Board gets assessment on caring for people in psychiatric crisis

At an hourslong conference on caring for people in psychiatric crisis, the San Diego County Board of Supervisors got an assessment of the current behavioral health system and actions underway to address current and potential future gaps in emergency and inpatient psychiatric resources in the region.

Behavioral health experts, elected and law enforcement officials and other stakeholders gave presentations and spoke to the board which, at the request of Chairwoman Kristin Gaspar, scheduled the conference after the recent closure of inpatient psychiatric hospital beds in North County and across the state.

The board’s concern is that without reliable sources for inpatient psychiatric care, patients end up in emergency rooms, jails or become homeless.

Conference participants stressed the need to focus their efforts on collaboration and supporting a robust system of care for those experiencing a behavioral health crisis. During the conference, some San Diegans shared their stories of mental illness and substance abuse and talked about the services that are helping them in their recovery.

Conference members learned that 9 percent of adults in San Diego County report a serious psychiatric distress on any given year. More than 4 percent of adults in the region are estimated to have a serious mental illness. Nine percent of adults in San Diego County are estimated to suffer from substance abuse disorder.

More than 16 percent of young people between the ages of 15 and 24 report serious psychological distress during the past year. Seven percent are estimated to have a serious emotional disturbance. And about 8 percent are believed to need help with alcohol and drug abuse.

There were 458 deaths by suicide in San Diego last year, and 641 people died from meth and opioid overdoses in 2017.

More than 80,000 San Diegans received treatment services during fiscal year 2017-2018. However, all 3.3 million San Diego County are reached through media campaigns, trainings and other outreach. The county budgeted $658 million for behavioral health services this fiscal year, which is a $200 million increase since the expansion of the Affordable Care Act four years ago.

The San Diego County Psychiatric Hospital served 600 patients monthly, and 60 percent are brought in by police, usually in response to a behavioral health emergency, and another 15 percent are brought in by the police or sheriff’s department, as arrestees on their way to jail or returning from jail. The rest present as “walk-ins.” The county funded 70 Psychiatric Emergency Response Teams this year. Approximately 50 percent of their contacts result in diversion from hospitalization or jail.

The county has 257 units of high-quality dedicated supportive housing currently fully leased up, with an additional 80 units under development and leasing, for 337 units. The homes are funded through the Mental Health Services Act. County partnerships with local mental health providers have established 1,322 additional supportive housing units for clients with serious mental illness or co-occurring disorders.

“As a society, we must take a meaningful look into how we support and restore those among us who have been deeply affected by trauma in their lives, especially our children,” Gaspar said. “It is critical that we begin to shift our focus toward prevention and integrating mental health and physical health at a very young age.”

The speakers indicated that some of the actions that have taken place provide immediate solutions to existing gaps but stressed that a comprehensive, long-term solution is needed.

The Exodus Recovery walk-in assessment center will be expanding services and to operate a 24/7 crisis stabilization center. It will include the ability for law enforcement to drop off individuals in psychiatric crisis. This service is expected to be available in early 2019.

The number of staffed beds at the county Psychiatric Hospital will increase from 45 to 82; it’s full capacity.

The county will continue working with Palomar Hospital to understand the impacts to their system and to help ensure they are equipped to handle increased volume.

Approximately 150 additional long-term care and step-down beds are being added to the county Behavioral Health system over the next year, which is expected to significantly reduce the number of patients in hospitals who no longer need psychiatric crisis care.

The speakers stressed the need to continue ongoing collaborations and convene partners across all sectors to look at what is working, assess the needs of the region and consider increasing resources to address the need for behavioral health services and establish a system of care that is fully integrated.