Transformational Change Report: January – June 2023

TRANSFORMATIONAL CHANGE REPORT January – June 2023 mhsoac.ca.gov MHSOAC — Transformational Change Report STATE OF CALIFORNIA LETTER FROM THE COMMISSION | JANUARY - JUNE 2023 Gavin Newsom, Governor Committed to Transformational Change Mara Madrigal-Weiss The report you’re about to read covers the latest six months of vital work we are doing at the Commission Chair Commission. Our report’s theme, Transformational Change, is not a declaration of triumphs achieved. Rather, it represents our continued and steadfast commitment to focus on improvement Mayra E. Alvarez within the initiatives that hold the greatest potential to transform California’s behavioral health. Vice Chair In Section 1, we outline our continued Community Engagement. We acknowledge and value the Mark Bontrager critical role of mental health peers, families, advocates, and community representatives in our Commissioner decision-making. This year, we have increased our on-the-ground outreach, organizing multiple site visits involving legislators, community leaders, and those impacted by our work. John Boyd, Psy.D. Commissioner Section 2, Innovation to Transformation, shares how we foster innovation to improve mental wellbeing in California. Through continued county investment, our Innovation Incubator supports Bill Brown collaborative efforts across the state to build and implement strategies that reduce unnecessary Sheriff, Commissioner involvement in the criminal justice system. Keyondria Bunch, Ph.D. Section 3 details our progress and next steps on 11 Strategic Initiatives, all striving to improve Commissioner mental health. We go deeper into two strategic initiatives: Full Service Partnership (FSP) programs, aimed to reduce psychiatric hospitalizations, homelessness, and incarceration, and Wendy Carillo the Early Psychosis Intervention Plus (EPI+) program, designed to assist adolescents and adults Assemblymember, experiencing their first psychotic episode. Commissioner In Section 4, we share how our Committee structure is designed to support our engagement Steve Carnevale strategy. In our pursuit of excellence, we are redefining the roles and goals of these committees Commissioner and expanding our approach to reach broader audiences. Rayshell Chambers Section 5 details how critical our Foundational Work is as we steer toward creating Commissioner transformational change in behavioral health. We are investing in communications, research, grants, and innovation to explore bold new ideas. This includes a renewed focus on our 2024-2027 Shuo (Shuonan) Chen strategic planning. Commissioner Section 6 contains an update on the MHSA Modernization plan. This Spring, the governor Dave Cortese introduced a proposal that evolves our state’s significant investments in behavioral health. We are Senator, Commissioner enthusiastic about many of the changes proposed, which will help keep individuals off the streets, avoid incarceration, and out of expensive hospital care. Itai Danovitch, M.D. Commissioner The trust you’ve placed in us has been the key to this transformational change, and we appreciate your interest and participation in Commission activities. As always, we encourage and welcome David Gordon your feedback. Together, we can continue building pathways to meet the needs of those we serve, Commissioner leading to a healthier California. Gladys Mitchell Commissioner Alfred Rowlett Commissioner Khatera Tamplen Commissioner Toby Ewing, Ph.D. Executive Director ii Transformational Change Report | January – June 2023 CONTENTS 01 Community Engagement 1 02 Innovation to Transformation 7 Vision Accomplished 8 Working in Collaboration 9 03 Strategic Initiatives: January - June 2023 Progress Report 16 Featured Initiative: Full Service Partnerships 25 Featured Initiative: EPI+ 27 04 Committees 29 05 Foundational Work: January - June 2023 Progress Report 31 Older Adults Grant 36 Advocacy Grantee Feature 38 Budget Update 39 06 MHSA Modernization 40 07 Stay in Touch 43 ii Transformational Change Report | January – June 2023 01 COMMUNITY ENGAGEMENT Transformational change happens when the public – particularly those who access public services – are invited to shape those services, and local and state governments invest in that process. The Mental Health Services Act exemplifies this commitment to community engagement through the inclusion of mental health peers, families, advocates, and community representatives as members of the Commission and in its deliberations and decision-making. Transformational Change Report | January – June 2023 Background “Nothing about us without us.” This rallying cry is the motto of those in the peer community, asserting that no behaviorial health policy should be decided without the direct participation of the people affected by that policy. We take this precept so seriously that it is the core of the Commission’s approach – we cannot and will not champion legislation without the voice of the community. To that end, the Commission spends a significant amount of time planning for, meeting with, and learning from Californians who are most impacted by the mental health challenges we face. Only through our various community partners – their We arranged two site visits to see firsthand how Imperial expertise and their challenges – can the Commission County’s behavioral health departments and school facilitate policy change to improve the lives of districts are using their MHSSA grant dollars to not only Californians. Our best community engagement reveals address challenges but also to partner to come up with who we are engaging, what we are trying to learn from effective solutions to bring mental health and wellness them, and how to set the audience up in a safe space to services to their students. hear everyone’s best thinking. We convened school leaders, clinicians, community In the first half of this year, we increased on-the-ground members, students, behavioral health experts, and outreach by organizing multiple site visits, inviting legislators to discover how mental health programs are legislators, community leaders, and others who impact benefiting students. We heard presentations directly and are impacted by the work of the MHSA. from enthusiastic students, but we also heard staff concerns about the sustainability of the programs, Two series of visits were particularly important for particularly when grant funding ends. To that end, the Commission – one showcasing the impact of the thanks to legislative presence, the legislature invited Mental Health Student Services Act (MHSSA) and the three of the students to present in front of the Assembly other underscoring the enormous value of Full Service Budget Committee on how the Mental Health Student Partnerships (FSPs). Services Act program has impacted them and their peers. Imperial County Convening - (MHSSA) As the grateful youths shared their experiences, what became abundantly clear was how the MHSSA has Imperial County sits at the southeast border of our transformed the school’s culture into a more welcoming state and is the least populous county in Southern space than they’d experienced in the past. California. Its residents grapple with high unemployment, immigration issues, economic instability, lower educational attainment levels, and health issues such as obesity and asthma. 2 Transformational Change Report | January – June 2023 “Students told us that coming to school was worthwhile. That they wanted to attend classes. They felt they could participate in ways they hadn’t before at other schools. They felt safe talking to their teachers about their mental health. They were comfortable going to counselors. For the first time for many, they didn’t feel judged.” ظ Sharmil Shah, Psy.D MHSOAC Chief of Program Operations The Commission’s visit to Imperial County was not only edifying, but it was also illuminating. We arrived there We have established the five areas where others will with a shared purpose: learn from the success of this need help: program, and use it to support and uplift youths in other counties. We learned that we must advance a new plan → Sustainability in which MHSSA grantees like Imperial County become → Program implementation technical assistance providers to others who need help establishing programs like this. → Workforce development → Data collection OUTCOME → Partnership development Thanks to these site visits and feedback from our grantees, we sent out an RFQ to compile a team of MHSSA grantees who will provide technical assistance to the rest of the state. We aim to gather an ongoing statewide, sustainable technical assistance approach that includes our grantees and a statewide coordinator. One student shared a story that illustrated the positive personal and academic outcomes of the Mental Health Student Services Act program. At home, he avoided conversations about his own mental health concerns, as his parents simply weren’t receptive. At school, he found the support and help he needed, and felt comfortable talking about mental health with peers, counselors, even his teachers. His attendance improved as a result, because school became a safer, welcoming space for him. 3 Transformational Change Report | January – June 2023 Sacramento - FSPs OUTCOME When we hear partners talk about the life-changing As a result of these visits, we set up a panel presentation services they receive, it underscores the importance and at a Commission meeting to discuss increasing FSP urgency of this work. At two Sacramento Full Service capacity, building technical assistance, and improving Partnership (FSP) site visits, we had the opportunity to do services so they best serve the individuals who could just that. We heard impactful – sometimes heartbreaking – benefit from them. stories from several partners, as well as staff and management, about their experiences with FSPs: Other Forms of Engagement Different events meet the needs of different audiences PARTNERS and different topics. The Commission is still recovering For many partners, the services we fund could be a and rebuilding from solely virtual engagement during matter of life or death. One woman told us that she the pandemic. In the last six months, we have been able did not think she would be alive today if she had not to hold more live community events. Listening sessions, received services and gotten into the FSP. FSPs can be bigger town halls, and focus groups each yield distinct powerful for individuals struggling with severe and results. persistent mental illness. This can result in substance use challenges, leading to a cycle through the criminal justice Future Planning system, the street, and hospitals. We know community engagement remains vitally STAFF important, so we have built even deeper intentionality Teams of people with a variety of job descriptions in the questions we ask, the format of our engagements, shared how hard this work is, how workforce shortages the locations, and the conversations we are having. This exacerbate it, and how this work requires committed and will help ensure that what we hear in engagements extraordinary mental health professionals. aligns with grant funding and policy recommendations. We aim to engage all Californians about mental health, MANAGEMENT determining who is not receiving the services they need Those responsible for ensuring fiscal sustainability and what the preventative barriers are. shared the challenges around the reimbursement models, the contract, and how contracts are set up. They also shared a hope that the Commission consider additional fiscal recommendations to support programs and counties. “We were hearing stories not simply of people surviving, but thriving thanks to FSPs. Many who shared their stories brought up the notion of paying it forward, as their lives are impacted to where they are now functional members of society who can give back.” ظ Sharmil Shah, Psy.D MHSOAC Chief of Program Operations 4 Transformational Change Report | January – June 2023 Events Map The following events map is a way of holding ourselves accountable. We can see where we have made progress, but also where we have opportunities to connect with more communities. It helps inform the regions we must prioritize to ensure we hear from as many people across the state as possible. IN-PERSON EVENTS Between January and June, the Commission participated in 27 in-person events and 12 virtual events. As the Commission recommits to in-person engagements, events will expand beyond Sacramento, the Bay Area, and the Southern California coast. 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Work — Workshop for Legislative Staff → UC San Francisco Public Psychiatry Fellowship Didactic → Speak Out! Make Change! Listening Session with CAMHPRO → Institute for Behavioral Healthcare Improvement Board Meeting 6 Transformational Change Report | January – June 2023 02 INNOVATION TO TRANSFORMATION Transformational Change Report | January – June 2023 Innovation Incubator VISION ACCOMPLISHED The incubator, created in 2018 with $5 million in one-time funding authorized by the Legislature, was designed to support county efforts in building and implementing innovative strategies that reduce unnecessary involvement in the criminal justice system. That year, the Commission consulted with county The Full Service Partnership agencies, community leaders, and subject matter experts A collaborative helping counties document the to develop frameworks for more effective behavioral effectiveness of their programs and standardize decision- health responses for individuals with behavioral health making and practices to improve results and reduce needs to slow the rapid and costly increase in the number disparities. of defendants found incompetent to stand trial. Data-Driven Recovery Project Since then, the Commission has worked with counties A project helping behavioral health, criminal justice, throughout the state to improve crisis response, and and criminal courts understand the flow of individuals successfully launched five multi-county learning through their system and identify opportunities to collaboratives: intervene better and earlier. The Psychiatric Advanced Directives 26 A collaborative helping counties empower individuals with mental health conditions to inform their treatment during a crisis, which has powerful potential to de- counties participate in one or more escalate conflicts and improve care. of these collaboratives Crisis Now Academy 19 A project providing information and coaching to help counties develop alternatives to a criminal justice response to individuals in crisis. innovation projects developed and launched The Fiscal Sustainability Project A project working with counties to help them analyze $34,921,280 the costs and benefits of projects with limited-term funding and determine which ones are sustainable with ongoing funds. used to fund MHSA innovation initiatives This model for transformational change through a portfolio of projects demonstrated the potential to link community engagement and policy development, to incentivize funding and technical assistance, and to drive innovation projects that produce outcome-driven programs. 8 Transformational Change Report | January – June 2023 WORKING IN COLLABORATION As of 2020, the Innovation Incubator funds were exhausted, but the collaboratives birthed from the Innovation Incubator are ongoing. In multiple instances, the Commission’s seed money generated support that counties needed to utilize their own Innovation funds, advancing and strengthening the capacities of counties for innovation and continuous improvement. SCALING INNOVATION INCUBATOR OUTCOMES Full-Service Partnerships Twelve years into the launch of the MHSA, California counties have an opportunity to step back and evaluate the way that data is used state-wide to understand the linkage between service delivery and outcomes achievement. This topic is especially relevant for adult FSP Providers, which help California’s most vulnerable individuals avoid hospitalization, homelessness, and incarceration, and ultimately increase their overall wellbeing and independence. Today, a nine-county collaborative – alongside Third Sector PARTICIPATING COUNTIES (a nonprofit consulting firm) – is developing a specific Fresno, Sacramento, San Bernardino, Siskiyou, vision and a plan to evolve the approach to using adult Ventura, Stanislaus, Lake, Napa, San Mateo FSP data, with the goal of giving counties the tools to continuously improve adult FSP outcomes. INITIAL INVESTMENT $1,000,000 COUNTY INN INVESTMENT $8,178,392 9 Transformational Change Report | January – June 2023 Psychiatric Advance Directives People with mental health needs, at times, may not be able to have a collaborative interaction with service providers or emergency personnel – especially if the person is in crisis. Behavior exhibited by a person in crisis may draw the attention of law enforcement, thereby initiating a path into the criminal justice system. Practices that establish care directed by the person with mental health needs before a crisis show promise in preventing disruption of community-based services. The use of psychiatric advance directives is one method PARTICIPATING COUNTIES to explore using innovative funding to expand the tools Fresno, Mariposa, Monterey, Orange, available to local behavioral health departments. Shasta, Tri-City, Contra Costa INITIAL INVESTMENT $562,500 COUNTY INN INVESTMENT $19,754,565 10 Transformational Change Report | January – June 2023 Crisis Now Multi-County Collaborative Crisis response systems are critical infrastructure for local agencies serving individuals with serious mental health needs. Effective systems can improve outcomes for individuals while reducing avoidable law enforcement involvement and preventing incarceration. Many counties, however, particularly smaller and more rural counties, are challenged to develop and sustain comprehensive crisis response systems. The National Action Alliance for Suicide Prevention in 2016 documented a proven strategy to crisis response with four PARTICIPATING COUNTIES core elements: City of Berkeley, Butte, Inyo, Mono, Nevada, Placer, Plumas, Sacramento, Shasta, Solano, Yolo 1. High-tech crisis Call Centers that coordinate all aspects of an immediate crisis response. 2. Mobile Crisis Outreach Teams that work in the community with those at risk and reduce the need for uniformed officers to provide mental health triage in INITIAL INVESTMENT the streets. $500,000 3. Facility-based Crisis Centers that divert away from hospital emergency departments and provide crisis- specific interventions in safe and secure environments; and COUNTY INN INVESTMENT 4. Commitment to evidenced-based safe care practices, $3,364,000 such as Trauma-Informed Care, Zero Suicide in Healthcare principles, and a multidisciplinary approach to crisis resolution. This “Crisis Now” model enables counties to assess community needs, enhance access to care, and realize overall cost savings. The Crisis Now model is endorsed by the National Association of State Mental Health Program Directors and Crisis Intervention Team International. 11 Transformational Change Report | January – June 2023 Data Driven Recovery Project TWO COHORTS – Capacity Building and Continuous Quality Improvement The project’s main impact has been a targeted, long-term technical assistance program to inform practice, data systems, and stories. This helps counties develop a shared set of priorities and understanding of how behavioral health and justice partners could cooperate across systems. Nine counties across the state were able to merge data about jails, behavioral health, probation, homelessness, PARTICIPATING COUNTIES and courts to inform some of the biggest challenges and El Dorado, Lassen, Marin, Merced, Modoc, Nevada, opportunities facing counties — reducing incompetence Plumas, Sacramento, San Bernardino, Yolo to stand trial, preparing for CalAIM, and understanding the real-time impacts of COVID-19. These counties also wrote micro-grant plans using their data and system planning to test an idea and assess the impact. County-level work was amplified by a multi-county INITIAL INVESTMENT community of practice that used monthly meetings to $1,829,000 bring partner counties together to hear briefings on emerging issues/challenges and share approaches from other DDRP counties. Lessons learned from the DDRP were incorporated into assessments and planning documents to drive continuous improvement – and shared in COUNTY INN INVESTMENT presentations to state, county, their community partners, $3,624,323.39 and interested counties on how they can pursue system improvements. 12 Transformational Change Report | January – June 2023 Fiscal Sustainability Technical Assistance and Capacity Building This project addressed three core problems: an over- reliance on limited-term or one-time funding, a limited ability to assess in real time the effectiveness of strategies, programs, and services, and a limited ability to identify true costs and benefits while also building capacity and elevated policy options that would support cost-effective and sustainable projects over time. PARTICIPATING COUNTIES Sacramento, San Luis Obispo, Santa Barbara INITIAL INVESTMENT $375,000 Fiscal Mapping Capacity Building This project is intended to identify, assess, and develop existing revenue streams that counties can be tapping. It also focuses attention on policy options that would lead to more manageable and sustainable funding streams. The goal is to support cost-effective strategies and services for preventing and reducing criminal justice involvement among those with mental health needs. PARTICIPATING COUNTIES Sacramento, San Luis Obispo, Santa Barbara INITIAL INVESTMENT $50,000 13 Transformational Change Report | January – June 2023 Systems Analysis Project Continuous Quality Improvement, TA, capacity building This project assessed common barriers to developing transformative innovations, and ways the Commission can improve its approval process and support learning from innovation projects. PARTICIPATING COUNTIES ALL INITIAL INVESTMENT $530,000 Dissemination of Learning Projects This project disseminated to state and county leaders the lessons and key issues identified by the Commission’s multi-county collaboratives, provided detailed and tailored follow up information to counties interested in pursuing improvements, and evaluated the options for an enduring statewide collaborative involving county and state agencies to reduce public costs and improve outcomes for individuals with mental health needs who are at risk of criminal justice involvement. The secondary project built capacity and catalyzed local PARTICIPATING COUNTIES system change in critical areas, such as crisis services, Full- ALL Service Partnerships, cross-agency data-sharing, and fiscal sustainability. INITIAL INVESTMENT $198,000 14 Transformational Change Report | January – June 2023 BEYOND BETA Thanks to the learnings from these Innovation Incubator programs, the Commission has now adopted and deployed its transformational change model to other public priorities. Schools as Centers for Wellness Toward mental wellness for all The Commission’s examination of the mental health needs The Governor and the Legislature in 2022, recognizing of school children resulted in a comprehensive policy the demonstrated value of this approach, revised the framework and the Legislature’s creation and expansion Mental Health Wellness Act to authorize the Commission of the Mental Health Student Services Act. The to use those funds in ways that can work with community Commission is now facilitating technical assistance and partners to respond to emerging or urgent needs with systemwide learning and evaluation to help county- best-available practices – from children to elders, from school partnerships improve and sustain their efforts. prevention to crisis response. Striving for Zero The Legislature directed the Commission to develop a new strategic plan to guide the State’s Suicide Prevention efforts. The Legislature responded with grant funding to build capacity within communities and re-establish the Office of Suicide Prevention in the California Department of Public Health. 15 Transformational Change Report | January – June 2023 03 STRATEGIC INITIATIVES The Commission currently supports 11 strategic initiatives. These multifaceted, interrelated efforts together aim to improve mental wellbeing in California. Transformational Change Report | January – June 2023 Strategic Initiatives JANUARY - JUNE PROGRESS REPORT allcove™ Youth Drop-in Centers Half of all mental health conditions begin by age 14, and 75% develop by the age of 25, making early detection and treatment urgent and critical. Based on a proven model from Australia, allcove™ youth drop-in centers expand early access to integrated mental health care for youth between 12 and 25 years of age. An allcove™ center has opened in Santa Clara, and five more communities have been awarded grants to open new centers. These centers provide a one-stop shop for mental health, physical health, substance use counseling, and educational, vocational, and peer support services, all informed by a youth advisory group. PROGRESS WHAT’S NEXT → Stanford successfully hosted the first-annual allcove™ → There will be two additional public hearings on FSPs statewide conference in April 2023. this year in August and November. → Youth Advisory Groups from each allcove™ center → We are working on scheduling a site visit to an FSP for collaborated to create the conference theme, children and families. “Moment of Pause; Reflect, Connect, and Inspire.” → We also anticipate conducting community → Stanford’s Central Advisory Team (CAT) provided engagement to better understand how FSPs are scholarships to allow youth to attend. working, what the barriers are for serving individuals, and what technical assistance needs are identified by → The Children and Youth Behavioral Health Initiative providers/county partners. RFA was released in June 2023. (See Featured Initiative: EPI+ on page 27 for more information.) Criminal Justice Prevention Following the 2017 adoption of its Together We Can report, the Commission is using an array of tools – research, policy development, financial incentives, and technical assistance – to implement its recommendations to help counties and their community partners build proactive and effective service systems that reduce criminal justice system involvement for those living with unmet mental health needs. PROGRESS WHAT’S NEXT → The criminal justice work is currently focused on Full → There will be two additional public hearings on FSPs Service Partnerships. this year in August and November. → The Commission had a public hearing in April on → We are working on scheduling a site visit to an FSP for FSPs, along with a site visit to two FSP programs in children and families. Sacramento. (For more information, see Featured Initiative: Full Service Partnerships on page 25.) → We also anticipate conducting community engagement to better understand how FSPs are working, what the barriers are for serving individuals, and what technical assistance needs are identified by providers/county partners. 17 Transformational Change Report | January – June 2023 Early Psychosis Intervention Plus Nearly 100,000 adolescents and young adults experience their first psychotic episode each year in the U.S. With half of all mental disorders manifesting by the age of 14 and 75 percent by the age of 25, the Commission is expanding the provision of high-quality Coordinated Specialty Care in seven grantee counties, focusing on early detection and intervention to improve the lives of adolescents and young adults, significantly reducing the impact of mental health challenges. This work is supported by the Early Psychosis Intervention Plus Committee. PROGRESS WHAT’S NEXT → The Commission is collaborating with the Department → The Children and Youth Behavioral Health Initiative of Health Care Services to release an RFA to expand RFA will be released in July 2023. the number of Coordinated Specialty Care clinics in California through the Children and Youth Behavioral → We are holding ongoing learning collaboration Health Initiative. (See Featured Initiative: EPI+ on meetings among EPI+ and Learning Health Care page 27 for more information.) Network participants. Impacts of Firearm Violence More than 3,400 people die from firearm violence in California each year; about half of these are homicides and just under half are suicides. In addition to the detrimental physical health problems that follow firearm violence – including emergency department visits, hospitalizations, and death – firearm violence also can cause trauma and lead to immediate and ongoing mental health challenges for individuals, families, and communities. This initiative explores the mental health impacts of firearm violence and works to develop strategies to prevent firearm violence and respond to those impacts. PROGRESS WHAT’S NEXT This project advanced from describing the problem of → We will be continuing interviews with key informants firearm violence to beginning to identify paths forward and subject matter experts. through the following activities: → There will be more in-depth engagement with → Dozens of interviews with key informants and subject psychologists at the July 2023 PDSC meeting. matter experts. → We are organizing a listening session with families → A second subcommittee meeting on threat affected by firearm violence, to occur in July or August assessment and response in schools in January. 2023. → Two site visits — to a gun range in Sacramento and → We are planning for youth engagement at a 4H a trauma prevention/violence response program for Shooting Sports Leadership Institute event in August children in Los Angeles. 2023. → A panel on trauma, mental health, and firearm violence during the May 2023 Commission meeting. → Engagement with psychologists at the PDSC annual training event in May. → Attended the Community Violence Intervention Conference from June 26-27, 2023. 18 Transformational Change Report | January – June 2023 Innovation & Innovation Incubator The Mental Health Services Act (MHSA) includes a rare and explicit commitment to fostering innovation in providing services and support. The Commission works to support counties in creating and presenting innovation plans for approval. Additionally, the Commission supports the Innovation Incubator. Created in 2018 with $5 million in one-time funding, the Innovation Incubator brings together county behavioral health agencies, subject matter experts, and other partners to drive innovations that improve mental health outcomes for individuals and communities. PROGRESS WHAT’S NEXT Innovation → Commission staff will continue to work on the implementation of the remaining elements of the → The Commission approved 28 Innovation projects Innovation Action Plan and will finalize the three new (totaling $122,959,436.86). These projects focus on a multi-county collaboratives mentioned above. statewide enhanced electronic health record system, integrated care, crisis response, peer-led services, and services for underserved populations. → Commission staff are also working on implementing elements of the Innovation Action Plan (approved by the Commission in November 2022). An Innovation FAQ will be released shortly to help counties develop more transformative innovation projects. Incubator → Although the original projects funded from the award of $5 million in 2018 have concluded, the Commission continues to use the model to advance transformational change. We do so through the development of multi-county collaboratives utilizing the Crisis Now model, Impact Financing strategy for FSPs, and developing and implementing allcove™ centers statewide. → Three additional innovation projects (totaling $231,603,472) from three counties were approved on June 15. They are focused on youth, workforce challenges, and housing. 19 Transformational Change Report | January – June 2023 Mental Health Wellness Act California’s Mental Health Wellness Act grant program provides $20 million each year to improve community response to people facing mental health crises. Grants have supported the ability of crisis responders to connect those having a mental health episode with wellness, resiliency, and recovery-oriented programs that offer the least restrictive settings appropriate for their needs. PROGRESS WHAT’S NEXT EmPATH EmPATH → The Commission approved Mental Health Wellness → Contracts to establish six new EMPATH units will begin Act funding on September 22, 2022, for the July 1, 2023. Kick-off meetings with all grantees will establishment of EmPATH units. There will be six take place in July 2023. grants to support the scaling of EmPATH units throughout California with the overall goal of reducing the need for psychiatric hospitalization, justice system involvement, and reducing homelessness. Older Adults → The Commission sent out RFA intent to award for older adults in April. We awarded 3 Age Wise programs and 8 PEARLS. → Finalized and awared contracts for grantees. 20 Transformational Change Report | January – June 2023 Prevention & Early Intervention Everyone should have the opportunity to be well and thrive, yet one in four people worldwide will experience a significant disruption to their mental wellbeing at some point in their lifetime. Guided by the Governor and Senate Bill 1004, the Commission launched a policy research project to explore opportunities for prevention and early intervention in mental health. PROGRESS WHAT’S NEXT → The Commission formally adopted the Prevention → During the next half of the year, staff will engage and Early Intervention Report, Well and Thriving, Commissioners to prioritize and operationalize during its March 23 meeting in San Diego. implementation opportunities for the PEI report, beginning with the Commission’s current initiatives. → During the same meeting, the Commission also approved two additional PEI priority areas which → The Commission’s director and project staff lead specify funding for all TAY and Community Defined will present the PEI report during the 2023 Annual Evidence Practices. Conference of the National Association of County and City Health Officials, scheduled for July 12 in Denver, → In April 2023, the Commission issued an information Colorado. notice to counties that is reflective of the new PEI priority language. 21 Transformational Change Report | January – June 2023 School Mental Health The Schools and Mental Health Project is a multi-year effort to guide funding and policy decisions supporting the provision of mental health services to promote the academic and social success of young people. The Commission has funded school-county partnerships through grants to expand and better integrate mental health services in schools. PROGRESS WHAT’S NEXT → We collected data from grantees in February 2023, → We will finalize the contract with WestED. which was the third collection overall. → We will be working with WestEd to develop a → WestEd was selected to be the MHSSA external comprehensive community engagement plan. evaluator in January 2023. → There will be a review of the MHSSA evaluator project → CEG developed and released the Technical Assistance plan. Plan for MHSSA. → We will hold upcoming site visits with locations to be → We conducted MHSSA in-person site visits in determined. Calaveras (January 2023) and Imperial County (March 2023). → MHSSA Collaboration meetings are scheduled for September 6 and December 6. → We held MHSSA Collaboration meetings in March and June. → We will select TCTs and begin implementing the TA plan. → We released an RFQ for Technical Assistance (TA) and Technical Coaching Teams (TCTs). Students presented testimonials on May 1, 2023, at Assembly Budget Subcommittee No. 1 on Health and Human Services. 22 Transformational Change Report | January – June 2023 Suicide Prevention Suicide in California is a significant public health challenge. Guided by data and community input, the Commission developed a statewide strategic plan for suicide prevention that incorporates the latest information and evidence to guide state and local actions for saving lives. Following the Commission’s 2019 adoption of the plan, the Commission is working with governments and community partners to implement recommendations from the report with the goal of reducing the rate and incidence of suicide in California. PROGRESS WHAT’S NEXT → We expanded Suicide Fatality Review training and → Staff are preparing a summary of the Commission’s technical assistance to five additional counties. suicide prevention initiatives to be presented during the September Commission meeting. → We continued our support of the Suicide Prevention Learning Collaborative, helping 37 counties advance → A Suicide Prevention Learning Collaborative strategic planning and implementation efforts Statewide Convening will be held from February 28 through ongoing training and technical assistance. through March 1, 2024, in Carlsbad, California. → We linked mental health consumer data and suicide data with hospital data to explore service trends related to suicide risk. 23 Transformational Change Report | January – June 2023 Workplace Mental Health Nearly one in five Americans live with a mental health condition, yet there are no well-established and agreed-upon standards in the U.S. to guide public and private employers about how to increase mental health awareness in the workplace, support prevention, and respond to needs with recovery strategies. The Commission has developed a framework of voluntary standards to support mental health in the workplace for all Californians. PROGRESS WHAT’S NEXT → The Commission adopted the report Working Well: → Staff will work with employers to adopt the Standards. Supporting Mental Health at Work in California on February 23, 2023. → The Commission will seek funding and authority to establish the Center of Excellence on Workplace Mental Health. Youth & Peer Empowerment The Commission works through advocacy funding, sponsored legislation, sponsored youth participation, and Committees to amplify the voices of youth and peer leaders seeking to create innovative solutions in the pursuit of emotional wellbeing and prevention. PROGRESS WHAT’S NEXT → The Youth Engagement Toolkit — the final product → We are working on a plan to release the Youth of the Youth Innovation Project Planning Committee Engagement Toolkit to the target audience counties. chaired by Commissioner Khatera Tamplen — was completed and will be released soon. → The anti-bullying initiative will continue to grow and the Commission will receive impact data in July 2023. → The anti-bullying initiative Right Our Story was launched. → The Peer and Clinical Fellows will work with their teams to infuse the voice of peers and clinical → Anti-Bullying Week of Action (May 7-13, 2023) research into practice at the Commission. included many live events to support youth. → The Commission seeks to partner with up to five → We hired the Commission’s first Peer and Clinical County Offices of Education (COEs) that may Fellows. potentially provide training and technical assistance to local community-based organizations. → The Commission awarded K-12 Advocacy Program grants to twenty grantees in early June 2023. → The Commission will host a K-12 youth convening in January/February 2024 to train youth in advocacy strategies. 24 Transformational Change Report | January – June 2023 FEATURED INITIATIVE Full Service Partnerships BACKGROUND Full Service Partnership (FSP) programs serve people with severe and persistent mental health needs in the community — rather than in locked facilities or hospitals. These programs, which are required under California’s Mental Health Services Act, apply a “whatever it takes” approach to partnering with individuals on their path to wellness and recovery. When they are implemented with fidelity to the model and part of a robust continuum of care, FSPs can reduce costs, improve the quality and consistency of care, enhance outcomes, and, most importantly, save lives. Today, more than 70,000 individuals are enrolled in an FSP program across the state. Full Service Partnerships represent a nearly $1 billion GOVERNOR’S ESTIMATION annual investment in public funds and have tremendous potential to reduce psychiatric hospitalizations, homelessness, incarceration, and prolonged suffering by Californians with severe mental health needs. THE FSP MODEL 7,000–12,000 More than 20 years ago, pilot programs established that we could serve people with mental illness in the community as effectively as we could in state hospitals – and serve them more efficiently. In these individuals will qualify for CARE Court services each year pilot programs, documented outcomes included clients staying out of hospitals and the criminal justice system, getting housed, making or rekindling social connections, and securing employment. Today, FSPs still work toward those same outcomes. But many people likely qualify for the program who are not getting seen. This reality becomes evident when we look at the number of people deemed incompetent to stand trial and who are in state hospitals waiting to stabilize enough to proceed. The ultimate goal is to work upstream – focusing on early intervention According to HHA workgroup, around and prevention – to help reduce the need for FSP programs in the 4,000 people future. Working upstream will reduce homelessness, incarceration, and hospitalizations, saving time, resources, and lives. To reach this goal, the each year have an Incompetent to Commission is focused on prevention, building capacity, and improving Stand Trial (IST) referral. Demand services at a local level. This includes determining who is getting the is outpacing supply and there are necessary services and who we are not yet reaching so we can begin currently more than 1,600 people serving clients earlier in their mental illness. on the waitlist to enter state hospitals after an IST referral. 25 Progress: January-June 2023 Short-Term Impact → We performed site visits to two FSP programs in In the short term, we aim to better understand FSP Sacramento, hearing and learning from participants efficacy, including what barriers exist to serving about their struggles as well as their triumphs in individuals and what technical assistance can best getting services, getting stabilized, and getting into support providers and county partners. This knowledge recovery. will help inform standards that all providers and community partners can work toward. → We had our first public hearing on FSPs in April. This panel presentation allowed for a conversation around Long-Term Impact challenges and opportunities for capacity building, The longer-term goal for the statewide evaluation of technical assistance, and improving client services FSPs is to assess which programs maintain clients in and support. Wanting to shine a light on FSPs, we the community, keep individuals from cycling through initiated a multi-county collaborative project as part hospitals and the criminal justice system, and help them of the Innovation Incubator. The FSP work now builds live in stable housing environments. The evaluation will off of those lessons learned as the collaborative help establish best practices and provide implementation continues, with new counties joining the effort. guidance to FSPs across the state. Childhood Age Youth All Ages Transition Transformational Change Report | January – June 2023 FOCUSING Upstream eff orts EFFORTS UPSTREAM SCHOOL MENTAL HEALTH ALLCOVE™ YOUTH DROP-IN CENTERS EARLY PSYCHOSIS INTERVENTION+ FULL SERVICE PARTNERSHIPS Downstream results REDUCED FEWER LESS HOMELESSNESS HOSPITALIZATIONS INCARCERATION A PATH TO TRANSFORMATIONAL CHANGE 26 Transformational Change Report | January – June 2023 FEATURED INITIATIVE EPI+ BACKGROUND Every year in the United States, nearly 100,000 adolescents and young adults experience their first psychotic episode. The Early Psychosis Intervention Plus (EPI+) program was designed to help young Californians with mental health needs before those needs escalate to severe or disabling. Through a coordinated specialty treatment approach, which includes evidence-based therapies, family support, medication management, 8,000 and recovery-oriented practices to address psychotic symptoms and promote resilience, EPI+ establishes a framework for supporting collaborative efforts to shift the emphasis in California’s mental health young people in California system from reaction to early detection and intervention. experience their first episode of psychosis annually THE EPI+ MODEL EPI+’s coordinated specialty care clinics put everything in one location for people experiencing psychosis. This includes psychiatrists, peer support, family advocates, group counseling, and supported California has only employment and education. This one-location approach is an effective, evidence-based treatment that people in the first episode of psychosis 10% need to help improve outcomes. The high number of young people experiencing symptoms of psychosis leads to increased homelessness, especially in places with no or limited of the Coordinated Specialty Care clinics to meet the need Full Service Partnership funding. Early prevention can stop this cycle — and that’s where EPI+ comes in. 27 Transformational Change Report | January – June 2023 Progress: January-June 2023 Short-Term Impact The Department of Healthcare Services asked us to In the short term, we aim to learn as much as possible administer rounds four and five of the Children and about successfully treating people in the early stages of Youth Behavioral Health Initiative. These grants total psychosis. Our learnings are particularly important in approximately $150 million. Round four is for youth- rural areas with limited access to services such as peer driven programs, and round five is for prevention and support and counseling. This expansion to counties such early intervention programs. Requests for applications as Lake and Kern helps us hone EPI+’s “hub and spoke” across the state will allow us to provide grants to more model for the future. counties and more organizations that will operate Long-Term Impact specialty care clinics. An increase in the number of specialty care clinics will help us keep up with the Our long-term goal is to grow and expand EPI+ to other number of people who will have their first episode of areas of the state. We will achieve this through the psychosis each year. Children and Youth Behavioral Health Initiative and county funding. In addition, we will work to define the strategy for funding workforce expansion, public awareness, and research on access barriers for diverse communities. 28 Transformational Change Report | January – June 2023 04 COMMITTEES The Mental Health Services Act charges the Commission with engaging the public. Committees allow Commissioners and the public to dive deep into questions and advise the full Commission. Transformational Change Report | January – June 2023 BACKGROUND The Commission appoints standing committees as a mechanism for community engagement. While committees have offered space for participation for some community members, the Commission has struggled to define the roles and goals of committees. To this end, the Commission is widening its approach in collaboration with UC Davis in the statewide to community engagement to facilitate, design, and Interdisciplinary Collaboration and Cultural transform the mental health system in California. The Transformation Model (ICCTM) Learning Collaborative, process of linking Commissioners, staff, consumers, which aims to address health inequities in access and researchers, providers, policymakers, and other utilization of quality mental health services. community partners now informs our work. Now, with committees augmented by a thoughtful Community engagement goes beyond committees to and strategic approach to community engagement, involve broader audiences, and the Commission seeks to the Commission has the opportunity to reach new model excellence in community engagement through our communities and facilitate pathways for community projects, including the Prevention and Early Intervention, members to drive transformational change. Early Psychosis, and Workplace Mental Health initiatives. As the Commission formulates the 2024-2027 strategic plan, it aims to incorporate more community engagement best practices into a framework. The Commission has sponsored similar initiatives 30 Transformational Change Report | January – June 2023 05 FOUNDATIONAL WORK In its effort to create transformational change for wellbeing in California, the Commission uses research, grants, innovation, communications, and more to explore bold new ideas. These tools underpin Commission initiatives to create more robust evidence and exploration. During the first six months of the year our administration has continued to prepare budgets and contracts, support personnel and hiring, and coordinate logistics to enable transformational change at the Commission, with a focus on developing a 2024-27 strategic plan. Transformational Change Report | January – June 2023 BACKGROUND The 2024-27 strategic plan resets and renews the Commission’s goals for driving transformational change, defines how Commissioners will steward the strategy, and how the staff will improve operations to achieve the goals and objectives. The plan will recap the progress that was made toward This level of robust analysis and engagement informing the goals in the 2020-23 strategic plan, what the the plan is intended to produce a shared understanding Commission has learned from its current initiatives, and among governmental and NGO partners, people with opportunities to improve its model for transformational lived experience, family members and community change. The plan will synthesize the Commission’s leaders regarding the imperative and opportunities to priorities going forward; the goals and objectives drive the transformational change required to improve defining initiatives and projects; and metrics for results and reduce disparities. That guidance from this tracking progress. engagement process will be incorporated into a draft 2024-27 strategic plan, which will be reviewed by the The plan also will include a framework designed to Commission in late 2023. assess system-level opportunities to improve mental health care and services, including methodologies for The Commission is receiving analytical support and selecting, designing, and evaluating future initiatives. expert guidance from Boston Consulting Group (BCG), This framework will provide guidance on how to assess a highly regarded consulting firm with extensive the potential impact of initiatives and combinations of experience supporting public agencies and expertise in those initiatives. health and mental health care. The Commission has begun a broad and deep community engagement process to help the Commission assess its progress, establish priorities, and refine its strategic approach. This work was initiated in virtual discussion open to the public on June 16, when about 50 people – including peers, family members and advocates – provided feedback on the Commission’s activities, strengths, and opportunities for improvement. 32 Transformational Change Report | January – June 2023 Foundational Work JANUARY - JUNE PROGRESS REPORT Advocacy Grants In approving the Mental Health Services Act (MHSA) in 2004, California voters mandated the use of transparent and collaborative processes in determining mental health needs, priorities, and services. The Act aims to change the way people access mental health services and participate in policy planning. It also seeks to change public perception and reduce the stigma associated with mental health challenges. Through MHSA funding, the Commission awards grants to local and state-level organizations to provide advocacy, training, education, and outreach on behalf of nine specific populations: clients and consumers, diverse racial and ethnic communities, families, K-12 students, LGBTQ+, parents and caregivers, transition-age youth, veterans, and immigrants and refugees. PROGRESS WHAT’S NEXT → The Commission’s FY 2022-23 budget provided → Listening sessions will be held in the Fall of 2023 $670,000 annually to support advocacy focused on to hear from the public and community-based the mental health needs of K-12 students. organizations about the specific mental health needs of veterans, parents and caregivers, LGBTQ → In Spring 2023, the Commission released a Funding communities, consumers, families of consumers, and Proposal for a K-12 Advocacy Program with a diverse racial and ethnic communities. response date of April 21, 2023. The Proposal specified an award of up to $20,000. → All funds will be dedicated to supporting the mental health and wellness advocacy efforts of K-12 students in their local communities. Communication The Commission leverages communication opportunities to improve public understanding of mental health needs, the potential for recovery, the value of services, and the opportunity for transformational change to significantly improve results. The Commission publishes its own communications in addition to leveraging strategic partnerships, and per the 2020-2023 Strategic Plan, has significantly improved the quality and quantity of communications to increase public understanding of mental health needs, the potential for recovery, the value of services available, and the opportunity for transformational change to significantly improve results. PROGRESS → The Commission marked the one-year anniversary in → During Mental Health Awareness Month in May, the June of the premiere of Hiding In Plain Sight: Youth Commission’s anti-bullying initiative achieved success Mental Illness on PBS. This Commission-supported connecting with youth victims of race-based bullying, youth documentary has reached 98% of American as directed by the Legislature. By the end of the households. The national conversation resulting from the month, the youth-designed and driven social media expansive reach of this film not only supports but elevates campaign “Right our Story” had received 102 million California’s role in increasing awareness of youth mental impressions, resulting in more than 100,000 social health challenges and helping to reduce stigma. engagements, with more than 8,400 users choosing to 33 Transformational Change Report | January – June 2023 follow the campaign across all social channels, and/or WHAT’S NEXT become members of the campaign’s Youth Advisory → The Commission is broadening its communications Committee. In addition, the campaign drove nearly efforts to reflect increased interest from those who 300,000 unique visitors to its microsite, where more are impacted by our state’s mental health needs. To than 340 bullying incidents and story submissions that end, the Commission is stratifying and growing were collected. The initiative’s success showcases its contact database, with a goal to expand our how youth are responding to digital tools. We can audience and serve them with a steady stream of see the power of digital initiatives to increase youth educational and actionable information as well as engagement around issues impacting their mental stories of impact. health. → The Commission will implement recommendations of → In an attempt to shape public understanding of its critical Suicide Prevention work over the upcoming mental health and wellbeing, rather than just months, which includes transferring the management communicate program outcomes, the Commission of the Striving for Zero website and commensurate has put an increased focus on developing and prevention efforts such as “Lethal Means Safety” to distributing communications that people will read, the Office of Suicide Prevention. understand, and act upon. In the reports, policy papers, meeting summaries, fellowship descriptions, → The Commission is developing 2024-2027 Strategic strategic slide presentations, recruitment brochures, Plan tracking tools to ensure the plan stays on track posters, and infographics we’ve developed over the and all progress is communicated clearly to our past six months, we’ve ensured the use of inclusive audiences. As part of this work, the Communications and thoughtful language, incorporated clear data team will provide input on initiative nomenclature, charts and visualizations, and sourced community structure, and ordering. A new communications plan, imagery that reflects the diversity of our state. Some designed to accompany the forthcoming Strategic of the resulting outputs of these efforts are: Plan, will build on and evolve the goals achieved in the current Strategic Plan. • Workplace Mental Health Report: “Working Well” • Prevention and Early Intervention Report and Implementation Plan • Impacts of Firearm Violence Subcommittee Meeting Summary • Innovation Incubator Report: “Insights to Action” • “Focusing Efforts Upstream” infographic • MHSSA Grant Program Update deck and infographics • “Lethal Means Safety” website, strivingforzero.org • Multiple one-sheets and fliers clearly describing Commission initiatives 34 Transformational Change Report | January – June 2023 Legislation Created and guided by legislation, the Commission tracks legislation that impacts its work. Periodically, consistent with the Commission’s policy projects and publicly adopted priorities, the Commission will sponsor or support legislation. PROGRESS → During the 2022-23 budget process, the Legislature • SB 509 (Portantino) would require a local and Governor authorized funds to continue educational agency to certify to the California supporting the allcove™ Youth Drop-In Centers Department of Education that 75 percent of Program, Early Psychosis Intervention Plus Program, its classified and certificated employees who and the Mental Health Wellness Act. Funds were also have direct contact with pupils at each school authorized for the Commission to conduct a study have received specified youth behavioral health on universal mental health screening of children and training. youth. WHAT’S NEXT → The Commission supported two bills in the first half → The Commission will continue to analyze the of 2023: Governor’s proposal to modernize California’s behavioral health system through SB 326 (Eggman) • AB 1282 (Lowenthal) would require the and AB 531 (Irwin) which significantly amend the Commission to develop a statewide strategy Mental Health Services Act and, if passed by the to understand, communicate, and mitigate Legislature, will go to the voters for approval on the mental health risks associated with the use of March 5, 2024 ballot. See MHSA Modernization on social media by children and youth as well as page 40 for more details. the mental health risks associated with artificial intelligence. Transparency Suite The MHSA Transparency Suite of dashboards provides high-level statistics showing county and statewide demand for mental health service programs, where money gets spent, programs offered, and associated outcomes. PROGRESS WHAT’S NEXT → We refreshed CSI and FSP dashboard data — inclusive → We will work with the evaluation committee to of two additional years of data (FY 2020-22). prioritize data dashboarding work. → We refreshed the Highlighting Differences to → The Commission will engage consumers, families, Understand Disparities Dashboard, which includes and other community partners to determine the updated CSI, FSP, and DOF data. dashboards they would like to see and the questions they hope to answer from the data we have. → We are updating the Fiscal Transparency Tool to include FY 2021-2022 data. → We are developing a dashboard for homelessness in CA. 35 Transformational Change Report | January – June 2023 FEATURED FOUNDATIONAL EFFORT Older Adults Grant California demographics are changing. By 2030, Californians 60 and over will comprise one-quarter of our population. This growing demographic faces an unmet need in terms of mental health care. Less than one-third of older adults in need of mental health services receive appropriate care, and older adults experience disproportionately higher rates of suicide. The prolonged COVID-19 pandemic also exacerbated the harmful impacts of social isolation and physical/cognitive decline on older adults and their family caregivers, 10,761,937 all of which add up to an increased need for organized advocacy and support for our most senior population. Californians will be age 60+ by 2030 We have an opportunity to learn more from and about older adults and their mental health. The Commission partnered with the California Department of Aging (CDA) to identify and act on the emerging needs of California’s fastest-growing population. In our partnership, we are: 25% → Collecting and analyzing population-level data (Medi-Cal, Medicare, Veterans Affairs, and commercial insurance). This will help to develop a person-centered, data-driven, equity-focused behavioral health system of care for older adults. of the population will be 60+ by 2030 → Identifying and developing the voices of older adults with lived experience and subject matter experts who specialize in older adult care to inform policy. This will lead to increased, organized advocacy for California’s fastest-growing demographic. Using funds from the Mental Health Wellness Act of 2013, we expanded two programs for aging adults, PEARLS and Age Wise. 36 Transformational Change Report | January – June 2023 IMPACT IN ACTION Programs for Older Adults PEARLS Age Wise The Program to Encourage Active, Rewarding After 2+ decades, San Bernardino County’s Age Lives for Seniors (PEARLS) is an evidence-based Wise program expanded during the COVID-19 program that aids older adults with depression and pandemic to address the increased needs of older develops coping skills. PEARLS provides home - adults. Age Wise includes in-home behavioral based care, medication management, and case health and case management services, counseling, management to older adults with chronic illness to peer and family advocacy, and community support reduce symptoms of depression and anxiety. and education. In less than six months we formed our CDA partnership As mentioned in our EPI+ section, The Department of and wrote an RFP. We recently awarded funding to 11 Health Care Services asked us to administer rounds four programs around the state — eight PEARLS and three Age and five of the Children and Youth Behavioral Health Wise programs. Those programs garnered great interest. Initiative, equaling $150 million in grants. These grants We hope other counties increase their capacity with other are another example of the Commission working in close funds, even if they did not receive a grant. We will finalize partnership with the State Administration. the contracts for grantees by June 30 and will continue to plan collaboration meetings for older adult programs throughout the summer. 37 Transformational Change Report | January – June 2023 FEATURED FOUNDATIONAL EFFORT The Cambodian Family In the summer of 2022, the Commission partnered with grantee The Cambodian Family (TCF). This Santa Ana non-profit provides services and support to refugee and immigrant families from Cambodia, Vietnam, Laos, Iran, Iraq, Afghanistan, Russia, Ukraine, Bosnia, Ethiopia, and Somalia. Since the start of its contract with the Commission, TCF has held 11 trainings in and around Orange County. These trainings focused on Cambodian refugee history, mental health issues and disparities, gaps 240+ and barriers, and strategies to increase access. TCF also has conducted a multitude of in-person outreach and engagement events in several different communities as part of the contract. training participants in year one of the Commission contract TCF’s work has significantly increased the Cambodian community’s ability to engage in mental health advocacy for themselves. This has manifested in: 1 The confidence gained through training 2,000+ 2 Improved access to information through the in-language translation of critical MHSA communications community members reached in year Program benefits became evident in an April 2023 public hearing held one of the Commission contract by the Orange County Health Care Agency. The hearing focused on the Mental Health Services Act (MHSA) three-year plan, MHSA spending, and the community program planning process. Bory Hok and Leang Seng, two members of the Cambodian-speaking community, took the podium before the Orange County Behavioral Health Advisory Board. They made the case for expanding early intervention and prevention services and data disaggregation during the public comment period. Hok and Seng received overwhelmingly positive feedback from board members and attendees alike. TCF is one of the eight local advocacy Hok and Seng were equipped with the training—and confidence—to make organizations funded through the these comments thanks to the work of TCF. Their presentation to the board Immigrant and Refugee Advocacy marked progress in uplifting the voice of the Cambodian population in the contracts. The purpose of these county. Additionally, the executive summary for the MHSA spending plan three-year projects is to empower was translated into the Cambodian language Khmer prior to the hearing, local immigrant and refugee demonstrating a major step forward in improving access to limited-English communities through advocacy, training, and outreach activities speaking communities in the county. and initiatives. 38 Transformational Change Report | January – June 2023 Budget Update The table below illustrates the budget for Fiscal Year 2023-2024, year-to-date expenses, committed funds, and funds that are potentially available for the Commission to use in the future. APPROVED ADJUSTED EXPENSE YTD POTENTIALLY ITEM FY 22-23 ADJUSTMENTS FY 22-23 ENCUMBERED EARMARKED TYPE EXPENSES AVAILABLE BUDGET BUDGET Operations Personnel $8,100,000 -$720,000 $7,380,000 $5,565,903 $1,138,058 $676,038 Core Operations $1,484,552 $300,000 $1,784,552 $1,092,994 $338,523 $767,232 -$414,197 Commission Communications $467,448 $420,000 $887,448 $403,198 $426,220 $86,925 -$28,895 Priorities Innovation $100,000 $100,000 $100,000 Research $1,116,000 $1,116,000 $217,691 $807,625 $125,008 -$34,324 Budget California Behavioral $5,000,000 $5,000,000 $5,000,000 Directed Outcomes Fellowship Evaluation of FSP $400,000 $400,000 $400,000 Outcomes (SB 465) MHSSA Evaluation and $16,646,000 $16,646,000 $105,499 $1,500,000 $15,040,501 Admin (avail over 5 years) Local Mental Health $20,000,000 $20,000,000 $20,000,000 Assistance Wellness Act MHSSA $8,830,000 $8,830,000 $320,000 $8,510,000 Community Advocacy $6,700,000 $6,700,000 $2,895,843 $3,134,157 $670,000 Children and Youth Behavioral Health $42,900,000 $42,900,000 $42,900,000 Initiative Money Held For Reserve -$250,000 Total $111,744,000 $111,744,000 $10,601,128 $18,216,525 $67,587,223 $15,089,123 39 Transformational Change Report | January – June 2023 06 MHSA MODERNIZATION California’s mental health system is among the most comprehensive and outcome-driven in the nation, yet it falls short of public expectations. The challenges of our mental health system drive feelings of hopelessness for the clients and families seeking services and deep frustration among the public who witness its outcomes and the taxpayers who fund public programs. Transformational Change Report | January – June 2023 BACKGROUND In 2004, California voters passed the Mental Health Services Act (MHSA), bringing hope to millions of Californians and their families who had struggled to address their mental health needs. The MHSA imposed a 1 percent tax on annual incomes over $1 million and applied new rules and requirements to transform California’s behavioral health system. Today, the MHSA generates more than $3 billion each year, which makes up about one- third of all public mental health funding in the state. Yet, despite the scale of this funding and statutory → Establishing minimum standards for Full Service direction to focus on prevention and early intervention, Partnerships and other programs, including many Californians still face barriers to care. In March of new mandates for Medi-Cal billing, tapping into this year, Governor Newsom announced a 2024 ballot commercial insurance reimbursements where initiative to improve how California responds to mental relevant, and partnering with managed care health needs, with a focus on addressing homelessness organizations and strengthening the integration of mental health care and substance use disorder services. In addition → Strengthening fiscal, programmatic, and outcome to proposing revisions to the MHSA and other statutory accountability and operational changes, the Governor is championing Many components of the Governor’s behavioral health a multi-billion dollar bond measure to support housing reform proposal will require voter approval and will be and infrastructure to improve behavioral health systems on the planned March 2024 Ballot, with implementation of care. envisioned for 2025 and 2026. At its April 2023 meeting, the Commission heard an early In proposing the reforms, the Administration hopes to: description of the proposal from state leaders. In June of 2023, Senator Susan Eggman amended SB 326 to reflect → Address California’s homelessness crisis. the Governor’s ambitious reform proposal. The proposal supports funding “10,000 new clinic beds and homes...” and “will create new, dedicated The key elements of the proposal, which goes beyond housing for people experiencing homelessness who modifications to the MHSA, support a broader rethinking have behavioral health needs, with a dedicated of how California responds to behavioral health needs, investment to serve veterans...” including: → Help those with substance use disorders. → Renaming the MHSA to become the Behavioral Health The proposal includes those with substance use Services Act (BHSA) disorders as people who can be served by BHSA → Making revisions to funding allocations, including a funding. This includes “more resources for housing requirement for counties to dedicate 30 percent of and workforce, and continues community support for BHSA funds to support housing prevention, early intervention, and innovative pilot programs – all with new and increased accountability → Requiring counties to better integrate behavioral health for outcomes and through an equity lens.” strategies, including mental health and substance use disorder services, and to reflect all sources of local behavioral health funding in those plans 41 Transformational Change Report | January – June 2023 → Elevate Full Service Partnerships. → Address behavioral health workforce needs. The proposal focuses funding on Full Service The proposal recognizes the need to “expand a Partnerships and other services for the most seriously culturally-competent and well-trained behavioral ill, with the intent to prioritize community services health workforce to address behavioral health and supports while including prevention and capacity shortages and expand access to services” early intervention. It also includes infrastructure with a Statewide Workforce Initiative. investments for capital and workforce. The Governor’s proposal has attracted significant support, → Expand population-based prevention initiatives. particularly its potential for addressing California’s County allocations would include a mandatory homelessness crisis. It also has raised questions percentage for population-based behavioral health from community advocates over how it will result in and wellness programming. improved outcomes as the measure is not envisioned to significantly increase behavioral health resources. WHAT’S NEXT? On July 27, 2023, the Commission organized a panel presentation on the proposal to support opportunities for Commissioners and community members to learn more, share support, and raise concerns. The Legislature, Senate Health, and Assembly Health committees will hear the proposals in August 2023. 42 Transformational Change Report | January – June 2023 STAY IN TOUCH  https://mhsoac.ca.gov/  https://www.facebook.com/mhsoac  https://twitter.com/MHSOAC  https://www.youtube.com/mhsoac  https://www.instagram.com/mhsoac 43