SUBJECT: IMPLEMENTING A PILOT PROGRAM TO ENHANCE SUPPORT TO PEOPLE WITH SERIOUS MENTAL ILLNESS AT AFFORDABLE HOUSING DEVELOPMENTS (DISTRICTS: ALL)
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OVERVIEW
It is estimated that 21% of the homeless population suffers from a Serious Mental Illness (SMI). We have made great strides at the County to move forward on projects to provide housing for this population. As we continue to work to reduce homelessness in our region, we must ensure that we are providing quality services to our most vulnerable populations.
SMI is a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits major life activities. Placing individuals with SMI in environments ill-equipped to meet their needs not only undermines their potential for success but also poses risks to both their well-being and the broader community. Individuals with SMI require a high level of care and support and we strive to ensure people receive the support they need. When we make a commitment to stakeholders that we will offer “wrap-around services” we must ensure that they are truly wrap-around- 24 hours a day, 7 days a week.
No Place Like Home (NPLH) is a State program that funds the development of permanent supportive housing for persons who are in need of mental health services and are experiencing homelessness, chronic homelessness, or are at risk of chronic homelessness. There are 19 affordable housing developments throughout the County, either currently operating or in development, that include NPLH units.
To ensure the success and sustainability of these developments, it is imperative that we institute a policy requiring all affordable housing developments with NPLH units to have personnel on-site, 24/7, who are trained in Mental Health First Aid, and have knowledge and the ability to directly contact the County’s 24/7 behavioral health crisis services. Additionally, we should ensure that new residents moving into affordable housing developments with NPLH units have access to enhanced clinical support at the onset of their residency and on an ongoing basis, as appropriate. Currently, not all residents with SMI receive clinical support. This action will support connection to services, counseling, crisis intervention, and medication management, which will assist in stabilizing individuals with SMI, working to lessen the severity of their symptoms and enhancing their overall well-being. These adjustments will decrease the likelihood of mental health crises and interactions with law enforcement, thereby promoting public safety and community cohesion.
Today’s action would implement a pilot program within four affordable housing developments in North County San Diego that have NPLH units to increase clinical support services for residents with SMI to seven days per week. Today’s action would also require on-site personnel within the four North County affordable housing developments, to be trained in Mental Health First Aid and receive training on how to refer people to 24/7 behavioral health crisis response resources. Today’s action would also initiate a requirement for the four affordable housing developments in North County to develop a plan to support and address the unique needs and challenges of residents with SMI. This plan would include a strategy to ensure that on-site personnel are able to monitor who is entering the building through a check-in and check-out process.
RECOMMENDATIONS
SUPERVISOR JIM DESMOND
1. Direct the interim Chief Administration Officer to work with County departments, including Behavioral Health Services and Housing and Community Development Services, to implement a pilot program to increase services for residents with serious mental illness living in the four affordable housing developments with No Place Like Home units in North County to include enhanced clinical support seven days per week.
2. Direct the interim Chief Administration Officer to work with Behavioral Health Services and Housing and Community Development Services, to ensure all personnel on-site at the four affordable housing developments in North County receive Mental Health First Aid training and be trained on how to refer people to 24/7 behavioral health crisis response resources.
3. Direct the interim Chief Administrative Officer to work with County departments, including Behavioral Health Services, Housing and Community Development Services, and affordable housing developers and property management companies for the four developments that include NPLH units in North County to develop a plan to support and address the unique needs and challenges of residents with SMI and to support the health and safety of residents and the surrounding community. These plans should include:
a. A strategy to ensure that visitors to the property are checked in and out. It is imperative that on-site personnel are aware of who is on the property to support the health and safety of its residents.
b. An assessment of current staffing needs, and what is needed to ensure there is at least 1 Mental Health First Aid trained staff on-site 24/7, which can include: security guards, property management, and service providers. This assessment should identify any gaps in personnel being on-site, and suggestions for how to fill those gaps.
4. Report back to the Board within 90 days with an update on the plans for the four developments in North County that have NPLH units.
5. Report back to the Board within six months with an update on the progress, outcomes, and a plan to implement these changes countywide.
EQUITY IMPACT STATEMENT
By enhancing behavioral health services for those with serious mental illness, the County of San Diego would be expanding services to a currently underserved population. The County of San Diego is committed to providing equal access to services and housing to people with SMI who are homeless or at risk of homelessness. There is a severe lack of living opportunities in the County of San Diego.
SUSTAINABILITY IMPACT STATEMENT
This proposed action contributes to the County of San Diego’s Sustainability Goal of protecting the health and well-being of all San Diegan residents. Enhancing behavioral health services for those with serious mental illness will help facilitate self-sufficiency and rehabilitation of some of the County’s more vulnerable residents.
FISCAL IMPACT
Recommendation #1:
Funds for this request are not included in the Fiscal Year (FY) 2023-24 Operational Plan and FY 2024-26 CAO Recommended Operational Plan for the Health and Human Services Agency. If approved, this request will result in estimated costs and revenues of approximately $200,000 in FY 2023-24 and $600,000 in FY 2024-25. This funding would support implementation of a pilot program to enhance clinical support for residents with serious mental illness living in the four affordable housing developments with No Place Like Home units in North County. The department will need to identify funding prior to proceeding with the recommended action, as none is currently available. Once funding is identified, the department will return to the Board with a mid-year action to adjust the budget if necessary. There will be no change in net General Fund cost and no additional staff years.
Recommendation #2:
Funds for this request are included in the Fiscal Year (FY) 2023-25 Operational Plan for the Health and Human Services Agency. If approved, this request will result in estimated costs and revenues of approximately $35,000 in FY 2023-24 and no costs and revenues in FY 2024-25. The funding source will be Mental Health Services Act Prevention and Early Intervention funds. This would fund training to ensure all personnel on-site at the four affordable housing developments with No Place Like Home units in North County, estimated at approximately 255 individuals, receive Mental Health First Aid training. There will be no change in net General Fund cost and no additional staff years.
Recommendations #3-5:
There is no fiscal impact for these items. 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
It is estimated that 21% of the homeless population suffers from a serious mental illness (SMI). We have made great strides at the County to move forward on projects to provide housing for this population. As we continue to work to reduce homelessness in our region, we must ensure that we are providing quality services to our most vulnerable populations.
SMI is a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits major life activities. Placing individuals with SMI in environments ill-equipped to meet their needs not only undermines their potential for success but also poses risks to both their well-being and the broader community. Individuals with SMI of require a high level of care and support and we strive to ensure people receive the support they need. When we make a commitment to stakeholders that we will offer “wrap-around services” we must ensure that they are truly wrap-around- 24 hours a day, 7 days a week.
No Place Like Home (NPLH) is a State program that funds the development of permanent supportive housing for persons who are in need of mental health services and are experiencing homelessness, chronic homelessness, or are at risk of chronic homelessness. There are 19 affordable housing developments throughout the County, either operating or in development, that include NPLH units.
To ensure the success and sustainability of these developments, it is imperative that we institute a policy requiring all affordable housing developments with NPLH units to have personnel on-site, 24/7, who are trained in Mental Health First Aid, and have knowledge and the ability to directly contact the County’s 24/7 behavioral health crisis services. Additionally, we should ensure that new residents moving into NPLH units have access to clinical support at the onset of their residency and on an ongoing basis, as appropriate. Currently, not all NPLH clients receive clinical support. This will support connection to services, counseling, crisis intervention, and medication management, which will assist in stabilizing individuals with SMI, working to lessen the severity of their symptoms, and enhancing their overall well-being. These adjustments are anticipated to decrease the likelihood of mental health crises and interactions with law enforcement, thereby promoting public safety and community cohesion.
Today’s action would implement a pilot program in North County San Diego, which includes four affordable housing developments NPLH units, to increase clinical support services for residents with SMI to seven days per week, for eight hours per day. The four NPLH developments include:
• Windsor Pointe- Carlsbad, District 3
• Valley Senior Village- Escondido, District 5
• Greenbrier Village- Oceanside, District 5
• Santa Fe Senior Village- Vista, District 5
Today’s action would also require on-site personnel within the four North County affordable housing developments, estimated at 255 total individuals, to be trained in Mental Health First Aid and to receive training on how to refer people to 24/7 behavioral health crisis response resources. Today’s action would also initiate a requirement for the four affordable housing developments in North County to develop a plan to support and address the unique needs and challenges of residents with SMI. This plan would include a strategy to ensure that on-site personnel are able to monitor who is entering the building through a check-in and check-out process.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today's proposed action supports the Equity Initiative of the County of San Diego’s 2024-2029 Strategic Plan by making health and housing a focus by reducing disparities and disproportionality and ensuring access for all through a fully optimized health and social service delivery system and upstream strategies while utilizing policies, facilities, infrastructure, and finance to provide housing opportunities that meet the needs of the community.
Respectfully submitted,
JIM DESMOND
Supervisor, Fifth District
ATTACHMENTS
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