Santa Clara County Mental Health Services Act Santa Clara County Collaborative

1. Santa Clara CountyMental Health Services ActSanta Clara County Collaborative March 17, 2005 Department of Mental Health

2. Overview Mental Health Services Act

3. MHSA Funding • 1% tax on taxable personal income over $1 million to be deposited into a Mental Health Services Fund (MHSF) in State Treasury • Administered by State Department of Mental Health • Oversight by 16-Member Accountability Commission • Distributed to Counties Via Current State-County Contract • $300 Million in FY05; $700 Million Est. in FY06 • Is used to expand, not supplant services; can “not be used to supplant existing state or county funds utilized to provide mental health services.”

4. Nine Categories of Expenditures • Local Planning • Services to Children • Services to Adults & Older Adults • Innovative Programs (within 1&2) • Prevention and Early Intervention • Education and Training • Capital and Technology Development • State Planning and Administration • Prudent Local Reserves

5. Initial Funding FY04-08 • FY04-05 funds (est. $300 Million) 45% - Education and Training (DMH fund) 45% - Capital Facilities Technology (DMH fund) 5% - Local Planning (to counties) 5% - State Implementation (to DMH Admin). • FY06, FY07 and FY08 (est. $600 – 700 Million) 10% - Education & Training 10% - Capital and Technology 50% - Children, Adult, Senior Services 5% - Innovative Programs 20% - Prevention and Early Intervention 5% - State Administration

6. MHSA is Intendedto • Introduce effective new service models that promote well-being, recovery and self-help • Introduce prevention and early intervention to prevent negative impact of serious mental illness • Enhance human resource, technology and capital infrastructure of current system • Reduce stigma and change negative social perceptions of mental illness • Correct fragmentation and inadequate funding

7. Mental Health Prevalence Data • Research indicates the prevalence of mental illness in US is 8.55% (adjusted for age and ethnicity). • This equals 145,000 Santa Clara County residents, with 26,639 living at 200% or below of poverty. • Current SCC MH system serves 18,000 year, with less than 10,000 ongoing

8. MHSA in Perspective • CA public system had $3.1 Billion in expenditures in FY 2001/02. • MHSA is projected to provide $700 Million in new revenue in FY 2005/06 with est. 55% going to direct service expansion. • Initial full year will increase direct services by 15% • SCC share for first phase expansion of direct services is projected to be between $10 - $18 Million, depending on DMH allocation method.

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

11. Overview Santa Clara MHSA Planning Process and Approach

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

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. 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 & EarlyIntervention 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

15. 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

16. Planning Phases • Engagement and Commitment • Invite Stakeholder Involvement • Share Intent and Vision • Lay Out Planning Landscape • Learning and Assessment • Learn Current System • Learn Needs of Consumers, Stakeholders, Community • Learn Best Practice Strategies to Meet Needs • Prioritization and Planning • Establish Local Mission, Values & Transformation Objectives • Prioritize Local Needs • Select Most Effective Strategies to Meet Local Needs • Implementation • Obtain State Approval • Select Local Providers • Initiate, Monitor and Evaluate Services

17. Planning Steps • Affirm System Values and Philosophy • Collaborative • Individualized Plans • Community Based • Strengths Based • Access and Choice • Cultural Proficiency • Early Identification • Family-Driven

18. Planning Steps - Framework • Determine and Prioritize Local Mental Health Needs Current Public MH System Intervention Unmet Need Citizens in need Early Intervention Prevention All Citizens Across Lifespan

19. Children, Youth and Young Adults 0 - 5 years 6 - 12 years 13 - 17 years 18 - 25 years Adults and Older Adults 26 – 35 years 36 – 49 years 50 – 59 years 60 + years Planning StepsLifespan Framework

20. Planning Steps - System Framework • Establish System Structure and Stakeholder Involvement System Policy and Management System Performance:Expectations & Results Stakeholders Provider Services Provider Performance: Expectations & Results Individual & Family Client Level Outcomes: Expectations & Results

21. Planning Steps - Accountability • 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?

22. Planning Steps – Establish Priorities • Local System – Establish Desired Outcomes for All Ages (DMH Suggestions) • Meaningful Use of Time and Capabilities (school, work, activity) • Safe and Permanent Home • Network of Supportive Relationships • Access to Help in a Crisis • Reduction in Incarceration/Juvenile Justice Involvement • Reduction in Involuntary Services

23. Review of MHSA Requirements for First Phase Community Services and Supports Plan Expansion & Transformation of Direct Service System

24. Key Elements • Funds two components: • Services to New Enrollees for Four Age Groups • System Capacity • Plans must identify key community concerns • Plans must determine initial “focal populations” for MHSA funding by age group • Plans must refer to Cultural Competency Plan to address ethnic disparities • Plans must analyze need and unmet need by age, ethnicity and gender

25. DMH “Logic Model” • Logic models display program components in a logical flow: • Identify community issues • Assess unmet mental health needs • Decide on focal populations • Identify strategies for system capacity • Assess system capacity • Develop workplan • Develop budget

26. Children, Youth and Family Population • Focus on population for whom there are no other funding sources because they are ineligible for them or they need services which are not funded by existing sources. Must be unserved or underserved • In juvenile justice system • Placed out of county • At risk of out of home placement • Uninsured

27. Transition Age Youth (TAY) Between 16 and 25 who are Unserved or Underserved • Homeless or at risk of being homeless • Aging out of public systems such as child welfare • Have experienced their first major episode of mental illness

28. Adults with SMI Including Co-Occurring SA Who are Unserved or Underserved and: • Homeless or at risk of being homeless • Involved in the criminal justice system or at risk of such involvement and/or • At risk of institutionalization.

29. Older Adults 60 and Over With SMI, Including Co-occurring Disorders and: • Unserved or underserved and • Have a reduction in functioning • Are homeless or at risk of being homeless • At risk of institutionalization, nursing home care, hospitalizations, and ER services.

30. Determining Critical Concerns ThrivingWith Mental Illness Low Need Emotionally Content SA Remission Physically Healthy Stable Home, Friends & Family Safe Relationships Employed Adult Active Senior Child in School Out of Jail Safe from Stigma Out of Trouble Safe From Harm or Harming in Community Meaningful School, Work Activity Stable Home, Family, Social Relations Health & Well Being Suicidal Emotional Suffering SA Addicted Physically Unhealthy Homeless, Isolated, Sexual Survival Removed Child Jobless Adult Inactive Senior School Failing Child Jailed Adult Victimized Senior Delinquent Child Failing With Untreated and Under-treated Mental Illness Hi Need

31. Next Steps • Work Groups Being Formed • Extensive Inreach & Outreach Launched • Identify Critical Concerns by Age • Research Best Practice Strategies • Prioritize & Determine Three-Year Expansion • Submit Services & Supports Plan – 10/05