Orange County is set to get its first emergency medical centers dedicated
to treating people who suffer sudden psychiatric episodes, addressing
a void that critics say long has burdened local hospitals and left mentally
ill patients with inadequate treatment.
County supervisors voted Tuesday to accept a nearly $3.1 million competitive
state grant that will help pay for building renovations and program start-up
costs for the expanded care at two undetermined locations.
Supervisor Andrew Do credited newspaper articles stemming from
a 2014 Orange County Register investigation with revealing that the county’s lack of an outpatient emergency
mental health care center had resulted in psychiatric patients being sent
to hospital emergency rooms, where they sometimes were held for hours,
or days, without treatment. That also delayed medical treatment for other
patients at those ERs.
Hospital emergency rooms generally are ill-equipped and often lack the
proper expertise to treat patients suffering psychiatric episodes, said
Dr. Michael Brant-Zawadski, executive medical director of Hoag Neurosciences
Institute. Likewise, those same patients often don’t need to be
held at inpatient psychiatric facilities, which keep people for multiple days.
The county’s new “crisis stabilization program” will
provide a middle-ground treatment method that currently is missing.
“Patients could be evaluated, discharged and transferred to the proper
outpatient treatment program,” Brant-Zawadski said. “Other
counties, like Alameda, already have a robust psych emergency program,
where ambulance and cops take people who have mental issues to those places
instead of emergency rooms.
“This is a great step forward,” he said.
Once the centers open, all Orange County police and emergency medical personnel
will be told to take people suffering mental episodes or those under involuntary
psychiatric holds to the new centers. Patients will be able to stay at
the new facilities for just shy of 24 hours, at which point they’ll
need to be released or transferred to an inpatient facility.
Tom Loats, director of behavioral health at St. Joseph Hospital, said adding
a psychiatric emergency program should free up the county’s limited
psych beds, which are sometimes occupied by people who would benefit from
A 2015 grand jury report found that the county had 16 beds for every 100,000
residents – less than one-third the number the California Hospital
Association recommends to meet the needs of psychiatric patients.
“Crisis stabilization units take all comers, so there is no limit
on the number of patients they will triage,” Loats said. “I’ve
always said you don’t know whether we have too few beds until you’re
doing it right on the front end.”
Orange County has in recent years publicly discussed expanding its 10-bed,
inpatient psychiatric crisis stabilization unit in Santa Ana. But real
movement began in August 2015 when Supervisors Do and Lisa Bartlett formed
an ad-hoc committee to study the county’s $323 million mental health system.
In March, after meeting with hospital and law enforcement groups, the two
supervisors hosted a forum to seek public input on what’s wrong
with county mental health services. That same month, the county’s
Health Care Agency applied for the $3.1 million state mental health grant.
In April, Bartlett and Do directed county staff to seek partnerships with
local medical facilities to operate new emergency psychiatric centers.
And in July, the California Department of Health Care Services released
a statement clarifying that restricted revenue from the Mental Health
Services Act, which provides funding for county mental health programs,
could be spent on involuntary mental health services. The Health Care
Agency said that funding will be spent on the new facilities.
Brant-Zawadski said the medical community had been pressuring county officials
for years to seek state grants and other funding to improve local mental
“They are finally acting on the pressure,” he said.
Do said in a statement that he expects the changes will improve the quality
of medical care for everyone in Orange County by relieving pressure on
hospital emergency rooms.
The county doesn’t yet know where the centers will be located or
when they will open. But a Health Care Agency representative said the
grant requires that the contracts and plans for the facilities be in place
by the end of 2017.
Bartlett has proposed positioning one in north Orange County and one in
the south. And Do has said the new facilities would need to be near, or
linked to, existing medical facilities so that they can admit people with
mental health issues who also have physical injuries.
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