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Frequently Asked QuestionsBackgroundQ. Where does this new Mental Health Services Act (MHSA) money come from? A. In November 2004 California voters passed Proposition 63, the Mental Health Services Act (MHSA). The Act levies an additional 1% tax on personal incomes in excess of $1 million. The MHSA is intended to "transform the public mental health system." The goal of the Act is to create a state-of-the-art, culturally competent system that promotes wellness/recovery for adults and older adults with severe mental illness and resiliency for children with serious emotional disorders and their families. The California Department of Mental Health (DMH) seeks to build a system where access will be easier, services are more effective, out of-home and institutional care are reduced, and stigma toward those with severe mental illness or serious emotional disturbance no longer exists. Q. Where are all the different components of the MHSA? A. There are several components to the MHSA:
The different components of the MHSA will be rolled out over the next few years. Q. How is Contra Costa County's share of the money determined? A. The State Department of Mental Health has developed a complex formula for allocating available funds across all counties in the state. The level of funding available to disburse is determined by the Prop 63 legislation that produces tax revenue for this purpose. The amount of funding available each year is based on revenue from income taxes, the amount will vary from year to year. To level out year-to-year variances, DMH has established a reserve that will allow them to disburse the funds more continuously from year to year. Q. Why are there so many rules about how the money can be used? A. MHSA funds represent the first new infusion of money into California's Public Mental Health system in many years. There are many points of responsibility for these funds. The legislation itself created a strong set of requirements including an extensive statewide stakeholder process. The stakeholder process then set another set of requirements and expectations. Existing state statues contain lengthy requirements as well. There must be accountability for meeting the spirit and intent of the legislation, as well as accountability for spending the money. Q. What is the Oversight and Accountability Commission and what is their role? A. The MHSA legislation calls for the establishment of the Mental Health Services Oversight and Accountability Commission (MHSOAC). It is body of 16 individuals appointed by the Governor, with designated slots for consumers and family members along with representatives from various government and other agencies. Its responsibilities include:
More information on the MHSOAC Q. What is the State Department of Mental Health's role? A. The legislation states that the Department of Mental Health (DMH) shall manage and disburse MHSA funds. It also assigns other responsibilities including but not limited to: Developing regulations for implementing the Act, providing technical assistance to counties, reviewing county plans and implementing a statewide workforce development plan. DMH works closely with county mental health departments. Philosophy and ApproachQ. What are the five MHSA principles? Where did they come from? A. The five values that will shape all new Community Services and Supports under MHSA have been defined by the California Department of Mental Health. They are:
More about the vision of MHSA and the DMH's Guiding Principles for implementation Q. How do these principles apply to Contra Costa's programs? A. These principles are consistent with CCMH's approach to services already. Their emphasis by the State Department of Mental Health will help Contra Costa to keep its eye on its own vision as many changes occur. Q. What is Systems Transformation? A. In the context of MHSA, Systems Transformation means the transition to a mental health system that supports the 5 principles or values of:
Q. What does that mean to us here in Contra Costa County? A. The State Department of Mental Health advises counties to start "small and smart" to test new methods to achieve the values of MHSA. We are focusing first on the "transformational" Full Service Partnerships to a limited number of consumers, as well as undertaking a few key Systems Development efforts. We need to pilot these programs, learn lessons from them, and improve them further. Once effectiveness is established in these smaller environments, our longer-term goal is to expand the effective ones throughout our system. Q. What is Person-Centered Planning? A. Person centered means that the person, and not their illness, is at the center of any treatment plan(s). The person being served is being asked about their wishes and their stated request is driving the services. Q. MHSA places a lot of emphasis on diversity. What types of diversity does it emphasize? A. MHSA seeks to support programs that value, respect, and appropriately meet the needs of the wonderfully wide variety of people that live in our county and may need our services. This includes diversity by race/ethnicity, languages spoken, cultural identify, sexual and gender identify, and religion/belief. It also includes people with lifestyles that may be different because of drug or alcohol use, involvement with the criminal justice system, or experience with homelessness. Emphasizing diversity in the service delivery system also means that the way in which services are delivered incorporate different belief systems about mental health, well-being, and healing. Because of this, it is important to consider methods that have not always been considered "traditional," including provision of supports that have not historically been billable to MediCal. Q. MHSA places a lot of emphasis on consumer and family involvement. What does that mean in Contra Costa? A. Contra Costa County already has a long history of consumer and family member involvement in the design, delivery and oversight of mental health services. We will continue and increase this. You will see more consumers and family members in paid positions within the county, in community agencies working with the county to implement MHSA, and on governing bodies. Our commitment to involving consumers includes our expansion of the Office for Consumer Empowerment (OCE). Using Systems Development Funds, OCE will be expanding its training program to better prepare consumers to work in the mental health field. Consumers and families are also becoming increasingly involved in driving their own course of recovery. This type of involvement is essential to long lasting recovery. MHSA supports this with its emphasis on Person-Centered Care Plans and on peer-led and family-led recovery supports. Services1. Full Service PartnershipsQ. What is a Full Service Partnership (FSP)? and how does that relate to our MHSA Program? A. Full Service Partnerships are a type of services and supports required by DMH. A majority of MHSA Community Services and Supports funds must be spent on these partnerships. Each individual enrolled as a Full Service Partner (FSP) must be offered an individualized services and supports plan. The county and its community partners then work with the individual and his/her family, as appropriate, to assist that person/family in achieving the goals identified in their plan, or "whatever it takes." These plans will be person/child-centered. Each FSP will have a single contact - their Personal Service Coordinator (for young adults and adults) or Case Manager (for children) with a caseload that is low enough so that: (1) Their availability to the individual and family is appropriate to their service needs, (2) They are able to provide intensive services and supports when needed, and (3) They can give the individual served and/or family member considerable personal attention. In Contra Costa County, peer and parent partners and broader Integrated Service Teams will also be highly available to support individuals and families in meeting their individualized plans. Supports must be available to FSPs 24 hours a day, 7 days a week. Flex funds are also available to provide consumers/families "whatever it takes" to help them achieve their individualized care plan. Q. What is a Personal Service Coordinator? How is that different than what we currently do? A. A Personal Service Coordinator (PSC) is an individual member of the Integrated Services Team who develops a relationship with, and provides primary support to, the Full Service Partner (consumer). This includes facilitating the development of a person-or child-centered recovery or care plan, and coordinating "whatever it takes" to access the supports and services necessary to support the individual consumer or child/family to achieve the goals of their plan. This position replaces the role of case managers in more traditional services. Q. Who decided who the FSPs would serve? A. As required by the Act, Contra Costa Mental Health conducted a yearlong community planning process to determine which populations would be served with the first component of MHSA funds - Community Services and Supports. The planning took place in the age-related segments of: Children, Transition Age Youth (16-24), Adults (25-59) and Older Adults. Community members who applied to participate on Stakeholder Planning Groups selected the populations to be served within these age segments. Contra Costa Mental Health then selected the first geographic areas in which to roll out these services based on geographic need and service opportunities. The goal is to eventually serve all geographic areas of the county. Q. What and where are the new programs and when do they start? A. Four new service programs have been approved. Three are now in the start-up phase. County Mental Health Departments are required to spend the majority of their first Three-Year allocation of Community Services & Supports Funds on Full Service Partnership Programs. These services are:
The capacity to develop these services will be developed primarily within the county health system. This program is planned to start in late 2007. CCMH chose to not make the Older Adults Program a Full Service Partnership program, as there are currently virtually no specialized mental health services for older adults in CCMH. As a Systems Development program, we will be able to serve more older adults across the county. However, it is envisioned that, once a stronger service infrastructure has been developed through this program, a Full Service Partnership can be developed in the future. Q. What is being contracted out to the community and why? A. The majority of services being developed under the Community Supports and Services portion of MHSA are being contracted out to the community. Reasons for this include that it was the Stakeholder Planning Committees' preferences and the cost of providing 24-hour/7 day a week services within the county system. Also, community based organizations are usually known to the neighborhoods where we will be serving consumers and family members. However, the county will provide some direct clinical care to these populations and will provide oversight, enrollment processes, training, technical assistance, gate keeping and quality assurance. Q. How long will these programs last? A. Mental Health Services Act funds will be continuously appropriated. The tax that was established by the legislation does not end at any point in time (unless the legislation is overturned). It is important to be aware, however, that the number of California residents with incomes over $1 million is relatively small, approximately 35,000, and there could be large fluctuations in the revenue from year to year - depending on the economy. To address this, the Department of Mental Health has established a system for saving some of the funds each year to create a reserve that will help to fund the leaner years. Q. How are we going to reach ethnic communities and better or differently than in the past? A. Careful, focused effort is being put into reaching ethnic communities better and differently than in the past. The goal to reach these communities is clearly stated in the Plan. Community-based agencies that receive contracts to provide services under MHSA will be expected to demonstrate their cultural competence to reach the target communities. Ideally, some contractor agencies will be from and of these communities. Providers of services will also be held accountable to reach the desired populations. Additionally, MHSA funds will be used to include issues related to cultural sensitivity and cultural competency as a part of its broader "Transformation" training efforts. Q. Won't this create "two tier" system of care for consumers? A. We are required by regulation to target "unserved" and "underserved" consumers and children-along with additional criteria prioritized by our Stakeholders- with our new Full Service Partnership programs. Full Service Partnerships will provide more intensive, and hopefully higher quality services that are generally not available, as of yet, to the majority of mental health consumers statewide. It is important to remember, however, that this represents the initial stage of a phased quality improvement effort that is intended to be spread throughout the system over time. Other Programs and Services Under MHSAQ. Are there funds for anything other than FSPs? A. The first component of MHSA funding is Community Services & Supports - funds for Full Service Partnerships and Systems Development activities. In addition to the programs described above, new Systems Development Activities to be implemented include a new staff training program; a Wellness Program at Concord Adult; expanding the Office for Consumer Empowerment; Hiring of Bilingual Family Partners and additional Adult Family Coordinators; and coordinated planning efforts around Transportation and Co-occurring Mental Health/Substance Abuse treatment. There are several other components of the MHSA that the Department of Mental Health will roll out to Counties over the next few years. These include: Education & Training; Prevention & Early Intervention; Capital Facilities & IT, and Innovation. Consumer IssuesQ. How can a consumer become an FSP?
A. The emphasis of these first Full Service Partnerships is on the unserved or underserved. Q. How can a consumer get housing from MHSA? A. Under DMH regulations, housing made available under Community Services & Supports is restricted to Full Service Partners. However, there are additional MHSA housing efforts currently in development by DMH. Q. If a current county consumer doesn't become a FSP, will they continue to receive the same level of services as in the past? A. Yes, the service level of current county consumers should not be affected in any way by MHSA. Some current consumers may actually receive enhanced services. For example, one of our Systems Development Strategies is to pilot a Wellness Program at Concord Adult Mental Health. Many consumers (not just Full Service Partners) will have access to new wellness services as they are developed. These may include individual or group nutrition education and fitness classes. Successful programs piloted in Central County will eventually be replicated throughout the county for all consumers. Q. How can a consumer provide input into the program? A. A consumer can provide input into the program by getting involved with the Consumer Involvement Steering Team. Contact the Office for Consumer Empowerment at Contra Costa Mental Health Administration: 925-957-5142 Staff Issues and OpportunitiesQ. How can staff stay informed about MHSA? A. Contra Costa Mental Health has recently implemented a periodic "Did You Know That..." one-page document issued by email and fax to managers and supervisors for distribution to all mental health department staff. The goal of is to help keep staff regularly informed about MHSA. If you're not receiving it and would like to, send an email to sbradley@hsd.cccounty.us It is also posted on the Health Services web site: www.cchealth.org , click on Mental Health, and then "MHSA." Q. Who will staff the new programs? How can current staff apply? A. The majority of the new Full Service Partnership Programs are being contracted out to Community Based Organizations. However, there are new County positions that are tied to Systems Development and administrative functions. Keep an eye out for positions that will be put out to bid: Mental Health Clinical Specialists, Clerks, Family Nurse Practitioner, and Registered Nurse. Some of the new positions for which no employment list exists will require an examination process. Q. If a current county staff member does not take a position in on of the MHSA programs, how will their current job be affected? A. One change that will affect staff in non-MHSA programs from this first phase of funding has already taken place. Modifications to CSI data have already been implemented to meet MHSA needs. Additional changes/new services may take place in the future, however, as other MHSA-funded programs (e.g.: prevention, capital development, information systems) are designed and implemented. Q. How will old programs in Mental Health be affected by the new MHSA programs? A. At first, existing programs should not be affected at all by the new MHSA-funded Full Service Partnership programs. Ideally, however, these Full Service Partnership will be expanded to additional areas of the County. Staff of existing programs may see their consumers gain access to some new services developed with Systems Development funds. This may include the Wellness Program to be piloted at the Concord Clinic, or expansion of the Spirit training program of the Office for Consumer Empowerment. Q. How do I refer a consumer for enrollment into an FSP? A. At this point, the referral system is still in development. We are in the process of contracting with community agencies for the majority of service provision. Referrals and enrollment will be worked out as soon as those contractors are on board. The county will retain a gate keeping role for eligibility determination and enrollment into the programs. More information about this will be available in early 2007. Q. Who does the tracking for FSP? How long will this go on? A. Tracking for FSPs is the responsibility of County Mental Health Departments, working in partnership with the designated contract agencies who will be serving FSPs. Tracking of FSPs will continue as long as an individual is enrolled, or until DMH changes its policies. DMH has established new performance outcome measurements for FSP enrollees. The overall goal is to be able to demonstrate better outcomes over time for FSP enrollees. We will be tracking FSPs using new forms developed by DMH that include an Initial Assessment, Quarterly Updates, and Key Event tracking. Q. Will my paperwork change even if I'm not staffing an FSP? A. The most significant change that a non-FSP staff person will see at this stage of MHSA implementation has already occurred - the CSI data was amended to meet new MHSA needs. There may be additional data reporting in the future for non-FSP clients, but at the present time, all the forms in circulation meet the reporting requirements. Q. Does MHSA mean more audits? A. Probably yes. MHSA represents a large sum of money from a new source and there will undoubtedly be high accountability for how it is spent. More importantly, the State will be looking at the new programs funded by MHSA and the overall client outcomes for individuals enrolled in the new programs.
Last updated November 16, 2006
Content provided by Contra Costa County Mental Health Division of Contra Costa Health Services.
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