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Health and Human Services Agency (HHSA) with El Dorado County Sheriff’s Office concurrence recommending the Board:
1) Approve and authorize the HHSA Director and Sheriff to sign Memorandum of Understanding (MOU) 8008 for Psychiatric Emergency Response Team services, in the amount of $540,000 and for the retroactive term of three years from July 1, 2023 through June 30, 2026, to ensure continuity of services as the prior MOU expired June 30, 2023, with the option to extend the term of the MOU for one additional year for a term to not exceed June 30, 2027, for a total maximum obligation of $720,000;
2) Authorize the HHSA Director and Sheriff to execute amendments relating to MOU 8008, contingent upon approval by County Counsel and Risk Management, which do not increase Net County Cost; and
3) Authorize the HHSA Director, or the Chief Assistant Director of HHSA, to execute programmatic, administrative, and fiscal documents relating to MOU 8008.
FUNDING: 100% State funded Mental Health Services Act.
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DISCUSSION / BACKGROUND:
In 2004, California voters passed Proposition 63, the Mental Health Services Act (MHSA). MHSA imposes a one percent tax on personal income in excess of $1,000,000. The funds from the tax are distributed to California counties and are intended to transform the Mental Health System into one that is consumer and family driven, recovery-oriented, accessible, culturally competent, and a system that offers services appropriate for the population that is being served. MHSA requires counties to prepare a three-year program and expenditure plan, known as the MHSA Three-Year Program and Expenditure Plan. The MHSA plan has five components intended to address specific goals for priority populations and other key community mental health needs, which are: Community Services and Supports (CSS), Prevention and Early Intervention (PEI), Innovation (INN), Workforce Education and Training (WET), and Capital Facilities and Technology Needs (CFTN).
On June 20, 2023, the County’s MHSA Three-Year Program and Expenditure Plan for Fiscal Year (FY) 2023-24 through FY 2025-26 was adopted by the Board (File ID: 23-0933). As mandated by 2018 PEI regulations through Senate Bill 1004 (2018), counties are required to have a specific project that addresses access and linkage to mental health treatment to prevent a mental illness from becoming severe and disabling. Accordingly, the PERT project, a component of the PEI Community-Based Outreach and Linkage program, was budgeted in the adopted MHSA plan.
The PERT project is a collaboration between EDSO and HHSA Behavioral Health Division, in which Mental Health Clinicians are partnered with a Crisis Intervention Trained Deputy to provide direct mobile crisis response services to El Dorado County residents who may be undergoing a mental health crisis. MHSA funds HHSA Behavioral Health Clinician(s) and one full-time Sheriff Deputy position to jointly provide services under the PERT project.
The anticipated outcomes of the PERT project are to:
1) Raise awareness about mental health issues and community services available countywide;
2) Improve community health and wellness as a result of community-based PERT services; and
3) Increase community-based access to and linkage with medically necessary care and treatment to community members.
Through PERT, Crisis Intervention-trained Deputy Sheriffs, along with Mental Health Clinicians, jointly respond to law enforcement situations when a perceived mental health crisis is occurring. PERT members carefully evaluate each crisis situation, assess the mental health status of each individual, and provide individualized interventions in the field, which may include, but are not limited to: safety planning; referral to community-based resources; and crisis intervention. The PERT also provides follow-up services to individuals in need of PERT crisis intervention to provide stabilization and linkage to services.
This proposed MOU 8008 is a renewal of MOU 4888, fully executed July 9, 2020, by the HHSA Director and EDSO Sheriff, for the term of July 1, 2020, through June 30, 2023, for the provision of PERT services. MOU 8008, to be effective for the retroactive date of July 1, 2023, will ensure continuation of necessary PERT services without any service interruption.
Department of Health Care Services (DHCS) Behavioral Health Information Notice (BHIN) #22-064 (superseded by BHIN #23-025) was provided to counties on December 19, 2022, which mandates that counties provide for 24 hours per day, 7 days per week mobile crisis response by December 31, 2023. Following this Information Notice, DHCS has been providing Counties technical guidance and additional regulatory standards for the development of mandated mobile crisis services, of which the existing PERT Project would necessarily be a part. This required a re-evaluation of how to proceed with the integration of existing Monday-Thursday PERT services into an expanded 24 hour a day, 7 day per week model as the June 30, 2023, expiration of MOU 4888 approached. Given the many changing regulatory requirements initiated around the mobile crisis system development, and the lack of clarity regarding what implications these changes would have for the PERT Project, staff were unable to incorporate the required elements before July 1, 2023. Through the first quarter of Fiscal Year 2023-24, there were still discussions occurring for how the mandated Mobile Crisis services will be administered and how that would impact PERT. It was recognized that PERT services are intrinsically valuable to the community and will continue in alignment with the FY 2023-24-2025-26 MHSA Three-Year Plan and that an MOU to continue services, as is, was necessary without a break in services provided.
HHSA, with EDSO concurrence, recommends the Board approve of this MOU and its retroactive start date to ensure the continuity of the PERT services, until an expanded mobile crisis response MOU is in place.
ALTERNATIVES:
Should the Board decline to approve this recommendation, EDSO will continue to respond to mental health crisis situations without Behavioral Health Clinician support. However, the County Behavioral Health Division may be out of compliance with the DHCS mandate that county behavioral health jurisdictions provide 24-hours per day, seven days per week mobile crisis response by December 31, 2023.
PRIOR BOARD ACTION:
06/20/23, 23-0933, HHSA Adoption of FY 2023-24 - FY 2025-26 MHSA 3-Year Program and Expenditure Plan
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Approved by County Counsel, Sheriff’s Office, and Risk Management.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no General Fund cost associated with this Agenda item. MHSA funds offset costs in the Sheriff’s Office that may otherwise be funded through the General Fund. Sufficient appropriations were included in the fiscal year 2023-24 Budget and will be included in future budgets for the term of the MOU.
CLERK OF THE BOARD FOLLOW UP ACTIONS
N/A
STRATEGIC PLAN COMPONENT:
Healthy Communities
CONTACT
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency