In the small town of Clearlake, about a hundred miles north of San Francisco, Carole Ford, a great-grandmother with a mane of silver-gray hair, runs a community mental health center called The Bridge. She leads support groups and prepares meals for her mostly homeless clients. It's hardly glamorous work, but Ford says this is her dream job. “I know that I’m where I’m supposed to be -- and doing what I’m supposed to be doing,” she says.
But Ford, 71, hasn't always been so content. She had a traumatic childhood and many bouts of depression. As a younger adult adult she often felt suicidal. She recalls being dragged away to the hospital in Lake County, where she says she felt like she was dumped. There was no psychiatrist or therapist; no peer support or services of any kind.
Ford was often forced to wait in the emergency room for hours for an evaluation, suffering all the while. “First of all, you hate feeling the way you're feeling -- horrible, and you can't face life.” She adds, “You're there, waiting, sort of alone in your emotions. It definitely added to my anxiety.”
By the time county behavioral health workers arrived for evaluations, Ford was often so upset that she was perceived to be in danger of hurting herself. So crisis workers ordered her to be hospitalized -- more than once -- without her consent for a three-day hold. Ford says it was the last thing she wanted. But it wasn't a matter of admitting her to the hospital affiliated with the emergency room. That hospital had no beds for psychiatric patients. Employees had to scour the state, looking for a vacant psychiatric bed. “Then it's usually like another 2 to 3 hour drive,” says Ford. “Waiting, you're in limbo.”
Finally, Ford says, she would be dropped off, frightened and alone, at some unfamiliar place several counties away. “The door is locked behind you and here you are, surrounded by a bunch of strangers,” says Ford. “It was horrifying.”
Shortage of Acute Psych Beds
The guiding principle of medicine is to do no harm. Yet, advocates for people with mental illness say they go through this sort of ordeal all the time. Some lawmakers concede there's a problem. “There are still significant holes in the system and at or near the top of the list is the shortage of acute psychiatric beds,” says Darrel Steinberg, the President Pro Tem of the California Senate.
Advocates for reform wanted to move mental health treatment from locked hospitals to less restrictive, and less costly, community settings. The reform movement goes back to the 60s. People with schizophrenia or bipolar disorder who were once locked away in state asylums now often live with their illnesses in the community. But that reform movement may have gone too far too fast, some advocates say. Over the last 15 years, psychiatric facilities have closed in record numbers. California lost one in three hospital beds once reserved for behavioral health emergencies. At the same time funding shifted from inpatient to outpatient treatment, the system of community care never got fully built.
A wave of corporate hospital closures and county budget cuts resulted in California losing about 4,000 hospital beds once reserved for psychiatric emergencies. Some areas were hit harder than others. Most of the rural northern and Sierra counties have no inpatient mental health services at all.
"We Do Medical Care Here"
At Sutter Lakeside Hospital, in the county seat of Lakeport, you can have back surgery, or give birth, but chief administrator Siri Nelson says if you're hallucinating or suicidal, then you're out of luck. “We're not a psychiatric facility,” says Nelson. “We do medical care here.”
Serious mental illness is a brain disorder which also requires proper medical care. But Nelson says there simply isn't enough demand in this small county of 65,000 people to make a psychiatric unit profitable. And that calculation affects a wide array of other county services.
Because there are no local beds, last year Fire Chief Willie Sapeta had to transport 200 patients out of Lake County for psychiatric treatment. “Those transports can be a four-hour turnaround time to as much as a 10- or 12-hour turnaround,” he says, “when we've had to go to Salinas or up into Humboldt or Del Norte County.”
And it's not just paramedics who are affected. If the patient is considered potentially dangerous, then law enforcement has to step in. Sheriff's deputies have had to monitor patients in the emergency department for 10 to 12 hours at a time before a county behavioral health worker arrives.
Lt. Chris Chwialkowski, with the Lake County Sheriff’s Department, says the wait is a hardship for the patient, but also for his department. “If that deputy is on overtime, you're talking about time-and-a-half,” says Chwialkowski. "If that deputy's not on overtime, then you're taking a deputy off the street.”
It's a bad situation all around, says Kristy Kelly, behavioral health director for Lake County. “It's difficult for law enforcement because they may have to stand by to make sure that it's safe,” she says. “It's difficult for the ER because that's their patient and they want to move their patients on. It's difficult for the Mental Health Department because we're trying to find a placement and we're calling and calling and calling and calling, and we're getting a lot of nos.
With the scarcity of beds, the moment one patient is discharged from a psychiatric bed, another is moved in. So the timing has to be just right for Kelly’s people to find a vacant bed. “We just keep calling until we get a yes,” says Kelly.
Back at The Bridge, Ford described how she found peace. About 15 years ago, she reached out to self-help groups and embarked on what she calls a spiritual path. She is much more settled now and says it's been years since she was hospitalized.
Editor's note: This is the first of three stories about psychiatric inpatient services airing this week on The California Report.