Investigations

SLO County residents struggle to find treatment for mental illness

It was more than a decade ago when San Luis Obispo resident Sherrie Medinger admitted her 13-year-old daughter, who attempted suicide, into a Ventura psychiatric facility where she was treated for what would later be diagnosed as bipolar disorder.

“I remember driving up and down the coast crying my eyes out and not knowing what to do, worrying my daughter is going to die. It’s just horrible, trying to explain that in words to someone,” she said.

A single mother at the time, Medinger had to commute from her job as an occupational therapist in Santa Maria to Ventura several times a week to arrive in time for visiting hours.

The distance intensified Medinger’s fears about her daughter’s illness, she said. But she had no choice: To this day, San Luis Obispo County doesn’t have a psychiatric hospital for people with private insurance. As a result, hundreds of local patients with insurance are sent out of the county each year, many hours from home.

“The emotional and financial burdens were huge,” Medinger said. “Being so far away from home added to my young daughter feeling terrified.”

Those emotions have been rehashed in recent months as a private landowner seeks to build a pair of health-care facilities in a two-phase, estimated $65 million project on nearly five acres across from Twin Cities Community Hospital in Templeton.

Plans call for both a memory care facility and a psychiatric hospital.

But it’s the 91-bed psychiatric hospital that’s triggering the debate.

It’s designed to treat a full spectrum of mental illnesses such as depression, schizophrenia, eating disorders and attention deficit hyperactivity disorder. Patients would stay in separate units — for children, adolescents, adults and seniors — on private insurance for short-term, voluntary inpatient stays. The hospital would not treat those suffering from substance abuse.

Just recently, two advisory boards with the county’s Health Agency department recommended that the county Board of Supervisors fill an “imminent need for an acute inpatient psychiatric facility in San Luis Obispo County.”

Locally, the only inpatient psychiatric hospital is run by the county and offers 16 beds primarily for Medi-Cal patients in their worst stages of crisis.

The Templeton proposal, slated to be considered by the county Planning Commission on Dec. 10, has been met with mixed feedback from the community.

The Planning Commission’s decision could be appealed to the Board of Supervisors. The Templeton Area Advisory Group, which makes recommendations to the supervisors, voted against the proposal last November after hearing from a large crowd of opponents.

Differing views

Some say the project is too big for the area, would be a drain on local services such as law enforcement and would make rural Templeton a regional magnet for mentally ill out-of-towners from throughout the state who would linger on streets and parks.

“It’s almost ludicrous to me that they think this is the ideal location for this facility,” Templeton resident Murray Powell said.

But supporters say such a facility would fill a much-needed gap in mental health services in the county — particularly for children and seniors. And, they note, its proposed location is already home to other medical facilities.

Judy Vick, a licensed marriage and family therapist and the division manager of adult mental health services for the county’s Behavioral Health department, sees a critical need for such a facility locally.

“To not be able to assure … people that they can get their treatment here means we’re sending people anywhere from two-and-a-half hours away to seven hours away. I don’t think that’s adequate,” Vick said. “I understand all the concerns, but the bottom line is we have a lot of people in this community that need this level of service.”

What SLO County has now

Many in the mental health community agree that the county’s current inpatient resources are inadequate.

“The resources are insufficient to meet the needs of a county this size,” county Behavioral Health Administrator Anne Robin said.

She hasn’t taken a stance on Templeton’s proposed psychiatric hospital and spoke solely on the county’s current service need.

San Luis Obispo County is licensed by the state to run a 16-bed inpatient Psychiatric Health Facility for people deemed an immediate danger to themselves or others or unable to care for themselves safely due to a mental illness.

The PHF, or “Puff” as it’s called, primarily serves patients with Medi-Cal, California’s health program for low income residents. The PHF can take people voluntarily or involuntarily.

The PHF is unlike the proposed psychiatric hospital in Templeton. And, both are completely different from Atascadero State Hospital, a high-security facility that treats mentally ill male inmates from the correctional system and other violent offenders.

“For people with private insurance, there’s no place for them currently,” Robin said. “For an average person, if they had a breakdown and wanted to commit suicide and had a suicide plan, we would evaluate them here and then make arrangements to send them to an out-of-county facility where they accept private insurance, because we only have 16 beds and a stack of Medi-Cal patients.”

Statistics suggest need

One in four adults experiences mental illness in a given year, according to statistics by the National Alliance on Mental Illness, with one in 17 people having a condition such as schizophrenia, major depression or bipolar disorder.

About 20 percent of youth ages 13 to 18 experience severe mental disorders in a given year. For ages 8 to 15, the estimate is 13 percent, the statistics say.

For Medinger and her daughter, those statistics were more than numbers — they were their reality.

“Both of us were so afraid — her depression was so bad … and she was so suicidal that I didn’t know if I was going to lose her,” Medinger said.

In 2014, 714 San Luis Obispo County residents of all ages were served at out-of-county psychiatric hospitals, according to data from California’s Office of Statewide Health Planning and Development.

That figure includes both patients transferred from the PHF and patients who checked in independently.

The county transferred between 275 and 314 patients from the PHF to out-of-county psychiatric hospitals annually from 2012 to 2014 for reasons ranging from lack of space locally, patients it can’t serve and patients needing long-term stays, officials said.

Mark Schneider, the chief executive officer of Vizion Health LLC, the company that would operate the Templeton psychiatric hospital, said he anticipates as many as 1,000 patients the first year and then about 2,520 patients a year after that.

Joseph of Atascadero, who didn’t want his last name used to protect his privacy, is among the hundreds of people who have gone outside the county for inpatient care.

Joseph, now 30, was diagnosed with schizophrenia at 19 while away at college. Today, his parents say their son’s condition has worsened since they moved from Virginia two years ago. They attribute his regression to the area’s lack of mental health services.

The family says being so far away when Joseph is hospitalized is emotionally draining.

“You just want to hug him and you can’t. And when he calls you, scared, you can’t go to him and tell him it’s OK,” said his mother, Lisa Kania.

Overall, Robin said the PHF is adequate for the role it serves, but more psychiatric beds are needed in the county.

“SLO County really is under-bedded for this size population,” Robin said, pointing to statistics in a 2014 report by the California Hospital Association.

The association recommends one bed per 2,000 people in any given population, to provide adequate psychiatric hospital care.

Under that standard, San Luis Obispo County should have 140 beds to serve its population of about 279,000. Instead, it has 16.

Other counties also don’t meet the association’s recommendation.

In 2012, the statewide bed rate was one for every 5,809 people while the nation’s average was one bed for every 4,845 people, the association’s study states. With only 16 beds, San Luis Obispo County has one bed for every 17,437 residents.

Some opponents of the Templeton project are skeptical of a recommendation by an association that represents hospitals. The Tribune looked for other psychiatric bed-to-population recommendations but was unable to find such standards among various state and federal agencies and organizations.

Questions about size

As the Templeton proposal heads to the Planning Commission, proponents and opponents continue to dispute the need for a psychiatric hospital of its size.

Those concerned with the project say the number of patients transferred to out-of-county hospitals shows there wouldn’t be enough demand to keep a 91-bed facility in business. “Yes, we need more than the 16 beds, but is it 100?” Templeton resident Shirley Sigmund said of the proposed facility’s capacity.

Robin said that, while she hasn’t taken a position on the Templeton proposal, there is a need in the county for more beds.

“We have people calling hospitals every day and asking, ‘What’s your availability?’ and working to move people,” Robin said.

Medinger says the number of beds doesn’t matter as much as having a local facility to begin with.

“I would personally guess that currently there are some people who don't get inpatient treatment at all because they either can’t afford to go out of the county, are afraid to be further away, or, if children, the parents don’t want them that far away,” she said.

DETAILS OF THE TEMPLETON HOSPITAL PROPOSAL 

Here’s a look at some of the details and highlights of the Templeton behavioral health hospital proposal:

The property: 5-acre site at 1155 Las Tablas, Templeton, is across from Twin Cities Community Hospital.

Property owners: Harvey and Melanie Billig of Carmel. The couple lived in San Luis Obispo County from about 1973 to 2000. He was an ophthalmologist; she was mayor of San Luis Obispo from 1981 to 1985.

Previous proposal: In 2007, the county approved a 192-bed assisted living facility. The Billigs eventually dropped the plan because of financing and other issues. Current proposal: 91-bed psychiatric hospital (previously planned as 96 beds) and 55-to-60-bed memory care facility for patients with Alzheimer’s disease and dementia. The 35,000-square-foot memory care facility would be built first. An operator has not yet been selected.

Psychiatric hospital details: The 70,000-square-foot behavioral health hospital would be operated by Vizion Health LLC, a new company based in Charlotte, N.C. The operator anticipates 1,000 patients the first year and about 2,520 patients annually after that.

Patients would be in locked “care pods” grouped by age: a 21-bed unit for children ages 6 to 12; a 21-bed adolescent unit for ages 13 to 18; a 21-bed unit for adults 18 to 65; and a 20-bed unit for seniors 65 and older.

Eight more “swing beds” could be moved among the pods as needed. Each pod would have a dining area, recreation area, nursing station and its own staffing. Patient stays would be voluntary and typically last 8 to 10 days.

Treatment plans: Therapy and medication for conditions such as depression, anxiety disorder, suicidal thoughts, schizophrenia, social phobias, eating disorders, post-traumatic stress disorder in veterans, and attention deficit hyperactivity disorder in children. No substance abuse treatment.

Insurance: Private insurance, Medicare, retired military health plans and other funding sources. Federal law prevents funding for Medi-Cal patients ages 16 to 64.

Discharge: Patients would need a doctor’s assessment before discharge. Any patient deemed a danger to themselves or others would be transferred to the county psychiatric facility.

Jobs: The psychiatric hospital would create about 200 medical and staff jobs; the memory care center would provide about 30 jobs. Each would bring additional jobs in the construction phases.

Quote: “It’s a hospital for people in mental crisis, as opposed to a physical crisis. The fundamental process is … they come in and stabilize the patient with a treatment process and then (patients) go back to their private psychologist and other outpatient care.” Melanie Billig

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