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The illusion of stakeholder engagement. Who are we really serving, the SMI and behavioral health community or those with control over about $900m annually?

Three weeks ago, I wrote an email shown below to the person that we were told, in BHAB sub-committee and other meetings, would oversee the new community engagement work of the Behavioral Health Services (BHS) department. Three weeks later I still haven’t received a reply. I assume that 0.01% of the reasoning behind this lack of response originates from this person and, that the remaining 99.9% can only be attributed to the senior management of the BHS. My followup response in any case is shown below as well.

I will keep documenting my efforts then, and ideally, one day, be heard that the things we are both doing and not doing as a BHS and BHAB does not seem to be what was designed by legislators and voted upon by a significant majority of Californian’s and the resulting Mental Health Services Act (MHSA), nor the spirit or intent of the law.

Why does government seem to only follow laws that have a big stick behind them? The MHSA does not have such a stick. As a result,across the state, many of the MHSA elements that could help us transform our state’s mental health and substance-use disorder flaws, suffer.

What am we trying to change?

  1. The fact is, BHAB itself is not asserting it’s ability and authority to ensure the BHS is authentically and meaningfully engaging stakeholders in the evaluation, planning, and budgeting process of how both MHSA funds and other funds are allocated to address many seriously pressing problems affecting every single person in the county – soaring homelessness, overdose deaths, jail death-rates, an impending pandemic-related mental health whiplash, and regular old community behavioral health issues.

    To this end, the BHAB does not implicitly meet it’s obligation to fulfill one of its core duties, #6 in the Duties section of its Bylaws. The BHS is finally making progress in the area but, there are glaring issues that are concerning. Many other obligations in the bylaws are yet unfulfilled or only superficially addressed by what has become a misdirected BHAB. The bylaw, reflecting required state law, reads:

“6. Review and approve the procedures used to ensure citizen and professional involvement at all stages of the planning process. Involvement shall include individuals with lived experience of mental illness or substance use disorders and their families, community members, advocacy organizations, and mental health professionals…”

p4 Behavioral Health Advisory Board Bylaws, 2021
  1. The BHS is sitting on nearly $174m in MHSA excess funds, on top of the ~$33m prudent reserve. These funds are provided by the state tax on millionaires and intends to serve our community with the resources needed to address our residents’ mental health challenges. Although the state allows a three-year period for much of this excess-fund balance to be spent, why on earth would we be sitting on so much, when there are so many challenges facing us? During the pandemic we didn’t touch one dollar of our Prudent Reserve. The excuse of needing so much money to be used in case of dire emergency, was proven moot by the pandemic.
p43 FY 2022-23 Annual Update Mental Health Services Act Expenditure Plan
  1. The MHSA requires a MHSA Three-Year Plan and Expenditures Report and Annual Updates ostensibly to detail where the BHS is going to focus their nearly $900m budget to address our behavioral health challenges. A draft was released September 6th, and the Public Hearing today, October 6th. Why are we asking the public and stakeholders to opine, and the BHAB to vote on a plan, after the real BHS budget and plans have been approved in the last May-June annual county budget cycle, and after we will have already spent one third of the budget?
  2. Finally, in my opinion, there has been a systematic decapitation of the BHAB members over the last year and-a-half. I know of at least five dedicated, committed, subject-matter expert BHAB members that have been removed from the board without rhyme or reason, including this author.

    If I were a gambling man I would say those of us that were removed were the ones that dared challenge the existing BHS Director and who were also the ones pulling the hardest towards up-righting this BHAB. This wasn’t the actions of Supervisors rotating their appointments, these were targeted expulsions. And I for one was offended. Am I wrong? Show me cause why any of us were removed.

Letters of Inquiry

Here’s my follow-up and original emails to this individual:


October 6, 2022 (emailed)

Dear [BHS staffer],

I’ve been really disappointed you didn’t respond to this email in over three weeks. I have spent over 9 years working as a volunteer, putting in thousands of hours of work, to try to improve our county having served four Supervisors through the Alcohol & Other Drugs Advisory Board (ADAB) and Behavioral Health Advisory Board (BHAB), especially those involving community engagement.

To be insulted by this organization so repeatedly and consistently is beyond the pale.

I have failed the community greatly. That’s what bothers me most. And, because I haven’t learned how to kowtow and behave, contrary to the entire spirit and intent of the Mental Health Services Act (MHSA), all my lived experiences and current efforts are wasted to a stubbornly deafened government organization who’s claims the statement embedded into its primary administration building that “Good government demands the intelligent interest of every citizen.” on one side of the building and ‘The noblest motive is the public good.’ on the other.

The hypocrisy in this county administration and leadership is appalling.

I encourage you to find ways to hear dissenting voices. It will be the only way we will break out of the paralysis and inability to address the multiple-front crises of outrageous levels of homelessness and related deaths, our overdose deaths, and our growing rate of jail deaths – all by people crying out loudly or silently about their mental health conditions.

Until you can hear the people in front of you, you will not be able to authentically hear those who need us most, especially those who have been disenfranchised and marginalized for decades.

We can do better!

Thank you.

Jerry


September 13, 2022 (emailed)

Dear [BHS staffer],

I understand you met with several BHAB Members to help them understand the work the BHS is doing towards fulfilling their Community Program Planning (CPP) processes.

I’m writing to learn how you would prefer feedback regarding different facets of the CPP and ultimately the manner in which the BHS, UCSD, CHIP, and ARC conduct the work within the Statement of Work in the underlying contract. There are also a number of facets not addressed in the contract but, are elements that from my perspective need to be addressed.

You no doubt have either read or heard about my persistent attempts to communicate for years with the BHS regarding this area of work. That said, their consistent response to my many pleadings has been nothing but silence. The level of disrespect I have experienced from the BHS is beyond acceptable. So, I will not continue banging my head against the wall trying to contribute.

As another consequence of the BHS’s I will be much more careful spending my precious time in trying to explain my concerns until I understand your preferences.

Finally, please consider me a willing and interested participant in the work you conduct. I come from a wide range of lived experiences in the behavioral health and criminal-legal systems and technology-related strategies.

Thank you very much!

Jerry

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