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County moves forward with ambitious plan to remake mental health system

San Diego Union-Tribune - 9/29/2022

For the record:

1:10 p.m. Sept. 29, 2022: A previous version of this story misspelled the last name of researcher Gregory Aarons. We apologize.

County supervisors universally praised a sweeping vision for transformation of the region's mental health care system Tuesday, highlighting the specificity of the plans brought forward so far.

As outlined by Luke Bergmann, the county's director of behavioral health, the model recommends shifting toward less-restrictive venues to serve the thousands of residents who use such care daily, adding nursing home and "respite" capacity but holding relatively steady on the local number of beds in locked hospital behavioral health units.

"To get where we need to be, we have to radically expand our infrastructure and workforce," Bergmann said.

Though the task is massive, the supervisors didn't seem particularly daunted.

Terra Lawson-Remer, whose third district spans the coast from Coronado to Carlsbad, said the plan begins to correct decades of underfunding.

"We've had, really since the early 1980s, an abandonment of our collective public responsibility to behavioral health across California, and certainly here in San Diego County; where that has led us is a place of pretty acute crisis," Lawson-Remer said.

The plan, what county staffers are calling an "Optimal Care Pathways Model," calls for working with public and private health care providers and other government agencies to encourage and provide incentives for prevention of up to 40 percent of current stays in locked units.

That's a very specific goal, and one that Joel Anderson, who represents East County, praised for its clarity. Too often, he said, efforts around mental health initiatives have seemed over focused on "checking boxes" rather than on laying out tangible goals.

"People were going through the motions, but they weren't thinking about outcomes," Anderson said. "What I love about this is it's outcome based."

Anderson thanked board chair Nathan Fletcher for his long-standing advocacy of local mental health reform, and Fletcher said in a statement after the meeting that he is "pleased with our progress, but there remains significantly more work to do."

Bergmann made it clear that such a reduction, and a simultaneous shift to a more preventive model of operation, will not occur overnight. But he added that he will return in mid-October with a long-range facilities plan to set the model presented Tuesday in motion.

Some aspects of that plan have already been shared with the public, such as working with Alvarado Hospital in La Mesa to create an expanded inpatient unit that would be jointly operated with UC San Diego Health. The unit, Bergmann added, is intended to serve at the county's main safety net facility, taking that job from the county's existing behavioral health hospital on Rosecrans Street in San Diego's Midway district.

Rosecrans, he said, could then be redeveloped as a skilled nursing facility for those in need of long-term behavioral health treatment.

Plans are also underway to add board-and-care capacity at a county-owned property on Third Avenue and at an as-yet-undisclosed location in El Cajon. Together, the director said, those two locations could take a big bite out the estimated 400 additional board-and-care beds needed to house those who finish mental health treatment but still need a stable place to stay.

"While our goals are ambitious, we will be making substantial headway in short order," Bergmann said.

The county is also moving forward with a plan to build a mental health hub in El Cajon with a crisis stabilization center where patients can stay for up to 24 hours. While Tuesday's presentation indicated that the service should be up and running by the fall of 2024, officials still have not specified its exact location.

Children are also a significant part of the county's multi-pronged behavioral health improvement program, with a "screening to care" initiative expanding in local schools and expansion plans underway at Rady Children's Hospital.

The UC San Diego School of Medicine also announced this week that it has received a $12 million, five-year grant from the National Institutes of Mental Health to create a research center to study better ways to improve child access to mental health resources. The center is to be directed by researchers Lauren Brookman-Frazee and Gregory Aarons.

This story originally appeared in San Diego Union-Tribune.

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