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San Diego's mental health crisis

 April 21, 2023 at 12:00 PM PDT

S1: It's time for roundtable. I'm Matt Hoffman. This week , we're taking a look into a new in-depth Union-Tribune investigation into San Diego's mental health care crisis. What they found coming up next.

S2: At every single turn , something was going on and you could see just how overwhelmed the system is everywhere.

S1: We're talking with two journalists from the project and we hear from the head of San Diego County's behavioral health services on how they're trying to address the growing need.

S3: There is need currently in our society for mental health care.

S1: Roundtable is coming up next. 72 hours. That's the amount of time a person can be held by mental health officials or law enforcement if they're found to be a danger to themselves or others or are severely disabled. It's also the title of a nearly two year long reporting project from the San Diego Union-Tribune , 72 Hours Inside San Diego County's Mental Health Crisis. It tells a sweeping three day narrative into the heart of the behavioral health treatment in San Diego. And it reveals a mental health care system that's overwhelmed and undermanned at multiple levels. This week on Roundtable , we have two of the journalists behind this project. Blake Nelson is the East County reporter with the San Diego Union Tribune. And Dana Littlefield is also here. She's an editor with the UT who helped lead this investigation. I want to welcome you both here to roundtable. And we just want to mention , if you're experiencing a mental health or behavioral health emergency , the number to call for help and resources is nine , eight , eight. That's the suicide and crisis Lifeline. So , guys , this project , it's called 72 Hours. It involved nearly two dozen UT reporters heading out all across the county for three days last April. And it Dana , your team says they found San Diego's behavioral health system overwhelmed at every step.

S2: I worked in kind of a dual capacity in this project because , yes , I am an editor. I'm public safety editor. But also I stepped up to do a little bit of reporting for this project as well. So I was one of the people who sat in with dispatch. And I personally , you know , having covered law enforcement and courts for a very long time , I've seen a fair amount of things. But I was truly surprised to see the volume of mental health related calls that came in just to San Diego PD over those three days. And we could see it in the streets. The reporters saw it in the streets where , you know , there were people who appeared to be , you know , we're not clinicians , but people who appeared to be in crisis. There were people who tried to respond , law enforcement usually first , but then there was quite a bit of waiting that had to be done while those law enforcement officers maybe figured out , you know , how to handle this particular person , should that person be taken in on a 72 hour hold ? There were , you know , many instances of clinical settings where beds were not available and , you know , instances where , oh , there might be a bed. Oh , but no , there isn't. You know , that kind of glimmer of hope that that went away just at every single turn. Something was going on. And you could see without , you know , having to furrow your brow and thinking about and think about it too long , you know , just how overwhelmed the system is everywhere.

S1: And , Blake , I know you were on the ground.

S4: So there is sort of a step by step process of the places you're supposed to go when you are in a crisis. And at every single step , there were not enough people , not enough resources , not enough beds. So , you know , you May 1st go to if you're having a mental health breakdown , you May 1st go to a crisis stabilization center. We were repeatedly seeing people stuck in those centers beyond a 24 hour limit set by the state because there were no hospital beds available. We were seeing dozens and dozens of people stuck in the ERs , including children who had expressed suicidal thoughts , stuck at Rady Children's. Once you got into hospitals , we were either seeing few empty beds or even when there were empty beds , there weren't enough staff to monitor the patients and so they just still couldn't take anyone. Then to make things even worse , even when you're ready to get out of the hospital. The county has lost so many residential care facilities that sometimes you can get stuck in the hospital. We found one patient who had been in Sharp Mesa Vista for 242 days. Scripps had had a patient for 530 days. A patient at the county psychiatric hospital had hit 711 days. So it is just backlog after backlog after backlog.

S1: And can one of you sort of break down how San Diegans in crisis are cared for when it comes to emergency psychiatric needs ? I mean , you guys sort of hit on this a little bit , but it sounds like first responders and law enforcement are typically sort of on the front lines here.

S2: Usually what you see right away when somebody is in crisis is , you know , the 911 calls coming in or the person , him or herself or a loved one calling a police department , sheriff's department , some other law enforcement agency to say , hey , we need help here. What I was able to see is , you know , when the calls came in , a lot of those calls , as we just mentioned , had to hold because you might have a law enforcement who's there. They recognize that we might need to call in a team , a psychiatric emergency response team to respond. And that would be a team that would include both , you know , law enforcement as well as mental health clinicians who could , you know , evaluate and deal with the situation at hand. But there aren't enough of those. So a lot of time you had waiting and waiting and waiting and waiting for that. And then once determination was made to perhaps put this person on a 72 hour hold , then you've got the person now in transit to the psychiatric hospital , you know , county mental health. And then there's a whole process there for the person to actually be admitted if there is indeed room for that person to be admitted.

S1: And , you know , during your guys's three day reporting project last April , you found that law enforcement countywide received nearly 250 calls relating to mental health , and the majority of those calls were 5150. It was mentioned a lot in your guys's stories.

S2: That is the 72 hour hold. So under state law , that is the amount of time that a person can be held involuntarily. If , as you mentioned earlier , Matt , you know , if that person has been deemed a danger to him or herself , if that person is severely disabled , I feel like I'm forgetting a component.

S4: Blake threat to themselves , threat to others or gravely disabled.

S2: But to others , yes. So so that is a tool that can be used by law enforcement. But , you know , it's not a fix. That's for someone who needs help immediately right now. And it is for a lot of people , a pretty traumatic experience. You know , when your liberty is taken away from you , you're , you know , put into a clinical setting. You don't want to be there. You are in the throes of crisis. The goal is to get the person stabilized right away and , of course , reduce the threat to themselves and to other people. But , you know , this can be a very , very traumatic , disturbing , unpleasant time for the person who's going through that as well as , you know , if that person has family members who are available and or witnessing , it's hard for them to it's a pretty big strain. So it might be the kind of thing where it is necessary , but it comes with its own set of problems as well.


S4: You know , there was one officer I talked to who placed a 5150 on a guy at the airport. And it was it was very , very calm. This guy had sort of come to the realization of I am tired of being homeless. I am thinking about hurting myself. I need help. And it was so when they brought him to the county psychiatric hospital , a lot of times you're handled. Cuffs would handcuffed even though you're not under arrest , which can sort of add to the trauma of this. And a lot of times they don't take off the handcuffs until you're medicated. But in this case , the guy was so calm , everyone was so calm , the handcuffs came off right away. You know , it looked like it was going in the right direction. There was another example. I talked to one of the doctors at a psychiatric hospital at Sharp Mesa Vista. It was a very contentious decision to place this woman in his office on a 5150. She was yelling and fighting. They had to bring in a whole team that was a very , very contentious stay that lasted much longer than three days. You can extend the hold if you get permission from a from a court official. But one of the things we noted in the epilogue to the story with that second anecdote is that woman , the doctor told me , called him months and months later and said , I'm very sorry. I'm really you know , I appreciate all that you did for me. I don't remember very much of what happened , but I really appreciate you helping me in in that tough , that tough moment. So there are there are some some bright spots here.

S1: You know , oftentimes when law enforcement responds to these types of mental health crises , they aim to do so with a team. Somebody mentioned it earlier , It's a psychiatric emergency response team. And it involves a clinician that's paired up with law enforcement. And reading your guys's 72 hour series , it seemed one of the most repetitive requests from dispatcher Police is a per team available ? Is a per team available ? And I know that I don't know if it was you , Blake , but you all followed one per team clinician.

S4: But a lot of times he's just going out and talking to people on the streets , in parks. And then when there is a crisis , he'll get pulled in with law enforcement. He he spoke very highly of what that working relationship looks like with law enforcement. I think the issue he runs into that all clinicians are running into is there's not enough of them. And so he's on one call that can last hours and hours and hours , especially if someone has to be admitted to jail or someone needs additional treatment or more interviews. That takes him out of the field for a long , long time. And then if other issues happen , there's just nobody to send.

S2: I think one thing that was interesting to me , listening to calls coming into dispatch , I know I figured that you would have dispatchers requesting the teams on on behalf of the officers who are on scene and vice versa. Officers telling dispatch , Oh yeah , we're going to need a per team out here. Can you can you get one out here ? But what was surprising to me was the number of calls that I heard were the people in crisis themselves were requesting. Peart. I heard that over and over and over again. I heard a woman say , you know , I'm tired. I'm tired of this. You know , can somebody I need a team , I need somebody to come talk to me from specifically a per team. And the woman , you know , she knew exactly what she believed she needed and what she wanted. She said , not only do I want the per team , but I want the per team to take me to Sharp Mesa Vista.

S1: And it sort of brings us to this topic of a non law enforcement response for these types of things. And there's been a push in recent years not to involve the police , and that's where these mobile crisis response teams come into play. No police involved , just clinicians out in the field.

S2: The idea behind them is not only that you have a group of people who are trained to deal with a variety of crises on multiple levels , but the other side of that is that simply the mere presence of law enforcement can tend to escalate a situation. So by removing that part of the equation , you've got something hopefully a little bit calmer to to deal with a less volatile situation potentially to deal with. So , you know , there aren't as many mobile crisis response teams as there are teams right now. But I know that that's something that the county is working on.

S1: And Blake , go ahead.

S4: I just add in two things. One , one of my colleagues spoke with the head of an LGBTQ resource center in North County who's especially just effusive about how wonderful these teams are to come to his center. When someone's in a crisis or having a breakdown. He he loves having that option. One thing that's important to note , though , is mobile crisis response teams will not deal with anyone who's potentially violent or has a weapon , which takes a slice of of these crises off the table immediately. So if there's any threat of anyone being hurt , that is not what they're going to do. And even if if that exists with a clinician , the clinician is going to step back and let law enforcement deal with it. So that's that's an important caveat to sort of note here.


S2: The project all of the data that we gathered really illustrates that. But , you know , more anecdotally , just from my own perspective , for what that's worth , absolutely without question. I've seen more and more situations where mental health is a huge component of whatever crime story we happen to be reporting on. If there's a breaking news incident that we are responding to. Meaning our newsroom is responding to far more often than you know , a decade or so ago when I well , more than a decade ago when I started working at the UT , we're just seeing it more and more and more. And these situations are extremely complicated because they're unpredictable. And you have to the people who are responding to to deal with these situations have to deal with the safety of those who are in crisis , those who might be around the people who are in crisis. And then , of course , the first responders themselves is an exceedingly difficult , complicated situation every time.

S1: If you're experiencing a mental or behavioral health crisis , the number to call for help and resources is 988. Stick with us here on roundtable. After the break , our mental health system discussion continues. You're listening to KPBS Roundtable. We're speaking with the San Diego Union Tribune , Blake Nelson and Dana Littlefield. We're talking about their recent investigation into San Diego's behavioral health system. You all did a great job of highlighting a lot of personal stories in this project.

S4: He's in his 20s named youhow do because in some ways their stories are very , very similar. But they their lives have taken very dramatic turns in different directions. Krystal several years ago was hearing voices that were telling her terrible , horrible things. She had a conversation that she doesn't really remember with a neighbor while holding a knife. While she was hearing some of these voices , the neighbor called the police. And as her case started to work its way through the criminal justice system , someone told her about this thing called behavioral health court. That's for people who are in the criminal justice system , but who also have serious mental illnesses. And it's sort of a way to keep people out of jail if they commit to therapy and living in a group home , taking medication and stuff. And her life has just improved so dramatically over the past couple of years. One of my colleagues was in the courtroom with her when she had this sort of big victorious moment with the judge. The judge advanced her to the this next level of the program as she's in school. She's got a job. She's just doing very , very well. And it was really , really inspiring to see how just day in and day out , she is working really , really hard and getting better. Contrast that with this man in his 20s named youhow do. He was an immigrant exchange student from China , was studying physics at UC San Diego and was released from a mental health facility on Monday. We chose these three days , the 72 hour period at random , and he just happened to get out on Monday. And on Wednesday he was arrested for allegedly shooting a California Highway Patrol officer while in the middle of a crisis. I have to emphasize , allegedly here , he has not yet been convicted. He has pleaded not guilty by reason of insanity , but he started to spiral during the 72 hours that we were we were reporting and it ended very , very violently. And and an officer almost lost his life , but the officer survived and he do is still in custody.


S2: And one of the very first things that I heard and saw , referring to the monitors that the the dispatchers are watching as the calls come in , was a call about a potential suicide from the Coronado Bridge as reporters as a newsroom. We don't often Yes , sometimes we do , but we don't often write about individual suicides. We have a number of rules about how it is that we report on that information. I should say that we have done broader stories about suicide and told individual stories about people and families in that context. But , you know , typically we don't write something every time , you know , someone takes his or her their own own life , particularly if it's done , you know , in a in a private sort of setting. So it so for us to not only begin the project with that incident , you know , it was near the beginning of the reporting on this. It was early Monday morning , about 10 a.m. And then to go back and actually hear from the family and hear about who this person was and how they were dealing with that very intense , heart wrenching , excruciating loss. It was just again , it's not something that we do in every instance. And it you know , all , of course , due respect to that family and what they're going through , I don't mean to trivialize any of that in any way , but having their story linked another perspective , another , you know , another layer to this story that we were trying to tell. I am grateful that the family opened up to us in that way. But of course , also very sorry that they experienced this loss in the first place.

S1: And Blake , let's discuss where people who are in a mental health crisis can go for help or actually get some treatment. It sounds like there's a lot of different options available , all that sort of different levels of acuity. Yeah.

S4: Yeah. So you can check yourself into what's called a crisis stabilization center on your own. You don't necessarily have to be brought there by law enforcement. You'll be assessed at a place like that , and officials can decide whether or not they think you need to go to a locked psychiatric unit at a hospital. There are definitely crisis lines to call like 988 , the national suicide hotline number. There are clubhouses that the county funds around the county for people just sort of day in , day out , places that people can go in day and day out to receive all sorts of help and services. I think one of the biggest issues that experts flagged for us is most of the resources that currently exist are for people in a severe crisis , and even those are strained and there is less for people who are heading toward a crisis but have not necessarily gotten there yet. And so one of the things the county government especially is trying to do is shift to a more preventative model by hiring people with mental illnesses who have struggled with mental illness in the past , who can function as what they're calling peer support specialists , who can sort of help people before it gets to the I need to dial 911 moment , but how long that's going to take , how many people need to be hired , how that's going to be paid for , that's still a moving target.

S1: But Blake , it also sounds like that reporting found just in these three days that many of these different options where people can seek treatment maybe in the later stages are full.

S4: I mean , the especially I can zero in on residential care centers , which are places that if you if you get out of the hospital but you still need help say cooking your own meals or it's not really safe for you to dispense your own medication. These are places you're supposed to go be able to go to live. But the county has effectively lost dozens and dozens of places like this over the past couple of years , which together had spaces for about 500 people. And so , you know , where are these people going ? Well , a lot of them are ending up on the streets. That can lead to all sorts of other problems , which is why so many of them are then ending up in jail. And so sort of as a county , we've cut spaces for a lot of people who need some extra help. This contributes to the homelessness issue , although that's very complicated. This contributes to the jail population. Yeah , this just contributes to stressors on so many other systems.

S1: This was sort of surprising and I'll just read the text quoted directly from your story. More than hospitals or crisis centers or nonprofits , San Diego jails are the region's largest provider of mental health care.

S2: So I think back in 2016 , I was involved in some reporting that really was launched from that particular fact that the county jails are the largest health care provider in the region. There are so many people who , again , like Blake just mentioned , who are not necessarily at the crisis level , will get to the crisis level , folks , in just a moment. But the person might be , you know , in the wrong place and people are calling and complaining about this person. The person is trespassing. The person is loitering in the wrong place. You know , there are all sorts of reasons that somebody can be picked up , taken to jail , and frankly , they stay there for quite a while. And that's where the sheriff's department is administering meds to people who need them. So that is at a lower level. Let's talk about the people in the crisis level. You know , so when someone is at the level where they are , you know , causing harm or threatening harm or they've , you know , perhaps broken into a building , a home or something like that , well , clearly , that's a person who's going to be arrested and taken to jail. The argument there , of course , is , is that really the proper place for that person ? Is there somewhere else some other kind of treatment environment where that person would be better served because their mental illness is directly related to that activity that landed that person in jail ? So that's a big part of the problem here. So my point is this , is that you have people at a variety of levels who are dealing with a variety of different kinds of mental illness , and they are taken to jail for lots of different reasons. And the jail is obligated to provide care to those people. And for a lot of them , that includes administering these psychotropic medications.

S1: You know , this mental health crisis that you all describe and really profiled is not just impacting adult San Diegans. You're reporting finds that the number of kids put on these 72 hour psychiatric holds. It's higher than the state average. And the rate of kids put into these holds has increased tenfold over the last 30 years. And your series , unfortunately , points to at least a couple instances of teens that were considering suicide.

S2: Exists when we're talking about young people , minors as opposed to adults. What I heard in my reporting , what I learned in my reporting and saw in my reporting was many situations where the first people who are dealing with a child who is in crisis , those are the educators. And I heard many calls coming from schools or maybe even group home situations where you've got an educator sitting with the child , isolating the child so that that person is not in contact with other children and , you know , trying whatever that person can do to calm the situation down and remove anything that from the situation that might be a problem , you know , potential weapons , that sort of thing. I remember specifically a call from a principal at a school , and I was so surprised at how calm , cool and collected this person appeared to be on the call. And basically they had isolated the child , taken away some things that could be dangerous. And the the principal was on the phone with dispatch being told that there was no one available to respond right away. And the principal's response was basically something to the effect of yet I know the gist of it was kind of I've been here before. So schools now are having to address how they will deal with this situation or these types of situations as they come up. And all of this has been exacerbated by the pandemic. You're finding more and more and more. Young people dealing with stressors and the schools actually having to figure out how they will deal with those stressors and how to get the child the assistance they need.

S4: Let me just also throw in a depressing stat that during this three day period that we looked at , Rady Children's Hospital always had at least ten mental health patients in the E.R. because there was no space at a psychiatric unit. And their head of behavioral health services said the hospital typically gets more than 20 suicidal children every day.

S1: You know , every single day newsrooms have to make decisions about what to cover , what to investigate. Why did you guys choose to to to do this series ? And we'd love to hear from both of you on this.

S2: Because it is such a problem. You can see it when you're walking down the streets. You know , when you maybe take a walk through , you know , these village , you can see people who are clearly in the throes of some type of mental health crisis. But what this what was interesting about this project and what was kind of one of the motivators of this project , I think I'm not speaking out of turn when I say Turkey Conners , who was lead editor on this project , you know , she and I wanted to show that this isn't just about the person you might see on the street who's in crisis. This is something that's happening in every neighborhood , in every , you know , socioeconomic level , you know , at every age level. It's everywhere. And a lot of it is happening behind closed doors or at least behind the doors that not all of us get access to. So it's happening inside people's homes. It's happening inside the hospitals. It's happening inside these care centers that we've mentioned. And we wanted to show all of that.

S1: And you guys did a great job of putting , you know , faces to this. Like you said , maybe people think it's maybe just people living on the streets , but it's students. It's neighbors , it's brothers and sisters.

S4: I mean , you can actually map where these calls are coming from , what zip codes. And the majority of calls are coming from homes. They're not coming from , you know , downtown. There are issues downtown. But when you actually look at this , it's coming from rural areas. It's coming from urban areas. And I think , you know , the privacy of people caught up in this system , especially people in the throes of crisis , was a paramount concern for us. And we you know , anyone whose name is in the story , it's because we spoke to them directly or their family gave us permission. You know , we were not especially when we were in these hospitals , we were taking extraordinary steps to make sure we were not putting anyone in the spotlight unfairly or wrongly. But I guess just to echo what Dana was saying , since everyone's sort of aware that mental health is an issue , I just don't think I certainly didn't have a good sense of the scale of the issue , partially because the privacy concerns it's brought. You can't just walk into a psych hospital and start filming. But I think that was a main driver of like because these privacy concerns are so are such an issue , nobody really understands the scope of this. And so we really got to dig into what does this look like on the ground day by day , minute by minute.

S1: It was a great series , very eye opening. And you guys had unprecedented access to this crisis. Dana Littlefield is an editor with the San Diego Union Tribune. And Blake Nelson is the UTS East County reporter. They're among the nearly two dozen reporters behind the new series 72 Hours Inside San Diego County's Mental Health Crisis. I want to thank you both so much for joining us here on Roundtable to share more about this incredibly important project with us.

S5: Thanks for having us. Thank you so much.

S1: If you're experiencing a mental health crisis , the number to call for help and resources is nine , eight , eight. Coming up , we're talking with the leader of the county's behavioral health services department. More on how they're addressing the growing need for mental health services. You're listening to KPBS Roundtable. I'm Matt Hoffman. We're continuing our conversation on San Diego's mental health crisis. We just heard from some members of the reporting team over at the San Diego Union Tribune. We were talking about their new series on San Diego's behavioral health system. And joining us now is Luke Bergman. He's director of San Diego County's Behavioral Health Services. And his department oversees many of these initiatives that the UT series mentioned. Luke , thanks so much for joining us here on Roundtable.

S3: Thanks for having me , Matt.

S1: So the 72 hour series from the Tribune gave some unprecedented access to see how the county's behavioral health system really works from the calls that police and the crisis teams get to how people are treated and then what happens after that. They described a mental health system that is overwhelmed generally.

S3: Kind.

S6: Kind.

S3: Of in our society for mental health care that pretty dramatically exceeds the resources that are put into it. We absolutely need more resources in this space than than have traditionally been been put into it. And so , you know , I think the the depth of the reporting from the Union-Tribune , I think , contributes to making a strong case for that.

S1: In the UTC's reporting , they mentioned a few instances where somebody is trying to get help who's going through a mental health crisis , but they're told that there's no room or there's not even maybe somebody available to respond.

S3: We need many solutions. One of the , I think , really important aspects of behavioral health that it's important to to sort of lead with is that it's very variable. There are lots of diagnoses that fit with under the broader umbrella of behavioral health condition. Most of the attention is is put on what we need to engage people who are in moments of crisis and what do we need to do sort of in those moments of kind of heightened agitation to de-escalate them and to and to get them somewhere. 5150 holds. That's part of a long standing policy in California that enables people to to basically be mandated into care in emergency settings and then potentially conserved for longer periods of time. I'll ton of attention and policy work goes into that 5150 hold process. The I would just say the broader public discourse , the the the the public imagination around behavioral health is mostly preoccupied with with that that moment of crisis. What doesn't get enough attention and where we really need , I think collectively to sort of shift our gaze toward is is the longer arc that we need people to sustain in care. We we think about behavioral health in terms of crisis. Almost inevitably. It's part of our language for describing and thinking about behavioral. I'd note , you know , other aspects of health care don't use the word crisis. We talk about critical care. We talk about acute care. We talk about intensive care. We talk about crisis only in the context of behavioral health. So that's getting tons of attention. What isn't getting attention is the fact that people who are in moments of crisis in behavioral health need ongoing care. In almost all cases , behavioral health conditions are chronic conditions. People need not just crisis care. They need continuous care over years and years.

S1: And I know that we've we've talked about that continuum of care. But some of these solutions and some of these preventative measures , we know that they they cost money , right ? I mean , can you give us a sense of maybe how much is being spent now ? I believe your department had one of the largest increases in the last county budget.

S3: It's more money wisely spent. It's true that the Behavioral Health Services Department budget has increased really dramatically and we would say needs to continue to increase to create spaces for those longer durations of continuous care that we need. And I'll just point to one category of service provision , Matt , to kind of really highlight and answer to your question , and that's Borden Care. Borden care are spaces in in San Diego County. These are mostly been group homes where people with serious mental illness can stay with 24/7 support. These aren't clinical settings. These are residential settings homes , but where people get support with activities of daily living that really sort of enable them to to , you know , ultimately in most cases and hopefully live live independently. We have had in San Diego County overall a 20% reduction in in the number of Borden care beds available. But Borden care is especially inaccessible to people on Medi-Cal who don't have resource. The cost of a board and care bed on average in San Diego County is $6,000. Most people on Medi-Cal only have $1,200 to spend on a board and care bed per month. So we need pretty massive additional resources in the Borden care space to build up that infrastructure in terms of the physical infrastructure , the beds , but also to establish a workforce that can care for people ongoing in those settings. I don't have a , you know , total number for that. I can I can tell you that it's much cheaper to build a Borden care bed than it is to build a hospital bed. We've we at the county have recently sought grant funding from the state that we would spend establishing additional boarding care spaces. We're seeking over $100 million of support from the state in order to do that and in order to establish about 200 boarding care slots.

S1: And when you say boarding care , I assume you're talking about like residential treatment facilities where somebody could stay for a few days.

S3: No , actually , let me let me clarify. So when I'm talking about boarding care , I'm talking about places that are that are , in most cases , generally their their home , their homes , their houses where people would stay not just for days , but months , minimally , sometimes years. So these are these are residential settings. They're not clinical settings. They're residential settings where people can have access to ongoing support. If there was one category of service that I would say we in San Diego County most need to invest in , it is this long term care board and care residential setting.


S3: The administration is definitely pushing money into this space in ways that they haven't before as kind of a part of the care court initiative. They've created a behavioral health bridge , housing fund that may help us to subsidize stays in Borden care. We at the county have for years been pushing money over which we have some discretion into Borden care operations to try to incentivize care for people on Medi-Cal in these spaces. I think the you know , the the big questions that are still outstanding. Are exactly the ones that you were that you were beginning to flag. What role could mainstream healthcare or hospital systems play in supporting boarding care settings ? That's an open question. I don't think there's great clarity about that. But I think it's it's a it's an area of work that really needs to be explored. And then ultimately a kind of a deeper question would be what role does our public insurance system potentially play in supporting these kinds of settings ? Generally , historically , our public insurance system , Medicaid doesn't pay for housing , pays for clinical services. And that's a very in terms of policy , that's a very bright line that has historically applied to how Medicaid works. At the same time , everybody in this field knows that health and housing are very intimately intertwined. And so there's a strong argument to be made that public insurance could play a more significant role in sustaining this kind of care in home settings.

S1: And when we talk about responses to those who are going through a behavioral health kind of emergency , there's been some work at the county to move away from a law enforcement only response , maybe if it's possible to just have a clinician go out there.

S3: The the just volume data that that we're beginning to see as early returns for our mobile crisis. Response teams across the county have been very , very positive. We're making contact with thousands of people over thousands of encounters that are in in most cases resulting in stabilization on site without needing to transport somebody for additional emergency care. I mean , these are cases that could very easily continue to escalate and result in really bad outcomes without this intervention. We're also seeing increasing numbers of 911 calls diverted from police response to mobile crisis response , team response and deployment. And it's important to remember the the Mobile Crisis Response Service is accessible through calling 908 , which is the federal mental health crisis hotline number , but also through 911. And at this point , though , you know , the the numbers , of course , didn't you know , they didn't reflect this distribution at the outset. But at this point , as things continue to evolve , about 45% of mobile crisis response team deployments start with a call to 911. They start with a call , in other words , that previously would have led to to police deployment and very likely not as positive and outcome as we're seeing with the mixed deployments.

S1: And as we wrap up here , a final question. You know , generally what resources are there for people who may be in need of some mental health services ? Where can people go ? We know we have the 908 crisis line.

S3: That's I would say , a most important thing to remind people that that it really is as simple as dialing three numbers to get access to the access and crisis line here. And that's a that's a very robust service in San Diego County. You can talk to a live clinician. It's not a recorded service. You were talking to a live licensed clinician who can communicate with you in over 150 languages and get you connected to ongoing clinical care. So if if anybody who is is listening is concerned about , you know , getting access to care and doesn't know where to begin , nine , eight , eight is certainly the best recommendation that I could make.

S1: Luke Bergman is director of the county's Behavioral Health Services Department. And Luke , thanks so much for joining us here on Roundtable.

S3: My pleasure. Thank you , Matt.

S1: We'd love to hear your thoughts on today's show. Leave us a voicemail at (619) 452-0228. You can also email us at Roundtable at You can listen to our show anytime as a podcast. KPBS Roundtable airs on KPBS FM at noon on Fridays and again at Sunday at 6 a.m.. Roundtable is produced by Andrew Bracken , and Rebecca Chacon is our technical director. I'm your host , Matt Hoffman. Thanks so much for being here with us.

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File photo of two children in front of a clinic, Feb. 22, 2022. CalAIM seeks to improve the availability of mental health care for young people insured by Medi-Cal, but a year since its rollout, obstacles remain.
Alisha Jucevic
File photo of two children in front of a clinic, Feb. 22, 2022. CalAIM seeks to improve the availability of mental health care for young people insured by Medi-Cal, but a year since its rollout, obstacles remain.

San Diego is facing a mental health crisis. A new reporting project from the San Diego Union-Tribune shows a mental health care system overwhelmed and undermanned at multiple levels.

Then, KPBS talked to the head of San Diego County’s Behavioral Health Services department on how they are approaching the problem.


Dana Littlefield, public safety editor, The San Diego Union-Tribune

Blake Nelson, East County reporter, The San Diego Union-Tribune

Luke Bergman, director, County of San Diego’s Behavioral Health Services department