Editorials

New psychiatric hospital was approved in SLO County 4 years ago. Will it ever be built?

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It was a hallelujah moment for mental health advocates on the Central Coast: Finally, San Luis Obispo County supervisors unanimously approved a 91-bed psychiatric hospital in Templeton, over passionate objections from not-in-my-back-yarders.

And then ... crickets.

After almost four years, the project still hasn’t broken ground. Some doubt it ever will, though the couple who proposed the facility are optimistic.

In the meantime, the Central Coast, like much of California, is left with a critical shortage of mental health beds. No one in Sacramento or Washington, D.C., seems to have the political will to do anything about it — ironic, given that after every mass shooting, politicians preach about the need for better mental health care.

It’s largely been left to the health care industry to fill the gaps in our mental health system, especially for private psychiatric patients who don’t qualify for government aid. For the mot part, hospitals are focusing on providing ever more advanced care to patients with cancer, stroke, heart disease and other physical ailments.

Patients with serious mental illness are typically cared for in hospital emergency departments until they can be transferred to a facility that offers in-patient psychiatric care. Sometimes that can take weeks, according to Dr. David Ketelaar, an emergency room physician at Marian Regional Medical Center in Santa Maria.

The need for psychiatric beds for children and adolescents is especially acute. There are only 706 in all of California, and not one of those is in San Luis Obispo, Santa Barbara or Monterey counties — even though mood disorders is the No. 1 cause of hospitalizations in children and teenagers.

With no local beds available, they’re sent to Ventura, Bakersfield, San Jose, San Francisco.

“They go alone to facilities hundreds of miles away,” said Ketelaar.

Templeton hospital
Harvey and Melanie Billig plan to build a 91-bed psychiatric hospital in Templeton. He is a retired doctor and she the former mayor of San Luis Obispo. The site, seen behind them in August 2015, is across Las Tablas Road from Twin Cities Community Hospital. David Middlecamp file photo dmiddlecamp@thetribunenews.com

Templeton mental hospital project

Bleak statistics like those are what helped convince county supervisors to approve a Templeton hospital with separate units for children, adolescents, adults and seniors — enough beds to serve San Luis Obispo County and other areas, as well.

The couple behind the project, former San Luis Obispo Mayor Melanie Billig and her husband, retired optometrist Harvey Billig, also want to build a separate, stand-alone memory care facility for dementia patients on their Templeton property.

Harvey Billing told The Tribune that financial negotiations are ongoing, and he promised there will be an announcement as soon as there’s something solid to report.

As to what’s causing the holdup, he pointed to hurdles, including the need for a permit from OSHPD — the Office of Statewide Planning and Development. He also said the San Luis Obispo County Public Works has been slow in approving a lot split for the property.

“Here’s the skinny,” he said. “Public works is very, very slow. They’re reinventing the wheel.”

Yet the application for the lot split wasn’t even submitted until March of this year — three years after the project was approved by the Board of Supervisors.

Since then, there have been some back-and-forths over technical aspects of the project, such as plans for street lights, utilities and drainage, but according to interim Public Works Director John Diodati, that isn’t unusual.

“As you can imagine, it takes time for us to review, send a letter with requests, and then have the applicant respond,” he wrote in an email.

Nor is it unusual for years to pass between a development’s initial approval and completion.

But this isn’t a shopping center, residential subdivision or industrial park — it’s a facility that really could mean the difference between life and death for some patients.

As much as we support the Billigs’ project, Central Coast families need help today, not 10 years from now.

How many inpatient beds are needed?

The lack of psychiatric beds in SLO County stands in stark relief when compared to recommendations from the California Hospital Association, which suggests 50 beds for every 100,000 people.

With a population above 283,000 people, that means San Luis Obispo County should have 141 beds.

Instead, it has only 16, and those beds — located at the county-operated Psychiatric Health Facility — serve Medi-Cal patients, including those on involuntary holds because they’re a danger to themselves or others, as well as County Jail inmates in crisis.

Santa Maria — where many residents in Nipomo and the Five Cities go for medical care — is in no better shape. It has no in-patient mental health beds, even though its population of 107,000 makes it the largest city between Ventura and Salinas.

Santa Maria’s situation could change in the not-too-distant future. Marian Regional Medical Center, owned by Dignity Health, is exploring the possibility of opening an in-patient psychiatric unit. It even has a location: the old Valley Hospital building that was donated to Marian.

That would require extensive remodeling, however, and there’s no firm date for when it could open.

Still, it’s a relief that the Templeton hospital isn’t the only project on the table.

It’s also encouraging that Dignity Health — which was formerly an official ministry of the Catholic Church — is expanding mental health services on the Central Coast.

In addition to the plan for an in-patient facility in Santa Maria, the newly remodeled Emergency Department at French Hospital Medical Center in San Luis Obispo includes rooms dedicated to psychiatric patients.

Yet some believe Dignity should do more.

Dr. David Bernhardt, a retired physician who’s been advocating for more mental health facilities for years, wrote a Viewpoint for The Tribune suggesting French add psychiatric beds, rather the additional medical beds called for in its expansion plans.

Officials at French say they need to serve the medical needs of a growing segment of the population: aging baby boomers who are putting a strain on medical resources.

French rejects the idea that it’s not caring for mentally ill patients

“We’re seeing behavioral health patients brought in by law enforcement at an alarming rate,” said Alan Iftiniuk, the hospital’s president and CEO. “French is the biggest recipient of those patients.” The revamped Emergency Department was designed with that new reality in mind, he added.

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An architectural rendering shows the mental health hospital proposed for Templeton. The project was approved by San Luis Obispo County in 2016. COURTESY OF HOCHHAUSER BLATTER ARCHITECTURE AND PLANNING

Mental healthcare crisis stabilization

Not everyone in the medical community is convinced it’s necessary to have 50 psychiatric beds per 100,000 population.

Intervening before there’s a need for hospitalization can make a big difference.

That’s the mission of the county’s Crisis Stabilization Unit — or CSU — a facility where patients can stay for up to 23 hours, during which time they’re evaluated, treated and connected with out-patient services in the community.

Marian Medical Center also is adding a Crisis Stabilization Unit, which should be open in 12 to 18 months. It will be larger than San Luis Obispo’s — accommodating up to eight patients instead of four — and if necessary, patients will be allowed to say longer than 23 hours, Dr. Ketelaar said.

Since San Luis Obispo’s CSU opened in March 2018, there has been a nearly 50% drop in the number of law enforcement requests to send patients to the county’s 16-bed in-patient psychiatric hospital.

Still, CSUs won’t totally replace psychiatric hospitals.

Until there are more local facilities, some patients still will wind up waiting for beds to open in other counties.

That’s unacceptable. Patients should not have to be shunted hundreds of miles away because it doesn’t make business sense for hospitals to care for them near their home communities.

Communities throughout California must recognize the need to provide for the physical and mental well-being of their residents, and determine what it will take to meet those needs.

State lawmakers must get a better handle on the extent of the problem, develop a plan of action and identify funding sources. That’s not as pie-in-the-sky as it sounds. Remember, California taxes the incomes of millionaires an additional 1% to raise funds for mental health services. That brings in around $2 billion per year.

Surely, some of that money could be allocated to mental health beds, especially in the 25 rural and semi-rural counties that have no beds at all. One or two regional facilities could help close that gap.

A regional model could also work on the Central Coast.

For example, if the Templeton hospital doesn’t move forward, the county could work with Marian Regional Medical Center to provide capacity for San Luis Obispo County patients.

By approving the Templeton hospital, the Board of Supervisors acknowledged the stunning shortage of mental health in-patient facilities in our area.

Ideally, work on that project will start soon.

If not, the crisis will persist, and our Board of Supervisors cannot ignore it.

County leaders must explore every avenue to ensure that these vulnerable members of our community receive the care they need and deserve.

Their lives literally depend on it.

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