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DATE: |
November 4, 2025 |
14 |
SUBJECT
Title
ENHANCING HOMELESSNESS SUPPORTS THROUGH EXPANDED WITHDRAWAL MANAGEMENT SERVICE ACCESS (DISTRICTS: ALL)
Body
OVERVIEW
The County of San Diego (County) Health and Human Services Agency (HHSA) and Behavioral Health Services (BHS) are charged with supporting a robust and accessible specialty behavioral health continuum of care throughout the County. This continuum, as it pertains to substance use disorder treatment, includes inpatient and outpatient drug treatment, specialized long-term care, community-based care, crisis diversion, and residential services inclusive of withdrawal management. Withdrawal management services, often referred to as “detox”, provide supportive medical care for individuals experiencing withdrawal symptoms as they cease or reduce the usage of addictive substances. These programs include 24-hour, non-medical, residential substance use treatment, recovery, and ancillary services for adults over the age of 18.
Gaps in withdrawal management service capacity exist within the County’s continuum of care. This insufficient capacity hinders the County’s ability to address ongoing substance use crises, especially among populations experiencing homelessness. There are 102 withdrawal management service beds available for the Medi-Cal population throughout the region, and only four of those beds are located in County District 1, where a significant proportion of individuals experiencing homelessness reside. Gaps in withdrawal management accessibility also contribute to delays in care for thousands of residents with substance use disorders and contribute to more than 27,000 substance use related emergency department visits annually. Additionally, over a third of individuals entering BHS care for a substance use disorder present with a housing need, and data show that engagement in treatment and recovery services increase the likelihood of becoming housed. Expanding these services will address critical gaps in care and strengthen the connection between behavioral health treatment and housing stability for some of the County’s most vulnerable residents.
Today’s item seeks to expand withdrawal management capacity by 44 residential beds within the downtown area of the City of San Diego. These services will address service gaps and provide timely, clinically managed stabilization, improve system flow from crisis to treatment and enhance access to care for an additional 2,700 residents annually. This targeted investment will provide critical behavioral health services to some of our region’s most vulnerable populations, including the unhoused, and supports the County’s Substance Use Optimal Care Pathways model and 2025-2030 Strategic Plan.
RECOMMENDATION
SUPERVISOR PALOMA AGUIRRE AND SUPERVISOR MONICA MONTGOMERY STEPPE
1. In accordance with Section 401, Article XXIII of the County Administrative Code, Authorize the Director, Department of Purchasing and Contracting to issue a Request for Statement of Qualifications for Adult Substance Use Residential Withdrawal Management Services within the City of San Diego, and upon successful negotiations and determination of fair and reasonable price, award contracts for an Initial Term of up to one year, with four 1-year options, and an additional six months, if needed, and to amend the contracts, as needed, to reflect changes in program, funding or service requirements, subject to the availability of funds and approval of the Director, Behavioral Health Services Department.
EQUITY IMPACT STATEMENT
As a regional steward of public health, the County must ensure that services address the social determinants of health by being accessible, capable of meeting the needs of a diverse population, and equitably distributed throughout the region to those most in need. The County utilizes a population health approach, robust data analysis, and input from consumers, community-based providers, healthcare organizations, and other stakeholders to identify community needs and design services that yield meaningful outcomes. Establishing additional withdrawal management services in the downtown San Diego region will increase capacity and accessibility of critical behavioral health care where a disproportionately high population of unhoused community members reside.
SUSTAINABILITY IMPACT STATEMENT
Today’s proposed action aligns with County Sustainability Goal #2, to ensure equitable access to County services. Establishing inpatient care services within the HHSA Central Region prioritizes equitable access to essential behavioral health inpatient services for Medi-Cal eligible adults, enabling those in need of higher levels of care to be connected to care in close proximity to where they reside.
FISCAL IMPACT
Funds for this request are included in the Fiscal Year 2025-26 Operational Plan in the Health and Human Services Agency. If approved, this request will result in approximate costs and revenue of $1.5 million in Fiscal Year 2025-26 and $2.9 million in Fiscal Year 2026-27. The funding source is State funding from Realignment and Drug Medi-Cal (DMC). There will be no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
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Details
ADVISORY BOARD STATEMENT
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BACKGROUND
Nearly 10,000 people experience homelessness every night in San Diego County. According to The California Statewide Study of People Experiencing Homelessness 2023 Report from the University of California, San Francisco, 66% of people experiencing homelessness report living with an untreated mental health condition, 60% report at least one chronic health condition, and 35% report experiencing chronic substance use. These outcomes significantly shorten life expectancy and make exiting homelessness challenging. In 2024, there were 293 cases of deaths among the homeless population which were drug or alcohol related, according to data from the Medical Examiner’s Office.
Additionally, a California Health Interview Survey found that over one in four adults in San Diego County reported needing help for mental or emotional problems or alcohol or drug use in 2024. Of those who needed help, one in seven (13.9%) did not see a healthcare provider and over half (58.0%) reported unstable housing. These findings highlight a significant gap in access to behavioral health care and underscore the complex link between mental health, substance use, and social determinants such as housing stability. Addressing these interconnected challenges requires a coordinated, integrated system of care that supports individuals across all stages of recovery from crisis intervention to long-term stabilization.
Withdrawal management services, often referred to as “detox”, provide supportive medical care for individuals experiencing withdrawal symptoms as they cease or reduce the usage of addictive substances. These programs include 24-hour, non-medical, residential substance use treatment, recovery, and ancillary services for adults over the age of 18. Within a comprehensive continuum of care, withdrawal management serves as the bridge between crisis and stability. These services also help individuals safely transition into long-term treatment such as counseling, medication-assisted recovery, and community-based supports. Without this critical first step in the recovery process, people are at greater risk of relapse, medical complications, or disconnection from needed services. Connection to behavioral health services like withdrawal management also promotes housing stability. Over a third of individuals entering BHS care for a substance use disorder present with a housing need, and data show that engagement in treatment and recovery services increase the likelihood of becoming housed.
Gaps in withdrawal management service capacity exist within the County’s continuum of care. This insufficient capacity hinders the County’s ability to address ongoing substance use crises, especially among populations experiencing homelessness. There are currently 102 withdrawal management treatment beds in San Diego County for the Medi-Cal population. Only four of these beds are located within County District 1, including the East Village area within the City of San Diego where a significant proportion of the region’s homeless population resides. Existing gaps in withdrawal management capacity contribute to delays in care for thousands of residents. Additionally, regional hospitals report more than 27,000 substance use-related emergency department visits each year, further underscoring the need to expand withdrawal management service capacity.
Today’s item seeks to expand withdrawal management capacity by 44 residential beds within the downtown area of the City of San Diego. These services will address service gaps and provide timely, clinically managed stabilization, improve system flow from crisis to treatment, and expand access to care for an additional 2,700 residents annually. This targeted investment will provide critical behavioral health services to some of our region’s most vulnerable populations, including the unhoused, and supports the County’s Substance Use Optimal Care Pathways model and 2025-2030 Strategic Plan.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed action supports the County of San Diego’s 2025-2030 Strategic Plan initiatives of Equity (Health) and Community (Quality of Life) as well as the regional Live Well San Diego vision by enhancing access to substance use treatment services for unhoused populations throughout the region.
Respectfully submitted,
PALOMA AGUIRRE MONICA MONTGOMERY STEPPE
Supervisor, First District Supervisor, Fourth District
ATTACHMENT(S)
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