Behavioral health director reports staffing gaps, costly hospitalizations and utilization trends

County behavioral health staff provided a director's report detailing personnel moves, recruitment efforts, funding pressures and utilization statistics.

Staff updates: The department has hired a full-time IT worker and is recruiting a part-time records specialist with some IT skills as a backup. The department is also interviewing for a part-time administrative assistant to support scheduling and relieve existing staff until a nurse (LVN or RN) can be hired; past hires for similar positions have not always worked out. The director said a certified peer support specialist position is being developed as a county job classification; staff hope to post and fill the position in early 2026. "I am working on the new job descriptions for the position of certified peer support specialist," the director told commissioners.

Cost and finance: Staff reported a recent client with repeated hospitalizations that have generated more than $100,000 in charges the county must pay because the clients are uninsured or Medi-Cal beneficiaries covered by county responsibility. Staff said these costs illustrate the need for realignment funds or a prudent reserve to cover high-cost, unbillable hospital stays.

Utilization and quality: Behavioral health quality staff reported September utilization numbers: about 230 open specialty mental health charts and 196 unduplicated clients served in that month (roughly an 85% open-client service rate). New intakes rose to 34 in September (up from 22 in August). Crisis contacts and mobile crisis documentation were low for the month; psychiatric placements and 5150 evaluations were reported in single-digit numbers for the period. Substance-use services reported improved penetration (89% for September) and increased new intakes.

Staff noted ongoing work on state-required materials (integrated member handbook templates, mobile crisis implementation addenda) and stakeholder outreach for MHSA planning. The state audit process was also active: the county had an entrance conference with the Department of Health Care Services and is preparing for an exit interview and a possible corrective action plan.

Commissioners asked clarifying questions about who is financially responsible for hospital bills and about youth service definitions (staff explained EPSDT rules extend some benefits up to age 21). No formal county budget decisions were made during the report; staff cautioned that some of the cost pressures would be raised with the Board of Supervisors as part of budget and realignment discussions.