New Mandate Could Further Stress San Diego’s Clogged Behavioral Health System

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Traditionally, there have been three phases of medical take care of sufferers in psychiatric misery: the emergency room, an inpatient hospital mattress the place sufferers may stabilize and post-hospital care for specialised therapy. 

A shortfall within the latter class has triggered a systemwide backup.  

Exhibit A: On a single day in late August, 10 of the 36 inpatient behavioral well being beds at Scripps Mercy Hospital in Hillcrest have been crammed with sufferers ready to maneuver to a different degree of care, that means greater than 1 / 4 of Scripps beds weren’t obtainable to sufferers in disaster.  

The county has funded so-called disaster stabilization items the previous few years so fewer psychiatric sufferers enter native ERs after which inpatient beds, however sufferers nonetheless want someplace to go after they depart native hospitals. 

These hospital sufferers awaiting beds at long-term care amenities waited a median of 48 days between July 2021 and April, in accordance with county knowledge obtained by Voice. 

Christiana Paul, a vp at Sharp Mesa Vista Hospital, mentioned waits problem each sufferers and hospital workers. 

“It simply actually sticks this individual with us for these lengthy durations of instances the place this individual has cycles of nice enchancment, after which due to the size of the time within the hospital, (they) might even regress, which could be very demoralizing for the affected person and the workers,” Paul mentioned. 

The San Diego County Psychiatric Hospital has been hit with lengthy waits too. The county studies common wait instances to maneuver sufferers from the county hospital to a state hospital surged to a median of about three years from July 2020 by June 2021. That’s up from about 5 months within the 2019 fiscal 12 months. 

“Generally now we have to go for a unique degree of care, or they wait within the hospital till we are able to place them,” mentioned Annie Vizcarra, social companies supervisor at Alvarado Parkway Institute.  

Aaron Mellon, a skilled peer counselor with bipolar dysfunction who grappled with homelessness on and off for greater than a decade, estimated he has watched a number of dozen associates stabilize in hospitals solely to be pressured again onto the road.  

“For lots of people, it’s a endless loop,” Mellon mentioned. 

Clairemont resident Anastasia’s 26-year-old son has bipolar dysfunction with psychotic options and has been hospitalized a number of instances since 2020. She mentioned he struggled at unbiased residing amenities even whereas enrolled in an intensive therapy program.  

Anastasia mentioned she was repeatedly informed there have been no openings in board-and-care properties, which usually present residents with help with treatment and higher oversight. The properties lengthy thought-about essential housing choices for folks with critical psychological sicknesses are a shrinking useful resource statewide. 

After one five-day hospital keep for an an infection and one other 5 days at nursing facility this spring, Anastasia and her son’s case managers agreed he shouldn’t return to his unbiased residing dwelling, however there was no house in a board-and-care dwelling.  

He moved into her Clairemont dwelling, forcing Anastasia to get permission to work at home. 

Carol, a retired trainer who lives in Tierrasanta, mentioned her 41-year-daughter recognized with schizophrenia has been kicked out of greater than 15 unbiased residing properties within the final 13 years. A number of facility managers have mentioned she belongs in a board-and-care facility.  

“She wants the next degree of care,” Carol mentioned.  

They haven’t discovered it. 

Certainly, 2-1-1 San Diego reported the area misplaced practically 400 board-and-care beds over the past decade. 

Expert nursing amenities match for behavioral well being sufferers with medical points are additionally scarce. 

Psychiatrists say the sicker the affected person, the harder it’s to discover a place for them. 

Earlier this 12 months, the state awarded the county $12.4 million for a 12-bed psychiatric unit in its Edgemoor Expert Nursing Facility to permit residents to get psychiatric care with out transferring. 

Transferring into psychological well being rehabilitation amenities means lengthy waits, too. 

Native hospital methods mentioned waits rose considerably in the course of the pandemic however are leveling off at a one-to-three month wait. 

The scenario may have been worse. Earlier than the pandemic, the county funded dozens extra psychological well being rehabilitation beds. 

The area has additionally added practically 2,300 everlasting supportive housing slots for previously homeless people who find themselves thought-about notably susceptible – together with folks with critical psychological sicknesses – since early 2019. However these additions haven’t dramatically diminished waits in hospitals and lots of behavioral well being sufferers require extra help than these amenities supply.  

“The actual fact of the matter is we simply want extra post-acute care,” mentioned Dimitrios Alexiou, CEO of the Hospital Affiliation of San Diego and Imperial Counties. 

Nadia Privara Brahms of the county’s behavioral well being companies division lately informed an advisory board the county plans to spice up step-down care and can share its wants at a Sept. 27 assembly. 

“As an alternative of being caught in additional acute care or not with the ability to get care in any respect as a result of these ranges of care or sorts of beds that they want don’t exist, the objective is to proceed to construct out capability a lot of which is within the decrease, much less restrictive areas of care to verify shoppers get linked after which they can get care long-term,” Privara Brahms mentioned.