What's So Great About the MHSA?
Transformational change from the ground up
MHSA: A Brief History
Forty years ago, the State of California shut down many state hospitals for people with severe mental illnesses without providing adequate funding for community mental health services. To address the urgent need for recovery-based, accessible community-based mental health services, former Assembly member Darrell Steinberg, along with mental health community partners (including NorCal MHA, ACCESS California's parent agency), introduced Proposition 63, the Mental Health Services Act (MHSA).
In 2004, California voters approved Prop 63 and the MHSA was enacted in 2005 by placing a one percent tax on incomes above $1 million. It provided the first opportunity in many years to expand county mental health programs for all populations: children, transition-age youth, adults, older adults, families, and most especially, the un- and under-served. It was also designed to provide a wide range of prevention, early intervention, and treatment services, including the necessary infrastructure, technology, and enhancement of the mental health workforce to support it.
Prop 63 began as approximately 10% of the entire public mental health budget; it now comprises approximately 24%. (Source)
Unprecedented Levels of Stakeholder Involvement
With the passage of the MHSA, the voters of California sent an unequivocal message to public mental health agencies throughout the state: the public mental health system was broken, too many people were falling through the cracks and suffering needlessly, and something drastic needed to be done to reverse course.
Clients and community stakeholders across the state rejoiced at the prospect of a truly client-driven mental health system that is responsive to the needs of the people it serves and fully accountable to the public. The MHSA was intended to transform the public mental health system, not only through the generation of new revenue to fund the expansion of services, but also by requiring unprecedented levels of ongoing stakeholder input and involvement at all levels of public mental health policy, program planning, implementation, monitoring, quality improvement, evaluation, and budget allocations. (WIC § 5848(a).)
To achieve this, the MHSA requires counties to implement a broadly inclusive Community Program Planning (CPP) process to identify local-level needs, define MHSA funding priorities, and guide the creation, implementation, oversight, and evaluation of MHSA-funded programs, and any changes or updates thereto. Through the CPP process, counties must bring together mental health clients, their families, representatives of traditionally un-, under-, and inappropriately-served populations, and other local stakeholders to develop a shared vision for MHSA programming and spending based on the unique needs of individual communities and the stated interests of clients being served in their local mental health systems. (9 CCR §§ 3200.070, 3300.)
The MHSA directs counties to spend up to 5% of their annual MHSA revenues on planning costs. This allocation must include funds to pay for the costs of clients, family members, and other stakeholders to participate in the CPP process. (WIC § 5892(c); 9 CCR § 3300.)
The MHSA's Six General Standards
Another unique aspect of the MHSA is the six General Standards counties are required to adopt when planning, implementing, and evaluating all programs funded by the MHSA. These General Standards apply to all MHSA-related activities, including the CPP process, development of Three Year Program and Expenditure Plans and annual updates to such Plans, and the manner in which counties deliver MHSA-funded services and evaluate such services. (9 CCR § 3320.)
The MHSA's six General Standards are:
Community Collaboration: The process by which clients and/or families receiving services, other community members, agencies, organizations, and businesses work together to share information and resources in order to fulfill a shared vision and goals. (9 CCR § 3200.060.)
Cultural Competence: Incorporating and working to achieve nine specific goals for cultural competency into all aspects of policy-making, program design, administration and service delivery. (9 CCR § 3200.100.)
Client-Driven: Clients have the primary decision making role in identifying their needs, preferences and strengths and a shared decision-making role in determining the services and supports that are most effective and helpful for them. Programs and services use clients’ input as the main factor for planning, policies, procedures, service delivery, evaluation and the definition and determination of outcomes. (9 CCR § 3200.050.)
Family-Driven: Families of children and youth with serious emotional disturbance have a primary decision-making role in the care of their own children, including the identification of needs, preferences and strengths, and a shared decision-making role in determining the services and supports that would be most effective and helpful for their children. (9 CCR § 3200.120.)
Wellness, Recovery, and Resilience Focused: Planning for services shall be consistent with the philosophy, principles, and practices of the Recovery Vision for mental health consumers: (a) To promote concepts key to the recovery for individuals who have mental illness: hope, personal empowerment, respect, social connections, self-responsibility, and self-determination; (b) To promote consumer-operated services as a way to support recovery; (c) To reflect the cultural, ethnic, and racial diversity of mental health consumers; and (d) To plan for each consumer’s individual needs. (WIC § 5813.5(d).)
Integrated Service Experience: The client, and when appropriate the client's family, accesses a full range of services provided by multiple agencies, programs and funding sources in a comprehensive and coordinated manner. (9 CCR § 3200.190.)
MHSA: Follow the Money
California millionaires pay a 1% tax on all income earned over $1 million
The Franchise Tax Board collects these taxes and holds the money in the state's
Mental Health Services Fund
Up to $140 million/year is allocated to pay back bonds for MH housing programs
(Prop 2, 2018)
5% is allocated to statewide agencies for
DHCS, MHSOAC, OSHPD, CBHPC, DPH
The remainder of MHSA funds is allocated to counties based on a methodology created by DHCS
MHSA: Funding Components
Once counties receive MHSA revenues from the state, they are required to spend them on the following programs:
Prevention and Early Intervention (PEI): Counties must allocate at least 20% of their annual MHSA revenues to PEI programs.
Community Services and Supports (CSS): The remainder of MHSA revenues are allocated to the CSS category. Other funding components are paid with CSS funds.
Innovative Programs (INN): Counties must allocate 5% of their total annual MHSA revenues to INN. Funding for INN programs are paid out of the CSS category.
Capital Facilities and Technology (CF/TN), Workforce Education and Training (WET), and Prudent Reserve (PR): Counties may allocate up to 20% of their average annual MHSA revenues for the past five years to this category. This funding is taken from the CSS category.
Community Program Planning (CPP): Counties must allocate some portion of their annual MHSA revenues to community planning. This amount cannot exceed 5% of their annual MHSA revenues for that year. Funds are paid out of the CSS category.
(WIC § 5892(a)-(c).)