Inter-Departmental Correspondence

Health System



April 20, 2009


May 19, 2009







Honorable Board of Supervisors



Jean S. Fraser, Chief of the Health System


Louise Rogers, Director, Behavioral Health and Recovery Services



Modification to Agreement with State Department of Mental Health for Mental Health Services Act Funding



Adopt a Resolution authorizing the President of the Board to execute a Modification to the Agreement with the State Department of Mental Health for Mental Health Services Act funding, extending the term from July 1, 2004 through June 30, 2013, increasing to the maximum allocation to $34,677,418.



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 Agreement contributes to this commitment and goal by providing funding for mental health services as described in the approved San Mateo County Mental Health Services Act (MHSA) Three-Year Plan.


Behavioral Health and Recovery Services (BHRS) provides a range of services to promote wellness and recovery and to support consumers remaining in the lowest possible level of care. The provision of intensive case management is one established level of care. The Full Service Partnership (FSP) services funded through this Agreement contribute to this measure.


Performance Measure:


    FY 2008-09

    FY 2009-10

Clients maintained at current or lower level of care.





On February 6, 2007, your Board approved an Agreement with the State Department of Mental Health (DMH) for MHSA funding in the amount of $15,216,123 for the term March 1, 2006 through June 30, 2008. On January 29, 2008, your Board approved a superseding Agreement with DMH that revised the term of the Agreement to July 1, 2004 through June 30, 2008, and increased the maximum MHSA funding amount to $17,760,871. On October 7, 2008, your Board approved a second superseding Agreement extending the term through June 30, 2009. The Agreement allows DMH to make unilateral modifications for expected funding increases during the term of the Agreement, but not changes to the Agreement term. DMH has executed several unilateral modifications during the contract term to increase the maximum funding amount. It is anticipated that further modifications will be brought to your Board for approval.



This Modification extends the term of the Agreement through June 30, 2013. Funding is included for four MHSA components: Community Services and Supports (CSS), Information Technology, Capital Facilities and Prevention and Early Intervention (PEI) services. CSS services include three expenditure categories: outreach and support, system transformation strategies, and FSP services. Fifty percent of CSS funding is required to be directed to FSP services. BHRS submitted a plan to DMH for Information Technology, which was approved on July 22, 2008. The plan will partially fund a new integrated business and clinical information system and ongoing technical support. Capital facilities projects that fit the State parameters for this funding have not yet been identified.


BHRS submitted a proposal for PEI services that was approved by the State on December 11, 2008. The PEI plan comprises an Early Childhood Community Team project, which incorporates components that build on current models in our community in order to support healthy social and emotional development of young children (from birth to three years of age); a Community Interventions for School Age and Transition Age Youth, which reaches out to them in non-traditional settings through interventions that provide population and group based services to at-risk children and youth (ages six to 25); a Primary Care/Behavioral Health Integration project that identifies and treats adults and older adults in primary care who do not have serious mental illness, and are unlikely to seek services from the formal behavioral health system; a Total Wellness project aimed at identifying and helping manage health conditions of seriously mentally ill adults and older adults found in the behavioral health system; and an anti-stigma project to help reduce stigma around behavioral health across all age groups.


The Agreement Modification has been reviewed and approved by County Counsel and Risk Management. The County Manager approved a waiver of the three-year term limit. Under the terms of this Agreement DMH may continue to make unilateral modifications to respond to variances in available State funding, to provide additional planning funds, to implement new services in our approved plan or to expand services already implemented.



The term of the modified Agreement is July 1, 2004 through June 30, 2013. The Agreement maximum is $34,677,418. The BHRS FY 2009-10 Recommended Budget includes MHSA funding in the amount of $22,129,831, which includes rollover and anticipated annual growth funds. There is no Net County Cost associated with this Agreement Modification.