News

Santa Clara County aims to open youth inpatient psych unit by mid-2016

Mothers advocate for unit to be combined with full-service medical facility

After about six months of staff research and community input on the lack of inpatient psychiatric beds for adolescents in Santa Clara County, Supervisor Joe Simitian and county staff indicated at Tuesday's Board of Supervisors meeting that they hope to bring beds to the county by June 2016.

Simitian first brought the issue to the board in May with a request for staff to analyze the feasibility of opening an inpatient unit for children and adolescents in Santa Clara County. The county has not had an acute-care, inpatient psychiatric unit for youth for more than 20 years, so an average of 20 adolescents each day are receiving inpatient psychiatric care outside of the county, from San Mateo to Sacramento, according to Simitian's report to the Board of Supervisors. (Read: Why so few hospital beds for teens?)

Several mothers of such youth spoke to the impact of having to go outside the county for critical mental health support, each holding an 8-inch-by-10-inch photograph of their child. One Palo Alto mother, Alison Morantz, described the "nightmare" of having to go outside of not only the county but the state for her young son's inpatient psychiatric hospitals stays — from Utah to Massachusetts to Ohio and now, the Children's Hospital of Pittsburgh in Pennsylvania, where he will soon turn 10 years old, she said.

"My husband and I tag-team around the country trying to support him while parenting our daughter here at home in Palo Alto," she told the board. "I can't tell you how life-changing it would be for us to at the very least be able to have him in the community so we could have some semblance of a family life."

Sarah Gentile, a Los Altos resident, stood at the podium holding a photograph of her teenage son, who was hospitalized last year at Mills-Peninsula Health Services in San Mateo — the closest hospital to the Palo Alto area with adolescent inpatient beds — after expressing to his psychiatrist that he had a suicide plan.

Since that day in the emergency room at El Camino Hospital in Mountain View when she discovered that her son could not receive inpatient psychiatric care within the county, Gentile has become a driving force in a crusade to change that reality, meeting with county officials and connecting with other parents.

"I've been at many of these meetings over the past few months with parents of commercially insured children who have serious mental health issues and our message has been clear: 'When our children are in crisis and most in need of medical care, we have nowhere to go,'" Gentile told the board.

"Just like other illness, illnesses of the mind worsen without treatment. By not having the necessary inpatient partial-hospitalization programs needed to treat the most severely ill of our children, not only do some of our children die by suicide, the number of seriously mentally ill adults in our county ultimately increases," she added.

Staff on Tuesday recommended that the county issue a Request for Information so that potential vendors can submit proposals for "programmatic, facility and service elements needed for a child and adolescent inpatient hospital unit."

These elements, as recommended by the county's Behavioral Health Services Department, would be an acute psychiatric unit serving children and youth from 5 to 17 years old who present a primary psychiatric illness "that cannot be treated in a less restrictive setting," a staff report reads.

The unit would be open to all children and adolescents with Medi-Cal and commercial insurance as well as those who are uninsured. Services would be provided by a multidisciplinary team of psychiatrists, pediatricians, registered nurses, licensed clinical social workers and/or master-level clinicians and occupational/recreational therapists, according to the staff report.

Toni Tullys, who was named director of the county's new Behavioral Health Services Department (the result of merging the Mental Health Department and the Department of Alcohol and Drug Services) in November 2014, described on Tuesday a "robust stakeholder process" that led to this recommendation.

The county convened an Acute Children's Hospital Work Group — which included representatives from the county, Emergency Psychiatric Services, outpatient psychiatrists, pediatricians and community organizations, among other groups — to gather input from local families and conduct a focus group with members of a Hospital Council, representing eight county hospitals.

Feedback from these various stakeholder groups was "very consistent," Tullys said.

"One is, 'Yes, open something here in Santa Clara County'; two is, 'Make sure that the services are age appropriate'; three, 'Make sure that the services are family friendly and really responding to the needs of the family'; four, and I would say that this has been the most significant item, is 'Ensure that there is a discharge plan in place and that there are services available for a child or youth coming out of an acute hospital setting,'" she said.

The work group, Hospital Council focus group participants and the county's Behavioral Health Board all support the idea of developing an inpatient unit within the county, according to the staff report.

Staff also analyzed data over the last five fiscal years for all children and youth admissions to Emergency Psychiatric Services as well as all admissions to psychiatric contract hospitals, but for the latter, only for Medi-Cal and uninsured patients. (The Behavioral Health Services Department has requested a county data set, expected in January, for commercially insured children and youth who are admitted to acute inpatient hospitals, according to a staff report.) In fiscal year 2015, there was a total of 878 admissions to Emergency Psychiatric Services and 493 Medi-Cal and uninsured admissions to private hospitals.

During their research, staff also discovered that the county tried several years ago to develop a child and adolescent psychiatric facility. A Request for Proposal was made in November 2011 with the intent "to establish local, safe, secure and developmentally appropriate crisis evaluation and inpatient care," the staff report states. The county didn't end up moving forward due to budget constraints, according to the report.

The new facility now being discussed could also be either a standalone unit — which is required to provide patients with 24-hour access to a physician if needed but does not have immediate access to an emergency room, staff said — or attached to an existing hospital. The mothers in attendance on Tuesday expressed concern that a freestanding unit might be less equipped to deal with patients with both psychiatric and medical conditions.

Teresa Gallo, a San Jose resident, said her daughter was misdiagnosed in 2011.

"She was misdiagnosed with bipolar for 10 months and because of this misdiagnosis, Tessa is today at Lucile Packard Children's Hospital, many times restrained to her bed and probably will have to be taken care of 24/7 for the rest of her life," Gallo said, indicating that her daughter has pediatric acute-onset neuropsychiatric syndrome (PANS).

"I'm here today to make sure you understand the importance that creating a psych hospital attached to some sort of medical facility for all children to receive the treatment they need and make sure that they're not misdiagnosed," Gallo said.

She offered another example: an adolescent who has cancer who might become depressed or suicidal.

"He may come into our new facility, but he may also need chemotherapy. Others may come in and need X-rays, MRIs, CT scans, spinal taps, IVIGs, plasmapheresis, strep test, genetic testing to make sure they're treated and diagnosed properly," she said. "None of these things are possible to receive at a standalone psych facility."

Supervisor Cindy Chavez -- who represents District 2, which covers part of San Jose -- pointed to the nonprofit EMQ FamiliesFirst's relatively new crisis stabilization unit, a small, short-term standalone facility in Campbell for children and adolescents who are at risk of suicide. While the unit is "fantastic," Chavez said, it's limited in the services because it is not connected to a full medical-services facility. Chavez requested that staff prioritize medical services in its Request for Information.

"I am very interested in us pushing the envelope in terms of potential medical partnerships," she said. "I think that's critical."

In response, Simitian stressed that a longer-term vision around such a facility, while valuable and worth pursuing, should not be given higher priority than getting beds themselves into Santa Clara County.

"I don't want to diminish the importance of all the other issues that people have raised about the quality of care, the nature of the care," he said earlier in the meeting, "but my goal is to get whatever it is we need, however we define that, in this county for the reasons we discussed ... to do everything we can to see that we can't actually get some beds in this county before we get to the middle of the coming year."

The board voted unanimously to receive staff's report and direct staff to issue a Request for Information.

Tullys said staff expects to release the request in mid-January, develop a Request for Proposal to release in February and hope to have the entire process completed by early May.

Having beds available in the county by June 2016 is "is strongly our goal," Tullys said.

After the meeting, Gentile noted that she and two other mothers have to go outside of the county for psychological services for their children, as commercially-insured youth don't have access to the wraparound mental-health services that the county provides to its Medi-Cal and uninsured clients.

"The lack of in-county inpatient services is just the 'tip of the iceberg' for commercially-insured families whose children have illnesses of the mind," she said.

Related content:

Resources: How to help those in crisis

Santa Clara County Supervisors approve study on youth psych beds

Simitian: Need for inpatient psych beds for teens is 'significant'

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

Why so few hospital beds for teens?

Editorial: No beds for teens

Comments

41 people like this
Posted by hopeful
a resident of College Terrace
on Dec 15, 2015 at 10:07 pm

This makes me guardedly hopeful that we may eventually have an inpatient pediatric/adolescent psych unit in Santa Clara country. I am humbled by the courageous moms who continue to advocate for so many other youths in our community. God bless them.


41 people like this
Posted by Courtney
a resident of Midtown
on Dec 16, 2015 at 8:36 am

GREAT NEWS!!! Sarah Gentile you are incredible and amazing and your efforts are coming to fruition! You have been the driving force for this to happen and deserve a medal for all your time and love. I am so happy this issue has been escalated to where it should be and proud to know Sarah.


32 people like this
Posted by Bette H
a resident of Los Altos
on Dec 16, 2015 at 8:49 am

Thank goodness and thanks to everyone who spoke up on this difficult topic. Still in my prayers for a smooth road forward.


33 people like this
Posted by Sarah1000
a resident of Los Altos
on Dec 16, 2015 at 9:13 am

Thank you to Elena and the Palo Alto Weekly for educating the community on this important issue. I am blessed to have gotten to know all the members of our community who have been hard at work much longer than I have at improving mental health care for everyone. I especially want to thank Michael Fitzgerald, the Director of Behavioral Health at El Camino Hospital, for his presence at yesterday's meeting and Dr. Tom Tarshis of BACA who has been so responsive to requests to help from families who have contacted me in desperation. I am also grateful that Supervisors Simitian and Chavez as well as Toni Tullys (SCC Behavioral Health Director) care so passionately for our children who are in crisis. I believe that we are at the beginning of an inspiring and rewarding journey in Santa Clara County.


33 people like this
Posted by Ellen Wheeler
a resident of Mountain View
on Dec 16, 2015 at 10:22 am

I am so grateful to read this long-awaited result. Kudos to Supervisors Simitian, Chavez, and the rest of the board for this thoughtful vote. Special kudos to the parents who trudged down to these meetings for months. I know Sarah Gentile from her leadership on this issue in Mountain View. She and Trudy Palmer have been giants in this effort. Thank you to all!


37 people like this
Posted by Robin Fox
a resident of Mountain View
on Dec 16, 2015 at 11:05 am

Amazing. Congratulations and thank you to all involved. Sarah Gentile, thank you for being a voice for youth.


36 people like this
Posted by Dana Bunnett
a resident of Los Altos
on Dec 16, 2015 at 11:34 am

Such an important issue for our county's children and youth. Having local resources that will allow parents to support their children in crisis is an important "upstream" strategy that will make a difference by decreasing the likelihood that youth with mental health issues will grow into adults who are stable and able to thrive in the community. It is a strategy that should prevent later engagement in the adult justice system. Thank you to the parents who raised this issue and to the BOS for being willing to invest the resources to address it.


29 people like this
Posted by Dana Bunnett
a resident of Los Altos
on Dec 16, 2015 at 11:36 am

Of course I meant INCREASING "the likelihood that they will grow into adults who are stable and able to thrive in the community."


34 people like this
Posted by Christine Case-Lo
a resident of Mountain View
on Dec 16, 2015 at 11:44 am

Thank you to all the parents who have advocated long and hard for this much needed service for our children. This is a huge relief to see and end in sight to have local beds for kids in need!


30 people like this
Posted by Trudy Palmer
a resident of Los Altos
on Dec 16, 2015 at 11:44 am

I am so proud of everyone in Santa Clara County who is working on wellness for our teens!!
SELPA 1 CAC's Subcommittee on Mental Health is pleased to report that our collaboration with CHAC on our "Free the Teens" support group for depressed & anxious teens has finished it's pilot program. Free the Teens also includes whatever wrap around services an adolescent may need. We will be critiquing the support group efforts & hope to offer a continuing/new Free the Teens program in the New Year.


10 people like this
Posted by enough!
a resident of Charleston Gardens
on Dec 16, 2015 at 12:06 pm

It's needed. Good.


33 people like this
Posted by anne
a resident of Green Acres
on Dec 16, 2015 at 12:38 pm

A humble thank you to Sarah and the parents in the trenches who have done so much to ensure other children will not endure what theirs have. Thank you to all the helping hands willing to do what it took for this mch needed support for teens in our community. You will never know which lives you have saved, but it will save lives.


13 people like this
Posted by Courtney
a resident of Midtown
on Dec 17, 2015 at 7:17 pm

This is such great news and so needed in Santa Clara County. Sarah Gentile has attended all the Board of Supervisor meetings to voice her concern about the lack of beds and met with individual board members and their support staff to really drive home the importance and absolute necessity of beds for youth! Thank you Sarah, you are an incredible and compassionate woman.


9 people like this
Posted by Mara
a resident of Los Altos
on Dec 24, 2015 at 3:49 pm

Thank you to all the parents like Sarah who stand together to help all of our children. To the Board of Supervisors at Santa Clara County, I applaud your decision and hope that you become a model throughout our country. Thank you all for working to provide this vital care for our youth. Your time and leadership will save precious lives.


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

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