MOORLACH UPDATE — Youth Mental Health Care — September 15, 2018

Santa Clara County is very similar to Orange County. It has 1 million fewer people, but it has a dynamic business community, including Silicon Valley. It also has major universities and a robust county Health Care Agency. Its concerns about addressing those with mental health issues mirror those here in the OC.

There is one big exception, however. The Children’s Hospital of Orange County, which recently opened an incredible, state of the art, pediatric floor for young people addressing mental health issues. CHOC has stepped up to meet a major need. After you read the Mountain View Voice piece below, you will see how blessed our community is.

The Mountain View Voice provides a very thorough analysis of mental health services in Santa Clara County. While reading it, you can insert “Orange” for “Santa Clara” and you’ll receive a great tutorial on what is occurring here. The good news is that there is a collaboration of public and private sector leaders working to continue improving the OC’s status.

This would be a good time to tell you that Governor Brown signed SB 688 yesterday. It is my bill to improve the reporting of the Mental Health Services Act (MHSA) by counties so that there is apples-to-apples comparisons on expenditures between the 58 counties (see MOORLACH UPDATE — Quiet Bills, And Not So Quiet — May 3, 2018 ). Each of the counties watch their counterparts closely, and when there’s innovation, it should be mimicked. And, when there’s waste, it should be called out. Consistent accounting leads to better accountability.

Also, as a member of the California Senate Mental Health Caucus (see, I’ve had the privilege to meet and listen to Dr. Steven Adelsheim, the Director of the Center for Youth Mental Health and Wellbeing at Stanford University. He is mentioned in the Mountain View Voice piece below. And, his program and Headspace in Australia are models the OC needs to review.

Just yesterday, I met with the CEO of the mental health care assistance nonprofit Living Success Center, located in Costa Mesa, who confirmed the administrative nightmare that working with the Orange County Health Care Agency’s Mental Health Services has become (see This would be an area where legislative improvements can be pursued.

For more on SB 1004, see MOORLACH UPDATE — SB 1004 and CIRM — September 10, 2018.

As for providing psychiatric beds, my bill, SB 1273, was a moving force in adding more of them in the OC and the other 57 counties (see MOORLACH UPDATE — SB 1255 and SB 1273 — July 25, 2016). Unfortunately, it was for those at the age of majority or older. So, refocusing on minors is another area for legislative opportunity.

With regards to the languishing MHSA funds, this year I have met with Elaine Howell, the State Auditor, and Toby Ewing, the Executive Director of the Mental Health Services Oversight and Accountability Commission. I also asked tough questions of Jennifer Kent, Director of the California Department of Health Care Services during a hearing of the Senate’s Select Committee on Mental Health. Improvements at the state level must be pursued.

Now that the 2017-2018 Session has concluded, it is that time of they year to construct legislation for 2019. You may see me collaborating with Sen. Jim Beall of Santa Clara County to formulate streamlining efforts to move the MHSA funds to areas where they would be best utilized. Providing clarity and leadership is the crying need, and I hope we can provide it next year.

If you have recommendations in this area of healthcare, please do not hesitate to let me or my staff know.

County struggles to meet ‘overwhelming’ needs

State’s patchwork system makes youth mental health care hard to provide

by Kevin Forestieri

Back in 2006, Chris Tanti sought to reinvent the way Australia delivered youth mental health services.

With an early $50 million in government funding, Tanti and his organization, Headspace, would spend the next decade creating a network of 100 mental health centers serving 355,000 people throughout the country, each one with its own personality. Some were located in shopping districts like downtown Mountain View, Tanti said, while one was in a remodeled former train station.

Each Headspace center has a broad range of help at the ready — psychiatrists, psychologists, primary care doctors, occupational therapists, social workers, nurses and more — but the vibe is nothing like a sterile medical clinic.

The centers and the way they were marketed had such little resemblance to mental health clinics, while essentially playing the same role, that roughly half of the children and young adults who walked through the door were self-referrals. They showed up looking for help, even if they weren’t quite sure what was wrong with them, Tanti said.

Could something like Headspace take root in California, where the health care model and financing is so different from that of Australia’s? A number of organizations in the Bay Area, notably the Stanford Center for Youth Mental Health, are seeking to emulate Headspace, widely considered to be the gold standard for youth mental health care. Stanford Hospital recently received $15 million in Santa Clara County funds to open clinics in San Jose and the North County area.

Just north of the county border in Menlo Park, a program called SafeSpace launched last year aiming to fill the same niche as Headspace, with Tanti serving as the organization’s CEO for its first year. Its downtown center is open as a hub for middle and high school students, with a direct link to clinical services just a block away.

Getting a Headspace model that could serve anyone who walks through its doors will likely be a significant uphill battle — California doesn’t have the type of government-sponsored health care system that Australia has, Tanti said. Instead, Stanford would need to broker agreements with commercial insurance companies and public agencies. These contracts are often seen as a significant barrier to providing care, made more difficult by the fractious nature of Medi-Cal and how individual counties provide mental health services.

“The need is so overwhelming,” said Steve Adelsheim, director of Stanford’s Center for Youth Mental Health and Wellbeing. “Part of the concern is that when we open there will be many, many people coming. Will it be an overwhelming task? We won’t know.”

A fragmented system

The structure of mental health care services in California is unusual compared to most of the country. Among the biggest challenges is trying to circumvent bureaucratic roadblocks and tap into roughly $8 billion in mental health care funding provided by the state each year.

For the last six decades, California has taken steps to reduce the role of the state in providing mental health care, opting instead for a decentralized system that pushes most of the administrative and financial responsibility to the state’s 58 counties. This patchwork approach of counties trying to fill mental health care gaps ends up isolating mental health from the rest of the Medi-Cal model.

Few other states do this “carving out” that delegates Specialty Mental Health Services down to the county level, something that requires a waiver from the federal government every two years. Other states, including Iowa, Nebraska and New York have sought to shift behavioral health services back to statewide Medicaid managed care plans.

One of the downsides of California’s fragmented system is that every county has approached mental health care in a different way, without any continuity, according to Sheree Lowe, vice president of Behavioral Services at the California Hospital Association. She said it’s hard enough that behavioral health is so underfunded in California, but it only adds to the difficulty of getting care when every county is approaching the problem in a different way.

If private practices want to provide psychiatric care or therapy for Medi-Cal patients and have the government pay the bill, it’s an uphill battle. Lowe said they not only have to contend with relatively low reimbursement rates, but also have to work their way through the bureaucratic slog of contracting with individual counties. It’s unreasonable to think a small practice has the administrative bandwidth to ink contracts with so many different government agencies.

“Imagine a psychiatrist in private practice in Sacramento having to have contracts with 30 different counties. For a one-man psychiatrist office — that’s just too much to ask,” she said. “Most psychiatrists refuse to contract with commercial and Medi-Cal payers and put the burden on patients to pay and get reimbursed from the insurance companies.”

One study found that psychiatrists are among the least likely physicians to accept new patients on public insurance, with only 37 percent accepting Medi-Cal, according to a report by the California Healthcare Foundation. Payment amounts were the number one problem cited, followed by “administrative hassles” and delays in payments.

For families, those numbers translate into long delays in getting care and a lot more legwork for patients searching for a timely appointment, said Saul Wasserman, government affairs committee co-chair for the California Academy of Child and Adolescent Psychiatry.

“You can find a child psychiatrist now if you’re willing to pay out of pocket,” he said. “You may or may not be able to find someone if you are on a PPO-type insurance plan, and if you’re using public insurance like Medi-Cal, it’s impossible.”

More than half of Santa Clara County’s half-billion dollar annual budget for mental health and substance abuse services doesn’t actually finance county-operated programs, instead flowing out to roughly 40 different community-based organizations (CBOs). This includes a network of nonprofits and health care agencies peppered throughout the county and serving tens of thousands of patients each year.

Although Santa Clara County consistently passes state performance reviews and requirements with flying colors — and has received praise for its Crisis Stabilization Unit for youth as a means to avoid hospitalization — there are signs that the county has struggled to maintain good relationships with its partners.

Last year, a group called the Community Health Partnership brought together 35 people from health care clinics, mental health nonprofits and hospitals serving North County and West Valley cities and asked them, candidly, what kind of problems they have working with the county. The long list of grievances show that CBOs rarely have the administrative bandwidth to make it through the laborious application process with the county, particularly smaller nonprofits with shoestring budgets. The contracts, they said, usually comes with a fairly low reimbursement rate and burdensome reporting requirements.

Santa Clara County Supervisor Joe Simitian, who requested the report, told the Voice that the results didn’t come as a surprise to him, reaffirming that nonprofits and the larger community see the county as a bureaucracy that is slow to respond to crises and difficult to work with.

“County staff has to work harder to overcome some of that bureaucratic inertia that likely affects counties of our size,” Simitian said. “It’s a great big battleship, and it’s difficult to turn it in even a degree or two.”

Simitian said it’s worth remembering that the county has its own hands tied in many ways, with burdensome restrictions by state and federal agencies on how money is spent. The latest example was the county’s contract with an intensive outpatient program called ASPIRE, operated by El Camino Hospital, which took two years of planning and creativity in order to comply with the billing structure allowed by Medicaid.

Contracting for services isn’t so difficult when the county is looking to buy widgets, Simitian said, but the same can’t be said for mental health services. Spending is heavily constrained and monitored, and services often simply don’t fit within the framework of state law.

“The provisions that are in state law to try and make sure that the process doesn’t involve misuse of public funds, doesn’t have favoritism and gives people the best product at the lowest price — which is fine, if you want to buy widgets,” he said. “But if you want to solve complex social problems like the mental health needs of teens in our area, the process doesn’t function particularly well.”

Even without the bureaucratic slowdown, Lowe said the state’s strategy of isolating Specialty Mental Health Services from the state’s health care system is fundamentally part of the problem, and a vestigial approach to mental illness that’s based on stigma. Physicians have more difficulty coordinating care, and patients are expected to figure out where to go for services.

“What we need is some leadership from the governor’s office on down to take on the crisis that is present today and re-engineer it,” Lowe said. “Maybe if we had one health care delivery system and treated the whole person, and stopped cutting them off at the neck, that might improve the stigma discrimination. I think it’s actually fed into the problem.”

Not a bed in sight

One glaring hole in Santa Clara County’s mental health services is the dearth of hospital services for children and teens in crisis.

In emergency cases, where children are a danger to themselves and others, many local families often face the gut-wrenching decision to send their children as far away as Sacramento, often for an entire week of inpatient treatment, because Santa Clara County fails to offer a nearby alternative.

And while county officials have acknowledged the problem and considered how to fill this crucial gap in health care services since 2011, the region’s most vulnerable children are still being directed out of the area for inpatient psychiatric services.

Sarah Gentile, a Los Altos parent who has made a name for herself as a mental health advocate in Santa Clara County, said she has been assisting families as an advisory resource for years, helping navigate through a confusing and spotty network of mental health services. She said one of the “heartbreaking truths” that comes up time and again is that the younger and sicker a child is, the fewer the resources available in Santa Clara County.

Inpatient psychiatric facilities play an important role, providing treatment in a secure and heavily supervised environment for patients suffering acute psychiatric symptoms including psychosis or “active suicidality” — behaviors that put themselves and others at high risk of harm. Many of the patients who are admitted are compelled via a “5150” involuntary psychiatric hold.

Despite having a life-saving role, psychiatric beds are hard to come by — particularly for children and teens. Up until last year, Santa Clara County had zero psychiatric beds for children and adolescents, despite a population of more than 1.9 million residents. It was by far the largest county without any beds for kids, with Kern County in second place with 882,000 residents, according to data compiled by the California Hospital Association.

Since then, Santa Clara County has approved a contract with a new psychiatric hospital, San Jose Behavioral Health, to offer six of its beds for child and adolescent patients, though the deal was seen as a stopgap measure until a dedicated facility for children and teens is established. The facility still doesn’t take children 12 or younger, who make up a small portion of the total patients.

Parents with teenagers in Santa Clara County often find themselves having to send their children to the Mills-Peninsula Inpatient Adolescent Department in San Mateo, while younger children are often sent to Sacramento, Gentile said. Throw in any kind of co-occurring physical condition or a mental health disorder like schizophrenia, she said, and families very likely have to go out of state for care.

Gentile said her family grappled with the problem in 2015, when her son had a major depressive episode and landed in the hospital. She said it was bizarre to hear that a world-renowned organization like Lucile Packard Children’s Hospital, just a short drive from her home, couldn’t serve her child.

“I was in disbelief that a children’s hospital with Stanford’s resources and reputation would turn away critically ill children who need mental health treatment,” she said.

Frustration over the poor access to mental health care bubbled over at an El Camino Hospital board meeting in 2016, with several parents making an emotional appeal for youth inpatient psychiatric care. One mother said she was “filled with despair and fear” that she had nowhere to go if her child with special needs ever has a depressive episode, and called it “incomprehensible” that prestigious award-winning hospitals in the region would fall short of providing services to children in the same situation.

Deborah Scharfetter, a parent of two, recounted how her teenage daughter had gone through five months of severe depression — too sick to attend school and too ashamed and embarrassed to admit her situation — before deciding she needed to go to the hospital.

“When she was at tremendous risk of self-harm, of death, her community sent her away, the hospital — this hospital, where she was born — did not help her recover, they sent her away,” she said. “You sent her away.”

The problem is pervasive in California, with state laws and changing attitudes toward involuntary psychiatric care driving down the number of psychiatric beds going back decades, said Lowe of the California Hospital Association. The total number of beds sank from 9,353 in 1995 to 6,702 in 2016, a nearly 30 percent drop despite the state’s rising population. Although experts recommend one psychiatric bed for every 2,000 people, in California it’s closer to one for every 5,900 people.

Lowe said the anemic number of child and adolescent psychiatric beds — around 650 in a state with 39 million people — is likely linked to the high cost of staffing. Others suggest it has more to do with patient numbers that fluctuate throughout the year, with a big drop during summer.

It also stems from having 58 counties all administering separate Medi-Cal contracts with different terms, requirements and constraints, Lowe said. Sacramento isn’t just a destination for Santa Clara County kids in crisis; it pulls from more than half the counties in the state.

“In Sacramento County we have three free-standing acute hospitals, and they provide care and services to over 30 of our counties,” she said. “They have 30 different billing systems that they have to follow. The administrative burden is extreme.”

Gentile said she finds the whole situation unconscionable, given the economic prosperity in the region and huge sums of public and private money earmarked for mental health services.

“The fact that neither Santa Clara County nor Stanford provide care for these children while acquiring millions of dollars specifically to treat mental illness is especially shameful,” she said.

A swing and a miss

So what exactly is the holdup in Santa Clara County? Concrete efforts to establish an inpatient psychiatric facility for children in the county go at least as far back as 2011 — not long after a youth suicide cluster in Palo Alto — when the county sought bids for a facility to serve the more than 600 kids who show up in emergency rooms each year in need of psychiatric hospital care. The request for proposals (RFP) fell flat due to “budget constraints” at the time, according to county reports.

The idea was resurrected in June 2015, when Simitian announced he would spearhead an effort to meet the “significant needs for inpatient psychiatric care for kids.” Simitian’s proposal essentially called out the practice of sending hundreds of youth to Alameda, Contra Costa and Sacramento counties for treatment as problematic, and vowed to find ways to get the inpatient unit built.

“I’m worried that having this treatment option so far away deters kids and families from seeking the help they need,” Simitian said at the time. “We know that these beds are an integral and essential part of the continuum of care. The next step is to figure out how to get the best possible help for these kids closer to home.”

Several hospitals and nonprofits laid out their visions, with the most ambitious coming from a proposed joint venture between El Camino Hospital, Kaiser Permanente and Lucile Packard Children’s Hospital. The idea, floated in April 2016, described an 18-bed facility built on the El Camino campus serving youth ages 12 to 17, with an opening date slated for 2020. The vision included step-down services like partial hospitalization and intensive outpatient services so patients could ease back into a normal life after being discharged.

Despite the fanfare, the idea fell flat, and county officials at the time did little to explain why it fizzled. A press release from Simitian’s office late last year stated that the process had simply ended “without a successful bid” in January 2017.

Behavioral Health Services Director Toni Tullys told the Voice that one organization did submit a proposal, but subsequent discussions with county staff revealed that it needed almost twice as much money as the $1.8 million allotted — about $3.5 million — to get the psychiatric unit off the ground. The county denied the request for extra money and the RFP was closed with no contract.

The tepid response could have been due to the RFP itself, which made a pretty big ask without much compensation. The county stated it was seeking a 20-bed facility that could serve ages 4 to 17, a huge range of ages that don’t commingle very well.

The RFP also stated that the provider would need to have a child psychiatrist available 24 hours a day, along with a pediatrician, psychiatric nurse, social workers or marriage and family therapists, a nutritionist, a pharmacist, a behaviorist and therapists qualified to assess and treat substance abuse. The contract needed to be ready to go live starting Oct. 1 that year — five months after the RFP was submitted — and the county was willing to pay $1.8 million for the first year of operation.

One interested party referred to it as “a recipe for bankruptcy.”

A new proposal, due to appear in front of the Board of Supervisors this month, will instead propose having Santa Clara County take the lead, though it’s unclear when the facility would finally be built.

In the aftermath of the failed RFP, Simitian said he gathered representatives from all the major hospitals in the area, including Kaiser, El Camino and Stanford, and asked them frankly what it was going to take to get the inpatient unit built.

“Ultimately what became apparent was that everybody wanted to do their part, but nobody felt they could take the entire challenge on themselves or take the lead with a new facility,” he said.

Gentile said she was frustrated with the county’s slow response to the problem, but was likewise baffled that no one else had stepped up to the plate. Stanford just opened its new children’s hospital last year, doubling the square footage and number of beds, but the expansion plans didn’t include a single bed for inpatient psychiatric care, she said.

Tiffany Maciel, whose search for psychiatric help for her young son turned into a full-time job that took four years, said she questioned the idea that the start-up costs for an inpatient psychiatric unit exceeded what hospitals could pay, particularly when Stanford had just wrapped up a $1.2 billion expansion. It rings hollow, she said, when Stanford envisions itself as a partner with a county-led psychiatric unit rather than taking the lead.

“Most parents who are involved are pretty angry at Stanford and the new pediatric facility that doesn’t have a single pediatric mental health bed for kids in crises,” Maciel said. “When the county put out the RFP they said couldn’t raise the money to build it, but how much did Stanford spend on their new facility?”

A funding logjam

The consensus among public officials and the medical community is that mental health services are underfunded, and that taxpayer dollars could go a long way toward supporting early intervention and new, innovative approaches to fill — or at least reduce — big gaps in access to effective services.

It’s all the more surprising, in light of a major state audit report this year revealing that counties across California have failed for years to spend money earmarked for mental health services. The audit concluded that the counties had amassed $2.5 billion in unspent funding, some of which had been sitting in bank accounts for a decade. Santa Clara County is no exception, with a total of $133 million in unspent funds.

Individual counties receive funds through California’s Mental Health Services Act (MHSA), an income tax measure passed by voters in 2004, to spend on mental health programs as each county sees fit. The money is broken up into three categories to ensure counties invest in a range of services: community services and support, innovative programs and prevention and early intervention. The act now generates one-fourth of all state dollars devoted to mental health.

The MHSA follows the same mold that the state has been following for decades, which puts individual counties in the driver’s seat for spending public dollars on mental health services. But with so much money going unspent, some state lawmakers are questioning the wisdom of a hands-off approach, seeking instead to claw back funds and hold counties accountable for a backlog that shouldn’t exist.

State officials say the the problem could be blamed, at least in part, on lax oversight and an unwillingness to compel counties to spend close to $2.2 billion in funds each year. The MHSA includes language that allows California to “revert” unspent money back to the state after three years, but state health officials have declined to do so since at least 2008, according to a recent testimony to state lawmakers by Toby Ewing, executive director of the Mental Health Services Oversight and Accountability Commission.

The audit found that $230 million in MHSA funds should have reverted to the state but haven’t.

The majority of California counties have also failed to meet deadlines for submitting annual reports on how the money is spent, and are two or three years behind, according to the oversight committee. As of February 2017, for example, fewer than half of public agencies had filed 2014-15 spending reports, which were due by the end of December 2015. The state audit used numbers from Santa Clara County’s 2014-15 annual report because the county was one of 12 agencies in the state that had yet to submit a 2015-16 annual report.

Amid the ongoing debate over forcing counties to give back unspent money, counties were not being entirely candid about the extent of money available — oversight commission members reviewed fiscal reports and discovered large, unspent funding balances that were “not publicly revealed and discussed as part of the mandatory community planning process required of the counties,” Ewing said.

Gentile said the unspent funding, to her, represented a big disparity between the rhetoric of county leaders and politicians — that mental health care for children and youth is a top priority — and complacency.

“I lost all hope when the state released its 2017 audit, which showed that Santa Clara County has been holding over $133 million in unspent mental health funds,” she said. “I have little faith that these politicians will ever make good on their commitment to help our children.”

Behavioral Health Services Director Tullys said there are “many, many reasons” for the $133 million figure in the annual report. Difficulty starting up programs, lack of guidance from the state and fluctuations in funding from one year to the next all play into the problem. Some county officials claim that restrictions and oversight requirements are too burdensome, while others complain that counties didn’t get enough direction on how to spend the money.

The county also gets to hang on to some of that $133 million as “prudent” reserves of about $20 million, which arguably inflates the total amount of unspent cash.

Tullys, still relatively new to the position since joining in December 2014, said she has made it a top priority to find the “gaps” in the Mental Health Services Act. The county hired an outside firm, which Tullys described as a a “crackerjack” team of experts, to spend a year sifting through all of the billing, utilization and expense papers.

The result is a recently published three-year plan — making Santa Clara one of only two counties in the state to do a full system assessment, Tullys said — that acts as a road map for using much of the unspent funding. Stanford’s version of the Headspace program alone helps draw down $15 million from the innovation fund.

“The (firm) confirmed that there were gaps and put them into the plan. We’re spending down $90 million in the first three years,” she said. “Yes, there was unspent money, but we had done the assessment and now we’re putting out money to new services.”

California lawmakers have pushed in recent months for policy changes that would either streamline the use of MHSA funds or put the threat of reversion back on the table. Senate bill 1004, authored by state Sens. Scott Wiener and John Moorlach, proposes clear guidelines for money spent on prevention and early intervention, with a preference toward children and teens. Top priorities would include childhood trauma prevention, early detection of psychosis and mood disorders and “engagement strategies” for young adults, particularly those in college.

Senate bill 192, authored by state Sen. Jim Beall, was signed into law Sept. 10. It says all county funds subject to reversion will be sent back to the state as of July 1, 2020, and put into an account and eventually redistributed — essentially following through on a promise made in the original language of the MHSA.

Both bills have received a mixed response, with SB 1004 catching heat from counties seeking to retain autonomy as well as from mental health advocacy groups worried that adults and the elderly would be excluded from services provided under the bill. In an op-ed penned by Wiener and MHSA author and Sacramento Mayor Darrell Steinberg, the two did not concede ground.

“We make no apologies,” the opinion piece reads. “Fifty percent of serious mental illness takes root by age 14, and 75 percent by age 25. So, intervening at the earliest age possible to avoid the consequences of years of untreated illness? It’s not only common sense, it is just.”

The Voice compiled a list of youth mental health resources available in Santa Clara County.

This article is the second in a two-part series that was supported by a USC Annenberg Center for Health Journalism 2018 California Fellowship.


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MOORLACH UPDATE — Joint Author Details — July 7, 2018

Now that the California Legislature has started its summer break, it seems the media attention of late has been focused in the Opinion pages. This is true of my last UPDATE (see MOORLACH UPDATE — Watching Our Votes — July 4, 2018).

In the first editorial below, The Sacramento Bee has a piece about SB 1004 on its website by former Assemblywoman Cheryl Brown. I enjoyed working with Ms. Brown and built a good relationship with her while she was in Sacramento, during my first half-term. Because of my affection for Ms. Brown, allow me to provide more detail than normal and to share two themes that have been evolving recently in my life.

The first is building relationships with members across the aisle (see MOORLACH UPDATE — AB 521 — November 12, 2015). On occasion, I will coauthor a bill introduced by a Democratic Legislator. This year I upped the game and Joint Authored two bills with Democratic Senators.

Senate Bill 1206, the No Place Like Home Act of 2018 was introduced by Senator, and former President Pro Tem, Kevin De Leon and myself (see It was recently replaced by Assembly Bill 1827, a budget trailer bill, due to the urgency of needing to get this measure on the November ballot (see For more background on this proposal, see MOORLACH UPDATE — SB 1273 and MCO Tax — February 27, 2016.

You will see this effort as Proposition 2 on the November General Election ballot. You know that I usually oppose general obligation bonds, but this proposed bond has an existing revenue stream to pay the principal and interest. I would call this technique hypothecating or securitizing an income stream to get the principal up front in order to begin constructing or investing in a project immediately.

The revenue source is the Mental Health Services Act (MHSA), created by voter approval through Proposition 63 of 2004. It is also known as the millionaires tax, so the revenues should be reliable as long as wealthy residents are willing to pay for the great weather. I say this, as there are signs that high net worth individuals have been leaving the state since the passage of Gov. Brown’s income tax increase resulting from the successful passage of Proposition 30 in 2012. This was a proposition that I opposed (see MOORLACH UPDATE — Costa Mesa Voter’s Guide — October 6, 2012 ).

The MHSA revenues helped me to find funding to implement Laura’s Law in Orange County through the passage of SB 585 (Steinberg). It also helped me to change state law to provide more crisis stabilization unit beds to assist our public safety officials when they encounter an individual facing a mental health crisis (see MOORLACH UPDATE — Mentally Ill Inmates — June 11, 2016).

Appreciating this strategy, I was an early supporter of the No Place Like Home effort by Sen. De Leon, which uses a small percentage of MHSA revenues to repay the bondholders. The proceeds will be used to construct or refurbish immediate housing for the mentally ill homeless population.

This year I also joint authored Senate Bill 1004 with Sen. Scott Wiener of San Francisco (see This bill focuses on prevention and early intervention, as mental illness is showing up in impacted children as early as age 14. The sooner it is diagnosed, the better the opportunity to implement appropriate strategies. A great example would be CHOC’s pediatric psychology efforts, a new treasure in my District, which I mentioned in my May 1st UPDATE (see

Why do I provide so much detail? Because the MHSA is rather vague and has confused counties to such a degree that they have accumulated nearly $2.5 billion in unspent funds.

Consequently, providing some clarity in this area would be helpful. Which brings me to the second theme. I have found myself focusing on the topic of mental illness. It started while I was a County Supervisor in trying to understand and implement Laura’s Law (see MOORLACH UPDATE — Laura’s Law Journey — August 11, 2014).

This evolution has found me joining the Mental Health Caucus and being appointed this year to the Senate Select Committee on Mental Health. I remind everyone that I was a business major, not a pre-med major. So, this has been an education for me over the past dozen years or so, starting with the killing of Kelly Thomas in Fullerton (see MOORLACH UPDATE — Kelly Thomas Reverberations — January 15, 2014).

With that, I joined Sen. Wiener to provide clarity. SB 1004 seeks to clarify where some of the funding should be prioritized. Former Assemblywoman Brown fears this will impact the share of the pie for the elderly. I believe this fear is unfounded. Instead of opposing the bill, she should work with me and others in the Mental Health Caucus to draft a bill that focuses funding attention for the elderly and even pursues an effort to classify dementia and Alzheimer’s as mental illnesses eligible for MHSA funds.

The second column is in the Press-Enterprise and Daily Breeze and it follows the theme recently presented in MOORLACH UPDATE — Janus Decision — June 28, 2018.

It refers to an effort I pursued last year (see MOORLACH UPDATE — There Ought Not Be A Law — April 23, 2017 and MOORLACH UPDATE — Earning a Living — November 30, 2017). Ironically, the argument that Sen. Morrell received for stopping his efforts was the same one used to kill my bill.

What a tragedy that Assemblyman Low would bow to the pressures of an industry group’s representatives in attendance with their weak opposition argument, but could totally ignore the long line of opponents to his bill, AB 2943, when it recently came before the Senate Judiciary Committee, of which I am Vice Chair. All the more when the number of individuals wishing to testify against his bill was so large that they had to fill the balcony of the Senate’s largest hearing room and the hallways, requiring one and one-half hours to let them all come to the microphone. The ironies continue.


Legislature must not slight seniors in mental health money


Special to The Sacramento Bee

An important measure to expand access to mental health care services in California is going through the Legislature, but it would make it more difficult for counties to serve older adults.

Senate Bill 1004, which was approved by the Assembly Health Committee on June 19, would amend Proposition 63, passed by voters in 2004 to provide funding for county mental health services with a 1 percent tax on annual incomes of more than $1 million.

Sens. Scott Wiener, D-San Francisco, and John Moorlach, R-Costa Mesa, who introduced SB 1004, appear to be at odds with the needs of older adults because the bill shifts the focus of the Mental Health Services Act primarily to young people.

The bill says that 75 percent of mental illnesses begin by 14 years of age, citing a study showing the relationship between early trauma and life-long problems.

Most of them grew up when mental health problems were less understood, diagnosed or appropriately treated. As a result, many tend to shy away from mental health services. Yet adults between 45 and 64 old are at the highest risk for suicide nationally, and in recent years California’s suicide rate among adults 65 and older has been higher than the national average.

The senior community believes that SB 1004 should also address the mental health needs of seniors as much MHSA money remains unspent. The California Commission on Aging offered amendments stressing that older adults are also at risk of anxiety depression, anxiety, psychological traumas and suicide.

Sadly, the Assembly Health Committee did not consider the amendments. As a result, the Commission on Aging opposes SB 1004 because it would make it more difficult for seniors to secure the mental health services they need.

Cheryl Brown is a member of the California Commission on Aging and former chairwoman of the Assembly Committee on Aging and Long-Term Care. She can be contacted at cheryl1242.


Will ‘sunset review’ shut the

lights on onerous licensing


By STEVEN GREENHUT | Press-Enterprise

SACRAMENTO — One of my favorite Ronald Reagan quotations illustrates the problem of an ever-growing government: “Government programs, once launched, never disappear. Actually, a government bureau is the nearest thing to eternal life we’ll ever see on this Earth!” In my decades covering public agencies, I can think of only a handful of rollbacks — and they usually ended up perversely expanding government power.

In one recent case, the state Legislature gutted a state tax board, known as the Board of Equalization. But its powers merely were shifted from elected officials to bureaucrats in different agencies — and now California taxpayers are more frequently getting the shaft. That’s how government works.

Last week, a simple bill (sponsored by my employer, the R Street Institute) would have rolled back licensing requirements for only one of the hundreds of trades and professions that require a state license to work. Burdensome education requirements, fees and testing become obstacles for lower-income people to get gainful employment that doesn’t involve flipping burgers. The requirements often have no relevance to public safety, but usually are the result of powerful interest groups that use government to lock up some part of the market.

Last year, Sen. John Moorlach, R-Costa Mesa, introduced a bill that would have eliminated such requirements in a variety of fields, but it was a non-starter given its broad scope. It was referred to multiple committees and dead on arrival. So this year Sen. Mike Morrell, R-Rancho Cucamonga, introduced legislation that targeted one particular — and particularly ridiculous — set of licensing rules involving people who want to shampoo, arrange, dress and curl (but not cut) hair for a living.

If you shampoo hair for pay at, say, elderly people’s homes or at a salon — and haven’t spent as much as $19,000 at a barbering and cosmetology school — then you are an outlaw. It’s illegal to do so in California. The Board of Barbering and Cosmetology posts this Frequently Asked Question on its website: “I would like to hire a person for the sole purpose of shampooing or preparing consumers services; can I do this?” The answer: “No, only a licensed barber, cosmetologist or apprentice can wash a consumer’s hair or prepare a consumer for services.”

Did I mention that a shampooer needs 1,500 hours of training, whereas a first responder/emergency medical technician only needs 120 to 150 hours of training? The Morrell bill passed the full Senate with only two “no” votes, but was killed last week in the Assembly Business and Professions Committee on a 14-3 vote in spite of the fact that most of us have shampooed our own hair for years without calamity.

The hearing room was packed with students from local cosmetology schools. It should surprise no one that the main beneficiaries of the current rules are the schools that charge hefty tuitions for such training, nor should it be a surprise that the state bureaucracy (the Department of Consumer Affairs) estimated excessive fee-revenue losses if the bill became law. Those estimates are hard to fathom given how unimaginable it is that people currently go through the whole licensing rigmarole and then only use the degree mainly to shampoo and arrange hair.

But government agencies see any kind of minor regulatory rollbacks as a threat to their authority. There’s always that fear of the slippery slope. There’s also an economic term known as “regulatory capture.” It’s typical in all aspects of government for industries that are being regulated to dominate the agencies that do the regulating.

The main argument that the Assembly Business and Professions Committee Chairman Evan Low, D-San Jose, used to oppose the bill is that the issue can be handled in the forthcoming Sunset Review hearings. The Assembly and Senate business and professions committees hold these annual hearings in the fall to “discuss the performance of the boards and make recommendations for improvements,” according to the legislative website. The term “sunset” comes from the legislation, which would sunset the many boards out of existence unless they justify their existence.

This is one of those cool ideas that sounds much better in theory than in reality. Government agencies should indeed have to explain what they do to stay in business. But California’s Sunset Review process rarely leads to the sunset of anything. Senate Bill 999’s opponents note that the review led to legislation last year that eliminated the Board of Guide Dogs for the Blind. That was a welcome development, but the elimination of that pointless board was backed by regulators and the industry itself.

By contrast, SB999 is opposed by the beauty industry and the bureaucracy. Nevertheless, I’ll take legislators at their word and closely watch as they advocate for the end of onerous regulations that benefit business owners at the expense of aspiring low-income workers. Wouldn’t it be great if California’s Legislature turned out to be the exception that proved Reagan’s rule?

Steven Greenhut is Western region director for the R Street Institute. He was a Register editorial writer from 1998-2009. Write to him at sgreenhut.

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MOORLACH UPDATE — OC Housing Trust — May 1, 2018

Things have temporarily quieted down on the homelessness front, so allow me to provide an update on my recent efforts in the Senate.

I am a joint-author for SB 1004 (Weiner) and assisted in presenting the bill two weeks ago before the Senate Health Committee (see MOORLACH UPDATE — Right to Peaceably Assemble — April 13, 2018). This bill will provide Mental Health Services Act (Proposition 63) funding for early prevention and intervention for children with a mental illness. This is an appropriate focus for this revenue source. For a first-hand opportunity to see how critical this niche is, please ask to visit the pediatric ward for psychiatric services (see You will be amazed.

I am also the joint-author of SB 1206 (De Leon), which I also presented to the Senate Health Committee last week (see MOORLACH UPDATE — The Joys of Presenting Bills — April 24, 2018). This is the “No Place Like Home” ballot measure that we hope to place on the November ballot. Obtaining funds by borrowing against a reliable revenue source will provide funding for permanent housing with support services for mentally ill homeless individuals.

My concern for the homeless population continues. The most recent discussion that is developing in Orange County is the effort to organize the 34 cities and the County in establishing a Housing Trust to build 2,700 housing units throughout the County for homeless individuals that will blend in and provide necessary supportive services. Norberto Santana, Jr., Editor of the Voice of OC, provides his perspective in the first piece below.

The second piece is from the Orange County Breeze and provides a perspective on the Sanctuary State topic. The Orange County Breeze serves the Cypress/Los Alamitos area and this issue has become a major subject of concern.

It was well past midnight on the last day of the 2017 Session, when SB 54, the Sanctuary State bill, came up for a vote. I thought this bill encapsulated that entire year. The whining, the showmanship and the caustic rhetoric was pervasive. So SB 54 was probably the perfect capstone for last year. Consequently, I stood up and shared my brief thoughts (see

Could OC Use a Regional Housing Agency?

Jamboree Housing Corp.

A Jamboree Housing Corp. development in Anaheim, known as Diamond Apartment Homes, which has permanent housing and mental health services for formerly homeless people. Representatives of the OC cities’ association and Orange County United Way cited it as an example of the type of housing that would be built under the 2,700 units plan.

By Norberto Santana, Jr.

Orange County business and civic leaders are smart to push for the creation of a new regional housing construction agency that can actually build affordable and permanent-supportive housing across our region.

Continuing to wait on the Orange County Board of Supervisors to come up with effective regional governing policies for critical quality of life challenges like homelessness and housing is proving to be a dangerous gamble.

The explosion of homeless encampments – alongside the Santa Ana riverbed, near Angels’ Stadium and at the county civic center – is a stark testament to county supervisors’ ignoring the issue, year after year.

County supervisors’ hasty eviction effort for riverbed homeless earlier this year landed them in federal court and has since left all Orange County cities under threat of having their anti-camping ordinances invalidated by U.S. District Judge David O. Carter.

In addition, their inability to get affordable or permanent supportive housing projects built across Orange County in recent years also has many questioning whether the County of Orange should be the lead agency on any future housing effort.

Given how poorly county supervisors have performed on homelessness, I think there’s only one way that Orange County ends up supporting an affordable housing bond.

Get the money out of the hands of politicians.

That’s why it seems to me that these smart business and civic leaders are moving now to see if they can craft state legislation to create some sort of regional housing construction agency.

We will have to work hard as a community to ensure that any kind of regional housing agency in Orange County is very, very transparent – in real time – to ensure that funds don’t get squandered. That means ensuring authorizing legislation sets that kind of standard and administrators that create that kind of culture.

Now, there was some hope that supervisors might create a housing commission to manage a regional vision and strategy on housing construction.

That never materialized.

According to several sources I interviewed, an interesting model to look at is the City of San Diego Housing Commission – which provides rental assistance, addresses homelessness and creates affordable housing.

In Orange County, there are two sites – already in public ownership and with appropriate zoning – that would be gems in a regional housing strategy.

There’s the 100-acre county-owned property in Irvine near the Great Park that is already in a SB2 zone, which allows fast development for homeless shelters. Note that early land use plans for the Navy transfer of the former El Toro Marine Air base centered heavily around homelessness.

There’s another 100-acre property in Costa Mesa, the Fairview Developmental Center, which has been zoned institutional for 50 years and has already been used as a setting for mental health treatment. Fairview is currently owned by the state and State Senator John Moorlach – for years, the lone advocate on homelessness on the board of supervisors – has introduced legislation advocating the transfer of Fairview to local public ownership.

Both properties could easily see development plans and projects created that are consistent with community standards and would quickly create a solid regional system to combat homelessness.

An Orange County Affordable Housing Construction Authority could mirror the model utilized at the Orange County Transportation Authority (OCTA) where board members are a mix of county supervisors and city officials.

Except, I would issue the challenge to organizers to include more private sector people and non-politicians on the board of directors as opposed to the approach at OCTA or even worse the Orange County Fire Authority, which is such a big board of politicians that the agency doesn’t get good governance or direction.

Notice that earlier this month, when Orange County Supervisors were asked at their public meeting about the potential of supporting state bonds for housing construction, virtually none supported the effort.

In March, The Kennedy Commission called on supervisors to support an affordable housing bond for the Fall 2018 election.

“With local funds the County of Orange will be in a position to leverage significant federal and state resources to help address our current housing and homeless crisis,” wrote Kennedy Commission Executive Director Cesar Covarrubias. “With the 2017 Housing Package, the State of California is making a significant investment to address homelessness and provide affordable housing. But these state funds will only be available to counties that make similar investments to help leverage funding.”

Given everything the board of supervisors has been through on homelessness in court – exposing the utter weakness of the county system of care and permanent supportive housing – supervisors still don’t have a strategy or even an interest in finding resources to build relevant housing.

In fact, the only time during the county public discussion on housing that County Supervisor Michelle Steel even spoke up was to register her opposition to future state housing bonds. Supervisor Todd Spitzer publicly pulled up the bill setting up the statewide bond (SB2) on his phone and was critical.

Politicians politick. They can’t help it. It’s part of their DNA.

But it doesn’t get anything done.

And we should all wake up to that fact.

Recent poll shows majority of Californians support sanctuary for undocumented immigrants

By Shelley Henderson

The results of a recent poll by the Institute of Government Studies at UC Berkeley show a strong division among California voters on the so-called sanctuary law, with 56% of respondents favoring sanctuary and 41% opposing (3% were undecided).

Faced with a poll like this, the first thing to seek out is how the questions were asked. Here is the text of the two questions:

Last year California passed a state law that provides sanctuary to undocumented immigrants living in the country and limits cooperation with federal immigration officials who are attempting to deport these immigrants. Generally speaking, do you favor or oppose this law?

Some cities in California have passed local laws that attempt to opt out their communities from the new state law. If local officials in your city were to propose to opt out your community from the state’s new law providing sanctuary for undocumented immigrants, would you favor or oppose it?

This targets the California Values Act (SB 54) and the ordinance enacted by the City of Los Alamitos that resulted in an ACLU lawsuit — without saying so right out loud.

The questions paint the scene so as to make federal authorities (read: the Trump Administration) as targeting all illegal immigrants. Practically speaking, ICE tried to pick up illegal aliens already in the custody of local authorities in order to deport them because, beyond the local legal trouble, they were in the country illegally and thereby subject to deportation.

To my knowledge, Los Alamitos is the only city to have passed an ordinance “to opt out” of the California Values Act. That ordinance actually states that the City views the federal Constitution as supreme over Sacramento puppeteers.

All other entities — cities plus at least two counties, Orange and San Diego — have voted to support the federal lawsuit, which actually calls out three different State laws:

SB 54 restricts how local law enforcement communicates with federal immigration authorities. AB 103 directs the California attorney general to inspect facilities where the federal government is detaining immigrants in the state. And AB 450 penalizes California employers who give Immigration and Customs Enforcement agents access to employee records or some areas of businesses without a warrant or subpoena.

In any case, I think that the poll would show different results with questions less sympathetic with the California Legislature’s sanctuary mania.

Further, seeing the circus after the City of Los Alamitos swore fealty to the United States Constitution, who would want their own city to open itself to political pumpkin-chucking and an ACLU lawsuit? Little Los Alamitos has maybe two-days of attorney fees accumulated in a GoFundMe appeal. The municipal budget won’t support prolonged litigation. It is inevitable, without outside help, that the tiny city (population 12,000) will have to concede the legal bullying, not on principle but for lack of funds.

Poll internals for the first question

The news release about the poll includs breakdowns for answers to the both question above.

Most interesting is that just about everybody has an opinion. The “I dunno” segment is tiny — a mere 3%.

Democrats wildly support the California Values Act. Republicans even more strongly oppose it. Those with no party preference lightly favor it, with a higher percentage of undecideds/don’t knows.

That big split was loudly displayed at the most recent Los Alamitos City Council meeting. Partisans on both sides deployed tactics to drown out the other side. Drums? Check! Megaphones? Check! Folk songs? Check! Amped band? Well… I think supporters of the sanctuary law outdid the opposition on this particular tactic.

Neither those in favor nor those opposed were addressing moderates in a way that might convince rather than bully or beat down. The poll shows that moderates mildly favor the California Values Act, 52% to 43%.

Poll internals for the second question

As with the first question, everybody has an opinion.

Of further interest is that those with no stated party affiliation break 42% to 50% in opposition to a local ordinance like that in Los Alamitos. That split carries the question into majority opposed territory — something Democrats alone couldn’t reach.

As you might expect, Democrats heavily oppose a local ordinance, 19% to 75%. Republicans even more heavily approve, 85% to 13%.

The mushy middle — political moderates — are evenly split.

And it is again coastal California against inland California: coastal counties heavily oppose (38% to 56%) and inland counties favor (53% to 42%). Orange County continues its historical anomalous identity among coastal counties.

Votes for SB 54

For the record, Assemblyman Travis Allen (R-72), and State Senators Janet Nguyen (R-34) and John Moorlach (R-37) voted against SB 54.

State Senator Josh Newman (D-29) and Assemblywoman Sharon Quirk-Silva (D-65) voted in favor of SB 54.

Senator Newman faces a recall brought about because he (and Assemblywoman Quirk-Silva) voted in favor of increasing the state gas tax.

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MOORLACH UPDATE — Homelessness Plan? — March 27, 2018

The Orange County Board of Supervisors listened to community members at today’s Board meeting on the hottest new subject: homelessness.

It’s amazing what can happen when a Federal Judge squeezes a balloon.

This is not an easy subject, and there is no perfect solution. Dealing with it generates a various number of emotions.

Let me start with a link from NBC Channel 4 on a balanced way to cover this topic:

Fairview is the subject (see MOORLACH UPDATE — Homelessness Pace — March 24, 2018).

The Daily Pilot provides another balanced perspective in the first piece below. The next two pieces are from CBS Los Angeles News. Their journalism is an opportunity to address poor and lazy workmanship. So please allow me to set the record straight.

The Daily Pilot details that there is no “plan.” But CBS states that I’ve “laid out a plan.” Their reporter did not contact me. The subsequent reporter repeated the same claim. The first reporter has interviewed me in the past. Now she has even given me two titles. A little better scholarship would have been helpful.

There is no immediate plan. I have been working on Fairview Developmental Center for quite some time. It is an opportunity. One that will take at least two to three years to implement. And the current request would be in the area of housing some 100 people.

So, when a Federal Judge starts demanding solutions within days, it will only stir up the wrong emotions for many constituents.

Trying to be part of the answer has generated numerous exchanges of note. The number of individuals who have courageously told me their personal stories has been amazing. Many constituents have children who were on the streets and homeless due to mental illness or drug addiction. Our community’s young adults need help.

And many of the exchanges were with people who want to help financially to provide facilities for the OC’s homeless and mentally ill community.

In fact, I’m just back from the Children’s Hospital of Orange County (CHOC), where I attended their Mental Health Inpatient Center Opening Celebration. It’s remarkable what can be done for Orange County’s children when donors and leaders step up to the plate. This is what Orange County does. When there is a need, we try to address it.

Let’s hope that Judge Carter can assemble those who wish to help and create a real plan to work with the numerous assets that are available in Orange County to construct locations that serve as a national model.

Costa Mesa City Council will discuss using Fairview Developmental Center as homeless shelter


The Costa Mesa City Council will meet Wednesday to discuss a proposal from an Orange County supervisor and a state senator for part of the Fairview Developmental Center property at 2501 Harbor Blvd. in Costa Mesa to be used an as emergency homeless shelter. (File Photo)

Costa Mesa City Council members will hold a special meeting Wednesday to discuss a concept an Orange County supervisor and a state senator unveiled last week for using part of the Fairview Developmental Center property in Costa Mesa as an emergency homeless shelter.

The meeting will start at 5 p.m. at the Costa Mesa Senior Center, 695 W. 19th St. An official agenda had not been released as of late Monday afternoon.

Though a concrete plan hasn’t been announced, Supervisor Shawn Nelson and state Sen. John Moorlach (R-Costa Mesa) floated the idea Friday that the 114-acre, state-owned property at 2501 Harbor Blvd. is an intriguing shelter possibility because it’s centrally located and already has infrastructure that could be used to house and provide services to the homeless.

“If we can find a campus to address a significant need in this county that we can rally around, then this is one of those opportunities that we just don’t want to let pass by,” Moorlach said in an interview Friday.

For weeks, county leaders have been grappling with how to house hundreds of homeless people who were recently evicted from encampments along the Santa Ana River. The move to clear those camps prompted homeless advocates to file a federal lawsuit.

County supervisors approved a plan last week to eventually move former riverbed residents — many of whom are currently staying in motels — to temporary shelters in Huntington Beach, Irvine and Laguna Niguel.

But leaders in Irvine and Laguna Niguel have voted to sue the county over the shelter plan, and Huntington Beach officials have pushed against the plan for a location there.

Fairview Developmental Center opened in 1959 and currently provides services and housing to 133 people with intellectual and developmental disabilities, according to the California Department of Developmental Services.

Like similar facilities around the state, Fairview is scheduled to close as part of an effort to transition people out of institutional-style centers and into smaller accommodations that are more integrated into communities.

The goal is to move Fairview’s remaining residents to other living options by 2019, according to the state.


Costa Mesa Residents

Outraged At Homeless

Shelter Plan

COSTA MESA (CBSLA) — A possible solution to Orange County’s homeless problem is sparking an emergency meeting in Costa Mesa.

As CBSLA’s Stacey Butler reports, the mere mention of turning a state-run facility for the developmentally disabled in Costa Mesa into a temporary homeless shelter has neighbors spinning.

“It’s crazy. We have heroin overdoses all over the streets here already right now. If they move those people here it’s gonna be unlivable for people here,” said William Hart.

“It’s upsetting because we already have a problem with the homeless here, breaking into people’s patios and stealing stuff,” said Jamie Infanger. “A lot of drug rehabs, a lot of drugs, a lot of people that are homeless around here looking for their next fix.”

As those living in Irvine, Laguna Niguel and Huntington Beach fight the county’s plan to put the homeless in their communities,Orange County Senator and member of the Board of Supervisors John Moorlach laid out a plan last week to house the homeless recently evicted from the riverbed in part of the Fairview Developmental Center that neighbors say is all but empty.

Neighbors say the problem is there is an elementary school, high school and a Boys and Girls Club too close for comfort.

Jack Sykes said he is “absolutely” worried about the plan and that he won’t feel safe.

“We’ve already got issues in the area,” said Sykes. “Adding to it isn’t the answer.”

The emergency meeting called by the Costa Mesa City Council is taking place on Wednesday night at 5 p.m. at the Costa Mesa Senior Center. Hundreds are expected to attend.

OC Supervisors Could

Abandon Controversial

3-City Tent Plan For


SANTA ANA (CBSLA) — Orange County supervisors Tuesday could decide to abandon a controversial plan to erect large tents in Irvine, Huntington Beach and Laguna Niguel to temporarily house homeless people recently removed from the Santa Ana riverbed.

Dozens of protesters are expected at the meeting, which kicks off at 9 a.m.

Supervisors on March 19 held a special meeting to approve consideration of “sprung structures,” which are large tents hotels often use to handle overflow from ballrooms. The supervisors voted to direct staff to research the logistics and then work with officials in each of the three cities, but the plan never got far as residents and city leaders erupted with outrage and threatened litigation.

Last month, hundreds of homeless people were cleared from a two-mile stretch of the Santa Ana riverbed – from Santa Ana to Anaheim — after months of wrangling between homeless advocates and county and city officials.

During the ordeal, the Orange County Catholic Worker group and several homeless people filed a federal lawsuit against the governments of O.C., and the cities of Anaheim, Orange and Costa Mesa, claiming that removing the homeless from the riverbed violated a broad range of constitutional protections. OCCW argued that evicting the transients would disperse them to the surrounding cities, where they will be cited for trespassing, loitering and anti-camping laws.

The lawsuit resulted in a deal between the advocates and municipal officialsin which the homeless would be removed from the riverbed and then be given 30-day motel vouchers while the county looks for more permanent solutions.

Those vouchers are set to run out, however.

County officials are confident they have enough beds to handle the transients from the riverbed, but to satisfy U.S. District Judge David O. Carter, who is overseeing the federal lawsuit, they pledged to pursue the large tents in the three cities in case they lacked enough beds.

The plan was to put 200 beds in Irvine, with 100 each set aside in Huntington Beach and Laguna Niguel. If the beds were filled in Irvine then officials would then turn to Huntington Beach and then to Laguna Niguel.

Hundreds of Irvine residents turned out Sunday to voice their opposition to placing the homeless in a temporary shelter across from the O.C. Great Park, which consists of 100 acres of county-owned land.

Officials in Huntington Beach complained the property in their city is plagued with methane gas issues, and Laguna Niguel officials say the plot of land under consideration in their city is next to the now-shuttered O.C. Superior Courthouse, which has issues with asbestos and mold.

Last week, meanwhile, state Sen. John Moorlach and O.C. Supervisor Shawn Nelson laid out a plan to house the homeless in part of the Fairview Developmental Center in Costa Mesa.

That plan has also been met with a great deal of opposition. Neighbors say there is an elementary school, high school and a Boys and Girls Club nearby.

The urgency to find additional beds came from Carter’s plan to see a similar relocation of transients from the Plaza of the Flags area next to the Central Justice Center courthouse in Santa Ana. But Carter told supervisors at a court hearing last week he would tap the brakes on that plan to make sure officials have enough beds for the 170 or so transients there.

Nelson will chair Tuesday’s meeting as Chairman Andrew Do is out of town.

Nelson has long championed putting up a temporary shelter at the Great Park, because Irvine officials have zoned it for the homeless. The Huntington Beach and Laguna Niguel sites are not yet zoned for the homeless.

At the special meeting March 19, the supervisors also voted to spend $70.5 million of money earmarked for the mentally ill to provide beds for the transients through the construction of a new facility or renovation of existing facilities.

The O.C. homeless crisis came to the forefront last September, when the Anaheim City Council declared a state of emergency for the more than 400 people who have been living in a tent city in the shadow of Angel Stadium.

That same month, the Santa Ana City Council also declared the homeless issue around the Santa Ana Civic Center a public health and safety crisis, while the O.C. Board of Supervisors approved a plan to increase law enforcement along the riverbed from Santa Ana to Anaheim.

In November, Orange County permanently closed the west side of the flood control channel between Santa Ana and Fountain Valley. During the process, authorities reportedly found about 1,000 bikes hidden in a tunnel system under a concrete flood control channel. Deputies also began strictly enforcing public access hours along the Santa Ana River Trail. Access is only allowed between 7 a.m. and 6 p.m.

Deputies began slowly clearing the encampments in January, when they began going tent to tent along the Santa Ana River telling people the area will be closed and they need to move. The area was completely cleared out in February.

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