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planning to tear down the hospital's existing emergency psychiatric services building, which Smith described as outdated, and build a unit with about 36 to 40 beds for adolescents.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.