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Extracted from Consolidated Report
This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.
Santa Cruz County Grand Jury
• 2023-2024
Diagnosing the Crisis in Behavioral Health
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 14 findings
F1
Page 446
The chronic understaffing in the Behavioral Health Division (BHD) and their contractors is negatively impacting the department’s ability to meet goals and to provide services in a timely and effective manner.
Related Recommendations (3)
R1
Page 448
Competitive salaries and hiring incentives should be put in place for all vacant Behavioral Health Division (BHD) positions that don’t already have them. The BHD should consider the salaries and hiring incentives offered by Santa Clara County as a guide - such as hiring bonuses, loan repayment, public service loan repayment, and workforce tuition.The Personnel Department must plan for increases in salary and incentives with the goal of including them in the next budget cycle. (F1, F2, F8)
R2
Page 448
The County Personnel Department should plan to do an analysis of the hiring process for BHD positions and put measures into place to reduce the time it takes to hire by at least half. They should streamline the process and make use of up to date automated processes (F1, F2, F3)
R4
Page 448
The County Personnel Department should develop connections and internships with nearby universities that have Psychology and Social Work programs to groom a clinical workforce. A plan for this should be completed (F1, F2) Recommendations about the Crisis Stabilization Program
F2
Page 446
The County Personnel Department has been slow to respond to the chronic understaffing in the Behavioral Health Division. It has not put measures into place to speed up the hiring process or to create competitive salaries and incentives for the non-medical personnel who staff the BHD positions. Nor have they created connections with nearby universities to groom a clinical workforce. This causes unnecessary delays in hiring mental health professionals.
Related Recommendations (4)
R1
Page 448
Competitive salaries and hiring incentives should be put in place for all vacant Behavioral Health Division (BHD) positions that don’t already have them. The BHD should consider the salaries and hiring incentives offered by Santa Clara County as a guide - such as hiring bonuses, loan repayment, public service loan repayment, and workforce tuition.The Personnel Department must plan for increases in salary and incentives with the goal of including them in the next budget cycle. (F1, F2, F8)
R2
Page 448
The County Personnel Department should plan to do an analysis of the hiring process for BHD positions and put measures into place to reduce the time it takes to hire by at least half. They should streamline the process and make use of up to date automated processes (F1, F2, F3)
R3
Page 448
The County Personnel Department should institute an annual competitive analysis for all open BHD positions that includes consideration of the extraordinarily high cost of living in Santa Cruz, benefits and incentives. This should be completed (F2, F3)
R4
Page 448
The County Personnel Department should develop connections and internships with nearby universities that have Psychology and Social Work programs to groom a clinical workforce. A plan for this should be completed (F1, F2) Recommendations about the Crisis Stabilization Program
F3
Page 446
Both the Personnel Department and the Behavioral Health Division do not have enough analysts to allow an adequate review of their programs and systems, including analyzing the County’s hiring process. This makes it difficult for them to improve services. Findings about the Crisis Stabilization Program
Related Recommendations (2)
R2
Page 448
The County Personnel Department should plan to do an analysis of the hiring process for BHD positions and put measures into place to reduce the time it takes to hire by at least half. They should streamline the process and make use of up to date automated processes (F1, F2, F3)
R3
Page 448
The County Personnel Department should institute an annual competitive analysis for all open BHD positions that includes consideration of the extraordinarily high cost of living in Santa Cruz, benefits and incentives. This should be completed (F2, F3)
F4
Page 446
The Crisis Stabilization Program (CSP) has been diverting patients experiencing a mental health crisis to hospital emergency departments too frequently, delaying diagnosis, delaying treatment, and placing an extra burden on the emergency departments, which are already overcrowded. The emergency departments then become responsible for finding an inpatient facility for patients who cannot be safely discharged to outpatient care, which further stretches limited resources.
No recommendations for this finding
F5
Page 446
The limited hours that the Mobile Emergency Response Team and Mobile Emergency Response Team for Youth operate interfere with a timely assessment of patients in a mental health crisis, negatively impacting patient care. Diagnosing the Crisis in Behavioral Health published June 12, 2023 2022-2023 Consolidated Final Report with Responses 439
Related Recommendations (1)
R5
Page 448
To eliminate the frequent offloading of the Behavioral Health Division (BHD) clients to local hospital emergency departments, the Board of Supervisors and BHD should evaluate ways to increase the number of Crisis Stabilization Program chairs and psychiatric beds available, which may include planning for another adult Psychiatric Healthcare Facility. This evaluation and planning process should be completed (F5, F7)
F6
Page 447
An inadequate number of beds at the Psychiatric Healthcare Facility (PHF) results in the practice of sending patients out of county, which negatively impacts the patient’s care, and is expensive for the Behavioral Health Division.
Related Recommendations (1)
R6
Page 448
The Behavioral Health Division should improve the services provided by the Mobile Emergency Response Team and the Mobile Emergency Response Team for Youth by improving staffing and expanding coverage to 24/7. This should be completed (F6)
F7
Page 447
The County plans to close the current Crisis Stabilization Program (CSP) to patients under 18 after June 30, 2023, and the new CSP/PHF in Live Oak will not be open until late 2024 or early 2025 compromising crisis care to minors for 18 months or more. Finding about High Cost Beneficiaries
Related Recommendations (1)
R5
Page 448
To eliminate the frequent offloading of the Behavioral Health Division (BHD) clients to local hospital emergency departments, the Board of Supervisors and BHD should evaluate ways to increase the number of Crisis Stabilization Program chairs and psychiatric beds available, which may include planning for another adult Psychiatric Healthcare Facility. This evaluation and planning process should be completed (F5, F7)
F8
Page 447
The large number of high cost beneficiaries results in additional demands on an already overloaded behavioral health system. Finding about the new Watsonville facility
Related Recommendations (3)
R1
Page 448
Competitive salaries and hiring incentives should be put in place for all vacant Behavioral Health Division (BHD) positions that don’t already have them. The BHD should consider the salaries and hiring incentives offered by Santa Clara County as a guide - such as hiring bonuses, loan repayment, public service loan repayment, and workforce tuition.The Personnel Department must plan for increases in salary and incentives with the goal of including them in the next budget cycle. (F1, F2, F8)
R7
Page 448
The Behavioral Health Division should ensure that there is a smooth transition plan and back up plan for the treatment of children and youths from the current Crisis Stabilization Program to the planned new facility in Live Oak other than diverting them to emergency departments. This should be completed by September 30, 2023. (F8) Diagnosing the Crisis in Behavioral Health published June 12, 2023 2022-2023 Consolidated Final Report with Responses 441 Recommendation about Step-Down, Homelessness, and Jail Inmates
R8
Page 449
The Behavioral Health Division should request sufficient funding from the County to provide adequate step-down care so patients do not relapse and need yet more care. This request should be in place (F8, F10 – F12) Recommendations about Latino/a Utilization of Mental Health Services
F9
Page 447
The new Sí Se Puede Behavioral Health Center in Watsonville is a big step in the right direction, and will provide significantly increased service capacity, but it is still not enough. Findings about Step-Down, Homelessness, and Jail Inmates
No recommendations for this finding
F10
Page 447
The lack of step-down care for patients completing both inpatient and outpatient treatment often results in patients relapsing and needing retreatment, which is bad for the patient and increases costs for the Behavioral Health Division.
Related Recommendations (1)
R8
Page 449
The Behavioral Health Division should request sufficient funding from the County to provide adequate step-down care so patients do not relapse and need yet more care. This request should be in place (F8, F10 – F12) Recommendations about Latino/a Utilization of Mental Health Services
F11
Page 447
The high rate of homelessness and Substance Use Disorder in the County results in the Behavioral Health Division’s clients that are especially demanding and difficult to treat.
Related Recommendations (1)
R8
Page 449
The Behavioral Health Division should request sufficient funding from the County to provide adequate step-down care so patients do not relapse and need yet more care. This request should be in place (F8, F10 – F12) Recommendations about Latino/a Utilization of Mental Health Services
F12
Page 447
The Behavioral Health Division is insufficiently funded and staffed to provide adequate step-down care for their patients, many of whom are homeless, and/or recently released from jail, and thus have a need for support. Findings about services to Latino/as
Related Recommendations (1)
R8
Page 449
The Behavioral Health Division should request sufficient funding from the County to provide adequate step-down care so patients do not relapse and need yet more care. This request should be in place (F8, F10 – F12) Recommendations about Latino/a Utilization of Mental Health Services
F13
Page 447
Outreach to the Latino/a community is insufficient because of the lack of bilingual and bicultural staff contributing to disproportionate underutilization of mental health services within the Latino/a community.
Related Recommendations (2)
R9
Page 449
The Behavioral Health Division should continue to improve bilingual/bicultural outreach to the Latino/a population, including whether any language besides Spanish reaches the threshold to warrant offering the bilingual pay differential. Improvements should be in place (F13, F14)
R10
Page 449
The Behavioral Health Division should review the recruitment and retention of bilingual staff, including an increase to the current bilingual pay differential, in an effort to improve bilingual services. This should be completed (F13, F14)
F14
Page 447
The current pay differential for bilingual staff is insufficient to attract and retain suitably qualified staff making adequate outreach to the Latino/a community difficult. Diagnosing the Crisis in Behavioral Health published June 12, 2023 440 Santa Cruz County Civil Grand Jury
Related Recommendations (2)
R9
Page 449
The Behavioral Health Division should continue to improve bilingual/bicultural outreach to the Latino/a population, including whether any language besides Spanish reaches the threshold to warrant offering the bilingual pay differential. Improvements should be in place (F13, F14)
R10
Page 449
The Behavioral Health Division should review the recruitment and retention of bilingual staff, including an increase to the current bilingual pay differential, in an effort to improve bilingual services. This should be completed (F13, F14)
Agency Responses 1
Government agencies' official responses to this report's findings and recommendations. Click on a response to see the structured breakdown.