ALAMEDA COUNTY
Mental Health Services Act (MHSA) 3-Year Program and Expenditure Plan
Community Participation and Feedback Survey

1. Survey Instructions

The Mental Health Services Act (MHSA) of Alameda County wants your ideas on how to strengthen its mental health and wellness programs to better serve you and your community. What do you think should be a part of our work in the next three years (e.g., more services for youth, more home visits to senior citizens, more housing supports, different mental health treatment options)? Also, what are some new or innovative ideas you’d like Alameda County to try out?

This survey is part of a larger community planning process that also includes community meetings throughout Alameda County from July to September 2017. If you would like information about the meetings, please click HERE.

There are 15 questions in the survey and it takes about 10 minutes to complete. ALL QUESTIONS ARE OPTIONAL, and you're welcome to leave questions blank if you do not want to respond. Also, the survey is anonymous.

Thank you for your help with this community effort!

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* 1. Is this your first time providing input and information for our MHSA Community Planning Process?

Yes

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* 2. Please rank the importance of each Child/Youth/Transition Age Youth's mental health issue listed below by importance (1 being Absolutely Essential through 5 being Not Important at This Time).

	1=Absolutely Essential	2=Very Important	3=Moderately Important	4=Slightly Important	5=Not Important at This Time
Academic Success	Academic Success 1=Absolutely Essential	Academic Success 2=Very Important	Academic Success 3=Moderately Important	Academic Success 4=Slightly Important	Academic Success 5=Not Important at This Time
Social Isolation/Feeling Alone	Social Isolation/Feeling Alone 1=Absolutely Essential	Social Isolation/Feeling Alone 2=Very Important	Social Isolation/Feeling Alone 3=Moderately Important	Social Isolation/Feeling Alone 4=Slightly Important	Social Isolation/Feeling Alone 5=Not Important at This Time
Community Violence and Trauma	Community Violence and Trauma 1=Absolutely Essential	Community Violence and Trauma 2=Very Important	Community Violence and Trauma 3=Moderately Important	Community Violence and Trauma 4=Slightly Important	Community Violence and Trauma 5=Not Important at This Time
Juvenile Justice Involvement	Juvenile Justice Involvement 1=Absolutely Essential	Juvenile Justice Involvement 2=Very Important	Juvenile Justice Involvement 3=Moderately Important	Juvenile Justice Involvement 4=Slightly Important	Juvenile Justice Involvement 5=Not Important at This Time
Homelessness	Homelessness 1=Absolutely Essential	Homelessness 2=Very Important	Homelessness 3=Moderately Important	Homelessness 4=Slightly Important	Homelessness 5=Not Important at This Time
Out-of-home Placement/Foster Care	Out-of-home Placement/Foster Care 1=Absolutely Essential	Out-of-home Placement/Foster Care 2=Very Important	Out-of-home Placement/Foster Care 3=Moderately Important	Out-of-home Placement/Foster Care 4=Slightly Important	Out-of-home Placement/Foster Care 5=Not Important at This Time
Suicide	Suicide 1=Absolutely Essential	Suicide 2=Very Important	Suicide 3=Moderately Important	Suicide 4=Slightly Important	Suicide 5=Not Important at This Time
Depression	Depression 1=Absolutely Essential	Depression 2=Very Important	Depression 3=Moderately Important	Depression 4=Slightly Important	Depression 5=Not Important at This Time
Family Conflict/Stress	Family Conflict/Stress 1=Absolutely Essential	Family Conflict/Stress 2=Very Important	Family Conflict/Stress 3=Moderately Important	Family Conflict/Stress 4=Slightly Important	Family Conflict/Stress 5=Not Important at This Time
Employment	Employment 1=Absolutely Essential	Employment 2=Very Important	Employment 3=Moderately Important	Employment 4=Slightly Important	Employment 5=Not Important at This Time
Substance Use/Abuse	Substance Use/Abuse 1=Absolutely Essential	Substance Use/Abuse 2=Very Important	Substance Use/Abuse 3=Moderately Important	Substance Use/Abuse 4=Slightly Important	Substance Use/Abuse 5=Not Important at This Time

Please list Other important mental health issues for the child/youth/transition age youth population

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* 3. Please rank the importance of each Adult/Older Adult mental health issue listed below by importance (1 being Absolutely Essential through 5 being Not Important at This Time).

	1=Absolutely Essential	2=Very Important	3=Moderately Important	4=Somewhat Important	5=Not Important at This Time
Homelessness	Homelessness 1=Absolutely Essential	Homelessness 2=Very Important	Homelessness 3=Moderately Important	Homelessness 4=Somewhat Important	Homelessness 5=Not Important at This Time
Social isolation/Feeling Alone	Social isolation/Feeling Alone 1=Absolutely Essential	Social isolation/Feeling Alone 2=Very Important	Social isolation/Feeling Alone 3=Moderately Important	Social isolation/Feeling Alone 4=Somewhat Important	Social isolation/Feeling Alone 5=Not Important at This Time
Incarceration of Mentally Ill Adults	Incarceration of Mentally Ill Adults 1=Absolutely Essential	Incarceration of Mentally Ill Adults 2=Very Important	Incarceration of Mentally Ill Adults 3=Moderately Important	Incarceration of Mentally Ill Adults 4=Somewhat Important	Incarceration of Mentally Ill Adults 5=Not Important at This Time
Ongoing Multiple Hospitalizations	Ongoing Multiple Hospitalizations 1=Absolutely Essential	Ongoing Multiple Hospitalizations 2=Very Important	Ongoing Multiple Hospitalizations 3=Moderately Important	Ongoing Multiple Hospitalizations 4=Somewhat Important	Ongoing Multiple Hospitalizations 5=Not Important at This Time
Suicide	Suicide 1=Absolutely Essential	Suicide 2=Very Important	Suicide 3=Moderately Important	Suicide 4=Somewhat Important	Suicide 5=Not Important at This Time
Community Violence and Trauma	Community Violence and Trauma 1=Absolutely Essential	Community Violence and Trauma 2=Very Important	Community Violence and Trauma 3=Moderately Important	Community Violence and Trauma 4=Somewhat Important	Community Violence and Trauma 5=Not Important at This Time
Domestic Violence	Domestic Violence 1=Absolutely Essential	Domestic Violence 2=Very Important	Domestic Violence 3=Moderately Important	Domestic Violence 4=Somewhat Important	Domestic Violence 5=Not Important at This Time
Inability to Find Employment	Inability to Find Employment 1=Absolutely Essential	Inability to Find Employment 2=Very Important	Inability to Find Employment 3=Moderately Important	Inability to Find Employment 4=Somewhat Important	Inability to Find Employment 5=Not Important at This Time
Substance Abuse	Substance Abuse 1=Absolutely Essential	Substance Abuse 2=Very Important	Substance Abuse 3=Moderately Important	Substance Abuse 4=Somewhat Important	Substance Abuse 5=Not Important at This Time
Inability to Obtain an Education	Inability to Obtain an Education 1=Absolutely Essential	Inability to Obtain an Education 2=Very Important	Inability to Obtain an Education 3=Moderately Important	Inability to Obtain an Education 4=Somewhat Important	Inability to Obtain an Education 5=Not Important at This Time
Parenting Issues/Family Stress	Parenting Issues/Family Stress 1=Absolutely Essential	Parenting Issues/Family Stress 2=Very Important	Parenting Issues/Family Stress 3=Moderately Important	Parenting Issues/Family Stress 4=Somewhat Important	Parenting Issues/Family Stress 5=Not Important at This Time
Chronic Health Issues	Chronic Health Issues 1=Absolutely Essential	Chronic Health Issues 2=Very Important	Chronic Health Issues 3=Moderately Important	Chronic Health Issues 4=Somewhat Important	Chronic Health Issues 5=Not Important at This Time

Please list Other important mental health issues for the adult/older adult population:

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* 4. Are there any populations or groups of people whom you believe are not being adequately served by the current MHSA programs in Alameda County? Please check all that apply.

Children 0-5

School Age Children

Transition Age Youth (TAY)

Adults

Older Adults

LGBTQQI-2S

Veterans

Jail releases and clients on probation (system impacted clients)

Parents/Family members

Persons with disabilities

Persons experiencing mental health crisis

Persons experiencing homelessness

Immigrants and refugees

African American community

Asian community

Latino community

Native American community

Pacific Islander community

Other population(s), please specify

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* 5. Based on your answers in question 4, please identify who you feel are the three most under served groups (please be very specific):

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* 6. What issues make it more challenging for consumers and their families to receive mental health services? Please check all that apply.

Lack of transportation to appointments

Limited availability of appointments

Location of clinics or service providers

Lack of language access (services not provided in a client's primary language)

Stigma around mental illness in your community

Other (please specify)

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* 7. Please list any suggestions for programs or services that would
enhance consumers' wellness and recovery and better meet the needs of your community.

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* 8. This question is to hear from you on Innovative Ideas to improve and transform our county mental health system. The goal of the Innovation program is to contribute to learning and improving in three ways:
1. Introduce new mental health practices/approaches including prevention and early intervention
that have never been done before, or
2. Make a change to an existing mental health practice/approach, including adaptation for a new
setting or community, or
3. Introduce a new application to the mental health system of a promising community driven
practice/approach that has been successful in non-mental health contexts or settings.
Please list below any innovative ideas about improving mental health services that you may have:

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* 9. Which of the following MHSA Service Areas do you feel have been effective in addressing our local mental health concerns and negative outcomes that may result from untreated mental illness? Please check all that apply.

Full Service Partnerships (serves adults and transitional age youth with mental health issues that result in homelessness, involvement in justice system, and frequent use of emergency psychiatric hospitalization)

Integrated Behavioral Health and Primary Care

Consumer Wellness Centers (serves adults with wellness and recovery services and link with community supports)

Employment and Vocational Services and Supports

Suicide Prevention (crisis hotline/training and education)

Family Education and Support Centers

Crisis Services for Children/Youth/Transition Age Youth

Age 0-5 Mental Health Services

Crisis Services for Adults and Older Adults

Housing Services

Culturally Responsive Prevention Programming and Supports

School-based Mental Health Services

Mental Health Outreach Teams

Stigma and Discrimination Campaign

Mental Health Services for Re-entry population

Crisis Services for Limited English Communities (specifically Latino and Asian communities)

Co-occurring Services (Services to improve mental health and substance use disorders)

Workforce Development Projects

Other Areas you feel have been effective: (please specify)

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* 10. Please tell us about yourself.
My AGE GROUP is:

0-15

16-25

26-59

60+

75+

Decline to State

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* 11. My GENDER is:

Male

Female

Transgender

Gender queer

Another gender identity

Decline to State

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* 12. I primarily reside in this CITY:

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* 13. My RACE/ETHNICITY is:

African American or Black

African

American Indian or Alaska Native

Asian

Caucasian or White

Hispanic or Latino

Middle Eastern/North African (MENA) Descent

Native Hawaiian or Other Pacific Islander

More than one Race/Ethnicity

Decline to State

Other (please specify)

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* 14. If you marked "ASIAN" under question 13 please tell us about your Nationality/Country of Origin:

Asian Indian/South Asian

Cambodian

Chinese

Bhutanese

Burmese

Japanese

Korean

Vietnamese

Mien

Mongolian

Other (please specify):

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* 15. Which of the following groups do you primarily identify with or represent (please only choose one group)?

Mental health client/consumer

Family member of a mental health consumer

An interested member of the community

Education agency

Community-based mental health service provider

Homeless community/Housing services

County Behavioral Health staff

Faith-based organizations

Substance abuse service provider

Hospital or healthcare provider

Law enforcement

NAMI

Veteran or Veteran Services

Other community-based organization (not MH service provider)

Decline to State

Other (please specify)

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* 1. Is this your first time providing input and information for our MHSA Community Planning Process?

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* 2. Please rank the importance of each Child/Youth/Transition Age Youth's mental health issue listed below by importance (1 being Absolutely Essential through 5 being Not Important at This Time).

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* 3. Please rank the importance of each Adult/Older Adult mental health issue listed below by importance (1 being Absolutely Essential through 5 being Not Important at This Time).

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* 4. Are there any populations or groups of people whom you believe are not being adequately served by the current MHSA programs in Alameda County? Please check all that apply.

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* 5. Based on your answers in question 4, please identify who you feel are the three most under served groups (please be very specific):

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* 6. What issues make it more challenging for consumers and their families to receive mental health services? Please check all that apply.

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* 7. Please list any suggestions for programs or services that wouldenhance consumers' wellness and recovery and better meet the needs of your community.

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* 9. Which of the following MHSA Service Areas do you feel have been effective in addressing our local mental health concerns and negative outcomes that may result from untreated mental illness? Please check all that apply.

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* 10. Please tell us about yourself.My AGE GROUP is:

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* 11. My GENDER is:

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* 12. I primarily reside in this CITY:

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* 13. My RACE/ETHNICITY is:

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* 14. If you marked "ASIAN" under question 13 please tell us about your Nationality/Country of Origin:

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* 15. Which of the following groups do you primarily identify with or represent (please only choose one group)?

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* 16. Thank You for your Time! This area is for any additional comments you would like to give us:

* 7. Please list any suggestions for programs or services that would
enhance consumers' wellness and recovery and better meet the needs of your community.

* 10. Please tell us about yourself.
My AGE GROUP is:

* 16.
Thank You for your Time!

This area is for any additional comments you would like to give us: