title
Consider a “support” position of AB1769 (Frazier) which requests $14 million in State General Fund to construct a mental health residential program on the Beck campus in Fairfield on the site designated for a mental health facility in the master plan
body
Published Notice Required? Yes ____ No _X _
Public Hearing Required? Yes ____ No _X _
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services (H&SS) recommends that the Board of Supervisors consider a “support” position of AB1769 (Frazier) which requests $14 million in State General Fund to construct a mental health residential program on the Beck campus in Fairfield on the site designated for a mental health facility in the master plan.
SUMMARY/DISCUSSION:
AB 1769 (Frazier) (Attachment A) proposes to support Solano County in creating a new residential treatment facility with $14 million in State General Fund to design, plan and build the facility. The proposed licensed board and care will have a total of 16 bedrooms with 32 beds to provide housing and services for those with severe mental illness (Attachment C). The proposed facility comes at a time when local communities are particularly concerned about the impact that homelessness and the lack of safe and stable housing available in the community. The lack of housing has a particularly detrimental effect on people with mental illness who need supportive housing in order to thrive. The proposed facility would include 24-hour supportive services provided under a contract with H&SS Behavioral Health. Operational funding would be available through a combination of diverted higher end placements, moving some clients at the same level of care closer to home, and Mental Health Services Act (MHSA) funding for clients engaged in MHSA Community Services and Supports programs.
The proposed facility design would have an 8 room, 16 bed board and care for one half of the facility and an 8 room, 16 bed adult residential mental health program (also referred to as augmented board and care) for the other half, pending licensure by the State Department of Community Care Licensing for the adult residential. Both levels of care are needed as demonstrated in the attached bed space summary (Attachment B). Statewide, there has been a tremendous reduction in licensed board and cares due to licensing demands, minimum wage requirements, and housing prices; the board and care model is difficult to sustain financially without additional County support. The residential level of care includes a set of mental health services delivered in the board and care setting. This level of care is most likely to enable success of individuals discharging from locked settings and has components which are billable to Medi-Cal. The costlier services provided in locked, long-term care are not billable to Medi-Cal, and only certain acute inpatient admissions are billable to Medi-Cal (admissions for youth up to age 21 and adults over age 64 and inpatient services provided in hospitals with 16 or fewer beds are reimbursable by Medi-Cal).
Strengthening the capacity to serve at these lower levels of care can reduce lengths of stay at higher levels of care, prevent admissions to acute or locked care settings, reduce or prevent law enforcement engagement, and reduce homelessness resulting from destabilization. Therefore, there are two priority populations: people ready to discharge from locked mental health settings (either acute or long-term care) and people whose mental health condition would likely result in inpatient admission, which can ultimately result for some in LPS conservatorship under the County Public Guardian and placement in a locked, long-term care facility. Adding local service capacity as proposed is advantageous both financially and in accordance with the federal Olmstead Act requires that individuals are placed in the least restrictive level of care and community-based settings when appropriate. Engagement in an appropriate level of care helps promote mental health recovery and reduce potential detrimental outcomes such as homelessness, criminal justice involvement, and medical or mental health deterioration.
Located on the Health and Social Services campus at 275 Beck Avenue, this planned location is aligned with the goals of the County’s master plan for capital facilities and the Beck campus specifically. Its convenient H&SS location provides a unique opportunity to assure that services provided are oriented toward the whole person and integrated across mental health, medical services, and other social services programs. Convenient access to medical care will assist these individuals in addressing the complex medical needs that many individuals with severe mental illness experience which contributes to their life expectancy being 25 years less than others. Easy access to outpatient mental health clinic will promote client engagement continuity in outpatient care, both of which are critical for maintaining mental health recovery. With the crisis unit also located on the same campus, proactive crisis intervention and stabilization can help prevent further deterioration and the need for a more restrictive and costly level of care. The Department will be able to engage clients at a higher and more holistic level and measure outcomes achieved through this more comprehensive engagement.
FINANCIAL IMPACT:
This bill, if signed into law, would bring Solano County $14 million dollars to utilize over a four year period. Additional placement capacity at this level of care should also reduce the total financial investment in higher levels of care. The costs associated with preparing the agenda item are nominal and absorbed by the department’s FY2018/19 Adopted Budget.
ALTERNATIVES:
The Board may choose not to support this bill. However, this is not recommended as it would bring a much needed expansion in capacity to serve mentally ill clients and was proposed in collaboration with Solano County staff based upon a gap analysis.
OTHER AGENCY INVOLVEMENT:
This action is sponsored by Assembly member Frazier and is endorsed by the Solano County Local Mental Health Board and Solano County’s NAMI advocates. It is aligned with ongoing community feedback regarding the need to provide more housing and supports for people in our community with severe mental illness.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION