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County copes with severe shortage of psychiatric beds

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Napa County suffers from a lack of beds for people in psychiatric crisis, leading some of its most vulnerable citizens with long waits and fewer mental health care options.

“We don’t have enough beds for our population; that’s the bottom line,” said Jill Kinney, a spokeswoman for St. Helena Hospital.

For someone with mental health problems, “there are holes in our national, state and local safety nets that folks can fall into,” said Bill Carter, Napa County mental health director.

“It’s a health crisis,” said Vanessa deGier spokeswoman for the St. Joseph Health system, which operates Queen of the Valley Medical Center. “It’s a huge concern for Napa County and throughout the state.”

In one recent example, an elderly female patient, reportedly suffering from dementia and psychosis, remained in the emergency room of Queen of the Valley for six days in late October because an appropriate psychiatric facility couldn’t be immediately found to accept her.

She was brought to the hospital because she was deemed a danger to herself or others, under what is known as a 5150 hold. When someone goes to the ER on a 5150 hold, the county works to place them in a designated psychiatric facility.

Such holds are meant to last 72 hours. A six-day stay is unusual, said Carter. In this case, once the patient arrived at the Queen, there was nowhere for her to go.

“This is a monthly occurrence,” and an increasingly common problem, said Carter.

For example, last Monday “at one point we had three people in different (psychiatric) emergency settings for whom we could not find a discharge placement for some period of time,” said Carter.

As of 2012, California had lost more than 30 percent of the psychiatric inpatient beds it had in 1995, a drop of more than 2,800 beds, according to the California Hospital Association.

California offers one psychiatric care bed for about every 5,800 people. Experts recommend a ratio of 1 bed for every 2,000 people, according to a 2012 California Hospital Association report.

“That shortage gets exacerbated when someone presents with a complicated profile,” for example if they are elderly, or have a health condition or are unusually aggressive, Carter said. “When you add those to a psychiatric profile it becomes very difficult to find facilities that will admit those patients.”

Citing patient confidentiality, representatives from the Queen said they could not comment on the recent patient who had to remain for six days in the ER.

A contributing reason for an extended stay in the emergency room can be that some patients take more time to evaluate, Carter said. Some might be admitted with a perceived psychiatric problem but then other medical problems are identified. “It can be complicated,” he said.

Napa State Hospital and St. Helena Hospital are the two facilities in the county with psychiatric inpatient beds, said Carter. The county also has access to two beds at Crestwood Behavioral Health in Vallejo.

Napa State has many different programs for forensic patients who have committed crimes and others who may have longer term needs, but the unit that is available for short-term acute psychiatric treatment (5150 holds) has 15 beds, said Carter.

St. Helena hospital has two mental health campuses, said Kinney. The Center for Behavioral Health in Vallejo has 61 inpatient beds. In St. Helena, the hospital system offers 21 psychiatric care inpatient beds.

“We are one of few these days” to offer psychiatric inpatient care, said Kinney. It’s expensive to provide such care and the government is cutting the amount of money they reimburse facilities for such care.

Carter explained that when the country and state began to shift from public institutional care to private care, the number of mental health care options began to decline. There’s also a significant shortage of psychiatrists in the nation along with other mental health care providers.

To help alleviate the problem, St. Helena Hospital plans to open a senior psychiatric mental health unit Upvalley in December, offering 13 beds.

The Vallejo campus takes all forms of insurance except adult MediCal. The St. Helena campus take all insurances, including adult MediCal, said Kinney. At those facilities, “we run about 90 percent occupancy,” which for a hospital is considered full, he said.

In addition, the county plans to open a crisis stabilization unit that could accept psychiatric patients from the emergency department, where they could stay for just short of 24 hours, said Carter. It will most likely open in the next 10 to 12 months and be located at the Health and Human Services campus in south Napa or share space with the Queen.

“It would not solve the problem,” said Carter, but “it would give (patients) someplace else go other than the ER once medially stable,” he said. “Opening that would add a higher level of emergency psychiatric care that Napa County does not currently have.”

“If there were adequate behavioral health services available locally, a patient without a medical condition would not come to the ER in the first place,” deGier said, “but rather go directly to a facility that has the resources and expertise to care for him/her.”

“As a society, we have not made mental health and mental illness a priority,” said Carter. “There is a lot of stigma associated with it. We need to invest more in services than we have in the past.”

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Business Editor

Jennifer Huffman is the business editor and a general assignment reporter for the Napa Valley Register. I cover a wide variety of topics for the newspaper. I've been with the Register since 2005.

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