Mental Health Services Act:
A County Perspective
California Mental Health Policy Forum
February 11, 2005
Presented by
Nancy Peña, Ph.D., Director
Santa Clara County Mental Health
The Opportunity

Social Analysts have revealed flaws in
the current system, providing objective
evidence of the negative individual,
social, and financial outcomes that are
resulting from neglect of the mental
health of our citizens
The Opportunity



Local systems are stretched beyond capacity
and unable to meet demand
Administrators are distracted by the burdens
of bureaucracy and financial crisis and
uncertainty
Clinical leaders are preoccupied with
operational demands and are unable to
focus on effective quality improvement
efforts that insure excellence in practice and
optimal client outcomes.
The Opportunity


Consumers and family members are without
adequate care and are demanding that
mental health be addressed with the same
urgency as health care
They are demanding freedom from stigma,
a path to recovery and wellness, excellence
in service, and inclusion as partners in their
own care and in the service delivery system
The Opportunity


Advocates and Stakeholders have presented
the issues to Californians and have offered a
compelling set of strategies to correct the
current system flaws.
Citizens have affirmed the reality of the
current crisis, and have mandated solutions
to be financed and implemented.
Providing System
Stakeholders a Window of
Opportunity to Make
Far-Reaching Change
The Challenge

Mental Health Directors and Provider
Leaders Need to step Up and Provide
Leadership to this Exciting New Era in
Public Mental Health History….
The Vision
Is not created or facilitated by
legislation or money
Is created by Leaders
◆
◆
◆
◆
in clarity and soundness of ideas
in effectiveness of communication
in influence and engagement
in sustained purpose and action
The Vision
DMH: “To… expend funds made
available through this initiative to
transform the current mental health
system in California …This will not be
“business as usual”. Eventually access
will be easier, services more effective and
out-of-home and institutional care will be
reduced.”
The Vision
Outlines Transformation Areas:
 Consumer and Family Participation and
Involvement
 Programs and Services
 Community Partnerships
 Cultural Competence
 Outcomes and Accountability
The Process
Santa Clara County 
Broad based stakeholder process

Stakeholder Leadership
Committee to:




Review Development of Plan
Facilitate Stakeholder Involvement
Educate Community
Advise Board of Supervisors
Santa Clara County
MHSA Planning
Structure
State Dept. of
Mental Health
Accountability
Commission
Board of
Supervisors
Mental Health
Board
BOS Committees
(HHC, CSFC, PSJC)
County Executive
SCVHHS Exec. Dir
MHSA Stakeholder
Leadership Committee
Children’s
System of
Care Work
Work Group
Data,
Technology,
Budget
Work Group
Focus
Group
Adult/
Older Adult
System of Care
Work Group
Project
Management
Team
Prevention &
Early
Intervention
Work Group
Community Stakeholder Forums, Focus Groups, and
Consumer Engagement Groups
Focus
Group
Cultural Competency
Focus
Group
Readiness Forums
Focus
Group
Recovery/Self Help
Readiness Forums
Focus
Group
The Process
Monthly Stakeholder Leadership Meetings
for:



Information and Status Reports
Input from Broad Community
Readiness Forums
Work Group Meetings:




Child, Adolescent, Young Adult SOC
Adult and Older Adult SOC
Prevention and Early Intervention
Data, Infrastructure and Human Resources
Regular Reports Board and Board
Committees and Mental Health Board
The Process - Santa Clara County
Partial List of Stakeholders

Mental Health Department (chair)

Police Chief Association

County Executive’s Office (co-chair)

SCC Sheriff

Mental Health Board (co-chair)

Department of Social Services

Mental Health Self-Help Centers

Probation Department

MHD Office of Consumer Empowerment

Superior Court

National Alliance for the Mentally Ill

District Attorney’s Office

Association of Mental Health Contractors

Public Defender’s Office

Non-AMHCA mental health providers

County Office of Education

Labor Organizations

School District Superintendents

Foster Care Association

First Five Commission

Residential & Group Home Providers

Council on Aging

Parents Helping Parents

Office of Affordable Housing

Department of Alcohol and Drug Services

Domestic Violence Council

Public Health Department

School Linked Services

VMC Acute Psychiatric Services

United Way

Custody Health Services

Interfaith Council

Valley Medical Center

Silicon Valley Council of Non-profits

Office of the Public Guardian

San Andreas Regional Center
The Process – Phase I
 Engagement and Commitment

Invite Stakeholder Involvement

Share Intent and Vision

Set Tone of Inclusion

Establish Collective Receptivity

Align Expectations Without Losing
Optimism

Outline Planning Landscape
The Process – Phase II
 Learning and Assessment
 Learn Current Service Delivery System

Learn Needs and Interests of Consumers,
Family Members, Providers, System
Partners, Community – (left and right
brain approaches)

Learn Best Practice Strategies to Meet
Needs

Learn Outcomes & Accountability Models
The Process – Phase III
 Prioritization and Planning
 Establish Local Mission, Values &
Transformation Objectives
 Prioritize Local Needs
 Select Effective Strategies to Meet Local
Needs
 Complete Planning Components
The Process – Phase IV
 Implementation
 Obtain State Approval & Funding
 Select Local Providers
 Establish Local Accountability
Structure
 Initiate and Monitor Services
 Evaluate Services
Santa Clara County MHSA
Planning Framework
– Across the Lifespan For Each Developmental Group Describe:
• Population Size
• Service Utilization
• Geographic Distribution
• Prevalence Info
• Ethnicity and Immigration
• Risk & Special Populations
• Gender
• Unmet Need
• Age
• Stakeholder Input
Santa Clara County MHSA
Planning Framework
– Across the Lifespan For Each Developmental Group
Assess Each Transformation Area:
Where Are We?
 Consumer & Family
Where Do We
Want to Be?
Involvement
 Community Partners
 Programs & Services
 Cultural Competency
 Accountability and
Outcomes
Assess
Strengths &
Weaknesses
in each area
Determine
Transformation
Objectives in
each area
The Impact on County
Service Systems
Pressure to:
 Establish Formal Interagency Policy
Forums
 Establish System Goals for All Ages
 Assure Consumer & Family Influence
and Involvement at all levels
 Outline System Values and Philosophy
The Impact on County
Service Systems
Pressure to:
 Determine and Prioritize Consumer
Needs
 Implement effective culturally
competent prevention, early
intervention and treatment services
 Demonstrate process quality and
favorable outcomes
The Impact on County
Service Systems
Local System – Establish Common
Goals for All Ages
Stability in
Family &
Social
Relations
Health &
Well Being
Success in
School/Work
Meaningful
Activity
Safe From
Harming or
Being Harmed
in Community
Examples of System Outcome Objectives
Health Insurance
Stable Living
 School Attendance
 CJ Recidivism
Health Visits
 # Placements
 Graduations
 Days incarcerated
Health Status
 DV Incidents
 Work stability
Victims of Crime
 Suicide
CJS Diversions
The Impact on County
Service Systems
Affirm System Values and
Philosophy
 Access and Choice
 Collaborative
 Cultural Proficiency
 Individualized Plans
 Early Identification
 Community Based
 Family-Driven
 Strengths Based
The Impact on County
Service Systems
Establish System Structure and
Stakeholder Involvement
Stakeholders
System Policy and
Management
Provider Services
Individual & Family
System Performance:
Expectations & Results
Provider Performance:
Expectations & Results
Client Level Outcomes:
Expectations & Results
The Impact on County
Service Systems
Determine and Prioritize Local Mental
Health Needs
Current Public
MH System
Intervention
Citizens in
need
Early Intervention
Prevention
All Citizens Across Lifespan
Unmet Need
The Impact on County
Service Systems
Demonstrate process quality and
favorable outcomes
What Are We Trying to Change?
Who Do
We
Serve?
What Practices Do We Employ and Why?
How Do We Insure Quality of Practices?
How Do We Measure Results?
What Results Do We Achieve?