Category Archives: Substance Abuse

The Mental Health Services Act – Then and Now

For a variety of reasons, I am being asked much more than ever about the thinking behind various provisions of the mental health services act when we are writing it in 2003 and how that relates to some of the challenges we now have.

Not surprisingly, most of the challenges we now are seeing involved issues we anticipated when we wrote the Act.  We have posted all of the preliminary drafts of the MHSA on our website in case anyone is curious about how the language evolved from the first draft in May 2003 to the final language in September.

The Act still looks like it correctly identified what was needed to fulfill our goals.  But many parts of it have not been implemented the way it was envisioned and a lot has changed from what we knew in 2003 when it was written. In 2006 I had a different way of viewing how would be implemented and significantly underestimated how challenging it would be for state agencies to regularly update regulations which I thought could be an ongoing process with updates every three years. I also significantly underestimated the delays and challenges in developing outcome data.

In this blog I will speak to some of the issues and some of the solutions.  Mostly what is required is a recognition that we have not revisited the guidelines (which led to regulations), all of which were developed before the applicable parts of the act had been implemented.

Now that we have had many years of implementing each part of the act is time to revisit the guidance (leading eventually to updated regulations) through a series of separate workgroups, that can move us more firmly in the direction that I think we all know is where we need to go.

Continue reading The Mental Health Services Act – Then and Now

A Long Strange Trip – and About to Get Stranger

I have been lobbying since 1977, and with CCCBHA since 1986, and in all of those years there has never been one like 2017. One where Sacramento is totally consumed by what will, or will not, happen in Washington DC and what it might mean.

Our agencies are impacted by what it means for Medicaid, and the state and counties will act with that looming shadow.  Immigration policies create threats for many families we serve. For many of us and our staff, we have personal concerns that go beyond any of these specific issues.

These fears and uncertainties are so big that they are now part of every meeting and conversation. What we can do about it must take precedence over everything else. So, all of my blogs this year will start with this subject and my latest thinking. Continue reading A Long Strange Trip – and About to Get Stranger

Proposition 64 Funds Can Close Gaps in Realignment and MHSA Funding and Structure

Proposition 64 (Marijuana Legalization) directs 60% of its funds to “Education, Prevention, Early Intervention and Treatment” for substance use disorders including related services such as mental health for youth and their families.

The measure includes a page or more of detail on how the funds “could” be spent, but from my reading this is the only specific limitation on how it must be spent. Youth is not defined, which leaves that up to the legislature which should define it as primarily ages 12-25 with prevention and early intervention for younger children and the “and their families” including parents.

The estimates on the amount of tax on marijuana sales revenues from this portion of the measure range from $300 million to $800 million – with $500 million as a best guess for the first year (2018-19). We then expect revenues to rise in future years.

This is a very significant level of new funding – nearly as much as the original funding from Proposition 63 of 2004 (The Mental Health Services Act) and more than half as much as the original mental health sub-account of 1991 realignment or behavioral health subaccount of 2011 realignment. Continue reading Proposition 64 Funds Can Close Gaps in Realignment and MHSA Funding and Structure

MHSA Now and Then: Need for Comprehensive Needs Analysis and Planning

For the past year I have been participating in a work group regarding Older Adults focusing on the extent to which the Mental Health Services Act (Prop 63/MHSA) has resulted in developing a system of care for that population. Recently I was interviewed, mainly in my capacity as a co-author and principal drafter of that law with questions about our expectations, how it is going, and what needs to happen.

Continue reading MHSA Now and Then: Need for Comprehensive Needs Analysis and Planning

California Well Positioned for Excellence Act (CCBHC) Certification, Management and PPS

December 20, 2015

On Monday, December 7th, I participated in the National Council for Behavioral Health’s second all day training for state associations to support state planning to develop proposal under the Excellence in Mental Health Act Certified Community Behavioral Health Centers program which will significantly increase funding and significantly reduce documentation requirements for outpatient behavioral healthcare. See my paper documenting that the value of this is about $1 Billion statewide in the first year and growing.

A centerpiece of that training was the review of a new and expanded “Integrated CCBHC Certification Criteria Feasibility and Readiness Tool (I-CCFRT)”.
In studying that tool and discussions with other state association representatives I learned that the structure of county mental health in California (not yet the case for substance use disorders- but should eventually be with the implementation of the Organized Delivery System) is well aligned with the requirements for CCBHC certification, management and establishment of a prospective payment system.

Continue reading California Well Positioned for Excellence Act (CCBHC) Certification, Management and PPS

12 Months of Planning for Biggest Changes in Decades

November 16, 2015

  • Opportunities and challenges for counties and providers
  • New Alcohol and Drug Organized Delivery System
  • CCBHC/Excellence in Mental Health Act Certification and PPS
  • Whole Person Healthcare Integration Pilots under Section 1115 Waiver

All of these issues have to be addressed in the coming year by counties and providers.

When I speak with community behavioral health agencies, the biggest issue for most seems to be the lack of contract expansion and the frustration that counties don’t seem to make that a very high priority and claim that they don’t have the significant growth in revenues that all of the state revenue charts indicate they have received or soon will receive.

Continue reading 12 Months of Planning for Biggest Changes in Decades