The Santa Clara County Board of Supervisors unanimously directed staff on Tuesday to move forward with a proposal to build a county-run inpatient psychiatric unit for adolescents at Santa Clara Valley Medical Center in San Jose.
The facility would address a longtime dearth of hospitalization options for local teens in mental health crisis, who are most often sent beyond the county’s borders for inpatient psychiatric treatment. All five supervisors agreed that it’s time for the county to address the life-or-death issue that is affecting an increasing number of young people and families across Santa Clara County.
The very early cost estimate for the facility is $50 to $70 million. County Executive Jeffrey Smith cautioned Tuesday that even this price range is “inaccurate” given there are not yet any architectural or construction plans. Smith said the county should be able to fund the project with lease revenue bonds, which are paid off by lease payments from the facilities that were financed by the bond. He said a more exact cost estimate will come back to the board for approval in the next four to six months.
In a motion, the supervisors also approved the creation of a workgroup to oversee the project and asked staff to come back with a more in-depth facilities assessment for Valley Medical Center.
The county is preliminarily planning to tear down the hospital’s existing emergency psychiatric services building, which Smith described as outdated, and build a unit with about 36 to 40 beds for adolescents. The county is also hoping to partner with local private hospitals and mental health service providers to create a “continuum of care” for teenagers when they come into and leave the inpatient unit. Potential partners include Lucile Packard Children’s Hospital Stanford, Kaiser Permanente, Uplift Family Services (which runs a 24/7 mobile service for teens in crisis and a short-term stabilization unit for youth in San Jose), El Camino Hospital in Mountain View and others.
Supervisor Dave Cortese asked if the facility will serve 18-year-olds who are still in high school and would thus be better suited to an adolescent than adult psychiatric unit. Smith said it’s possible to have “flex beds” to address that issue.
The board’s vote came after about 30 people — including parents, clinicians, elected officials and local hospital representatives — spoke in support of the proposal.
Representatives from El Camino Hospital, Lucile Packard and Fremont Hospital, which has psychiatric beds available for children and adolescents, emphasized the high demand for such a facility. (Last year El Camino, Packard and Kaiser proposed to the county that they jointly open a teen inpatient unit — a proposal the county turned down.)
Crysta Krames of Fremont Hospital, where Santa Clara County youth are often sent for services, said the unit is completely full and the hospital recently opened a dedicated unit for adolescents with eating disorders. Just this weekend, the hospital just turned away an 8-year-old, 9-year-old and 11-year-old who had been referred to the inpatient psychiatric unit, she said.
Sherri Sager, chief government and community relations officer for Lucile Packard Children’s Hospital Stanford, said mental health is on track to become the “most predominant diagnosis” for all children and adolescents in the next few years. Anxiety and depression are on the rise in the United States, and suicide continues to be the second leading cause of death for people ages 10 to 24, said Philippe Rey, executive director of nonprofit Adolescent Counseling Services.
Three Palo Alto school board members — President Terry Godfrey, Melissa Baten Caswell and Jennifer DiBrienza — urged the supervisors to approve the proposal. Godfrey described the need for inpatient psychiatric care as a long-term problem that the county will be “dealing with … for awhile.”
Parents and supervisors said locating an inpatient unit at an hospital will also meet a critical need for youth with both psychiatric and medical needs. Terry Gallo said her daughter, who has autoimmune encephalitis, spent 10 months in different standalone psychiatric facilities throughout northern California where staff could not conduct the tests necessary to diagnose and address her medical condition. Her daughter now has brain damage and lives in a group home, Gallo said.
“There are many children in this county with a dual diagnosis,” she told the supervisors. “I beg you when you put this building together that you have some easy way to access the medical facility so that every child can be taken care of.”
Several speakers described the “harrowing” experience of trying to support a hospitalized teenager from far away. Christina Chen, a 2013 graduate of Palo Alto High School, said friends who have been hospitalized outside of the county experienced inconsistent quality in care, had a harder time recovering — and as a result became “disillusioned” with seeking help in the future.
The “lack of continuity of care was detrimental to their recovery and their relationship to the mental health system as a whole,” she said.
Chen urged the county to not only bring inpatient services closer to where they’re needed but to make sure the unit is sufficiently staffed and culturally competent.
Supervisor Joe Simitian has spearheaded the effort to address Santa Clara County’s lack of inpatient hospital beds for teens, which has been ongoing for years. Simitian was unaware of the issue until a community member raised it with him about three years ago. He and the other supervisors expressed an eagerness to move forward on the project as quickly as possible.
Yes, the youth inpatient psychiatric hospital discussed at the BOS meeting today is a great aspiration. However, it will be many years in the making, at best. I’m surprised that the Palo Alto community is not looking to our children’s hospital to start admitting children who need short-term inpatient mental health care. The newly expanded LPCH Stanford will more than double the size of the hospital but will still not provide a single bed to help a suicidal teen? LPCH has the means and expertise to help our children now. Is it not wrong that they turn away all children who are having a mental health crisis? It’s a hospital for children!
I could not agree more with Sarah1000! Lucile Packard is great at talking the talk (what a lovely sound byte by Sherri Sager) but has consistently refused to walk the walk. Why won’t they take the (obvious) step of allocating some of their lovely and expansive new space to kids with psych illness? Hmm, let’s think really hard. Could it possibly be that they don’t want to deal with the hard psych cases – the kids with “behaviors” (a dirty word at LPCH) – because their nurses hate dealing with them and they just lose the hospital money? It doesn’t take a brain surgeon to connect those dots. NIMBYism at its worst. The real question is why the community has let them get away with it for so long.
RaeyaJ- Thank you for the support but I would like to clarify that I am in support of inpatient psych services at LPCH because of the wonderful care and support my daughter received there during her treatment for a neuro-muscular disease (especially from the nurses). Also, I believe that it is a misconception that suicidal teens have extreme behavioral issues. Teens who are extremely depressed often lack the energy to perform everyday tasks such as attending school or showering. Just getting out of bed can be a challenge for them.
It is interesting that I can find no article on PA Online that explains why the county turned down proposals from El Camino Hospital/Kaiser/Packard for an adolescent treatment facility. Please provide a link if you can find one.
I also think it is unconscionable that Stanford Hospital does not have an in-patient mental health ward in their remodeled presumably world-class children’s hospital. I guess the only “community benefits” that count are those that are profitable to Stanford.
Hi Marie – LPCH, El Camino and Kaiser responded to an initial “Request for Information” but not the later “Request for Proposal.” The RFP ultimately failed because it was too costly to develop this kind of facility. See two articles below:
https://www.paloaltoonline.com/news/2016/04/11/teen-psychiatric-facility-could-open-at-el-camino-hospital-in-mountain-view?utm_campaign=magnet&utm_source=article_page&utm_medium=related_articles
https://paloaltoonline.com/news/2017/02/08/county-approves-contract-for-teen-inpatient-unit-but-still-looking-for-more
Seriously, Stanford can’t afford an inpatient facility for teens? In 2013, the “non-profit” Stanford hospital was third most profitable hospital in the country with profits of $224.7 million. They can’t plead poverty.
Parents,
While I also support the great care that the Packard Children’s hospital provides, you have no idea of what is required of a true psychiatric facility. My son tried to commit suicide at age 12, I drove him to LPH where he was assessed and transferred to John Muir hospital in Pleasanton by ambulance. I was not allowed to ride with him and was told by John Muir admitting I should not show up till the next day (now 9 pm). Psych facilities are locked facilities. Shoe laces, hoodie strings, anything sharp is removed, no matter what the issue. No one can enter without permission and patients cannot leave–it is a very nice confined facility. For suicide risk kids, someone site =next to the bed all night long with a hand on the child’s leg or arm. This in not a “normal” hospital environment but is set up to protect the child from whatever the issue is. It is truly another world….but one that is sorely needed. I had to drive almost 2 hours each way to “visit” him during their visiting hours–strictly enforced. And he was there for 2 weeks. Local beds are sorely needed but they are very special beds and confinement buildings and cannot be “shared” with other medical issues–that is why it is so expensive.
As a follow up to my post: what I described may seem extreme, BUT if you have had a child who was at risk of suicide, you would be VERY grateful for what these locked facilities can provide, and the caring and compassionate workers who work tirelessly to keep your kids safe are invaluable. They provide the lifeline that your kids need–think of it as in intensive care unit for the mind.
Been there- My son spent ten days in Mills Adolescent Psychiatric Unit in San Mateo when he was 17 and in the midst of a major depressive episode. A typical Mills room is pictured at the top of the above article. Very bare in comparison to a room of a child who has undergone a transplant, for example. No expensive machinery, no expensive medications. Please remember that LPCH is not like a typical adult hospital either. They treat very complex cases. Even children who need to be in isolation.