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Agenda Report
March 13,2023
TO: City Council
FROM: Mayor Victor M. Gordo
SUBJECT: PARTNERSHIP WITH THE COUNTY OF LOS ANGELES TO EXPAND
ESSENTIAL HEALTHCARE AND MENTAL HEALTH SERVICES IN THE
CITY OF PASADENA
It is recommended that the City Council:
1. Find that the proposed action is not a project subject to the California Environmental Quality Act (CEQA) pursuant to Section 21065 of CEQA and Sections 15060 (c)(2), 15060 (c)(3), and 15378 of the State CEQA Guidelines and, as such, no environmental document pursuant to CEQA is required for the project; and
2. Direct the City Manager to work with Los Angeles County to explore the feasibility of identifying appropriate properties in the City of Pasadena for possible co-location and joint occupation for purposes of expanding essential healthcare and mental health outpatient services in the City.
BACKGROUND:
As one of three cities in the State of California with its own Health Department, and one of a small number of cities in the State with a continuum of care, the City of Pasadena has played a unique role in advancing public health services in our community.
Notwithstanding its investment in public health, every demographic across our City, including north Pasadena, continues to experience acute challenges associated with access to healthcare, mental health services, and homeless services.
It is important to keep in mind that while Pasadena has its own Public Health Department, the Department's legal health jurisdiction emanates from state statute and does not extend to mental health services. The legal jurisdiction and responsibility to provide those services falls to the Los Angeles County Department of Mental Health (LACDMH).
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MEETING OF.
03/13/2023
AGENDA ITEM NO,
A
Partnership with LA County to Expand Essential hlealthcare and Mental hlealth Services in Pasadena March 13, 2023
Pre-COVID-19, vast numbers in our community were already struggling with access to health and mental health services. The COVID-19 pandemic has exacerbated physical and mental health issues experienced by members of our community—and we must recognize the effect it has had on the mental health of those most vulnerable, including children and seniors, and act to directly address these issues.
As the pandemic was unfolding and our community's health and mental health needs grew, I engaged Dr. Lori Morgan, CEO of Huntington Hospital for assistance. I learned from Dr. Morgan that Huntington Hospital provides inpatient services, but outpatient services and coordinated health and mental health services are significantly lacking, if not non-existent. Dr. Morgan set in motion my reaching out to Dr. Jonathan Sherin, then-Director of LACDMH.
After several one-on-one conversations with Dr. Sherin, you will recall that on May 2, 2022, I asked him to brief the City Council and our community on the status of mental health services available to our residents.
I also requested Dr. Sherin discuss the LACDMH's May 2021 published report which identified neighborhoods in northern Pasadena as "high priority" for additional primary care services, as well as LACDMH's approach to adding or augmenting available mental health services.
In presenting to the City Council, Dr. Sherin also made clear the following three systemic impediments:
1. Mental health services fall within the jurisdiction of and are funded by and provided by LACDMH;
2. Health services, including addiction issues, fall within the jurisdiction of and are provided by the Department of Health Services (DHS) and, astonishingly;
3. When an individual presents with both a mental and health challenge (dual diagnosis), the LACDMH is only funded and authorized to treat the "mental health" challenges of the individual and is prohibited from and not funded to treat the "addiction challenges" of the individual. Instead of providing comprehensive services, patients bounce from one clinic to another as they seek treatment for health and mental health challenges. Often these clinics are on separate ends of the County. This silo approach to treating persons with a dual diagnosis highlights a broken system—health and mental health providers are forced to refer dual diagnosis patients (e.g. mental health and addiction challenges) to the DHS for services to treat physical health challenges, including addiction, and to a separate system—LACDMH—for treatment of mental health challenges. Most often, these services are provided tens of miles away from one another.
Partnership with LA County to Expand Essential Healthcare and Mental Health Services in Pasadena March 13, 2023
At that meeting, Dr. Sherin made clear to the City Council the need to fix the system by allowing for comprehensive treatment of both mental and physical health challenges of individuals who present with dual diagnosis—and doing so at one location—thereby eliminating the need for persons to go from clinic to clinic. Dr. Sherin also made clear his commitment to partnering with us to assist Pasadena to lead and pilot such a model.
Like so many others, I walked away from Dr. Sherin's presentation convinced that for Pasadena to meet its commitment to strengthening mental and behavioral health services for all Pasadena residents, particularly those that are most vulnerable, we would need to learn from Dr. Sherin, take up his challenge, engage partners to help us, think differently and creatively, and then be prepared to act boldly.
Importantly, the presentation by Dr. Sherin made clear to me that we must partner with Los Angeles County to ensure we operate within the state jurisdictional statutes and gain access to funding.
In early summer 2022, I invited Supen/isor Barger, Dr. Lori Morgan, Jane Haderlein, and initially Interim City Manager Cynthia Kurtz—followed by City Manager Miguel Marquez—to form a working group to discuss mental health sen/ices provided by Huntington Hospital, community partners, and the LACDMH. At the time, Councilmembers Tyron Hampton, Felicia Williams (now Vice Mayor) and our former colleague John J. Kennedy volunteered to participate in the effort, and have provided tremendous feedback, guidance and assistance. Since joining the City Council, Councilmember Jones has provided key and instrumental insight.
Over the past year, there have been several meetings consisting of members of this working group. One of the lessons learned from our meetings is the desperate need for mental health workers and clinicians in the State of California and County of Los Angeles, and the desperate shortage—even before the pandemic—for more mental health professionals and clinicians. For example, according to CalMatters1:
"A report published by the University of California, San Francisco, in 2018 - even before the pandemic sent need skyrocketing - predicted that by 2028, demand for psychologists and other therapists would be 40% more than supply. For kids, the shortage is especially dire. Close to a third of California's 58 counties have no child and adolescent psychiatrists at all, according to the American Academy of Child & Adolescent Psychiatry."
Given this information, it became clear that improving the delivery of mental health and health services requires working into this effort the attracting, recruiting, and educating of more mental and health professionals.
With that goal in mind, I invited Fuller Seminary President David Goatley, and the Dean of Fuller School of Psychology Dr. Ted Cosse to join our effort and advise how we might increase the number of students Fuller School of Psychology prepares to join the Partnership with LA County to Expand Essential Healthcare and Mental Health Services in Pasadena March 13,2023
mental health workforce—and maybe even grow the School of Psychology with tuition reimbursement from the County in exchange for a commitment to meet the needs of our community. Already the Fuller School of Psychology educates 300 professionals annually.
Furthermore, Pacific Oaks College educates upwards of 255 mental health and social work professionals annually right here in Pasadena. I have been in contact with Pacific Oaks President Dr. Jack Paduntin and Vice President of Academic Affairs Dr. Bree Cook and invited them to participate as a potential resource for preparing and educating mental health workers, and they enthusiastically agreed that Pacific Oaks College would participate in our effort.
In short, we have established a working group that now seeks to establish a unique partnership and model that brings together academia (the Fuller School of Psychology and Pacific Oaks College), our private hospital (HMH), the County of Los Angeles, and the Office Supervisor Barger—and with adoption of the motion now before the City Council—I am asking that we direct our City Manager and his staff to formally partner with the County to explore a joint venture that would meet a critical community need, including identification of suitable properties within the City of Pasadena that could be the home for this collaborative opportunity and comprehensive approach—at one location.
Immediately following our most recent working group meeting this past Thursday, March 2, 2023, Supervisor Barger asked me to assist her in Grafting a motion to put before the Board of Supen/isors at its March 7, 2023 meeting (see attached motion).
On March 7, 2023, Supervisor Barger presented the motion, and I attended the Los Angeles County Bord of Supervisors meeting to urge the Board of Supervisors to approve the motion brought forth by Supervisor Barger.
The now adopted motion directs the County of Los Angeles to explore and dream with us a better service delivery model for co-located health and mental health services. It also seeks to address the acute challenges experienced across Pasadena and, particularly, north Pasadena regarding access to health and mental health services, the need for additional primary care services, and the growing need for additional outpatient mental health services in Pasadena.
As a result, I am pleased to report that at its meeting on March 7, 2023 meeting, the Los Angeles County Board of Supervisors expressed strong support and enthusiastically and unanimously approved the attached motion by Supervisor Kathryn Barger to partner with the City of Pasadena to explore the expansion of health and mental health services, and:
• Direct the Chief Executive Office, in conjunction with the Departments of Mental Health, Health Services, and Public Health, to work with the City of Pasadena and its Public Health Director to explore the feasibility of identifying Partnership with LA County to Expand Essential hlealthcare and Mental Health Services in Pasadena March 13, 2023
appropriate properties in the City of Pasadena for possible co-location and joint occupation for purposes of health outpatient services and housing. • Authorize the Chief Executive Office to send a letter of interest for any identified properties for possible acquisition.
• Direct the Chief Executive Office in conjunction with the Departments of Mental Health, hiealth Services, and Public Health to develop a funding plan based on the scope, plans and budgets developed for acquisition, capital costs, and operations of the property for outpatient services and housing and return to this Board for authority to proceed with acquisition of any property needed to comply with this motion.
I look forward to our City working with the County on exploring a joint venture that would meet a critical need for health outpatient services and housing in our community. The model to be explored includes Huntington Hospital, Los Angeles County Department of Mental Health, Los Angeles County Department of Health Services, the CEO of Los Angeles County, and our respective private providers.
Moreover, this partnership will include the Fuller School of Psychology, Pacific Oaks College and all other academic institutions whose mission it is to prepare people to help those with mental and health challenges to join our partnership. The Fuller School of Psychology, which annually educates and prepares 300 students as clinicians, and Pacific Oaks, which educates 255 health and mental health professionals, are right here in Pasadena and could provide the desperately needed mental health workforce needed by the County to address the need for more services in Pasadena.
Colleagues, I now ask that we adopt a similar action and direct our City Manager to work with the County CEO, the County Department of Health Services, and the County Department of Mental Health Services to explore and think creatively and deliberately with the goal of augmenting and improving the delivery of mental health and health services to all residents of Pasadena—let's act, and act creatively and boldly.
COUNCIL POLICY CONSIDERATIOJl:
This action supports the City Council's strategic planning goal to support and promote quality of life, and ensure public safety and public health.
ENVIRONMENTAL ANALYSIS:
Since this action is not a project subject to CEQA, no environmental document is required.
Partnership with LA County to Expand Essential hlealthcare and Mental Health Services in Pasadena March 13,2023
FISCAL IMPACT
There is no fiscal impact at this time.
Respectfully submitted,
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VICTOR M:GORtlO
Mayor
Partnership with LA County to Expand Essential Healthcare and Mental Health Services in Pasadena March 13, 2023
REFERENCE:
1. Coffman, J., Bates, T., Geyn, I., and Spetz, J. California's Current and Future Behavioral Health Workforce, Healthforce Center at UCSF, February 12, 2018. httDs://healthforce.ucsf.edu/sites/healthforce.ucsf.edu/files/Dublication- Ddf/California%E2%80%99s%20Current%20and%20Future%2QBehayioral%20Health% 20Workforce.Ddf
Partnership with LA County to Expand Essential Healthcare and Mental hlealth Services in Pasadena March 13, 2023
MOTION BY SUPERVISOR KATHRYN BARGERMARCH 7, 2023
PARTNERSHIP WITH THE CITY OF PASADENA TO EXPAND ESSENTIAL
HEALTHCARE AND MENTAL HEALTH SERVICES
The Board of Supervisors has made significant investments to increase access to primary care and mental health services across Los Angeles County (County). Subsequently, County Health Departments have made great strides in ensuring all communities have equitable access to these resources. This effort has been in tandem with the priority to ensure our homeless and housing resources are accompanied by necessary healthcare services.
The City of Pasadena (City) has engaged in this effort and, being one of the only cities in Los Angeles County with their own public health department and continuum of care, they played a unique role in advancing these services in their community. The area of north Pasadena has experienced acute challenges with access to healthcare and homeless services. In May 2021, the Department of Health Services published a report that identified the neighborhoods in northern Pasadena as "high priority" for additional primary care services. There is also a growing need for additional outpatient mental health services in this community as well.
Given the high-need nature of the area, it would be appropriate for the County and City to explore a joint venture that would meet a critical community need, including identification of suitable properties within the City of Pasadena that could be the home for this collaborative opportunity.
I, THEREFORE, MOVE THAT THE BOARD OF SUPERVISORS:
1. Find that approval of these proposed actions, is not subject to California Environmental Quality Act (CEQA) pursuant to CEQA Guidelines Sections 15061(b)(3) and 15378 because the actions do not commit the County to a project and will not have the potential for causing a significant effect on the environment.
2. Direct the Chief Executive Office, in conjunction with the Departments of Mental Health, Health Services, and Public Health, to work with the City of Pasadena and its Public Health Director to explore the feasibility of identifying appropriate properties in the City of Pasadena for possible co-location and joint occupation for purposes of health outpatient services and housing.
3. Authorize the Chief Executive Office to send a letter of interest for any identified properties for possible acquisition.
4. Direct the Chief Executive Office in conjunction with the Departments of Mental Health, Health Services, and Public Health to develop a funding plan based on the scope, plans, and budgets developed for acquisition, capital costs, and operations of the property for outpatient services and housing and return to this Board for authority to proceed with acquisition of any property needed to comply with this motion.