After about six months of staff research and community input on the lack of inpatient psychiatric beds for adolescents in Santa Clara County, Supervisor Joe Simitian and county staff indicated at Tuesday's Board of Supervisors meeting that they hope to bring beds to the county by June 2016.
Simitian first brought the issue to the board in May with a request for staff to analyze the feasibility of opening an inpatient unit for children and adolescents in Santa Clara County. The county has not had an acute-care, inpatient psychiatric unit for youth for more than 20 years, so an average of 20 adolescents each day are receiving inpatient psychiatric care outside of the county, from San Mateo to Sacramento, according to Simitian's report to the Board of Supervisors. (Read: Why so few hospital beds for teens?)
Several mothers of such youth spoke to the impact of having to go outside the county for critical mental health support, each holding an 8-inch-by-10-inch photograph of their child. One Palo Alto mother, Alison Morantz, described the "nightmare" of having to go outside of not only the county but the state for her young son's inpatient psychiatric hospitals stays from Utah to Massachusetts to Ohio and now, the Children's Hospital of Pittsburgh in Pennsylvania, where he will soon turn 10 years old, she said.
"My husband and I tag-team around the country trying to support him while parenting our daughter here at home in Palo Alto," she told the board. "I can't tell you how life-changing it would be for us to at the very least be able to have him in the community so we could have some semblance of a family life."
Sarah Gentile, a Los Altos resident, stood at the podium holding a photograph of her teenage son, who was hospitalized last year at Mills-Peninsula Health Services in San Mateo the closest hospital to the Palo Alto area with adolescent inpatient beds after expressing to his psychiatrist that he had a suicide plan.
Since that day in the emergency room at El Camino Hospital in Mountain View when she discovered that her son could not receive inpatient psychiatric care within the county, Gentile has become a driving force in a crusade to change that reality, meeting with county officials and connecting with other parents.
"I've been at many of these meetings over the past few months with parents of commercially insured children who have serious mental health issues and our message has been clear: 'When our children are in crisis and most in need of medical care, we have nowhere to go,'" Gentile told the board.
"Just like other illness, illnesses of the mind worsen without treatment. By not having the necessary inpatient partial-hospitalization programs needed to treat the most severely ill of our children, not only do some of our children die by suicide, the number of seriously mentally ill adults in our county ultimately increases," she added.
Staff on Tuesday recommended that the county issue a Request for Information so that potential vendors can submit proposals for "programmatic, facility and service elements needed for a child and adolescent inpatient hospital unit."
These elements, as recommended by the county's Behavioral Health Services Department, would be an acute psychiatric unit serving children and youth from 5 to 17 years old who present a primary psychiatric illness "that cannot be treated in a less restrictive setting," a staff report reads.
The unit would be open to all children and adolescents with Medi-Cal and commercial insurance as well as those who are uninsured. Services would be provided by a multidisciplinary team of psychiatrists, pediatricians, registered nurses, licensed clinical social workers and/or master-level clinicians and occupational/recreational therapists, according to the staff report.
Toni Tullys, who was named director of the county's new Behavioral Health Services Department (the result of merging the Mental Health Department and the Department of Alcohol and Drug Services) in November 2014, described on Tuesday a "robust stakeholder process" that led to this recommendation.
The county convened an Acute Children's Hospital Work Group which included representatives from the county, Emergency Psychiatric Services, outpatient psychiatrists, pediatricians and community organizations, among other groups to gather input from local families and conduct a focus group with members of a Hospital Council, representing eight county hospitals.
Feedback from these various stakeholder groups was "very consistent," Tullys said.
"One is, 'Yes, open something here in Santa Clara County'; two is, 'Make sure that the services are age appropriate'; three, 'Make sure that the services are family friendly and really responding to the needs of the family'; four, and I would say that this has been the most significant item, is 'Ensure that there is a discharge plan in place and that there are services available for a child or youth coming out of an acute hospital setting,'" she said.
The work group, Hospital Council focus group participants and the county's Behavioral Health Board all support the idea of developing an inpatient unit within the county, according to the staff report.
Staff also analyzed data over the last five fiscal years for all children and youth admissions to Emergency Psychiatric Services as well as all admissions to psychiatric contract hospitals, but for the latter, only for Medi-Cal and uninsured patients. (The Behavioral Health Services Department has requested a county data set, expected in January, for commercially insured children and youth who are admitted to acute inpatient hospitals, according to a staff report.) In fiscal year 2015, there was a total of 878 admissions to Emergency Psychiatric Services and 493 Medi-Cal and uninsured admissions to private hospitals.
During their research, staff also discovered that the county tried several years ago to develop a child and adolescent psychiatric facility. A Request for Proposal was made in November 2011 with the intent "to establish local, safe, secure and developmentally appropriate crisis evaluation and inpatient care," the staff report states. The county didn't end up moving forward due to budget constraints, according to the report.
The new facility now being discussed could also be either a standalone unit which is required to provide patients with 24-hour access to a physician if needed but does not have immediate access to an emergency room, staff said or attached to an existing hospital. The mothers in attendance on Tuesday expressed concern that a freestanding unit might be less equipped to deal with patients with both psychiatric and medical conditions.
Teresa Gallo, a San Jose resident, said her daughter was misdiagnosed in 2011.
"She was misdiagnosed with bipolar for 10 months and because of this misdiagnosis, Tessa is today at Lucile Packard Children's Hospital, many times restrained to her bed and probably will have to be taken care of 24/7 for the rest of her life," Gallo said, indicating that her daughter has pediatric acute-onset neuropsychiatric syndrome (PANS).
"I'm here today to make sure you understand the importance that creating a psych hospital attached to some sort of medical facility for all children to receive the treatment they need and make sure that they're not misdiagnosed," Gallo said.
She offered another example: an adolescent who has cancer who might become depressed or suicidal.
"He may come into our new facility, but he may also need chemotherapy. Others may come in and need X-rays, MRIs, CT scans, spinal taps, IVIGs, plasmapheresis, strep test, genetic testing to make sure they're treated and diagnosed properly," she said. "None of these things are possible to receive at a standalone psych facility."
Supervisor Cindy Chavez -- who represents District 2, which covers part of San Jose -- pointed to the nonprofit EMQ FamiliesFirst's relatively new crisis stabilization unit, a small, short-term standalone facility in Campbell for children and adolescents who are at risk of suicide. While the unit is "fantastic," Chavez said, it's limited in the services because it is not connected to a full medical-services facility. Chavez requested that staff prioritize medical services in its Request for Information.
"I am very interested in us pushing the envelope in terms of potential medical partnerships," she said. "I think that's critical."
In response, Simitian stressed that a longer-term vision around such a facility, while valuable and worth pursuing, should not be given higher priority than getting beds themselves into Santa Clara County.
"I don't want to diminish the importance of all the other issues that people have raised about the quality of care, the nature of the care," he said earlier in the meeting, "but my goal is to get whatever it is we need, however we define that, in this county for the reasons we discussed ... to do everything we can to see that we can't actually get some beds in this county before we get to the middle of the coming year."
The board voted unanimously to receive staff's report and direct staff to issue a Request for Information.
Tullys said staff expects to release the request in mid-January, develop a Request for Proposal to release in February and hope to have the entire process completed by early May.
Having beds available in the county by June 2016 is "is strongly our goal," Tullys said.
After the meeting, Gentile noted that she and two other mothers have to go outside of the county for psychological services for their children, as commercially-insured youth don't have access to the wraparound mental-health services that the county provides to its Medi-Cal and uninsured clients.
"The lack of in-county inpatient services is just the 'tip of the iceberg' for commercially-insured families whose children have illnesses of the mind," she said.