The Mental Health Services Act (MHSA) Resources Clearinghouse is maintained by the California Institute for Mental Health through funding by the Department of Health Care Services (DHCS) and Proposition 63, the Mental Health Services Act. This website highlights best and promising practices in MHSA Innovations and Prevention and Early Intervention with a focus on the work counties are doing.
About MHSA Prevention and Early Intervention
In 2004, California voters passed the Mental Health Services Act (MHSA), which provides funding to help transform county mental health services for children, transition age youth, adults, older adults, and families. The MHSA addresses a broad continuum of prevention, early intervention, treatment and recovery needs. It sets aside 20% of its funding for prevention and early intervention (PEI). State guidelines indicate this funding is to be used to prevent mental health problems and/or to intervene early in mental health crises with relatively short duration and low intensity strategies. It is not to be used to fill gaps in treatment or recovery services. The core premise of PEI is negative outcomes of mental illness are preventable and early intervention can significantly alter the progression and severity of the symptoms of mental illness.
MHSA PEI services are provided in many places throughout the community. For example, PEI services can be offered in schools, preschools, senior centers, community centers, places of worship and immigrant and refugee service centers, to name a few. Each county funds PEI projects based on community collaboration and broad stakeholder processes. A planning process determined each county’s local priorities and desired outcomes as well as strategies to address those priorities and outcomes. As a result, each county’s plan is different and addresses the needs of the community, and, subsequently, there are a variety of PEI services offered across the state.
PEI programs are generally delivered in natural community settings, places where community members typically go for purposes other than mental health treatment. This includes settings frequently accessed by racial, ethnic, and cultural groups and in a manner appropriate for these groups (including language) to increase their access to these services.
Why PEI is Important
- It is central to transforming the public mental health system from a “failed first” system to a “help first” system. People will be able access services before a significant disruption in their lives.
- It will emphasize strategies to reduce the following negative outcomes that may result in untreated mental illness: suicide, homelessness, unemployment, removal of children from homes, school failure or dropout, incarcerations and prolonged suffering.
- Research shows mental health prevention and early intervention works! By intervening early in the manifestation of symptoms of mental illness and providing services found to be effective at preventing the onset of symptoms of mental illness, fewer individuals, families, and communities will experience the numerous costs of these crises in their lives.
- Similar approaches have been used for cancer and heart disease, advancing effective treatments while at the same time investing resources in effective prevention. As it is for cancer now after a 50+ year journey, there may be a time in the future when there will not be stigma associated with talking about mental illness and we will all know what to do to promote mental health and wellness.
- Investing now in prevention and early intervention will reduce the need for more expensive treatment and recovery services in the future.
- The emphasis on community which plays an important part in facilitating wellness, promoting mental health and preventing the negative outcomes of untreated mental illness. State guidelines indicate community collaboration is core to planning and implementation of PEI. The goal of community collaboration is to bring members of the community together to address community wellness.
- It is built around intended outcomes tied to stakeholder identified priorities. This works better than choosing programs first and then adopting outcomes – making PEI projects outcomes driven rather than program driven means programs can change over time if they do not yield desired outcomes.
About MHSA Innovations
Mental Health Services Act (MHSA) Innovation funds provide exciting opportunities to learn something new that has the potential to transform the mental health system.
In 2009, the California Department of Mental Health (DMH) issued an Information Notice containing the Proposed Guidelines for the Innovation component of the MHSA (DMH Info Notice 09-02). These Guidelines were developed by the Mental Health Services Oversight and Accountability Commission (MHSOAC) and define an Innovation program as one that:
- contributes to learning
- tries out new approaches that can inform current and future practices
The Guidelines identify three types of Innovation programs:
- programs that introduce new practices/approaches that have never been done before anywhere
- programs that make a new change that has never been done before to an existing practice/approach, including adaptations for a new setting or community
- programs that introduce a new application to the mental health system (never done before) of a practice/approach that has been successful in non-mental health settings
The Guidelines also indicate what an Innovation program is not:
- it is not a program with a primary focus on providing a service rather than on learning
- it is not a program that implements a practice or approach that has been successful in other communities but new to another community (not for bringing in successful innovations to a community that doesn’t have it yet)
Essential Purpose of MHSA Innovation Programs
Another characteristic of MHSA INN programs is that they must contribute to learning in at least one of four areas. The MHSA specifies that innovative programs shall have at least one of the following purposes as an essential purpose for the learning that occurs in the program:
- To increase access to underserved groups.
- To increase the quality of services, including better outcomes.
- To promote interagency collaboration.
- To increase access to services.
Although most Innovation programs are likely to have at least two of these purposes as long-term goals – improving the quality of services and achieving better outcomes – one of these four purposes should be identified as the principal essential purpose tied to what exactly will be learned. For example, some programs will test out a new approach to improving access for a particular underserved group. In this case, the ultimate goal is to have better outcomes for that group but the essential purpose of the Innovation program is to learn if this new approach will increase access.