Mental health policy in California: the “millionaire's tax” and the Mental Health Services Oversight and Accountability Commission
| DOI | https://doi.org/10.1108/13619321211289281 |
| Pages | 211-220 |
| Published date | 30 November 2012 |
| Date | 30 November 2012 |
| Author | Deborah Lee |
| Subject Matter | Health & social care |
Mental health policy in California: the
‘‘millionaire’s tax’’ and the Mental Health
Services Oversight and Accountability
Commission
Deborah Lee
Abstract
Purpose – This article’s aim is to describe the history, purpose, challenges, strategies, and progress
of California’s Mental Health Oversight and Accountability Commission (MHSOAC), created by
California’s pioneering Proposition 63 (Mental Health Services Act). California voters passed this
initiative in 2004 to expand and transform public mental health services.
Design/methodology/approach – This case study is based on observations of the author, who has
worked with the Commission since its inception, and the study is adapted from a 2009 article by one
of the original Commissioners who served from 2005-2008. The article focuses on challenges and
opportunities for oversight in an environment of stakeholders’ high and diverse expectations, limited
direct state authority, and significant and broad budget challenges.
Findings – The Commission prioritizes evaluation as its principal strategy with a primary goal of
using evaluation results for quality improvement. Implementing this strategy, with limited county
reporting requirements, inadequate data systems, and insufficient funds designated for evaluation, is a
continuing challenge.Other key challenges – andopportunities – include passionate stakeholderswith
high and divergent expectations, a de-centralized public mental health, and a statewide fiscal and
budget crisis.
Research limitations/implications – The paper relies on the observations of two key participants:
a former Commissioner and the Commission’s staff psychologist. Participant observation brings
opportunities for bias as well as insight. Diverse stakeholders undoubtedly would provide different
perspectives on the progress of Proposition 63 and on the MHSOAC.
Practical implications – The Commission developed a logic model that defines strategies for oversight
and accountability and links these strategies to Proposition 63’s intended outcomes for California’s
public mental health services system and clients.
Social implications – The success of California’s Proposition 63 in transforming mental health delivery
from a ‘‘fail first’’ crisis system to a ‘‘help first’ ’ proactive system has implications for integrated
healthcare delivery that includes mental health.
Originality/value – The California emphasis on recovery, resilience, and wellness for diverse people
with and at risk of serious mental illness is consistent with national and world-wide recommendations
and initiatives and is one of the largest efforts to transform a mental health system to reflect these values.
Keywords Mental health services, Transformation, Recovery, Collaboration, Stakeholder analysis,
Evaluation, Quality assurance, Initiative, United States of America, Public policy
Paper type Case study
Introduction
Despite long-standing and widespread opposition to new taxes, Californians in 2004
approved a ‘‘millionaire’s tax,’’ Proposition 63, levied on the 30,000-plus individuals with
taxable net income over $1 million (1 percent on every dollar above $1 million). Enacted in
January 2005 as the Mental Health Services Act (MHSA), the law created an independent
DOI 10.1108/13619321211289281 VOL. 17 NO. 4 2012, pp. 211-220, QEmerald Group Publishing Limited, ISSN 1361-9322
j
MENTAL HEALTHREVIEW JOURNAL
j
PAGE 211
Deborah Lee is based at
the Mental Health Services
Oversight and
Accountability Commission,
Sacramento, California,
USA.
Portionsof this article are
adaptedfrom cited selections of
an article by Dr Saul Feldman
aboutCalifornia’sProposition63:
The ‘‘MillionairesTax’’ and
Mental HealthPolicy in
California.Health Affairs 28,
809-815,2009. Saul Feldman
(saulfeldman@lycos.com)
is Presidentof the Bay Area
Foundationin San Francisco.
He was appointedto the
Oversightand Accountability
Commission(OAC) by Gov.
Arnold Schwarzenegger in
June 2005 and serveduntil
mid-2008.
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