Inter-Departmental Correspondence

Health Services Agency



November 16, 2004


December 7, 2004



Honorable Board of Supervisors


Charlene A. Silva, Director of Health Services



Amendment to the Agreement with Santa Clara County




Adopt a resolution authorizing the President of the Board to sign an amendment with Santa Clara County increasing the number of guaranteed beds in the Santa Clara Main Jail for San Mateo County inmates requiring inpatient mental health treatment from one to two beds and increasing the agreement maximum by $25,000, from $800,000 to $825,000.


Approve an ATR transferring $325,762 from other Health Services Agency units to Correctional Health, Other Charges.



On June 29, 2004, your Board approved an agreement with Santa Clara County to provide one guaranteed bed in the Santa Cara Main Jail for San Mateo County inmates requiring inpatient mental health treatment. The total amount of the agreement maximum was $800,000 for a one-year term from July 1, 2004 through June 30, 2005. At that time, Correctional Health staff were negotiating with Santa Clara staff for a second guaranteed bed. However, staff were unable to obtain a commitment from Santa Clara staff for a second bed.


At final budget hearings in September 2004, Health Services provided a report to your Board outlining options for inpatient mental health treatment services for jail inmates. These options were considered because Santa Clara County had recently increased its daily inpatient treatment rates from $166 per day to $1,190 per day. Historically, San Mateo County has contracted for four guaranteed beds in the Santa Clara Main Jail. Based on an analysis of the costs and risks associated with re-opening a treatment service in the County’s jail, the September report recommended that the County contract with Santa Clara County for two beds while enhancing Correctional Health staffing to reduce the need for inpatient treatment services at the Santa Clara Main Jail. Your Board approved the additional recommended staffing.



The restructuring of mental health services in San Mateo County jails has allowed for expanded mental health coverage for suicide screening, outpatient treatment and behavior management. However, some of the most seriously mentally ill inmates still require involuntary inpatient treatment, generally for short periods of time. Correctional Health’s enhanced staffing approach assumed that there would be two guaranteed beds available in Santa Clara County to meet these inpatient treatment needs. The occupancy rate for the Santa Clara beds has averaged 1.7, although at any given time as many as four inmates have required treatment. While Santa Clara staff were unable to commit to a second bed during initial negotiations, Santa Clara has now agreed to guarantee a second bed.


This amendment assures access to two beds at all times in the Santa Clara County jail psychiatric inpatient unit. The amendment prorates the costs for the second bed, which is guaranteed for the period of October 1, 2004 through June 30, 2005.


Vision Alignment

The inpatient mental health treatment plan keeps the commitment of assuring basic health and safety for all and goal number 8: Help vulnerable people – the aged, disabled, mentally ill, at-risk youth and others – achieve a better qualify of life. The plan contributes to this goal by assuring that critical mental health care is provided.


Fiscal Impact

The term of the agreement is unchanged from July 1, 2004 to June 30, 2005. The agreement maximum is increased by $25,000, from $800,000 to $825,000. The annual cost of a guaranteed bed is $435,350. The prorated cost for the second guaranteed bed, available from October 1, 2004 through June 30, 2005, is $325,762. The agreement maximum was set to also include costs associated with mandated court proceedings (e.g., Riese Hearings for forced medication, requiring attorney and paralegal time) and 60% of charges for any acute medical services (such as emergency hospitalization at Santa Clara Valley Medical Center) that may be required. Such associated costs have not been incurred thus far this year.


The ATR appropriates funding in the amount of $325,762 for the cost of the second guaranteed bed. Health Services will achieve cost savings in other divisions, primarily in the Mental Heath division, to assure revenue to fund the additional inpatient mental health treatment bed. This approach for providing mental health treatment for jail inmates is more cost-effective than providing inpatient treatment directly through a County-housed service. There is no additional net county cost required for this amendment and ATR.