California’s Mental Health Services Act (Prop. 63) The National Association of County Behavioral Health Directors (NACBHD) Legislative Conference Washington, D.C. March 3, 2005 Presented by Patricia Ryan Executive Director, CMHDA

How Did California Do It? Began with an effective and involved mental health coalition. Had a visionary and energetic Legislative Champion in Assemblyman Darrell Steinberg. Conducted polls and focus groups early on, that helped shape an effective message. Developed a broad, grassroots fundraising campaign – did not rely substantially on big donors. Took advantage of the internet to spread message and raise funds.

Purpose The stated purpose of the Mental Health Services Act is to “expand mental health services” in California.

Five Program Areas for Funding 1 - Prevention and Early Intervention ☻ Includes Outreach, access, reduction of stigma, reduction of discrimination. ☻Emphasis on reducing negative outcomes of suicide, incarcerations, school failure or dropout, unemployment, prolonged suffering, homelessness, removal of children from their homes 2 - Services to Children (SOC) ☻Emphasis on System of Care and wrap around services, including Transition Age Youth

Five Program Areas for Funding 3 - Adults and Older Adults (SOC) ☻Focus on recovery vision using the Adult System of Care model, consumer-operated services, ethnicity and cultural diversity ☻Includes Transition Age Youth & MIOCRG-type programs 4 - Education and training ☻Includes staff needs assessment by counties ☻Five-year education and training plan by state ☻Educational stipends and forgiveness loans and other strategies to increase the mental health work force ☻Education and curriculum development to “retrain” staff, regional partnerships

Five Program Areas for Funding 5 - Innovative Programs ☻Includes increased access to underserved groups ☻Increased quality of services and better outcomes ☻Promotion of interagency collaboration and increased access to services

Effective Date The Mental Health Services Act became effective January 1, The additional taxes raised began to be collected on that date. The taxes will be collected on a monthly basis

Funding Source & Restrictions Source: 1% of income over $1 million Deposited to Mental Health Services Fund (MHSF) in State Treasury Monthly Administered by DMH Invested in the manner as other state funds, with interest to accrue to the MHSF Funds used to expand, not supplant services; can “not be used to supplant existing state or county funds utilized to provide mental health services.”

Authorizing Regulations DMH is required to adopt Emergency Regulations in 2005 (as necessary) to implement the Act. The regulations must be developed with the “maximum feasible opportunity for public participation and comments.”

Distribution of Funds – FY 04/05 Funds distributed to local authorities shall be deposited in a local MHSF 45% - Education and Training. 45% - Capital Facilities and Technological Needs. 5% - Local Planning. 5% - State Implementation.

Distribution of Funds FY 05/06; 06/07; 07/08 10% - Education & Training Placed in a Trust Fund 10% - Capital and Technology Distributed in accordance with formula negotiated with CMHDA to implement county plans Funds unused within 10 years will revert to the state MHSF

Distribution of Funds FY 05/06; 06/07; 07/08 20% - Prevention and Early Intervention Distributed in accordance with formula negotiated with CMHDA To implement county plans Can increase over time if other needs (SOC) are met 5% - State DMH Admin, MHPC & Oversight and Accountability Commission Includes research and evaluation

Distribution of Funds FY 05/06; 06/07; 07/08 5% - Innovative Programs Must be approved by the Oversight and Accountability Commission 55% - Children’s, Adults, Older Adults SOC To serve persons with serious emotional disturbance and serious mental illnesses Funds unused after 3 years will revert to the state, except for funds placed in a reserve with a state approved plan Up to 5% of total county allocation may be used for planning (including covering costs for consumer and family participation)

Distribution of Funds After No longer a prescribed percentage of the funds that must go to categories Funds may be used for: Services for children, adults and older adults Technological needs and capital facilities Human resource needs A prudent reserve to ensure that services do not have to be significantly reduced in years in which revenues are below the average of previous years.

County Plans: Requirements & Process  Each year State DMH will inform counties of the amount of funds available. Each county MH program (or two or more acting jointly) must submit to DMH for approval a three-year expenditure plan, updated at least annually Except that proposals for prevention and innovations will be commented on by DMH as to applicability to the MHSA and approved by the Oversight & Accountability Commission County must assure development with local stakeholders 30 day review & comment Public hearing at end of 30 days Each plan must include any substantive written recommendations for revisions, and summarize and analyze the recommended revisions.

County Plans: Requirements & Process DMH will establish requirements for the content of the county plans, including reports on the achievement of performance outcomes. However, each plan must include the following: A program for Prevention and Early Intervention*. A program for services to children based upon the System of Care model, including a program for wraparound services (or why it is not feasible to do wraparound), the number of children to be served, and the cost per child. A program for services to adults and older adults based on the System of Care model, including the number of adults and older adults to be served, and the cost per person.

County Plans: Requirements & Process Each plan must include the following (continued) A plan for Innovative Programs*. A program for Technological Needs and Capital Facilities needed to provide the services. Identification of shortages in personnel to provide services pursuant to the plan, and assistance needed from the Education and Training Programs fund. Establishment and maintenance of a prudent reserve to ensure that the county program will continue to be able to serve children, adults and older adults during years in which revenues for the Mental Health Services Fund are below recent averages. The programs must also address the needs of transition age youth. *Must be reviewed and approved by the Mental Health Oversight and Accountability Commission

DMH Review Process DMH will evaluate each proposed expenditure plan and determine: The extent to which each county has the capacity to serve the proposed number of children, adults and older adults; The extent to which there is an unmet need to serve those individuals; The amount of available funds. Provide each county with an allocation from the funds available. DMH will then contract for the provision of these services with “each county mental health program.”  DMH will use staffing needs assessments from counties to develop a five-year education and training plan.

Oversight and Accountability Commission Sixteen person Commission that will be connected in some way to the California Mental Health Planning Council* Review county plans Approve county proposals for Prevention and Innovation projects * Not clear how this will work.

County Opportunities Develop a mental health service delivery system that supports recovery/resiliency Implement values-driven evidence-based/best practices through the prevention/early intervention and SOCs – including innovative programs Provide wrap around services in all Systems of Care Use innovation funds for self-directed care and other EBPs Prevention and early intervention – could include training for broader community, e.g., landlords Provide prevention services, such as school-based interventions, suicide prevention, etc.

County Questions/Concerns How will the methodology for determining how much each county is eligible for be determined? How will “local supplantation” be defined? What happens is a county Board of Supervisors is opposed to the initiative and will not authorize participation? How do we ensure that each county has a fair chance at getting its share of the funding? How does a county manage expectations due to years of pent-up demands: How do we protect against attempts to divert the money for other uses (education, etc.)?