Mental Health Services Act: A County Perspective California Mental Health Policy Forum February 11, 2005 Presented by Nancy Peña, Ph.D., Director Santa

Mental Health Services Mental Health Services Act: A County Act: A County PerspectivePerspective

California Mental Health Policy California Mental Health Policy ForumForum

February 11, 2005February 11, 2005

Presented byPresented byNancy Peña, Ph.D., DirectorNancy Peña, Ph.D., Director

Santa Clara County Mental HealthSanta Clara County Mental Health

The OpportunityThe Opportunity

Social Analysts have revealed Social Analysts have revealed flaws in the current system, flaws in the current system, providing objective evidence of providing objective evidence of the negative individual, social, the negative individual, social, and financial outcomes that are and financial outcomes that are resulting from neglect of the resulting from neglect of the mental health of our citizens mental health of our citizens


Local systems are stretched beyond Local systems are stretched beyond capacity and unable to meet demandcapacity and unable to meet demand

Administrators are distracted by the Administrators are distracted by the burdens of bureaucracy and financial burdens of bureaucracy and financial crisis and uncertainty crisis and uncertainty

Clinical leaders are preoccupied with Clinical leaders are preoccupied with operational demands and are unable operational demands and are unable to focus on effective quality to focus on effective quality improvement efforts that insure improvement efforts that insure excellence in practice and optimal excellence in practice and optimal client outcomes.client outcomes.


Consumers and family members are Consumers and family members are without adequate care and are demanding without adequate care and are demanding that mental health be addressed with the that mental health be addressed with the same urgency as health caresame urgency as health care

They are demanding freedom from They are demanding freedom from stigma, a path to recovery and wellness, stigma, a path to recovery and wellness, excellence in service, and inclusion as excellence in service, and inclusion as partners in their own care and in the partners in their own care and in the service delivery system service delivery system


Advocates and Stakeholders have Advocates and Stakeholders have presented the issues to Californians presented the issues to Californians and have offered a compelling set of and have offered a compelling set of strategies to correct the current strategies to correct the current system flaws.system flaws.

Citizens have affirmed the reality of Citizens have affirmed the reality of the current crisis, and have mandated the current crisis, and have mandated solutions to be financed and solutions to be financed and implemented.implemented.

Providing System Providing System Stakeholders a Stakeholders a Window of Opportunity Window of Opportunity to Maketo MakeFar-Reaching Change Far-Reaching Change

The ChallengeThe Challenge

Mental Health Directors and Mental Health Directors and Provider Leaders Need to step Up Provider Leaders Need to step Up and Provide Leadership to this and Provide Leadership to this Exciting New Era in Public Mental Exciting New Era in Public Mental Health History….Health History….

The VisionThe Vision

Is not created or facilitated by Is not created or facilitated by legislation or moneylegislation or money

Is created by LeadersIs created by Leaders

◆ in clarity and soundness of ideasin clarity and soundness of ideas◆ in effectiveness of in effectiveness of

communicationcommunication◆ in influence and engagementin influence and engagement◆ in sustained purpose and actionin sustained purpose and action


DMH: “To… expend funds made available through this initiative to transform the current mental health system in California …This will not be “business as usual”. Eventually access will be easier, services more effective and out-of-home and institutional care will be reduced.”


Outlines Transformation Outlines Transformation AreasAreas:: Consumer and Family Participation

and Involvement

Programs and Services

Community Partnerships

Cultural Competence

Outcomes and Accountability

The ProcessThe Process

Santa Clara County -

Broad based stakeholder process

Stakeholder Leadership Committee to:

Review Development of PlanReview Development of Plan Facilitate Stakeholder InvolvementFacilitate Stakeholder Involvement Educate CommunityEducate Community Advise Board of SupervisorsAdvise Board of Supervisors

Board of Supervisors

State Dept. ofMental Health

BOS Committees(HHC, CSFC, PSJC)

County ExecutiveSCVHHS Exec. Dir

MHSA StakeholderLeadership Committee

Data, Technology,

Budget Work Group

Prevention & Early

InterventionWork Group

Children’s System of Care Work

Work Group

Adult/Older Adult

System of Care Work Group

Community Stakeholder Forums, Focus Groups, and Consumer Engagement Groups

Cultural Competency Readiness Forums Recovery/Self Help Readiness Forums

FocusGroup

FocusGroup

FocusGroup

FocusGroup

FocusGroup

Accountability Commission

Mental Health Board

Project Management

Team

Santa Clara CountyMHSA Planning

Structure

The ProcessThe Process

Monthly Stakeholder Leadership Monthly Stakeholder Leadership Meetings for:Meetings for:

Information and Status ReportsInformation and Status Reports Input from Broad CommunityInput from Broad Community Readiness ForumsReadiness Forums

Work Group Meetings:Work Group Meetings: Child, Adolescent, Young Adult SOCChild, Adolescent, Young Adult SOC Adult and Older Adult SOCAdult and Older Adult SOC Prevention and Early InterventionPrevention and Early Intervention Data, Infrastructure and Human ResourcesData, Infrastructure and Human Resources

Regular Reports Board and Board Regular Reports Board and Board Committees and Mental Health BoardCommittees and Mental Health Board

The Process - Santa Clara County The Process - Santa Clara County Partial List of StakeholdersPartial List of Stakeholders

Mental Health Department (chair)Mental Health Department (chair) County Executive’s Office (co-chair)County Executive’s Office (co-chair) Mental Health Board (co-chair)Mental Health Board (co-chair) Mental Health Self-Help Centers Mental Health Self-Help Centers MHD Office of Consumer MHD Office of Consumer

Empowerment Empowerment National Alliance for the Mentally Ill National Alliance for the Mentally Ill Association of Mental Health Association of Mental Health

Contractors Contractors Non-AMHCA mental health providersNon-AMHCA mental health providers Labor OrganizationsLabor Organizations Foster Care Association Foster Care Association Residential & Group Home ProvidersResidential & Group Home Providers Parents Helping Parents Parents Helping Parents Department of Alcohol and Drug Department of Alcohol and Drug

Services Services Public Health Department Public Health Department VMC Acute Psychiatric Services VMC Acute Psychiatric Services Custody Health ServicesCustody Health Services Valley Medical Center Valley Medical Center Office of the Public GuardianOffice of the Public Guardian

Police Chief Association Police Chief Association SCC Sheriff SCC Sheriff Department of Social Services Department of Social Services Probation Department Probation Department Superior Court Superior Court District Attorney’s Office District Attorney’s Office Public Defender’s Office Public Defender’s Office County Office of Education County Office of Education School District Superintendents School District Superintendents First Five Commission First Five Commission Council on Aging Council on Aging Office of Affordable Housing Office of Affordable Housing Domestic Violence Council Domestic Violence Council School Linked Services School Linked Services United Way United Way Interfaith Council Interfaith Council Silicon Valley Council of Non-Silicon Valley Council of Non-

profitsprofits San Andreas Regional CenterSan Andreas Regional Center

The Process – Phase IThe Process – Phase I

Engagement and CommitmentEngagement and Commitment Invite Stakeholder InvolvementInvite Stakeholder Involvement

Share Intent and VisionShare Intent and Vision

Set Tone of Inclusion Set Tone of Inclusion

Establish Collective Receptivity Establish Collective Receptivity

Align Expectations Without Align Expectations Without Losing Losing Optimism Optimism

Outline Planning LandscapeOutline Planning Landscape

The Process – Phase II The Process – Phase II

Learning and AssessmentLearning and Assessment Learn Current Service Delivery SystemLearn Current Service Delivery System

Learn Needs and Interests of Learn Needs and Interests of Consumers, Consumers, Family Members, Family Members, Providers, System Providers, System Partners, Partners, Community – (left and right Community – (left and right brain brain approaches)approaches)

Learn Best Practice Strategies to Meet Learn Best Practice Strategies to Meet NeedsNeeds

Learn Outcomes & Accountability Models

The Process – Phase IIIThe Process – Phase III

Prioritization and Planning Establish Local Mission, Values & Establish Local Mission, Values &

Transformation ObjectivesTransformation Objectives

Prioritize Local NeedsPrioritize Local Needs

Select Effective Strategies to Meet Local Select Effective Strategies to Meet Local NeedsNeeds

Complete Planning ComponentsComplete Planning Components

The Process – Phase IVThe Process – Phase IV

Implementation

Obtain State Approval & FundingObtain State Approval & Funding

Select Local ProvidersSelect Local Providers

Establish Local Accountability Establish Local Accountability StructureStructure

Initiate and Monitor ServicesInitiate and Monitor Services

Evaluate ServicesEvaluate Services

Santa Clara County MHSA Santa Clara County MHSA Planning Framework Planning Framework

– – Across the LifespanAcross the Lifespan - -

• Population SizePopulation Size

• Geographic DistributionGeographic Distribution

• Ethnicity and ImmigrationEthnicity and Immigration

• Gender Gender

• AgeAge

• Service UtilizationService Utilization

• Prevalence InfoPrevalence Info

• Risk & Special PopulationsRisk & Special Populations

• Unmet NeedUnmet Need

• Stakeholder InputStakeholder Input

For Each Developmental Group Describe:Developmental Group Describe:

For Each Developmental Group For Each Developmental Group Assess Each Transformation Area:

Consumer & Family Involvement

Community Partners

Programs & Services

Cultural Competency

Accountability and Outcomes

Where Are We?

Assess Strengths & Weaknesses in each area

Where Do We Want to Be?

Determine Transformation Objectives in each area

Santa Clara County MHSA Santa Clara County MHSA Planning Framework Planning Framework

– – Across the LifespanAcross the Lifespan - -

The Impact on County The Impact on County Service SystemsService SystemsPressure to:Pressure to:

Establish Formal Interagency Policy Establish Formal Interagency Policy ForumsForums

Establish System Goals for All AgesEstablish System Goals for All Ages

Assure Consumer & Family Influence Assure Consumer & Family Influence and Involvement at all levels and Involvement at all levels

Outline System Values and Outline System Values and PhilosophyPhilosophy

The Impact on County The Impact on County Service SystemsService SystemsPressure to:Pressure to:

Determine and Prioritize Consumer Determine and Prioritize Consumer NeedsNeeds

Implement effective culturally Implement effective culturally competent prevention, early competent prevention, early intervention and treatment servicesintervention and treatment services

Demonstrate process quality and Demonstrate process quality and favorable outcomesfavorable outcomes

The Impact on County The Impact on County Service SystemsService Systems

Local System – Establish Local System – Establish Common Goals for All AgesCommon Goals for All Ages

Health & Well

Being

Stability in Family & Social

Relations

Success in School/Wor

k Meaningful

Activity

Safe From Harming or

Being Harmed in Community

Examples of System Outcome ObjectivesHealth

Insurance

Health Visits

Health Status

Suicide

Stable Living

# Placements

DV Incidents

School Attendance

Graduations

Work stability

CJ Recidivism

Days incarcerated

Victims of Crime

CJS Diversions


Affirm System Values and Affirm System Values and PhilosophyPhilosophy Access and Choice

Cultural Proficiency

Early Identification

Family-Driven

Collaborative

Individualized Plans

Community Based

Strengths Based


Establish System Structure Establish System Structure and Stakeholder Involvementand Stakeholder Involvement

Individual & Family

Provider Services

System Policy and

Management

Sta

keh

old

ers

System Performance: Expectations & Results

Provider Performance: Expectations & Results

Client Level Outcomes: Expectations & Results


Determine and Prioritize Local Determine and Prioritize Local Mental Health NeedsMental Health Needs

Prevention

Early Intervention

Intervention

All Citizens Across Lifespan

Citizens in need

Unmet Need

Current Public MH System


Demonstrate process quality Demonstrate process quality and favorable outcomesand favorable outcomes

Who Do We Serve?

What Are We Trying to Change?

What Practices Do We Employ and Why?

How Do We Insure Quality of Practices?

How Do We Measure Results?

What Results Do We Achieve?

Documents

Mental Health Services Act: A County Perspective California Mental Health Policy Forum February 11, 2005 Presented by Nancy Peña, Ph.D., Director Santa