County Supervisors Weigh In On Solutions To 'Public Health Emergency'
KPBS Midday Edition Segments / June 26, 2019
San Diego County Supervisors took a number of steps to address what they called "a public health emergency," with a new plan to strengthen mental and behavioral health services region-wide.
Speaker 1: 00:00 You're listening to KPBS midday edition. I'm jade Hindman. I'm Maureen Cavanagh, San Diego County supervisors are taking steps to increase the number of badly needed psychiatric treatment beds in San Diego. The supervisors voted to expand the counties contract with Palomar Hospital and begin the process of establishing 24 seven crisis intervention centers across the county. Joining me to talk about this new county initiative is Luke Bergman, director of county behavioral health services and Luke, welcome to the program. Thanks so much for having me. What do the board of supervisors approve yesterday when it comes to these regional 24 seven crisis intervention centers that they want to see across the county?
Speaker 2: 00:42 The supervisors approved the expansion of crisis stabilization unit services at Palomar health from six crisis stabilization unit chairs to 12. So we're doubling the size of uh, of Palomar health crisis stabilization unit capacity. And then the supervisors also approved moving forward with planning for the establishment of two 12 chair, community based crisis stabilization units. Also to be situated in North County to address uh, urgent needs that we see there
Speaker 1: 01:18 ever since Tri city hospital closed. It's psychiatric crisis treatment center. The North county has needed an alternative. Will this expansion of the contract with Palomar hospital help that situation in any way?
Speaker 2: 01:31 We feel strongly that it will help the situation that won't entirely solve the situation. There will be additional challenges into the future, we know, but we think that the decisions that were made yesterday to support the expansion in particular of crisis stabilization unit chairs at Palomar health, uh, Escondido campuses will, will help immediate needs that we're feeling right now in the northern region of our county.
Speaker 1: 01:56 The county voted to begin the process of creating a series of crisis intervention centers starting in the North county because that's where the need now his greatest, what types of services would these 24 seven crisis centers provide? So they provide, okay.
Speaker 2: 02:12 Combination of a psychopharm pharmacological services, so medication, um, for, for a mental illness and for substance use disorders and behavioral therapeutic interventions. Um, things like motivational interviewing, cognitive behavioral therapy, those kinds of things that we know work well, uh, to help people stabilize in the midst of a, of a mental illness, uh, behavioral health related crisis.
Speaker 1: 02:39 So let me ask you, with these centers only be for people brought in for observation by police or a psychiatric emergency response. Teams
Speaker 2: 02:48 lease, we'll have opportunities to drop people off at these crisis stabilization centers and we, and we think that that's a really important function that they'll, that they'll serve. But it's also really important that there'll be accessible to community members not engaged by law enforcement. So, so people can walk in if they know that they're in need of help. People can be transported by family members or members of their, their social networks who have identified a need for help and they'll be very accessible, um, to those folks as well.
Speaker 3: 03:18 What's the timeline to establish these centers? Because the supervisors called the lack of treatment beds a public health emergency.
Speaker 2: 03:26 So the timeline is one that we are addressing with urgency. Um, and that's why we will be undertaking the expansion of services at Palomar health, uh, in immediately that work is already underway and, and we should see it happening within the next few months. We should see some significant movement there. The timeline with respect to the establishment of community based crisis stabilization services. And these again are our services that would not be within a hospital, may be proximate to a hospital, but would be distinct from them. Um, is is also one that we're approaching with urgency, but is, is less certain, um, because we have to address citing issues, um, which is challenging community, uh, communities, uh, in some cases see these services, uh, as burdens instead of assets. I would argue that it's really important that we make more clear. We in the behavioral health community make more clear that you know, that where homelessness is of course a burden to communities where mental illness and substance use, uh, you know, prevalence or of course burdens to communities. These services which really effectively address these issues are assets for communities. And so as we are able to cite these services, we will move them forward as quickly as, as possible.
Speaker 3: 04:48 I've been speaking with Luke Bergman, director of county behavioral health services. Look, thank you. Thank you so much. Joining me now is KPBS reporter Alison Saint John Allison, welcome. Glad to be with you Maureen. San Diego County's lack of psychiatric emergency treatment was brought to a crisis. When Tri City hospital announced last year it would be closing it's crisis stabilization unit. Why did it say it was doing that? Well, it gave three reasons and one of them was new state laws. We're requiring them to upgrade their psychiatric facilities that would have cost millions of dollars. And I think it's important to mention here that tries city has tried for years to get a bond measure through the community to upgrade their facilities in general and it has failed, which is partly why we see Palomar with an enormous new hospital and tri city kind of struggling with it's older facilities is tri city does, didn't never get that bond measure passed in the community. Then the second reason was poor reimbursement and the third was a shortage of staff or shortage of uh, psychiatrically trained staff. Now, yesterday, the board of supervisors debated whether or not to give tri city money to build a crisis stabilization on their
Speaker 1: 05:58 campus. Can you tell us about that debate?
Speaker 3: 06:01 Yes. Well Supervisor Jim Desmond, who represents that area has, uh, talked with Tri city leaders and was trying to negotiate a situation where the county would invest $14 million to build a new crisis stabilization unit, like the ones that Lube Bergman was referring to on their campus. Um, the supervisors were not that happy with that. They cited. So for example, um, UCFD and Palomar have also faced problems keeping their psychiatric services going bought, have managed to die. And Jacob's specifically said that Tri city has fallen down on their responsibilities and, uh, that they shouldn't be rewarded by getting $14 million from the county to build new facilities on their site. So eventually the supervisors did agree to negotiate not only with tri city, but with any other hospital that would be interested in entering a partnership with them to build new psychiatric facilities on their campuses.
Speaker 1: 06:59 There did seem to be, as you mentioned from superhead supervisor Jacob, uh, sort of hostility towards tri-city and the decision that they made is tri city to blame for that by poor management. Is that, is that part of the problem?
Speaker 3: 07:15 Well this is a question. Tri City has experienced a lot of management upheavals in the last year. It is a district hospital with publicly elected board, uh, similar to Palomar but it has had some problems with its board members and the board has disagreed violently. One board member was actually forbidden to come to the meetings. They have had a high turnover of CEOs as a result. So I would say that there is an element of truth to the fact that the supervisors are questioning the stability of management at Tri city
Speaker 1: 07:50 supervisor Nathan Fletcher and assembly member Tasha Burner Horvath threatened Tri city with an audit if they don't come up with a plan to reopen the crisis center. Now has there been any movement on that score? Well, tries
Speaker 3: 08:04 city responded very strongly to that. Leanne grass, their board chair responded and said this was a, you know, uh, misuse of political power to be sending letters like that to them. That they are very committed to providing services for their local community. That they are looking for ways where they can continue to provide services. They are still providing outpatient services. And when she spoke, uh, at the board of supervisors meeting, she kind of implied that the county should be taking more responsibility in this region for mental health services and that they are also to blame for not providing enough resources. Something which I think a lot of people would agree with. And is one reason why the county has now decided to spend millions more dollars this year in its budget on behavioral health issues.
Speaker 1: 08:53 Do you think any other hospitals will be interested in negotiating
Speaker 3: 08:56 with the county to build a crisis stabilization unit? Well, Maureen, I think that's a pretty interesting question because there are some hospitals in north county that have kept very quiet in this debate, for example, in Encinitas. And uh, the question is, would they be interested in hosting such a unit? As Luke Bergman mentioned, there might be some problems getting the community to step up and say, yes, they would host these units. So it may turn out that Tri city is the only hospital that would be interested in partnering with the county on such a unit. And it's very important for the counties vision to create these new units. But I think they want to make sure that tri city is willing to help pay for the, or pay for the operations of it once it's built. In fact, I believe one of the supervisors said during this debate that you think that it's hard placing housing, new housing in San Diego County try placing a crisis stabilization unit. Exactly. And, and uh, we heard Kristen gas bar during the board meeting, putting out a call really to local elected leaders to be more open to accepting such facilities in their communities because they're complaining that they're having to send their police officers down to the county health hospital and Rosecrans. But if they don't accept units like the county is proposing to build, this will remain a stalemate. I've been speaking with KPBS reporter, Alison Saint John Allison. Thank you. Thank you. Maureen.