Mental Health Services Act (MHSA)

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About the MHSA

Forty years ago, the State of California shut down many state hospitals for people with severe mental illnesses. They did so without providing adequate funding for community mental health services. In 2004, former Assembly Member Darrel Steinberg, along with community advocates, including Cal Voices, proposed Proposition 63 (the Mental Health Services Act or MHSA). The MHSA levied a one percent income tax on personal incomes of over $1 million to fund. The purpose of this tax was to fund community based mental health systems and services in California.

In November 2004, California voters passed Proposition 63. It provided the first opportunity in many years to expand county mental health programs for all populations: children, transition-age youth, adults, older adults, families, and most especially, the un- and under-served. The Act creates a broad continuum of prevention, early intervention, innovative programs, services, and infrastructure, technology and training elements.

Prop 63 began as approximately 10% of the entire public mental health budget; it now comprises approximately 24%.

Read the Current MHSA as of January 2020

MHSA Quick Facts

Passed by voters in 2004
Places a one percent tax on incomes above $1 million
Provides funding for
- prevention and early intervention services
- community based mental health services
- stakeholder involvement
- improvements in infrastructure, technology, and enhancement of the mental health workforce to support community based mental health services

MHSA Six General Standards

Another unique aspect of the MHSA is the six General Standards counties are required to adopt when planning, implementing, and evaluating all programs funded by the MHSA. These General Standards apply to all MHSA-related activities, including the CPP process, development of Three Year Program and Expenditure Plans and annual updates to such Plans, and the manner in which counties deliver MHSA-funded services and evaluate such services. (9 CCR § 3320.)

The MHSA's six General Standards are:

Community Collaboration
Cultural Competence
Client-Driven

4. Family-Driven

5. Wellness, Recovery and Resilience Focused

6. Integrated Service Experience

Click on each tab to learn more about each General Standard.

Community Collaboration

The process by which clients and/or families receiving services, other community members, agencies, organizations, and businesses work together to share information and resources in order to fulfill a shared vision and goals.

(9 CCR § 3200.060)

Client Driven

Clients have the primary decision making role in identifying their needs, preferences and strengths and a shared decision-making role in determining the services and supports that are most effective and helpful for them. Programs and services use clients’ input as the main factor for planning, policies, procedures, service delivery, evaluation and the definition and determination of outcomes.

(9 CCR § 3200.050.)

Wellness, Recovery, & Resilience Focused

Planning for services shall be consistent with the philosophy, principles, and practices of the Recovery Vision for mental health consumers:

To promote concepts key to the recovery for individuals who have mental illness: hope, personal empowerment, respect, social connections, self-responsibility, and self-determination;

To promote consumer-operated services as a way to support recovery;

To reflect the cultural, ethnic, and racial diversity of mental health consumers; and

To plan for each consumer’s individual needs.

(WIC § 5813.5(d).)

Stakeholder Involvement

Clients and community stakeholders rejoiced at the prospect of developing a client-driven mental health system responsive to the needs of the people it serves and accountable to the public.

The MHSA requires ongoing stakeholder input and involvement at all levels of the public mental health system (WIC § 5848(a)). Counties must involve key stakeholders at all levels of the public mental health system.

In the Community Program Planning (CPP) process counties must gather stakeholder input on policy development as well as all areas of programming, including:

planning
implementation
monitoring

quality improvement
evaluation
budget allocations

A county's CPP process must include all relevant stakeholders, including but not limited to:

mental health clients
family members of mental health clients
representatives from unserved, underserved, and inappropriately served populations
any other local stakeholders (9 CCR §§ 3200.070, 3300.)

Stakeholders help counties identify local-level needs and define MHSA funding priorities. through the CCP counties are better able to develop services and supports to meet the needs of those served by local mental health systems.

The MHSA requires counties to spend up to 5% of their annual MHSA revenues on planning costs. This allocation must include funds to pay for the costs of stakeholders to take part in the CPP process. (WIC § 5892(c); 9 CCR § 3300.

Follow the Money

California millionaires pay a 1% tax on all income over $1 million dollars

MHSA Funding Components

In addition to the 5% funding requirement for the CPP, counties must also use revenues for the following five components:

Community Services and Support (CSS)
Prevention and Early Intervention (PEI)
Innovation (INN)
Capital Facilities and Technological Needs (CFTN)
Workforce Education and Training (WET)

Click on a tab below to learn about each of these components.

Prevention and Early Intervention

The PEI component funds programs designed to prevent mental illnesses from becoming severe and disabling, with an emphasis on improving timely access to services for underserved. `Counties must allocate at least 20% of their annual MHSA revenues to PEI programs.

(9 CCR § 3200.060)

Innovation (INN)

The INN component funds projects designed to test time-limited new or changing mental health practices that have not yet been demonstrated as effective. The purpose of the INN component is to infuse new, effective mental health approaches into the mental health system, both for the originating county and throughout California.

These projects may focus on increasing access to underserved groups, increasing the quality of services including measurable outcomes, promoting interagency and community collaboration, or increasing access to mental health services.

Counties must allocate 5% of their total annual MHSA revenues to INN. Funding for INN programs are paid out of the CSS category.(9 CCR § 3200.050.)

Capital Facilities and Technology (CF/TN)

The CFTN component funds projects designed to enhance the infrastructure needed to support the behavioral health system, which includes improving or replacing existing technology systems and/or developing capital facilities to meet increased needs of the local mental health system.

(9 CCR § 3200.120.)

Counties may allocate up to 20% of their average annual MHSA revenues for the past five years for CF/TN and WET.

Prudent Reserve

Counties must also establish and maintain a Prudent Reserve (PR) for revenue decreases. The PR is funded with monies allocated to the Community Services and Supports component and cannot exceed 33% of a county's average distribution for the previous five years.

Useful MHSA Reports and Documents

The following documents provide more information about the MHSA, including State of the Community Reports created by ACCESS.

ACCESS State of the Community Reports

2017-2018
2018 - 2019
2019 - 2020

MHSA
Documents

MHSA | January 2020
MHSA Regulations
MHSA General Standards
MHSA Program Components

Other
Resources

Program Planning Guidelines
Stakeholder Bill of Rights