Help close to home for kids in crisis
“Why aren’t there any hospital beds for kids and teens in mental health crisis here in the County?”
That simple question from a constituent alerted Santa Clara County Supervisor Joe Simitian to the dire need for local inpatient child- and adolescent-focused crisis services.
Simitian was dismayed to learn that each year, more than 600 young people assessed by County Crisis Stabilization Units were admitted to hospitals outside the County for acute psychiatric care – and that was only a portion of the annual total since many kids and teens not utilizing Crisis Stabilization services also required hospitalization.
Santa Clara County youth diagnosed as being a danger to themselves or others faced an involuntary hold in an Emergency Room until a psychiatric inpatient bed was located. If hospitals in surrounding counties were full, patients were sent as far away as Sacramento, Vallejo, or Concord.
“This is about families struggling through the hardest thing they'll ever face, and being torn apart at precisely the time they need to be together,” Simitian said. “It’s better therapeutically for these kids to be close to their community when they’re in crisis – close to their family, their friends, and their own local mental health providers.”
Further, families sometimes ended up paying thousands of dollars for ambulance transport out of pocket, since parents are often barred from driving their children to the facilities because of liability and safety protocols.
Worried that the emotional and financial toll of long-distance psychiatric treatment could deter kids and families from seeking the help they needed, Simitian committed to forging a local solution.
“On any given day as many as 20 Santa Clara County children are being hospitalized for psychiatric emergencies outside the County, some more than a hundred miles away. We can, and we will, do better,” he vowed.
Simitian’s efforts led to the approval, in 2018, of a $222 million state-of-the art behavioral health facility with the first County-run inpatient psychiatric services for children and adolescents – “a critically needed part of the continuum-of-care for kids in crisis,” he said.
“The need for these beds is urgent. I am grateful the County moved quickly to make a significant impact for families struggling with very difficult and challenging situations,” said County Behavioral Health Board member Sigrid K. Pinsky.
“The County has also helped to educate the public about this critical need; shining a light and breaking the stigma is an important step,” Pinsky added. “This new facility will provide the best available care in a safe environment for kids in crisis. Importantly, families will finally be able to stay close by and be connected with the after-care resources and supports which greatly increase the chance of success.”
Forging a community solution
In early 2015, Simitian reached out to County Behavioral Health staff, local hospitals and mental health agencies, school districts, and parents to better understand the need for youth inpatient beds and the obstacles to providing them. That June, his referral requesting County staff to devise a plan to provide a local solution for kids in crisis received unanimous support from the Board.
Simitian continued to meet with potential partners and stakeholders, and in April 2016, the County released a Request for Proposals (RFP) to operate an inpatient youth psychiatric program. (To address short term needs, that August, the Board contracted with San Jose Behavioral Health to provide 17 inpatient psychiatric beds for teen ages 14 to 17.)
Ultimately, after lengthy negotiations, the RFP closed in early 2017 without a successful bidder: the financial undertaking required was too much to bear for any one group or organization.
Throughout the year, Simitian continued to push for a collaborative, long-term County-facilitated solution, landing on the idea of locating an inpatient youth psychiatric hospital facility on the Santa Clara Valley Medical Center campus in San Jose.
Kaiser Permanente, El Camino Hospital, and Lucile Packard Children's Hospital at Stanford all expressed support, and a willingness to provide both expertise and medical services.
“This is what happens when community, civic leadership, and public health organizations work together,” Simitian said. “When everyone does their part, we can do so much more.”
Better support for kids – and adults
The Board unanimously supported Simitian again in November 2017, directing County staff to develop a specific plan for the Valley Medical Center campus.
In October 2018, the Board approved the staff recommendations – made with input from a variety of community stakeholders – to replace a disparate set of mental health services at the Medical Center with a new two-story building with 24 beds for children and adolescents in need of acute inpatient psychiatric care.
County staff further recommended replacing aging adult inpatient psychiatric facilities by putting an adult services center on the second floor of the new facility, with separate entrances from those serving children and adolescents.
Simitian said he was “surprised, but pleased,” that his initial referral – which focused on juvenile mental health needs – had also resulted in what he called “a clearly needed upgrade in County facilities for adult mental health.”
Currently, behavioral health services on the Medical Center campus include Emergency Psychiatric Services and Mental Health Urgent Care, in the Don Lowe Pavilion, and Adult Psychiatric Inpatient Services, in the Barbara Arons Pavilion.
The proposed facility, which will replace the nearly 50-year-old Don Lowe Pavilion at a preliminary estimated cost of $222 million, will include:
- Six-bed Child Inpatient Psychiatric Unit.
- 18-bed Adolescent Inpatient Psychiatric Unit.
- Groundbreaking six-bed pediatric medical/psychiatric inpatient unit for youth who have co-occurring medical issues.
- Separate 36-bed Adult Inpatient Psychiatric Unit.
- Mental Health Urgent Care department serving children/adolescents and adults in separate, but adjoining, suites that could share resources such as professional staff, support staff, and storage.
- Patient and Family Support Center, available pre-or post-acute hospitalization, offering individual and family therapy, medication evaluation, peer support, multi-family groups, integration with physical health services, and pharmacy services.
- The proposal also relocates Emergency Psychiatric Services to a building with closer proximity to the Emergency Department.
In 2019, County staff will prepare detailed construction and operational plans for the facility, which will serve commercially insured, Medi-Cal, and uninsured individuals. In addition to serving County patients, the child and adolescent units will likely receive referrals from Kaiser Permanente, Lucile Packard Children’s Hospital at Stanford, El Camino Hospital, Uplift Family Services, and others as appropriate.
“This facility has the potential to serve more than a thousand families annually, given that the typical patient stay is just six or seven days,” said Simitian.
Staffing for the new facility will be collaborative, using the breadth of community expertise in the mental health field to provide and connect with a comprehensive safety net, including preventive, emergency, acute, transitional and long-term mental health services for youth.
“This collaborative method will enable us all to advance a more comprehensive approach to adolescent mental health needs, including providing much needed inpatient beds, as well as reducing the number of patients who reach the point of crisis and require hospitalization, by focusing on early intervention and outpatient care programs,” said Christopher G. Dawes, former president and CEO of Stanford Children’s Health and Lucile Packard Children’s Hospital.
“An effective way to help youth and their families is to connect them quickly with services that meet their immediate needs and also teach mental wellness skills they can use for life,” agreed Dr. William Faber, Chief Medical Officer of El Camino Hospital. “We have learned that access to these services close to home and available to everyone is vital.”
“I’m pleased that access to quality mental health care, particularly for children and families in crisis, is a clear priority for our Board,” Simitian said. “This new facility is a significant capital investment. But we see it as an investment in our kids’ emotional wellbeing, as well as their futures.”
Simitian said he has just one frustration: “Everything takes too long.”