental illness from receiving services.
Section 3905. (a) The following are Priority Populations for Prevention and Early Intervention programs:
(1) Racial/ethnic populations and other unserved/underserved cultural populations, including lesbian/gay/bisexual/transgender populations.
(2) Individuals experiencing onset of a serious mental illness or severe emotional disturbance, as defined in the Diagnostic and Statistical Manual of Mental Disorders.
(3) Children and youth and transition age youth in stressed families such as families affected by unemployment, homelessness, substance abuse, violence, depression or other mental illness, absence of care-giving adults, or out-of-home placement.
(4) Individuals exposed to traumatic events or prolonged traumatic conditions, including but not limited to grief, loss, and isolation.
(5) Children and youth and transition age youth at risk of school failure.
(6) Children and youth and transition age youth at risk of or experiencing involvement in the juvenile justice system.
(7) Individuals experiencing co-occurring substance abuse issues.		 This regulation severed funding from a requirement to help people with serious mental illness by creating new ‘priority populations’ who were not required to have a mental illness or be at risk (ex. the first degree relative of someone with mental Illness).

It diverted funds to employment programs, substance abuse programs, grief programs, tutoring programs, crime prevention programs and substance abuse programs for people without mental illness. It prioritized the youngest while serious mental illness does not materialize until late teens and early twenties.
Section 3200.251. “Prevention and Early Intervention” means …(1) prevent serious mental illness/emotional disturbance by promoting mental health, reducing mental health risk factors and/or building the resilience of individuals, and/or
(2) intervene to address a mental health problem early in its emergence.		 The first part of this reg misstates the purpose of the legislation to “prevent serious mental illness” (No one knows how) ”promoting mental health” (make people happier) and “reducing mental health risk factors” (versus serious mental illness) and “building the resilience of individuals”.

Paragraph (2) limits funds to ‘mental health problems early in emergence versus people with serious mental illness whenever they need help. For example, one of the best ways to prevent mental illness from becoming severe and disabling is to ensure treatment. That may be needed early or late in the emergence of the illness.
Section 3920 (b) Prevention programs shall be designed to reduce risk factors or stressors and build protective factors and skills prior to the diagnosis of a mental illness and shall include one or both of the following:

 

Section 3200.259.  “Selective Prevention Activity” means a prevention activity within a PEI program that targets individuals or a subgroup whose risk of developing mental illness is significantly higher than average, such as older adults who have lost a spouse or young children whose mothers have postpartum depression.

Section 3200.305.  “Universal Prevention Activity” means a prevention activity within a PEI program that targets the general public, or a population group that has not been identified on the basis of individual risk, such as an activity that educates school-aged children and youth on mental illnesses.

 3920(b) requires the expenditure of MHSA funds on people “prior” to diagnosis. There is no language that suggests PEI funds were meant for those without any mental illness at all. It also suggest that there are known ‘protective factors’ and ‘skills’ that can prevent serious mental illnesses like schizophrenia and bipolar. We are not aware of any. Using MHSA funds to lower risk factors in populations without mental illness is perhaps one of the most inefficient, less productive, most wasteful uses of MHSA funds. The primary risk factor of developing serious mental illness is being born to someone with serious mental illness.

“Selective Prevention Activity” allows expenditure for people at risk of developing any mental illness, rather than limiting it to those with “serious mental illness” or to preventing mental illness from progressing to ‘serious mental illness”. We are not aware of research that schizophrenia or bipolar rates are increased by normal rights of passage like losing a spouse. (Although they can exacerbate symptoms in those already diagnosed). High risk should be those with one or two parents with serious mental illness. They are not mentioned in the reg.

“Universal Prevention” diverts funds to the public who have “not been identified on the basis of individual risk”. The program was meant to help people at risk, not those who have “not” been identified as being at risk. It basically diverts funds to PR firms. FN 2

Section 3920.   (c) Early Intervention programs shall target individuals exhibiting signs of a potential mental health problem, and/or their families, to address the individual’s mental health problem early in its emergence.
(1) Services shall not exceed one year, unless the individual receiving the service is identified as experiencing first onset of serious mental illness with psychotic features, as defined in the Diagnostic and Statistical Manual of Mental Disorders criteria for a psychotic disorder, in which case, an intervention shall not exceed five years.(g) PEI programs shall serve individuals and populations in non-traditional mental health settings such as primary healthcare clinics, schools, and family resource centers; unless a traditional mental health setting enhances access to quality services and outcomes for unserved/underserved populations.		 3920(c) diverts funds away from “serious mental illness” or even “mental illness” to people exhibiting signs of a potential mental health problem.” In fact, it diverts funds even further away to cover “their families”.3920(c)(1) requires stopping services for individuals experiencing onset of serious mental illness after one year if they are not psychotic and after five years if they are. The services needed to prevent mental illness from becoming severe and disabling may be long-term life long services. This reg prohibits that expenditure contrary to the legislation.

3920(g) pushes for services to be outside where mentally ill people are: i.e. mental health settings.
Section 3950.  (a) The County shall participate in the Department’s accountability, evaluation and improvement activities for the Prevention and Early Intervention (PEI) component as follows:
(1) Submit the PEI Program Accountability and Evaluation Report as required in section 3570 and the Local Outcome Evaluation of a PEI Program Report as required in section 3515, unless exempt per section 3515, subdivision (g).
(2) Participate in on-site reviews conducted by Department.
(3) Complete surveys conducted by the Department.		 3950 requires “evaluation” by MHAOC. That is a good thing. But minutes from the oversight committee show the Oversight Commission evaluates “based on what counties said they were going to do, rather than actual on-the-ground assessment.”

FN 1http://www.oal.ca.gov/CCR.htm click on CCR, click online on next page, click on List of CCR titles on next page, click on Title 9. CA Office of Admin Law says that is how to get them and they are official. Accessed 8/27/2012. Some of the regulations discussed here were promulgated, some merely given as direction, some promulgated and allowed to lapse. However, all are being relied on by counties when determining spending priorities.They are still on MHSAOC and CADMH websites and counties are still relying on them, although some seem to have expired, lapsed or never been promulgated.

FN2 Universal Prevention Activity is the most egregious blatant attempt to divert PEI funds to unintended uses. It diverts funds from helping individuals to creating brochures, radio programs, and other activities aimed at the public. People who are “not identified on the basis of individual risk”. MHSAOC defines it on their web site as “one of the categories of prevention funded by the California Mental Health Services Act (MHSA). Universal prevention programs target the whole population or a subset of the population that does not have a higher risk for developing the symptoms of mental illness” There is nothing in Prop 63, that suggests the funds were meant other than for people with mental illness. http://www.preventionearlyintervention.org/go/PromotingWellnessPrevention/UniversalPrevention.aspx

Oversight Commission Minutes http://mhsoac.ca.gov/Meetings/docs/PriorMeetingMinutes/2011/MinutesApproved_Sept2011.pdf