COUNTY OF SAN MATEO

Inter-Departmental Correspondence

County Manager

DATE:

July 12, 2007

BOARD MEETING DATE:

July 24, 2007

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

David S. Boesch, Assistant County Manager

SUBJECT:

Reorganization of Mental Health and Alcohol and Other Drug Services

RECOMMENDATION:

1.

Adopt a Resolution:

A.

Accepting the report that outlines a plan to reorganize Mental Health and Alcohol and Other Drug Services (AOD); and

B.

Authorizing the Directors of the Health Department and Human Services Agency to create a Behavioral Health and Recovery Services Division located within the Health Department that includes both Mental Health Services and AOD and to submit final budget amendments necessary to implement these changes.

2.

Adopt an Ordinance amending the Salary Ordinance adding a Behavioral Health Director to the Health Department to lead the new Behavioral Health and Recovery Services Division.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all.

Goal 5: Residents have access to healthcare and preventive care.

Goal 8: Help vulnerable people—the aged, disabled, mentally ill, at risk youth and others—achieve a better quality of life.

The Resolution and Salary Ordinance Amendment (SOA) contribute to this commitment and these goals by developing an integrated system of care for individuals and families who are affected by substance use disorders and mental illness as well as those with co-occurring disorders within the broader Health Department mission.

Performance Measure:

Measure

FY 2006-07
Estimated

FY 2007-08
Projected

Percent of Mental Health and AOD providers who will have completed the COMPASS, a self-assessment instrument of co-occurring treatment capability.*

N/A

90%

*This measure is an interim measure pending development of indicators of improved client access, services, and quality of life.

BACKGROUND:

In 1992 the Alcohol and Other Drug Division was transferred from the Health Department to the newly created Human Services Agency (HSA) to maximize collaboration with various social services programs. During the past several years Health and HSA staff have worked together on a number of projects and initiatives, including Partners for Safe and Healthy Children, Health’s Roadmap for Alcohol, Tobacco and Other Drug Prevention, and AOD’s Strategic Directions 2010. In 2006 the Health Department agreed to provide $860,000 to AOD for the period March 1, 2006 to June 30, 2008 to support (1) enhanced services delivered by AOD providers to individuals with co-occurring disorders and (2) a clinical consultant to provide program development and quality improvement technical assistance to both AOD treatment providers and County departments. Early in 2007 the County Manager directed the two departments to explore the options available if AOD were to be transitioned from HSA to the Health Department. In February a group of key managers from both departments met with me as the Transition Committee to begin discussions related to this transition and to set up a committee structure for examining various aspects of a transition. The following committees, which include staff from both departments, have been meeting over the past several months to accomplish this work: Oversight, Organizational, Financial (includes contracts), and Facilities (includes information technology).

DISCUSSION:

The Transition Committee has reviewed plans for the consolidation of Mental Health and AOD into an integrated Behavioral Health and Recovery Services division within the Health Department. The Committee recommends proceeding with this model, and the report provides details of this proposed reorganization. We are also recommending that a position of Behavioral Health Director be created to lead this division, and an SOA adding this position to the Health Department is included for your approval. It is anticipated that the reorganization will not have significant financial impact; however, details are not yet available pending further analysis by staff. In the meantime, approval of these actions is requested in order for the department to move forward with the reorganization under the leadership of a Behavioral Health Director.

Several other staffing changes will be necessary in the Health Department in order to effect this reorganization, and these will be brought to you for review and approval as part of the final budget process in September. The Committee anticipates that changes may be necessary in HSA, as well as it readjusts staffing to accommodate for the loss of positions that have had shared responsibility for AOD and other HSA programs. These will be brought to you at the time of the final budget hearings. The Board memo and resolution have been reviewed and approved by County Counsel.

FISCAL IMPACT:

The tentatively Adopted FY 2007-08 Budget for Mental Health is $108,784,625 with a Net County Cost of $13,629,256. AOD’s budget is $17,865,987 (Net County Cost: $3,891,942). The combined tentatively Adopted Budget for the two programs prior to consolidation is $126,650,612 (Net County Cost: $17,521,198). The projected annual cost of the new position of Behavioral Health Director is $248,000, which will be partially offset by Mental Health Services Act funding and Realignment and AOD funding available for administrative expenses. Information regarding financial impact will be provided during the final budget hearings in September.