Signs of Hope

Signs of Hope – from leading national behavioral health policy advocate Chuck Ingoglia

At CCCBHA’s February membership meeting we were fortunate to have Chuck Ingoglia of the National Council for Behavioral Health as a presenter.  There is probably no one in behavioral health closer to the action in Washington DC and better positioned to make our case.  He had good news to report in that there is growing support for maintaining federal support for behavioral health.  He noted that everyone’s advocacy is making a difference and that the more extreme potential funding cuts are less likely to be enacted.

However, he also cautioned that everything is still at great risk.  I know that everyone is anxious about what might happen and what we can do to help.  The National Council holds a 30-minute public webinar every two weeks on Wednesdays at noon Pacific time.  The next webinars will be March 1st, 15th and 29th.  Go here to register.

Rethinking MHSA Innovations – Google and IDEO now interested in behavioral health

When we wrote the Mental Health Services Act (Prop 63) we envisioned that the Innovations Program would lead to statewide innovations that advance the whole system and encourage counties to try big and bold ideas that might work much better than the status quo.  We envisioned that each project would have a report providing knowledge of an innovative practice that all should consider, or would lead to knowledge that a particular innovation did not produce an expected result and should not be implemented.  It would also recognize that there would be some results that were in-between that required further study to answer that question.

The main point is that the entire Innovation’s Program would be of value to all counties and stakeholders statewide.  We now recognize that by relying exclusively on the local stakeholder process to develop innovation projects, and having each project done only in one county, it has limited the opportunities for that type of advancement..

CCCBHA developed a paper articulating our ideas on how the MHSOAC could collect a series of the most promising innovations and encourage counties to work together to choose from that list of recommended projects. The projects would also have a single statewide or regional evaluation.

This concept seems even more important now that leading technology innovators such as Google (through their subsidiary Verily) and IDEO are showing interest in partnering with the MHSOAC and counties to develop new ideas.

Verily’s mental health team is led by Tom Insel, former director of NIMH, who sees potential for technology to significantly improve timely help for people to accomplish prevention and early intervention goals as well as apps and other supports for people who are receiving or have received more intensive services or who would otherwise benefit from ongoing support.

These ideas and others were presented at a meeting Verily hosted in January which will lead to a bigger innovation summit.

Out of that summit will come recommendations to improve how innovations projects are developed and could accomplish our goal of having all $90 million benefiting all counties and their stakeholders and soliciting the best new ideas.

Misconceptions on the Impact of No Place Like Home (NPLH) MHSA Housing Program on MHSA Funding

At the Innovations meeting, and the recent CCCBHA meeting, I heard several county and community agency leaders state that No Place Like Home (the $2 Billion MHSA housing bond program) would take 12% of MHSA funds in 2017-18.  NPLH has two components, $1.8 billion that is competitive among counties other than LA, and $200 million that is allocated to all counties by formula.  Apparently, many believe that the portion of NPLH that is allocated to all counties by formula in a non-competitive way is outside of the bonds that would be financed over 30 years and would simply come off the top in the next fiscal year.  That is not correct.  The $200 million of the bonds and costs will be spread over 30 years just like the rest of the program.

There will be other impacts on MHSA funds once projects are built. These will consist of direct services which are likely to be full service partnerships, with many graduating to lower levels of care, reflecting a prioritization of people who are homeless or at risk of chronic homelessness.  It also may include housing support services to the extent that these are not covered by the housing bond or other housing funds that can be leveraged by the bond funds.  However, those costs won’t occur for many years and should have no bearing on MHSA available funds for 2017-18 and 2018-19.

Workforce Education & Training (WET) Summit March 9th – Needs to go beyond MHSA

Led by the California Mental Health Planning Council, a broad array of public behavioral health system organizations (including CCCBHA) are planning the Sacramento  WET Summit.

The main impetus for the summit is that the $450 million MHSA set aside for a ten year statewide workforce program has been spent. The Act provides that after that time, spending for workforce attraction and retention needs to come from each county’s CSS funds through the stakeholder-driven development each year of a three year spending plan, or as an annual update.

The Department of Health Care Services has responsibility to write regulations for that part of the Act, and one inevitable follow up from the summit is to provide direction in the formulation of those guidelines.

Many also believe there should be a portion set aside for a continuation of state programs and that will undoubtedly be discussed.  (CCCBHA has not yet taken a stand on that issue, which we hear is presently getting mixed reviews among counties.)

I am sure it will also address the need to expand use of rehabilitation specialists and peer support.  It is likely to also consider how technology can help.  But my biggest hope is that it will get beyond the MHSA as a funding source. Workforce challenges don’t just impact the public behavioral health system.  Commercial networks, hospitals, colleges, prisons, the VA health system, and all providers and funders of services report workforce shortages.  Solutions should include financial contributions from all of these groups.

This is not just a California problem but seems to be both a national and international challenge.  (I subscribe to a monthly newsletter from an organization called the International Institute for Mental Health Leadership (Link: www.iimhl.org) that provides updates on innovative policies and programs from all English speaking countries. Most of these articles show programs which seem more advanced than the U.S. especially in prevention, early intervention, stigma reduction and integration with physical health.  They also have a meeting every 15 months and  this month’s meeting in Australia features a special one-day workforce summit much like the one in California next month.

This is a time of significantly increased societal and policy support for mental health and addictions, and the demand for services is growing everywhere. Somehow the interest among young people in careers in this field is not growing commensurately and that strains all systems.

This is not going to be solved quickly or simply, but hopefully after the summit we will see some good ideas and growing interest.

 

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