Report 2019-119 Recommendation 5 Responses

Report 2019-119: Lanterman-Petris-Short Act: California Has Not Ensured That Individuals With Serious Mental Illnesses Receive Adequate Ongoing Care (Release Date: July 2020)

Recommendation #5 To: Shasta County Health and Human Services Agency

To evaluate and address shortages in the capacity of its treatment facilities, Shasta should, by August 2021, conduct an assessment that determines the number and type of treatment beds that it needs to provide adequate care for individuals who require involuntary treatment. Once the county completes the assessment, it should adopt plans to develop the needed capacity.

1-Year Agency Response

Please see report

California State Auditor's Assessment of 1-Year Status: Fully Implemented

The agency's August 2021 Behavioral Health Bed Optimization Report includes an assessment of treatment bed needs and the plans for increasing treatment capacity. By providing this report, the agency demonstrated it has fully implemented our recommendation.

6-Month Agency Response

Between now (six-month review) and the 12-month review, Shasta will implement the areas described and outlined in the six-month report submitted here.

Summary Recommendations of Findings & Implementation Responsibilities:

1. Invest in additional Mental Health Rehabilitation Centers (MHRC) with life skills components to ensure bed capacity with fixed beds dedicated for use by the Shasta County's HHSA Behavioral Health program. Responsible for Implementation: HHSA Adult Services Transition, Admissions & Discharges (TAD), Public Guardian, Contracts departments and leadership

2. Complement all behavioral health bed investments with temporary supportive housing, permanent supportive housing or residential care facilities. Responsible for Implementation: HHSA Office of the Director, Economic Mobility Branch - Housing Department, Adult Services Contracts department, STAR program, leadership and system partners

3. Develop more capacity of subacute beds and services, residential treatment beds and services which provide longer-term care, including supportive housing units and services, and board and cares. Responsible for Implementation: HHSA Office of the Director, Adult Services Contracts department and leadership

4. Work to improve quality of care and client transitions across subacute and residential treatment beds and services. Responsible for Implementation: HHSA Adult Services Public Guardian, Mental Health and leadership

5. Support efforts to relax or eliminate the federal Medicaid SMI/SED IMD exclusion. Responsible for Implementation: HHSA Director, Adult Services Branch Director

6. Build out Pre-Hospital services - enhanced mobile crisis services, psychiatric ER (CSU), MH/SUD treatment options. Responsible for Implementation: HHSA Office of the Director, Adult Services Branch, crisis program, SUD program, leadership

California State Auditor's Assessment of 6-Month Status: Partially Implemented

Shasta provided an additional report of its treatment resources and needs. However, at this time the county's report does not specify the number or type of treatment beds that it needs. The county also has not set measurable goals for the actions it plans to take, as indicated in the response above. For example, the county plans to invest in additional mental health rehabilitation centers with dedicated beds to ensure capacity for county patients, but it is unclear how many beds the county needs to add. It will be difficult to assess the county's progress in this area if it does not quantify its needs.

60-Day Agency Response

1. Shasta County HHSA analysts Joseph Carpenter and Josette McKrola, Adult Services Clinical Division Chiefs Monteca Zumalt and Genell Restivo, Deputy Director Robin Bowman, Public Guardian Program Manager Amparo Buck and Director Paige Greene will work collaboratively to conduct an assessment to determine the number and type of treatment beds needed to provide adequate care to individuals receiving involuntary treatment by the six-month review date.

2. After assessment is complete, Adult Services contract Analysts Stewart Buettell and Patricia Pratt, Clinical Program Coordinator Mey Chao-Lee, Clinical Division Chiefs Monteca Zumalt and Genell Restivo, Deputy Director Robin Bowman, and Director Paige Greene will adopt plans to develop needed capacity.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2019-119

Agency responses received are posted verbatim.