County to invest $75 million in mental health care training with new program

A 2022 report concluded that San Diego County faces a mental health care staffing crisis, needing 18,500 more mental health care workers by 2027 to catch up with chronic understaffing, to replace those who leave the profession and to meet the growing demand for services.
While it will not cover the whole gap, a new program launched at Liberty Station in Point Loma Thursday makes a $75 million investment intended to grow local behavioral health staffing. Dubbed “ELEVATE,” the new program, approved by the county Board of Supervisors in 2023, uses a special innovation grant from the state’s Mental Health Services Act to fund a range of initiatives, from apprenticeship programs for entry-level positions to graduate-level training targeted at growing the number of professionals able to diagnose and treat mental illness.
The county selected San Diego’s Policy & Innovation Center to create and oversee ELEVATE in conjunction with the workforce consulting firm Trailhead Strategies.
As documented in The San Diego Union-Tribune’s 72 Hour Project, the region’s mental health care system, like many in the nation, has been operating over capacity for years.
County Supervisor Terra Lawson-Remer, who spoke at Thursday’s launch event, noted that recent efforts to build local mental health care infrastructure, from crisis-stabilization units to special rapid-response teams, does no good without trained caregivers.
“With this investment, San Diego isn’t just meeting today’s crisis — we are building a model for the nation,” Lawson-Remer said. “And most importantly, we’re ensuring that when a child, a parent or a neighbor is in crisis, they can get the care they need, right here at home.”
Designed with advice from a wide range of professionals working in the organizations that serve local residents with mental health care needs, the program attempts to support multiple points of entry into the industry, seeking to train about 3,000 people over the next five years, some of whom will be working toward entry-level jobs and others who will work toward greater levels of education that will allow them to earn higher levels of licensing.
At the base of the pyramid, a program created with the San Diego Workforce Partnership and the San Diego and Imperial Counties Community Colleges Regional Consortium hopes to train about 700 applicants for entry-level positions as substance use counselors, case managers and community health workers. The approach would be similar to training in the building trades, with trainees working as apprentices to existing organizations that serve mental health clients, allowing them to learn on the job and eventually apply for state job certification.
Another program, undertaken with the National Association of Mental Illness of San Diego and Pacific Clinics, will seek to train 500 people to pass the state’s exam to work as peer support specialists, an informal role filled by those who have themselves navigated treatment. California began offering these certifications in 2022.
A third program works with national nonprofit Social Finance to offer zero-interest forgivable loans to mental health care workers who want to pursue the masters-level training necessary to become licensed to work in roles such as clinical social workers, licensed professional clinical counselors and marriage and family therapists. Loans can be at least partially forgiven if graduates work serving the county’s Medi-Cal residents for at least five years after graduation. San Diego State University and Cal State San Marcos in North County are the initial partners providing these programs, though other local universities may also participate, with 1,200 workers anticipated to be trained over the next five years.
SDSU and UC San Diego are also collaborating on a new doctorate-level program to train 135 registered nurses to become psychiatric mental health nurse practitioners. The relatively-new designation allows these specialists to diagnose mental illness and prescribe psychiatric medications in collaboration with a psychiatrist.
Karen Macauley, director of the School of Nursing at SDSU, said that grant funding from the ELEVATE initiative for the nurse practitioner expansion program will help the school’s new nurse practitioner program produce more mental health scare specialists than it otherwise would.
The first class this year has a dozen enrollees, but that number is expected to increase next year and beyond. Students study for three years to earn their doctor of nursing practice degree, which requires 1,000 hours of supervised clinical practice. UCSD, which has its own psychiatric nurse practitioner fellowship, is expected to use its clinical connections to help students earn those hours.
The program is structured so that students only have to come to campus eight times per semester with the balance of their coursework available through remote learning.
“We’ve been working over the last two years on developing the curriculum for the program with the Department of Community Psychiatry at UCSD,” Macauley said.
Her counterpart at UCSD is Dr. Steve Koh, who directs the program..
Stephanie Gioia-Beckman, a senior director at the Policy & Innovation Center, noted that all of these different job classifications require many hours of supervised work in addition to classroom instruction. Generally, this supervision time has been difficult to secure, and a big part of the ELEVATE initiative is working with more than 90 mental health providers in the county already contracted with the county to serve patients covered by Medi-Cal to streamline the process of getting clinical practicum hours.
“We need a system that kind of marries the curriculum and what’s happening on-site,” Gioia-Beckman said. “Right now, it just isn’t as seamless as it could be and it puts, in some cases, the onus on the student to go find those clinical partnerships.”
All programs also allow students to continue working at existing jobs, or in their future jobs through apprenticeship, in acknowledgement that many do not pursue further education because they need to be able to keep paying their bills in the short term.
Lawson-Remer cited the connection between education and clinical practice, and the ability to keep working while learning, as the key factors in making progress in the larger goal of significantly growing the local mental health care workforce.
“It’s really important to sort of unlock the bottleneck for folks who otherwise wouldn’t even try to get the degrees that we need,” she said. “Or, once they got the degrees, they would be so drowning in debt that they just immediately leave San Diego and go into private practice.”