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MENTAL HEALTHSERVICES ACTTHREE YEAR PLAN
Carol Burton, Interim Director
Tracy Hazelton, MHSA Division Director
Cecilia Serrano, Assistant Finance Director
Alameda County FY18-20 MHSA Three Year PlanBoard of Supervisors’ Health Committee March 26, 2018
Mental Health Services ActWhat is it?
MHSA emphasizes Transformation of the Mental Health System and Improving the Quality Of Life for people living with mental illness
In 2004, Alameda County voters overwhelmingly approved Prop 63 Supported by 54% of California voters and 66% of Alameda County
voters Funded by 1% tax on individual incomes over $1 million
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MHSA: What is the budget?
FY 17-18 Approved Budget of $451.2M 600 County Civil Service positions 3,000+ positions with community-based providers
MHSA Annual Budget is $83.8M (approximately 18% of the BHCS Total Budget)
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MHSA: Who Does It Serve?
Individuals with serious mental illness (SMI) and/ or severe emotional
disorder (SED)
Individuals not served /underserved by current mental health system
Voluntary services
Non-supplantation: MHSA may not replace existing program funding
or used for non-mental health programs
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MHSA: Regulations
COMPONENT RESTRICTIONSCommunity Services & Supports (CSS)
• 50% must be spent on “Full Service Partnership clients”
Prevention & Early Intervention (PEI)
• 20% of total allocation must be spent on PEI
• >50% must be spent on activities that serve clients age 25 or younger
Innovative Programs(INN)
• 5% of total allocation must be spent on INN
• Must be spent on one-time innovative projects that address a “learning question” with duration of no longer than 5 years
Workforce Education & Training, Capital Facilities/ Technology
• 10 year spending plan
• Can choose to add up to 20% of previous 5-year allocation average to Capital Facilities, Workforce Development or Prudent Reserve
All MHSA funds
• Supplantation is not allowed
• Counties are required to conduct a Community Program Planning (CPP) input process every 3 years in relation to their Three Year MHSA Plan
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MHSA: Five Plan Components
Community Services & Supports
(2006)
Prevention & Early
Intervention(2008)
Workforce,Education &
Training(2009)
Capital Facilities & Technology
(2009)
Innovative Programs
(2010)
31 ongoing programs
29 ongoingprograms
9 programs and strategies
1 site / EHR project
Multiple time-limited projects
$55.0Mannually
$26.3Mannually
$7.6Mover 10 years
$16.2Mover 10 years
Varies based on projects
Plan Approval Timeline
MHSA: FY 18/20 Three Year Plan
January 12 – February 16, 2018 30 Day Comment Period
February 16, 2018 Mental Health Advisory Board
March 26, 2018 Board of Supervisors – Health Committee
April 2018 Full Board of Supervisor Approval
MHSA Three Year Plan is submitted to the Department of Health Care Services & the Mental Health Services Oversight and
Accountability Commission
MHSA: FY18-20 Three Year PlanStakeholder Input Process
Outreach • 1,000 invitations and MHSA Surveys
Community Input• 5 large Community Input Forums (1 in each Supervisorial District) with
interpretation (250+ attendees)
• 18 Community Focus Groups (138 participants)
• 550 MHSA Surveys Completed
87% 1st Time Participants
MHSA: Stakeholder InputChildren, Youth & Transitional Age Youth
PRIORITY MENTAL HEALTH NEEDS
MHSA PROGRAMS
Suicide Current MHSA Programs: Suicide Prevention trainings, Crisis Hotline, Teen Text Line & Willow Rock Crisis Stabilization and Residential programs
Community Violence & Trauma
Current MHSA Programs: Full Service Partnerships,Youth Center MH programming, & multiple trainingcurriculumsPending: INN proposal focused on African American TAY
Homelessness Current MHSA Programs: Full Service Partnerships & Housing ServicesPending: TAY Residential Services
MHSA: Stakeholder InputADULTS & OLDER ADULTS
PRIORITY MENTAL HEALTH NEEDS
MHSA PROGRAMS
Homelessness Current MHSA Programs: MHSA PermanentSupportive Housing, Full Service Partnerships, Intensive Outreach programs & Primary Care Clinic (Trust Clinic)
Domestic Violence Current MHSA Programs: Crisis Stabilization Services
Suicide Current MHSA Programs: Crisis Stabilization Services, Mobile Crisis, LGBT Peer Support, Suicide Hotline, Crisis Intervention Training, grief counseling & suicide prevention trainingsPending: Expanded Mobile Crisis Teams & Mobile Evaluation & Zero Suicide Initiative.
MHSA: Stakeholder InputUnderserved Populations
PRIORITYPOPULATION
MHSA PROGRAMS
PersonsExperiencing Homelessness
Current MHSA Programs: MHSA Permanent Supportive Housing, Full Service Partnerships, Intensive Outreach programs & Primary Care Clinic (Trust Clinic)
Personsexperiencing Mental Health Crisis
Current MHSA Programs:: Crisis Stabilization/ Residential Services; Intensive Outreach; Assisted Outpatient Treatment, Community Conservatorship & Post Crisis Peer MentorshipPending: New INN proposal to assist and transport adults in crisis to the appropriate setting
Older Adults Current MHSA Programs: Full Service PartnershipsMobile Mental Health Services; Older Adult LGBT Peer Support & an Older Adult Service Team
Immigrants/ Refugees
Current MHSA Programs: Underserved Ethnic Linguistic Pop.Pending: INN 5 Grants - API and Refugees to increase system engagement
Effectiveness in AddressingMental Health Needs
Top Ranked MHSA Programs*Full Service Partnerships
Family Education and Resource Centers Integrated Behavioral Health and Primary Care
Suicide PreventionSchool-based Mental Health Services
*On our Community Input Survey, individuals were asked to identify MHSA programs that they thought were effective, in addressing local MH concerns and negative outcomes that may result from untreated mental illness
COMMUNITY SERVICES & SUPPORTS FY18-20 Plan Changes
Full Service Partnerships (FSP) – Expansion and RFP Total 14 teams with up to 50 clients per team
MH Services focused towards the African American Community Re-entry Mental Health Services Support Services at MHSA Housing sites Training/ TA on accurate diagnosis & treatment and healing practices
Older Adult Service Team FY18-19 New Older Adults Service Team will serve approximately 60 clients
per month
COMMUNITY SERVICES & SUPPORTSFY16-17 FSP Outcomes Ten FSP Programs serving: TAY, Adult, Older Adult, Forensic,
Chronically Homeless FSP Clients Served: 843 individuals
FSP Criteria
FSP Outcomes
(Avg)Reduction in Hospital Days 65%Reduction in Hospital Admits 35%Reduction in PES (Psych. Emergency) 57%Primary Care Linkage w/in 12 mo. 95%Income increase within 12 mo. 62%
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PREVENTION & EARLY INTERVENTION
The MHSA allocates a minimum of 20% of the Mental Health Services Fund to counties for Prevention & early Intervention (PEI) as a key strategy to:
Prevent mental illness from becoming severe and disabling and
Improve timely access for underserved populations.
Prevention Early Intervention Outreach Access &
LinkageStigma &
DiscriminationSuicide
Prevention
12 ongoing programs
3 ongoingprograms
8 ongoingprograms
4 ongoingprograms
1 ongoingprogram
1 ongoing program
MHSA PEI CategoriesFY 17/18 $26,388,585
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• Underserved Ethnic & Linguistic Populations
• AfricanAmerican Culturally Responsive Services
• RFP in FY 17/18
Request For Proposal released in FY17-18: Expansion of Ethnic and Underserved Linguistic
Populations (UELP) will serve: • Afghan, African, Asian, Native American, Native
Hawaiian/Pacific Islander, Filipino, South Asian and Southeast Asian
New PEI Programs focused on the African American Community
PREVENTION & EARLY INTERVENTIONFY18-20 Plan Changes
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UnderservedEthnic & Linguistic Populations (UELP)
• Afghan/ S. Asian• Asian/ Pacific
Islander• Native
American• Latino
UELP Strategies: Outreach & Engagement Mental Health Consultation Early Intervention Services
FY16-17 Outcomes: 7,244 Prevention events served 39,188 clients 659 Early Intervention clients were served
As a result of PEI services clients reported:– Increased ability to deal with a crisis – Improved access to resources for their families– Decreased internalized stigma – Increased access to mental health services
PREVENTION & EARLY INTERVENTION FY16-17 Outcomes
WORKFORCE EDUCATION TRAINING FY 18-20 Plan Changes
FY 17-18: Completing its ten-year block grant from the Mental Health Services Act
Completing assessment of workforce and training needs with BHCS county and contracted community based organizations (CBOs) through an online survey and focus group to gather feedback from stakeholders
Data from the WET assessment will determine the next phase of Workforce and Training for BHCS
WORKFORCE EDUCATION TRAINING FY16-17 Program Outcomes
Internships– Graduate Intern Stipend Program: Awarded 20 stipends in the
amount of $6,000 for 720 internship hours worked Educational Pathways
– Implemented Summer Career Exploration program to high school students from diverse background
– Piloted mental health paraprofessional leadership training program for unserved and underserved immigrant and refugees
– Piloted program for training to consumers who will receive Medical Assistant certification with placement in primary care facility
Financial Incentives– Implement the State Mental Health Loan Assumption Program
for 50 clinicians
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INNOVATIVE PROGRAMSFY18-20 Plan Changes
Round Five Innovation 18-month Grants
Suicide Prevention, Zero Suicide Initiative Behavioral/Mental Health Career Pathways for high school
and Undergraduate Students Mental Health Technology Applications Final Round of Innovations in Reentry API/ Refugees: RFP to be released in 2018
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Round Two Innovations in Re-entry Highlights
2016-2017: Projects to develop toolkits and program models for Re-entry population:
• Increase Stakeholder Engagement and Capacity • Reentry Workforce Development for Peer Services • Medi-Cal Billing Readiness Assessment Tool
INNOVATIVE PROGRAMFY16-17 Program Outcomes
INNOVATIVE PROGRAMSProposals In Development
Crisis: Community Assessment and Transport Team (CATT)
SUD: Cannabis Education Program for TAY with Mental Health Challenges
Trauma: Introducing Neuroplasticity to Mental Health – A Holistic Approach to Intervening with Children
Trauma: TAY Emotional Emancipation Circles
INNOVATIVE PROGRAMSProject Approval Process
FY18-19 Project Timeline for NEW INN Programs
October-March Develop Draft INN Proposals
April – May Community & Stakeholder Input on INN Proposals
June - July Board of Supervisors Approval
August-September • INN Proposal Presentation to MHSOAC• INN Plan Submittal to State
• Note: INN Funds cannot be spent until the Mental Health Services Oversight and Accountability Commission approves the project(s).
Mental Health Services Act FY 18-20 Fiscal OverviewMHSA Funding Estimates for CSS, PEI, INN (in millions)
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Sources FY 17/18 FY 18/19 FY19/20
Available Unexpended Funds $63.54 $47.43 $26.47 MHSA State Allocation $67.30 $66.67 $69.04 Interest Earned $0.53 $0.40 $0.28
Total Available in MHSA Trust Fund $131.37 $114.50 $95.79
Budgeted Expenses FY 17/18 FY 18/19 FY 19/20
MHSA Programs (CSS, PEI, INN) $83.86 $87.95 $88.53
Designated Prudent Reserves (includes interest) $0.08 $0.08 $0.08
Total Budgeted Expenses $83.94 $88.03 $88.61
YEAR-END UNEXPENDED FUNDS $47.43 $26.47 $7.18
69.0
88.5
36.4
7.2
- 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0
100.0
BHCS Long Range MHSA Funding Estimates for CSS, PEI, INN (in millions)
MHSA Allocation Expenditures Prudent Reserve Available TF- - - Dotted lines denote FY estimates
Mental Health Services Act
Mental Health Services ActPrudent Reserve (in millions) Counties must establish and
maintain a Prudent Reserve (PR) to ensure the county program will continue to serve the MHSA target populations in which revenues for the MH Services Fund are below recent averages Counties may fund the local
prudent reserve to a level the county determines is appropriate and consistent with Welfare Institution Code (WIC) BHCS FY 17/18 Prudent Reserve is
$36.3 million at 46.5%
12.6
18.0
27.1
36.2 36.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
9/10
10/1
111
/12
12/1
313
/14
14/1
515
/16
16/1
717
/18
18/1
919
/20
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Insert pages included in Bay Area News Group PublicationsAll inserts are also posted on our MHSA website
www.ACMHSA.org
MENTAL HEALTH SERVICES ACTMaking a Difference in Alameda County