Counties Face Barriers To Overhauling Emergency Mental Health Care

Counties are working to overhaul their mental health networks as more Californians seek psychiatric care at hospital emergency departments, but some counties are running into financial roadblocks, the Orange County Register reports (Wolfson, Orange County Register, 10/27).

Background

The number of psychiatric beds across California has declined in recent years. According to a California Hospital Association study, the number of psychiatric beds in Orange County fell by nearly 58% from 1995 to 2012, leaving just 16.6 beds for every 100,000 residents.

Psychiatric patients often have to wait hours or days for a mental health evaluation and, if necessary, for a psychiatric bed to open up.

Meanwhile, EDs are left with less capacity to treat patients with other issues -- such as broken bones, burns or chest pain -- and such individuals often are diverted to other hospitals (California Healthline, 10/27).

Details of Overhaul Efforts

Eight California counties have designated emergency centers to treat individuals seeking immediate psychiatric care.

In Orange County, officials have made plans to overhaul the emergency mental health system, including opening two dedicated psychiatric emergency service centers where ambulances and law enforcement officers could take individuals who are experiencing mental distress or who are on psychiatric holds.

The first center would be established by expanding the Evaluation and Treatment Services, a county-run crisis stabilization and triage unit. The second would be opened in south Orange County.

The centers would be able to hold patients for up to 23 hours to determine which individuals require admission in an inpatient psychiatric facility.

Financial Challenges

In Orange County, the overhaul was expected to be completed by June 30, 2015, but stakeholders say financial issues may delay the progress.

Annette Mugrditchian, director of adult mental health services for the county, said, "The budget for expanding ETS is being worked on," adding, "We are trying to identify where the money comes from."

In addition, officials have predicted that the second proposed psychiatric emergency center in Orange County could cost $5.2 million annually to staff.

Meanwhile, Steve Moreau, CEO of St. Joseph Hospital in Orange County, said that "the reimbursement system and complexity" of treating individuals with emergency mental health issues "can be a real drain" on hospitals (Orange County Register, 10/27).