Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health and Recovery Services
Subject: Amendment to the San Mateo County Mental Health Services Act Annual Update for FY 2024-25
RECOMMENDATION:
title
Adopt a resolution authorizing the approval of an amendment to the San Mateo County Mental Health Services Act Annual Update for FY 2024-25 and submission to the State Mental Health Services Oversight and Accountability Commission 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 has provided dedicated state funds to expand and transform behavioral health services. Since 2006, MHSA expenditures have been approved by this Board as part of the larger County Health budget. State legislation requires that a MHSA Three-Year Program and Expenditure Plan, subsequent MHSA Annual Updates and any proposed amendments be approved by this Board.
On September 12, 2023, this Board approved the MHSA Three-Year Plan for FY 2023-26 and the Annual Update for FY 2023-24.
On June 11, 2024, this Board approved the subsequent MHSA Annual Updates for FY 2024-25.
On November 7, 2024, the Behavioral Health Commission (BHC) held a public hearing, closed a 30-day public comment, and voted to submit the proposed amendment to this Board for approval.
DISCUSSION:
The MHSA Three-Year Plan for FY 2023-26 included several priority strategies and plans to spend down one-time revenue increases due to delayed tax filings, as well as a projected and unprecedented annual adjustment to the MHSA revenue. A one-time spend plan included “big-ticket” items such as 1) housing developments; 2) capital facilities expenditures; 3) technology needs; and 4) system transformation projects.
The MHSA Annual Update for FY 2024-25 proposed to continue programs and expenditures as planned with some proposed increases to the ongoing budget for the sustainability of core Behavioral Health and Recovery Services (BHRS) services. At this time, it is necessary to amend the MHSA Annual Update for FY 2024-25 to include these additional proposed plans and expenditures, as follows:
1. Property Purchase Proposal - BHRS South County Clinic - a re-allocation of the unspent funds is being proposed in the amount of $5,000,500 to purchase a property to replace the current BHRS South County Clinic building. The clinic is currently at a leased property at 802 Brewster, Redwood City, CA, 94603. The lease expires on March 31, 2026. BHRS anticipates that the lease renewal rate will be significant and far beyond a reasonable rate for the property. The current property is outdated and has significant safety and pest concerns.
2. Innovation (INN) Project Plans - four INN Project Plans are being proposed for approval. MHSA INN funds must be used for projects that meet criteria for being innovative and may not be used for ordinary services. The proposed amendment will allow for the use of MHSA INN funds in the amount of $870,000 in this current FY 2024-25 for BHRS procurement activities and to launch two of the four projects that are launch-ready.
o Peer Support for Peer Workers. Total amount proposed: $580,000 for four years ($450,000 service delivery, $55,000 BHRS administration, $75,000 program evaluation). The project creates a team of trained peers to provide on-demand peer support services for peers and family members in the workforce.
o Animal Fostering and Care for Client Housing Stability and Wellness. Total amount proposed: $990,000 ($870,000 service delivery for three years, $120,000 program evaluation). The project will provide temporary animal foster care, veterinary and pet support services to adult and older adult clients living with serious mental illness (SMI) and/or substance use disorders (SUD) for whom pet care is an urgent and temporary barrier to receiving a higher level of care such as residential treatment or hospitalization or maintaining their housing stability.
o Allcove Half Moon Bay - launch-ready. Total amount proposed: $1,600,000 for four years ($1,500,000 service delivery for three years, $100,000 BHRS administration, evaluation to be provided by Stanford as part of the multi-county collaborative). Local INN funding will supplement and support the delivery of mental health support groups, individual therapy, and other early intervention treatment services at the proposed center for youth ages 12 to 25 and their families.
o Progressive Improvements for Valued Outpatient Treatment- MediCal billing capacity - launch ready. Total amount proposed
$5,650,000 for five years ($5,000,000 service delivery for five years, $200,000 BHRS administration, $450,000 program evaluation). The project will support community-based organizations that are interested in becoming certified providers of specialty mental health services for individuals living with SMI/SUD and/or bill MediCal for allowable for early intervention services. The project has the potential to support the sustainability of critical Community-Defined Evidence Practices (CDEPs) by identifying Medi-Cal billable components of CDEPs.
The resolution has been reviewed and approved by County Attorney as to form.
Full-Service Partnerships (FSP) are one of the core programs funded by MHSA and every year performance measures for FSPs are provided to this Board for the MHSA Annual Updates. The FSP service model provides intensive “whatever it takes” mental health services and supports to eligible youth and transition-aged youth, adults, and medically fragile older-adult clients. 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. It is anticipated that 75% of FSP clients, who have the highest intensity needs of all BHRS clients, will be maintained at a current or lower level of care.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Actual |
FY 2024-25 Projected |
|
Percentage of FSP clients, who have the highest intensity needs of all BHRS clients, maintained at a current or lower level of care |
73% 297 of 409 clients |
75% 335 of 446 clients |
EQUITY 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. These funded programs (e.g., FSPs, Pathways Program, California Clubhouse, Lived Experience Academy) provide direct treatment and recovery supports and elevate the importance of providing culturally responsive services. Marginalized communities are engaged through services and programs that are culturally informed and tailored to engaging marginalized cultural and racial communities. As part of the planning and prioritizing of MHSA funding, community members of diverse racial, ethnic, and cultural backgrounds (Asian Indian/South Asian 5%, Chinese 7%, Filipino 5%, Black/African American, 4% Hispanic/Latino 19%, Native Hawaiian or Pacific Islander 2%, White/Caucasian 43%) participate in ongoing MHSA public meetings, surveys, input sessions, key interviews, and the BHC 30-day public comment process. Additionally, a total of 85 unduplicated clients and family members received 804 stipends in FY 2023-24 for their participation in the MHSA Steering Committee, the BHRS Office of Consumer and Family Affairs, and the BHRS Office of Diversity and Equity programming including the Health Equity Initiatives.
FISCAL IMPACT:
BHRS anticipates MHSA funding including interest for FY 2024-25 in the amount of $58,142,860, of which $5,000,500 will be used to purchase the property and $870,000 will be used for the INN projects. 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 amendment.