Special Economic Development and Intergovernmental Relations Committee Meeting - September 27, 2023: Behavioral Health Capacity
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Special Economic Development and Intergovernmental Relations Committee Meeting - September 27, 2023: Behavioral Health Capacity
The special meeting of the Economic Development and Intergovernmental Relations Committee convened on September 27, 2023, to address the insufficient capacity of behavioral health beds in the San Diego region. The committee received updates from the County of San Diego Behavioral Health Services Department, the Hospital Association of San Diego and Imperial Counties, and the San Diego Police and Fire Departments. Public testimony highlighted personal experiences, the need for prevention and housing, and concerns about the current crisis response system. The meeting was informational, with no votes taken on the agenda items.
Consent Calendar
- The committee unanimously approved the committee actions from September 3, 2023, with a motion from Council President Pro Tem and a second from Councilmember Campbell.
Public Comments & Testimony
- Joyce Sanyata (Resident, District 3) expressed support for the county's continuum of care approach and emphasized the need for collaboration and better crisis response for homeless individuals.
- Dan Schmikowski urged redevelopment of the Midway area to include a larger mental health facility and referenced societal normalization of deviant behavior.
- Sandy Miskowski (Lived Experience Advisors) asked for public education to use Mobile Crisis Response Teams (MCRT) instead of 911, and highlighted the link between chronic lack of sleep and mental health symptoms in homeless populations.
- Blair Beekman encouraged the city to learn from Santa Clara County’s progressive approaches and focus on counseling services and trust-building.
- John Brady (Lived Experience Advisors) called for the police to implement a disability registration system to improve interactions, and stressed that housing is the ultimate solution.
- Levi Giaflioni (Lived Experience Advisors) noted the need for infrastructure (shovels in the ground) and more residential facilities, and criticized the lack of compassion.
- Kathleen Lippitt thanked Dr. Bergman and supported the shift from crisis to prevention, calling it cost-effective.
- Judy Strang (Coastal Parent Association) asked for a bifurcation of facilities for those with and without housing, and requested staffing details for facilities.
- Jordan Latchford (Downtown San Diego Partnership) emphasized the need for behavioral health teams downtown and broader training for unhoused care teams.
- The Original (caller) expressed distrust, alleging that mental health designations are used to control people, and criticized the city for not addressing root causes.
- Dr. Christian Wallace (Grossmont Healthcare District) thanked the committee and noted the impact of lack of discharge options on emergency department throughput.
- Becky Rapp called for stronger drug prevention policies, citing personal experiences with marijuana leading to psychosis and suicide.
Discussion Items
Item 1: Update from County of San Diego Behavioral Health Services Department
- Dr. Luke Bergman, Director of Behavioral Health Services, presented the county's strategy to shift from a crisis-oriented system to a continuum of care, focusing on crisis diversion, subacute services, and community-based care. He highlighted that about two-thirds of the 60 beds at the county psych hospital are occupied by long-term patients awaiting step-down care. The county aims to convert that hospital to subacute care and develop a board and care campus on Third Avenue with up to 100 units. The "Optimal Care Pathways" model estimates needed increases: 359% in community crisis diversion bed days, 142% in community-based care (board and care), and 64% in subacute services. For the CARE Act (starting October 1, 2023), the county estimates needing 130 additional ARF/RCFE slots, 180 permanent supportive housing slots, and other settings. The county received $16.6 million for community care expansion and $44.3 million for behavioral health bridge housing. Councilmember Campillo questioned the adequacy of bed projections given a 19% loss of ARF beds since 2017 (about 3,850 beds lost) versus the county's addition of 170 beds. Dr. Bergman explained the CARE Act estimates are for a narrow cohort and that the county needs to build larger facilities and attract new operators. Councilmember Campbell (a physician) praised the approach and asked about stabilization timelines; Dr. Bergman noted psychosis can stabilize in hours to days with medication. Council President Pro Tem Montgomery Steppe asked about workforce incentives; Dr. Bergman mentioned a $75 million workforce initiative including potential help with home ownership. He also noted the need to address NIMBYism and view behavioral health facilities as community assets. Councilmember Lee asked about collaboration with municipalities; Dr. Bergman stressed the importance of shifting perception of behavioral health infrastructure from liabilities to assets. Dr. Bergman also noted that housing costs impact board and care operators' decisions to leave the business.
Item 2: Update from Hospital Association of San Diego and Imperial Counties
- Karen Sumek (VP) presented data showing that over the past five years, about one-third of inpatient psychiatric bed days are "admin" or non-billable days, meaning patients are medically ready for discharge but awaiting placement. Acute days are decreasing while admin days are increasing. Christina Paul (Sharp Healthcare) and Jerry Gold (Scripps Health) provided examples: at Scripps Mercy, one-third of 36 inpatient beds are occupied by patients waiting for long-term care placement; average length of stay increased from 8.4 days (2018) to 15 days; ED wait times for inpatient beds doubled from 24 to 48 hours. Some patients stay over 800 days. They noted disparities: Medi-Cal patients have double the readmission rate of commercially insured patients due to limited post-acute options (e.g., no reimbursement for intensive outpatient programs for Medi-Cal). They estimated that eliminating admin days could free up 50 inpatient beds per day, and 50-70 patients daily wait in EDs for admission. They called for support to increase step-down resources. Councilmember Campillo asked about shared health information systems; Ms. Sumek noted San Diego Health Connect exists but is not fully functional and not all providers participate. She advocated for more data transparency and inclusion of prevalence data. Councilmember Campbell asked about advocacy; Ms. Sumek said the county has not opted to cover partial hospitalization and intensive outpatient services under Medi-Cal, while Alameda and Contra Costa counties have. She also noted that county case managers often take 7-14 days to connect with discharged patients.
Item 3: Update from SDPD Neighborhood Policing Division and San Diego Fire Department
- Deputy Fire Chief Jody Pierce and Dr. Aaron Meyer (Psychiatrist) presented on the impact on first responders. In FY23, SDPD responded to 15,000 mental health calls, spending 65,000 hours (cost: $9.7 million). 0.03% of callers (28 people) accounted for 2% of call volume. Fire Department paramedics are often primary behavioral health providers. Lieutenant Michael Sturck reported that MCRT handled 1,200 calls in SDPD jurisdiction in FY23. He noted that withdrawal management beds dropped from 108 to 27 currently. He proposed a single facility for psychosis, substance use, and simple possession to reduce hospital and law enforcement burden. He also discussed the Serial Inebriate Program (SIP), which was successful but less effective post-COVID. The expansion of grave disability under SB 43 may increase demands on police. Councilmember Campbell asked about training; Dr. Meyer explained that first responders are trained in mental status exams to recognize behavioral manifestations of psychosis. Councilmember Lee emphasized the need to shift from crisis response to prevention and noted the city's EMS system realignment may create opportunities for alternate response. Vice Chair Montgomery Steppe thanked first responders and apologized for the meeting's abrupt end.
Key Outcomes
- All three items were informational only; no motions or votes were taken.
- The committee postponed Item 4 (unidentified) to a future meeting due to time constraints.
- The meeting was adjourned to the next regular meeting on October 4, 2023 at 2 p.m.
Meeting Transcript
Good afternoon, everyone, and welcome to the special economic development and intergovernmental relations committee meeting of September twenty-seventh, twenty twenty-three. I've convened the special meeting of the economic and development and intergovernmental relations committee today to discuss the insufficient capacity of behavioral health beds within the San Diego region. Members of the public who wish to provide virtual testimony, mess enter the virtual queue by raising their hand before the virtual queue closes. The queue will close when the last virtual speaker finishes speaking or five minutes after in-person testimony ends, whichever occurs first. This will allow for better meeting management between the two platforms and ensure the committee is able to manage and conduct city business. We appreciate the public's cooperation. Chair Campio. Thank you. I will now call this meeting, special meeting of the economic development and intergovernmental relations committee meeting of September 27, 2023 to order and call the role. Vice Chair Montgomery Step. Here. Council Member Campbell. Here. Councilmember Lee. Yep. I'm also present also in Chambers as Nikki Bennett, associate and fiscal policy analyst from the Office of the IBA, Deputy City Attorney Kate Malcolm from the Office of the City Attorney, and Stephen Hill, Senior Policy Advisor from the Office of the Mayor. Sarah, please continue with public comment instructions. Thank you, Chair. If you are in person, please complete a speaker slip located at the entrance of chambers and place it in the box indicated at the speaker's lecture and at the front of the room. Please do so in a timely manner to ensure proper meeting management in-person testimony. We'll conclude before virtual testimony begins. Members of the public can join the webinar by computer, tablet, or smartphone by accessing the link which is listed online in the preamble language of the agenda on the city's webpage. To join the Zoom webinar by telephone, please call 1669-2545252. And when prompted, input webinar ID 160381-2925 pound. This information is also available on the agenda and will appear on the screen during the public comment period for each agenda item. Please note that if you're watching via City TV Channel 24 or online, there may be a delay. Please participate via the audio on your phone and mute your TV or computer when it's your turn to speak. If you wish to speak to a particular item, please wait for that item to be called and then raise your hand by tapping the raise your hand icon if you are a call and participant or by pressing star nine on your cell phone and landline. If you raise your hand during a non-comment period, your hand will be lowered. Chair. Thank you, Sarah, for reviewing those instructions for the benefit of the public. At quorum being present, we will now dispense with the approval of committee actions from September 3rd, 2023. Sarah, please proceed. Thank you, Chair. We've received no speaker slips here in chambers and I see no hands in the virtual queue. So that will conclude public testimony on the past committee actions. Thank you. We will now seek a motion and a second and vote on approval of the committee actions. Do I have a motion? Have a motion from the Council President Pro Tem and a second from Councilmember Campbell. We'll now call the roll. Vice Chair Montgomery Step. Yes. Councilmember Campbell. Yes. Councilmember Lee. Yes. And I also vote yes. That passes unanimously with all members present. We'll now move to committee members, mayoral staff, city attorney, and IBA comments.
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