It's a big move, eliminating an entire department of important state services.
Over and over yesterday, in two separate health and human services budget subcommittee hearings, officials insisted that eliminating the California Department of Mental Health was not a diminishment of services, but rather a reorganization.
"There are ways we can create better efficiencies, better ways of integrating behavioral and physical health," Toby Douglas of the Department of Health Care Services said. "It will happen gradually, it will happen over the next year. We want to work with the Department of Mental Health, to make mental health an essential component of health care delivery."
The question from the hearing room full of health care advocates was: How do you eliminate a whole department, and still keep heightened focus on its subject of mental health?
Joe Mortz, a member of the California Network of Mental Health Clients' board of directors, said no state officials mentioned that this was on the horizon during a recent mental health meeting.
"Transparency is not happening," Mortz said. "This looks like the state is just dumping mental health care and substance abuse, and that's just not good policy."
Betty Reinhardt of the California Alliance of Mental Illness urged the state to move slowly on such a big undertaking.
"You know, we didn’t start off with [an attitude that said] we want to keep the Department of Mental Health and that’s it," she said. "We just have a lot of questions, and so far there are no answers to our questions. We oppose dismantling DMH until it can be replaced in the proper way."
Rusty Selix, executive director of the Mental Health Association in California, had a specific idea:
"It matters where in the Department of Health Care Services this will be," Selix said. "It's important that a deputy director [level position] is in there, appointed by the governor. That is something that isn’t in what they've proposed at this point."
Selix said that having a department devoted to mental health, all by itself, is an indication that it's a high priority for the state.
"There's tremendous fear in the community of eliminating the Department of Mental Health, and to have nothing directly focused on that is a big concern," he said. "We're afraid of losing that attention."
That concern was echoed by lawmakers.
On the Assembly side, Holly Mitchell (D-Los Angeles) pointed out that since it was not strictly a cost-saving budget measure -- but more of a major administrative reorganization -- there was time to consider it at length, and that the subcommittee not formally approve it.
"My sense is that there is support for the direction," she said. "It is clear this is a very complex issue. We have an opportunity to fully engage in the realignment and reshaping of a department that is so integral and so important to California.
"My suggestion is that we not take action today, but punt it to the policy committee."
On the Senate side, the legislators did approve the revision language, but with the understanding that this is the beginning of a long, collaborative and transparent process.
"I would go to my grave regretting what might happen here in our decisions regarding mental health and substance abuse," Sen. Mark DeSaulnier (D-Concord) said. "This isn't about a budget cut to go backwards. It’s an opportunity to do it in a better way, a more holistic way. We can develop a model that is better for everyone."
And that was exactly the sentiment echoed by DHCS' Toby Douglas.
"Our mission is to preserve and improve the health of Californians," he said. "We believe in a broad, strong robust behavioral health system. We are not losing that focus, but we feel we can use our expertise to maximize the financing ... to provide the best care and best outcomes, brought about in a way that is a benefit for everyone."