Mental Health Services Act (MHSA)

Overview of Mental Health Services Act (MHSA)

Established in 2004 by the passage of Proposition 63, the Mental Health Services Act (MHSA) requires each county mental health department to submit an integrated three-year plan that is reviewed annually.

In their MHSA plans, counties are required to submit a listing of all programs for which MHSA funding is requested and identify expenditures for each type of funding (for example, in the Community Services and Supports component, Full Service Partnership, System Development, and Outreach and Engagement) and for each target age group (Children and Youth, Transition-Aged Youth, Adult, and Older Adult).

More than $8 billion has been generated since Proposition 63 went into effect in 2005 as the Mental Health Services Act.  Proposition 63 is funded by levying a 1 percent tax on personal income above $1 million. Revenues are distributed directly to counties, with no more than 5 percent used for state-level administration. County allocations are based on total population, households with incomes below 200 percent of the federal poverty level, percentage uninsured, and prevalence of mental illness. Allocations are adjusted based on cost of living and existing resources. Counties with fewer than 200,000 residents receive a set amount.

Target populations include children and adolescents with Serious Emotional Disturbance and transition-aged youth who are unserved, underserved, or inappropriately served (e.g., homeless, frequent hospital users, individuals with criminal justice history). The MHSA includes a Prevention and Early Intervention (PEI) component, the purpose of which is to prevent mental illness from becoming severe and disabling.

Proposition 63 also established the Mental Health Services Oversight and Accountability Commission (MHSOAC) to oversee the implementation of MHSA. MHSOAC oversees the Adults and Older Adults Systems of Care Act, Human Resources, the Children’s Mental Health Services Act, PEI and Innovation Programs. Prior to March 2011, the MSHOAC oversaw the review and approval process of the Innovative (INN) and Prevention & Early Intervention (PEI) components of MHS. However, Assembly Bill 100 shifted the role of the MHSOAC from review and approval towards evaluation, training, and technical assistance to counties for planning. As of June 2012, MHSOAC resumed approval of county INN plans.

Currently, the MHSOAC receives and reviews all county integrated three-year plans, annual updates, and annual Revenue and Expenditure Reports. The California Department of Health Care Services­ – Mental Health Services Division provides information about funding and reporting guidelines. Local County Boards of Supervisors approve MHSA funding for all other components, including PEI and Community Services and Supports (CSS).

Mental Health Services Act – Prevention & Early Intervention (MHSA-PEI)

Description

MHSA allocates 20 percent of the Mental Health Services Fund to counties for PEI as a key strategy to prevent mental illness from becoming severe and disabling and to improve timely access for underserved populations. PEI programs emphasize strategies to reduce negative outcomes that may result from untreated mental illness: suicide, incarcerations, school failure or dropout, unemployment, prolonged suffering, homelessness, and removal of children from their homes.

PEI proposed regulations define “prevention” as efforts to bring about mental health and related outcomes for individuals at greater than average risk of developing a potentially serious mental health disorder, including addressing relapse prevention for individuals in recovery from a serious mental illness. Prevention, according to current PEI guidelines, works by “reducing risk factors or stressors, building protective factors, and increasing support. Prevention promotes positive cognitive, social, and emotional development and encourages a state of well-being that allows the individual to function well in the face of changing and sometimes challenging circumstances.” MHSA calls for an approach to prevention that is integrated, accessible, culturally competent, strength-based, effective, and that targets investments with the aim of avoiding costs (in human suffering and resources) for treatment services.”[i]

“Early intervention” is defined as addressing people early in the onset of a mental disorder. PEI proposed regulations intend early intervention to measurably improve the mental health problem or disorder very early in its manifestation and avoid the need for more extensive mental health treatment or services.

Eligible Child or Adolescent Populations

PEI programs must serve all age groups and at least 51 percent of county PEI funding must target individuals between the ages of 0 and 25. Counties with a population less than 200,000 are exempted from these age requirements.

Services Covered

MHSA-PEI funding supports:

  • Outreach to families, primary care health care providers, and others to recognize the early signs of potentially severe and disabling mental illnesses.
  • Access and linkage to medically necessary care provided by county mental health programs for children with severe mental illness, as defined in Section 5600.3 of the Welfare and Institutions Code.
  • Reduction in stigma associated with either being diagnosed with a mental illness or seeking mental health services.
  • Reduction in discrimination against people with mental illness.
  • Strategies to reduce negative outcomes that may result from untreated mental illness, including:
    • Suicide;
    • Incarcerations;
    • School failure or dropout;
    • Prolonged suffering;
    • Homelessness; and
    • Removal of children from their homes.

MHSA-PEI funds a variety of practices for individuals at risk of or with early onset of a potentially serious mental illness that can include evidence-based practices such as:

  • Aggression Replacement Training (ART)
  • Cognitive Behavioral Therapy (CBT)
  • Functional Family Therapy (FFT)
  • Incredible Years (IY)
  • Multisystemic Therapy (MST)
  • Parent-Child Interaction Therapy (PCIT)
  • Positive Behavior Intervention and Supports (PBIS)
  • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Funding Process

Funding is approved of and administered by each county’s behavioral health or mental health department after review and comment by the local Mental Health Board. Counties submit an integrated plan comprised of the relevant MHSA components to MHSOAC.

As of January 2012, the Mental Health Services Oversight and Accountability Commission (MHSOAC) had approved over $1 billion of PEI funds for all 58 counties. An additional $129 million was approved for statewide PEI efforts to prevent suicide, reduce stigma and discrimination, and improve student mental health.[ii]

Additional Information

California Mental Health Services Act, Prevention and Early Intervention Clearinghouse: Click here to visit website.

Mental Health Services Oversight and Accountability Commission: Click here to visit website.

Mental Health Services Act–Community Support Services (MHSA-CSS)

Description

MHSA allocates 55 percent of funds to Community Services and Supports (CSS) to provide funding for services identified in children’s and adults’ system of care treatment plans that are not funded through any other source (public or private insurance). These systems of care are the programs, services, and strategies identified by each county through its stakeholder process to serve unserved and underserved populations with a serious mental illness, and include an emphasis on eliminating racial and other disparities.

Eligible Child or Adolescent Populations

All ages must be served by a county’s CSS components. Disparities in access to services for underserved populations and regions of the county must be addressed.

Services Covered

CSS provides funding for services identified in a children’s and adults system of care treatment plans that are not funded through any other source (public or private insurance).

MHSA-CSS funds a variety of practices that can include evidence-based practices for individuals with a serious mental illness such as:

  • Aggression Replacement Training (ART)
  • Cognitive Behavioral Therapy (CBT)
  • Functional Family Therapy (FFT)
  • Incredible Years (IY)
  • Multisystemic Therapy (MST)
  • Parent-Child Interaction Therapy (PCIT)
  • Positive Behavior Intervention and Supports (PBIS)
  • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Funding Process

Funding is approved of and administered by each county’s behavioral health or mental health department. Counties submit an integrated plan comprised of the relevant MHSA components to MHSOAC.

Additional Information

Mental Health Services Act – Components: Click here to view website.

More information about county CSS investments can be found on each county’s behavioral health or mental health department website.

Return to Overview of Mental Health Funding Streams

[i] Mental Health Services Oversight & Accountability Commission – MHSA Prevention, Early Intervention, and Innovation, Report of Findings, September 2012 Revised. Page 5 (citing PEI Guidelines, 2008, p. 7.).
[ii] Mental Health Services Oversight & Accountability Commission. (December 2012). Prevention and Early Intervention (PEI) Fact Sheet. Available at: http://www.mhsoac.ca.gov/MHSOAC_Publications/docs/FactSheet_PEI_121912.pdf