New start offers immediate and interim psychiatric care
For the past 27 years Dominican Hospital has been the go-to place in Santa Cruz for acute psychiatric services, or immediate, short-term care. However, when the county’s contract with Dominican’s Behavioral Health Unit is up in 2013, it will seek a new place to house many of those in need of psychiatric care. In the coming years the county plans to build a separate Psychiatric Health Facility [PHF] that will include 16 more beds than are currently available.
“It became clearer and clearer to Dominican and to their parent corporation, Catholic Healthcare West, that operating the psychiatric unit really didn't work for them financially and in business terms,” says Leslie Tremaine, director of Mental Health and Substance Abuse Services. “And that is not unique to Catholic Healthcare West. That's happening all over the country to general hospitals that have had psych units.”
California governments from Humboldt County to Orange County have transitioned from health units that operate in hospitals to ones that function independently but nearby.
In light of severe budget concerns, Santa Cruz County is putting extra thought into the decision. “We need to make sure that this is a fiscally sound process for the county,” says Tremaine. “We’re in such a budget mess right now. The last thing we need to do is make it any worse.” However, proponents of the project say the new facility would be cost effective and should have a lower operating cost.
Rama Khalsa, Santa Cruz's Health Services Agency administrator, says the county can save money in the switch because there will be fewer restrictions and rules that, for example, dictate the ratio of nurses to patients. She estimates the increased efficiency will allow them to tailor their institution to fit the needs of recipients, and adds that counties can typically save $200 to $600 in operating costs per day after making the transition.
The new start also gives the Santa Cruz County Health Services Agency (HSA) the opportunity to start from scratch. They hope that this experience will help them learn what could make for a better facility.
At a town hall meeting in Watsonville on Feb. 16, Khalsa, Tremaine and 3rd District County Supervisor Neal Coonerty listened to the concerns of community members and looked for input on what an ideal facility would look like for Santa Cruz. Kathleen Kilpatrick, a nurse from Watsonville High School, expressed frustration that the unit will not accommodate children.
Len Lofano, chief deputy for the Santa Cruz Sheriff’s Department, said that he would like to see law enforcement carry less of the burden of handling psychiatric patients. He called the county jail system the “the de facto bed source” for psychiatric patients in the county, a position he says the Sheriff’s Department would not like to be in.
Other suggestions ranged from that the facility should not have any beds, which can be “coercive” in nature, to it should have more beds to accommodate more people. Tremaine, who is focusing on the programming for the new facility, says she is listening closely to concerns. “We’re trying to use the time to really ask people, 'what is it that you think could be a good service for this county?'” she says.
Coonerty believes that planners of the proposed facility will be better off with the input they received from town hall attendees, many of whom were family members of patients. “I think this is part of a long process, and we need to get input and real life stories and what works and doesn't work, and I think that's what we're getting,” Coonerty says. “We're really gathering information. It's nice we have this long process in order to do this.”
As the plan moves forward, officials hope to find a site in the mid-county region for the new facility to be built so that it will be near Dominican Hospital and other medical resources in case a patient's health problems grow larger than their psychiatric concerns. Both Dominican Hospital and county officials would like the transition to be as smooth as possible.
“I'm really heartened and happy that all of that will continue, because people need so many different approaches to healing,” says Martina O'Sullivan, director for community engagement at Dominican. “I think that's what we're really about here—to make sure that whatever comes next will be all that people need as they are on this journey.”
If you would like to offer comments, please visit santacruzhealth.org.
written by Sylvia Caras, March 02, 2010
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Nurses and other healthcare unions have fought long and hard for these patient/staff ratios and all of us, whether current patients or future, benefit. To now state that this transition away from these ratios will save money is shortsighted.
My mother is in a unionized medical rehab unit and clearly benefits from the same ratio arrangement, as do I as her care manager. She is well cared for, closely attended and the providers are rested and show no evidence of overwork.
To move away from ratios is to invite some image of patients lying around for longer times and families having a harder time accessing helpers for information.
This is a big move back to the bad old days of warehousing.