Mental Health Services Act: A County Perspective

1. Mental Health Services Act: A County Perspective California Mental Health Policy Forum February 11, 2005 Presented by Nancy Peña, Ph.D., Director Santa Clara County Mental Health

2. The Opportunity • Social Analysts have revealed flaws in the current system, providing objective evidence of the negative individual, social, and financial outcomes that are resulting from neglect of the mental health of our citizens

3. The Opportunity • Local systems are stretched beyond capacity and unable to meet demand • Administrators are distracted by the burdens of bureaucracy and financial crisis and uncertainty • Clinical leaders are preoccupied with operational demands and are unable to focus on effective quality improvement efforts that insure excellence in practice and optimal client outcomes.

4. The Opportunity • Consumers and family members are without adequate care and are demanding that mental health be addressed with the same urgency as health care • They are demanding freedom from stigma, a path to recovery and wellness, excellence in service, and inclusion as partners in their own care and in the service delivery system

5. The Opportunity • Advocates and Stakeholders have presented the issues to Californians and have offered a compelling set of strategies to correct the current system flaws. • Citizens have affirmed the reality of the current crisis, and have mandated solutions to be financed and implemented.

6. Providing System Stakeholders a Window of Opportunity to MakeFar-Reaching Change

7. The Challenge • Mental Health Directors and Provider Leaders Need to step Up and Provide Leadership to this Exciting New Era in Public Mental Health History….

8. The Vision • Is not created or facilitated by legislation or money • Is created by Leaders • in clarity and soundness of ideas • in effectiveness of communication • in influence and engagement • in sustained purpose and action

9. The Vision DMH:“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.”

10. The Vision • Outlines Transformation Areas: • Consumer and Family Participation and Involvement • Programs and Services • Community Partnerships • Cultural Competence • Outcomes and Accountability

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

12. 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 Team 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 Cultural Competency Readiness Forums Recovery/Self Help Readiness Forums Santa Clara County MHSA Planning Structure

13. The 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

14. 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 Contractors Non-AMHCA mental health providers Labor Organizations Foster Care Association Residential & Group Home Providers 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 The Process - Santa Clara County Partial List of Stakeholders

15. The Process – Phase I • Engagement and Commitment • Invite Stakeholder Involvement • Share Intent and Vision • Set Tone of Inclusion • Establish Collective Receptivity • Align Expectations Without Losing Optimism • Outline Planning Landscape

16. The Process – Phase II • Learning and Assessment • Learn Current Service Delivery System • Learn Needs and Interests of Consumers, Family Members, Providers, System Partners, Community – (left and right brain approaches) • Learn Best Practice Strategies to Meet Needs • Learn Outcomes & Accountability Models

17. The Process – Phase III • Prioritization and Planning • Establish Local Mission, Values & Transformation Objectives • Prioritize Local Needs • Select Effective Strategies to Meet Local Needs • Complete Planning Components

18. The Process – Phase IV • Implementation • Obtain State Approval & Funding • Select Local Providers • Establish Local Accountability Structure • Initiate and Monitor Services • Evaluate Services

19. Santa Clara County MHSA Planning Framework – Across the Lifespan - • Population Size • Geographic Distribution • Ethnicity and Immigration • Gender • Age For Each Developmental Group Describe: • Service Utilization • Prevalence Info • Risk & Special Populations • Unmet Need • Stakeholder Input

20. Santa Clara County MHSA Planning Framework – Across the Lifespan - For Each Developmental Group Assess Each Transformation Area: Where Do We Want to Be? Where Are We? • Consumer & Family Involvement • Community Partners • Programs & Services • Cultural Competency • Accountability and Outcomes Assess Strengths & Weaknesses in each area Determine Transformation Objectives in each area

21. The Impact on County Service Systems • Pressure to: • Establish Formal Interagency Policy Forums • Establish System Goals for All Ages • Assure Consumer & Family Influence and Involvement at all levels • Outline System Values and Philosophy

22. The Impact on County Service Systems • Pressure to: • Determine and Prioritize Consumer Needs • Implement effective culturally competent prevention, early intervention and treatment services • Demonstrate process quality and favorable outcomes

23. The Impact on County Service Systems • Local System – Establish Common Goals for All Ages Safe From Harming or Being Harmed in Community Stability in Family & Social Relations Success in School/Work Meaningful Activity Health & Well Being Examples of System Outcome Objectives • CJ Recidivism • Days incarcerated • Victims of Crime • CJS Diversions • Health Insurance • Health Visits • Health Status  Suicide • Stable Living • # Placements • DV Incidents • School Attendance • Graduations  Work stability

24. The Impact on County Service Systems • Affirm System Values and Philosophy • Access and Choice • Cultural Proficiency • Early Identification • Family-Driven • Collaborative • Individualized Plans • Community Based • Strengths Based

25. The Impact on County Service Systems • Establish System Structure and Stakeholder Involvement System Performance:Expectations & Results System Policy and Management Provider Performance: Expectations & Results Stakeholders Provider Services Client Level Outcomes: Expectations & Results Individual & Family

26. The Impact on County Service Systems • Determine and Prioritize Local Mental Health Needs Current Public MH System Intervention Unmet Need Citizens in need Early Intervention Prevention All Citizens Across Lifespan

27. The Impact on County Service Systems • Demonstrate process quality and favorable outcomes What Are We Trying to Change? Who Do We Serve? What Practices Do We Employ and Why? How Do We Insure Quality of Practices? How Do We Measure Results? What Results Do We Achieve?