It was a shock to us and many readers to discover that when local teens facing an acute mental health crisis need hospitalization, Stanford University's world-renowned children's hospital must turn them away.
And even more surprising, in the entire county -- the sixth largest in California and the largest north of Los Angeles -- not a single hospital, including the county-funded Valley Medical Center, offers such services.
When local adolescents in crisis are taken by parents, police or paramedics to the Stanford or other emergency departments and they are deemed to need hospitalization, they wait -- often for many hours -- while the emergency-room staff tries to find an available bed at one of the few Bay Area hospitals with adolescent psychiatry units. And an ER staff person must physically stay with them constantly until they are transferred.
When and if a bed is located, policies dictate that the teen must be transported by ambulance, a humiliating and costly practice, often not covered by insurance.
With all the attention teen suicides have received since the first Palo Alto contagion in 2009, the resources that have been poured into programs and services to address adolescent mental health needs, and all the focus on de-stigmatizing mental illness, the common assumption was that acute cases were being gently handled within our local hospitals by physicians familiar with the unique conditions facing Palo Alto youth.
Incredibly, not so.
Thanks to a local family that shared its story with the Weekly, the distressing reality of this inadequate system is now out in the open. With 50 students at Paly and Gunn high schools alone having been hospitalized during this school year, dozens of families have discovered this gap in available resources.
The nearest inpatient facilities are at Mills-Peninsula Hospital in San Mateo, which has only 17 beds, and Fremont Hospital, with 25 beds. St. Mary's Hospital in San Francisco has 20 and Alta Bates in Berkeley has 34.
According to Supervisor Joe Simitian, who is asking county staff to look into the problem, each year more than 600 youth in Santa Clara County are being referred elsewhere for treatment.
And when a bed can be found, the long distances place added strains on families needing to participate in therapy sessions and conform to strict visiting policies and hours.
There are many explanations offered for why acute inpatient psychiatric care for children and adolescents is so sparse, but they all boil down to finances. Most challenging is that hospitalizations of adolescents largely occur during the school year, leaving specialty units with few patients during summer months. Staffing becomes a challenge, and maintaining a secure unit that has empty beds during the summer is costly.
Hospitals make money by keeping their beds filled, and setting aside beds that can only be used by limited types of patients reduces flexibility. Insurance-coverage limitations on mental health inpatient services are another challenge.
Interestingly, the economics support a 15-bed adolescent inpatient eating disorders clinic at El Camino Hospital, operated in partnership with Stanford, but admissions are limited to youth who are medically compromised due to abnormal eating behavior.
In addressing the soaring rates of adolescent mental health needs, Stanford's Division of Child and Adolescent Psychiatry has focused its attention on educational outreach in schools and the broader community and on increasing staffing in its outpatient child and adolescent psychiatry clinic. There are no current plans to develop inpatient services.
Patients come from all over the world to be treated for virtually every physical condition imaginable at Stanford Hospital and Lucile Packard Children's Hospital Stanford. Medical miracles occur almost every day, often at tremendous and uncompensated expense, and our local community is fortunate to have leading experts in most medical specialties at our doorstep.
That makes it particularly hard to understand why neither the children's hospital, which is more than doubling in size and adding 149 beds, nor the adult hospital, which will add more than 350 beds as part of its expansion, are considering these needs.
While preventative mental health programs and outpatient treatment should remain important priorities, we urge health care leaders to address the lack of services for those teens needing acute inpatient care. World-class communities and institutions should not be quietly shipping their most vulnerable off to other places for treatment.