Advocating for Systemic Transformational Change
December 8, 2021
An Interview with Toby Ewing, Executive Director
Oversight and Accountability Commission of the Mental Health Service Act
The Commission works through partnerships to catalyze transformational changes across service systems so that everyone who needs mental health care has access to and receives effective and culturally competent care. -Commission Mission Statement
Toby Ewing has served as Executive Director of the Mental Health Services Oversight and Accountability Commission (OAC), for more than five years, following roles as a committee consultant at the California State Senate, research director at California Forward and project manager for the Little Hoover Commission. He previously served as the Director of the California Research Bureau and the California Cost Control Commission. Toby also has a deep personal commitment to mental health. Toby has experienced the loss of suicide, and his family has felt the impact of involuntary hospitalization and justice involvement because of unmet mental health needs.
1) What would you recommend to parents and caregivers at the local county level hoping to understand and benefit from Mental Health Services Act (MHSA) investments in counties specifically for children’s behavioral health services?
– Family and caregiver advocacy is an important part of the MHSA. Mental health services grow and become better when parents, caregivers, and family members share which programs and services are working, which need improvement, and what needs additional funding.
– The Commission is focused on system change. There will always be finite resources for mental health services, so we need to make sure these resources are having the greatest impact. Part of that work is to leverage existing resources and build out partnerships that result in more efficient, integrated services. We need to expand our understanding of how we can improve mental health outcomes, particularly through prevention strategies. Parents and caregivers recognize what is needed, what works and what does not work because of the roles they play in the lives of children and youth. They also can be key in fostering the relationships in their communities that can bring together robust mental health partnerships across public and community agencies, such as schools, park districts, health systems, service providers, and mental health departments.
– In addition to advocating for a specific service need, parents and caregivers wanting to get involved might consider advocating for systemic transformational change that will fill that need and sustain the service long into the future.
2) Big picture, what do you hope to see come out of MHSA funded “stakeholder grants,” and specifically out of the parent and caregiver stakeholder grant, i.e., Parents and Caregivers for Wellness (PC4W)?
– The Commission’s intention for stakeholder grants is not to have the stakeholder awardees advocate for our positions. Instead, these funds are designed to support stakeholders so that they can promote awareness and advocacy that reflects their needs and perspectives. Stakeholder grants are intended to promote robust stakeholder engagement in ways that reflect the diversity of California’s mental health communities.
– Each awardee has proposed a strategy for pursuing the goals of the grant program, and we monitor their work for consistency against that proposal. That said, with the intention being that the work will be community driven, the Commission is not directing how that work gets done.
– We are certainly hoping, at both the local and state level, there is a significant elevation of parent and caregiver voices in program and policy decisions.
3) What investments/initiatives have you already launched that you feel most proud of in terms of how the Commission has contributed to addressing the behavioral health needs of California’s children and youth?
– The Commission’s strategic plan is focused on transformational change, and we have made significant progress in supporting our state and local partners to move California’s mental health system to focusing on outcomes, effective interventions, and prevention.
– Following an initial investment of SB 82/Triage funds to support school-county mental health partnerships, the Legislature passed, and the Governor signed the Mental Health Student Service Act (MHSSA) to expand that work.
– Similarly, the Commission partnered with county behavioral health leaders and Stanford University experts, to explore opportunities to bring a globally-recognized best practice for youth drop-in centers to the U.S. Originating in Australia, a highly successful youth drop-in center called “Headspace” is being propagated. Based on this model, Santa Clara County leaders have developed “allcove”, the first youth-driven drop-in program in the U.S. With additional funding from the Governor and Legislature, we are funding five additional local partners to pilot the “allcove” model in other parts of the state.
– We are doing similar work with multiple counties to support the availability of coordinated specialty care to respond to early psychosis needs. The Commission has provided some $30 million to support a partnership between service providers, technical experts, and researchers at UC Davis and other universities to improve access to care and outcomes.
– Each of these projects – school mental health, youth-drop in, and early psychosis services – are part of a broader strategy to improve care through pilots that we can scale as we demonstrate success.
– The Commission is currently funding partnerships between local education agencies and county behavioral health agencies in 38 counties and we hope to expand those opportunities to all California counties in the coming months. These partnerships help existing systems align their goals and efforts, making them more efficient and effective at helping students.
– The Commission has also been advocating for a stronger voice for youth in the design of services to meet their needs. Prior to the pandemic, we formed a Youth Innovation Planning Project Committee that organized and ran three Idea Labs to support county innovation planning. Though hampered by the pandemic, we continue to work to elevate the voice of youth in mental health program and policy decisions.
4) What investments/initiatives will the Commission be making in the near future that you feel may have the most potential impact, in terms of addressing the behavioral health needs of California’s children and youth?
– Right now, we are focused on delivering on our current commitments in school mental health, early psychosis, and youth drop-in centers. We need to better understand the impact of these investments and then work to scale them statewide.
– We also are finalizing a draft report on prevention and early intervention to highlight opportunities to reduce the need for direct services and to strengthen partnerships across our communities.
– While the Commission recognizes that new investments are needed in many areas, we also must get better at how we use existing resources.
– Part of that focus is to better understand and respond to disparities. I recognize this is also an area of priority for the California Mental Health Advocates for Children and Youth (CMHACY). The Commission is drafting a Racial Equity Action Plan as part of our work to address disparities with the goal that the plan will guide our work on data, funding, and programming to reduce disparities.
– I also want to mention that the Commission is sponsoring AB 573 as part of our work to elevate the voice of youth. AB 573 would require every county to appoint a youth mental health board to become involved in the development of local strategies to meet the needs of youth, including the local work on school mental health.
5) How can parents and caregivers be proactive, at both the county and state policy levels, in advocating for increased resources to be allocated for children’s behavioral health services?
– To fundamentally improve outcomes, parents and caregivers need to be clear on the outcomes they hope to achieve, and advocate for increased attention on those outcomes. While it is important to advocate for increased revenue, at the same time, it is crucial that we better use existing resources.
– Parents and caregivers need to be clear on the goals they want to accomplish, and then join with community partners to focus on those goals and how we meet them.
– California has an opportunity to set clear and consistent goals for access to care, prevention, while maintain a focus on outcomes. Parents and caregivers can partner with state and local agencies to establish goals and measurable outcomes, then monitor progress as services are implemented.
– The MHSA provides an unprecedented opportunity to be successful, through prevention, early intervention, and innovation. We need to tap into the expertise and advocacy potential of parents and caregivers to be clear on where we need to focus and how we can be successful.