Cost and continued complexity were no hindrance to the county Board of Supervisors Tuesday as they unanimously approved an ambitious plan to remake the region’s mental health system with an emphasis on keeping residents out of jails and emergency departments.

Though more votes will be necessary to complete the county’s vision, the board’s actions were significant votes of confidence in the path chosen during more than a year of research by a broad-based coalition of government experts, private health providers and interested advocates.

Taken together, the budget impact of the decisions made Tuesday will be $6.7 million during the current fiscal year with a $15 million annual operational cost starting to appear in the county budget during the 2020-2021 budget year.

That cash will help establish and operate a new psychiatric crisis-stabilization center at the county’s Live Well Center in Oceanside, start planning for two new mental health service hub complexes in San Diego and Escondido and provide $3 million to purchase psychiatric care for seniors at the newly-completed geriatric psychiatric unit at Alvarado Hospital Medical Center in La Mesa.


The board also approved soliciting bids for a two-acre, county-owned property at Fig Street and Valley Parkway in Escondido. Formerly home to the county’s Family Resource Center, the property, which already houses a 14-bed residential treatment center, has been otherwise vacant for several years but would be upgraded to provide a much broader range of mental health services in collaboration with Palomar Health.

Kristin Gaspar, whose district includes the property, said she believed that using it, and another county property on Third Avenue in San Diego, will put services closer to where they’re needed.

“It will allow us to provide better care to the people who need it the most — the patients,” Gaspar said.

These investments come in addition to millions already earmarked to help build a new 16-bed psychiatric unit at Tri-City Medical Center in Oceanside and to help pay for more mental health staffing at Palomar Medical Center, which saw significant increases in emergency department wait times after Tri-City shuttered its mental health units in 2018.


Palomar officials reported to the board Tuesday that the additional county investment, which helped bring in more mental health specialists, has already helped reduce wait times by about 8 hours.

But Tuesday’s vote was just a first step.

The county will need to identify much more funding in order to execute the grandest parts of its plans, which call for a total of four mental health “hubs, with the first two on Third Avenue and at the current site of Palomar Medical Center Escondido expected to cost more than $100 million.

There are also plans to offer hospitals and other health providers with mental health units enhanced Medi-Cal reimbursement rates in exchange for results that intercept mental health problems early and prevent jail time or emergency department admissions. This work will require additional contracting for “upstream” mental health services that would be broadly distributed in the community and guided by a league of counselors who would develop long-term relationships with clients, guiding them to the right services and checking in regularly to make sure they’re staying on track.


It’s a vision, said Karen Lenyoun, the mother of a son recently discharged from a hospital after what she said was a 78-day mental health stay, that has been a long time coming. For so many years, she said, she watched her son bounce from appointment to appointment, always in response to severe behavior that might have been prevented, had the system been more coordinated from the outset.

“His story is one of recurring program-centered treatment rather than person-centered help,” she said. “With this new proposal before you today, I hope that the account I have just outlined is a picture of the way we were.”

Kids are not left out of the county’s broad plans.

Officials touched on a new school safety plan, still in development, that would dedicate special mental health workers to participate in new psychiatric emergency teams designed to respond to mental health emergencies in schools. San Diego Unified alone, one county official said, had 427 instances during the 2018-2019 school year where a student had to be removed from school because they were believed to be a potential danger to themselves or others.


Capt. Joseph Florentino of the district’s police force told board members that the new plan under development would take all steps possible to be gentler with these situations, making sure officers wear plain clothes, drive regular cars and, whenever possible, make sure that clinicians, not officers, help kids exit school without handcuffs involved.

“One of the most difficult things, when you’re a police officer, is when you’re trying to make sure that a child is treated like a patient and not like a criminal,” Florentino said. “Nothing breaks your heart more than seeing a 7 year old being pulled out of an elementary school and put in the back of a police care because we have no other transport options.”

The program, which is under development with the county and with the county district attorney’s office, is also taking steps to make sure that kids who are removed for mental health help are given a gentler reintroduction to school. District Attorney Summer Stephan highlighted a new “handle with care” app that allows law enforcement to notify individual school administrators when a student has experienced a traumatic event at home that make smake them more likely to act out in class.

“They just send this message to the school saying ‘handle with care’ so when the child shows up in school and is acting out and defiant because they just saw their dad hauled away because they just beat their mom, they’re able to handle them with care and not have an unnecessary suspension that ends them in truancy and down the criminal path,” Stephan said.


A new partnership with Rady Children’s Hospital for additional crisis stabilization services is also planned.