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Why Losing 30 Psychiatric Beds In Oceanside Means A Crisis For San Diego County

Tri-City Medical Center in Oceanside, June 2018.
Nicholas McVicker
Tri-City Medical Center in Oceanside, June 2018.
Why Losing 30 Psychiatric Beds In Oceanside Means A Crisis For San Diego County
Why Losing 30 Psychiatric Beds in Oceanside Means A Crisis For San Diego County GUEST: Dr. Michael Plopper, chief medical officer, Sharp Behavioral Health Services

Tri-City hospital is moving forward with plans to shut down its inpatient psychiatric facilities and that's prompted concern from the San Diego County Board of Supervisors. San Diego Union Tribune reports that in response to the pending closure county supervisors have requested an assessment of local psychiatric services. The potential loss of Tri Cities 18 bed locked behavioral health unit and 12 bed crisis stabilization unit will put an additional strain on San Diego's mental health resources. Meanwhile several new hospitals being planned and built across San Diego are not including beds for psychiatric patients in the new facilities. The reason is that mental health resources are shrinking here and across the state are varied and complex. Joining me to explain is Dr. Michael Klopper chief medical officer of the sharp behavioral health services. Dr. Popper welcome to the program. Thanks for having me. The impending closure of those 30 psychiatric beds at Tri-City hospital in Oceanside seems to have caused considerable concern. Can you explain what people are worried about what could happen with those closures. Well there's a great deal of concern in the community and particularly in North County. For the citizens out there Tri-City has been providing inpatient psychiatric care for many years to that community and the communities become understandably quite reliant on that. The impact includes on other hospitals taking up the slack so to speak having more patients coming to their emergency rooms or our emergency rooms and also impact on the police as the police oftentimes are tasked with taking people from the community on 51 50s or 72 hour holds to hospitals. And so for those who would have been going to try city they'd those officers now need to drive considerable distances pretty much taking themselves off line while transporting mentally ill patients to other facilities further south. So it has an impact on the community in terms of reduction of services right in their neighborhoods and and service they've come to rely on them for many years as well as on the police and on other facilities. It's it's it's a major major issue. Can you tell us what kinds of patients are treated at the locked behavioral health unit and the crisis stabilization unit. Typically it would be people admitted in voluntarily. Initially they may stay voluntarily after that but typically they're admitted on a hold oftentimes from the community with the police and then stay you know several days two weeks in the inpatient unit while stabilizing and then return to the community or might need placement and some other type of facility after the hospitalization. And it's your belief that with these beds closing many of those patients might just wind up in jail. Well a there would be a certain portion you might but typically they would be transported by the police to other facilities. Now Tri-City is not alone in shutting down psychiatric services. It's a state wide problem. What are some of the reasons for that. Well the reasons that are articulated by Tri-City include the necessity to improve their physical plant and make it legit ligature free. This is right. These are regulations from Medicare and from a joint commission to make facilities as ligature free as possible to reduce the possibility of hanging. So in other words they actually have to change the physical structure of their environment in order to make it impossible for patients to hang themselves. That's the goal and we've been doing that. Mais Avesta and that Grossmont over a long period of time as we modernize our units it gives us an opportunity to ensure that their literature free while at the same time trying to create a healing environment. And so it is a costly endeavor but I think it's a worthy endeavor. I don't think that should be the sole reason why that service should close down in North County and I think the major reason really is reimbursement. Now several new hospitals are being built in the county and they are not planning to include psychiatric beds in their new facilities. Why is that. The ones who have done that include UCSD and Scripps Mercy I believe as they are looking to build new physical plants to meet seismic standards in the early twenty twenties and are saying that they're not sure they're going to include behavioral health services in those remodels. To me it's a great disservice to the community and to their health care systems and to the patients that go to their facilities that they wouldn't be providing those types of services. Both organizations have provided inpatient psychiatric care for over a half a century to this community. We need to find solutions to that and they need to remain participants in this process. You can't count on one or two hospitals or healthcare systems to carry the load for everybody else. How many beds should San Diego County have for these patients and what do we actually have available. We currently have just under 700 licensed beds. That doesn't mean all those beds are staffed throughout the county. We have 204 of those beds at our two facilities at Sharpe's. Were by far the largest contributor to services for the mentally ill in the community. If we had adequate after care after hospitalization resources including longer term inpatient and longer term treatment facilities for patients who may remain on conservatorship it might need a few months to stabilize before returning to the community. We have two such facilities in the community now that are full. We have a waiting list in our hospitals of about 60 patients in the community are waiting to get into those facilities that are staying in our psychiatric hospitals and therefore plugging up our efforts to be able to discharge and admit new patients so they are sort of no longer meeting the requirements for inpatient care but we have nowhere else to send them. So that impacts our emergency rooms very directly in terms of trying to get patients out of the emergency rooms and into our facilities because were full all the time but if we had adequate aftercare resources adequate board and care homes we don't have enough board and care homes and we've lost about a third of our board and care homes in the community in the last 10 years. And that's a major impact on our ability to be able to get people out of our hospitals out of or I am and living in the community safely but with adequate resources and services. And by the way this has affected our homelessness problem that a long period of time of having inadequate resources of this type in this community has contributed to the the about 40 percent of people who are homeless and mentally ill. I've been speaking with Dr. Michael plop our chief medical officer of sharp behavioral health services. Dr. Klopper thank you. Thank you Mary.

The state of California has been losing psychiatric beds in locked units at a steady rate over the last 25 years.

In 1995, there were 29.5 beds per 1,000 persons available in the state. By 2015, there were just 16.9, according to the California Department of Health Care Services. The goal is 50 beds.

San Diego County's numbers will get much worse if current trends continue. The planned closing next month of Oceanside's Tri-City Hospital's locked behavioral health unit and its crisis-stabilization unit represents 30 psychiatric beds disappearing. The move has triggered the Board of Supervisors to order a comprehensive study of the county's mental health system, according to San Diego Union-Tribune reporter Paul Sisson.


Related: Mental Health Advocates Concerned By Loss Of Inpatient Beds At Tri-City

Two Hillcrest hospitals, Scripps Mercy and UC San Diego Medical Center, will rebuild starting in 2020 calling into question the future of psychiatric beds there.

As reported by The Union-Tribune, the building plans for both projects will encroach on the land where the psychiatric units current sit.

In an email, a Scripps spokesperson said, "It is our goal to replace the existing behavioral health beds and we are currently exploring ways to do that."

There are several reasons for the losses at Tri-City.


–Underfunding. Medi-Cal has decreased funding, so most psychiatric units operate at a loss.

–Mandated building requirements. Both federal and state regulations mean expensive retro-fitting or new construction. Hospitals are being rebuilt without expensive locked psychiatric units.

–Personnel. There is a general lack of psychiatrists statewide.

Dr. Michael Plopper, chief medical officer of Sharp Behavioral Health Services, surveys the landscape of San Diego County's Mental health Services and assesses what is really needed on Midday Edition. He notes that dealing with mental illness is a community-wide problem. When some institutions stop offering these services, others must pick up the slack, including other hospitals, police and homeless service providers.

Corrected: April 22, 2024 at 9:00 AM PDT
Editor's note: this story has been updated to include a statement from Scripps clarifying the future of psychiatric beds in Hillcrest.
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