California Network of Mental Health Clients

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California Network of Mental Health Clients
Mental Health Services Act A Status Report
Real Transformation Clients Taking the Lead
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Presented byDelphine BrodyDirector, MHSA
Client Involvement Program, California Network
of Mental Health Clients (CNMHC) Sally
ZinmanExecutive Director, CNMHC
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California Network of Mental Health Clients MHSA
Implementation Team

• Anna Lubarov. Bay Area
• Blanca De Leon, South
• Carol Patterson, Bay Area
• Carole Ford, Central Valley
• Catherine Bond, Central Valley
• Dave Schroeder, Central Valley
• Dave Housseini, Central Valley
• Delphine Brody, Bay Area
• Donna Nunes-Croteau, Central Valley
• Douglass Murphy, Bay Area
• Georgia DeGroat, Far South
• Gail Green, South
• Karen Zimmer, Far North
• Kathie Zatkin, Bay Area

• Michele Curran, Central Valley
• Kevin Murphy, Far North
• Jay Mahler, Bay Area
• Joyce Ott-Havenner, Far North
• Linford Gayle, Bay Area
• Patty Gainer, Central Valley
• Meghan Stanton, Central Valley
• Nancy Thomas, Bay Area
• Rob Chittendon, Far North
• Sally Zinman, Bay Area
• Sharon Kuehn, South
• Susan Gallagher, Central Valley
• Sylvia Caras, Bay Area
• Tracy Love, Bay Area

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Transformation Our Vision

• The CNMHC envisions a world in which mental
  health clients and survivors of all ages and
  cultures live fulfilling, independent lives, free
  of discrimination and stigma
• A world where programs and services are always
  voluntary and without conditions, never forced or
  coerced
• A world where people can access, if they choose,
  a wide array of voluntary self-directed,
  client-run, trauma-informed, culturally and
  linguistically competent programs and services
  that meet people where theyre at, including
  but not limited to traditional, self-help,
  alternative and holistic services, and culturally
  diverse ways of healing
• A world in which collaborative networks of
  programs and services provide quality peer and
  non-peer support and advocacy in every service
  venue, with the common goal of helping to
  facilitate people's wellness and recovery so as
  to empower them to be change agents in their own
  lives, and ultimately to support others personal
  transformations and to participate in the
  continued transformation of the mental health
  system, as we expand our knowledge base on how to
  do this well
• A world where survivors of violence, abuse and
  trauma can expect service providers to respect,
  listen to, and support them, regardless of
  whether the service providers are peers or
  non-peers, whether the services are traditional,
  alternative/holistic, or culturally specific ways
  of healing, or whether or not clients agree with
  their providers' assessments regarding the best
  course of treatment
• A world where we are valued and respected as
  friends and as members of our families and
  communities
• A world in which clients are fully and
  meaningfully employed in all levels of the mental
  health system, in self-help, and in the broader
  workforce, without fear of discrimination.

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The MHSA from the client perspective
Nothing about us without us!
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What is the Mental Health Services Act?

• The MHSA was voted into law as Proposition 63
  on the California ballot in November 2004.
• The Act requires County mental health service
  providers to offer services and programs that
  have been designed by the residents of that
  County,
• Counties must follow a planning process and
  requirements developed by the State Department of
  Mental Health (DMH) with stakeholder input.
• MHSA programs must be client/family-driven,
  wellness/recovery-based, and voluntary.

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How is it funded?
The MHSA is funded via a 1 State tax on earned
income over 1 million, starting with the second
million.
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How is it supposed to work?

• Stakeholders (clients, family members, mental
  health professionals and service providers) are
  supposed to be part of the MHSA program design
  teams in each county, along with local
  representatives from education, law enforcement,
  businesses, and the general public.
• Clients and family members of all cultures and
  age groups are supposed to be asked for their
  recommendations and have full involvement in all
  levels of MHSA policy-making.
• A collaboration of agencies is supposed to be
  involved in serving a broad range of clients
  needs.
• Diversity outreach and inclusion is supposed to
  be a priority throughout the process.

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How far along are we in this process?

• Most counties have submitted a plan for MHSA
  Community Services and Supports (CSS) spanning a
  three-year period, which must be renewed
  annually.
• The other counties plans are being developed.
• Presently, the DMH is developing regulations
  for four new components
• Capital Facilities Information Technology
• Innovative Programs
• Prevention Early Intervention, including
  Reduction of Stigma and Discrimination

• Education Training (Workforce Development)
• There is a small/rural county exception on
  these timelines.

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Consumer-driven
Consumer-driven means consumers have the primary
decision-making role regarding mental health and
related care Consumers are the primary authors
and decision-makers in developing policies
affecting local, state, and national mental
health service delivery. All meetings and
preliminary discussions about the scope of policy
design efforts involve consumers. Consumers
outnumber government staff, contractors and
secondary stakeholders non-recipients of mental
health services and are the first and primary
stakeholder. - Excerpts from the Center
for Mental Health Services Draft Principles of
Consumer-Driven Care
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Our values reflected in the MHSA
5813.5 (d) Planning for services shall be
consistent with the philosophy, principles and
practices of the Recovery Vision for mental
health consumers. (1) To promote concepts key to
the recovery for individuals who have mental
illness hope, personal empowerment, respect,
social connections, self-responsibility, and
self-determination. (2) To promote
consumer-operated services as a way to support
recovery. (3) To reflect the cultural, ethnic,
and racial diversity of mental health
consumers. (4) To plan for each consumers
individual needs.
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MHSA Our priority, our concerns

• At the 2003 Client Forum, members voted to make
  the MHSA (then Prop 63) our highest public policy
  priority.
• However, many concerns were raised that the Acts
  implementation might not comply with the laws
  intent
• Will the implementation be accountable to the
  values and intent of the Act?
• What authority will the DMH demonstrate to
  require that Counties comply with the Act?
• How can we ensure that Counties do not use the
  new funds to back-fill old systems?
• Will MHSA funds be used to support the same
  old, same old that hasnt worked and has
  disempowered clients?
• How can we guarantee the integrity of the
  implementation?

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MHSA Our recommendations
Before the DMH developed their Requirements for
Counties Three-Year CSS Plans, the Networks
MHSA Client Implementation Team produced a
position paper with our recommendations. The
following slides summarize some of our key
recommendations each of these is followed by
excerpts from the DMH Three-Year Plan
Requirements in which our ideas were reflected.
How??
Who?
What?
When?
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Voluntary services Our top priority
The CNMHC recommended that the DMH, in accordance
with the intent of the Act, allow only voluntary
services to be funded with MHSA monies.
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DMH Requirements regarding voluntary services
Individuals accessing services funded by the
Mental Health Services Act may have voluntary or
involuntary legal status which shall not affect
their ability to access the expanded services
under this Act. Programs funded under the Mental
Health Services Act must be voluntary in nature.
- Excerpt from the DMH Three-year Program and
Expenditure Plan Requirements, Community Services
and Supports Component, August 2005, page 1
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Essential involvement of clients
CNMHC members also voiced an overriding concern
that we achieve essential involvement of clients
in all aspects of local and statewide MHSA
planning and implementation processes.
Towards this goal, the CNMHC recommended that
clients and client advocates focus on four target
areas to derive the highest value from the new
law
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Our recommendation

• Client involvement
• Overarching all of the CNMHCs recommendations
  is the essential involvement of clients in every
  aspect of the implementation of the MHSA
  starting with its planning, moving on to its
  execution, then to the oversight and evaluation.

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The DMH agreed
1. Significant increases in the level of
participation and involvement of clients and
families in all aspects of the public mental
health system including but not limited to
planning, policy development, service delivery,
and evaluation. - Excerpt from the DMH Vision
Statement and Guiding Principles for DMH
Implementation of the Mental Health Services Act,
February 2005, page 2
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2) Client-operated services
Our recommendation
Client-operated programs should be developed in
every County. Each County should have, as a
component of its plan, a description of how it
will utilize consumer-operated programs in the
implementation of the CSS programs.
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The DMH agreed
2. Increases in consumer-operated services such
as drop-in centers, peer support groups, warm
lines, crisis services, case management programs,
self-help groups, family partnerships,
parent/family education, and consumer provided
training and advocacy services. - Excerpt from
the DMH Vision Statement and Guiding Principles
for DMH Implementation of the Mental Health
Services Act, February 2005, page 2
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3) Clients as providers in the MH workforce
Our recommendation
The hiring of consumers is a major statewide
priority that must be reflected in each
Countys CSS plan.
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Our recommendation
Clients as providers Workforce development
Each County will develop and implement a
consumer provider training program using existing
client-developed curriculums as models.
The hiring of consumers will take place at all
levels throughout the mental health system,
including management, administrative, and direct
service. County hiring plans will include a
wide variety of work schedules full-time,
part-time, volunteers, job-sharing, etc.
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Once again, the DMH agreed
Objective D. Promote the employment of consumers
and family members at all levels in the mental
health system. Objective I. Promote the
meaningful inclusion of mental health consumers
and family members, and incorporate their
viewpoints and experiences in all training and
education programs. - Excerpts from the DMH
Mental Health Services Act Workforce Education
and Training Five-Year Strategic Plan, Second
Draft, 9-25-2006, pp. 17, 19
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4) Campaigns to address discrimination stigma
Our recommendation
In consultation with mental health stakeholders
and the Oversight and Accountability Commission
(OAC), the DMH develop a strategic plan on how
stigma and discrimination will be addressed.
The DMH should make available to local mental
health programs and interested stakeholders
current information and research on effective
strategies for combating stigma and
discrimination.
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State-level response
The MHSA Components calling for a reduction of
stigma and discrimination are in the process of
being developed. The OAC has a statutory
responsibility to develop strategies to overcome
stigma, which must infuse all the work of the
Commission. CNMHC members are actively involved
in the Committees responsible for the developing
the Requirements.
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Some key stakeholder concerns reflected in DMH
Guiding Principles

• Consumer-operated services
• Wellness/recovery/resiliency
• Cultural and linguistic competency
• Outcomes and accountability
• Age-specific needs
• Community partnerships

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Our current concerns

• Apparent exclusion of badly served and
  underserved clients from initial MHSA programs
• According to reports, County Three-Year CSS
  Plans, at the direction of the DMH, target people
  who are unserved, but not people who have been
  badly or inappropriately served or underserved.
• The target population should be expanded to
  include the many people who have been
  inappropriately served through institutionalizatio
  n, coercion and force, as well as people who are
  underserved, i.e. have not received enough of the
  types of services they are seeking. Otherwise,
  the quality of life for most clients in the
  public mental health system will remain unchanged.

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Our current concerns

• Diminishing client involvement
• By now, the DMH has approved most Counties
  Three-Year CSS Plans.
• As these Counties move closer to implementing
  their three-year plans, clients from many
  Counties report the levels of client involvement
  and influence to have sharply decreased.
• The DMH should enforce existing regulations
  that promote and protect client involvement
  throughout MHSA implementation, to ensure that
  the process is carried out correctly.

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Our current concerns

• MHSA funding of inpatient hospitalization
• The DMH has enacted an emergency regulation that
  allows Counties to use MHSA dollars for inpatient
  hospitalize adults participating in MHSA
  Full-Service Partnership programs for up to 30
  days.
• Article 6 COMMUNITY SERVICES AND SUPPORTS
• ...
• Section 3620. Full Service Partnership Service
  Category.
• ...
• (k) Notwithstanding Section 3400 (b)(2), the
  County may pay for short-term acute inpatient
  services, not to exceed 30 days, for clients in
  Full Service Partnerships when the client is
  uninsured for this service or there are no other
  funds available for this purpose.
• California Welfare Institutions Code
• The CNMHC has strongly opposed this regulation
  since it was proposed in August 05.

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Our current concerns

• MHSA funding of inpatient hospitalization
• This regulation violates the letter and spirit
  of the Act, and is discriminatory toward all
  mental health clients.
• In addition, it threatens to undermine all of
  our efforts over the past two years to ensure
  that MHSA services must always be voluntary and
  never forced.
• If enforced, this regulation may erode clients'
  trust in the MHSA and its promise of
  transformation.
• The regulation may also disproportionately
  impact homeless people and people in
  board-and-cares with Axis I labels and histories
  of hospitalization.
• According to the DMH, emergency regulations are
  enacted for "the immediate preservation of the
  public peace, health and safety, or general
  welfare". This seems to imply that the DMH and
  perhaps some Counties and hospitals expect a
  flood of new inpatient commitments of uninsured
  adults when they begin accessing mental health
  services under the Act.
• If you are concerned about this emergency
  regulation, please sign up to receive CNMHC News
  Alerts for updates and information on how you can
  help stop it.

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Overarching client values Programs and services
Employment
Peer Support
Holistic
Self-Help
Voluntary
Trauma Informed
C h o i c e
Client-Driven
Empower- ment
Recovery Oriented
Diversity
Community Based
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A call to leadership
Moving from token involvement in decision-making
leadership
to
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Whos behind the wheel
of mental health policy?
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Real transformation Clients taking the lead
The Mental Health Services Act is a tool for real
transformation. Clients taking on a collective
leadership role is the means. It is the charge
and responsibility of California clients to move
from involvement in decision-making to
leadership. Real transformation will only occur
when clients, with the support of the whole
mental health community, get in the drivers seat
and take their rightful place as leaders.
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Culture Change
Thanks in large part to our involvement in the
design and implementation of the MHSA, the
California client movement is experiencing
transformation, moving from involvement to
leadership. Client involvement and leadership are
the driving forces of culture change, but this
transformation of hearts and minds wont happen
overnight. If you dont see big changes right
away, dont get discouraged transformation calls
for skill-building, far-ranging vision and
determination.
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Questions?

• Contact us!
• California Network of Mental Health Clients
• MHSA Client Involvement Program
• Sacramento Office 1-800-626-7447
• Email delphinegrrl_at_gmail.com
• Web www.californiaclients.org