Title
Health and Human Services Agency (HHSA) recommending the Board:
1) Adopt the County’s Mental Health Services Act (MHSA) Fiscal Year (FY) 2019-2020 Annual Update;
2) Approve the following Innovation projects to be submitted to the California Mental Health Services Oversight and Accountability Commission (MHSOAC): and
a) Community-Based Engagement and Support Services, more commonly referred to as “Community Hubs.” This existing project was approved by the MHSOAC on August 25, 2016. HHSA is recommending proposed modifications to increase the project term by one (1) year (for up to $1,250,000 in FY 2020-2021) and to increase funding in FY 2019-2020 by up to $300,000;
b) The MHSOAC has contracted with Stanford University to provide technical assistance to counties for the implementation of the "allcove" project, which provides integrated mental health programs for youth to get early mental health care, primary care, early substance use treatment, and other services in support of youth mental health care;
c) Innovations to reduce Criminal Justice Involvement of People with Mental Health Needs, a data-driven project. The MHSOAC has already approved this Statewide project, and counties may join the collaborative project; and
d) Partnership between Senior Nutrition and Behavioral Health to reach home-bound older adults in need of mental health services (new proposal).
3) Authorize implementation of the MHSA FY 2019-2020 Annual Update through June 30, 2020, or until the FY 2020-2021 through FY 2022-2023 Three-Year Program and Expenditure Plan is adopted by the Board, whichever occurs later. (Est. Time 15 Min.)
FUNDING: State Mental Health Services Act 85%, Federal Grants 13%, AB 109 Realignment/State General Fund 1%, Miscellaneous/Fee-for-Service 1%.
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BACKGROUND:
California voters passed Proposition 63 (MHSA), in November 2004 and MHSA was enacted into law January 1, 2005. MHSA imposes a one percent (1%) tax on personal income above $1,000,000. The funds are distributed to the counties throughout the State and are intended to transform the mental health system into one that is focused on wellness, recovery and resiliency.
Under MHSA, each county is required to develop a Three-Year Program and Expenditure Plan (Plan), followed by two subsequent years of Annual Updates to the original Plan. The purpose of the Annual Update is to review existing projects and to make deletions, modifications, or additions to the original Plan. Therefore, planning, implementing, and updating each Plan and Annual Update is an ongoing, annual process.
On June 20, 2017, the Board adopted and authorized implementation of the MHSA FY 2017-2018 through FY 2019-20 Three-Year Program and Expenditure Plan (File 17-0551, Item 33). On June 26, 2018, the Board adopted and authorized implementation of the MHSA FY 2018-19 Annual Update (File 18-0874, Item 47).
Every MHSA Plan and Annual Update has five (5) components: 1. Prevention and Early Intervention (PEI), 2. Community Services and Supports (CSS), 3. Innovation, 4. Workforce Education and Training (WET), and 5. Capital Facilities and Technological Needs (CFTN). PEI, CSS, WET, and CFTN are final upon Board adoption of the Plan and Annual Updates, however, all Innovation projects must receive final approval by the MHSOAC prior to implementation.
Plans and Annual Updates are developed with input from community members and stakeholders, which MHSA identifies as individuals with severe mental illness (SMI) or serious emotional disturbance (SED), families of individuals with SMI or SED, service providers (including substance use disorder and health care providers), law enforcement agencies, education providers, social services agencies, veterans and veteran agencies, and other interested parties.
In August 2018, HHSA’s Behavioral Health staff began engaging the community and stakeholders in development of the FY 2019-20 Annual Update and Innovation proposals. This engagement process is known as the Community Program Planning Process (CPPP). CPPP meetings were announced via press releases, flyers and the Behavioral Health Division’s CPPP webpage. The press releases were distributed to local media contacts and newspapers, posted on HHSA’s Facebook page, and posted on the County’s main website and Behavioral Health’s website. Additionally, Behavioral Health staff maintains an email distribution list of over 1,100 individuals who have expressed interest in receiving MHSA-related information. CPPP meeting flyers were emailed to all individuals on the email distribution list. Finally, Behavioral Health staff noted the planning of the meetings in the November 2018 and January 2019 Behavioral Health Division Update, a monthly report, which is distributed to Behavioral Health Commissioners and other interested parties.
During the CPPP period, Behavioral Health staff hosted or attended community meetings at a variety of locations county-wide. Meetings were offered both during the day and evening. A total of 121 individuals attended the meetings. Behavioral Health staff also participated in HHSA’s Open House events in South Lake Tahoe and Diamond Springs, where approximately 250 community members stopped by the MHSA booth. At CPPP meetings, Behavioral Health staff presented historical information about MHSA and staff presented a review of the current and proposed MHSA projects, including Innovation proposals. Participants were given opportunities to ask questions and provide feedback on all projects.
Additionally, the public was invited to provide input on the FY 2019-20 MHSA Annual Update PEI projects via a survey, available in both English and Spanish, that was distributed electronically to over 1,100 individuals and was made available at every community meeting and at both Open House events.
Behavioral Health received 302 completed surveys. The survey results indicated that most individuals were aware of at least some of the PEI projects. It also indicated that the majority of the survey respondents were mental health consumers (82 responses or 27.15%) and when asked where individuals get their information about community events, 63.29% indicated they get information from email and 40.07% indicated they get information from Facebook posts. Major themes conveyed through the surveys and community meetings included a need for more services in general, a need for mental health clinicians in the schools, a need for services for individuals with co-occurring mental illness and substance use disorders, services for chronic homelessness, and support for all Innovation proposals.
Stakeholder and public input was considered in drafting the FY 2019-20 Annual Update, and included to the extent possible given the funding levels of MHSA and other services available in the County.
On April 19, 2019, the draft FY 2019-20 Annual Update and Innovation proposals were posted for a 30-day Public Comment period. A press release was issued regarding the publication of the draft Annual Update, a Facebook posting was made on the Health and Human Services Agency page, and an email notification was sent to the MHSA email distribution list. The Public Comment period ended May 19, 2019.
Twenty-seven public comments were received during the Public Comment period. Seven (7) of those comments were general in nature, two (2) comments referenced budget clarifications, five (5) comments were on PEI, three (3) comments were on CSS, one (1) comment was on WET, and nine (9) comments were about Innovation. Of the Innovation comments, the majority (five comments) were specific to the Community Hubs proposed modifications. Comments received regarding the Community Hubs ranged from requesting clarifications regarding the proposed project modifications, clarification on the role of Public Health Nurses, requesting more data collection, and offering support of the project.
In addition to the public comments, Behavioral Health also received 23 letters of support for the Community Hubs. The letters were from hospitals, health centers, churches, libraries, school districts, and other non-profits, countywide. The letters referenced the importance of the prevention and early intervention aspect of the Community Hubs program; the use of universal screening tools; outreach and engagement in the more isolated and rural areas of the county; the knowledge, expertise, and passion of the Hub employees; services that are delivered in a culturally and linguistically competent manner; and referrals to mental health/physical health/dental health. A copy of these letters may be obtained from Behavioral Health.
In addition to stakeholder and community member review of the FY 2019-20 Draft Annual Update and Innovation proposals, the Behavioral Health Commission created a four-person Ad Hoc Committee to review the Draft Annual Update, including the Innovation proposals. Two members of the Ad Hoc Committee met on May 9, 2019, with a third member providing their input via telephone after the May 9, 2019 meeting. The report out from the Ad Hoc Committee was scheduled for the May 22, 2019 Commission meeting, which was also the Commission-hosted MHSA Public Hearing on the FY 2019-20 MHSA Annual Update.
At the May 22, 2019 meeting and after the Public Hearing for the Annual Update concluded, the Behavioral Health Commission heard a separate item, which was a report out from the Ad Hoc Committee. The report out primarily focused on the Community Hubs Innovation modification proposal. The Ad Hoc Committee reported that they did not agree with the modification of the Hub program, but that it was not a unanimous decision. At the conclusion of the discussion, the Chair indicated he did not believe the Commission as a whole had had enough time to fully consider the Draft Annual Update or the input of the Ad Hoc Committee and recommended that the Behavioral Health Commission adjourn and continue the item to a regular meeting with the sole item on that agenda being further discussion of the Behavioral Health Commission’s recommendations on the Annual Update. On June 12, 2019, the Behavioral Health Commission voted to recommend the MHSA plan and the Innovation plan for Hubs be approved as written and submitted to the Board of Supervisors.
Substantive comment received during the Public Comment period and the Public Hearing are documented in the Annual Update. Behavioral Health reviewed all comments and determined any needed modifications to the Annual Update and/or Innovation proposals.
The final FY 2019-20 Annual Update includes three (3) new PEI projects, deletes one project that concludes on June 30, 2019, and modifies six (6) projects. There is one new CSS project, one (1) deleted project, and four (4) modified projects. Under Innovation, the Restoration of Competency in an Outpatient Setting project ended on April 3, 2019, however Restoration of Competency services in the jail setting will continue as previously provided. The Community Hubs, which was originally approved by the MHSAOC on August 25, 2016, is being modified to increase the term by one (1) year for a total of five (5) years, with an increase in funding for the MHSOAC-approved FY 2019-20 operations and new funding in FY 2020-21. There also is one (1) new Innovation proposal, and two (2) additional Innovation proposals, both of which have the support of the MHSOAC but El Dorado County’s participation still must be approved by the MHSOAC. There is one (1) modified WET project and three (3) modified CFTN projects.
The total revenues budgeted for all five (5) MHSA components is $26,456,817 and the expenditures for all components is $20,924,937. This includes expenditures of $3,555,972 in PEI, Innovation, and CFTN funds that are subject to reversion back to the State if not spent by June 30, 2020. The projects included in the FY 2019-20 Annual Update are client-centered, family-focused, community-based, culturally and linguistically competent, and are a reflection of the stakeholders’ and community’s voice at the CPPP meetings, comments, survey responses, and substantive comment received during the 30-day Public Comment period and at the Public Hearing.
DISCUSSION:
The County’s Behavioral Health Division has considered stakeholder and community comments, concerns, and recommendations, especially with regard to modifying the Community Hubs Innovation proposal. The Community Hubs was originally approved by the MHSOAC as a four-year project, to conclude in September 2020. Throughout the CPPP, the community and stakeholders supported modifying the Community Hubs Innovation project.
The Behavioral Health Division respectfully requests that the Board of Supervisors adopts the Annual Update and Innovation proposals, as presented.
ALTERNATIVES:
1) Should the Board disapprove the Community Hubs modification as outlined in the Title section, Item 2 - a, the Community Hubs project will end September 2020, the end date of the originally approved project, and approximately $1,500,000 in Innovation funding will revert back to the State.
2) Should the Board disapprove all Innovation proposals, as outlined in the Title section, Item 2 - b through d, the Criminal Justice Involvement of People with Mental Health Needs, the allcove project, the Partnership between Senior Nutrition and Behavioral Health to reach home-bound older adults in need of mental health services, and the Community Hubs modification would be declined, thereby reverting approximately $1,500,000 to the State due to the Community Hubs program ending September 2020, and placing additional Innovation funds at risk of reversion.
3) Should the Board disapprove the FY 2019-20 MHSA Annual Update in its entirety, as outlined in the Title section, Item 3, this would result in up to $3,558,972 in Innovation, PEI, and CFTN funding reverting back to the State, and, consequently, those funds would not be available for expenditure by the County on MHSA projects.
PRIOR BOARD ACTION:
1) June 20, 2017, File 17-0551, MHSA FY 2017-18 - FY 2019-20 Three-Year Program and Expenditure Plan
2) June 26, 2018, File 18-0874, MHSA FY 2018-19 Annual Update
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
N/A
CAO RECOMMENDATION:
It is recommended that the Board approve this item.
FINANCIAL IMPACT:
Anticipated MHSA revenues and expenditures were included in the FY 2019-20 Recommended Budget. Should the Board of Supervisors approve the MHSA annual plan update, and a budget impact is identified, HHSA will follow County processes to prepare a corresponding budget amendment to address the discrepancy. Additional revenue sources that offset the MHSA expenditures have also been budgeted. There is no Net County Cost associated with the MHSA program.
CLERK OF THE BOARD FOLLOW UP ACTIONS
N/A
STRATEGIC PLAN COMPONENT:
Healthy Communities
CONTACT
Don Semon, Director