Santa Cruz County Grand Jury
• 2023-2024
• Agency Response
Diagnosing the Crisis in Behavioral Health Underfunded, Understaffed & Overworked
⚠️ Aviso de traducción: Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
⚠️ 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 14
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.
No recommendations for this finding
F2
Page 14
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.
No recommendations for this finding
F3
Page 14
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
No recommendations for this finding
F4
Page 14
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 14
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
No recommendations for this finding
F6
Page 15
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.
No recommendations for this finding
F7
Page 15
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
No recommendations for this finding
F8
Page 15
The large number of high cost beneficiaries results in additional demands on an already overloaded behavioral health system. Finding about the new Watsonville facility
No recommendations for this finding
F9
Page 15
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 15
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.
No recommendations for this finding
F11
Page 15
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.
No recommendations for this finding
F12
Page 15
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
No recommendations for this finding
F13
Page 15
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.
No recommendations for this finding
F14
Page 15
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
No recommendations for this finding
Conclusions 1
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CL1 Page 14The longstanding and serious staffing shortage at the Behavioral Health Division is a contributing factor to all the issues discussed in this report, such as lack of step-down capability, services for marginalized groups including homeless persons, those involved with the criminal justice system and racial minorities. Until the staffing level is significantly improved, expecting improved service in any of these areas is unreasonable. The Grand Jury typically recommends an increase in funding when an agency has more responsibilities than budget, even while understanding that if there were funding available to increase the budget, this would already have been done. In this case, however, not only are County residents not getting adequate mental health services, the cost to the County is also higher because patients sometimes need to repeat treatment.
Commendations 1
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CM1 Page 17C1. The Grand Jury commends the Behavioral Health Division for development of a Psychiatric Healthcare Facility for children and youths which will provide much needed mental health services for this population. C2. The Grand Jury commends the Behavioral Health Division’s efforts to develop a wide range of crisis care services that are not routinely offered in similar sized counties, including Mobile Emergency Response Teams for adults and youth, a Crisis Services Program, and a Psychiatric Health Facility. Diagnosing the Crisis in Behavioral Health published June 12, 2023 Page 17 of 27