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A Civil Grand Jury says Alameda County’s mental health system is ‘fragmented and unresponsive.’

County mental health officials reject its call to reassess how they spend $100 million a year to deliver safety net services.

Sometimes your only choice in life is to laugh or cry. I did both the day I called an Alameda County mental health hotline on behalf of a troubled adult only to get a voicemail that said, “If this is a mental health emergency, please hang up and dial 911.”

That was a year ago. At roughly the same time, the Alameda County Civil Grand Jury released a report based on its investigation of the safety net services I was trying to access. “Alameda County residents witness daily the inadequacies of our mental health system,” they wrote, calling it “fragmented and unresponsive” and adding, “entry to the system must be streamlined.”

County residents who’ve experienced the frustrations that the Grand Jury describes will have a chance to push for change when the Board of Supervisors considers how to spend the state revenues it gets from the Mental Health Services Act (MHSA).

… We have a mental health system in denial. It’s time for the public to do an intervention.

The MHSA became law in 2004 when California voters ratified Prop 63. The act placed a one-percent income tax surcharge on earnings above $1 million to create a pool of money that flows to local agencies. Alameda County gets roughly $100 million a year in MHSA funds. It uses that money to contract with more than 100 community-based organizations that provide prevention and treatment services to people who qualify for county help and have a serious mental illness or are at risk of becoming mentally ill.

I encountered this MHSA-funded system while trying to help a mentally ill adult on Medi-Cal. Friends and neighbors directed me to service providers, but whenever I reached a person, their organization was over capacity. Some calls that went to voicemail weren’t returned.

One Friday a sympathetic county worker called me back to say they could refer the person to a county-funded psychiatric clinic, but only if the person called them to ask for help. They had no phone, so I found them and loaned them mine. They got the referral, but the clinic was so swamped that by the time they got to see the psychiatrist, they’d slipped back into denial and the treatment opportunity was lost.

The problem is with “the system itself, not the people working within it,” the Grand Jury said, criticizing a “questionable allocation of resources” which they attributed to “the unavailability of useful and coordinated data.” Their top recommendation was that the county should make a comprehensive assessment of the mental health needs of vulnerable residents – that hadn’t been done since 2015 – and create a strategic plan to spend MHSA resources more cost-effectively. Grand jurors characterized current funding decisions as “shooting in the dark.”

County officials answered each of the Grand Jury’s 22 findings and recommendations by saying agree, partially agree, or disagree, and adding an explanation. Mental health officials disagreed with the recommendation for a comprehensive needs assessment and strategic plan. The county “does not approach this type of assessment from a single ‘needs/gaps’ viewpoint,” they wrote. “It does instead evaluate current programs, client services, utilization, and demographic data … to determine whether additional investment, expansion or program recalibration is needed.” In short, the system works and each year they make tweaks to improve it.

In April, Alameda County Behavioral Health, the department that oversees MHSA funding, will release its draft plan for the coming fiscal year. The public can comment until late June or early July when the Board of Supervisors votes on the final MHSA budget.

This is the time to get informed and involved. A realistic goal would be to get the assessment and strategic plan underway in the coming fiscal year and have its findings available the year after. Speaking out may not help those who need safety net services immediately. The adult I mentioned is fortunate to have family members who could afford to buy them private insurance, so they no longer need public help.

But as a person in remission from mental illness, I think about the people who struggle with mental illness and have no other recourse than our frayed, MHSA-funded safety net. The Grand Jury has given Alameda County a simple plan for how to start mending it: Step back. Assess the mental health needs of vulnerable residents. Rethink how we try to meet those insurmountable needs with the resources at hand.

The fact that county officials disagree suggests we have a mental health system in denial. It’s time for the public to do an intervention.

The official link to the Alameda County Grand Jury Final Report for 2021-2022 is confusing. The top of your screen will say “2018-2019 Alameda County Grand Jury.” Ignore that. Scroll down the PDF and you will see that it is the 2021-2022 report. To read the mental health section, scroll to page 13 of the PDF. Please click here to begin

 The county’s responses to the Grand Jury report can be found here. Two sections pertain to the mental health investigation. The Board of Supervisors responds on page five of the PDF. The Alameda County Behavioral Health department responds on pages 10 through 21.

Alameda County residents seeking help can visit a guide to local mental health resources compiled by ACFASMI — Alameda County Families Advocating for the Seriously Mentally Ill. Learn more about ACFASMI here.

I’ll post updates when the MHSA plan becomes available for public comment and before it goes to the Board of Supervisors for a vote.

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