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Planning Underway for Mental Health Service Transition in 2013
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Planning Underway for Mental Health Service Transition in 2013
County to Build New Facility as Dominican Closes Behavioral Health Unit
By Linda Fridy
Three decades after Santa Cruz County turned over acute psychiatric services to Dominican Hospital, it will once again be responsible for cases of immediate need in roughly four years, based on a transition plan the two organizations have been developing.
County Health Services and Dominican began discussing a new approach two years ago, when Dominican told the county it did not wish to renew its contract expiring June 2010. The hospital has agreed to operate its behavioral health unit through 2013 to give the county time to design and build a new psychiatric health facility.
The new center will serve individuals who fall under section 5150, which allows law enforcement to contain involuntarily psychiatric patients who pose an immediate danger to themselves or others.
"It's a good time for this transition," said Martina O'Sullivan of Dominican Hospital.
As the unit's former director and the hospital's current director of community engagement, she has watched trends in mental health treatment shift. When Dominican opened its behavioral health unit in 1983, it had 28 beds. Over time, as treatment options have allowed patients to move to outpatient services more quickly, the number of beds has dropped to 16.
The new acute psychiatric facility would also have 16 beds, which corresponds with the maximum allowed by Medi-Cal reimbursement for the county.
Finances play a significant role in both the decision to shift responsibility and the design.
Not a Profitable Unit
Dominican Hospital has been losing money on the behavioral health unit for years. It lost $3.2 million in 2006, according to a report to the county, and expenses increased 20 percent between 2006 and 2008.
Dominican's wage structure is driven by the larger Catholic Hospital West union negotiations, and reimbursements have lagged behind expenses.
Dominican was an early sponsor of CHW, which operates religious-sponsored hospitals in the western United States and is one of the larger non-profit operators in the nation.
In addition to staffing costs, California-based hospitals also face more stringent seismic and staffing requirements.
"There's a large amount of new requirements. Lots of large new costs and no reimbursement are a recipe for disaster," said Rama Khalsa, the county's director of health.
The county's new facility will be licensed as a mental health unit, rather than the stricter medical health requirements for a building that is part of a hospital, she explained.
The county does not plan to operate the new center itself. Khalsa said two experienced providers are interested in the project, and possibly a third contractor may also bid.
A New Location
The new facility will not be located on Dominican's campus, but the county does want it in close proximity to allow for ease of transport between the two facilities. Often, a person diagnosed with severe mental problems may have physical complaints and require acute care hospitalization. Dominican is the county's primary provider to care for medically indigent patients.
The agencies have been looking at sites and narrowed the search from 33 down to three. The building will be about 15,000 square feet.
Total costs for the land, design and construction are estimated at $8 million. Dominican has offered to pay the county $1 million annually for the first five years after the transition to help with the costs.
The new facility will be able to serve most of the patients that Dominican now handles, with the exception of those requiring extensive medical care in addition to psychiatric services, Khalsa explained.
Those most often sent to an acute psychiatric facility are severely depressed or suicidal individuals, who receive counseling and management of medications. Patients suffering long-term or severe mental illness who experience a crisis will also get treatment including managing or changing medication.
Another category of acute care patient is a young adult, often in his or her 20s, who has a first-time intense psychiatric event, such as severe depression or thoughts of suicide, hallucinations or other difficulties identifying reality.
Outpatient Services to Also Be Offered
Some services will be available offsite or on an outpatient basis.
The facility will not treat minors, she said, nor will it provide a setting for those needing time to sober up from alcohol or drugs.
When Dominican opened its unit, it was on the forefront of mental health treatment, O'Sullivan recalled.
It was the first hospital-operated acute facility in California.
Now trends have shifted away from hospital operations and many California counties are undertaking similar plans to build and contract a separate facility, said Khalsa.
The space will still have locked rooms to keep patients from doing harm to themselves or others, but it will offer a broad set of clinical interventions, Khalsa said.
"The old visions of what a psychiatric ward are come mostly from movies and aren't what (these places) really are. …These are stereotypes you see from movies or exploitive television, not what good acute therapy is like. It labels our patients and their families in inappropriate ways," she said.
The community will have a voice in the new facility.
Khalsa welcomes the input of anyone who has interacted with mental health services.
"What's the best treatment we can design?" she asked.
O'Sullivan expressed confidence that the hospital and the county will continue to work well together to make the transition a success.
"We're giving ourselves time," she said. "We've got four years to continue to work on the planning."
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