San Bernardino County in fiscal year 2014-15 spent an average of $135,650 on each of 31 psychiatric patients, a total of $4,205,150. That care for adults and children with psychiatric disabilities included lodging in a hospital setting. The county is on track in the current fiscal year running from July 1, 2015 through this coming June 30, to spend yet more.
This week the county board of supervisors acceded to a recommendation from the director of the San Bernardino County Department of Behavioral Health, CaSonya Thomas, that it approve a $9,155,629 retroactive memorandum of understanding with the California Department of State Hospitals for hospital beds and inpatient health care and support services provided to adults and children with psychiatric disabilities, for the period of July 1, 2014 through June 30, 2016.
Thomas asked the board to provide her department with the authority to use so-called Realignment funds to cover the cost of the memorandum of understanding – essentially a contract – with the state to pay for the $9.1 million-plus worth of psychiatric care some two to three dozen county residents are getting at state-run or state-licensed facilities. Realignment funds consist of what was originally state money freed up by the state of California for return to its 58 counties through reducing the state prison population of roughly 156,000 inmates consisting mainly of men (93%), Latinos and African Americans (roughly 67%) and 60 percent-drawn from Los Angeles County to no more than 137.5% of its 85,000-inmate design capacity. This realignment is effectuated by shifting much of that population to county jails and through releases of non-violent offenders. Realignment was intended to free up money to meet a court-order to provide more funding for medical and mental health care for the state’s prison and general population.
According to Thomas, “The California Welfare and Institutions Code Sections 4330 through 4335 require the California Department of State Hospitals and the county to maintain an agreement for the utilization and reimbursement of state hospital beds. The memorandum of understanding with the California Department of State Hospitals will allow the behavioral health department to meet this requirement and reimburse the California Department of State Hospitals for psychiatric inpatient hospital beds and inpatient health care and support services to adults and children with psychiatric disabilities for 2014-15 and 2015-16. Approximately 31 unduplicated patients were served during 2014-15 at an annual average cost of $135,650 per client. Each patient’s length of stay varies and is dictated by the severity of the patient’s mental illness. The increase in the amount for reimbursement for 2015-16 is due to the inclusion of Superior Court referrals, an increase of clients needing this level of care and the higher overall acuity of the clients in state hospital beds requiring longer stays.”
The behavioral health department is responsible for providing mental health and substance use disorder services to county residents who are experiencing major mental illness and/or substance use disorders. A basic part of the service delivery system consists of providing psychiatric inpatient state hospital services to the seriously and persistently mentally ill population. The behavioral health department provides care that consists of county operated clinics and contracted service providers delivering a variety of mental health treatment services within each geographic region of the county. The state hospital psychiatric unit allows the behavioral health department to accommodate seriously and persistently mentally ill patients at an appropriate level of care in a psychiatric inpatient state hospital setting.
The highest level of care is the state hospital psychiatric unit; the next highest level of treatment is provided through the Institute of Mental Disease.
Patients in need of a lower level of care are placed in board and care facilities. Programs at each facility depend on the patient’s level of care, specific patient needs, and condition under which the patient is admitted. State hospitals provide services to patients who are committed pursuant to sections of the Penal Code and Welfare and Institutions Code or who are found to be incompetent to stand trial.
County residents in need of state hospital level of services are primarily admitted to Metropolitan State Hospital (Metro) in Norwalk and Patton State Hospital (Patton) in San Bernardino. Metro, a skilled nursing facility, specializes in acute care (severe symptoms that last for a short period of time), sub-acute care (recent onset, somewhat rapid symptoms lasting less than 3 months), and psychiatric rehabilitation. Patton provides state-of-the-art sub-acute mental health care and treatment to forensic and civilly committed patients in need of a structured, secure environment.
On June 24, 2014 the board of supervisors approved the prior memorandum of understanding with the California Department of State Hospitals for the period of July 1, 2013 through June 30, 2014. Annually, the behavioral health department notifies California Department of State Hospitals of the number of state hospital beds anticipated to be used by the county in the upcoming year.
Historically, there is a delay by the California Department of State Hospitals in sending a new memorandum of understanding due to the negotiations with counties pertaining to the bed rates and budget schedules.
During the negotiation period, the prior memorandum continued to serve as the county’s bed agreement. The behavioral health department received the memorandum of understanding from the California Department of State Hospitals for the period of July 1, 2014 through June 30, 2016 on October 26, 2015.
The behavioral health department fiscal and program staff worked with the California Department of State Hospitals to verify the bed rates and budget schedules for the county.
The board of supervisors this week approved Thomas’s request for the $9,155,629 retroactive memorandum of understanding with the California Department of State Hospitals for hospital beds and inpatient health care and support services.