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Abstract

Implementation of Proposition 63, now called the Mental Health Services Act (MHSA), is hoped to be a major lever of transformational change in California's public mental health system. In order to fully assess the impact of the changes brought about by MHSA implementation, it is necessary to have an understanding of each county's starting point. While the county mental health departments collectively have much in common, there are also significant differences among them that may impact the success of MHSA.

In California, each of the 58 counties as well as the City of Berkeley and the Tri-City Mental Health Center (Pomona, Claremont and La Verne) are designated as the local mental health authority responsible for providing mental health services. The state's Department of Mental Health and the Department of Health Care Services (Medi-Cal) set broad program and fiscal policies and have specific legal and contractual requirements for the counties' mental health programs. At the same time, the counties have considerable flexibility and local control over the service delivery system, resulting in notable differences in county programs across the state. Identifying and understanding these differences may prove to be key to evaluating each county's efforts, strategies and accomplishments in MHSA implementation. In many respects, each county is its own "control" or point of comparison, but comparisons across counties in evaluating MHSA impacts may prove useful in identifying various factors that affect success in MHSA implementation and systems change.

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