Category Archives: Mental Health and Education

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.

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 they were envisioned and a lot has changed from what we knew in 2003 when it was written.
Continue reading Mental Health Services Act: Then and Now

AB 1250; Prop 63 and 64; School Mental Health

AB 1250 (Jones- Sawyer): Extreme limits on County contracting.  This is the biggest threat ever to member agencies. Strong opposition seems to be making an impact, but the outcome is uncertain.

By now all members should be familiar with this SEIU and ASFCME sponsored bill which would make it virtually impossible for counties to continue to contract out for the types of services our members provide. Continue reading AB 1250; Prop 63 and 64; School Mental Health

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

Shedding Light on County Behavioral Health Finances

I was fortunate to have two outstanding summer interns from the University of California: Monica Venegas and Deepika Dilip. They produced this report which is now as complete as it is going to get, so it is time to share what they found and provide some explanation.

Since this is not a formal report, but intended only to provide a meaningful snapshot of what information was available, I asked them only to develop information on the 20 largest counties (by population). While this excludes 38 counties it does cover about 95% of the state’s population and behavioral health funding.

Continue reading Shedding Light on County Behavioral Health Finances

After 10 Years, Fine Tuning is Needed for the Mental Health Services Act

After about ten years of implementation some fine tuning is needed for the Mental Health Services Act to better achieve its goals

This Thursday May 26th the Little Hoover Commission will hold its Prop-63-Logosecond hearing on the Mental Health Services Act (MHSA). At issue is its conclusion that state officials have not implemented the recommendations they made in January 2015.

At the same time legislators are taking unprecedented steps to earmark funds (Senate No Place Like Home budget proposal; AB 2017 McCarty – College Students; AB 2279 – Fiscal Reporting). CCCBHA and I support these efforts and join other stakeholders in recognizing the need for some fine tuning of this act.

Continue reading After 10 Years, Fine Tuning is Needed for the Mental Health Services Act

Hot Legislative Topics in January 2016: Housing and School Mental Health

(January 25, 2016)

A Lot More in Housing than Just the Prop 63 $2 Billion Bond Proposal

Housing has centered on the $2 Billion Proposition 63 Mental Health Services Act (MHSA) proposal by Senate President Pro Tem Kevin de Leon and Darrell Steinberg that was presented together with a proposal to have local pilot programs to house other homeless people through new state funds as well as an increase in the SSI/SSP benefit for people who are disabled.

Besides that proposal, the governor’s budget reinforced the need to increase the SSI/SSP benefit and proposed funding to cities, counties and providers to provide housing and services for people coming out of state prison.

Continue reading Hot Legislative Topics in January 2016: Housing and School Mental Health

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

Early Psychosis Programs – taking it to scale

Early psychosis programs began about 20 years ago in Melbourne Australia led by a psychiatrist who observed data showing that there was an incredibly greater recovery rate among those people with schizophrenia who were first seen within a few months after the onset of psychosis.

Their program demonstrated that for that population they were able to achieve a success rate of 80% being discharged from the intensive treatment program to medication only after 18 months and full time employment or education as compared to a success rate of only about 20% for people for whom treatment is delayed for more than a year after the initial experience of psychosis.

This success has generally been replicated in other programs. Until recently, nearly all such programs were small “pilot” programs including about a dozen funded by the MHSA in California.

Continue reading Early Psychosis Programs – taking it to scale