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San Diego County Supervisor Fletcher eyes large behavioral health initiatives in 2020


See the full article by Charles T. Clark in the San Diego Union-Tribune. Photo by Sam Hodgson of the U-T.

"About a year ago Nathan Fletcher returned to public life with a landslide 30-point victory over former District Attorney Bonnie Dumanis in the District 4 county supervisor race, riding a campaign that promised a fresh perspective and an eagerness to push county government to more aggressively address mental health services, housing and public health.

As only the second Democrat to join the San Diego County Board of Supervisors in 25 years, Fletcher embodied many progressives’ hopes that dramatic change would be on the horizon, even as the former assemblyman cautioned that things wouldn’t happen overnight.

Now, one year into his tenure on the board, a county that in prior years rarely landed on the progressive side of issues this year has gone left on a couple of occasions and, more important to Fletcher, the county government has proven significantly more ambitious about tackling the region’s largest issues.

“In 2019 I think we saw the county begin to take bold action, to lead, to push, and I am really encouraged by what we have done,” Fletcher said in an interview last week. “We have a long way to go and a lot more to do, but I am incredibly encouraged by year one.”

He credited Board Chairwoman Dianne Jacob with setting the aggressive tone early.

Fletcher, who like fellow freshman Supervisor Jim Desmond replaced a 24-year incumbent on the board, has had his fingerprints on several of the board’s more high-profile actions of the past year.

He partnered with Jacob in September to move the county toward launching its own community choice energy program that will allow residents to shop for energy providers beyond just San Diego Gas & Electric, something Jacob had been urging the board to consider for years but couldn’t gain traction with because she lacked a second.

The county is waiting to see what kind of governing authority it would adopt for the energy entity before implementing it.

Fletcher also partnered with Supervisor Greg Cox on a variety of initiatives related to child welfare, including a proposal that provides an additional $1.65 million for training the region’s social workers and a proposal that creates a new approach to handling Child Welfare Services hotline calls.

The two also advocated for expanding child welfare staffing on an unprecedented scale, adding 125 positions of mostly protective service workers, clinical psychologists and senior workers or supervisors. It was part of the county budget adopted in June.

Fletcher, who was appointed to the California Air Resources Board, also headed up initiatives related to air quality and the environment, including penning proposals that more tightly regulated industrial air pollution and that led to the county developing an “electrical vehicle roadmap” to spur electric vehicle ownership and reduce greenhouse gas emissions.

Fletcher said one of his main missions is improving behavioral health.

“Broadly, issues of behavioral health, mental health and substance abuse were my highest priority during the campaign and they continue to be my highest priority to date and going into next year,” he said. “I think the board has really moved in the right direction in terms of greater investment.”

Under the budget adopted earlier this year, Health and Human Services spending climbed about 7.1 percent, totaling more than $2.26 billion, and Behavioral Health Services added about 143 staff positions, mainly to support the Edgemoor Distinct Part Skilled Nursing Facility and the county’s psychiatric hospital, which has been increasing the number of available beds.

Fletcher headed up several initiatives related to mental health services and substance abuse, but his most significant effort was his plan — approved by the board in October — to turn a derelict county-owned property on Third Avenue in Hillcrest into a regional mental health hub.

The property, which formerly housed the county’s child protective services department, was planned for sale to be turned into high-priced condos before Fletcher began advocating for using it for a different purpose.

Noting the location was within walking distance of Scripps Mercy Hospital and UC San Diego Medical Center Hillcrest, Fletcher sold fellow supervisors and eventually local hospital and health care executives on creating a hub to offer a broad range of services, from outpatient consulting and medication management to quiet respite for those in immediate crisis. It will have about 60 inpatient beds.

The project, which is expected to cost between $110 million to $115 million, will be co-operated by the county, UC San Diego Health and Scripps Health. It will be dubbed the Central Region Behavioral Health Hub.

Fletcher said the hub is a huge step advancing behavioral health services in the region. In early 2020 he plans to begin rolling out a behavioral health campaign focused on a series of structural changes to the system, including creating mobile outreach crisis teams, expanding data sharing and launching new training programs.

“I believe we have the opportunity to do something with behavioral health that will be the first in the nation, to really design an integrated, coordinated, effective system,” Fletcher told the Union-Tribune last week.

“I don’t want to just band-aid over a crisis, say ‘we did our part’ and move on. I want us to fundamentally rebuild and restructure so that 30, 40, 50 years from now, someone will look back and say that group of folks did something really hard and wonderful.”

Outside of behavioral health and its interconnected issues, Fletcher said he anticipates much of his focus in 2020 will turn to transportation.

Fletcher took over as head of the San Diego Metropolitan Transit System Board of Directors in October, grabbing the reins just as the agency is gearing up to put a sales-tax increase before voters on the November 2020 ballot.

The proposal, which could roughly double the agency’s $300 million annual budget, could face an uphill battle. Not only would approval require a two-thirds majority vote of the public, it also would be the first all-transit tax measure in San Diego region’s history.

Tax increases traditionally are a tough sell, but Fletcher said he believes the appetite for transit is there, noting that ridership is up at MTS and improved transit carries benefits for riders and non-riders alike.

“The overwhelming majority of San Diegans will always drive their car, but investment in transit benefits everyone whether they use transit or not, and I think voters and constituents understand that,” Fletcher said. “I don’t buy into the notion of transit versus roads. If we want to make the roads less congested, the single most effective way to do that is to invest in transit.”

The next regular Board of Supervisors meeting is set for Jan. 14."