1. Mental Health Board Training Roles and Responsibilities
September 2018

2. Agenda/ Meeting Objectives
Introductions
The meeting objectives are to understand:
The charter and composition of a Mental Health Board
The mandated responsibilities of a Mental Health Board
Ways to fulfill these responsibilities
How to conduct a meeting
Requirements of the Brown Act
Mental Health services provided by Napa County
MHSA funding and services covered
State-wide organizations that provide support

3. Composition of the Mental Health Board

4. California Welfare and Institutions Code (WIC) 5604 established that every California County have a Mental Health Board
Each mental health board consists of 10 to 15 members who are appointed by the Board of Supervisors
Exceptions for counties under 80,000 population
Local MHBs interview and recommend appointees to the BOS
Boards are encouraged to appoint individuals who have experience with and knowledge of the mental health system
Member’s term is three years
Appointments are staggered so that approximately 1/3 expire in each year
Board members must be a resident of the county

5. Composition of Mental Health Board
WIC 5604 defines the composition of the board
Fifty percent of the board should be consumers or family members of consumers
At a minimum, Board should have at least 20% consumers and at least 20% families of consumers
One member of the board shall be a member of the local BOS
Board membership should reflect the ethnic diversity of the client population in the county
Composition of Mental Health Board
15 Member Board
Consumer
20% 3
Family Member of Consumer
Combined Consumer & Family Member of Consumer
50% 8
Board of Supervisors 1

6. Some citizens are excluded from being MHB members
No Board member or spouse can be employed by
a county mental health service
the State Department of Health Care Services
A mental health contract agency
However, a consumer can be employed by any of the above
Members of the board must abstain from voting on any issue in which they may have a financial interest

7. As a Board member, you will help to build the culture and values of the Board
Selection of new members
Participation in discussions
Proposals for study of community issues
MHB liaison on committees
Reporting responsibilities

8. Duties of the Mental Health Board

9. Overall mission of a Mental Health Board
Review and evaluate the community mental health needs, services, and facilities
Advise the Napa County Mental Health Director and Board of Supervisors regarding any aspect of the County’s mental health programs 
Advocate for improvement/changes to benefit those who have mental health issues

10. Review and evaluate the community’s mental health needs, services, facilities, and special problems
How to fulfill the duty:
Present programs by community organizations to the Board during meetings
Present programs by mental health division staff during meetings
Develop a system of evaluation of residential facilities/programs and conduct site visits
Hold “town halls” or “community forums” regarding current community issues
Work with mental health division staff regarding special issues
Monitor BOS agendas for activities regarding mental health

11. Review any county agreement entered into pursuant to Section 5650 of the Welfare & Institutions Code
How to fulfill the duty:
Staff presentations of the annual budgets, sources and uses of funds for the mental health division
Review contracts and agreements:
Managed Care Agreement
Performance Agreement
Conditional Release Program (CONREP)
State Hospital Bed Agreement
MH Division’s Mental Health Services Act (MHSA)
Annual Plan Updates
Triennial Audit
External Quality Review Evaluation of Medi-Cal Specialty MH Services
Projects for Assistance in Transition from Homelessness (PATH)

12. Review and comment on the county’s performance outcome data and communicate its findings to the California Mental Health Planning Council
How to fulfill the duty:
Complete the annual Data Notebook prepared by the CBHPC
Review and approve the report prior to submission
Advise BOS & MH Director based on findings

13. Review and approve the procedures used to ensure citizen and professional involvement at all stages of the planning process
How to fulfill the duty:
Ensure that citizens are recognized and provided an opportunity to speak at meetings
Ensure that meetings are conducted in locations accessible to members of the community
Hold “town halls” or “community forums” to determine what community members people think about specific issues
Publicize meetings and topics to generate awareness and interest in the Board’s activities

14. Submit an annual report to the BOS on the needs and performance of the county’s mental health system
How to fulfill the duty:
Use the planning document of the Board as a basis for the Annual Report
Present the Annual Report to the BOS in person and accompanied by other Board members
Use the Annual Report to highlight key accomplishments and issues

15. Advise the BOS and the local Mental Health Director regarding any aspect of the local mental health program
How to fulfill the duty:
Monitor the BOS Agenda, including staff reports to see what relevant information is being sent to the BOS and
Speaking with the BOS and Mental Health Director regarding issues of importance to the MHB
Reporting during meetings activities in the community that are pertinent to the MHB
Hold “town halls” or “community forums” to discover what people think about issues

16. How to fulfill the duty:
Review & make recommendations on applicants for the appointment of a local mental health director; the Board will be included in the selection process prior to the vote
How to fulfill the duty:
Review job description prior to posting
Review applications received and participate in selection of final applicants for interviews
Participate in interview panels
While the Board has a voice, they do not select the Director

17. BOS may transfer additional duties or authority to a Mental Health Board
BOS may ask the MHB to investigate issues or complete a special report on any aspect of mental health in the community

18. State Legislature expects the Board to assess the impact of the realignment of services from the state to the county, to clients and on the local community
Realignment is about the money that is distributed from the state to the county to meet the costs of mental health services

19. Maintain an active, involved Mental Health Board
How to fulfill the duty:
Work toward achieving full MHB membership that reflects the diversity of the populations served
Provide training to members so they understand their role and are encouraged to participate in all related activities
Maintain a high attendance and participation at all MHB meetings, including all committees and/or workgroups
Maintain representation on appropriate local, regional and state boards, committees, councils, etc., and regular reporting to the Mental Health Board

20. Each Board member should visit at least one mental health facility under contract to the county each year
Executive Committee chooses sites to visit in consultation with Mental Health Division
MHB members indicate their interest & availability
MHB Secretary provides Lead Reviewer
Site Contact information
Current Contract
“Facility/Program Observation Report” form
Lead Reviewer contacts facility to schedule the site visit
After visit, Lead Reviewer sends the Team’s report to the Executive Committee
After approval, Team presents to the Board

21. Conducting and Participating in Effective Mental Health Board Meeting

22. Meeting ground rules focus on being mindfully present and treating everyone with respect
Show up, be on time, be prepared
Allow the facilitator to 'direct speaking traffic'
Listen respectfully and appreciatively
Be open-minded and objective and make decisions based on evidence
Speak to the question or issue, not in response others
No side talk
Be brief, stay on point
Respect confidentiality
Cell phones and pagers on silent

23. Use "person-first language" when talking about people with mental illness
Don’t use phrases that depersonalize the individual
Mentally disturbed
Schizophrenic
Mentally ill or emotionally handicapped
Mentally afflicted
Whacko, crazy, nuts or fruitcake
Victim or sufferer
Person-first language, refers first that they are people and secondarily that they have a disability
Person with schizophrenia
Person with a mental illness
Person with bipolar disorder
Person with an emotional disability

24. Robert’s Rules of Order are a common approach to running/managing a meeting
Chair runs the meeting and sets the tone
Follows requirements of Brown Act
Knows requirements of the rules for the meeting
Treats all with respect
Chair makes sure that members know what is being debated and voted upon
Conducts the voting
Handles points of order and appeals
Secretary is responsible for a written record/minutes of what is done during the meeting
Minutes capture each action but not necessarily all discussion
Agenda is the standard order of business

25. Motion is a formal proposal from a member of the group to take action
Member be recognized by the Chair before speaking
A member makes the motion: “I move that …”
Another member seconds the motion: “I second the motion”
The chair states the motion: “It is moved and seconded that ... Are you ready for the question?”
Members can debate the motion
Chair can close discussion if no further debate
Chair puts forth the motion and asks for vote Motion passes with a quorum vote

26. Minutes record discussions and actions taken
First paragraph includes all the basic information about meeting
Includes a paragraph for each subject matter discussed
Gives time of adjournment

27. The Brown Act Government Code Section 54950-54963

28. All public agencies in the state of California are subject to the Brown Act which governs open meetings for local government bodies
Brown Act was enacted in response to mounting public concerns over informal, undisclosed meetings held by local elected officials
Brown Act defines rules of procedure by which all elected boards conduct their meetings
1953 statute signed by former U.S. Supreme Court Justice and California Governor Earl Warren…called the Ralph M. Brown Act
City councils, county boards, and other local government bodies were avoiding public scrutiny by holding secret "workshops" and "study sessions." 

29. Introduction to the Brown Act describes its purpose and intent:
The Legislature finds and declares that the public commissions, boards and councils and the other public agencies in this State exist to aid in the conduct of the people's business.
It is the intent of the law that their actions be taken openly and that their deliberations be conducted openly. The people of this State do not yield their sovereignty to the agencies which serve them.
The people, in delegating authority, do not give their public servants the right to decide what is good for the people to know and what is not good for them to know.
The people insist on remaining informed so that they may retain control over the instruments they have created.

30. All meetings are open to the public
Meeting is any gathering of a quorum of a legislative body to discuss or transact business under the body’s jurisdiction
Serial meetings, meeting consecutive members to discuss an issue, are prohibited

31. Some types of gatherings are not subject to the Brown Act
Individual contact, unless it constitutes a ‘serial’ meeting
Attendance at a seminar or conference open to the public
Attendance at a community meeting open to the public
Attendance at another legislative body meeting
Attendance at social or ceremonial occasions
Attendance at a standing meeting of the MHB

32. Special meetings that deviate from typical schedules can be called for a variety of reasons
Discuss or act on a matter that is pressing enough not to wait for a regular meeting
Meeting convenes someplace other than standard meeting site
Meeting is held at a different time than its regular calendar

33. Public must be notified of all Regular and Special meetings
Regular meeting Agendas must be posted at least 72 hours before the meeting in a location freely accessible to the public
Special meeting Agendas must be posted at least 24 hours before the meeting

34. Meetings must be held within the jurisdiction of the legislative body
All meetings must be in Napa County
Meeting sites must be accessible to all
No member of the public is required to register his/her name or provide any other personal information in order to attend a meeting

35. Teleconferencing to reach a quorum is permitted but is complicated
Notice and Agenda must identify the remote locations
Notice and Agenda must be posted at the remote location and be accessible to the public
Public must be able to participate from remote locations

36. Agenda is required for all meetings
Agenda must be posted and easily accessible to the public least 72 hours before the meeting
Must specify time and location of regular meeting
Must contain a brief description of each item of business to be transacted or discussed
No action or discussion can be taken on any item that does not appear on the posted Agenda

37. Public has rights to documents and to address members of the MHB
Agendas and other documents distributed to the MHB must also be available to the public at the meeting
Public may address members of the MHB regarding matters on or off the Agenda
Items not on the Agenda can be noted but not discussed
Public may preserve proceedings by photography or electronic recording and may broadcast them to the community
The MHB may limit the public comment
“Reasonable’ is typically defined as 3 minutes per speaker per topic

38. Standing Committees and Temporary Committees operate with different requirements
Standing Committees, such as, the Executive Committee must meet all requirements of the Brown Act
Ad hoc/Temporary committees, such as Work Groups, are not governed by the Brown Act
Temporary committees serve only a limited or single purpose
Composed of less than a quorum of the MHB
Includes no one who is not a member of the MHB
Creates its own meeting schedule
Dissolved when specific task is completed

39. Napa County HHS Mental Health Division Services

40. Something about size and budget…TBD

41. Speak to Size & Budget

42. Napa County Mental Health offers community-based mental health services in partnership with regional organizations, individual providers, and hospitals
Adult Mental Health provides a variety of services for adults 18 years of age and older including:
Emergency and crisis services
Mental health counseling
Therapy may be provided through on-site mental health staff or contracted organizational providers 
Pre-screening and referrals
Psychiatric evaluation and ongoing medication management
Adult resource center “Innovations Community Center is a peer- run program in which staff and volunteers foster an atmosphere of support

43. Crisis Stabilization Services Program provides immediate response on a short term basis
Services lasting less than 24 hours to help individuals of all ages affected by problems and symptoms associated with acute mental health crises
Designed to stabilize and alleviate the crisis and symptoms, allowing individuals to return home or transition to the appropriate level of care
Includes medication evaluation and psychiatric medication to those who have a serious mental health problem 

44. Case management services are tailored to assist individuals in reaching their wellness and recovery goals
Accessing medical and other treatment services
Assistance in maintaining appropriate housing
Housing and employment placement support
Intensive case management services
Psychosocial assessment
Service planning and coordination
Most people qualify for reduced fees or have access to insurance or other benefits that will cover part or all of our fees  

45. Mental Health Case Management for Older Adults provides treatment and consultation to individuals 60 years of age and older who suffer from mental illness
Case management
Family support or collateral services
Individual and group counseling
Lanterman-Petris-Short (LPS) conservatorship and monitoring
Linkage to resources and supports
Medication monitoring
Mental health rehabilitation services
Placement
Referrals to other relevant resources including community based organizations
Assessments

46. Older Adult Full Service Partnership Program is designed to support chronically mentally ill, underserved, at-risk adults age 60 years and older
Prioritizes services to Latino seniors and other un-served / underserved populations as well as those at risk of out of home placement, institutionalization or homelessness
Provides connection to counseling and support groups
Referrals to family support groups
Socialization programs
Substance abuse treatment
Transitional housing support
Wellness and recovery plans
Housing and employment placement support

47. Offer services for children, youth and their families who struggle with serious behavioral and mental health issues
Child and Family Behavioral Health, (CFBH), serves Medi- Cal eligible and special education designated children, adolescents, and transitional age youth requiring related mental health services
Children's Medication Services provides psychiatric care, psychiatric evaluations, and when appropriate, psychiatric medication for children and adolescents
In-home therapeutic behavioral support for children and adolescents who are receiving mental health services and are at risk of out-of-home placement and hospitalization or residential care

48. Mental Health Services Act

49. More detail TBD
CAMHPC – California Mental Health Planning Council
CALBHBC – California Association of Local Behavioral Health Boards & Commissions
CIBHA – California Institute for Behavioral Health Services

50. Mental Health Services Act (MHSA) created in 2004 by Prop 63 to expand and improve public mental health services
CA public mental heath funding was insufficient to meet demand of half the population that needed it
Cultural, racial and ethnic populations have been disproportionally affected
“Safety net” of underfunded system had become the criminal justice system, courts, and emergency rooms

51. MHSA is funded by 1% tax on incomes over $1 million
Approximately 1500 programs have been developed across the state
Mental Health Services Act Components include:
Community Services and Support (CSS)
Community Services and Support - Housing
Capital Facilities Technology Needs (CFTN)
Workforce Education and Training (WET)
Prevention and Early Intervention (PEI)
Innovations (INN)

52. State Mental Health Organizations