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HomeMy WebLinkAboutMINUTES - 05222001 - C.124 r � '- CONTRA .� FHS #46 .'���- `:s �-`t�, F. COSTA TO: BOARD OF SUPERVISORS COUNTY rdY,�{� FROM: Family & Human Services Committee V DATE: May 22, 2001 SUBJECT: Mental Health Programs and Funding SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDATION(S): 1. ACCEPT the report from the Mental Health Director on current mental health programs and funding. 2. ACKNOWLEDGE the importance of the Mental Health Coalition's service priorities: consumer-run community centers, affordable housing, services for transition age (17-25) young adults and residential treatment facilities. 3. DIRECT the Health Services Department to develop a funding proposal for consumer-run community centers for consideration by the Family and Human Services Committee. 4. DIRECT the Health Services Department to begin a process in collaboration with the Mental Health Coalition to assess program needs, current availability, capital and operational requirements, cost-effectiveness and program outcomes (including potential reduction on the demand for higher, more costly levels of care) in the four priority areas of the Mental Health Coalition. 5. DIRECT the Health Services Department to assess the adult mental health services available in other counties, including scope of services and funding sources. CONTINUED ON ATTACHMENT: —YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR_ ECOMMENDATION OF BOARD COMMITTEE PPROVE OTHER I�YM1 SIGNATURE(S):. MARK DESAULNIER FiEDERAL D.GLOVER ACTION OF BOARD ON May APPROVED AS RECOMMENDEDXX OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A XX UNANIMOUS(ABSENT ----- 1 TRUE AND CORRECT COPY OF AN AYES: NOES: ACTION TAKEN AND ENTERED ABSENT: ABSTAIN: ON MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN. Contact:Sara Hoffman,335-1090 ATTESTED MAY 22, 201 JOHN SWEETEN,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR cc: CAO Donna Wigand,Mental Health Dr.Walker,Health Services BY / EPUTY Mental Health Coalition(via Mental Health) i 6. REQUEST the County Administrator's office and Health Services Department to bring recommended positions on pending legislation related to mental health coalition priorities to the Board for their consideration. BACKGROUND/REASON(S) FOR RECOMMENDATION(S): On April 9, 2001, the Family and Human Services Committee received a report from Donna Wigand, Mental Health Services Director, on the mental health budget and programs. Mike Cornwall, Chair of the Mental Health Coalition, presented their four top priorities for the year 2001. In addition, various members of the Coalition and the public spoke in support of the Coalition's priorities. Donna Wigand stated that Contra Costa's Mental Health Division is the ninth largest in the state with a budget of$67.5 million. Acute inpatient care is State-mandated. Approximately $6 million per year is spent on 24-hour services for crisis intervention/psychiatric emergency services. Approximately 2/3 of all clients, however, are not hospitalized and are, diverted to other levels of care. Approximately $5 million is spent on long term care outside of the state hospital system and for mental health rehabilitation centers, skilled nursing facilities (SNF) and IMDs. In addition, the division receives approximately $2.4 million a year to act as administrative HMO for all mental health Medi-Cal patients. Another $18 million is spent on the children's system of care and $15 million for the adult system. The children's system of care has benefited from both a 5-year federal grant and a new Medi-Cal benefit (EPSDT). However, there has been no new funding stream to support the adult system of care. Consequently, the biggest service gaps are in the adult mental health service system. Supervisor Mark DeSaulnier asked what kind of discretion the division has to divert clients from hospitals in order to avoid costs. Ms. Wigand replied that, currently, the County has two residential treatment facilities, which are a step down from hospital care. One of the contract facilities provides residential treatment for up to one year. It has a capacity of 12 beds. The other facility is'a crisis facility that handles clients for one to two weeks. It also has a 12-bed capacity. However, there are no beds available for an "in between" (or transitional) length of care. The division is currently working to site a facility and would ultimately like one in each of the County's three regions. Supervisor DeSaulnier asked if we could quantify the cost benefit of such facilities. He said that we need to frame it as a fiscal argument and a very good investment. Ms. Wigand responded that currently 12-16 of the psychiatric hospital beds are deemed "administrative days" which means that billing is not permitted at the acute Medi-Cal rate. Currently, we receive between $200 to $300 per day for these beds while the cost of care runs $800 to $1000 per day. Ms. Wigand said one of their highest priorities was to site a residential treatment facility, since that level of care is Medi-Cal billable. Supervisor Federal Glover asked what the capital costs were for a treatment facility. Ms. Wigand responded that the Board had allocated $900,000 in capital financing for a 16-bed facility. The facility would be limited to 16 beds because that is the maximum allowed by regulation for Medi-Cal billing. She also stated that Solano County took over four years to successfully site a facility. The Committee then opened the meeting to public testimony. Ralph Hoffmann, Mental Health Commissioner, spoke on the need to site residential treatment facilities. He stated that the problem is `Year" and "denial," not NIMBY. He expressed concern that there a number of huge gaps and holes in the mental health system and that many people don't even get into the system for treatment. On the human side, he spoke of the suicide of a 39-year old man who left behind a five-year-old son. Barbara Anspaugh told the committee of her son who has been missing since March 1999. She said that Contra Costa County needed a better support system for the mentally ill, better transitional support and better training for case managers regarding the latest medications. Mike Cornwall, Mental Health Coalition Chair, reviewed the four priorities of the coalition: ➢ Client run community centers ➢ Housing ➢ Services for transition age (17-25 years) young adults 2 ➢ Residential treatment facilities He stated that the mental health community is united behind these priorities and that they had arrived at a consensus among the primary mental health constituencies, including the Client Network, the Contractors Alliance, Local One, the Mental Health Association, the Mental Health Commission and the National Alliance for the Mentally III. Client Run Community Centers - Mike Cornwall stated that a center was very much needed in West County and that existing centers need to add evening and weekend hours as well. He stated that prevention is really the key to preventing hospitalization. Dave Schroder stated that these centers provided peer counseling and a place for people to go. It helps avoid hospitalization. He also stated that Sacramento funds two centers on a budget of $500,000 and Solano County also funds two centers with a budget of $400,000. Barbara Lyon also expressed her support for the consumer run community centers. Ralph Hoffmann also spoke in favor of the consumer run community centers. Michelle Curran stated that the community centers are both needed and necessary; that they provide a safe environment for socialization, counseling, support from peers and advice on patient rights. She said that there are quite a few differences within the mental health community and the fact that all agreed on the importance of the community centers was extremely significant. Jamie Anker said that she was a mental health survivor and that there were many gaps for those with dual diagnosis. She felt that the mental health and substance abuse systems of care needed to coordinate better. She also supports community centers being open evenings and weekends, which is when people need them most. She also said that there needs to be training for providers and doctors and help for families and children of people with mental health problems. Marlene Weiss said that her son, who had schizophrenia died 21 months ago and that the community centers are very important (see attachment for Ms. Weiss' complete statement before the committee). Herb Putnam stated that the draft budget for the community center is a "bare bones" budget at $452,000. After deducting the current Mental Health Division contribution of$125,000, the needed augmentation is $327,000. Housing — Mike Cornwall explained that there needed to be a continuum of housing alternatives, ranging from residential treatment facilities to supported interdisciplinary facilities to board and care. He suggested that the County map the availability of housing. Currently, there is one FTE to provide housing support. He felt that one was needed per region. Services for Transition Age Youth - Kathy McLaughlin stated that it was necessary to intervene with young adults early, otherwise they would require higher levels of care as they get older. Currently, there are five FTEs, but no supervisor for transition services and, consequently, there is poor coordination. She stated that they need to have three teams for transitional youth in each of the three regions. Residential Treatment Facilities - Lynn Gurko expressed her opinion on the need to move to less restrictive environments that are more nurturing and homelike. The difficulty is that people begin to identify with the higher levels of care, which impedes their recovery. Supervisor Federal Glover asked about the current capacity of the consumer run community centers. Ms. Gurko responded that West County is opening for weekends only and is funded through June 30, 2001, under a SAMSA grant. The East County facility is funded through Contra Costa County, along with grant money and the Concord/Martinez centers have a combination of County funding and donations. Donna Wigand overviewed pending legislation that affects mental health. She also referenced the LAO report published two years ago entitled "Mental Health Underfunded from the Start." In addition, the Little Hoover Commission recently released a report that said that adult mental health services are underfunded by at least 50%. With regard to state funding, she also reported that the division has submitted a grant application for a mobile crisis response team. They should know in June about this grant funding. Supervisors Mark DeSaulnier and Federal Glover thanked everyone for their testimony and concern about mental health issues. They, too, expressed their concern over the importance of mental health issues. Dr. William Walker, Director of the Health Services Department, stated that he would be willing to come back to the Family and Human Services Committee with a proposal on funding the community centers. After further discussion, it was agreed to request the Health Services Department to assess the resources and scope of service in other counties and to come back with their proposal on evaluation of early intervention and prevention, strategies such as proposed by the Mental Health Coalition, including such outcomes as the reduction of the number of repeat clients, 3 the reduction of suicides and the demand for expensive hospitalization. The committee also noted that partnerships are very necessary; that city governments and school districts bear the cost when there are mental health problems and that those costs need to be understood. In addition, there are links to homeless programs, substance abuse programs and justice programs. To the extent there can be a comprehensive approach to helping people, it would benefit all of these programs. Supervisor DeSaulnier suggested that it would helpful to go to the Mayors' Conference, the Police Chiefs Association and the Public Managers Association and others to communicate the need for a comprehensive approach that engages all public sectors in a partnership. The committee also requested that the County Administrator's Office and the Health Service Department present to the Board positions on legislation that would be supportive of efforts to expand services to people with mental health problems. 4 Self-J�elp ResourceDevelopment Committee 1420 \/i1ioW pass Road Sju:te 120 Concord, CA Q4520 Marlene \Y/eiss, Carr (9?5) ?8o-o676 Remarks made by Michele D. Curran to the Family and Human Services Committee on April 9'h 1 2001. These remarks are respectfully submitted at the request of Supervisor Mark DeSaulnier. I come before you today to speak of the uniqueness of the mental health community's alliance as it is directed to Mental Health Consumer Concerns, Inc. Community Centers. I know that Supervisor DeSaulnier is familiar with the mental health community's differences and,Supervisor GIover, you will soon discover that there are variances on many levels among the mental health stakeholders..While our goals may be quite.similar, the paths we take are often far apart. For instance, there is the continual discussion of what to call those of us who have experienced symptoms of mental discomfort, with the strongest debate coming from the persons with symptoms. You will hear the terms mental health consumers, mental health services consumers, clients, ex- &current patients and mental health survivors. Then there is the naming of the discomfort--=are we the psychiatric disabled, do we have a psychological disorder, are we mdntally ill or mentally disabled—the.terms are very personal and have deep meaning to each of us.. The most derisive debate is about the source of discomfort—primarily because the source dictates the treatment. Is it biological or trauma-induced? Is it a result of heredity or our environment?Is it a chemical imbalance or a reaction to.an assault of the psyche? And when treatment methods are approached=is it best to abate symptoms and then begin other modes of treatment or'should the source of the discomfort be rooted out prior to. any treatment that would alter the consumer's state? So given these differences—and they are not to be brushed aside lightly—then the ability for .all the stakeholders to assert an alliance on the importance of the .Self-Help Community Centers within the continuum of care exhibits that this method of service has been recognized throughout the County and the mental health community as both needed and necessary: It also highlights that the placement of Community Centers on the Mental Health Coalition priority recommendations is based on the belief of its place.of significance within the system of care. If this committee and, in turn, the Board of Supervisors look upon the Community Centers as a "club house" and just an extra perk for a few of Contra Costa residents,. then of course policymakers will continue to devalue the services and to under fund the program. But should the Board of Supervisors decide to upgrade the value level of these self-help services, you have the opportunity. to strengthen these programs and to give dignity to the dedication and efforts shown by the staff of these four centers. Let's take a moment to examine the functions of the Community Centers in the continuum of care and as an adjunct to more traditional settings of treatment from the view of each of the mental health community stakeholders. Clinicians/Service Providers—for those who are familiar with the Community Centers, the self-help programs offered are seen as being part of symptom abatement (such as isolation and a lack of feedback) and of personal empowerment, which includes independent living skills. Family members/caregivers—not only do these self-less, caring people appreciate the former services but they also have a strong appreciation.of the Community Centers as an opportunity for care respite and the comfort of knowing that their loved one is safe, warm and treated with dignity. And for the administrative overseers (such as the Board of Supervisors)—all of you can be assured the Community Centers are quite "program successful", and thus funding worthy, and is a.cost effective service bynoting the decrease on both the quantity of hospital admissions and the duration of those hospital stays (a reference to the "more bang for the buck" theory of administration). Participation in the Community Center services/programs assists.consumers in managing symptoms and to.begin on a journey of personal recovery. The most affected of all of the stakeholders is the mental health services consumer. Because of .the "circle . ofcare" approach offered at 'Mental. Health Consumer Concerns, Inc. Community Centers, a center member.can utilize'the services/programs in the manner most appropriate for the member's needs and can participate in center activities at the level of personal choice. I have included-the.short essay from which I quoted during my remarks at.the April 9 meeting of the Family and Human Services Committee. Instead of repeating my selected quotes, I feel . it would be more informative for the Supervisors to have Mr. Smith's full document.. Thank you for allowing:me to submit:these remarks in this more 'formal manner and for the opportunity to share them with all members of the Board of Supervisors. I also appreciate Ms. Hoffman,for her assistance in the distribution of this information. I'must commend the intense concentration that Supervisor DeSaulnier and Supervisor Glover gave to the presenters during thecommittee session. It seems the whole audience was left with.al sense that our issues had been given a fair sounding and was openly received. you, ichele D. Curran; member,:Contra Costa Self-Helpt Resource Development Committee Mental Health Consumer Concerns, Inc. Administrative and Program Specialist . MENTAL HEALTH CONSUMER CONCERNS, INC. PATIENTS' RIGHTS ADVOCACY AND TRAINING • PEER SUPPORT SERVICES 1420 Willow Pass Road, Suitc 120 Concord, CA 94520 Tel: (925) 646-5788 To: Board of Supervisors, Contra Costa County Fax: (925) 646-5787 From: Damon Smith, Coordinator, Concord Community Center Re: Requesting funding for Consumer Self-Help Community Centers I'd like to introduce you to the Concord Community Center--self-help centers, in general; what they are and how they benefit people with psychiatric disabilities, the general community and the County. Self-help centers are organizations created by and for people with psychiatric disabilities. Self-help centers provide a large number of services for people with mental illness. The unique quality of these services is possible because those who facilitate client programs are consumers of the mental health system themselves, and know what clients are going through. We provide a caring and non-judgmental influence on other consumers and we are able to gain their trust, because they know we are living with the same challenges. We have much needed experience that consumers can use to help themselves to have a better life. When people with psychiatric disabilities are feeling and doing well they can contribute to their community in many employment and volunteer capacities. They pay taxes, vote and provide support to their own families. The public is benefited when people who might otherwise more conspicuously demonstrate systems of their illness are helped to understand the benefit of blending in and making others feel comfortable. When people with mental illness are doing well, they stay out of the hospital, which saves the County system hundreds of dollars each year. Clients regularly speak of how the Concord Community Center has helped them find solutions to stay out of the hospital. This is a list of some of the services the Concord Community Center provides consumers: 1. A safe environment to come when consumers are not feeling well 2. A safe place to come and socialize and to receive the benefit of interaction with others 3. A place where consumers can talk with their peers and receive council and support from others who know what it is like to be mentally ill and will not judge them 4. Peer counseling on housing and homelessness issues; on doctors and medication; on employment and disability; on improving social skills; on hygiene and personal care; on navigating the mental health system; on finances; on patient's rights; on emotional challenges 5. Various groups and activities to promote wellness and a feeling of well being which include: a. Depression group f. Spirituality b. Bipolar group g. Arts and Crafts c. Women's group h. Painting class d. Meditation i. Creative expression e. Yoga j. Anger management 6. Groups that provide an opportunity to socialize, to voice votes and opinions on Community Center activities, rules and services: a. Morning chat b. Community Meeting c. Board games and chat 7. Each morning Breakfast, coffee and snacks are served 8. Each noon Lunch is served, providing much needed nutrition and, often our clients only meal 9. Books and magazines are provided for consumers to read 10. Clothing and sleeping bags are available, particularly important to the homeless 11.Access to telephone for local calls 12. Comfortable furnishings and environment to help consumers feel at ease 13. Referrals to other agencies who can help consumers with other specific needs 14. Information in the form of newspapers, flyers and handouts 15. Outside speakers and teachers who bring much needed information and knowledge to consumers 16.An opportunity for employment to gain working skills and a job history that will help consumers in the working world 17. Stipend positions which assist consumers financially and add to their sense of self- worth -1 have a vision of what the Concord Community Center could be—above and beyond the services listed above: ➢ Opportunities for employment and benefits at a living wage ➢ Outside teachers to teach a variety of skills in an ongoing and more comprehensive manner--to the extent that consumers could earn credits and certificates which would be recognized by schools and potential employers ➢ A larger facility where more clients could feel comfortable. This is very important, especially as we continue to work on outreach and increase our attendance ➢ More ability to purchase arts and crafts supplies and to provide training that will allow consumers to create arts and crafts for sale, which would augment their personal finances ➢ A store front location where consumers can make simple products to sell to the public thus creating jobs and employment experience and creating money for their own benefit and that of the Community Center ➢ Computers with access to the internet for consumers use and education ➢ More employees for the Community Center, thus allowing all staff the opportunity to attend conferences, meetings and to receive further training--there would be more ideas to gain much-needed donations and time to research resources for the needs of the consumers. ➢ A facility with a kitchen and greater food storage capacity, where food can be frozen and a larger amount of perishables stored—a place where food can be-prepared more easily in greater volume. ➢ The ability to train and hire regular kitchen staff, to cook and prepare foods and do cleanup, thus creating jobs and preparing consumers to return to work ➢ To have the time and resources to do homeless consumer outreach, and to have the materials and resources to better help the homeless mentally ill and better meet the needs of all homeless consumers ➢ To obtain a vehicle for transportation of consumers and staff for outings, appointments, meetings, trainings, other agencies and consumer household activities These are a few of the improvements I would like to see come about. I ask that our request for adequate funding be given careful consideration. The Concord Community Center and the other Community Centers have proven to be of great benefit to Contra Costa County. The effect of healthier people with psychiatric disabilities is priceless. The relief to the public at large, in being more comfortable, is priceless. The relief to the County in the cost of hospitalization is evident and great. We need to expand and improve these Community Centers so we can reach a greater number of people with mental illness in Contra Costa County and increase the benefits already being attained by our present services. Please feel free to come and visit the Concord Community Center and experience this unique and beneficial program. APR-11-2001 15:20 ANTIOCH MENTAL HEALTH 510 427 8645 P.02 Budget of Estlmated Program Expenditures Consumer-run Community Centers 12 Mos. Budget East CV Concord Martinez West Cty Total INCOME Contra Costa County 50,047 29,339 46,015 125,401 Funding Needed 69,435 67,343 66,807 123,482 327,065 119,482 96,682 112,822 123,482 452,466 EXPENSES PERSONNEL Center Coordinator (1 FTE)(12.54.hr.) 26,083 26,083 26,083, 26,083 104,333 Assistant Coordinator(1 FTE)(10.82/hr 22,506 22 506 22,506 22,506 90,022 TOTAL SALARIES 48,589 48,589 48,589 48,S89 194,355 FICA 3,717 3,717 3,717 3,717 14,868 Workers Comp 573 573 S73 573 2 293 SUI 972 972 972 972 3,887 Kalser Health Plan 3,509 3,509 3,509 3,509 14,034 TOTAL BENEFITS 8,771 8,771 8,771 8,771 35,083 TOTAL PERSONNEL S7,360 57,360 57,360 57,360 229,438 OPERATING EXPENSES Art supplies 1,200 1,200 1,200 1,200 4,800 Conferences/Spec.activities 5,000 51000 5,000 5,000 20,000 E ui ment p2rchase 4 000 4,000 Equipment rental 1,250 1,250 1,250 1,250 5,000 Janitorial supplies 500 500 500 500 2,000 Meeting expenses/Food Bank 600 600 600 600 2,400 Office supplies 1,200 1,200 1,200 112-0-0 4,800 Per Diem for Volunteers 4 part-time per Center 11,648 11,648 11,648 11,648 46,592 Postage 300 300 300 .300 1,200 Printing/advertisingPrinting/advertising 500 S00 500 500 2,000 Rent 18,000 11,340 18,000 47,340 Staff travel 2,500 2,500 2,500 2,500 10,000 Telephone 1,800 1,800 1,800 5,400 Utilities 3,000 3,000 3,000.- 9 000 TOTAL OPERATING 47,498 24,69 40,838 51,498 164,532 INDIRECT ALLOCATED 14,624 14,624 14,624 14,624 S8,496 GRAND TOTAL 119,482 96,682 112 8 2 21 123,4821 452,466 Mental Health Consumer Concerns, Inc. TOTAL P.02 ` WILLIAM R. WALKER, M.D. CONTRA COSTA HEALTH SERVICES DIRECTOR DONNA'IVL. WIGAND, LCSW _ i ME"ITAL HEALTH MENTAL HEALTH DIRECTOR ADMINISTRATION CONTRA COSTA 595 Center Avenue, Suite 200 HEALTH' SERVICES Martinez, California 94553 Ph (925) 313-6411 Fax(925) 313-6449 To: Family and Human Services Committee Supervisor Mark DeSaulnier, Chair Supervisor Federal Glover, Member From: Donna M. Wigand, LCSW Mental Health Director Date: April 3, 2001 Subject: Referral #46 - Mental Health RECOMMENDATIONS After hearing presentations and testimony, CONSIDER recommending that the Board of Supervisors: (1) ACCEPT the report from the Mental Health Director on current mental health programs and funding. (2) CONCUR with the Mental Health Coalition's prioritization of service needs, including consumer-run community centers, affordable housing, services for transition age (17- 25) young adults and residential treatment facilities. (3) DIRECT the Health Services Department to develop an assessment of program needs in each of the four priority areas, including scope of service alternatives, capital and operational requirements for each alternative and potential funding sources. (4) DIRECT the Health Services Department to present its assessment to the Board of Supervisors during budget hearings, including cost-effectiveness and potential reduction on the demand for higher, more costly levels of care. (5) ADOPT appropriate legislative positions on pending bills which could have an impact on the four priority levels. Contra Costa Corr.m,ln.ity Substance AbuSe SPrvYr; Con'ra Costa Frnerwvy I:"-ed cal Sart-: Co-aia C osta Er'.v"or -w ta'He,alh Cor'ua Costa Health Plan ��!"'!, ,�' -r,nt,i(_:i',.-,... ,.. .. :.i;,t'ii'j';rn'•, -;•its.?_.,,. ,. li.;ilt": r:,:ir;;(...iS:i ,. . .. .::•i:•,. -. I,,,..,, :';,rc, ;ilr,r Co:tir,i:.os;.;Itr•,71i1i , r t Family and Human Services Committee April 3, 2.001 Page 2 BACKGROUND On March 20, 2001, the Board of Supervisors referred to the Family and Human Services Committee a request to return to the Board within 60 days with a proposal for program and budget strategies to implement priorities identified by the Mental Health Coalition. In addition, the proposal was to identify state legislative priorities to improve local mental health systems and funding. This report responds to the Board's directive. Mike Cornwall, Chair of the Mental Health Coalition, will be making a presentation on their service priorities. The Department has alerted various constituency and advocacy groups and informed them of the FHS meeting, inviting their comments and testimony. Attached please find the documents that will be presented at the April 9, 2001, meeting of the Family and Human Services Committee: Attachment I - Mental Health Coalition Priorities Attachment II - Health Services/Mental Health Division FY 2000/2001 Program Budget Attachment III - Pending Legislation Related to Mental Health Coalition Priorities Attachment I Gorltra Costa Col �,,*,,,n tat- Health C 0 aQ- YEAR 2001—YEAR OF MENTAL HEALTH CONTRA COSTA MENTAL HEALTH COALITION PRIORITIES Our Mental Health system is currently in crisis. It is significantly _ underfunded (50%) and fails to meet the needs of some of our most vulnerable citizens. The members of the.Mental Health Coalition feel very strongly that the Year of Mental Health" should focus on systemic changes, both in terms of the specific service areas presented below and in terms of a broad public education campaign and overarching philosophy. We have agreed that the following four areas of service needs are our top priorities: ➢ Client-run community centers (establish a center in West County and fully fund the other 3 existing centers in East and Central County) ➢ A full array of housing available throughout the county ➢ Services for transition aged (17-25) youth ➢ Residential Treatment Facility(ies) The Mental Health Coalition represents a broad spectrum of mental health consumers, family members, service providers, and interested community members. It is composed of representatives from each of the primary mental health constituencies, including: • The Client Network • The Contractors' Alliance • Local1 • The Mental Health Association • The Mental Health Commission • National Alliance for the Mentally III (NAMI) Additional information on the Coalition and our priorities is attached Mental Health Coalition Priorities For Year 2001—Year of Mental Health" Continued As we add services to try to meet the mental health needs of our community, we want to emphasize the need for all current and new programs to: ♦ Provide community education that will help to reduce or eliminate the stigma associated with mental illness ♦ Address diversity---cultural and language competency and capacity; gender; age/generation issues; parent/family/child issues; access barriers; etc. ♦ Ensure that services are available both across the continuum and in all geographic regions ♦ Insist on collaboration, cooperation, and participation of ALL county departments, especially Substance Abuse; but also including Health, Public Health, Community Services, Employment and Human Services, and Law Enforcement and Juvenile Justice—as well as community based organizations, city government, education, and other advisory boards and commissions In addition to our four top priorities, there are also many other services, which we consider are needed to fully serve our mentally ill community members. They are: • Transportation • Mobile Response Teams (Mental Health and Law Enforcement) • Intensive case management upgrades, especially in West County • Vocational/employment/education services • Expanding TBS (Therapeutic Behavioral Services) to non-MediCal clients • Family advocacy, in particular special education and AB3632 • 5150 form revision • Increasing the service capacity of community based organizations • Cost of Doing Business increases on contracts with non-profit health providers • Some percentage of new monies be RFP'd Attachment II Excerpts from 2000-2001 Recommended Budget C. MENTAL HEALTH (0467) Purpose: To serve serious and persistent mentally disabled adults and seriously emotionally disabled children and youth. FTE: 220.2 Gross Expenditures: $67,518,826 Financing: 62,928,209 Net Cost: 4,590,617 Funding Source: Charges to other HSD divisions 8% $ 520,758 Medicare 7.1% 4,821,613 Medi-Cal 26.9% 18,161,387 Medi-Cal UP Managed Care 2.3% 1,543,650 Medi-Cal O/P Managed Care 1.3% 860,329 Private Pay Insurance 2.0% 1,378,169 Mental Health Grants 11.9% 8,065,169 Realignment Funds 36.2% 24,466,271 Expenditure Transfer .5% 357,600 Other Revenues 4.1% 2,753,263 County General Fund 6.8% 4,590,617 Adjustment: Increases gross appropriations by $1,753,650, including $730,000 FY 00-01 impact on Board awarded COLA, Contractor COLA calculated on salaries, benefits and admin. costs; staffing at 1/00 levels, $140,000 for employee health and workers' compensation insurance premium increases and a like General Fund decrease. An $800,000 IMD increase includes a $725,000 Medi-Cal revenue increase for Skilled Nursing Facilities and $75,000 from the General Fund. Impact: Provides for continuation of services at maintenance levels. Augmentation of Skilled Nursing Facilities permits reduction in more expensive (to the General Fund) Institutes of Mental Disease. Realignment funds are included in the net County costs of the programs below. Excludes$450,000 Residential treatment facility funding budgeted in the General Fund I 1. Support Services Description: Functions include personnel administration, staff development trainin! procuring services and supplies, physical plant operations, contract negotiations ani administration, program planning, deveiopment of policies and procedures, preparation c grant applications and Requests for Proposals, monitoring service delivery and clier complaints, utilization review and utilization management,quality assurance and qualit management, quality improvement, computer system management, and interagenc coordination. FTE: 27.9 Level of Discretion: Discretionary Gross Expenditures: $3,557,068 Financing: 2,937,469 Realignment/ Net Cost: 619,599 Funding Sources : County General Fund, SAMHSA grant funds, FFP portion of Short/Doyle Medi-Cal Admin. & Utilization Review cost reimbursement, Medi- Cal Activities reimbursement, and reimbursement for lease of property. 2. Outpatient Mental Health Crisis/Psychiatric Emergency Service Description: Outpatient clinic crisis intervention and stabilization, psychiatric diagnostic assessment, medication, emergency treatment, screening for hospitalization and intake, disposition planning, and placement/referral services. FTE: 7.2 Level of Discretion: Very Limited Gross Expenditures: $6,126,487 Financing: 2,655,439 Net Cost: 3,471,048 Funding Sources: FFP portion of Medi-Cal, Medicare, HMO, Private Pay/Insurance and County General Fund. 3. Institute for Mental Disease abd Skilled Nursing Facility Care Description: Institutre for Mental Disease and Skilled Nursing Facility(SNF)care providing moderate to long-term psychiatric treatment in a locked ("L" facility) setting for clients who have been discharged from acute hospital care. Includes, for some clients, augmented services to teach living skills needed to make the transition from care-to more independent (and less costly),.settings. FTE: N/A Level of Discretion: Very Limited Community Based Organization Contracts: 1. Crestwood Hospitals 2. Telecare Gross Expenditures: $5,233,657 Financing: 1,611,552 Realignment/ Net Cost: 3,622,105 Funding Sources: SSI/SSP, Patient Share of Cost and County General Fund 4. State Mental Hospital Care Description: Long-term, psychiatric inpatient care at Napa Hospital for adults and Metropolitan Hospital for adolescents and children who require structured treatment and are too severely mentally disabled to be placed in a less restrictive setting. FTE: N/A Level of Discretion: Very Limited Gross Expenditures: $869,871 Financing: 0 Realignment/ Net Cost: 869,871 Funding Sources: County General Fund. 5. Local Hospital Inpatient Psychiatric Services Description: Acute inpatient psychiatric care at Contra Costa Regional Medical Center, involuntary evaluation and short-term treatment .for seriously and persistently mentally ill clients who may be a danger to themselves or others. FTE: 0 Level of Discretion: Very Limited Gross Expenditures: $13,499,210 i Financing: 6,412,322 Realignment/ Net Cost: 7,086,888_ Funding Sources: FFP portion of Medi-Cat, Medicare, HMO, Private Pay/Insurance and County General Fund. 6. Medi-Cal Psychiatric Inpatient and Outpatient Specialty Services (Managed Care) Description: Community based acute psychiatric inpatient hospital services and outpatient specialty mental health services for Medi-Cal eligible adults and children. Until December 31, 1994, the State Department of Health Services paid for inpatient psychiatric services. On January 1, 1995, the funds were transferred to local Mental Health programs to manage all the psychiatric inpatient needs of Medi-Cal beneficiaries. On April 1, 1998, the responsibility for outpatient specialty services was passed on to local Mental Health programs to manage those services. FTE: 2.9 Level of Discretion: Very Limited Community Based Organization and Other Contracts 1. Herrick Hospital 2. California Specialty Hospital 3. Telecare Solano 1. Several fee-for-service, individual, group and organizational providers. Gross Expenditures: $2,403,979 Financing: 2,403,979 Realignment/Net Cost: 0 Funding Sources: State Medi-Cal allocation base. 7. Adult Mental Health Services Description: a. Crisis/Transitional/Supervised Residential Care: Short-term, crisis residential treatment for clients who can be managed in an unlocked, therapeutic, group living setting and who need 24-hour supervision and structural treatment for up to 30 days to recover from an acute psychotic episode. This service can be used as a short-term hospital diversion program to reduce the length of hospital stays. This category also includes 24-hour supervised residential care and semi- supervised independent living services to increase each client's ability to learn independent living skills and'to transition ("graduate")from more.restrictive levels of residential supervision to less restrictive (i.e., more independent) living arrangements, including Board and Care facilities. A contractor is being selected to operate up to 16 new crisis residential beds primarily for consumers who no longer need acute care from Contra Costa Regional Medical Center. The goal is to launch operations by July 1, 2000. Planning is also underway for a 16-bed transitional facility where consumers can reside and receive support services for up to one year. Expectations are that this program will be in operation by the next calendar year. b. Outpatient Clinic Treatment and Outreach Services: Scheduled outpatient clinic services, including psychiatric diagnostic assessment, medication, short- term individual and group therapy, rehabilitation, and collateral support services for seriously and persistently mentally ill (SPMI) clients and their families with acute and/or severe mental disorders. Also includes community outreach services not related to a registered clinic patient. c. Case Management Services: Case managers provide screening, assessment, evaluation, advocacy, placement and linkage services in a community support model. Case management is also provided through supportive housing services. this includes two multidisciplinary Health, housing and integrated services Network (HHISN) team that serve West County and Central County. d. Habilitativellntensive Day Treatment&Socialization/Vocational Services Programs: Organized therapeutic treatment and activity programs (less than 8 hours per day) for adults who are recovering from a psychotic episode and who need training in socialization and independent living skills. e. Outreach/Advocacy Services: Drop-in multi-purpose service Centers assist the homeless mentally disabled to secure information, counseling, transportation, clothing, financial benefit counseling and housing. Case Management is also provided at the centers. The Vocational Outreach/Administration Service develops vocational contracts and provides administrative services to support pre- vocational training for mentally disabled adults . The Consumer Self-Help Network provides development, promotion, and financial support for former and current users (consumers) of mental health system services through self-help groups, peer support groups, advocacy, and a newsletter. FTE: 81.0 Level of Discretion: Some Discretion Community Based Organization and Other Contracts 1. MH Consumer Concerns 2. Residential Care .3. Phoenix Programs 4. SERVE 5. Rubicon 6. Telecare Gross Expenditures: $15,267,308 Financing: 6,233,503 Realignment/ Net Cost: 9,033,805 Funding Sources: FFP portion of Medi-Cal, Medicare, HMO, Private Pay/Insurance, SAMHSA Block Grant, McKinney Path Grant, and County General Fund. 8. Child and Adolescent Services Description: a. Local Institutional/Hospital Care: Acute psychiatric inpatient treatment for children and adolescents is provided in private hospitals in order to avoid placing minors in the same psychiatric units as adults at Contra Costa Regional Medical Center. b. Out-of-Home Residential Care/Treatment Service Programs: Structured residential therapeutic treatment service programs for seriously emotionally disturbed (SED) children and adolescents, providing individual, group and family therapy. c. Intensive Day Treatment Services: Therapeutic treatment, educational and activity programs (less than 8 hrs/day) for children/adolescents who have behavioral/emotional disorders or are seriously emotionally disturbed (SED), psychosocially delayed or "at high risk." d. Outpatient Clinic Treatment and Outreach Services: Outpatient clinic, school-site and in-home services, including psychiatric diagnostic assessment, medication, therapy, collateral support and crisis intervention services for seriously emotionally disturbed(SED)children and adolescents and their families. e. Child/Adolescent Case Management Services: Case managers provide screening, assessment, evaluation, advocacy, placement and linkage services to assist children and adolescents in obtaining continuity of care within the mental health, health care and social service systems. Community and school-based prevention and advocacy programs provide community education, resource development, parent training, workshops and development of ongoing support/advocacy/action groups. f. EPSDT (Early Periodic Screening and Treatment) Program: Provides comprehensive mental health services to Medi-Cal eligible severely emotionally disturbed persons under age 21 and their families. Services include assessment; individual, group and family therapy; crisis intervention; medication;day treatment and other services as needed. g. Summit Center Day Treatment Program(Boys): Provides multi-disciplinary assessment; individual, group and family therapy; a milieu program with level system; and a parent support group to 20 seriously emotionally disturbed wards of the court. h. Seneca at Oak Grove: Provides highly structured residential therapeutic treatment program including school, day treatment, mental health services, crisis services for 16-18 severely emotionally disturbed adolescents. Includes an in-home crisis response component to avert residential treatment. This program is scheduled to start in June 2001. L Chris Adams Girls Center: Provides multi-disciplinary assessment; individual, group and family therapy; a milieu program with level system; and a parent support group to 30 seriously emotionally disturbed wards of the court. j. Family Partnership Program: Provides long-term, periodic in-home support and crisis intervention services to families with limited coping skills who experience cycles of chronic instability escalating to crisis. Whole Circle: Afive- year federally funded grant supports wraparound as a philosophy, process, and service for high service use children and their families. This includes involvement of many county agencies, expanded family involvement with family members as paraprofessional staff members, and creation of the in-home crisis response component of Seneca Oak Grove. FTE: 90.4 Level of Discretion: Some Discretion Community Based Organization Contracts 1. CHD (Prevention) 2. La Cheim School 3. Early Childhood Mental Health 4. La Cheim Residential Treatment Centers 5. We Care - Barbara Millif Center 6. Lynn Center (CCARC) 7. Seneca Center 8. YMCA 9. Families First 10. Victor Treatment Centers 11. Asian Pacific Psych Services 12 Lincoln Child Center 13. Fred Finch Youth Center 14. Rape Crisis Center 15. Seneca at Oak Grove Gross Expenditures: $18,328,823 Financing: 14,872,745 Realignment/ Net Cost: 3,456,078 Funding Sources: FFP portion of Medi-Cal, HMO, SAMHSA Grant Funds, Private Pay/Insurance, expenditure transfer to other County departments, and County General Fund. 9. Special Client Services Description: For special client populations or target groups of children and adults with special needs. a. Mentally Disordered Offenders: State funded"Conditional Release"Program providing mental health services to criminal justice offenders who are on parole. b. Services for the Hispanic Community in West County: Community Outpatient Clinic and Outreach Services primarily for Latino, Hispanic and other Spanish-speaking adults, children and families. c. Foreign Language and Hearing Impaired Interpretation: Foreign language interpreters and sign language interpreters to assist the County staff in providing crisis intervention, inpatient hospital and outpatient clinic treatment services. d. Patients' Rights and Advocacy Services: Patients' rights advocacy and training services, including the provision of information to voluntary and involuntary psychiatric patients who have been hospitalized. Includes representation and advocacy services at hearings for hospitalized adults and minors. e. Crisis and Suicide Intervention Services: Crisis and grief counseling services county-wide, including a 24-hour telephone service and community education. FTE: 10.8 C Dual Diagnosis Services: Dual Diagnosis specialists-. will assist approximately 40 clients a year to stabilize their health and overall well being. They will also assist with the housing, daily living linkages and advocacy needs that help postpone decompensation and prevent relapse. SAMHWorks: Specialty services are provided and being developed for the Employment and Human Services Department's CalWORKS participants and their children when mental health problems create barriers to employment. Level of Discretion: Some Discretion Community Based Organization Contracts 1. Board & Care Homes 9. Rubicon 2. Life Support (various) . 10. Touchstone 3. Recovery Management Services 11. Family Stress 4. MH Consumer Concerns 12. W Coast Children's' Ctr 5. Crisis Center 13. Early Childhood M.H. 6. Desarrollo Familiar 14. Lynn Center, CCARC 7. Asian Community MH 15. Barbara Milliff Center 8. Asian Pacific Psychological Services Gross Expenditures: $2,182,423 Financing: 1,334,929 Realignment / Net Cost: 847,494 Funding Sources: State Conditional Release Program contract and County General Fund. 10. Fixed Assets Description: To provide for the acquisition of capital equipment and for needed capital improvement projects required by the Mental Health Division. FTE: 0 Level of Discretion: Optional Gross Expenditures: $50000 Financing: 0 Realignment/ Net Cost: 50 000 Funding Sources: County General Fund • Attachment III Pending Legislation Related to Mental Health Coalition Priorities A few new bills speak to various aspects of re-designing the public mental health system and such re-design could impact all priority areas. • SB 30 (Chesbro) would require the Department of Mental Health, the Department of Finance and the Office of the Legislative Analyst to form a workgroup to study various options to restructure mental health services and funding for recommendations to the Legislature and the Governor on or before January 31, 2002. • AB 334 (Steinberg) would make various statements of legislative findings and intent regarding the need to provide sufficient funds to counties for adult mental health and related services. The following bills are more relevant to Contra Costa's priorities of consumer-run community centers, affordable housing, transition age services, and residential treatment facility. • SB 891 (Ortiz) would create demonstration project grants for self-help organizations to provide services for soon-to-be-discharged patients and to give grantees access to these patients prior to discharge. • AB 602 (Cedillo) would create a demonstration project to provide and coordinate services for homeless mentally ill individuals. • AB 748 (Chavez) would state legislative intent to address housing and service needs of homeless veterans by creating more transitional and multi- family housing and homeownership opportunities. • AB 1119 (Hertzberg) would extend AFDC-FC aid to children in foster care beyond their 181 birthdays if they are in school or vocational training.