County’s Top Behavioral Health Official Resigns

San Diego County’s top behavioral health official is resigning amid significant uncertainty around federal funding and the rollout of a slew of major initiatives.

Luke Bergmann, who has served as the county’s behavioral health services director for about six years, notified the county he “is leaving county service,” a county spokesperson confirmed late Tuesday.

Spokesperson Tammy Glenn did not immediately say when Bergmann revealed he would move on or when he would officially depart his post.

Bergmann’s resignation comes just two weeks after he appeared at a special Board of Supervisors meeting detailing plans to expand the county’s addiction treatment system and the prospect of drastic federal Medicaid cuts that he cautioned would affect all behavioral health programs in the county. Bergmann had already expected a projected county budget shortfall for next year and changes tied to state Proposition 1, passed by voters last March, to force tough calls.

Throughout the meeting and in a LinkedIn post soon after it, Bergmann seemed focused on continuing to lead the county as it headed into potential funding storms.

“We will need unprecedented collaboration and creativity to ensure continued access to care,” Bergmann wrote after the March 4 meeting. “How can we turn this crisis into opportunity?”

Now the county will be moving forward without the man who spent years guiding its behavioral health response and overseeing an unprecedented increase in new services.

In a statement, Glenn wrote that the county appreciated Bergmann’s “innovation and vision in supporting the needs of the region.”

“The county team remains committed to the important work we do, and we will ensure a smooth transition during this period of change,” Glenn wrote. “We thank Dr. Bergmann for his service and wish Dr. Bergmann the best in his future endeavors.”

Bergmann did immediately not respond to messages from Voice of San Diego on Tuesday.

His resignation comes months after a wave of high-level county departures and the appointment last June of longtime county official Ebony Shelton as the county’s chief administrative officer.

It doesn’t appear that Bergmann’s exit was forced by county supervisors. They have largely supported him in recent history.

Supervisor Terra Lawson-Remer, who called the March 4 hearing, expressed disappointment about Bergmann’s resignation in a statement.

“Luke Bergmann has been a leader and a shining light at our county, driving innovation and the transformation of our behavioral health care system,” Lawson-Remer wrote. “His departure is a huge loss for our entire county.”

Lawson-Remer noted that Bergmann left behind detailed plans to expand mental health and addiction treatment options that she pledged to continue moving forward on despite a series of upcoming challenges.

Fellow Supervisor Monica Montgomery Steppe was also upset by the news — and said she remained committed to executing the vision that Bergmann laid out.

“It’s deeply disappointing that, amid a behavioral health and homelessness crisis, we are losing a foundational leader in this field,” Montgomery Steppe wrote. “This departure makes our work even more challenging, but I’m committed to supporting the innovative ideas Dr. Bergmann pushed to implement for our region.”

Bergmann joined the county’s behavioral health operation in 2018 after nearly a decade working in New York’s municipal hospital system, the largest health care network in the nation.

After his arrival in San Diego, Bergmann urged the county to reorient its approach to mental health care by introducing new services such as crisis stabilization units to address the region’s clogged psychiatric care system and reduce the burden on local hospitals. The county now has six crisis stabilization units where patients in crisis can stay for up to 24 hours rather than go to hospital emergency rooms that had been flooded with behavioral health patients. Two more units will open soon.

Bergmann also oversaw the eventual deployment of 44 countywide teams that respond to non-violent behavioral health crisis calls with goal of avoiding police responses that can be more traumatic and dangerous.  

“Over the last five years, we have built a crisis and diversionary service network that didn’t exist before,” Bergmann said during the county meeting earlier this month.

During that time, Bergmann has become one of the county’s most prominent non-elected officials. He has spoken at countless community meetings and conferences and is often quoted by news outlets far from San Diego speaking about California’s behavioral health reforms.

Soon after his arrival in San Diego, Bergmann was also thrust into discussions with multiple hospital systems planning to close inpatient psychiatric beds. One of the highest profile was with Tri-City Medical Center in Oceanside, which announced in 2018 that it would close its inpatient unit. Under Bergmann’s leadership, Tri-City ultimately agreed to partner with the county to build a 16-unit psychiatric health facility.

There have been setbacks too. For example, a high-profile plan to pursue a mental health hub with UC San Diego crumbled late last year after Bergmann failed to reach a deal with the health system.

State reforms brought even more controversy and tension with city officials including San Diego Mayor Todd Gloria.

Gloria and others have long wanted the county to respond with more urgency to the region’s intertwined behavioral health and homelessness crises. Though Bergmann oversaw an unprecedented increase in county behavioral health expansions, Gloria and other city officials have viewed Bergmann as more focused on planning an ideal behavioral health system than on rapidly opening new inpatient and treatment beds they argue are needed to serve the most vulnerable San Diegans.

Yet in October 2023, Bergmann and his team became among the first in the state to implement a controversial CARE Court system aimed at serving people with serious untreated psychotic disorders, drawing praise from state officials for their early results. But Gloria and families of people with serious mental illnesses have been frustrated with a rollout that hasn’t matched the rhetoric surrounding the law.

Then, at Bergmann’s urging in December 2023, county supervisors voted to postpone implementation of a state conservatorship expansion law. That decision drew fire from Gloria and Gov. Gavin Newsom, though the county still implemented the law a year earlier than many others in the state this January.  The county spent months preparing to enact the legislation but during that time didn’t add a significant number of beds expected to be in greater demand, again spurring frustration from Gloria and others. The passage of Proposition 36, which aimed to direct third-time drug offenders into treatment, only added to expectations of increased demand.

And even before more recent threats of federal cuts, Bergmann and other county officials feared harsher budget realities.

County officials late last year projected a nearly $140 million budget shortfall for the fiscal year that begins in July, a deficit that staff has said will require some cuts to county programs.

Bergmann has also been cautious about Proposition 1, a state bond measure passed last year that he has said could deliver funding for hundreds of new behavioral health beds and slots – and a forced reshuffling of priorities that could hurt existing behavioral health programs.

In January, Bergmann and Lawson-Remer cheered the region’s more than two dozen project proposals, including two from the county, they hope will receive state bond funds.

But Bergmann previously told Voice that changing priorities under Proposition 1 mean some programs and services that now rely on state millionaires’ tax funds helping back that bond could be on the chopping block if the county and providers can’t find other cash to support them. For example, the county will have less state money for programs focused on preventing behavioral health crises and reduced cash for services including crisis stabilization units.

“What I’m concerned about overall is that there is a significant diminishment in the availability of (tax dollars) to support our ongoing bread and butter, core clinical service continuum,” Bergmann said early last year.

The prospect of massive Medicaid cuts has only increased Bergmann’s budgetary concerns recently.

For example, he warned during the March 4 Board of Supervisors meeting that a slashed Medicaid budget would imperil federal dollars that now cover 70 percent of costs for the county’s various substance use treatment programs.

Now the county will be navigating these challenges without Bergmann.