Sacramento County Board of Supervisors Behavioral Health Services Retreat – August 20, 2024
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Sacramento County Board of Supervisors Behavioral Health Services Retreat
On August 20, 2024, the Sacramento County Board of Supervisors held a special all-day retreat focused on behavioral health services. The meeting provided a comprehensive overview of the county's behavioral health continuum, highlighted new and upcoming initiatives, and included presentations from the UC Davis MIND Institute, the Behavioral Health Youth Advisory Board, and county staff. The retreat was chaired by Supervisor Kennedy and featured extensive discussion on the complexity of the system, funding challenges, and the need for community integration.
Public Comments & Testimony
- Nancy Brinelson (Family Advocates for Individuals with Serious Mental Illness) expressed support for new initiatives such as assisted outpatient treatment, CARE Court, and SB 43, but urged the board to prioritize family voice and integration of various advisory boards. She noted that the system is designed to let people become severely ill before they qualify for involuntary treatment.
- Wade Brinelson (co-chair, Advocates for Individuals with Serious Mental Illness) recommended stronger collaboration between the county's behavioral health system and schools, including using California Department of Education Healthy Kids survey data to measure outcomes. He also noted that many schools have mental health programs that could be better integrated.
- Dr. Karin Sacco (mental health board chair and CWRT advisory committee co-chair) praised the Community Wellness Response Team (CWRT) but highlighted that community awareness of 988 and CWRT is very low. She urged the board to provide additional resources for marketing and to require 911 dispatchers to refer calls to 988.
- Jim York (member of the public and person in recovery) offered to bring AA/NA meetings into tiny home facilities and stressed the importance of consistent, daily support for individuals in recovery.
Discussion Items
- Behavioral Health Care Continuum Overview – Dr. Ryan Quist and staff presented the division's mission, funding sources ($668 million budget, 660 FTEs, 90% contracted out), and services for 40,000 consumers annually. They explained the distinction between the county's responsibility for serious mental illness/substance use disorders and managed care plans for mild-to-moderate needs. The presentation covered child and family services (FIT, wraparound, TBS, full-service partnerships), adult services (core outpatient, FSPs, housing supports), substance use disorder treatment (withdrawal management, MAT, residential), and inpatient/acute services (CSUs, psychiatric hospitals, and a new youth CSU/PHF under BCHIP Round 4).
- UC Davis MIND Institute Overview – Dr. Marjorie Solomon described the institute's history, research (268.7 million in NIH grants), clinical care (8,000 patient visits annually), and community outreach (training, support groups, mobile van). She emphasized the institute's focus on neurodevelopmental conditions and the transition to adulthood services.
- Behavioral Health Special Initiatives – Staff presented the Thrive programs (justice-involved full-service partnerships), the CalAIM 90-day pre-release benefit, the Community Wellness Response Team (CWRT) (which went 24/7 in March 2024, with 150 field responses in Q4 2024, 70% resolved in community), and the Homeless Engagement and Response Team (HART) (outreach to encampments and shelters).
- Behavioral Health Youth Advisory Board – Two youth representatives, Cloud Peterson and Rada Chowhan, presented their advocacy efforts, including recommendations for school-based mental health clinicians, telehealth apps (Bright Life Kids, Soluna), and challenges in youth recruitment. They requested the board's assistance in promoting vacancies and sharing social media posts.
- Behavioral Health New Initiatives – Staff discussed several upcoming changes:
- Proposition 1 (Behavioral Health Services Act): Effective July 1, 2026, consolidating MHSA from five funding buckets to three (housing, full-service partnerships, and behavioral health services/supports). The state is still defining allowable uses; 30% must go to housing, with 50% of that for chronically homeless. The board was informed that the county will need to conduct community planning.
- CalAIM: Includes payment reform, mobile crisis benefit (required for Medi-Cal, but county funds allow all residents to access CWRT), and behavioral health as a hub for enhanced care management. Delays in provider reimbursement from managed care plans were noted.
- BH Connect (IMD waiver): Opt-in decision expected soon; would allow federal funding for facilities >16 beds in exchange for new community-based services (ACT, FACT, first-episode psychosis, transitional rent, supported employment, peer support, etc.). Staff noted many services are already in place.
- SB 43: Expands grave disability definition to include severe substance use disorder. The county deferred to Jan 1, 2025; staff provided an update on criteria, due process, and early data from two counties that went live (few clients meeting SUD-only criteria, most are released after 72-hour hold). A final recommendation on implementation date will come in October/November.
- CARE Act (SB 1338): Slated for Dec 2024 implementation. Staff clarified it does not allow court-ordered treatment; it creates awareness of individuals not voluntarily seeking care. Courts are developing processes.
- Increased Bed Capacity: MHRC beds increased from 131 to 175; substance use residential beds expected to increase from 196 to 472 by 2025-26. BCHIP Round 3 ($23.5M for MHRC) is being restructured with a community partner; Round 4 ($21.8M for youth CSU/PHF) is on track; Round 5 includes partnership with Wellspace for 150 beds.
Key Outcomes
- No formal votes were taken; the retreat was informational.
- Staff will return to the board in October/November 2024 with a recommendation on whether to proceed with SB 43 implementation on January 1, 2025, or defer further.
- A board letter on BH Connect (IMD waiver) opt-in with cost-benefit analysis is expected in the coming months.
- The BCHIP Round 3 MHRC project will be brought to the board for approval in September or October 2024 to transition the grant to a community-based organization.
- The Behavioral Health Services Act (Prop 1) community planning process will begin once state guidance is released, likely in early 2025.
- The youth advisory board requested that supervisor offices help promote board vacancies and share social media content.
- Staff acknowledged ongoing efforts to improve CWRT marketing and collaborate with 911 dispatchers to divert calls to 988.
Meeting Transcript
We have a quorum so we can get started. Supervisor Desman. Thank you. I'll call this meeting to order. This is the August 15th special meeting of the Sacramento County Board of Supervisors. Would the clerk please call the role? Good morning. Can you hear me? Yes. Good morning. Supervisors Hume, Frost, Desmond, Kennedy. Here. And you have a quorum. Thank you. Okay. So this meeting is not being broadcast live, but it is being recorded and it will be published online for the public after the meeting is concluded. Let me spend this here. The Board of Supervisors fosters public engagement during the meeting and encourages public participation, civility, and use of courteous language. The board does not condone the use of profanity, vulgar language, gestures, or other inappropriate behavior, including personal attacks or threats directed towards any meeting participant. Seating is limited and available on a first come, first served basis. Each speaker will be given two minutes to make a public comment and are limited to making one comment per agenda or off agenda item. Please be mindful of the public comment procedures to avoid being. Can you hear okay? To make a comment, uh fill out a speaker request form and hand it to clerk staff. The chairperson will open public comments and uh for each agenda or off agenda item and direct the clerk to call the name for each speaker. When you hear your name, please come to the podium to make your comments. And I'm trying to scroll down. Sorry about that. You may also send written comments to board clerk at SACCounty.gov. Your comment will be routed to the board and filed in the record. If you need an accommodation pursuant to the Americans with Disabilities Act or for medical or other reasons, please see clerk staff or assistance, or you can contact us by phone or email at boardclerk at SACCounty.gov. Thank you in advance for your courtesy and understanding of the meeting procedures. Thank you very much. And now would everybody please uh take a big bite of food and join me in the Pledge of Allegiance. I pledge allegiance to the flag of the United States of America and to the Republic for which it stands. One nation under God, indivisible, with liberty and justice for all. Mr. Villanueva. Thank you, Chair Kennedy. Um, just a couple of quick uh comments and brief comments. I know uh the team has put together a fantastic um binder there for you, and we'll go into much more detail as it relates to the agenda. But just um I think this is an incredibly important uh topic that we sit and have a discussion about related to behavioral health services. And um, and as we touch on these things, some of the things that we'll be touching on is uh the continuum of care overview. We'll have our host, which is this is a fantastic uh facility from UC Davis Mine Institute provide us with a uh uh an introduction to their program. We'll talk about behavioral health special uh initiatives and then break for lunch, and then we'll have behavioral health new initiatives. And I think some of the things on that particular topic related to Prop 1 SB 43 and others will um hit on the key areas I know the board's very interested in. Um this is like I said before, this is an exciting topic to talk talk about, and I appreciate the board taking for the most part the entire day to have this discussion of behavioral health services. Um, in my and supervisor Kennedy, I were talking about in my tenure here at the county. I don't think we've ever spent this much time uh talking about uh this particular topic and going over it. And and hopefully we'll get to touch on many of the the acronym soups that the behavioral health staff use, whether that's fit or crack or CWRT or HERT or FIT or you know, and the list goes on and on, CSUs and a whole bunch of other things that they actually touch on.
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