Tehama County approves $3.6 million Crestwood contract amendment for inpatient mental-health placements

The Tehama County Board of Supervisors on April 28 authorized amendment No. 1 to Agreement 2025-150 with Crestwood Behavioral Health Inc., updating facility rate exhibits and setting a maximum contract amount not to exceed $3,600,000, effective July 1, 2025, through June 30, 2028.

Jamie Botke, Health Services Agency, told the board the county currently has 10 clients placed across five Crestwood facilities and that state-level changes in designation of institutes of mental disease (IMDs) prompted fee-schedule updates. Botke said the funds are non‑general‑fund and are paid from mental-health realignment and Mental Health Services Act dollars. "These are multi‑year placements and we update the fee schedule as the state designations change," Botke said.

Supervisor questions focused on cost and procurement. One supervisor noted that some placements can cost "$7,000 to $8,000 a month" per client and asked whether the county had solicited competitive bids. Botke said the county maintains a set of contracts for similar placements statewide and works regularly with the public guardian's office to place clients close to home when possible. "We are constantly looking at what is the best fit for the clients," Botke said.

Becky Emery, Social Services Director and interim public guardian, said placements are recommended by treating physicians and approved by courts when required, and staff conduct ongoing reviews and site visits. "Crestwood has different levels of care, which provides continuity as clients step down through levels of treatment," Emery said.

Members of the public raised worries about the county's handling of public‑guardian services and the size of the expenditure. Caller Louise Wilkinson said the county should be "very, very careful" with these funds given recent administrative changes and urged reinstatement or certification of a public guardian. Another caller questioned whether the county had a credentialed public guardian and said recent changes had costs and oversight implications.

The board voted to approve the amendment; the item carried unanimously. Staff said they will continue to pursue local placement options when feasible and to coordinate with the public guardian and clinical staff to step clients to the least‑restrictive appropriate setting.

Next steps: the executive director is authorized to sign amendment No. 1 and staff will continue contract oversight and placement reviews. The board was told the county will keep searching for in‑county service options when grants or opportunities arise.