County supervisors agreed Tuesday to updates on several statewide mental health initiatives, although big questions remain unanswered.
The likely approach to implementing Senate Bill 43, the new state law that expands involuntary treatment to people disabled by substance use, gained clarity Tuesday. But crucial details, like increasing resources to protect hospital emergency departments, remain vague.
Likewise, no details have yet been revealed about which local mental health programs may be eliminated or reduced in order to shift spending from mental health care to housing services and substance abuse treatment, such as requires Proposition 1, the statewide millionaires tax referendum, which voters narrowly passed in the March 5 primary election.
In early December, the County Council voted to delay implementation of SB43 at the request of local hospitals and other medical providers who were concerned that expanding the definition of “severely disabled” to include people with substance use disorders clogged emergency services as law enforcement officers and other first responders began picking up residents in the “5150” holds.
San Diego, like most counties in the state, opted not to take the new law into effect on January 1, delaying action for a year to give providers time to develop a system capable to protect emergency services from an influx of suffering patients. symptoms of drug and alcohol use.
Over the past three months, county behavioral health officials have met with medical providers and organizations serving unhoused residents to develop a plan.
Aides are calling for in-depth training on the new definition of severely disabled people, with a focus on law enforcement officers who are most often called when a community member feels uncomfortable facing to the behavior he observes, most often in public places.
However, there is less specificity about how people needing drug treatment will get it.
A big unresolved problem, experts note, is the fact that medical providers are unable to bill Medi-Cal, the state’s health plan of last resort, for addiction services.
Although a new program called SD Relay, expected to begin operating this summer, will help those who agree to voluntarily enter drug treatment offered by county contractors, there is currently no precedent to follow in providing of such treatment for serious cases requiring care in a closed place. hospital units.
“To date, the State has not established Medi-Cal reimbursement rates for locked-in primary and standalone treatment (substance use disorders),” the county report states.
This is also the case with crisis stabilization units, which offer up to 24 hours of respite in locked centers equipped with recliners rather than beds. These centers have eased much of the pressure on North County emergency services, providing an alternative drop-off location for people held in 5,150 detentions established under the previous criteria, which include behavior likely to endanger endangering oneself or others in addition to a serious disability.
Although the county report indicates that existing contracts will be updated to accommodate more people detained under the revised law, there is no precise estimate of how many additional people the already taxed system will need to absorb.
If a recent editorial in the Chronicle of San Francisco written by emergency physician Maria Raven is a hint, it could be a lot. Unlike San Diego, San Francisco launched SB43 earlier this year, and Raven says “our emergency department and others like it in the region are overwhelmed.”
Council President Nora Vargas cited the situation in the North as proof that the decision to delay implementation for a year was the right one.
“All the practitioners really understood that we have to have a system in place before we can actually do this and do it well,” Vargas said.
Despite the challenges and the example of difficulties in San Francisco, there was some optimism that by the end of the year, medical providers and government planners will be able to marshal the resources necessary to avoid significant pain in the new year. .
Mike Phillips, senior director of patient advocacy and housing services for Jewish Family Services of San Diego, an organization that helps involuntarily detained people exercise their patient rights, said he was optimistic after co-chairing a group of “stakeholders” tasked with finding a way to thread the SB43 needle.
“In my 20 years of work, I have never seen the community come together like they have over the last few months,” Phillips said.
Now that the barriers have been identified, he said, they can be eliminated through state-level advocacy and deeper local planning.
“I truly believe we will be ready by January 1, 2025,” Phillips said.
However, all of this work will have to be done even as a major source of funding for mental health care is in flux due to the passage of Proposition 1. The main title of the initiative is more than $6 billion in bonds to support additional mental health care. investments across the state, and officials said Tuesday they believe San Diego is in a strong position to receive some of those funds.
But the proposal also requires counties to change how they spend revenue from the Mental Health Services Act, which imposes a 1% tax on annual personal income above $1 million. Now, 30 percent of that revenue must go toward housing, a shift of about $80 million from the roughly $275 million San Diego County expects to receive in the next fiscal year.
Without discussion, supervisors approved a request to return staff in 120 days with a plan to “research and invest” Prop. bond funds. 1. There was no discussion of which existing mental health programs would give way in order to meet the measure’s requirements for increased spending on “housing intervention programs.”
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