SAN JOSE – In December of 2014, at a holiday party, Sigrid Pinsky asked County Supervisor Joe Simitian a simple and direct question: “Why aren’t there any inpatient hospital beds for kids and teens in mental health crisis in Santa Clara County?”
Simitian remembers, “I thought, that can’t be right; I went back to the office and discovered it was absolutely right – and undeniably wrong. Wrong, wrong, wrong.” Now, more than eight years later, after a lot of hard work and what Simitian calls “painful” delays, construction is about to begin. “Finally,” said Simitian, “It’s really going to happen.”
Santa Clara County’s inpatient psychiatric hospital for children and teenagers – part of a sparkling new center for behavioral health services – begins construction Wednesday with a ceremonial groundbreaking for a state-of-the-art facility. Demolition, excavation and grading of the site began last fall. As Simitian noted, “Before we could put something up, we had to knock something down.”
The three-story Adolescent Psychiatric Facility and Behavioral Health Services Center – linked to Santa Clara Valley Medical Center (VMC) – will provide inpatient hospital care as well as emergency and outpatient psychiatric services for children, adolescents, and adults.
This 207,000 square-foot facility will feature divided age-appropriate amenities, including indoor and outdoor therapeutic environments, that allow for a continuum of care in a single setting.
“This couldn’t be more welcome news,” said Simitian, who serves as Chair of the County’s Health and Hospital Committee, and who proposed the project in June 2015, less than six months after hearing from Pinsky, his District Five constituent. “This is the kind of acute care facility we’ve long needed in Santa Clara County for young people in crisis – a sanctuary where they can safely begin to heal, close to home.”
Pinsky, who now serves on the County’s Behavioral Health Board, observed, “Youth mental health needs were critical and mostly unmet in 2014 when I talked to Joe about the lack of beds in our County. The mental health crisis is worse now. Joe got right to work. Because of the Board's leadership and steadfast efforts on this deeply important issue, Santa Clara County will have a state-of-the-art facility. It is tremendously satisfying that our County will soon be able to properly serve the hundreds of youth struggling with mental health challenges, and make the stressful situation more manageable for their families. I am absolutely delighted that we have started construction.”
Filling the behavioral health treatment gap
Simitian says he led the effort to add inpatient care to youth-focused mental health services in the County after “considerable due diligence.” Simitian was alarmed to learn that each year several hundred young people were transferred from emergency rooms in the County to hospitals as far as 100 miles away for acute psychiatric care.
“This is about troubled teens at risk of doing damage to themselves or others. 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,” said Simitian. “This goes to the heart of community health and wellness.”
In 2018, at Simitian’s request, the Board unanimously approved development of the only County-run acute inpatient psychiatric facility for children and adolescents – one that would also provide a much-needed physical upgrade for adult behavioral health services that were scattered in aging buildings on the medical center campus.
Designing an Environment for Healing
The new facility – wrapped in terracotta tiles and glass, with tree-lined terraces for privacy and to bring “the outdoors inside” – will also replace the 50-year-old Don Lowe Pavilion, which has housed adult Emergency Psychiatric Services and Mental Health Urgent Care. Designed by HGA and Cunningham Group architects, and located on the west side of the VMC campus, design features include:
- Adolescent inpatient care (on the third floor) with 21 beds for patients ages 13 to 17 years, and an outdoor terrace. Children 12 years and younger have a separate unit with 14 beds and their own outdoor space.
- Adult inpatient units (on the second level) with 42 beds and two tree-screened outdoor terraces.
- Emergency Psychiatric Services (EPS) on the ground level, with separate secured ambulance entry bays and treatment spaces for minors and adults. This level will also house: a shared pharmacy; divided outpatient urgent care for minors and adults; separate outdoor spaces for minors and adults walled for privacy and security; an outdoor courtyard for staff respite. A light-filled main lobby and atrium entrance facing Middle Drive.
- A rooftop basketball court, part of a walled and mesh-covered outdoor recreation space.
All of the services will share resources such as professional staff, support staff, and storage. A skyway linked to VMC’s Emergency Department will allow patients who have co-occurring medical issues to be treated on-site. An underground tunnel connects the facility with VMC’s Receiving and Support Center, allowing for easy transport of prepared meals and supplies.
The current schedule calls for the project to be completed and open to patients in late 2025.
Forging a Solution for Santa Clara County Kids in Crisis
When Simitian began the process of bringing inpatient psychiatric care for children and adolescents to the County back in 2015, he did so by reaching out to behavioral health staff, local hospitals and mental health agencies, school districts, and parent advocates to assess needs and obstacles.
When youth are diagnosed as being a danger to themselves or others, they are placed on a “5150” – an involuntary 72-hour hold – and transferred to the nearest inpatient facility.
With hospital beds in San Mateo, Alameda, and San Francisco counties in short supply, some families are referred to facilities in Vallejo, Concord, Santa Rosa, or Sacramento. Because of liability and safety protocols, parents are often not allowed to drive their children, which can mean hours in an ER waiting for an available bed, and potentially paying thousands of dollars for ambulance transport.
“Way too many of our kids are being hospitalized for psychiatric emergencies outside the County. Separating these kids from their families at one of the toughest times in their lives, that's just hell on them,” Simitian said. “I’m also worried that the specter of long-distance treatment could deter kids and families from seeking the help they need in the first place.”
Currently the County contracts with San Jose Behavioral Health to serve a limited number of teens ages 14 to 17 years. “It’s far from what is needed to meet the demand, and doesn’t offer anything for younger kids” said Simitian, noting also that the psychiatric facility is in South San Jose, “far removed from significant portions of the County.”
The VMC site has the added benefit of being part of a larger county-owned health and hospital complex, “with all the medical resources that provides,” Simitian added. “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.”
A Shared Responsibility
The facility’s psychiatric services for teens and children will have a collaborative foundation, utilizing the breadth of community expertise to provide a comprehensive safety net, including preventive, emergency, acute, transitional, and long-term mental health services for youth.
"I see this as a shared responsibility, an approach that captures the talent and resources of healthcare providers throughout the county,” said Simitian. "Whether a family is commercially insured, paying out-of-pocket, relying on Medi-Cal, or wholly uninsured, I want to be sure there's a place for their kids when and where they need it most.”
Key health partners include Stanford Medicine Children’s Health, Kaiser Permanente, Pacific Clinics, and El Camino Health, which has provided inpatient adult psychiatric services for many years, as well as ASPIRE (After School Program Interventions and Resiliency Education), a highly regarded outpatient education program for youth from middle school to 25 years of age.
It is anticipated that the child/adolescent unit will receive referrals from these local health care providers and others, as appropriate, due to the lack of available community resources and high need for these services.
“This is an important step forward in providing the full continuum of mental health care, closer to home, for local children and teens,” said Sherri Sager, Senior Vice President and Chief Government Relations Officer at Stanford Medicine Children’s Health.
Centralized Care with a Network of Support
The County plans to work closely with community-based partners on services to ensure full family involvement, rapid stabilization, and transition home with support, as well as on expanding and developing programs for kids to prevent additional hospital stays.
“That’s one of the clear advantages of the County operating a centralized facility designed purposefully to support behavioral health,” said Paul Lorenz, Chief Executive Officer at VMC. “We’re particularly gratified to be offering a spectrum of much-needed care for children and adolescents.”
“A collaborative approach will enable us to address acute mental health needs for youths by delivering inpatient care, and to reduce the number of patients who reach the point of requiring hospitalization by strengthening early intervention and outpatient services,” Lorenz added. “When a child is ready for discharge, we will be able to work in tandem with Behavioral Health Services on case management and transition to a community-based setting, involving a patient’s family every step of the way.”
Simitian noted that a 35-bed inpatient facility for children and adolescents has the potential to serve "hundreds and hundreds of families” annually, given that the typical patient stay in such a facility is just over six days.
“The need was clear. The partnerships were there. This was a solvable problem. But somebody had to take the lead. I’m proud that our County stepped up in this way. I’m delighted that construction is finally under way,” Simitian said. “But truly, given the need, we can’t get it done too soon.”
In December of 2014, Supervisor Joe Simitian learns that there are no inpatient hospital beds for kids and teens in mental health crisis in Santa Clara County. None.
2015 Simitian reaches out to County Behavioral Health staff, local hospitals, mental health agencies, school districts, and parent advocates to better understand the need for and obstacles to providing inpatient youth psychiatric care locally.
2016 County staff prepares a Request for Proposals (RFP) which closes without a successful bidder, the financial undertaking being too much for any one entity.
2017 Simitian re-engages with County staff and potential partners to forge a collaborative local solution. At Simitian’s urging, the Board of Supervisors unanimously approves development of an Adolescent Psychiatric Facility on the Valley Medical Center campus.
2018 The Board unanimously approves construction of a state-of-the-art behavioral health facility that will house the only County-run inpatient psychiatric services for children and adolescents.
2019 County staff commences stakeholder and user group meetings, programming development, site selection, and financial planning.
2020 At Simitian’s request, County staff provides monthly status reports to the Board’s Health and Hospital Committee on facility design, planning, and construction to ensure the project stays on track.
2021 Design documents are approved for the new state-of-the-art facility designed to meet the unique needs of mental health patients.
2022 Demolition of the existing structure is started to make way for the new facility.
2023 Construction begins on the Adolescent Psychiatric Facility and Behavioral Health Services Center.