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: San Mateo County Mental Health Services Act Three-Year Program and Expenditure Plan FY 2023-24 through FY 2025-26 and Annual Update FY 2023-24
RECOMMENDATION:
title
Adopt a resolution authorizing the approval and submission of the San Mateo County Mental Health Services Act Three-Year Program and Expenditure Plan Fiscal Year 2023-24 through Fiscal Year 2025-26 and Annual Update Fiscal Year 2023-24 to the State Mental Health Services Oversight and Accountability Commission and the Department of Health Care Services.
body
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 Plans and Annual Updates be approved by the County’s Board of Supervisors.
The Behavioral Health Commission (BHC) held a public hearing and voted to close a 30-day public comment period on July 5, 2023. The BHRS is now recommending approval of the Three-Year Program and Expenditure Plan Fiscal Year (FY) 2023-24 through FY 2025-26 and Annual Update FY 2023-24 by this Board of Supervisors.
DISCUSSION:
In November 2022, a comprehensive Community Program Planning (CPP) process to develop the MHSA Three-Year Plan commenced. Planning was led by the MHSA Manager, the Behavioral Health Commission MHSA Co-Chairpersons, an MHSA Three-Year Plan Workgroup, and the MHSA Steering Committee. Planning by these groups included review of 44 local plans, assessments, and evaluation reports.
Additionally, over 400 community members participated in the CPP process via surveys, 31 community input sessions, key interviews, and a 30-day public comment process. The process began in November 2022 and concluded July 2023. The following areas of focus and priority expansions were selected to implement over the next three years:
Behavioral Health Workforce
• Implement recruitment and retention financial incentives such as retention bonuses, signing bonuses, educational loan repayment for staff and contracted providers.
• Provide support, retention and leadership development of peer and family support workers (training, fair compensation, career ladders, flexible hours, and mentorship).
• Implement supports for direct service staff, including peers, to advance in their careers, specifically BIPOC staff (e.g., scholarships to pursue licensure, mentorship).
Access to Services
• Expand drop-in behavioral health services that includes access to wrap around services for youth.
• Coordinate behavioral health services for cultural and ethnic communities (centralize services, outreach, and education for the Chinese community, hire bilingual/bicultural peer staff, etc.)
Crisis Continuum
• Expand non-armed 24/7 mobile mental health crisis response following recommendations in the BHC’s Crisis Services Recommendations, the San Mateo County Mobile Crisis Response System Report, and other stakeholder input.
In FY 2023-24, there will be a significant MHSA one-time revenue increase due to delayed tax filings and a projected and unprecedented annual adjustment. The proposed Fiscal Strategy below supports a spend down of this one-time funding and the current unallocated funds in the MHSA Trust Fund:
1. Ongoing Spending over Projected Revenue: FY 2023-24 ongoing budget is $63,430,428 which includes the following increases in funding allocations to priority programs. This ongoing budget will be over the projected revenue starting in FYs 2024-25 and 2025-26 of $57,924,555 and $57,151,589 respectively.
• Increases to Full-Service Partnerships (FSP), including new CARE Courts FSP and FSP Housing supports.
• Increases to Workforce Education and Training strategies, including new Behavioral Health Workforce recruitment and retention priorities
• Increases to Prevention and Early Intervention, including new Access to Services and Crisis Continuum priorities and substance use prevention expansions
• Increases to Innovation projects for five new project approvals
• Increases across ongoing programs for Cost of Living and permanent position conversions
2. One-Time Spend Plan: this will target “big ticket” items and total $34,095,000 over the next three years.
The FY 2023-24 MHSA proposed budget can be found on Appendix 5 of the MHSA Three-Year Plan.
The resolution has been reviewed and approved by 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 the MHSA is its FSP program described above; it is anticipated that 85% of FSP clients shall be maintained at a current or lower level of care.
PERFORMANCE MEASURE:
|
Measure |
FY 2022-23 Actual |
FY 2023-24 Estimated |
|
Percentage of FSP clients maintained at a current or lower level of care |
84% 395 of 446 clients |
85% 275 of 326 clients* |
*Based on data through 8/4/2023
FISCAL IMPACT:
BHRS received $33,489,616 in MHSA funding including interest in FY 2022-23. BHRS anticipates MHSA funding for FY 2023-24 of $86,773,003. 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 Plan.