Mental Health Services Act MHSA Full Text
3 Year Plans, Annual Updates, Innovation Plans
The Mental Health Services Act (MHSA) of 2004 passed by the voters as “Proposition 63,” increased overall State funding for the community mental health system by imposing a 1% income tax on California residents with more than $1 million per year in income. The stated intention of the proposition was to “transform” local mental health service delivery systems from a “fail first” model to one promoting intervention, treatment and recovery from mental illness. A key strategy in the act is the prioritization of prevention and early intervention services to reduce the long-term adverse impacts of untreated, serious mental illness on individuals, families and state and local budgets. All MHSA projects and programs shall be planned, developed, approved, implemented, monitored and updated through a community stakeholder process.
According to WIC 5813.5, MHSA Planning for services shall be consistent with the philosophy, principles, and practices of the Recovery Vision for mental health consumers:
- To promote concepts key to the recovery for individuals who have mental illness: hope, personal empowerment, respect, social connections, self-responsibility, and self-determination.
- To promote consumer-operated services as a way to support recovery.
- To reflect the cultural, ethnic, and racial diversity of mental health consumers.
- To plan for each consumer's individual needs.
Role of Mental Health Board
"County mental health programs shall prepare and submit a Three-Year Program and Expenditure Plan (Plan) and Annual Updates for Mental Health Service Act (MHSA) programs and expenditures" (Welfare and Institutions Code Section (WIC) § 5847)
It is important to understand the roles of the MHB, the Mental/Behavioral Health Director and the Board of Supervisors (or Governing Body).
MHSA funds are divided into six components. County mental health agencies are required to develop detailed plans for the use of MHSA funds in each of these components, then submit those plans to the Mental Health Services Oversight and Accountability Commission (MHSOAC) or State for approval. The following are the components.
1) Community Program Planning: Community Program Planning (CPP) refers to the state-mandated, participatory process implemented by counties in partnership with stakeholders to determine appropriate uses for available MHSA funds. Counties are tasked with developing CPP processes in line with the needs and culture of their communities. The planning process requires extensive community input. Counties identify local “underserved populations” most severely affected by, or at risk of, serious mental illness and then develop “culturally and linguistically competent approaches” to connect with and meet the needs of those underserved populations (such as interpreters and translation services, Culturally appropriate mental health services, strategies for outreach to racial and ethnic county-identified target populations
The CPP process is used to:
1) Assess the current capacity;
2) Define the populations to be served;
3) Determine strategies to provide effective services.
The MHSA work plan is developed from this process.
2) Community Services and Supports (CSS) Community Services and Supports are the programs, services, and strategies that are being identified by each county through its stakeholder process to serve unserved and underserved populations, with an emphasis on eliminating racial disparity. It is the largest component of the MHSA. The CSS component is focused on community collaboration, cultural competence, client and family driven services and systems, wellness (which includes concepts of recovery and resilience), and integrated service experiences for clients and families. Housing is also a large part of the CSS component. County MHPs have three years to spend CSS funds.
3) Prevention and Early Intervention (PEI): The goal of PEI is to help counties implement services that promote wellness, foster health, and prevent the suffering that can result from untreated mental illness. The PEI component requires collaboration with consumers and family members in the development of PEI projects and programs. The Mental Health Services Oversight and Accountability Commission (MHSOAC) controls funding approval for the PEI component of the MHSA.
4) Innovation: The goal of Innovation is to increase access to underserved groups, increase the quality of services, promote interagency collaboration and increase access to services. Counties select one or more goals and use those goals as the primary priority or priorities for their proposed Innovation plan. “Innovation projects are novel, creative and/or ingenious practices/approaches that contribute to learning and that are developed within communities through a process that is inclusive and representative, especially of unserved, underserved and inappropriately served individuals” Innovation Projects are required to:
A. Introduce a mental health practice or approach that is new to the overall mental health system, including, but not limited to, prevention and early intervention, or
B. Make a change to an existing practice in the field of mental health, including but not limited to application to a different population, or
C. Apply to the mental health system a promising community-driven practice or approach that has been successful in non-mental health contexts or settings.
County MHPs have three years to spend each annual INN allocation (five years for Counties with population 200,000 or less). The MHSOAC controls funding approval for the Innovation (INN) component of the MHSA.
5) Capital Facilities and Technology Needs (CFTN): The CFTN component works towards the creation of a facility that is used for the delivery of MHSA services to mental health clients and their families or for administrative offices. Funds may also be used to support an increase in peer-support and consumer-run facilities, development of community-based settings, and the development of a technological infrastructure for the mental health system to facilitate the highest quality and cost-effective services and supports for clients and their families.
6) Workforce Education and Training: The goal of the Workforce Education & Training (WET) and WET Regional Partnerships component is to develop a diverse workforce, with the following goals:(1) Addressing identified shortages in occupations, skill sets, and individuals with unique cultural and linguistic competence in urban and rural county mental health programs and private organizations providing services in the Public Mental Health System; and
(2) Education and training for all individuals who provide or support services in the Public Mental Health System, to include fostering leadership skills. This education and training contributes to developing and maintaining a culturally competent workforce, to include clients and family members who are capable of providing client and family-driven services that promote wellness, recovery and resilience, and lead to measurable, values-driven outcomes.
Regional partnerships are an important part of WET because schools and training sources serve individuals across county lines. For example, community colleges, universities, graduate and professional programs serve individuals across various geographic regions of California.
By law, the State allocates MHSA funds from the Mental Health Services Fund (MHSF) to County Mental Health Plans (MHPs) for three components: Innovation (INN), Prevention and Early Intervention (PEI) and Community Services and Supports (CSS).
3 Years: CSS, PEI, and INN components must be spent within three years (or within five years for INN for Counties with population 200,000 or less).
10 Years: Capital Facilities and Technological Needs (CFTN), Workforce Education and Training (WET) and WET Regional Partnerships must be spent within ten years of allocation.
UNSPENT FUNDS: The law requires any unspent MHSA funds held by County MHPs to be kept in interest-bearing accounts. County MHPs are required to treat any interest earned as additional revenue for the specific component. County MHPs have differed in their use of interest earned. Some have spent it as it is earned while others have allowed interest to accumulate as a cash reserve.
Funds not spent within their mandated timeframes are to be returned to the State for re-allocation to County MHPs, a process called "reversion". Prudent Reserve funds are not time limited and are meant to remain permanently with the County MHP until needed.
ON-LINE DATA: The Mental Health Services Oversight & Accountability Commission (MHSOAC) provides Annual Revenue and Expenditure spreadsheets and charts: http://mhsoac.ca.gov/fiscal-reporting. Reports are also available from the CA Department of Health Care Services (DHCS) website:
 In California, Medi-Cal mental health waivers establish MHPs, which have the responsibility to provide psychiatric inpatient hospital services and outpatient specialty mental health services within their region. The 59 County MHPs include 57 county regions (including Sutter and Yuba Counties combined as one region) along with two city regions, including the City of Berkeley and Tri-City (Pomona, Claremont and La Verne within Los Angeles County).
 Once funds are received, County MHPs are permitted to meet local needs by transferring funds from CSS to three other components: Capital Facilities and Technological Needs (CFTN), Workforce Education and Training (WET) and WET Regional Partnerships. Counties also are permitted to transfer some portion of CSS funds to a Prudent Reserve account, a "rainy-day" fund used to protect levels of service when MHSA funding is not sufficient to support ongoing programming. Prudent Reserve account information is not currently shown within this tool.
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More information on how California funds mental health: A Complex Case: Public Mental Health Delivery and Financing in California, CA Healthcare Foundation, 2013