County Signs Sixth Mental Health Contract

San Luis Obispo County approved a new $1.7 million contract with a private mental hospital to provide lockdown mental health services.
“With the exception of State hospitals and other acute care hospitals,” reads a staff report from County Health Agency Director, Mike Hill, “Mental Health Rehabilitation/Institutions for Mental Diseases [IMD] facilities offer the most intensive level of care in the residential care continuum.”
Plainly stated, the County is contracting with the privately-owned facility to lock up dangerous people with mental health problems, rather than try to provide services through it’s own facilities, notably the county jails.
“IMDs are locked residential facilities,” Hill said, “that are primarily engaged in providing intensive care of persons with severe mental illness, which includes medical attention, nursing care, assessment, clinical treatment and other related services. Intensive services including psychiatrist coverage are offered 24 hours per day / 7 days per week.”
Such facilities are for people who didn’t respond to traditional treatment.
“Most clients placed in these facilities have not succeeded in outpatient settings and less restrictive residential placements,” Hill explained. “Often, IMD clients have been placed under conservatorship by the courts. Although the desired outcome is to move clients to the least restrictive level in which they can be successful, a certain percentage of the population with severe mental illness will, at any given time, need the level of treatment offered in an IMD setting.”
There are different kinds of IMDs, including psychiatric hospitals; psychiatric health facilities (PHF) with over 16 beds; skilled nursing facilities with a certified special treatment program for the mentally ill; and mental health rehabilitation centers or MHRCs.
“Due to the severity of their symptoms, clients placed in IMDs are unable to live successfully in a less restrictive setting,” hill said.
Back in 2019, with the County embroiled in a controversy over the treatment of County Jail inmates with mental illnesses, including several in-custody deaths, the Board of Supervisors signed several contracts with IMD facilities.
“On July 9, 2019,” Hill told Supervisors on Feb. 2, “your Board renewed contracts with five contractors for IMD residential placements: Dycora Transitional Health & Living-San Jose, LLC; Crestwood Behavioral Health, Inc.; CF Merced Behavioral, LLC, dba Merced Behavioral Health Center; Sylmar Health and Rehabilitation Center, Inc.; and 7th Avenue Center, LLC.”
These existing contract facilities are spread across the state in Santa Cruz County, Merced County, Los Angeles County, Kern County, and Santa Clara County.
The contract with Vista Pacific would be the County’s sixth facility and it is in Riverside County, so SLO County residents who need this level of mental health help will be sent away for treatment, because SLO County doesn’t have such facilities.
“This additional facility is necessary,” Hill said, “to provide appropriate care for new, higher acuity clients, as well as geriatric clients, who have a diagnosis or condition that the currently contracted facilities are not able to adequately treat.
“Additionally, in the wake of the COVID-19 pandemic, many residential facilities have reduced capacity for, or even halted, placement of new and even returning clients.”
The County has had several people check into its own Psychiatric Health Facility which has just a handful of beds. “There are several clients who were admitted to the PHF several months ago,” Hill said, “and despite readiness to be transferred to an appropriate residential facility, have remained on the PHF due to lack of beds in other residential facilities. Behavioral Health became aware of Vista Pacifica and discovered they have an excellent reputation, have open beds, and are willing to admit clients from our county.”
The out-of-county facilities are regulated by the State. “The contract providers,” Hill said, “are licensed by the State Department of Health Services as skilled nursing facilities and ‘Institutions for Mental Diseases’ with special treatment programs [and] certified by the Department Health Care Services.”
Costs are charged like a motel room — on a per day basis — and bills are only accrued when SLO County has patients in any of the six facilities.
Hill explained, “The FY 2020-21 Behavioral Health Department approved budget includes $1,720,426 [of which $685,793 is funded with General Fund support] for Mental Health Rehabilitative/IMD services, which assumes an average of 20 clients for a total of 7,300 days, at an average rate of $235.68 per day.
“The currently contracted basic rates for FY 2020-21 vary from $227 to $303 per day.
“While Vista Pacifica offers several different levels of care and rates, it is anticipated that the service level and corresponding rate used most often will be The Level “A” Augmented Service Rate at a rate of $281.91 per client per day as specified in the contract. The average daily rate for currently contracted IMD facilities during FY 2020-21 is $266.24.”
The Vista Pacific contract is for one year, however, Hill was given the authority to renew the contract for another year without first getting Board approval at the same rate.