Sonoma County mental health nonprofits dodge budget cuts this year, but brace for big cuts next year

Sonoma County nonprofits that provide mental health and substance abuse services may have dodged a bullet this fiscal year, but come June many fear they may be facing a cannonball.

With strong direction from some members of the Board of Supervisors, county officials are now looking for ways to backfill a $1.8 million deficit in the Behavioral Health Division. While the move eliminates the need for cuts to nonprofits, next year’s Behavioral Health deficit could be as high as $19 million.

In a letter sent to nonprofits late this week, county health services director Barbie Robinson relayed the “good news” but warned that “challenging, and at times, painful dialogue” lies ahead.

“At this time, with the probable backfill in funds, we hope to mitigate all contract reductions for FY 17-18,” Robinson wrote, referring to the fiscal year that ends June 30. “Conversely, even with this prospective good news, this one-time backfill does not solve for our current $16-$19 million projected budget deficit in FY 18-19.”

The sheer magnitude of next year’s projected deficit has some mental health advocates fearing a major blow to the county’s mental health safety net. It comes at a time when some residents are facing unprecedented emotional and psychological challenges brought on by last year’s fires, widespread worries over gun violence and the ongoing fallout from the nation’s opioid epidemic.

“In the long run it’s going to cost the county more money taking care of things on the criminal justice side,” said Robin Bowen, executive director of Child Parent Institute, or CPI. “The health of our community, that’s the biggest loser in this whole struggle.”

Bowen’s organization was one of nearly 50 “community partners” that had been asked to plan for significant cuts to their current budgets, cuts that would have left some service providers very little funds to finish out the last three months of the current fiscal year.

CPI was asked to cut its budget by 35 percent, or $338,000. The cut would have jeopardized perinatal mental health services for 21 to 28 of the 60 to 80 moms the nonprofit serves and dramatically reduced the number of abused and neglected children CPI helps with counseling and treatment, from 110 to 70.

The move to backfill Behavioral Health’s current deficit is supported by county supervisors, who agree the cuts were proposed too late in the year. If implemented, the cuts would likely have forced some nonprofits to lay off staff and even shutter programs altogether, they said.

“We can’t unravel this mental health safety net that we’ve created over the years,” said Supervisor Shirlee Zane, adding that nonprofits “need some time” to plan for such cuts.

“It’s hard enough to recruit good staff with 3 percent unemployment and zero percent housing,” she said. “How in the heck are they ever going to find those people again if we decimate those programs?”

But next year, the cuts could be even bigger.

In a Board of Supervisors meeting this week, Robinson laid out in sobering detail years of “poor fiscal forecasting, the lack of internal controls and operational inefficiencies” that have led to perennial budget deficits.

Late last year, the division faced an $11 million shortfall, but Robinson was able to reduce the gap by eliminating vacant positions, part-time workers and through the use of one-time state funds and fund balances from several mental health funding streams.

Briana Khan, a spokeswoman for the County Administrator’s Office, said the county has to come up with $2.26 million to fully fund its contracts with nonprofits. She said $1.8 million would likely come from the county and another $400,000 would come from the federal government’s participation in the Medi-Cal program, the state’s version of the federal Medicaid program.

Khan said the county is looking at two options for coming up with the $1.8 million. One is possibly tapping into transit occupancy tax, or TOT funds, and the other is using money from the county’s redevelopment property tax trust fund.

Some local nonprofits that had been asked to make immediate cuts were relieved to hear they were receiving a reprieve.

Michelle Rogers, executive director of the Early Learning Institute, said the county had asked her organization to make a 15 percent cut in prevention and early intervention funds it gets from the state’s Mental Health Services Act. The $19,000 cut, while small compared to cuts other nonprofits were facing during the current fiscal year, would threaten ELI’s “watch me grow” program, which provides social and developmental screenings to more than 1,000 children in Sonoma County from birth through age 5 and not yet in kindergarten.

Rogers said there are no other “funding streams” that will cover such services for this age group. She said about 240 of the kids screened require further help, including developmental disability services, an appropriate play group and social and emotional support for parents with behavioral health challenges.

“What we know for kids is that for every dollar we spend on intervention before they go to kindergarten, we save $7 to the education system,” she said.

That means fewer dollars spent later on special education, counseling at school and extra reading and math support, she said.

Nonprofit executives said they appreciate the work Robinson and county officials are doing to try to bring fiscal responsibility to the county’s $95 million Behavioral Health division. About $40 million of that money goes to 118 nonprofits that provide an array of services, including supportive housing, criminal justice diversion programs, suicide counseling and psychiatric emergency services.

At at a supervisor’s meeting this week, Rod Stroud, the health department’s assistant director, said that for years behavioral health officials had been vastly over-projecting the federal government’s contribution to Medi-Cal, the state’s version of the Medicaid program. He said that in order to balance next fiscal year’s budget, behavioral health will have to reduce its projected revenue by $16 and $18 million. In her letter to providers, Robinson put the deficit at between $16 million and $19 million.

Bowen, executive director of CPI, said the county will face tough decisions.

For years, county officials have worked with nonprofit providers and other local health care leaders to create an “upstream” model of care that emphasized prevention at the earliest stages possible.

County elected officials and health officials have repeatedly stated their goal was to make Sonoma County the healthiest county in the state by 2020. It was well on its way, reaching fifth in the County Health Rankings survey by the Robert Wood Johnson Foundation in 2017.

This year, however, it dropped to seventh, a decline some experts attribute to gains made by other counties.

“Are we still on track to be one of the healthiest communities in the state, or are we giving up that goal?” asked Bowen. “Are we still a community that believes in upstream measures to prevent people ending up in our jail?”

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @renofish.