Santa Barbara County Psychiatric Acute Care Bed Shortage Leads to Long Waits, ER Holds | Mental health care in crisis

[Noozhawk’s note: This article — part of a Noozhawk special project in partnership with the USC Annenberg Center for Health Journalism — is the first in a series investigating the shortage of acute care psychiatric beds for people experiencing a mental health crisis in Santa Barbara County. Noozhawk recognizes that mental illness and the challenges of navigating the mental health system are vulnerable experiences to share. Pseudonyms are being used for two of the local residents in this story, at their request.]

Jim was diagnosed with paranoid schizophrenia when he was 15 years old.

Over the past two decades, the Orcutt resident has bounced around Santa Barbara County Department of Behavioral Wellness clinics, emergency departments and psychiatric hospitals as far away as Pasadena to receive the care he needed. need to manage his diagnosis.

Jim experienced another psychotic breakdown in the winter of 2021 and was unable to get in touch with his practitioner at a behavioral wellness clinic in Santa Maria.

“My son just started decompensating,” said Alice, Jim’s mother who lives in Goleta.

“It became very painful and his condition worsened. Eventually they had to put him on hold 5150 and he was held in an emergency room for probably about 10 days,” she told Noozhawk.

Jim’s stay in the ER was so long because Santa Barbara County had no acute care inpatient bed to release him to.

His situation is not unique.

Santa Barbara County has only 16 acute psychiatric inpatient beds for patients at its psychiatric health facility at 315 Camino del Remedio in Santa Barbara. The facility is operating at near-maximum capacity every day, according to John Winckler, division chief of clinical operations in the Department of Behavioral Wellness.

Any facility with more than 16 beds is categorized differently and excluded from Medi-Cal reimbursement, making care at these large facilities cost twice as much without this federal match, according to the California Department of Health Care Services.

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A California Department of Health Care Services report assessed each county’s psychiatric inpatient treatment beds and determined whether they had enough for their population (denoted in green), did not have enough for their population ( designated in yellow) or had no beds (in red). Santa Barbara County ranked sixth out of the state’s 58 counties. (California Department of Health Services illustration)

The lack of mental health short-term inpatient beds available in Santa Barbara County not only strains hospital emergency departments due to the extreme lengths that patients must be held before being discharged safe, but it also prevents these patients from receiving the critical acute care they need.

A 2021 assessment of behavioral health services in California ranked Santa Barbara County sixth among 58 counties with the largest gap between the number of psychiatric inpatient beds that exist and the number of beds that are needed.

The report found that the county has less than 40% of the beds needed to care for its population: 16 beds available and 43 beds needed.

“More than half of the counties (38) reported needing additional acute hospital services (e.g. acute care psychiatric hospitals or acute care psychiatric units) for adults,” according to the Department of Care Services report. health.

“Seventy percent (42 respondents) identified an urgent need for this service for children and young people.

A person is placed on 5150 hold if they meet at least one of the following criteria: the person is a danger to themselves, the person is a danger to others, or the person is severely disabled by their mental illness.

When a person is placed on 5150 standby at county hospitals, they remain in a standby phase until the 5150 is canceled after 72 hours or the person is transferred to an inpatient psychiatric treatment bed . There are also 5,585 detentions, which are similar involuntary psychiatric detentions for minors.

Nearly 10% of detentions written out at Santa Barbara Cottage Hospital between January and November 2021 expired because placement in a locked-down mental health facility was unavailable, according to data obtained by Noozhawk. The hospital reported 952 involuntary patients during this period, with the monthly number between 69 and 119 people.

The average length of stay for patients in the Cottage Hospital Emergency Department Detention Unit in 2021 was 24 hours, a 33% increase from 2019.

“If a patient waits 22-23 hours for a bed and we don’t have any other diagnoses for that patient, they wait that long due to the lack of (acute inpatient) beds in the county” , Darcy Keep, administrative director of psychiatry and addiction medicine at Cottage, told Noozhawk.

Santa Barbara County is the only county in California where law enforcement officers cannot put someone on hold 5150 – someone from the Department of Behavioral Wellness Mobile Crisis Team must come assess the person to place the hold.

It is not unusual to wait several hours for a mobile crisis team to arrive to make the assessment, further lengthening the time that acute mental health patients are stuck in emergency departments waiting. secure placement, according to emergency physician Dr. David Ketelaar. physician at Marian Regional Medical Center in Santa Maria.

“Once you determine they need to be put on hold and you physically assess them, when the beds aren’t available, you hold them until proper care is available,” Ketelaar told Noozhawk. .

“It makes you lose the ability to accept a new person in the emergency room.”

The average ER visit for someone presenting with pneumonia, a broken arm, or other physical condition is about two to four hours at Marian Regional Medical Center, but the average length of stay for someone waiting 5,150 is 37 hours, according to Ketelaar.

About 30% of patients waiting at Marian in November 2021 had their wait canceled and sent home, he said.

The average length of stay for these patients was 42 hours, but stays ranged from 14 to 124 hours.

The person who was detained the longest had to stay in the emergency room for more than five days.

The average length of stay for patients undergoing mental health assessments at Marian in 2017 was 27 hours, and that number has steadily increased over the past four years, reaching 31 hours in 2021, according to data obtained by Noozhawk.

“It tells me the problem is getting worse no matter what everyone is doing,” Ketelaar said. “The system is collapsing around us.”

Of Marian’s patients who were successfully sent to Santa Barbara County Psychiatric Health Center in November, it took an average of nearly three days to get them there, according to data obtained by Noozhawk.

“I will be happy when that number drops to 10-12 o’clock,” Ketelaar said.

What’s next in the series

This report is the first in Noozhawk’s series analyzing Santa Barbara County acute care beds for patients in mental health crisis.

The next article will be published on April 26 and will explore where local residents are sent for care when the county has no available space at its psychiatric health facility in Santa Barbara – and how much it costs to send patients to establishments outside the county the county .

This series is produced as part of a project for the 2021 USC Annenberg Center for Health Journalism Data Fellowship.

– Noozhawk contributing writer Jade Martinez-Pogue can be reached at .(JavaScript must be enabled to view this email address). Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.

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