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Transformation of the California Mental Health System: Stakeholder-Driven Planning as a Transformational Activity

Dr. Cashin, Dr. Scheffler, and Ms. Felton are affiliated with the Nicholas C. Petris Center on Health Care Markets and Consumer Welfare and Dr. Miller is with the School of Social Welfare, University of California, Berkeley. Dr. Adams is with the California Institute for Mental Health, Sacramento. Send correspondence to Dr. Cashin at the Nicholas C. Petris Center on Health Care Markets and Consumer Welfare, 140 Earl Warren Hall, MC7360, Berkeley CA 94720 (e-mail: ccashin{at}berkeley.edu). An earlier version of this article was presented at the World Psychiatric Association Section on Mental Health Economics meeting, "Investing in Mental Health Policy and Economics Research," March 9–11, 2007, Venice, Italy.

OBJECTIVE: This study describes strategies developed by California counties to transform their mental health systems under the 2004 Mental Health Services Act (MHSA). This voter initiative places a 1% tax on annual incomes over $1 million; tax monies are earmarked to transform county-operated mental health services into systems that are oriented more toward recovery. MHSA implementation itself can be considered "transformational" by balancing greater standardization of mental health service delivery in the state with a locally driven planning process. METHODS: A qualitative content analysis of the three-year plans submitted by 12 counties to receive funds under MHSA was conducted to identify common themes, as well as innovative approaches. These 12 (out of 58) counties were chosen to represent both small and large counties, as well as geographic diversity, and they represent 62.3% of the state population. RESULTS: This analysis showed that the state guidelines and local planning process generated consistency across counties in establishing full-service partnerships with a "whatever it takes" approach to providing goal-directed services and supports to consumers and their families. There was, however, little convergence around the specific strategies to achieve this vision, reflecting both the local planning process and a relative lack of clear policy and guidance on evidence-based practices. CONCLUSIONS: There are many obstacles to the successful implementation of these ambitious plans. However, the state-guided, but stakeholder-driven, transformation in California appears to generate innovative approaches to recovery-oriented services, involve consumers and family members in service planning and delivery, and build community partnerships that create new opportunities for consumers to meet their recovery goals.

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