Title
Health and Human Services Agency (HHSA) recommending the Board:
1) Review El Dorado County’s Mental Health Services Act (MHSA) Three-Year Program and Expenditure Plan, covering Fiscal Years (FY) 2023-24 through FY 2025-26;
2) Provide direction on the MHSA Plan FY 2023-24 through FY 2025-26, prior to the June 20, 2023 request for adoption of the MHSA Plan, which is intended to become effective July 1, 2023; and
3) Receive a presentation on the Fiscal Year 2023-24 through FY 2025-26 MHSA Plan.
FUNDING: 72% Mental Health Services Act funds, 21% Federal Medi-Cal, 2% Federal Block Grants, 1% Realignment/State General Fund, and 4% Miscellaneous/Fee-for-Service.
Body
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, recovery-oriented, accessible, culturally competent, and a system that offers services appropriate for the population that is served.
MHSA requires counties to prepare a three (3) year program and expenditure plan, known as the MHSA Three-Year Program and Expenditure Plan. The MHSA Plans and Annual 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.
This year, the draft Fiscal Year (FY) 2023-24 through FY 2025-26 MHSA Plan was publicly posted for a 30-day review and public comment period on March 7, 2023 through April 7, 2023. On April 19, 2023, after the close of the 30-day period, the Behavioral Health Commission conducted a public hearing to receive any additional input from the community. Any substantive comments that were received about the draft MHSA Plan during the 30-day comment period or the public hearing process were summarized and included in the draft MHSA Plan.
The MHSA Plan established five (5) components that address specific goals for priority populations and key community mental health needs. The components are Community Services and Supports (CSS), Prevention and Early Intervention (PEI), Innovation (INN), Workforce Education and Training (WET), and Capital Facilities and Technology Needs (CFTN).
Component 1: CSS, focuses on the development of recovery-oriented services for children, youth, adults, and older adults with serious mental illness.
New CSS Projects:
1. Recreation Therapy Project: This project was added to expand service delivery options for current CSS clients.
2. Lanterman-Petris-Short (LPS) Project: AB 2242 added the requirement for care coordination under the LPS Act and provided the option for MHSA funding to support services defined within the act.
Modified CSS Projects:
1. The majority of CSS projects were increased by, on average, 30% to account for cost of living increases impacting all levels of service delivery as well as program expansion initiated by California Advancing and Innovating Medi-Cal (CalAIM).
2. Forensic Services Project (FSP): Care Court, was signed into law by Governor Newsom through SB 1338. El Dorado County (EDC) is required to fully implement this program by December 1, 2024. Project funding will also support the administrative work necessary to prepare for implementation.
3. Peer Leadership Academy: This project was previously called the Consumer Leadership Academy. The name has been changed and description updated to better align with California Mental Health Services Authority’s (CalMHSA) Peer Support Specialist Certification process and expansion of Peer services throughout the county system of care.
4. Student Wellness Centers and Mental Health Supports Project: This project was found to best align with PEI goals and outcome measures and was absorbed by the existing PEI Student Wellness Center Project.
Discontinued CSS Projects:
1. Community Transition and Support Team (CTST) Project: This project was removed because the services described were best suited under other existing projects (FSP, Wellness and Recovery). This project may be reconsidered in future MHSA Plans or Annual Updates after the scope of services has been thoroughly re-evaluated.
Component 2: PEI projects are designed to prevent a mental illness from becoming severe and disabling, to the extent possible. The included PEI projects meet the PEI regulations as amended in 2018 and Senate Bill 1004 (2018).
New PEI Projects:
1. Clubhouse El Dorado Project: This project was added after direct stakeholder input was provided.
2. Bridge the Gap Project: This project was added to address the current delays in service for mild to moderate youth.
Modified PEI Projects:
1. The majority of PEI projects were increased by, on average, 15% to account for cost of living increases impacting all levels of service delivery as well as program expansion due to increased need for mild/moderate mental health services.
2. Older Adult Enrichment Project: This project was restructured to better integrate services under one project after recognizing the duplication of efforts when the project was previously described as three independent programs (Senior Peer Counseling, Friendly Visitors, Senior Link). This project has also been moved to the Early Intervention Program of PEI services to best represent the therapeutic epicenter that Senor Peer Counseling provides.
3. Goods and Services to Promote Positive Mental Health and Reduce Mental Health Risk Factors Project: A sub-program, County Emergency Support, was added to this project in order to more definitively provide MHSA funded goods or services in times when there is a federal, state or local emergency declaration.
4. Prevention Wraparound Services: Juvenile Justice Project: After a reduction of allocated fund in the FY 2022-23 MHSA Annual Update, due to multiple years of substantial underspending, this project saw a substantial increase in referrals and the provider’s capacity to serve those clients throughout FY 2022-23. As a result, this project’s annual allocation is being increased to $500,000. This increase is supported by Child Welfare Services.
5. Student Wellness Center Project: This project has been expanded to include services provided at local High Schools, which was previously provided by the CSS Student Wellness Centers and Mental Health Supports Project. It was recognized that the goals and outcome measures provided by this project better align with PEI. In addition, the need was recognized to align all Student Wellness Centers under one project for better continuity of services between grade levels.
6. Mental Health First Aid and SafeTALK Projects: This project was expanded to include an annual trainer course administered by EDC Behavioral Health as well as an option for a Community Funding Assistance Program.
7. Community Education Project: This project was restructured in order to maintain the specificity of the Parenting Classes description, now as a separate program, while allowing expansion of additional community education opportunities. Within this restructure the Whole Family Wellness Pilot Program was added as a collaborative effort with Shingle Springs Health and Wellness, providing educational opportunities for family members of clients receiving Mental Health or Substance Use services.
8. Community-based Outreach and Linkage Project: A sub-program was added to allow for the expansion of mobile crisis services currently receiving alternative funding for infrastructure development.
9. Suicide Prevention and Stigma Reduction Project: This project was expanded to better align with the EDC Suicide Prevention Strategic Plan. This project also includes an opportunity for Community Funding Assistance.
Discontinued PEI Projects:
1. Expressive Therapies Project: This project was heavily impacted by the Public Health Emergency caused by the coronavirus and programming was not able to be resumed. Due to the absence of programming under this project throughout FY 2020-21, FY 2021-22 and FY 2022-23 this project is being removed from this MHSA Plan. This project may be reconsidered in future MHSA Plans or Annual Updates after the scope of services has been thoroughly re-evaluated.
Component 3: INN 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 Supervisors (Board) adoption of MHSA Plans and Annual Updates that include INN projects, the Mental Health Services Oversight and Accountability Commission (MHSOAC) also must approve INN projects. INN projects cannot exceed five (5) years in duration.
New INN Projects:
1. The following projects are being proposed through this MHSA Plan and are pending Board and MHSOAC approval:
- Nature Therapy for Youth Project
- In-Clinic Certified Therapeutic Recreation Specialist Project
- Crisis Now Multi-County Collaborative
- Early Psychosis Learning Healthcare Network
- Psychiatric Advance Directives
Components 4 and 5: WET and CFTN 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.
New WET projects:
1. Recruitment and Retention Project: This is a new project developed to address workforce shortages. This project includes the opportunity for Behavioral Health staff license and certification reimbursement previously listed under the Workforce Development Project as well as Hiring Incentives and Educational Funding.
Modified WET projects:
1. Workforce Development Project: This project was expanded to include an annual provider conference.
New CFTN projects:
1. County-wide Clinic Project: This is a new project added to address the geographical challenges of providing services in El Dorado County.
ALTERNATIVES:
Should the board disapprove of the proposed MHSA Plan Updates for FY 2023-24 through FY 2025-26, including the denial of modified, new and/or discontinued projects, this may result in not only HHSA’s inability to provide continuity of care for clients currently receiving MHSA-funded services from contracted vendors but may also result in El Dorado County being out of compliance with the requirements of the MHSA. Consequently, the FY 2020-21 - 2022-23 MHSA Three-Year Program and Expenditure Plan would continue as the foundation for MHSA services in the County, without the recommended updates that were framed by community members and stakeholders through the required public planning process.
PRIOR BOARD ACTION:
1) 08/30/22, 22-0832, HHSA 2022-2023 MHSA Plan Update
2) 07/19/22, 22-1046, Approval of 2022-2023 Suicide Prevention Strategic Plan
3) 06/22/21, 21-0713, HHSA MHSA Plan Update 2021-22
4) 06/09/20, 20-0446, HHSA MHSA FY 2020-21 - FY 2022-23 Plan Approval
5) 06/25/19, 19-0936, HHSA MHSA Plan Update FY 2019-20
6) 06/26/18, 18-0874, HHSA MHSA FY 2018-19 Annual Update
7) 06/20/17, 17-0551, HHSA MHSA FY 2017-18 - FY 2019-20 Three-Year Program and Expenditure Plan
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
HHSA Social Services, El Dorado County Office of Education, El Dorado County Probation Department, Library Services, and Sheriff’s Office
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with the MHSA program. MHSA revenue and expenditures were included in the FY 2023-24 Recommended Budget, and will be included in future year budget requests. Additional revenue sources that offset the MHSA expenditures have also been budgeted.
CLERK OF THE BOARD FOLLOW UP ACTIONS
N/A
STRATEGIC PLAN COMPONENT:
Healthy Communities; Improved health, well-being, and self-sufficiency of El Dorado County communities, residents, and visitors.
CONTACT
Olivia Byron-Cooper, MPH, Interim Director, Health and Human Services Agency