Agenda

Return

C. 83

To:	Board of Supervisors
From:	FAMILY & HUMAN SERVICES COMMITTEE
Date:	October 8, 2019

Contra

Costa

County

Subject:

Update from Behavioral Health Services and the Mental Health Commission on the Public Mental Health Care System

APPROVE	OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR	RECOMMENDATION OF BOARD COMMITTEE

Action of Board On: 10/08/2019

APPROVED AS RECOMMENDED

OTHER

Clerks Notes:

VOTE OF SUPERVISORS

AYE:

John Gioia, District I Supervisor
Candace Andersen, District II Supervisor
Diane Burgis, District III Supervisor
Karen Mitchoff, District IV Supervisor
Federal D. Glover, District V Supervisor

Contact:	Julie DiMaggio Enea (925) 335-1077
cc:	FHS Staff CAO-Muni Svcs Deputy Behavioral Health Director Warren Hayes BH Medical Director

I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown.
ATTESTED: October 8, 2019
David Twa,

BY:	, Deputy

RECOMMENDATION(S):

ACCEPT the joint update report from Behavioral Health Services and the Mental Health Commission on the public mental health care system, child and teen psychiatric services.

FISCAL IMPACT:

None. This is an informational report.

BACKGROUND:

On October 30, 2017, the Family and Human Services Committee (FHS) accepted a report from the Health Services Department addressing various mental health services issues and concerns raised by the FHS, the Board of Supervisors, the Mental Health Commission, the Civil Grand Jury, and members of the public. These issues and concerns centered upon the difficulty in accessing mental health care, particularly for children and youth experiencing serious emotional disturbances. Indicative of this lack of access was the 1) increase in Psychiatric Emergency Services visits, 2) long wait times to access care, and 3) shortage of clinical staff, especially psychiatrists. The Health Services Department report addressed these issues and concerns, and reported upon the initiatives and progress made to date. The FHS asked the Department to provide an update to the Mental Health Commission in six months, and to the FHS annually thereafter. The last status report made to FHS was on September 24, 2018.

BACKGROUND: (CONT'D)

On September 23, 2019, FHS accepted the attached report that updates issues identified in the report entitled, "Contra Costa County Mental Health Commission Response to Behavioral Health Services Update to Grand Jury Report No. 1703 and Referrals 115 and 116".

Behavioral Health Director Suzanne Tavano summarized the staff report, advising that under Managed Care, the County must meet certain State compliance standards. She reported that the County has met the standards for the required number of providers but fell slightly short of the standard for timeliness in consultations and medication. She noted that there had been incremental improvement, with non-psychiatry wait times meeting the 10-day standard and psychiatry wait times close to meeting the 15-day standard. She highlighted the expansion of tele-psychiatry as one of the strategies used by the department to reduce wait times.

Ms. Tavano discussed how the department has analyzed the flow of people through the behavioral health system and determined that housing is a serious bottleneck and should be the focus of current attention. Behavioral Health works closely with the County's Homeless (H3) program to smooth the transition of people from hospital to locked facility to community housing settings. She noted that funding and regulatory silos hinder these efforts. She observed that the lack of adequate step-down programs result in lengthier hospital stays than are strictly necessary.

Supervisor Gioia noted that H3 has been working with the City of San Pablo to leverage HUD funding to construct 60-70 units of housing with supportive services in San Pablo. He praised the City of San Pablo for its strong collaboration with the County on the housing project, a library, a fire station, a WIC (Women, Infants and Children) site, and the West County Health Center.

Ms. Tavano commented that the County's open-door policy to psychiatric emergency services (PES) is generous when compared to other counties, noting that the majority of counties do not have crisis stabilization units (CSUs) as does Contra Costa County. She noted that the average daily population at PES is 40, which is a challenge in that limited space. She remarked on the push and pull between PES beds and hospital beds, and the way cost reimbursement influences that relationship. She reported visiting adult and children CSUs and thought that the Willow Rock CSU (Alameda Co.) might be a good model to implement in this county if separate space for a children's facility could be identified. She noted how traumatizing it can be for a child to witness a W&I 5150 (psychiatric emergency) event. She concluded by stating that the County and its community contractors struggle to find qualified providers due to lack of competitive salaries.

Barbara Serwin spoke on behalf of the Mental Health (MH) Commission, praising the new Behavioral Health leadership and their fresh approach to solving old problems. She appreciates the division of responsibilities among the new leadership. She is of the opinion that PES redesign should be the priority, citing the findings in a 2019 grand jury report. She reported that the MH Commission will reach out to community partners to collate best practice concepts and bring those to the FHS Committee for consideration.

Douglas Dunn provided a handout (attached) that discusses the impacts of a shortage of step-down programs and housing for persons discharged from locked facilities. He claimed that the County's locked facility budget was balanced only by a temporary savings in other programs. He recommended that the County support the repeal of the Medi-Cal reimbursement exclusion.

The following people spoke about the need of community-based mental health services providers for additional funding, and of their struggles to maintain staffing and services with uncompetitive salaries: Dan Geiger, Rich Wengal, David Bergeson, Susanna Marshland, Leticia Galyean, Antoinette Harris, Pete Caldwell, and Jay Berlin.

Supervisor Gioia assured the speakers that the Board of Supervisors is aware of their predicament and, earlier this year, authorized the formation of a work group to study the problem. He advised that Health Services Director Anna Roth will contact the agencies soon. He observed that Contra Costa County has a lower tax base than neighboring counties and also lacks a local sales tax that many other counties enjoy. He advised that the Board's Finance Committee is studying a proposal for a local sales tax initiative and, should it be pursued, will need the help of community partners to raise awareness of the need. Ms. Tavano added that HSD has already begun gathering salary data from the County's community contractors and has also engaged an outside consultant to assist with the study effort.

The Committee accepted the report and directed Health Services-Behavioral Health to report back in one year.