The Mental Health Services Act was a ballot initiative (Proposition 63) passed in 2004 that set a one percent tax on adjusted gross incomes above $1 million. This money is to be used by county mental health departments to provide new and innovative mental health services with a more recovery and consumer-driven focus. MHSA divided this tax revenue into five main funding categories: Community Services and Supports, Workforce, Education and Training, Capital Facilities and Information Technology, Prevention and Early Intervention, and Innovation. The Community Services and Supports (CSS) portion is to be used for service delivery enhancement, direct service provision, and outreach to bring previously unserved or underserved consumers into the system. There are three program categories that can be funded through CSS: full service partnerships (FSP), system development, and outreach and engagement (DMH 2005
Full service partnerships’s use a team approach to provide comprehensive, community-based psychiatric treatment, rehabilitation, and support for “whatever it takes” to move toward recovery and resilience for target populations. Individuals enrolled in FSPs are assigned a personal service coordinator who coordinates necessary services and supports 24 h a day, seven days a week. FSPs may provide housing, employment, peer support, wellness centers, crisis stabilization, food, clothing, respite care and other services necessary to meet individual recovery goals (MHSA Expenditure Report Fiscal Year, 2005–2006). The DMH has specified that at least 51% of CSS funds must be used for FSP programs. Small counties were exempt from this requirement for the first two years.
The admission criteria for FSP programs require an individual have a serious mental illness (or in children a serious emotional disturbance) and be currently unserved or underserved. The definition of underserved is extremely broad, including anyone who does not receive services to support their wellness, recovery or resilience (California Code of Regulations. Mental Health Services Act 2010
). In addition to having a serious mental illness and being unserved or underserved, participants must meet one of the following criteria including: homelessness, at risk of homelessness, involvement or at risk of involvement with the criminal justice system, at risk of institutionalization, frequent users hospitals and/or emergency room treatment for mental health care, or for transition age youth, aging out of the child and youth mental health system, child welfare system or juvenile justice system (California Code of Regulations. Mental Health Services Act 2010
). Figure presents the criteria for adult entry into FSP. See the California Code of Regulations for additional information (California Code of Regulations. Mental Health Services Act 2010
Fig. 1 FSP criteria for adults. Petris Center Analysis of the California Code of Regulations. Mental Health Services Act 2010
Currently, MHSA is only budgeted to provide intensive FSP services to 10–15% of clients in the public mental health system, which necessarily limits access to these services. To help remedy this, there has been some discussion of creating levels of FSP services so that as individuals begin to recover and are more able to manage their illness independently, they can receive a lower level of services, freeing up funds for more individuals, including more of the underserved, to receive the types of intensive services provided by FSPs (Abbott et al. 2009
; Adult Systems of Care Committee 2008
System development funds are to be used for programs that will affect all mental health clients, while outreach and engagement funds are to be used to bring the unserved and underserved, particularly racial/ethnic groups into the mental health system. MHSA also defines four age groups that must be addressed in the county CSS plans: children and youth, transition age youth (age 16–25), adults and older adults (age 60 and over).
To receive CSS funds, each county was required to submit a 3-year plan that addressed both children and adult systems of care, subject to guidelines and approval by the State Department of Mental Health (DMH) (MHSA Expenditure Report Fiscal Year 2005–2006, 2005). DMH also provided guidelines and a small amount of funding for required county-level planning processes. The planning guidelines specified that consumers and family members must be included in the process, particularly people who were previously unserved or underserved, and those who are not part of any formal advocacy group. The counties also were required to include representatives from relevant agencies, including law enforcement, education, and social services (Program Expenditure Plan Requirements 2005
). The stakeholder process involved topic-specific workgroups, the development of publicly available discussion documents, and general stakeholder meetings. It is estimated that over 100,000 stakeholders participated across the state (MHSA Fact Sheet 2007
). By January 2009, all 58 California counties had submitted CSS plans, and these plans had been approved by the DMH (MHSA community services and supports plan approval status 2009
). In addition, counties who received funding were required to provide the DMH with annual updates. The guidelines for the fiscal year 2008–209 update require a workplan listing, descriptions of new proposed programs, and documentation of a 30-day review process (Mayberg 2008
). Forty-six counties submitted annual updates to DMH.