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Mental Health Services Act (MHSA)

The Mental Health Services Act (MHSA) was approved by California voters in November 2004 to provide funding to create fundamental changes to the access and delivery of mental health services throughout the state. Once enacted into law in January 2005, it became known as the Mental Health Services Act (MHSA).  The MHSA called upon local counties to transform their public mental health systems to achieve the goals of raising awareness, promoting the early identification of mental health problems, making access to treatment easier, improving the effectiveness of services, reducing the use of out-of-home and institutional care, and eliminating stigma toward those with severe mental illness or serious emotional disturbance.  Counties were also required to collaborate with diverse community stakeholders in order to realize the MHSA’s vision of recovery and wellness.  This vision was based on the belief in the strengths and resiliency of each person with mental illness and has been fundamental to the development of more comprehensive, innovative, culturally responsive services for individuals and families served by local mental health systems.

MHSA Guiding Principles

Five MHSA principles guide planning and implementation activities:

  1. Cultural Competence
    Services should reflect the values, customs, beliefs, and languages of the populations served and eliminate disparities in service access.

  2. Community Collaboration
    Services should strengthen partnerships with diverse sectors to help create opportunities for employment, housing, and education.

  3. Client, Consumer, and Family Involvement
    Services should engage clients, consumers, and families in all aspects of the mental health system, including planning, policy development, service delivery and evaluation.

  4. Integrated Service Delivery
    Services should reinforce coordinated agency efforts to create a seamless experience for clients, consumers and families.

  5. Wellness and Recovery
    Services should promote recovery and resiliency by allowing clients and consumers to participate in defining their own goals so they can live fulfilling and productive lives.

San Francisco’s Integrated MHSA Service Categories

San Francisco’s initial MHSA planning and implementation efforts were organized around MHSA funding components (e.g., Community Services and Supports (CSS), Workforce Development Education and Training (WDET), Prevention and Early Intervention (PEI), and Innovation (INN)).  In partnership with different stakeholders, Revenue and Expenditure Plans were developed for each of these components.

The MHSA, however, required that these plans be ultimately merged into a single Integrated Plan.  Through our community planning efforts, we realized that developing an Integrated Plan with a common vision and shared priorities is difficult when funding streams were used as the framework.  In partnership with our stakeholders, we simplified and restructured the MHSA funding components into seven MHSA Service Categories in order to facilitate streamlined planning and reporting (see Exhibit 1).

These MHSA Service Categories have allowed us to plan programs and services for specific populations and to expand our continuum of services with clear outcomes – including integration of peers into service delivery, promoting culturally competent care, increasing access to housing and employment, and developing high quality recovery-oriented treatment services. 
It is important to note that the majority of our MHSA Service Categories include services funded by INN.  INN funding is intended to provide our mental health system with an opportunity to learn from new practices or approaches that will support system change and improve client, consumer, and family outcomes.

SF MHSA Service Category

Recovery-Oriented Treatment Services

  • Includes services traditionally provided in the mental health system (e.g., individual or group therapy, medication management, residential treatment)
  • Uses strengths-based recovery approaches

Mental Health Promotion &  Early Intervention (PEI) Services

  • Aims to reduce risk factors
  • Promotes a holistic view of wellness
  • Delivers programs in community settings

Peer-to-Peer Support Services

  • Offers recovery and other support services that are provided by consumers and family members

Vocational Services

  • Helps consumers secure employment (e.g.,  training,  job search assistance and retention services)


  • Helps individuals with serious mental illness who are homeless or at risk of homelessness secure or retain permanent housing
  • Facilitates access to short-term stabilization housing

Behavioral Health Workforce Development

  • Recruits members from unrepresented and under-represented communities
  • Develops skills to work effectively in the mental health field

Capital Facilities/ Information Technology

  • Improves facilities
  • Increase client access to personal health information