San Diego County’s next major investment in mental health care is likely to land in the city of San Diego’s Midway District, with the county’s behavioral health department eying its property on Rosecrans Street as the location for a “behavioral health wellness campus” and planning to submit the project for the second round of Proposition 1 funding in the fall.
Nadia Privara Brahms, acting director of Behavioral Health Services for the county, mentioned the project last week during an update to the county Board of Supervisors that was focused on recent gains in substance use treatment capacity serving the region’s nearly 1 million Medi-Cal enrollees.
Significant gains, officials said, have or will soon be made in the numbers of beds and treatment slots, pushing hard toward a previous goal of service transformation countywide by 2030. But getting to that destination will require additional projects not yet in the pipeline.
For decades, the county’s health care services departments, including public health headquarters, were located in a large, single-story building on the Rosecrans site, which sits just south of Interstate 5 next to the San Diego County Psychiatric Hospital. The health services complex is now empty with its final occupants moving north and east to buildings at the county’s operations center on Overland Drive in Kearny Mesa, creating an empty space for additional mental health services.
For the moment, the county is not saying more about exactly what sorts of services would be located there once the old buildings are removed.
“We will provide more information once details are solidified,” Privara Brahms said.
The county’s five-year “Optimal Care Pathways” model, a framework adopted under previous behavioral health director Luke Bergmann, estimates that significant increases are necessary to meet the needs of Medi-Cal recipients across the region. The substance use treatment update accounted for activity in the 2024-2025 budget year, which ended on June 30. The report indicated that combined local resources will serve nearly 7,000 residents in residential care, already nearly meeting the 2030 goal of 8,851. The goal for outpatient care is 18,390, with collective capacity now sitting at about half that number and housing resources similarly about half way to the 2030 goal of 5,033.
Additional projects now under construction or expected to begin construction soon, including several awarded in the first round of Prop. 1 funding announced this spring, are expected to serve enough clients in residential care settings to meet 2030 goals, but will fall short of providing enough residential care treatment slots, long-term housing and short-term transitional housing.
Voters approved Prop. 1 in 2024, narrowly supporting $6.4 billion in state bonds to fund projects across California designed to significantly increase resources for mental health care and substance use treatment. In the first round of awards, reserved for projects deemed “shovel ready,” meaning planning and design work is complete and buildings are ready for construction, San Diego County received seven awards worth a combined total of $185 million.
Lindsey Purdie, executive director of The Crossroads Foundation, San Diego’s oldest recovery home for women in operation since 1957, said that recent expansions in county contracting for services around drug and alcohol treatment are being felt in the community of organizations that serve those on Medi-Cal. But, as last week’s report indicated, there is still a distance to cover for total need to be met.
“We find that, especially for women, there are days when all of us, all of the women’s programs here in San Diego, are calling around trying to find beds, because there are more beds for men than there are for women,” Purdie said.
The need remains most acute, she added, in detoxification, the first step taken when a person determined to overcome addiction begins treatment. Plans are underway, she said, to convert two of the foundation’s 20 beds for use in detoxification work, and the organization is looking for an additional property to further expand that function.
“The main drug of choice nowadays is fentanyl of some type, and also alcohol,” Purdie said. “For fentanyl and alcohol use, you need to have medically supervised detox, because people can die if they are not detoxed properly.
“The first 48 hours are critical, and oftentimes they need some type of medication so they don’t go into a seizure. There are plenty of private detox centers in San Diego, but they don’t accept Medi-Cal clients, and so, for our clients, there is still often not anywhere for them to go.”