Meeting Minutes October 19, 2017, 6:00 PM 8:00 PM Meeting Location 7001-A East Parkway map Sacramento, CA 95823 Conference Room 1 Meeting Attendees: MHSA Steering Committee members: Michaele Beebe, Stacy Boulware Eurie, Michelle Callejas, Ed Dziuk, Anatoliy Gridyushko, Lynne Keune, Brent Malicote, Alice Murphy, Paul Powell, Stephanie Ramos, Gordon Richardson, David Schroeder, Sayuri Sion, Frank Topping, Dante Williams, Uma Zykofsky General Public Agenda Item I. Welcome and Member Introductions The meeting was called to order at 6:08 p.m. MHSA Steering Committee members introduced themselves. II. Agenda Review The agenda was reviewed and members supported moving agenda items to allow the program presentation to come before the Announcements and MHSA Updates. III. IV. Approval of Prior Meeting Minutes MHSA Prevention and Early Intervention (PEI) Program Presentation Mobile Crisis Support Teams (MCST) The August 2017 draft meeting minutes were reviewed and approved with no changes. Jane Ann Zakhary, MHSA Program Manager, provided context and background on this agenda item, reminding the SC that the Mobile Crisis Support Teams were created as part of Sacramento County s MHSA Prevention and Early Intervention (PEI) component. They are one of several programs that address suicide prevention and recently expanded from two teams to four teams. See Attachment A MCST Overview and Attachment B MCST Brochure. Members of the Mobile Crisis Support Teams (MCST) program introduced themselves: Jennifer Reiman, Mental Health Program Coordinator Sandra Stowell, Senior Mental Health Counselor Deputy Emily Ball, Sacramento Sheriff s Department Tracy Knickerbocker, TLCS Peer Navigator. Ms. Reiman gave further background. The MCST is a collaborative effort between Division of Behavioral Health Services, law enforcement agencies (Sacramento City Police Department, Sacramento Sheriff s Department, Citrus Heights Police Department, and Folsom Police Department) and TLCS, Inc. as the contracted peer support provider. The program is funded by MHSA PEI revenue and SB82 grants. The MCST Questions? Email us at: MHSA@SacCounty.net or call (916) 875-MHSA Page 1 of 13
program became operational in April 2015 with two teams, one downtown and one in the south area. In November 2016, with support from the MHSA Steering Committee, the program was expanded to add two additional teams, operating in three new geographic areas: north Sacramento, Citrus Heights, and Folsom. The peer support staff also increased from one to four peers. The MCST program provides timely crisis assessment and intervention services to individuals of all ages, with or without insurance, who are experiencing a mental health crisis. It does this with the goals of reducing unnecessary hospitalizations and unnecessary jail stays and providing a compassionate response to those experiencing crisis in the community, while at the same time keeping everyone in the community safe. The teams are accessed through law enforcement dispatch. Each team is comprised of a dedicated officer, a licensed senior mental health counselor, and a peer support specialist. The officer is responsible for clearing the scene and ensuring safety, as well as applying Crisis Intervention Training. The officer also shares information to ensure appropriate response and steps back when possible to allow the clinicians or peers on the team to engage in a way that is supportive and private. The counselor checks the Avatar system to see if the person in crisis is already receiving services so providers can be mobilized. The counselor also meets with the individual and does an assessment to help determine the best course of action and what interventions might be useful. The peer on the team conducts follow-up. Sandra, Emily, and Tracy then shared details of two success stories. Member Questions and If I had a family member experiencing a crisis and I called dispatch, could I request you guys or would dispatch have to make that decision? You should let them know what the issues are, that there is a mental health crisis. Because the resources are limited, we don t want to see calls stacked up waiting for us. We want your loved ones to get help as quickly as possible. If we are not on another call, yours would be prioritized as one for us to go to. If we are, the officers who do respond know they can call us for coaching on the way over. One of the things that is good about this ride along model is that the clinician has eyes on all the calls that come in from dispatch and helps to triage which have a mental health component and have the most need for the MCST. As a long-time advocate, I d like to congratulate you for what seems to be jobs well done. What you do is very important. Of the 144 people referred to community resources, what is the number Questions? Email us at: MHSA@SacCounty.net or call (916) 875-MHSA Page 2 of 13
who made it to their first appointment? What is the average time for a suicidal person to get a visit after they are referred to you? We have been working to improve and refine our data collection system. One thing that has helped a lot has been the increased number of peer support specialists, as they have proved invaluable follow-up. When a call comes in for a 5150 or a suicidal subject it goes to the top of the list for dispatch. Nine times out of ten there is an officer available to go immediately. We will hold calls to cover that officer as well. The biggest time factor is usually proximity. The delay ranges from about three minutes to ten within our most common range, but one end of the Delta is an hour away from the other. In some cases where the need is distant but urgent, we will call on other resources such as the Highway Patrol or Galt Police Department who can get there faster. Thank you for this presentation. I know you could be doing other things and you are here. I appreciate that very much. Thank you very much. What is your experience serving young people? If you could have one new resource, what would it be? Calls for youth are a minority of the ones we get, but we do get them. Also, occasionally the Sheriff s Department school resource officers for Elk Grove Unified School District will call on us for help in cases where they suspect there might be a mental health concern or they believe the youth could benefit from these services. That s been very helpful, getting some of these youth set up with services who have not had them before. Sometimes youth are being interviewed in cases where there has been a report of abuse or sexual assault and we take those calls as well. An interview in those situations can be traumatizing in and of itself and we can support them through that. As for a new resource, 12 more clinicians on patrol would be great, spread across the area. I know the Sheriff s Department would be on board with that, but it always comes down to funding. Do you have any sense how many calls come in on the weekend or on Mondays that would have come to you if they d come in during your operation time from Tuesday through Friday? This could help to in determining need. We will be getting all the different law enforcement agencies together this year to coordinate data tracking. We know that some of this data is gathered internally, such as the number of 5150 calls and outcomes, but figuring out what we wish to track together and how to share it is the next step. What kind of training do the law enforcement personnel get on mental health and what training do the mental health personnel get on law enforcement? Being in law enforcement I ve always had an interest in mental Questions? Email us at: MHSA@SacCounty.net or call (916) 875-MHSA Page 3 of 13
health. I got my degree in psychology and thought I d be some sort of clinician. I worked in youth services for a few years and had the opportunity to take the Mental Health First Aid trainings. So when we were developing the new model for the Crisis Intervention Team, I was eager to sign up. Since joining, I ve attended the Memphis Model CIT training and multiple conferences and oneday update training sessions. Recently the entire team, including the officer, got to attend the CIT training in Yolo County. We also attended the Commercially and Sexually Exploited Children (CSEC) conference. Anything we are doing on the mental health side we are extending invitations to the officers to attend. I m a licensed clinical social worker and love to learn so I take every training I can. Recently I attended a NAMI conference in the Bay Area and there was a major component on law enforcement and law enforcement interaction with the mental health community. In fact, I got to take a class from the guy who came up with the Memphis Model CIT training. That was very interesting. I m really excited for you guys and I hope you keep your enthusiasm. What is the reaction to you from other officers? In all the time I have done ridealongs, working with about 500 officers, I think there were only two who were not supportive and happy to have me there. Even they didn t make it difficult for me, but they were perhaps too close to retirement to take a close interest. Not only are most deputies really happy to have a clinician there, I have watched many of them change the way they interact with people after observing demonstrations of other ways it can be done. One seasoned deputy tells me every time he sees me how glad he is I m there because it makes things so much easier. So from my perspective there has been a lot of change. I get consultation calls from fellow officers asking for advice or whether a specific call would be appropriate for us. I think a lot of them are more aware that there are services people can be referred to and many of them are more willing to take the 24 hour class rather than the shorter 8 hour class. It s been a really good relationship. I think they really want to do what s right by people and help them stay out of jail, even if that takes a bit longer, rather than just kicking the can down the road. Could you speak to cultural sensitivity? What do you do with Spanish-speaking or other non-english-speaking people in crisis? Mostly we use the Language Line. I also try to refer to appropriate cultural resources. For instance, if the person in question is involved with a local church or religious community I may reach out to them, while trying to be sensitive to how this will look to them and not approaching it from the point of view that people need to Questions? Email us at: MHSA@SacCounty.net or call (916) 875-MHSA Page 4 of 13
get all their mental health needs met by the county. Also, when we know that someone who we have been dispatched to help is already receiving services elsewhere, we ll call the provider while we are on the way there and let them know what is going on and ask if there is anything they can do or tell us that might help. As the regional CIT coordinator, I d like to let all the SC members here know that if you would like to attend the 24-hour class or the eight-hour class, we have two dates coming up that still have openings. One is in November and the other will be in February. V. Announcements Frank Topping: Sacramento City Council meets Tuesday nights beginning at 5 p.m. for public input. One of the subjects currently under discussion is a plan to use $98 million of Sacramento County MHSA money. Stephanie Ramos: NorCal MHA applied for and was awarded the statewide client advocacy grant, so over the next three years I and other NorCal MHA staff will be focusing on statewide advocacy issues in the mental health system. Part of our program will be having an ombudsman advocacy helpline. This will be for anyone involved in any stakeholder process, including the MHSA. See Attachment C ACCESS California Ombudsman Advocacy Helpline. NorCal MHA is also doing a stakeholder feedback survey. We d like to find out from California communities what needs they can identify that we can assist in advocating for on a state level. See Attachment D ACCESS California Survey. The next 70-hour WISE U Training Academy for people currently working or interested in working in peer support roles will start on January 8, 2018. Individuals who go through the training also get an individualized career plan and mentorship. We work with them to find them appropriate placement, ranging from volunteer roles to full-time paid peer support. There is an age minimum of 18 for this Training Academy. See Attachment E WISE U Brochure. Brent Malicote: Yesterday there was an anti-bullying rally downtown at the Unity Center. It was a well-attended and successful event. There were students from Elk Grove, San Juan and Natomas school districts and other locations and there were also district superintendents who spoke about the anti-bullying efforts in their schools. VI. Executive Committee / MHSA Updates Executive Committee Update No updates this month. MHSA Updates Jane Ann Zakhary, MHSA Program Manager, provided the following MHSA update: Questions? Email us at: MHSA@SacCounty.net or call (916) 875-MHSA Page 5 of 13
Journey of Hope Art Exhibit As a reminder, the Journey of Hope Art Exhibit is on display at the Elk Grove Fine Arts Center. This is the 3 rd Annual Journey of Hope exhibit, in which people with lived experience have shared their stories and artists have interpreted those stories and portrayed them through art. This exhibit started on October 7 th and concludes on October 21 st and is very powerful and worth your time. There are flyers at the back of the room. See Attachment F Journey of Hope Art Exhibit. Uma Zykofsky, Mental Health Director, provided the following MHSA updates: Celebrando Salud The Cultural Competence Committee did great work for and at the Celebrando Salud event that took place at South Side Park on October 8, 2017. Celebrando Salud also had good representation from our community providers. Whole Person Care initiative The County and the City of Sacramento have been engaged in discussions regarding how best to work together to address the issues surrounding homelessness. Both the County and the City have created initiatives to tackle this problem. On Tuesday, there was an item before the Board of Supervisors relating to the City of Sacramento s request for services in regard to its Whole Person Care application. We have agreed on some parts of a shared plan to move forward. For instance, we are committed to providing mental health and alcohol and drug services to all members of the community, including those people who would be served by Whole Person Care. We are also committed to the suggested efforts to coordinate existing resources and those currently under development at the county level by Ann Edwards and Cindy Cavanaugh with those being developed by the city. County report to the Board explained to the Board why the county had decided not to apply for funds via the Whole Person Care application grant. We also emphasized that for the past three years our focus and commitment has been on expanding and improving our treatment services and capacity. That is our primary responsibility and we have made great strides. You will recognize many of them, such as the different Crisis Residential programs, the TAY Full Service Partnership, the program for young people impacted by CSEC problems, and many other programs. We continue to do this work. The City of Sacramento applied and received an award for its Whole Person Care application that relates to navigation services in this community, but as the city doesn t deliver health care services it is collaborating with some community health care Questions? Email us at: MHSA@SacCounty.net or call (916) 875-MHSA Page 6 of 13
providers and local hospital systems. The City s primary focus is navigation to services. Mayor Steinberg has approached the Board of Supervisors and has presented a major request, asking the Board to approve redirecting $54 million from the County s MHSA funds to support the city s Whole Person Care application. The request is based on calculations made by the Mayor and his team regarding MHSA funding and what is available for use. County staff do not find ourselves in agreement with these calculations. The Board has asked for clarification from County staff on local MHSA programming and funding information as it evaluates the request it has received from the City of Sacramento. Specifically clarification has been focused on the county s MHSA fund balance, specifically the $98 million cited by Mayor Steinberg s staff as available unspent funds. This cited figure of $98 million is actually a combination of factors and some of the details can get lost when you are in a room with competing requests. In a moment Jane Ann will provide details on the budget numbers involved in this request and the state rules on MHSA fund reversion and AB114, something that has come up in this budget conversation. After that we will take some questions, but I also want to mention that right now the plan is that within the next couple of weeks the County meaning myself and the County Executive s Office will be going back to the Board to provide a detailed accounting of our fund balance so the Board of Supervisors can make a fully informed decision on the proper course of action for this request that is on the table. Jane Ann and Uma together provided the following MHSA update: Overview of Assembly Bill (AB) 114 MHSA Reversion MHSA funding that is subject to reversion is a subset of unspent funds no longer available for spending after a designated timeframe (typically three years, depending on component). Although there was not formerly a process in place to handle reversion, AB114 codified the rules on this and has given some clarity as to how it will be handled. Until guidelines are developed by the Department of Health Care Services (DHCS), we are not operating with complete knowledge, but we do know no county will suffer retroactive reversion and any county with funds at risk for reversion will have the opportunity to avoid it by developing a plan that meets specified criteria. See Attachment G Overview of AB114 MHSA Reversion and Attachment H Assembly Bill 114 Text. As stated, is still awaiting information from DHCS to accurately calculate AB114 impact. However, the great majority of our unspent MHSA funds are in the Community Services and Supports (CSS) component and we are confident Questions? Email us at: MHSA@SacCounty.net or call (916) 875-MHSA Page 7 of 13
that has no CSS funding at risk for reversion. There is potential risk for reversion in the Innovation (INN) and Prevention and Early Intervention (PEI) components. The proposed Behavioral Health Crisis Services Collaborative, known as INN Project #3, as supported by this SC, will address any INN funds at risk of reversion. This is the Collaborative developed in partnership with Placer County and Dignity Health. For PEI funds, there is some reversion risk to some of the one-time funds and expansion dollars we received in the early years, but we believe careful consideration can match plans and programs to meet our current service priorities and likewise avoid any potential reversion. Again, there is no state clawback or grab for county MHSA funds. We have the opportunity to develop plans to spend dollars at risk locally and avoid reversion. The state will publish instructions and estimates of county funds at risk, and counties will have the opportunity to analyze and appeal these state estimates if they believe they contain errors. All counties will have until July 1, 2018 to submit a plan to address spending funds at risk and will have three years to spend those dollars. AB114 is new legislation, passed within the last two weeks, and we are tracking developments very closely. Although the state has released some preliminary information, they plan to release more formal information and figures soon, perhaps by the end of this month. We will continue to track this and report back to you. Please note the Funding Summary on the last page of the power point presentation before you. We have presented on this before and it is excerpted from the Fiscal Year 2016-17 Annual Update on page 81. The $98 million under discussion is the sum of funds across all MHSA components on Line G (the Estimated FY 2016-17 Unspent Fund Balance). By far the greatest part of that is the $73.5 million in funding column A, the total unspent CSS funds. That sounds like, and is, a very big number. However, it is important to remember what we have talked about here before, all the things those CSS dollars have been identified for. First, CSS is the component used to sustain other components over the long run. It sustains Innovation projects that have proven successful past the Innovation funding period. It sustains Workforce, Education and Training (WET) activities past the onetime WET funding timeframe. It sustains the Capital Facilities/Tech Needs component for our Electronic Health Record development. It is also where the funding comes from to sustain the county s MHSA investment in Permanent Supportive Housing (PSH). As we have previously reviewed, we funded the development of Questions? Email us at: MHSA@SacCounty.net or call (916) 875-MHSA Page 8 of 13
161 PSH units across 8 affordable housing developments. Every 15 or so years that costs us approximately $20 million to refinance. Also important, if we do not sustain that investment it is not only those 161 units at risk. There are over 600 units in total in those developments that could be lost as affordable housing for our community. We are planning for that refinancing commitment. We are using our unspent funds together with incoming revenue to pay for our previously approved CSS programming and activities on an ongoing basis. On a yearly basis we spend more than we take in. If you look again at the FY 2016-17 Funding Summary, you will see that in CSS funding alone we are spending more than was received in that year. This was not accidental overspending but was done deliberately. We looked very carefully at the dollars available and at the funding projections and attempted to use this to create and fund needed services that would plug gaps in our system. For instance, our efforts to expand CSS funded programming by $16 million since 2014. It is important to keep this in mind in regard to the City s request, because as that request is for money for treatment services the $54 million would come from the CSS component. We will have to break down the funding numbers very carefully so we can be sure to let the Board know which components might have any flexibility in what the money can be used for. Also, one of the things discussed by those who have proposed this request was whether has been too conservative in its projections of what it would cost to refinance its PSH investment and whether it might be better to spend the money now and worry about the refinancing later, closer to when it comes due. To us, that responsibility to refinance is pretty important. Because of the urgency of this request, this matter will probably go to the Board before the next SC meeting. The City very much wants a response and the Board wants to move forward quickly with whatever decision is made. When we know the Board date, we will send it to you. We know that our MHSA dollars and programs have done and continue to do a lot for people who are homeless or precariously housed in this community. Many of you here work in programs with people who are at risk. There is also no question that there is a very serious homeless emergency across the country and in our community. Everyone advocating in this area has their hearts in the right place. When we go back to the Board we will have responses that are perhaps not what some of them might wish, but we believe this is because they are not in our place but are looking at the numbers from a much higher level. Another thing that should be clarified is that no one yet has a firm idea as to what amount of funds here or across the state might be Questions? Email us at: MHSA@SacCounty.net or call (916) 875-MHSA Page 9 of 13
at risk of reversion. The state has put out draft estimates, but they do not fully take into account all the revenue and expenditure reports that have been submitted. For and many other counties, these draft estimates do not match up with the records held locally. Before any decision is made based on reversion risk, it will be important to fix in place exactly what the numbers actually are. There are two things of which we are sure. First, we are doing nothing illegal; we have followed the rules since the inception of MHSA. Second, because we have been careful to spend money on the first money in is the first money out model, our calculations show no money in the county s CSS component at risk of reversion. That is the component that funds Full Service Partnerships. For some of the other questions, such as the exact amount it will cost to refinance the PSH developments or the exact amount of money at risk in other components, we are going to do more research and dig deeper into the numbers from providers expenditure cost reports and the changing numbers from the state. Member Questions and Could information be added to the county MHSA website to make it easier to track these funding numbers? Once we have a better tool to track this information ourselves that is something we can consider. The MHSOAC is putting something out there for every county and the DHCS is putting something out there as well, but so far all the numbers provided are preliminary. We did hear and took to heart the SC s recommendations regarding clearly explaining these nuances throughout the upcoming MHSA three year plan, including the area in the back containing the budget pages. Is there a plan for a community stakeholder process that will make decisions as to how the funds at risk for reversion will be spent? Yes, there will be a planning process as in the past, but before it begins we want to identify the amount at stake. To reiterate, the new Innovation project the SC has already supported should address any reversion risk of INN dollars, so what we would be talking about would be dollars and activities relating to the PEI component. I have two concerns. First, if housing services are endangered, that is something Darrell Steinberg urged us to do back in 2003. Second, can the city take $54 million in MHSA money without the Steering Committee s approval? At the moment, the housing is not in danger. We are going to have to make clear that we plan in good faith to ensure that this housing is protected. That will be part of the conversation with the Board. You are correct, that housing is part of the MHSA investment the community s investment and the Board needs clear information Questions? Email us at: MHSA@SacCounty.net or call (916) 875-MHSA Page 10 of 13
about what is at stake. Regarding your second concern, whether they can take this money, it is a request. It was put on the table by the Mayor and it will be deliberated on by the Board. If there is direction to relook at the MHSA plan, it will come back before the SC to get your recommendation. Regarding the Prudent Reserve, I notice it does not appear to be shown on the Funding Summary excerpt in front of us. In the complete Funding Summary shown on page 81 of the annual update it looks like it contains about $20 million. Do the numbers shown here include that money? It is good you brought this up. This is another area in which some of the proponents of the funding shift are operating off of bad information. We cannot access those funds at will. We can access them when the state tells us we can and the state can do so only when certain circumstances have been met. The Prudent Reserve is a separate account required by Welfare and Institutions Code. It requires that each county establish a Prudent Reserve and sets specific conditions under which counties can access those funds. Essentially, when revenue dips below the most recent five year average and a county would be forced to cut programs or reduce the numbers served, the state then pulls the trigger to allow those funds to be accessed. If you look back at the last annual update, you ll see some of this information is summarized on page 88 in Section F. Prudent Reserve. Is funding for the Mental Health Urgent Care Crisis Clinic in jeopardy? INN Project 2, the Mental Health Crisis Urgent Care Clinic, is right now very close to implementation. It is one of our Innovation projects and as such it can be funded for up to five years by Innovation funding. Assuming it is successful and because it is intended to fill a critical need we hope and plan it will be as explained earlier it could be sustained after that first five years through the use of CSS funding. So yes, potentially future funding for this project and the other Innovation projects is on the table. This is one of the things that was asked of us, why we had to plan for sustainability of Innovation projects when we didn t know if they would be successful or not. We believe the Urgent Care Clinic will fill an urgent need and we want it to succeed and be sustained. This may be challenged. It may be considered that the Mayor s request represents a more urgent need for those resources to fill. Does the Board still meet on Tuesdays for these issues or is it Tuesdays and Thursdays? Tuesdays and sometimes Wednesdays. So the city wants the county to put up $54 million of MHSA funds. Are they not putting up any money? The city has a projected amount of $64 million from the Whole Questions? Email us at: MHSA@SacCounty.net or call (916) 875-MHSA Page 11 of 13
Person Care grant. They are asking that the county match that with $54 million to go toward treatment services. Some of the community providers are sympathetic to the city s request. Others are very concerned. From what has been explained here regarding the workplan and spending money down and AB114, I am not concerned about reversion. It is a hard argument to make regarding concern for overspending, though, when there s so much unspent money on the books. I appreciate that you have committed to explaining these budget details in more depth in future. I feel strongly that Steering Committees should be involved in allocations of MHSA funds. If there were to be a sudden rethinking of local MHSA budget policy in which a large amount of MHSA funds were suddenly to be made available for purposes outside our current plan, there are a lot of providers who serve hundreds or even thousands of people at risk of homelessness and those resources should be considered for those services already in place before being used to fund a match for a grant. I really hope this comes back to the Steering Committee. The county includes a lot more than just the City of Sacramento. I know the City of Sacramento probably makes up the greatest part of the county s population, but what about all the other parts of the county, like the City of Galt or the City of Citrus Heights or the City of Elk Grove? To make things fair, are they all going to be getting a piece of the pie too? We will keep that question in mind. Sacramento is one city among many and the Board represents the entire county. We also are going to have to keep in mind that this homeless crisis is very big and very real throughout our community. Perhaps we should each contact our own personal Supervisors as constituents with our thoughts on this. Napa and Sonoma county fires have driven a lot of people here and I am wondering if there is anything we can do to help. We ve had people coming to La Familia s door and asking for help who have lost everything. The PEI program is very small and there isn t anywhere near enough money to make a real difference. Some homeless people were directed to go to CalExpo recently but were all evicted after a few days when the concern came up that it was possible that some of them could perhaps be from out of the county. This is absurd. We shouldn t step over one homeless person to offer a blanket to another. Also I wish to express my support for the decisions the SC has already made, such as funding the Urgent Care Clinic. VII. General Steering Committee Comment None. Questions? Email us at: MHSA@SacCounty.net or call (916) 875-MHSA Page 12 of 13
VIII. General Public Comment IX. Adjournment / Upcoming Meetings Chris Barton: I see that in the Funding Summary it shows that there are no unspent funds in the WET component and that in the last year $969,931 was transferred from CSS to sustain WET activities. Cindy Kennedy: I notice that the numbers given here for FY2016-17 are shown as estimates. Do you have the actual numbers for FY2016-17? That is the table from the budget page from the FY2016-17 Annual Update. We are in the process of updating those numbers and that report will be finalized in the next couple months. The meeting was adjourned at 8:12 p.m. Upcoming meetings will be held on November 16, 2017 December 21, 2017 Interested members of the public are invited to attend MHSA Steering Committee meetings and a period is set aside for public comment at each meeting. If you wish to attend and need to arrange for an interpreter or a reasonable accommodation, please contact Jay Ma one week prior to each meeting at (916) 875-4639 or MaJay@saccounty.net. Questions? Email us at: MHSA@SacCounty.net or call (916) 875-MHSA Page 13 of 13