History of Service Area Boards and the State Council on Mental Health

The community mental health movement and the development of the citizen and consumer-run service area boards is the brain-child of President John F. Kennedy in the early sixties. In 1963, President Kennedy urged Congress to pass the Community Mental Health Centers Construction Act (Public Law 88-164) that mandated and signaled the opening of the era of community care for the mentally ill. Federal monies were provided to the states for the creation of clinic-based community mental health centers to provide five essential services to a defined geographical area (service area): inpatient, outpatient, partial hospitalization, emergency, and consultation/education.

The Community Mental Health Centers Act aimed to make mental health and substance abuse services more available, affordable, and accessible by localizing them within communities. The Act defined the community mental health center as, “a facility providing services for the prevention or diagnosis of mental illness, or care and treatment of mentally ill patients, or rehabilitation of such persons, which are provided principally for persons residing in a particular community or communities in or near which the facility is situated.”

Service area was defined as, “the geographic territory which includes one or more communities served or to be served by existing or proposed community mental health facilities, the delineation of which is based on such factors as population distribution, natural geographic boundaries, and transportation accessibility.” Another requirement of the Act was the stipulation that citizen advisory boards (service area boards) be established for the designated state agency entrusted with the administration of the community mental health centers in each state. Thus, in 1975, the federally mandated service area boards were developed.

The role of the citizen had now changed from that of passive supporter to one of a dynamic catalyst who could participate actively in the decision-making processes of the community mental health centers, as a result of the passage of the Community Mental Health Centers Amendment Act. Concerned citizens became advisors to the community mental health centers and came from various occupations and backgrounds including: newspaper publisher/editor, attorney, business person, banker, physician, mental health association member, public school official, and hospital administrator. The role of the community board in partnership with state-operated mental health and substance use services was to identify unmet community needs and organize innovative program responses.

In 1981, Congress passed the Omnibus Budget Reconciliation Act (Public Law 97-35) which eliminated federal funding for community mental health centers and other mental health and substance use services. Federal funding for mental health and substance use services was replaced with Block Grants to states for the purpose of giving states greater discretion in the allocation of federal funds and transferring of responsibility for the mentally ill back to the states.

In 1984, with Act 218, the Hawaii State Legislature, amended chapter 334 of the Hawaii Revised Statutes (HRS) to establish a fifteen member State Council on Mental Health and Substance Abuse, and to establish fifteen member service area boards to advise each Community Mental Health Center service area. The service area boards were called the Service Area Boards on Mental Health and Substance Abuse, and the law stated that the role of the Council and boards was advisory.

In 1985, Act 6 amended the law to change the membership of the service area boards from fifteen members to nine members. The member’s role consisted of participating in development of Community Mental Health Center (CMHC) plans and budgets and of providing advisement of service area needs. Members of the boards are service area residents and service area providers, with a majority being residents and non-providers of mental health or other health services.

In 1986, Congress passed the State Mental Health Planning Act (Public Law 99-660 and 101- 639), which authorized small grants to states to develop community-based programs and the institution of state planning councils. The state planning councils were comprised of citizens from the catchment areas to advise, review, monitor and evaluate all aspects of the development and implementation of the State Plan.

In 1993, with Act 210, the Hawaii Legislature amended the name of the State Council on Mental Health and Substance Abuse to the State Council on Mental Health and changed the composition of the Council from 15 members to 21 members. Meanwhile the service area boards retained their name, the Service Area Board on Mental Health and Substance Abuse.

As a result of the Department of Justice’s law suit and resultant settlement agreement with the Adult Mental Health Division (AMHD) in 1989, the Community Plan for Mental Health Services was implemented as an order of the court on January 21, 2003. The Plan expanded the oversight of the Service Area Administrators (SAA) to the county level as opposed to the CMHC service area level to which a unique service area board (SAB) was attached, defined by specific census tracts. As a result of this change, the number of SABs (Leeward Oahu, Central Oahu, Kalihi-Palama, Diamond Head, Windward Oahu, Hawaii, Kauai, and Maui) decreased and a SAB was assigned for each county rather than each center. In the Community Plan, the SAA responsibility in relation to the SAB was to write an annual Comprehensive Integrated Service Area Plan. This integrated plan addressed service needs identified in the seven service areas (Crisis Services, Treatment, Case Management, Community Housing, Psychosocial Rehabilitation, MISA, and Forensics) and county specific analysis and solutions.

In 2004, a minor change was made to HRS §334-11, regarding the service area boards, to reflect changes in the Community Plan. The only change made to the statute on SABs was substitution of the board to advise each SAA rather than each service area center.

Currently, the service area boards are guided by the Hawaii Administrative Rules, the HRS §334-3, §334-11, and the Sunshine Law (HRS §92-1). Members serve on a voluntary basis and are appointed by the Governor and confirmed by the Senate. A member is usually appointed to a four-year term, and thereafter, a maximum of another four-year term. One member of each service area board has a dual role by also serving on the State Council on Mental Health. The purpose of this dual role is to bring county-level issues and concerns to the State Council. The board elects its own officers and creates its own by-laws, in compliance with federal/state statutes and administrative rules. Meetings are open to the public for the purpose of assuring that all decisions and recommendations are made publicly.

The State Council on Mental Health exists to advise the department on allocation of resources, statewide needs, and programs affecting two or more service areas. The Council reviews and comments on the statewide comprehensive integrated service plan, and serves as an advocate for adults with serious mental illness, children with serious emotional disturbances, other individuals with mental illnesses or emotional problems, and individuals with combined mental illness and substance use disorders. One member sits in a dual role membership on the Hawaii Advisory Commission on Drug Abuse and Controlled Substances.

The Council is made up of residents of the State of Hawaii, including individuals representing state agencies, specifically, mental health, education, vocational rehabilitation, criminal justice, housing, and social services; public and private entities concerned with the need, planning, operation, funding, and use of mental health services and related support services; adults with serious mental illnesses who are receiving, or have received, mental health services, and the families of such adults or families of children with serious emotional disturbances.

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