SANTA CRUZ – The Santa Cruz County Board of Supervisors at a meeting Tuesday unanimously approved plans for funding more robust mental health services in the county.
Improvements include the implementation of 24/7 mobile crisis response, a call center with dispatch directly to mobile crisis teams, dedicated crisis support for youth and the staffing of peer support specialists.
The changes come at the directive of Crisis Now, a national effort led by mental health experts that outlines a model for providing behavioral health services.
Key elements to the Crisis Now model include improving the quality of centers that provide immediate care during a mental health crisis, as well as having better mobile crisis teams and a more streamlined 988 call center.
Santa Cruz County currently operates a 988 crisis line that serves as the “entry point” for mental health services in the county, a report issued by the Crisis Now program said.
The calls are answered by the Suicide Prevention Service of the Central Coast, which is a regional call center dedicated to Santa Cruz, San Benito and Monterey counties. When calls are received, they are redirected to the appropriate resources based on the perceived level of risk and care needs.
988 is a national crisis and suicide prevention line that is intended to provide help to individuals experiencing mental health crisis across the country, and the regional call center servicing Santa Cruz County reported a 93% increase in incoming calls from 2021 to 2022.
Crisis Now evaluators identified multiple areas of improvement for the call center that would allow them to align with national best practices.
Among these are adding technology to allow for geo-location, outpatient appointments, direct referrals to available crisis beds and dispatching mobile crisis teams. These changes, the Crisis Now report said, would make 988 “a true crisis contact center hub.”
Currently, Santa Cruz County has two types of mobile crisis response teams. The first type includes the Mobile Emergency Response Team, or MERT, and the Mobile Emergency Response Team for Youth, or MERTY. They both operate Monday through Friday from 8 a.m. to 5 p.m. MERT and MERTY staff are comprised of clinical staff who have the authority to perform evaluations for involuntary detention of mentally disordered individuals.
The second type of team is mental health liaisons who work alongside law enforcement. Working through the Watsonville and Santa Cruz police departments and the county Sheriff’s Office, teams are available seven days a week from 8 a.m. to 6 p.m. and are reached through 911.
According to a memo by the Santa Cruz County Health Services Agency, 36% of all calls for service between the hours of 8 p.m. to 7 a.m. are mental health-related, revealing a “need to expand mobile crisis response outside of the Monday through Friday day shift hours.”
In a report, Crisis Now evaluators gave Santa Cruz County a score of two, or “basic,” on their five-point scale that assesses mobile crisis services because “their availability is limited and teams are not dispatched via the crisis call center.”
Despite the plans to expand the hours and reach of mobile crisis services and improve the quality of crisis care facilities, challenges with staffing in behavioral health positions present a big hurdle, according to the county and the Crisis Now report.
A report from the Santa Cruz County Civil Grand Jury titled “Diagnosing the Crisis in Behavioral Health: Underfunded, Understaffed and Overworked” found the Santa Cruz County Behavioral Health Division of the Health Services Agency was understaffed, with around a 30% staff vacancy rate. This includes management, clinicians and support staff.
This understaffing is the main cause of the lack of sufficient crisis care facility response, the county said in the Crisis Now report.
Santa Cruz County currently has one crisis stabilization unit, or CSU, that provides immediate care and connection to community services. It has 12 beds, with eight designated for adults, and served 106 individuals monthly on average, according to the Crisis Now report.
While the Santa Cruz County CSU resembles the type of crisis care included in Crisis Now’s national guidelines, “individuals in crisis are denied services on a daily basis,” reads the report. The facility is often on “Code Red,” meaning that they frequently do not accept new admissions due to staffing shortages and issues with recruitment and retention.
Some supervisors asked at Tuesday’s meeting whether the implementation of the Crisis Now plan is feasible considering the hiring crisis.
Santa Cruz County Health Services Agency director Monica Morales said that part of the Crisis Now plan includes hiring more people who do not have clinician credentials, or peer technicians, which may make hiring easier as well as reduce tensions that can come with dispatching law enforcement.
“What we’re not going to do is sugarcoat the situation. The data speaks for itself,” Morales said at the meeting. “What this model presents, though, is a vision of where we want to do and where we need to go.”
The board approved the Crisis Now implementation plan for a term of July 1, 2023 to June 30, 2026, with an option to extend through June 30, 2028 pending legislative direction. Projected expenses for the three-year plan are around $5 million.
Funding will come from the Mental Health Services Act, passed by voters in the state in 2004 to expand mental health services for Californians with funding from a 1 percent income tax on personal income of more than $1 million per year.
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