COUNTY OF SAN MATEO

Inter-Departmental Correspondence

County Manager's Office

DATE:

April 13, 2004

BOARD MEETING DATE:

April 20, 2004

TO:

Honorable Board of Supervisors

FROM:

John Maltbie, County Manager

SUBJECT:

County Manager's Report #6

1.

Mental Health Services Act, an initiative to appear on the November 2004 ballot

Recommendation

Adopt a resolution in support of the Mental Health Services Act, an initiative to appear on the November 2004 ballot.

Background

If approved by voters, the Mental Health Services Act would fund the expansion of services and programs for mentally ill children, adults and seniors. The Mental Health Services Act builds on proven integrated services models, such as the mental health "children's system of care" and the "integrated services" adult system of care (AB 2034). Services would include outreach, mental health treatment, community support including case management, short and long-term housing and employment services, prescription drugs, and gap coverage for essential medical treatment. The initiative also funds innovative mental health promotion and prevention activities as well as provides for human resource capacity building to address shortfalls in mental health professions including psychiatrists, nurses and social workers.

The program would be administered through the existing County Mental Health Plans. Counties would receive funds based on a case rate for each individual in need of services as identified in an annual needs assessment and plan for services.

The Mental Health Services Act ballot initiative was developed by the California Mental Health Association, the Office of Assemblyman Darrell Steinberg, and numerous mental health organizations including: the California Mental Health Planning Council, the National Alliance for the Mentally Ill, and the California Mental Health Directors Association.

The initiative would generate funding for the increased services through an additional 1% tax on taxable income in excess of $1 million. It is expected that the initiative would generate over $600 million dollars annually for mental health services in California. The initiative would prohibit new funding to supplant current funding to ensure an overall increase in mental health funding.

On March 19, the Campaign for Mental Health submitted over 643,000 signatures-nearly double the number needed to qualify (374,000) for the November 2004 ballot.

Discussion

Multiple state and national studies have found that only about 50% of necessary mental health services are available to our population. The World Health Organization's "Burden of Disease" study found that four of the top ten disabling conditions were mental disorders. Untreated mental illness results, not only in individual and family tragedies, but also in major social and economic costs to our communities and state.

Proponents contend the initiative would save the state and local government on costs for incarceration, medical care, social services and other services as a result of earlier, more comprehensive and better treatment of mental illness. Experience with programs such as the Mental Health Children's System of Care, the Mentally Ill Offenders Crime Reduction Act (MIOCR), and Integrated Services for Homeless Mentally Ill Adults (AB 34 & AB 2034) have demonstrated substantial savings in jail and criminal justice costs and out of home placement costs when adequate and effective mental health services are provided.

In addition to existing state and local review and audit mechanisms, the initiative would create the Citizens Oversight and Accountability Commission which would provide annual reviews of counties' expenditures.

Vision Alignment

Support of the Mental Health Services Act would further the County's commitment to ensure basic health and safety for all and supports Goal # 5 and 8 to provide access to health care and preventative care and to help vulnerable people, including the mentally ill, achieve a better quality of life.

Fiscal Impact

How much each county receives will be based on a locally conducted needs assessment and identification of how many seriously mentally ill individuals require services. However, each county's "Realignment" base is being recommended as a rule of thumb to project potential funding levels. For San Mateo County we might then anticipate approximately $25 million in new funding for mental health services. If we assumed an annual expenditure of $6,000-10,000 per seriously mentally ill client, this would provide services to 2500-4000 additional individuals. This funding would also be available to increase services to clients who require more resources than we are currently able to provide.

2.

Resolution of support if amended for AB 1876 (Chan), health bay beaches

Recommendation

Adopt a resolution of support if amended for AB 1876 (Chan), health bay beaches.

Background

AB 1876 would expand the definition of a public beach to include public bay beaches and require testing similar to that of other public beaches. The bill would also require warning signs be multilingual if other, nearby municipal advisory signs are multilingual. The criteria for selecting public bay beaches subject to monitoring would be based on the number of visitors-those beaches with more than 15,000 annual visitors.

The duty to monitor these beaches would be mandatory only when the Legislature has appropriated sufficient funds as determined by the State Director of Health Services.

Discussion

According to Dean Peterson, Director of Environmental Health, two issues remain that are of concern to the California Conference of Directors of Environmental health-determining the number of visitors at beaches and the sufficiency of funds. Both Dean Peterson and a representative of Save the Bay (sponsor) believe a compromise is near.

The proposed amendment would read on page 4 line 30 of the bill:

"(i) The public beach is visited by at least 15,000 people annually, as determined by the local health officer."

According to Dean Peterson, only Coyote Point Park would satisfy both the definition of a public bay beach as well as the 15,000 annual visitor rate and, as a result be subject to the monitoring and posting provisions of the bill. However, Environmental Health currently monitors both Coyote Point Park as well as the Foster City lagoon area. As a result, the bill as currently drafted and as proposed to be drafted would not increase current costs to the County. However, seeking an amendment to ensure that sufficient additional funds are appropriated would provide greater assurances.

While the cost of posting warning signs is of some concern (but not as a result of the bill), the multilingual requirement will likely not have a significant additional cost if any. Environmental Health currently uses an "international" symbol as a warning.

Vision Alignment

Support of AB 1876 (Chan) if amended as proposed above would help the County ensure basic health and safety for all and work toward Goals #7-to maintain and enhance the public safety of all residents and visitors.

Fiscal Impact

If enacted as presented to Environmental Health Director Dean Peterson, AB 1876 would create no additional costs to the County and may create grant-funding opportunities.