Hospital leaders, politicians and community members celebrated the completion of El Camino Hospital's state-of-the-art mental health facility last week, marking a major investment in psychiatric care in a state that's starved for inpatient beds and high-quality services.
The two-story, 56,000-square-foot facility on the southern end of the hospital's Mountain View campus is a far cry from the cold, institutional psychiatric hospitals of decades past, with huge windows on all sides and three courtyards for patients to enjoy the outdoors while staying in the hospital -- day or night.
Psychiatric services are typically perceived as unprofitable and usually take the back seat to other services, but that's not what El Camino has done, said Michael Fitzgerald, the hospital's behavioral health services director. High-cost features like wide, welcoming hallways, expansive meeting spaces and private rooms for each inpatient are incorporated into the design to make the building feel welcoming. The accommodations, while optional, took priority over cramming in as many beds as possible.
"If it was all about psych beds it wouldn't have been built. It's about the quality and specialization for the community," Fitzgerald said. "Our community deserves this. Every community deserves this."
The plan is to break up the 36 beds in the unit by need, with a special area of between six to nine beds set aside for patients suffering from perinatal mood conditions and post-partum depression, complete with staff specially trained to support new mothers. El Camino will be one of only two hospitals in the country to provide such a service, making it a landmark on the West Coast that will likely see high demand, Fitzgerald said.
About a dozen of the beds will be clustered together for patients suffering from behavioral health illnesses that are "expressive," meaning they are visibly ill and struggling with a disorder. The remaining beds will be for patients with mood disorders like depression and anxiety who don't have expressive issues but are "really suffering internally," Fitzgerald said, many of them feeling so beaten down that they need inpatient care in a welcoming environment.
It may seem like an obvious adjustment to break up the new facility that way, but it's pretty uncommon.
"Every other place in this county has one unit, one department," Fitzgerald said.
The architect for the building describes how safety and security of patients and staff influenced every design decision, limiting blind corners and any fixtures that patients may use to harm themselves or others. Windows are designed to prevent shattering and the doors to patient rooms can be removed in less than a minute. Other safety mechanisms are hidden and not being publicized.
Security measures notwithstanding, Fitzgerald said the building incorporates many of the design elements he's been advocating for since the 1960s -- an open unit with outdoor space and a "community" feel with couches and visiting families instead of isolation. The facility is dubbed the "Taube Pavilion" after Tad and Dianne Taube donated $5 million for the naming rights, placing it among the hospital's largest donations to date.
Despite the fanfare and tours of the new facility over the weekend, it won't be ready to admit patients until early next year. Staff training and licensing by state regulators is expected to continue through mid-December, and it will be another two to three weeks after that before patients are admitted, according to an Oct. 10 staff report. With the extra space, El Camino is hoping to serve 1,400 patients next year, according to hospital officials.
California doesn't have nearly enough inpatient psychiatric beds to meet the demand, according to a report by the California Hospital Association. Tally up all the inpatient care units and free-standing psychiatric hospitals, and California has roughly one bed for every 5,834 people -- about one-third of what is recommended by researchers.
The problem has largely gotten worse over time, with a series of hospital closures and downsizing starting in the 1990s. The number of beds shrank from 9,353 in 1995 to as low as 6,331 in 2011 before a gradual recovery through today. Santa Clara County has 12.7 beds per 100,000 residents, the third-lowest in the greater Bay Area behind Contra Costa and Marin counties. Santa Clara would need 969 more beds to meet the needs of the county's 1.9 million residents, the report states.
Last year, the Santa Clara County Board of Supervisors backed plans to build a new inpatient psychiatric facility at Valley Medical Center in San Jose, which would include 66 inpatient beds. Of those beds, 30 would be set aside for children and adolescents 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. El Camino's new psychiatric unit only provides beds for adults.
Data from 2016-17 shows more than 600 youth in Santa Clara County were assessed for inpatient hospitalization and admitted into psychiatric hospitals outside of the county for acute care, often for between five and seven days.
The estimated cost for El Camino's new mental health building was over $96 million as of Oct. 28, significantly higher than the original $51 million price tag, even taking into account escalation. Many of the accommodations, including 100% private patient bedrooms, drove up the final cost. Still, Fitzgerald said the building was worth doing right, and could serve as a shining example for nonprofits, community hospitals and universities to emulate in the future.