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Adopt a resolution adding the oversight of substance use services under the Mental Health Advisory Board and renaming it to the Behavioral Health Advisory Board (BHAB), thereby consolidating the functions of the Alcohol and Drug Advisory Board into the new Behavioral Health Advisory Board, consisting initially of the existing membership from the Mental Health Advisory Board; Adopt new BHAB bylaws; and Authorize the recruitment for the new BHAB member categories
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Published Notice Required? Yes _____ No __X___
Public Hearing Required? Yes _____ No __X___
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services (H&SS) recommends that the Board of Supervisors:
1) Adopt a resolution adding the oversight of substance use services under the Mental Health Advisory Board and renaming it to the Behavioral Health Advisory Board (BHAB), thereby consolidating the functions of the Alcohol and Drug Advisory Board into the new Behavioral Health Advisory Board, consisting initially of the existing membership from the Mental Health Advisory Board;
2) Adopt new BHAB bylaws; and
3) Authorize the recruitment for the new BHAB member categories.
SUMMARY:
The authority of the Solano County Mental Health Advisory Board was established pursuant to the Bronzan-McCorquodale Act which may be found at Part 2 of Division 4.7 of the California Welfare and Institutions Code (commencing at section 5600 et seq.). The board is a mandate as part of the County’s contract with the State to provide specialty behavioral health services. Solano County’s Mental Health Advisory Board was established in 1977. The last update to the bylaws was in 2014. Since then, the State law has changed, and the bylaws have been revised to reflect those changes.
The Mental Health Advisory Board approved the BHAB bylaws (Attachment C) at its meeting on October 17, 2023. However, technical/clerical changes were made to correct non-substantive errors, to define the reference to “BHSA” as the Behavioral Health Services Act (SB 326), and to change the bylaws date (from November to December) to align with the month the bylaws are coming before the Board of Supervisors for consideration. The Board of Supervisors is asked to adopt these corrected BHAB bylaws (Attachment B).
FINANCIAL IMPACT:
The cost associated with preparing this agenda item is nominal and absorbed by the Department’s FY2023/24 Working Budget. There is no financial impact for this decision.
DISCUSSION:
County behavioral health agencies are required to maintain a Mental Health Advisory Board per Welfare and Institutions Code section 5604. Many counties now have integrated mental health and alcohol and drug boards to reflect the change in terminology and national standards under the “behavioral health” umbrella. Since there is no statutory requirement to have a stand-alone drug and alcohol advisory board, per California Association of Local Behavioral Health Boards and Commissions (CALBHB/C), as of 2022, over 50% of the local boards/commissions have merged (35 of 59) to advise regarding both alcohol and drugs and mental health.
There are also programmatic and clinical mandates in relation to integration of mental health and substance use. The H&SS Behavioral Health Division was renamed and supports both mental health and substance use services and is now clinically integrated to serve and link those participants with appropriate services. The Behavioral Health Division manages a variety of substance use related funding to ensure integration of services and effectiveness and provides oversight of the intergovernmental agreement contract between the Department of Health Care Services (DHCS) with Partnership HealthPlan of California under the Organized Delivery System (ODS) State waiver for Drug Medi-Cal (DMC) services in 2020. Additionally, under California Advancing and Innovating Medi-Cal (CalAIM), the State’s Medi-Cal reform, it is a requirement that by January 2027 there will be full administrative integration of specialty mental health and substance use disorder services through coordinated treatment across the continuum of care, streamline contracting, data sharing, compliance, and beneficiary information.
Integration of substance use services has been prominent in every aspect of the State’s Behavioral Health Reform. Currently, the Mental Health Services Act (MHSA) funds a large portion of mental health services. Proposition 1, if approved by the voters at the March 5, 2024 statewide primary election, and new legislation enacted under SB 326 “The Behavioral Health Services Act” (signed by the Governor on October 12, 2023 and effective immediately) would recast the MHSA by, among other things, renaming it the Behavioral Health Services Act (BHSA), expanding it to include treatment of substance use disorders, changing the county planning process, and expanding services for which counties and the State can use funds. To affirm current efforts towards integration and in anticipation of these legislative changes, the H&SS Behavioral Health Division is recommending updating the bylaws of the Mental Health Advisory Board.
Included in SB 326 is the requirement that each county have a “behavioral health board” instead of a “mental health board.” Behavioral health encompasses both mental/emotional well-being and substance use. Effective January 2025, Welfare and Institutions Code section 5604 clarifies that the behavioral health board shall review and evaluate the local public mental health system and review and evaluate the local public substance use disorder treatment system. The behavioral health board shall advise the governing body on community mental health and substance use disorder services delivered by the local behavioral health agency. Because of the inclusion of substance use disorders in the purview of the behavioral health board, the Behavioral Health Division recommends that the current Mental Health Advisory Board and the Alcohol and Drug Advisory Board be consolidated into one new Behavioral Health Advisory Board and the existing members of the Mental Health Advisory Board be appointed to the new Behavioral Health Advisory Board.
Membership revisions to the bylaws include:
Veteran/Veteran Advocate: The law now requires at least one member of the board to be a veteran or veteran advocate in counties with a population of over 100,000. “Veteran advocate” means either a parent, spouse, or adult child of a veteran, or an individual who is part of a veterans’ organization, including the Veterans of Foreign Wars or the American Legion. The county will notify the veterans service officer about vacancies on the board.
Youth: Amongst the 50% of the membership who are consumers, or the parents, spouses, siblings, or adult children of consumers, who are receiving or have received behavioral health services, the law requires at least one of these members be an individual who is 25 years of age or younger.
Lived Experience with Substance Use: A minimum of three members shall have experience with a substance use disorder (SUD) through professional experience or lived experience (a minimum of one year in recovery is required for individuals with lived experience of SUD as indicated in their application). This would include members of the community who engage with individuals living with mental illness or substance use disorder in the course of daily operations, such as representatives of county offices of education, large and small businesses, hospitals, hospital districts, physicians practicing in emergency departments, city police chiefs, county sheriffs, and community and nonprofit service providers.
Local Education Agency: At least one member of the board shall be an employee of a local education agency. The legislative intent is for counties to give a strong preference when appointing a local educational agency member to individuals who have experience providing mental health services to students.
Currently, the Mental Health Advisory Board has eight members, one of which must be a Board of Supervisor representative. Of the eight, one is a veteran, two have lived experience with mental health and substance use, one has lived experience with mental health, and five are family members (many hold multiple lived experiences). The new membership would require recruitment of, at a minimum, an additional person with substance use disorder experience, a young adult under 25, and a member of the local education agency. The Board has already discussed convening its Membership Committee in January 2024 to begin recruitment efforts and marketing/education to help the community understand the responsibilities and roles of the Board and also ensure diversity and representation across demographic and cultural groups.
ALTERNATIVES:
The Board could choose not to approve of the consolidation of the two advisory boards into the new Behavioral Health Advisory Board or the updates to the bylaws, but this is not recommended as these changes conform to SB 326 and CalAIM and include the new categories of membership.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed the revised bylaws. Current and recently expired ADAB members were notified in advance of this item and the proposed recommendation.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION