Mental Health Services Act

1. Mental Health Services Act CMHDA Children’s System of Care June 21, 2007 CMHDA Children's System of Care

2. MHSA Housing Program(proposed guidelines) CMHDA Children's System of Care

3. Program Description (draft) The Mental Health Services Act Housing Program (MHSA Housing Program) provides funding for the capital costs and operating subsidies to develop permanent supportive housing for persons with serious mental illness who are homeless, or at risk of homelessness, and who meet the MHSA Housing Program target population criteria. CMHDA Children's System of Care

4. Program Funds • Provides up to $75M annually to finance the development, acquisition, construction or rehabilitation of permanent supportive housing • Up to $40M annually for Operating Subsidies CMHDA Children's System of Care

5. Permanent Supportive Housing • Supportive housing means housing with no limit on length of stay and that is linked to on-site or off-site services. • Services must help the tenant retain the housing, support recovery and resiliency, and maximize the ability to live and work in the community. CMHDA Children's System of Care

6. Target Population (draft) The target population is defined as low income adults, older adults, or transition-age youth with serious mental illness as defined in Welfare and Institutions Code Section 5600.3 (b) (1) who at time of assessment for housing services meets the criteria for MHSA Community Services and Support services in their county of residence and are homeless or at risk of homelessness. CMHDA Children's System of Care

7. Target Population Homeless is defined as; • Living on the streets, • Lacking a fixed, regular, and adequate night time residence. (This includes shelters, motels and living situations in which the individual has no tenant rights) CMHDA Children's System of Care

8. Target Population At risk of homelessness includes the following: • Transition-Age Youth exiting child welfare or juvenile justice systems; • Individuals discharged from institutional settings; • Individuals released from local city or county jails; • Individuals temporarily placed in Residential Care Facilities upon discharge from one of the institutional settings; • Individuals who have been assessed and are receiving services at the county mental health department, and who have been deemed to be at imminent risk of homelessness, as certified by the County Mental Health Director. CMHDA Children's System of Care

9. Target Population Institutional settings includes; • Hospitals, including acute psychiatric hospitals, psychiatric health facilities (PHF); • Skilled nursing facilities (SNF) with a certified special treatment program for the mentally disordered (STP); • Mental health rehabilitation centers (MHRC); • Crisis and transitional residential settings CMHDA Children's System of Care

10. Supportive Services • All applications must include a supportive service plan and budget, which must meet MHSA requirements and must be approved by DMH. • The application must include commitment for service funding from the County Mental Health Department. All projects must identify a qualified service provider who will provide supportive services to the residents. • The services provided must be appropriate to the target population, and designed to assist the target population residents to live independently. • The applicant must provide a clearly articulated service delivery program and property management plan. CMHDA Children's System of Care

11. Housing Models (draft) The MHSA Housing Program provides funding for both Rental Housing and Shared Housing Developments. Shared Housing is a development that is rented to and shared by two or more unrelated adults, each of whom is a member of the MHSA target population. A Shared Housing Development must; Provide a separate lockable bedroom for each adult, Insure each adult tenant has a lease and is responsible for paying rent, Be restricted for occupancy to members of the target population, Contain a kitchen and bathroom CMHDA Children's System of Care

12. Housing Models Rental Housing developments are apartment buildings with 5 or more units which include; -Both general occupancy buildings and special occupancy buildings, -All units, shall include at a minimum, a sleeping area, a kitchen area and a bathroom, -Restriction for occupancy to members of the target population CMHDA Children's System of Care

13. Rent and Occupancy Requirements • All MHSA units must be restricted for occupancy by target population households earning 50% or less of the county median income (as adjusted by family size) • Tenant rent should not exceed 30% of tenant income CMHDA Children's System of Care

14. Funding Limits (draft) The MHSA Housing Program will fund up to; • $100,000 per restricted unit in a Rental Housing Development • $100,000 per bedroom in a Shared Housing Development, in which each bedroom is restricted for rental to a tenant who meets the target population definition • Applicants may obtain additional funds from grants, tax credits, other deferred, forgivable or residual receipts loans from governmental and private loan sources, and other county mental health funds CMHDA Children's System of Care

15. Operating Subsidies An Operating Subsidy provides funding to fill the gap between what the tenant can afford to pay for rent and the actual cost of operating the unit. • Projected $40M annually for Operating Subsidies • Operating subsidies are available for up to 20 years • Only the operating costs of the units that house the target population may be subsidized with operating subsidies CMHDA Children's System of Care

16. Application Process • The MHSA Housing Program application will be posted on the DMH and CalHFA websites • Application will include MHSA Housing Program specific requirements • All projects will be required to submit a completed application with all attachments • Applications may be submitted on an ongoing basis to obtain funding CMHDA Children's System of Care

17. CalHFA reviews financing package Application Flowchart Housing proposal submitted to DMH DMH Review of Project and Services Joint proposal developed by county and developer DMH/CalHFA joint approval of project CMHDA Children's System of Care

18. Funding Distribution • Each county will receive MHSA Housing Program funds based on a formula recommended by the counties • In an effort to “jump start” the MHSA Housing Program, it is our intent to provide the counties with an initial planning estimate of $400M • Nothing shall prohibit county mental health departments from utilizing other available funds for this program CMHDA Children's System of Care

19. MHSA Capital Facilities(proposed guidelines) CMHDA Children's System of Care

20. A “capital facility” is a building secured to a foundation which is permanently affixed to the ground that is used for the delivery of MH services to mental health clients and their families or for administrative offices. Capital Facilities(draft) CMHDA Children's System of Care

21. MHSA Capital Facilities Program Capital Facilities funds may only be utilized to: • Acquire land • Acquire buildings • Construct buildings • Renovate buildings • Establish a capitalized repair/replacement reserve for buildings acquired with Capital Facilities Funding CMHDA Children's System of Care

22. Capital Facilities Funds CAN Be Used: • To purchase a building for use as clinic, clubhouse, wellness and recovery center, office space, etc. • To purchase land where a clinic, clubhouse or other types of building that support the goals of the MHSA can be built. • To make an existing building more accessible to clients and family and compliant with the Americans with Disabilities Act (ADA). • To establish a capitalized repair/replacement reserve. CMHDA Children's System of Care

23. Capital Facilities Funds CANNOT Be Used For: • Master leasing or renting of building space. • Purchase of vacant land with no plan for building construction. • Acquisition of facilities not secured to a foundation that is permanently affixed to the ground, i.e., cars, buses, trailers, or recreational vehicles. CMHDA Children's System of Care

24. Restrictive Settings Capital Facilities funds shall be used for buildings that serve clients in less restrictive settings, however, if a county submits a proposal for a Capital Facilities project that is a restrictive setting, in accordance with Welfare and Institutions Code Section 5847(a) (5), the County must demonstrate the need for a building with a restrictive setting by submitting specific facts and justifications for the Department’s review and approval as follows: CMHDA Children's System of Care

25. Restrictive Settings (cont’d) • There is an unmet need within the county for a restrictive facility in order to adequately serve individuals with severe mental illness and/or serious emotional disorder. • These needs cannot be adequately served in a less-restrictive setting • It is not feasible to build the required facility using non-MHSA funds. The County shall include specific reasons for non-feasibility. • The County has pursued, and been unable to obtain, other sources of funding. • The proposal for a restrictive facility was developed through a Community Program Planning Process. CMHDA Children's System of Care

26. Narrative Overview For each proposed Capital Facility project, the County must submit a narrative overview that provides a conceptual framework describing how the County has planned for the use of Capital Facilities funds to support programs and services to be implemented through the MHSA CMHDA Children's System of Care

27. Narrative Overview (cont’d): This overview must describe: • The stakeholder involvement in the identification of the County’s Capital Facility needs, priorities and decisions. • How the proposed project supports the programs and services in the CSS, PEI and/or Innovation components of the County’s Three-Year Program and Expenditure Plan CMHDA Children's System of Care

28. Narrative Overview (cont’d): The County must also identify how the proposed project is consistent with the five fundamental concepts inherent in the MHSA and identified in the CSS component of the County’s Three-year Program and Expenditure Plan • Community Collaboration • Cultural Competence • Client and Family driven • Wellness, recovery and resiliency focused • Integrated service experience for clients and families CMHDA Children's System of Care

29. Capital Facilities Project Plan: • Type of building: New construction, acquisition or renovation. • Intended purpose: Including programs/services to be provided. • Location: Proximity to public transportation and description of surrounding area. • Client/individuals, and age groups to be served. • Building use: If other than providing mental health programs/services provide percentages designated for other uses and relationship, if any, to mental health program. CMHDA Children's System of Care

30. Capital Facilities Project Plan (cont’d): • Budget and budget narrative describing: • Project Expenditures • Total MHSA Capital Facilities Funding • Other Funding Sources • Ongoing Capital Repair Reserves • Estimated Time Frames for Project Phases • The Project Management in Place • The Project Feasibility for Designated Time Period CMHDA Children's System of Care

31. MHSA Capital Facilities Examples: • Co-locate mental health services with primary care clinics • Family Resource Centers for “one-stop” service • Facilities for mental health services located on school grounds • Assessment centers • Short-term crisis residential care to avoid hospitalization and allow for a quick return to the family. • Crisis stabilization facilities for children and transitional age youth that are separate from adult facilities. • Community-based assessment centers for children and youth, which encourage the participation of family members in the assessment process. • Facilities which embrace enhance and promote the cultural needs and preferences of users of the building CMHDA Children's System of Care

32. For More Information • www.dmh.ca.gov/MHSA • Toll-free line (within California): (800) 972-MHSA (6472) CMHDA Children's System of Care