Simitian: 'Significant' need for inpatient psych beds for teens

County supervisor pushes for staff to analyze feasibility of opening unit in Santa Clara County

After several months of researching the demand for adolescent inpatient psychiatric services in Santa Clara County -- and the utter lack of hospital beds for youth in crisis -- Supervisor Joe Simitian is bringing to the Board of Supervisors a request for staff to analyze the feasibility of opening an inpatient unit for children and adolescents.

An average of 20 adolescents each day are receiving inpatient psychiatric care outside of the county, according to Simitian's report to the Board of Supervisors. Teens in crisis who seek emergency care at local hospitals are sent outside of the county to be hospitalized, with the closest available beds to Palo Alto at Mills-Peninsula Health Services in San Mateo. Teens from all over the county can be sent to farther-flung hospitals in San Francisco, Berkeley, Fremont, Vallejo, Concord and even Sacramento. Adolescent inpatient psychiatric units in the Bay Area run as large as 34 beds (Alta Bates Summit Medical Center in Berkeley) and as small as 17 at Mills-Peninsula.

Four-hundred and twenty-four Santa Clara County youths who were either uninsured or on Medi-Cal visited out-of-county hospitals from last July through this February, and each stayed an average of 6.6 days, according to Simitian. There were 653 duplicated visits by Santa Clara County youth to out-of-county hospitals during the same period.

More than 200 commercially insured youth and 189 uninsured or MediCal beneficiaries were sent for treatment outside of the county after seeking care at the nonprofit EMQ Families First's new Crisis Stabilization Unit in Campbell.

"To the extent that this is a question of medical economics, I think the numbers pretty clearly indicate we have a real and significant need right here in Santa Clara County," Simitian said Monday.

"This is a tangible, specific, fixable shortcoming in the system," he added.

After hearing from a parent in the community about the local dearth of inpatient beds for teens, Simitian said, he and his staff began looking into the issue. He said he was startled to discover this reality, especially in one of the largest counties in the country.

But with fresh leadership at the top of his organization – the county brought a new Department of Behavioral Health Services director on board in November – and a clear, demonstrated need, Simitian said he's "cautiously optimistic" that the county can help local teens access inpatient psychiatric care closer to home.

The county's primary concern is to create a safety net for lower-income families whose adolescents are on Medi-Cal or uninsured, but having an inpatient unit within the county would be a community-wide benefit, Simitian said.

"It's both a question of, how do we make sure that the kid who is getting help gets it in the best possible set of circumstances, but also that we don't essentially allow the existing system to be a deterrent for families who just aren't able or willing to send a youngster off to a remote location," he said.

Simitian will be requesting at the June 9 Board of Supervisors meeting for staff to prepare a report within the next six months on the feasibility of either opening or contracting for an inpatient psychiatric unit to be located in the county.

Staff will be asked to look at potential impacts on youth and families; potential cost-savings and expenditures of opening or contracting for such a unit; the appropriate size of the unit given the known population; feasibility of creating or contracting with a "flex" unit to account for known decreases in the patient population during summer months; feasibility and benefits of opening a unit within the County Hospital system versus issuing a request for proposals; and any additional considerations discovered during research on the subject.

Simitian said his office has had preliminary conversations with hospitals and organizations in Santa Clara County and will continue to work with them throughout the process.

"The challenge is to figure out what works and what doesn't, and I think we know that these beds are an integral and essential part of the continuum of care," he said. "To be here in largest county in the Bay Area and be without that resource, that seems to me -- it's startling, at least to me."

The Board of Supervisor's meeting will begin at 9 a.m. on Tuesday, June 9, in the Board Chambers, 70 West Hedding Street, San Jose. View Supervisor Simitian's recommendation here.

Related content:

Why so few hospital beds for teens?

When a teen is in mental health crisis, what's working -- and what isn't

Storify: Palo Alto community urges support for teen wellbeing

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21 people like this
Posted by Me
a resident of Adobe-Meadow
on May 25, 2015 at 12:51 pm

Joe- thank you for showing me that you are actually working hard on a real important issue such as this one.

4 people like this
Posted by Sic Semper
a resident of Leland Manor/Garland Drive
on May 25, 2015 at 12:53 pm

As usual, too little too late.

4 people like this
Posted by Joe
a resident of Another Palo Alto neighborhood
on May 25, 2015 at 2:19 pm

Doesn't the County of Santa Clara operate an incredibly expensive hospital? Shouldn't that hospital be expected to handle a significant portion of this "unmet need"?

33 people like this
Posted by Sarah1000
a resident of Los Altos
on May 25, 2015 at 4:12 pm

Thank you SO much Joe and Elena. I had no idea that Mr Simitian was already at work on this issue. What a blessing you are to our community. I will be at the Board meeting to show my support.
(I am hopeful that Elena is writing a similar article detailing Stanford's plans for adolescent mental health services. Fingers crossed!)

18 people like this
Posted by Mara
a resident of Los Altos
on May 25, 2015 at 5:20 pm

Thank you for using your time and resources to be a voice for our children. You wiill be saving lives offering this desperately needed care. Hopefully, this can be a model for other communities throughout the state.

11 people like this
Posted by $tanford $tinks
a resident of Embarcadero Oaks/Leland
on May 25, 2015 at 5:30 pm

Amazing that such a huge and overpriced hospital such as $tanford does this. They charge four times the basic room rate as El Camino, and have dreadfully neglectful inpatient care.

For this reason, many insurers are disallowing teaching hospitals such as Stanford, because of overpricing and under servicing, as well as over-reliance on med students, interns, and first-year residents-- all of whom under- supervised ( often attending physicians not even being on the same FLOOR).

This from the horses' mouths: Aetna, Blue Shield, Health Net.

10 people like this
Posted by Marietta
a resident of another community
on May 25, 2015 at 5:31 pm

So great to have hopes of progress! Thanks to all involved!!!

8 people like this
Posted by Diana Weistart
a resident of Palo Alto High School
on May 25, 2015 at 5:56 pm

I live in Denver and am closely following this issue. Thank you, sir, for your proposal. Mr.
Simitian, please stay on this matter. Denver is watching!

15 people like this
Posted by Parent in the community
a resident of Palo Alto High School
on May 26, 2015 at 6:38 pm

Thank you so much for another in a series of so VERY important articles bringing awareness and focus to to a serious community problem facing our Children! Joe and his office has done a phenominal job of investigating, evaluating and now bringing us in striking distance of a solution. Sic Semper, I could not disagree with you more as it is NEVER too late to bring meaningful change to a community in crisis and this avenue has real potential to make a true difference. My heart goes out to all that have had to suffer through this "local dearth of inpatient beds for teens" but knowing that the voice of that suffering is being shared, heard, and acted upon as is evidence by the series of PA Online articles is so heartening and inspirational. Grass roots activism along with responsible political representation is not dead! Keep up the great work!

11 people like this
Posted by Susan
a resident of Los Altos
on May 26, 2015 at 6:44 pm

Mr. Simitian - Thank you for addressing such an important and immediate need for our community - and for giving us hope that our hospitals will listen and support the families who support them.

3 people like this
Posted by Bette H
a resident of Los Altos
on May 26, 2015 at 10:09 pm

Great to see some progress on such an important issue. Thanks to all involved.

2 people like this
Posted by parent in the community
a resident of Palo Alto High School
on May 27, 2015 at 10:50 am

Joe, would it be feasible to extend your recommendation to include youth that are 18 (or above) yet are still High School students? Evidently, as soon as the youth turns 18, options disappear and the youth in crisis is transported to Valley Med Psych Unit. Some of the most 'last risk' youth are those in their last semester of high school who frequently are 18 or older. Thanks again for the great work!

3 people like this
Posted by School District CFO
a resident of another community
on May 27, 2015 at 9:36 pm

Thank you for your efforts to save the lives of our children! This is such an important issue for every community and a topic that is a great personal concern. I applaud your efforts and look forward to an update after the Board meeting.

1 person likes this
Posted by I'd like to help save our children
a resident of Adobe-Meadow
on May 27, 2015 at 11:47 pm

Thank you for bringing this issue to the forefront. We need to do what it takes and how ever much it takes to help our kids. I don't mind paying taxes for this very thing - it is trailer park subsidies Joe proposed that I appose.

Sorry, but further commenting on this topic has been closed.

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