The Los Angeles County Board of Supervisors voted unanimously Tuesday to expand the availability of in-patient mental health care in the face of a worsening, decades-long shortage.
Supervisor Kathryn Barger, who authored the motion, said the wait time for a bed in one of California’s five state psychiatric hospitals is a year or more, leaving severely ill patients without the care they need. She cited mental health experts who estimate that 50 public mental health beds are needed per 100,000 residents and said Los Angeles County has less than half that number.
“If we do not address the homeless mentally ill, in eight years, people are going to feel like we did nothing,” Barger told her colleagues.
Mental health advocates painted a picture of hospitals deluged with patients in crisis they cannot adequately serve, including children and teens who need specialized care. Some said emergency rooms have seen an increase in violent patients that facilities aren’t set up to manage.
All that demand also means that patients with other medical issues end up with longer emergency room waits. And in an effort to free up beds, mentally ill individuals are released without the resources they need to stay well, according to Dr. Jonathan Sherin, who heads the county’s Department of Mental Health.
“The need to right size our hospital network is paramount,” Sherin told the board. “We have nowhere near the number of sub-acute (or) step-down types of beds” needed for patients to transition out of acute care.
A woman who has worked at Antelope Valley Hospital for 35 years said there has been a shortage of beds throughout that time.
“We have many people who are chronically mentally ill who need those step-down … beds and they wait for nine months in a little hallway of 12 beds to get into these facilities and then these facilities are only rehabs,” Lauri Ross told the board. “There’s some people who need to stay in a hospital where they can have safety, they can have security … they can have their medications … We have a patient who comes to us who believes he owns Walmart and he keeps getting arrested because he takes things from Walmart and he needs to be able to be in one of those beds.”
Facilities have been starved of funding at both the federal and state level. The federal government has long excluded Medicaid reimbursement for residential mental health treatment for non-elderly patients but recently announced that it would offer funding for innovative programs.
California, which moved to de-institutionalize mental health care in the late 1970s over concerns about abusive treatment, would need to support the county’s request for dollars under a Medicaid waiver.
The board directed DMH to develop a plan to generate more beds, including identifying potential sites and available funding and assessing the patient population, including in county jails.
Peter Eliasberg of the American Civil Liberties Union of Southern California said only patients in need of the highest level of care should be in a locked-down psychiatric ward, stressing the need for community-based care. He also urged the board to release jail inmates found incompetent to stand trial to be treated in the community.
“I am sick and tired of the sad reality that the number one provider of mental health services is the jail, where it is done poorly,” Eliasberg said.
In addition to expanding resources, Sherin said his department would be instituting performance-based accountability for existing care providers.
“There’s very little incentive for the hospital system to provide the level of care that we would like to see” under current contracts, Sherin said.
More than one family member told the board that loved ones died while awaiting access to treatment.
“I put my brother’s name on a waiting list but, unfortunately, by the time I had finally gotten the cruel phone call last October saying that a bed was available, my brother had passed away a few weeks before and racked up nearly a million dollars in medical bills due to his mental illness,” Christina Rackohn told the board.
Rackohn said more beds wasn’t a panacea, but she was confident that if more beds had been available, her brother would have gotten the help he needed sooner and not ended up homeless.
A report is expected back in 120 days.