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Help for Kids in Crisis Where They Need it Most: Close to Home


On Tuesday the Board of Supervisors will vote on constructing an inpatient psychiatric facility for youth in crisis in Santa Clara County — an issue that goes to the heart of community health and wellness, said Supervisor Joe Simitian.

“This is about 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, who has led the effort to add inpatient care to the continuum of youth-focused mental health services in the county.

“On any given day nearly 20 Santa Clara County children are being hospitalized for psychiatric emergencies outside the county, some as far away as Sacramento,” 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.”

The County has assessed demand and worked with a variety of community stakeholders, said Simitian. “The need is clear. The potential for partnerships is there. This is a solvable problem. At this point, somebody's got to step up. I think that ‘somebody’ is our County. The proposal now pending has the potential to be a huge step forward."

Board approval would direct County staff to prepare detailed construction and operational plans for an Adolescent Acute Psychiatric facility with up to 36 beds on the Santa Clara Valley Medical Center campus in San Jose. The operational foundation would be collaborative, 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.

"If we see this as a shared responsibility, an approach that captures the talent and resources of healthcare providers throughout the county, I think anything is possible,” 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 potentially include Lucile Packard Children’s Hospital Stanford, Kaiser Permanente, Uplift Family Services, El Camino Hospital, and others.

“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.  We have learned that access to these services close to home and available to everyone is a key component,” said Dr. William Faber, Chief Medical Officer of El Camino Hospital. “We’ll continue to work with the County to improve mental health services for young people, and we commend them for considering the addition of inpatient psychiatric beds for youth.”

Santa Clara County’s proposal is “a new and important resource for the community,” agreed Christopher G. Dawes, president and CEO of Stanford Children's Health and Lucile Packard Children's Hospital Stanford. “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.”

“There is a clear need for more psychiatric beds for youth in Santa Clara County,” said Chris Boyd, Senior Vice President and Area Manager, Kaiser Permanente Santa Clara, “and Kaiser Permanente supports the work that our community has embarked on to address this need. We look forward to collaboration with community partners across Santa Clara County.”

Three years ago, a constituent alerted Simitian to the need for youth psychiatric services with a simple question: “Why aren’t there any inpatient hospital beds for kids and teens in mental health crisis here in Santa Clara County?”

Simitian was dismayed to learn that each year, more than 600 young people were transferred from emergency rooms to hospitals outside the county for acute psychiatric care. 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.

Given the absence of local inpatient psychiatric care hospital beds, some families are referred to facilities in Vallejo, Concord, San Francisco or Sacramento. Because of liability and safety protocols, parents are often not allowed to drive their children. In many cases, that means hours in the ER waiting for an available bed, and paying thousands of dollars for ambulance transport out of pocket. 

“Separating these kids from their families at one of the toughest times in their lives, that's just hell on them. 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,” said Simitian. In 2015, Simitian reached out to County behavioral health staff, local hospitals and mental health agencies, school districts, and parent advocates to assess needs and obstacles. County staff developed a formal Request for Proposal (RFP) for an outside organization or coalition to provide inpatient psychiatric care for children and adolescents in Santa Clara County.

After the RFP process ended without a successful bid in January 2017 (due to the high cost of service provision), Simitian convened County staff and potential partners yet again to “try to find a way to bring everyone’s resources together and provide a solution locally.”

To immediately address the needs of youth requiring acute inpatient mental health care, in February the Behavioral Health Services department of the Santa Clara Valley Health and Hospital System negotiated an agreement with a newly licensed psychiatric facility, San Jose Behavioral Health, to serve teens ages 14 to 17 years.

“It’s a good start, but far from what the County needs to meet the demand,” said Simitian, adding that San Jose Behavioral Health is in South San Jose, “far removed from significant portions of the county’s population. The Valley Medical Center site has the added benefit of being part of a larger County-owned health and hospital complex, with all the medical resources that provides.”

Close proximity to medical services is important, said Toni Tullys, Director of Behavioral Health Services for the County’s health and hospital system. “By creating a facility at the Valley Medical Center, youth who have co-occurring medical issues could be treated on site.”

The County plans to work closely with community partners on transitional services, expanding and developing programs for kids, ”to prevent additional hospital stays,” said Tullys. 

“That’s one of the clear advantages of the County operating this kind of facility,” said Paul Lorenz, Chief Executive Officer, Santa Clara Valley Medical Center (VMC). “The hospital will provide acute inpatient care, and when a child is ready for discharge, we would work closely with Behavioral Health Services on case management and transition to a community based setting.”

Uplift Family Services (UFS), which has provided the County’s Crisis Stabilization Unit since September 2014, is “looking forward” to partnering with the County in support of a centralized psychiatric hospital for children, said Laura Champion, Executive Director. “UFS will continue to provide a continuum of services that would work seamlessly with the new hospital to ensure full family involvement, rapid stabilization, and transition home with support.”

Simitian noted that a 36-bed facility has the potential to serve "hundreds and hundreds of families” annually, given that the typical patient stay in such a facility is just six days.

Lorenz agreed. “There are no acute care hospitals providing inpatient psychiatric services for children and adolescents between Santa Clara County and Kern County,” 250 miles to the south, he said. “This represents a geographic void. A facility at VMC would serve the county, but also provide regional services, regardless of economic background.”

VMC’s specialty center for spinal cord and brain injuries is an apt comparison, added Lorenz. “We receive referrals from other hospitals in the county, as well as south and as far north as Davis. It’s a regional service, not just from an accessibility and financial standpoint, but also from a quality of care standpoint. This is what we want to do with psychiatric care, with staff unparalleled in their ability to treat these children. That’s why partnerships are so critical.”

Dr. Jeffery Smith, County Executive, estimated that the operational and construction plans will come back to the Board of Supervisors for consideration and approval within a year.