San Diego County budget would hike spending 10 percent, boost behavioral health services

A man and a woman wearing masks stand on a street corner offering items to a man in a sweatshirt.
Mobile crisis response team members offer assistance to a person in Oceanside on April 27, 2022. The county’s draft budget aims to expand the use of such teams, part of a broader investment in behavioral health care.
(Eduardo Contreras/The San Diego Union-Tribune)

The draft budget would add money for emergency treatment and staff up for the state’s CARE Court model for mandated mental health care.


San Diego County’s proposed $8.1 billion budget released Thursday would increase spending by 10 percent over last year, and add $67 million for behavioral health services.

The draft spending plan would boost mental health care and substance use treatment, fund an expansion of mobile crisis response teams and dedicate money to preparing for the county’s participation in a state program to mandate mental health treatment for some people with severe mental illness.

It would also hike public safety spending, hire more staff to fund safety-net programs such as CalWORKS, CalFresh and Medi-Cal, boost wages for home caregivers and add money to the county’s “innovative housing trust fund,” which bankrolls affordable housing production. And it would add nearly 500 staff positions, bringing the county’s total workforce to 20,337.

The proposed budget “addresses issues that are important to us all,” including “homelessness, building healthy and safe communities, investing in working families, mental health and substance use disorders, sustainability and justice reform,” Interim Chief Administrative Officer Helen Robbins-Meyer wrote in the executive summary.

This year’s draft plan reflects big funding boosts to the county’s Health and Human Services Agency, which would add 354 new staff positions and gain $377 million in spending — a 13.4 percent jump. Its biggest addition would be a $125 million hike for behavioral health services, including mental health care and substance use disorder treatment.

Of that, about $37.5 million would go toward shoring up basic services the county already provides through Medi-Cal — including therapy, medication, in-patient and residential services and addiction treatment, said Luke Bergmann, the county’s director of behavioral health.

The goal, he said, is “making sure that basic system is as good as we can be, is competitive for a scarce workforce, and ensures that we use recent evidence-based practices and best-care models.”

Other investments will expand on newer services that the county has launched in recent years, including mobile crisis response teams, which dispatch mental health clinicians, case managers and peer support specialists to respond to nonviolent mental health and substance use emergencies.

A new report says Mobile Crisis Response Teams have responded to nearly 3,600 calls since the program launched two years ago

The teams launched in North County in 2021 and were gradually expanded countywide. A nearly $11 million hike to crisis care would help boost the number of those response teams from 20 to 31 and add staff that reflect specific patient populations, such as younger people and different cultural communities, Bergmann said.

“We know that we are seeing dramatic increases in needs for behavioral health care among young people,” Bergmann said. “So we are tailoring services for that.”

The budget also allocates $18.3 million to meet requirements of Community Assistance, Recovery and Empowerment Court, better known as CARE Court, a state program that will mandate care for some people with untreated mental illnesses such as schizophrenia and other psychotic disorders.

San Diego County, as one of seven piloting the program, must establish such courts by Oct. 1. The process, Bergmann said, will be “quite labor-intensive,” requiring new staff to investigate people flagged for court-ordered care and then draw up treatment plans for those who need them.

The Community Assistance, Recovery and Empowerment Court, or CARE Court, has been heralded as a way to expand the number of people who could be mandated treatment for mental health disorders

Other proposed health agency spending would boost pay for home caregivers, promote food assistance and senior nutrition programs and fund affordable housing development.

The department’s budget also sets aside $25 million for the “innovative housing trust fund,” which bankrolls housing for low-income families, seniors, veterans, youth and homeless people.

Public Safety — which includes the sheriff’s and fire departments, emergency medical services, child support services, the district attorney and more — is the next largest expense for the county and would get a $137 million, or 5.5 percent, budget boost.

Most of that increase, $82.4 million, would boost salaries and retirement contributions. It would also add 40 new staff positions and set aside $10.6 million to help people leaving the criminal justice system deal with mental health and substance use disorders, along with another $12.8 million for court programs to address those issues.

The Capital Program, which supports the county’s infrastructure, would get a major boost — up $87.1 million, or 50 percent, over last year. That will fund the county’s planned $127 million public health lab, which will feature a genome-sequencing laboratory, wastewater surveillance and other technical services when it opens in 2025.

Capital funds will also pay for a new Jacumba fire station, Otay Valley Regional Park and an East County crisis stabilization unit to provide short-term care for people experiencing mental health emergencies.

Of that federal pandemic aid, the county’s biggest expenditures were more than $800 million for testing, tracking and vaccinations and more than $300 million in rental assistance.

The county’s Finance and General Government Group would get an additional $73.9 million, up 9 percent, to cover 40 new staff positions, pay and benefit increases, major office maintenance and digital record system upgrades.

The Land Use and Environment Group would see a $37.2 million, or 6 percent, budget hike for raises, road maintenance, traffic signal improvements, watershed protection projects, maintenance of the county’s parks, libraries and landfills and adoption of the Decarbonization Framework, which aims to make the county carbon-neutral by 2045.

The Board of Supervisors will hear presentations on the spending plan Thursday, followed by additional community meetings and public hearings on the proposed budget throughout May and June.

Find the full schedule here: