Mental Health Services Act

1. Mental Health Services Act California Department of Mental Health January 19, 2005

2. Goals for Training • Provide information about the • Content of the Mental Health Services Act • Initial implementation strategies • Requirements for County Funding Requests for initial planning.

3. Content of Mental Health Service Act

4. Mental Health Services Act • Proposition 63 was passed by the voters in November, 2004 • It’s now the Mental Health Services Act (MHSA) • It became effective January 1, 2005.

5. Purpose of the Act • Define serious mental illness as a condition deserving priority attention • Reduce long-term adverse impact from untreated serious mental illness • Expand successful, innovative service programs • Provide funding to adequately meet the needs • Ensure that funds are expended in a cost effective manner and that services are provided consistent with best practices

6. MHSA Components • Community Program Planning • Community Services and Supports • Children/Youth, including Transition Age • Adults, including Transition Age • Older Adults • Capital Facilities and Technological Needs

7. MHSA Components (cont.) • Education and Training Programs • Prevention and Early Intervention • Anti-Stigma • Early identification • Early intervention • Suicide prevention • Services to underserved populations • Innovation

8. Community Program Planning • Planning costs shall include funds for county mental health programs to pay for costs of • Consumers, family members and other stakeholders to participate in planning process • Planning and implementation required for private provider contractors to be significantly expanded to provide additional services under the County Program and Expenditure Plan

9. Community Services and Supports • Purpose—Services to individuals with serious emotional disturbance and serious mental illness • Overarching Issues • Outcomes and Accountability • Cultural Competence • Underserved and unserved populations • Welfare and Institutions Codes 5878.1-3, 18257

10. Community Services and Supports—Children/Youth • Provide each child/youth all the necessary services in the treatment plan • Developed in partnership with youth and their families • Individualized to strengths and needs of each child and their family • Wrap around services available

11. Community Services and Supports—Adults • Provide each adult all the necessary services in the treatment plan • Services consistent with recovery vision • Hope, personal empowerment, respect, self-responsibility, self-determination and social connections • Promotes consumer operated services • Reflects diversity of consumers • Plans for each individual’s needs

12. Community Services and Supports—Transition Age • Programs established for children/youth and adults must address the needs of transition age youth ages 16-25 year.

13. Community Services and Supports—Older Adults • Provide each older adult all the necessary services in the treatment plan • Consistent with principles for adult services • Ensure age-appropriate focus and access for the older adult population

14. Capital Facilities and Technology • Needed to implement county Program and Expenditure Plan • Plan for proposed facilities with restrictive settings shall demonstrate that needs for those individuals cannot be met in a less restrictive or more integrated setting. • Plan for proposed technology is to support the requirements of the MHSA

15. Education and Training • Focus—dedicated funding to remedy shortage of qualified workforce • Overall • Expand outreach to multi-cultural communities, increase diversity of workforce, promote web-based technologies and distance learning • In training programs, promote inclusion of • Viewpoint of mental health consumers and family members • Cultural competency

16. Education and Training • County needs assessment compiled into statewide summary • Addressing each professional and other occupational category • State develops 5-year education and training development plan • Approved by California Mental Health Planning Council

17. Education and Training • Pipeline/Recruitment • Develop strategies to recruit high school students • Training • Expand capacity of postsecondary education • Expand loan forgiveness and scholarships • Create a stipend program • Promote employment of mental health consumers and family members • Retraining • Train and retrain staff consistent with principles of the Act

18. Prevention and Early Intervention • Purpose—prevent mental illnesses from becoming severe and disabling • Outcomes—reduce duration of untreated severe mental illness • State develop statewide program • Welfare and Institutions Code Section 5840

19. Prevention and Early Intervention • Elements • Provide outreach and services to identify and treat early signs of mental illness • Ensure access to medically necessary care • Reduce stigma and discrimination • Develop strategies to reduce negative outcomes from untreated mental illness—suicide, incarcerations, school failure, homelessness, etc. • Ensure timely access for underserved populations

20. Innovation • 5% set aside from • Community Services and Supports • Prevention and Early Intervention • Purpose • Increase access to underserved populations • Increase quality of services • Promote interagency collaboration • Increase access to services

21. Transformed System • Important to further operationalize and clarify vision/goals so that we’re all working toward the same end. • Consistent use of and clarification of terminology • Clear desired outcomes • Provides basis for critical decisions throughout the implementation of the MHSA.

22. State Administration • Oversight and Accountability Commission • 16 members unpaid—appointed by • Attorney General, Superintendent, Senate, Assembly • 12 by Governor • Review and approve county plans for Early Intervention/Prevention and Innovation • Develop strategies to overcome stigma • Advise Governor and Legislature regarding mental health services • California Mental Health Planning Council • State Department of Mental Health • Including interagency partners

23. California Mental Health Planning Council • Approve DMH 5-year Workforce Development Plan • Approve outcome measures

24. DMH Role (identified in Act) • Review and approve County Plans (with the Oversight and Accountability Commission) • Evaluate capacity of each county to provide those services • Provide technical assistance to counties • Inform counties of the amount of funds available.

25. County Mental Health • Submit 3-year plan updated annually addressing all components of the MHSA and prudent reserve

26. Funding • 1% increase in personal income tax for adjusted gross income over $1 million • Deposited into Mental Health Services Fund • Monthly based on specified proportion of personal income tax receipts • Adjusted two years later to actual • Funds to be used to expand services, not supplant other county or state funding • Consumer share of cost based on existing sliding fee scale • Uniform Method for Determining Ability to Pay (UMDAP)

27. Distribution of FundingBy MHSA Component

28. Estimated Funding • FY 04/05 $254M • FY 05/06 $672M • FY 06/07 $713M • FY 07/08 $758M

29. MHSA In Perspective • The community mental health system had $3.1B in expenditures in FY 2001/02. • The Community Services and Supports component of the MHSA is projected to provide approximately $350M in revenue in FY 2005/06 for direct Community Services and Support services. • With additional estimated federal matching funds, the estimated increase is about 15%. • Funding should have increasing impact over time, with increased focus on prevention and expanded access, as well as a growing revenue source

30. Mental Health Services ActInitial Implementation Strategies

31. Implementation Strategies • Build long-term vision of transformation of mental health system • Focus on outcomes • Inclusive stakeholder process • Effective participation of clients and family members throughout is critical • Multiple components of the MHSA will eventually be integrated • Initial implementation will be staggered • Shorter-term strategies may supplement • Ensure implementation in every county

32. Other Sources for Vision • President’s New Freedom Commission on Mental Health Report • Institute of Medicine’s Crossing the Quality Chasm Report • California Planning Council’s Master Plan • Little Hoover Commission Reports • Reports of the Select Committee of the California Legislature

33. Timeframes • Implementation will be staggered • Moving toward comprehensive, integrated strategies • Multiple strategies implemented concurrently at different stages • Initial priority • Community Program Planning • Community Services and Supports • Begin conceptualizing requirements and development of workplan for all components

34. Proposed Process for Each Component: Implementation Stages • DMH develops draft products • Stakeholders provide input • Revise and finalize procedures and requirements • Local planning and review • State review/approval of local plans • Local implementation • Technical assistance, oversight and accountability

35. Conceptualizing a Workplan

36. Shorter-Term Strategies • Looking for opportunities to implement programs/services • Consistent with vision • Shorter timeframes • Consistent with overall strategy • Stakeholder agreement • Potential Examples • Network of Care (www.networkofcare.com) • Suicide Prevention strategies • Telemedicine

37. Proposed State Process • DMH is committed to an effective stakeholder process • Communication—two-way • Web, including a subscription service • In person meetings • Facilitator • Written communication—letters, e-mails • Toll-free phone • Pre-meetings for consumers and families • Training

38. County Plan Development Process • With Stakeholders • Develop comprehensive needs assessment • Determine the amount and impact of unmet and undermet needs • Determine priority populations and outcomes • Consistent with state priorities • Develop strategies—consistent with recovery and resiliency principles • Assess capacity • Propose a budget • Including need for prudent reserve

39. Local Review of Program and Expenditure Plans • Draft county plan to be available for review and comment for at least 30 days • Local Mental Health Board/Commission to conduct public hearing on draft plan after 30 day comment period • Adopted plan shall summarize and analyze recommended revisions

40. MHSA Requirements for County Funding Requests Community Program Planning

41. Funding Request Requirements • Purpose • Request MHSA funding to develop Community Services and Supports Plan • Submitted by County Mental Health Director • Deadline March 15, 2005 • Early review for those submitted by February 15, 2005 • 30 day state review • Expect 8 to 10 pages of narrative

42. Narrative—Funding Request 1. Community Program Planning must include consumers and families • Meaningful involvement • Full partners • From inception of planning through implementation and evaluation

43. Narrative—cont. 2. Community Program Planning must be comprehensive and representative • Active participation by stakeholders • Required by MHSA (WIC Section 5848(a)) • Providers of services • Law enforcement • Education • Social Services • Also consider outreach to many others • Ensure diversity

44. Narrative—cont. 3. Clear designation of responsibility within the county and adequate staffing to be successful and inclusive • Specify responsibilities for various functions • When consultants are used, how will their activities and products be integrated into the existing county organization

45. Narrative—cont. 4. Full participation requires training of stakeholders in advance • By stakeholder group, describe • types • amounts • content

46. Budget 5. Budget and narrative description • Format provided • available electronically

47. Funding Request Requirements • Funding • Requests up to county maximum specified in Exhibit B-1 • Minimum of $75,000 for every county • Balance—county’s proportion of prevalence of mental illness in households under 200% of poverty • Timeframe—until Community Services and Supports plan is submitted to state.

48. Funding Limitations • These funds shall not be used to supplant existing…county funds (WIC Section 5891) • Allowable costs are additional costs incurred by counties to plan for MHSA • Costs for staff who have been redirected at least 50% of their time to MHSA are eligible for MHSA funding. • Funding distributed in two equal payments • County Funding Request is approved and sufficient funding is available in the Mental Health Services Fund

49. Completed Submission • Exhibit A-1 • Face Sheet signed by county mental health director • Narrative description of planning process • Budget and description

50. DMH Review Criteria • Reflects the scope of the MHSA • Is complete and response to DMH Letter 05-01 • Describes reasonable planning activities in light of funding requested.