Introduction to MHSA – (cut to the chase below)
The Bronzan-McCorquodale Act (aka the Mental Health Services Act (MHSA)) is a funding source consisting of a 1% tax collected on revenues California millionaires that earn over $1m annually. All told, the MHSA funds about 35% of California’s mental health services.
The MHSA requires counties to establish an Advisory Board composed in part of family members of people who are in mental health crises, or utilizing mental health services, or the individuals in crisis or utilizing services themselves. These members are appointed by individual Board of Supervisors and serve at their pleasure in an advisory capacity for a period of three years.
Millionaires and voters no doubt favored the MHSA funding solution in part because there would be group of informed and engaged mental health system users helping monitor and making recommendations to their governing bodies in issues of concern.
Several California counties merged their Mental Health Board (MHB) with their existing Alcohol & Other Drug Advisory Board (ADAB) into a unified Behavioral Health Advisory Board (BHAB). San Diego County has such a BHAB. The reasoning has been to improve the continuum of care and eventual outcomes of those experiencing mental health and alcohol or other drug-abuse crises.
The mission of California’s mental health system shall be to enable persons experiencing severe and disabling mental illnesses and children with serious emotional disturbances to access services and programs that assist them, in a manner tailored to each individual, to better control their illness, to achieve their personal goals, and to develop skills and supports leading to their living the most constructive and satisfying lives possible in the least restrictive available settings.5600.1. Welfare & Institutions Code
State Law – Welfare and Institution’s Code
California’s Mental Health or Behavioral Health Advisory Boards are mandated to perform many responsibilities. These are outlined in the California Welfare & Institutions Code (WIC).
Some of BHAB’s primary responsibilities include these duties detailed in WIC Section 5604.2. (a):
- Review and evaluate the community’s public mental health needs, services, facilities, and special problems in any facility within the county or jurisdiction where mental health evaluations or services are being provided, including, but not limited to, schools, emergency departments, and psychiatric facilities.
- Review any county agreements entered into pursuant to Section 5650. The local mental health board may make recommendations to the governing body regarding concerns identified within these agreements.
- Advise the governing body and the local mental health director as to any aspect of the local mental health program. Local mental health boards may request assistance from the local patients’ rights advocates when reviewing and advising on mental health evaluations or services provided in public facilities with limited access.
- Review and approve the procedures used to ensure citizen and professional involvement at all stages of the planning process. Involvement shall include individuals with lived experience of mental illness and their families, community members, advocacy organizations, and mental health professionals. It shall also include other professionals that interact with individuals living with mental illnesses on a daily basis, such as education, emergency services, employment, health care, housing, law enforcement, local business owners, social services, seniors, transportation, and veterans.
- Submit an annual report to the governing body on the needs and performance of the county’s mental health system.
- Review and make recommendations on applicants for the appointment of a local director of mental health services. The board shall be included in the selection process prior to the vote of the governing body.
- Review and comment on the county’s performance outcome data and communicate its findings to the California Behavioral Health Planning Council.
- This part does not limit the ability of the governing body to transfer additional duties or authority to a mental health board.
The Chase: Ensuring All Stakeholders are Engaged In the Planning and Budgeting Process
With this background in mind, this post is to introduce three additional responsibilities which require BHABs to ensure stakeholders are engaged throughout the planning and budgeting processes. The provisions also allow for adequate funding to ensure stakeholders are engaged.
1. MHSA provides funding which can be allocated towards various planning responsibilities:
“The allocations pursuant to subdivisions (a) and (b) shall include funding for annual planning costs pursuant to Section 5848. The total of these costs shall not exceed 5 percent of the total of annual revenues received for the fund. The planning costs shall include funds for county mental health programs to pay for the costs of consumers, family members, and other stakeholders to participate in the planning process and for the planning and implementation required for private provider contracts to be significantly expanded to provide additional services pursuant to Part 3 (commencing with Section 5800) and Part 4 (commencing with Section 5850).”California WIC 5892.(c)
How does this translate to San Diego County? The 2019-2020 Annual Plan Update illustrates our MHSA program budget at $214m, approximately one-third of the total BHS budget of over $700m.
5% of this amount equals over $10m that could be spent ensuring informed stakeholders are engaged. How much do we spend specifically on our annual Community Engagement Forums? Under $200k each year. That equates to our spending less than 1/50th of the potential budget to engage stakeholders.
2. MHSA Provides funding for board members to do work related to mental/behavioral health board:
“(a) The board of supervisors may pay from any available funds the actual and necessary expenses of the members of the mental health board of a community mental health service incurred incident to the performance of their official duties and functions. The expenses may include travel, lodging, childcare, and meals for the members of an advisory board while on official business as approved by the director of the local mental health program.California WIC 5604.3.
(b) Governing bodies are encouraged to provide a budget for the local mental health board, using planning and administrative revenues identified in subdivision (c) of Section 5892, that is sufficient to facilitate the purpose, duties, and responsibilities of the local mental health board.”
We have yet to establish a budget for BHAB members to do our work. We were asked to pass a $250 annual limit per director last year. If every BHAB member used that allowance, that equates to a $5k budget.
3. WIC provides BHAB ensures engaging stakeholders in the 3-Year Plan & Update process:
“(a) Each three-year program and expenditure plan and update shall be developed with local stakeholders, including adults and seniors with severe mental illness, families of children, adults, and seniors with severe mental illness, providers of services, law enforcement agencies, education, social services agencies, veterans, representatives from veterans organizations, providers of alcohol and drug services, health care organizations, and other important interests. Counties shall demonstrate a partnership with constituents and stakeholders throughout the process that includes meaningful stakeholder involvement on mental health policy, program planning, and implementation, monitoring, quality improvement, evaluation, and budget allocations. A draft plan and update shall be prepared and circulated for review and comment for at least 30 days to representatives of stakeholder interests and any interested party who has requested a copy of the draft plans.”California WIC 5848.
We have held a series of Community Engagement Forums at the beginning of the year where we heard from a few hundred stakeholders. About half of these participants are employed by county BHS providers. They provide valuable feedback indeed but, shouldn’t we be focusing primarily on getting consumer feedback on a much more robust scale?
This is the beginning of what I intend are more informative posts that help explain the challenges we face. Ideally, key stakeholder representatives will read this and receive it as an invitation to discuss strategies to help us help the community. If you are such an interested person please contact us here.
About the Author
The author serves on the Behavioral Health Advisory Board (BHAB). As such, I do not represent BHAB in any posts or contributions you’ll find on this page and throughout this website.
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