Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health and Recovery Services
Subject: San Mateo County Mental Health Services Act Annual Update FY 2025-2026
RECOMMENDATION:
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Adopt a resolution authorizing the approval and submission of the San Mateo County Mental Health Services Act Annual Update for Fiscal Year 2025-2026 to the State Commission for Behavioral Health and the Department of Health Care Services.
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BACKGROUND:
In 2004, California voters passed Proposition 63, known as the Mental Health Services Act (MHSA), which made additional state funds available to expand and transform behavioral health services. Since 2006, MHSA resources and expenditures have been approved by this Board as part of the larger County Health budget. State legislation requires that the MHSA Three-Year Program and Expenditure Plan and subsequent Annual Updates be approved by the County’s Board of Supervisors.
On September 12, 2023, this Board approved the MHSA Three-Year Program and Expenditure Plan FY 2023-24 through FY 2025-26 and Annual Update FY 2023-24. Subsequently, this Board approved the MHSA Annual Update for FY 2024-25 on June 11, 2024.
On April 2, 2025, the Behavioral Health Commission held a public hearing and voted to close a 30-day public comment on the MHSA Annual Update FY 2025-26. Behavioral Health and Recovery Services (BHRS) is now recommending approval of the update by this Board of Supervisors.
DISCUSSION:
The MHSA Annual Update is intended to describe any changes to the programs and expenditure plans to the MHSA Three-Year Plan, previously approved by this Board, and report on annual program outcomes.
The MHSA Three-Year Plan included several priority strategies and plans to spend down the unanticipated one-time revenue increase due to delayed tax filings and a projected and unprecedented annual adjustment to the MHSA revenue. Priority strategies included addressing behavioral health workforce capacity, expanding access to services for youth and the Chinese community, as two underserved populations in our County, strengthening the behavioral health crisis continuum of care and increases to Full-Service Partnerships (FSP), including the new CARE Courts FSP and FSP housing supports. FSP programs are evidence-based and incorporate a “whatever it takes” approach to supporting adults living with serious mental illness and children and youth living with serious emotional disturbance in achieving their individual recovery goals and needs. A One-Time Spend Plan included “big-ticket” items such as 1) Housing Developments; 2) Capital Facilities Purchases; 3) Technology Needs; and 4) System Transformation Projects.
For this current MHSA Annual Update for FY 2025-26, the strategies set forth in the MHSA Three Year Plan will continue as planned, prioritizing FSPs and FSP housing supports, developing workforce capacity and recruitment/retention strategies, improving prevention and early intervention services specifically for youth and the Chinese community, and implementing crisis continuum and substance use prevention strategies.
The FY 2025-26 MHSA proposed budget can be found on Appendix 3 of this MHSA Annual Update.
The resolution has been reviewed and approved by the County Attorney as to form.
A client is considered "maintained at the current or lower level of care" if, during the fiscal year, they did not have a new admission to a higher level of care or had one or more new admissions to a program with the same or lower level of care. One of the many BHRS programs funded by MHSA is its FSP program described above; it is anticipated that 70% of FSP clients shall be maintained at a current or lower level of care. Previous reporting on this performance measure was based on outdated criteria, and the baseline may shift in future years.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Actual |
FY 2024-25 Estimated |
FY 2025-26 Projected |
|
Percentage of FSP clients maintained at a current or lower level of care |
68% 291 of 425 clients |
70% 273 of 391 clients |
70% 298 of 425 clients |
COMMUNITY IMPACT:
MHSA-funded programs and services positively impact marginalized communities, especially cultural, racial, and ethnic communities struggling with severe mental health and substance use conditions. Programs such as FSPs, Pathways, California Clubhouse, and the Lived Experience Academy elevate the importance of providing culturally responsive services. In addition, cultural humility trainings, multicultural organizational development, and trauma-informed systems are incorporated into the services and programs delivered by BHRS and contracted providers.
FISCAL IMPACT:
BHRS will receive approximately $72,368,590 in MHSA revenue including interest by the end of FY 2024-25. BHRS anticipates MHSA revenue including interest for FY 25-26 to be approximately $52,950,164. (BHRS notes that FY 2024-25 MHSA revenue was unusually high, due to a non-occurring adjustment.) Funds that are not yet allocated through our internal planning process or Request for Proposals to the community are held in a Trust Account. This Account is also used to manage the fluctuations in funding that occur from year to year, as well as to support maintenance of effort and cost increases for current programs. There is no Net County Cost associated with this annual update.