Mental Health Services Act California Department of Mental Health January 19, 2005

Goals for Training Provide information about the Content of the Mental Health Services Act Initial implementation strategies Requirements for County Funding Requests for initial planning.

Content of Mental Health Service Act

Mental Health Services Act Proposition 63 was passed by the voters in November, 2004 It’s now the Mental Health Services Act (MHSA) It became effective January 1, 2005.

Purpose of the Act Define serious mental illness as a condition deserving priority attention Reduce long-term adverse impact from untreated serious mental illness Expand successful, innovative service programs Provide funding to adequately meet the needs Ensure that funds are expended in a cost effective manner and that services are provided consistent with best practices

MHSA Components 1)Community Program Planning 2)Community Services and Supports a)Children/Youth, including Transition Age b)Adults, including Transition Age c)Older Adults 3)Capital Facilities and Technological Needs

MHSA Components (cont.) 4)Education and Training Programs 5)Prevention and Early Intervention a)Anti-Stigma b)Early identification c)Early intervention d)Suicide prevention e)Services to underserved populations 6)Innovation

Community Program Planning Planning costs shall include funds for county mental health programs to pay for costs of Consumers, family members and other stakeholders to participate in planning process Planning and implementation required for private provider contractors to be significantly expanded to provide additional services under the County Program and Expenditure Plan

Community Services and Supports Purpose—Services to individuals with serious emotional disturbance and serious mental illness Overarching Issues Outcomes and Accountability Cultural Competence Underserved and unserved populations Welfare and Institutions Codes , 18257

Community Services and Supports— Children/Youth Provide each child/youth all the necessary services in the treatment plan Developed in partnership with youth and their families Individualized to strengths and needs of each child and their family Wrap around services available

Community Services and Supports— Adults Provide each adult all the necessary services in the treatment plan Services consistent with recovery vision Hope, personal empowerment, respect, self- responsibility, self-determination and social connections Promotes consumer operated services Reflects diversity of consumers Plans for each individual’s needs

Community Services and Supports— Transition Age Programs established for children/youth and adults must address the needs of transition age youth ages year.

Community Services and Supports— Older Adults Provide each older adult all the necessary services in the treatment plan Consistent with principles for adult services Ensure age-appropriate focus and access for the older adult population

Capital Facilities and Technology Needed to implement county Program and Expenditure Plan Plan for proposed facilities with restrictive settings shall demonstrate that needs for those individuals cannot be met in a less restrictive or more integrated setting. Plan for proposed technology is to support the requirements of the MHSA

Education and Training Focus—dedicated funding to remedy shortage of qualified workforce Overall Expand outreach to multi-cultural communities, increase diversity of workforce, promote web- based technologies and distance learning In training programs, promote inclusion of Viewpoint of mental health consumers and family members Cultural competency

Education and Training County needs assessment compiled into statewide summary Addressing each professional and other occupational category State develops 5-year education and training development plan Approved by California Mental Health Planning Council

Education and Training Pipeline/Recruitment Develop strategies to recruit high school students Training Expand capacity of postsecondary education Expand loan forgiveness and scholarships Create a stipend program Promote employment of mental health consumers and family members Retraining Train and retrain staff consistent with principles of the Act

Prevention and Early Intervention Purpose—prevent mental illnesses from becoming severe and disabling Outcomes—reduce duration of untreated severe mental illness State develop statewide program Welfare and Institutions Code Section 5840

Prevention and Early Intervention Elements Provide outreach and services to identify and treat early signs of mental illness Ensure access to medically necessary care Reduce stigma and discrimination Develop strategies to reduce negative outcomes from untreated mental illness—suicide, incarcerations, school failure, homelessness, etc. Ensure timely access for underserved populations

Innovation 5% set aside from Community Services and Supports Prevention and Early Intervention Purpose Increase access to underserved populations Increase quality of services Promote interagency collaboration Increase access to services

Transformed System Important to further operationalize and clarify vision/goals so that we’re all working toward the same end. Consistent use of and clarification of terminology Clear desired outcomes Provides basis for critical decisions throughout the implementation of the MHSA.

State Administration Oversight and Accountability Commission 16 members unpaid—appointed by Attorney General, Superintendent, Senate, Assembly 12 by Governor Review and approve county plans for Early Intervention/Prevention and Innovation Develop strategies to overcome stigma Advise Governor and Legislature regarding mental health services California Mental Health Planning Council State Department of Mental Health Including interagency partners

California Mental Health Planning Council Approve DMH 5-year Workforce Development Plan Approve outcome measures

DMH Role (identified in Act) Review and approve County Plans (with the Oversight and Accountability Commission) Evaluate capacity of each county to provide those services Provide technical assistance to counties Inform counties of the amount of funds available.

County Mental Health Submit 3-year plan updated annually addressing all components of the MHSA and prudent reserve

Funding 1% increase in personal income tax for adjusted gross income over $1 million Deposited into Mental Health Services Fund Monthly based on specified proportion of personal income tax receipts Adjusted two years later to actual Funds to be used to expand services, not supplant other county or state funding Consumer share of cost based on existing sliding fee scale Uniform Method for Determining Ability to Pay (UMDAP)

Distribution of Funding By MHSA Component 1/05- 6/05 Next 3 years Community Program Planning (5% of each component ongoing) 5% Community Services and Supports*55% Capital and Technology45%10% Education and Training45%10% Prevention and Early Intervention*20% Innovation (5% of *) State Implementation5%

Estimated Funding FY 04/05$254M FY 05/06$672M FY 06/07$713M FY 07/08$758M

MHSA In Perspective The community mental health system had $3.1B in expenditures in FY 2001/02. The Community Services and Supports component of the MHSA is projected to provide approximately $350M in revenue in FY 2005/06 for direct Community Services and Support services. With additional estimated federal matching funds, the estimated increase is about 15%. Funding should have increasing impact over time, with increased focus on prevention and expanded access, as well as a growing revenue source

Mental Health Services Act Initial Implementation Strategies

Implementation Strategies Build long-term vision of transformation of mental health system Focus on outcomes Inclusive stakeholder process Effective participation of clients and family members throughout is critical Multiple components of the MHSA will eventually be integrated Initial implementation will be staggered Shorter-term strategies may supplement Ensure implementation in every county

Other Sources for Vision President’s New Freedom Commission on Mental Health Report Institute of Medicine’s Crossing the Quality Chasm Report California Planning Council’s Master Plan Little Hoover Commission Reports Reports of the Select Committee of the California Legislature

Timeframes Implementation will be staggered Moving toward comprehensive, integrated strategies Multiple strategies implemented concurrently at different stages Initial priority Community Program Planning Community Services and Supports Begin conceptualizing requirements and development of workplan for all components

Proposed Process for Each Component: Implementation Stages DMH develops draft products Stakeholders provide input Revise and finalize procedures and requirements Local planning and review State review/approval of local plans Local implementation Technical assistance, oversight and accountability

Conceptualizing a Workplan Components Stages Community Program Planning Community Services and Support Capital and Technology Education and Training Prevention and Early Intervention Innovation

Shorter-Term Strategies Looking for opportunities to implement programs/services Consistent with vision Shorter timeframes Consistent with overall strategy Stakeholder agreement Potential Examples Network of Care ( Suicide Prevention strategies Telemedicine

Proposed State Process DMH is committed to an effective stakeholder process Communication—two-way Web, including a subscription service In person meetings Facilitator Written communication—letters, s Toll-free phone Pre-meetings for consumers and families Training

County Plan Development Process With Stakeholders Develop comprehensive needs assessment Determine the amount and impact of unmet and undermet needs Determine priority populations and outcomes Consistent with state priorities Develop strategies—consistent with recovery and resiliency principles Assess capacity Propose a budget Including need for prudent reserve

Local Review of Program and Expenditure Plans Draft county plan to be available for review and comment for at least 30 days Local Mental Health Board/Commission to conduct public hearing on draft plan after 30 day comment period Adopted plan shall summarize and analyze recommended revisions

MHSA Requirements for County Funding Requests Community Program Planning

Funding Request Requirements Purpose Request MHSA funding to develop Community Services and Supports Plan Submitted by County Mental Health Director Deadline March 15, 2005 Early review for those submitted by February 15, day state review Expect 8 to 10 pages of narrative

Narrative—Funding Request 1. Community Program Planning must include consumers and families Meaningful involvement Full partners From inception of planning through implementation and evaluation

Narrative—cont. 2. Community Program Planning must be comprehensive and representative Active participation by stakeholders Required by MHSA (WIC Section 5848(a)) Providers of services Law enforcement Education Social Services Also consider outreach to many others Ensure diversity

Narrative—cont. 3. Clear designation of responsibility within the county and adequate staffing to be successful and inclusive Specify responsibilities for various functions When consultants are used, how will their activities and products be integrated into the existing county organization

Narrative—cont. 4. Full participation requires training of stakeholders in advance By stakeholder group, describe types amounts content

Budget 5. Budget and narrative description Format provided available electronically

Funding Request Requirements Funding Requests up to county maximum specified in Exhibit B-1 Minimum of $75,000 for every county Balance—county’s proportion of prevalence of mental illness in households under 200% of poverty Timeframe—until Community Services and Supports plan is submitted to state.

Funding Limitations These funds shall not be used to supplant existing…county funds (WIC Section 5891) Allowable costs are additional costs incurred by counties to plan for MHSA Costs for staff who have been redirected at least 50% of their time to MHSA are eligible for MHSA funding. Funding distributed in two equal payments County Funding Request is approved and sufficient funding is available in the Mental Health Services Fund

Completed Submission Exhibit A-1 Face Sheet signed by county mental health director Narrative description of planning process Budget and description

DMH Review Criteria 1. Reflects the scope of the MHSA 2. Is complete and response to DMH Letter Describes reasonable planning activities in light of funding requested.

The only limits are, as always, those of vision. James Broughton