To: Sonoma County 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 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.
B) Adopt 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. (4/5th vote required)
(4/5th Vote Required)
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 (MH) 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. Given the permanent status of the program, Department of Health Services (hereinafter, “DHS” or “the Department”) management is requesting to extend, through October 2, 2023, 2.40 time-limited full time equivalent (FTE) staff that were added in December 2019 to support the “pilot” program for three years through December 2022. When CDSH releases allocation for ongoing Diversion funding, the Department will return with a permanent staffing plan. The job classifications are 1.0 Senior Client Support Specialist, 1.0 Behavioral Health Clinician, 0.2 Staff Psychiatrist, and 0.2 Psychiatric Nurse. Of these allocations 2.0 FTE are currently filled with .40 FTE vacant.
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.
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 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 22-23 Adopted |
FY 23-24 Projected |
FY 24-25 Projected |
|
Budgeted Expenses |
$205,380 |
$423,100 |
$435,800 |
|
Additional Appropriation Requested |
$205,380 |
|
|
|
Total Expenditures |
$410,760 |
$423,100 |
$435,800 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
$410,760 |
$423,100 |
$435,800 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
$410,760 |
$423,100 |
$435,800 |
Narrative Explanation of Fiscal Impacts:
The Department is requesting to extend 2.4 FTE time-limited positions until October 2, 2023. The funding from December 1, 2022 through October 2, 2023 will be from 1991 Mental Health Realignment. The Department is awaiting notification of CDSH funding allocation for the Mental Health Diversion program. The Department will return with a Board update on funding and staffing requests.
The time-limited 2.40 FTE ended in December 2022 with a budget of $205,380 in FY 2022-2023. In order to cover a full year’s worth of payroll, budget appropriations must be doubled to $410,760. A 3% Cost-of-Living Adjustment (COLA) was assumed for payroll in each subsequent fiscal year.
1991 Mental Health realignment has an estimated fund balance of $11.3M at the end of June 30, 2023.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
|
|
|
|
|
|
|
|
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Narrative Explanation of Staffing Impacts (If Required):
No staffing impacts are anticipated since these 2.40 FTE’s 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.
If the Board does not approve the extension the time-limited staff, the Mental Health Diversion program will cease to exist. Law Enforcement involved individuals who are eligible for Mental Health Diversion program will not be diverted from incarceration.
Attachments:
Attachment 1 - Personnel Resolution
Attachment 2 - Budget Resolution
Related Items “On File” with the Clerk of the Board:
None