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Santa Clara County Mental Health Services Act

Presentation to Silicon Valley Council of Nonprofits

Department of Mental Health

March 17, 2005

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Presentation ObjectivesOverview Mental Health Services Act

Overview Santa Clara MHSA Planning Process and Approach

MHSA Opportunities for Local Providers

SVCN Input to Priority Community Concerns

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Overview Mental Overview Mental Health Services ActHealth Services Act

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The Opportunity

Social Analysts revealed flaws in current system, providing objective evidence of negative individual, social, and financial outcomes resulting from neglect of the mental health of our citizens (Little Hoover Commission; President’s New Freedom Commission; IOM Crossing the Quality Chasm)

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The OpportunityLocal systems stretched beyond capacity and unable to meet demand

Administrators distracted by burdens of bureaucracy and financial crisis and uncertainty

Clinical leaders preoccupied with operational demands; unable to focus on effective quality improvement efforts that insure excellence in practice and optimal client outcomes.

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The OpportunityConsumers and family members without adequate care are demanding:

Mental health be addressed with the same urgency as health care

Freedom from stigma

A path to recovery and wellness

Excellence in service

Inclusion as partners in their own care and in the service delivery system

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The OpportunityAdvocates and Stakeholders have presented the issues to Californians offering 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.

Providing System Stakeholders a Window of Opportunity to Make Far-Reaching Change

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MHSA Funding1% 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.”

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Nine Categories of Expenditures

1. Local Planning

2. Services to Children

3. Services to Adults & Older Adults

4. Innovative Programs (within 1&2)

5. Prevention and Early Intervention

6. Education and Training

7. Capital and Technology

Development

8. State Planning and Administration

9. Prudent Local Reserves

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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 – 800 Million)

10% - Education & Training10% - Capital and Technology 50% - Children, Adult, Senior Services 5% - Innovative Programs20% - Prevention and Early Intervention 5% - State Administration

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MHSA is Intended to 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

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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

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MHSA in PerspectiveCA 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.

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The MHSA VisionDMH: “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.”

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The MHSA Vision Outlines Transformation Areas: Consumer and Family Participation and

Involvement

Programs and Services

Community Partnerships

Cultural Competence

Outcomes and Accountability

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Overview Santa Clara MHSA Planning

Process and Approach

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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

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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

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Board of Supervisors

State Dept. ofMental Health

BOS Committees(HHC, CSFC, PSJC)

County ExecutiveSCVHHS Exec. Dir

MHSA StakeholderLeadership Committee

Data, Technology,

Budget Work Group

Prevention & Early

InterventionWork Group

Children’s System of Care Work

Work Group

Adult/Older Adult

System of Care Work Group

Community Stakeholder Forums, Focus Groups, and Consumer Engagement Groups

Cultural Competency Readiness Forums Recovery/Self Help Readiness Forums

FocusGroup

FocusGroup

FocusGroup

FocusGroup

FocusGroup

Accountability Commission

Mental Health Board

Project Management

Team

Santa Clara CountyMHSA Planning

Structure

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The Process - Santa Clara County Partial List of Stakeholders

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

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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

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Planning Steps

Affirm System Values and Philosophy

Access and Choice

Cultural Proficiency

Early Identification

Family-Driven

Collaborative

Individualized Plans

Community Based

Strengths Based

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Planning Steps - Framework

Determine and Prioritize Local Mental Health Needs

Prevention

Early Intervention

Intervention

All Citizens Across Lifespan

Citizens in need

Unmet Need

Current Public MH System

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Planning StepsLifespan Framework

Children, Youth and Young Adults

0 - 5 years 6 - 11 years12 - 15 years16 - 25 years

Adults and Older Adults

26 – 35 years36 – 49 years50 – 59 years60 + years

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Planning Steps - System Framework

Establish System Structure and Stakeholder Involvement

Individual & Family

Provider Services

System Policy and

Management

Sta

keh

old

ers

System Performance: Expectations & Results

Provider Performance: Expectations & Results

Client Level Outcomes: Expectations & Results

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Planning Steps - Planning Steps - AccountabilityAccountability

Demonstrate process quality and favorable outcomes

Who Do We Serve?

What Are We Trying to Change?

What Practices Do We Employ and Why?

How Do We Insure Quality of Practices?

How Do We Measure Results?

What Results Do We Achieve?

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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

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MHSA Requirements Community Services

and Supports Plan – 1st Phase

Expansion & Transformation of Expansion & Transformation of Direct Service System – Est. $10-18 Direct Service System – Est. $10-18

Million for Santa Clara CountyMillion for Santa Clara County

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Key Elements

Funds two components: Services to New Enrollees for Four Age Groups System Capacity (Change)

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

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DMH “Logic Model”Logic models display program components in a logical flow:

Identify community issuesAssess unmet mental health needsDecide on focal populationsIdentify strategies for system capacityAssess system capacityDevelop workplanDevelop budget

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Children, Youth & 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

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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

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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.

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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.

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Counties Must Prioritize Concerns

Plans must be geared to impact negative effects of untreated mental illness for all ages, and must address:

Homelessness Inability to work Isolation IncarcerationInstitutionalizationInability to be in normal school environmentschool failureRemoval from home/parentsRisk of juvenile justice involvementOther concerns identified by stakeholders

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Determining Critical Concerns

Health & Well

Being

Stable Home, Family, Social

Relations

Meaningful School, Work

Activity

Safe From Harm or

Harming in Community

Suicidal Emotional Suffering SA Addicted

Physically Unhealthy

Thriving With Mental Illness

Failing With Untreated and Under-treated Mental Illness

Homeless, Isolated,

Sexual Survival Removed Child

Stable Home, Close Friends & Family

Safe Relationships

Emotionally Content SA Remission Physically Healthy

Jobless Adult Inactive Senior

School Failing Child

Jailed Adult Victimized Senior Delinquent Child

Employed Adult Active Senior

Child in School

Out of Jail Safe from Stigma

Out of Trouble

Low Need

Hi Need

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MHSA Opportunity for Local Providers

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MHSA Offers Local Providers

Opportunity to Engage To Become Involved as Stakeholders

To Educate and Inform Your Boards, Staff and Families, and Business Partners

To Actively Involve Your Consumers and Families

To Actively Partner With System Players in Your County

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MHSA Offers Local Providers

Opportunity to Learn and Assess Understand Stakeholder Views

Know the System and Community

Understand Consumer Opinions and Needs

Learn Most Effective Strategies and Competencies that Meet Needs

Assess Agency Strengths and Weaknesses Relative to Transformation Expectations

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MHSA Offers Local Providers

Opportunity to Prioritize and Plan

Revisit Mission and Business Objectives

Affirm Practice Philosophy, Values and Process

Outline Cultural Competency Objectives

Articulate Process Standards and Outcome Expectations and Track Results

Determine Infrastructure Needs to Maintain Process Standards and Achieve Outcomes

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MHSA Offers Local Providers

Opportunity to Implement Changes

Establish Family Partnerships

Restructure care planning process

Implement Cultural Competency Initiatives

Implement Process Improvement Strategies

Evaluate & Report Service Outcomes

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MHSA Next StepsWork Groups Being FormedExtensive Inreach & Outreach LaunchedIdentify Critical Concerns by AgeResearch Best Practice StrategiesPrioritize & Determine Three-Year PlanSubmit Services & Supports Plan – 10/05

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Input from SVNP Memberson Critical Needs

For More Information:

Nancy Pena, Ph.D., Director, MHD, 408-885-5783Sheila Yuter, MHSA Coordinator, 408-885-3885

Santa Clara County MHD Website www.sccmhd.govState Dept. Mental Health website www.dmh.ca.gov