MHSA - Mental Health Services Act

The Mental Health Services Act funded by a new tax on high income individuals, is designed to expand and transform California’s county mental health service systems.   It stipulates that the State Department of Mental Health (SDMH) will contract with County Mental Health Departments to develop and manage the implementation of MHSA's provisions.  However, it is important to note that in the first year of implementation, no services will be funded. Before we are able to implement the legislation, the SDMH has much to do.  In the first few months immediately following its passage, the SDMH will:

1. Obtain federal approvals and Medi-Cal waivers,  state authority, additional resources and technical assistance in areas related to implementation

2. Establish detailed requirements for the content of local 3 year expenditure plans

3. Develop criteria and procedures for reporting of county and state performance outcomes

4. Define requirements for the maintenance of current state and local efforts to protect against supplanting existing programs and their funding streams

5. Develop formulas for how funding will be divided or distributed among counties

6. Determine how funding will flow to counties and set up the mechanics of distribution

7. Establish a 16 member Oversight and Accountability Commission, comprised of elected State officials and Governor appointees along with procedures for its review of county planning efforts and oversight of SDMH implementation

8. Develop and publish regulations and provide preliminary training to all counties on plan development and  implementation requirements

Within the first month, Alameda County Behavioral Health Care Services (BHCS) will

• build upon its longstanding, broadly representative budget stakeholders’ group and shift focus toward guiding plan development 

• expand membership (beyond consumers, families, providers and over 100 community based programs projects and agencies) to include other important interests, including representatives from social services, education and law enforcement agencies 

• The stakeholders’ group will school itself in the purpose and multiple objectives, requirements and limitations of Prop 63 while the State is developing the processes and content for local implementation. 

• In addition to participating in State meetings and conferences, within the first three months BHCS will seek technical assistance and resources for designing and conducting its planning efforts; both short and long term consultation and resource development are under review 

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Purpose and Intent  

1. To make serious mental illness among seniors, adults and children a priority and promote early intervention and prevention services and medical and supportive care to prevent mental illnesses from becoming severe and disabling.

2. To reduce the long-term adverse impact on individuals, families and state and local budgets resulting from untreated serious mental illness

3. To expand successful, innovative programs that have demonstrated their effectiveness for adults, children and seniors, including culturally and linguistically competent approaches to the underserved and others most severely impacted by or at risk of serious mental illness

4. To provide state and local funding for services that cannot be paid for with other funds, and

5. To ensure that all funds are expended in the most cost-effective manner and in accordance with recommended  best practices subject to local and state oversight and accountability

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Funding Categories  

MHSA specifies three different stages of local funding. Again, no services will be funded in the first year of implementation.  It is anticipated that new services will not be approved and funded by SDMH until late 2005 or 2006.  Also, noteworthy is that the Oversight Commission and SDMH will base each allocation for each category of funding upon detailed plans with prior approval, annually. 

Stage 1.   For the First Year the legislation allocates:

• 45% of available funds for local Capital Facilities and Technology Needs, including much of our existing planning for a new management and clinical information system

• 45% for Education and training, including a State mandated local needs assessment identifying shortages in each professional and other occupational categories in order to increase the supply of professional staff and other staff that county MH programs anticipate they will require to provide the increase in services afforded by Prop. 63

• 5% for local planning in developing both its first stage plan and a subsequent three year plan

• The remaining 5% of total available funds are reserved for SDMH and its implementation of Prop. 63, including the Oversight commission and the state MH Planning Council in its role in overseeing Education and Training initiatives

 Stage 2.    The legislation requires an approved 3-year plan and for each of three years allocates:

• 10% to education and training programs

• 10% to capital facilities and technological needs using a formula to be developed with the California MH Directors Association (CMHDA)

• 20% to Prevention and Early Intervention programs to prevent mental illness from becoming severe and disabling, again with a formula developed by CMHDA

• 5% for Innovative Programs that increase access to services and to underserved groups (including transition age youth), that promote interagency collaboration, and that increase quality and outcomes of services; proposals are directly approved by the Oversight commission

• The remaining funds are allocated locally to:

1.       Services for children with severe mental illness in concert with a children’s system of care

2.       Services to adults and seniors with severe illnesses, with planning consistent with the Recovery Vision for mental health consumers, the adult system of care, cultural and ethnic sensitivity, consumer led services supporting recovery and evidence-based practices such as MIOCR (care management for the mentally ill in the CJ system), AB2034 (homelessness) and individualized care planning, and

3.       A prudent reserve to help maintain new programming in years when certain revenues decline below the average of previous years.

Stage 3.   Distribution of funds after 2007-08

1.       Funding is no longer prescribed by category

2.       Funding may be used for

• Services to children, adults or older adults

• Technological needs and capital facilities

• Human resource needs

• A prudent reserve