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Guest Opinion: Time to act collaboratively for county's at-risk kids

 

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.

Related content:

Resources: How to help those in crisis

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

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

Santa Clara County supervisors approve study on youth psych beds

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

Why so few hospital beds for teens?

Storify: Palo Alto community urges support for teen wellbeing

Joe Simitian is a member of the Santa Clara County Board of Supervisors and represents the Fifth District. He can be reached at 408-299-5050 and supervisor.simitian@bos.sccgov.org.

Comments

37 people like this
Posted by Sarah1000
a resident of Los Altos
on Mar 4, 2016 at 5:50 pm

Thank you so much Supervisor Simitian for leading the effort to bring youth inpatient mental health care to Santa Clara County. In 2014, I was shocked when I took my then-17 yr old son to a local ER for treatment during a major depressive episode only to be told that they would have to "call around" to find somewhere that would "take" my son. Six hours later, he was sent out-of-county by ambulance. Our county's extraordinary medical institutions must come together to treat children who suffer from illnesses of the mind with the same care that they provide to youth with physical illnesses. Now, with the support of our Board of Supervisors, these providers are in a position to create a meaningful continuum of care for our children. Thank you in advance to all our wonderful hospitals and nonprofits who will step forward to provide mental health care to the youth of Santa Clara County.


29 people like this
Posted by Donna
a resident of Los Altos
on Mar 4, 2016 at 7:47 pm

Supervisor Simitian, I deeply appreciate your effort to stand behind the creation of acute care facilities for adolescents in Santa Clara County. I believe my family can count ourselves lucky when my child had two trips to Mill-Peninsula instead of a facility even further from home. With the growing epidemic of anxiety, depression and suicidal ideation among our adolescents, it is getting increasingly more difficult to find space close to home. It is unconscionable to me that the administration of our nearby state of the art medical facilities can't find a way to provide the facilities we need to keep our children safe. What message do we send our children when "medical economics" is preventing the creation of acute care facilities to enhance their emotional well-being. Thank you again for your tireless efforts to bring the much needed care to our families. Maybe of coalition of leaders from local health care facilities can bring the care we need to our children in Santa Clara County.


27 people like this
Posted by Christine Case-Lo
a resident of Mountain View
on Mar 4, 2016 at 8:13 pm

Thank you so much Supervisor! I can not tell you what a relief it would be to have options for my son should be be in crisis. He is autistic with very high anxiety, and having to take him out of the County to find him help would be difficult. But we have some financial resources. What about all the families that don't? Having nearby hospital beds to help these kids would save families and save lives. Thank you thank you.


25 people like this
Posted by Ellen Wheeler
a resident of Mountain View
on Mar 4, 2016 at 8:59 pm

Thank you for your leadership on this critical issue, Supervisor Simitian. Your leadership is admirable. I hope that you can persuade others to collaborate on this effort. It's important to our community.


29 people like this
Posted by profit
a resident of Mayfield
on Mar 4, 2016 at 10:29 pm

Perhaps Santa Clara County could subsidize an adolescent in-patient facility to compensate for the anticipated loss of revenue during the summer months. This might make such a facility more cost-efficient to Stanford/LPCH.


26 people like this
Posted by Courtney
a resident of Midtown
on Mar 5, 2016 at 8:17 am

Senator Simitian thank you for taking the time to write this article and let us know where the County stands with mental health beds for our youth. I hope that your voice and the voice of your supportive staff will hear the requests and not only reply as they did that they are concerned and can't do it all but they can go a few steps further and implement a plan and have this done by summertime. Having a 51/50 crisis on your hands as a parent with small kids, the fear, worry and immediate need for help while in crisis deserves to be a short drive away, especially with the harm both short term and long term that can be done. Would love a follow up to see how these hospitals plan to help would be much appreciated. Thank you again for your support.


27 people like this
Posted by Bette
a resident of Los Altos
on Mar 5, 2016 at 9:44 am

Supervisor Simitian, thank you for taking the time to write this article and for all you are doing on behalf of our at-risk youth. More power to you!!!


26 people like this
Posted by Teresa Gallo
a resident of another community
on Mar 5, 2016 at 11:45 am

Thank you so much for fighting for our children. Our daughter was once sent to Bakersfield and most of the time was kicked out after 72 hours. There are so many things wrong with our system. Thank you for being our voice.

Teresa Gallo


7 people like this
Posted by Marc Vincenti
a resident of Gunn High School
on Mar 5, 2016 at 1:27 pm

Hi, Fellow Onliners,

My hat is off to Supervisor Simitian, and to everyone rallying to his cry, for working for better medical care for our troubled youth--"to serve these kids here at home where they belong."

Besides modernizing our hospitals, we can improve the other key institution--our schools--so that our District "here at home" becomes more sustaining and health-giving.

Please join with Save the 2,008, the Palo Alto coalition to foster an even better life at our high schools. Let's make them friendlier, less alienating, less rife with distrust, distraction, and sleep deprivation.

Save the 2,008 offers six simple proposals to moderate class-sizes, homework amounts, cheating, and other toxic, everyday conditions.

Please visit savethe2008.com and join the 426 citizens--parents, grandparents, rabbis and ministers, LMFTs, professors, PAMF physicians, etc.--who've signed their support.

Thanks again to Supervisor Simitian and those in support of his energetic work and valuable initiative.

Sincerely,

Marc Vincenti
Gunn English Dept. (1995-2010)
Campaign Coordinator
Save the 2,008
savethe2008@gmail


28 people like this
Posted by Gunn parent
a resident of Gunn High School
on Mar 5, 2016 at 3:19 pm

Thank you Supervisor Simitian. This community is an epicenter for this crisis among our kids and the current situation is unconscionable. Voices need to be raised and Lucille Packard needs to step up and help this community by providing much-needed beds. Adolescent psych beds are not money makers for hospitals. However, I believe that Stanford can afford to provide this essential service for our kids. It is shameful not to. It all comes down to money and political will. My child has been a 5150 twice and we have had to be in San Francisco and Berkeley. The travel to get to these places to see our daughter everyday has only intensified our nightmare. For shame, Lucille Packard.


27 people like this
Posted by Robin
a resident of another community
on Mar 5, 2016 at 8:55 pm

I'm inspired by your willingness to step forward and take action for this important issue. I'm also deeply saddened at the lack of beds for teens. As a teen myself who battled suicide and self injury, I can relate to those who are hurting and need a safe place to stay. Please keep standing up for the youth in need of inpatient stay.


4 people like this
Posted by Olenka Villarreal
a resident of Community Center
on Mar 5, 2016 at 9:49 pm

There is no better time than in the midst of this crazy election to pause and appreciate an honest, kind and results-driven leader like Supervisor Simitian.

Joe started as President of the Palo Alto School Board in 1983, then continued to serve our town as Mayor in 1996 and has been working his magic all around the county and beyond ever since.

I'm delighted to see these gracious reader comments to Joe's piece. He needs to know that we appreciate ALL he has done for us, and will continue to do.

Friends of Joe's will be hosting a fun private event both to thank him and make sure he stays in office! If anyone reading this is interested in learning more, please email me at olenka@magicalbridge.org.


4 people like this
Posted by Caroline Vertongen
a resident of Portola Valley
on Mar 6, 2016 at 11:59 am

Thank you for your article posted on March 4. Earlier this year, you and other elected officials in San Mateo and Santa Clara County received a 40 page summary describing the deficiencies of our current education and healthcare system. I provided you with my own experience, the testimonies of others, and a summary of lawsuits by students , educators, parents, and healthcare providers all addressing the deficiencies of our California education and healthcare system. The issues are complex and I agree with your comment that we will need a collaborative effort to resolve the issues. However, we will need full transparency to understand and solve the complexity of the problems, and accountability to make our efforts sustainable. Thank you for asking "why don't we have any hospital beds in Santa Clara County for teens at risk hurting themselves or others? We should also ask, Why do we have so many teens at risk ? and Why are the available resources not working? As a concerned community member having raised two children in the Bay Area and as healthcare professional with training in Occupational Therapy, child development, developmental learning disabilities, psychology, neurology and mental health I understand the complexity of the problems. Unfortunately, I was retaliated against for disclosing the systemic problems in education and healthcare and I am not alone. Many healthcare providers and educators are subjected to mobbing for disclosing the abusive and illegal conduct that takes place behind closed doors. The high number of lawsuits pending against our state and federal agencies address the lack of safety, lack of equity and lack of quality in education, the lack of proficiency in vocational training, the manipulation of accreditation and credentialing, and the misuse of funding. All reflect the lack of respect for the law.
The Bay Area is experiencing a crisis. The issues are complex and we need sustainable solutions. I applaud you for your leadership and call for action.
I hope you will inspire other elected and appointed officials to support this collaborative community approach starting by solving the mental health crisis of our teens.
Thank you


9 people like this
Posted by Geoff
a resident of Mountain View
on Mar 7, 2016 at 8:09 am

Well said. Hopefully new capacity can be created within the Acute care facility at Santa Clara Valley Hospital. In addtion to the chronic shortage of child/adolescent psych beds in the area all of the existing facilities in Northern California are free standing. They are often unwilling to accept kids who have both psych and medical issues. Having a unit within an acute care hospital would allow acess to both psychiatric and medical care simultaneously.


12 people like this
Posted by fcservices
a resident of Evergreen Park
on Mar 7, 2016 at 10:14 am

Thank you, Supervisor Simitian, for your advocacy on this important public health issue. Thank you also to the parents, concerned community members, and professionals who have been increasing awareness of the need for local, accessible acute psychiatric services. It is critical for resources to be easily accessible, so teens and their families can focus on what is most important: healing.


2 people like this
Posted by realitycheck
a resident of Fairmeadow
on Mar 7, 2016 at 11:36 am

While this is sincerely laudable, I wonder how many do not see the correlation between the services we can (or cannot) provide both children and adults and the services we do provide to illegal immigrants -- or more specifically, $23.5 billion ANNUALLY to provide free education, food, driver's licenses, emergency healthcare, incarceration, etc., to illegal immigrants. Moreover, the state is moving forward with a high-speed train boondoggle of $68 - $98 billion! Yet at our public school, we are asked to donate hundreds of dollars per child to provide "supplemental" teaching staff, such as a music teacher, art teacher, science teacher, in a town with condos that don't sell for less than a million dollars. Why is one of the wealthiest counties in the state unable to afford to hire more behavioral healthcare workers or build needed facilities? We need to wake up to what our elected officials are doing with our money and hold them accountable to the priorities of the voters.


3 people like this
Posted by solon
a resident of Old Palo Alto
on Mar 7, 2016 at 5:19 pm

could this be in a single family home in palo alto w/ six bedrooms? could it have the security features, medical equipment, ambiance, and so on, safety, zoning, etc?

i am willing to find a house for donation for such a cause, this has been possible for teen age pregnant girls, elderly group living, etc, group homes for developmentally disabled, why not just a donated house and make it work?

Today almost nay level of care can be provided in a home

joe,thank you,again

could you post link to 40page report please


6 people like this
Posted by Cats
a resident of Portola Valley
on Mar 7, 2016 at 9:19 pm

Dear Joe,
We are so lucky to have you as a representative. Our family has experienced this as well. It causes such needlessly exhausting amplification of stress to families already in acute crisis.

Another issue I hope you can bring your leadership to: self-harming instruments such as razor blades and X-acto knives are easily available to kids. A mom friend went around to all the stores in walking distance of her middle-schooler who cuts, and none of them would agree to make it harder for kids to get blades. Her daughter has been cycling through mental health facilities and hadn't yet stabilized beyond the point of compulsive self-harm. (They've had to give up pencils in their house because pencil sharpeners have razor-like blades.) Of course it would be difficult to prohibit sales of sharp objects of all kinds, but it was sad to hear of businesses refusing to consider making it harder to buy the easiest self-harm tools.
Thank you.


9 people like this
Posted by Lori
a resident of Atherton
on Mar 8, 2016 at 4:44 pm

Supervisor Simitian, thank you for building awareness about this dire situation that deeply affects our youth. With a 20% depression rate nationwide and several experts in Santa Clara County and San Mateo County estimating that the rate is likely closer to 40% for our local high school teens, it is time that we all work together to find solutions to providing more in-county beds and treatment options for our children. I'd encourage us to also look for opportunities for mental health intervention earlier in the cycle--ideally providing early-stage, easy-access, de-stigmatized care before the children's situations require hospitalization.


5 people like this
Posted by Mara
a resident of Los Altos
on Mar 9, 2016 at 8:43 pm

Thank you Supervisor Simitian for all of your tireless effort to bring inpatient mental health care to Santa Clara for our youth. You have listened and have become a voice for our children. Thank you for stepping forward and representing our community. It is our hope that more counties will learn from your model. Hospitals and nonprofits working together can provide the mental health care that we so desperately need for our children.


3 people like this
Posted by Sarah1000
a resident of Los Altos
on Mar 12, 2016 at 11:27 am

There's an article in today's Mercury News online about how to keep the mentally ill out of our jails. Mental illness, like any other chronic disease, worsens without treatment. With no inpatient psychiatric care for our most seriously ill youth, we are literally creating the adults with untreated mental illness who wind up in our jails. Our providers must come together to provide treatment for our children.


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