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