California Health Official Helped London-Based Company and Traveled on Its Dime
- Toby Ewing, the executive director of the California Mental Health Services Oversight and Accountability Commission, resigned due to a conflict of interest, as he worked to protect state funding for Kooth, a UK-based digital mental health company, while traveling on the company's expenses.
- Ewing's lobbying efforts were influential in restoring funding for Kooth's mental health app despite a proposed budget cut, raising ethical concerns about the commission's priorities and the influence of corporate interests on public funds allocation.
- The launch of digital mental health apps, intended to address California's youth mental health crisis, has seen low adoption rates, further complicated by the scandal surrounding Ewing, which undermines public trust in the commission's effectiveness and transparency.
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A Scandal Unfolds: Toby Ewing's Resignation and the Conflict of Interest
In a shocking turn of events, Toby Ewing, the executive director of the California Mental Health Services Oversight and Accountability Commission (MHSOAC), has resigned following revelations of a significant conflict of interest. The scandal centers around Ewing's efforts to protect the state funding for Kooth, a London-based digital mental health company, while traveling to the UK courtesy of the company.
The Background: Kooth's Contract and the Budget Cut
Kooth was awarded a four-year, $271 million contract to develop Soluna, a free mental health app designed for California users aged 13 to 25. This initiative is part of Governor Gavin Newsom's $4.7 billion youth mental health plan, which aims to provide young Californians and their families with access to professional telehealth services free of charge.
However, in May of this year, the Newsom administration proposed a $140 million budget cut for the apps, which would have effectively defunded the program. Both the state Assembly and Senate budget committees proposed eliminating the entire program to save the state $360 million in the face of California's $45 billion deficit.
Ewing's Efforts to Save Kooth's Contract
Toby Ewing, determined to protect Kooth's contract, began a relentless campaign to persuade legislative staffers to restore the funding. His efforts were documented through emails and calendars reviewed by KFF Health News. Ewing met with key Senate staff members, including Scott Ogus, deputy staff director of the Senate Budget and Fiscal Review Committee, and Marjorie Swartz, a consultant for Senate President Pro Tempore Mike McGuire.
Ewing's push was not just limited to meetings; he provided legislative aides with detailed ideas to improve Kooth's youth teletherapy app, suggesting that "California has to have a digital strategy." His persistent lobbying ultimately led to the restoration of funding for Kooth's app, although the exact reasons behind this decision remain unclear.
The London Trip: A Conflict of Interest?
Ewing and three MHSOAC commissioners — Mara Madrigal-Weiss, Bill Brown, and Steve Carnevale — traveled to London in June. Public disclosure forms reveal that Kooth paid $15,000 in travel expenses for Ewing, Madrigal-Weiss, and Brown. The trip was initially justified as an opportunity to exchange ideas with mental health policy leaders, but it has been widely criticized as a conflict of interest.
Critics argue that the trip, while ostensibly for professional purposes, had the appearance of a favor to Kooth. This perception is compounded by the fact that Ewing was also emailing Kooth executives with suggestions for improving their app while in London. The message "We expect you to be involved in whatever we dream up" reflects a level of intimacy and influence that raises serious ethical questions.
The Fallout: Resignation and Investigation
Ewing's actions have sparked a fierce backlash from mental health advocates who claim that the commission is favoring corporations over the needs of people with mental health and substance use issues. Susan Gallagher, executive director of Cal Voices, a mental health advocacy organization, accused the commission of being co-opted by big corporations, stating, "You’re lobbying behind the scenes for these people to get money. That is not your job. You serve the people".
The commission's actions have been called into question, with some pointing out that MHSOAC is an independent body tasked with ensuring that funds from the millionaires tax are used appropriately by counties for mental health services. The controversy has led to Ewing's resignation, effective November 22, after he had been placed on paid administrative leave pending an investigation since September.
The Impact on Mental Health Services
The Kooth app and its companion app by Brightline were launched in January to address a critical need for young Californians to access professional telehealth services. Despite their launch, the apps have seen very slow uptake. By May, only about 20,000 of the state’s more than 12.6 million children and young adults had registered on the apps, with only 2,800 coaching sessions completed.
The slow adoption rate raises questions about the effectiveness of these digital solutions in addressing the state's youth mental health crisis. The controversy surrounding Ewing's actions may further exacerbate these issues, as the public’s trust in the commission is now at stake.
Conclusion
Toby Ewing's resignation marks a significant turning point in the management of California's mental health services. The scandal highlights the complexities and challenges in balancing professional duties with personal interests, particularly when public funds are involved.
As California continues to grapple with its youth mental health crisis, it is crucial that the commission maintains transparency and integrity. The public's trust must be rebuilt, ensuring that future decisions prioritize the needs of Californians over those of corporate interests.
