There is a Dec 10^th Report to the Board of Supervisors from the Department of Health Services titled ” Measure O Update for Fiscal Year 2023-2024” which updates them on the progress of Measure O, our sales tax-funded Behavioral Health and Homeless Community Solutions Initiative. 

Executive Summary: The Sonoma County Board of Supervisors requested an update on Measure O during the June 2024 Budget hearings. This update covers fiscal year 2023-2024 expenditures by category; estimated fund balance for fiscal year 2024-2025 and fiscal year 2025-2026; and provides a review of outcomes and numbers served from last fiscal year. Additionally, staff will highlight Measure O successes and discuss the approach for current and future Measure O funding.

Discussion: In November 2020 Sonoma County voters passed Measure O to provide essential funding for mental health and homeless services with 68.07% of the vote. Measure O, a one-quarter cent sales tax, was estimated to generate over $25 million each year for ten years to help protect essential mental health and homelessness services.

The Measure O Sales Tax Ordinance identified five categories of services to be funded with the revenue: 1) Behavioral Health Facilities, 2) Emergency Psychiatric and Crisis Services, 3) Mental Health and Substance Use Disorder Outpatient Services, 4) Homeless Behavioral Health and Care Coordination, and 5) Transitional and Permanent Supportive Housing. The Measure O Expenditure Plan designates a set percentage of funding for each category.

On December 7, 2021, the Board of Supervisors established a Citizen’s Oversight Committee to monitor the implementation of Measure O. The Citizen’s Oversight reviews expenditures for alignment with the intent of the Measure and does not make or recommend funding decisions.

On October 23, 2024, the committee voted to confirm that the Measure O expenditures for Fiscal Year 2023-2024 met the intent of the measure. This past fiscal year was the 3rd full year of Measure O funding. Tax revenues for the year again exceeded the initial projections made when voters considered Measure O. Tax receipts totaled $32 million as opposed to the initially projected $24 million (total revenues including interest and unrealized gains was $34.2 million) The surplus has provided capacity to pursue expanded opportunities within the established categories to support our community.

For Fiscal Year 2023-2024, below are the Measure O funds used/spent by category: · Behavioral Health Facilities: $7,055,539 · Emergency Psychiatric & Crisis Services: $12,425,458 · Mental Health & Substance Use Disorder Outpatient Services: $1,275,496 · Behavioral Health Homeless & Care Coordination: $7,842,652 · Transitional & Permanent Supportive Housing: $3,345,616 The total projected Measure O revenue for FY 2024-2025 is $32,865,501.

In FY 24/25 a total of $66.2M of Measure O resources are available for programming, financed with $33.3 in fund balance and $32.9M of total revenues.  The approved FY24-25 budget includes $37.5 million in expenditures for Measure O.  The Department will be seeking $10.2 in additional appropriation in FY 2024-2025 Q4. Given the total planned expenditures of $47,739,541 for FY 2024-25 budget, the ending fund balance in June is projected to be $18,478,541.

Details of the various expenses by categories with additional information can be found in Attachment A Presentation.

The Mobile Support Team and Crisis Assessment Prevention and Education described below highlight recent updates from the Measure O-funded Mobile Support Team (MST) and Crisis Assessment Prevention & Education (CAPE).

· In December 2022, California Department of Health Care Services (DHCS) established a new Medi-Cal benefit providing 24/7/365 community-based mobile crisis intervention services to those experiencing a behavioral health crisis. On April 16, 2024, county staff launched Sonoma County’s 24/7 call center and a revamped Mobile Support Team (MST) to meet this need. The MST is partnering with SAFE (which serves Petaluma, Rohnert Park, Cotati and Sonoma State University) and inRESPONSE (which serves Santa Rosa)) to provide countywide coverage. The Sonoma County 24/7 call center and revamped MST is available to all Sonoma County residents regardless of insurance status. An additional $5M in Measure O funds are being held for contingencies from potential MST expansion based on future county and Regional Model City needs. The actual draw on the fund balance will be recalculated based on Federal Financial Participation action receipts from the Medi-Cal program.

· Crisis Assessment Prevention & Education (CAPE). CAPE provides school-based behavioral health support and interventions to schools in Sonoma County. Four mental health teams are strategically located across the county. CAPE is reinstituting in-person response to students experiencing behavioral health crisis and linking students to substance use disorder treatment services for to youth and young adults.. The program is active and expanding, providing services such as: direct linkage to County Behavioral Health services and navigating other health insurance to connect to treatment; substance use and suicide prevention and early intervention – educational presentations and campaigns, linkage, and referral; and peer support and groups. In the 2024-2025 school year , CAPE will be partnering with these schools: Analy High School and Laguna High School in West County; and  Sonoma Valley High School, Creekside High School, Adele Harrison Middle School, Alta Mira Middle School, and Hanna Boys Center in the Sonoma Valley.

Successful Outcomes from Measure O

The Psychiatric Health Facility (PHF) has continued to operate at its full capacity of 16 beds, serving over 150 individuals annually due to Measure O funding.

The Crisis Stabilization Unit (CSU) served nearly 1,000 individuals and was also able to continue operations at full capacity due to Measure O until the current temporary closure due to facility issues. The Mobile Support Team has expanded into a Regional Collaboration that utilizes exciting new approaches to crisis response.

Measure O has also laid the groundwork for new programs launching this year, including CAPE, additional support for the Valley of the Moon Short Term Residential Treatment facility, and the expansion of Medi-Cal drug service.

This year also saw the finalization of incorporating Homelessness Services into DHS with Measure O providing 100% of funding for the Homeless Encampment Assistance and Resource Team (HEART) and Solving Obstacles for Unsheltered Lives (SOUL) programs, and a significant amount of funding ($4.2M) for George’s Hideaway. The George’s Hideaway project is a Permanent Supportive Housing (PSH) Project Homekey site near Guerneville. Measure O funds were used to support site renovation (including planning, water/sewer, and demolition work) under oversight of the Community Development Commission (CDC).  This site will provide supportive care including therapy, substance use disorder care, benefit navigation, job training and life skills.

Also, in September of this fiscal year, the funds allowed for the release of the Measure O: Behavioral Health & Homelessness Community Solutions Notice of Funding Availability (NOFA) in the amount of $5.6 million, including $4.2 of Measure O funding and $1.4 million in Homeless Housing, Assistance and Prevention (HHAP) funding. The NOFA is open to applications from interested parties, community partners and any other local government agencies. The NOFA covers multiple program areas within each Measure O category with a specific focus on areas of identified need including on service navigation, staffing shortages, education/training and upstream approaches, peer support, individual and family counseling, and cultural competence. Additionally, the HHAP portion of the NOFA prioritizes permanent supportive housing, rapid rehousing, emergency shelter (congregate and non-congregate), street outreach, capital expenses for permanent supportive housing or enhancing existing emergency shelter projects for privacy, and lastly, operating subsidies for permanent supportive housing and rapid rehousing.

To determine priorities and opportunities for strategic application of Measure O funding in the future, department leadership plans to conduct a detailed budget and program analysis and identify areas where Measure O funding could be used and where other funding sources could be leveraged. The goal is to separate annual, recurring commitments from the projects where funding could be shifted as they mature and/or become self-sustaining. 

The remaining Measure O funding would be a mix of unallocated fund balance and expected revenues.  Staff plans to release a recurring Notice of Funding Availability (NOFA) for which Community Based Organizations and local government partners could apply. Through an open application process, a Community Advisory Panel will be selected to help review NOFA proposals and make recommendations to the Board for final approval. Staff will present the outlines of this proposal to the Board for further guidance and direction at the Board meeting.