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Outreach worker Michelle Manchester speaks during a meeting in Orange, CA on Thursday, March 23, 2023. She was part of a meeting with workers from the county’s Office of Outreach and Engagement, part of the Orange County Health Care Agency, and county leadership. (Photo by Paul Bersebach, Orange County Register/SCNG)
About $1 billion will again go toward the mental health services provided by the OC Health Care Agency over the next three years thanks to a 1% tax on personal income over $1 million that was created several years ago by California voters.
The 2004 Mental Health Services Act earmarked the funding that in the years since has helped the county extend its reach from the 40,000 people Medi-Cal would cover in a year to more than 200,000 people a year by allowing the OC agency to provide services not billable to the state health care sytem and expand mental health programs aimed at its underserved population.
“(MHSA) allows us to do all the things we would really want to do in order to serve a person really well and take care of their mental illness,” Veronica Kelley, chief of the county’s Mental Health and Recovery Services, said. “It allows us to build out our system of care more thoroughly.”
State regulations give large counties three years to spend their allocated MHSA funds. After that, any unused money reverts to the state for redistribution. The funding the county is getting through this new round is about the same as prior years and the allocation is based on what’s been spent in previously.
In a recently released draft of its spending plan, the OC Health Care Agency’s Mental Health and Recovery Services laid out its breakdown allocating the $1 billion the county will receive through mid-2026 toward its direct services, early prevention resources and programs geared toward individuals living with serious mental illness, including a housing allowance. Other funding will go toward mental health innovations, workforce training and technological advancements.
Michelle Smith, the agency’s mental health services act coordinator, said the budget plan is built with a lot of input from community members.
“We have ongoing stakeholder and community feedback sessions all year round, so we take a look at what our stakeholders are telling us continues to be a need in the community and we will design (or expand) a program, estimate the cost for those programs and then integrate that into the budget,” Smith said. “And we’ve done a very good job of spending those MHSA dollars and haven’t had any money revert (back to the state).”
Outreach and engagement is one of the agency’s many programs fully funded by the MHSA money Orange County receives. With the money, education, life skills classes, support groups and in-person outreach are made available to residents at risk of developing or displaying early signs of mental illness or substance abuse disorders.
“We have about 60 staff who go out into the community and they work with people who are unhoused, who have a serious mental illness or an addiction,” Kelley said. “They are out there on the street helping people connect to resources, find shelter and get treatment. We could not have done that prior to the Mental Health Services Act.”
The MHSA also requires that every county conduct a needs assessment to ensure that the support and resources are reaching unserved and underserved communities. In Orange County, this includes the Asian Pacific Islander population, Latinos and veterans, Kelley said.
“Veterans have always been a target population because we don’t have a Veterans Administration hospital in this county, so we know we have about 40,000 veterans in this county, and we need to serve that,” Kelley said.
A challenge the Mental Health and Recovery Services department faces is workforce shortages. The state of California is looking at about a 30% vacancy rate when it comes to behavioral health providers and clinicians, according to Kelley. The OC vacancy rate is about 24%.
“We can all get paid far more if we went to work for private industry, but we choose to work here,” Kelley added. “It’s hard to find people who want to work in this space because it is hard, but it is the most fulfilling job.”
So some of the MHSA funds will be going toward workforce retention.
Another challenge is overcoming the stigma surrounding mental illness and substance abuse.
“There is no difference between someone who has a methamphetamine addiction and somebody who has diabetes; both are illnesses that occur in the body and they both have treatments that could be provided,” Kelley said. “We just look at addiction as being a moral failing, instead of a physical illness that has psychological components to it. Overall, the misunderstanding about mental illness and substance use is also difficult to deal with because it’s hard then for people to receive services, if they don’t understand the issue.”
The funding received allows public health officials to go out into the community and educate folks on mental illness and substance abuse in a way that was not possible prior to the Mental Health Services Act.
Orange County will also take part in the state’s new Community Assistance, Recovery and Empowerment (CARE) Court system. The court program is aimed at helping those suffering from untreated mental health and substance use disorders with a court-ordered care plan that includes several supportive services, such as access to medication and housing.
“We are experiencing a lot of changes in our regulations. With the CARE Court we’re going to be going live with in October, that is also funded through the Mental Health Services Act,” Kelley said. “I think we are just working really hard, and we are hopeful that we will be able to continue to provide the high level of care that we are currently giving to the residents of Orange County.”
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