1 Santa Clara County Mental Health Services Act Presentation to Silicon Valley Council of Nonprofits Department of Mental Health March 17, 2005

2 Presentation Objectives Overview Mental Health Services Act Overview Santa Clara MHSA Planning Process and Approach MHSA Opportunities for Local Providers SVCN Input to Priority Community Concerns

3 Overview Mental Health Services Act

4 The Opportunity Social Analysts revealed flaws in current system, providing objective evidence of negative individual, social, and financial outcomes resulting from neglect of the mental health of our citizens (Little Hoover Commission; President’s New Freedom Commission; IOM Crossing the Quality Chasm)

5 The Opportunity Local systems stretched beyond capacity and unable to meet demand Administrators distracted by burdens of bureaucracy and financial crisis and uncertainty Clinical leaders preoccupied with operational demands; unable to focus on effective quality improvement efforts that insure excellence in practice and optimal client outcomes.

6 The Opportunity Consumers and family members without adequate care are demanding:  Mental health be addressed with the same urgency as health care  Freedom from stigma  A path to recovery and wellness  Excellence in service  Inclusion as partners in their own care and in the service delivery system

7 The Opportunity Advocates and Stakeholders have presented the issues to Californians offering a compelling set of strategies to correct the current system flaws. Citizens have affirmed the reality of the current crisis, and have mandated solutions to be financed and implemented. Providing System Stakeholders a Window of Opportunity to Make Far-Reaching Change

8 MHSA Funding 1% tax on taxable personal income over $1 million to be deposited into a Mental Health Services Fund (MHSF) in State Treasury Administered by State Department of Mental Health Oversight by 16-Member Accountability Commission Distributed to Counties Via Current State-County Contract $300 Million in FY05; $700 Million Est. in FY06 Is used to expand, not supplant services; can “not be used to supplant existing state or county funds utilized to provide mental health services.”

9 Nine Categories of Expenditures 1.Local Planning 2.Services to Children 3.Services to Adults & Older Adults 4.Innovative Programs (within 1&2) 5.Prevention and Early Intervention 6.Education and Training 7.Capital and Technology Development 8.State Planning and Administration 9.Prudent Local Reserves

10 Initial Funding FY04-08 FY04-05 funds (est. $300 Million) 45% - Education and Training (DMH fund) 45% - Capital Facilities Technology (DMH fund) 5% - Local Planning (to counties) 5% - State Implementation (to DMH Admin). FY06, FY07 and FY08 (est. $600 – 800 Million) 10% - Education & Training 10% - Capital and Technology 50% - Children, Adult, Senior Services 5% - Innovative Programs 20% - Prevention and Early Intervention 5% - State Administration

11 MHSA is Intended to Introduce effective new service models that promote well-being, recovery and self-help Introduce prevention and early intervention to prevent negative impact of serious mental illness Enhance human resource, technology and capital infrastructure of current system Reduce stigma and change negative social perceptions of mental illness Correct fragmentation and inadequate funding

12 Mental Health Prevalence Data Research indicates the prevalence of mental illness in US is 8.55% (adjusted for age and ethnicity). This equals 145,000 Santa Clara County residents, with 26,639 living at 200% or below of poverty. Current SCC MH system serves 18,000 year, with less than 10,000 ongoing

13 MHSA in Perspective CA public system had $3.1 Billion in expenditures in FY 2001/02. MHSA is projected to provide $700 Million in new revenue in FY 2005/06 with est. 55% going to direct service expansion. Initial full year will increase direct services by 15% SCC share for first phase expansion of direct services is projected to be between $10 - $18 Million, depending on DMH allocation method.

14 The MHSA Vision DMH: “To… expend funds made available through this initiative to transform the current mental health system in California …This will not be “business as usual”. Eventually access will be easier, services more effective and out- of-home and institutional care will be reduced.”

15 The MHSA Vision Outlines Transformation Areas:  Consumer and Family Participation and Involvement  Programs and Services  Community Partnerships  Cultural Competence  Outcomes and Accountability

16 Overview Santa Clara MHSA Planning Process and Approach

17 The Santa Clara County MHSA Planning Process Broad based stakeholder process Stakeholder Leadership Committee to:  Review Development of Plan  Facilitate Stakeholder Involvement  Educate Community  Advise Board of Supervisors

18 The Process  Monthly Stakeholder Leadership Meetings for:  Information and Status Reports  Input from Broad Community  Readiness Forums  Work Group Meetings:  Child, Adolescent, Young Adult SOC  Adult and Older Adult SOC  Prevention and Early Intervention  Data, Infrastructure and Human Resources  Regular Reports Board and Board Committees and Mental Health Board

19 Board of Supervisors State Dept. of Mental Health BOS Committees (HHC, CSFC, PSJC) County Executive SCVHHS Exec. Dir MHSA Stakeholder Leadership Committee Data, Technology, Budget Work Group Prevention & Early Intervention Work Group Children’s System of Care Work Work Group Adult/ Older Adult System of Care Work Group Community Stakeholder Forums, Focus Groups, and Consumer Engagement Groups Cultural CompetencyReadiness ForumsRecovery/Self HelpReadiness Forums Focus Group Focus Group Focus Group Focus Group Focus Group Accountability Commission Mental Health Board Project Management Team Santa Clara County MHSA Planning Structure

20 The Process - Santa Clara County Partial List of Stakeholders Mental Health Department (chair) County Executive’s Office (co-chair) Mental Health Board (co-chair) Mental Health Self-Help Centers MHD Office of Consumer Empowerment National Alliance for the Mentally Ill Association of Mental Health Contractors Non-AMHCA mental health providers Labor Organizations Foster Care Association Residential & Group Home Providers Parents Helping Parents Department of Alcohol and Drug Services Public Health Department VMC Acute Psychiatric Services Custody Health Services Valley Medical Center Office of the Public Guardian Police Chief Association SCC Sheriff Department of Social Services Probation Department Superior Court District Attorney’s Office Public Defender’s Office County Office of Education School District Superintendents First Five Commission Council on Aging Office of Affordable Housing Domestic Violence Council School Linked Services United Way Interfaith Council Silicon Valley Council of Non-profits San Andreas Regional Center

21 Planning Phases Engagement and Commitment  Invite Stakeholder Involvement  Share Intent and Vision  Lay Out Planning Landscape Learning and Assessment  Learn Current System  Learn Needs of Consumers, Stakeholders, Community  Learn Best Practice Strategies to Meet Needs Prioritization and Planning  Establish Local Mission, Values & Transformation Objectives  Prioritize Local Needs  Select Most Effective Strategies to Meet Local Needs Implementation  Obtain State Approval  Select Local Providers  Initiate, Monitor and Evaluate Services

22 Planning Steps Affirm System Values and Philosophy  Access and Choice  Cultural Proficiency  Early Identification  Family-Driven  Collaborative  Individualized Plans  Community Based  Strengths Based

23 Planning Steps - Framework Determine and Prioritize Local Mental Health Needs Prevention Early Intervention Intervention All Citizens Across Lifespan Citizens in need Unmet Need Current Public MH System

24 Planning Steps Lifespan Framework Children, Youth and Young Adults years years years years Adults and Older Adults 26 – 35 years 36 – 49 years 50 – 59 years 60 + years

25 Planning Steps - System Framework Establish System Structure and Stakeholder Involvement Individual & Family Provider Services System Policy and Management Stakeholders System Performance: Expectations & Results Provider Performance: Expectations & Results Client Level Outcomes: Expectations & Results

26 Planning Steps - Accountability Demonstrate process quality and favorable outcomes Who Do We Serve? What Are We Trying to Change? What Practices Do We Employ and Why? How Do We Insure Quality of Practices? How Do We Measure Results? What Results Do We Achieve?

27 Planning Steps – Establish Priorities Local System – Establish Desired Outcomes for All Ages (DMH Suggestions)  Meaningful Use of Time and Capabilities (school, work, activity)  Safe and Permanent Home  Network of Supportive Relationships  Access to Help in a Crisis  Reduction in Incarceration/Juvenile Justice Involvement  Reduction in Involuntary Services

28 MHSA Requirements Community Services and Supports Plan – 1 st Phase Expansion & Transformation of Direct Service System – Est. $10-18 Million for Santa Clara County

29 Key Elements Funds two components:  Services to New Enrollees for Four Age Groups  System Capacity (Change) Plans must identify key community concerns Plans must determine initial “focal populations” for MHSA funding by age group Plans must refer to Cultural Competency Plan to address ethnic disparities Plans must analyze need and unmet need by age, ethnicity and gender

30 DMH “Logic Model” Logic models display program components in a logical flow: Identify community issues Assess unmet mental health needs Decide on focal populations Identify strategies for system capacity Assess system capacity Develop workplan Develop budget

31 Children, Youth & Family Population  Focus on population for whom there are no other funding sources because they are ineligible for them or they need services which are not funded by existing sources. Must be unserved or underserved  In juvenile justice system  Placed out of county  At risk of out of home placement  Uninsured

32 Transition Age Youth (TAY) Between 16 and 25 who are Unserved or Underserved  Homeless or at risk of being homeless  Aging out of public systems such as child welfare  Have experienced their first major episode of mental illness

33 Adults with SMI Including Co-Occurring SA Who are Unserved or Underserved and:  Homeless or at risk of being homeless  Involved in the criminal justice system or at risk of such involvement and/or  At risk of institutionalization.

34 Older Adults 60 and Over With SMI, Including Co-occurring Disorders and: Unserved or underserved and Have a reduction in functioning Are homeless or at risk of being homeless At risk of institutionalization, nursing home care, hospitalizations, and ER services.

35 Counties Must Prioritize Concerns Plans must be geared to impact negative effects of untreated mental illness for all ages, and must address: Homelessness Inability to work Isolation Incarceration Institutionalization Inability to be in normal school environment school failure Removal from home/parents Risk of juvenile justice involvement Other concerns identified by stakeholders

36 Determining Critical Concerns Health & Well Being Stable Home, Family, Social Relations Meaningful S chool, Work Activity Safe From Harm or Harming in Community Suicidal Emotional Suffering SA Addicted Physically Unhealthy Thriving With Mental Illness Failing With Untreated and Under-treated Mental Illness Homeless, Isolated, Sexual Survival Removed Child Stable Home, Close Friends & Family Safe Relationships Emotionally Content SA Remission Physically Healthy Jobless Adult Inactive Senior School Failing Child Jailed Adult Victimized Senior Delinquent Child Employed Adult Active Senior Child in School Out of Jail Safe from Stigma Out of Trouble Low Need Hi Need

37 MHSA Opportunity for Local Providers

38 MHSA Offers Local Providers Opportunity to Engage  To Become Involved as Stakeholders  To Educate and Inform Your Boards, Staff and Families, and Business Partners  To Actively Involve Your Consumers and Families  To Actively Partner With System Players in Your County

39 MHSA Offers Local Providers Opportunity to Learn and Assess  Understand Stakeholder Views  Know the System and Community  Understand Consumer Opinions and Needs  Learn Most Effective Strategies and Competencies that Meet Needs  Assess Agency Strengths and Weaknesses Relative to Transformation Expectations

40 MHSA Offers Local Providers Opportunity to Prioritize and Plan  Revisit Mission and Business Objectives  Affirm Practice Philosophy, Values and Process  Outline Cultural Competency Objectives  Articulate Process Standards and Outcome Expectations and Track Results  Determine Infrastructure Needs to Maintain Process Standards and Achieve Outcomes

41 MHSA Offers Local Providers Opportunity to Implement Changes  Establish Family Partnerships  Restructure care planning process  Implement Cultural Competency Initiatives  Implement Process Improvement Strategies  Evaluate & Report Service Outcomes

42 MHSA Next Steps Work Groups Being Formed Extensive Inreach & Outreach Launched Identify Critical Concerns by Age Research Best Practice Strategies Prioritize & Determine Three-Year Plan Submit Services & Supports Plan – 10/05

43 Input from SVNP Members on Critical Needs For More Information: Nancy Pena, Ph.D., Director, MHD, Sheila Yuter, MHSA Coordinator, Santa Clara County MHD Website State Dept. Mental Health website