Calling it a much-needed resource for youth in crisis, the Santa Clara County Board of Supervisors on Tuesday gave a full-throated endorsement of plans to build a new psychiatric facility aimed at serving children and teens.
And while the proposed inpatient hospital is conceptual and nowhere near ready for final approval, supervisors affirmed at the Oct. 16 meeting that the high price tag -- estimated at $222 million -- was the right kind of investment to make for mental health care services that are hard to find in the Bay Area.
"I doubt there's any other city, county or state that has done so much for those in need as this county has," said Supervisor Mike Wasserman, listing about $1 billion in recently approved expenditures. "And I for one am very proud of being part of this board of supervisors."
At the heart of the discussion was a feasibility study exploring where an inpatient psychiatric unit could be housed at Santa Clara Valley Medical Center, which suggests that a 66-bed inpatient hospital facility could be built on the southern end of the campus in place of the Don Lowe Pavilion.
Of those beds, a total of 30 would be available to children and adolescents from ages 6 to 17 -- a resource that mental health experts and advocates say is virtually nonexistent in the state. Families with children experiencing a mental health crisis often find themselves traveling to Sacramento and beyond to find care.
Parent Terry Downing, a member of the group Rebuilding Together Silicon Valley, told the Voice that her daughter was misdiagnosed with bipolar disorder as a child in 2011 and suffered permanent damage as a result. She recalls having to travel all the way to Bakersfield for her daughter's inpatient care. The hospital stay lasted several days, she said, requiring her to travel to Bakersfield and back each day to support her child.
Since then, Downing -- along with a group of mothers who faced similar challenges -- have been pressing supervisors and county leadership to either build or finance the construction of an inpatient unit serving children and youth.
"For as long as I live, I'm going to fight to get some kind of medical site facility opened for children," she said. "It's something that's so needed, and there's very few of these in the nation."
The study envisions a holistic approach for the new psychiatric facilities, linking inpatient units for children, adolescents and adults with nearby emergency psychiatric services and mental health urgent care. Along with beds for young children and teens, the proposal makes a small but invaluable carve-out for children suffering from co-occurring mental and physical illnesses. No other child psychiatric hospital in the Bay Area has a unit like it, according to a county staff report.
Jo Coffaro, a regional vice president of the Hospital Council, gave glowing praise to the county for both its proposal and its support for mental health services, saying that it stands out among the 50 California counties she works with.
"Santa Clara County is a leader in many things," Coffaro said. "Thank you for being a leader on behavioral health issues, especially around youth."
The behavioral health facility would provide services to all patients, including those covered by Medi-Cal, Medicare and commercial insurance, and the uninsured. It's expected to receive referrals from major hospitals including Kaiser, Stanford and El Camino due to the "lack of available community resources and high need for these services," according to the staff report.
Data for 2016-17 shows that more than 600 Santa Clara County youth were assessed for inpatient hospitalization and later admitted into psychiatric hospitals outside the county for acute care. The average length of stay for inpatient psychiatric care is between five and seven days, and being located out of the area can put a strain on both patients and families.
Although the focus is on child and adolescent psychiatric care, the $222 million in estimated costs would also be paying for a replacement of Valley Medical Center's adult psychiatric unit, which is old and needs to be replaced. County Executive Jeffrey Smith described the current building as out of date, debilitated and designed at a time when long corridors and "warehousing" of patients was the standard of care.
"It makes the facility not only difficult to use for modern types of services, but also somewhat dangerous and difficult to access for nursing and staff," he said.
It wasn't clear from the outset that an adult inpatient unit would be included in the project, but Supervisor Joe Simitian said internal conversations among county staff concluded that it made sense to move forward on a "21st century" approach to adult psychiatric care with the same project.
"Once the administration sort of dug in on the mental health needs of kids and teens, they came to the conclusion that we shouldn't miss the opportunity to move forward with facilities for adults as well," Simitian said. "That's in significant part because of the aging facilities that have a relatively short lifespan ahead of them."
Several Palo Alto residents, including Palo Alto Unified school board member Melissa Baten Caswell, Palo Alto PTA Council member Nancy Krop and school board candidate Stacey Ashlund all voiced support for the proposal. Caswell said the hospital should prevent youth from being pushed out to Sacramento, Sonoma and the East Bay for care, far from where their families live, and encouraged supervisors to support a broad range of services to prevent readmission after kids are discharged.
"The continuity of care after a mental health stay is possibly the most important thing to make sure the patient doesn't come back," she said.
Supervisor Cindy Chavez said she would prefer to find some way to directly connect the new inpatient building to the hospital's emergency department. She pointed out that Valley Medical Center serves a significant number of people who end up in the emergency room for attempted suicide or overdoses, and that it would be important to link physical and mental health services. Smith said the county could have more latitude to place the psychiatric facility in a location closer to the emergency department if it successfully purchases O'Connor Hospital in San Jose -- county officials recently made an offer to buy O'Connor and St. Louise Regional Hospital in Gilroy for $235 million.
"We have more options if we purchase O'Connor, but either way, this kind of facility can be fit onto the VMC campus relatively easily," he said.
Supervisor Dave Cortese supported moving forward with the psychiatric facility, but added that the board of supervisors needs to strive for a culture shift in the way the county treats mental health, reversing a long-standing trend of treating mental illness on a "criminal platform" rather than one based on health care. Locked and secure inpatient facilities like the one being proposed have an important place, he said, but he urged the board to do some soul-searching on how to help patients before it reaches that point.
"I do believe ... if there was ever a county that could figure out how to completely shift, completely pivot, this system as far as it can possibly go to a health care platform and get it off the criminal platform as much as possible, that would be us," Cortese said.
The meeting took an emotional turn after one speaker, reading comments on behalf of Santa Clara County parent Kathleen King, relayed how King's daughter had recently died by suicide after suffering from depression. The symptoms, including sleep deprivation, were so severe that at one point she was taking five kinds of medication. She said it's possible that a stronger network of mental health services, including the psychiatric center envisioned by the board of supervisors, could have made a difference.
Responding to King's story, Chavez said the county needs to heed the challenge that Cortese put forward -- going beyond just getting the new facility built -- so that families don't have to face going to those funerals.
The next steps, following the meeting, would be to solidify the plans for where to place the psychiatric facilities and in what configuration, and get down to "brass tacks" on staffing, operational costs and how to serve patients on all types of medical coverage, Smith said.
The proposed medical facility is the latest in an ongoing effort to create a local inpatient psychiatric unit serving children and adolescents, following back-to-back Requests For Proposals (RFPs) in 2011 and 2016 that failed to get results. County officials concluded that outside organizations weren't best suited to lead the effort, precipitating the latest feasibility study with Santa Clara County as the lead agency.
Despite the slow process and the false starts, Downing said she's positive that this latest proposal is going to be different, and that she's very confident it will happen this time. She said it's frustrating to see the feasibility study's sluggish timeline -- which shows the psychiatric facility could take five or six years to complete -- but said it will be worth the wait.
"Children are very, very underserved in the psychiatric community, and that needs to change," she said. "If we want to keep our homeless off the streets and not have jails filled with psychotic individuals, we need to treat these children. Period. "