Stephen W. Mayberg, 64, who has headed the state's Department of Mental Health through three administrations and sweeping shifts in philosophies of care, announced Thursday that he will retire at the end of the month.
"I really need to recharge my batteries," said Mayberg, who has been director for 18 years. "It's a clean time to leave. It's the end of an administration. My appointment is over."
Mayberg's abrupt departure comes on the cusp of Gov.-elect Jerry Brown's administration and after Brown selected a new head of the Health and Human Services Agency, which oversees Mayberg's department.
It also comes as the department works to bring its troubled state mental hospitals into compliance with a federal consent judgment that mandates better care for patients. Despite a costly effort to turn the facilities around, violence has been a growing problem, data show.
Assaults against patients and staff have increased, particularly at Napa State Hospital, where the strangling of a psychiatric technician two months ago has triggered widespread staff dissent and calls for change. A patient has been charged in the slaying, the first killing of a staff member in the system in two decades.
The population of the state's hospitals -- once dominated by mentally ill people committed through the civil courts -- is now overwhelmingly drawn from the criminal justice system. While some are vulnerable and severely ill, others are predatory and manipulative with criminal tendencies and even gang affiliations.
"The population we have now is completely different than it was even five years ago," Mayberg said. "That's going to require structural changes and rethinking staff issues."
Ken Murch, chief negotiator for the California Assn. of Psychiatric Technicians, said that given the difficult challenges of the changing hospital population and tight state budgets, Mayberg "has done a good job. I think he listens well."
But many staff members and some union representatives said they had raised safety concerns with his administration for years to little response.
"Our union and others were frustrated in our working relationship with DMH leadership," said Dr. Stuart Bussey, president of the Union of American Physicians and Dentists, which represents the hospitals' psychiatrists and other medical doctors. "Hopefully the Brown administration will look outside the current DMH organization for an effective leader."
Mayberg stressed that his departure "has nothing to do with the politics or the problems." He added that the state hospitals are in compliance with nearly all federal demands.
Born in Minnesota, the Yale University graduate and clinical psychologist headed Yolo County's mental health department for a dozen years, beginning in 1981. He was an outspoken critic of the Department of Mental Health, which had endured 14 directors in 20 years. When Gov. Pete Wilson appointed him as head of the department in 1993, it was "put up or shut up," he told The Times in 2002.
In time, he was managing a $6.4-billion budget and 12,000 staff members, overseeing five state mental hospitals -- one built on his watch for a growing population of sex offenders deemed mentally ill -- and two prison-run programs. He has weathered U.S. Department of Justice oversight that began with the investigation of one hospital in 2002 and spread systemwide.
Mayberg also shepherded a transition away from institutional care toward greater community-based care, passing complex funding streams through to counties and monitoring them. He has steered a massive boost of dollars into county coffers from Proposition 63, the millionaires' tax passed by voters in 2004 that sets aside dollars for voluntary community-based mental health programs.
As a commissioner on President George W. Bush's New Freedom Commission on Mental Health early in the decade, he took part in the shift away from a model of care that treats symptoms to one focused on a philosophy of recovery and empowerment.
In a letter of appreciation to Mayberg on Thursday, Kristy Kelly, president of the California Mental Health Directors Assn., said that amid the tumult of changes in care, "you created an environment that has encouraged innovation and responsiveness to the voices of clients and their families within our diverse communities."
In a farewell note to staff and others, he wrote, "We are building a system around individuals and families, not the needs of the bureaucracy."
His departure marks the end of an era. "He endured for a long time under very stressful conditions," said California Psychiatric Assn. President Randall Hagar.