SUBJECT
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SAN DIEGO COUNTY BEHAVIORAL HEALTHCARE BOARD CONFERENCE AND RETURN TO THE BOARD WITH UPDATES IN AUGUST 2025 (DISTRICTS: ALL)
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OVERVIEW
Behavioral healthcare available to County residents with severe mental illness (SMI) and/or substance use disorder (SUD) has become an issue of regional significance, and it is imperative that the San Diego County Board of Supervisors (Board) takes steps to explore the problem in greater depth, along with generating potential solutions.
The Board and the County of San Diego (County) have taken the lead in addressing the region’s behavioral healthcare crisis and spearheaded a profound transformation to move the local behavioral health care delivery system from a model of care driven by crises to one centered on continuous, coordinated care and prevention. These efforts, broadly referred to as the Behavioral Health Continuum of Care (Continuum of Care), are guided by data, focused on equity, and designed to engender collaborative work across silos, within and outside of government.
The Board has made historic investments in behavioral health services, expanding access to treatment, crisis response, and long-term recovery programs to meet growing regional needs. Board Conference will provide an update on the progress made, remaining challenges, and future opportunities to further transform the behavioral health system in San Diego County. County leaders will discuss how investments in crisis stabilization units, mobile crisis response teams, and treatment expansion are helping shift the region away from a fragmented, crisis-driven model toward a more effective and coordinated system of care. This discussion will also highlight how continued expansion of services and integration with housing, healthcare, and public safety systems will be critical in ensuring that individuals can access the care they need before reaching crisis.
RECOMMENDATIONS
VICE-CHAIR TERRA LAWSON-REMER
1. Receive information presented in the San Diego County Behavioral Healthcare Board Conference that includes the Substance Use Disorder Optimal Care Pathways model as a framework for future planning.
2. Direct the Chief Administrative Officer to return with updates on the Substance Use Disorder Optimal Care Pathways model in August 2025.
EQUITY IMPACT STATEMENT
In the United States, health inequities continue to persist based on an individual’s race, ethnicity,
sexual orientation, gender identity, and disability. Improving the County’s Behavioral Health Services’ Continuum of Care will help address the needs of many vulnerable populations in the County of San Diego.
SUSTAINABILITY IMPACT STATEMENT
Convening the Behavioral Healthcare Board Conference supports the County’s Sustainability Goals by exploring the need to provide just and equitable access to behavioral health services.
FISCAL IMPACT
There is no fiscal impact associated with these recommendations. There may be future fiscal impacts based on recommendations from today’s action. Any such recommendations would return back for consideration and approval by the Board. Upon return by staff, funding for future costs will need to be identified by the department before determining whether any new investments would be able to proceed. At this time, there will be no change in net General Fund cost and no additional staff years.
Impending federal policy changes may have significant impacts on the financial sustainability of local mental health and substance use treatment programs funded through Medicaid, or Medi-Cal in California. Therefore, any significant Medicaid policy changes will impact the County’s ability to financially sustain behavioral health Medi-Cal programs. Additionally, current growth in realignment funding, which is used as a match to federal expenditures, has not kept pace with operating increases for existing programs.
BUSINESS IMPACT STATEMENT
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ADVISORY BOARD STATEMENT
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BACKGROUND
Behavioral healthcare available to San Diego County residents with severe mental illness (SMI) and/or substance use disorder (SUD) has become an issue of regional significance, and it is imperative that the San Diego County Board of Supervisors (Board) take steps to explore the problem in greater depth, along with generating potential solutions.
The County of San Diego (County) has made significant progress in shifting its behavioral health system from one that primarily responded to crises to one that prioritizes early intervention, stabilization, and long-term recovery. Expanding access to treatment and crisis response services has been a critical part of this effort, ensuring that individuals can get the care they need before turning to emergency rooms or law enforcement.
A key part of this transformation has been ensuring that individuals experiencing behavioral health crises are connected to the right level of care. The expansion of crisis stabilization units has provided immediate, community-based alternatives to emergency rooms, while the growth of mobile crisis response teams has created new pathways for intervention that allow clinicians, rather than law enforcement, to respond to behavioral health emergencies. At the same time, investments in residential treatment, outpatient services, and housing-linked recovery programs are creating long-term solutions for individuals who need continued care and support.
As these efforts continue, the focus remains on strengthening access to services, improving coordination across the behavioral health system, and ensuring that the right mix of treatment, crisis care, and long-term recovery support is available to meet the needs of the region.
On September 27, 2022 (23), the Board adopted the Behavioral Health Optimal Care Pathways (OCP) model, outlining the optimal and future capacity that would best support people with limited opportunities for placement due to complex needs, lack of existing services, inadequate capacity, and/or other specialty care needs. The model focuses on diversion to the least restrictive environment and supports the medical, social, and environmental needs of individuals more effectively by improving access and connecting them to ongoing care.
Since that time, the County has continued to leverage the OCP model to inform strategic investments, build capacity, and allocate resources to improve the lives of the nearly 100,000 individuals served by the County’s Behavioral Health Services.
This Board Conference will provide an update on the progress made, remaining challenges, and future opportunities to further transform the behavioral health system. County leaders will discuss how investments in crisis stabilization units, mobile crisis response teams, and treatment expansion are helping shift the region away from a fragmented, crisis-driven model toward a more effective and coordinated system of care. This discussion will also highlight how continued expansion of services and integration with housing, healthcare, and public safety systems will be critical in ensuring that individuals can access the care they need before reaching crisis.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions support the County of San Diego’s 2025-2030 Strategic Plan Initiatives
of Equity (Health) and Community (Quality of Life and Partnership) by working to strengthen partnerships, expand access, and reduce stigma. These efforts will result in services for County residents that are more responsive, accessible, and effective leading to improved outcomes for our most vulnerable residents.
Respectfully submitted,
TERRA LAWSON-REMER
Supervisor, Third District
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