San Luis Obispo County Supervisors applaud the swearing-in of officials on Jan. 3, 2023. From left are Jimmy Paulding, Dawn Ortiz-Legg, Bruce Gibson and Debbie Arnold. John Peschong was absent.
After decades of inaction, political will for addressing gaps in mental health care may be growing in San Luis Obispo County. On Tuesday, the new San Luis Obispo County Board of Supervisors identified improving behavioral health services as a top priority for the county. Bridging gaps in behavioral health services was added to the list of short-term board priorities for fiscal year 2023-24, along with issues like homelessness, workforce housing and water resiliency, among others, according to discussion at the Jan. 23 supervisors meeting. “The way these priorities come is, I do receive priorities from every board member, and I take a look at those priorities, and based on where I see some consensus, that’s what you see before you today,” County Administrative Officer Wade Horton said while presenting the priority list at the meeting. Although focusing on mental health care may seem like a new development, SLO County politicians and staffers had been aware of the need to improve the availability of behavioral health services here for some time now, Horton told The Tribune. However, behavioral health challenges seen nationwide such as the youth mental health crisis and the impacts of fentanyl poisoning have now reverberated throughout SLO County as well, bringing renewed focus to the consequences of gaps in local services. “I think there’s really been an impact on mental health in our community, and its not just here. It’s countrywide,” Horton said. San Luis Obispo County Administrative officer Wade Horton. David Middlecamp email@example.com The county had a rocky year in 2022 as the shortcomings in behavioral health services became increasingly apparent after a grand jury report pointed to gaps in the health system and families spoke out about how the shortage of psychiatric beds and substance use treatment locally and statewide led to dire consequences for their loved ones. Behavioral health was named a priority issue for the board the same week SLO County Behavioral Health Services Director Anne Robin announced to staff she would be retiring in August. The announcement of Robin’s retirement and the supervisors’ focus on the department are unrelated events, SLO County interim health agency director Nick Drews told The Tribune. Prioritizing behavioral health means department may be spared budget cuts The new Board of Supervisors convened under a budget deficit in 2023-24, meaning many departments under county governance may be facing cuts in the coming year, Horton explained. By identifying gaps in behavioral health services as a consensus issue for the board, it means the department could be insulated from future budget cuts since it is currently a political priority for supervisors, Horton said. “(Identifying board priorities) helps the department heads and the public understand what the board priorities are,” Horton said. “Behavioral health, since it is a board priority, they’re going to submit opportunities to augment their budget to expand services.” Since it is a deficit year and county staff and administrators got necessary raises last year, the county budget is not going to grow substantially despite the influx of property tax, sales tax and transient occupancy tax, Horton said. “Slicing up that pie, it’s a science and an art, and politics comes into play in that,” Horton said. Of course, nothing is set in stone until the priorities are set and the budget is finalized. “It could go an erratically different direction once they all see what we’re talking about, or it could stay consistent,” he said. Healthcare stakeholders announce two new projects for Behavioral Health The county plans to partner with various healthcare stakeholders to address challenges with behavioral health services in SLO County this year. “It’s a two-pronged approach,” Horton said at the Jan. 23 meeting. One project of this informal public-private partnership — comprised of county leadership, the nonprofit Transitions Mental Health Association (TMHA) and hospital leadership at Dignity Health and Tenet Health — is undertaking more analysis into how best to bridge the gulf in local behavioral health services. In October 2022, TMHA confirmed it is working with an external consulting group to conduct a gap analysis into behavioral health services in SLO County. Along with the gap analysis, the county Behavioral Health Department released a request for proposal Monday commissioning an external consultant to create a five-year strategic plan for the department that aligns with county and statewide goals for delivering behavioral health services to Medi-Cal patients. Consultants interested in working with SLO County Behavioral Health are to submit their proposals by Feb. 20, according to the request for proposal shared with The Tribune. SLO County to partner with local hospitals to expand psychiatric beds Another project county leadership is undertaking aims to grow the number of local psychiatric beds certified to treat patients placed on acute mental health holds. Currently, San Luis Obispo County can treat a maximum of 16 Medi-Cal or indigent patients placed on mental health holds at the Psychiatric Health Facility (PHF) in San Luis Obispo. Staff walk in adult residential hallway at the SLO County Psychiatric Health Facility (PHF) in a file photo from Sept. 2, 2015. David Middlecamp firstname.lastname@example.org There are no sub-acute psychiatric beds and no beds for adults with private insurance, or pediatric or senior psychiatric patients in the county. A 2021 report from Rand Corp. evaluating the psychiatric bed shortage in California said communities of about 100,000 residents, roughly a third the size of San Luis Obispo County, need about 50 psychiatric beds to serve local needs. By that measure, SLO County should have close to 150 mental health beds to properly serve its population of 282,000 people. Beds at the PHF are only available to adults who are deemed indigent, incarcerated or use Medi-Cal. “We don’t have enough beds and we need more beds,” Horton said. County leadership and hospital operators are evaluating how to better use the county-run Crisis Stabilization Unit (CSU) in San Luis Obispo. The facility is unlocked and can serve up to four patients in crisis for a maximum of 24 hours a day, according to past Tribune coverage. Patients can check into the facility voluntarily and leave voluntarily. Rooms are spartan and often shared at the SLO County Psychiatric Health Facility (PHF). Men and women have separate rooms. email@example.com The July 2022 grand jury report identified the CSU as an underutilized resource, with about one patient visiting each day, serving a monthly average of 45 patients, according to the report. The unlocked CSU is not licensed to treat psychiatric patients placed on mental health holds who require care at a locked facility. These patients frequently wait in emergency departments at SLO County hospitals until they can be transferred to a Lanterman-Petris (LPS) Act-designated facility for treatment. The Lanterman-Petris Short Act, a state act passed in California in 1967, ended the practice of involuntary and indefinite confinement of mental health patients in psychiatric hospitals. LPS-designated mental health facilities are licensed by the county. These types of facilities are typically locked and used for temporary involuntary commitment for the duration of a patient’s mental health hold. An LPS-designated facility might be a licensed psychiatric hospital, licensed psychiatric health facilities or LPS-certified crisis stabilization units, according to the act. The CSU in SLO County is currently staffed by the Sierra Mental Wellness Group and is not locked or LPS-certified. An opportunity to add LPS-designated psychiatric beds is emerging since the contract between the unit operator and the county will expire in 2023, Horton said in the Jan. 23 meeting. “How do we maximize the use of that CSU, and is there a potential of changing or modifying that CSU so it could potentially qualify as a facility where it will be LPS-certified?” Horton said in the meeting. “So that it will potentially provide similar functions as our psychiatric health facility (PHF), it would expand the number of beds in our county.” County leadership has been working with hospital leaders at Tenet Health Central Coast and Dignity Health to leverage the capacity of the hospital systems in San Luis Obispo County, Horton said. “We’re all interested in how we can better work together to address some of the many challenges that are facing our community when it comes to caring for homeless and caring for the mental health challenges that we’re seeing,” Horton told The Tribune. “We’re looking between our three organizations for how can we augment and expand services in our county.” Head of SLO County Behavioral Health Agency to retire in 2023 The Board of Supervisors identifying behavioral health as a political priority came the same week that SLO County Behavioral Health Services Director Anne Robin confirmed she would be retiring this summer. Robin, a therapist by training, will have served in the role for about nine-and-a-half years come her last day, scheduled for Aug. 1. The health agency is in the process of finalizing the job description and will be releasing it sometime in the coming weeks, Robin said. “My hope would be possibly a deputy director in a different county behavioral health department might be interested in moving here so there’s less of a transitional shock, or we might have some internal candidates who are interested potentially,” Robin said. Anne Robin, San Luis Obispo County Behavioral Health Department director, speaks about ways to reduce anxiety amid the COVID-19 crisis at a coronavirus news conference on Wednesday, July 22, 2020. David Middlecamp firstname.lastname@example.org The goal is that Robin would be able to overlap with her successor for at least 30 days, SLO County interim health agency director Nick Drews said. “There’s a lot to learn and a lot of knowledge to be passed forward,” Drews said. “That’s why it was so beneficial for Anne to grant us this much time so that we can get as much overlap as possible.” Even if a new head of Behavioral Health is not announced at the time of Robin’s retirement, Robin said the strength of the division management team in the department means she would leave confident the department will stay afloat despite the absence of a department head. “I’m not worried about things falling apart, because the management group is so fabulous,” Robin said. Behavioral health services gaps spotlighted in 2022SLO County as a community felt the impact of gaps in the behavioral health system in 2022 as more families spoke up about the challenges their loved ones face in the absence of local services. In July 2022, a report from a SLO County grand jury investigation found the department continuously failed residents who required mental health services. “SLO County fails to provide the kind of unified, integrated and ‘single’ voice leadership” needed to (deliver) mental health services in a manner that meets the needs of our community while simultaneously respecting and appropriately protecting the professionals who strive to provide such services,” the 2021-22 grand jury wrote in the report. Robin told The Tribune in July she agreed that staffing challenges and gaps in services particularly for youth and the elderly were problems in SLO County, but disagreed with some of the findings that placed the responsibility for all gaps in behavioral health services on the agency. “Our responsibility, as the mental health plan for Medi-Cal, is to pay for medically necessary inpatient services for Medi-Cal beneficiaries of SLO County,” Robin told The Tribune. “We are not mandated to provide all of them.” One of the claims in the grand jury report was that individuals placed on a mental health hold sometimes wait days in SLO County emergency departments for a bed to open up at a certified mental health facility. Physicians and hospital officials in SLO County told The Tribune how beds occupied by mental health patients awaiting transfer to a new facility strains healthcare resources. By transitioning the CSU into an LPS-designated facility, the shortage of psychiatric beds for Medi-Cal and indigent patients could be alleviated. The grand jury report may have illuminated some of these issues for the general public, but it was not the catalyst for the county. “I think that the grand jury report helped to bring to light these issues to the public, but it didn’t change any county plans or what we were already working on,” Horton said. “I think the grand jury report highlighted efforts and discussions that were already underway.” The Tribune reported on a number of tragic stories last year that stemmed from the gaps in mental health services and infrastructure here. In March 2022, the family and friends of Reidly Varner, an Atascadero teen who died from fentanyl poisoning, shared how she struggled to access help for substance use and mental health treatment in SLO County. Candice Varner of Atascadero holds a photo of her daughter, Reidly, on Feb. 10. 2022, a year after the 17-year-old’s death. Reidly died on Feb. 16, 2021, of fentanyl poisoning. David Middlecamp email@example.com The family of Joseph Perez, an Atascadero man with schizophrenia, told The Tribune how two incidents that occurred during mental health emergencies left him tangled up in the local justice system. In early July, a GoFundMe was established after the death of a father who struggled to access mental health treatment. And in September 2022, a young woman with schizophrenia was taken to Arizona by a sex offender after her family said she was denied long-term mental health treatment in SLO County. “What the board did by highlighting and making (behavioral health) a priority, they made it clear to the public and the county department which programs they’re interested in augmenting,” Horton said. “Staff is already having these discussions with hospital CEOs on how can we better work together and leverage our resources to expand services, and on top of that, the grand jury report happened, and on top of that, the board of supervisors decided to make behavioral health a priority.”
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Sara Kassabian is a reporter at The San Luis Obispo Tribune, covering the North County and health news. Sara is from the East Bay Area and studied journalism at the University of Colorado Boulder. She received a master’s degree in global health at UC San Francisco, and has previously worked in health, science and tech communications. Follow Sara on Twitter @sarakassabian.