Anecdotal notes of what was of interest to me or that I thought you might like to see. No attempt at being neutral or comprehensive.

MHSOAC (the A for act has been deleted. Does the Commission sees it’s charge as overseeing *all* mental health services?)

Friday, March 23, Sacramento

Sylvia Caras

The auditorium of the Secretary of State focuses on the stage, not interactions. The lighting is dim, the seats pop up unless one is sitting on them so there’s no place to organize papers except underneath. The toilets outside the hall are out of order - it is necessary to go upstairs and down a long hall. There are some 60 in the audience, only a few familiar faces, the Commissioners sit in a long row, and all but Ridley-Thomas are present.

Agenda: Planning Council, DMH, Directors will have standing agenda slot. Public comment will be Friday mornings.

Steinberg: major housing announcement coming very soon

Jennifer Clancy, the new ED is well-connected and gave an excellent presentation about proposed role and functions of the OAC. Her PowerPoint suggested that Props 10, 36, and 71 might be threats (I don’t know what those are, why they make MHSA work at risk). She suggests while DMH is responsible to the county’s and the state, the OAC is responsive to the public. I think DMH is pretty responsive to the public. The sought public health outcomes relate to suicide, incarceration, school failure/dropout, unemployment, prolonged suffering, homelessness, removal of children from homes. "Behaving well" is a sought outcome for children and adults and I think we need to be sure that there’s lots of room for difference in the applications of behaving well. What I think is really meant is acceptable social behavior, acceptable in the middle-class sense. I think clients need to be careful about this. It is suggested that the OAC role is to make ‘mental health’ relevant to the public. (The Surgeon General suggested that 20% could use services; relevance might mean touching even more.) There’s also a suggestion that the OAC is the voice. I hope that this voice will use client-centered words, that we won’t hear about victims and suffering and stigma and "the homeless."

Mayberg: researchers have SAMHSA money, will be studying transformation in California, will develop a toolkit. Leff, HSRI, is a principal.

Question on cultural competence standards. Someone needs to communicate that there is a client culture that also needs to be included. Eliminate disparities. Rachael Guerrero will be included.

Henry: clarify what public-driven means; second very specific clarification question about goal v explanation

Prettyman: questions "behaving well"

Henning; not in favor of consultants, especially long term consultants

Person suffering with mental illness has transformed to person living with mental illness. I’m very, very pleased!

Infrastructure:

Two family advocates term-out in the same time; two consumers term-out in the same time, terms are extended until one hears otherwise. Up to Governor. However, four political appointments will no longer be in those roles.

Proposed composition of Executive Committee questioned by Commissioner whose role wouldn’t be on it.

Budget line-item for family members and consumers to fund attendance. (Family member first in language). No dollars presented (because public?). Increased staffing proposed from 8 to 10 and higher levels. Temporary/consultants recommended ‘til July budget passed. Current budget caps any salary at 60K. Steinberg says not enough to get the expertise needed. Budget Change Proposal (BCP) to be put forward. Current budget is around $1 million. BCP $1.8 million.

Bagley-Keene: Steinberg - everything should be public; others worry about continuity, feasability. Chesbro, committees too subject to open meeting laws. Lockyer’s representative: Public might comment and it would interfere with the work load. Steinberg: circulate material, public can comment. Clancy: will research with AG exactly how B-K applies to committees.

Linford spoke up forcefully about not calling us the serious mentally ill, not labeling the Commission slots in that way.

Darlene also supported respectful language.

I stopped at a Mediterranean café I like on K Street, bought humus and feta and olives for supper, am tucked in with the Wall Street Journal and a television remote.

Friday, March 24

I travel with a little timer/clock. This morning I set it for three minutes to brew tea, it rang, the shut-off button stuck, it rang, I couldn’t get the battery cover off, it rang, then I couldn’t get the battery out, it rang, finally I popped out the battery, the noise stopped, the battery rolled under the furniture, ... Not a peaceful way to start the day, but it did wake me up.

Rain was predicted but so far this morning is only overcast, cool, but it was drizzling some and not in other places along the five block pleasant walk, rolling my suitcase, to the meeting. The meeting room is toxic, heavily perfumed, one attendee scents the whole corridor, bathroom, ...

9:05 quorum of 9, 40 in audience, Michele, Jay, ....

Handouts:

Law Enforcement and MHSA Funding

"While there will always be a role for mental health/law enforcement collaborative programs, it will be significantly reduced as we transition to a transformed mental health system."

There are ten guiding principles and no mention that services must be voluntary.

The document has no author, date, citation.

Training Standards

Anti-stigma without mention of prejudice or discrimination.

The document has no author, date, citation.

Prevention & Early Intervention Theory of Change 3.23.06

the plans are big on statewide standardization

throughout families come before consumers

it speaks of promising practices which is language I like

Jennifer: "you guys"

Van Horn: pilot program in Southern California community college for Recovery Specialist Certification.

Linford: suggested requiring Offices of Consumer Affairs in each county

Poat: we aren’t proceeding in a logical and linear order

Aguilar-Gaxiola: Mental health issues are largely irrelevant to the public, access to care is a pervasive and persistent problem; quality of care is a long way from what it could be. Included the Mzarek & Hagerty 1994 promotion spectrum that ends with continuing care instead of recovery. Medical care is not the primary determinant of health.

Prevention expert panel planned for July.

Cannon: Early Detection and Preventive Treatment Services (EDAPTS)

starts with suffering and stigma (I am already judging negatively); interventions became more invasive the more advanced the illness (for instance from exercise to surgery - we could argue that drug intervention is at the advanced end of the invasion spectrum as well as force) progression from genetic, ... environmental "insults," ... psychosis; at greatest risk of youth between "12 and 30 who have experienced changes in their thoughts, behaviors or emotions in the past 12 months"; identify prior to disease onset, drug treatments are partially effective in symptom relief (who defines symptom, relief? S.) and modest effects on long-term social outcomes, developmentally sensitive family treatments are a particularly acceptable and effective intervention, proposal presented about youth and I don’t see any youth included in the proposal planning or implementation. Prodome (prior to the syndrome) (Steinberg mocks clear explanation; seems anti-intellectual) - prior to onset (aura in epilepsy); in mental illness, psychotic like symptoms and signs, voices, suspiciousness, metaphysical interests (new and unusual beliefs). 25% of referrals come from school counselors who notice new/unusual behavior. Treatment works, "well-established," just ignores the objections advocates have been making for a long time. Argument of fear, if you don’t do this now this first time, if you don’t accept the Dx and stay on your meds, next time will get worse, crash and burn, irreversible damage, ...

(I found the presentation content and style condescending and covered old known material. S.)

Steinberg intervenes with a reminder that there aren’t yet standards for one time expenditures, making me assume that this has been given 75 minutes on the agenda as a one-time OAC possible expenditure. Steinberg apparently has some investment in this being funded, wanting to bypass the not-yet-in-place ongoing funding process. Probably to do something *now.*

Chesbro: how tell what’s normal abnormal adolescence compared to prodrome?

Presenter: Instrument tells, also shows that 20% of the population hear voices. 50% of people who meet instrument criteria develop an illness (so we medicate 100%? S.); the other half are on a downward spiral.

About 60 in audience, not so many familiar faces.

Lunch break:

Public comments:

Though I asked, Poppy can’t order the comment cards, says they get shuffled anyhow.

Nelson: include public comment before you are making a roadmap: fund research?; make sure research is diverse and not academic, include dual-diagnosis

Higashi; suggestions?

(I would have added participatory action research)

Steinberg; this morning was the concept of their research, not a proposal. (Michele says they were here at DMH/Mayberg’s request; it surely sounded to me as if Steinberg were pushing them, even as he now protests not which serves to underscore the proposal).

Shwe, Chair-Elect, Planning Council: include COSP

Van Horn: prodromal aspects have been missing, putting that new knowledge to work

Gross: provider, s.e.d., 90% of kids she serves are not on the psychosis trajectory, need to look at whole realm.

Steinberg: one broad study or more segmented?

Not one size fits all. Lots of evidence-based practices out there.

Chesbro: 10% based on who your agencies serves?

Yes

Roth: NAMI, going into schools is an excellent idea; train primary care providers; if a pediatrician had recognized ... , we wouldn’t have ... jail, etc etc Train those we first see someone when they are ill.

Gainor, CNMHC: add OAC formal complaint process, notice, inclusion, accessible sites, financial support, tokenism, ... Steinberg, another commissioners not attending, whispering, ... "lost in translation"

Steinberg: important issue, compelling need, ombudspersons to address individual complaints (that won’t do it), not OAC’s role

State level

takes it back to county, can’t hear individual appeals, staff intensive, ... Communication not really happening.

Agendize

Yes

Gayle: I agree, ombuds, ...

Prouty, SEIU: include direct-care staff in planning training, peer buy-in: career ladders, ongoing need to raise wages

Marley, advocate: youth at risk, substance abuse, co-occurring, cultural anthropology model, anonymity

Torres, San Joaquin; barriers within the system, sanction-checks, consumer disallowed because student loan payments in arrears

(Names were called three at a time, so I don’t have notes on two)

Brody: anti-stigam and discrimination project

Steinberg: submit report

I said:

My name is Sylvia Caras, I live in Santa Cruz. I’ve timed this to exactly three minutes.

First, thank you for the hard work shown by the goals and structure you yesterday reviewed and for this morning’s presentations.

For to transform a system in shambles needs immediate work in the context of a longer plan.

I’m an elected member of the American Public Health Association Mental Health Section Executive Planning Council so I’m especially pleased to have heard the emphasis on public health.

Like everyone, people who experience moods swings, fear, voices and visions need social and community networks for peer support and for peer early intervention. Like everyone, we need jobs and homes and friends and recreation and non-toxic food and water and air. Like everyone, these are also the needs of kids and youth

In particular, I urge restraint in screening kids, screening youth. Instead, I want us to be asking why are kids acting out, why are teens in such distress? Instead of personalizing, making kids victims of illness, let us look at our educational system and other determinants, nutrition, sleep, exercise, allergies, environmental illness, violence, ...

And I would suggest that the first place to start is with social violence, to end the social permission for partners to hit each other and for parents to have sex with their kids. Studies consistently confirm a very high rate of sexual and physical abuse among persons who later get diagnosed with mental illness. If this kind of trauma were reduced, I anticipate a significant parallel reduction in the rates of psychological distress and long-term trauma based illness.

I would hope that early intervention does not mean more fuel for the mental health industry, more kids diagnosed and medicated. I would hope that early intervention would mean peer support and outreach teams in place 24/7, not for a crisis, not for an emergency, but at the first sign of a problem, to avert, to deescalate, to attend to needs. Consumer-driven, youth-driven early interventions.

That’s what I think real prevention would be about.

Steinberg: Where’s the starting point?

I wish I had thought to say the earlier the starting point the more long term savings and the less short-term impact.

Betty White, Children Exposed to Violence, DOJ, asked for me card! Who knew there was even such a program?

one I missed:

Question for the floor: increasing demand without services in place

Steinberg: it shouldn’t just be MHSA dollars

Curran:

Gallagher, Sacramento: where are youth?

Steinberg: take OAC to a high school

meet when youth are not in school, evenings, weekends; establish a committee for youth input; we don’t want to start imposing

California youth connection

Steinberg: plight of foster kids

Zayley, ED Sherif’s Ass’n: training for law enforcement, collaborative programs

Herrick, MHSA program manager, Sacramento County: "his story" - alcohol, school drop-out, military, school psychologist, ... consequences of his arrests as a youth follow him today!

(I have a police record that follows me too; I rarely think to raise it as an issue.)

Stakeholders beyond clients and family members, law enforcement, business, city, ... Don’t limit input.

Action: adopt strategic direction and organizational structure recommendation.

Henry: what are we voting on? Page and item number

Clancy: role, make mental health relevance, hold state and counties accountable for public health outcomes; strategies, diversity, increase collaboration, increase communication; structure, executive committee, add electeds to diagram, making stakeholders more central, change stakeholder to consumer and family, ... budget, ... What dould have been a straight-forward, "Move the recommendation" became a comma by comma conversation, amendments, 7 minutes to go, not yet to law enforcement, ... some won’t vote a blank check.

Steinberg: DMH MHSA budget is 8 million; MHSA asking for 1.8 is not unreasonable as an initial budget.

Aye’s carry for role, budget, strategic plan

It’s 3 PM, adjournment time, and we haven’t gotten to

Mental Health/Law Enforcement

Instead of voluntary, "guided by the Attorney General’s opinions."

Revision is by Tricia Wynne (for one of the electeds). She also added that each partner must bring resources to the table (but that doesn’t have to mean dollars). And that all MHSA funding is for mental health services within mh/le collaborative programs. Motion passes; this all takes about 90 seconds. This neatly bypasses the voluntary question, leaves decisions to the AG. It will be interesting to see how this plays out.

Darlene thanked me for mentioning violence. She said she and Mary had been taking notes, that they hadn’t ever thought about violence in the prevention context. Well, I first developed a web page and presentation about this in 2000 (www.peoplewho.org/abuse); six years isn’t bad for first being heard.

Now it’s 5 PM on Friday and it is raining hard.