CORRECTION: Due to a reporting error, the original version of this story incorrectly identified John Muir Medical Center, Concord as the facility where Maria Ramirez's granddaughter was taken. We regret that error. The post has been edited so that it no longer contains the incorrect information.
By Elaine Korry
Maria Ramirez began caring for her granddaughter when the girl was just a toddler. Her granddaughter began hurting herself -- cutting her arms and swallowing things -- before she was 10. Soon, says Ramirez, she couldn't let the girl out of her sight. “She was running in front of cars, just really impulsive,” says Ramirez. “It was out of control, and I was really scared.”
Ramirez has a job and health insurance, so she did what any parent or guardian would do: she took her granddaughter to her local hospital for treatment. But instead of finding help, she always got the same reply, “No beds, no beds.”
Ramirez, a Bay Area artist who loves gardening, says she knew early on that her granddaughter was going to need help. “She was a hard child to make smile. She was very serious,” says Ramirez.
She was also very anxious. The girl couldn't leave the bathroom if there was water in the tub. A wrinkled bedspread could ruin her day. By the time she was 12 she was taking medication and seeing a therapist. But she was not getting better.
Then one day she stabbed herself. Ramirez rushed her to a psychiatric emergency service, where she remained for days.
“It had been five days, and she was not getting helped,” says Ramirez. “She was confined. There was no intervention, there was no therapy, there were no services. There was nothing.“
Finally the girl was admitted to a child psychiatric facility.
No Regional Planning
Liz Stallings is the chief operations officer at John Muir Behavioral Health Center in Contra Costa County and expert on child mental health care. She, says the scarcity of hospital beds is a problem throughout California. “We have 12 child beds here at John Muir Behavioral Health, and they are occupied all the time from all over the state,” says Stallings.
Stallings, a psychiatric nurse, also chairs the California Hospital Association Center for Behavioral Health. The CHA has been sounding an alarm over the steady loss of hospital beds for adult and child psychiatric emergencies. In the entire state there are now fewer than 100 beds reserved for children 12 and under. Most of those beds are in the Bay Area or the Los Angeles basin; the overwhelming majority of California's 58 counties have no beds at all for your children experiencing a psychiatric emergency.
This didn't happen overnight, according to Stallings. Lawmakers decentralized mental health care in the 1990s, which gave counties more local control -- at the expense of regional planning. Both private and county hospitals started closing psychiatric wards to save money. “There is no planning process,” says Stallings. “They just expect me to absorb these patients.”
Since John Muir's beds are always occupied, local children can wind up stalled in the ER, like Ramirez' granddaughter. Or they are sent far away, where their parents can't visit or attend family therapy.
It's a problem officials in some counties are working to address.
Gail Price was appointed to the Santa Clara County Mental Health Board after her own son's psychiatric emergency. Now she co-chairs of the Family, Adolescents & Children’s Committee At 17 he had an episode of bipolar mania, which took the entire family by surprise. “It is very anxiety-producing, and most people are not prepared for this,” says Price.
Price was shocked to find that wealthy Santa Clara County doesn't have a single hospital psychiatric bed for adolescents. So she rallied all her connections and finally got her son admitted to a hospital about an hour away. He’s doing better now, but Price never forgot the experience. “We're comfortable. We speak English; we have transportation and resources. We were very fortunate, but I often think of individuals who did not have the advantages we had,” says Price.
Some of the hospital closures were done with the best intentions: public health officials and some mental health advocates insist psychiatric patients respond better to treatment in community settings, instead of being locked in a hospital. Price says that may be true for stable patients, but in a real emergency such as her son’s, Price says people need more structured intervention. Not only that, she adds, budget cuts have left most county services, including mental health, in tatters. “Frankly, I think it's a lack of political will,” says Price. “The data's there, and it's clear we have a moral responsibility to do something.”
When mental illness is treated, people can recover. But left untreated, their jobs and relationships can suffer. Many people with a serious mental illness wind up homeless or in jail. Earlier this year, state lawmakers recognized that after years of deep budget cuts, they needed to shore up the mental health system. Under the leadership of Sen. Darrel Steinberg, (D-Sacramento), the legislature approved $206 million in new mental health funding.
“What's lacking in the system is the crisis beds that allow somebody to get stable and the people who can help somebody get from those settings to a place where they can begin to get help,” says Steinberg.
Ramirez's granddaughter now lives in a psychiatric residential program for teenagers.
Editor’s note: This is the second of three stories about psychiatric inpatient services airing this week on The California Report. In part one, reporter Elaine Korry looked at the lack of psychiatric inpatient services for adults. In part three, Korry looks at how new mental health funding will be implemented.