County to pursue groundbreaking mental health training programs

With the approval of three new initiatives Tuesday, San Diego County is taking its first steps in addressing a mental health care worker shortage that is predicted to grow significantly over the next five years.

On a unanimous vote, county supervisors affirmed a new “workforce and retention program” which, if it receives state approval, would create a renewable training and tuition fund, an “upskilling” program for existing professionals and a loan forgiveness and “home ownership incentive” program for behavioral health specialists.

Finding ways to address the cost and availability of training to attract new workers, and to retain those already serving clients, was a significant recommendation of last year’s assessment of mental health care needs in San Diego County, though low wages and difficult working conditions were also large factors that remain unresolved.

Supervisor Terra Lawson-Remer emphasized Tuesday that the program is only part of the action necessary to truly come to grips with what the report estimates will be a shortage of 18,500 professionals by 2027.

“It’s imperative that these positions come with wages and benefits necessary for workers to really be able to make a living and make ends meet and for these to be sustainable jobs in the long term,” Lawson-Remer said. “I think this proposal is a step in the right direction but absolutely want to keep us really focused on long-term solutions which is increasing wages, increasing benefits and improving working conditions for folks that are serving our community in the behavioral health field.”

In October, the board directed county staff to return in 180 days with fleshed-out ideas about how pay might be increased, especially in some jobs that the workforce study indicated were among the worst-paid in the state. Psychiatrists, for example, had an average 75th percentile median wage of about $165,000 in San Diego County compared to a median of $329,385 among all Californian metropolitan areas. On the other side of the spectrum, psychiatric aides compensated in the 75th percentile — the point at which half made less and a quarter made more — were said to make about $31,000 annually compared to about $42,000 in metro areas statewide.

Though they have not abandoned the wage issue, supervisors also did not say Tuesday when they will be ready to discuss pay. Any significant movement should be visible in the county behavioral health department’s annual budget presentation later this month.

The three initiatives included in Tuesday’s approval would be submitted to the state Mental Health Services Oversight and Accountability Commission as a five-year innovation project. The commission oversees use of money that counties received from the Mental Health Services Act, which imposed a 1 percent state income tax for filers earning more than $1 million annually.

The pilot program would run from July 2024 through June 2029, expending about $75 million in county MHSA funds during that span. At about $15 million per year, the outlay would be a relatively small percentage of overall services act revenue, which totaled $251 million in the 2021-22 budget year, according to the county.

After five years, an outside evaluator would examine the program’s results and make recommendations on whether it reached its goals and should be continued.

Three initiatives inside the larger trial program include:

• An outcomes-based renewable training fund which would provide no-interest loans and upfront financing “to students completing behavioral health clinical training and supervision programs.” Students wouldn’t have to start paying these training loans back until they had a county job paying at least $50,000 per year. Staying on the job for five years or more would result in any remaining balance being forgiven. About 1,900 new workers are estimated to be hired through the program, which would spend about $4.6 million annually during the five-year period, according to a draft state application.
• An “upskilling” program would spend about the same amount annually on helping existing workers with the county or with county-contracted organizations earn licenses or certifications for a range of jobs such as community behavioral health worker, peer support specialist, substance abuse disorder counselor, licensed behavioral health clinician and psychiatric nurse. For some positions, the process will involve apprenticeship programs, offering scholarships as a way of helping to retain workers. About 750 workers are expected to participate.
• A tiered loan forgiveness and home ownership program would allocate about $2 million per year toward helping “establish an incentive for county staff to live and work in San Diego County.”

Details on all three initiatives are not fully fleshed out in the documents made public so far. Luke Bergmann, director of behavioral health services for the county, said this week that additional information, especially application processes and other critical details such as who will be eligible, will be specified if state approval is received.
“We want to make sure that the state is supportive of this,” Bergmann said.

As near as he could tell, the director added, using mental health services revenue to support workers would be a first.

“MHSA funding has traditionally been used to stand up small direct services programs,” Bergmann said. “It has not been used before to address workforce issues, certainly not at this scale.”