Santa Clara County Planning Kickoff Mental Health Services Act

1. Santa Clara CountyPlanning KickoffMental Health Services Act January 26, 2005 Department of Mental Health

2. Welcome on Behalf of… • Board of Supervisors • County Executive • SCVHHS Executive Director • Mental Health Director • Mental Health Board • Consumers & Providers

3. Meeting Objectives • Orient Stakeholders to MHSA • Engage Stakeholders in Planning Process • Overview Planning Process • Obtain Stakeholder Input

4. Agenda • Overview - MHSA Requirements • DMH Vision & Transformation Expectations • Local Planning Process & Timelines • Brief Overview of SCVHHS MHD • Stakeholder Input to Vision & Involvement • Next Steps and Closure

5. Purpose of the Mental Health Services Act (MHSA) The stated purpose of the Mental Health Services Act is to “expand mental health services” in California

6. MHSA Funding • 1% tax on taxable personal income over $1 million to be deposited into a Mental Health Services Fund (MHSF) in State Treasury • Administered by State Department of Mental Health • Oversight by 16-Member Accountability Commission • Distributed to Counties Via Current State-County Contract • $300 Million in FY05; $700 Million Est. in FY06 • Is used to expand, not supplant services; can “not be used to supplant existing state or county funds utilized to provide mental health services.”

7. MHSA is Intendedto • Introduce effective new service models that promote well-being, recovery and self-help • Introduce prevention and early intervention to prevent negative impact of serious mental illness • Enhance human resource, technology and capital infrastructure of current system • Reduce stigma and change negative social perceptions of mental illness • Correct fragmentation and inadequate funding

8. Current Situation in California • Estimates (Year 2000) are that over 1,000,000 adults, older adults, and children/youth living at or below 200% of poverty in California are in need of treatment. • The public system provides an estimated 460,000 persons with services indicating we would need to more than double capacity to meet the needs of those who rely on public services.

9. Mental Health Prevalence Data • Research indicates prevalence of mental illness in US is 8.55% (adjusted for age and ethnicity). • This equals 145,000 Santa Clara County residents, with 26,639 living at 200% or below of poverty. • Current SCC MH system serves 18,000 year, with less than 10,000 ongoing

10. MHSA in Perspective • CA public system had $3.1 Billion in expenditures in FY 2001/02. • MHSA is projected to provide $700 Million in new revenue in FY 2005/06 with est. 50% going to direct service expansion. • Initial Full Year Will Increase Direct Services by 15% • SCC share between $17 - $30 Million, depending on DMH allocation method.

11. MHSA Overview of Plan Components

12. Nine Categories of Expenditures • Local Planning • Services to Children • Services to Adults & Older Adults • Innovative Programs (within 1&2) • Prevention and Early Intervention • Education and Training • Capital and Technology Development • State Planning and Administration • Prudent Local Reserves

13. Initial Funding FY04-05 • FY04-05 funds (est. $300 Million) 45% - Education and Training (DMH fund) 45% - Capital Facilities Technology (DMH fund) 5% - Local Planning (to counties) 5% - State Implementation (to DMH Admin).

14. Distribution of Funds inFY06, FY07 and FY08Est. $600 – 700 Million 10% - Education & Training 10% - Capital and Technology 50% - Children, Adult, Senior Services 5% - Innovative Programs 20% - Prevention and Early Intervention 5% - State Administration

15. Distribution of Funds After 07-08Est. $700-800 Million • No longer designated percentage to specific categories. • May be used for: • Services for children, adults and older adults • Technological needs and capital facilities • Human resource needs • A prudent reserve to ensure that services do not have to be reduced in years in which revenues are below previous years.

16. Local Planning • $12.7 Million (5%) FY05 funds go to counties for planning as outlined by DMH. • Each county is to receive $75,000 plus county share of the statewide prevalence of mental health need for those living at or below 200% of poverty. • Santa Clara County will receive $302,000 for planning (project management, provider and stakeholder training, needs assessment)

17. Expansion of Direct Service SystemFirst Phase of Funding – FY06 • Children and Transition Age Youth • Emphasis on effective intervention models • County implementation of wraparound • Must address Transition Age Youth • Current definitions of eligible populations

18. Expansion of Direct Service SystemFirst Phase of Funding – FY06 • Adults and Older Adults • Recovery focus, consumer-operated services, attention to culturally competent services • Focus on AB2034 – wrap style for hard-to-serve • MIOCR-type programs effective with criminal justice populations • Attention to dual diagnosed population

19. Innovative Programs5% in FY06 • Included as part of system of care expansion • Includes increased access to underserved groups • Increased and better outcomes • Promotion of interagency collaboration and increased access to services

20. Prolonged suffering Homelessness Removal of children from their homes Implementation ofPrevention & Early InterventionProbable 2nd Phase – FY06 • Includes outreach, access, reduction of stigma, reduction of discrimination. • Emphasis on reducing negative outcomes of: • Suicide • Incarcerations • School failure/dropout • Unemployment • Plan Requirements expected before 7/05

21. Implementation of Education and TrainingImplementation TBD • Includes staff needs assessment by counties • Five-year education and training plan by state • Educational stipends and forgiveness loans and other strategies to increase the size of the mental health work force • Education and curriculum development to “retrain” and increase staff capability, create regional partnerships

22. Implementation of Human Technology and Capital ProjectsImplementation TBD • DMH to establish requirements for counties to apply for funding for information service and capital projects

23. State Department of Mental Health Vision of a Transformed System

24. DMH Proposed Intent • Build long-term vision of transformation of the current mental health system • Initiate phased-in multiple plan components which will eventually be integrated

25. “To… expend funds made available through this initiative to transform the current mental health system in California …This will not be “business as usual”. Eventually access will be easier, services more effective and out-of-home and institutional care will be reduced.” Letter to Stakeholders DMH Director Steve Mayberg

26. DMH: Vision Statement Includes Improvements in: • Consumer and Family Participation and Involvement • Programs and Services • Community Partnerships • Cultural Competence • Outcomes and Accountability

27. DMH: Key Source Documents • 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

28. Santa Clara County Planning

29. Santa Clara County MHSA Planning Process • Broad based stakeholder process • Stakeholder Leadership Committee to: • Review Development of Plan • Facilitate Stakeholder Involvement • Educate Community • Advise Board of Supervisors

30. State Dept. of Mental Health Accountability Commission Board of Supervisors Mental Health Board BOS Committees (HHC, CSFC, PSJC) County Executive SCVHHS Exec. Dir MHSA Stakeholder Leadership Committee Project Management Data, Technology, Budget Work Group Children’s System of Care Work Work Group Adult/ Older Adult System of Care Work Group Prevention & Early Intervention Work Group Community Stakeholder Forums, Focus Groups, and Consumer Engagement Groups Focus Group Focus Group Focus Group Focus Group Focus Group Readiness Forums Readiness Forums Readiness Forums Readiness Forums Santa Clara County MHSA Planning Structure

31. SCC Planning Process • Monthly Stakeholder Leadership Meetings for: • Information and Status Reports • Input from Broad Community • Readiness Forums • Work Group Meetings: • Child, Adolescent, Young Adult SOC • Adult and Older Adult SOC • Prevention and Early Intervention • Data, Infrastructure and Human Resources • Regular Reports Board and Board Committees and Mental Health Board

32. Mental Health Department (chair) County Executive’s Office (co-chair) Mental Health Board (co-chair) Mental Health Self-Help Centers MHD Office of Consumer Empowerment National Alliance for the Mentally Ill Association of Mental Health Contract Agencies Non-AMHCA mental health providers Labor Organizations Foster Care Association Parents Helping Parents Department of Alcohol and Drug Services Public Health Department VMC Acute Psychiatric Services Custody Health Services Valley Medical Center Office of the Public Guardian Police Chief Association SCC Sheriff Department of Social Services Probation Department Superior Court District Attorney’s Office Public Defender’s Office County Office of Education School District Superintendents First Five Commission Council on Aging Office of Affordable Housing Domestic Violence Council School Linked Services United Way Interfaith Council Silicon Valley Council of Non-profits San Andreas Regional Center Local Planning ProcessPartial List of Stakeholders

33. Planning Requirements • Consumer and Family Centered • Broad Stakeholder Involved • “Transformation” Designed • Reflective of MHSA and DMH Vision • Inclusive of Practice Proven Service Models • Improved Cultural Competence • Improved Outcomes & Accountability • Reduced Institutionalization • Reduced Stigma

34. Planning Phases • Engagement and Commitment • Invite Stakeholder Involvement • Share Intent and Vision • Motivate and Include In Planning • Learning and Assessment • Learn Current System • Learn Needs of Consumers, Stakeholders, Community • Learn Best Practice Strategies to Meet Needs • Prioritization and Planning • Establish Local Mission, Values & Transformation Objectives • Prioritize Local Needs • Select Most Effective Strategies to Meet Local Needs • Implementation • Obtain State Approval • Select Local Providers • Initiate, Monitor and Evaluate Services

35. Initial Timeline Estimates January 2005 State Final Requirements for Planning Funds BOS Approves Planning Process County Launches Local Stakeholder Planning Process Project Management Contractor Selected February 2005 Project Management Plan Completed County Submits Planning Proposal State Publishes Implementation Requirements for First Phase Readiness Forum on Cultural Competency Status Report to Stakeholder Leadership Committee

36. Initial Timeline Estimates March–June 2005 State Finalizes MHSA Implementation Requirements County Completes Adult & Child SOC Expansion Plans Mental Health Board Holds Public Hearing on Plan County Submits FY06 Community Services Expansion Plan County Initiates Local Planning of other Program Areas July-Dec 2005 State Approves Community Services Expansion Plan State Allocates Service Expansion Funding State/County Finalize FY06 Performance Contract County Implements Expanded Services County Continues Planning in Other Expenditure Areas

37. Current Public Mental Health System

38. SCC Mental Health SystemCurrent Mandates • There are 4 primary target populations served by current public mental health systems: 1)Individuals served involuntarily under LPS, 2)Eligible Special Education students, 3)Eligible Medi-Cal beneficiaries, 4)Eligible poor and uninsured • MHSA will expand direct services to #3 & #4 • MHSA will introduce prevention & early intervention to all populations

39. SCC Mental Health System Overview • FY05 Budget $190 Million • Services to 18,000 Unduplicated • Four Divisions of Services • Adult & Older Adult • Children & Families • Acute Emergency & Inpatient • Custody Adult Mental Health

40. Stakeholder Input • To Vision • To Planning

41. Next Steps and Closure