ADOPTED MINUTES
Mental Health Board
Wednesday, January 14, 2009
City Hall, Room 278
San Francisco, CA
BOARD MEMBERS PRESENT: James L. McGhee (Chair); Jagruti Shukla, MD, MPH (Vice- Chair); James Shaye Keys (Secretary); Bridgett Brown; Officer Kelly Dunn; John Kevin Hines; LaVaughn Kellum King; Tom Purvis; Lisa Williams; and Virginia Wright.
BOARD MEMBERS ABSENT: M. Lara Siazon Arguelles; Njoroge Tho-Biaz, MA;
BOARD MEMBERS ON LEAVE: Hale M. Thompson.
OTHERS PRESENT: Dr. Robert Cabaj, Director of Community Behavior Health Services (CBHS); Helynna Brooke (MHB Executive Director); Loy M. Proffitt (MHB Administrator) and Roger Kat, Caduceus Outreach Services.
CALL TO ORDER
The meeting was called to order at 6:42 PM. by James L. McGhee, Chair
ROLL CALL
Ms. Brooke called the roll.
AGENDA CHANGES
No agenda changes were made.
Item 1.0 DIRECTORS REPORT
Mr. McGhee: Dr. Bob Cabaj, the Director of Community Behavioral Health Services (CBHS), will give the Director s report and then follow that with a presentation of the current state of budget cuts and its impact on services.
Dr. Cabaj: As of January 1, 2009 Veterans are eligible for mental health services as mandated by the California Assembly Bill 3083 and the bill also amended the Welfare and Institutions Code, which recognized Post-Traumatic Stress Disorder (PTSD) as another behavior health illness. We may have veteran s administrators coming to 1380 Howard once a week to help veterans navigate the mental health system. The current main resources for veterans are at Fort Miley, at the end of Geary Boulevard. The Veteran Affairs (VA) just opened a new outpatient clinic near 2nd and Howard.
Governor Arnold Schwarzenegger, would like to have access to the Mental Health Service Act (MHSA) money, also known as Proposition 63. The governor is considering a $226.7M cut in the General Fund. To make up the short-fall in the General Fund the governor would like to use the MHSA money to fund the Mental Health Managed Care program. Using the funds this way would violate the voter s will and it would take the passage of a voter s initiative for the MHSA money to be used this way. There are several components in the MHSA. The Workforce Development and Education Training (WET) plan was accepted by the state, and requests for proposals (RFP s) will go out soon. The Prevention and Early Intervention (PEI) plan will be submitted to the state next week.
Mr. Keys: How much of the WET and PEI monies will go toward funding community based organizations (CBO)?
Dr. Cabaj: All the WET money will go toward CBOs. The majority of the PEI money will go out to bid. There was a change in the allocation of PEI money for early psychosis programs and services.
Mr. Keys: What is the RFP process?
Dr. Cabaj: A committee is composed of citizens, program members, stakeholders, and department staff who will evaluate issues and develop the RFP s. The contracts office works with the committee and also provides the training to RFP selection committee members
Monthly Director s Report
January 14, 2008
COMMUNITY SERVICES AND SUPPORTS UPDATE
Program documentation reviews of all MHSA-funded agencies will begin in February 2009. These reviews will cover all services provided for the fiscal year ending on June 30, 2008, and will be conducted in conjunction with the Controller s fiscal monitory review and CBHS contractual compliance reviews. The MHSA reviews will focus on financial and programmatic documentation to verify the accuracy of expenses reported in the monthly invoices and services reported either through the BIS system or through the agencies internal productivity monitoring system.
GOVERNOR S PROPOSED BUDGET REGARDING USAGE OF MHSA FUNDS
The Governor has proposed decreasing the General Fund in 2009-10 by $226.7 million, by funding Mental Health Managed Care with Proposition 63 funds. Since this requires amending the non-supplementation requirement of the Mental Health Services Act, implementation of this proposal will require the holding of a special election and the passage of a voter initiative. No date has as yet been determined for a special election. The Mental Health Association has firmly opposed this proposal and acknowledges that much of it would require more deliberations before this proposed budget and/or voter initiative can be considered. They will be closely monitoring developments as they unfold.
INFORMATION TECHNOLOGY COMMUNITY PLANNING COMMITTEE S FIRST MEETING
The first official meeting of the new I.T. Community Planning Committee will take place at The Village Community Center, 1099 Sunnydale Avenue, on Tuesday, January 13, 2009, from 3 pm to 5 pm. Members of the new committee will be introduced, and preliminary discussions will get underway on how best to make use of the $4 million allotment earmarked for information technology improvements. The public is cordially invited to attend.
MHSA HOUSING
It was recently announced that construction of a 172-unit residential development at 220 Golden Gate Avenue will begin in the summer of 2009, with an estimated period of construction set for 18 to 24 months. Seventeen of the units will be designated for those with mental illness as part of the MHSA housing program. To qualify for this program, in addition to meeting all of the DAH requirements, a potential tenant must meet all MHSA criteria for mental illness and homelessness or at risk of homelessness. Rent levels for MHSA units will be set at 30% of tenant income. The MHSA contribution of $3.4 million to the $60 million construction budget breaks down as follows: $1.7 million designated for construction costs, and $1.7 million designated for operating subsidy.
MHSA ADVISORY COMMITTEE MEETINGS:
The Mental Health Services Act Advisory Committee meets bi-monthly from 3-5 pm, alternating between advisory meetings and community forums. The next scheduled meetings are:
Wednesday, February 18, 2009 Thursday, April 16, 2009
Advisory Committee Community Forum
1380 Howard Street TBD
San Francisco, CA 94103
THE EYE OF THE STORM- Thursday, February 5 & Friday, February 6, 8:30am-4:30pm,
San Francisco Federal Building. Mental health professionals are increasingly called upon to respond to large-scale, community-wide disasters. This workshop will provide participants with essential knowledge and skills for intervening effectively with mental health needs in the complex and intense aftermath of disaster. Topics will include types of disaster, trauma caused by disaster, risk groups, and phases of disaster recovery. Clinicians will learn how disaster mental health interventions differ from psychotherapy, and will learn effective mental health interventions to be used in a variety of disaster settings and time phases.
To register for this training, please contact Norman Aleman, CBHS Training Coordinator at 415-255-3553 or email norman.aleman@sfdph.org
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Past issues of the CBHS Monthly Director s Report are available at:http://www.sfdph.org/dph/comupg/oservices/mentalHlth/CBHS/CBHSdirRpts.asp
To receive this Monthly Report via e-mail, please e-mail richelle-lynn.mojica@sfdph.org
The Current State of Budget Cuts and Its Impact On Services
Dr. Cabaj: We have a bad year. As you recall, we have already posted over $14M in mid-year cuts to the Department of Public Health (DPH) by Mayor Gavin Newsom. The Mayor proposed a 5% cut across the board for all civil services and contracts, and a 25% cut in funding for substance abuse programs which will be implemented Feb 20, 2009.
The next round of budget cuts will more likely affect the administrative positions before cuts in mental health programs and services. At least sixteen layoff notices were sent out to CBHS staff with the mid-tier cuts just mentioned. If these people have seniority, they may qualify for other positions in the civil service system. The cut in positions includes a few mental health specialist but most are administrative and general.
Originally, Mayor Newsom first asked to cut $27M. The additional cuts in the budget were due to the deficit in the San Francisco County s cash flow up to the end of 2008. CBHS had been asked for a disproportionate cut in General Fund cuts because the general fund is not evenly distributed in the Department. Substance abuse services have a higher proportion of General Fund money than other departments. There is some reserve funding acting as a back up for medical services. Tapping into the reserve may be needed before the end of the fiscal year.
DPH has now been asked to cut $101M for fiscal year 09-10, with some of those cuts due by February 27th. As you know, substance abuse and mental health have a large share of General Fund, and roughly cuts in substance abuse and mental health could be as high as $40M and $60M, respectively. Some substance abuse programs obtained 100% support from federal funding for drugs Medi-cal services (primarily methadone-related services) and these substance abuse programs do not require any General Fund match so are not likely to be cut. For mental health, 60% of its General Fund is used for Medi-cal match, leaving only 40% that can be cut without losing revenue.
Dr. Mitchell Katz does not want to cut primary care, because he believes that primary care is the central hub of all services in the Department of Public Health (DPH). Some people believe that primary care could provide all of the behavioral health services needed in San Francisco. Many people feel, though, that our severely ill clients cannot be fully accommodated by primary care. Dr. Katz wishes to preserve the San Francisco General Hospital (SFGH) and the Laguna Honda Hospital partly due to bond requirements, as part of re-building these hospitals, and partly due to institutional regulations.
The combination of Governor Schwarzenegger s proposed decrease in the state s budget and of Mayor Newsom s cut in the funding for San Francisco will definitely impact programs and services.
From the state level, CBHS receives over $200 M for behavioral health services (including MHSA funding). At the county level, if the cut is too much and we couldn t meet the Medi-Cal service requirements, we could lose up to that amount of money. Many programs would have to cut back services or the whole program may be eliminated permanently. There may no other comparable programs or services to meet the demand for mental health services. In addition, some services do not cost the City much at all. For example, the Early Periodic Screening, Diagnosis and Treatment (EPSDT) is the funding used for serving children covered by Medi-Cal, and EPSDT only requires a 5% match in funding. Cutting children s services and programs may not make sense since we would loose great amounts of revenue besides loosing the services.
Ms. Brown: I eschew cuts in mental health programs and services. Someone on the board ought to be at the State meetings, and someone from the State ought to come to our mental health board meeting. We need to be involved in the State budget process.
Mr. Hines: Thank you Dr. Cabaj for sharing this information with the board. What are two or three specific things we can do to help save the behavioral health cuts?
Dr. Cabaj: Currently, there is pressure to integrate more mental health services with primary care and do away with some clinics, civil services, and contractors. All this could change because no one knows what the Board of Supervisors (BOS) is planning to do. So talking with Board members will help.
Activism at the state level could help; for example, veterans helped pass AB3083 successfully and got some of the medically covered codes modified, such as PTSD. We also still have on the table a cut in the City s General Funds for $1.5M to mental health service for indigent clients except for indigent people who are seriously ill or in a crisis. The Board will need to hear that plan and agree to it.
Dr. Shukla: Given our current state of the economy, and what is going on in Sacramento, are there groups of people who can influence what programs or services get cut?
Dr Cabaj: That is a good question Dr. Shukla. Mayor Gavin Newsom has proposed the dollar amount; but the department heads decide what positions to cut. Barbara Garcia has set up a task force of 50 people to solicit the public s inputs on substance abuse, mental health and health services network.
Mr. McGhee: We have not been involved at the departmental budget level. MHB needs to get involved.
Dr. Cabaj: You need to bring that issue up to Ms. Garcia. I believe she was planning to be as inclusive as possible but not have a group too large to actually accomplish its tasks. The Health Commission has also wanted to be part of the budget process. In terms of a budget issues, the Health Commission will begin to hear them February 3rd.
Dr. Shukla: It seems a budget cut insidiously breeds preferential treatments like the squeaky-wheel groups get the most funding, of course, at the expense of the most needed people like those living in the southeast sector.
Ms. Brown: We are paralyzed from doing anything when we get information afterward. How can the MHB get consulted and have some say in the budget cut process?
Dr. Cabaj: Another issue is that San Francisco has a strong labor union. There is a strong focus on priorities like children and women s services and programs for minorities and the homelessness. Administrative cuts will be inevitable and usually do not have a lot of public input. Departmental managers are the ones that make the administrative cuts before the clinical cuts are made.
Ms. Brown: These cuts may eliminate most or all women s services if all programs are required to cut the same percentage
Dr Cabaj: You just alluded to a dilemma of whether an across-the-board cut or selective cuts should be made. There are two initiatives that would affect provision of mental health services for the southeast sector, because it is an underserved area.
The Mayor has a new task force being led by Dr. Sandra Hernandez for contractor overview and possible future consolidations, which can benefit developments for the Southeast sector. Also, we have done a lot of our work though contractors with multiple contracts in small amounts such as $10K to $20K. We are looking at re-grouping contracts into larger amounts with more services which will also benefit the Southeast. In addition, it may be time to go back to the old district model by having services much more focused on the local community and services packaged to meet the needs of that particular community, braiding contracts and civil service. There are a lot more agencies in the Tenderloin than in the Southeast sector. Maybe we need to shift resources to the Southeast sector to include services and programs for women and other affected groups. That is also another reason we are delaying the request for proposals (RFPs), to create community based programs, such as for the Southeast sector.
Ms. Brown: As a consumer of the mental health system, I hope there are no cuts on the consumer end.
Ms. King: My son was hospitalized for mental illness at SFGH, and he was put on psychiatric medications which required overnight stays. However, after two days, the hospital discharged him early. When I advocated for his further stay, a hospital administrator said regrettably that the hospital did not have a choice. Had I not been there to advocate for him and find alternative supportive services, he would have been released at best to a shelter and at worse onto the street. What happens to mentally ill patients who get early discharge while their heads are still under a fog of medication and they don t have family to care for them?
Dr. Cabaj: There are only two acute units at SFGH. 60% of the patients do not meet the acuity definition, so they are discharged as soon as possible. Now, a newly reconfigured non-acute unit is available to support some of those patients. Regarding the ethnic focus, SFGH will preserve all of its current focuses: LGBT, Asian, African-American, Latino, Women and HIV-infected.
Ms. Dunn: I was recently at SFGH and learned from a Chinese psychologist that he was being laid off after being on the job for fifteen years. When I inquired about the acute and non-acute units, he said that there will only be one acute unit for all of San Francisco. Also, he mentioned that they do not need as much nursing staff to maintain a non-acute unit. I was appalled that one acute unit could take care of San Francisco!
Dr. Cabaj: I do not know anything about having one acute unit. Thank you for bringing it to my attention. I will follow up on this information.
1.2 Public comment relevant to Item 1.0
Mr. Roger Kat: He is from Caduceus Outreach Services. The program focuses on psychiatric care for the poor and the homeless. He stated that he has been a consumer and was on the mental health board himself. He said that if services are cuts then people will go to the emergency room at the hospital for care. This is more likely to overwhelm the emergency room at hospitals both in terms of staff and expensive resources. He urged Dr. Cabaj and the Mental Health Board to insure that Caduceus Outreach Services not be cut.
Dr. Cabaj: The Mental Health Board can influence the San Francisco Board of Supervisors and the Health Commissioners. Both the old Board of Supervisors and the Health Commissioners were strong advocates of mental health issues. But there are several newly elected supervisors, who were elected in the November 2008 elections, and we do not know their positions on mental health. This advisory board can meet these supervisors to solicit their support in mental health services and programs.
ITEM 2.0 ACTION ITEMS
2.1 Public comment relevant to Item 2.0
No public comments.
2.2. Resolutions
2.2. a RESOLUTION (MHB -2009-1): Be it resolved that the minutes of the Mental Health Board meeting of November 12, 2008 be approved as submitted.
Resolution unanimously approved.
2.2. b RESOLUTION (MHB 2009 2): Be it resolved that the minutes of the Mental Health Board retreat of December 13, 2008 be approved as submitted.
Resolution unanimously approved.
2.2. c RESOLUTION: (MHB 2009 -3) Be it resolved that the minutes of the Mental Health Board Special Meeting of December 17, 2008, a Public Hearing on the Mental Health Services Act Prevention and Early Intervention (PEI) Plan be approved as submitted.
Resolution unanimously approved.
Goal #1: Further investigate mental health services and advocate for increased funds in the Southeast sector, and present findings to relevant stakeholders and policymakers for the City and County of San Francisco.
Goal #2: Outreach to community organizations such as the National Alliance on Mental Illness (NAMI), In Your Own Voice, to youth organizations, the media, newspapers, and blogs. Attend community meetings. Outreach to encourage people to seek mental health careers and participate in the Workforce Development and Education Plan.
Goal #3: Investigate elderly issues like suicide prevention, socio-economic concerns, general safety, timely access to medical services and advocate for mental health services for the elderly.
Goal #4: Investigate mental health issues for veterans, including women veterans, through research and communications to advocate and collaborate with current stakeholders.
ITEM 3.0 Reports
3.1 Report from the Executive Director of the Mental Health Board.
3.2 Report of the Chair of the Board and the Executive Committee:
Mr. McGhee: The Executive Committee would like to expand the committee to have more representation from the board. First, I would like to appoint LaVaughn Kellum King as Chair for the Southeast Sector Outreach and RFP Planning Committee. This would automatically put her on the Executive Committee as a committee chair. Second I would like to appoint Lara Arguelles to the Executive Committee as a member at large. If there is anyone else who would like to serve on the Executive Committee, please let me know. It would require that you attend two meetings per month.
I am on the California Local Mental Health (CALM) board and will go to Ontario, CA to make reports.
The State of California Governor is contemplating a consolidation and reorganization of boards, and many people are questioning the timing as suspect. For example, the California Board of Psychology will close two days a month. Many boards oppose any consolidation.
3.3 Report by Members of the Board on Their Activities on Behalf of the Board.
Ms Dunn: San Francisco and San Jose offer crisis intervention training for the police force and fire department personnel. I will be working closely with Ms. Brooke on the upcoming PCIT training.
Ms. Brown: I got a call from the Community Awareness Treatment (CAT) center, which provides services for the most at risk homeless individuals, suffering from multiple problems, to speak to clients on social security income (SSI) and state disability income (SDI) entitlements.
Mr. Keys: I spoke with President David Chiu who is the new president of the Board of Supervisors and Supervisor John Avalos on mental health issues and on working with them on the budget.
Ms. King: On Monday 1/12/2009, Helynna and I attended the emergency services preparation presentation in the Southeast sector. I discovered how few services are available. Two Walgreens are there for resources in an emergency. Scarce psychiatrists are available to help with mental health traumas in an emergency. Two churches are being retrofitted for earth quake. Two pediatritions could be at risk for malpractice lawsuits if they treat adults in an emergency.
Mr. Hines: I attended a meeting in San Antonio, TX. In front of 800 people I spoke about mental health issues. I will also speak in the future to military people who will be deployed to the Iraq and Afghanistan wars.
3.4 New business - Suggestions for future agenda items to be referred to the Executive Committee.
Dr. Shukla: We just heard from Dr. Cabaj about Governor Schwarzenegger s interest in the MHSA money. I would like to refer to the Executive Committee that the board look into how a special election on Proposition 63 might change MHSA focus.
Dr. Cabaj: A voter s initiative could be put forth in a special election. The change could determine whether or not the governor can access the MHSA money and how he can determine the use of the money.
Mr. Keys: I would like the board to write a response that opposes Governor Arnold Schwarzenegger taking the MHSA money.
Ms. King: We need to call the San Francisco Board of Supervisors and inform them of the governor s intention to take MHSA money.
Mr. McGhee: There are four new supervisors and we can educate them.
3.5 Public comment relevant to Item 5.0
Mr. Kat: He mentioned that the Caduceus Outreach Services was very involved in establishing the crisis training for the police.
Adjournment
Meeting adjourned at 8:29 PM.