To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera, 707-565-4774
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Department of Health Services Behavioral Health Staffing Allocations
End
Recommended Action:
Recommended action
A) Adopt a personnel resolution amending the Department of Health Services position allocation list to extend 2.40 full-time equivalent time-limited position allocations through December 31, 2024 to support the Mental Health Diversion program, as detailed in the attached resolution, effective October 17, 2023.
B) Adopt a resolution authorizing budgetary adjustments to the fiscal year 2023-2024 adopted budget, programming $469,000 in 1991 Mental Health Realignment to finance costs associated with the requested position allocations. (4/5th Vote Required)
(4/5th Required Vote)
end
Executive Summary:
The California Department of State Hospitals (CDSH) Diversion Program is a collaboration between CDSH and county governments to develop or expand diversion programs for individuals with serious mental illness who face felony charges and could be determined to be incompetent to stand trial. The need for a Mental Health Diversion program, which allows some people with mental health issues to receive treatment in lieu of prosecution and jail when they are charged with a crime, was initially implemented as a pilot program in fiscal year 2018-2019 and has subsequently been established as a permanent program through the Budget Trailer Bill SB184 Chapter 47 along with 2022 Budget act.
The Department of Health Services (hereinafter, “DHS” or “the Department”) is requesting to extend 2.40 time-limited staff through December 31, 2024. The Department plans to convert these positions to permanent allocations at a future date once the State identifies ongoing funding for the program. The job classifications are 1.0 Senior Client Support Specialist, 1.0 Behavioral Health Clinician, 0.2 Staff Psychiatrist, and 0.2 Psychiatric Nurse.
On January 10, 2023, when the Board authorized the extension of the same 2.40 full-time equivalent time-limited position allocations through October 2, 2023, the Department indicated it would return with a permanent staffing plan when the CDSH released allocations for ongoing Diversion funding.
This item includes a request for approval of a resolution authorizing budgetary adjustments to the fiscal year 2023-2024 adopted budget to reflect additional revenues and expenditures associated with the requested position allocations in the amount of $469,000.
Discussion:
The State Hospital system is significantly impacted by the numbers of individuals with felony charges and incompetent to stand trial referred to them. Sonoma County was one of 15 counties with the highest rate of these referrals. California Department of State Hospitals (CDSH) made funding available to these counties to fund diversion programs designed to reduce the number of these individuals’ needing placement in the State Hospital system.
These services are a high priority for the Department. They are a part of an overall initiative involving the Sheriff’s Office and the Probation Department to divert individuals with mental illness from the criminal justice system into the healthcare system. This program also supports collaboration between the other safety-net departments, such as Public Defender, District Attorney, Superior Court, and Probation.
There are currently no community-based providers providing treatment in-lieu of prosecution services necessary to support the MH Diversion program. MH Diversion program staff will integrate with existing programs/services serving individuals with serious mental illness arrested and incarcerated for behavior connected to their illness. The Department is requesting staffing time extension to provide these services in the Behavioral Health Division of the Department of Health Services.
Staff Duties
The duties of the aforesaid staff are necessary to administer the Mental Health Diversion program.
The Behavioral Health Clinician position provides specialty mental health services. The services include assessments, treatment planning, motivational counseling, and crisis intervention.
The Senior Client Support Specialist position provides specialty mental health services. The services include case management, mental health rehabilitation services, crisis intervention, and link to other needed services.
The Psychiatric Nurse position provides specialty mental health services. The services include assessment of overall health needs, assessment of mental health needs, assessment of clients’ response to medications, taking vital sign measurements, and assisting with medication management.
The Staff Psychiatrist position provides specialty mental health services. The services include psychiatric assessment, medication management, and consultation with members of the treatment team.
Additional MH Diversion Program Information
Target Population for the Mental Health Diversion Program - The CDSH Diversion Program provides state funding to counties to primarily serve individuals who are:
• Eligible for diversion under Penal Code Section 1001.35, et. seq., Diversion of Individuals with Mental Disorders;
• Diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder;
• Charged with a felony; and
• Not a significant safety risk if treated in the community.
In addition, there must be a significant link between the individual’s mental illness or homelessness and the crime they are charged with.
Fiscal Year 2023-2024 Budget Appropriations
This item includes a request for approval of a resolution authorizing budgetary adjustments to the fiscal year 2023-2024 adopted budget to reflect additional revenues and expenditures associated with the requested position allocations in the amount of $469,000.
Incompetent to Stand Trial Growth Cap Penalty
Senate Bill (SB) 184 (Chapter 47, Statutes of 2022) established a growth cap for all counties for individuals committed as Incompetent to Stand Trial (“IST”) on felony charges pursuant to Section 1370 of the Penal Code. The IST growth cap baseline for counties is equal to the total count of IST referrals in FY 2021-22, and counties are subject to annual penalties if they exceed their baseline cap in any given fiscal year. Sonoma County’s baseline is 61 IST referrals. Based on unreconciled referral counts provided by the State for the first three quarters of FY 2022-23, the County’s projected referral count for the full fiscal year is approximately 100. As a result, Sonoma County is on track to pay a growth cap penalty for FY 2022-23 of approximately $2.3 million, which must be paid using local sources, like County General Fund. The final penalty amount for FY 22-23 will be determined around March-April 2024, after FY 22-23 reconciled data has been reviewed by counties to formally dispute errors and correct any discrepancies in the data. The County will be responsible for paying the penalty within 90 days of receiving the final penalty invoice.
The IST Growth Cap penalty paid by the county will be deposited into a State Mental Health Diversion (“MHD”) Fund. The CDSH will subsequently make payment back to a county from the MHD Fund equivalent to the penalty payment amount paid by the county. All funds a county receives from the MHD Fund must be used to support local initiatives designed to prevent the arrest of individuals with serious mental illnesses. Counties subject to penalty payments pursuant to WIC section 4336 will be required to submit a plan for the use of funds in accordance with one or more of the activities outlined below prior to disbursement to the county. After funds from the MHD have been received by a county and beginning in FY 2024-25, the county will be required to report to CDSH annually regarding the actual use of the funds. Funds paid to a county from the MHD Fund shall be used to support one or more of the following activities:
1. Pre-booking Mental Health Diversion to serve those with serious mental illness and prevent their felony arrest. This may include funding the treatment, support services, or housing of individuals who have been approved by a court to participate in Care Court. The target population that shall be served are individuals demonstrating psychosis manifesting as hallucinations, delusions, disorganized thoughts, or disorganized behavior at the time of the interaction.
2. Post-booking Mental Health Diversion, which may include treatment, support services, and housing, to serve those with serious mental illness and who are likely to be found IST, to prevent the IST determination and divert the individual from incarceration. The target population that shall be served are individuals diagnosed with a mental disorder as identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, including, but not limited to, bipolar disorder, schizophrenia, and schizoaffective disorder but excluding a primary diagnosis of antisocial personality disorder, borderline personality disorder, and pedophilia, and who are presenting non-substance-induced psychotic symptoms.
3. Re-entry services and support, which may include housing, to serve those who have been restored to competency following a felony IST commitment and directly released to the community from jail.
More information and associated recommendations will be provided to the Board of Supervisors at a later date, after County staff receive further guidance from CDSH with respect to developing expenditure plans.
References:
Senate Bill 1223 Chapter 735 -
https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB1223
Senate Bill 184 Chapter 47, Statues of 2022 -
<https://legiscan.com/CA/text/SB184/id/2600107>
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 2: Identify gaps in the Safety Net system of services and identify areas where departments can address those gaps directly and seek guidance from the Board when additional resources and/or policy direction is needed.
Strategic Plan Alignment - Appropriately staffing Behavioral Health programs and aligning staff requirements with available funding supports the County's goal of a Safe, Healthy, and Caring Community by ensuring that the County's most vulnerable population has access to behavioral health services. In addition to alignment with the County's Strategic Plan, Behavioral Health programs support the Department's Strategic Plan goal of ensuring that individuals have access high quality and coordinated services for health, recovery, and wellbeing by strengthening the behavioral health infrastructure.
Prior Board Actions:
On January 10, 2023 the Board A) adopted a personnel resolution amending the Department of Health Services allocation list to extend 2.40 full-time equivalent time-limited position allocations through October 2, 2023 to support the Mental Health Diversion program, extension effective December 1, 2022 and B) adopted a resolution authorizing budgetary adjustments to the fiscal year 2022-2023 adopted budget, programming $205,380 1991 Mental Health Realignment finance cost associated with the requested position allocations.
On September 10, 2019 the Board adopted a personnel resolution effective September 10, 2019 adding 13.70 full-time equivalent positions. This action included approval of the time limited 2.40 FTE’s.
Fiscal Summary
|
Expenditures |
FY 23-24 Adopted |
FY 24-25 Projected |
FY 25-26 Projected |
|
Budgeted Expenses |
|
$271,500 |
0 |
|
Additional Appropriation Requested |
$469,000 |
|
|
|
Total Expenditures |
$469,000 |
$271,500 |
0 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
|
$271,500 |
0 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
$469,000 |
|
|
|
Contingencies |
|
|
|
|
Total Sources |
$469,000 |
$271,500 |
0 |
Narrative Explanation of Fiscal Impacts:
The Department is requesting to extend 2.4 FTE time-limited positions through December 31, 2024. Funding for the position extensions will use 1991 Mental Health Realignment funds to support operations. Once the State allocates permanent funding, the Department will draw down primarily for the Mental Health Diversion program. The Department will return with a Board update on funding and permanent staffing requests.
The time-limited 2.40 FTE ends on October 2, 2023, and these positions were not included in base budget. However, the FTEs are part of the authorized allocations to the Department. The Department is requesting a full year of appropriations estimated to be $469,000. A Cost-of-Living Adjustment (COLA) was assumed for payroll in FY 24-25.
1991 Mental Health realignment has an estimated fund balance of $11.3 million at the end of June 30, 2023.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
2470, Senior Client Support Specialist |
6,409.20 to 7,788.44 |
1.0 |
0 |
|
2503, Behavioral Health Clinician |
7,896.27 to 9,597.27 |
1.0 |
0 |
|
2534, Staff Psychiatrist |
20,846.85 to 25,339.38 |
0.2 |
0 |
|
2091, Psychiatric Nurse |
9,609.45 to 11,680.91 |
0.2 |
0 |
Narrative Explanation of Staffing Impacts (If Required):
No staffing impacts are anticipated since these 2.40 FTEs are currently active, but in a time-limited capacity. The Staff Psychiatrist and Psychiatric Nurse positions are currently vacant. The incumbents who held the Senior Client Support Specialist and the Behavioral Health Clinician positions have been temporarily transferred to funded allocations and will return to their original allocations upon conversion.
Attachments:
Attachment 1 - Personnel Resolution
Attachment 2 - Budget Resolution
Related Items “On File” with the Clerk of the Board:
None