Behavioral Health Services Act Integrated Plan

This doesn't quite respond to the question, which asks about the processes the County BHS has in place now. Additional detail should be provided here regarding the existing roles and obligations of the BHS case management with regards to Medi-Cal members in the SMHS system that are transitioning out of or between MCP Comm. Support housing services, including recuperative care, STPHS, and Transitional Rent. To the extent BHS case management or other staff have a role in supporting pre-discharge transition planning, it should be identified.

Per DHCS CS Policy Guide, Housing Support Plans may be completed by other entities other than HTNS providers. See DHCS Comm. Support Policy Guide, Vol. 2, p.17-19. The language here should be broadened so as to ensure consistent messaging with DHCS Policy.

A general comment about the accessibility of the Integrated Plan and its accessibility: Individuals with limited tech knowledge or capacity would have had significant challenges navigating this online portal and comment tool. Further, the linked pdf version of the 501-page IP lacked any form of clear table of contents, headers, subheaders, or clear pagination. For the broader public generally, and especially for those that lack experience with technology and tools that could help parse through such a document, delivering the draft document in this fashion will certainly have discouraged broader engagement and feedback. To support broader and meaningful engagement, the public should be afforded a draft IP that is more organized and accessible, and additional time to provide comment.

While identifying older adult needs, there is too little detail included in this section and the rest of the IP regarding the specific spending, programming, and goals for older adults within FSP. Many of the contracts serving older adult populations through community-based enabling and supportive services were terminated in the process of transitioning from MHSA to BHSA priorities. It is unclear to what extent those services will be sustained through CDPH or other sources of funding. The BHSA IP should more clearly identify the impacts of those eliminated services on older adult, limited English proficient, and other vulnerable populations, and identify those sources that will address those ongoing needs.

What is the breakdown of services provided across the infant, children and youth age range?

Infants, children, and youth (all those under 21 years of age) represent 38% of all individuals served across the behavioral health care continuum. This population only receives 18.5% of the total spending.

Budgeted at $1.05 billion for adults/older adults and $238.8m for children/youth, the County will spend over four times the amount on adult and older adults individuals compared to infants, children, and youth. Investing in early childhood, childhood and youth mental health services prevents the development of mental illness or more severe and disabling mental health conditions.

We need a better breakdown of ages of children and TAY served.

We need more a detailed breakdown of expenditures for different age ranges among infants, children, youth, and TAY in order to truly analyze and provide feedback on the BHSA Proposed Budget. What is the age breakdown of funding buckets for 0 - 5, 6 - 12, 13 - 18, TAY, Adult, Older Adult?

Services for Infant/Family and Early Childhood Mental Health requires specialized training to meet the needs of the unique population. How is the County ensuring its providers and contractors have adequate access to the appropriate training resources? Does the ELEVATE funding have set asides for skill building to serve infant and children ages 0 - 5 and their caregivers/families?

For other Early Intervention programs listed above, a Program Description was provided. What is the Program Description for item which lists 26 services/locations?

I appreciate the Community and Engagement Departments efforts to comply with the State's requirements under BHSA. That said, dissolving all Behavioral System of Care Councils that existed for 3 decades as the County embarks on this important transition from MHSA to BHSA seems short-sighted. It seems like it would have been possible to comply with BHSA requirements while also continuing to engage the hundreds of providers, constituents, families, lived experience experts, and community leaders already involved as stakeholders in the councils.

Based on Table 1 on page 486, total funding across all funding streams—including housing services—for children and youth ages 0–21 is approximately $257,238,307 in Year 1 and $238,803,843 in Year 2.

However, when excluding SUD residential and housing services – given that there are no SUD residential programs serving under 18 in San Diego and housing services predominantly serve TAY and adults —the adjusted funding more accurately reflecting services for children under age 18 is approximately $233,426,824 (17%) in Year 1 and $216,739,567 (16.7%) in Year 2.

This adjustment suggests that the proportion of funding directly supporting children may be lower than initially reflected in the total figures.

We would appreciate confirmation of this interpretation, including whether SUD residential and housing investments are appropriately attributed to the children and youth category in Table 1.

Based on Table 1 on page 486, Mental Health Early Intervention funding for children and youth appears to decrease from approximately $27.7 million in Year 1 to $13.5 million in Year 2. This loss is not made up in any other category or year.

Can you provide clarification on the cause of this significant reduction? Specifically, which funding stream(s) account for this change, and which programs or services are anticipated to be reduced, eliminated, or otherwise impacted?

Table 1 on page 486 indicates that 475 children and youth (0-21) are projected to be served annually through SUD residential services, with total funding of $10,849,866 across all funding streams.

Can you clarify whether SUD residential providers in San Diego County currently have the capacity to serve children under age 18? If not, should this category be understood as primarily serving individuals age 18 and older?

Based on Table 1 on page 486, total funding for mental health and SUD early intervention and prevention services for children ages 0–21 appears to be approximately $34.8 million.

In contrast, Table 7 on page 495, which outlines Behavioral Health Services and Supports (BHSS), indicates total Early Intervention funding for children and youth 0-25 totals $51.43 million .

Can it be assumed that the difference between these two figures is attributable to the broader age range reflected in Table 7? Specifically, does this imply that approximately $16.63 million of Early Intervention funding is allocated to transition-age youth (ages 22–25), with the remaining $34.8 million supporting children and youth under age 21?

We would appreciate clarification on how funding is distributed across age groups in these tables to ensure accurate interpretation.

Table 1 on page 486 presents projected funding and individuals served across mental health, substance use disorder, and housing services within the behavioral health continuum, inclusive of all funding streams. Within the housing services category, approximately 5,500 youth ( under 21 years) and 575 adults will be served.

However, Table 5 on page 493, which details BHSA Housing Interventions programs and services, projects that 740 youth and 17,989 adults will be served. As the latter table appears to represent a subset of the broader continuum outlined in Table 1, the significantly lower adult count in Table 1 is difficult to reconcile.

Additionally, the projection of 5,500 youth served within housing services in Table 1 is unexpected, as this figure appears substantially higher than typical utilization for youth within housing-focused programs.

We would appreciate clarification on the source of this discrepancy between the two tables, including how populations are being categorized and which specific programs are included in the estimate of 5,500 youth served within the housing services category.

Continue to come back to peers of All Ages 4-104 to get person-person feesback. - even in person if possible, to crease community support and interaction. — all year. I love that I heard adjustment to plan can be tweaked during the 3-year period. Hopefully large tweaks are included.

Thank you for the outreach. It came late but appears to be improving. I hope clinical experts are listening and recognize that there is such a thing as lived expertise, which is not often listened to or heeded. The key is to address education with doctors, clinical and all staff. Recovery model Needs to start in med school. Actions like giving 67 year old drugs to people with disfiguring side effects, is inexcusable. And subscribing an antipsychotic like Haldol based on whether this is a person who gets agitated is inexcusable. Take a look at these medications. We have new ones for a reason. Make sure this gets to clinical staff.

In addition, pay close attention to when doctors are ordering emergent intramuscular medication. Often it is for extreme agitation but NOT meeting the definition of emergency. Look into why there is agitation to begin with. Healing places should be a place of calm and activities should be structures to allow choices in people to engage in soothing activities. Not happening.

I spoke with 11 youth ages 10-17 today at an inpatient hospital and asked them what programs and services they wanted and needed. They told me “Animal therapy, lots of art, outdoor activities “. They were happy to be asked. When I asked if their phones caused them stress, they wholeheartedly agreed!

Peer support recovery partners. Emphasis on recovery. From hospital to home and continuing or beginning and also beginning at outpatient level.


Youth

Orgs with Outdoor activities - hiking sports nature walking etc
Art
Lots of art for both adults and youth - performing, dancing Vidal. Many opportunities to display and engage in art

The fact that BHS delivered a template-filled-out form to the community to get feedback on their private planning process is telling about how they communicate with the community. Not well. Although there are myriad engagement sessions reported, the fact is that stakeholders were not at the planning tables where, for six months, the BHS staff did their usual planning process with little to no meaningful and authentic planning-related engagement. A five-minute explanation of a program, a 45-minute presentation about the new BHSA, and a 30-minute Q&A session with pre-configured questions is not engagement. It's more like a steered conversation with limited opportunities for >>informed<< feedback.
Who knows, from my experience in the last decade, I can only surmise that leadership is convinced they are doing a great job, and will engage residents, consumers, and people who advocate for them as little as possible, while shouting as loudly as they can about what a great job they are doing.
Frustrated? You bet.
This was not a Community Planning Process.
This is not a reasonable document to provide comments and feedback on. It lacks context, form, and purpose. It's a filled-out form. A plan to spend $3.9 billion before stakeholders are required to be included in the process. I'm not holding my breath.
This is not a collaboration, it's a checked box, to assure the state that the community was meaningfully engaged.
Do we seriously have to legislate what the word meaningfully means? Do we have to legislate what 'engagement throughout the planning process' means?
The superficiality of engagement efforts I took part in, or now read about, is maddening. Most were presentations at existing meetings, with brief periods to collect comments. We can't see those comments, but, we can certainly see pages and pages of dates those comments were made. Seriously?
We also paid $400,000. for a CPP report from UCSD, but it is not included here. We cannot see the recommendations that professional community engagement experts provided us. Why didn't we have access to this report in January, February, or March when it was literally sitting on a shelf.
San Diegans deserve better. People experiencing serious mental illness, kids ideating suicide, our endless number of homeless neighbors, those overdosing on Fentanyl... all deserve a voice.
I guarantee you, with 100% certainty, that the priorities outlined throughout this plan, would not (necessarily) be the priorities county residents would agree to pursue.
The community is tired of being told what the plan is. They are tired of voicing their opinions, hearing an acknowledgement, then seeing no change, and not receiving any report from the county the following year.
An uninformed community cannot speak up. This has to end. This veil of privacy by an organization that has seen its budget mushroom to $1.3 billion a year, with scant insight by its Behavioral Health Advisory Board, a handful of light-duty 'education' opportunities, and little to no understanding by the community, and even well-versed stakeholders of the planning process... the one where actual data is delivered, programs and services evaluated, comparisons, questions, hard-hitting challenges... priorities... we were not at those tables between September and March.
Until the community insists on seats at the planning table, who are well informed >>throughout the year<< about programs, services, challenges, gaps, opportunities... the whole enchilada... any mention of the community being part of the 'planning' process is meaningless.
Now, with so many programs being cut, with a significant part of the budget now going towards homelessness, without deep, meaningful, community engagement... I'm expecting more of the same. A lot of people are suffering, and a lot of shoulder shrugging. I hope I am wrong.
I care. Deeply. But I have hit my head on the BHS wall for years with little to no real impact. Until we approach our community behavioral health challenges as a community, we are dead in the water.
C'mon San Diego, there's a whole lot of people that need your voice to ensure their voice is heard. A special thanks to the ten people who commented on this plan through this interface. Your insight is gold.
I shared more through BHSAplans.com and BHABrehab.com, and would love to contribute to the conversation of redesigning this 'community planning process' into a truly authentic community-led behavioral health care delivery system. One can hope!

There is also no mention of dementia in the IP which is of grave concern. Dementia is a mental health diagnosis and is especially prevalent among older adults. Individuals with co-occurring dementia (including Alzheimer’s disease and other dementias) and mental health or behavioral disorders are not uncommon within the health care system. However, these individuals have frequently been denied access to services due to the presence of a dementia diagnosis. Further, the development of a late life dementia in individuals with a history of mental illness sometimes also results in a loss of access to mental health services. Individuals with co-occurring dementia (including Alzheimer’s disease and other dementias) and mental health or behavioral disorders or symptoms are entitled to seek services from specialty mental health providers if they meet medical necessity criteria in Title 9, Code of Regulations (CCR), Section 1830.205. This regulation also specifies that individuals with one of the 18 eligible mental health diagnoses cannot be excluded from accessing mental health services simply due to the presence of a condition that is not covered in Title 9, CCR, Section 1830.205(b)(1).

There are 490,000 adult and older adult family caregivers in San Diego County. Over 50% provide support to individuals with Alzheimer's disease or related dementias. Research demonstrates that the more severe the case of dementia, such as that caused by Alzheimer’s disease, the more likely the caregiver is to experience depression. Local SCRC data confirm statewide and national statistics. Between January 1, 2023 – September 30, 2025, family caregivers reported the following:

• 33% experienced clinical depression using the Patient Health Questionnaire 9-item (PHQ-9) screening tool.
• 13% experienced moderate to severe depressive symptoms.
• 18% experienced significant loneliness and isolation using the Caregiver UCLA Loneliness 3-Item Scale.
• 24% experienced high caregiver burden scores using the Caregiver Zarit Burden Scale.
• Other research has also demonstrated that 1 in 4 dementia caregivers have contemplated suicide more than once in the past year.

These rates are much higher among ethnically minority populations, LGBTQ, and lower socio-economic older adult caregivers.

Object to development of the Arbor Ave site without the necessary environmental impact report and mitigation of traffic and parking issues ensuing from this project.

This section indicates an increase in behavioral health needs among older adults, including untreated behavioral health conditions and social isolation. However, it does not indicate any specific programs to address the increased needs of older adults or funding. The current SDCBHS plan does not include any specific EI older adult program to be funded by BHSS locally. It is an opportunity for our county to carve out funding to address the mental health needs of older adults and their family caregivers.

Trauma informed care is very important to the success of mental health programs. It recognizes that trauma and chronic stress (like that experienced by adult and older adult family caregivers) influence coping strategies and behaviors.

Southern Caregiver Resource Center, along with Justice in Aging and thirty-two (32) California based organizations believe that the BHSA has an opportunity to address the behavioral health needs of older adults and address long-standing barriers to care for this population. It is essential that older adults are prioritized at every stage of BHSA implementation.

We request reconsideration along with the following:

1. Include adult and older adult family caregivers who suffer from or are at great risk of distress (like moderate to severe depression, adjustment disorders, or generalized anxiety disorders) (W&I Code section 14184.402, subdivision (c) and implemented in DHCS guidance [13]), as a priority population in the County Integrated Plan (IP).

Under the IP's BHSS EI programs, there are 30 programs for children/youth, approximately 4 programs SMI (non-age specific), 2 programs for adults, and Zero EI programs older adults. There is also one (1) PEI community-defined program (Native American Dream Weavers) being included in the IP. Riverside County's IP includes Cognitive Behavioral Therapy for Late Life Depression (CBTLLD) and Program to Encourage Active and Rewarding Lives (PEARLS). Each County has some discretion regarding the EI programs to include under local BHSS. SDCBHS should include evidence-based and community-defined programs specifically designed for older adults including adult and older adult caregivers who experience high levels of depression, loneliness, generalized anxiety disorders, and adjustment disorders which qualify as a priority population (W&I Code section 14184.402, subdivision (c) and implemented in DHCS guidance [13]).

Stakeholder feedback was solicited for the IP which had already been developed. Feedback provided that was not part of the IP's priorities was not included, and stakeholders were told to advocate with California Department of Public Health. Please put more weight on the feedback from longtime community partners and stakeholders in future IP development.

Unfortunately, decisions to eliminate effective programs that had been offered to the community for over 17 years were made without any prior consultation with the provider. Example, Southern Caregiver Resource Center received a letter from the County in October 2025 informing the agency that their highly effective evidence-based psychoeducational programs (CALMA and CG TLC) delivered under the PEI Caregiver Support Services contract (#568046) would be eliminated effective 6/30/2026 with no prior warning or discussion or even transition planning. Southern Caregiver Resource Center has been a contractor for BHS since 2009. SDCBHS should have discussions with longtime community partners/stakeholders/contractors before making final decisions as they have a negative impact on the organizations and consumers who rely on the services.

Social connectedness is extremely important. Research demonstrates that assessing for risk of loneliness and isolation is paramount for older adults, and especially for the older adult caregiving population, due to the many negative health outcomes that are linked with loneliness and social isolation, including depression, increased mortality, decreased sleep quality, cognitive decline, and decreased physical and mental quality of life (Musich, et al, 2015). There are 490,000 adult and older adult family caregivers in San Diego County, over 50% provide to individuals with Alzheimer's disease or related dementias. Data from Southern Caregiver Resource Centers demonstrates that between January 1, 2023 – September 30, 2025, family caregivers reported the following:
• 33% experienced clinical depression using the Patient Health Questionnaire 9-item (PHQ-9) screening tool.
• 13% experienced moderate to severe depressive symptoms.
• 18% experienced significant loneliness and isolation using the Caregiver UCLA Loneliness 3-Item Scale.
• 24% experienced high caregiver burden scores using the Caregiver Zarit Burden Scale.

The IP does not include any programs that address the serious mental health needs of family caregivers that are needed to keep adults and older adults with dementia safe and out of institutions. Southern Caregiver Resource Center offers several evidence-based programs, including Caregiver TLC: Thrive, Learn & Connect (CG TLC), Cuidando Juntos, and CALMA which have demonstrated to significantly reduce depression, caregiver burden, and loneliness through social connection, and improve overall health and mental health among family caregivers. Southern Caregiver Resource Center's programs have need terminated by SDCBHS effective 6/30/2026 and should be reinstated.

For populations 65+, are you evaluating other mental health conditions such as dementia during admission and/or discharge? Roughly 10% of population 65+ suffer from dementia (80% caused by Alzheimer's disease). Psychosis is common symptom of dementia. Family caregivers should be identified upon discharge. There is no mention of dementia (which is a mental health diagnosis) in the plan. County needs to partner with organizations like Southern Caregiver Resource Center to decrease ER admissions and help individuals transition back into the community.

The criteria for adults and older adults seem to be more in line with issues/concerns for "adults". It would be helpful to see the data under the criteria separated by age ranges.

While this data is incredibly important, it reinforces the suggestion that age-data must be disaggregated, because young children are not captured in acute care statistics like this, and we are capturing no equivalent for them in another system of care. The case is also made with all of the above listed data that there is an overemphasis on crisis and acute care over preventative or care in the mild to moderate range. Investments in those preventative spaces can help keep a child, youth, or TAY from escalating to a crisis further along in their life, but if we are not capturing that data, we have no baseline of how we are meeting those needs or what the jump from mild/moderate to crisis services is.

You should identify the age range for adults and for older adults. There are mental health conditions that are more prominent among older adults such as depression, dementia and the negative mental health associated with isolation and loneliness, especially among older adult family caregivers.

It is not adequate to lump 'under 21' all together as an age range. In doing so, not only are the needs and services of young children completely lost in the data, but it also tends to capture only acute and crisis care, rather than preventative measures and overall behavioral health. Ideally, this would include disaggregated data for ages: 0-5; 6-12; 13-18; and 19-26. (A baby step in this could be starting with 0-5, 6-18, and 19+.) Disaggregating the data would more accurately capture the age-specific services, and deficit of services, within each of these nuanced and different periods of life. For example, the diagnosis and treatment of a 3-year-old, even in crisis, looks dramatically different than that of a 20 or even 13-year-old. Considering younger children requires that we include an entirely new and different set of systems for data gathering, and that requires cross-department and cross-community collaboration. This must be done to ensure that we are, in fact, considering and serving all San Diegans and not shirking a responsibility to serve young children, kids, youth, and transition-age youth simply because it falls outside of data that's been captured and what's been done, historically.

Page 1 - I did a word search for subjects that are important to me and found that these subjects don’t exist in your plan: patient rights and patient advocacy.

I won’t presume that you did not touch on those subjects because it has been difficult to navigate through this document.

What I would like to do is explain why those topics are just as important as any you will address.

1) First, I am aware that this is an area of concern for the county. If we do not address the loss of liberty of individuals who sometimes cannot speak for themselves, it appears that it still remains a secret and contributes to the continuing stigma of mental health in our society.

2) You will find the following all present in every hospital in this county: trauma, stigma, and even abuse. The degree varies among hospitals and types of patients. The patients that are able to speak up for themselves in what staff members consider a socially appropriate way may be treated fine. However, patients tell me, and I have seen, patients who demand their liberty or communicate with emotions, are “agitated” or annoying, will often be treated poorly, especially if they are refusing medication. Medieval tactics are still used in hospitals, often before alternative means are attempted. Forced injections of medication, where patients underwear of often forceful pulled down, physical restraint by holding and mechanical restraints, painful 4-point restraints holding someone down with the purpose of helping them calm down? Seclusion - a cruel form of punishment where a patient is not allowed to leave a room and is not sure when they will be. Supposedly another way to “help” them calm down.

These methods are not supposed to be used unless a person is in immediate danger of harming themselves or others. Unfortunately, these “tools” are also used to quiet someone who is “agitated” or to punish someone who has attempted to elope. This has been testified to in multiple legal hearings.

I am hopeful that universal recovery education for staff will help these facilities to treat their patients in a humane manner, as other methods appear not to have made much of an impact.

I also think County BHS should focus more on the people languishing in long-term locked facilities. Some have been there for years. It is truly a crime to keep people locked up when the have done nothing wrong except experience an illness.

State laws have served to support this inhumane deprivation of rights, but our County should aim to brainstorm alternative methods that give people the care they need and preserve their dignity and freedom. When someone is “physically” ill, they are treated warmly and given special treatment. They are given a comfortable adjustable bed and their own phone and TV, as well as bedside service.. When they are “mentally” ill they are basically arrested, forcefully put in handcuffs and given a room with basically a flat Vinyl mat. I could go on, but it’s exhausting.

Finally, when I mentioned the police treatment, that should make it clear how important the MCRT is for transportation. I am aware that the state is attempting to remove funding and behavioral health directors have rightfully advocated against it.

Community Engagement - when hospitals are asked for their opinions, peers should be asked to comment and both be able to answer the same questions, if applicable, and comment on the hospital staff’s opinions.

In addition, when you have a group of peers to interview, they should also be asked to comment on how services impact them from a cultural perspective.

When school-aged children and youth consistently identify the need for school-based services, especially with the stress and fear of ICE destroying families, BHS needs to provide adequate resources asap. Families are afraid to leave the home and going to therapy is not something they are able to do. Offering support in the school setting goes hand in hand with the MCRT School Pilot

“Peer Respite” should be termed “Peer-Run Respite.” The accepted model is that the houses should be owned and operated by a peer-run organization.

Community planning - public comment period.

1) Public comment should be 60 days. This will allow for input sessions that are not just giving feedback, but helping to build the plan. We helped to host some input sessions but they end up being so general as not to make a difference. 60 days would allow peers to educate themselves and. E educated about the current plan. Then, the engagement sessions could focus on various section of the plan so that input is more specific and helpful when amendments are needed.

2) Finally, unfortunately the plan was hard to handle. I can’t speak to how it works on a desktop or laptop computer, but I’ve heard it is still difficult. I am currently using the both the pdf and the unwieldy engage website that collects comments. There are no page numbers on either. In addition, as I toggle back and forth, I lose the page I am on and it’s frustrating. I have a feeling that most people in the community are trying to use their phones too. I just thought these notes might be helpful.

P. 150 Full Service Partnerships. Comments from peers over the years. My case manager doesn’t call me back. Certified Peer Support Specialists need to be incorporated more. I don’t know enough about them to give more in-depth input. However, I think there should be peer supporters hired to connect peers directly to these services, to help navigate the community from a recovery perspective. FSPs should attract peers, not police them. They should be so good that they take the place of both inpatient and outpatient care.

P 140 or near - workforce education.

Much needs to be accomplished in this area. First, I didn’t see reference to certified peer support specialists, though I hope that comes later in the plan.

1) First, there are many certified peers looking for employment - some full-time, some part-time. What I hear from peers seeking part-time, they want to remain secure that they will not lose access to social security if they need it. I am getting the impression also that they want to protect their mental health. To this end, I am hearing that “peer support for peer supporters” is also a need. Besides training for certified peer support specialists (which is high quality) we need just as high quality training and preparation for those who will be working with them. Professional peer support is specific. It is professional but not clinical. I fear those supervising or working with peer specialists will either diminish their capacity or expect them to complete clinical tasks. They are needed in high numbers in hospitals. On the milieu of a hospital unit, professionals are not outreaching much to the patients. Most nurses do not spend much time talking to the patients but instead stay in the nurses’ station and are often irritated when patients know on the door or the glass to get their attention. It would be as wrong for a CPSS to simply take on the role of a mental health worker or to take on the role of a social worker. So, training for these other workers, including doctors, is essential.

2) Staying on the topic of training… what would considerably improve the performance of doctors, nurses and social workers is recovery-oriented training. Hospitals are based solely on the medical model (despite what you may hear). This sole focus has been detrimental to patients If professionals view patients as diseased and deficient, the patients are more likely to be vulnerable to mistreatment and even abuse when they resist the medical model, including medication.

If there is mandatory training on recovery methods, patients will feel valued, more supportive activities will provided, it is more likely that the negative effects of stigma will be addressed and people will be more likely to want to care for their own conditions

P. 131 - first psychosis program. Where do you do the outreach. There are many who are hospitalized for first psychosis and should be provided with information and referred to the program through their doctor and social workers. While I’m commenting on this type of coordination, I believe that for those who are already connected with outpatient care, there should be training or something that would direct the doctor to connect with a patient’s outpatient doctor after asking a patient’s permission

This comment is for page 112 - Early Intervention.. while I feel it is important to direct prevention and early intervention toward children and youth, I think it is essential to recognize that adults, too, are helped by these services. Many times they come in the form of recovery services. This is true even for people who have been hospitalized - to prevent relapse.

A comment from the peer perspective on p. 53 ff re community planning process. I saw this process expanding and improving toward the end of 2025 and the first quarter of 2026.

General comments on CCP: 1) make sure it is interactive. When people give their input, let them know it has been considered and what has become of it. Let them know how many others also agree with them and what will be done about it. 2) Consider peer comments with extra weight. Lived experiences is a reality. And “the customer is always right” in the sense that you want to make them happy. The state is not actually your boss, it is the people you serve. 3) peer involvement at the level of developing plans but also informing the community planning process. Peers heard from a county employee at a peer council meeting that it was their public discussion of peer respite houses (mainly for short term living for crisis prevention), yet no one from County BHS approached to peers to find out more information and ideas for implementation. As a result, the peers heard that County BHS planned to include peer respite in their new campus. Again, nothing was mentioned to peers, for example peers being able to connect the County to people who do this in other counties and to direct them to the model for doing this. 4) a wider reach - TV/radio. 5) return to councils that report directly to the BH Director and not funneled through an organization that serves as a gatekeeper rather than a conduit and prohibits any kind of advocacy. Have councils for youth outside of school hours and outreach doctor to them. Try youth mental health orgs. When I participated as a visitor to the child and TAY councils. There were no youth involved. 6) Going back to 1 - I participated in 3 UCSD intentions and had no idea where that input went.

The comment relates to social connection at approx p 51. Social connection is extremely important. One type of program effective for this where County BHS can help is clubhouses. A clubhouse model that woukd be most effective would be peer run, with certified peer support specialists. There could be some organization around informal voluntary groups, communal preparation of meals and times to socialize and relax. Unfortunately, there is a new model being touted as the way to go - it the type with the “work order day”. Doe that sound like a clubhouse you woukd like to belong to? One that would be conducive to a peer recovery setting and social connection. Instead it belongs in workforce and development, a place where peers could also decide to spend their time and then head off to the clubhouse for social connection and the formation of friendships with people also engaging in the recovery process.

I think it’s a good idea to call things what they are. If the intention is a clubhouse, it should be peer/member run and contain the activities that those members want to engage in. If it operates within a framework of helping peers to be productive through assigned tasks to prepare for entering the workhouse, it should be made something else. Something more akin to employment prep, etc.

My first comment is of the state process in general. It is based on an erroneous premise. That is that carried out by SB 43 - increasing the ability to involuntarily detain and commit people to locked inpatient services will be for the better good of local communities and will be an improvement in mental health care.

This is wrong headed and also based on politicians wanting to “clean up” areas where unhoused people are visible. Any further efforts based on this flawed purpose may also unfortunately be flawed.

The state and our county need to listen to peers as has finally started to happen at the end of 2025 and the first 4 months of 2026. I hope you will take in the comments of peers and let them help you design programs and services that they know will help them.

It’s going to be difficult in this new structure presented by the state because there buckets of funding don’t necessarily mirror the needs of the county.

I will do my best through my review of this document to see how the priorities of peers can fit into what appears to be a fairly rigid structure. However I am heartened by what I had heard - that sine percentages on the community services side may be increased.

Part Time Professional positions should be considered. There are skilled professionals that are specifically interested in Part Time work.

Disparities in older adult behavioral health are documented throughout this draft across many domains (DMC-ODS, SMHS, FUM, homeless service access, etc); and community engagement has extensively detailed how important it is to not only continue those services that have been provided in the past but to augment them. (see Caregiver Coalition provides detailed examples of how and why, p.292-293 and Affordable and supportive housing is needed for older adults with complex BH needs p.305-306, etc.)
YET
there is not a single dollar in the budget that I can find that is specifically allotted to older adults (All 21 year old plus are effectively grouped together). I highly recommend that we be intentional about budgeting and planning to serve the unique needs of older adults, which is the fastest growing demographic in San Diego and fastest growing segment of our homeless population. It will be much more efficient to do this proactively than reactively.

Plan states that engagement with older adult stakeholders “will be utilized to develop the services” though there is no specific Housing Intervention programming for older adults

This is one of the most substantive older adult-specific passages as it describes incorporating older adult needs into FSP development through data analysis, stakeholder engagement, and FSP service design with caregiver support.
- This is descriptive of a planning process but it doesn’t specify any services, dollars, or targets for older adults within FSP. My patients have previously depended on many of these service providers (the community engagement and input sections talking about these various programs, which can be life-altering and life-saving, are important)