I remember the conversation well. I was talking to a constituent, a neighbor, at a community gathering. Out of the blue, she asked me a direct and unexpected question: Why don't we have any hospital beds here in Santa Clara County for teens who are at risk of hurting themselves or others?
Frankly, my first thought was, "That can't be right." But as too many families in our county already knew, and as I would quickly learn, it was entirely right. And it's entirely wrong.
On any given day there are probably two dozen Santa Clara County teens receiving what's known as "acute psychiatric care," requiring a stay in a secured and supervised hospital bed. In our county of 1.9 million residents blessed with world-class health care providers, the number of suitable hospital beds we have for these teenagers in trouble is exactly zero.
Over the course of a year, an estimated 1,462 kids are forced to go elsewhere for the emergency psychiatric help they need. Where do they go? Wherever there's a bed available, which could be San Mateo, San Francisco, Alameda, Contra Costa, Sonoma or even Sacramento County. In other words: a long way from home. (Read: When a teen is in a mental health crisis, what's working -- and what isn't)
While the typical hospital stay is "only" six or seven days, these remote locations make a traumatic situation that much harder for both the kids and their families. Sending a child to a hospital that could be hours away makes maintaining a supportive connection daunting at best.
Even those who are lucky enough to find a bed at Mills-Peninsula in Burlingame discover that a trip to this "nearby" facility can be an hour or more each way in rush-hour traffic. But more often than not, given the greater distances involved, such visits are simply impossible. A youngster in need is cut off from the friends, family and mental health providers who know them best.
This is true regardless of economic means. Whether you're uninsured, rely on Medi-Cal, are commercially insured, or paying out of pocket, you could be looking at a round trip of up to 250 miles. For many families, this precludes the kind of access that's critical to mental health recovery.
And on top of the stigma often attached -- wrongly -- to seeking mental health treatment, parents faced with a difficult decision about hospitalization of their child are even more likely to be deterred from seeking help if it requires sending that child several counties away.
By now you're probably asking yourself the obvious question: Why don't we have space closer to home for kids in need of acute psychiatric care? Regrettably, it's not for lack of demand. Readers of the Weekly know all too well the mental health needs of young people in our community. Nor is it for lack of expertise or commitment. In fact, our area is fortunate to have an extraordinary number of talented and committed mental health professionals.
So what's the problem? It comes down to medical economics.
None of our local hospitals is in a position to fund the cost of youth inpatient psychiatric facilities and staff without some assurance that the beds will be filled and the costs will be covered. We're faced with the perverse incentives of health care finance; we have to hope we have enough troubled kids to cover the costs of the hospital beds that would serve them.
We do have reason to be optimistic, however. There is a solution.
Prompted by that troubling question from a constituent a year ago, I set out to get some answers. I worked with county staff to assess the nature and extent of the problem. To their credit, the leadership of the county's Behavioral Health Department immediately acknowledged the problem and quickly became convinced that it affected far more families than was commonly understood.
County staff began talking with community members and mental health professionals to consider options. I did the same, beginning conversations with folks I thought could be part of the solution. What I discovered was encouraging.
Leadership at Packard Children's and El Camino hospitals here in the North County acknowledged the problem and expressed a desire to help, though they understandably said they couldn't do it all.
At the county's Health and Hospital System (HHS) and at Kaiser Permanente, the story was the same: We know there's a need, we want to help, but we can't do it all. And the same from Acadia Healthcare, a Santa Clara County newcomer. Time after time my exhortations were met with the same questions: Will others help as well? And will the county do its part?
I'm convinced the county will do its part. My colleagues on the Board of Supervisors understand the problem, and they're prepared to step up. But it will take the combined time, talent and resources of all of the county's mental health professionals and hospitals to serve these kids here at home where they belong.
The county has recently issued a request for health care providers to weigh in with potential solutions. I urge them to step forward.
If everybody who says they care is really willing to do their part -- to cooperate, to collaborate, to work in partnership -- we can create a new model that's both medically sound and economically sustainable. It won't take a lot of hospital beds to have a big impact. Even a relative handful of beds has the potential to help hundreds of families every year.
I believe the professions of concern I've heard are real. And I believe it's time we act to give these kids and their families what they need and deserve: a place to turn, at the toughest time in their lives, right here at home in Santa Clara County.