Mental Health Board Training Roles and Responsibilities

1. Mental Health Board Training Roles and Responsibilities September 2018

2. Mental Health Board Training:  TOPICS Introductions The Mental Health Board • Composition • Duties Effective Meetings • Conducting a Meeting • Brown Act Napa County Mental Health Division • Budget • Services Mental Health Services Act Statewide Mental/Behavioral Health Organizations

3. Composition of the Mental Health Board

4. California Welfare and Institutions Code (WIC) 5604 established that every California County have a Mental Health Board Each mental health board consists of 10 to 15 members who are appointed by the Board of Supervisors • Exceptions for counties under 80,000 population Local MHBs interview and recommend appointees to the BOS Encouraged to appoint individuals who have experience with and knowledge of the mental health system Board members must be a resident of the county Member’s term is three years Appointments are staggered so that approximately 1/3 expire in each year

5. WIC 5604 defines the composition of the board • Fifty percent of the board should be consumers or family members of consumers • At a minimum, 20% consumers and 20% families of consumers • One member representing local BOS • Should reflect the ethnic diversity of the county’s client population

6. Some citizens are excluded from being MHB members With one exception, no Board member or spouse can be employed by • a county mental health service • the State Department of Health Care Services • A mental health contract agency • However, a mental health consumer can be employed by any of the above Members of the board must abstain from voting on any issue in which they may have a financial interest

7. As a Board member, you will help to build the culture and values of the Board Selection of new members Participation in discussions Proposals for study of community issues MHB liaison on committees Reporting responsibilities

8. Duties of the Mental Health Board

9. Overall mission of a Mental Health Board Review and evaluate the community mental health needs, services, and facilities Advise the Napa County Mental Health Director and Board of Supervisors regarding any aspect of the County’s mental health programs  Advocate for improvement/changes to benefit those who have mental health issues

10. Review and evaluate the community’s mental health needs, services, facilities, and special problems How to fulfill the duty: Present programs during Board meetings • Community organizations • Mental health division staff Develop a system for evaluating residential facilities/programs and conduct site visits Hold “town halls” or “community forums” regarding community issues Work with mental health division staff regarding special issues Monitor BOS agendas for activities regarding mental health

11. Review any county agreement entered into pursuant to Section 5650 of the Welfare & Institutions Code How to fulfill the duty: Staff presentations of the annual budgets, sources and uses of funds for the mental health division Review contracts and agreements: • Managed Care Agreement • Performance Agreement • Conditional Release Program (CONREP) • State Hospital Bed Agreement • MH Division’s Mental Health Services Act (MHSA) • Annual Plan Updates • Triennial Audit • External Quality Review Evaluation of Medi-Cal Specialty MH Services • Projects for Assistance in Transition from Homelessness (PATH)

12. Review and comment on the county’s performance outcome data and communicate its findings to the California Mental Health Planning Council How to fulfill the duty: Complete the annual Data Notebook prepared by the CBHPC Review and approve the report prior to submission Advise BOS & MH Director based on findings

13. Review and approve the procedures used to ensure citizen and professional involvement at all stages of the planning process How to fulfill the duty: Ensure that citizens are recognized and provided an opportunity to speak at meetings Ensure that meetings are conducted in locations accessible to members of the community Hold “town halls” or “community forums” to determine what community members people think about specific issues Publicize meetings and topics to generate awareness and interest in the Board’s activities

14. Submit an annual report to the BOS on the needs and performance of the county’s mental health system How to fulfill the duty: Use Board planning document as a basis for the Annual Report Present the Annual Report to the BOS in person Use the Annual Report to highlight key accomplishments and issues

15. Advise the BOS and the local Mental Health Director regarding any aspect of the local mental health program How to fulfill the duty: Monitor the BOS Agenda and staff reports to see what relevant information is being sent to the BOS and Speaking with the BOS and Mental Health Director regarding issues of importance to the MHB Participate in community meetings that are relevant to the MHB Hold “town halls” or “community forums” to discover what people think about issues

16. Review & make recommendations on applicants for the appointment of a local mental health director; the Board will be included in the selection process prior to the vote How to fulfill the duty: Review job description prior to posting Review applications received and participate in selection of final applicants for interviews Participate in interview panels While the Board has a voice, they do not select the Director

17. BOS may transfer additional duties or authority to a Mental Health Board BOS may ask the MHB to investigate issues or complete a special report on any aspect of mental health in the community State Legislature expects the Board to assess the impact of the realignment of services from the state to the county, to clients and on the local community • Realignment is the money distributed from the state to the county to meet the costs of mental health services

18. Maintain an active, involved Mental Health Board How to fulfill the duty: Work toward achieving full MHB membership that reflects the diversity of the populations served Provide training to members so they understand their role and are encouraged to participate in all related activities Maintain a high attendance and participation at all MHB meetings, committees, and/or workgroups Maintain representation on appropriate local, regional and state boards, committees, councils, with regular reporting to the Mental Health Board

19. Each Board member should visit at least one mental health facility under contract to the county each year Executive Committee chooses sites to visit in consultation with Mental Health Division MHB members indicate interest & availability MHB Secretary provides Lead Reviewer • Site Contact information • Current Contract • “Facility/Program Observation Report” form Lead Reviewer contacts facility to schedule the site visit Lead sends Team’s report to the Executive Committee Team presents to the Board

20. Conducting and Participating in Effective Mental Health Board Meeting

21. Meeting ground rules focus on being mindfully present and treating everyone with respect Show up, be on time, be prepared Allow the facilitator to 'direct speaking traffic' Listen respectfully and appreciatively Be open-minded & objective, decisions based on evidence Speak to the question or issue, not in response others No side talk Be brief, stay on point Respect confidentiality Cell phones and pagers on silent

22. Use "person-first language" when talking about people with mental illness Don’t use phrases that depersonalize the individual • Mentally disturbed • Schizophrenic • Mentally ill or emotionally handicapped • Mentally afflicted • Whacko, crazy, nuts or fruitcake • Victim or sufferer Person-first language, refers first that they are people and secondarily that they have a disability • Person with schizophrenia • Person with a mental illness • Person with bipolar disorder • Person with an emotional disability

23. Robert’s Rules of Order are a common approach to running/managing a meeting Agenda is the standard order of business Chair runs the meeting and sets the tone • Follows requirements of Brown Act • Knows requirements of the rules for the meeting • Treats all with respect Chair makes sure that members know what is being debated and voted upon • Conducts the voting • Handles points of order and appeals Secretary is responsible for a written record/minutes of what is done during the meeting • Minutes capture each action but not necessarily all discussion

24. Motion is a formal proposal from a member of the group to take action Member be recognized by the Chair before speaking A member makes the motion: “I move that …” Another member seconds the motion: “I second the motion” The chair states the motion: “It is moved and seconded that ... Are you ready for the question?” Members can debate the motion Chair can close discussion if no further debate Chair puts forth the motion and asks for vote Motion passes with a quorum vote

25. The Brown ActGovernment Code Section 54950-54963

26. All public agencies in the state of California are subject to the Brown Act which governs open meetings for local government bodies Brown Act became law in 1953 Enacted in response to increasing public concerns over informal, undisclosed meetings held by local elected officials Defines rules of procedure by which all elected government agencies and boards conduct their meetings

27. Introduction to the Brown Act describes its purpose and intent The Legislature finds and declares that the public commissions, boards and councils and the other public agencies in this State exist to aid in the conduct of the people's business. It is the intent of the law that their actions be taken openly and that their deliberations be conducted openly. The people of this State do not yield their sovereignty to the agencies which serve them. The people, in delegating authority, do not give their public servants the right to decide what is good for the people to know and what is not good for them to know. The people insist on remaining informed so that they may retain control over the instruments they have created.

28. All meetings are open to the public Any gathering of a quorum of a legislative body to discuss or transact business under the body’s jurisdiction Serial meetings are prohibited • Meeting or calling consecutive members to discuss an issue

29. Some types of gatherings are not subject to the Brown Act Individual contact, unless it constitutes a ‘serial’ meeting Seminar or conference open to the public Community meeting open to the public Another legislative body meeting Social or ceremonial occasions

30. Special meetings that deviate from typical schedules can be called for a variety of reasons Discuss or act on a matter that is pressing enough not to wait for a regular meeting Convene someplace other than standard meeting site Held at a different time than its regular calendar These meetings must be posted and open to the public

31. Public must be notified of all Regular and Special meetings Regular meeting Agendas must be posted at least 72 hours before the meeting in a location freely accessible to the public Special meeting Agendas must be posted at least 24 hours before the meeting

32. Meetings must be held within the jurisdiction of the legislative body MHB meetings must be in Napa County Meeting sites must be accessible to all No member of the public is required to register his/her name or provide any other personal information in order to attend a meeting

33. Teleconferencing to reach a quorum is permitted but the process is complicated Notice and Agenda must identify the remote locations Notice and Agenda must be posted at the remote location and be accessible to the public Public must be able to participate from remote locations

34. Agenda is required for all meetings Agenda must be posted and easily accessible to the public least 72 hours before the meeting Must specify time and location of regular meeting Must contain a brief description of each item of business to be transacted or discussed No action or discussion can be taken on any item that does not appear on the posted Agenda

35. Public has rights to all documents and to address members of the MHB during meeting Agendas and other documents distributed to the MHB must be available to the public at the meeting Public may address members of the MHB regarding matters on or off the Agenda • Items not on the Agenda can be noted but not discussed Public may preserve proceedings by photography or electronic recording and may broadcast them to the community The MHB may limit the public comment • “Reasonable’ is typically defined as 3 minutes per speaker per topic

36. Standing Committees and Temporary Committees operate with different requirements Standing Committees, such as, the Executive Committee must meet all requirements of the Brown Act Ad hoc/Temporary committees, such as Work Groups, are not governed by the Brown Act Temporary committees serve only a limited or single purpose • Composed of less than a quorum of the MHB • Includes no one who is not a member of the MHB • Creates its own meeting schedule • Dissolved when specific task is completed

37. Napa County HHS Mental Health Division Services

38. Realignment, Medi-Cal & MHSA are top sources of revenue for Napa mental health services Napa County Mental Health Revenue by CategoryFiscal Year 2018-19 Budget = $32,845,885 Other Revenue (fees & charges), 3% Medi-Cal (Billing, Administration & Quality Assurance), 27% Realignment, 32% General Fund, 14% Federal & State w/o Realignment, 3% MHSA, 21%

39. Contracted services account for nearly half of expenses Napa County Mental Health Expenditures by CategoryFiscal Year 2018-19 Budget = $32,845,885 Salaries & Benefits, 37% Contracts, 48% HHSA Administration, 9% Services-including business travel & mileage, 1% Supplies-including client support, 1% Property Management, IT, Communications, 4%

40. Napa County Mental Health offers community-based mental health services in partnership with regional organizations, individual providers, and hospitals Adult Mental Health provides a variety of services for adults 18 years of age and older including: • Emergency and crisis services • Mental health counseling • Pre-screening and referrals • Psychiatric evaluation and ongoing medication management • Adult resource center “Innovations Community Center is a peer-run program in which staff and volunteers foster an atmosphere of support

41. Crisis Stabilization Services Program provides immediate response on a short term basis Services lasting less than 24 hours Helps individuals of all ages affected by problems and symptoms associated with acute mental health crises Designed to stabilize and alleviate the crisis and symptoms, allowing individuals to return home or transition to the appropriate level of care Includes medication evaluation and psychiatric medication to those who have a serious mental health problem 

42. Case management services are tailored to assist individuals in reaching their wellness and recovery goals • Accessing medical and other treatment services • Assistance in maintaining appropriate housing • Housing and employment placement support • Intensive case management services • Psychosocial assessment • Service planning and coordination • Most people qualify for reduced fees or have access to insurance or other benefits that will cover part or all of our fees  

43. Mental Health Case Management for Older Adults provides treatment and consultation to individuals 60 years of age and older who suffer from mental illness Family support or collateral services Individual and group counseling Lanterman-Petris-Short (LPS) conservatorship and monitoring Linkage to resources and supports Medication monitoring Mental health rehabilitation services Placement Referrals to other relevant resources including community based organizations Assessments

44. Older Adult Full Service Partnership Program is designed to support chronically mentally ill, underserved, at-risk adults age 60 years and older Prioritizes services to Latino seniors and other un-served / underserved populations as well as those at risk of out of home placement, institutionalization or homelessness Provides connection to counseling and support groups Referrals to family support groups Socialization programs Substance abuse treatment Transitional housing support Wellness and recovery plans Housing and employment placement support

45. Offer services for children, youth and their families who struggle with serious behavioral and mental health issues Child and Family Behavioral Health, (CFBH) • serves Medi-Cal eligible and special education designated children, adolescents, and transitional age youth Children's Medication Services provides psychiatric care, psychiatric evaluations, and when appropriate, psychiatric medication In-home therapeutic behavioral support • For children and adolescents who are receiving mental health services • For those at risk of out-of-home placement and hospitalization or residential care

46. Mental Health Services Act

47. Mental Health Services Act (MHSA) created in 2004 by Prop 63 to expand and improve public mental health services CA public mental heath funding was insufficient to meet demand of half the population in need Cultural, racial and ethnic populations have been disproportionally affected “Safety net” of underfunded system had become the criminal justice system, courts, and emergency rooms

48. MHSA is funded by 1% tax on incomes over $1 million Approximately 1500 programs have been developed across the state Mental Health Services Act Components include: • Community Services and Support (CSS) • Community Services and Support - Housing • Capital Facilities Technology Needs (CFTN) • Workforce Education and Training (WET) • Prevention and Early Intervention (PEI) • Innovations (INN)

49. Statewide Mental Health Organizations

50. Statewide Mental/Behavioral Health Organizations • California Association of Local Behavioral Health Boards & Commissions (CALBHBC) California Behavioral Health Planning Council (CBHPC) County Behavioral Health Directors Association (CBHDA) Mental Health Services Oversight and Accountability Commission (MHSOAC) • California Institute for Behavioral Health Services (CIBHA) National Alliance on Mental Illness (NAMI) California National Council for Behavioral Health