San Diego County supervisors approve measures to expand behavioral health capacity, workforce and revise LPS guidelines

SAN DIEGO — The San Diego County Board of Supervisors on April 8 unanimously approved a package of actions to expand behavioral health services for Medi‑Cal beneficiaries, grow the local behavioral‑health workforce and adopt revised procedures for involuntary psychiatric holds under the Lanterman‑Petris‑Short (LPS) framework.

County behavioral health staff told the board they are pursuing multiple steps to increase capacity across the continuum, including negotiating to add up to 30 Medi‑Cal‑eligible psychiatric inpatient beds at Paradise Valley Hospital, issuing requests for statements of qualifications (SOQs) for partial hospitalization programs (PHP) and intensive outpatient programs (IOP) for adults, and seeking contracts to add chemical dependency recovery hospital (CDRH) beds. Staff also asked the board to adopt revised LPS designation guidelines and processes to align with recent state law changes.

The actions respond to a county planning model that estimated large increases in needed capacity across crisis diversion, subacute services and community‑based care. County staff described a multi‑year gap between current utilization and modeled “optimal” capacity and said the proposals are intended to reduce avoidable inpatient stays and improve care transitions.

Key elements approved or described by staff: - Negotiations with Paradise Valley Hospital to establish up to 30 additional psychiatric inpatient beds for Medi‑Cal‑eligible adults; discussions were described as underway. - Authorization to issue SOQs for adult PHP and IOP services (day treatment) to create Medi‑Cal‑accessible options for adults; county staff noted an existing children’s PHP/IOP launched last year and said adult PHP/IOP services are currently not available through county‑funded programs. - Authorization to pursue up to 22 new chemical dependency recovery hospital (CDRH) beds for Medi‑Cal‑eligible adults, if sites are identified and agreements reached. - Update on substance use treatment expansions, including an El Cajon clinic (Revive Pathway) that has 200 opioid treatment program (OTP) slots and is discussing adding another 50 slots. - Status of recuperative care and residential capacity: a competitive procurement approved in October 2024 for 49 recuperative care beds (16 county CERTs beds and 33 community beds expected operational by mid‑2025); ongoing renovations at the county CERTs site with anticipated completion activities into 2026; and related plans that staff said would add roughly 73 substance use residential treatment beds as part of broader efforts. - Work to increase licensed board‑and‑care capacity countywide; staff reported a roughly 97% increase in licensed board‑and‑care slots since 2022 to about 475 slots and described a central‑region community‑based care (CBC) project in Hillcrest that staff estimate could add about 10 board‑and‑care slots and more than 10 recuperative care beds. - Workforce initiatives: the board approved creation of the Elevate Behavioral Health Workforce Fund, a program the county described as including a pay‑it‑forward, 0% interest loan product, upskilling and apprenticeship supports, and a loan forgiveness component after five years of service in a county‑funded behavioral health program. Staff said informational sessions began in late March and the fund is anticipated to support about 2,800 people over five years. - Policy and compliance updates: staff described steps to align local policies and LPS facility designation processes with Senate Bill 43 (effective Jan. 1, 2025) and requested adoption of revised LPS designation guidelines.

Public comment during the item included about 14 requests to speak (six in person and eight by phone) and two emailed comments on file; speakers included residents who expressed both support for expanded services and sharp criticism of aspects of county approaches, raising concerns about involuntary treatment, medication practices, privatized facilities and oversight. Several supervisors and county officials also recognized departing staff and thanked Behavioral Health Services personnel for the work to implement the board’s January directions.

Supervisor Montgomery Stepp moved the staff recommendations; Supervisor Anderson seconded the motion. The board adopted the recommendations unanimously, with Vice Chair Lawson Reimer announcing the motion passed with all supervisors present voting aye.

Staff indicated they would proceed with the authorized SOQs and contract steps and are continuing negotiations and planning work described to the board. Several items described by staff — including renovations to CERTs and new CBC development — will require future project‑level planning, contracting and, in some cases, construction timetables before services become operational.