‘A very, very difficult transition’: Kings View to end mental health services in Shasta, citing HHSA contract delays 

The nonprofit Kings View, which serves clients in 23 counties across the state, is ending its services in Shasta. The decision comes, Kings View leaders say, after another delay in the nonprofit’s most recent contract process with Shasta County’s Health and Human Services Agency. 

Kings View has been serving about 120 mental health clients in Shasta through two programs operating on behalf of HHSA’s Behavioral Health branch. Its first contract with Shasta began in 2018.

Over the last six years, the 75-year old nonprofit says it’s faced repeated challenges in Shasta when it comes to both timely contracts and getting reimbursed for services that were provided to clients during gaps in between contracts. 

A few weeks ago, Kings View learned that it would likely experience another prolonged gap in its contract with HHSA. That was the point at which the organization reluctantly decided to stop providing services in Shasta, Kings View Communications Director Beverly Raine said this week.

Publicly available Shasta County documentation confirms Kings View’s claims about contract gaps, but is not detailed enough to verify whether or not those gaps created financial losses for the nonprofit. 

In a series of statements yesterday and today, HHSA said the county had “paid for all contracted eligible expenses for Kings View” with the exception of the most recent June invoice, adding that it would need additional information to determine whether financial losses had been incurred by the agency during gaps in contracts.

Kings View’s contract with the county ended June 30. The nonprofit said it’s currently in the process of handing off clients and closing up its Redding-based wellness center. 

Some impacted clients pose a risk to both themselves and the community

About 20 of Kings View’s Shasta clients are enrolled in a state-mandated program known as Assisted Outpatient Treatment or AOT which provides court-ordered community treatment under what’s known as Laura’s Law. The legislation, which was signed into law in California in 2002, is named after Laura Wilcox, a 19-year old mental health clinic volunteer who was killed by someone with severe mental illness in 2001.

Under Laura’s law, individuals qualify for AOT if they have a serious mental illness that has resulted in either incarceration, psychiatric hospitalization or violent behavior towards themselves or others within the last several years. It’s specifically intended to reduce the risk of harm from individuals who experience what’s known as “anosognosia,” or a lack of awareness of their mental illness. 

The program does not force the use of medications but does provide support to assist with both medication access and use, along with other needs. California counties which have implemented AOT have reported significant cost savings through reduced hospitalization, incarceration, and homelessness, all of which are prevalent issues in Shasta. 

Kings View Clinical Officer Marilyn Sliney said a team of four nonprofit staffers have been working with Shasta AOT clients to meet their significant support needs in ways intended to protect both the clients’ wellbeing and the broader community’s safety.

“They are mostly referred through the court system,” Sliney said. “These are people who are at very high risk, very high need. The AOT program helps to keep them safe and increases the safety of the community, by helping them to manage their pretty severe mental health diagnoses.”

AOT is just one of two programs that the nonprofit has been running in Shasta. The other, Sunrise Mountain Wellness Center, located off Hilltop Drive in Redding, has been providing a variety of holistic mental health support services to about 100 clients each month, regardless of income level or insurance. Walk-in clients have been able to receive free lunches, transportation, peer mentoring and access to a number of social activities and behavioral health classes that provided them with stability, engagement and care. 

The nonprofit says it operated the two programs interdependently in Shasta, using a shared building and regional director to provide cost efficiencies. Both programs were funded by the state’s Mental Health Services Act, which was replaced by the Behavioral Health Services Act this year.

Updated requirements under BHSA have meant changes are necessary in how the wellness center is operated in order to allow it to continue to qualify for state funding through the county. It’s a similar challenge to that being faced by Hill Country Community Clinic’s program in Burney, which has also been receiving MHSA funding for a wellness center through a contract with HHSA.

In interviews this week, Kings View staffers said last November was when the two nonprofits began engaging in discussions with the county about how to evolve wellness center programming to comply with new funding rules as they came into effect mid-year. The changes require more evidence-based programming, Sliney said, something Kings View was prepared to offer under a “clubhouse” model that can be funded through a subset of BHSA known as BH-Connect. 

HHSA confirmed many of those statements, saying RFPs for the clubhouse model were awarded to both Kings View and Hill Country in May to facilitate new funding for community services under BHSA guidelines. Kings View’s latest contract ended June 30, and the organization has been awaiting execution of a new contract.

Issues occurred when Kings View learned only a few weeks ago that the county was not prepared to enter into a new contract for months, perhaps six months or more, leaving a substantial gap between when the current contract ended and when a new one might be executed. 

The nonprofit says it can’t absorb the cost of maintaining staff during a prolonged contract delay. And without the cost efficiencies from the wellness center, the nonprofit says, it also cannot afford to continue to provide AOT services under a new contract this year. As a result, the nonprofit is ending both services in Shasta.

Sliney called the decision a “very, very difficult transition for Kings View to make,” saying while the organization is committed to providing services to individuals in need and has a special passion for the work in Shasta, it’s clear that the nonprofit’s work here cannot continue, at least not under these circumstances.

“Unfortunately, as much as we are mission-driven, we are also an organization that has fiscal responsibilities,” Sliney explained, “and sadly there have been instances historically where there’s been a gap in contract [with HHSA] and some of those instances we were not able to be reimbursed for any of those costs in that gap.” 

She said the county’s initial discussions with Kings View this May indicated that September was a likely start date for the new clubhouse model. That was workable, Sliney said, explaining that Kings View was willing to continue paying staff costs for the wellness center over that time period, despite knowing that those costs would never be reimbursed. It wasn’t until the organization learned a few weeks ago that the earliest date for execution would likely not be until January that a decision to withdraw from Shasta was made.

Kings View Communications Director Raine explained it this way.

“Kingsview is a nonprofit organization, so we have to be stewards of our budgets and our revenues and it was just more money than we could agree to absorb,” Raine said. 

In response to questions from a reporter, HHSA said the agency had paid “all contracted eligible expenses” through May adding that it was unable to speak to the specific issue of financial losses without additional data.

HHSA added that both Kings View and Hill Country were informed that executing a contract could take three to six months or longer, “depending on the process of negotiations.” Asked why executing the contract with Kings View would take months to accomplish, HHSA shared that “in general, a three-month duration is a reasonable and typical time frame to execute a contract,” adding that a “typical contract” could take six months. Sliney said HHSA has told the nonprofit that the contract delay was due to the county’s need to continue sorting out issues related to state funding.

Moving forward, HHSA confirmed for Shasta Scout that it will be serving the needs of AOT clients in-house. The agency said it tentatively planned to hire between 2-4 staff to meet AOT needs, and would be planning to fill those roles within the coming months. 

“The County is working closely with Kings View to transition clients into HHSA’s care while maintaining continuity of services and minimizing disruption,” HHSA Administrative Branch Director Erin Watts said.

In an interview yesterday, Kings View staffers expressed deep concern for the clients the nonprofit has been serving in Shasta, especially those in the state-mandated Assisted Outpatient Treatment program or AOT, whose care is intended to prevent harm. 

Sliney described the Kings View AOT team as always out in the community wherever patients are staying, helping them to manage their emotional regulation, mental health impacts and need for resources —  including food, shelter and clinical treatment. She said it’s a level of care that’s imperative to ensure not only their wellbeing but also community safety. 

“They have to be supported and served” Sliney said, “or there is going to be increased emergency services, hospital visits, or physical or safety issues involved.”

Kings View had similar concerns for wellness center clients, expressing worries that they won’t be connected with the resources and human connection they need to stay stable. HHSA responded by saying that the agency’s Peer Support Program “provides similar assistance,” adding that a peer support specialist is available to youth and adults regardless of their insurance provider.

Moe Shimizu contributed reporting for this story.

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