Grand Jury 2023. 6cI Non-compliant response received Jane Batoon-Kurovski Fri, Nov 17, 2023 at 10:35 Am

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. X AGREE PARTIALLY DISAGREE DISAGREE Response explanation (required for a response other than Agree): We recommend that they find more roles and move quicker on hiring peer support, which will go a long way to address the chronic understaffing, help with retention and save money in the process.

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. X AGREE PARTIALLY DISAGREE DISAGREE Response explanation (required for a response other than Agree): The hiring process is slow, complicated, and opaque. The Mental Health division is given a budget to work with and is constrained in their ability in what they are able to offer. In addition, the Behavioral Health division has worked and is working with local non-profits, colleges, and universities.

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. X AGREE PARTIALLY DISAGREE DISAGREE Response explanation (required for a response other than Agree):

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. X AGREE PARTIALLY DISAGREE DISAGREE Response explanation (required for a response other than Agree): The absence of crisis stabilization program being provided by Dominican Hospital, Watsonville Hospital or any CBO in the county, places additional burden on Behavioral Health division to provide these services. We recommend that at minimum, each hospital create a 23-hour crisis stabilization center on their campus, similar to what Dominican Hospital provided until 2013. Telecare was the only provider that offered a contract.

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. X AGREE PARTIALLY DISAGREE DISAGREE Response explanation (required for a response other than Agree):

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. X AGREE PARTIALLY DISAGREE DISAGREE Response explanation (required for a response other than Agree):

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. AGREE X PARTIALLY DISAGREE DISAGREE Response explanation (required for a response other than Agree): The provider Telecare notified the Behavioral Health division that it would no longer accept patients under 18. This was not a plan by the Behavioral Health division.

The large number of high cost beneficiaries results in additional demands on an already overloaded behavioral health system. X AGREE PARTIALLY DISAGREE DISAGREE Response explanation (required for a response other than Agree): Mental Health is expensive, underfunded and a chronic illness requiring multiple episodes of treatment.

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. X AGREE PARTIALLY DISAGREE DISAGREE Response explanation (required for a response other than Agree): The model should be assessed to see if it can be replicated in other areas in the County.

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. X AGREE PARTIALLY DISAGREE DISAGREE Response explanation (required for a response other than Agree):

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. X AGREE PARTIALLY DISAGREE DISAGREE Response explanation (required for a response other than Agree): We find the terminology dehumanizing and the lack of affordable housing is not addressed.

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. X AGREE PARTIALLY DISAGREE DISAGREE Response explanation (required for a response other than Agree): The absence of participation by Central California Alliance for Health and from the private sector to provide prevention and early intervention and behavioral health services as a whole is a significant contributor to the lack of support.

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. AGREE X PARTIALLY DISAGREE DISAGREE Response explanation (required for a response other than Agree): This does not account for the stigma that mental health has in the Latina/Latino/LatinX community, nor does it mention the new mental health facility at 1430 Freedom Blvd in Watsonville, and that hiring states preferred bilingual.

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. AGREE X PARTIALLY DISAGREE DISAGREE Response explanation (required for a response other than Agree): The pay differential is comparable to other surrounding counties; however, we believe it should be increased. This does not account for the huge hiring challenges across the county nor how the cost of housing impacts recruitment of bilingual staff.