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