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Intro to the San Diego Behavioral Health Advisory Board

The county Behavioral Health Advisory Board (BHAB) was created in 2015 when the former Alcohol and Other Drug Advisory Board (ADAB) merged with the Mental Health Advisory Board (MHAB). Because are so many intersections between mental health issues and substance use disorders, it was believed there would be many efficiencies counties could enjoy once these entities joined forces. The idea is taking hold and notably, through the CalAIM initiative, the governor is directing all counties conduct such a merger by the year 2027.

The original MHAB was formed in 2005 as the county began fulfilling its duties outlined in the Welfare and Institutions Code (WIC) Mental Health Services Act (MHSA). Prop 63 requires California millionaires pay 1% of income exceeding $1m, and directed those funds be allocated solely towards mental health services throughout the state. In 2019 the MHSA(i) was reinforced through AB-1352.

Clients and community stakeholders across the state rejoiced at the prospect of a truly client-driven mental health system that is responsive to the needs of the people it serves and fully accountable to the public. The MHSA was intended to transform the public mental health system, not only through the generation of new revenue to fund the expansion of services, but also by requiring unprecedented levels of ongoing stakeholder input and involvement at all levels of public mental health policy, program planning, implementation, monitoring, quality improvement, evaluation, and budget allocations.(ii)

To achieve this, the MHSA requires counties to implement a broadly inclusive Community Program Planning (CPP) process to identify local-level needs, define MHSA funding priorities, and guide the creation, implementation, oversight, and evaluation of MHSA-funded programs, and any changes or updates thereto. Through the CPP process, counties must bring together mental health clients, their families, representatives of traditionally un-, under-, and inappropriately-served populations, and other local stakeholders to develop a shared vision for MHSA programming and spending based on the unique needs of individual communities and the stated interests of clients being served in their local mental health systems.(iii)

The MHSA directs counties to spend up to 5% of their annual MHSA revenues on planning costs. This allocation must include funds to pay for the costs of clients, family members, and other stakeholders to participate in the CPP process.(iv)

ACCESS California

The MHSA allows counties to spend up to 5% of their annual MHSA revenues on CPP costs. This allocation must include funds to pay for the costs of clients, family members, and other stakeholders to participate in the CPP process.iv

I describe key elements required in the MHSA more generally here. The WIC requires that:

  1. An advisory board of stakeholders be created which would inform Supervisors about the plains and expenditures of the MHSA funds. At the time of the legislation bill proponents described the responsibility as that of being created to provide ‘oversight’ of the funds.
  2. The advisory board would report to Supervisors from their own lived experience and subject matter expertise, as well as by being continually informed by interfacing with their BHS as well as other stakeholders, especially consumers and their families.
  3. The advisory board ensure that these consumers and other community stakeholders are meaningfully engaged in all phases of the 3-year planning and budgeting process.
  4. That up to 5% of the CSS portion of the MHSA funds, be available to fulfill the requirements of the Community Program Planning (CPP) process.

Status Quo

The status quo prior to our newest Board of Supervisors has been that the BHS develop a MHSA Three-Year Plan and budget nearly autonomously, almost entirely independent of the BHAB, and certainly without many perceive is with meaningful community and stakeholder engagement. For a more formalized community engagement we hold a brief series of forums late in the year and from which we receive relatively subjective feedback all over the map.

There are BHS related community engagement efforts made through various BHS councils as well as informal interactions between BHS and stakeholders. However, the BHAB has been largely sidelined and has become what seems more a bobbing-head committee that endorses whatever the BHS puts in front of it, rather than being the highly useful resource I believe we could become.

Our Progress

At our BHAB board retreat, used to review the previous calendar year and plan for the next. To help us through the process, we were given access to a BHS staffer who facilitated our taking this path. BHAB Members selected three priority topics for 2021, and we subsequently formed three workgroups focused on Criminal Justice, Alcohol and Other Drugs Continuum of Care, and Stakeholder Engagement. We developed strategic objectives for these workgroups and will work to accomplish those.

Stakeholder Engagement

The work of the Stakeholder Engagement Workgroup could potentially includes:

  • Working with BHS to define the county’s Community Program Planning (CPP) processes by:
    • Identifying key elements and timing of the MHSA 3-Year Plan and budgeting process
    • Identifying opportunities to engage stakeholders and collect feedback.
  • Better understanding the Supervisors, BHS Director’s, and senior county executive staff’s vision.
  • Better understanding the various programs and services we currently deliver in the context of how they address meeting the county leadership’s objectives,
  • Working throughout the year to engage community stakeholders appropriately.
  • Developing a systematic feedback loop so that we can inform Supervisors of our findings and stay informed ourselves of each of your respective interests.

The Future

Over the long-term the BHAB can be a much more effective advisory board. However, that will take both time and effort by the Supervisors, BHS leadership and staff, and the BHAB itself. Areas we need to focus on include:

  • Identifying BHAB’s responsibilities and the skills and talent Members should have to fulfill those responsibilities.
  • BHAB Member recruitment. We need quality people that have the skills and time needed to do our job effectively.
  • Operationalize other key BHAB responsibilities beyond those on Stakeholder Engagement.
  • Ensuring we are focused on measurable outcomes and the tactics we are using to achieve those outcomes, especially those that reflect our effectively meeting our equity targets.
  • Building relationships with our communities, especially those previously under-served.

We need to reshape BHAB for the future so that it can sustain its responsibilities, no matter what political force is in control. We have seen for at least the last decade what a BOS looks like when they do not put their constituents first and on an equitable basis.

The intent of our advisory board is that we would give non-conflicted feedback to the Board of Supervisors without being influenced by county funding or politics.

Naturally, in government everything is political but, the most important point is that Supervisors are given authentic and valid feedback from a highly engaged and knowledgeable source in BHAB – rather than from relying on department leadership and staff dependent on annual funding allocations.

Let’s all work together to reform our BHAB to be the powerful champion for stakeholders it was designed to be.

References

i | Bronzan-McCorquodale Act | aka Mental Health Services Act | Welfare and Institutions Code Section 5600, and Section 5604 describing Advisory Boards | Complete MHSA Text (2020)

ii | Welfare and Institutions Code Section 5848(a) — Oversight and Accountability

iii | California Code of Regulations, Section 9 CCR §§ 3200.070 and 9 CCR § 3300

iv | WIC § 5892(c); 9 CCR § 3300

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