Title
Health and Human Services Agency recommending the Board:
1) Adopt El Dorado County’s Mental Health Services Act (MHSA) Three-Year Program and Expenditure Plan, covering Fiscal Years (FY) 2020-21 through FY 2022-23, which will become effective July 1, 2020; and
2) Authorize the implementation of the Three-Year Program and Expenditure Plan through June 30, 2021 or until the FY 2021-22 MHSA Annual Update is adopted by the Board, whichever occurs at the later date.
FUNDING: Mental Health Services Act, with expenditure offsets from other Federal, State and Local Funding Sources.
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DISCUSSION / BACKGROUND:
In 2004, California voters passed Proposition 63, the Mental Health Services Act (MHSA). MHSA imposes a one (1) percent tax on personal income in excess of $1,000,000. The funds from the tax are distributed to California counties and are intended to transform the Mental Health System into one that is consumer and family driven, is recovery-oriented, accessible and culturally competent, and offers services appropriate for the population that is served.
MHSA requires counties to prepare a three-year program and expenditure plan, known as the MHSA Three-Year Program and Expenditure Plan and to prepare annual updates, known as Annual Updates. The MHSA Plans and Updates are to be developed with input from local stakeholders, including adults and older adults with severe mental illness; families of children, adults and older adults with mental illness; providers of services; law enforcement agencies; educational agencies; social services agencies; veterans and representatives from veteran organizations; providers of substance use disorder services; and health care organizations. This public planning process is utilized to provide an opportunity for stakeholders and interested parties to discuss mental health policy, program planning, implementation, monitoring, quality improvement, evaluation, and budget allocations.
The draft Fiscal Year (FY) 2020-21 - FY 2022-23 MHSA Three-Year Program and Expenditure Plan was posted on April 13, 2020 for review and public comment for 30 days. At the close of the comment period, the Behavioral Health Commission conducted a public hearing to receive additional input from the community. Any substantive comment that was received about the draft Plan during the 30-day comment period or the public hearing process was summarized and included in the final Three-Year Program and Expenditure Plan.
MHSA established five (5) components that address specific goals for priority populations and key community mental health needs. The components are Prevention and Early Intervention (PEI), Community Services and Supports (CSS), Innovation (INN), Workforce Education and Training (WET), and Capital Facilities and Technology Needs (CFTN).
PEI projects are designed to prevent a mental illness from becoming severe and disabling, to the extent possible. The PEI projects also promote positive mental health by reducing risk factors by intervening to address mental health problems in the early stages of the illness, and to reduce the sigma and discrimination associated with mental illness. This Three-Year MHSA Plan adds the following new PEI projects: Friendly Visitor, Goods and Services to Promote Positive Mental Health and Reduce Mental Health Risk Factors, and the Forensic Access and Engagement Project. All PEI projects are reflective of community and stakeholder input and the projects meet the PEI regulations as amended in 2018 and Senate Bill 1004 (2018).
The second component, CSS, focuses on the development of recovery-oriented services for children, youth, adults, and older adults with serious mental illness. Included in CSS is a new Full Service Partnership Forensic Services project, which is designed to address criminogenic risk factors, needs, and/or behaviors for individuals participating in the El Dorado County problem-solving collaborative courts or other formal diversion programs.
The Innovation component consists of projects that are designed to contribute to learning, rather than a primary focus on providing a service. In addition to the Board of Supervisor adoption of MHSA Plans and Annual Updates that include Innovation projects, the Mental Health Services Oversight and Accountability Commission (MHSOAC) also must approve Innovation projects. On February 27, 2020, the MHSOAC approved Behavioral Health’s request to modify the Community-Based Engagement and Support Services (aka “Community Hubs”) project. The Board of Supervisors previously approved this modification on June 25, 2019 (File 19-0936). The modification included increasing funding by $250,000 for a total budget of $3,010,021 and extending the project end date to June 30, 2021. Additionally, on January 23, 2020, the MHSOAC approved the “Partnership between Senior Nutrition and Behavioral Health to Reach Home-bound Older Adults in Need of Mental Health Services” Innovation project. The Board of Supervisors approved this project at their June 25, 2019 meeting (File 19-0936). There are no new Innovation projects in this MHSA Plan.
The remaining components include Workforce Education and Training and Capital Facilities and Technological Needs. These components serve to support the development of a well-trained, qualified, and diverse workforce and strengthen the foundation of the mental health system. Since these components are no longer funded by the MHSA, counties transfer funds from the CSS component to fund these projects. There are no major changes to the projects included in these components.
Legislatively, the MHSA was amended to authorize counties to use MHSA funds to provide services to persons who are participating in a presentencing or post-sentencing diversion program, or who are on parole, probation, post-release community supervision, or mandatory supervision, effective January 1, 2020. The projects in this Plan incorporate providing services these individuals.
ALTERNATIVES:
Failure to adopt the MHSA Three-Year Program and Expenditure Plan will not only result in an inability to provide continuity of care for clients currently receiving MHSA-funded services from contracted vendors, but it will result in HHSA being out of compliance with the requirements of the MHSA, which includes adoption of a Three-Year Program and Expenditure Plan. Consequently, the FY 2019-20 MHSA Annual Update would continue as the foundation for MHSA services in the County.
PRIOR BOARD ACTION:
1) 6/20/17,17-0551, MHSA FY 2017-18 - FY 2019-20 Three-Year Program and Expenditure Plan
2) 6/26/18,18-0874, MHSA FY 2018-19 Annual Update
3) 6/25/19,19-0936, MHSA Plan Update 2019-20
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
N/A
CAO RECOMMENDATION:
Approve as recommended.
It should be noted that HHSA will place a number of related agreements for services on the next Board agenda for consideration and approval, provided the MHSA plan is approved with this item.
FINANCIAL IMPACT:
MHSA revenue and expenditures were included in the FY 2020-21 Recommended Budget, and will be included in future year budget requests. 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:
County of El Dorado Strategic Plan Project - Healthy Communities; Improved health, well-being, and self-sufficiency of El Dorado County communities, residents, and visitors.
CONTACT
Don Semon, Director