California’s mental health commission announced Thursday that its executive director would resign amid revelations that he traveled to the United Kingdom courtesy of a state provider while trying to avoid a budget cut that would have defunded the company’s contract.
Toby Ewing, executive director of the Mental Health Services Oversight and Accountability Commission, will resign effective November 22. Documents obtained by KFF Health News show that he attempted in June to protect state funding for Kooth, a London-based digital mental health company. with a contract to develop a virtual tool to help California address its youth mental health crisis.
He had been on paid administrative leave pending an investigation since September.
Ewing’s resignation was announced after a four-hour closed-door session of the mental health commission. During a public hearing before the announcement, advocates for mental health services accused the commission of favoring corporations instead of serving people with mental health and substance use issues.
The commission is an independent body charged with ensuring that counties properly use funds from a millionaires’ tax for mental health services.
“They’re being co-opted by big corporations,” Susan Gallagher, executive director of Cal Voices, a mental health advocacy organization, said during Thursday’s meeting. “You’re lobbying behind the scenes to get these people money. That’s not your job. You serve the people.”
Ewing declined to comment.
Last year, Kooth signed a four-year, $271 million deal with the Department of Health Care Services, which is independent of the commission, to create Soluna, a free mental health app for California users ages 13 to 25 years.
The app, along with one for younger users from the company Brightline, launched in January to meet the perceived need of young Californians and their families to access professional telehealth for free. It is a component of Gov. Gavin Newsom’s $4.7 billion youth mental health plan.
The apps have had very slow uptake since their launch in January. In May, the Newsom administration proposed a $140 million budget cut for apps. Both the state Assembly and Senate budget committees proposed eliminating the entire program to save the state $360 million compared to California’s $45 billion deficit.
But funding for Kooth’s app ended up being restored. It is not clear why. Emails and calendars reviewed by KFF Health News showed Ewing lobbied legislative staff in June to reinstate the proposed cut.
Approximately two weeks later, Ewing was joined by MHSOAC commissioners Mara Madrigal-Weiss, Bill Brown and Steve Carnevale on a trip to London. Public disclosure forms show Kooth paid $15,000 in travel expenses for Ewing, Madrigal-Weiss and Brown. The forms do not show that the company paid for Carnevale’s trip.
While Ewing was in London, a colleague told him that the final state budget had been approved and funding for Kooth’s application had been restored. Ewing emailed a Kooth executive with ideas to improve its teletherapy app. About a week later, he wrote: “We hope you will participate in anything we come up with.”
At Thursday’s commission meeting, Stacie Hiramoto, director of the Coalition on Racial and Ethnic Disparities in Mental Health, said the public will view the trip to London as a serious conflict of interest.
“Maybe there was no crime and maybe the company was good,” Hiramoto said, referring to Kooth. “But you don’t understand the appearance of the conflict?”
Carnevale said at Thursday’s meeting that the Newsom administration asked the commission to involve the legislature during budget negotiations.
“The governor’s office approached us asking us to help them support the arguments and that’s what we did,” Carnevale said. “We came back and explained our positions on the digital solutions provided generally, without any particular comment on any particular company or product.”
Newsom’s office did not immediately respond.
Carnevale said the trip to the United Kingdom was not budget related. He said the trip “was a great success” in exchanging ideas with mental health policy leaders.
DHCS Director Michelle Baass told lawmakers in May that about 20,000 of the state’s more than 12.6 million children and young adults had signed up for the apps. Together, they had only been used for about 2,800 training sessions. The department has not provided more recent figures to KFF Health News.
Madrigal-Weiss defended her support for mental health apps and praised youth-led design. He cited data that most Kooth users liked virtual training sessions and more than half came from underserved communities.
According to Kooth’s contract, obtained through a records request earlier this year, his pay depends partially on how many people use his app. Kooth won’t get a pay raise until it reaches 366,000 users.
Kooth’s stock price fell about 20% on Thursday after KFF Health News published an article about Ewing’s efforts to restore funding for his contract and trip to London.
Gabe Brison-Trezise contributed to this report.
This article was produced by KFF Health Newswho publishes California Healthlinean editorially independent service California Health Care Foundation.
