Help Alameda County spend $176M of millionaires' money

By Tom Abate

The Alameda County Board of Supervisors is soliciting public comments before it decides how to spend $176 million of millionaires' money to help low-income residents with moderate to severe mental illness and other mental health needs.

The comment period precedes a board vote expected in late June or early July to approve a new budget for the Mental Health Services Act (MHSA).

The MHSA became law in 2004 when voters approved Proposition 63, which placed a 1% tax surcharge on Californians whose annual incomes exceed $1 million.

Since 2004, the state has collected more than $30 billion from the now nearly 100,000 Californians who meet that threshold, based on estimates published in the Los Angeles Times.

Each year a share of that money is distributed through the state's 60 county and city health departments, each of which decides how to weave its safety nets.

An Alameda County Grand Jury investigation called the local MHSA program "fragmented and unresponsive" and its spending decisions like "shooting in the dark."

This year’s Board of Supervisors vote comes after an Alameda County Grand Jury investigation called the local MHSA program "fragmented and unresponsive" and its spending decisions like "shooting in the dark."

In that report, which was released last year, grand jurors recommended that Alameda County officials assess overall mental health needs and identify gaps in service to address "the inadequacies of our mental health system."

What follows is an overview of the draft budget county supervisors will consider in the coming months and information on how to comment or participate in a May 15 virtual public hearing sponsored by the county’s Mental Health Advisory Board.

What does the Mental Health Services Act fund?

The draft budget estimates that Alameda County will spend about $221 million to treat mental illness and provide mental health services in fiscal year 2023-24.

About $176 million of that comes from the MHSA tax surcharge. Medi-Cal is expected to contribute another $38 million, with roughly $7 million coming from elsewhere.

The MHSA budget supports five categories of spending.

Community Services and Supports (CSS) programs are intended to help needy residents or homeless people manage or recover from moderate to severe mental illness, which must often include housing.

The draft calls for $171 million in CSS spending, or more than three-quarters of the budget, to fund 46 programs. But seven programs with budgets of roughly $10 million or more account for over half of the total.

The largest allocation is $21 million to subsidize, arrange or otherwise provide housing to more than 2,200 people with some mix of mental illness, homelessness and/or substance abuse. This works out to a per-client cost of $9,500, but program managers are also working with other governmental agencies to acquire another 199 living spaces for the mentally ill.

The second largest program is budgeted to spend about $13.7 million to help stabilize people in mental health crises. Two sites, one for adults and the other for 12- to 17-year-olds, will help about 1,130 people at a bit over $12,000 per intervention.

Prevention and Early Intervention (PEI) programs seek to help people of all ages and backgrounds deal with mental health issues before they become crises. The county proposes to spend $24 million on 22 PEI programs, including $2.1 million for a suicide prevention text line; $2.5 million for programs aimed at K-12 youngsters; and $9 million for a variety of mental health programs tailored to people of different ethnic, racial and linguistic groups.

Innovation. The county will spend $8 million on five pilot projects next year. They include a $2.75 million effort to dispatch unmarked vehicles staffed by a mental health clinician and emergency medical technician to mental health emergencies rather than a police car and ambulance. The county says that in its second year, this approach persuaded nearly 40 people a month to accept and find mental health assistance. The budget calls for fielding 12-15 such teams in the trial’s third and final year and expects to resolve three-quarters of all calls without setting off sirens, before evaluating the future of its Community Assessment Treatment Team or CATT innovation.

Workforce Education and Training (WET) programs will get $8.2 million to help train current staff to acquire additional skills, recruit candidates for hard-to-fill positions, and improve staff diversity and language fluency.

Capital Facilities and Technological Needs (CFTN) programs develop physical and data infrastructure. Projects included in this $9.97 million allocation will help convert the St. Regis retirement complex in Hayward to a respite care facility for physically and mentally frail homeless people and to the continuing to find a county-owned property on which to build an African American Wellness Hub Complex.

May 15: Give input on mental health programs

I’d never heard of the "MHSA" until last year when I tried but failed to help a young person on Medi-Cal get psychiatric services from the county.

As I started poking around, I found a new Grand Jury report that said, "Alameda County residents witness daily the inadequacies of our mental health system." It told me that I was not alone.

Since then, I’ve studied the issues and met people with intensely personal experiences and knowledge who often don’t know how and where to state their cases most effectively.

If you have a story to tell or an idea to share, make yourself heard in the next few weeks.

Email your comments to MHSA@acgov.org. Treat the subject line like the "headline" of your story for the best effect.

You can also network with others with an interest in the subject by joining a virtual public hearing on May 15 at 3 p.m.

The hearing will be conducted by the Mental Health Advisory Board, made up of local volunteers appointed by the supervisors. Join the Zoom meeting (meeting ID: 873 6608 0958; passcode: 774947) or dial by phone.

Find complete meeting details on the advisory board website.

This article originally appeared on Tom Abate's website and has been reprinted with permission. Read his take on the Grand Jury investigation into Alameda County's mental health services and his recent commentary on Alameda County mental health funding, which was published in the East Bay Times.

Tom Abate is a former Bay Area newspaper reporter and science journalist who now writes independently at tomabate.com.