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Approve the Mental Health Services Act Annual Update for FY2023/24 including a review of services rendered in FY2022/23
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Published Notice Required? Yes _X____ No ____
Public Hearing Required? Yes __X___ No ____
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services (H&SS) recommends that the Board of Supervisors approve the Mental Health Services Act (MHSA) Annual Update for FY2023/24 including a review of services rendered in FY2022/23.
SUMMARY:
In November 2004, California voters passed Proposition 63, which imposes a one percent income tax on personal income in excess of $1 million to provide funding to support county mental health programs through five funding streams: Prevention and Early Intervention (PEI), Community Services and Supports (CSS), Innovation (INN), Workforce Education and Training (WET), and Capital Facilities and Technological Needs (CFTN). Using this funding, MHSA programs address a broad continuum of prevention, early intervention, and direct services, along with the necessary infrastructure, technology, and training elements to effectively support the mental health system. Counties administer MHSA programs and are required to create and implement, with the local community input, three-year integrated plans.
The Solano County Board of Supervisors approved the MHSA Three-Year Plan for FY2020/21 through FY2022/23 (Attachment B) on January 26, 2021. In accordance with Title 9 of California Code of Regulations, sections 3300 and 3315, the MHSA Annual Update for FY2023/24 was developed through a comprehensive community program planning process with community input gathered through four community meetings, including one virtual meeting, which took place between June 10, 2024 and June 18, 2024. A public hearing was conducted on June 18, 2024, in partnership with the local Mental Health Advisory Board, to review and endorse the Annual Update. There was a lot of discussion during the public hearing and no written public comments were received. On July 10, 2024, the draft version of the Annual Update (Attachment A) was posted online for a mandatory 30-day public review and comment period.
On September 12, 2023, the Board approved the MHSA Three-Year Plan FY2023-2026, which covers FY2023/24, FY2024/25, and FY2025/26. In March 2024, voters approved Proposition 1, which makes significant revisions to the Mental Health Services Act and renamed the Mental Health Services Act (MHSA) to the Behavioral Services Act (BHSA). Proposition 1 is aimed at improving access to behavioral health services and expanding services to include substance use disorder treatment. The planning process for full implementation of Proposition 1 will begin in January 2025 and implementation will begin July 1, 2026.
FINANCIAL IMPACT:
All programs and services described in the Annual Update of the Three-Year Integrated Plan are funded with MHSA revenue and revenues generated through Medi-Cal billing. The total expenditures reported for MHSA programs in the FY2022/23 Annual Revenue and Expenditure Report were $35,190,612, of which $24,304,245 was funded with MHSA revenue. The remaining expenditures in the amount of $10,886,367 were primarily funded through federal Short Doyle Medi-Cal and third-party payors. There is no financial impact to the County General Fund.
DISCUSSION:
The MHSA Three-Year Plan and the current Annual Update outline a continuum of care which is comprised of prevention, early intervention, intensive treatment, and recovery services, as well as targeted strategies to improve the system as a whole, to reduce disparities and to develop and train the workforce. MHSA has five major components, and the following information includes descriptions of each component and programs funded under each component.
Prevention and Early Intervention (PEI) - requires the County to engage in community-wide stigma and suicide reduction, and to focus on preventing mental illness from becoming severe and disabling for consumers of all ages, and in particular, youth under the age of 25. Solano County’s PEI funds are used for the following six regulatory approaches for PEI programs and services:
1. Suicide Prevention - suicide prevention strategies include community-wide suicide prevention and stigma reduction efforts such as providing evidence-based mental health and suicide prevention training, guns safety campaign, observance of National Suicide Prevention Week, improving the suicide screening process by adding new questions, continuing the Each Mind Matters campaign, availability of community-based Mobile Crisis program, availability of crisis transport, and availability of school-based mobile crisis in partnership with Solano County Office of Education (SCOE) which is funded by Mental Health Student Services Act Grant (MHSSA).
2. Stigma and Discrimination Reduction - support local schools in partnership with SCOE and local school districts in providing stigma reduction training, improving the 35 school-based wellness centers, continued collaboration with California Mental Health Services Authority (CalMHSA) community-wide stigma reduction efforts, strengthening the family and peer support program in partnership with community-based agencies, and providing timely and adequate stigma and discrimination reduction services for the African American, Asian American Pacific Islanders, Latino/Hispanic, and Native Indigenous communities in Solano County.
3. Outreach for Increasing Recognition of Early Signs of Mental Illness - continue providing evidence-based training such as Be Sensitive Be Brave for Mental Health and Suicide Prevention and giving access to asynchronous training.
4. Access and Linkage to Treatment - continue the Triple P parenting curriculum, an evidence-based parent education model for the needs of children ages birth to 5 years and their families, funded in partnership with First 5 Solano.
5. Prevention - continue the partnership with Solano Pride and other community-based agencies in providing LGTBQ+ outreach and program access, expand collaboration with SCOE for the school-based mobile crisis by providing an additional PEI-funded clinician, continue partnership with community-based agencies to provide older adult peer to peer program and enhanced cooperation with SCOE and community-based agencies in providing mental health prevention training and services in selected school sites in Solano County.
6. Early Intervention - continue providing support for the pregnant and post-partum maternal program in partnership with Solano County Public Health, an enhanced partnership with the University of California at Davis (UCD) and community-based organizations in providing early psychosis treatment program, older adult case management and treatment and improved collaboration with SCOE and community-based agencies in providing early intervention mental health training and services in selected school sites in Solano County.
Community Services and Supports (CSS) - provides intensive services for children with serious emotional disturbance and adults with persistent and severe mental illness and at least 51% of the funding must be allocated to the provision of Full-Service Partnership (FSP) programs. Solano County’s CSS funds are used for the following programs/strategies:
1. Full-Service Partnership (FSP) programming - continue partnerships with community-based organizations and enhanced services of Health and Social Services, Behavioral Health in providing intensive services for children and youth, Transition Age Youth (TAY), and adults such as educational support, family stabilization, and linkage to substance abuse services to reduce or prevent hospitalizations, involvement in the juvenile justice systems and to avoid homelessness and placement loss.
2. General Systems Development - continue providing crisis services and support through the Crisis Stabilization Unit (CSU), operating 24 hours a day, seven days per week, and the Crisis Aftercare and Relapse Prevention team strategy to reduce recidivism/reentry to inpatient facilities. Provide programs focused on values of wellness and recovery through the County Wellness and Recovery Unit (WRU) and in partnership with community-based agencies with services for peer consumer support groups and employment and educational programs for individuals with psychiatric and co-occurring challenges. Provide targeted system support through the three County operated regional adult outpatient clinics and in partnership with community-based agencies to provide intensive case management services 1-2 times a week and continue collaboration with community-based agencies in providing intensive program services for children ages three to six years with complex mental health diagnosis. The three-year plan will continue to support outpatient mental health services for children and adolescents ages 6-21 years who have been identified as the Katie A. subclass or referred by Solano County Child Welfare Services or Solano County Behavioral Health and the jail release re-entry and diversion for adults who have mental health and co-occurring conditions and are incarcerated.
3. MHSA Housing - in partnership with community-based agencies, continue to provide transitional and permanent housing to individuals with serious mental illness (SMI) to prevent homelessness, hospitalization, and involvement in the justice system.
4. Outreach and Engagement - provide training and presentations to the community at large, screenings, referrals and linkages, brief case management, interpreter services, and cultural brokering for consumers actively engaged in the County’s behavioral health system.
Innovation (INN) - requires implementation of innovative demonstration projects identified by local members that will support system improvements, increase access to services for the underserved and unserved communities, and improve consumer outcomes. Solano County conducted a separate community program planning process as required by statute to identify new INN project(s) to start in FY2023/24. Solano County’s INN funds have been used for the following State approved INN project:
1. The Early Psychosis Learning Health Care Network (EP LHCN), a statewide learning collaborative, developed an application-based screening tool that gives clinicians easy access to consumer-level data for real-time data sharing with consumers, allowing programs to learn from each other through a training and technical assistance collaborative. This INN project was completed on June 30, 2024, and new INN projects will be developed for FY2024/25.
Workforce Education and Training (WET) - provides countywide training and skills building, including training in evidence-based strategies for the local mental health workforce and partnering professionals. This component has not been funded by the State since 2014, but counties may transfer funds from CSS to this component.
Capital Facilities and Technological Needs (CF/TN) - provides funds for the acquisition and renovation of facilities, including housing with supportive services for seriously mentally ill consumers. CF/TN also provides funding for electronic health record (EHR) systems, data measurement and outcome tools. This component has not been funded by the State since 2014, but counties may transfer funds from CSS to this component.
MHSA funding is greatly impacted by the economy and is unpredictable. In addition, Proposition 1 will impact the funding distribution of the MHSA components, will require shifting funding and may necessitate reductions to specific programs that fall under the PEI. The MHSA coordinator will work to keep community partners apprised of potential local impacts and work collaboratively to ensure there is appropriate community engagement in ongoing program planning efforts. Behavioral Health will continue to closely monitor the budget and if the fiscal landscape changes, will adjust accordingly to ensure Solano County’s most vulnerable populations receive the service and supports they need. The annual updates will be particularly important during the course of the MHSA Three-Year Plan FY2023/2026 as the actual dollars available become known over the course of the Plan.
ALTERNATIVES:
The Board may choose not to approve the Annual MHSA Update. This is not recommended as the Annual Update has been developed in accordance with the provisions of the MHSA, including significant community input, and the endorsement of the Behavioral Health Advisory Board. Not approving the Annual Update would put the County out of compliance with MHSA requirements.
OTHER AGENCY INVOLVEMENT:
The MHSA Annual Update was developed in collaboration with community partners, which included consumers, family members, county and community-based providers, law enforcement, local educational agencies, veterans, faith-based organizations, and the local Behavioral Health Advisory Board.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION