Sonoma County approves contract for inpatient psychiatric facility

For more than a decade, Sonoma County health officials have been trying to figure out a way to open locally a small psychiatric facility to treat people who often sit for days in a regular hospital, waiting for an available bed in some out-of-county psychiatric hospital.

Such a place - known as a psychiatric health facility, or PHF - could draw matching federal dollars, cutting in half the cost of inpatient psychiatric care. But more importantly, it would keep mental health patients in the county, close to their friends and family, during difficult times when they require inpatient psychiatric care.

Sonoma County health officials are now closer than ever to achieving that goal.

Last week, county supervisors unanimously approved a master agreement to lease, design and construct a PHF at the former Valley of the Moon Children’s Center off Highway 12 in Sonoma Valley.

County health officials, hospital executives and mental health advocates say the 16-bed locked psychiatric unit is a key missing piece in the county’s spectrum of behavioral health care.

“As things stand now, because there is such a shortage of psychiatric hospital beds in the state, people have to often go outside of Sonoma County to receive services,” said Bill Carter, the county’s director of mental health services.

“This creates an opportunity for them to receive services closer to home, which is important because you want people to be near their support system,” he said.

Carter added that because of the lack of psychiatric beds in the county, people often have to wait long periods in local emergency departments or the county’s 24-hour Crisis Stabilization Unit in southwest Santa Rosa, a sort of emergency unit for mental health patients. Such facilities, especially hospital emergency rooms, are not the appropriate setting for patients who require longer-term treatment, he said.

Barbie Robinson, the county’s health services director, said the “dearth” of inpatient psychiatric facilities is a troubling trend across the state and the country. She said California lists less than two dozen inpatient facilities for its 58 counties.

“We’re really excited about it being here,” Robinson said. “For Sonoma County to be able to establish a psychiatric facility is really going a long way for us being able to really have the necessary resources and support to strengthen our own system of care.”

Under the master agreement, the county would lease the facility to University Partners, LLC, as a tenant.

It, in turn, would then sublease the property to Crestwood Behavioral Health, which operates more than 1,800 licensed beds at more than 24 facilities across the state.

The county will pay for all necessary design, entitlement, rehabilitation, construction and improvement costs, which are currently estimated at $4.3 million. County project management costs are expected to be another $495,600.

The local PHF is expected to open as soon as the end of 2020 or early 2021. Patients will receive intensive psychiatric treatment for an average of eight days, officials said.

The project seeks to remedy a vacuum in emergency psychiatric care, created more than a decade ago.

In 2006, the county had 60 psychiatric beds available for low-income residents. The first, the county-owned Norton Center, was operated by Sutter Health and had 30 beds. It was reduced to half that capacity just before the Chanate Road facility closed in 2007.

The second, operated by Memorial Hospital at a satellite facility on Fulton Road in west Santa Rosa, was staffed for 30 beds in 2006 and reduced to 18 beds when it closed in 2008.

Both facilities were tied to regular hospital facilities, and as such were eligible for matching federal Medicaid funding for most adults. As a “freestanding” psychiatric hospital, the privately run Aurora Santa Rosa Hospital is not eligible for federal Medicaid funding for many adults.

When the county sends mental health patients to Aurora or any other freestanding psychiatric hospital, it must pay the full cost of the stay, which can be anywhere from $1,000 to $1,200 a day, Carter said. Federal law prohibits the use of Medicaid funds to freestanding psychiatric hospitals with more than 16 beds.

Robinson said the county has negotiated with Crestwood a daily fee per bed of about $1,000.

But because the PHF has only 16 beds, the county can seek matching federal funds, reducing the overall daily cost per bed to about $500.

“This gives us hope. It’s not going to solve all our problems but it gives us beds,” said Mary-Frances Walsh, executive director of the Sonoma County chapter of National Alliance on Mental Illness.

Last December, the county’s three hospitals contributed a total of $624,999 toward the creation of a PHF. Tarek Salaway, senior vice president and area manager of Kaiser Permanente in Marin and Sonoma counties, said its contribution of more than $200,000 was part of its effort to help address the “increasing need for equal access to mental health services for Sonoma County residents.”

Dan Peterson, CEO of Sutter Santa Rosa Regional Hospital, said he hopes the 16-bed facility will help local patients get the care they need. “This transitional space has been a great need in our community for some time, so we’re eager to see it open,” he said.

Not everyone who lives with a mental illness will require admission into a secure psychiatric facility, said Dan Schurman, community health investment manager with St. Joseph Health, which runs Santa Rosa Memorial Hospital. But without the facility, the whole system of health care is impacted, he said.

“That backs up capacity so we can’t treat other patients, and it just has a ripple effect throughout the whole system,” he said.

But Schurman warned that much work is still needed to improve and expand “lower levels” of mental health treatment.

“Unfortunately, when people don’t have access to the treatment that they need at the time that they need it, then they deteriorate, and they end up in higher levels of care that are more expensive and more problematic,” he said.