EDITORIAL: Learn from California's mental health experience

Dec. 29--Without question, North Dakota needs to spend more on effective mental health services, the Herald's series on mental health has documented.

And luckily for the state, farsighted lawmakers agree. Gov. Jack Dalrymple's budget boosts funding for the services by 13 percent, in part because of the recommendations of an interim legislative committee, a Herald story reported.

But as North Dakota's legislative session approaches, California's experience should be both an example and a cautionary tale.

In 2004, California voters passed Proposition 63, which increased spending on mental-health services by an estimated $7.4 billion over the past 10 years. But too little of that money wound up helping the people who need it most, audits and investigations have revealed.

That's because of the state's poor oversight -- a mistake North Dakota should take great care not to repeat.

"In California, only 13 initiatives affecting taxes have passed," Wikipedia notes.

"Of these 13, only four have increased taxes." One of the four is Proposition 63, which hiked taxes on millionaires by 1 percent in order to finance dramatic reforms and expansions in the state's mental-health service network.

That was then. This is now:

"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," the Los Angeles Times reported in August 2013.

"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 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."

Here's the problem: Proposition 63 was meant to help people with "severe mental illness" and "to prevent mental illness from becoming severe and disabling," as Jaffe's group describes on its website.

"But mission-creep, insider dealing and lack of oversight have enabled both worthy and unworthy social services programs to masquerade as mental illness programs and claim they are eligible for funds.

"Helping people get better marriages, more fulfilling jobs or higher grades are declared unmet mental health needs and showered with dollars, while the seriously ill with schizophrenia continue to live under lice-infested clothing, eating from Dumpsters and screaming at voices only they can hear.

"Nationwide, the mentally ill are three times as likely to be incarcerated as hospitalized. In California, it's almost four times," the website notes.

Does California's experience mean North Dakota's programs inevitably would meet the same fate? Not at all. Among countless other differences, North Dakota's efforts have a set of goals, a statewide health care culture and a legislative history all their own.

But what happened in California should remind North Dakotans that good intentions aren't enough. To be effective, government needs oversight -- and the overseers themselves must pledge unflagging allegiance to Ronald Reagan's timeless doctrine, "Trust, but verify."

-- Tom Dennis for the Herald

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