Joining us today. Welcome
To our with us here today to.
Serve as panelists as a temp
stand the complexities or
mental health care fund our
state. This will be again today
when he- we're not. The
proposition. Sixty three and
the of mental health funding in
California. Mental health
please enter a plea is the
lives of every one in ours.
People's ability to function
and carry out their normal
activities in life. They are
often compounded by stigma
making it hard for people to
talk openly about their
experiences and this is
particularly true for
communities of color. The one
in six Californians experience
some mental illness. Not only
do a sixth of California. And
some mental illness but one
every twenty four has a mental
illness so serious it becomes
difficult for them to function
in daily. Individuals with.
Mental illness have life
expectancies twenty five
shorter than the average
population. Twenty five years
shorter mental health issues
prevent men of health issues it
is the leading more towards.
The other social determinants
of health we know so well
office. Hold and people are
struggling to get. Increased
substance abuse addiction. And
oversee the stats and alarming
in in. We never get worse is
invested in both can and will
help treatment approximately
thirteen and a half million
Californians are currently
enrolled in medical program
which guarantees mental health
care to those who need it.
Moreover only six to seven of
California's. Population lacks
health insurance any kind. Of
mental health laws have adopted
federal and- to ensure we
invest hundreds of millions of
dollars of mental health
services act dollars in
prevention and early
intervention however even with
such significant investments
major issues exist. With the
current. I'll be highlighted I.
Believe that we need to tackle
our current mental health
crisis. To bring most advanced
forms of care to scale across
the state. We need the
political will necessary to
elevate brain illness as a top
tier priority. Today. Based
mental health system. Since
well and where the system can
improve I am eager to learn
from our parts on the ways in
which we can work towards
achieving together just and
equitable mental health care
fund estimates. In this hearing
will explore. Three and
successes and its challenges
prevention and early
intervention we will revisit
prop sixty three in
specifically discussed and
outcomes based model. And
finally and certainly not least
we will hear a presentation on
the California advancing in
innovating medi cal cal Azeem a
multi year initiative by the
age the us. Improve the quality
of life. Some of our population
without further ado I'd like to
welcome our first panel. We use
how. And I'm always. Be
respectful his time in his work
in offering the mental health
service act. Start with Gerald
on. For holding this hearing I.
You just percent grateful I am
out where they just later will.
This to me yes. Yeah because it
it takes if we're going to make
the changes. That are necessary
to help more more people so
thank you. I. We are able my
take it's a- minutes with bring
the. Okay in give you did which
is actually in line with. I
have read in preparation your
preparation for this hearing
you know we always talk about
the negative around mental
health and about the history of
the system right the closure
the hospitals the failure to
follow through and follow up
on. Finding a decent system a
community. I want to tell you a
good story. Yeah yes nice store
back in nineteen ninety eight.
Junior family member spent a
lot of time in this room my
first year I introduce. Was
built as a legislator eight
thirty five. It was the
integrated services for the
homeless mentally ill I thought
I could get three hundred fifty
million dollars and I declared
victory at the end the year one.
And we got ten million dollars
to start. I lit projects in
Stanislaus county secretary I
mean LA cam. Showing that if we
did as the right kind of out
read and write. Services for
the homeless mentally ill we-
not. Get cycle beginning. Then
department of mental health and
doctor Steve may Berg worked
with this county is an all day
colder's to actually produce
publicly understood outcomes
that if the shock the
legislature they sure made them
a very happy because they
demonstrated significant
reductions in. In business
looking at the end jewel's year
before entering services and
the nine months or so after
significant reduction days of
home significant redoubt in in
psychiatric hospitals.
Significant reduction in a rest
in days spent in jail because.
Probably understood outcomes
the next year when the budget
was still in good shape. We did
a B. twelve thirty four and
were able to increase the
amount of funding to fifty five
million dollars. Now for the
year. Two thousand and one
through the next great
reception in two thousand nine
when I was M. despite too much
in debt. Terms of the state
budget. No guy ever saw to cut
AB twenty thirty four because
once again fifty five million.
In thirty plus counties in one
city I believe Berkeley. That
prod demonstrated. Consistent
positive and I say again easily
public. Comes. Negative
outcomes that were taxing the
sit them in in huge waves. The
late rusty see looks and I
decided midway through that
period of time that well we
were very happy with the
results with fifty five million
dollars helping about five
thousand people a year. Was
obviously just a drop in the
bucket and the a B. two thirty
reserve covering up prevention
early intervention or any of
the. X. of untreated mental. He
did props three and you know
this. Right all the
stakeholders together raise the
minimum amount of money
necessary for initiative and in
two thousand four got fifty
three bus burst the vote passed
prop sixty three. I submit to
you that. The story is told
about the mental health
services act. To me in it has
been a great success get you
can and I. Innovation a systems
began to be transformed and
most importantly of real people
in the tens of thousands who
have got that bond and whatever
it takes in addition to the
generally. Can strategies it.
Test. And yet if it had had.
Porsche fifteen if we're gonna
be on. We did not apple eight
eight B. thirty four AB twenty
before. What kind of reporting
to. The public in the state the
outcomes. And it's a bit. Take
as much responsibility as
anyone because we got started
with this thing back in two and
five into. The checks but
because in part. I think. This
says. In addition is a two step.
They sort of pushed way and.
Take a course. French attitude
towards they see it not putting
words in their mouth. I'm
selves but as a catalyst or to.
Combined with a real pretty.
Reform and being a single
system. It is so when I look at
the MHSAA part of the whole
number little than just these
couple is that okay should I
just. Okay you have the floor
okay. I'm sensitive to I think
that you put ME aimed me in
context in some ways it's been
it's short comings have been
blamed for some of the first to
the mat health system but in
truth the MHSAA it's actually
one of five sept mental health.
Got a major city we have we-
bottom. Jails. Yeah we've got
Medicare managed care and we've
got commercial pay. And all of
those disturbance act in it
indirect. Integration and how
we put all the massive sources
are potentially if we had real
parity by the way. Master sword
under a single umbrella say
what it take. It in there too
often Commons story from people
across all what say don says.
For themselves loved one what
ages pays room all of. Well in
part because of. The lack of
real parity and I don't when I
talk about parity I don't. It's
versus three visits for ten
visits to a therapist I mean
what's covered and what's not
covered. A lot of the nation.
Brown street and in some ways
not cover. By and large kommer.
HSA in part is had to be.
Peanut butter. If you will
spread rather Finley across a
lot of different probes any
tips. And as a result not that
focus you spoken about in the
F. rations this hearing. My
what. The whole issue to. Did
the day it was a whole. Thanks
to flee. It is for the act. I
know some of these are. The 90%
of the full service partnership
dollars on on sheltered
homelessness brought on by a
lot of different popular
contain. A to a senior to tell.
Other counties John Sheridan
did in Los Angeles county that
while they're doing with their
full service partnership there.
I would. Like the MHS focused
on three categories. Help your
home there are so most
important imperative it's
getting. A roof I've been very
publication know about. All I
hate to a room full ones
permanent housing first
navigation center and shelter
is necessary but we have a
tough public policy in this
says it's okay for people to
live out doors. I don't think
it it. As you said twenty five
years. Bless I know it same for
people with untreated chronic
mental this. Would like to see
twenty focused on unsure
homelessness on ale. Yeah
diversion and after your for-
leaked down by the way there's
a huge laugh. The most problem
and then on kids and I pick
four categories in the you're
just mine. Trauma based care
for kids exposed to violence.
The psychosis identification
and intervention for teenage.
College based mental health
services an intense amount in
the mental health services for
kids child our system for your
kids. I would like to see the
money spent on that. And then
to see an outcome based system
at. Yeah rich but as simply
understood is the eight four
outcome based system the
counties are responsible. Out
comes around the money. And
then. For their complete flex
the lady and break the eighty
S. held accountable for outcome.
And I would use if you were
back in the get into the. The
books. Here the framework of
the eight X. thirty six what
was a transformative act. It
created an outcome I'm for it
chop. I would if not making
progress comes date. Gradually
beginning with technical
assistance whatever assistance
is needed help them meet those
outcomes and go. Lee with the
potential never to be used. Of
us of St. Tension and to go
over the county was not doing
anything or spending money on
other than what. The outcomes.
Required. What I think we need
to do not how and pay for this
this is currently covered under
the MHSAA. The MHSAA. That's
reform of the image to say in
my view needs to be. Discussion
if we can gain those additional
forces either from the
insurance companies and or the
federal government we can then
insure that we're not doing any
harm in making the M. essay.
Which more focused and outcome
based. What it is to do now we
believe we can do some of this
legislates a some of it. Can be
done through executive order
eventually might. Be done. I
don't want to take the money
from the counties I would like
I think the companies do a
great job. But I think between
the state and the fifteen years
we've gotten away. From the
fundamental principle of AB
twenty thirty four and twenty
thirty four. Where we report to
the public consistently. That
these dollars are actually
saving a lot also giving
taxpayers. That's part of
busting stigma by the way as
well because people feel like
all my god what is the money
big reserves here this that and
the other. Into a consistent
about presenting outcome. Gonna
believe that homelessness for
exam. Isn't we know do if we
only do a solid eight resources
in a way that achieve the
outcomes that we all will.
Thank thank you and- we are
used to senators not having
time limits chocolate in place
any on you thank you. Next we
have Michelle Cabrera. A good
afternoon chairman members
Michelle cabinet at I'm the
executive director with the
county behavioral directors
association of California. And
very grateful to be sitting up
here with the- author of the
mental health services act to
along with. The late resi Felix
both of you giants in the field
of mental health thank you so
much for your work. It's true
that. That mental health
advocates for claim that we are
in the midst of an
unprecedented mental health
crisis. Nationwide service. Are
up and in California too few
children are being treated for
their mental illness.
Depression and anxiety- up when
Californians walk out of their
homes they are confronted the
brute brutal in humanity.
Thousands of their neighbors
living on the streets. Intent.
X. many whom struggle with
substance use disorders a
mental illness. In the face of
these challenges the reeds
reports and serve MHS dollars.
How it civil that forward in
the image as a fourteen years
ago if this is the state of the
world. Have we failed. A friend
now a resounding. The successes
of the ME all around us hiding
in plain sight. Today bridging
the images say to the tune of
almost billion federal
financial. While at the same
time the fact is that it's a-
money. These sorts of
interventions include
prevention not paid for by
medical school partnerships
work force and in for
infrastructure investments
housing which foods rental
subsidies board their patches
building so I'll sing a
vacation of. Landlord trip so
important. Full part of this
partnership. Employment and
education services law
enforcement partnership. We
ride alongs with law
enforcement we train them on
how to better engage our client.
Impart their live experience.
H. meant find practices his
portent in a state. This. Are
there any roles with in my
house the uninsured who are
covered by our services and yes
individuals with private
commercial coverage. Who have
been announced for understood.
Despite the preemie they've- we
fund research you are an HSA
dollars and so much I literally
could go on. So I'll start to
describe it more of the con. I
like senator. Where the a
discussion today. Helps to
point us to. Just they were
experiencing at staff is also
aired some. Which the pass up
out to supplement my talking
points we do start a. Many
years ago and orders are sought
help us address a man on the
eve of the great budget wrist.
The early ops we. Twenty two
thousand six and the recession
was just about. Without lower
than they are today around two
and fifty six million total
state wide and yes today there
are around two point four in I
will note that just two years
ago in twenty seven. We were
receiving around one point
seven billion HSA today at two
point four. Stress it speaks to
the relative of and what kind
of today- but those changes
well and so often counties are
let trying to reach again it
might happen next and wanting.
They were able to sustain the
rams. In the years of any real.
Many of the N. MHSAA the MHSAA
basically saved our public
safety net from being decimated
not only did we back fill the
state director as the state
directed us to in the budget
process but the state also so
close to a billion an image as
a revenues into the state
general fund was a top of truth
is. In California and so.
Justified the court to come out
of the Great Recession we
encounter several additional
major changes to the public
behavioral health system that I
think are noteworthy the first
one twenty eleven realignment
which brings with a
responsibility to find EPS D.
T. mental health services for
children and youth the
implementation of the
affordable Care Act which adds
many many. New medic I'll
enrollees both are. Parolees.
Also people who work previous
one not enrolled. And the
within DHS the elimination of
the department of health on top
of. The changes but since the
Great receptacle and pulled. Up
to what's work. Compliant and
faithful to the act- we have
implemented with great fidelity
to the regulatory and fiscal
rules that have been laid out
for us we've maximized the
funding I we've incredibly
successful at breeding funding
and leveraging. The MHSAA and
that's really how it is spread
and did two is a- as I said
earlier it's now can trip.
Around two billion dollars and
as money to medic cow- end this
doesn't factor in the non medic
hal reimbursed services onto
the MHSAA and there are some.
Peter is that it be working big
public health and. What
optional. A high and mighty top.
No fast as the national rate.
First city and also cultural
relevance- it's really
important in a state like
California that we do invest in
making sure that our services
are more cold culturally
appropriate and wall could do
more. The fact that we. HSA has
out as to innovate in this.
Better the culture an early
this program for a county that
targets the meat Steckel
community we have a community
garden project that helps
reduce stigma for the mom
community to come in to
services and in San Bernadino
approach program that builds
trust with homeless and-
jewel's. Traveling veterinarian
who support their pets and
helps bring into services. This
is ground breaking an effect.
On prevention without the MHSAA
we would not be able to do
anything to fund prevention and
stigma reduction typically not
covered under insurance
including. Where diagnosis and.
Acuity requirements must be met
in this on reimbursable. On the
part for those individuals who
.
We would argue that the service
partnership model. The seat has.
We've been doing it for over a
decade now in California and
we've gone beyond my cal the
bronze McCourt Dale act blouse-
requires us to serve
individuals regardless of
pairing California but only to
the extent that resources are
available and we would argue
that without revenue we really
wouldn't be able to. Catch to
try to meet those. So what's
wrong. Not done a great job
they are so and I hope that and
today. Hope to that. Loud.
Ported in one county or another
through the any to stay. How is
this moving the needle state.
Wide what about the store and
we can't stop active. Hold up
in state level and at this
importing this requires a few
things we need to make a state
entity responsible for this
this is a matter of investment
and clarifying the rules of
ours to state regulators we
need to use the data that the
counties are sending to the
state even that will change
like making the reports that we
the second machine readable.
Could help open up the
thousands of. Nations counties
have struggled the most. And
what is new in the early the a
season up strict
interpretations of what
constituted an innovation were
extremely. As was approval
process thanks to our
leadership at the- this has
changed but smaller counties
trouble- in that their
allocations are so small that
it makes it almost impossible
for them to lift up a group
program. Flexibility park how
can you my name. Is. A
wonderful in that it requires
us to engage communities and
develop three year. Update
brown how we spend our funding
in several. Be easily from one
complete. In the years before
we had greater flexibility your
evasions the significant. Issue
when it county allocates. But
the funding each pop no percent
of our make. HM I 8% is not
where we talk about on CS and
50% that goes to FSP design
what this means practically.
Even if our community part. To
invest more works. Job we're
limited and can put their. Its
restriction along with the
inability to back to our story
that assignment Bracey together
we do need to move to a- small.
Our counties of said give us
the targets and we will meet
them at the trade off for
greater flexibility. Second
district in that. We cannot use
HSA funds on substance
disorders this is important
clearly the thing that the- as
this crisis with an HSA funds.
You would know as a clinician
talked her out I'm glad that
often. A person is struggling
with addiction. Really hard to
tell what the underlying mental
illness. They're dealing with
it is and until we can engage
them and bring them services
for their substance use to. It
is very difficult what's going
on there I'm are finding really
categoric Janet and I am
actually. Into play it out safe
as well. We have to. Funding
under SB eighty two which help
the price. No place like home
our recent today since their
ships are work force through
the M. say. He competed one
county to another for a finite
pot of funding and then we end
up with differences from one to
the other not based on- what
makes the most sense or are
does this CD six every. One who
was able to compete for those
for a resource and went out I
would say that we need to level
set our expectations me to say
given how widespread the needs
are for. Health safety net what
role should the MA to say in
that and that begs the
question. In two day in medic
cow overall working 25% of
budget for Medicare. Yes mental
illness the image is only 25%
And I'm only 5% is. The only
source of that we have for
important activities of medic
cow so for two to an outcomes
based system how will medic how
be aligned. To support those
comes run counter to them.
White outcomes. Is that the M.
HSA supports our behavioral
health system is staggering
it's everywhere from providing
critical investments in
prevention and early invent
intervention all the way
through to providing critical
support to the crisis. And a
cute ends of the continuum and
everything in between. If sure
these dollars work well. Of the
various about thank you for the
opportunity. Thank you and
we'll save questions for the
and if that's okay- doctor
Connelly deputy secretary of
behavioral health with DH CS.
Thank you Mister chair about
your doctor ambulant thank you
to the committee for having me
today glad to be here to speak
on behalf of the
administration- and again
appreciate your time and glad
to be here. With me stop Bergen
and others on the panel.
Behavioral health substance use
disorders. Is a critical
element of individual and
community well being a governor
who some. Believe that all.
Your health services that they
need to live to live happy
healthy and fulfilling lives.
Proposition sixty three of the
other panelists I've already
mentioned is a key part of that
the mental health services act
is produced high quality. Shin
and programs. Let's MHM things
that's true we've we've
discussed that already it's
also an ambitious policy
framework for providing
comprehensive community based
systems of care in all of the
above approach or strategy for
mental health- again it
includes prevention earlier.
Talked about these different
elements of. Repent and others
are supportive services that
are needed also. In sure tan
de. Gusman two other funding.
Mental health services and of
all been middle. Communities
I'm in water community wellness
goals that we have. The
financing streams are
structured though as we've
heard- and they they are
supportive of all of those
different names but with
different sort of structures
and restrictions that are
attached with them. Eight
twenty related to services and
prevention and- in those. Both
of us service ports. Full part
of full service partnership
model. Current estimate it did
an HSA will generate over two
dollars Avenue during this
fiscal year that is in. Them
middle service delivery.
Systems I kept up a billion we
heard today. Port that a lot of
that money also spent on
medical funded services which
is an effective strategy of up
actually in large. And in our
communities through accessing
federal Medicaid matching funds
with an HSA dollars. In
addition a broad nature of the
community services and supports
component of an HSA enables-
counties as we as we heard to
support many services that are
also not funded through medico.
And the list. We're seeing
across the state right now-
images a services is helped
have also help consumers reduce
involvement in the criminal
justice system. And create
community. Input I mean there
is the doctor five. For the
deputy director of the
department of health this is
we'll talk about in the next
battle as well. I mean to say
both enables the medical
program. More bust impact in
this way that. Rapper the two.
Or could back in unity- wide
and human centered impact in
terms of mental health
services. Speaking of our
communities I think one of the
really innovative and valuable
aspects of an HSA is it's
intentional route- in
community. And the community
planning process. Increased to
culturally and specifically
linguistic services- in is
truly unique in that fashion
and it's a requirement written
into the statute into the law-
in some images say is special
in that Californians have
chosen to raise this revenue.
Have voted in favor of this act
and really or ties health
wellness mental health and
wellness. By a vote for this
the side proposition. As I said
at the beginning. Of the law is
much more that funding source
it's ultimately about impact.
Enabling people to look healthy
full lives. Up speaking just a
little bit about the in. One
very prominent example again as
the full service partnership
model. Of intensive community
based out of service. Employing
will take approach to provide
service. Roughly two thousand
people as of November second of
this year or- in- in. Our
programming as we call it. And
that includes twelve thousand
children up to the age of
fifteen. Thirteen thousand
transitional age with twenty
six thousand adults and seventy
five hundred older adults above
the age of sixty. And that that
service side that service-
mock. Actually supporting some
really I think tremendous-
innovative programming counties
just two examples of that
instead Luis Obispo captives
of. Treatment that provide
services to individuals who are
on formal probation for a
minimum of. Two years and. For
whom mental health treatment is
been a fat burner legal
different difficult. Program so
it's not mandatory. And there
are there are folks who have
not been seen by other systems
previously so. For decide
discharge from jail and not
engaged in services in a timely
fashion- in addition St Bernard
you know county has a very
innovative. Transitional age
youth- behavioral health
hostile model called the state.
This was a particularly entry
model. So treatment for. Me
ages it. Or it's a short term
bond crisis residential center
for those X. psychiatric
episode- Christ's the program
bases itself and therapeutic
community design. And since it
also has- impressive-
interdisciplinary model in
plain sight yet psychiatric
nursing social service and
vocational services- some
outcomes that are impressive-
29% of the youth who presented
with a significant issue
related to psychosis or thought
disturbance disturbance had
those issues improve or
resolved by district in
addition there's a more
holistic approach to carry. The
percent of presented the next
significant medical or
otherwise physical. Issue had
decided. In project so with
that 5% set aside but given its
successes now funded and the
community services and
supports- portion let me just
say to support its ongoing.
Operation. Impact of say the
challenges Sir there is a
success is the other panel. I'd
metric analysis outcomes are
are areas that we can all work
on together establishing- and
enhance monitoring process to
establish statewide goals for
children- transitional age
youth adults. Older adults and
families remain important areas
for improvement okay currently
draft three your plants in it
based goals for. Their spending
up dollars however we could
benefit from a more explicit
statewide planning process to
establish what outcomes we
expect from the funding for the
programming what sort of can
was quality improvement
analysis and evaluation we
expect. And how we communicate
the- public and to our and how
we can. As a more coalition to
advance I think this is also a
particular. Time of
opportunity- as we've heard
again- from the panel for
behave. Transmit. The
department of health care
services recently relax reduced
its California advancing at.
Cal. Medicaid waiver renewals
and- it's from the medical
program. Haitian. But of
Medicare reforms again signals
up. And is there a opportunity
of for example. Of health care
services as has problems. Many
member risk. Percent which is
which again. I'll get over it
will determine health in middle
earth to. Work seamless thank
Chris. Three improving outcomes
driving delivery system
transformation in modernizing
systems and for integrating
behave services within the
broad array of help this is
available in our communities
and so. I think the terrific
aspect of these goals is that
all I'm applied it may just. So
MHD pro instate goals. No in
two both both programs impact
of service act that supported
by both of those those vehicles
coordinate service to more
fully address consumers. Person
fashion more I think that I may
just taxable all of the above
approach through. Aug medic out
in the new focus. The
determinants of health Brenda
divisions DH CS will also
comment later panel about the
L. callin a later this
afternoon. In June. Converse
with consumers family is
counties later holders to
create more stable statewide
miss in our expectations for it
and I just say how we align
that with Caroline we also need
a commitment to push toward
that common set of goals that
we agree upon and use enhanced
data collection to Kitty-
continuously push ourselves now
comes in and finally. It
important that we don't lose
the local flexibility and as of
community interventions
program. That will help to
those. Connelly Dr Huber. Tech
distraught. A check person
around Mila and the color.
Often he service thank you for
the opportunity Hey my name is
doctor Nicole Eberhart and I'm
a senior behavioral scientist
at the rand corporation my ran
colleague Dr socks got actual
it is also in attendance and
available to answer questions
today. Rand is a nonprofit
nonpartisan research
organization headquartered in
Santa Monica California. Rand
has been conducting independent
county funded evaluations of
proposition sixty three known
as the mental health services
act for over eight years I am
eager to share some of what we
have learned as you contemplate
the future of mental health
funding in California.
Proposition sixty three as we
all have discussed has greatly
increased funding for mental
health in California. I'm with
new funding comes new
responsibility to evaluate the
resultant programming to
understand its impact and
ensure effectiveness
accountability and value. To
this and I will share some key
findings of rand's of
operations a prop sixty three
programming with you today.
I'll start by discussing some
of successes and then I'll
examine some of the challenges
to implementing prop sixty
three. At six that's number one
new capacity. To provide
prevention and early
intervention so. With a 20% The
intervention or P. hello sign
extensive expansion of P. I.
programming around you see the
team evaluated evidence based
earlier intervention programs
for children in Los Angeles
county and found that children
who receive these P. I.
services benefited we looked at
vulnerable children receiving
preventive care and found that
nine out of ten good well
meaning that despite their of
Arbil. The low the threshold
clinically. And if you get
mental health issues wi fi and
got. Please of symptoms can.
Deliver immersive events media
the root of the campaign found
that it reached more than one
in five Los Angeles county
youth in a short period of time
exposure to this campaign it
was a system with more support.
Around mental illness more
knowledge of how to help for
mental health problem. P. I
Ming at it while. Angeles
county's camp new the mental
health services already mesa
has been and. Men's health the
I. campaigns twenty then come
it is a joint or thought hound
he's pulling reimburses to
gather our projects are
valuation on the cow Mrs P. I.
campaign which Californians and
improve key outcomes they were
associate reduce stick back
toward those of mental illness
increased use of mental health
services and increase
confidence to interview. Those
at risk for suicide. Success
number two expanded capacity-
individuals with serious mental
illness. Prop sixty three
enabled expansion full service
partnership or FSP program that
as other panelists describe
revised wraparound service is
that do whatever it takes to
help those with serious mental
illness. With participation is
associated with improvement in
key outcomes this is again a
Los Angeles county so it's no
criminal justice this
involvement hospitalization for
mental health. Action primary
care. Sex free proxy deep
ramming it says David caught.
Savings associated with
specific components a prop
sixty eight. In evaluating
costs associated with LA
county's FSP program. We found
that the program reduce service
related expenditures by eighty
three million dollars. Twenty
five that reduction. The cost
savings were largely to. Reduce
spending on a person among
adults although there are the
big. So help hospitalization
and homelessness we also found
evidence that cal mesa
statewide P. I. programs you'll
that positive return investment
for example the each my matter
stigma reduction campaign. Is
associated with increased
treatments which is projected
to. Thirty six dollar return to
the state for every dollar
invested the higher. Yeah I
program is college in unit. Our
system with increased use of
mental health treatment which
is projected to increase
graduation rates in turn
leading to higher lifetime
earnings an average return to
the state of six dollars for
every dollar invested. Suicide
in training programs are also
projected to return money to
the state the reverted medi cal
emergency care because it's a
set. Times and increase state
thank. That's benefit analyses
do not capture all the
financial personal or societal
benefits improving. Our saving
someone's life is valuable
regardless of the cost. What's
one limited funding for state
by Pierre projects. Although
prop sixty three has some
notable successes challenges
still remain some P. I.
programs could be more
efficiently implemented as a
statewide effort than by each
individual county. However
California's decentralized
county minister mental health
system to challenging to work
on projects counties only
contribute a. Small portion of
that I funds to the comments
the state. Amount has greatly
how Mrs infection and then I
such. It projects at the level
they were at when we conducted
many of these evaluations well
we found some promising results
these games have likely not
been fully maintained.
Challenge number two this is
something some of the other
panelists have spoken to it
well limited capacity for whole
person care. It's a mental
health the highly vulnerable
popular. Elation and
unemployment. The criminal
justice system or with the
department of child and family
services. The current system is
prepared to treat all of
people's complex it's in a
coordinated manner. The because
it is not set up to compensate
whole person care to best serve
California to mental illness
California may need to develop
the first meant and for me
consist. Support whole person
care all its consumers.
Challenge number three
insufficient county level
evaluation data just something
again other panelists have
spoken to. Invite sixty three
funding we found that we did
not always have the right data
to answer our evaluation
questions for instance some key
indicators of recovery from
serious mental illness are not
being measured by count is
another outcomes are not being
measured as well as they could
be. California can facilitate
future evaluation by updating
it mandated data collection
proceed. Careful consideration
to be taken to minimize non
county mental health provider
one I think the utility of the
data collected. Thank you thank
you doctor mark finally we of
course how she died from the LA
a. Good afternoon to the chair
into the- the committee- might.
Deal with the legislative
analyst's office. There should
be now a package of form the
basis of offices remarks today.
I'm I'll be presenting on
several issues within a major
day and potential solutions to
those issues that the
legislature could consider to
improve the academic forward.
Before I begin I just want a
knowledge six is within images
say that a couple of our- that
couple of. Eggs on the panel
have spoken to- no doubt that
they've absolutely. Able within
the act. I'll be referencing
pages up and- base from this
page. At the circle. For me an
MH assays work for men
component. Providing background
information on that funding.
And several options for the
legislature to convince her to
increase funding for sports
programs going forward. This
material the end of our hand
out. Getting on. We describe
the first issues let's. Relate
to map out. Okay however these
are often not tied to
meaningful and measurable
targets. There are also
intended outcomes in the act
for different components such
as homelessness reduction under
the prevention and early
intervention component but it
isn't clear to what extent
there's an outcome based
strategy. That encompasses all
of the ME they. Potential
solutions legislature could
seek to make. How come only in
images they are well.
Developing durable targets link
to these outcomes. It is there
the legislature identify new
outcomes. Was as well. And
finally the legislature could
provide policy direction to
facilitate a strategy. That
incorporates measurable
outcomes at a higher level
covering all of them a to say.
Moving to page three. We
describe the next issues for
legislative consideration. Two
evaluation infrastructure. Data
collection and outcome measures
is not consistent pretenses.
This entity is responsible for
comprehensive evaluation
functions are provided with
adequate resources to do so we
know that images they oversight
responsibility. Are currently
split between the department of
health care services and the
men this is all. But he can
play see. What cap may be
available for this purpose. The
legislature could also provide
policy direction on
infrastructure sure is. The
elected aligned with measurable
outcomes successful practices
can be equally shared among
counties and between counties
in the state. And that it's
clear what entity or entities
will be responsible for
carrying out a more rich robust
evaluation strategy. Moving to
page four we describe our last
issues for legislative
consideration. To the need for
new. Framework to guide fun
isn't. Car and make a funding
is not explicit. The act
reflects a policy called to
prioritize treatment over
prevention and early
intervention services the
inflexibility in this broad
funding allocation does not
allow the focus of a major same
plantation to shift if new
information on program
effectiveness comes to light.
Potential solutions the
legislature provide policy
direction to develop a
framework for using outcome.
Data. Straight to be through
with. They're seeking the
authority to periodically
reassess funding allocations if
evidence. Indicates that
funding should be redirected
toward different practices.
Your cooking seeking many
allocation to dated priorities
we know that it's unclear if
that seeking voter approval and
also know that care for the
duration to be given the
potential trade offs if funding
is redirected away from certain
categories. If this is the case
alternative funding sources may
be needed to sustain programs
in those areas. Finally
beginning on page six. But some
background information on the
workforce development component
of an HSA as well as option for
increasing work force funding
going forward. Currently
Cappies can dedicate up 215% of
MHSAA revenue to work force
education and training or wet
grams. However the ceiling also
includes the total funding
counties may dedicate to
capital and technology and
prudent reserves. As mentioned
our hendo and in the materials
for this hearing. Extra in its
initial. Years fun otherwise
going to counties. For other
part was directed to five what
is. Figure out six described
types of programs these plans
addressed. After that funding
expired in seventeen eighteen
the legislature provided
additional an HSA funds. On a
one time basis for what in
eighteen nineteen. And twenty.
Am I say funds- fund to fund
five year will. Be twenty.
Counties are also now required
to provide thirty three per and
in may answer but- you're on
page seven describes annual
average what funding by fiscal
year. We know that finding
going forward is considerably
lower than fighting in the axe
initial years was. If the
legislature wishes to increase
funding for what programs.
Dedicate additional portion
state cap funding for this.
Purpose dedicate additional
general fund for this purpose.
Or dedicate funding wise for
local. Done in the years of the
images say. With that I'll
conclude our offices remarks
thank you. The thing with that
just for housekeeping purposes
we will do public comment at
the end of. All of our panel
so- with that I will bring it
up to the door and see any
question. Number four thank you
sure. So it's she the. The
expertise in which all of you.
Hi today what I'm looking for
is a legislator. In a fire
problem what is going to cost
and- so what you need to do to
fix it. I don't know I'm going.
We didn't do that. Now what
we're gonna do to fix the- you
know we always talk about if
you can does owns. Duffel with
yes. I want. The experts to
come to this legislature and
say if you do this and you find
this we will get you this.
Simple as that. You tell us go
with the wet we spent four
hundred and forty five million
dollars of mesa. I don't have
any data tells me. Or yeah how
much we- I already in
California in before for Reagan.
That we did have a mental
health. Hospital. No we do have
hospitals which are prisons for
the criminally insane. But we
don't take an- consider the
wind DDS decommissioned the
DC's. The mental help take over
I spoke. Not re will assist the
work before was it meant
something that. Actually have.
How comes fun with expectations.
No in my county of Solano I
have. Beds for car. Okay. In
there because we were coming
home. My. Sosa need good prices
bed I think they're buying. It
in the- three hours to get
bounced to the- the hospital.
In our area. If it's a fifty
one fifty they stay for seventy
two hours or less and then
there. Then put into county
jail. Tell us what we need to
do to us. How much do you need.
Give us a number. And then the
you promise that you will fix
it. That's what we're looking
for we have Stamberg whose lead.
Cold you don't need to. What
version fixes this is somebody
will make it a priority. To
help these poor people they
need the help that they so
deserve a bleak me. And we
don't have to have these
battles in. Nexus from the
right address he. Thank you Sam
remember Fraser. One of the
skills I had to learn being of
position was asking questions
and not having to because many
statements because it. Led to
you trying to understand a
problem that was more complex
than there was before us. And I
do want to focus a little bit
if I can. Feinberg as the
author of the mental health
service. With rusty see lex.
You said initially this was a
home. If. You said after four
teen years you and the public
feels it's- turn. I'm with-
looking to complete the round I
think insufficient chin
homelessness. Not in every
county in every county. The
home. Say not enough the full
service partnership
requirements are broad day is
long as an individual that's
the definition of serious and
persistent mental illness they
can qualify now the people
receiving full service
partnerships if they're not
homeless. They are neat they.
They have a real neat it's not
to diminish in any way he'd.
Question that's really be the
hard question being after
everyone agrees on out we need
to have more not. Disturb think
that's easy consensus and that
has been a shortfall if of the
act. The top issue though. Is
whether or not the act should
be focused its expenditure
should be focused on. Several
things as opposed to many
things it's a foot off the
question in a way. Do you want
to do a few things really. Or
do we want to do it. All in
holes it throughout the stem.
When I say that the initiative
initially was thought of not
exclusively but largely around
the issue of homelessness. An
icy are ninety thousand on
sheltered homeless people in
California I want this act more
focused on on sheltered homes.
Though an obviously had to
integrate with those on this
that suffer. From serious
mental as enter substance abuse
because I agree with gel the
cold curry disorder. Make sure
do a refresh assembly member
Frasier is that it will become
what occurs often in the
legislation isn't a criticism
it's an observation. That every
stay cold or will have an
outcome that they want. And
then you'll have the outcomes.
That will create a consensus.
And no prescription in the act
in it. No that wouldn't be
content. Do we want to billion
dollars do you really. On.
Three things as it was to
twenty thing. I said in my it
the way dressed my objective
what I think should be acted
jetted bout focus is to
integrate this with Calais him
and with the real parity
discussion and real parity
action the peace in cal matters
today about how we can even get
a reporting bill through the
legislature. Time and governor
really speaks to how far I have
to go to actually have it. But
there's a lot of money you know
I was happy to raise. I think
you look. Just problem we
probably need more money but
this is a systems problem and
the systems have to work much
better together to meet the
objectives that we lay out
MHSAA should. Not be that what
was the term that somebody used
are. Shin the rebar at I don't
think. I think you should the
driving. Five towards the most
serious unaddressed
consequences of untreated
mental illness I laid out my
categories and people could
play out different categories
fair enough. I'm sheltered
homelessness people cycling in
and out of jail. And kids writ
large break the kids it is
enough three four five category.
And that's. As we are to be get
the public knowing that they're
getting huge. Here necessarily
by the way because the lack of
parity in because of the lack
of. An aggressive way right
that's what I that's what I
think we should all be striving
for. You speak talk systems and
this is a physician what learn
body systems you're a pulmonary
cardiovascular of renal system
and yet you need all parts
working to stay healthy. Out of
my issue when looking at mental
health has been how fragmented
the system is even within mild
moderate and serious and
persistent. Yes and the
struggle that comes with that-
Cabrera brought up so of being
substance abuse within those
treatments and. I do think the
administration is on a very
good. For calling him and I
don't mean to get ahead of
ourselves here. I knew then
what role mental service act
will plot and if I can delve
deeper into something you said
Michelle Cabrera. You said F.
as peas were the seed for whole
person care. I guess my
question is it and redundant if
we have a whole or how we.
Ensure that the money is our
big fan both quest all truly
comprehend what a- but what is
it play a role if whole person
care becomes a statewide
program an entitlement. So it
is very much in line with the
hell he- a panel but of course
at you know what I was. Give a
nod to mayor Steinberg around
the service partners. It takes
out all in that. It's been
around for a while it has and
based in county behavioral
health and with our contracted.
Providers or when counties are
running them themselves through
small. We are wrapping. Is
immensely clients with.
Whatever they need to see
children the help. The thing.
Two drivers and- our medic to
find a place to live get them
I'm. Not sure is treatment but
purpose so that they can hello
in the long run I. Have a at
some of. Until the end of life
that is nature of his chronic
illnesses and- but but the
prescription for that is not a
medical model prescriptions
solely and I do believe that
the rest of medic how. Is
stretching to try to catch up
with public behavioral health
has has had a strong foothold.
For some time how I think it
ties back to Callie is that
this state I tried. Structure
within medic how managed care
plans and it will be a stretch
for- plans because it's not
really their bread and butter
and so counties are prepared
and willing to. Work very
closely with medic how managed
care to make sure that- complex
beneficiary the crop delivery.
Are able to benefit. From. So
the three the level and
intensity of housing services
and supports that we're able to
provide as county behavioral
health that's not what's being
provided or. Under in lieu of
services thank. Manage distant
site looking to score a win
with CMS on return on
investment by avoided emergency
room visits we're really
looking to improve people's
lives and help them in their
cover in the long run and so it
might not be too avoided enough
emergency room visits to
compensate for the fact that
you're helping someone get an
education and achieve
employment status over the long
run but you've if you've helped
that per person find their
perfect. And well being than by
our. Our goals have been met.
So I think. Are some unique I'm
I think one of the- a better
grade girl health. Support
systems not just our health
system but our public safety
child welfare education. And
other systems much more
effectively. Again we're
already there we need to
improve how. Systems and I just
feel. Part discussion and my
calc framed the been about
getting to work with our
partners and so now we're in
here my meaning to try to
challenge but to say that. We
have opportunity to try to make
improvements as well you have
found if I keep. This one more
question and pass it off to
someone. I wanted to ask the
infrastructure. To switch were
a key component early on with
then MHSAA. But seem as if they
have not. Continue to receive
funding while. They're still a
need for a diverse workforce
and more bets. One are the
property. Or how we work to
ensure that. Can build the beds
that are needed as well as-
continue to train the work
force that's the- so there are
two parts to this question one
is on work force and one SR
crisis beds all take the crisis
that. In first- we as counties
are interested. Happy to see to
cal apply for a new. Unity
provided by the fed broke up.
And the Alef endemic. I receive
federal financial participation
so medic Medicaid funding of
federal funding for- stays in
what are considered in some
mental disease I am dis. These
are for mental health
facilities of more than sixteen
beds. Which means no state
money for individuals who have
to be in- oftentimes impatient
but also other settings for
their mental health trip. This.
Is which to be institution and
put unity rather than have them.
Face being locked up for the
rest of their lives these are
really important tenants of our
community behavioral health
movement and we need to-
preserve them however. The big
sucking sound in cap behavioral
health budgets today are these
days that we're we're spending
our realignment dollar sign we
don't have a lot left over for
unity based services. When we
have. Full at that cute end of
the spectrum and it does tie
back to parity because when
individuals with private
commercial coverage are not
able to get the care they need-
and they fail in to the public
behavior health system- they
end up medic how beneficiaries
the B. and- beneficiaries of
the public behavior health
system. And it ends up costing
all of. Tivoli need to take
some time the federal waiver is
very carefully crafted it-
provides for a maximum of
thirty. Day length of stay in
these I. M. D. facilities so it
and require. I maintain the
current. Both based mental
health services in California
but demonstrate that were
actually in. Number. Very
balanced and cost wave needy
our counties are really eager.
And what what is we guarantee
that we would take the new
money that we could bring into
our system with this waiver and
build out the community based
continuing because once we
create new capacity. In lower
levels levels of care we can
step people down to assembly
member Frasier's and get people
moving on the cover not have
them be stuck at it it to show
up. Whether it's not he- you
have to do something to start
to fly to create better flow
here. Every thing where.
Talking. About into terms of
community baby be health this
is. To be working how space.
Their top not one issue
everybody's focus on it it's
really exciting but we will not
be able to do one tenth of the
things we aspire to do. It we
don't as a state. In
infrastructure. And that is.
All das places. So even to it
did get the job done on
certification so that we can
pull in federal dollars for our
medic help as well that's going
to be step one and help our
work force- step. Can help
forces we need a. Round gaps.
System we don't accept that for
any Kerr were. Especially for
behavioral health works we need
to at all levels out it is a
state for who's needed where.
It see about that I'm so that's
another. Piece for yes MHS it
was being discreet work force
it gives region by region.
State your is if you're Shasta
and you're trying to recruit a
psychiatrist- Sierra county
told me they don't not only do
they not have a six in the
county they don't have a stock
they don't have a one way try
the psychiatrist wants to move
there it's really really tough
and you know. He's been try. Me
at. If I'm as a state about how
we're going to. You know ensure
access to people of the state
but that that's. Really also a
matter of your ship and we're
really excited as we like the
mention. And I'm trying to
address those solutions and I
will bring it full circle if I
can because maritime Burke
talked about the right to have.
Your shelter as you would wish.
And. Yet the array one of. My
very rarely say this about the
land. Initially with. Regards
to. This was that we- right to
housing as well we did in the
I. D. D. community. And I.
Sorry mayors are no no no no I
just. It's a key point. Well in
its it. We don't have autistic
kids out on. And yet we have
mentally. People who also.
Comes out on the street and
there's a role for the
legislature to work towards.
Can I just respond. Okay your
point he make I. Hope I didn't
take it from you are you. Like
I say the identical thing. All
of the time illustrates what's
at stake here potentially with
MHSAA re. So I do I'm not in
New York city's. Form of a
right to shelter H. said to be
getting. Because they are
having in class. The intense.
Case management services in an
effort to get people into
permanent housing in their
system and yet. The result
lawsuit some for many decades.
In New York City 95% of the un
sheltered. 95% of the homeless
population sheltered and
indoors five out. During you at
a thousand B. to California as
well. And so what does it cost
them to do a very in perfect
right to shelter we would want
to do it better. About one
point six billion dollars a
year to bring seventy five
thousand people indoors. Our.
Estimate California is that
there are ninety thousand on
shelter. Beat up. There one
point six billion to do it
right to say two point five
billion. You don't think we
could find two point five
billion dollars a year for.
Distinguished horses in this
state. B. A. L. this. In this
area yes the shame on all. If
MHSAA were focused in the way
that I described. Hey we didn't
hurt anybody because we will
then the rebar with medi cal
managed care and. And a and D.
we couldn't find the first
billion dollar. Both of that to
put. Estimated get houses.
People first and roof and then
to get them to help in the
services. All the men triple H.
jin other local. Couldn't get
to two point five million
dollars and. Actually get close
to ninety thousand people
indoors using the MHSAA. I
think we could and that's what.
This is becoming. An epidemic
crisis not only public health
and public it was becoming a
political crisis. And why
shouldn't this acted.
Originally was intended. Going
to action okay or not all of
the money. One four billion.
Some of it already going down
shelter. And then at. Cap six
hundred fifty million dollars
to maybe will come this this
next year of the budget is
still killing okay. And we
could put together the
resources action. Next is to
get that put that state. An
academic discussion about
wouldn't it be nice if we made
MHSAA more more outcome based.
Be a real discussion here about
priorities as well. Thank you.
Are you sure your belief 1100%
What I see the is. We've got a
great study back for that did
you really. Sure was two point
two billion efficient. Sir you
care for the. In California two
point two billion dollars
deficient. Yeah we did nothing
about it in the budget we
augmented for thirty five
million dollars but. The need
is two point two billion
dollars that is. My first visit
I've been elected official. For
seven years I've- I might thank
you me answers you guys are the
experts give me the he says my
frustration because that's a
lot of money and we made
promises when we go out for a
ballot measure. Asking for help.
In the counties are paying for
it stays open it. Bears
repeating for everything.
Everything's. Closed and they
pay for everything proof. Hard
work but we won't. They have an
expectation that there's gonna
be a are you but what I'm just
not step. For me to this so
when you talk about housing I
was a general contractor
developer. When we talk about
green in numbers and mandates.
Through municipality what the
required affordable of moderate
the acidic is there come.
Should it. It has this it
additional housing component
requires municipalities to have
a dramatic impact in this field
or they don't get their past
through. Number two. I'm not
seeing a lot of effort would
collaborate. At the counter if
on this I see. You know then
and I'm not trying to knock the
counties but I see some county
sitting on a large amount of
mesa money also that stagnates
that's not being utilized. My
county was one of them. Matter
of fact it was three o'clock is
with mayor Steinberg lives of.
Them but I felt very strongly.
In some. Money party had made
to us. With the. That is that
creates that requirement from
for this better not mitigation
but trying to get a handle on
this housing own number but. So
components so if it's kind of
look. Happen because we think
was this in housing is optional
involuntary all optional we do
the best we can it's all bottom
up there is no legal
requirement that we bring that
provide a roof for everybody in
this state and it's over. A
public policy and then we. Our
resources. Yeah imperative.
It's going to continue to that
is not it's not the it's all of
us is not just the counties
thank you for the county it's
the city's it's all of us meant
when I'm trying to say is I
agree with you. Talk about
spreading Pena thought yeah. We
throw a lot of stuff. A little
amount of it a lot of stuff and
get very small. You're right we
do need to prime eyes. Hard to
make it it's- just very little
games. On this question of
homelessness if I may chair- I
think it's important to note to
in a few cases of this. One is.
With all due respect to- mayor
Steinberg. Of I'm- our worry
center and- individuals who
face under the plan to Max who
are among our homeless
population- we have an LA
county are homeless outreach
team who did a survey of the
nineteen most. Vulnerable
people living a good row five
of. The nineteen- regional
center client. So that to me
ask. To see if they can tear in
the net for people who have.
Phillips as well as mental
illness- I think that this is
in a really important issue
that we need to address and
unfortunately it does get
rolled up in the bigger issues
around homelessness. On
homelessness- this is another
area where I don't know that I
quibble. So much with the
solutions fairly we do need to.
Press the- illness. Is to
preserve. Countless people
living on the streets- I
definitely at I can tell you
and I can provide you with the
research and analysis that
backs this up- be. Issues are
not what's being our- crisis to.
It is one. Income inequality
and there being no place for
very low income people to live
and so if we want to get people
off of the streets quick we
need to provide them with
subsidies we need to provide
them with affordable places to
live other wise as a
consequence of a failure to act
to. The low income people find
a place we're going to the
menu. Do you sing more.
Behavior health because my of
extended time living on
sheltered on the streets
definitely will has and we have
an active we have. Back this up
it creates it it exacerbates it
worsens people health
conditions. So that. Not many
it act. Two police. Are people
going into homelessness that is
the import and we do not have a
farm. This conversation about
the other things that we're
finding. Prevent inter services
these three buckets because it
is I'm not enough comfort for
us a two we definitely are not
looking at cal aim as a back
fill for what might be lost if
we shift these resources around
somewhere else so we do think
that there needs to be of a
fuller conversation about that
not to create more peanut
butter at so that we can make
sure that core infrastructures
not. Austin to achieve very
important other games. Seems
like a perfect. Thank you very
much again I think it was great.
Thank you thank you thank you.
So we'll we're not
. Panel as
his. Engine temperature in here
next go to Michelle Garber.
Thank you and I hope you don't
get too tired of me by the end
of today. So the- panel was
presented with several
questions about of the 20% of
the mental health services fact
finding which goes to fund
prevention and early
intervention. And one of the
questions was does California
need a larger in. Of prevention
and early intervention services
and- the end. Yes half of all
counts. I am cases of diagnose.
Mental illness begin by age
fourteen and three. Buy it for
us this alone points to the
fact the absolute bigger
investment and prevent.
Intervention the medical model
often compelled us towards a
feel our system of care where
an individual must read me a
diagnosable state of sickness
before a treatment can be
delivered and our entire system
is oriented around trying to
reduce overall costs related to
that disease burden. Prevention
it came she could be the point
but it's not currently
California spending an
estimated four hundred million
dollars on prevention and early
intervention services through
the MHSAA this is the crowning
that on it the jewel in our
crown. However I have to be
that this should not be a set
up where we're robbing Peter to
pay merry as that we have
outstanding significant debt to
both of them. Part of the
reason my cow port. Removing
the percentage like he ends
that are built into the act. If
a cow. Improving the lives of
millions with serious mental
illness was to invest save. 25%
maybe thirty of its funding the
intervention or prevent it
would not be permitted to do
were essentially locked into a
model boxes up the pie. Purpose
of prevention and inter Andean
under the MHSAA to prevent
mental illness is from becoming
so disabling a proof time
access for under served under
served populations and remove
stigma US seven negative
outcomes associated with
untreated mental illness and
I'll just put a pin in that
because- you will see that here
under prevention and early
intervention outcomes. Have
already been built into the
fabric of the MHSAA and those
outcomes are homeless this
suicide removal of children
from their homes educational
failure unemployment criminal
justice involved and prolong
suffering- these goals are also
put up along side. Groups of
reducing disparities- and
promoting recovery in other
goals there are certain things
that counties are required to
do your prevention early
intervention and certain things
that are optional so the
required bucket we are required
to fund to prevent activities
except first. Counties we are
required to do early
intervention outreach for
Christine the recognition on
the early signs of mental
illness and access and linkage.
To be meant as well as stick my
next. Optional are improved the
act as for underserved
populations and believe it or
not suicide prevention counties
already have to determine-
mental health indicators that
are used to measure a reduction
to prolong Sir suffering and-
for any of the other six a
negative outcomes the program
six. To affect. Also to make
our intended reductions of each
and then explain how were-
evaluating this so we do
actually do a lot right now
related to outcomes measurement
those sorts of things. But
again it within the required
framework that we've been given
by our regulators so if there
are any assistance is it's that
we haven't been. Existent
template or if those aren't the
right outcomes the ones that
we- I am a guy that we've been
given that men. Were also mixed
a further refinement. In early
intervention fund. To SP one oh
oh four of two thousand
eighteen which outlines the
following priorities for.
Mentioning the intervention
childhood trauma prevention.
And early intervention early
six and mood ordered. Reaching
age meant a one at get a
student and I need you that was
college of programs and
culturally attend linguistic
programs and strategies to
target the mental health needs
of older adults and older
adults it's really important
as- aging is actually associate
with a- higher likelihood of
and- almost. Be here health
directors. Not support the
state- limiting what we can do
in terms of prevention and
prevention up to just practice
toward what are considered
back. This is. The reason is
that with a population is
versus California it's
imperative that we work
alongside individuals with
mental illness and our local
communities to lift up. New
ideas new interventions and
ways of expressing already
tested best practices that
were- with these different
populations. These are our-
this isn't as we develop new
programs in new ways to. And we
build a new evidence that we've
actually done this through the
MHSAA if things are researched
and a value to it that's their
outcomes. Examples and this is
just sort of a list so to give
you a sense of evidence E. I.
models that we're currently
fun- peer support. This is
going to talk more about up the
space shuttle from what we
would have brought that to
California without the MH day-
early psychosis programs were
currently developing bees in
half of all counties- including
in Solano county where- like
hell but if. He's as well as
Kaiser commercial beneficiaries
have been able to access those
services. Funding advance
directive for mental health
this is super important for
Jules who- may end up in the
crisis end of the continuum
because it allows them to
express their desires for
treatment- and then in addition
to this training. For it land
as well as school force meant
to help them de escalate and
know how to engage with
individuals with serious mental
health art county behavioral
health directors. Very much
support movement in the
direction of a more population
based health model for
behavioral health delivery
where we can double down on
prevention and early
intervention we believe that
any movement to reshape the
MHSAA. Must recommit the state
to these important goals and
draw from all the great work
we've already done in this
space and again that gets back
to the hole. In our
conversation we just had up to
focus the inmates say where to
put the attention you know the
one thing I did not. And the
list at. Out was put in check
and you know we have to look at
how are we as a system going to
prevent individuals from
entering the public. Health
system in the first place when.
Art by. Some kind right there's
gotta be accounted. That end
are the public safety net we're
there right now to help catch
people. When they fall but to
many people falling into our
system. I would argue at he
says that. Sing societal part
things like hold off. Problems
the engines out some the case
of homelessness can argue that.
Our do it in this way to say to
prevent our clients from tree
homelessness in the first place
we can't prevent- the volumes
of people they're going coming
into. Today writ large and so
the. The chain and the strategy
to address that on a statewide
basis must be much. Bigger the
we would argue is for all our
systems to do better- we need
to go beyond our basic parity
requirements and go the extra
mile to acknowledge the need
for improved access and bill.
Put up police say because this
pro. In the commercial. System
as well as public system we
need to start to take serious
mental illness. Crisis will be
one- not solely with an HSA
reform thank you. Next we
apparently on mir. But it's
good afternoon. My ex afternoon
inter person around the life
members of the assembly budget
subcommittee I'd like to thank
you for this opportunity.
Discount to depart. I'm almost
person who has been empty purse.
Anyway sorry but it is blessed
it is my history so- when MHSAA
was just about what initiative
with prop sixty three- and as
nami affiliate member and
eventually I nami California
board member. I advocated for
that passage of this
proposition hello with so many.
Date pass the- have watched and
contributed and impacted by
prop the- its maturation as
MHSAA. During this time at the
very beginning actually. On. I
have I was on. Because of M.
HSA funding I was eventually
employed to run a large peer
run organization in Los Angeles
county call project return peer
support network. Which has a
nearly 90% MHSAA find it. It's
very our pure organizations
around that date- primarily it
just say find it I was. The
MHSAA find dead stigma
reduction- each mine map first
the first PP mantra. People
would say well wait are you and
that and then they would tell
me about their cousin or their
sister or themselves live with
a mental health condition and-
I could get help I am. Nine I'm
not. After spending four years
working for the federal
government the director of the
office of consumer affairs the
thought he said. This is
minutes. Work for the county of
LA. Like dancing. Up without
the MHSAA funded in the program
was to take. So I'm. You would
a not just a year and a
consumer but I. T. E. R. I am
the evidence that MHSAA
programs can achieve their
intended outcomes especially
for those like me who been
diagnosed with that
schizophrenia I'm a suicide
attempt survivor and have.
Experienced homelessness. Even
though we're talking a lot
about numbers and die. I think
it import. It you have this
kind of yes in this time. I
believe that no one would want
to be my friend- that I was not
worthy of help and worse that I
was not worthy of love I did
not even believe that my
struggles were due to having a
mental health condition. I
rejected any form of help and I
also. Rejected the people who
loved me and supported me the
most and that's my- only. It
specially appear. Like me as-
an American woman. Having
access to support in ways. And
it was like dipping my toe in
the water and giving it a try
it is. First described. Help
them giving them this
opportunity to just try it out
our MHSAA programs touch the
lives of so many for those in
most need- people at risk of
homelessness as an example are
outcome from appear respite.
Shows peers are successful in
people that shelter in house.
Your respite the voluntary
short when I. Right community
based. Crisis port to help find.
And it's. Transformation grant.
Grant ran out they were
continuing with and just fun. A
lot less county adopted dot
model opened up to peer
pressure centerless county
again. Turn off. And then
because of its. Shifted to arm
a CSS funding- and then
currently there's a new
restaurant opening on me to
county which will also be I am
to say dollars. Would it lead
need more pure rest across the
state to reach and support
people. And connection to
treatment and supports people
with very high complex needs
living with Smith says and co
occurring substance use
disorders need to know your
approach and people meet where
they are to. Better. They're
trained in evidence based
practices such as seeking
safety Wallace recovery action
plan intentional Pierson. And
professional interviewing and
with the addition of sharing
their personal story of
recovery with interest support.
We see- and evidence has shown
that people move from
homelessness to being house.
Unemployed or on disability to
employ and from the least to
show. Your support is also
proven to help people
participate in and it here to
try and. Family members to feel
confident believe. We were
really hoping this year with SB
ten that well we know what
happened. You know what
happened a little. While but
what we're really hoping is
that we can join the other
forty eight states. To
certificates. Working on site
provide to address. With your
mental health condition our
current substance use
conditions. An HSA funding is
needed now more than ever to
ensure that we have. Robot
array of recovery and
resilience evidence. This. That
are based on evidence does in
the most need. Those outcomes
live it to the people who are
being served sometimes I think
thinking about things very
traditionally. The tree. To
medication. Being in a hospital
when in fact some of the things
we're thinking about that
Medicaid mean find certain P.
no just having a friend being
able to hang out with some able
to. Connect with a with a lot.
How to do that I'm we- want to
make sure that those outcomes
are important to us as well
when funding has arbitrate
limits that do not support
counties to address plaques
needs I worry that we can never
be able to address- the needs
of those who are. More than
house houses the physical
structure we actually don't
pull a community meeting and I
cystic here the ports recovery.
Only at. The need. We need this
and we deserve better. Of the
street that folks are home.
They're looking for is love and
people not math or other things
that are real interest for them
to really look. Next shipping
out there and connected. This
can do in the community. So I
telling you my- pretty now the
only thing I can stress is that
this is not really about
statistics as I said I am not a
statistic my peers are not a
statistic our family or not
statistics this is about people
and unfortunately. Com. So I
wish we could have a very
simple answer but they're-
never usually a simple answer
to. We need something to drink
that allow it relentlessly go
after practices practitioners
peers and program that can help
those who most need to thrive
and for community to thrive as
well. And I know it can be and
I'm here. Today because
evidence that it can be done
and I'm not the only. I might.
Leader leaders as well so free
is not easy. To say funding to
help us move forward in our
recovery thank you. Thank you
miss merry and- before we go on
the Toby Ewing I just wanted to
say that. Important peer
support is. Not been advocating
because I sought success within
the emergency department. It
was this year. Order through SP
ten and how we can go forward
with that piece of legislation.
But if my office can be helpful
at all I'd like to be able to
with you and anyone. Else who's
interested in that. Next we
have to be. Definite to chair.
Mister Mister amulet the
stripper staff. I've sat in
this room with you are in the
other room actually many times
and so I appreciate your
persistence on this issue you
know I was able as hall. For
the. Panel this conversation
aren't new there are. Okay you
taking time some of the files
and. I heard a lot of hobby
brief just because of the time
and I certainly will get. It's
funny to call the E. which may
have- there's a couple of
things that I just wanted to
highlight. That the it is the
P. to say that really sets it
up. If you go back to that.
California struck our mental
health system before today yeah
who was no strategy to engage
early our system rationed
access based on the severity of
an illness and so family
members and community members
consumers came to the little
Hoover commission at the time
and said that many people were
turned away because the illness
was not sufficiently severe
than to qualify for care so the
P. I. component. Of the M. HSA.
Is this elegant vision pace
that recognizes that we can't
afford to treat our way out of
the challenges that we faced in
California whether it's
homelessness or criminal
justice involvement. Tell off
of me so many of the. In terms
of the seven negative outcomes
the thunder PI- PI also was
monumental and that is
identified that brought a ray
of outcomes and if you look at
the- up to the merging or. Or
global definitions of well
being put forth by the United
Nations or the position
tracking among operation
develop. A line very closely.
To the notion that people may
perform. An employee being in
one with that. Health safe and
avoiding service seventh. So P.
I. is groundbreaking because it
says that we need to invest in
strategies that are upstream
that engage people very early
and very cost effective ways
and do so beyond the
traditional clinical modalities
of what we might think of this
as mental health and the
language I think torque it was
a little shocking to our mental
health system because it called
upon the system. Is that it had
not in the past in in that ten.
Time Sistine over the. Issue is
around how many span. Or over
the purview of behavioral
health directors. May not. The
tool women for example or to
address housing rights and
that's very real. One of the
one of the ways in which. This
tension at least that to the
commission that we see it. Is
up there as pot. Purses the
image there is a revenue stream.
I think it's very clear the-
well and it. Today a and
heading even with said more
than. Rating are insufficient
if we're going to think about
prevention in. Terms of all of
those things and so we don't we
don't think that way listening.
To have what we think about
this. The mission really design
systems that will support
prevention that touch upon all
of those issues not just
through the delivery of mental
health. Services and responses
and not even just through
public sector. Dollars but the
cop and today was around the
commercial side okay. But if.
And at full or reducing child
deaths so many of the
interventions that the state
has been promoting have nothing
to do with spent a public
dollar and they have to do with
education and awareness and
changing behavior you know
raise your hand if when you
were a kid to put suntan lotion
on. And raise your hand if
you're not doing that today
because we learned a lot about
what it means to provide. It
prevention is really leverage
not just the financial
resources that the state has
made available through I just
say or to the other phone at
end up to support our county
driven public mental health
system so a I heard a lot about
the various components to the
M. HSA. In about some of the
pertinent that were there
they're in every county there
is one or more bands that are
fundamental key care- ticket
we've he of her and today we
can highlight more- the
commission has really been
working to identify a handful
of those programs that are cost
effective and begin to roll
those out as a statewide
strategy not necessarily in
every county early psychosis
programs the best example that
we have with support from the
legislature- with support and
partnering with. UC system and
the money's. If seven. As was
mentioned it's partnering with
us to try to build out a
statewide system of or the-
Roach- in partnership with our
universities and it's a
learning piece to that. Head
space came up with to call all
co here- the school mental
health work suicide prevention
work the commission recently
adopted the state. Suicide
prevention plan it should be
released publicly in the next
couple of weeks. This is late
and push it out. Hello. Hey is
in part of these discussions we
get asked quite a lot. I the
check in this is related to the
quick we are finding SP ten oh
four. SP ten of four has a
couple of. One is to direct
them to give the counties
directing that to priority. P.
I've thanks ten for the
programs to the extent that.
Come with us they are counties
the option of deviating from
that list. It also asked the
commission to establish a
framework for evaluating PI.
Part of the challenge we have
is that if he recognized our
our traditional primary
secondary and tertiary
prevention modalities borrowing
from the public health model
and you apply that to the
broader. Issues that P. E.
identifies from from
homelessness and involved. How
long suffering it's very
difficult to say how do we
value wait a strategy when IT
such with this such a broad
array of intersections between
primary secondary tertiary and
these domains. Where the
commission is today is we've
night. California I think that
Max shared understand what
prevents. The mental health
space. Between the at sign. An
HSA riding if we take. Work the.
Issues that are touched upon
and then and then look at them
through that primary. A lot.
The process of engaging the
World Health Organization ten
yeah National Academy of
sciences and others to begin at
this question. Can't how can we
begin to create a shared
framework for understanding
what prevention means and
mental health. Through which we
can begin to identify.
Principles for making decisions
about how to prioritize. The
much broader town. That had
deployed. Since he I'm a county
I think there are based on the
work done with the county is
the conversation that we've had
with our research experts and
other partners there are some
things that that we could that
California could do that you
could do to strengthen the
strategy around funding
allocations- for example we've
counties that have been they
have been required to return
CSS fun. Because they felt like.
101% all. Available need on the
tools that they are. They'd
like to shift the I. but they
can't. Actually which are there
are no more unmet needs that
those domains for disturbing
disturbing these dollars get
set aside and the legislature
can re imagine what that
distribution looks like that
language was envisioned for
estate why prop. Right and that
when all needs are met each
county can that that. An
example I guess it was a-
research indicates they serve
everybody who's eligible for
CSS dollars but they can't
actually reallocate those
dollars Intel LA and San Diego
in Orange County and everybody
else is in the same spot so
there are some opportunities we
think that that could lead to
some. The case CSS that- set
aside for F. S. P. actually has
been met. But but short of that
it's very early for us in in
all the literature that we've
had in all the effort that
we've talked about. Think about.
How to pick what's the best
cost of that prevent. Find
Sierra orange in LA with that
I'd I'd be happy to respond any
questions you might have and I
want to thank you again for the
opportunity thank you Tony and-
next we have Kelly Pfeiffer and
will return for questions at
the end of the path okay better
employment staff thank you so
much it's a- honor to be here.
Any moment in time in
California. Racial opportunity
to change. Because the moment
like this where the governor
the administration. See the
latest. Of. We have this unique
moment in time with the medical
waiver for men. Thank as saying
you know what can we do about
this particular waiver the
other saying what is the
Medicare program in the future
look like and what would
America from look. Really
delivered on behavioral health
outcomes and overall care
outcomes and that's what my
colleague Brenda I'm really
should be talking about. And
also on this this MHSAA as much
as we focus on a visit aren't
working having practiced in
other states it's incredible.
To sing in a to. Work in a
state where. These services can
be. Either way. Friends are we
bring in. Your may I brief
testimony some. Ready about. He
agreed with mers I can set some
all star. These are the we're
going to see a different center.
Loves to read we'll help
business to making sure we're
not putting our people with
mental illness and substance
use disorder instructional
justice system and really take
care of our high risk kids and
what's interesting about PI- in
particular damage as well as
you can really see. Townies. In
this work we do have is state
what I'd metrics and being able
to quantitatively to distort.
Robust evaluations and you'll
see some real impressive
results but we can't yet tell
that story at the statewide
level of my department's
committed to that. And. The
third team- it just about
making sure as we face the work
we do rate what works. Reflect
in a couple a few ways that an
HSA NPI has its frame now is
making an impact on. These
populations Amir stammer talked
about- you know first in terms
of criminal justice a- full
service part. There's a bit of
us to evaluation Toby against
did was. As in people and they
have. A full service
partnerships and I'm people but
it's been a program had half
the arrest afterwards as they
did before and if you look at
the subpopulation with frequent
arrest those of that restaurant
we went down by two thirds. And
those who are homeless arrest
weightless I have no we do have
a statewide. Story to tell
about service partnerships I
think is important remember.
And then what P. of corpses in.
Where is says within the
program cannot reduce income
and equities and housing costs
but we can intervene at that
critical moment in time before
someone loses their housing.
And prevent them from ending up
in the criminal justice system
are of with homelessness. And
then there's the other
population of high risk kids
many of the programs you'll
see. Five into the- hi only a
few days with diction and make
sure that that doesn't. Happen
county welfare program because
no outcome is better by foster
care so as we can king family
there. Again okay- we change it
to say let's protect what works
I'm a just a few questions on
my own departments- work around
Pete as you know the work how
old. Work with news we do
fiscal oversight making sure
that the spending the county
matches the three year plan
that their- is. To have the
prudent reserves to make sure
that as we have recessions that
were able to continue the
programming and we do program
oversight as well including on
site reviews- working with to
make each come. MHM. Is done
well and if they need for
corrective action. Working with
that county and I'm also great
to the procedures you provided
us. To have I have to do more
techno. Since it. To make him a-
I do want to be honest about
the challenges and I think I'll
close with that have. You I'm
glad we can have a specific
panel on on statewide goals and
metrics because- we really do
have. An impact I pray. And by
setting ourselves some goals
and then working with the
counties many a county. Things
that matter that measure that
are really impactful as
Michelle had mentioned- but we
had don't yet tell that story
at the statewide level. Am I
due a refund when that is that
is the best part of an HSA is
this local flexibility in the
local control because. We are
able to represent tumors in
families in planning because
then. You know we are not the
needs of LA is said. Then that
flexibility is a real challenge
when it comes to innovation
fund because some of the best
innovations are when you were
first follower Nanda so the
first time to do something but
taking a with. Ex and spreading
across the state and so. Lots
of reading work happening
around the psychosis mentioning
that. For kids. You get the men
within two weeks and if you're
waiting a few years. It was
mentioned but of people with
mental illness self medicating
with substances and a working
how lame is trying to recognize
that these clean lines we used
to see between substance use
disorder and mental illness or
not so clean anymore and when
especially young people present
was psychosis as a family
doctor it's a it's a futile
exercise to try to say is this
because there's like- because
they're using math we- people
where we are. To beat Pete
telling a- especially with kids
the street is a. To work in a
state that's invested. So
heavily in the care of their
most vulnerable with the band
and. During the many people and
we haven't made a film kept.
But we can do better portal
called on the table to. Thank
you. Members when it's Ralph
when visiting the sailors
office as you may know back in
Feb or two thousand eighteen we
should report on the funding
and oversight of the mental
health services act and found
significant challenges. That
prevented the effective use of.
But it period of eleven twelve
through fifteen sixteen one of
the main issues we found was
that health service. Oversight
of the counties and use of the
funds was not effective. Purses
did not fired guidance to
counties regarding how to spend
that much safe fun and it was
lacking in its ability to
oversee what how if the funds
are spent appropriately. This
concerns on oversight allowed
to hundreds of dollars to spend
every. That could have been re
giver. Okay back to other
counties so they could be used
to provide those services. Port
debt of nearly three hundred
ninety million dollars as July
seventeen that was subject
reversion. The state law did at
the in act one time change a
two thousand seventeen that'll
locals to retain those funds. A
group plan on. What was our
concern that health. Not this
stylish no plane river. Says
has established a reversion
process- for reverting unspent
funds to it up to the counter
and then out reallocated back
to the counties. The thing. We.
Also concerned with was with
the level of image say funds
that the counties. In receptors.
A lot but so far the
appropriate reserve level we've
always held reserves. Five
hundred and thirty five million
dollars. Which was reserve will
pull of a proxy 4% or else is
identify most reserve what
about 33% which would have
freed up a hundred and fifty
seven million dollars in
additional funding they could
have been used for mental
service says- since our audit
in two thousand eighteen the
legislator. Legislator in SP
one nine two amended state law
I captopril reserve a 33% Again
this is something that was
important. Edits also we noted
that SP one ninety to clarify
that. The in. P. C. A. S. we
humbly dot in unsafe. Of
interest that had just been a
key. Yes but interest falls
principle this could offer. To
be. Force structure. And of
levels will help ensure that
the candies actually spend the
money and not just a mass
hundred million dollars in
unspent funds. We also noted so
positive approved Paul the day.
Since since we- interactive
image say transparency database
on its public website that
provides financial and
informational information on
the state programs among the
tables you can review and
compare eventually funded
programs a key characteristics
such as target populations
budgets and program goals.
Including prevention and early
intervention funds- this was
something that available.
That's set up. Understanding of
where the funding is good. Been
approved of that information
was available at the county
levels but you have to go
through report after report and
I don't think that's something
that the average person was
doing now that's available
publicly with thing that's a
positive thing. We all did that
at the time a report the
counties were. Not providing
their annual revenue
expenditure reports on time.
Matter of fact at the twelve
and these were. It reported
some he health care services
has established a process them.
To withhold 25% of actual of
annual. At current county
finally. I do also want to
mention that we do have a
current auto involving images
Hey although we cannot see.
Letterman pitcher short act
LPS- regarding the in treatment
for resources for patients or
involuntarily held- the scope
of this because I would you say
is the primary funding source
for county mental services. The
audit will touch or may touch
upon funding and out. Existing
programs in counties so that
report is US scheduled to
release in April twenty twenty.
The concludes my remarks. And
I'm available for any questions
thank you Sir next we have
doctor Eberhart. I'm in the
first panel on my rand
corporation colleagues and I
have been paying sixty three. I
programming for over eight
years I will use some of the
things from these evaluations
to inform some of the questions
posed to this panel. You pose
the question this California
need a larger and- did not
directly. Funding level for P.
I. investments. However our
valuation findings to provide
at. The I. programs are
beneficial and that investing
in PI. In your stream cost
savings for the state. With
respect to benefits be found
that Los Angeles county. My
server is and so our men's
community engagement pain in
the county that's fully engaged
in people and- how to get help
for a mental problem. At the
state level we found that P. I.
campaign is worse give use much.
On this. Pulse services. Then
to intervene with those at risk
for suicide these are just a
few of the benefits I. Buy our
evaluations. We also found
evidence at St P. I. programs
yield it up. That's meant by
leading a cop says this man.
Yes he did with financially
beneficial outcomes such as
higher productivity earnings
and employment programs that
reduce suicide rate potential
to return large amounts of
money to the state. The
reverted medic how healthcare
costs. The times and priest
income tax revenue from all her
life thanks again. Angel
benefit is that our list of
cost. It is important to
provide a full continuum of
mental health care. Early chin
to treatment for those serious
mental illness spending on
prevention can be controversial.
When there are so many
seriously mentally ill people
and their needs. But the value
to support the next guy. Entry
incompetent they are both
spectrum of mental health
services. You ask to ensure the
state limit the P. I. options
for counties based on best
practices. Well I know that
look tension county and the cow
may sit stay away yeah I put.
Have carefully chosen event.
This is an- elevations of these
pro. Deed indicated that they
are effective in the diverse
and vulnerable populations
served in California. Although
many evidence PI practices are
available. Counties in the
state could consider using a
small letter practices. But in
a support. Implemented in the
populations for which it is
intended and delivered in a
manner intended but it is not
feasible to monitor how a large
number of practice is are being
administered. This thing on a
smaller subset a practice.
Easier to ensure they are
administered as intended and
yield the did Rick. Since he is
particularly if he's
collaborate on investments in
training monitoring out by you
with. Were there are trade offs
given how did California is on
the- take. The county's engage
in counties also need to delete
to tailor the implementation of
evidence based practices to the
unique local needs and
populations although there are
advantages to why the
implementing a smaller number
of evidence based practices
there in line with statewide
goals any effort to streamline
option should consider counties
needs. To be responsive to
local stakeholders. What
challenges have counties face
in spending their prop sixty
three finds well I certainly
won't go up on this issue given
that our evaluations did not
directly address spending
challenges and the other
panelists here certainly better
equipped to weigh in. But I am
aware that some counties have
not been spending out their P.
I. dollars which might give the
impression that the funds are
not needed. However some county
support that they have trouble
spending P. I. funds because
the funding stream is viewed as
not being flexible enough to
meet their needs. For instance
county state that the time
frame in which funds need to be
spent makes it pulled you stop
and launch. A new program. In
counties may still have some.
Yeah hi I just say. Challenging.
And accountability how lex
ability in using P. I find. I
appreciate having the
opportunity to weigh in today
based on my experience as an
evaluator of prop sixty three
funded program since twenty
eleven in the interest of time
I try to keep my comments today
focused with limited examples
very but my ran colleagues and
I have written eighty reports
relevant to prop sixty three
over the past eight years. And
I would be happy to answer
questions about our work today
or at a later point in time.
Thank you again. He tapped.
Thank you doctor Dr read the
two of them. They aren't my
homework read them all. There
is a top. I the specifics that
sounds great I'm but before I
begin wanted off a similar
refrigeration. Just anybody on
the panel so we look at the P.
A. is there an integration.
With the locals constraint is
expelled when you look days in
the schools and we talk about
early. In. My understanding is
that there is that the schools
just knowing ministers to the
ID population and we have. Ways
to college counselors so we
have this. Set of children that
are not supported by a mental
health aspect to it. Thank you
up legislation just been passed.
But it's still going through
the part of education on how
it's supposed to be implemented
is there a collaborator could
her. Are there because it's
being gullible to administer to
children. To phase. There are
lot example counties
collaborating with schools-
Alameda county has a very
aggressive program of using
their P. E. I. finds through
their schools Sam. Plaster
county I'm less certainly Los
Angeles and I think you
Michelle might have tells. Only
made a commitment and the
directors here if you can talk
about that a parting with their
schools. I am a few years ago.
Mission set aside a portion of
our SPD two funds in order to
incentivize these partnerships
and- more than a third of the
counties stepped up to the
plate. And applied we were
unable to provide funds to all
of those counties some counties
indicated they wanted to they
didn't have the capacity to go.
Through the application process
that led to the passage of the
mental health student services
act. X. I'm. To do that there
is had. That would get in the
way of school in county
partnerships however as you
heard there are some rules and
there are some restrictions in
and what we find. Is that the
will is often there but what's
missing is the house. In that
these partners can struggle and
how to cook how to collaborate
because of differences in
culture because of training
rules- often- miss sender
endings of the vagaries of hip
and verba. Fat both federal
policies that restrict it and
sharing. Same time their tents
from throughout the state. Sure
pull the information out of
those examples I think what you
heard from the auditor with
reference to the transparency
informational website. Is
there's more out there than we
can keep track of but what we
want to do. Eight experts best
to be able to learn from their
peers and so I would say yes it
is happening. All over the
state but it is not happening
in every community and every
school. Today a major. Cool
county health and school
districts in almost every
county throughout the state
what we don't have is the scale
so that in every school site
you have a county behavioral
health partnership. And what
I've learned from folks is that
there are several- years to
this one as their explicit
mandate. We've done a lot of
work. Partnership putting the
map the budget- which Toby just
referenced but the other piece
is- you know you have to have
willing partners on both sides
and- on I would say that you
know right now the best way
that we can approach this is by
trying to organize a pot luck
of financing where everybody is
a little bit. Into the bowl- of
all children in California our
medic how eligible the other
for not and fix. The car. Want
a screening for insurance when
a student comes through the
door. Needing services and so
we have to figure out a way to
account for that half of the
population that is not medic
hal reimbursable so that's one
kind of structural barriers. Or
issue that we need to get to-
the other piece to your
excellent point is that there
are. School be based at mental
health or behavioral health
support providers in schools
today who are really trained in
oriented around helping
students be prepared to learn
and to achieve their
educational goal and I want to
be really clear. That the V.
work that we're putting forward.
About supplementing those Sir
it's not I. Am replacing being
replaced by them it's a
different. Service talk. Kenny
behavioral health then in need
for us to ever going to really
get to this population based
prevention model of median
children in families where
they're at and you know after
the age of five I it is Dr I'm
black kids don't. Time. In the
pediatrician's office- you know
my daughter so excited she she
does they're back couple years.
And so unless you get sick we
don't go to the doctor- and but
where kids are is in school and
where their- issues are likely
to be getting surface through
behavioral issues in the
classroom and so you know we're
already seeing the results of
this and yes- are Fresno county
directors here and she's got a
fence sick model in place but-
they're- much more we could do
is this. Aston tools- schools
also have very limited space
available for one on one
behavioral health sections and
so that's another kind of
structural issue. But we can
get over those hurdles- if we
really. Have a will to double
down on this. Piece of the
continuum. And so but soon it
is simply to think about
charters. To know K. twelve
need to think be thinking about
those this pre K. opportunities
as well- but the opportunities
are also there for those
students that were serving
their community colleges who
often vulnerable. Because of
poverty and other kinds of
issues but also there are you.
I had some conversations with
universe. System about what we
can build some collaborative
partnerships between K. and
that the campus. Also those
places with a lots of expensive
areas of expertise particulars
campuses at that have health
systems and so we really are
trying to facilitate the kinds
of parts of that you're talking
about and I would say the peace
that that that really encourage
you to think about is the T. is
the technical assistance pace.
It it it can be very difficult
for asking people to change
their behavior to change how
they spend money to share risk
for institutions that have
historically competed with each
other right they go they go
before you well then they say
every dollar that goes into
health is a dollar that's not
available for education or vice
versa and now we're trying to
say we have to win. To actually
leverage bow. I appreciate
that. But if he- ever was made
for you say that the most.
Effective this can occur. Where
they are in in in mass you know
when we talk about. Early
education home what a child
could feel comfortable about
reaching out about anxiety
about other issues about.
Anything that has about a
mental health component that
it's okay the stigma can be
removed and that there. Well to
reach out to that individual on
site to get the help. Because I
mean kids can be me. And it
starts right snowballing and so
I'm just hoping that we can.
Start a- start a process
through the health class
whatever it is. That we have
that. Dialogue with that each
individual student saying. Okay
if you're feeling anxiety or if
you're feeling suicidal if
you're feeling what ever. Talk
to social. Back in the day what
does a school we had that
counselor. Okay the kids today
don't have those counselors on
site. And a lot of my schools.
And so we called the trainers.
Has the ID population is
supported you know and- I think
that we need to be able to.
Look at the collaboration from
the mental health experts with.
Be a part of education. And
collaborate how we can better
advance billionaire
intervention and education- to
be able to have. That. Santa
Barbara CM and not orange enter
a Kern sounds of this percent
of our a and deal that we had a
over a hundred fifty high
school age students who came
together for and mental health
division I. The university of
California Santa Barbara. What
they groups with some adult
allies but very much you've
driven- almost to a one they
identified the need for a safe
place on campus where young
people could decompress relax
could seek help right they they
propose bean bags in hand next
hanging chair. In open plan
it's a new things you need to
do to create a safe place for
young people but very
consistent with with with with
your observation that's what
young people said that they
need in their counties- the
outcome of that we hope is that
the counties that were in the
room heard from their use as
part of a community planning
process what we want to do is
bring those counties together
to say how to make that happen.
So they don't reinvent the
wheel how do we begin to remove
some of the barriers to making
that happen how do we do the
education there S. identify
funding streams you can. Use
that matches the innovation
funds that you can use P. E. I.
for the- other sources of
funds- but it's complicated
it's difficult. Again because
oftentimes these are not. That
have done this and so we're
really trying to build a
partnership for doing to more
of the fifth generation labs
all focus on school middle off
so I think. Your comments are
very consistent with with what
we're hearing from young people
all of. Posted there. Also look
at the private insurers and
figure out how we can hold them
accountable for. That summer
social safety net and- yes-
towards early interventions and
prevention's I think it's an
important part of the
conversation but I wanted to
come back if I could to- mayor
Steinberg's comments regarding.
Whether there were efficiencies
and focusing early
interventions and. I come at it
trying to figure out if there
is a way for us to. Either sent
a virus or encouraged and types
of programs so that we could
have collaboration at a
statewide level. I look towards
the early psychosis as an
example of one of those types
of programs without again
trying to be overly
prescriptive. With any specific
proposal but simply if that
county was having issues with a
certain metric trying to meet
T. their trauma or child
welfare system. Could we have a
learning collaborative could we
have similar to the end. Later
that we have that could be
helpful in allowing counties
tell learn best practices from
other counties. Wondering if
you had a calming you are
describing the state of the
MHSAA today and. What I would
say is that you know on early
psychosis at has been a focus
there how. Fast it. MHM on with
some federal grants but.
Referring to my we have early
psychosis programs in more than
half of our counties either up
or into mensa thirty five out
of five fifty eight counties
early psychosis programs not
see here but probably doesn't
make sense to put one okay. I'm
just this from my first his. We
are knocking the part and the
learning collaborative's are
really an opportunity for the
clinicians to get together and
talk like clinical practice
what's working and what's not.
We are tailoring early
psychosis intervention so we
lifted one up in one county and
found that for the largely
immigrant monolingual Spanish
speaking population that they
were supposed to be serving the
provider was not. Hitting the
target they had English
speaking clinicians they were
not meeting the place where
they were at culturally-
linguistically we modified the
program we said do over we need
to a retailer this program so
that meets the needs of this
particular community in
geography. That's exactly what
we should be doing on early
psychosis and I think you know
it's early days because the
field is kind of early. Days.
Really laugh sting. I'm I think
the question then becomes.
Those other kind of more home
grown types of innovations that
we're implementing where to. We
open. Up the space for clients
and we say tell us how you want
to be done tell us how you get
and they tell us do we not.
Move for some of these other.
You know more pointed north
star star type of goal. And.
Then we just need your full be
we've read. And some space.
Create an evidence based around
community defy diss that
otherwise wouldn't be available
we're not perfect it's not you
know I won't say that there
isn't room for improvement in
terms of- all all of the
various dimensions of diversity.
Being out do not reflect the
populations that we need to
serve in California and those
are areas where we could make
targeted investments in
different ways from a workforce
development standpoint- but and
we also need to be mindful that
are talked to by- psycho social
model and so it's not all about
clinical part right some of
this stuff for the people for
medical model for may feel
kinda squishy but it might be
just as if not more effect of
it getting to where they need
to be in terms of their
recovery. And so I think- you
know yes some focus is helpful
because maybe it'll give folks
more confidence in the work
that we're doing but in terms
of some of the specific exam
were given. All our response.
That's what we're doing right
now today in something. It may
feel like it's not enough like
on the school based tips right
we're not in every school.
Comes a girly side assist. A
foreign at in right now New
York doing pretty well as well
but they're small I hear what
you're Sir. You know I was.
Troubled I think is the best
word can by the auditor had any
set oversights currently not
active that me and went through
two fifteen and sixteen. But
and we have done quite a bit in
the recent budgets that will
help us to ensure adequate.
Reserves as well as counties
ability to be able to spend
within their three plans. But
I'm trying to. Really look at
this as. A resource to limit
and we. The dollars we have
and- I tend to focus looking
now cops now I've actually been
moved a bit by brands who.
Reminds a we are people who are
seeking care who receive the
care and aren't just numbers
and how important it is for us
to look at the whole person
within this discussion. But my
fear is we do have limited
resources and how do we.
Effectively apply. This
discussion. The currently
occurring at the county wide
level. Okay I'm on its side
it's make. Us better on the
whole we welcome accountability
in for you each of the lines
they tend. Going into this new
role knowing that our team is
working hard to address them
that the- revision process was
implemented this last round of
revisions was less than 1% of
the total budget so we see
counties really stepping up-
and doing the work to make sure
the funds are spent
responsibly- the reserve. Issue
clearly was an issue and now
that we have the legislation
capping reserves there's a plan
to make sure that each county.
Goes down to that reserve level
curse. Clear and if they got
the L. A. C. could you. On the
phone AS teach CS the command
to modern their data. Brand
before but then we and I think
we're gonna be better five
years from now than where we
are now- the lateness of the-
ari ours has been resolved a I-
it turns out when you withhold
money that people. Work in on
time I don't think it's the
only mechanism that this the
store closes counties. It
should be during the case I
think it worked and we look
forward. To an ecstatic. M.
chair you may. Take because
this work and I just wanted to
point out and it might be the
nice transition to the next
panel. Is that project started
with building a data
foundation. For the early
psychosis programs building off
of the New York model actually
and we recently brought. The
folks from NIMH and from
ontrack New York to Sacramento.
In partnership with them some
of the different administration
and counties- but a hundred
fifty people. To look at that
model but I won't. Say that I'm-
thanks to me we're trying to
get done where we have a model
how do we implemented with
fidelity to the point that rand
is making. How do we build the
agreement across providers in
terms of the data that we're
collecting and analyze that in
a way that uniform. So that we
can tell the press the
individual story the
programmatic story and the
statewide story and the intent
is that we do have a statewide
system over. The services that
are available to everybody
including Sierra county even
though Sierra county may not
operate a program through
regional approaches to that
collaboration. And I do think
that is where California's
farthest along in terms of
building out the infrastructure.
Again data data data right and
that can lead to the kinds of.
And ten other read. So push us
to move towards the most cost
effective the most efficient
care because we can begin to
look at how quickly as doctor
fiver says the two week
engagement versus the two year
engagement what does that mean
in terms of proving educational
outcomes reducing. On reducing
its involvement well if we can
do that for this eco system we
do that in. Their component.
And I do believe that is a- way
into our third panel thank you.
So you don't this is a. Okay
yeah well then I won't. Go into
the thought about it. Your view
of the. Yeah thank you for any.
Do you. This is. Do it. Well we
but I think you're- a little
bit. Yeah okay. You know. I'm
leaving I'm just taking. We
will begin our third panel on
transformation the alchemists
based director you talked. Yeah
in chair and members- you take
the behavioral health director
in Fresno county and a special-
greeting to my assembly member
and a doctor were ambulance. A
county behavior health
directors support a movement
away from MHS state funded
programs are built around
finding percentages and instead
moving toward accountability
for outcomes because we also
want to know how do we use data
science and outcomes
measurement to improve people's
lives rather than show
compliance with rules and
regulations. Which were pretty
good act counties today collect
the men. And use that as a
programmatic into. It
extensively by the best
research institutions
throughout the state you've
heard from brand UCLA and UC
Berkeley have also done studies
of some of our programs. To
understand of our efforts are
working. And often they are.
Are full service partnership
model which has been
repeatedly- evaluated has
demonstrated to work for
reducing hospitalizations
emergency room visits
incarceration and homelessness.
All of which are important.
Goals for the people we serve
the problem. Transparency place.
We. Counties in the event.
Ending but the structure of the
funding which is built around
both aspirational goals as well
as in fast funding percentages
with categorical. Grant
programs within those has not
served us well allocations the
percent yes that community this
is. It works even less well in
small counties which have to be
more integrated and we're 20%
of a small overall image as say
allotment is a really small
amount as an example I'll give
you. Alpine county which has a
population of one thousand one
hundred compared to my county
which is a little over a
million- the MHSAA allotment
for two thousand and seventeen
was two hundred and seventy
five thousand dollars. Total to
meet all of the program thank
and regulatory requirements
which have been laid out by the
state. Another important point
is that there are often not
clean lines between the
components for example we have
innovations which are also
prevention and early
intervention. Focused and
there's been historically
blurred lines between what
constitutes P. E. I. in CSS due
to a lack of clear guidance at
times from the state. Rather
than get hung up and ensuring
compliance with funding
percentages we believe we
should a wind around the goals
that Californians want to
achieve. One important note is
that as a county behavior
health director I wear multiple
hats. Which need to be
considered when we develop
outcomes we are part public
behavioral health part
departments we are a medical
specialty mental health plan
were an insurance company. And
we also deliver direct services
are oversee the direct-
provision of services and we
are 1100% accountable to our
local communities and their
stakeholders. Based on this
unique perspective I offer the
following for efforts to shift
away from the funding buckets
to a system based on
accountability for outcomes.
Any outcomes we develop need to
be measurable based on
available data and reflect not
just the over arching statewide
goals for MHSAA but need to
reflect local priorities as
well and stakeholder needs. We
can't have a one size fits all
approach for example we know
that suicide rates in
California's rural northern
counties are much higher than
the rest of the state and might
need different approaches. We
want to move to a population
health based model. And the
more restrictive and
categorical we get with our
funding particularly for
prevention it really turns into
not a prevention program but a
fail first program you have to
be homeless for to meet your
needs you have to be in the
involved in the criminal
justice is. Pressed to meet
your needs as opposed to a true
public health type prevention
program which is for our one.
The MHSAA propose outcomes also
need to be aligned with the
rest of our funding. An HSA
represents just 20% of the full
statewide investment in public
behavior health spending and
it's only a quarter of most
counties behavior health
budgets. This means that the
rest of medic cow as well as
funding for homelessness
education in criminal justice
system should be aligned with
the outcomes goals that we do
determine. Along the same lines
as a has been mentioned
previously two thirds of
Californians are covered by
private insurance. Not medic
cal so to the degree that we
are seeking to prevent those
individuals from becoming so
severely mentally ill that they
qualify for county behavior
health services. And by the way
I have parents contact me
regularly finding out how they
can get their kids off their
insurance in inter county
behavioral health services. The
state along me. Lawmakers need
to ask for increased
accountability for those plans
as well. We recommend an
approach where a body of
experts which include clients
family members representatives
of county behavioral health.
And doubt us to come together
with the state. To assess
available down and did. Post
white outcomes- if we should
not write it into an
initiative- we need to be able
to- make. As flexible respond
to emergent public health needs
and improvements in data
collection a measurement
science so as we learn things.
People to change the outcome.
Bond to that- and by writing it
in it just made a costly and
inefficient to make any
changes- county behavior health
directors but- strongly that we
should allow for the majesty of
find services for individuals
with the primary S. U. decent
diagnosis. Often hard to get in
under. That at the. Underlying
mental illness when some
struggle a deck and. Ideas move
individuals away from is it.
Safe whether it's in jails
impatient for a cycling in
enough homelessness allow. Flux
lady to deal with what I reckon.
But in our. Use this much were
swept in that progress. Given
the complexity of the variables
were dealing with and the
breadth of the scope of our
work accountability should come
in the form of technical
assistance training and
investment to drive improved
quality and outcomes throughout
the state understanding that
California's diverse
communities will require us to
embrace differences based on
population speeds. Finally it's
a bit surprising to me that
we've barely touched on the
concept of the. Massive amount
a lack of affordable housing in
cal. I could not our obligation
to serve the homeless
population. And we will not
solve homelessness unless those
in a position of authority are
accountable for addressing. The
need for affordable housing in
our state we cannot stick our
head in the sand. And that
we're simply going to solve.
The first show that we have.
Ninety days in with very full
shelters that filled up within
a couple of weeks these are
people you know we typically
hear from. A lot of our local
elected officials not you
doctor. The. The homeless on
our street in front so
. To be
housed in yeah the shelter.
Days they're not. The ability
to get a lease on mon for very
sinister reason. The housing
for them and sub what to them
until they can build a rental
history- we have other programs
have gotten three no. Place
like home awards that we're
working on but still- into
account those in authority has
a waiting list of forty to
fifty thousand people. Need a
portable housing. Got dressed
that issue in California or we
will not solve homelessness. We
see the outcomes and how we've
been able to transform
individual lives- you heard a
little bit and mention of our
schools program- that program
became operational in January
of this year and we're already
seeing. Three and four fold
increases in access to mental
health in our rural areas- with
the advent of our schools
partnership. In that program
prevention and early
intervention. Used to Kate
school. Teacher things like.
Impact on. Regulation the
impact on adult responses to
student behavior and strategies
for D. aesculap E. de
escalating behavior including
verbal strategies and
environmental supports- they're
teaching mindfulness and
developing trauma response of
class rooms- and we are getting
referrals not just to tell.
Kids who insurance right the
most and poor school district.
Some of the riffs wells were
from kids with an insurance
screened in with mental health
it is a hub and spoke model.
Services in schools they can
get services in the hub as well
as in the community and in
their home and we are providing
services to charter schools as
well it's a five year rollout
in alternately every school in
Fresno county will have access
to that program- we're engaging
in learning collaborative's you
heard mentioned the-
psychiatric advance directive
Fresno in Monterey or taking
the lead on that we want the
people we serve. To have a role
in determining- even the
response to them during a
crisis and we're really looking
forward to that work- but it's
still not enough as we don't
really have a single aggregator
or entity responsible for the
evaluation of the effectiveness
of. Graham. Directors of said
loud and clear we are ready to
demonstrate. Ability the
outcomes put before us we just
need more flexibility and the
right set of measures to
harness the strengths of our
unique public behavioral health
system. Thank you for the
opportunity to address the
committee and I'm happy to
answer any question. Thank you
director you talked to viewing.
Thank you again to be doing on
behalf of the mental health
services over some kind of a
commission. Know that the
original nineteen ninety one
realignment. Was structured
where the funding would. So the
lot tremendous amount of flex.
In exchange for tents on out.
Away from that man it leaves
the state side in the sense
that we struggled to identify
this key metrics although we
have them- in many instances
they're not regularly use for
example the budget process or
or to shape. Policy discussions
it's the same time. We have not
made the center. In her with
the L. S. comments in the right.
Haitian you're aware with leave
presented on the commission's
work to make information
available on finding on
programs and outcomes. And so
we're making some progress we
are working with the department
to get today. Tax dollars in
revenues in nature. Than funds
I deeply that we need to stand
on the fuller picture. Of
finding. Who highlight or shame
those counties that are
spending dollars that's not the
issue at all this too is to
actually resource the
communities that are doing
planning is to help them
understand what options are
available how much money do you
have to spend what's on the
table and recognizing the
damages say is 20% overall but
in some communities it's more
than that it's twenty five or
thirty or forty percent. Of the
counties funding we ought to
look at the other five that are
available to ask. This question.
Missed opportunities dried up
the kinds of analyses that we
need to be able to do in terms
of funding the programs pieces
the second part of our
transparency effort and again
that is to help people
understand what's out there as
a given county. To understand
who's doing well what. The most
common health program in which
to help. I'm more need there
then we can accommodate at the
moment this strategy of helping
the public and helping
stakeholders understand what's
in place today who they're
surveying and how and how
impactful I think is the
foundational piece to really.
Move the state towards outcomes
it means crowdsourcing at a now
that's about on healthcare this
is. What what city is here and
it's okay can do. Simple he
said that the out. Mentioned
earlier to but the FSP data and
we're saying he never can-
improvements in reducing
criminal justice involvement
but that's at a tiny area. Very
tiny area we are currently
investing. In understanding how
to link school data with mental
health data so we can
understand the impact that
these kinds of programs have on
children and families. We're
trying to work the eighty day
to link mental health and
employment data we want to work
with the SS ensemble for data
we have an active contact with
UCLA to skin all of the data
sets that are available to
help. States and other
countries are actually
measuring performance for
mental health and they've given
us some preliminary information
on a couple of the P. E. I.
comes but the intent is to
actually build out those
metrics and begin to report.
Ways that really shaped. This
broad public accountability in
in on we get out. In a lot. Of
teams. Have been forced. Side
of thirty that we have is the
ability. To see the dialogue
just to communicate to the
public what's working what's
not. But we have to put with
that a strategy to move from
not king to what working. We
lose that hope. And that that's
in the public so you know
consistent this I think. It
thank. We could move more
effectively in and we could
move more expansively. If
consist with the alley if the
infrastructure were in place I
don't think. Start with. What
we need to do. Data we have in
through that process. If
there's the. Visit the you that
require. So you know I'd I
would love to talk to you some
more about steps that we could
take am I certainly wouldn't
want to go fast or too big
because this is. Complicated
stuff I will say that we are
farther along. Than most other
states. A couple of pockets.
Psicosis work in New York. And
the mental health field is
farther along than just about
any other area of public
investment. We know a lot about
transportation right but when
it comes to health care in the
complexity of a system like
this. We actually have greater
transparency around dollars and
programs and outcomes than in
most of the public program
hello. And so it. Pratt that we
collectively have made even
though we have to make much
more thank you thank you-
telling him is trying to focus
some of the efforts on reducing
or some of the redundant
reports and so I do think
there's an effort and I would
like to. Lot guarding maybe
there are ways within the state
cap that we can. Focus or
assist you in data collection
but we will follow up cut off
line. Next we have doctor five
for. Greater will be quite
brief visit when echo some of
the things I heard from Toby
mean transparency is a powerful
chip. In my career and family
medicine and the army you can
change how we practice space.
But I hate. The other. One of
the biggest malls Peter is
there are and if you can create
standardized metrics we can see
how you're performing. On the
transparencies powerful so Hey
I can see that we collect a lot
of data and we don't. We could
do a better job of making an
intimate confirmation and I
think that's what our- team for.
He says this. At ten ten many
counties core data formats we
don't have an electronic
waited- synthesize it counties
are different in their
geography of their population
size their demographics and
their work force in their
programming and the work we're
doing in the department of
trying to integrate different
data sources as part of our
overall data modernization
effort is slow and painful and
I wish I could go faster but I
can tell you we're committed.
To doing that. I'm data press
P. even as I was before we
don't have great attention. And
so we do if you are part goals
set the Cup come down from our
governor's office and our
agency I think would be a great
time deciding on what
performance out. Match so the
most meaningful. That can also
collected given without adding
additional work force these are
decisions. Your name we've got
a very real take a process
because we do. The answers and
so I think this would be one of
those things that we would need
to do. Collectively. We do have
a great opportunity in the
innovation fund and as I
mentioned before. Bulls to not
to look is what looks. Tell you
take there's a lot. The firm
proof read. The county try to
figure out something that's
brand new from scratch how do
you take well have. Spread them
and really be. Sure it works.
Thank you five. Hello brand
from non. Afternoon Jeremy let
members of the subcommittee- my
name is Angela brown and I'm
here on behalf of nami
California. Is that better yes.
Our name is Angela Brandon I'm
here on behalf of nami
California we are the statewide
affiliate of the country's
largest mental health advocacy
organization- the National
Alliance on mental illness- are
nineteen thousand members and
sixty two affiliates include
many people with serious mental
illnesses their families loved
ones and supporter. When the
MHSAA was passed in two
thousand four it was done
because of so much work the
dedicated advocates consumers
and family members some of
which are here in the room
today. And it was then and
still is a really remarkable
thing for community mental
health. It promised to
transformation the mental
health system from crisis.
Driven to one that's focused on
prevention and wellness
expanding so close previously I
heard population. Recovering
empowerment spurred this
cultural shift in the way that
we think about. How. And it's
through that that leasing and
have more choice and- a and the
door. Decisions that affect
them than ever before. But
we're challenged because we
don't know what the impact of
the billions of dollars that
have been infused into the
system. Has been. As shared by.
Many of the folks here today on
this panel in the previous
panels. We can't adequately
determine the and. Free hands
of pulp come data about weather
and- and safety programs have
light proving before his lives.
As we move for. Is I mean form
must be the implementation of
collection analysis and broad
dissemination of image as a
program outcomes. Right now
there's no formal requirement
of any of the custodial
partners of the MHSAA to
provide a report to the
legislature on the status of
the outcome in progress toward
achieving I mean **** urban
healthcare services does
collect and provide reports on
refugee. Revenue and
expenditure reports- we don't
have anything that really
describes the impact on people
and our state the whole- we
would recommend that specific
and measurable benchmarks and
goals be determined and sat
over time. And that they are
based on the current statutory
purpose of the image as a
prevention and early
intervention programs. That are
attending. T. reductions in
suicide incarceration. About
unemployment prolong suffering
homelessness remote little from
their homes. And we ignite that
you. Have shared that's an
incredibly complex thing to do
a lot of our section. That is a
lot lamb and when which not
everything fits sleep talks on
that is the one thing that is
really missing from our ability
to meaningfully tell the story
of how image as a is impacted.
Communities and without that.
Any refresh or in or
reconsideration would be
premature. Our organization did
submit a letter to the
subcommittee- I won't read that
to you but I will sort of touch
on some of our priority issues
those are that statewide and
local an HSA funded programs
must be Klein and family
driven- an HSA funds should not
be diverted away from direct
support of. This is to pay. And
somehow. We've heard. From
there about housing- there in.
Exit program agencies tasked
with dressing doesn't. It this
compares statements I mean
housing is more than just a
place to live there's- a huge
consideration for income
equality in income inequality
and all of the other factors
that are. Leading folks on the
street. Not just to healthy.
It's just a fun spent on
housing should assure clients
caregivers and family members
have access to a variety of
thing assistance as their needs
change over time. A fund should
not be diverted to supply. It's
for the treatment of housing
needs of individuals with a
history of criminal justice
system contacts. Fund should
not be diverted to supplant
other entities responsibilities
for children and youth who
could benefit from additional
mental health screening and
treatment. And we've heard
that. We know that their
successes with the full service
partnership programs and we
feel strongly that a large
majority of I mean just a
French spent on. Community
support and service should be
required to implement. Partners
testing for clients. It's
available online as mentioned
through the only see their set.
Of transparency tools- you know
for the first time. Ever I
think it's. Builders to access
what funding is available on
the counter what's that some
programs are being provided and-
toward more direction when I
got. But that's just where.
We're not quite that. What we
like as a cohesive and
comprehensive effort to take
that date until the meaningful
story business my action or
Dino words were more than just
the date and we're more than
just the numbers you know we
are the successes and we are
the challenges and we find a
way to tell that story
together. So please keep
conversations continue the
consideration must be made to
develop a prop. That considers
the future of image to say.
Three more US robust effort to
encourage our stakeholder
community- that nothing about
us without us. Is no something
to put on a button or wearing a
tee shirt not really. Hard
content of the MHSAA and to
move ahead with considerations
on how to refresh this that
needs to be done. Including the
views of the folks at the MHSAA
means the most to clients and
family members- and we
encourage you not doing it at a
Amanda was well there are a lot
of folks around the state.
Although here in the capital of
mine. It's hard to get here for
a number of reasons- so we just
only encourage that the process
purposefully seeks their
feedback- because this is
critical to ensuring that
whatever happens with the M. is
done in partnership with the
community it's on hand in hand
with consumer and family
members. Which is the engine in
the hallmark of the MHSAA and-
I thank you for giving me the
opportunity to share with you
today in. I'm available for
thank you miss Brandt next we
have found the car. Noon. And
members of the committee thank
you for having me here today.
My name is Karen Vick I am the
policy director for cal voices
formally known as nor cal MHA.
We are the oldest pure run
mental health advocacy
organization in California all
of our sixty plus employees
personally identify as
consumers and or family members
in addition we have thirty
access ambassadors in every
region of the state to provide
local Casey in their counties
and at the state level. And
that's through our MHS so it.
Did I'm access ram. I have this
mental. How main points that I
would like to discuss today
number one- California's is
truly believes that the M. HSA
does not need to be changed or
refreshed it's simply needs to
be enforced. Number. Number two
with each current can see can
changes. Not mine. Is the
altering the M. HSA and number
three I'm going to echo Angela
clients in consumers must be
treated as a sexual partners
and all discussions regarding
proposed changes to the M. HSA.
Out something that director
eutectic point. At yeah to a
lack of affordable housing not
mental illness a twenty
seventeen study by hood found
that only 26% of homeless
people nationwide live with
mental illness we also know
that homelessness can cause
mental illness. We don't know
the numbers there but we can be
pretty sure. Fewer than 26% of
the homeless population live at
the mental yes at the time of.
Yes so I that's what I've heard
please don't derail MHSAA money
for an affordable housing issue
if seventy more than 76% of
homeless people do not even
have a mental illness. Comments
we're we're hearing comments
today about the need for
statewide performance outcomes
of a focus on specific
populations statewide guidance
on priorities for the M. HSA.
To say was written and passed
back in. Two thousand four. To
address all of these issues.
Missy. For Smith of the act.
We've been hearing today all.
We've. Been hearing about how
successful FS PSR and his bees.
Thirty one ship it is 60% in
homelessness of. Emergency stop
84% The images also based on
the highly effective AB thirty
for a beat. All which would.
Posit out. And I have some code
sections that that I think have
been sort of- code sections of
the image as say that have been
sort of. Beef. Well for
institutions code section fifty
eight I've. The V. eight in
design. The joint plan for a
coordinated evaluation of
client outcomes in the unity
based mental health system. The
California services services AT
and similarly the- the section
fifty eight forty C. three year
plan shell clued reports on the
pavement performance outcomes
for services funded by the
process. And established.
Jointly each CS and the only
see and collaborate CB a thank.
And there's no more I can bore
you with code sections. But I
do agree upon was director you
tech dot. Beat these outcomes
are provided for in the M. HSA
and it it needs to be something
that happens outside of the act
with all relevant stakeholders
determining what what what is
our state plan. It is provided
for in the act but it doesn't
need to be codified directly in
the act. Eight and again it's
we also agreed that that is why
the act was not written with
specific outcomes in it because
needs change I think if what
would be the sure is working
great then aren't. Going to
change maybe maybe we want to
focus on homelessness it's been
involved here after years
should be set in stone. A
second thing that we've heard
about today. And a key piece of
the image. Strict
accountability funds. The.
Mobile template said in your
side panel independent paid
members to provide his
expenditures they can cut off
funding for programs that are
not effective. That has never
been that was the promise to
voters when we passed the M.
HSA and it has never happened.
I'm enforcement of the act has
steadily declined beginning
with AB one hundred and twenty
seven. And again in twenty
twelve wind damage got
dismantled. Some from from AB
one hundred which which was to
build that started to take off
and force minute to say. It is
they they wrote this in eighty
one hundred it is the intent of
the legislature to insure
continued state oversight and
accountability of the mental
services act. In eliminating.
State approval of county mental
health programs. Which I expect
state. To establish a more if.
During that. Complies with the
mental health services act. And
I don't hear from the little
Hoover commission. It it in
their in their letter. Of ever
in the wake of the commission
second review that the state
must identify a well defined
leader to administer oversee
and enforce the MHSAA or it
will remain difficult to
articulate a cohesive vision.
And ensure accountability. To
alleviate many of the visible
statewide impacts of mental
illness. And given given me the
arm out but if we're in the act
we really believe. The goal of
the state can be accomplished
without rewriting or refreshing
the MHSAA. We also believe that
now is not the time for
significant. Changes to the M.
HSA the images they have strong
not sub patient provisions. It
was written. To gaps in
available services and to
provide services. He provided.
Yes is Caroline proposal which
was just released. Actually it
knowledges that the agency has
not considered the potential
impact that overhauling the
entire meant tells. May have on
non medical mental health
program. Stake holders on the
following questions what impact
would a fully integrated.
Medical delivery system have on
on mad cow program mandates.
Eight until this is act Sam's a
block grants. I would also now
this is the only director MHS
state in the entire car. The
images. Proximally 20% of
county behavioral health
funding. And counties apply in
another portion of an HSA funds
toward. Fun. The whole system
proposed name and a focus on
the same populations that this
MHSAA refresh intends to target.
We really believe that any
changes to the and just speak
after. So that we know where
the tree. Talking about human
beings who are already in
treatment they're already in
this piece we can't just come
in. And put a whole bunch of
money in P. E. I. because what
happens to these real human
beings- live their lives
because of the effective
treatments that they're
receiving. And third- this
must. Numbers just say as in
merry drop mental health policy
damage to say was ground
breaking in the levels of
stakeholder involvement that it
requires it requires counties
to demonstrate a partnership
with constituents and
stakeholders throughout the
process that includes
meaningful stakeholder
involvement. Not only are. On
mental health C. program.
Program implementation-
monitoring quality improvement
evaluation and budget
allocations. And I will say.
Any processes are happening in
the counties but consumers are
not involved in all of these
elements this is another this
is another of enforcement. If
this in for we have at the
county level I'm going. All the-
being able to say Hey this is
working in our local community
this is not working. I'm
Clinton consumers are the stake
holders for stake holders who
are the most significantly.
Acted by any changes to the
public and a whole system you
must be AT. And meaningfully
involved. So we ask that the
legislature do its part to ink
clued consumers and other
stakeholders in any discussions
regarding proposed updates or
revisions to the MHSAA. I'm and
we also beg you please ensure
the I'm- oriented ankle driven.
And that strict enforcement
mechanisms are created thank
you much thank you. I will
comments brief for this
analysts we will wants to focus
on calling him as well- but did
want to thank both cal voices
and nominee for we were very
intentional and making sure
that the discussion would not
be complete without making it
very numbers are. Present as
well- and in that light I
actually. Plan on being two our
December sixteenth hearing that
from the county is. Yeah each
all the center common area
where they are doing dedicated
out reach towards a culturally
and linguistically part of our
relation that struggles. To
receive says. But I do think
there. I will be with you
director detected does not
appear that we have a lack of.
But a lack of. Fighting why did
inefficient manner so we can
digest it and help to make
informed decisions is the goal
of what I'm trying to bring to
the conversation and so I
looked towards working with go
exceed of figure. Out there are
additional resources that may
be needed or we can. Convert
ten. Trace in about proving.
With that I will thank this
panel for coming forward and
invite up the fourth panel on
callin
. Thank you we will.
Begin with our chief Brenda
greatly. Good afternoon I'll
Brenda great was chief of the
medic how the new medical
behavioral health division at
the California department of
health care services just one I
think a committee. For inviting
us to come here today to speak
about cal. And you know just
even sitting here throughout
the afternoon- it's been great
just to hear the comments and
really the thinking that's
going on- about how killing
can. Are really helps
strengthen our delivery systems
because out based intent. I'm
so essentially- with cal aim
the over arching goals. Add to-
somewhat so you're an
initiative up through the
quality of life. Things are
beneficiaries- through the
implementation of broad
delivery system programs and
payment reforms across other
medical program and essentially
we're looking to- manage member
risk through a whole person
care approaches to really
thinking broadly about the
needs of individuals- and then.
Also considering- how best to
address social science of. Also
look stern and seamless system-
by reducing the car accident
increasing flexibility it's not
always the easiest systems and
systems to navigate- looking at
how we can better strengthen
those processes to improve
access- and then also improving
quality outcomes which I know
it's just- our discussion- in
the last- up and doing. Through
value based initiative as mark.
Our system producer data
systems it came in. I'm so
we're looking to do all of this
in the coming months. Hey y'all
farms under workers for the-
which will be kicked. Number so
just a little plug that we- are
continue how these work groups
in anybody's- public's welcome
to attend listen and provide
feedback you throughout the
work groups or even after the
work groups and we accept a
written comment as well folks I
thought as I for today I'm so
are in kind of going over. The
diff. Souls related to
behavioral health. Of the
foundation is our best of
payment. And former looking to
incentivize outcomes and
quality over volume and cost
right now I we have as a C. P.
E. or certified public
expenditure process and we're
looking to move away from that
to watch. Where I'm vestments
can be made the deliveries
with. Mental health and
substance use delivery systems
I'm still. In a clip our county
partners all as well through
our stakeholder groups to do
this- Wanamaker we thought for.
Want to disrupt services. If
the current up finding out of
our system so doing a manner.
And are really like said this
the foundation of so many of
the proposals on which I'll go
over about things like. Ten
then all. Trying to other word
we're working on it and-
building a robust. Continuum of
care. So and then another
benefit. Describe a supporting
better coordination with
physical hall so I know there's
been a question of the I for
cations in- the managed care
plans in mental health plans
because the benefit split
between the two deliveries. Do
the US address that through a
financing and care.
Coordination approaches.
Medical moving. On both my
health and substance use to
order our delivery systems-
currently the current
definitions outdated it's
confusing- it's really a good
talking to Rio remember examine
that- and. So you in doing so.
We're hoping to provide clarity
and boy does allowances- and-
the service. As well we're also
looking at looking at a help
cleaning can be done for
services before diagnoses are
made because that's another
area of confusion which I think
director you'll take mentioned
as well we are also looking at
our behavior hauled
administrative an integration
so- there's two types of
integration. When we talk about
this there's the behavioral
health which is mental health
and substance use disorder
services and then that's one.
Out that we're looking at. And
I think early. On was the
foreign aggression. Plans which
is I. integration within manage
care which are are some a
separate track. The mental
health and substance use
disorder integration our boat
to- improve efficiencies and
access for beneficiaries. To be
able to- have an easier time
with screening. So that they're
not necessary so the clinicians
can can be able to do the.
Right now to accept delivery
system and so some overlap some
that do not- so it's almost a
double duty- same thing with-
benefits to the system level we
have a separate. Records are no
health record since use decide
assigned the source of the
whole some of the news with
Europe. On a call you
organizations to separate
reviews- and then also with our
compliance reviews two separate
reviews so looking to see how
we might be able to streamline
the process. I'm sure. You also
get. More view of the system. I
in addition with regional I'm
trying- some of the county is-
are particularly rural counties
but other counties wall
struggle with- getting access
to providers as we talked
about. Or even using these
administrator. Be able to
leverage. I approve of is it.
My is the resources the noble
for these counties. The dish
are we have another- effort
proposal on- the seriously
mensal misters mental illness
stirs emotional disturbance I
am D. institutions for mental
diseases waiver which was
talked about a little bit
earlier today shop and so
we're- focusing workgroups on
that route workgroup meetings
on this. A demonstration
opportunity that's- available
through the centers for
Medicare Medicaid services-
it's an opt in so we need to
decide or through go through a
stakeholder process to decide
whether or not to. Apply
there's a lot of. Things
involved so one of our first.
Making sure that it. Is working
on this for thinking about this
is aware of all those
requirements I was really to
build out a continuum of care
and- if the decision or the
recommendation is made to apply
for this waiver then what
considerations does the state
need to make when developing
the application to us the
amounts. And then in addition
to four look into- for
substance use disorder or drug
medi cal organized delivery
system- roll that into the
nineteen. The waiver process
with the exception of the
residential piece when I'm in
in that. I improvements to be
current- special terms and
conditions for a DMC ODS
waiver- through lessons learned
these things that we've learned
as we've implemented- the ODS
and several counties with
thirty. I'm so we. I'm take a
comprehensive approach- many is
element arm I've met and are
part of a. And so that folks
could access the system in an
appropriate way. I'm in
addition to cal in which is a
huge undertaking. And we've
also got sent several things
it's been blank walls- help at
this stage- you know with the-
implementation of the
affordable Care Act. Hi the it
up. Have a random you're
standing one another too odd
for care coordination- we've
also- through other efforts we
have and other requirements
we've developed a dash or so
we're putting out data it's a
it's a nice. Foundation. We're
growing it form to incorporate
additional data I'm going to
expand it qual. I do look at a
different are elements between-
the managed care system animal
house system- so it'll include
things- I'll just give a couple
examples but I guess- adherence
to antipsychotic medications
for individuals with
schizophrenia or diabetes and
cardiovascular disease
screening so just a couple of.
Course that measures that will
be incorporating. Also been
working for quite a few years
on- implementing the managed
care final rule- so we've
implemented a network adequacy
standards and monitoring and
mental health parity through
that. Effort hello. The
strategy for quality in our
department so- that's
throughout the whole depart.
Behavioral health- but it's a
comprehensive approach to
looking at quality. And then
most recently as I mentioned we
just establish a medical
behavioral health division but
always underwent are a
reorganization within the
department and- we're hoping-
that the goal of. This to a
federal law in the north. Some
one keep tape since he's with
under. As well because I we are
breaking mental health and
substance use disorder services
even closer together within our
own department which will
hopefully a nice foundation for
the work that will be doing
with that with account he's our
stakeholders- through
integration so I think that
that I will pass it. Thank you
special cover thank you. Some
for all the time and attention
all. And shifting gears for
just. And all. How lame is
really centered on medic cow
where a majority of our clients
get their coverage from- it
with medic our county
behavioral health is really the
specialty to. For chilled PST
T. as well as- medic how
eligible into goals of all ages
living with a substance use
disorder Callie and provides
the state's framework. For
medic health system
transformation and it's really
anchored around the new all. Of
our with. Smoke far. Teen
waiver creek. Aces drug medic
delivery system well this whole
person care pilots I'm Kelly
missed significant for county
behavioral health and that it
proposes numerous important
reforms to the rules about how
we're organized. We get. We is.
Believe what proved access to
services and also help us to
improve the quality ordination
of for our with other systems
touching our clients- so I'm
just going to kind of provide a
little bit of dimension to the.
Various initiatives that Brenda
laid out and the first one.
Quick points all necessity. He
not only for who gets it into
medic how- specialty mental
health and S. T. D. services so
I'm super important as it
relates to the E. P. S. T. T.
benefit for children- today-
for both adults and kids were
we are required to determine a
diagnosis based on an initial
assessment of someone as weeks
before- you know humans are not
static eating. Right would come
in and as as a
. On the physical
health side dishes. To. Around
trying to manage that audit
risk and why. Pourtant will not
just because you know you get
dating and it said. Mark on
your great because that comes
with. A lot to. Office of the
inspector general's report you
know and that we had to go back
to the federal government one
of the things we started to ask
is can you be a real health is
how much of this is a function
of federal requirements on us
and how much of it is a
function. Of our own doing in
other words what of this comes
from state. Law this comes from
federal law. To I'm AT fulfill
the E. P. S. C. T. mandate for
children- full letter of the
law and expand services to
those who appropriately need to
be in the specialty delivery
system for a health services.
And I'll give you one quick
example kind of a cross over
with. Two children who were
very early on in in the stages
of their mental illness. And so
as a result they adjusted and
they got creative that. Stops
third serving those children
they issued. All of their
provider and it you know here
henceforth rather than bill
medic health for the services
you will use this P. E. I.
dollars when kids meet these
you know conditions that we got
this allowances around well
other counties are. Getting the
same services using a medic
Holland get it drying down
federal financial participation
this is this is not the state.
Offering we should have a
consistent set of rules around
you know who we're serving and
who were not and try. To my
seeing- the federal financial
participation as. It's the
federal man the federal law
requires that we try. Well as
possible so. This and provide
that care since making sure.
You're playing images eight in
terms of payment or form I
couldn't agree with more with
what Brenda said it really is
the backbone of delivery system
transformation for counties and
again this is another place.
Where we have a very- Byzantine
date. Meant system it requires
are per. Il to the minute I can
imagine that. And it's one of
the issues that that's
impacting our ability to retain
qualified workforce- we hear
routinely from county
directors. Folks are are
leaving there's they're talking
with their boots because they
don't they they really just
can't deal with the amount of
documentation they have to
provide and then with this if
it risks. If you don't do it
right it's dissolved out. Looks
bad for the state and for cap.
Being from a C. P. S. certified
public expenditure based
reimbursement system which by
federal law does require a very
high scrutiny the high bar
standard of documentation. To
an inter governmental answer-
will be is significant in that
it will. Still be fee for
service so we're not sort of a
radical sh. But it will I was.
The terms of the documentation.
And it'll allow us to do more
to invest in quality- an
improving the delivery system
for our provide a we see it is
a really nice next step that
can move us on the road to
getting to- of a value. Based
system. So really. I'm I'm set
at the end do you eyes. Earlier
much more just to say that we
do believe that it is in this
picture and that we can
hopefully. Bring again bring in
more federal dollars but it
time build out back base for
structure. That we- one align
incentives better there-
enhance care managed and in
lieu of services are the
state's vision for how he. To
replace what we did under the
cap based. And it's a pretty
big shift I do want to call out
one thing the in lieu of
services is- an option for
states that comes out of the
final rule and so it's- tied
it's in federal law- it
requires capitation and since
we're not a capitated entity we
would participate in in lieu of
services. Who ship managed care
plan- and then stick. Them
enhanced care management which
is- of trip out back capacity
within medic how many care to
do. Thank search court before
opportunities for us to build
stronger partnerships with
medic how managed care through
these initiatives. But with
some important caveats first of
all I'm the that. In my are the
managed care plan brown how.
All up rams flows from a
population health management
plan that they have to put
together and. Kudos to DH CS
for putting that on the table
because it's really moving a
proper. And we're all right.
Your physical health to engage
in services because don't
typically just show up at the
primary care clinic or when
they are in the emergency
department they quickly want to
divert them or move them
somewhere else you know it's
been a little bit of a struggle
to get folks into physical
health care and we see that
struggle reflected in their
physical health outcomes being
the primary drivers of early
preventable deaths for our
clients right. And so we
believe strongly that the medic
how managed care plan should
require. Work with and their
population help manage and-
because or to work with our
clients and there does need to
be better collaboration beyond
what's already in the ammo. Use
we need to develop much
stronger data sharing it it
will require. Investment I
think aligning our payment
methodology for two out of the
rest of the health world works
will help facilitate some of
that change and transformation
but I'm to my earlier comments
so much of the social
determinants work and the
public health work that were
already doing is Connie
behavioral health. Is actually
not going to be captured in the
context of- cal aim even
through the wonderful as that
we're gonna be making on these
other pieces within managed
care- so it's important that we
understand those things and
it's also. And they were. Under.
Do is the behavior of. Much of
anywhere else and to the hall
the behavioral health space is
so different from physical
health in terms of what you can
go out in the open market and
just purchased and bring into
network so we think that yes we
should look. At ways that we
can really add some support
find the full two great pilot.
Great between Inland Empire
health plan and San Bernardino
county there's some amazing
clinical level integration work
happening in riverside for
example we want to figure out
ways that we can spur these
innovations and keep them going
but to think that- managed care
plans is going to go out be
able to go out. I off the shelf
and sort of. Their services
what we're doing is a little
bit now not not. It the we need
to be you know very. Conscious
about how we move forward with
that- we. Do have a tremendous
amount of. Complete add that
flow from federal law at. Ten
both in terms- and our
compliance requirements for
network adequacy I would argue
in many cases are more rigorous
than those that are required of
the managed care plans today
and. So we're going to continue
to try to meet those height
bars. At Lowe's up. My name I
in our- estimates cal aim in no
way will back fill. MHSAA
dollars in in. I'm. Medical in
a different way a change our
payment systems per the payment
reform proposal laid out and to
build out these partnerships
with medic help manage care
that we can do a better job of
adequately serving the medic
how beneficiaries were in our
program today. But as I said at
the beach. This hearing. Is a
long and important list of
MHSAA fun activities that. Are
not funded through Medicare all
today that are not proposed
funded under Medicare all that
in many. To senator key point
in mayor Sam regulate which
includes a chronically
homeless- involve population.
Or at risk kids and so we
really need to be thoughtful
about some of the trade. No
commercial plan parity thing
that is the long game again the
set the delivery system does
not exist today and so really
what we're gonna have to lift
up his over time and again cal
aim is not gonna be able to
play again whatever those holes
are they gonna be. Eating
potentially by shifting or
moving at. Dollars want to be
really cool. Thank you for.
Thank you and- in respect to
the. To the many people who are
here I will keep my comments
short we will have time to
further discuss calling. But I
did want to say how excited I
was. Being up for twenty. An
eighty plus pages that it was-
there's quite a bit of hope
within the document and the
value seems in the right place
the brain is a part of the body
and the better we can
integrating create stingless
systems the more efficient will
be in providing care and I just
appreciate the department's
effort to end the county's
efforts in working through-
those hard conversations that
need to be had it. Try you
should now. With we will finish
this and all and move on to
public comment. Thank you. It
is going to be the process for
public comment is there a is
there a- limit. As their just
in terms of the number of
people who are here I would.
Try to keep it to her too okay.
One size doesn't fit all. So
well I can and I'm talking
about culturally competent
practices you cannot separate a
mind from a culture you can't
separate a mine from identity
and there is a state wide. My
program right dresses the needs
of six Senate cat population
and that's the cap you reduce.
Sixty three at the state level
and is not funded the counties
is not expected to be picked up
by the counties at least in L.
A. county and whose continued
existence and the ability to
meet the needs of underserved
populations we'll be going away
the year after next. The
population groups there is
served is African American
which is my population native
American and Asian Pacific
islanders Latino en L. G. B. T.
Q. I am. Thank you to the
director of whole systems
learning and have. The try
program turning. Resilience and
really for each he. Asian
parole and- foster informed
foster we meet every single
outcome in our program we have
take getting involved
individuals that. Are homeless
there are now housed employed
starting a business. We there
pick it pop. Six of them to
dress trom needs. Yes all of
our individual because. We're a
community defined evidence
practice and we find that over
two thirds. Okay D. and we
serve them these are the people
that are over looked these are
the people you did not hear you
heard maybe cultural content
one. These needs are met by
just that by. Just seconds.
These needs are not by a- bit
so. Thank you thank you. Hi my
name's Jason Robinson and I am
a person in long term recovery
so thank you for- for your
hearing at hand doctor around a
lot. My help as you move
forward in your best cation of
an HSA. Look at things. I've
been implemented. Add carrots
by Rick from. Your support is a
critical part of MHSAA
philosophy and outcomes my E.
organization is a pure run
organization in Los Angeles
county and we have
approximately fifty staff full
time everybody with lived
experience we have say funding
does. Run right. And we have to
run a program at. I was in Los
Angeles county which takes on
average two hundred dates from
assessment to move in 40% of
people that call us. For
housing movin within two days
of calling saying they want
housing. Twenty they ask for
housing one of the reasons that.
Is because we're using census
data and my- but all eyes on
the single fan. Market and
rental houses it anytime in Los
Angeles there are ten thousand
single family homes for rent
one of the things that's
happened with the discussion
around housing is that it's
been dominated by developers.
Who've been taking away he from
this. Your support as an
essential element of housing
first practices so when we look
at MHSAA incorporating a way to
make sure that peer support is
involved at every ask of pro.
Is essential we heard about
full Sir. Partnerships as we
rolled out mental health
services in Los Angeles county.
Understanding of how to
integrate your support and
people with lived experience we
have that data now the other
thing that's. Important when we
look at hospitalization rates
California has a sick. Large or
great the hospitalization rate
than the knack. National bridge
and one of the reasons it's not
because of how. Is this
research clearly shows that
merely referring somebody to a
self help support group in the
community cuts the re
hospitalization. Rates by 50%
okay and peer support
specialist group which between
people even services people.
Dead the base services so
please make sure out some
separate. Leave with a- leave
thank you Sir. I'm willing I'm
on track for me this. What are
the provider. African American
great tease the part six
California rich despair no you
want in your in your day out as
no avail. Percenter sweet
potato project. You know the.
With a book another one. A son
about any of. Reducing
disparity predicate is. Invest
in our culture we come can you
define back this. Did you in
this. Let me please come and-
let's talk about what a deep
dive of a stakeholder
engagement could look like with
the populations that we start
because it's up to. Six of the
NHL. Shouldn't be that way and
we want to be a. X. thing on
twenty. Looking at in the se-
inside when it that's my little
CRT P. a piece but I wanted
something- different a little
heavy can you. With me and I
want to thank. She ate great
genius. Nearest neighbor. And
planning that needs for this
you need think of like an image
of state. But it the lines and
it happened in the there's a
there's an invisible elephant
open the corner of the room and
had to be black for the pink
elephant it's a black elephant.
And you look. Nothing. Areas
that he says. Her time. This
car serration fall steep yes.
In schools talk about I risk.
If you want to go make a
difference is what it's about
being. Amex the plants I have a
solution. You would focus on
children spelled. All with two.
What do they have in common.
Breath taking disproportion
aliki of African Americans.
Right taking. African Americans
are in 7% Of the California. We
5040% 40% if you do this within
cost Asian if you what with
foster if you do it with every
single category this process.
Does not these kinds of very.
The man. Who some women now
phrase. This is Bob. This and.
Putting gauge when you want to
be effective with us you've got
to be with us you got to engage
us to be committed. To process
a one and done in and out Hey
folks group that's not work
relationship. We're sorry.
That's what keeps brown when
we're not widgets are sold
relationship in the process if
you want an income at the
thought that the financial
impact we keep. Has this get
this. Without I want to get the
a DH. A stakeholder things
coming up. You still there okay
so we're we're- an advisory
committee I think I'm not going
to convince. Yes did you do. It
I'll go with the first minute.
I'm not well this. People five
people one African American not
one. Thank goodness cute. Here
is the king. We're going to.
That has to be addressed it has
to be done with innovation.
Thing is sex with hot. We can
be any spaces Bubba thank you
some. Well in. With IBM then
saying much of the- I'm morning.
Our office is based in the LA
area but I'm with the
California Blackmun's how can
we are a statewide organization
and we were in the five
population areas five there is
a California counties that have
the highest popular of black
women and girls and so I tell
people all the time. Get to.
It's working what's not
working. For the most part.
Things are not working it is
incredibly challenging. For the
women that were with and their
families and the communities.
Where they live and we can play
to access mental health care
services. Whether or not to
sing it through the public
school system or through the
private. Your the challenges
are there and I'm sure a lot of
people in this room who is
specially when you talk about
in a severe mental health cases.
Work mostly with women who are
on the cusp. And we consider
our standing in the gap. Clean
the limitations of Star.
Culturally come the absence of
pot. Exist to the work force me
that. So we the value three.
There is project because of
that funding we're in year
three being to. I'm. Have
tested a program that we have
that we're gonna. Can find. We
have been able to train black
women to be. At. Right now
we're doing the program in Los
Angeles we've done in
Sacramento in- December Dino
will be in the bay area in
February and we're going around.
Trying to DO Fresno.
Partnership with the with our
friend Fresno. One that we know
this funding is going to end in
two years and that scares me so
much because we've done such
incredible work- women who
really are standing on the edge
of needing fines. For their you
know even even needed to be
hospitalized. This serious
mental breakdown and having to
deal with it for a- minute
which is nationally recognized
based on traditional African
American and African
culturally. Lee deeply rooted-
believed impress some practices
and we are seeing. Incredible
success. These were trained by
us and then go out into the
community so. I did I saw. AT
and to be able to help too we
could we create resource list
on our own because we have to
screen those resources so
thoroughly because you don't
want to send someone to a place
that when they go through a-
intake process they're not
going to see a therapist for
six to eight weeks. That's
inconceivable unconscionable
okay. Place where they can
come. On in. Talkin healing
dealing share in all of those
things. I mean I could go on
and I we have a website you
know you really I could go on
but I but I want to say because
of the funding. For the
California reducing despair
project. We were able to see us.
I am in a- oil in the first so.
We are very powerful but
there's. So these dollars and
to know that it'll end in two
years and that there's a novel
nothing it played. Another
phase of it or a chance to. In
order to even wait those. You
know those outcomes and then
see how we continue. Most of
them have never heard of it
unfortunately and that is a
problem as well so you've
invested sixty million dollars
in something that is working so
please I mean I I'm hoping
everyone in the line hears it
and the people begin to talk
about it so. Thank you for the
opportunity. What she said.
Good afternoon Frank center
into some additional resources
that you may or may not be
avail aware of we were. Hired
by the AC to do a study the
first ever and only study about
older older Californians and
their use of mental health-
services to the MHSAA and we
produced. A number of policy
briefs including one about
indicators and then also
looking. From grams and also I
did. And I think it I just you
can. I'm about Cashen today and
one is that there seem to be
kind of an assumption that P.
E. I. money was for children
and youth and I just wanted to
make sure that you all know
which I'm sure you do that P.
E. I. programs are beneficial
for all age groups across the
life. And on into an agreement
with Mister Corey. I hope that
you'll. Be rid. Of the HSA as
it was craft fundamental
component of the- life. Which
you. So as you think about
prioritizing as you think about
these kinds of special
populations that were-
discussed at length today I
want to make sure that you
understood the older fans are
soon to be 20% of our
population they have high unmet
needs their greatly under
served we've got the data the
OAC has the data we want to
make sure that you continue
looking at all the populations
across the entire lifespan as
you think about. Your
prioritization thank you thank
you ma'am. Hello. I am Richard
Keller from Santa Cruz County
California I am a consumer a
mental health worker at the
local psychiatric help facility
and an advocate for people with
disabilities seniors and their
families I am a volunteer. What
nami California and assets
California. Voice I am.
Concerned about the idea of
changing the end cap of the
mental health services out
without any input from the
mental health community
families service providers
serving in the mental health
community. Problem is the
California department of health
care services and the mental
health services oversight
commission is not doing their
job in enforcing establishing
policies procedures guidance
for counties to follow and
measurements. Of funded
programs and service is working
to improve the lives of mental
help. Community in California
so who. Should report the state
of California auditors report
have did. Meditation being
followed up to third job in
fall mental hopes. Did your
okay only follow. In which even
the- funding the lack of
enforcement has gotten worse
since the California
department- surfaces the tall.
Okay. The county so this noted
in this site soon the lack of
guidance from the state as part
of the problem. We need. The
checkpoint part move healthcare
services not the health
services dirty I sing measure
outcomes our team fiscal
finding is being bullied serve
as an advocate I have seen
individuals are meant to halt
get out of homelessness
navigating them through and
getting disability benefits
affordable housing healthcare.
And connected to support
services such as. And
supportive housing. I will
monitor and make noise for My
so. We might. It is four men in
making the mental health
services at work to help them
at community improve their
lives with lean. Says funds we
are here we are United we are
not going away just sit start
junior thank you. It is the
people have read them and-
receive them as well. If any
way we can try. To work
comments closer to a minute I
don't think the lines moving
and- everyone has. That for you
but I am gonna read my comments
because I stood in line so
sorry so my name is Theresa
pass greeny and I am the proud
mom of an adult son who lives
aerobically with serious mental
illness on he has spent the
majority of his adult life in
locked facilities. Are her.
Show up at any point in time
hello but he must be counted
because he is us too and so our
families like mine I support
them in California's position
statement on the MHS. Refresh
however there is much more
discussion that must take place
in. Public and not just like
your- original intent props.
May just was not intended to
fix every social determinants
of health and in humanity in
California it was intended to
fund the greatest health
disparity of serious mental
illness the current emphasis on
the sweeping her homelessness.
Let's focus on the fact that
families are wired to make. In
order enter yes needed for
stability any fix for the
homelessness crisis must go
beyond a right to shelter and
it must go beyond only those
currently on sheltered a right
to shelter plan must. Include
access to a full continuum of
psychiatric services and
include a full of what I have
caught what might I point. That
here families. If we are going
to unclog the human log jam in
our streets prisons jails in
the back bedroom Eiji. Federal
then we must focus on both the
un shelter homeless and the at
risk of homeless at some my
populations who cannot live
independently we first need a
right to treatment before we
forced anyone with a serious
mental illness to fail first
suffer and die if we want to
California for all. Then the
California a must be on
bridging. The ideological to
the mother when we cover.
Spared Asian and care for sick
I just didn't make one other
comment there's been. The after
being on former mayor mayor
Starnberg and the and rusty see
lex which is true but I'd also
like to read there was another
co author she is referred to as
the mother of mental health
service act and her name is
rose king who I've been pledged
to work with. For the last
fifteen years she couldn't be
here today in. Writing but- so.
And actually has a different
opinion than than dot then
Darrell Steinberg on the intent
of the act thank thank you
ma'am. Hello my name is Juanita
Pena and I am from napa. I'm
Minami member. They have truly-
been there for me and my
daughter for it's been twenty
years now- my daughter Erica
his. Thirty eight she has get
so effective disorder. And
through her journey now has a-
IBM. He is starting to show
symptoms of mental health
issues cool. But the big banks
do work for now we across this
kind of meant to me. I'm not as
eloquent as a lot of these
people are but I'm going to
just say what I have to say she
is currently in crisis she's in
a treatment facility here in
Sacramento got a call about
five days ago from her because-
she that. Concerned and her
treatment works. And they told
me that I bet. The doctor half
of. Because of her constant-
marijuana use and this is after
maybe two years of her doing a
really great- Eric you're doing
great good girl everything's
going well but then she kinda
stumbles and falls and. Okay
here out here kind of thing so
there anymore. She's going to
be displayed we just got a call
and let you know. I'm like okay
what. Point we don't know we'll
probably send her back to nap
and she's going to have to stay
at the napa stabilization
crisis unit for about three
days and I'm like okay well
what's going to happen after
that. We don't know. So that's
my- beef right now- she was
getting the B. T. L. dialect
people. Say. It be April third
it's not working for her. Top
there today and said what
another third party and that's
what I told rice's I'm just so
tired she's been in and out of
juvenile hall she's been in
group homes since she was
fifteen now thirty eight she's
been at Patton state hospital
napa state hospital- for trying
to kill the baby while he was
still in the stomach. And I was
there to intervene. I was not
pretty- so she's a very intense.
A lot of problems she because
X. me and this option so that.
I can't. I'm deal my great
right now so I just need to
know that this doctor is not
going to ultra taker offer
medication because that's not
helping the right. It's
specific options for the more
intense patients more evidence
based research. My daughter is
the compensation teen as I
speak she does not need unitive
approach but a rehabilitative
approach so please help- she
has. Feeling like she has no
purpose right now no meaning in
life and she's like who cares I
may just go kill myself. So
that's what I'm left with. To
handle at the end of the day
okay. To cry. But I don't know
what my account. And as we go
into suicidal watch I just hope
she's okay and I pray that you
take this in consideration for
my daughter and others like it
because this is our reality and
like you said. There has to be
a flow there has to be a. Point
in life where these people are
people just get the place. So
please helper thank you ma'am.
Hi people full I'm also with
cal voices in and access and
representing the MHC M. H. S.
A. client consumer family.
Member culture and the recovery
culture the recovery model can
be tested to. Steam men no
doubt we remain dysfunctional
it is a fail first system of
attrition no one gets in with
heated attempts with agencies
hope that you you will wear
them down and quit and when you
do break through the first
treatment phases not recovery
but often times a flavor of the
month- team of medications that
will worsen. Oftentimes
worsening condition. We recover
propose. If in your belief in
yourself your body is it do you
to heal listening to your- feet.
Good news. Habits and brain
body chemistry the breaking of
old patterns no longer serving
you except in a spiritual guide
of your own understanding
following your bliss to art
music self realization actual
shin after five absurdities
feeling good looking good. Good
so others the check in positive
outcomes all you need. A path.
I've dealt license not yet
visited yet awaiting you and
your mindfulness we're here for
you and you are here for you
let it be so. Thank you Sir.
Good afternoon check us tell us
because we have of the
California council many be
behavior health agent which is
comprised of community. Mental
health and substance abuse
disorders nonprofit
organizations across the state.
Paul in the offering a passage
of prop sixty three C. B. H. A.
is committed to advocating for
the appropriate use of the
funds in keeping with the
spirit and intent of the act-
the ever help landscape has
changed in the fifteen years
since the act was passed in CBJ
supports. That. Concerns as the
state goes in this process.
Small in housing that any
images a fund it's. Graham sure
thing to be here to help us
provide those individuals who
utilize images. Housing should
retain their eligibility for
housing funded up. To solve
this. Should be amended- for
the use of images a month for a
city services. For those of you
for those who are incarcerated
in on parole. E. MHSAA language
should be amended to find the
cystic are straight. And parole
pop shins to reenter the
community. Standard behavior
health after release.
Innovation I'd be increased 25%
28% to fund pilot programs
including alternate payment
model plans and ensure that
counties me based organizations
can apply directly for this fun.
Prevention early intervention
pose that the percent set aside
for Pete I should be in. 30%
target the to penetration rate
in under under. Our county our
engagement in case management
for the under served. School
based mental health insure that
were much essay funds are
involved collaborations
required between schools and
local committee based
organizations. On the work
force strictly behavior health
workforce pipeline by providing
funding for education and
training opportunities at the
primary school high school and
college levels. And from the
expansion the roles of peers
and other non licensed health
care professional. Sep I used
to sort of counselors. This is
the care separate cells the
children systems of care for
the adult an older adult
systems of care. By dividing
the committee service and
support funding into two
systems of care and rewrite the
guidelines for each. Older
adults identify the prevalence
of older adults impacted by
hope this. Hi fi the different
levels of need for adults then
the full. The term in the most
cost effective you the four of
the fines added. On at this
piece for older population. And
finally- on evaluation and
accountable. Both of the
language of the image a say
regarding the reports that
counties must DAC gaps in the-
I see an ally consequence.
Going to do so and- the rules
and responsibilities at the
very least. If I wish and
accountability thank you Sir.
Good evening so bad with United
ways of California animal
attempt to stream comments that.
In in housing we believe that
prop sixty three can be a
cattle. Mrs as a whole and as a
key element in drawing down
federal match for Medicaid
spending as well as realizing
the true intent of the PST T.
I've we ever wanted to
transform the mental health and
substance use. Disorder system
we need to become much more
intentional around PI and begin
a shift away from over path
ology Ising our children and
youth and particularly those
that are exposed to trauma.
Trauma does not equal mental
illness but untreated I'm I can
lead to serious health and
mental health risks and hard
realities we face on the
streets today we think that the
partnership between counties
and schools cannot be
overstated and well examples of
using P. I **** in this manner
exist we believe. More can and
should be done and at the role
commute. Successful will be
necessary. This is where the
support of the legislature and
the- ocean comes into play. We
can help establish local
collaborative- frameworks to
make this happen. Klay in terms
of housing we can concur with
other stakeholders and
panelists. That homelessness is
not- is not primarily an issue
of mental illness but one of
affordability housing stock in
income inequality. No doubt
that the role the MHSAA has and
will continue to have instant-
is substantial it is only a
slice of the statewide pie.
Having a an alignment with
other efforts such as cal aim
will be important in
addressing- the housing and
homelessness crisis that has
been many decades in the making
and I think you for the
attention of this committee to
this issue. Thank you thank you
ma'am. A good afternoon.
Members of the committee my
name is now I have to ask miss
and the- legislative policy
analyst praxis California. I am
with cal voices formally nor
cal MHA the oldest Pirenne
mental health agency.
Organization our advocacy
organization in California. I
am a consumer with lived
experience and I support my
colleague Mister carries
testimony from earlier today.
The MHSAA does not need to be
changed to refresh it simply
simply needs to be reinforced.
For state level report since
two thousand thirteen and
verify the lack of oversight
and accountability to local
community planning process
sees. And also by state level
agencies that created the on
spam HSA surplus. That
represents a broken system that
we talk about today. If today's
hearing is in response to the
homelessness crisis. Then you
should know that those those
that are at greatest risk or
people with extremely low
income. And the income
disparities primarily put focus
upon black and brown
communities. Approximately
ninety four thousand- over
seventy four percent. Of those
experiencing homelessness are
in more need of living wages
and affordable transit.
Oriented housing rather than
mental health services. The
MHSAA find is reserved for
mental health services for
fourteen million public mental
system clients. I secondly I
wanted to echo that client and
consumers must be treated as a
central partners. In our
discussions regarding the
proposed change changes to the
M. HSA. At one additional
comment that I wanted to
include what was to Mr Mr
freighter assembly member
Frasier's I request. For budget
asks for primary policy
proposals C. R. D. P. has been
looking for- budgetary
reallocation or- sponsorship
for the last couple of years.
The O. A. C. as- push them to
find to advocate for their own
funding so that would be one
thing to perfect primary
prioritize. For moving forward
as a permanent funding
structure also the governor
knew some propose that the
budget was a primary source for
funding for peer support
systems in California on the
veto of. S. B. ten so there is
an opportunity to present
services as a priority point in
the budget this year. Good
evening Mister chair I'm fairly
dating on behalf of the
California state association of
counties I'm going to be very
specific us the sack and our
members the county supervisors
of California support five
different things that would
include counties retaining the
funding you've seen many
examples today of how. Counties
work with non profits schools
other local government entities
and. Some we really strongly
encourage flexibility we do up
some disorder. Really serve
those folks would help quite a
bit- don't wanna narrowing up
senator Steinberg talks about
serving homelessness and those
in the criminal justice system
and we don't again. Want people
to fall into those categories
before we can help them right
now with them and just say we
can help the before that
happens. And we do not ship the
last few years along with the
homeless is funny to really
focus on that. For those who
are homeless plus all age
groups. Who need services who
aren't homeless- we also think
cal aim is a great opportunity
and really are really excited
about the- sense of partnership
from DH CS and appreciate
their- obstacle- working groups
and seeking counties in but as
well as- of course consumers
and providers. At least port
accountability and transparency.
This as the director the truck
had to. Do it we work. It the
present reserve level when
people criticize the reserves
to figure out how the money can
be use we've done everything we
can to make it specific and
make all picture all counties
are complaining we need your
help to have that single
oversight entity to make it
happen. Thank you thank you
ma'am. Kelly Brooks I'm here
this afternoon on behalf of the
urban counties of California.
The fort to our fourteen county
members represent 80% of the
total population of the state
we too are please. Public
conversation going on around
the whole. Act were lakes
supportive of increased
flexibility and I think this is
a good opportunity to have
further conversations about.
Making substance use disorder-
up primary diagnosis of
substance use disorder. As a
potential- that at me to say
could from those services- we
would encourage a very careful
and thoughtful discussion
around MHSAA. Particularly
since we know so many of our
counties are using I meant to
say is match for federal
Medicaid funds. And so we don't
want to see our existing mental
health services system.
Disrupted by a potentially
moving money around. We ought.
To represent the count or side
who has use that mental health
services act as the glue- to
their entire mental health
system they're doing very. Made
of things up around integrating
primary care and behavioral
health and the kinds of things
that I think cal aim is headed
port. They. Make sure their
system continues to be event.
I'm dead and then finally.
Homeless and mental health I
was just at a conference last
week with the return
researchers from UC San
Francisco looking at adults
over the age of fifty who are
becoming homelessness. And
behavior health isn't the
reason the. Reason. Chris
stoner Mertz California. Family
services we have a hundred and
forty five members serving
children and families in the
child welfare juvenile justice
behavioral health and education
systems. I'll be brief and will
submit a more expansive
comments- primarily I just want
to say that I think that with
the current development of
Callaham
. Efforts increased at.
Access to services. Really
appears to help that insert
pushing the boundaries of the
current funding options and we
have to hold ourselves
accountable to serving our most
vulnerable and marginalized
please. Thank you ma'am. Good
afternoon my name is Jeff
right. I am here today. Ng I
look sorry. Thank you I'm a
cowboy his family in nor cal
MHA I also work with nami
Sacramento and I'm in
California I am a consumer with
live experience and I support
cal was his testimony today. So
I agree with cal voices you
guys to not changing MHSAA but
to enforce it quite consumers
must be treated and recognized
as essential partners and our
questions regarding proposed
changes what MHSAA no that that
number change also the client
in a concert I couldn't
overcome homelessness my mind
at the time. Were on now Dylan
their own stock. I've learnt
coping with mental illness. So
I continue services that are
provided. We will. A. P. sports
specialist that I work with
others and be a part. Of. As
clients some as in all your
decisions. Carol tool from the
in on it. Thank you for the
opportunity to speak about the
M. H. S. A. ends to speak of
the mission support for
maintaining the original intent
of proposition. Sixty three the
promise of serving a car. Ben
along with all the other
population aid groups and
cultural groups I'm really
needs to be recognized I'm
Frank from UCLA I mentioned her
research what she didn't
mention was that they felt that
adults get about one. Point 5%
The fact that they probably are
stigmatized in any other
population groups- age why.
Early intervention hundreds of
them from falling into. I
should ending. Woman as your
health. Did you lose friends
and your economic situation
falls- I wanted to thank
director Cabrera for mentioning
the issue of homelessness in
the older adult population.
Outs are complete- rapidly
became the largest percentage
of the population. The research
is that I did from doctor
Margot the show. Found that up.
These people to go into
homelessness but once an older
adult becomes homes they fall
into. So we urge you to think
of them now if the framework we
don't ask for more he asked to
be considered does your needs.
Good afternoon and thank you
for this opportunity and
everyone being. The. Mitch
Daniels tolerant and I'm with
the center for applied research
Lucien we only sell T. a
provider for the G. B. T. Q.
hub with. Funded under other
the. Parties project he said
the path just be looking at
community so persistently
pervasively being under Serb
and continued. By being
overlooked by the system that's
about. To try self today of a
major it's always not about
that their job. Our top two
they'll want it and we're
hoping that the assembly the
subcommittee will begin to take
your role seriously as
representatives of the
community. To really make this
brief ash worthwhile thank you.
Afternoon miss Sierra model I.
Think of despair this call.
Remco has been. As well as
immigrant and refugee entities
and those community based
organists else. Best to see to
making table since two thousand
and seven I just wanna make
sure it's noted that we do
support testimony. I am me
hello voices thank. On the
council also wanna thank you
chair around the lot for the-
for the stake holders. State
department representatives here
about our priorities regarding
the disappearance of the
changes in the image of say.
Although we- meeting taking
place regarding possible just
am I just say. Invited yet to
those discussion tables this is
ironic considering that some of
the most important principles
of the just say include
transparency and collaboration
with community. Garden all
images say related shin I'm not
all decision to be consumer
family. Event consumer
community say nothing about us
without us. Please do not think
that we believe the images say
as per. It is that we want any
changes in in which or
administrator the act. If you
ask most of the racial ethnic
and cultural communities. In
the state. We are still waiting
no from the V. six benefits
NET. Coal company programs that
reduce disparities and programs
are provided and programs that
provide are provided by people
and organizations from our
communities that's that's best.
I worked for and with Steve
Felix since thousand and five.
All and he told me you see. For
your- because. To the D. for
them to get their- funding and
these not evidence based
program. Are the types of
programs approach are suited
for our unity is preferred by
is and would fall under key.
Just is faced but many of those
programs and partner are
supported and promoted at the
low level how many state
entities besides the office of
health equity under department
of public. Invite here support
at its members. Communities of
color including room called.
Boyce's Patek seven. Program
methods that would actually
reduce to spirit prioritizing
changes the image say. How the
image to say is changed by
either legislation. Or another
the people of California.
Stakeholders all of us. These
are put into place thank you
human. Hi my name's reader
Koster I come from every county
I live. Change we don't have
time for change we need things
to work. We need you to work
with the community this way you.
I don't know how. Over the. Die
out here which with all the
changes that are going. Or do
something and then follow. We
don't have time. I prefer you
know twenty nine people have
died the streets and I'm also
homeless and I'm very. A record
with my community- I've done
the first rules rented comedian
Selena's a- I was part of the
pledge program to bring the
Porter parties were needed in
the homes community. Okay that
don't want and we like. Fun to
have the money do what you're
supposed to do with it because
we don't have time to wait for
all the decisions and just do
this now this do that now we
need something that works work
with us. And what we need you
guys are asking each other you
know because you. Live what.
Through you know we're trying.
Well. You can going to jail the
child is you can't be here but
the cat directors anywheres so
what is what you do and you're
right it does make you go crazy
that's what. What what. You
can't be here. What were the
new don't. Then you're not
worthy of. Because we're all
just taste homelessness we
don't manage funds we live in.
You're doing people are dying
we don't have time for all the
different changes. We need
things now are to do more with
very short. Because every check.
Tell you what we need. Thank
you thank you. Hello my name is
Pamela Weston. Good afternoon
members of the committee I'd
like to call you appear to.
What you don't see a note as my
son died in and check by train
having him in two thousand
fourteen brother rob was a
veteran and- this is. State
hello. The kid because through
Nani he learned how to ask for
information and apartment you
have to change anything- you
took a cultural relevancy. For
eleven years. We've got to my
county and there's a mini
planning process I learned.
Part of cowboys since under.
Code section five. Five eight
one three point five. D. and-
nine California code of
regulations. Three two zero it
has principles like me
collaboration coach. Thank you.
The impact historical bias that
can influence on the. The
bullhorn. Thank you she. If you
can change a thing as a. Twenty
it spent not reported me
planning process. You you can
mandate they spent five
percent. Meaning to an
unrepresentative. I ask them to
go out where did they did
innovation from Mexican we have
intersections so I would ask
you to. Not fret. Two two eight
and like what governor Newsome
as there should be no door. We
can't do anything. What you
don't know about this but you
set the standard. At the plus.
The steering committee
underneath the bore the mental
health commission because right
now. Times staff or in the
service managers throughout the
state. The work so with that
you. Is to ensure that he. The
mental service me planning. And
we had a we have a cultural
competence action plan that
consultant. But the
representatives of the
commission they'll look at the.
And has a timely manner but it
doesn't. And we in two thousand
seventeen. Prior to that it
should be districts. Nobody you
know it. Is not what's wrong
with this. Our resiliency so
would not be California I
learned how to advocate for
what I didn't have when my son
was the light. Through smart
advocacy and found exactly and
that meant. A contract and we
have engine health. But for the
community for the mayor for
what and a couple there.
There's no accountability and.
But to help. Please wait. Let's
do it now the- people to do it
do you. And the next meeting
can you have a public place
because there was a more
community. Different than. Then
you have to get to know what
the work we've done my name is
Pamela Austin I was co voices
I'm access some bass under for
the bay area. I best for.
Please civic. Regional.
Approaches I would you mandate
and enforce the 5% The planning
process at. That would be back
but- we think. That we work
with at the event listen if we
you could follow up with those
of us that want to. Access to
be able to have you come to my
right county. Cultural
relevancy actually. Your lives
by is. We have to I was
homeless and the people would
read it here they have nowhere
to go and there's women that
are are dying. Read was trying
to get the help. Please clean
center I. So dot. It's really.
Thank you thank you. Good
evening I'm beau goes down for
makeup costume and I'm the
parent of most. Early mentally
ill of those whose very life
ends on various my search.
Programs. Personally tell. It
was not meant to be the sol
the- meant to help wanted
twenty. What I heard today
concerns me because I've. The
intent of the A. M. HSA. And
rob are more vulnerable. An
existing M. HSA funding to
counties to try and solve the
homeless was crisis. Whether
the persons are mentally ill in
addition all. Of Buck up we
just for and more. Any funded
server. Would rob can. Programs
and I'm gonna talk about now
I've also mental health
commissioner. No health
commission insurable just
finance committee and I can
tell you that. The behavioral
health is using MHS safe. All
of. Your program serving nearly
six first two twenty four seven
real whatever it takes full
assertive community. Treatment
wraparound assist standards
another. All the staff is a six
to eight. I'm ready I'm- only
six point five dollars
including the competitive no
place like home for. To
establish twenty year. A
supportive housing for
transition it. And the set by
transition aid you gonna do
treatment program. Small I
thank you since. Haber help is
just wrapped up its image as a
planning pro bono process
eighteen months ago as-
vigorously at. Thousand service
provider. Family members and
consumers. Here's what came out
of those meetings S. how small
the mentally ill and not to
help families another.
Community under his spell. He
is the one county in the state.
Hello matching the per dollar
federal Medicare bad not only
the state would grow program
start image just funded. Goes
up in smoke if the state
unwisely continues to rob an
HSA funds from counties. Aside
for. S. you this substance used
to. Yes that frankly the Middle
help back will be largely loan
there are other ways in which
we can discuss all of. I come
from the San Diego. Reason I
also done and I've been in
country for nineteen now. I am
running and on- ethnical based
organization called. Sisters if
it. Is a go up in the San Diego
Orange County in those. The
good old I need in it is the T.
do you of refugees have a lot
right the name. Left the
country to the nearby country
to come to not his states and
coming to his. Is this. Is a
very cool to amend the recorder
of San Diego county. Says that.
By eighty point of five three
feet unemployed the U. K. much
the number. The refugees to pub.
With the development we
developed it missing school and
a. Thank you to cut the
department. What's up a nursing
school with the school Duncan
brain refugees. Yes days and
they can city fied messing up
the stunned that gives the- yup.
We are serving burrows who
really in a mental crises in
the San Diego de a lot of
mental health issues going on I
will use of committing suicide.
There's a lot of domestic
violence in the community and
that is even up. The what use
is. The sea with the county who
did his poor financial support
in order to help Michael T. but
noticed in dot of support
coming through so dissed. I'm
when you when there is funding
the Sportpaleis Sunday refugees
should be included. Work with
there was it we want. He wanted
to come to finding it is a
little bit difficult especially
when you call an office at the
king to date with accent Hey.
If you are too much I done
maybe you don't know what
you're doing but we noted in
the community we know what. Not
sisters his **** serving
community eighteen years now we
have trucker. Community health
resources here I can leave to
use so you can learn more about
a will work I am very very
grateful for the- opportunity
to comment if. I missed before.
Thank you very much thank you
ma'am. Evening Mister chair of
Linda to what's on behalf of
the California Pat I think
health network. One port of
call for reducing disparities.
For the- then you heard from
countless community members
today the value of community
defined practices and we would
hope that these types of
practices are really woven into
the fabric of how we deliver
mental health services- so
number one just making sure
that we can sustain on these
programs and making sure they
don't just die as funds dry up
but they actually are taken
into consideration. By counties
at a love scene that they help
improve the health outcomes of
the most vulnerable under
served in a- community member.
At. We can continue I'm the
made so far thank you thank.
Hello my name is Carter I am.
Is on with cal. And I
definitely appreciate the
opportunity to give public
comment today and to be able to
beat him in this long
individuals who definitely
wanted to lend their voices it
is where topic I do want to
acknowledge before I. Give in
to my public comment. Attached
to her you have the public.
Left and it doesn't necessarily
support the camaraderie that I
do believe specifically the
MHSAA really. Calls for so I
just wanted to speak but I.
Still hear especially those
individuals who are decision
making. To revamp our revised-
things that have not accurately
been executed therefore it
cannot accurately be assessed
so I really feel as if the
MHSAA is accurately exit. Then
we can stand back and we can
make us as- to what we need to
revamp things or provide over
the case says and taste it's
six am nurture and they move
legislation we know this- we've
heard a significant amount of.
Meaning to stick that were
brought up today and in support
of the S. M. HSA and also in a
possible areas of improvement
yeah as a live experience
someone who has provided a
significant amount of different
levels of care of for various
MHSAA funded. Plans to
consumers of mental health
services here in Sacramento for
over a decade and now having
the- able to provide- support
and honesty it level. Oldest
and state why. Is the
organization here in California
support. How it really call
unprecedented amount of
meaningful. And stakeholder
involvement- I'd have to say
that. It's I see the point
system partnering not only
include Jack up can. As the-
cramming administration
revisions implementation and
all the other areas that MHSAA
funded programming. Is mandated
by the act to specifically do-
and I we have a panel of. And
that's full. We would be
violate their original intent
act by. Not ensure that you
have the part of consumers in
numbers. And provide. As we've
heard respective to whether or
not these expansions are these
new ideas that are at the table
are really what they need to
sell we must do a better job
job it and genuinely enforce
the act across the state order
early assessed it in attempt
revisions. If necessary. In
Cannes in up. The in our state
to its full statute and what.
Because I say as a previous
service- has provided those
definite fill in the gaps that
people can't get anywhere else
and I've seen people come from
the gutter and florist because
of the MHSAA as it is right
now- so I really just want to
consider our apps.
Consideration that the image of
the state as it is and it's
really work forcing it and then
after we've had a proper time
to. Set it. Pollution of the
community thank you thank you.
Hi thank you commission for
hearing us. Just like to echo
what Tiffany said- it is rather
contain set for seven hours but
we really believe what we have
to say that's why there's so
many people here that more.
Speaks to the value of input-
for us to be clear at the end
of the day I've I've come with
people with. Elise or physical
disabilities that that through
this whole thing and heard. One
speaker but none of those.
People are here to hear us so I
just want to say that. My name
is. The way. It is. The others
have been here today- I. Am
also someone who is happier. I
have lived experience I've been
hospitalized in state yeah.
Spittle I'm also a mother I had
a child who had autism and-
diet. And cancer six years ago
it's Chris. And another. US
panic disorder. And IT. I also
have a sister who was diagnosed
with schizophrenia many many
years ago. Also growing up I
was chronically homeless from a
very young age and with my
children. So I also grew up in
a culture of poverty and I know
what it means to be a big pile
of money and think I know how
to spend it better than
anything else. I know how much.
Homelessness is a big deal
because it was me. I. I've been
a counselor and working in
crisis services. Five you. An
advocate if it hadn't been. For
MHSAA programs and peer support.
The fifteen minutes from
paradise. As you know with the
camp. A we had a- we. Now have
a four thousand people that on
back to pick. The community as
a fifty this. And a lot of that
falls in our community. And now
in a that led state in. Fire
now has thousands and thousands
of people they're traumatized
living in trailers to this day.
I heard me talk about ninety
homeless people. I've done a
lot of studying was sharing and
visited other based. On that
fifty thousand of those Thomas
P. born out on. Distribute
right what does that mean the
other counties. They're
different needs and different
approaches and different
counties. I represent the
Superior region where the
northernmost sixteen counties
we go from the ocean to the
Nevada border from the Oregon
border to just north of
Sacramento. We are a will hate
wide part of tell off nor and
culture you know you have. To
the bay but they forget about
the four hours north. I
represent the report in
northern California real
northern California. In a. Is
that the techniques and the
this this is offer to someone
it tent on a sidewalk in. It's
going to be completely
different than the person next
out. Next waters of the
Sacramento in mount Shasta
they're two completely
different there are
similarities but- unless you
give that people are back to
the communities and the peers
and people that are in those
places. You won't know what
that is. So I'm asking you
today a backup Calvert says
position don't fret or re
organize or otherwise alter
image okay as. Until you
enforce it the way it is. I'm
and also include. And power
support certify S. continue and
expand educational programs I'm
here today because of the poor
from campro share name me
access they taught me what this
is about in that. Case we
shared that with more. We may
not even need at this meeting
I'm not so I heard you that
collaboration is complicated it
takes up. Rick it is. And is
about pulling people from who
know what it's about to tell
you what they need. And here's
also offers a level
accountability you want John
ability than us the. That's
right and. The person who had
been peers and price this is
what I can tell you. The new
flat. Your work force is
filling in gaps that are
shortage providers. After. Ste
at Staten give us dignity and
let us county holders and peers
decide as I just say all right
has written as it already I
that decide our way and we are
the experts are recovery and.
Good evening my Cascada I
represent less familiar
accounts center we are one of
the key fob. Jewel projects
through the California using
this project. Aside learn. In
the old days thirty five which
is used to- I was stuck in in
twenty five years and the
mental health and- to note
thirty five agencies. Do and
reached. I'm incredibly
innovative ways to serve an
engaged to get these. Sure for
many many years. I went to pick
up when I speak about
engagement hi engagement that
actually has come in from both
trends agents reach in the
community. By community re
reaching out the agencies that
we work with that can get. Aids
utilization of server but I can
tell you too many stories.
About success not all of our
agency but through the- he's in
this price. But really what is
that community define prop says
I really could not think of to
be. Our community is in the
cage so we can reduce Sperry's.
In thinking that straight into
presents and straight into
homelessness straight
utilisation of Sir says of
mental health that could be
avoided if we are. Prevention.
Schindler's up for them. I urge
you to please find this program
played on an- the two years
that we have left. Was re
create trouble for them no it
is happen. My name is Allison
Monroe. From Alameda county I'm
ready full doesn't mom and
family members in Alameda can.
List a that's the norm for them.
And so we have perhaps a
different point of view on
MHSAA. There's two things. Well
first of all we don't we're not
a refresh. Of M. HSA and the
direction that binder. Hello in
two homeless as. It's sick that
the homes with those prices are
likely to not. All my family
member. Would not stick in is
there. License license support
housing they're not burdened
cares. But MHSAA my hand care.
I've heard from Robert Wratten
without a county. To spend a
lot MHSAA my on both ears.
Capital in technologies funds.
This time or money to help the
sickest. So we went ahead and
place I am and we are not. Of
another. Process it would take
money that's supposed to be for
this basically now and spend it
in. Other cars cannot break
because I'm sure but not our
children's. There's two things
we want to things basically-
are the group does is called
Alemannic as me. One is what
treatment beds. Say at times
the money can be spent a lot
facilities but it has and it
could be it's me you can't
spend it on a long term.
Facilities or tail. But in a
few. Crisis treatment you would
help. And again we would like
it might be money Borden cares
that's something that's
desperately missing. But I
think we're a person the hope
of me Hey. To the can't record
trip days if he gets in trouble
if he is if he smokes if he
does this to that. He can come
back that place he home. That
put a boarding care ida B.
that's what we ought to be
doing. It to save money. Not
everybody. Is well enough to be
able to live in an apartment.
Good. I can't stand to put
billion to spend. Which should
be spent on many things are a
few things. Needs spent on the
ten thousand. In the state
county there's maybe six
hundred. The rooms in a jail on
bogus trifling charges. Those
people need to be helped and
they ought to ideally if the
system worked each one of them
would have a choice whenever
they needed it. Either a short.
Statement civility or. A good
boarding care bed. When they're
well. Can stable income. Was it
in more with one board I wish
under these. We only have.
Three Philip facilities like
synergy. And that's probably
enough you know I'm not talking
about a lot of people I'm not
talking about half the
population record the
population or even 4% of the
population I'm talking about
ten thousand people and their
families. And I brought this T.
shirt today it has a picture
mark repeat. He lives in Solano
county he lives on the street
he has schizophrenia and T. B.
R. I. any as a piece of metal
in his leg he has no eyes. But
he's homeless and his family's
tried everything. To get him
off the street. Everything he's
been switched back and forth
between the TV I system.
Whatever consists of. And the
mental health system and. He
wanders off from work at his
family watched him die in the
street very slowly. Here's they
bring in food you know they try
to dry out as close a bring a
phone. You know they listen to
what he has to say. But if our
state can't do the right thing
for this guy there is no kit of
ours is safe so that's why I
brought this teacher thank you
for let me talk. Thank you
ma'am. More to make. Hello from.
My name is
. To one it's. And
now she's even more frustrated
because in a way it happening
again. My. MH when the needs
haven't even been meant were
being met and are meant to hold
minority communities. Enforce
MH at the funds don't take any.
Money away let's make a- from
the number one who spoke today
we have the living experience.
We lived through this every day.
Thank you ma'am. Hi my name is
a shortage. I'm also from nami
Contra Costa I'm also a family
man thank you for listening to
me. As you. I bet you see any
issue that's speak even eight.
There's not Asian people the
onus. Strong stigma like other
coach and the also the line if.
And. People is this the home-
I'm here I think greed mentor
and the- the pre vision is more
important than that shorter
show the goal for. Forum he I
think. I do get the phone calls
a lot from because from the
family member on the these even
call me thank. The more there
because of the Senate. The four
knives on the she- know what to
do so she- toss the. Model on
their end so that's the whole
hard that she didn't know where
our hotel ask for help also- I
talked to a on TV see
international students he asked
for help as I told her him and
with the phone number he can
call one of the. Phone numbers
a hotline he said that he. Did
the call the one time. Other
understanding him I understand
that much. At prices he hung up
on the phone still and pay for
him the language is more
important so that's the. All I
ask is that the T. programming
costs across the county they're
small language if for that or
Chinese. And also nami has a
lot of a program like a vision
that Konami basics we only have
English materia I we can have a
phone that to translate the two
Chinese so. Get the teachers to
teach that program to get to
the issue and the also. The
also like I said that the
crisis line I really hope that
could directly save a life even
there's the language because
some part of that- so it does
all I hear for today. Thank you
for listening to me you can.
Diane my son has the disorder
at I'm in a complete treatment
all. Your services he walked
away from everything that was
offered to him fifty one
fifties don't work because
there aren't enough. He has to
wait to get into a bad or he
pulled through internet
internet internet over and over
and over. Not enough of a full.
When he was there for like a
three month period at batter.
Becoming homies off his meds
and he just. Spirals down again
hello. When he was off could
become violent and it was a
tragedy he tried to move his
stab me twenty six times. I
lived through it. My son I want
him to be treated ticket treat
meant and that means that bad.
In jail he can be in jail for a
long time. Him to go to the
apple doesn't. Have any bad
sick at least a two year wait.
And where is it for him can
refuse. And I'm- not by if you.
It's and he deserves to have
life. And he's been screwed
over by the spy system in
California probably has one of
the best in the country but
it's not more treatment. Number.
I have very few words I
actually winning. Person poker
disorder. I am seven years
sober and crap. On either of
those this is my birth Z. it'll
have to do it. But in all
seriousness. I'm so proud been
served in the last four years.
It's a. Incredible and physical
help the Clinton physical care
to talk I mean come. In Concord
at the. Would you Medical
Center there and also through
the adult health system. Cancer
about. But I would also like to
respect for the say to the one
that spoke the folks spoken up
about racial disparity. I was
twice beaten nearly to death by.
After working. In the Black
Panther movement in the past
thirteen Berkeley high school
and then once in the- deal dope
and. His resilience to. Not to
my brother. To this. So when I
see what is happening with the
rate disparity I really kill it
it hurts me. And a lot of times.
Raised in families that don't
have from pop to get some help
for. You for the truck to get.
Changes everyone's lives for
from there on out. So I'm just
saying I am so very thank. For
other people have done the
whole thing kills have given me
and I as a now- now put in not
just a couple of that I'll be
in in in Chinese and Italian.
And I got a lot- my list and
you can plan on seeing you
meeting. Thank you for your
time thank you Sir what. Time
and I would I would like to
apologize for but in two ation.
I rivers and Terry I represent-
families in. From all over are
you. I've invested for your my
life every local. Well the plan
took place. And I did not but.
Daddy I mean. Read the
newspaper every day. You got
something kid. So but I'd like
to do I love. Five we really
love each mine matters. Okay
forces that. Your part. Through
this. To me my back is taken.
Tell me to complain. Mine
matters is a California
movement it's in process with
non me into says with with
every organization we have. So
the way that it would all work
out. Is that if we can partner.
All the partners that are
through each mine matters let's
just talk about said bill ten.
That would. This so. Much
certainty would put rune
regulation to. Do what are. The
land of the free the bridge. SP
ten is essential and. Asking
you personally to the what do
university class through nor
cal mental. Which is now called
tell voices. Need to do. My
reflection identification what
I'd like to do is I'd like to
partner with you and to build
that if it takes an individual
member I would love to help
I've certified through non with
the culture distance
competencies. Certified through
Friday night live. Now each my
matters with the with the whole
system- Dover been set years
this month- I haven't taken a
on our car I haven't taken any.
Pills I haven't taken dictate
the pain. Part of a motor.
Football and I mean I've I've
got reconstructive surgeries
left right and try not to come
mama warrior. But I heard. I
heard we might. For team. My
family my friends Terry in us
hi and I would love the
opportunity to meet with you.
To thank you Sir. Any further
comment I don't wanna dissuade
anyone who wishes to speak at
this time. Seeing now I do want
to thank everyone. In the time
and- thing to pourtant for us
in the public how to hear from
the public that's why I and on
serve and listening- I do want
to say this is a start of a
conversation continue
throughout the year and I would
encourage you to engage in the
process that is being laid out
within callin him as well as
what we will do within
subcommittee that I chair. I'm
not- I want to thank everyone
including our staff who. Made
it. Percent your. I do
appreciate your time and thank
you everyone for coming