In California, Promise of Mental Health Law Not Yet Kept for Foster Youth

by Melanie Delgado

In 2004, California voters passed Proposition 63, the Mental Health Services Act (MHSA). The MHSA was enacted to provide funding that would expand and improve California’s mental health services. This groundbreaking legislation contained several unique provisions that promised to vastly improve mental health services in California.

One notable development was the MHSA’s requirement that counties create programs for transition age youth (TAY), which it defined as individuals between the ages of 16 and 25. This provision in particular held promise for transition age foster youth, a population that has historically struggled with mental health issues.

Not every transition age foster youth has a mental health issue, but they do suffer from mental illness at rates surpassing their similarly situated peers with no history of foster care. High rates of mental illness among transition age foster youth are understandable, given their circumstances. By the time they approach transition age, these youth have experienced more trauma in their young lives than most adults ever will.

So it stands to reason the MHSA, which carved out funding specifically for transition age youth, and which was explicitly intended to reduce the long term adverse impact of mental illness, would give transition age foster youth a place at the front of the line for this important funding.  Beyond their position needing mental health services, these are our children. When the dependency courts in California remove a child from his or her parents, that child becomes the child of the state. California assumes a parental obligation to ensure the safety, health and well-being of foster youth.

With this background, the Children’s Advocacy Institute (CAI) has twice examined how counties were utilizing their MHSA funding to expand services to transition age foster youth, once in 2010 and again at the close of 2013.

Neither showed much in the way of progress when it came to mental health services tailored to aging-out foster youth.

The 2010 report was released six years after voters approved Proposition 63. In the intervening years, the MHSA had taken in over $4 billion.

CAI examined how this funding was being used to serve transition age foster youth and found that the counties were not creating any programs exclusively for transition age foster youth with MHSA funding. In most cases, the programs for which transition age foster youth were named as a priority did not provide enough capacity to begin to meet the needs of the transition age foster youth in the county.

Following CAI’s 2010 report, several changes occurred in California that not only acknowledged the need for further mental health services for children and youth in foster care, but also had the potential to impact how counties were utilizing MHSA funding to serve transition age foster youth.

Assembly Bill 12 allows foster youth to remain in care to the age of 21. SB 989 requires counties to consider the needs of transition age foster youth when they are creating plans for MHSA funded programs. The Katie A. Settlement requires California to expand mental health care services to eligible children under Medicaid and provides counties with another opportunity to utilize MHSA funding to supplement funding for mental health services to foster youth, and to improve outcomes.

So, how have counties been performing since 2010, given all of these changes? That is what our second report set out to establish.

Here’s the good news: Many counties have taken steps to improve their MHSA-funded services for transition age foster youth.  They have consulted, to varying degrees, with transition age foster youth with regard to their needs and how those could best be served by MHSA funding. The Katie A. settlement agreement has forced counties to improve mental health services to foster youth. Some of these improvements are being funded with MHSA money.

The bad news: a large disparity remains in services between counties. The level of attention and services available to a transition age foster youth depends more on the county of that youth’s residence than the severity of the youth’s needs.

Mental health programs for transition age foster youth continue to be too sparse. Transition age foster youth should be the highest priority population for funding. Yet, CAI found no programs created for and serving exclusively for transition age foster youth after nearly 10 years.

There is no way to know if the programs the counties have created are serving the stated purpose of reducing the long term adverse impact of mental illness because there are no truly long-term outcome measures in place to inform lawmakers and mental health officials. CAI found no programs that follow up with clients five years after their participation in MHSA programs to analyze how former clients are faring over the long-term.

There are very few truly innovative programs. Most programs funded with funding for transition age foster youth appear to be simply a repackaging of old ideas. Meanwhile, truly innovative programs, such as CAI’s suggested TLC program, have not been implemented.

Finally, the governor and the legislature do not seem to have a problem raiding the fund when it suits them. In 2011, the legislature enacted, and Governor Brown signed, Assembly Bill 100, which allowed the state to borrow $862 million from MHSA funds – despite an explicit prohibition on this kind of action in Proposition 63 as it was passed by voters in 2004. Actions such as this harm the most vulnerable populations in the state and result in less funding for necessary programs.

The MHSA holds immense promise for improving the lives of the state’s own children as they enter a critical stage of their lives.  Unfortunately, to this point it remains a broken promise.

Melanie Delgado is a staff attorney for Children’s Advocacy Institute in San Diego

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