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Behavioral Health readies for Prop 1 overhaul and expands services for youth in custody
Summary
Fresno County Behavioral Health Director Susan Holt presented a $520.1 million appropriations plan and described preparations for state changes to the Mental Health Services Act (now BHSA), a March 2026 integrated plan deadline and an added clinical position to support youth at the juvenile justice campus.
Fresno County Department of Behavioral Health told the Board of Supervisors it is preparing for statewide changes to the Mental Health Services Act and will seek to manage workforce constraints while expanding clinical support for youth in custody.
Director Susan Holt presented recommended appropriations of $520,144,143 and revenues of $519,534,735; she noted the county's net county cost contribution for behavioral health remains about $609,408 "and has been flat for 10 years." Holt said the state's passage of Proposition 1 will convert the Mental Health Services Act into a broader Behavioral Health Services Act (BHSA) with new rules, data reporting and stakeholder engagement requirements that take effect July 1 and require preparation in the current fiscal year.
Holt said the county must produce an integrated plan for BHSA that the county administrative office will sign off on in March 2026 and bring to the board by June for approval. She also said the department is adding one clinical position to embed with Probation and provide services to older youth who remain in custody longer as a result of juvenile justice reform; that position will be funded from department revenues and coordinated with Probation.
Workforce pressures are acute across the behavioral health sector, Holt said, and the state will take 3% of BHSA dollars for workforce initiatives even as local managers seek to recruit and retain licensed clinicians. Holt said fee‑for‑service payment reforms have increased delivered Medi‑Cal claimable services by 10% in 2024'25 and that the department has expanded access to medication‑assisted treatment for opioid use disorder.
Ending: Holt said the department will return to the board as BHSA implementation details are finalized and as the department identifies any midyear changes needed to preserve priority services under the new state rules.
