Mental Health Services Act

California Department of Mental Health

January 19, 2005

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.

Content of Mental Health Service Act

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.

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

MHSA Components

1) Community Program Planning 2) Community Services and Supports

a) Children/Youth, including Transition Age

b) Adults, including Transition Agec) Older Adults

3) Capital Facilities and Technological Needs

MHSA Components (cont.)4) Education and Training Programs5) Prevention and Early Intervention

a) Anti-Stigmab) Early identification c) Early interventiond) Suicide preventione) Services to underserved populations

6) Innovation

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

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

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

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

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.

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

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

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

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

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

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

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

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

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.

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

California Mental Health Planning Council Approve DMH 5-year Workforce

Development Plan Approve outcome measures

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.

County Mental Health Submit 3-year plan updated

annually addressing all components of the MHSA and prudent reserve

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)

Distribution of FundingBy MHSA Component

1/05-6/05

Next 3 years

Community Program Planning (5% of each component ongoing)

5%

Community Services and Supports* 55%

Capital and Technology 45% 10%

Education and Training 45% 10%

Prevention and Early Intervention* 20%

Innovation (5% of *)

State Implementation 5% 5%

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

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

Mental Health Services ActInitial Implementation Strategies

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

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

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

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

Conceptualizing a Workplan

ComponentsStages

1 2 3 4 5 6 7

Community Program Planning

Community Services and Support

Capital and Technology

Education and Training

Prevention and Early Intervention

Innovation

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

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

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

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

MHSA Requirements for County Funding Requests

Community Program Planning

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

Narrative—Funding Request

1. Community Program Planning must include consumers and families

Meaningful involvement Full partners From inception of planning through

implementation and evaluation

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

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

Narrative—cont.

4. Full participation requires training of stakeholders in advance By stakeholder group, describe

types amounts content

Budget

5. Budget and narrative description Format provided

available electronically

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.

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

Completed Submission Exhibit A-1

Face Sheet signed by county mental health director

Narrative description of planning process

Budget and description

DMH Review Criteria

1. Reflects the scope of the MHSA2. Is complete and response to DMH

Letter 05-013. Describes reasonable planning

activities in light of funding requested.

The only limits are, as always, those of vision. James Broughton