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.