Mental Health Services Act: A County Perspective California Mental Health Policy Forum February 11, 2005 Presented by Nancy Peña, Ph.D., Director Santa Clara County Mental Health

The Opportunity Social Analysts have revealed flaws in the current system, providing objective evidence of the negative individual, social, and financial outcomes that are resulting from neglect of the mental health of our citizens Social Analysts have revealed flaws in the current system, providing objective evidence of the negative individual, social, and financial outcomes that are resulting from neglect of the mental health of our citizens

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

The Opportunity Consumers and family members are without adequate care and are demanding that mental health be addressed with the same urgency as health care Consumers and family members are without adequate care and are demanding that mental health be addressed with the same urgency as health care They are demanding freedom from stigma, a path to recovery and wellness, excellence in service, and inclusion as partners in their own care and in the service delivery system They are demanding freedom from stigma, a path to recovery and wellness, excellence in service, and inclusion as partners in their own care and in the service delivery system

The Opportunity Advocates and Stakeholders have presented the issues to Californians and have offered a compelling set of strategies to correct the current system flaws. Advocates and Stakeholders have presented the issues to Californians and have offered 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. 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

The Challenge Mental Health Directors and Provider Leaders Need to step Up and Provide Leadership to this Exciting New Era in Public Mental Health History…. Mental Health Directors and Provider Leaders Need to step Up and Provide Leadership to this Exciting New Era in Public Mental Health History….

The Vision Is not created or facilitated by legislation or money Is created by Leaders ◆ in clarity and soundness of ideas ◆ in effectiveness of communication ◆ in influence and engagement ◆ in sustained purpose and action

The 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.”

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

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

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

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

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

The Process – Phase I  Engagement and Commitment  Invite Stakeholder Involvement  Share Intent and Vision  Set Tone of Inclusion  Establish Collective Receptivity  Align Expectations Without Losing Optimism  Outline Planning Landscape

The Process – Phase II  Learning and Assessment  Learn Current Service Delivery System  Learn Needs and Interests of Consumers, Family Members, Providers, System Partners, Community – (left and right brain approaches)  Learn Best Practice Strategies to Meet Needs   Learn Outcomes & Accountability Models

The Process – Phase III   Prioritization and Planning  Establish Local Mission, Values & Transformation Objectives  Prioritize Local Needs  Select Effective Strategies to Meet Local Needs  Complete Planning Components

The Process – Phase IV   Implementation  Obtain State Approval & Funding  Select Local Providers  Establish Local Accountability Structure  Initiate and Monitor Services  Evaluate Services

Santa Clara County MHSA Planning Framework – Across the Lifespan - Population SizePopulation Size Geographic DistributionGeographic Distribution Ethnicity and ImmigrationEthnicity and Immigration GenderGender AgeAge Service UtilizationService Utilization Prevalence InfoPrevalence Info Risk & Special PopulationsRisk & Special Populations Unmet NeedUnmet Need Stakeholder InputStakeholder Input Developmental Group Describe: For Each Developmental Group Describe:

For Each Developmental Group For Each Developmental Group Assess Each Transformation Area:  Consumer & Family Involvement  Community Partners  Programs & Services  Cultural Competency  Accountability and Outcomes Where Are We? Assess Strengths & Weaknesses in each area Where Do We Want to Be? Determine Transformation Objectives in each area Santa Clara County MHSA Planning Framework – Across the Lifespan -

The Impact on County Service Systems Pressure to:  Establish Formal Interagency Policy Forums  Establish System Goals for All Ages  Assure Consumer & Family Influence and Involvement at all levels  Outline System Values and Philosophy

The Impact on County Service Systems Pressure to:  Determine and Prioritize Consumer Needs  Implement effective culturally competent prevention, early intervention and treatment services  Demonstrate process quality and favorable outcomes

The Impact on County Service Systems Local System – Establish Common Goals for All Ages Health & Well Being Stability in Family & Social Relations Success in School/Work Meaningful Activity Safe From Harming or Being Harmed in Community Examples of System Outcome Objectives  Health Insurance  Health Visits  Health Status  Suicide  Stable Living  # Placements  DV Incidents  School Attendance  Graduations  Work stability  CJ Recidivism  Days incarcerated  Victims of Crime  CJS Diversions

The Impact on County Service Systems Affirm System Values and Philosophy  Access and Choice  Cultural Proficiency  Early Identification  Family-Driven  Collaborative  Individualized Plans  Community Based  Strengths Based

The Impact on County Service Systems 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

The Impact on County Service Systems Determine and Prioritize Local Mental Health Needs Prevention Early Intervention Intervention All Citizens Across Lifespan Citizens in need Unmet Need Current Public MH System

The Impact on County Service Systems 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?