San Diego County supervisors unanimously approved a $32 million, long-term loan to UC San Diego Health Tuesday, funding 30 additional beds in San Diego for patients with Medi-Cal coverage who need mental health care. The vote is a big deal for the overall system of behavioral health care in San Diego County, which has a long-recognized need for more dedicated psychiatric bed capacity. Patricia Maysent, chief executive officer of UC San Diego Health, noted during Tuesday’s meeting that there has been talk about the university and the county collaborating to expand such resources for a long time. “It’s been a long journey; eight years ago, we initiated discussions with (the county) on a regional plan to improve (behavioral health) services,” Maysent said. At first, the idea was for the university health system to run the county’s mental health hospital in San Diego’s Midway District, but that initial goal gradually evolved. Plans to build a mental health hub on a vacant county-owned parcel on Third Avenue in Hillcrest were set aside in favor of upgrading Alvarado Hospital, which had vacant space in its westernmost building. Renovating a floor at Alvarado, officials said, would be much quicker and less costly than building a new facility on Third Avenue. Such a pivot, officials said in August 2022, could deliver new beds by late 2023. But while plans were drawn up by the county and Prime Healthcare, the property’s former owner, ground was never broken. The stalemate continued until UC San Diego Health, spurred by significant patient overflows at its main hospitals in La Jolla and Hillcrest, stepped in and purchased Alvarado, renaming it UC San Diego Medical Center East Campus. The plan was always to have UCSD run the psychiatric unit planned for Alvarado, but now the university is in the driver’s seat. Maysent said during an interview on Monday that Prime’s plans remain intact. An existing 30-bed unit dedicated to serving seniors with psychiatric diagnoses on the building’s third floor will be broadened to serve those age 15 and older and an additional 30 beds would occupy the building’s now-vacant fourth floor. Half of the overall capacity would serve those with Medi-Cal coverage. “We’re going to take that existing design and just build it out,” Maysent said. “I think we can fast-track it, fingers crossed, through the state, with both the county and us working together, I think we can push it through in maybe 20 months,” Maysent said. While 20 months might seem quick to planners familiar with the glacial pace of hospital development in California, it might be shocking to those who were following along back in 2022 when then county Supervisor Nathan Fletcher pitched Alvarado as a quick-turnaround project that could be up and running by the end of 2023. After all, many reasoned at the time, the hospital building already exists and is licensed by the state. This would just be a remodel rather than new construction, and would not require high-end hospital infrastructure such as piping for medical gasses. Other than indicating that multiple approvals are necessary for the renovation, Maysent did not further specify the various elements that push the renovation timeline out to 20 months. However, it is clear that bringing more treatment beds online as quickly as possible is a more urgent goal than ever before. That’s because San Diego County is set to implement Senate Bill 43, a new law that expands the definition of gravely disabled to include those suffering from substance use-related illnesses, on Jan. 1, 2024. This law is expected to significantly increase the number of residents picked up on mental health care holds and transported to local emergency departments. And the need for more mental health treatment beds, noted Josh Bohannan, government relations director for Father Joe’s Villages, a respected San Diego nonprofit serving unhoused residents, is already acute, even without the effects of SB 43. A lack of available hospital beds is already a bottleneck for the organization’s federally qualified health center. “We do behavioral health support; we have psychiatry counselors, peer support specialists and behavioral health staff,” Bohannan said. But there is a limit, he said, to the types of services that can be offered at a community clinic. “After we help stabilize someone, there’s nowhere for them to go; our shelter beds are not the right fit for people experiencing severe behavioral health crises or issues.” Expediting the construction of mental health care infrastructure is a major goal of Gov. Gavin Newsom’s administration. In May, the governor said during a visit to a Northern California health center that “California is moving full steam ahead, getting funding out faster and implementing key reforms sooner to better help Californians.” And, in fact, Newsom clearly thinks that the quick renovation of Alvarado fits with his vision for quick action. In March 2023, the governor used Alvarado as the backdrop to announce Proposition 1, the $6 billion bond referendum for construction of mental health facilities that voters narrowly passed in March. While officials said Tuesday that they intend to seek Prop. 1 funding for some of the renovation, they also made it clear that the project will proceed regardless of funding source. But might there be a way for the state to help get the project built more quickly? Posed the question Tuesday morning, the governor’s media office had no immediate response. SB 43 was also on the docket with supervisors unanimously agreeing with a request from Supervisor Jim Desmond to ask the governor for $51 million in additional annual revenue to help cover the anticipated costs of additional transports to local emergency departments that the law is expected to generate, starting in 2025.