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Recommendation to direct City Manager to work with the Department of Health and Human Services and local mental health providers to explore the feasibility of establishing a more robust infrastructure for mental health services in collaboration and alignment with local mental health providers in Long Beach and the County of Los Angeles.
DISCUSSION
For the purpose of:
• Increasing access to mental health services across the City, including for schools.
• Increasing direct funding into the City for mental health services, particularly for mental health crisis response, coordination across programs and residential supports.
• Localizing and improving crisis mental health response and connection to services.
• Streamlining the City’s processes for coordination and access to services.
• Expanding the availability of residential care facilities and access in Long Beach, including hospital step-down beds.
• Providing more opportunities for engagement with local institutions for higher education and expand opportunities for social work and nursing student field placement to expand workforce potential.
Background
The City of Long Beach is home to the largest municipal health department in the state of California, with 550 employees and a budget of $170 million. Each year, the Department of Health and Human Services provides over 350,000 public health visits, 300,000 food and nutrition vouchers, 7,800 food facility inspections, 5,400 miles of spraying for mosquitoes, 2,700 public health nurse visits, 780 recreational water tests, and assists over 7,000 homeless individuals with locating housing and other services.'
The Department led, and continues to lead, Long Beach through the COVID-19 pandemic by standing up ambitious contact-tracing and testing programs, providing more than 350,000 vaccines free of charge to Long Beach residents, and leading the push to provide booster shots to the City's most vulnerable residents. HHS vaccinates over 1,600 residents every week and is on track to reach 80% of eligible residents fully vaccinated by January of 2022.2
Simply put, Long Beach's Health Department is one of its most important public policy tools. It has stepped up time and time again and delivered on the most important issues impacting community well-being. As the City faces ever-evolving challenges related to the COVID-19 pandemic, it is important that HHS stay intimately involved and supported as the actor in the City with the most direct knowledge of the impacts of COVID-19 and the track record of effective response to back it up.
The Problem
In addition to COVID-19, Long Beach has been dealing with another, less acknowledged pandemic for quite some time - a mental illness pandemic. Long Beach saw over 1,000 more mental health-related 911 calls in 2020 than in 2019. According to the CDC's National Center for Health Statistics, the share of adults experiencing symptoms of anxiety or depression ballooned from 11 % to a peak of 43% during the pandemic. As the pandemic continues, those levels remain almost three times higher than pre-pandemic levels, at 32%.3 One in three adults suffering from anxiety or depression should be treated as the public health crisis that it is - a crisis that deserves a proportionate response.
Although COVID amplified these issues, Long Beach was already facing an existing mental health crisis. According to LA County's Community Health Profile, Long Beach's suicide and drug overdose rates were already well above the county average."
Additional studies from local hospital St. Mary's Medical Center highlight some of Long Beach's other existing struggles when it comes to mental health. The City's rate of emergency room visits due to mental health issues is twice the state average, with 1 % of residents over 18 years old being hospitalized due to a mental health crisis within the studied 3-year period." Other issues that stood out in the study were hospitalization due to incidents of self-harm and hospitalization due to alcohol abuse, both of which far exceeded state and county averages.
While these issues are deserving of attention in and of themselves, it's clear that our healthcare providers think the whole of mental health needs to be more prioritized at the local level. Each of those three issues highlighted by St. Mary's received prioritization scores of 2.7 on a 3-point scale, which were the highest scores given in the report. Mental Health issues were also named by Long Beach Memorial Medical Center as the #1 priority health need for Long Beach."
This is all not to mention what is likely the most outwardly visible cause and result of mental health problems in Long Beach - the homelessness crisis. In the City's original Everyone Home Task Force Report, the coalition reported that more than half of Long Beach's over 2,000 residents experiencing homelessness experience mental health issues." In a report to City Council in August of this year, the Everyone Home Coalition mentioned the fact that, "administration and location of mental health, substance use, and reentry services largely fall under LA County jurisdiction" as one of their biggest ongoing challenges." Understanding why this challenge exists and how it impacts Long Beach's ability to provide mental healthcare to its residents is key to understanding Long Beach's mental health crisis.
As expressed by the Everyone Home Coalition, despite a great need for focus on mental illness as a public health issue, Long Beach's local control over its mental health services is limited. In the Department of Health and Human Service's Strategic Plan for 2021 - 2026, the City's planned mental health actions revolve around outreach, providing insurance for the uninsured, raising awareness, and trying to improve mental health outcomes through interactions with other locally provided health services such as pre-and-post-partum care or during developmental screening for infants and young children." This lack of large-scale coordinated action is not the City's fault - the issue lies with the ways mental health funding is distributed by the state.
The Mental Health Services Act (MHSA), passed via referendum as Prop 63 in November of 2004, established an additional 1 % tax on incomes of over $1 million per year in the state of California to fund mental health services programs. The MHSA begins with Section 5813.5, which states that "the state shall distribute funds for the provision of services under Sections 5801, 5802, and 5806 to county mental health programs."? The Act allows the county to assume responsibility over assessment, therapy, medication, case management/brokerage, crisis intervention, and other supportive services related to housing and employment.
The implications for a city like Long Beach are obvious - although the Health Department is funded primarily through direct allocations of state and federal funding, the funding for mental health services is held by the Los Angeles County Department of Mental Health (LACDMH). LACDMH directly provides or contracts with local providers in Long Beach to provide a full array of services, but in many instances, the level of service is insufficient to meet the need, the service planning and implementation is not in coordination with the City of Long Beach, and service provision is not sufficiently coordinated across local providers to ensure people in need of mental health supports don't fall through the cracks.
It is important to recognize that those experiencing a mental illness can face a much higher degree of difficulty than others in filling out eligibility forms and locating healthcare resources. According to data from the City's Homeless Management Information System, just 26% of enrollees for whom a mental health disability is identified are enrolled in a federal or state disability benefits program.
For a city that recognizes the need to treat mental and physical healthcare as equivalent, these asymmetries in program administration allow far too many to fall through the cracks of our mental healthcare system. Better coordinating the many different arms of Long Beach's mental health services apparatus is vital.
The Opportunity
There are encouraging local mental health service models in LA County that offer an alternative to the current system. The cities of Claremont, La Verne, and Pomona, three cities as far east from the County seat as Long Beach is south, have developed a TriCities Mental Health Services collaborative that receives direct funding from the state for outpatient services. While this option no longer exists at the state level, the Tri-Cities model provides insight to a strong collaborative structure for mental health and homeless response as well as crisis mental health response through their Psychiatric Care Assessment Teams (PACT), which partner with Claremont PO to help efficiently respond to social-emotional/mental health needs of Claremont residents and/or visitors by using trained mental health professionals to take the lead on non-violent, non-criminal calls to law enforcement for assistance, similar to alternative response models currently in discussion in Long Beach.
On October 28th, Claremont Vice Mayor Jed Leano and Director Roni Navarro of Tri-Cities Mental Health attended a briefing and policy discussion at the Ronald R. Arias Health Equity Center with Vice Mayor Rex Richardson, Deputy City Manager Theresa Chandler, representatives of the Department of Health and Human Services including Director Kelly Colopy, and other local stakeholders, including representatives from United Way, CSULB, Mental Health America, St Mary Hospital, Star View Behavioral Health, the LGBTQ Center of Long Beach, The Guidance Center, Memorial Care, and College Medical Center. The discussion highlighted the innovations Long Beach has put forward around mental health, such as utilizing Restorative Engagement to Achieve Collective Health (REACH) teams as first responders to mental health-related calls, adding a mental health clinician in the jail, and standing up a Priority Access Diversion Program through the City Attorney's office which connects persons experiencing mental illness, substance abuse and/or homelessness to residential treatment programs in lieu of prosecution.
Participants highlighted Long Beach's need for additional residential mental health facilities, more opportunities to train social work and nursing students through expanded internship programs, localization of direct response and improved response times, streamlined program navigation, and more coordination between existing programs. The idea of locally tailored mental health services collaboration was agreed on by participants of that meeting as an important tool for improving mental health services in Long Beach going forward.
Equity Statement
The Framework for Reconciliation, Under Goal 4, Strategy 1 of "Advanc[ing] Health Equity", calls on the City to "Increase investment in mental health and trauma services, including facilities, professionals, community responses, and culturally tailored resources." As we acknowledge communities of color face especially high rates of mental illness and psychological trauma, moving towards more locally tailored outreach and service provision can help reduce these inequities."
TIMING CONSIDERATIONS
[Timing Considerations]
FISCAL IMPACT
No Financial Management review was able to be conducted due to the urgency and time sensitivity of this item.
SUGGESTED ACTION
Approve recommendation.
BODY
[Enter Body Here]
Respectfully Submitted,
REX RICHARDSON
VICE MAYOR, NINTH DISTRICT
CINDY ALLEN
COUNCILWOMAN, SECOND DISTRICT
MARY ZENDEJAS
COUNCILWOMAN, FIRST DISTRICT