REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 11, 2024
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Mental Health Services Act Annual Plan Update for 2024-25
End
RECOMMENDATION(S)
Recommendation
1. Approve Amendment No. 1 to the Mental Health Services Act Three-Year Integrated Plan Contract No. 23-503, which includes the Mental Health Services Act County Compliance Certification, County Fiscal Accountability Certification, and County Prudent Reserve Assessment/Reassessment Certification forms, for an Annual Plan Update for 2024-25, including an increase in expenditures of $4,029,073, from $180,362,915 to $184,391,988, for the period of July 1, 2024 through June 30, 2025.
2. Approve the Annual Prevention and Early Intervention Report as required by Title 9 California Code of Regulations Section 3560.010 and incorporated into the Mental Health Services Act Annual Plan Update for 2024-25.
3. Authorize the Director of the Department of Behavioral Health, as the County Mental Health Director, to sign the Mental Health Services Act County Compliance Certification annual update form, as required by the California Department of Health Care Services, for the Mental Health Services Act Annual Plan Update for 2024-25, on behalf of the County, subject to review by County Counsel.
4. Authorize the Director of the Department of Behavioral Health, as the County Mental Health Director, and the Auditor-Controller/Treasure/Tax Collector, to sign the Mental Health Services Act County Fiscal Accountability Certification annual update form, as required by the California Department of Health Care Services, for the Mental Health Services Act Annual Plan Update for 2024-25, on behalf of the County, subject to review by County Counsel.
5. Authorize the Director of the Department of Behavioral Health, as the County Mental Health Director to sign the Mental Health Services Act County Prudent Reserve Assessment/Reassessment Certification form, as required by the California Department of Health Care Services, for the Mental Health Services Act Annual Plan Update for 2024-25, on behalf of the County, subject to review by County Counsel.
6. Authorize the Director of the Department of Behavioral Health, as the County Mental Health Director, to execute and submit Amendment No. 1 to the Mental Health Services Act Three Year Integrated Plan Contract No. 23-503 documents and any subsequent non-substantive amendments necessary, as required by the California Department of Health Care Services, to the State of California Department of Health Care Services, Mental Health Services Oversight and Accountability Commission, on behalf for the County, subject to review by County Counsel.
7. Direct the Director of the Department of Behavioral Health, as the County Mental Health Director, to transmit the documents in Recommendation Nos. 1, 3, 4, and 5, and any subsequent non-substantive amendments in relation to the Mental Health Services Act Annual Plan Update for 2024-25, to the Clerk of the Board of Supervisors within 30 days of execution.
(Presenter: Georgina Yoshioka, Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Promote the Countywide Vision.
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies and Stakeholders.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The approval and submission of the Mental Health Services Act (MHSA) Annual Plan Update for 2024-25 to the California Department of Health Care Services (DHCS), and Mental Health Services Oversight and Accountability Commission (MHSOAC) is required by the State to enable the Department of Behavioral Health (DBH) to receive and expend MHSA funds for the 2024-25 program year. Expenditures will not exceed $184,391,988 for MHSA program services as shown below and will be funded by MHSA funds. Adequate appropriation and revenue will be included in the Department of Behavioral Health’s (DBH) 2024-25 Recommended Budget.
|
MHSA Component |
Current 2024-25 Amount |
Recommended Increase/Decrease |
Recommended 2024-25 Amount |
|
Community Services and Supports (CSS) |
$129,268,094 |
$5,256,935 |
$134,525,029 |
|
Prevention and Early Intervention (PEI) |
$32,655,671 |
($596,615) |
$32,059,056 |
|
Innovation (INN) |
$3,628,892 |
($91,766) |
$3,537,126 |
|
Workforce Education and Training (WET) |
$6,271,789 |
($226,184) |
$6,045,605 |
|
Capital Facilities and Technological Needs (CFTN) |
$8,538,469 |
($313,297) |
$8,225,172 |
|
TOTAL |
$180,362,915 |
$4,029,073 |
$184,391,988 |
BACKGROUND INFORMATION
DBH is responsible for providing mental health and substance use disorder (SUD) services to San Bernardino County residents experiencing severe mental illness and/or SUD. The MHSA programs help to reduce symptoms of serious mental illness, improve functioning, reduce homelessness and justice involvement for clients, use non-stigmatizing and culturally appropriate approaches to educate communities about behavioral health conditions, and increase access to necessary behavioral health services.
In 2004, California voters passed Proposition 63, the Mental Health Services Act (MHSA), which established a state personal income tax surcharge of one percent on the portion of taxpayers’ annual taxable income that exceeds $1,000,000 for MHSA services. Since 2005, MHSA has provided funding to the County for services and resources that promote wellness, recovery, and resiliency for adults ages 26 to 59, and older adults ages 60 and over, with serious mental illness; for children and youth with serious emotional disturbances; and for family members of children and youth with serious emotional disturbances.
DBH developed the MHSA Annual Plan Update according to the guidelines provided by MHSOAC, including following the stakeholder process in California Welfare and Institutions Code (WIC) Section 5848 and California Code of Regulations Title 9, Division 1, Chapter 14, Sections 3300, 3315, and 3320, which include a 30-day public review and comment period from February 20, 2024 through March 21, 2024. A public hearing was held by the County Behavioral Health Commission (BHC) on April 4, 2024. The BHC affirmed DBH adhered to the MHSA Community Program Planning (CPP) process and supports the submission of the MHSA Annual Plan Update to the Board of Supervisors (Board) and the subsequent submission to the DHCS and MHSOAC. No substantive text edits were identified or updated during the stakeholder process.
WIC Section 5847 (a) and (b), directs the DBH Director, as the County Mental Health Director responsible for the administration of the County’s mental health services, to execute the compliance and fiscal accountability certifications and submit the MHSA Annual Plan Update to the MHSOAC and DHCS within 30 days of adoption by the Board. The MHSOAC maintains evaluation responsibilities over all MHSA components and maintains approval authority over the INN component only. After approval by the Board and submission of MHSA Annual Plan Update to the MHSOAC and DHCS, MHSA program services and operations will proceed with implementation of the Annual Plan. An MHSA Three-Year Plan or an Annual Plan Update to the Three-Year Plan, including an Annual Prevention and Early Intervention Report must be submitted by DBH for Board approval each year to report evaluation of outcomes and any required changes.
The MHSA Annual Plan Update highlights trends, program goals, and outcomes of DBH MHSA programs and provides a roadmap to a unified system of care. The emphasis of the Annual Plan Update is to link MHSA components, programs, and funding with Medi-Cal and/or other behavioral health programs to create an integrated service experience for County residents.
The Annual Prevention and Early Intervention Report is required by MHSOAC as a separate Recommendation for Board approval per Title 9 CCR Section 3560.010. The report is included as a part of the PEI Component of the MHSA Annual Plan Update.
The MHSA Annual Plan Update for FY 2024-25 consists of six MHSA components including: CPP, CSS, PEI, INN, WET, and CFTN.
• The CPP is not a specific “programmatic component,” but rather includes countywide stakeholder input and involvement in the planning, implementation, evaluation, and improvement of all MHSA component programs. Program changes identified through stakeholder input include increased behavioral health and housing supports for homeless individuals, expanded mental health crisis services, increased access to services for individuals experiencing first symptoms of the onset of a serious mental illness, and expanded places in the mountain communities for people to connect with mental health and substance use disorder services.
• The CSS component contributes to the ongoing transformation of the public mental health system by augmenting existing services; establishing a system of care for crisis services; developing programming to address the needs of transitional age youth; developing supportive housing and maximizing MHSA funds for housing opportunities; and enhancing and expanding wraparound services to children, youth, adults, and older adults.
• The PEI component is intended to reduce risk factors, increase protective factors, and intervene early in the progression of a behavioral health illness.
• INN projects are unique, as they are intended to contribute to learning and test the implementation of novel, creative, ingenious mental health approaches expected to contribute to learning for integration into the mental health system. All INN projects are time-limited and part of a rigorous evaluation process, which can include transitioning INN strategies into other funded programs or ending strategies depending on lessons learned.
• The purpose of the WET component is to recruit, develop, and maintain an appropriately educated and culturally competent workforce.
• The CFTN component provides funding to purchase or rehabilitate County-owned buildings that will be utilized in the provision of MHSA funded behavioral health services, such as the construction of Crisis Residential Treatment centers, and to support the implementation of new electronic and technological enhancements such as the electronic health record and billing systems.
On June 13, 2023 (Item No. 25), the Board approved DBH’s MHSA Three-Year Integrated Plan for 2023-24 through 2025-26 in the amount of $550,758,995, for the period of July 1, 2023 through June 30, 2026.
During 2024-25, DBH anticipates that MHSA programs will serve approximately 185,000 clients across the continuum of care. The cost per client varies widely depending upon specific MHSA program and the individual level of care provided, with estimated costs ranging from $339 to $1,741 per client.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health (Ellayna Hoatson, Contract Supervisor, 388-0858) on May 7, 2024; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on May 15, 2024; Auditor-Controller/Treasurer/Tax Collector (Rhawnie Berg, Deputy Chief Disbursements, 382-3166); Finance (Paul Garcia, Administrative Analyst, 386-8392) on May 22, 2024; County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on May 23, 2024.