What is MHSA?
Sacramento County Behavioral Health Services’ mental health system of care includes 260 programs/agencies involving county- and contract-operated mental health services that deliver services to approximately 32,000 children and adults annually.
Proposition 63 - aka the Mental Health Services Act (MHSA) - was passed by California voters in 2004. An initiative led by then-Assemblymember Darrell Steinberg, the Mental Health Services Act was a response to the inadequacy of California's historically underfunded mental health care system, especially for those with serious mental illness. It was originally intended as a replacement for psychiatric institutions, to help the state’s most severely impaired function in their communities. The MHSA is funded by imposing an additional one percent tax on personal income for individuals (but not corporations) in excess of one million dollars earned annually and generates more than $2 billion a year. MHSA funding is to be used to provide funding, personnel, and resources to support county mental health programs.
Translation: Instead of funding for services being prioritized in the general fund, the bulk of the county’s behavioral health (mental health + substance use prevention and treatment) services is dependent on the spending behavior of our state’s millionaires.
Wellness, recovery & resilience. Cultural competence. Client- and family-driven behavioral health systems. Integrated service experience. Community collaboration. These are the purported underlying values of the Mental Health Services Act. MHSA funding is earmarked for five funding buckets, named components based on the law’s priorities:
1. Community Service & Supports (CSS) are programs and strategies improving access to underserved populations, bringing recovery approaches to current systems, and providing “whatever it takes” services to those most in need. Programs offer integrated, recovery-oriented mental health treatment; outreach and engagement and linkage to essential services; housing and vocational support; and self-help.
2. Prevention and Early Intervention (PEI) supports the design of programs to prevent mental health issues from becoming severe and disabling, with an emphasis on bringing about positive mental health outcomes either for individuals and families who are at risk of, or showing early signs of serious mental illness, and improving timely access to services to underserved populations.
3. Workforce Education & Training (WET) has an overall mission of developing and maintaining a sufficient workforce capable of providing client and family driven, culturally competent services, that promotes wellness, recovery and resiliency, and lead to evidenced-based, value-driven outcomes.
4. Capital Facilities/Technological Needs (CF/TN) improve the infrastructure of California’s mental health system.
5. Innovation (INN) goal is to develop and implement promising and proven practices to increase access to mental healthcare. These are short-term programs, for two to five years, to “try-out” novel creative and/or ingenious mental health practices/approaches that are expected to contribute to learning rather than a primary focus on providing a service. If what is learned proves effective, an INN program could be funded under CSS or PEI in the future.
Per Welfare and Institutions Code (W&I Code) Section 5847 (a) and (b), counties must prepare and submit a Three-Year Program and Expenditure Plan (Plan) and Annual Updates (Update) for MHSA programs and expenditures to Mental Health Services Oversight and Accountability Commission (MHSOAC) and Department of Health Care Services (DHCS). The Plan must be complete and include all MHSA components. Per W&I Code Section 5848, counties are required to collaborate with constituents and stakeholders throughout the planning and development process of the Plan, and the Plan must be adopted by the County Board of Supervisors.
This is what our Board of Supes heard on Tuesday August 24: The Mental Health Services Act Fiscal Year 2021-22, 2022-23, 2023-24 Three-Year Program And Expenditure Plan, a 504-page document significantly condensed into an 8-page powerpoint presentation by Dr. Ryan Quist, the county’s Behavioral Health Services Director, and his boss Chevon Kothari, the county’s Health Services Director.
What’s up with Sac County’s MHSA Plan?
“The MHSA planning process and subsequent updates is a really important tool in order to be responsive to community needs as they change, as well as to be responsible to public funding and the way we spend that on behalf of our communities.”
- Chevon Kothari, Sac County Health Services Director
Dr. Quist gave a brief and underwhelming overview of the MHSA components and some of its programming highlights. For example, 51,826 individuals were served across the Prevention and Early Intervention (PEI) programs, included 47,109 callers who accessed the Suicide Crisis Line. Under the Innovation (INN) component, it was stated that MHSA funds will be utilized to expand the Mental Health Crisis/Urgent Care Clinic - a walk-in clinic for all ages specializing in short-term crisis intervention - to 24/7 service delivery, which will be a component of the county’s upcoming Wellness Crisis Call Center and Response Program.
This plan was supposed to come before the Board last year but the deadline was extended by the State due to the COVID-19 pandemic, with the hope that the delay would afford counties additional time to incorporate plans for addressing the additional mental health needs for services brought on by the pandemic. Despite having an extra twelve months for consideration and planning, Dr. Quist noted that he was bringing forth a similar program to what had already been approved in the past due to the assumption that there would be a significant slashes in revenue funds. However, the millionaires acted differently than expected and the MHSA funds came in at higher rates, which this plan did not incorporate due to the most recent revenue projections not being released yet by the State. Dr. Quist anticipates conducting another analysis with the revenue projections and will bring back to the Board any changes that may need to be discussed.
Translation: Even though they had extra time and with the pandemic intensifying the extra need for mental health resources, Sac County’s MHSA Three-Year Program and Expenditure Plan for Fiscal Years 2021 through 2024 is anything but extra. It’s a status quo plan for status quo programming.
Supervisor Serna asked how MHSA funds can be used with ARPA funds (no one knows yet); Supervisor Nottoli asked how MHSA programming will be expanded to provide behavioral health services to the expected 2000 refugees between now and September 30 to Sacramento County (no one knows yet); and Supervisor Desmond asked how MHSA funding and programming will be used to integrate and expand school-based mental health services (it won’t). County staff emphasized that they stay looking for new state and federal investments in mental health spaces to use for the dynamic and changing community needs (here’s an idea - how about we use funds that our county already has by taking them from the sheriff’s budget?)
The MHSA plan was unanimously approved, which means continuation of previously approved mental health treatment and prevention programming and related activities. $101,509,774 in total MHSA program funding for Fiscal Year 2021/22, with $13,196,792 in prudent reserves. All the more reason for us to be advocating for health and human services to be Sac County’s top priorities for ARPA fund allocation.