Sierra County Approves Three-Year Behavioral Health Plan

SIERRA COUNTY — Sierra County supervisors approved a three-year Behavioral Health Services Act plan Tuesday, putting in place the local roadmap for how the county will organize behavioral health funding, housing supports, substance use treatment access, youth prevention, and workforce efforts through fiscal years 2026/27, 2027/28, and 2028/29.

The approval was required before a June 30 state deadline, ahead of the July 1 start of California’s new Behavioral Health Services Act, or BHSA. The new law replaces the Mental Health Services Act, known as MHSA, and changes how counties must plan and spend money for mental health, substance use disorder services, housing-related supports, and accountability.

Behavioral Health Director Sheryll Prinz-McMillan told supervisors the new law combines programs previously handled in separate ways. She said BHSA “integrates both SUD services, substance abuse services, and mental health services all under one umbrella.”

The local plan comes from Proposition 1, narrowly approved by California voters in March 2024. Proposition 1 included two major pieces: the BHSA and a $6.4 billion behavioral health bond for treatment infrastructure, supportive housing, and community-based settings.

The funding source for BHSA remains the same as under MHSA: a 1% tax on personal income above $1 million. The county’s board memo says Proposition 1 does not cut existing behavioral health funding, but it does require counties to focus more of their efforts on people with the most serious mental health and substance use disorder needs, as well as people who are unhoused or at risk of homelessness.

For Sierra County, the board item lists $5,450,175 in revenue and the same amount in expenses over the three-year plan period. The memo says the money will fund a portion of the Behavioral Health Department budget, with no additional General Fund impact.

The plan also coordinates other funding streams that flow through the county’s behavioral health system. Those include Medi-Cal revenue, federal financial participation, 1991 and 2011 Realignment funds, the Community Mental Health Services Block Grant, the Substance Use Prevention, Treatment, and Recovery Services Block Grant, PATH homelessness funding, Behavioral Health Bridge Housing, and other state and federal sources.

Prinz-McMillan said the budget includes money passed through to outside providers and facilities. When Supervisor Lee Adams asked whether the $5.45 million figure was a cap or an amount the county expects to use, she said hospitalization and substance use recovery programs account for a large share of the spending.

The plan was released for public comment on May 8, and the comment period closed on June 11. The Behavioral Health Advisory Board held a public hearing the same day before recommending the plan to supervisors. The county also contracted with IDEA Consulting Group in April to help complete the state-required plan. The plan went through state review, with Prinz-McMillan saying state officials required “back and forth with amendments right up to the 9th hour.”

Tuesday’s approval establishes a state-approved three-year plan that determines how funding can be spent and how outcomes will be measured. The plan also gives readers a detailed look at behavioral health needs in the very small county. Sierra County reported 25 children and youth under 21 who received Medi-Cal Specialty Mental Health Services, 61 who received at least one substance use prevention or early intervention service, and 19 who were served by the Mental Health Plan while having an open child welfare case.

Among adults and older adults, the county reported 123 people who received Medi-Cal Specialty Mental Health Services, 26 who received Drug Medi-Cal services, and 16 who received both mental health and substance use disorder services. The plan also reported 12 adults or older adults who were chronically homeless, experiencing homelessness, or at risk of homelessness, 19 in the justice system, 48 incarcerated, and 15 who had reentered the community from state prison or county jail.

The county cautions that small numbers can make local data hard to interpret. Several categories are suppressed as “<11” under state privacy rules, and the plan notes that low numbers can skew trends and disparity analysis.

Access to care appears mixed. Sierra County’s specialty mental health service penetration rates were above statewide rates for both adults and children, but non-specialty mental health penetration rates were below statewide rates for both groups. The plan identifies older adults and youth as underserved for non-specialty mental health services and says Behavioral Health will work with Public Health and Partnership HealthPlan of California to improve access.

Homelessness is another major concern. The plan says Sierra County’s Point-in-Time homelessness rate is above the comparison rate for its Continuum of Care region, with adults ages 18 to 44 showing higher prevalence than other age groups. The plan also says people experiencing homelessness with severe mental illness or chronic substance abuse are above the regional comparison rate.

Housing is also where Sierra County’s plan most clearly departs from the standard state formula. Under BHSA, counties are generally expected to allocate 30% of local BHSA funds to housing interventions, 35% to Full Service Partnerships, and 35% to Behavioral Health Services and Supports.

Sierra County received state approval to use only 5% for housing interventions and move the other 25 percentage points into Behavioral Health Services and Supports. The county’s justification is its small population, limited client base, and small number of people expected to request housing assistance.

The plan cites Sierra County as the second least-populous county in California, with an estimated 3,098 residents. It says the county expects fewer than 15 people to request housing assistance.

Even with the reduced housing allocation, the plan identifies large local gaps in supportive housing, recovery and sober living housing, assisted living, room-and-board options, recuperative care, peer respite, short-term post-hospitalization housing, and permanent rental subsidies. The plan says apartments, single-family homes, mobile home communities, tiny homes, shared housing, motel stays, and non-congregate interim housing also have gaps, though generally not as severe.

Rather than using BHSA money to run rental subsidies, operating subsidies, landlord mitigation funds, housing navigation services, or capital housing projects directly, the county will focus the smaller housing allocation on participant assistance funds. Those funds can help with practical costs that keep someone from getting or keeping housing, such as application fees, vital documents, moving costs, household items, storage, fees in arrears, and security deposits for service animals.

The plan says participant assistance gives the county the most flexibility in a very small community. It anticipates serving 20 people per year through that housing intervention.

Youth services are another area where the plan shows continuity but also a clearer shift toward prevention and early intervention. Prinz-McMillan told supervisors the county’s priority populations over the next three years will continue to include people with serious mental illness, while also adding seniors and youth as priority populations.

For children, youth, and transition-age youth up to age 25, the plan continues early intervention work that can include outreach, screening, assessment, referral, brief outpatient treatment, telehealth medication management, case management, peer support, crisis response, suicide prevention, and substance use disorder services when needed. Evidence-based practices listed in the plan include Trauma-Focused Cognitive Behavioral Therapy and Parent-Child Interaction Therapy.

One of the youth programs named in the plan is SWAY, the Sierra Wellness and Advocacy for Youth program. SWAY is not described as a traditional clinic program, but as a prevention and youth engagement effort built around schools, community events, peer connection, youth leadership, mental health awareness, coping skills, resilience, and substance use prevention.

Recent county materials say SWAY has included events such as Fall Flapjack Friday, the Great October BBQ, an annual Easter egg hunt, and a youth speaker series. School-based prevention clubs have also been part of the youth engagement work, including Friday Night Live.

The county reported that youth leaders from those programs delivered 136 hours of youth-led meetings and 496 hours of educational programming focused on substance use prevention, mental health awareness, coping skills and resilience, leadership development, and community advocacy. County materials describe SWAY as a way to give youth a familiar, low-stigma setting to connect with peers and supportive adults before problems become crises.

For adults, the plan keeps the DeMartini House Wellness Center and Front Porch outreach model as important access points. The Wellness Center helps connect adults and older adults with behavioral health services, basic supports, and activities without requiring a traditional clinical entry point. Front Porch is designed for people who are not already connected to services. The plan describes the program as relationship-based engagement meant to reduce stigma, build trust, increase awareness, and link people to ongoing support.

Full Service Partnerships are another required BHSA category, aimed at people with some of the most intensive needs. State materials often describe Full Service Partnerships as a “whatever it takes” model, meaning services can wrap around someone with housing support, case management, treatment, crisis response, and other help.

Sierra County received state approval for exemptions from standing up full Assertive Community Treatment, Forensic Assertive Community Treatment, and Individual Placement and Support programs. The county cited limited workforce and limited need in a county of about 3,100 residents.

Instead, Sierra County plans to use Full Service Partnership Intensive Case Management and High Fidelity Wraparound. In plain terms, the county is proposing intensive, coordinated help for high-need clients, but not the larger multidisciplinary ACT-style teams used in more populous counties.

The plan says staff will work with the Wellness Center, emergency departments, probation, law enforcement, the Sheriff’s Office, and Collaborative Court to identify people with repeated crises or justice-system involvement. The goal is to connect people through warm handoffs, field outreach, peer support, housing help, benefits navigation, transportation support, crisis planning, and ongoing case management.

Substance use treatment access is also changing under the plan. Sierra County plans to expand field-based substance use outreach, meaning staff may meet people in homes, encampments, community spaces, or other non-clinical settings rather than waiting for people to come to an office.

The plan says field-based work may include screening, brief intervention, harm reduction education, overdose prevention, naloxone distribution, case management, recovery support, and referrals to treatment. It also calls for mobile case management, mobile peer support, mobile harm reduction, mobile crisis response, and re-engagement for people who have fallen out of care.

The county also plans to create a Medication Assisted Treatment (MAT) task force in 2026/27 with Behavioral Health staff, Medi-Cal managed care plans, regional substance use and MAT providers, and neighboring counties. MAT uses medications such as buprenorphine, naltrexone, and Vivitrol, along with counseling and support, to treat substance use disorders.

The plan says the task force will work toward same-day or next-day access through an open-access model. Sierra County plans to begin agreements with Tahoe Forest Hospital District MAT Clinic and Western Sierra Medical Clinic, both in Nevada County, to help cover the eastern and western sides of Sierra County.

A capital project in the plan is the proposed purchase of the Social Hall building in Loyalton. Behavioral Health would use BHSA Capital Facilities and Technological Needs funds to purchase the building, while the Sheriff’s Office and Probation would cover renovation costs.

The plan describes the building as a future space for behavioral health functions, justice-involved services, reentry programming, treatment services, early intervention, and Behavioral Health administration. The plan says the project is intended to improve coordination among Behavioral Health, Probation, and the Sheriff’s Office.

Workforce limits shape many parts of the plan. Sierra County reported a 33% vacancy rate for permanent clinical and direct-service behavioral health positions, with the greatest vacancies among licensed clinical social workers, marriage and family therapists, professional clinical counselors, psychologists, and psychiatrists.

The plan says Sierra County has a difficult time attracting licensed clinicians because of its rural location and small client base. It also says the county has depended on part-time and semi-retired clinicians and continues to lack key clinical roles.

To respond, Sierra County is asking for flexibility in workforce spending. Its Workforce, Education, and Training proposal would blend workforce activities into one umbrella program, allowing the county to use funds for training, certification, retention incentives, stipends, internships, or loan repayment when opportunities arise.

The plan also says new BHSA reporting and evidence-based practice requirements will add work for data management, compliance, and quality oversight. The county expects some loss of Medi-Cal billable service hours because direct-service staff will need time for training, documentation, and new implementation requirements.

With board approval complete, the county can submit final certification to the state and move into the first year of the BHSA plan. The plan will guide how Sierra County Behavioral Health spends a major portion of its funding, tracks state-required outcomes, and adapts existing programs under California’s new behavioral health system.