The Sonoma County Board of Supervisors on Tuesday gave conditional approval for officials to begin layoffs that would permanently reduce the size of the Health Services Department by 107 full-time vacant and filled positions.

The tentative cuts, which include a reduction in payroll spending of nearly $8.4 million, are part of a plan to close a looming $19 million budget deficit in the health department, one of the county’s largest.

However, the go-ahead on layoffs was granted with the understanding that county officials and supervisors would look for funds to curb the move between now and budget hearings scheduled for June.

“We are looking at every single possible dollar to mitigate these layoffs and soften the blow,” said Supervisor Shirlee Zane.

The layoffs would be rescinded during the budget hearings if alternative funding sources are found, she said.

The staff reductions include a plan to cut ties with nearly 30 Health Services employees and eliminate 78 vacant positions. That would reduce the size of the department from 650 full-time positions to 543, with most of the job eliminations coming from the county’s Behavioral Health Division, which oversees mental health and substance abuse treatment.

Aside from the staff reductions, the department is also proposing a $7.3 million reduction in funding for about 50 nonprofits providing direct health care-related services. The funding slated for elimination represents 20 percent of the $40 million in county funds received by some 118 nonprofits providing health services.

County Health Services Director Barbie Robinson has said the cuts were necessary to rein in perennial deficits caused primarily by years of inaccurate forecasting and revenue projections associated with Medi-Cal funds.

Earlier in the fiscal year, the department faced a current deficit of $8.6 million. Layoffs and funding reductions to nonprofit partners were averted through hiring freezes, the elimination of temporary employees and overtime, and the use of one-time funding.

Use of such one-time fixes cannot continue, Robinson said Tuesday. “Relying on grants and other funding sources is not a sustainable model,” she said.

Dr. Michael Kozart, Health Services’ medical director, said he and others are in the process of redesigning the Behavioral Health Division, prioritizing its “core mandate” of providing specialized services to those with moderate to severe mental illness.

“The system has grown in ways that exceeded that mandate,” he said.

Tuesday’s board authorization allows county officials to fulfill a 21-day notification requirement if layoffs are indeed necessary.

Supervisor Lynda Hopkins called the potential cuts to mental health and substance abuse programs a “terrifying situation.”

The proposed $7.3 million reduction to nonprofits would translate to a total loss of $10 million, because of foregone matching federal Medi-Cal dollars. The impacts would be severe for programs in high demand, nonprofit officials said.

“Have we done enough exploration of the human costs of these cuts?” asked Tom Bieri, director of Community Support Network, a nonprofit that runs Hope House, a Santa Rosa-based drug rehabilitation program.

Hours before supervisors began their discussion, which stretched late into the evening, about 40 behavioral health workers protested in front of the board chambers. The county employees, represented by Service Employees International Union Local 1021 and Engineers and Scientists of California Local 20, called on supervisors to oppose the cuts.

Thomas Cooper, a behavioral health clinician with ESC Local 20, said the cuts and contract reductions would destabilize and threaten programs established over decades.

“What Barbie Robinson wants to do in one fiscal year is solve a problem that developed over a five- or six-year period,” Cooper said.

In early March, the county’s longtime mental health and substance-abuse director, Michael Kennedy, went on paid leave in the wake of controversial and ultimately shelved plans to cut staff. Plans were put in motion a week later to replace him and the county has been tight-tipped about his job status and what fueled his departure.

Jen Keegan, a substance-abuse disorder specialist who coordinates services in the county’s drug court and DUI court program, said the county’s plans to eliminate drug abuse counselors come as the region struggles, like many others, with a widening pattern of opioid addiction.

“I’ve been with the county for 17 years and the clients we’re seeing in our programs are younger and they’re sicker,” she said. The prospect of cutting counselors in the middle of the crisis, she said, “is terrifying.”