California Network of Mental Health Clients

1. Mental Health Services Act: A Status Report California Network of Mental Health Clients Real Transformation: Clients Taking the Lead

2. Presented by:Delphine BrodyDirector, MHSA Client Involvement Program, California Network of Mental Health Clients (CNMHC) Sally ZinmanExecutive Director, CNMHC

3. Anna Lubarov. Bay Area Blanca De Leon, South Carol Patterson, Bay Area Carole Ford, Central Valley Catherine Bond, Central Valley Dave Schroeder, Central Valley Dave Housseini, Central Valley Delphine Brody, Bay Area Donna Nunes-Croteau, Central Valley Douglass Murphy, Bay Area Georgia DeGroat, Far South Gail Green, South Karen Zimmer, Far North Kathie Zatkin, Bay Area Michele Curran, Central Valley Kevin Murphy, Far North Jay Mahler, Bay Area Joyce Ott-Havenner, Far North Linford Gayle, Bay Area Patty Gainer, Central Valley Meghan Stanton, Central Valley Nancy Thomas, Bay Area Rob Chittendon, Far North Sally Zinman, Bay Area Sharon Kuehn, South Susan Gallagher, Central Valley Sylvia Caras, Bay Area Tracy Love, Bay Area California Network of Mental Health Clients MHSA Implementation Team

4. Transformation: Our Vision The CNMHC envisions a world in which mental health clients and survivors of all ages and cultures live fulfilling, independent lives, free of discrimination and stigma; A world where programs and services are always voluntary and without conditions, never forced or coerced; A world where people can access, if they choose, a wide array of voluntary self-directed, client-run, trauma-informed, culturally and linguistically competent programs and services that meet people “where they’re at”, including but not limited to traditional, self-help, alternative and holistic services, and culturally diverse ways of healing; A world in which collaborative networks of programs and services provide quality peer and non-peer support and advocacy in every service venue, with the common goal of helping to facilitate people's wellness and recovery so as to empower them to be change agents in their own lives, and ultimately to support others’ personal transformations and to participate in the continued transformation of the mental health system, as we expand our knowledge base on how to do this well; A world where survivors of violence, abuse and trauma can expect service providers to respect, listen to, and support them, regardless of whether the service providers are peers or non-peers, whether the services are traditional, alternative/holistic, or culturally specific ways of healing,or whether or not clients agree with their providers' assessments regarding the best course of treatment; A world where we are valued and respected as friends and as members of our families and communities; A world in which clients are fully and meaningfully employed in all levels of the mental health system, in self-help, and in the broader workforce, without fear of discrimination.

5. The MHSA from the client perspective: “Nothing about us without us!”

6. What is the Mental Health Services Act? • The MHSA was voted into law as Proposition 63 on the California ballot in November 2004. • The Act requires County mental health service providers to offer services and programs that have been designed by the residents of that County, • Counties must follow a planning process and requirements developed by the State Department of Mental Health (DMH) with stakeholder input. • MHSA programs must be client/family-driven, wellness/recovery-based, and voluntary.

7. How is it funded? The MHSA is funded via a 1% State tax on earned income over $1 million, starting with the second million.

8. How is it supposed to work? • Stakeholders (clients, family members, mental health professionals and service providers) are supposed to be part of the MHSA program design teams in each county, along with local representatives from education, law enforcement, businesses, and the general public. • Clients and family members of all cultures and age groups are supposed to be asked for their recommendations and have full involvement in all levels of MHSA policy-making. • A collaboration of agencies is supposed to be involved in serving a broad range of clients’ needs. • Diversity outreach and inclusion is supposed to be a priority throughout the process.

9. How far along are we in this process? • Most counties have submitted a plan for MHSA Community Services and Supports (CSS) spanning a three-year period, which must be renewed annually. • The other counties’ plans are being developed. • Presently, the DMH is developing regulations for four new components: • Capital Facilities & Information Technology • Innovative Programs • Prevention & Early Intervention, including Reduction of Stigma and Discrimination • Education & Training (Workforce Development) • There is a small/rural county exception on these timelines.

10. Consumer-driven • Consumer-driven means consumers have the primary decision-making role regarding mental health and related care: • Consumers are the primary authors and decision-makers in developing policies affecting local, state, and national mental health service delivery. • All meetings and preliminary discussions about the scope of policy design efforts involve consumers. • Consumers outnumber government staff, contractors and secondary stakeholders [non-recipients of mental health services] and are the first and primary stakeholder. • - Excerpts from the Center for Mental Health Services’ Draft Principles of Consumer-Driven Care

11. Our values reflected in the MHSA • 5813.5 (d) Planning for services shall be consistent with the philosophy, principles and practices of the Recovery Vision for mental health consumers. • (1) To promote concepts key to the recovery for individuals who have mental illness: hope, personal empowerment, respect, social connections, self-responsibility, and self-determination. • (2) To promote consumer-operated services as a way to support recovery. • (3) To reflect the cultural, ethnic, and racial diversity of mental health consumers. • (4) To plan for each consumer’s individual needs.

12. MHSA: Our priority, our concerns • At the 2003 Client Forum, members voted to make the MHSA (then Prop 63) our highest public policy priority. • However, many concerns were raised that the Act’s implementation might not comply with the law’s intent: • Will the implementation be accountable to the values and intent of the Act? • What authority will the DMH demonstrate to require that Counties comply with the Act? • How can we ensure that Counties do not use the new funds to back-fill old systems? • Will MHSA funds be used to support the “same old, same old” that hasn’t worked and has disempowered clients? • How can we guarantee the integrity of the implementation?

13. MHSA: Our recommendations Before the DMH developed their Requirements for Counties’ Three-Year CSS Plans, the Network’s MHSA Client Implementation Team produced a position paper with our recommendations. The following slides summarize some of our key recommendations; each of these is followed by excerpts from the DMH Three-Year Plan Requirements in which our ideas were reflected. How?? Who? What? When?

14. Voluntary services: Our top priority The CNMHC recommended that the DMH, in accordance with the intent of the Act, allow only voluntary services to be funded with MHSA monies.

15. DMH Requirements regarding voluntary services “Individuals accessing services funded by the Mental Health Services Act may have voluntary or involuntary legal status which shall not affect their ability to access the expanded services under this Act. Programs funded under the Mental Health Services Act must be voluntary in nature.” - Excerpt from the DMH Three-year Program and Expenditure Plan Requirements, Community Services and Supports Component, August 2005,page 1

16. Essential involvement of clients CNMHC members also voiced an overriding concern that we achieveessential involvement of clientsin all aspects of local and statewide MHSA planning and implementation processes. Towards this goal, the CNMHC recommended that clients and client advocates focus on four target areas to derive the highest value from the new law:

17. Our recommendation: Client involvement “Overarching all of the CNMHC’s recommendations is the essential involvement of clients in every aspect of the implementation of the MHSA; starting with its planning, moving on to its execution, then to the oversight and evaluation.”

18. The DMH agreed: • “1. Significant increases in the level of participation and involvement of clients and families in all aspects of the public mental health system including but not limited to: planning, policy development, service delivery, and evaluation.” • - Excerpt from the DMH Vision Statement and Guiding Principles for DMH Implementation of the Mental Health Services Act, February 2005, page 2

19. Our recommendation: 2) Client-operated services “Client-operated programs should be developed in every County. “Each County should have, as a component of its plan, a description of how it will utilize consumer-operated programs in the implementation of the CSS programs.”

20. The DMH agreed: • “2. Increases in consumer-operated services such as drop-in centers, peer support groups, warm lines, crisis services, case management programs, self-help groups, family partnerships, parent/family education, and consumer provided training and advocacy services.” • - Excerpt from the DMH Vision Statement and Guiding Principles for DMH Implementation of the Mental Health Services Act, February 2005, page 2

21. Our recommendation: 3) Clients as providers in the MH workforce “The hiring of consumers is a major statewide priority that must be reflected in each County’s CSS plan.”

22. Our recommendation Clients as providers: Workforce development “Each County will develop and implement a consumer provider training program using existing client-developed curriculums as models. “The hiring of consumers will take place at all levels throughout the mental health system, including management, administrative, and direct service. “County hiring plans will include a wide variety of work schedules: full-time, part-time, volunteers, job-sharing, etc.”

23. Once again, the DMH agreed: • “Objective D.Promote the employment of consumers and family members at all levels in the mental health system. • Objective I.Promote the meaningful inclusion of mental health consumers and family members, and incorporate their viewpoints and experiences in all training andeducation programs. • - Excerpts from the DMHMental Health Services Act Workforce Education and Training Five-Year Strategic Plan, Second Draft, 9-25-2006, pp. 17, 19

24. Our recommendation 4) Campaigns to address discrimination & stigma “In consultation with mental health stakeholders and the Oversight and Accountability Commission (OAC), the DMH develop a strategic plan on how stigma and discrimination will be addressed. “The DMH should make available to local mental health programs and interested stakeholders current information and research on effective strategies for combating stigma and discrimination.”

25. State-level response: The MHSA Components calling for a reduction of stigma and discrimination are in the process of being developed. The OAC has a statutory responsibility to develop strategies to overcome stigma, which must infuse all the work of the Commission. CNMHC members are actively involved in the Committees responsible for the developing the Requirements.

26. Some key stakeholder concerns reflected in DMH Guiding Principles • Consumer-operated services • Wellness/recovery/resiliency • Cultural and linguistic competency • Outcomes and accountability • Age-specific needs • Community partnerships

27. Our current concerns • Apparent exclusion of badly served and underserved clients from initial MHSA programs • According to reports, County Three-Year CSS Plans, at the direction of the DMH, target people who are unserved, but not people who have been badly or inappropriately served or underserved. • The target population should be expanded to include the many people who have beeninappropriately servedthrough institutionalization, coercion and force, as well as people who are underserved, i.e. have not received enough of the types of services they are seeking. Otherwise, the quality of life for most clients in the public mental health system will remain unchanged.

28. Our current concerns • Diminishing client involvement • By now, the DMH has approved most Counties’ Three-Year CSS Plans. • As these Counties move closer to implementing their three-year plans, clients from many Counties report the levels of client involvement and influence to have sharply decreased. • The DMH should enforce existing regulations that promote and protect client involvement throughout MHSA implementation, to ensure that the process is carried out correctly.

29. Our current concerns • MHSA funding of inpatient hospitalization • The DMH has enacted an emergency regulation that allows Counties to use MHSA dollars for inpatient hospitalize adults participating in MHSA Full-Service Partnership programs for up to 30 days. • Article 6: COMMUNITY SERVICES AND SUPPORTS • ... • Section 3620. Full Service Partnership Service Category. • ... • (k) Notwithstanding Section 3400 (b)(2), the County may pay for short-term acute inpatient services, not to exceed 30 days, for clients in Full Service Partnerships when the client is uninsured for this service or there are no other funds available for this purpose. • California Welfare & Institutions Code • The CNMHC has strongly opposed this regulation since it was proposed in August ‘05.

30. Our current concerns • MHSA funding of inpatient hospitalization • This regulation violates the letter and spirit of the Act, and is discriminatory toward all mental health clients. • In addition, it threatens to undermine all of our efforts over the past two years to ensure that MHSA services must always be voluntary and never forced. • If enforced, this regulation may erode clients' trust in the MHSA and its promise of transformation. • The regulation may also disproportionately impact homeless people and people in board-and-cares with Axis I labels and histories of hospitalization. • According to the DMH, emergency regulations are enacted for "the immediate preservation of the public peace, health and safety, or general welfare". This seems to imply that the DMH and perhaps some Counties and hospitals expect a flood of new inpatient commitments of uninsured adults when they begin accessing mental health services under the Act. • If you are concerned about this emergency regulation, please sign up to receive CNMHC News Alerts for updates and information on how you can help stop it.

31. Overarching client values: Programs and services Employment Peer Support Holistic Self-Help Voluntary Trauma Informed C h o i c e Client-Driven Empower- ment Recovery Oriented Diversity Community Based

32. A call to leadership Moving from token involvement in decision-making leadership to

33. Who’s behind the wheel of mental health policy?

34. Real transformation: Clients taking the lead The Mental Health Services Act is a tool for real transformation.Clients taking on a collective leadership role is the means. It is the charge and responsibility of California clients to move from involvement in decision-making to leadership. Real transformation will only occur when clients, with the support of the whole mental health community, get in the driver’s seat and take their rightful place as leaders.

35. Culture Change Thanks in large part to our involvement in the design and implementation of the MHSA, the California client movement is experiencing transformation, moving from involvement to leadership. Client involvement and leadership are the driving forces of culture change, but this transformation of hearts and minds won’t happen overnight. If you don’t see big changes right away, don’t get discouraged; transformation calls for skill-building, far-ranging vision and determination.

36. Questions? Contact us! California Network of Mental Health Clients MHSA Client Involvement Program Sacramento Office: 1-800-626-7447 Email: delphinegrrl@gmail.com Web: www.californiaclients.org