Considers the Homeless - Cost Benefit Study (202604) By Keith Torkelson MS, BS (HSB)

 

Outline

 

• Introduction
• Housing Help Line
• Call Center(s)
• Consumer Costs
• Substance Use Problems
• Homelessness
• Continuum of Care
• Fiscal Considerations
• Mental Health
• Incarceration
• Bed Shortage
• Behavioral Health Services Act
• Placements
• Chaos exceeding Order
• Cost/Benefit Savings
• BHSA – Selling the Solution
• Single Point Contact
• BHSOAC
• Innovation & Promising Practice
• Hospitalized
• Inmates
• Hospitalized
• Billing Rates
• Substance Use Disorder
• Service Utilization
• Frequent Flyers
• Homeless
• Budgeting
• Call Centers
• Patients per Year

Putting the MHSA to Sleep

Introduction

What are the odds that a homeless person in California will end up in the hospital?

Homeless individuals in California have a very high likelihood of hospital utilization, with data indicating they account for approximately 3% of all state hospital encounters annually. In 2021-2022, this resulted in nearly 873,000 encounters, including over 233,000 inpatient admissions and 639,000 emergency department (ED) visits.

 

1)In Orange County California how frequently do homeless end up in the hospital?

Homeless individuals in California, including Orange County, frequently utilize hospital emergency departments (ED) and inpatient services, accounting for approximately 3% to 4% of total state hospital encounters. Statewide data shows over 800,000 annual encounters for this population, with nearly half visiting the ED four or more times a year.

 

2)In Orange County California how frequently do homeless end up in the hospital?

Homeless individuals in California frequently utilize hospital services, with over 870,000 encounters (inpatient and emergency department) recorded from 2021-2022, often due to high rates of chronic illness, injury, and mental health issues. Orange County is among the top California counties for homeless hospital discharges, driven by high rates of trauma and substance-related issues.

 

Homeless Hospital Discharges

California hospitals are mandated to safely discharge homeless patients by securing a sheltered destination, offering meals, providing,weather-appropriate clothing, and arranging transportation (usually within 30 miles). SB 1152 requires a written policy, staff training, and coordination with community partners to prevent illegal "dumping".

 

Divert 10%

>Diverting 10% of the homeless heading for the hospital in California equals 80,000 less annual encounters.  At $1,000 per day this would free up more than $80 million per year. 

 

Dedicated Housing Helpline Promising Practice

Dedicated housing helplines and coordinated phone-based systems represent a promising, evidence-based practice for addressing homelessness and housing instability by providing immediate, low-barrier access to resources, triage, and specialized support. These services often act as the "front door" to a community's Coordinated Entry System (CES), connecting individuals directly to housing navigators, rental assistance, or emergency services.

 

Key Components of a Promising Practice Housing Helpline

24/7 Availability and Immediate Triage

Utilizing a 2-1-1 system or a dedicated, specialized line (e.g., 951-715-5050 for HHOPE in Riverside) allows for immediate crisis intervention and assessment.

"Housing First" Approach

Prioritizing quick placement into permanent housing without preconditions (like sobriety or employment).

Housing Problem Solving (Diversion)

Using specialized, trained staff to help people identify their own resources, networks, and immediate, creative solutions to avoid entering shelter.

Connection to Specialized Services

Beyond referrals, these helplines connect callers to comprehensive support, including legal aid for eviction prevention, mental health services, and rapid re-housing programs.

Trauma-Informed Care

Utilizing staff trained to recognize and respond to the trauma associated with housing instability and homelessness.

Data-Driven Coordination

Utilizing Homeless Management Information Systems (HMIS) to track, assess, and prioritize clients based on vulnerability and length of homelessness.

 

Examples of Promising Practices

2-1-1 Systems

Act as a central, 24/7 hub for finding housing, paying rent, or finding utility assistance.

Stay Housed LA

A partnership between local government and legal aid, offering a dedicated line (888-694-0040) for tenant rights and eviction protection.

Housing Navigators

Staff who act as the first point of contact to provide emergency placement and long-term stability planning.

Regional Specific Programs

For example, the HHOPE program in Riverside County offers a 24/7 line for behavioral health housing support.

 

Goals

Documented Outcomes

Improved Efficiency

Reduced time to housing placement and better utilization of limited resources.

Prevention of Homelessness

Increased ability to stop evictions before they result in homelessness.

Increased Stability: Higher rates of housing retention through individualized support services.

 

Is 211 Effective for finding housing options?

Yes, 211 is a highly effective, free, and confidential service in the U.S. and Canada for finding housing options, including emergency shelters, rental assistance, and transitional housing. By calling 211 or visiting their website, specialists connect individuals with local resources for rent, utilities, and housing stabilization.

 

Why can’t 211 end homelessness?

211 cannot end homelessness because it is an information and referral service, not a direct provider of housing, funding, or shelters. It acts as a connector to services that are already critically underfunded, overburdened, and in short supply, resulting in long wait times and few available beds.

 

Key reasons 211 cannot end homelessness include

No Direct Housing Power

211 connects callers to housing providers, but they cannot guarantee placements, immediately secure shelter, or directly pay for housing.

Severe Resource Scarcity

The demand for services far outstrips the supply. Even if 211 identifies a need, the corresponding resources (beds, rental assistance) are often unavailable or fully utilized.

Operational Limitations

The service is often underfunded and overworked, leading to, in some areas, wait times exceeding 13 hours.

Information Lag

Databases can be outdated, leading to referrals for services that no longer exist or are not currently taking clients.

 

What 211 is not?

211 is designed for crisis navigation, while homelessness is a systemic issue driven by a lack of affordable housing and poverty.  While 211 is a crucial tool for navigating available resources, it cannot solve the structural causes of homelessness.

 

Structural Causes of Homelessness

Structural causes of homelessness are systemic economic and societal issues that restrict access to housing, primarily driven by a severe shortage of affordable housing, stagnant wages, and inadequate social safety nets. These factors create a market where low-income individuals cannot afford housing, making homelessness a result of economic inequality rather than personal failure.

 

Summary of Costs of helping those disadvantaged and disabled in California

These are estimates.  Chances are these costs are more now in 2026.

Aside - Providing References & Citations in the face of broken links

To handle broken links in citations, provide the original URL with an access date (showing when you last saw it), use services like Perma.cc to create permanent archived snapshots, or find alternative stable links (like DOIs) if available, ensuring readers can still verify your source despite "link rot". The core principle is to give readers the best possible path to the original information, even if it's moved or gone, upholding academic integrity.

 

Across all Components

MHSA Funding & BHSA Funding

https://www.dhcs.ca.gov/services/MH/Pages/MH_Prop63.aspx

The Behavioral Health Services Act replaces the Mental Health Services Act (MHSA) of 2004. It reforms behavioral health care funding to prioritize services for people with the most significant mental health needs, while adding the treatment of substance use disorders (SUD), expanding housing interventions, and increasing the behavioral health workforce. It also enhances oversight, transparency, and accountability at the state and local levels. Additionally, the Behavioral Health Services Act creates pathways to ensure equitable access to care by advancing equity and reducing disparities for individuals with behavioral health needs.

 

Costs

Cost – Homeless

Homelessness is incredibly costly for communities, with public services like emergency care, jail, and shelters costing taxpayers tens of thousands of dollars per person annually, often exceeding the price of permanent housing solutions like supportive housing, which can actually save money by reducing healthcare and legal costs. While initial costs for emergency shelters or programs exist, the ongoing expenses for untreated health issues, frequent jail stays, and emergency room visits for unhoused individuals create a far greater financial burden than providing stable housing, highlighting a major economic argument for investing in housing first strategies.

 

Cost - Criminal Justice Involvement

The cost of criminal justice involvement is enormous, spanning billions in government spending (prisons, policing), individual/family financial ruin (lost wages, debt, fees), and societal impacts like reduced economic investment, with figures reaching trillions annually when considering lost productivity and social costs, disproportionately burdening poor communities and minorities. Costs involve direct system expenses (courts, corrections, probation) and indirect costs (victimization, reduced earnings, family hardship, mental health care).

 

Cost - In-patient Psychiatric

Inpatient psychiatric care costs vary wildly, often ranging from $500 to over $2,000 per day, potentially reaching $15,000 to $60,000 or more for a month-long stay, heavily influenced by insurance, location, facility type (hospital vs. private), length of stay, and services (therapy, meds, detox). While costs are high without insurance, it can be dramatically reduced with coverage, though out-of-pocket costs depend on your specific plan, deductibles, and co-pays.

 

Finding the Savings (Benefit)

 

How can a housing helpline lead to systemic savings?

A housing helpline can lead to systemic savings by serving as a proactive, early-intervention system that prevents homelessness before it occurs, reducing the immense public costs associated with emergency services, healthcare, and criminal justice involvement. By stabilizing households through fast connection to resources, helplines prevent the costly cascade of events triggered by eviction, ultimately providing a cost-effective alternative to emergency shelters and long-term care.

 

FYI - DHCS – California Department of Health Care Services

https://www.dhcs.ca.gov/

 

Substance Abuse

FYI - Drug Abuse Statistics

NCDAS: Substance Abuse and Addiction Statistics [2025]

https://drugabusestatistics.org/

Considers

Youth

Drug Related Crime Statistics

Overdose Deaths

Fentanyl Abuse Statistics

Alcohol and Drug Abuse Statistics (Facts About Addiction)

 

FYI - American Addiction Centers

How Many Americans are Addicted to Drugs or Alcohol?

https://americanaddictioncenters.org

 

Homelessness and Drug & Alchohol Use I

Previous research has estimated that 39% to 70% of homeless youth abuse drugs or alcohol. Substance use in this population has been reported as two to three times higher than that found among non-homeless young adults.

 

Homelessness and Drug & Alchohol Use II

Homelessness and substance use disorders have a complex, bidirectional relationship, with 20-35% of people experiencing homelessness reporting substance use issues. Substance use can lead to, and be a result of, homelessness, as individuals often use substances to cope with the stress of living on the streets. Key Findings on Homelessness and Substance Use: Prevalence: Roughly 38% of people experiencing homelessness are alcohol dependent, while 26% are dependent on other substances.

 

OC Grand Jury on homelessness

Homelessness: Is Orange County Moving in the Right Direction

Orange County Grand Jury (34 Pages) - PDF

https://www.ocgrandjury.org/sites/jury/files/2025-06/Homelessness_Is_Orange_County_Moving_in_the_Right_Direction_2.pdf

Summary – Concentration Homelessness

Homelessness in Orange County has been a persistent and growing issue for years. Despite substantial spending, the number of individuals experiencing homelessness continues to rise. The

crisis remains both visible and worsening. The most rapidly expanding homeless and at-risk-ofbecoming homeless populations are the elderly and those on fixed incomes, who are vulnerable to rising rents and other economic trends…In addition, the Grand Jury looked at the agencies in the County dedicated to addressing homelessness and sought to determine whether Orange County is moving in the right direction towards reducing it.

 

How is Orange County Addressing Homelessness?

Orange County Grand Jury (24 Pages) - PDF

https://ocgrandjury.org/sites/jury/files/2023-06/2022-06-23_How_is_Orange_County_Adressing_Homelessness.pdf

Orange County’s homeless population continues to be of great concern to residents. Seeing homeless individuals on the streets raises awareness of this persistent problem, but the elaborate efforts to address homelessness are less evident. Orange County’s response to homelessness is a collaboration led by the independent Orange County Continuum of Care Board (CoC), which oversees the distribution of federal and state homeless funding. The CoC is supported by the Orange County Office of Care Coordination (OCC) which administers contracts, monitors budgets, and evaluates the results of the funded programs.

 

Continuum of Care

The Orange County Grand Jury (OCGJ) studied the CoC to understand how the County is working to address homelessness. The collaborative efforts led by the CoC and OCC have resulted in progress in the fight against homelessness, including a system of care across multiple levels of government programs and community providers. It further established a coordinated entry system, a cooperative homeless information system, and consolidated applications for federal and state funds. Together, the members were responsible for a quick and effective response to the coronavirus disease (COVID) pandemic on the homeless, an increase in the number of shelter beds, a decrease in homeless encampments, more outreach and treatment alternatives, and new housing vouchers being available for permanent housing.

 

2025 Continuum of Care - Orange County CEO's Office

Orange County CEO’s Office (.gov)

https://ceo.oc.gov/care-coordination/homeless-services/continuum-care-archive/2025-continuum-care

Continuum of Care Board meetings are held every fourth Wednesday of the month from 2:00 P.M. - 5:00 P.M., except for the January, November and December 2025.  Since 1998, the County of Orange (County) has coordinated a comprehensive regional Continuum of Care (CoC) to develop and implement a strategy to address homelessness in Orange County. The Orange County CoC covers the Orange County jurisdiction, including 34 cities and Unincorporated Areas. Participation from County departments and agencies, local governments, homeless, housing and supportive service providers, community groups (including non-profits, faith-based organizations, interested business leaders, schools, individuals with lived experience, and many other stakeholders) is welcomed and encouraged.

 

Promotion

The Orange County Continuum of Care (CoC) Board, which manages local efforts to address homelessness, can be reached through the Orange County CEO’s Office of Care Coordination. For inquiries, board nominations, or to contact committee members, email CareCoordination@ocgov.com   or CareCoordination@ceo.oc.gov.

 

Medi-Cal & Housing

Medi-Cal, through California's CalAIM initiative, now offers "Housing Community Supports" to help members find, secure, and keep housing, addressing homelessness as a key social determinant of health by providing services like transition navigation, help with deposits, and rent assistance, with mandatory transitional rent starting in 2026 for high-risk individuals, aiming to improve health outcomes and lower healthcare costs.

 

CalAIM

California Advancing and Innovating Medi-Cal (CalAIM) is a long-term, multi-year initiative by the Department of Health Care Services (DHCS) to transform the Medi-Cal system into a more equitable, coordinated, and person-centered program. It addresses social drivers of health, providing services like housing support, for vulnerable populations.

 

Key aspects of CalAIM include:

Enhanced Care Management (ECM)

Provides high-touch, individualized care management for individuals with complex needs, focusing on coordinating services across health and social sectors.

Community Supports (CS)

Offers alternatives to traditional medical services, such as housing navigation, recuperative care, and asthma mitigation, aimed at improving health outcomes.

Population Focus

Targets high-risk groups, including the homeless, individuals with serious mental illness, substance use disorder (SUD) needs, and justice-involved individuals.

Behavioral Health Integration

Aims to streamline mental health and SUD services by integrating them into a single, cohesive system within each county by 2027.

Justice-Involved Initiative

Supports pre-release Medi-Cal enrollment and services for individuals in the 90 days prior to release.

CalAIM, which began implementation in 2022, serves over 14 million members in California. It builds upon previous initiatives like Whole Person Care and aims to reduce, if not eliminate, health disparities.

 

MHSA Fiscal Update

MHSA Three-Year Plan and Plan Updates | Orange County

OC Health – Planning – Say goodbye to the MHSA

https://www.ochealthinfo.com/services-programs/mental-health-crisis-recovery/mental-health-services-act-mhsa/mhsa-3-year-plan

MHSA Three-Year Plan and Plan Updates ; MHSA 2025-26 Plan Update Cover. MHSA Plan Update FY 2025-2026 FINAL (updated 6/30/2025).

 

BHSA Fiscal Update

https://www.ochealthinfo.com/BHSA3yearplan#docaccess-3d8dbd7c5be2c024d2f10d2fa2851e18

 

https://www.ochealthinfo.com/BHSA3yearplan

 

BHSA Revenue Stability Workgroup Report (12 Pages)

https://www.dhcs.ca.gov/formsandpubs/Documents/Legislative%20Reports/Revenue-Stability-Workgroup-Report.pdf

 

California State Association of Counties

https://www.counties.org/news-and-media-article/now-available-bhsa-revenue-stability-workgroup-report/

May 29, 2025

This week, the Department of Health Care Services (DHCS) released the Behavioral Health Services Act Revenue Stability Workgroup Report.

 

Homelessness And Health: Factors, Evidence, Innovations That Work, And Policy Recommendations

National Institutes of Health (NIH) | (.gov)

https://pubmed.ncbi.nlm.nih.gov/38315930/

by C Garcia · 2024 · Cited by 52

On a single night in 2023, more than 653,000 people experienced homelessness in the United States. In this overview, we highlight structural and individual risk factors that can lead to homelessness, explore evidence on the relationship between homelessness and health, discuss programmatic and policy innovations, and provide policy recommendations. Health system efforts to address homelessness and improve the health of homeless populations have included interventions such as screening for social needs and medical respite programs. Initiatives using the Housing First approach to permanent supportive housing have a strong track record of success. Health care financing innovations using Medicaid Section 1115 waivers offer promising new approaches to improving health and housing for people experiencing homelessness. To substantially reduce homelessness and its many adverse health impacts, changes are needed to increase the supply of affordable housing for households with very low incomes. Health care providers and systems should leverage their political power to advocate for policies that scale durable, evidence-based solutions to reduce homelessness, including increased funding to expand housing choice vouchers and greater investment in the creation and preservation of affordable housing.

 

The physical and mental health effects of housing homeless people: A systematic review

National Institutes of Health (NIH) | (.gov)

https://pubmed.ncbi.nlm.nih.gov/34423491/

by H Onapa · 2022 · Cited by 88

Housing is a significant determinant of health and is widely accepted as a key solution to address some of the health disparities that exist among the homeless. It is estimated that 150 million people worldwide are homeless, and approximately 1.8 billion lack adequate housing. However, understanding of how housing has a positive impact on the health of the homeless remains unclear and underdeveloped. This systematic review investigates intervention studies that report on the physical and mental health effects of housing homeless persons. A search of PubMed, PsycINFO, EBSCOHost-Academic Search Complete and the Cochrane Library was conducted for peer-reviewed articles published in English from 1999 to 2020 that had a combination of at least one housing intervention and health outcome, with a homeless sample. Three previous reviews and 24 studies were included for analysis. Most of the studies (n = 20) encompassed permanent supportive housing interventions that emphasised placing homeless people with mental illness directly into affordable housing with access to support services. The primary health outcomes reported were general physical and mental health, well-being, and quality of life. Despite inconsistent findings and significant issues identified in the reviewed literature, housing (in the short term) improves some aspects of health in homeless populations with human immunodeficiency virus, anxiety and depression.

 

United Way (The OC Way)

Orange County United Way

https://www.unitedwayoc.org/

Orange County United Way is dedicated to improving lives and strengthening our community. Learn more about our work and how you can get involved.

 

Queries & FAQs

 

Doesn’t The OC have enough call centers addressing housing for the disadvantaged?

 

Comparing MHSA to BHSA

The Behavioral Health Services Act (BHSA) replaces California's Mental Health Services Act (MHSA), fundamentally shifting funding and focus to include substance use disorders (SUDs) and prioritizing housing, with mandatory 30% funding for housing interventions for the homeless. Key differences include BHSA's stricter, uniform planning (Integrated Plans), enhanced data reporting (BHOATR), expansion to cover SUDs alongside mental health, and a stronger emphasis on accountability, transparency, and addressing disparities for high-need groups like the chronically homeless.

 

Segued to Costs

 

Cost per day in Federal Prisons

The average cost to house a federal inmate in a Bureau of Prisons facility was $129.21 per day in fiscal year (FY) 2024. This figure includes operating expenses but can vary depending on the facility type and specific needs of the inmate.

 

Bureau of Prisons

Based on data from the Federal Bureau of Prisons (BOP), the average cost of incarceration fee (COIF) for a federal inmate in a Bureau facility was $129.21 per day ($47,162 per year) in fiscal year (FY) 2024.  This figure represents the average cost across all security levels, with specific daily costs varying by facility and security level, such as $151.02 per day for minimum-security prisoners.

 

Cost per day in Orange County Jail

The cost to stay in Orange County Jail varies: it's typically around $165 for the first day and $140 for each subsequent day for specific pay-to-stay or work-release programs in cities like Santa Ana, while the general county cost for housing inmates (like undocumented individuals) can be higher, around $180 per day, though this is borne by taxpayers, not the inmate directly. These pay-to-stay fees cover lodging and board for eligible individuals in alternative programs.

 

Costs per day of Homelessness Cost(s)

The daily cost of homelessness varies significantly but is generally high, often exceeding the cost of housing, with studies showing average annual public costs from ~$10,000 to over $100,000 per person, translating to roughly $27 to over $270+ per day, driven by emergency services, healthcare (ER visits, hospital stays), and jail/police interactions, with chronically homeless individuals costing much more, though permanent housing solutions often save money long-term.

 

Costs per day of Psychiatric Hospitalization

Psychiatric hospitalization costs vary widely, typically ranging from $500 to over $2,000 per day out-of-pocket without insurance, potentially reaching $15,000-$60,000 for a month, depending heavily on insurance, facility type, location, and care intensity, with Medicare/Medicaid & private plans reducing costs significantly but still involving deductibles/copays.

 

Inpatient Psychiatric Stays

Average inpatient psychiatric placements typically last between 7 to 10 days for crisis stabilization. While some acute stays may be as short as 3 to 7 days, others for depression or more severe conditions can last 2 to 6 weeks. The goal is stabilization rather than a full cure, with stays rarely extending beyond 30 days in acute hospital settings.

 

How long does it take to find a bed in the community for a psychiatric patient?

Finding a community bed for a psychiatric patient often takes days, with average waits in emergency departments commonly ranging from 8 to 10 hours, but frequently stretching to several days. Due to severe bed shortages, some patients may wait weeks, months, or in extreme cases, nearly a year for specialized placements.

Segued to Behavioral Health Services Act (BHSA)

Special Topic

In the OC who do we submit a BHSA Innovations project plan?

In Orange County, California, BHSA (formerly MHSA) Innovations project plans are submitted to the Orange County Health Care Agency (HCA), Mental Health and Recovery Services.  Specifically, proposals are typically directed to the Behavioral Health Services (BHS) administration within the HCA, which then facilitates the necessary public review, local board approval, and final submission to the state.

Submission Process and Contact Info

Email: BHSA@ochca.com  (recommended for sending inquiries, feedback, and proposals).

 

Aside - BHSA

In Orange County (OC), you submit your Behavioral Health Services Act (BHSA) Integrated Plan (IP) to the California Department of Health Care Services (DHCS), but the local planning is done through the OC Health Care Agency (HCA), requiring community input and final approval from the County Board of Supervisors before state submission via a special DHCS portal by June 30th each cycle.

 

Is CalMHSA going to run all of PEI?

Yes, CalMHSA, the California Mental Health Services Authority, runs the Statewide Prevention and Early Intervention (PEI) Project as a collaborative effort among counties, developing and implementing initiatives like "Take Action for Mental Health" (building on "Each Mind Matters," "Directing Change," etc.) to reduce stigma, prevent suicide, and improve youth mental health statewide, though counties retain flexibility for local projects.

 

Is the MHSA going away?

No, the Mental Health Services Act (MHSA) isn't going away; it's being transformed into the Behavioral Health Services Act (BHSA), effective July 1, 2026, following California voters' approval of Proposition 1 in March 2024. The BHSA expands focus to include substance use disorders (SUD), prioritizes housing for the seriously ill/unhoused, increases workforce/accountability, and integrates mental health & SUD services under a new, modern framework, not cutting funding but refocusing it.

 

Call Centers

What does 211 do?

211 is a free, confidential phone number and online service that connects people to essential local health and human services, acting as a one-stop shop for information on food, housing, utility assistance, healthcare, employment, mental health, and crisis support, available 24/7 in multiple languages across the U.S.. It's a crucial resource for anyone needing help with daily needs or facing personal crises, linking callers to appropriate agencies and community resources.

 

What does OC LINKS do?

OC Links is Orange County, California's 24/7, free, confidential phone and online chat service connecting residents to behavioral health (mental health & substance use) services, offering information, referrals, and direct linkage to crisis response or support programs via trained clinical Navigators. They act as a single entry point for the county's mental health system, helping individuals, families, and first responders find help for issues like depression, anxiety, and substance misuse, even dispatching mobile crisis teams for urgent situations.

 

Is jail an entry point into the OCHCA Mental Health System?

Yes, jail serves as a significant entry point into the Orange County Health Care Agency (OCHCA) Mental Health System. Through Correctional Health Services (CHS), the jail system provides mental health screening, crisis intervention, and specialized treatment for inmates.

 

What is the new MHSA (BHSA) Break Down?

The new California Behavioral Health Services Act (BHSA), replacing the MHSA in 2024, shifts funding focus from broad prevention to targeted crisis response, emphasizing Housing Interventions, Full Service Partnerships (FSPs), and Behavioral Health Services & Supports (BHSS) for high-need individuals, with counties allocating funds (around 30% Housing, 35% FSP, 35% BHSS) starting July 2026, aiming to tackle homelessness and substance use with clearer goals and accountability.

 

Ditto - How long does it take for the average placement?

The time it takes to place someone from the hospital varies greatly depending on the situation, but it can range from a few hours to several days, depending on factors like the patient's condition, available beds, and coordination of care.

 

Here's a breakdown of factors influencing the placement process:

 

Patient Condition and Needs

 

Urgent Cases

Patients with severe conditions or needing immediate transfer to a specialized facility may require rapid placement, potentially within hours.

 

Non-Urgent Cases

For patients who are medically stable and don't need immediate transfer, the process can take longer, possibly several days, as arrangements are made for their next level of care.

 

Hospice

In some cases, patients may be admitted to hospice very quickly, while in other cases, it may take several days to coordinate care and arrange for necessary services.

 

Facility Capacity and Availability

 

Bed Availability

If the receiving facility has limited bed availability, it can delay the transfer process.

 

Staffing Issues

Hospitals facing staffing shortages may struggle to accept transfers or may hold patients for longer periods, even after a transfer is arranged.

 

Coordination and Logistics

 

Transfer Arrangements

Coordinating with the receiving facility, securing transportation (ambulance), and completing necessary paperwork can take time.

 

Insurance and Payment

Processing insurance information and ensuring payment arrangements can also add to the delay.

 

Other Factors

 

Specialized Care

If the patient requires specialized care (e.g., a specific type of rehabilitation), finding an appropriate facility can take time.

 

Patient Preferences

Patients or their families may have preferences for a particular facility, which can influence the placement process.

 

Average time for homeless placement in housing

Homeless placement times vary widely based on program type and location, generally ranging from 60 days for rapid re-housing programs to several months or even years for permanent supportive housing. While some targeted programs can house individuals in 3-5 days (e.g., in LAHSA's master leasing program), others may take 4–6 months for transitional housing.

 

Key Timeframes by Housing Type

Rapid Re-housing

Rapid Re-housing (RRH) is a short-term intervention to quickly move households from homelessness to permanent housing, typically lasting 4–6 months. Programs provide rental assistance, security deposits, and housing navigation, often placing individuals within 30–60 days. Key components include housing search, case management, and financial support

 

Permanent Supportive Housing

Permanent Supportive Housing (PSH) placement timelines vary significantly based on location, availability, and individual circumstances, often ranging from a few months to over a year. While some placements occur within 10 weeks to 6 months, high demand and, in some cases, complex documentation requirements can cause much longer waits.

 

Emergency Shelter

Emergency shelters provide short-term, temporary housing, often limited to a 6-month stay, for individuals and families experiencing homelessness or crisis. They offer a safe place to stay while working toward permanent housing.

 

Transitional Housing

Transitional housing is a temporary, supportive housing model designed to bridge the gap between homelessness and permanent, stable housing. These programs provide a safe, structured living environment—typically for 6 to 24 months—for individuals or families in crisis, such as those experiencing homelessness, fleeing domestic violence, or recovering from addiction.

 

Urgent Cases housing cases

Urgent housing cases—including imminent evictions, homelessness, or dangerous living conditions—require immediate action. If you are in immediate danger, call 911. For urgent housing assistance in the U.S., you can dial 2-1-1 to connect with local social services and emergency housing resources.

 

Non-urgent housing cases

Non-urgent housing cases typically involve issues that do not pose an immediate threat to health or safety, such as standard maintenance requests, disputes over lease terms, or long-term housing assistance applications. These cases often involve tenant rights issues that require mediation or legal guidance rather than emergency intervention.

 

Hospice

Hospice is specialized, team-based care for individuals with a terminal illness (typically a prognosis of 6 months or less) focusing on comfort, pain management, and quality of life rather than curing the illness. It is usually covered by Medicare/insurance, costing little to nothing out-of-pocket for patients. Services are provided at home, in nursing facilities, or specialized centers, and include medical care, emotional support, and bereavement services for families.

 

Bed Availability

Inpatient psychiatric bed availability in the U.S. is critically low, with only about 11 to 18 beds available per 100,000 people, well below the estimated need of 30-60 beds. Severe shortages, workforce limitations, and high demand often lead to long wait times in emergency rooms for psychiatric patients.

 

Health & Human Services Staffing issues

Health and human services (HHS) are facing critical, widespread staffing shortages driven by high burnout, unsustainable turnover (20-40% in some sectors), and an aging workforce. Key areas impacted include nursing, mental health, and direct care, with over 76 million Americans living in areas with shortages of mental health professionals. These gaps are resulting in reduced patient access, increased workloads for remaining staff, and reliance on costly temporary agencies.

 

Coordination of services – Housing

Coordination of housing services involves aligning housing, health, and social services to help individuals find and maintain stable housing, particularly for those experiencing or at risk of homelessness. Key components include Coordinated Entry Systems (CES) for assessment and prioritization, on-site service coordinators in specialized housing (e.g., for seniors/disabled), and partnerships with community organizations to offer resources like housing navigation and tenancy support.

 

Housing Logistics

Housing logistics involves managing the transport, setup, and maintenance of living spaces, ranging from temporary, large-scale worker camps to the specialized, heavy-haul transportation of modular homes. These services ensure efficient, safe, and turnkey solutions for remote workforce, emergency, or temporary housing needs. Key aspects include logistical planning, site installation, and facility maintenance, such as housekeeping and power management.

 

Housing Transfer Arrangements

Housing transfer arrangements allow tenants to move between units due to overcrowding, safety concerns, or unit rehabilitation, requiring a formal written request to property management. For voucher holders, this process, often called portability, involves coordinating with both initial and receiving housing authorities to move to a new jurisdiction.

 

Key Aspects of Housing Transfers

Reasons for Transfer:

Common reasons include changes in family size (requiring more or less space), physical hazards in the current unit, or urgent needs like safety transfers due to domestic violence.

 

Insurance - Payment for a homeless bed

Homeless individuals or families in California, particularly those on CalWORKs, can receive temporary, short-term, or permanent housing assistance to pay for beds in shelters or hotels. Temporary assistance generally covers up to 16 days ($85–$145/day for families), while specific municipal programs, like in Los Angeles, may fund interim housing beds at a daily rate of $80–$89.

 

Specialized mental illness and SUD care

Specialized care for mental illness and Substance Use Disorders (SUD) involves integrated, multidisciplinary approaches—such as dual diagnosis treatment—that address both conditions simultaneously for better recovery outcomes. These services range from inpatient/residential, including medical detox and 24-hour care, to outpatient, intensive outpatient (IOP), and telehealth options.

 

Patient Preferences

Patient preferences are the choices, values, and, beliefs individuals apply to their healthcare decisions, reflecting how they wish to be treated, involved in care, and how they weigh risks versus benefits. These preferences influence treatment, such as opting for surgery over medication, and extend to logistical choices like provider gender, communication methods, and digital scheduling.

 

AHCD

An Advance Health Care Directive (AHCD) is a legally binding document allowing adults (18+) to appoint a healthcare agent and outline medical preferences if they become incapacitated. It combines a living will and durable power of attorney for health care, ensuring wishes regarding life-sustaining treatment are respected.

 

PAD

A Psychiatric Advance Directive (PAD) is a legal document created during a person's wellness to outline preferences for mental health treatment, medication, and crisis care in case they lose decision-making capacity. It promotes self-direction and can appoint a health care agent to ensure wishes are respected, preventing coercive or unwanted treatments during crises.

 

Roommate Matching

Roommate matching is key to success; some roommate matches may occur organically, through meetings at shelter or in other programs. Many providers use a roommate matching process, much like those used for college dorms or other roommate situations, to help participants define preferences. For example, individual preferences for roommates may include gender, pets, substance use rules, quiet hours, or cleanliness.

 

Ditto - What does 211 do?

AI Overview - Learn more

211 is a free, confidential service that provides information and referrals to local human and social services, acting as a central point to connect people with resources for basic needs like housing, food, healthcare, and more.

FYI – MHSA Replaced by BHSA – Old School

Putting the Mental Health Services Act to Rest

Financial Considerations

Time Frame – February 2025 FY 2024-25 Projection

Reference - MHSA Fund Fiscal Update (A Le, 2025 (February))

 

Matrix - MHSA OC Funding Breakdown (Approximations, 2025)

How much MHSA money does OCHCA have to spend down?

The Orange County Health Care Agency (OCHCA) is managing a large pool of Mental Health Services Act (MHSA) funds, with a proposed draft budget for fiscal year 2025-26 totaling over $260 million across various components. As of early 2023, the county was navigating the allocation of roughly $1 billion in total MHSA funding scheduled through mid-2026.

 

FYI - BHSA – OCHCA 3-Year Plan (Draft)

https://www.ochealthinfo.com/sites/healthcare/files/2026-02/BH_IntegratedAnnualPlan2026-29_1.pdf

 

Housing Interventions

Full-Service Partnerships

Behavioral Health Services and Support (BHSS)

-Innovative BHSS Pilots and Projects

No Allocations in Plan

 

Full Service Partnership (FSP) Workgroup: Chi Lam (HCA), Ana Vicuna (Phoenix House), or Cheryl Seitter (HCA Liaison).

Behavioral Health Services & Supports (BHSS): Annette Mugrditchian (HCA) or Dr. Lorry Leigh Belheumeur (Western Youth Services).

Housing Interventions: Christina Weckerly (HCA).

 

Based on Orange County Health Care Agency (HCA) records, the email address for Annette Mugrditchian, LCSW, is amugrditchian@ochca.com.

 

April 9, 2026

Good day, Keith—

 

“Thank you for taking the time to share your idea and present such a detailed plan for consideration as part of our BHSA Housing Interventions (HI). We appreciate your commitment to improving housing solutions and your thoughtful approach to integrating multiple supports. Some aspects of your proposal align with the direction we are heading, particularly your emphasis on the value of peers in service delivery—something we plan to incorporate throughout our system of care.”

 

“However, I want to note that the bundle as a whole may not fully align with current BHSA guidance and our integrated plan for these interventions. For example, BHSA funding cannot be utilized for housing interventions already covered by Medi-Cal Managed Care Plans (MCPs), and counties must coordinate with MCPs to avoid duplication and leverage funding. Additionally, before services can be delivered, we need to confirm that individuals meet our population of focus through a formal assessment. Using a helpline as the primary entry point might pose challenges under these requirements. We are actively collaborating with our MCPs to refine workflows, including using our access lines to screen and schedule assessments as needed. Regarding your suggestion of a bed inventory, we agree that it could be a helpful resource, though it may not capture the full range of opportunities available to clients. Many clients can identify their own unit for Transitional Rent and then potentially use BHSA rental subsidies to support permanent housing, thereby broadening our housing options.”

 

“We truly appreciate your innovative thinking and will keep your idea under consideration as we continue to review the latest guidance and learn more about how best to serve our community. Thank you again for reaching out and for your ongoing advocacy. If you would like to discuss BHSA HI, let me know.”

 

AI-generated content may be incorrect.

 

Christina Weckerly Ramirez

Senior Health Services Manager | Behavioral Health Services 

Adult and Older Adult Services

 

405 W. 5th Street, Santa Ana, CA 92701

 

O (714) 834-8344   C (714) 586-6418

https://www.ochealthinfo.com/

 

20260413-M-Response-Sent

 

April 13, 2026 (M)

Greetings Christina,

 

Thank you for your response.  I will call you when I figure out our next tasks.  We were thinking to submit our Housing Solutions Bundle (OC Beds) as a Behavioral Health Services and Support (BHSS) Innovative BHSS Pilot or Project.

 

Keith “Buster” Torkelson

 

Selling a Project Idea Plan

Selling a project idea requires a structured plan focusing on articulating a clear problem, offering a concise solution (ROI/benefits), and persuading stakeholders through research and alignment with company goals. Key steps include identifying the opportunity, creating a persuasive pitch (one-page sell sheet), assessing risks, and identifying the target decision-makers.

 

BHSA Focus

The Behavioral Health Services Act (BHSA), passing in 2024 as part of Proposition 1, replaces the Mental Health Services Act (MHSA) in California to reform care, focusing on individuals with the most significant mental health and substance use disorders (SUD). It emphasizes housing, with 30% of funds directed to housing interventions, and prioritizes evidence-based, culturally competent care, especially for youth under 25.

 

State level running of BHSA Innovations

Beginning July 1, 2026, the Behavioral Health Services Act (BHSA)—which replaces the Mental Health Services Act (MHSA)—will restructure how innovation projects are run in California, shifting from county-run, locally approved projects to a state-led, competitive grant model managed by the Behavioral Health Services Oversight and Accountability Commission (BHSOAC).

 

How is it the BHSOAC?

The Behavioral Health Services Oversight and Accountability Commission (BHSOAC), formerly known as the Mental Health Services Oversight and Accountability Commission (MHSOAC), is a California state agency responsible for overseeing the transformation of the state's mental health and substance use disorder systems. The commission rebranded from MHSOAC to BHSOAC in response to the passage of Proposition 1 in March 2024, which enacted the Behavioral Health Services Act (BHSA) to update and modernize the state's approach to care.

 

BHSA Housing Interventions

Behavioral Health Services Act (BHSA) Housing Interventions are mandatory, dedicated funding streams (30% of total local BHSA funds) aimed at providing housing stability for individuals with severe mental illness or substance use disorders who are homeless or at risk of homelessness. These interventions include rental subsidies, operating subsidies, interim housing, and capital development for supportive housing, with a focus on those experiencing chronic homelessness.

 

BHSA Behavioral Health Services

BHSOAC Behavioral Health Services Oversight and Accountability Commission

https://bhsoac.ca.gov/about/

Functions

The Commission’s primary function is to oversee the implementation of the Mental Health Services Act. The Commission distributes grants, collects and shares spending and efficacy data on local programs, spreads best practices, conducts research into critical subject areas like criminal justice involvement of people with mental health needs, and engages experts to develop policy proposals and other pathbreaking solutions.

 

Transparency

Data collection is an increasingly important focus for the Commission; its Transparency Suite is an online tool that provides high-level spending and outcome metrics for programs by county.

 

FYI – Promotion

https://bhsoac.ca.gov/transparency-suite/

 

Prevention and Early Interventions (Transistional)

The Act charges the Commission with reviewing county spending of Mental Health Services Act money for prevention and early intervention programs. The Commission also distributes money raised through the Act for local innovation projects that pioneer new approaches to administration and treatment, like youth drop-in centers.

 

Stigma

Another of the Commission’s continuing endeavors is to develop ways to overcome the stigma that often faces people living with mental health challenges.

 

Grant Distribution

The Commission advises the Governor and Legislature on mental health policy. In addition, lawmakers have periodically given the Commission new responsibilities, including distributing grants to expand mental health services in schools, helping develop voluntary standards to support mental health in the workplace, and helping to build a statewide suicide prevention plan.

 

Aside - Change From the Inside: One Choice at a Time

Freedom to Choose Project

https://freedomtochooseproject.org/

The Freedom to Choose Project (FTC) is about redemption and the power of second chances. We help men and women impacted by incarceration step free of past identifications and help them re-identify themselves as valuable members of our society.

 

Aside

Can public school teachers have a misdemeanor on their record?

Yes, public school teachers can have a misdemeanor on their record, but it depends on the nature of the offense and state regulations. While minor offenses may not prevent hiring, misdemeanors involving violence, drugs, or dishonesty can lead to licensing denial, suspension, or revocation by state boards.

 

BHSOAC

The Behavioral Health Services Oversight and Accountability Commission (BHSOAC) administers the BHSA Innovation Partnership Fund. The BHSOAC is responsible for reviewing and approving county innovation plans. This replaces the original MHSA Innovation program, which the MHSOAC reviewed.

 

https://bhsoac.ca.gov/strategic-plan/2024-2027/strategic-plan-1-accelerating-transformational-change/

 

1812 9th Street

Sacramento, CA 95811

Phone: (916) 500-0577

 

Fax: (916) 623-4687

 

Email: bhsoac@bhsoac.ca.gov

 

Aside - Innovation Plan Approved - BHSOAC

 

bhsoac (.gov)

https://bhsoac.ca.gov/timeline/innovation-plan-approved/

Dec 5, 2024

The Commission approved Santa Clara County's MHSA Innovation Plan totaling $15 million over a four-year period to launch allcove™.

 

Aside - What is Allcove Santa Clara?

Allcove Santa Clara is an innovative, youth-focused drop-in center providing free or low-cost integrated care for young people aged 12–25. Developed with Stanford Medicine and located in Santa Clara County, it offers mental health support, physical health care, substance use counseling, and peer support in a safe, non-clinical environment designed to reduce stigma.

 

FYI - Orange County PIVOT Innovation Project (55 Pages)

Program Improvements for Valued Outpatient Treatment.

Behavioral Health Services Oversight & Accountability Commission (.gov)

https://bhsoac.ca.gov/wp-content/uploads/Orange_INN-Plan_PIVOT_1108024.pdf

By Orange County — The overarching goal of the PIVOT INN Project is to help Orange County, and other counties, prepare for the upcoming changes under the new legislation.

 

Aside - FYI – Legacy Project

OChealthInfo.com - PIVOT

https://ochealthinfo.com/sites/healthcare/files/2025-01/Orange%20County%20PIVOT%20Innovation%20Project%20Proposal_FINAL%2011.8.24.pdf

MHSOAC approval for the PIVOT INN Project. Following the approval of the MHSA Annual Plan.

 

FYI - Commission for Behavioral Health Seeking Input on Innovation Partnership Fund

California State Association of Counties

https://www.counties.org/csac-bulletin-article/commission-behavioral-health-seeking-input-innovation-partnership-fund

Mar 20, 2025 - Jolie Onodera Danielle Bradley

 

BHSA and BHSOAC

The Commission for Behavioral Health, formerly the Mental Health Services Oversight and Accountability Commission (MHSOAC), is seeking input on potential innovation projects that may inform the Commission on Innovation Partnership Fund (IPF) funding priorities. The Behavioral Health Services Act (BHSA) establishes the IPF and directs the Commission to administer that fund. This provision replaces the Innovation program in the original Mental Health Services Act, which provided funds to counties for innovation projects that the MHSOAC reviewed and approved.

 

Funding

The BHSA provides $20 million a year for five years, beginning in 2026, for grants to public, private, and nonprofit entities that promote innovate behavioral health programs and practices. The Commission may also combine Mental Health Wellness Act funding, which includes an additional $20 million per year, to fund innovative, evidence-based approaches for crisis prevention, early intervention, and response. The funded innovations must be designed to improve BHSA-funded programs, particularly those focused on underserved populations, low-income populations, and communities impacted by other behavioral health disparities.

 

The Commission is calling for concepts that introduce statewide system change opportunities to meet the goals of BHSA, which have been identified to promote the following:

 

Develop housing for people with behavioral health conditions

Integrate substance use disorder and mental health

Make workforce investments

Measure impact

Reduce disparities

Support for children and youth

Target individuals with the greatest need

 

Aside - Missed Deadline

Interested stakeholders are encouraged to submit input through this linked survey by Monday, April 14, 2025. Note: Participation in the survey does not constitute a solicitation for proposals that will lead to future funding. The Commission is soliciting input for informational purposes only.

 

Behavioral Health Transformation (39 Pages)

Mental Health Service Act Background

California Health and Human Services (.gov)

https://www.chhs.ca.gov/wp-content/uploads/2024/01/BHSA-Presentation.pdf

BHSA-Presentation

Innovation (INN), which encourages counties to experiment with new approaches to addressing mental illness. Source: Legislative Analyst's Office.

 

County Allocations: Behavioral Health Services and Supports.  35% for Behavioral Health Services and Supports (BHSS).

Includes early intervention, outreach and engagement, workforce education and training, capital facilities, technological needs, and innovative pilots and projects.  A majority (51%) of this amount must be used for Early Intervention services to assist in the early signs of mental illness or substance misuse. A majority (51%) of these Early Intervention services and supports must be for people 25 years and younger.

 

State Directed Funding: Innovation

$20 million annually will be directed to the Behavioral Health Services Act Innovation Partnership Fund, to develop innovations with non governmental partners.

 

The BHSOAC is the lead for these funds

The Behavioral Health Services Oversight and Accountability Commission (BHSOAC)—formerly known as the MHSOAC—acts as the lead for various state-directed funds, grants, and initiatives aimed at transforming behavioral health and supporting mental health services in California. California Health & Human Services (.gov)

 

Governor Newsom’s Transformation Of Mental Health Services (7 Pages)

Housing with Accountability. Reform with Results.

BHSA Fact Sheet

California Health and Human Services (.gov)

https://www.chhs.ca.gov/wp-content/uploads/2023/09/BHSA-Fact-Sheet-September.pdf

Sep 13, 2023

This effort will build 10,000 new treatment beds and housing units, helping serve over 100,000 people each year, with $6.38 billion funded by a bond on the March 2024 ballot to provide the resources needed to care for and house those with the most severe mental health needs and substance use disorders. It will update the Mental Health Services Act (MHSA) passed by voters 20 years ago to focus funds where they are most needed now.

 

Project as non-MHSA non-Innovations

A project designed as non-MHSA (Mental Health Services Act) and non-Innovation refers to a behavioral health initiative that is funded, implemented, and evaluated outside the strict regulatory requirements of the California Mental Health Services Act—specifically bypassing the 5% Innovation (INN) funding component. Such projects do not require approval from the Mental Health Services Oversight and Accountability Commission (MHSOAC) and are not subject to the mandatory five-year time limit or the stringent "learning-focused" criteria of INN projects.

 

Project is Innovative

An innovative project delivers new, high-value, or "ground-breaking" results by embracing uncertainty, risk, and agility, rather than following traditional, linear, or predictable, low-risk project methodologies. These projects require collaborative, creative teams that actively adapt to change, often using prototyping and stakeholder feedback to transform ideas into practical solutions that solve unmet needs.

 

Promising Practice

A promising practice is a program, strategy, or policy that has shown positive, measurable outcomes and has the potential to develop into a "best practice". These innovative approaches often demonstrate success in areas like education, community health, or social services, offering evidence-based solutions that improve quality of life, service, or performance.

 

Evidenced-based Practice (EBP)

Evidence-Based Practice (EBP) is a systematic approach to decision-making—primarily in healthcare, nursing, and psychology—that integrates the best current research evidence with clinical expertise and patient values/preferences. EBP aims to provide high-quality care, reduce variability in treatment, and improve patient outcomes by translating scientific findings into practice.

 

Behavioral Health Services Act (California)

Proposition 1: Potential System Impacts to Alameda County

FYI - Prop. 1 has Alameda County scrambling to preserve mental health programs

Substack · East Bay Insiders Newsletter

Steve Tavares - Mar 10, 2026

https://eastbayinsiders.substack.com/p/prop-1-has-alameda-county-scrambling

County officials warn state-mandated funding changes could eliminate prevention programs and leave up to 15,000 individuals without early mental health support.

https://www.chhs.ca.gov/wp-content/uploads/2023/09/BHSA-Fact-Sheet-September.pdf

An examination of costs, charges, and payments for inpatient psychiatric treatment in community hospitals (2012)

https://pubmed.ncbi.nlm.nih.gov/22588167/#:~:text=The%20average%20cost%20to%20deliver,and%20$4%2C147%20for%203.8%20days.

 

Program Analysis - Cost Benefit

Financial Considerations – Impact and Savings

Hospital and Inpatient – Psychiatry and SUD

 

Matrix - Cost Offset – Per Person – High End – Focus Behavioral Health

Psychiatr Serv 2012 Jul;63(7):666-71

Updated Hospital Costs per Day

As of 2022-2024 data, the average cost for a one-day inpatient hospital stay in the U.S. is approximately $3,025. Costs vary significantly by location and facility type, generally ranging from $2,500 to over $4,000 per day for non-profit and government-run institutions. These figures represent the expenses incurred by hospitals and are not the final charges billed to patients.

 

Disparity

Inpatient psychiatric treatment in community hospitals shows a significant disparity, with charges often 2.5 times higher than actual costs, while reimbursed amounts, particularly from Medicare, are often closer to, or sometimes lower than, the cost of care. In 2008, mental health/substance abuse stays cost an average of $5,700–$4,600, with costs varying up to fourfold between states. Payment models, such as the Medicare Inpatient Psychiatric Facility Prospective Payment System (IPF PPS), use a per diem rate, which is set to increase by a net 2.6% in 2025.

 

Factors like facility type, location, and level of care influence the cost.

 

Matrix - Costs – Per Person – In-patient Mental Health (2025)

Average Cost for Mental Health Residential Inpatient Treatment Programs?

https://amfmtreatment.com/cost/residential/

Last Reviewed: 20250405-F

 

Mental Health Treatment

In 2025, the cost of inpatient mental health treatment in Texas can range from $15,000 to $60,000, according to AMFM Mental Health Treatment. This range reflects a typical 30-day program, with daily costs potentially varying between $500 and $2,000.

 

Source of Statistics

(*) – Psych Ward charges 2.5 times higher than the hospitals’ reported costs to deliver.

 

Costs to Mitigate

“Mitigating might be defined as making “less severe, serious, or painful”.   In the case of Housing and Living Arrangements: It would be taking actions that lessen the gravity of a hardship such as moving”

 

Risk Mitigation

Risk mitigation is a “strategy to prepare for and lessen the effects of threats faced” by a consumer, landlord or data center.  “Rather than planning to avoid a risk, mitigation deals with the aftermath of a disaster and the steps that can be taken prior to the event occurring to reduce adverse, and potentially long-term, effects”.  Our Housing Solution Bundle is an effort about mitigation.

 

Hospitals Struggle – Demand Increasing

texastribune.org/2024/09/19/texas-medicaid-psychiatric-hospitals

Despite rising state mental health spending, private psychiatric hospitals are closing due to low Medicaid reimbursement rates, high operational costs, and staffing shortages. While public, state-run systems often focus on forensic patients (the criminal justice system), private facilities face financial instability that leads to bed reductions, even as demand for mental health services increases.

 

Program Analysis - Cost Benefit - Costs

Financial Considerations – Impact and Savings

Ballpark for Criminal/Justice Beds

Matrix – Cost(s) – Per Person – Criminal Justice Involvement (Low End)

https://www.bop.gov/policy/progstat/5380_006.pdf

 

Magnitude - $100.00 per day

Aside - FYI - Prison COIF

https://www.bop.gov/policy/progstat/5380_006.pdf

 

What is Cost of Incarceration Fee (COIF) in prison?

…committed to Bureau (of Prisons) custody, and. # serving a period of incarceration which began on or after. January 1, 1995. Unless exempted, the Cost of Incarceration Fee (COIF) is a financial obligation that sentenced inmates are required to satisfy at the earliest possible time. Aug 11, 1999

 

FYI – Links

FYI - Bureau of Prisons

https://www.bop.gov/

 

FYI - Incarceration Fees

https://www.federalregister.gov/documents/2023/09/22/2023-20585/annual-determination-of-average-cost-of-incarceration-fee-coif#:~:text=Based%20on%20FY%202022%20data,%2439%2C197%20(%24107.39%20per%20day)

Based on FY 2022 data, the average annual COIF for a Federal inmate housed in a Bureau or non-Bureau facility in FY 2022 was $42,672 ($116.91 per day). The average annual COIF for a Federal inmate housed in a Residential Reentry Center for FY 2022 was $39,197 ($107.39 per day). (Please note: There were 365 days in FY 2022.)

 

Orange County

Reference Year is 2025

Ballpark for Criminal Justice Beds (Continued)

Matrix – Cost(s) – Per Person – Criminal Justice Involvement (Higher End)

Incarceration Programs – Cost – Magnitude $150.00 per day

Last Reviewed: 20250404:

 

OCJ Mental Health Unit and Cost

Orange County is significantly expanding jail-based mental health services, including a $167 million plan to remodel the James A. Musick Facility into a "Mental Health Jail" with roughly 800+ beds and an estimated $61 million in annual operating costs. The Intake Release Center (IRC) currently serves as the main acute mental health housing facility, with services provided by the OC Health Care Agency.

 

Remodel the James A. Musick Facility (2024)

OC Sheriff opens new James A. Musick Facility

https://www.ocsheriff.gov/news/oc-sheriff-opens-new-james-musick-facility

SANTA ANA, Ca. (Nov. 19, 2024): Construction of the new James A. Musick facility is complete, employing an innovative custody model focused on increased rehabilitation services, enhanced safety and greater access to education and health services. The 324,000 square-foot, 896-bed facility will house minimum and medium-security incarcerated persons under a direct-supervision model, which marks a departure from traditional custody facility designs.

References for Criminal Justice (Incarceration)

 

Pay to Stay

(*) https://www.santa-ana.org/pay-to-stay-program/

Fees - There is no fee to apply or to obtain a letter of eligibility.

Requesting a letter of eligibility does not obligate program participation.

The first day of incarceration (administrative fees included) is $165.00.

Each subsequent day of incarceration is $140.00.

Program fees are paid in advance according to a predetermined schedule. Maximum payment frequency is every two weeks.

Fee payments may be in cash only.

 

Work Release | Anaheim, CA - Official Website

(**) https://anaheim.net/255/Work-Release

The Anaheim Detention Facility offers a work release (pay-to-stay) program.  Participants may accept visitors on Saturdays and Sundays between the hours of 2:00 p.m. and 5:00 p.m. The visits are non-contact. The work release program costs $150 for the first day and $100 for each day thereafter. There are no fees for the straight time program.  Payment is accepted either in full or in two-week increments with the first two-weeks due on or before the first day of participation. Letters of successful completion are only issued after the required time has been served and all fees have been collected.

 

FYI – Links

OC Grand Jury

https://www.ocgrandjury.org/

 

The State of Orange County Jails and Programs

https://ocgrandjury.org/sites/jury/files/2023-08/20070607-1_0.pdf

 

Incarceration – Federal Register

https://www.federalregister.gov/documents/2023/09/22/2023-20585/annual-determination-of-average-cost-of-incarceration-fee-coif#:~:text=Based%20on%20FY%202022%20data,%2439%2C197%20(%24107.39%20per%20day).

Program Analysis - Cost Benefit - Costs

Offset – Per Person – High End

Financial Considerations – Impact and Savings

Matrix - Cost – Hospitalization - For Year 2025 in California (unless)

20250403-TH: GenAI = Generative AI is experimental.

 

Futile Care in the ICU: Prevalence, Risk Factors, Costs - February 1, 2014

https://www.reliasmedia.com/articles/31064-futile-care-in-the-icu-prevalence-risk-factors-costs#:~:text=The%20average%20cost%20for%201%20day%20of,123%20patients%20who%20were%20perceived%20to%20be

 

What is futile care?

Futile care refers to medical interventions that provide no reasonable clinical benefit to a patient, such as failing to improve prognosis, not offering survival, or not enhancing quality of life. Often occurring in intensive care, these, treatments are considered "non-beneficial" or "meaningless" as they cannot achieve a curative goal. It is a controversial concept, sometimes defined by a lack of physiological effect or when treatment benefits are heavily outweighed by suffering.

 

UCLA Health (Sep 9, 2013)

Researchers assess frequency, cost of critical care treatments seen as 'futile' by doctors

https://www.uclahealth.org/news/release/researchers-assess-frequency-cost-of-critical-care-treatments

The average cost for a day of futile treatment in the ICU was about $4,000, the researchers found. For the 123 patients perceived as receiving futile ICU care, total costs during the three months of the study amounted to $2.6 million for the five ICUs. Although sizeable, this accounted for only a small portion (3.5 percent) of hospital costs for the full study cohort of ICU patients during the study period.

 

Again - Futile ICU Care

Futile ICU care, or non-beneficial treatment, refers to high-intensity, life-sustaining interventions that cannot improve a patient’s prognosis or fulfill their goals, often creating moral distress for clinicians. It is generally characterized by a lack of physiological, quantitative, or operational benefit. Such care frequently stems from family requests, poor communication, or difficulty accepting terminal illness, resulting in significant ethical conflicts, high costs, and reduced access to ICU beds for other

 

FYI - Becker's Hospital Review

https://www.beckershospitalreview.com/

 

3 to 5 day Stay

Whatever the patient's bill for care looks like, every inpatient stay comes with expenses, though it varies from one hospital to another.  Based on data from around January 2019, inpatient hospital stays are among the most expensive types of healthcare, with costs varying significantly based on diagnosis, insurance coverage, and location. In 2019, the average adjusted cost per inpatient stay in community hospitals was approximately $14,101. Here is a breakdown of the expenses and factors influencing inpatient bills during that period: Key Drivers of Inpatient Costs (circa 2019) Average Costs: While $14,101 was the average, costs ranged heavily, with many studies indicating that a typical 3-to-5-day stay could range from $10,000 to over $30,000 without insurance.

Matrix - Cost – Mental Hospitalization (2015 V 2025)

State Hospitals

A typical day in a California Department of State Hospitals (DSH) facility, such as Napa or Patton, is highly structured, focusing on intensive treatment for severe mental illness and forensic commitments (e.g., IST, NGRI). Patients engage in daily therapy, including specialized Dialectical Behavior Therapy (DBT) groups, individual therapy, and rehabilitation, aiming for stabilization and eventual community reintegration. Cost per day in California state mental hospitals varies, with at least one recorded case showing a rate of $520 per day for specialized care in 2020. Generally, state and local government hospital expenses for inpatient care are high, often averaging over $3,600 per day nationally for inpatient services, reflecting total operating costs.

 

It adds up!

https://www.dhcs.ca.gov/services/MH/Pages/medi-cal-behavioral-health-fee-schedules.aspx

 

Aside - Figure – Medi-Cal Fee Schedules – Fees are costs

• SMHS 24 Hour Services (Effective July 1, 2023)
• SMHS Day Services Rates (Effective July 1, 2023)
• SMHS Mobile Crisis Rates (Effective July 1, 2023)
• SMHS Outpatient Rates (Effective July 1, 2023, Revised April 5, 2024)
• SMHS Psychiatric Inpatient Rates (Effective July 1, 2023, Revised January 9, 2025)
• SMHS Therapeutic Foster Care Rates  (Effective July 1, 2023)

 

• DMC ODS 24 Hour Day Service (Effective July 1, 2023)
• DMC ODS Ambulatory Withdrawal Management (Effective July 1, 2023)
• DMC ODS Inpatient Withdrawal Management (Effective July 1, 2023)
• DMC ODS Mobile Crisis (Effective July 1, 2023, Revised October 28, 2024)
• DMC ODS Outpatient (Effective July 1, 2023, Revised May 10, 2024)
• DMC ODS Partial Hospitalization (Effective July 1, 2023)
• DMC ODS NTP Rates (Effective July 1, 2023)

 

• DMC County 24 Hour Day Service (Effective July 1, 2023)
• DMC County Mobile Crisis (Effective July 1, 2023)
• DMC County Inpatient Withdrawal Management (Effective July 1, 2023)
• DMC County Outpatient (Effective July 1, 2023, Revised May 10, 2024)
• DMC County Partial Hospitalization (Effective July 1, 2023)
• DMC County NTP Rates (Effective July 1, 2023)

 

Housing Help Line Benefit – $3E6

>Two of our goals with a Housing Help Line are to without referral, directly, place people in such a nourishing environment as to reduce days in the hospital, in jail, or on the streets.  If we successfully serve just one thousand individuals in one year and avoid for them one less day in the hospital we will save $1,000,000 in one year.  In our approximations we use a conservative hospital day stay rate of $1,000 per day. 

 

Incarceration – Savings – Annual Jail Time Burden

>If we deliver a high quality bed in the community for an individual in the criminal justice system and thereby reduce their yearly jail-time burden we also project some savings.  If we serve one thousand individuals with a criminal justice burden and reduce their stays by ten (10) days once again we could actualize a savings of $1,000,000.

Rimal B Bera MD’s Take

>Buster has a Behavioral Health Doctor (BHD) with whom he retains.  They spend about three (3) minutes each appointment discussing community level Housing fix ideas.  Buster’s BHD does not understand pubic behavioral health funding well.  Buster’s BHD labors over the issue of where the money for a Housing Solutions Bundle is going to come from.  Buster tries to explain the Mental Health Services Act (MHSA) funding stream and process.  Now we get to figure out how the Behavioral Health Services Act (BHSA) fits in.

 

BHSA

>For those institutions and agencies with little or no money executing this idea could pose quite a challenge.  That is why we spend the time projecting benefits including full impact savings.  California does not have huge excesses yet each year there is some Behavioral Health monies to spare.  We have included as dated table that describes some of the where California Behavioral Health Monies come from.

 

Figure – SUD - Type of Treatment – Costs – Per Episode (2006 & 2022)

https://drugabusestatistics.org/cost-of-rehab/

Figure – SUD - Type of Treatment – Costs – Per Person (2016 & 2022)

https://drugabusestatistics.org/cost-of-rehab/

https://drugabusestatistics.org/cost-of-rehab/

 

Cost of Rehabilitation Based on a 30 day Program

A 30-day addiction rehabilitation program typically costs between $5,000 and $20,000, with an average of approximately $12,500 for inpatient or residential care. Costs vary based on facility type, with luxury programs ranging up to $80,000+, while outpatient programs are generally cheaper, starting around $1,500 for a 30-day, less intensive course.

 

Metadata >

2017 – United Way

2017 United Way

Notes: Cost estimates consider utilization of…

 

Ambulance services

Bridge housing nights

ER services

Food pantries

Inpatient hospital stays

 

Mental health services

Motel/voucher/rental assistance services

Nights in jail/prison

Other health services

Permanent supportive housing nights

 

Policing

Rapid re-housing nights

Shelter nights

Soup kitchens

Substance abuse services

 

These estimates do not capture other potential costs including probation, changes in property values, park maintenance costs, etc. Reports from the last month are annualized.

 

Homeless Diversion

Homeless diversion is a strategy to prevent people from entering the shelter system by quickly connecting them to immediate, stable housing solutions and support, such as helping them stay with family or find other temporary housing with financial aid for deposits/rent, while also referring them to longer-term services for mental health or employment to maintain housing stability, often involving problem-solving and resources like short-term rental assistance or mediation. It focuses on rapid rehousing and preventing homelessness before it becomes chronic, utilizing approaches like housing location, security deposit help, and case management

 

Frequent Flyers - Homeless

Based on this methodology, we estimate from our interviews that the mean annual cost per person for all services, across all categories of housing configuration and chronicity, is approximately $45,000 (Figure 9, page 39).  Heavy service consumers, particularly of health and medical services, drive the average cost up greatly; so much so that if the most-costly 10% are dropped from the analysis, the mean annual cost per person drops from $45,000 to approximately $10,000. United Way (2017)

Metadata >

Homelessness Causes

The major factors precipitating homelessness in our sample (in order of frequency of mention) are:

Homelessness in Orange County, CA Study - True Costs of Homelessness to our Cities

Jamboree Housing Corporation – 2014/15

https://www.jamboreehousing.com/pages/what-we-do-resident-services-permanent-supportive-housing-cost-of-homelessness-study

Learn more about OC's homeless and how much homelessness is really costing Orange County in the findings of the first-ever Cost Study of Homelessness in OC.

 Cost Study of Homelessness in OC

The first-ever OC Cost Study of Homelessness (2017) revealed that homelessness costs Orange County nearly $300 million annually, with $120 million borne by cities. The study found that placing chronically homeless individuals into permanent supportive housing (PSH) is 50% cheaper than leaving them on the streets ($51,587 vs. $100,759 annually).

 

Yearly Budget – Finding $3E6

 

Scale and Magnitude – Call Centers

Financial Considerations

Matrix - Call Center Options – HOUSING Helpline (BedBusters or OC Beds)

(*) Reference Year 2025/26 by Anthony Lee (February 2025)

Last Reviewed: 20191227-F: Reference Document

 

https://bhsoac.ca.gov/

 

Securing Funding

Matrix – Three to Four Delivery Options – HOUSING Helpline (BedBusters)

Piggy Back on OC-LINKS

Standalone Dedicated Housing Help Line

BHSOAC Project

Contract with a Call Center

BHSS Innovative Pilot or Project

 

Promotion - Resources

OC Navigator

https://ocnavigator.org/m/ocn

Find help in Orange County by connecting with health, wellness, and other online resources. OC Navigator is brought to you by the OC Health Care Agency (OCHCA).

 

Preemptive Testing

Preemptive testing refers to conducting diagnostic, genetic, or software tests before symptoms appear, treatments begin, or bugs occur, aiming to guide future decisions and prevent adverse outcomes. Primarily used in pharmacogenomics, it maps a patient’s genetic profile to optimize drug selection, preventing, for example, adverse drug reactions (ADRs).

 

Fate of the OC Warmline

The NAMI Orange County (NAMI OC) Warmline has faced severe funding cuts as of July 1, 2025, resulting in the elimination of 24/7 service and major staffing reductions. To keep the non-crisis service running, it shifted to reduced hours of operation (12 PM to 12 AM), with NAMI OC leadership actively seeking alternative funding to restore full services. Key Details on the Fate of the OC Warmline: Funding Cuts: The county pulled funding for the program, which led to the layoff of 127 staff members.

 

Is OC-LINKS effective for housing needs?

OC-LINKS is highly effective as a navigation tool for addressing housing needs in Orange County by connecting individuals, particularly those with mental health or substance use issues, to behavioral health services, emergency shelters, and permanent supportive housing programs. It acts as a key referral service, often coordinating with broader initiatives like the Coordinated Entry System (CES) to secure stable housing for at-risk residents.

 

Pruned Data versus Concatenated Data Concatenation

Pruned data and concatenated data represent opposite approaches to data management and model optimization, typically used to address efficiency versus information retention in machine learning, bioinformatics, and database management. Pruning focuses on reducing the size of data or models by removing irrelevant, redundant, or low-value information, while concatenation merges multiple data sources, strings, or features together to create a larger, more comprehensive dataset or to handle complex, multi-modal inputs.

 

Patients in the psych ward waiting for bed referral

 

 

May 2012

Why Some Individuals Seeking Psychiatric Services are Waiting Extensive Lengths of Time for Beds in EDs and What Can be Done

https://chiamass.gov/assets/Uploads/bhtf-DMH-ED-LOS-and-Psych-Bed-Access-Initiative-May-2012.pdf

 

Time Trials

The "3-month rule" in mental health primarily refers to a legal, clinical guideline where involuntary medication treatment requires a second opinion after 90 days. Alternatively, it is used as a psychological guideline suggesting 12 weeks are needed for new therapies or habits to create lasting brain changes and show progress.

Based on Lived Experience (LE) - Hospital History

State of California - Psychiatric Patients

Last Update – 20260413-M

(*) Source – Google AI – Numbers are to be considered approximations.

NR = No Record

 

Did MHSA Innovation Component Succeed?

Based on available reports, the Mental Health Services Act (MHSA) Innovation component has generally been viewed as successful in its goal to foster new approaches, though it faced challenges with consistent implementation and, as a result, is being restructured into the Behavioral Health Services Act (BHSA) as of 2025. The component successfully created a space for testing novel, risky, or, creative mental health practices designed to improve service quality and outreach to underserved populations.

 

Key Indicators of Success:

 

Encouraging New Approaches

It successfully funded projects that stepped outside of "business-as-usual" approaches to test new, creative strategies, such as the Innovation Incubator.

 

Building Capacity

The Innovation Incubator provided technical assistance that improved local capacity for data management, analysis, and continuous quality improvement in counties.

 

Aside – Innovation Incubator

https://bhsoac.ca.gov/initiatives/innovation-incubator/

 

Tangible Results

Specific projects, such as San Bernardino County’s RBEST, showed measurable success, including a significant decrease in hospital admissions (up to 58.9% within 90 days).

 

Focus on Underserved Populations

The component successfully pushed for projects focusing on unserved, underserved, and inappropriately served individuals.

 

Challenges and Limitations:

 

Inconsistent Implementation

Flexibility in design led to varied success rates across different counties.

 

Evaluation Difficulties

While the goal was learning, measuring the long-term impact of these pilot projects was difficult.

 

Sustainability

Successful projects needed to find alternative funding sources after the initial 5-year maximum.

 

Transition to BHSA (2025):

Because of these challenges, the MHSA is being updated to the Behavioral Health Services Act (BHSA). The new structure aims to improve upon the innovation component by focusing on more uniform standards, accountability, and a stronger emphasis on full-service partnerships.

 

If MHSA Innovations Succeeded then why restructure it?

The restructuring of the Mental Health Services Act (MHSA) into the Behavioral Health Services Act (BHSA) in California, despite the success of many MHSA-funded innovations, is driven by the need to address evolving crises, close gaps in the original system, and modernize services for current needs. The restructuring aims to build upon MHSA's foundations rather than replace them, focusing on integrating care and enhancing accountability.

 

Example of Numbers

Matrix - MHSA OC Funding Breakdown (Approximations)

Financial Considerations

Time Frame – 2016-2021

Putting the MHSA to Sleep

First Generated: 20191227-F: