California Mental Health Services Act

In November 2004, voters in the U.S. state

U.S. state

A U.S. state is any one of the 50 federated states of the United States of America that share sovereignty with the federal government. Because of this shared sovereignty, an American is a citizen both of the federal entity and of his or her state of domicile. Four states use the official title of...

of California

California

California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...

passed Proposition 63

California Proposition 63 (2004)

Proposition 63 was a California ballot proposition on the November 2, 2004 ballot. Its official name and title on the ballot was the Mental Health Services Act...

, the Mental Health Services Act (MHSA), which has been designed to expand and transform California’s county mental health service systems by increasing the taxes of high income individuals. The MHSA will be funded by imposing an additional one percent tax on individual, but not corporate, taxable income in excess of one million dollars.

Overview

The voter-approved MHSA initiative provides for developing, through an extensive stakeholder

Stakeholder analysis

Stakeholder analysis in conflict resolution, project management, and business administration, is the process of identifying the individuals or groups that are likely to affect or be affected by a proposed action, and sorting them according to their impact on the action and the impact the action...

process, a comprehensive approach to providing community based mental health services and supports for California residents. Approximately 51,000 taxpayers are directly affected by the tax, which will generate an estimated $750 million in revenue during fiscal year 2005-06.

The MHSA addresses six components of building a better mental health system to guide policies and programs:

Community program planning
Services and supports
Capital (buildings) and information technology
Information technology
Information technology is the acquisition, processing, storage and dissemination of vocal, pictorial, textual and numerical information by a microelectronics-based combination of computing and telecommunications...

(IT)
Education and training (human resources)
Prevention and early intervention
Innovation

The MHSA stipulates that the California State Department of Mental Health (DMH) will contract with county mental health departments to develop and manage the implementation of its provisions. Oversight responsibility for MHSA implementation was handed over to the sixteen member Mental Health Services Oversight and Accountability Commission (MHSOAC) on July 7, 2005, when the commission first met.

The MHSA specifies requirements for service delivery and supports for children, youths, adults and older adults with serious emotional disturbances and/or severe mental illness

Mental illness

A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...

es. MHSA funding will be made annually to counties to:

Define serious mental illness among children, adults and seniors as a condition deserving priority attention, including prevention and early intervention services and medical and supportive care
Reduce the long-term adverse impact on individuals, families and State and local budgets resulting from untreated serious mental illness
Expand the kinds of successful, innovative service programs for children, adults and seniors already established in California, including culturally and linguistically competent approaches for underserved population
Provide State and local funds to adequately meet the needs of all children and adults who can be identified and enrolled in programs under this measure
Ensure all funds are expended in the most cost-effective manner and services are provided in accordance with recommended best practices, subject to local and State oversight to ensure accountability to taxpayers and to the public

Proposition 63 mandate

The requirements of the MHSA, mandated by approval of California Proposition 63 in 2004 with 53.4% of the vote, are intended to initiate significant changes, including:

Increases in the level of participation and involvement of clients and families in all aspects of the public mental health system
Increases in client and family operated services
Outreach to and expansion of services to client populations in order to eliminate ethnic disparities in accessibility, availability and appropriateness of mental health services and to more adequately reflect mental health needs
Increases in the array of services choices for individuals diagnosed with serious mental illness and children/youth diagnosed with serious emotional disorders, and their families.

Counties are required to develop their own three-year plan, consistent with the requirements outlined in the act, in order to receive funding under the MHSA. Counties are obliged to collaborate with citizens and stakeholders to develop plans that will accomplish desired results through the meaningful use of time and capabilities, including things such as employment, vocational training, education, and social and community activities. Also required will be annual updates by the counties, along with a public review process. County proposals will be evaluated for their contribution to achieving the following goals:

Safe and adequate housing, including safe living environments, with family for children and youths
Reduction in homelessness
A network of supportive relationships
Timely access to needed help, including times of crisis
Reduction in incarceration in jail
Prison
A prison is a place in which people are physically confined and, usually, deprived of a range of personal freedoms. Imprisonment or incarceration is a legal penalty that may be imposed by the state for the commission of a crime...

s and juvenile halls
Reduction in involuntary services, including reduction in institutionalization and out-of-home placements
Outpatient commitment
Outpatient commitment refers to mental health law that allows the compulsory, community-based treatment of individuals with mental illness.In the United States the term "assisted outpatient treatment" or "AOT" is often used and refers to a process whereby a judge orders a qualifying person with...

MHSA specifies three stages of local funding, to fulfill initial plans, three year plans, and long term strategies. No services will be funded in the first year of implementation; it is anticipated county plans, and subsequent funding of new services, will be approved by DMH perhaps as early as January, 2006. Allocations for each category of funding will be granted annually, based upon detailed plans with prior approval. For the first year of implementation, the initiative allocates:

45% of available funds for local capital facilities and technology needs, including much of our existing planning for a new management and clinical information system
45% for education and training, including a State mandated local needs assessment identifying county staff shortages in each professional (and other) occupational category, in order to increase the supply of necessary staff counties anticipate will be required to provide for the service enhancements affoded by proposition 63, in accord with its intent
5% for county planning in developing both first stage plans and subsequent three year plans
5% of total available funds are to be reserved for:
The California Department of Mental Health, for carrying out its collaborative role in implementing proposition 63
The California Mental Health Planning Council, for its role in overseeing education and training initiatives
The Mental Health Services Oversight and Accountability Commission

Department of Mental Health collaboration

In the first few months immediately following its passage, the DMH will:

Obtain federal approvals and Medi-Cal
Medi-Cal
The California Medical Assistance Program is the name of the California Medicaid program serving low-income families, seniors, persons with disabilities, children in foster care, pregnant women, and certain low-income adults...

waivers, State authority, additional resources and technical assistance in areas related to implementation
Establish detailed requirements for the content of local three year expenditure plans
Develop criteria and procedures for reporting of county and state performance outcomes
Define requirements for the maintenance of current State and local efforts to protect against supplanting existing programs and their funding streams
Develop formulas for how funding will be divided or distributed among counties
Determine how funding will flow to counties and set up the mechanics of distribution
Establish a 16 member Mental Health Services Oversight and Accountability Commission (MHSAOC), composed of elected State officials and Governor appointees, along with procedures for MHSOAC review of county planning efforts and oversight of DMH implementation
Develop and publish regulations and provide preliminary training to all counties on plan development and implementation requirements

The DMH has directed all counties to develop plans incorporating five essential concepts:

Community collaboration
Cultural competence
Client/family-driven mental health system for older adults, adults and transition age youth and family-driven system of care for children and youth
Wellness focus, which includes the concepts of recovery and resilience
Integrated service experiences for clients and their families throughout their interactions with the mental health system

The DMH, in assuming and asserting its primacy over MHSA implementation, has dictated requirements for service delivery and supports as follows:

Full Service Partnership Funds - funds to provide necessary services and supports for initial populations
General System Development Funds - funds to improve services and infrastructure
Outreach and Engagement Funding - funds for those populations that are currently receiving little or no service

Pharmaceutical industry influence

Few, if any, representatives of the pharmaceutical industry have openly participated in the town hall and stakeholder meetings during 2005. Many mental health clients and family members have requested easier access to less expensive medications during the initial stakeholder outreach process, while a similar number have expressed interest in alternative medicine

Alternative medicine

Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....

options.

Mental Health Services Oversight and Accountability Commission

Sixteen members have been appointed to the Mental Health Services Oversight and Accountability Commission (MHSOAC), whose role is to develop strategies to help mental health service clients overcome the stigma

Social stigma

Social stigma is the severe disapproval of or discontent with a person on the grounds of characteristics that distinguish them from other members of a society.Almost all stigma is based on a person differing from social or cultural norms...

of being labeled 'mentally ill', and to accomplish the objectives of the MHSA. Twelve members have been appointed by Governor Arnold Schwarzenegger

Arnold Schwarzenegger

Arnold Alois Schwarzenegger is an Austrian-American former professional bodybuilder, actor, businessman, investor, and politician. Schwarzenegger served as the 38th Governor of California from 2003 until 2011....

, joining four State government appointed officials.

The Commission advises the governor and legislature regarding actions the State may take to improve care and services for people with mental illness, and is required to annually review and approve each county mental health program for expenditures. Whenever the commission identifies a critical issue related to the performance of a county mental health program, it may refer the issue to the DMH.

The first meeting of the MHSOAC was held July 7, 2005, at which time Proposition 63 author Darrell Steinberg

Darrell Steinberg

Darrell Steven Steinberg is a Democratic politician from Sacramento, California. He is currently serving his second term in the California State Senate, representing the 6th District. He has been the Senate President Pro Tem since 2008...

was selected unanimously by fellow commissioners as chairman, without comment or discussion. After accepting the gavel, Steinberg was roundly praised for devising Proposition 63's 'creative financing

Creative financing

Creative financing is a term used widely amongst real estate investors to refer to non-traditional means of real estate financing, or financing techniques not commonly used. The goal of creative financing is generally to purchase, or finance a property, with the buyer/investor using as little of...

' scheme. Steinberg then said, "We must focus on the big picture," and stated his priorities with regard to the implementation of the MHSA:

Prioritize prevention and early intervention, without falling into the trap of fail first service provision,
Address "the plight of those at risk of falling off the edge," and to
Advocate for mental health services from his "bully pulpit
Bully pulpit
A bully pulpit is a public office or other position of authority of sufficiently high rank that provides the holder with an opportunity to speak out and be listened to on any matter...

."

MHSOAC commissioners

In accordance with MHSA requirements, the Commission shall consist of 16 voting members as follows:

The Attorney General
California Attorney General
The California Attorney General is the State Attorney General of California. The officer's duty is to ensure that "the laws of the state are uniformly and adequately enforced" The Attorney General carries out the responsibilities of the office through the California Department of Justice.The...

or his or her designee
The Superintendent of Public Instruction
California State Superintendent of Public Instruction
The State Superintendent of Public Instruction of California is the nonpartisan elected executive officer of the California Department of Education. The SPI directs all functions of the Department of Education and executes policies set by the California State Board of Education...

or his or her designee
The Chairperson of the Senate Health and Human Services Committee or another member of the Senate
California State Senate
The California State Senate is the upper house of the California State Legislature. There are 40 state senators. The state legislature meets in the California State Capitol in Sacramento. The Lieutenant Governor is the ex officio President of the Senate and may break a tied vote...

selected by the President pro Tempore of the Senate
The Chairperson of the Assembly Health Committee or another member of the Assembly
California State Assembly
The California State Assembly is the lower house of the California State Legislature. There are 80 members in the Assembly, representing an approximately equal number of constituents, with each district having a population of at least 420,000...

selected by the Speaker of the Assembly
Twelve appointees of the Governor
Governor of California
The Governor of California is the chief executive of the California state government, whose responsibilities include making annual State of the State addresses to the California State Legislature, submitting the budget, and ensuring that state laws are enforced...

, who shall seek individuals who have had personal or family experience with mental illness, to include:

two persons with a severe mental illness
a family member of an adult or senior with a severe mental illness
a family member of a child who has or has had a severe mental illness
a physician specializing in alcohol and drug treatment
a mental health professional
a county Sheriff
Sheriffs in the United States
In the United States, a sheriff is a county official and is typically the top law enforcement officer of a county. Historically, the sheriff was also commander of the militia in that county. Distinctive to law enforcement in the United States, sheriffs are usually elected. The political election of...

,
a Superintendent
Superintendent (education)
In education in the United States, a superintendent is an individual who has executive oversight and administration rights, usually within an educational entity or organization....

of a school district
School district
School districts are a form of special-purpose district which serves to operate the local public primary and secondary schools.-United States:...
a representative of a labor organization
Trade union
A trade union, trades union or labor union is an organization of workers that have banded together to achieve common goals such as better working conditions. The trade union, through its leadership, bargains with the employer on behalf of union members and negotiates labour contracts with...
a representative of an employer with less than 500 employees
a representative of an employer with more than 500 employees
a representative of a health care services plan or insurer

State government appointees

The initial government officials and designee appointed:

Senator Wesley Chesbro
Wesley Chesbro
Wesley P. Chesbro is a Democratic politician from California. He is currently the Assembly member for the 1st Assembly district in California. Previously, Chesbro served as a State Senator from California's 2nd district from 1998 until 2006...

(Democrat), of Arcata
Arcata, California
-Demographics:-2010 Census data:The 2010 United States Census reported that Arcata had a population of 17,231. The population density was 1,567.4 people per square mile...

, chair of the Senate Budget and Fiscal Review Committee and the Senate Select Committee on Developmental Disabilities and Mental Health.
Assemblyman Mark Ridley-Thomas (Dem), of Los Angeles
Los Angeles, California
Los Angeles , with a population at the 2010 United States Census of 3,792,621, is the most populous city in California, USA and the second most populous in the United States, after New York City. It has an area of , and is located in Southern California...

, a member of the Assembly Health committee and former L.A. city councilman.
Attorney General Bill Lockyer
Bill Lockyer
William Westwood "Bill" Lockyer is an American politician. He is the current 32nd State Treasurer of California, elected in 2006 and re-elected in 2010. He has also served as California Attorney General and President Pro Tempore of the California State Senate...

, of Hayward
Hayward, California
Hayward is a city located in the East Bay in Alameda County, California. With a population of 144,186, Hayward is the sixth largest city in the San Francisco Bay Area and the third largest in Alameda County. Hayward was ranked as the 37th most populous municipality in California. It is included in...

, a former State Senator and Assemblyman.
Darrell Steinberg (Dem), of Sacramento
Sacramento, California
Sacramento is the capital city of the U.S. state of California and the county seat of Sacramento County. It is located at the confluence of the Sacramento River and the American River in the northern portion of California's expansive Central Valley. With a population of 466,488 at the 2010 census,...

, an attorney, the author of Proposition 63, former Assemblyman. Steinberg is the appointee of the Superintendent of Public Instruction.

Governor's appointees

On June 21, 2005, Governor Schwarzenegger announced his appointment of twelve appointees to the MHSOAC:

MHOAC Vice Chairman Linford Gayle (declined to state party), 46, of Pacifica
Pacifica, California
Pacifica is a city in San Mateo County, California, on the coast of the Pacific Ocean between San Francisco and Half Moon Bay.-Overview:The City of Pacifica is spread along a six mile stretch of the north central California coastal beach and hills, nestled in several small valleys spanning between...

, a mental health program specialist at San Mateo County
San Mateo County, California
San Mateo County is a county located in the San Francisco Bay Area of the U.S. state of California. It covers most of the San Francisco Peninsula just south of San Francisco, and north of Santa Clara County. San Francisco International Airport is located at the northern end of the county, and...

Mental Health Services.
Karen Henry (Republican), 61, of Granite Bay
Granite Bay, California
Granite Bay is a census-designated place in Placer County, California, United States. It is part of the Sacramento–Arden-Arcade–Roseville Metropolitan Statistical Area. The population was 20,402 at the 2010 census, up from 19,388 at the 2000 census. The ZIP code is 95746...

, a labor attorney and a board member of California National Alliance for the Mentally Ill (NAMI). Henry is afflicted by 'rapid cycling' bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...

, has a son who has autism
Autism
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...

, and another son with a mental illness.
William Kolender (Rep), 70, of San Diego
San Diego, California
San Diego is the eighth-largest city in the United States and second-largest city in California. The city is located on the coast of the Pacific Ocean in Southern California, immediately adjacent to the Mexican border. The birthplace of California, San Diego is known for its mild year-round...

, the San Diego County
San Diego County, California
San Diego County is a large county located in the southwestern corner of the US state of California. Hence, San Diego County is also located in the southwestern corner of the 48 contiguous United States. Its county seat and largest city is San Diego. Its population was about 2,813,835 in the 2000...

Sheriff and president of the State Sheriffs Association, a member of the State Board of Corrections, and was for three years the director of the California Youth Authority (CYA). Kolender's wife died as a result of mental illness, and he has a son with a mental disorder.
Kelvin Lee, Ed.D. (Rep), 58, of Roseville
Roseville, California
-2010:The 2010 United States Census reported that Roseville had a population of 118,788. The population density was 3,279.4 people per square mile...

, a superintendent of the Dry Creek Joint Elementary School District.
Andrew Poat (Rep), 45, of San Diego, director of the government relations department for the City of San Diego, a member of the public policy committee for the San Diego Gay and Lesbian Center, and a former deputy director of the United States Office of Consumer Affairs. Poat represents employers of more than 500 workers on the commission, and says he will use his experience building multi-million dollar programs to bring together mental health advocates.
Darlene Prettyman (Rep), 71, of Bakersfield, is a psychiatric nurse, a board member and past president of NAMI California, and a past chairman and a member of the California Mental Health Planning Council. Her son has schizophrenia, and her stated priority is to enhance provision of housing for mental health service clients.
Carmen Diaz (Dem), 53, of Los Angeles, a family advocate
Advocate
An advocate is a term for a professional lawyer used in several different legal systems. These include Scotland, South Africa, India, Scandinavian jurisdictions, Israel, and the British Crown dependencies of Jersey, Guernsey and the Isle of Man...

coordinator with the L.A. County
Los Angeles County, California
Los Angeles County is a county in the U.S. state of California. As of 2010 U.S. Census, the county had a population of 9,818,605, making it the most populous county in the United States. Los Angeles County alone is more populous than 42 individual U.S. states...

Department of Mental Health and a board member of United Advocates for Children of California. Diaz has a family member with a severe mental illness.
F. Jerome Doyle (Dem), 64, of Los Gatos
Los Gatos, California
The Town of Los Gatos is an incorporated town in Santa Clara County, California, United States. The population was 29,413 at the 2010 census. It is located in the San Francisco Bay Area at the southwest corner of San Jose in the foothills of the Santa Cruz Mountains...

, is chief executive officer of EMQ (a provider of mental health services for children and youth), a board member and past president of the California Council of Community Mental Health Agencies, and a board member of California Mental Health Advocates for Children.
Saul Feldman DPA, (Dem), 75, of San Francisco
San Francisco, California
San Francisco , officially the City and County of San Francisco, is the financial, cultural, and transportation center of the San Francisco Bay Area, a region of 7.15 million people which includes San Jose and Oakland...

, is chairman and CEO of United Behavioral Health, a member of the American Psychological Association
American Psychological Association
The American Psychological Association is the largest scientific and professional organization of psychologists in the United States. It is the world's largest association of psychologists with around 154,000 members including scientists, educators, clinicians, consultants and students. The APA...

, the founder and former president of the American College of Mental Health Administration, and a former president and CEO of Health America Corporation of California. Feldman was appointed as a health care plan insurer.
Gary Jaeger, M.D. (Dem), 62, of Harbor City, is currently the chief of addiction medicine at Kaiser Foundation Hospital, South Bay, a member and former chair of the Behavioral Health Advisory Board of the California Healthcare Association, and former medical director of family recovery services at St. Joseph Hospital in Eureka
Eureka, California
Eureka is the principal city and the county seat of Humboldt County, California, United States. Its population was 27,191 at the 2010 census, up from 26,128 at the 2000 census....

. He says members of his family have an "80 percent rate of drug and alcohol abuse."
Mary Hayashi (Dem), 38, of Castro Valley
Castro Valley, California
Castro Valley is a census-designated place in Alameda County, California, United States. As of the 2000 census, it is the fifth most populous unincorporated area in California, and the twenty-third in the United States...

, president of the Iris Alliance Fund and a board member for Planned Parenthood
Planned Parenthood
Planned Parenthood Federation of America , commonly shortened to Planned Parenthood, is the U.S. affiliate of the International Planned Parenthood Federation and one of its larger members. PPFA is a non-profit organization providing reproductive health and maternal and child health services. The...

Golden Gate and member of the Board of Registered Nursing. Hayashi's concerns include transportation access for clients and paratransit
Paratransit
Paratransit is an alternative mode of flexible passenger transportation that does not follow fixed routes or schedules. Typically mini-buses are used to provide paratransit service, but also share taxis and jitneys are important providers....

services, and represents employers with 500 or fewer workers.
Patrick Henning (Dem), 32, of West Sacramento
West Sacramento, California
West Sacramento is a city in Yolo County, California. It is contiguous with Sacramento, but is separated by the Sacramento River which is also the county line, so West Sacramento is in a different county than Sacramento...

, is the legislative advocate for the California Council of Laborers. He was previously the Assistant Secretary at the Labor and Workforce Development Agency (An Agency that he helped create), deputy director for the Department of Industrial Relations and Prior to his State service Special Advisor and Congressional Liaison to President Bill Clinton. Henning is a member of the Career Technical Education Standards and Framework Advisory Group and the California Assembly Speaker's Commission on Labor Education. He represents labor.

Overview

Proposition 63 mandate

Department of Mental Health collaboration

Pharmaceutical industry influence

Mental Health Services Oversight and Accountability Commission

MHSOAC commissioners

State government appointees

Governor's appointees

See also

Government agencies

Private Organizations

Media coverage