COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Department

DATE:

February 17, 2006

BOARD MEETING DATE:

February 28, 2006

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Four-fifths vote

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director, Health Department

Gale Bataille, Director, Mental Health Services Division

SUBJECT:

Mental Health Services Act Plan Implementation

RECOMMENDATION:

1)

Adopt an ordinance amending the Salary Ordinance adding 42 positions to support implementation of the Mental Health Services Act Plan; and

2)

Approve an Appropriation Transfer Request (ATR) to recognize State Mental Health Services Act and related revenues and associated expenses in the amount of $4,566,290.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all

Goal 8: Help vulnerable people—the aged, disabled, mentally ill, at-risk youth and others—achieve a better quality of life.

The implementation of the Mental Health Services Act Plan contributes to this commitment and goal by expanding mental health services to unserved and underserved seriously mentally ill adults, older adults, and seriously emotionally disturbed children and youth.

Performance Measure:

Measure

FY 2004-05
Actual

FY 2005-06 Estimate

FY 2005-06
Projected

To increase the number of clients served in the Mental Health Services system

11,154

11,426

12,794

BACKGROUND:

California voters approved Proposition 63, the Mental Health Services Act (MHSA), in November 2004. The MHSA provided for increased funding for public mental health services for unserved and underserved seriously mentally ill adults, older adults, and seriously emotionally disturbed children and youth through a one percent increase in the state income tax for households with annual taxable income over one million dollars. The MHSA establishes the State Department of Mental Health as the agency designated to establish guidelines for use of the funds and to administer the program.

DISCUSSION:

On November 15, 2005 your Board approved the three-year MHSA Plan for submission to the State. In January of this year Mental Health staff and Mental Health Board members met with the State review panel and received a favorable review of the MHSA Plan. A letter from the State approving the MHSA Plan and confirming the award will follow.

The Plan contains “full service partnership” programs for seriously mentally ill adults, older adults, children/youth, and transition age youth; expanded community-based services; outreach and engagement activities targeting unserved ethnic minority and non-English speaking communities; primary care interface services; school-based services; criminal justice pathways for people with mental illness; a program for peer and parent partner employees to engage and retain clients in treatment; and self-help services. The Plan also includes a multi-year system redesign and training initiative designed jointly by Mental Health and Alcohol and Other Drug Services to expand the mental health system capacity to treat people with co-occurring mental health and drug and alcohol problems effectively.

The full service partnership programs will have substantial housing supports. The Mental Health Services Division has collaborated with the Housing Department and Human Services Agency to develop a request for proposals and plan for using this resource that supports the County’s ten year plan to end homelessness (HOPE).

The Salary Ordinance Amendment adds 42 new positions, totaling 33.5 FTEs, to provide services proposed in the MHSA Plan. The ATR includes funding for the 42 new positions as well as operating and contract expenses. Seventeen of the new positions contribute primarily to expanding clinical services to unserved and underserved adult, older adult, and child/youth populations in accordance with the goals of the MHSA. A significant new strategy for engaging and retaining these populations in treatment is the focus of eighteen new community worker positions that will be filled by individuals with experience as a mental health client or family member. There are five new administrative support positions including four clerical positions and one contract specialist. There are two new management positions: a clinical services manager to oversee the Health Department’s health disparities initiative and another to oversee and develop the system of care for older adult mental health services. There is the replacement of an existing deputy director position with an assistant director of mental health position, which restores the Division’s prior organizational structure.

The County Manager’s Office and Employee Public Service staff have reviewed and approved this plan.

FISCAL IMPACT:

The total expense included in the ATR is $4,566,290, which includes the cost of the additional positions, operating expenses and contracted services. These costs will be met with the MHSA revenue awarded by the State and other revenues that will be generated. Estimated salary and benefits costs are $777,500 for the remainder of FY 2005-2006. The balance of revenues added through this ATR ($3,788,790) will provide funds for contracted services ($3,515,536) and a variety of expenses, including one-time expenses to provide equipment, supplies and training for new employees. The ATR adds $3,607,635 in Mental Health Services Act funding, $761,172 in federal financial participation for Medi-Cal, and $98,742 in SB 163 WrapAround funding through the Human Services Agency. These services will also generate $98,741 in Medicare and other insurance. There is no additional Net County Cost associated with the MHSA Plan or with this ATR.