The Morning Report
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County supervisors voted unanimously on Tuesday to move forward with efforts to create a network of behavioral health hubs and crisis units countywide, starting in North County and central San Diego.
The goal is to shift the county’s mental health system from one overtaxed by emergency room visits and hospital stays to a more efficient chronic care system that helps patients stabilize before they fall into crisis.
“It’s not just one new facility or another facility, it is a reimagining of the entire system,” said County Supervisor Nathan Fletcher, who persuaded the county to proceed with a new multi-service hub in Hillcrest on a plot once eyed for condos.
Months after Fletcher spotlighted the dilapidated property, the county has committed to pursuing a hub with an array services on the plot in Hillcrest and another on a separate county-owned property next to Palomar Medical Center Escondido – plus new walk-in facilities in North County. It’s also planning on other behavioral health hubs in the eastern and southern reaches of the county. Rady Children’s Hospital said Tuesday it also hopes to establish a youth-focused hub on or near its Kearny Mesa campus.
All the new services will come at a significant cost. Building the Hillcrest hub alone is expected to cost $115 million, a sum the county hopes can be financed with the help of an influx of Medi-Cal dollars associated with changes at the county psychiatric hospital in Midway and partnerships with UC San Diego Health and Scripps Health.
Dr. Luke Bergmann, the county’s behavioral health director, said he expects the initial upfront costs to pay off over time by lessening the burden on the county, local hospitals and patients.
Bergmann and other county officials envision hubs as places where mental health patients can be assessed and given on-site care and then linked with longer-term care to help them avoid future crises that can be costly for both patients and the health system. They also hope to structure arrangements with hospitals that will help operate them to ensure patients leaving their facilities remain engaged in care.
“We have opportunities to more actively manage care and to do things to incentivize better upstream care for people enrolled in Medi-Cal with long-term cost savings in mind,” Bergmann said.
The approach is loosely based on the so-called hub and spoke model that health care authorities in Vermont and New Hampshire have used to aid patients addicted to opioids.
For now, patients grappling with behavioral health challenges are often forced into emergency rooms where they can spend days waiting for inpatient care, exacerbating their conditions. Once discharged from the hospital, they often struggle to access follow-up care or housing that can help them avoid future episodes.
“People who need care need to access to it wherever they are or live in the county,” Bergmann said.
The Hillcrest facility is expected to house about 60 inpatient psychiatric beds, a crisis unit where patients’ needs can be assessed, step-down care for patients discharged from the hospital and ongoing outpatient treatment. The Escondido site is likely to focus more on outpatient services and housing options for people who need mental-health aid.
County officials expect the Hillcrest and Escondido hubs to open in five to seven years.
Caroline Ridout Stewart, a retired psychotherapist and board president of substance abuse policy reform group A New PATH, said she appreciated the county’s focus on providing more services but wished the hubs could open sooner.
“Can we do it faster?” she said. “Can you please create these not in five years but in two or three?”
Stewart said she’s hopeful the hubs will ultimately pave the way for more sustained care – namely, in hospital beds – for patients who need it.
Other components of the overhaul are expected to come online much sooner.
The county is more moving forward with so-called crisis stabilization units that officials hope will eventually be spread across the county and lessen the flood of patients into local ERs. The crisis units allow patients to be quickly connected with psychiatric care, medicine and other supports for up to 24 hours. County leaders hope they will also be more convenient drop-off locations for police who are often tasked with ferrying patients to ERs, a process that can pull them from their beats for hours.
With supervisors’ approval on Tuesday, the county now plans to proceed with a new crisis unit at its Live Well Center in Oceanside. Supervisor Jim Desmond and county bureaucrats are also continuing to try to persuade Vista leaders to allow the county to open a crisis unit in their city.
Palomar Health is also set to soon expand its crisis services in Escondido with financial support from the county.
“It’s a significant opportunity for us to do a much better job than we’ve done in the past,” Palomar Health CEO Diane Hansen said of the county’s investments.
UC San Diego Health CEO Patty Maysent said her team has worked tirelessly to come to initial agreements with the county. But she also said the county and local hospitals still have a lot of work to do to make the behavioral health hubs and other new facilities a reality. There will be hospital licenses to seek, new contracts to sign and extensive planning processes to get it all done.
“This is still very hard to achieve,” Maysent said.