City Council
Report
City Council Meeting: February 25, 2025
Agenda Item: 11.B
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To: Mayor and City Council
From: Heather Averick, Director, Housing and Human Services Department Subject: Approval of First Modification to Contracts with Social Emotional Wellness Initiative, St. Joseph Center and Family Service of Santa Monica for Behavioral Health Strategy – Adult Crisis and Step-Down Services and Youth Behavioral Health Programming Recommendations
Recommended Action
Staff recommends that the City Council:
1. Receive reports: Adult Crisis & Children and Youth Behavioral Health Care Study and the Strengthening the System of Intensive Behavioral Healthcare Services for Adults in Santa Monica and Service Planning Area 5.
2. Adopt and approve Transitional Approach 3 – Decentralized Expansion from the Strengthening the System of Intensive Behavioral Healthcare Services for Adults in Santa Monica and Service Planning Area 5 report to build out behavioral health services locally.
3. Authorize the City Manager to negotiate and execute a first modification to agreement #11439 in the amount of $400,000 with Social Emotional Wellness Initiative to provide behavioral health support for children and youth in the City’s after school programs (Police Activities League (PAL), CREST, and Virginia Avenue Park (VAP)).This will result in a four-year amended agreement with a new total amount not to exceed $995,194, with future funding contingent upon Council budget approval.
4. Authorize the City Manager to negotiate and execute a first modification to agreement #11440 in the amount of $388,254 with St. Joseph Center to expand the capacity of behavioral health services for youth ages 10-24 enrolled in the Youth Resource Team (YRT) program. This will result in a four-year amended agreement with a new total amount not to exceed $6,907,777, with future funding contingent upon Council budget approval.
5. Authorize the City Manager to negotiate and execute a first modification to agreement #11431 in the amount of $900,000 with Family Service of Santa Monica to increase the capacity of behavioral health services available to children birth – 5
th grade and to expand substance use treatment services for middle and high school-aged youth. This will result in a four-year amended 2 of 15
agreement with a new total amount not to exceed $3,617,970, with future funding contingent upon Council budget approval.
6. Adopt a finding of no possibility of significant effect pursuant to Section 15061(b)(3) (Common Sense Exemption) of the California Environmental Quality Act (CEQA) Guidelines.
Executive Summary
Behavioral health refers to the connection between our behavior, mental wellbeing, and physical health and can include mental health conditions, substance use disorders, suicidal thoughts and behaviors, and life stressors. In recent years, Santa Monica, and Los Angeles (L.A.) County, has experienced a rise in behavioral health concerns, an increased demand for services, and staffing challenges due to the national behavioral health workforce shortage. Recognizing that there are significant gaps in the system of care, and that behavioral health is essential to the community’s overall health and wellbeing, the City pursued the development of a behavioral health strategy.
In late 2022, Council approved a contract with Initium Health (Initium) to conduct a comprehensive community engagement process to understand the key behavioral health needs in Santa Monica and assess the feasibility of developing a behavioral health crisis facility. Stakeholders identified significant gaps in adult crisis care and children and youth behavioral health care, and community feedback and research on best practices informed recommendations to enhance services in these areas. The Adult Crisis & Children and Youth Behavioral Health Care Study (Attachment A) outlines these key findings and recommendations.
Following Initium’s work, the City entered into a contract with Capstone Solutions Consulting Group (Capstone) to assess gaps in adult intensive behavioral health services (i.e., intensive outpatient treatment, substance use disorder (SUD) residential treatment, crisis services, intensive treatment services) in Santa Monica and across Service Planning Area (SPA) 5 and provide recommendations to develop and expand services. The Strengthening the System of Intensive Behavioral Healthcare Services for Adults in Santa Monica and Service Planning Area 5 (Attachment B) report identifies services that do not exist in SPA 5, services that exist but with insufficient capacity, and recommendations to expand adult intensive behavioral health services. 3 of 15
Staff recommend that City Council adopt and approve Transitional Approach 3 – Decentralized Expansion to build out behavioral health services locally, receive the Adult Crisis & Children and Youth Behavioral Health Care Study and the Strengthening the System of Intensive Behavioral Healthcare Services for Adults in Santa Monica and Service Planning Area 5 reports, and authorize the City Manager to negotiate and execute contract modifications to expand children and youth behavioral health services.
Background
Santa Monica has experienced a rise in behavioral health concerns in recent years – including mental health and substance use – mirroring trends in L.A. County and across the country. Historic events including the COVID-19 pandemic, the housing and homelessness crises, and distance learning for students have exacerbated existing behavioral health challenges. This has led to a growing demand for services. The impact of the recent Palisades Fire may be felt for years to come, as residents in mandatory evacuation areas relocate and local schools are impacted. Dealing with this tragedy is certain to put a strain on already limited resources. While some mental health and substance use services exist in Santa Monica and across SPA 5 (a geographic region including Malibu, Culver City, Beverly Hills, Marina del Rey, Venice, and West L.A.), they have not kept up with the increased need, resulting in untreated behavioral health challenges. This is particularly true for vulnerable populations, including people who are uninsured or under-insured, individuals experiencing homelessness, seniors, people with disabilities, and children and youth.
Providing access to behavioral healthcare is a core component in Council priorities of both addressing homelessness and maintaining clean and safe public spaces. While behavioral health is one of the Four Pillars of the Council-adopted strategy to address homelessness, both housed and unhoused Santa Monicans alike suffer from significant rates of behavioral health concerns. In response to these unmet needs, Council directed staff to explore options and determine feasibility for developing a coordinated behavioral health response.
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The City of Santa Monica engaged with Initium, which found significant gaps in adult crisis care and recommended expanding services, increasing awareness of existing services, and developing a behavioral health center focused on short-term crisis care.
Additionally, Initium found gaps in behavioral health services for children and youth across the continuum of care, including prevention and early intervention, crisis, and treatment and recovery services. The report recommended expanding and developing a variety of services for children and youth to address these unmet needs.
Initium’s study focused on all populations and all levels of behavioral health care. The community engagement process identified adult crisis care and step-down services (i.e., the services people engage with following a crisis) and youth behavioral health care as the most pressing needs in Santa Monica. Adult crisis care is particularly relevant for people experiencing unsheltered homelessness. Staff has identified partnership and funding opportunities that can immediately advance implementation of Initium’s recommendations to expand adult crisis care and youth behavioral health services.
Following completion of Initium’s study, the City contracted with Capstone to examine options for expanding services locally and across SPA 5. Capstone used data from local providers to assess gaps in intensive mental health and substance use programs as well as related step-down services in Santa Monica and across SPA 5 and provided recommendations for expansion of services.
Past Council Actions
Meeting Date Description
09/13/2022
(Attachment C)
Original bid to Initium Health for the development of a behavioral health strategy
Discussion
Adult Crisis and Step-Down Services
Assessment of Adult Crisis and Step-Down Services in SPA 5 Behavioral health systems in most communities are complex, fragmented, and piecemeal. Individuals in L.A. County voluntarily seeking care - or who are mandated 5 of 15
assistance - are met with an array of behavioral health providers (both private and public, non-profit and for-profit) that are difficult to navigate. These individuals are often required to move between multiple providers and systems to access the services necessary to meet their needs. All too often, especially in the case of highly vulnerable populations, patients encounter barriers. There is no ‘one-stop shop’ for those experiencing a behavioral health crisis in Santa Monica or SPA 5. Just as a person who has surgery is guided from the operating room to the intensive care unit, to a hospital bed or outpatient care, so too must someone seeking urgent care for a behavioral health crisis then be directed to ‘step down’ services that can involve medical detox or interim housing with onsite support services.
The full array of crisis and step-down services can be found in Capstone’s report, (Attachment B). Examples of services include crisis stabilization centers, hospitalbased behavioral health programs, psychiatric health facilities, medically managed inpatient detoxification facilities, and step-down services may involve outpatient and field-based services, adult residential facilities, and SUD residential treatment programs.
Gaps and Needs
The report identified several key service gaps:
Services that DO NOT Exist in SPA 5
Sobering
Center
Safe, supportive
environments in
which individuals
who are publicly
intoxicated can stay
for up to 24 hours
to become sober as
an alternative to the
ER or jail.
In-Patient
Substance Use
Detoxification
Residential and
hospital-based
settings that
support clients in
reducing and
ceasing the use of
substances.
Behavioral Health
Recuperative
Care
Short-term bridge
housing for people
experiencing
homelessness that
have been
discharged after an
ER visit or hospital
stay.
Enriched
Residential
Services
Intensive, structured
programs serving
clients discharged
from long-term
psychiatric care
facilities (e.g.,
psychiatric
hospitals) who are
not ready to function
independently in the
community.
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Services that EXIST in SPA 5 but with Insufficient Capacity Mental Health
Urgent Care
Center (UCC)
Facilities that
provide up to 24
hours of crisis care,
including
intervention,
assessment,
evaluation,
collateral supports,
therapy, SUD
counseling, and
peer support.
Crisis Residential
Treatment
Program (CRTP)
Programs intended
to stabilize people
during a psychiatric
crisis and prevent
unnecessary
hospitalization by
providing shortterm (14-90 days)
intensive and
supportive services
in a homelike
environment.
Acute Hospitals
Locked, inpatient
psychiatric hospital
facilities that accept
voluntary and
involuntary patients
in order to stabilize
individuals during a
crisis, enhance
social rehabilitation
skills, and facilitate
community
reintegration.
Psychiatric Health
Facility (PHF)
Locked, inpatient
psychiatric
treatment facilities
that accept
involuntary
patients, provide
similar services to
acute hospitals,
and offer a
community-based
alternative to
hospital care.
Subacute Beds
Locked, long-term
care for individuals
who no longer meet
criteria for acute
care/hospitalization
but who are not
ready to live in an
ARF or
independently.
Adult Residential
Facility (ARF)
with Services
Facilities for
individuals who
require more care
and structure than
a typical residential
setting and
additional funding
to cover the cost of
other essential
services (e.g.,
support with
ambulatory issues).
Interim Housing
with Behavioral
Health Services
Housing and a
range of on-site or
accessible
behavioral health
supports to build
stability.
Residential SUD
Treatment
Short- and longterm (programs
vary from 30 to 120
days) treatment in a
residential setting
for people who
experience
significant
impairments due to
a SUD.
Considering these gaps, Capstone noted the following key findings:
• There is a gap in SUD services: There is a clear and pressing need for additional SUD programs at multiple levels, including detoxification, residential treatment, and medication assisted treatment.
• Many services are always at capacity: While it may appear SPA 5 contains many elements of a robust intensive behavioral health system, critical elements 7 of 15
of the system consistently operate at capacity, including UCC, CRTP, SUD residential treatment, and residential programs for individuals with mental illness. • There are several vulnerable populations with specific needs: Adults in acute behavioral health crisis and people experiencing homelessness in acute behavioral health crisis require slightly different services that do not exist or exist in limited supply.
• Clients fall through the cracks: The limitations imposed by a system that is frequently full combined with the lack of processes that ensure treatment transitions has resulted in a situation where many clients fail to receive the services needed.
Options for Expansion
Capstone identified several approaches to expand intensive behavioral health services in Santa Monica and SPA 5:
1. Transformational Approach 1 –Campus-Based Safe Landing Model This model is a free-standing campus focused on addressing the needs of individuals with acute behavioral health crises as well as those who experience episodically worsening conditions due to the chronic nature of their illness. Services include an expanded Mental Health UCC (available to walk-ins and those brought in by first responders and mobile teams, an onsite sobering center, detox beds, available pathways for transition into residential treatment (CRTP, special needs recuperative housing, and Enriched Residential Services), and co-location of a small satellite or linkage with a larger organization providing mental health services for individuals housed in interim housing or enriched residential facilities.
2. Transformational Approach 2 – Safe Landing +: Centralized Campus-Based Treatment Program
This model is similar to the model above but with more intense focus on the needs of unhoused individuals. Services include 24/7 intake and evaluation services with medication support, interim housing with behavioral health support, limited recuperative services with linkage to primary care, medication support and 8 of 15
counseling, some sobering center components in the form of “sober coaches”, and, ideally, capacity to provide detox services.
3. Transitional Approach – Decentralized Expansion
This model does not rely on a single campus and instead builds out new services or expands existing services as opportunities become available. The primary focus and immediate need is expanding UCC beds. Other services to enhance as opportunities become available include medically managed detoxification, SUD residential treatment, mental health services, and special needs housing (i.e., bridge interim housing).
Next Steps to Expand Adult Crisis and Step-Down Services Significant resources and coordination between local cities, the County, and service providers are necessary to meaningfully enhance behavioral health services. City Council approval and adoption of Transitional Approach 3 – Decentralized Expansion to build out behavioral health services locally allows the City to expand and enhance services as opportunities become available. The City is already implementing the following strategies to substantively expand crisis and step-down services in Santa Monica and across the Westside:
• Therapeutic Transport Team (TTT) ($464,000): Since January 2024, Santa Monica first responders have access to a dedicated behavioral health team to better assist individuals in need of mental health care in the form of TTT. This program is a partnership between the City and the County Department of Mental Health (DMH), and will be extended through June 2026. The TTT is available five days a week to assist first responders with 911 and non-emergency calls for service for someone experiencing a mental health crisis. TTT can serve any adult, this program is part of Santa Monica’s push to collaborate with regional service providers for a coordinated, holistic approach to addressing homelessness and supporting other adults in crisis. Council can support expansion of TTT through advocacy with the County that includes:
o increasing TTT programming into the evening hours and weekends 9 of 15
o provide additional DMH clinicians to assist the Santa Monica Police Department’s Homeless Liaison Team (HLP)
• SaMo Bridge Program ($8 million): In the fall of 2024, the City Attorney’s Office, in partnership with Housing and Human Services and Santa Monica Police Department, was awarded $8 million in grant funding to create a diversion program focused on rehabilitation in place of incarceration. Starting in April, this ‘respite hub’ will build on the ongoing work to address homelessness and public safety by allowing law enforcement to direct low-level offenders to services and resources in lieu of the criminal justice system. In partnership with Exodus Recovery, Inc. (Exodus), adults will be able to enroll in a 90-day care coordination plan where resource navigators connect participants to regional resources that include behavioral health programming, including substance abuse treatment.
• Westside UCC Priority Placement ($400,000): The City is pursuing a partnership with Exodus to secure dedicated beds for Santa Monica at the soonto-be relocated Westside UCC. Four of the facility’s 16 beds would be prioritized for people from Santa Monica (i.e., if someone is brought to the facility from Santa Monica, they will have first access to four of the beds). This will be a significant resource given that the Westside UCC is the only facility of its kind on the Westside and is frequently at capacity. Capstone’s recommendation indicated that the City’s primary focus should be on expanding UCC beds. Staff is working on a Memorandum Of Understanding with Exodus to use Opioid Settlement Funds to secure four beds dedicated to Santa Monica clients. • Regional Behavioral Health Facility: Santa Monica is a member of the Westside Cities Council of Governments (WSCCOG) and is working closely with this group to support a Regional Behavioral Health Facility Implementation Strategy that would serve all adults, including people experiencing homelessness, and include crisis and step-down services. City staff have advised WSCCOG staff on the development of an advisory group, and shared learnings from our behavioral health study to closely inform this regional effort.
Staff is partnering with WSCCOG staff in the development of a Request for 10 of 15
Proposal to secure consultants to build upon the City’s work and provide recommendations regarding potential options for the development of a behavioral health center to serve SPA 5 (Attachment D). The City will support regional efforts that increase access to services for Santa Monica residents and priority populations, ensuring any funds contributed in the future by Santa Monica are also leveraged by neighboring jurisdictions.
• Advocacy for Safe Landing Site at the West LA Armory: The County is developing a Safe Landing site at the West LA Armory. They have stated this will be a pared down version of a traditional Safe Landing model and will include supportive interim housing, some medical care, and 24/7 triage beds. The City has continued to advocate expanding these services to include crisis stabilization and SUD treatment, which aligns with Transformational Approach 1. In addition to holding several meetings with County staff, the City of Santa Monica sent a letter to the County requesting they consider an enhanced Safe Landing model (Attachment E). City staff also presented to the WSCCOG Board on this effort, resulting in the member cities and Board sending letters to the County in support of expanded services.
• Behavioral Health Continuum Infrastructure Program (BHCIP) Round 2 Funding Opportunity: BHCIP is a program from the California Department of Health Care Services (DHCS) that awards funding to local jurisdictions to construct, acquire, and expand properties and invest in mobile crisis infrastructure related to behavioral health. DHCS anticipates that up to $1.1 billion dollars will be available in the next round and plans to release funding guidelines in 2025. Staff will monitor this program and apply for funds if there is an opportunity to expand local services and address the gaps in care identified in the approach Council adopts.
Youth Behavioral Health Services
Assessment of Behavioral Health Programming in Santa Monica for Youth 11 of 15
Local data shows gaps in services for the City’s youngest vulnerable population. There is current funding available to address urgent needs in the community’s youth system of care.
In 2012, spurred by the tragic events of a gang-related shooting that took the life of a teenager and a local high school student’s public death by suicide, the Santa Monica Cradle to Career initiative (led by the City) released the first Youth Wellbeing Report Card. As detailed in the Adult Crisis & Children and Youth Behavioral Health Care Study the latest report card data suggests that the proportion of students experiencing mental health challenges increases as they age. Twenty-five percent (25%) of 7th graders reported persistent feelings of hopelessness or sadness and 10% acknowledged contemplating suicide at some point in the past year. Among 11th graders, 38% reported persistent feelings of hopelessness or sadness and 15% acknowledged contemplating suicide at some point in the past year. Nationally, these numbers increase for LGBTQ+ youth and those involved in the juvenile justice system.
As noted in (Attachment A), Santa Monica Youth Wellbeing Report Card data shows that 40% of 11th graders reported having used an illicit alcohol or drug within 30 days of taking the California Healthy Kids Survey. Santa Monica youth are not immune to the dangers of illicit drug use. In 2022, three Santa Monica teens were hospitalized after they overdosed on ecstasy pills laced with fentanyl. The youth survived but the increased dangers of fentanyl-laced drugs persist. The Substance Abuse and Mental Health Services Administration reports that among adolescents aged 10-19, monthly drug overdose deaths increased nationwide by 182% from 2019-2021, and 84% of the fatalities involved illicitly manufactured fentanyl.
The City’s FY2023-27 Human Services Grants Program (HSGP) provides funding to multiple local nonprofit agencies to provide mental health intervention to Santa Monica youth. In addition, the City’s Phase II Development Agreement with Providence Saint John’s (PSJ) dictates that mental health providers from PSJ’s Child and Family Development Center continue youth services previously funded by the HSGP. However, 12 of 15
waitlists for currently funded mental health services persist, and the City did not receive any grant applications specific to treating youth substance abuse.
Next Steps to Expand Youth Behavioral Health Services
Initium’s Adult Crisis & Children and Youth Behavioral Health Care Study contains multiple recommendations for youth - from early childhood to early adulthood. Many will require significant resources not immediately available. However, staff recommend the following approaches to address youth behavioral health needs based on current need and available funds:
Youth Mental Health Specialists in City’s After School Programs ($400,000) Mental health support services available to children and youth at school sites do not currently extend to City-funded after-school programming (PAL, CREST, VAP). Afterschool program staff work with children and youth with a range of developmental and emotional challenges and require training and assistance to fully meet the needs of program participants. Support services will be individualized by site and could include group therapy, individual therapy, and staff consultation on managing challenging behaviors.
Recommendation: Increase program capacity by adding mental health services dedicated to after-school programming.
Agency to Operate Program: Social Emotional Wellness Initiative FY2025-27 Funding Request: $400,000 ($200,000 annually for two years) Funding Source: PSJ Phase II Development Agreement
Youth SUD Treatment ($400,000)
Currently no free services exist in Santa Monica to provide drug and alcohol treatment for youth. According to community experts, over 100 young adults are in immediate need of outpatient SUD treatment, and this number continues to grow.
Recommendation: Expand current services by funding additional specialized staff to provide youth substance use treatment services.
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Agency to Operate Program: Family Service of Santa Monica FY2025-27 Funding Request: $400,000 ($200,000 annually for two years) Funding Source: Opioid Settlement Funds (OSF)
Early Childhood Wellbeing Project (ECWP) Expansion ($500,000) The current ECWP program provides vital services to the City's most vulnerable children (birth – 5
th grade) and their families. The program consistently has a wait list.
Program expansion is needed to support local families with a range of challenges, which have grown to include housing retention, behavioral health support, crisis management and mitigation, immigration concerns, legal issues, and childcare needs.
Recommendation: Increase program staffing to expand caseload capacity from 30 to 100 children.
Agency Currently Operating Program: Family Service of Santa Monica FY2025-27 Funding Request: $500,000 ($250,000 annually for two years) Funding Source: PSJ Phase II Development Agreement
Youth Resource Team (YRT) Expansion ($388,254)
The current YRT program provides vital services to the City's most vulnerable youth (middle school through early adulthood) and their families. The program consistently has a wait list. To meet the growing demand for services, program expansion is needed.
The range of crises that youth have experienced in the last several years has created a significant need for intensive case management to support homelessness, behavioral health issues, substance abuse, crisis management and mitigation, immigration concerns, legal issues, childcare needs, etc.
Recommendation: Increase program staffing to expand caseload capacity from 100 to 150 youth.
Agency Currently Operating Program: St. Joseph Center
FY2025-27 Funding Request: $388,254 ($194,127 annually for two years) Funding Source: PSJ Phase II Development Agreement
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Environmental Review
The agreement modifications are exempt from CEQA pursuant to Section 15061(b)(3) of the CEQA Guidelines. The agreement modifications are covered by the commonsense exemption which states that CEQA does not apply, “where it can be seen with certainty that there is no possibility that the activity in question may have a significant effect on the environment.” The modified agreements will provide consulting services for fiscal and programmatic monitoring. Therefore, it can be seen with certainty that the agreements would not result in adverse physical impacts on the environment, and as such, is exempt from CEQA.
Financial Impacts and Budget Actions
Staff seeks authority to approve funding from the Special Revenue Source Fund, specifically the PSJ Phase II Development Agreement and the California Department of Health Care Services OSF, to modify the grant agreements listed below.
Agreement Modification Request
Agreement
/ Vendor Funding Source
Current
Authorized
Amount
(FY 2023-27)
Request
Amount *
(FY 2025-27) Account
Total
Revised
Contract
Amount
11439 -
SEWI
General Fund HSGP 595,194 01420006.556000.91930
995,194 Special Revenue
Source Fund PSJ 400,000 10420001.556100
11440 -
SJC
General Fund HSGP 3,111,250 01420006.556000.48053
6,907,977
3,408,473 01420006.556000.91931
Special Revenue
Source Fund PSJ 388,254 10420001.556100
11431 -
FSSM
General Fund HSGP 2,717,970 01420006.556000.48053
3,617,970 Special Revenue
Source Fund
PSJ 500,000 01420006.556000.91931
OSF 400,000 10420001.556000
TOTAL 9,832,887 1,688,254 11,521,141
* The amounts reflect the total amount for both fiscal years in the FY 2025-27 biennial.
Staff will incorporate any budget actions into the City’s FY 2025-27 Biennial Budget.
Funding for these programs beyond FY 2026-27 will be subject to a competitive process for the next cycle of the HSGP. All future year funding is contingent on Council budget approval.
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Prepared By: Natasha Kingscote, Administrator
Approved Forwarded to Council
Attachments:
A. Attachment A Initium Report Adult Crisis and Children and Youth Behavioral Health Care
B. Attachment B_Capstone Report_Strengthening the System of Intensive BH Services for Adults
C. September 13, 2022 Staff Report (Web Link)
D. Attachment D COG board notes
E. Attachment E_ Sup Horvath-BHS WLA Armory
F. Written Comments