County of San Diego July 5, 2012 - Mental Health Board Regular Meeting Minutes P.O. BOX 85524 San Diego, CA 92186-5524 (619) 563-2700 FAX (619) 563-2775/2705 MEMBERS PRESENT Lynn Howell - District 1 Joy Villavicencio Member At Large - District 1 Bob Hebbler District 2 Judith Yates - District 2 Dr. Gloria Harris - 1 st Vice-Chairperson - District 2 Susan Pallinger - District 3 John Sturm - Chairperson - District 4 Dr. Katherine Di Francesca - 2 nd Vice-Chairperson District 4 Tom Behr District 4 Cory L. Delaney District 5 MEMBERS NOT PRESENT Ami Strutin-Belinoff District 3 Phillip Deming District 5 Eric Revere - District 5 STAFF TO THE MENTAL HEALTH BOARD Alfredo Aguirre, Local Mental Health Director STAFF TO THE BOARD OF SUPERVISORS Steve Hadley, working with Pam Slater Price, in attendance. I. CALL TO ORDER The Regular Meeting of the Mental Health Board was called to order by Mental Health Board Chairperson John Sturm at 4:00 p.m. at the County Administration Center, 1600 Pacific Highway, Room 302/303, San Diego, California. John dedicated this meeting to Joe Moritz, a client advocate for the Gay and Lesbian Community, who recently passed away. INTRODUCTIONS Members of the Mental Health Board and the Mental Health Director introduced themselves. II. APPROVAL OF MINUTES The following corrections were noted: Pg. 3, 3 rd paragraph should read: Part of that is the issue of those who are bullied and their relationship to trauma. Pg. 7, second to last paragraph should read: not as good as adults. Pg. 2, 6 th paragraph should read: Ami Strutin-Belinoff has heard from teachers that there were six instead of Bob Hebbler. Pg. 13, 5 th paragraph should read: A Board member was contacted by the Dept. of Rehab instead of Bob Hebbler.
Page 2 of 10 Members present should include Lynn Howell, as she was in attendance and not absent. With the above amendments, the Minutes for were accepted. MS (Hebbler/Howell). All Ayes. No Opposed. No Abstentions. III. CHANGES TO AGENDA None. IV. HEARING FROM THE PUBLIC Marissa Ugarte Bilateral Safety Corridor Coalition (BSCC) Since 1977, Marissa has been working in prevention and aiding the victims of human trafficking. In 2004, BSCC became constituted as a group. The group is based in National City, but works countywide responding to emergencies with the police, and curbing demand for prostitution; The Johns Detail, and curfew sweeps. Her goal was to present to the Mental Health Board and ask them to consider a more holistic approach to commercial sexual exploitation and human trafficking. BSCC provides housing, counseling, and lawyers to expand and innovate some of the services that are being provided to these victims in order to keep them safe. BSCC hired Sheila Henry, who spoke next. Sheila Henry- Licensed Marriage and Family Therapist (MFT) Sheila works with Marissa on the unmet needs of the victims of human trafficking. They have often times been raped, beaten, and are suffering from Post Traumatic Stress Disorder (PTSD). They re working on a program for expansion to work with these victims, using some cutting edge innovative trauma therapy. Examples of the methods are hypnosis, imagery work, and mindfulness. Their belief is that the body and mind are connected. Sheila asked for donations for the BSCC so that they can continue to support some of these unmet needs. Both thanked the Mental Health Board for the opportunity to speak. V. PRESENTATION: Veteran s Treatment Review Calendar (VTRC) Pilot Review Project Presenters: Jude Litzenberger is a VTRC Coordinator. I, in addition she is also a veteran, a retired navy officer, and an attorney who practiced military and criminal Law. As part of a public/private partnership through the California Veterans Legal Taskforce, Ms. Litzenberger is the VTRC Coordinator and serves as the cochair of Returning Veterans Legal Taskforce; a community organization focusing on preparing a safety net for returning post 911 Veterans. The Honorable Roger Krauel is the VTRC Judge, who is responsible for setting up the San Diego Veteran s Court, and also sits each year at the Stand Down Court. Overview: Penal Code Section 11.79 directs that the court consider treatment rather than incarceration for any defendant serving in the military and suffering from a diagnosed mental health condition that is connected to their military service and related to the defendant s criminal conduct. The Veteran s Court in San Diego County reviews cases of veterans that meet the criteria in Penal Code Section 11.79, and considers something other than incarceration for the convicted offender. Most veterans do not come out of military service suffering a mental condition and they do not commit crimes so Veteran s Court serves just a small slice of the Veteran population. Veteran s Treatment Court in San Diego is also called the Veteran s Treatment Review Calendar (VTRC). The Veteran s Legal Taskforce identified a high concentration of post 9/11 veterans residing in San Diego, which is almost double that of Los Angeles County. San Diego County has a Veteran s organization that works together in collaboration with all the county agencies and serves as a safety net. In the first year there were 123 cases reviewed and evaluated at initial screening. Seventy of them were initially ineligible because their crimes were too severe or too minor, or the defendant did not remain in the area. Fifty-three of them were eligible to enter the assessment process. Twenty-one were admitted in the first year and
Page 3 of 10 between them, there were 39 deployments to Iraq and Afghanistan, averaging 1-5 combat tours per defendant. Eight participants had no criminal history prior to their VTRC case. Thirteen others had 48 total prior criminal cases. The VTRC program focuses on early identification and timely treatment for acute Post Traumatic Stress (PTS), Traumatic Brain Injury (TBI), Military Sexual Trauma (MST), Depression and Substance Abuse/Addiction. The criminal profile of a VTRC participant includes domestic violence, with most of the victims being family members, parents, children and spouses, prior DUI offenses, battery, vandalism, theft, and drug sales. Three participants were under the influence of alcohol when they committed these crimes. The VTRC program assists with housing needs, utilizing community housing services and residential treatment facilities. Veteran s Village of San Diego is the primary treatment facility for housing long term felony cases that would have otherwise gone to prison. They provide counseling, case management, intense monitoring of the participant s, and court appearances every two weeks. Impact of VTRC Pilot Project: Participants in VTRC did not commit crimes as young adults. They weren t beating their spouses or girlfriends. They went into the military and were promoted in a standard way and commended for their work. Their criminal behavior began after they came back from one or two deployments. One of the impacts of VTRC is a 4.7% recidivism rate in the first year versus an 80% recidivism rate for prison inmates. Secondly, San Diego as a community has a lot of resources that understand how to collaborate well with each other. For example, VTRC capitalizes on the 25 years of experience at Stand Down Court. Another impact is good citizenship. Participants are returned as members of the law abiding community. Some have gone back to college and some are starting college for the first time. Graduation records are kept to track whether participants have been law abiding for five years. There are give back projects as part of their treatment, such as volunteering and mentoring. Sober living situations help participants commit themselves to remaining sober because they are surrounded by their buddies, who make sure that they do not drink. The Probation Department and the VA hospital monitor participant s activities and administer drug tests. As a result, positive test results are rare. Financial Savings: VTRC has not been discarded because of the savings passed on by the program. $537,000 in jail costs were saved because participants are housed in places not funded by the county. $419,000 in treatment costs were saved because the VA is providing necessary treatment. The California Veterans Legal Task Force (CVLTF) is a non-profit that started last year to fund VTRC. The court has no money and the state has no money, so a private partnership was formed. The staffing for running the team, organizing management, and coordinating comes through CVLTF. Their motto is similar to the military s motto but unfortunately, people get left behind. The goal is to not leave anyone behind on any battlefield, including the legal battlefield. Volunteers of VTRC spent over 9,000 hours this last year to assist in running the court. The 24/7 part of VTRC includes volunteers who are combat veterans who mentor and partner with a veteran participant. Additional volunteers include law students and interns, mentor coordinators, and an AmeriCorps Legal Fellow in the Public Defender s Office, who coordinates office work. Jude s legal work last year was part time, pro bono. VTRC received a grant from the Department of Health and Human Services through Mental Health Systems, Inc., the Courage to Call Program, and there are additional private funders that have assisted with the costs of VTRC. Questions and Answers: Tom Behr suggested Board Members take the time to observe the drama that unfolds in the VTRC courtroom. He has observed and was very impressed. Judge Krauel stated VTRC is held on the first and third Friday of every month, except August, from 1:30 p.m. until the calendar is completed.
Page 4 of 10 Tom asked if the court system budget cuts will affect VTRC. Judge Krauel said VTRC was designed to withstand any future budget cuts because the court handles it own calendar and files it own files and the resources for this program are coming from outside sources. Tom felt VTRC should be above the radar in terms of public understanding, and since it is fueled so much by volunteers, should be an easy sell to keep the program going. Judge Krauel said San Diego makes it a traditional court, he doesn t use his military experience as part of the process. Tom feels the piece that is missing is the public understanding that the veteran does not go to jail but instead is in the custody of VTRC and being monitored by community resources. Judge Krauel said they have the most intense Probation and VA monitoring system and civilian mentors and fellow participants watching the veteran 24-7. Additionally they see the Judge every two weeks. Judge Krauel feels the public is not at risk and is being protected through this process. John Sturm asked what the capacity of cases was that they are working with. Judge Krauel said VTRC is being kept as a pilot program and they have set a limit of 40 cases while they are building the program and collecting resources. They anticipate proceeding with larger numbers as they go forward. John Sturm asked if the participants invited into this pilot program are being evaluated on their symptoms or their diagnosis presenting after the date of service. Judge Krauel explained there has to be a connection between their military status and mental condition and then a nexus between their mental condition and the crime that was committed. John Sturm asked if they were giving consideration to those that had a pre-condition beforehand or did they enter the program because of the combat and the trauma condition. Judge Krauel said they had to meet the criteria of PC 1170.9. Jude suggested that John was asking if they considered those with a preexisting condition before they went in the military. Judge Krauel pointed to statistics showing that 75% of VA assessments have a pre-existing condition. John Sturm stated there has been a lot on the news lately regarding the stigma of mental health, especially within the military, which is something we are still trying to overcome. Now there s another backlash that has been coming out, in that people are assuming that everyone in the military is coming back with something. He thinks the new challenge is to educate the public and make sure they know that is not always the case. Some people diagnosed don t always fit into a mold where they are going to be committing crimes. Judge Krauel agreed and said when speaking publicly about VTRC, he stresses that it s a very small portion of military veterans that wind up committing crimes. Bob Hebbler asked if the three candidates mentioned on the good citizenship slide were college graduates or graduates of VTRC. Judge Krauel confirmed they were graduates of VTRC. Judge Krauel announced that San Diego is the first county in the nation to have a Stand Down Court. The Public Defender s Office and Prosecutors started the Stand Down program and for the last 25 years this operation has been held nationally. VTRC is an outgrowth of Stand Down, which is being held July 13 th through the15 th. John Sturm announced that Stand Down is one of the biggest civic events and it has traditionally happened at the same time as the Gay Pride celebration. He is happy to see the date change as it provides the opportunity for many more to participate and help out. Judge Krauel agreed and stated this is another example of our community collaborating. This is a great place to live!
Page 5 of 10 VI. LOCAL MENTAL HEALTH DIRECTOR S REPORT (A. AGUIRRE) ACTION ITEM(S): Designation of Lanterman-Petris-Short (LPS) Facilities and Staff to Provide Involuntary Detention of Mentally Disordered persons for the Purpose of Evaluation and Treatment. Recommendation: Delegate the authority for designating facilities and staff to provide involuntary detention of mentally disordered persons for evaluation and treatment under the Lanterman-Petris-Short Act of l967, to the Director of the Health and Human Services Agency or his or her designee, subject to the approval of County Counsel and the State Department of Social Services. Alfredo noted this used to be a function of the Department of Mental Health, which no longer exists, so it is now going to be a function handled under the Department of Social Services. In the Trailer Bill that came out last week from the Governor after approving the budget, BHS lost the battle to have the responsibility fall under Health and Human Services. This function has always been a local function with few guidelines from the state. It has been left to the communities to handle. BHS works with partners to establish a business friendly model. The Welfare and Institutions Code speaks to procedures developed for involuntary detention and evaluation and treatment for persons with these conditions. The Act requires a person so detained be placed in facilities designated by the County Board of Supervisors for involuntary detention. Through this action, the local Mental Health Director and/or his designee will continue to have responsibility to ensure that involuntary detentions and treatment are in compliance with state law and the compliance meets state and federal regulations concerning involuntary detentions. BHS works closely with Jewish Family Services in coordination with patient s rights and providers. There are currently 16 adult facilities and three children s facilities and each facility is reviewed every three to five years. Alfredo is seeking support of the Mental Health Board. Questions and Answers: Judith Yates stated she was hung up on having the approving authority as Health and Human Services Director versus the Behavioral Health Director. She asked if that was procedural. Alfredo said that with something of this nature and having this much authority, a Deputy CAO is typically designated, representing the Board of Supervisors, who can appoint authority, governed by what the county chooses, which in this case is the local Mental Health Director. Dr. Harris asked if every individual who comes to the county hospital involuntarily would have to be approved by Alfredo. Alfredo stated that he designates the individuals who have that authority outside of law enforcement to detain and transport (5150) or to continue with the process of a hold, and the facilities that are designated where they are to be held, evaluated and treated. In essence his role is to establish the provider group that has this function. John Sturm asked if there were certain criteria for these providers. Alfredo said outside of law enforcement, the Psychiatric Emergency Response Team (PERT)[v1] Team, hospital Behavioral Health Units and their Mobile Crisis Teams, and the Senior Mobile Outreach Team have been designated by the local Mental Health Director to evaluate individuals with potential mental illness. This wasn t being managed well so the list has been cleaned up. With this authority, BHS develops the policy and procedures to designate so BHS will be reevaluating the current policy to swing the pendulum into the middle of that continuum.
Page 6 of 10 John Sturm asked if certain people could be appointed and sent to evaluate. Alfredo said it would be exactly as it was written authorizing people who have the authority to detain and transport to be sent for those reasons. Susan Pallinger asked what was different from how it was run four years ago with a 5150 in the PERT after BHS received complaints of the PERT Team taking a consumer to an EPU and that consumer not being admitted when PERT advised to go ahead and admit. Alfredo said they still have a responsibility as they are transported to the EPU to continue the evaluation process. With an EPU they can be held for 48 hours and with a doctor s signature, that person can be released. The professional responsibility of receiving the 5150 and continuing the evaluation process has not changed. BHS has narrowed the number of individuals that have the authority to approve a 5150. The facilities have not changed except when they ask for a re-designation of LPS. BHS would like to not have to go to the Board every time the criteria changes. The Board letter allows for the Director of HHSA to designate the Mental Health Director, which provides for a community process. If the criteria changes, Alfredo would bring this to the attention of the Mental Health Boar for their input. Alfredo is seeking Mental Health Board support. M /S (Yates/Behr). All Ayes. No Abstentions. Two Oppositions. Mental Health Plan Contract and Revenue Agreement for Medi-Cal Specialty Mental Health Care Services with the California Department of Mental Health and the California Department of Health Case Services. Recommendation: To ratify the interim Mental Health Revenue Agreement for the period starting April 1, 2012 and ending at the time when the Department of Health Care Services (DHCS) and County of San Diego Behavioral Health Services have finalized a successor Contract and Revenue Agreement or December 31, 2012, whichever is sooner, and, then, authorize the Director of Health and Human Services to enter into, sign, and amend as necessary, future contract and revenue agreements with DHCS to provide or arrange for the provision of specialty mental health services to Medi-Cal beneficiaries of San Diego County. Alfredo stated this action item is being brought to the Board on August 7 th. The new contract time period starts April 1 st and the Department of Mental Health did not come to a close until June 30 th. That is the reason both departments had to be included as counterparts in this agreement. Alfredo stated this is an interim agreement. He has been part of a team that has been hard at work in negotiating a bilateral contract that takes into account the interests of the state and the interest of local communities through the county. The team has struggled and there are a lot of financial risks involved in the realignment and changes happening with the budget and other things looming in terms of court orders to increase services for children. BHS wants to make sure the agreement outlines exactly what is expected of counties in terms of funding and they are working out the details. That is going to be a more complicated and more involved agreement. Los Angeles County Counsel is involved and has done a great job working with counsel from the Department of Health Care Services. Headway has been made. Alfredo is on the committee that is negotiating and believes by late fall, they will have another agreement to bring to the Mental Health Board for support. They will need Board of Supervisor authority for that agreement, which will take them from that period, moving forward, and then renewed annually because of changes in funding, changes in authority or who provides the carved out Medi-cal services for the mental health population. This will require yearly review. Alfredo told the Mental Health Board that their copy of this draft Board Letter does not include the designee part of the language. The Board will receive another draft copy with the corrected language.
Page 7 of 10 Alfredo noted that the current interim agreement, which is very thick, the template has the local Mental Health Director or in the case of our county, the Behavioral Health Director s name listed. This is more of a typo that needs correcting and will be added to the Board Letter. Alfredo mentioned that this agreement allows for federal funding to flow to the county. Currently, according to the Feds, there is no document that governs federal funding for the Medi-Cal population for specialty mental health services that flows through the state to BHS. This will give BHS a formal governing contract and will allow money to flow to counties. John Sturm questioned if this would extend the contract to a maximum of December 2017. Alfredo confirmed that it would. The Department of Health Care Services told CMS at the state level that they expect to have new contracts with the counties. BHS is in essence a contractor with the state. Alfredo is seeking Mental Health Board support. M/S (Di Francesca /Behr). All Ayes. No Abstentions. No Oppositions. Questions and Answers: Tom Behr asked what was meant by specialty mental health services. Alfredo explained it is the whole range of services provided for both Inpatient and outpatient services, including group care, day treatment, medication support, evaluation services, and crisis services. Tom Behr did not understand the second paragraph giving authority to sign and amend future contract and revenue agreements to the Mental Health Director. Tom felt it read like there was no review process or accountability at the Mental Health Board or Board of Supervisors level. He questioned if Alfredo had sole responsibility. Alfredo said responsibility will be solely with the Department of Health Care Services. Alfredo felt Tom s point was a good one and said BHS should probably keep the authorization recommendation to this particular contract because the new one would have substantive changes. Alfredo said it should read that this is an authorization for this particular contract because the intent was to come back for approval. Tom confirmed that this particular paragraph would only apply to this contract. With that amendment Tom Behr would support this. Dr. Harris asked whether a person has to prove citizenship in order to receive specialty mental health services. Alfredo confirmed that there is a requirement for citizenship and there is also an emergency provision of services built in under Medi-Cal. Judith Yates wanted to make it clear that doesn t mean if a person comes to the hospital they won t get care. Alfredo is speaking to the carve out of managed Medi-Cal services under the county auspices, that specialty care has the zero tolerance attached to it. That is not the case for all care that would be provided through emergency care at the hospital, including their own. Susan Pallinger asked Judith if that meant the federal funding would be taking care of that also. Judith said no, if a non-legal resident requires medically necessary hospital care there is not any reimbursement. If it is medically necessary, a portion of their stay is paid for through the contract the hospital has with the county. If it is an illegal resident the cost of that care falls into the category of charitable care. Alfredo felt there was an easy resolution to Tom Behr s concern and suggested they eliminate Recommendation #2 because Recommendation #1 says, and then authorize the Director of Health and Human Services Agency to designateand his or her a designee to sign this agreement and then come back to the Board. Tom agreed that would resolve the conflict.
Page 8 of 10 A motion was made by John Sturm to amend the language for this action item[v2] and vote on the recommendation. M/S (Yates/Behr). All Ayes. No Abstentions. VII. INFORMATION & DISCUSSION ITEMS: Triannual Law Enforcement Liaison Update (Dr. Ruth Kenzelmann) Dr. Kennzelman highlighted Optum employees accomplishments and gave them thanks. Optum Rx and Optum Insight are now housed in the building across from County Behavioral Health Services. Both agencies supported Optum at the NAMI walk. Dr. Kennzelman reiterated how San Diego County as a whole is collaborative and works well together and is a great place to live!. She summarized the different levels of service provided by Optum to the county: Access and Crisis Line (ACL) Optum is honored to be able to provide this valuable resource to the community. They play an active role in the community through the TIP, and Suicide Action Prevention Committee (SAPC) programs. Last year Sue Bergason introduced Question Persuade Se Refer (QPR), which is a training program for the community on how to talk to the public about suicide and get the resources they need. In April, Optum was accredited by the American Association of Suicidology (AAS), who accredits different crisis centers. Optum was audited with kudos in April. They have redesigned their brochures and posters, written in five languages, with the new ACL telephone number. Optum won an award for 24-Hour Program of the Year at the Mental Health Recognition Dinner. Utilization Management Starting in February, Optum began managing skilled nursing facilities. Treatment Evaluation Resource Management (TERM) Team - In August there will be an expansion of the Term Unit. Optum oversees Individual therapy and psychological testing, which is expanding into group therapy. Optum is setting guidelines for best practices for the group and monitoring them. AB109 Screening This process just began. AB109 involves parolees being released into the probation system. Optum is at the Hall of Justice and Vista Courthouse accessing participants being released to see if they need mental health and drug services. Questions and Answers: John Sturm asked how long the old ACL number will be working. Dr Kennzelman explained it would not be discontinued until they stop receiving calls at the old number. Dr. Harris asked what the process was for accessing individuals for AB109. Ruth explained it started in October. Parolees meet with a probation officer and then sign releases with Optum, who does an initial screening and follows with a detailed one later. Optum is researching access through the county to systems such as Anazai and Sanwit to research whether the parolee had a history prior to incarceration. Live Well, San Diego! Update (A. Aguirre) The First Five Commission sponsored a campaign for expectant mothers promoting healthy living. The messages are being displayed on numerous brochures and are available at Family Resource Centers and other locations across the county. ACL and BHS reception also have the information. The campaign advances messages of wellness through the Live Well, San Diego! Initiative.
Page 9 of 10 The City of Oceanside is following in the County of San Diego s footsteps and issued a proclamation on May 2 nd to promote living well. Nick Macchione and Candace Yea were on hand to receive the proclamation. On June 15 th Live Well San Diego conference was a success. There was an array of excellent presentations which broadened the wellness focus on aging making it relevant to all generations. Mental Health Services Act (MHSA) Update: (K. Ventimiglia) Alfredo presented the update. The Mental Health Board supported the MHSA Annual Update last month. There was a recommendation in the board letter dealing with the contractual relationship between what is done under MHSA and the State. The California Mental Health Directors looked into this and it was discovered that there was an over reach of the state for this contractual process. The process already in place, called the Performance Contract, keeps counties in compliance with state and federal regulations. The MHSA ACT[v3] referred to that as the place where MHSA should be embedded to make sure provisions and intent were followed. The county does not have to seek authority to have a contractual agreement about MHSA with the State. Once the Trailer Bills and Governor s Budget was approved last week the subject was quiet, so the counties are interpreting this as not having to do a separate contract. Therefore, the recommendation was pulled from the Board Letter and it will now be heard by the Board on August 7 th. This does not stop the enhancements from going forward as the funding is available. BHS looks forward to the Mental Health Board s support and will give them an update on August 7 th. Alfredo corrected an earlier statement he made regarding the question about Medi-Cal and eligibility. Staff clarified it is not citizenship that determines who is eligible for Medi-Cal, those with legal residency and above are eligible for Medi-Cal. Alfredo misspoke so he wanted to clarify. VIII. CHAIRPERSON S REPORT (John Sturm) In April, Prescription Drug Take Back Day was held again at 36 locations. The numbers of participants are growing. Seventy-seven percent of the attendees were new to the program. o Consumer/Client Vacancies Districts 1 (Cox) and 3 (Slater-Price) - John stated there was no pending applications for the vacancy in District 1 at this time. o Health Services Advisory Board Representative s Report None. o Dual Diagnosis Advocate/ADAB Representative s Report None. o CALMH/B Representative s Report John attended the CALM Board Meeting. One interesting item on the agenda was a presentation from the California Department of Corrections and Rehabilitation. John found interesting the distinct differences between male and female inmates. John s conclusion was that they haven t found the right answers to restraints and isolation issues yet but they are doing the best that they can. However John felt their solutions were still cruel and he felt we need more dignity for our consumers and clients whether incarcerated or not. o Advocate s Report for Multi Ethnic Concerns Joy Villavicencio did not attend. IX. OTHER ADVOCATE AND REPRESENTATIVE REPORTS a. J. Villavicencio, LCSW: Children, Youth and Family Advocate s Report - Did not attend. b. B. Hebbler: Client/Consumer Advocate s Report Bob was unable to attend the meeting. c. P. Deming, MFT: Older Adult Advocate s Report; Spirituality Committee Representative s Report None, Phillip was absent. d. d. TT. Behr: Housing Council Representative s Report Tom attended. The Corporation for Supportive Housing (CHS), specifically, the Hope San Diego Project, is a refinement of the Homeless Outreach Programs for Entitlement. CHS has been working with Father Joes for two
Page 10 of 10 and a half years on refining techniques for expediting SSI applications because the approval process takes 18 months to two years. Since March of this year, this is being rolled out to Tier 1 s. SSI has a 71% rate of getting approval within 89 days through a program called SOAR. There is a dedicated staff at the local office working on expediting the applications. In fact, one approval occurred within 21 days. Tom s question to Simone at CHS was why all of SSI doesn t work this quickly. John Sturm felt it was only clients that met certain medical criteria which could be verified and fast tracked. Dr. Harris asked in order to receive SSI for a mental illness whether a person had to have a history of mental illness or whether it was sufficient to simply receive outpatient care. John Sturm said it was based on each individual client s case depending on treatment and history and he advocates making sure doctors are documenting what they are doing so a client can make sure they retain their SSI benefits. It was confirmed that they have to document they are disabled not just that they have a diagnosis. e. Dr. K. Di Francesca: Veterans Forensic Issues Representative s Report Joy Villavicencio reported for Dr. K. Di Francesca. Joy toured the Pitchess Detention Facility in Los Angeles to observe the Veteran s Pod that they had, which is no longer there. San Diego County is in the early stages of considering a Veteran s Pod for this county. John Sturm noted Joy shared earlier what an asset leaders were in that community and how they were trying to motivate for Peer Advocates, which seems to be the word of the year. f. Eric Revere: Critical Incidents Committee Report - None. X. ANNOUNCEMENTS Alfredo Aguirre pointed to a program highlight in the Director s Report on the Salud Program, a Prevention and Early Intervention Program focused on older Latino adults, who are experiencing both depression and diabetes. This is a partnership between the County, San Ysidro Health Center, North County Health Services and UCSD. It is a very nice description of the program with very good outcomes. He thanked Piedad and her staff for supporting this. John Sturm mentioned if you can volunteer for Stand Down, please do so. XI. ADJOURNMENT 5:18 p.m. Motion to Adjourn M/S (Behr/Pallinger) Brown Act Procedure: As required by California Government Code 54950 et seq. (Ralph M. Brown Act), a copy of the packet of information that was mailed to Mental Health Board members at the point of posting of this agenda has been placed at the reception desk at 3255 Camino Del Rio South, San Diego, CA 92108, for public inspection. Members of the public wanting their own copy of the advance materials may request them under Government Code 6250 et seq. (Public Records Act) and receive them on payment of copying charges of $0.20/page, and actual mailing charges, if mailing of the material is requested. If you are planning to attend and need special accommodations, you must call Jackson Alexander at (858) 505-6521, at least three days in advance of the meeting.