Peter Beilenson, M.D., director of the
Department of Health Services, presented the Board of Supervisors on Aug. 6, with a plan to utilize Mental Health Services Act (MHSA) unspent funds more aggressively.
MHSA funding is facilitating a mental health delivery and treatment system in Sacramento County to provide care and reduce untreated mental illness by implementing programs under Community Services and Support (CSS), Prevention and Early Intervention (PEI), and Innovation (INN) that improve mental health practices. Additionally, MHSA funding supports countywide efforts to expedite services for individuals with serious mental illness, co-occurring substance use disorders and are homeless or at risk of becoming homeless.
Over the past few years, many of the counties in the state have accrued significant sums of MHSA funds due to a range of obstacles to expedite the spending of the funds. With this issue at hand, Dr. Beilenson tasked the County’s new
Behavioral Health Director, Ryan Quist, to pursue an aggressive plan for the County’s unspent MHSA funds. This new approach by Sacramento County includes making funds available for community outpatient services by using more agile strategies for planning and stakeholder input; expanding funding for existing programs with good outcomes; introducing new funding opportunities in each MHSA category; and basing future budget projections on historic, actual expenditures.
Beilenson said, “Sacramento County is taking decisive action to remove these obstacles. In a unanimous vote, the Board of Supervisors approved a new, agile process for setting priorities and putting funds out to bid to implement a massive three-year effort to make a major dent in the incidence and consequences of mental illness in the county using these MHSA resources.”
Community Services and Support (CSS)
CSS funds are used for mental health treatment services and support for children/youth and their families living with severe emotional disturbance, adults living with a serious mental illness, and housing for these populations. Examples of programs currently supported by MHSA CSS funds include Full-Service Partnerships, Regional Support Teams and Crisis Residential Programs.
The MHSA CSS funding expansion will allow the County to implement recommendations of our advisory boards to provide greater funding to our outpatient mental health services. This change will also free up realignment funding for in-patient psychiatric facilities and will decompress our local hospital emergency rooms, which typically don’t have the resources and are not an appropriate environment for mental health treatment. The County has proposed the following CSS funding expansion:
- $5.0 M – Regional Support Teams
- $5.0 M – Crisis Residential Programs
- $3.0 M – Augmented Board and Cares
- $2.0 M – Housing Treatment (transitional residential pool)
- $6.0 M – Housing Subsidies and Supports Now
- $14.0 M – Housing in Future Years
- $7.0 M – Children’s Mental Health Outpatient
- $744 K – Respite Services
- $650 K – Administration
Prevention and Early Intervention (PEI)
PEI can fund programs and activities designed to prevent mental illness from occurring or becoming more severe and disabling.
For the PEI, the County is also introducing a new proposal system for a competitive bid process for $10M in one-time-only/two-year-limited programs. This bid process will be open to a broad array of community providers and will target providers with trauma-based care and adverse childhood experiences type programs. For PEI, the County is going to expand programs that are working well and includes:
- $2.2 M: Mobile Crisis Support Teams
- $1.0 M: Foster Youth Supports
- $2.5 M: Existing PEI programs
- Suicide Prevention and Education
- Bullying Prevention
- Mental Health First Aid
- Early Psychosis Intervention
- Collaborative Courts
Innovation (INN)
INN projects are time-limited and are approved by the state’s Mental Health Services Oversight and Accountability Commission (MHSOAC) to test new and/or improved mental health practices or approaches to increase access to MHSA programs (including unserved/underserved), increase service quality, and promote inter-agency collaboration. Examples of current programs supported by INN funds include the Mental Health Urgent Care Clinic with Turning Point and the Behavioral Health Crisis Services Collaborative with Dignity Health.
The County is working with MHSOAC to provide $9M to the plan to expedite the planning process to develop new INN projects for approval before June 2020 and continue to leverage multi-county projects that are currently underway – examples include Criminal Justice Collaboration and strengthening Full-Service Partnerships.
A Look At The Numbers
FY 2018-19 FUNDS:
Estimated Unspent at Beginning of FY 2018-19*
CSS Funds PEI Funds INN Funds
$90.4 M $27.6 M $14.6 M
Expenditures Estimated Year-End Unspent*
CSS Funds PEI Funds INN Funds
$83.5 M $27.9 M $14.7 M
*Estimated unspent funds figures are dynamic and subject to change based on actual expenditures, finalized cost reports and cost settlements.
FY 2020-21 FUNDS:
Estimated Unspent at Beginning of FY 2020-21*
CSS Funds PEI Funds INN Funds
$58.7 M $24.9 M $13.2 M
Expenditures Estimated Year-End Unspent* with Additional Proposed Projects
CSS Funds PEI Funds INN Funds
$36.4 M** $12.3 M $0.3 M
*Estimated unspent funds figures are dynamic and subject to change based on actual expenditures, finalized cost reports and cost settlements.
**$14 M of CSS funds will be encumbered for housing projects.
The County’s expansion of CSS will help decompress the current system. PEI will reduce the number of people going to psychiatric inpatient hospitals and will provide a process to step inpatients down into less intensive and restrictive facilities.
“We are working towards a more comprehensive, more holistic system of behavioral health services. Through our public outreach and comment process, we are reaching out to all involved—providers, elected officials, individuals experiencing mental illness and their families, and advocates for improved healthcare—to come to a consensus on how to align the system in a more effective and proactive way. As a result, it will significantly reduce the suffering of the roughly one in five adults who will experience a diagnosable mental disorder during their lifetime,” said Beilenson.
