County Officials Discuss Behavioral Health Plan During Conference

SAN DIEGO, CA — The San Diego County Board of Supervisors is reviewing Wednesday the merits of a plan to create 16,000 behavioral health and substance use disorder treatment "slots" by 2030.

As presented by county health officials Tuesday, the Substance Use Disorder Optimal Care Pathways calls for:

-- doubling residential treatment capacity from 4,978 slots now to 8,851 slots in five years;
-- increasing outpatient treatment capacity from 9,332 slots to 18,390 slots, as way to ensure earlier intervention and long-term care; and
--- expanding housing resources linked to behavioral health treatment, from 2,627 slots to 5,033 slots for stable recovery options.

According to board Vice Chair Terra Lawson-Remer's office, a slot is "an episode of care," such as patient bed, group therapy session or appointment with a clinician who could administer medication.

The board voted 3-0 to receive the presentation, and directed Chief Administrative Officer Ebony Shelton to return with updates on the program in August. Supervisor Jim Desmond was absent on Tuesday.

Lawson-Remer said that over the last four years, county government has expanded treatment options and crisis response teams, and made it easier for people to access care, but it still has "quite a bit of work to do."

"Everyone in this room knows someone who has struggled with mental health or addiction," said Lawson-Remer, who has served as acting board chair since the departure of Nora Vargas, former District 1 supervisor, in early January.

"For too long, our system has failed to meet people where they are, and instead of getting help when they first need it, people have been forced to hit rock bottom before they can access treatment," Lawson-Remer added.

Along with his colleagues, Supervisor Joel Anderson thanked staff for their work.

"We're clearly headed in the right path -- it's just a matter of speeding up the process in getting to those goals," he added.

Supervisor Monica Montgomery Steppe said the approach "of simply creating places to put people" won't address the broader issue or serve people in need.

"With so many of our neighbors struggling, we owe it to them to do this work the right way," she added.

She said possible congressional cuts to the federal Medicaid program may jeopardize county programs.

Montgomery Steppe noted that nearly 1 million San Diegans are enrolled in Medi-Cal, the state program.

"This is a true risk and we have been working and will not accept this threat passively," she said, adding that residents and organizations need to be vocal about funding cuts.

According to a statement from Lawson-Remer and Montgomery Steppe, the county "has already made major strides" in improving substance use disorder services by adding more than 5,100 treatment slots since 2021.

Both supervisors added that other highlights are the opening of four crisis stabilization units and more mobile crisis response teams, as an alternative to residents ending up in an emergency room, jail or on the streets.

The county has progressed in shifting from a crisis model of care to one of chronic care methods and prevention, said Dr. Luke Bergmann, director of county Behavioral Health Services department.

"We know that catching people earlier in their behavioral health journeys increases the likelihood of connecting them to treatment before they reach a crisis," he said. "We want episodes of crisis be the exception, rather than the norm."

Dr. Nicole Esposito, also with Behavioral Services, said nearly 20% of California residents need treatment for substance use disorder, but just 11% get the help they need.

"Our system has long lacked a cohesive treatment strategy to identify and engage people in treatment and keep them engaged throughout their recovery," Esposito said. "We recognize that each person's journey to recovery is unique," and it's important to offer multiple avenues to treatment and other support in every phase of life.

She added that the county has identified several key strategies, including partnering with hospitals, prescribing medication, reducing the stigma around treatment and increase peoples' willingness to get help.

Tuesday's conference included the perspective of county law enforcement and criminal justice representatives. Cmdr. Jim Emig of the Sheriff's Office stressed the need to maintain Psychiatric Emergency Response Teams, noting someone in a behavioral health crisis is also a public safety concern.

Rachel Solov, chief deputy district attorney, said that from a criminal justice system perspective, there's a strong prevalence of people suffering from substance abuse or mental health issues in the criminal justice system.

There is a need to increase substance abuse treatment, and safely respond to those deemed incompetent to stand trial, Solov said.

"If we can keep people out of the justice system in the first place, we are far better serving the public," she said.

— City News Service