Santa Barbara County Feels Strain of Psychiatric Facility Bed Shortage for Cen-Cal Patients

Final for J-100

Maggie Knowlton, J-100

Thu, July 1, 2021 10:00 AM

Word Count: 949

Speeding down the road at a steady clip, crisis mental health worker Rhonda James* is unsure what she will find when she gets to the ER. She will likely encounter one of three things: a drunk or high patient, an unhoused person recently displaced due to the local river bed clean-up, or someone who needs a hold because of a mental health crisis.

In America, 1 in 20 adults experiences serious mental illness each year, approximately 13.1 million people, according to NAMI, The National Alliance on Mental Illness.

The outcome is never great for those who have no health insurance or for those with state insurance. The clock is ticking, and frequently the hold expires, and they may never find a bed.

“Vista Del Mar never re-contracted with the county, 30 adult beds were lost, only the children’s Cen-Cal is accepted now.” according to James. Without these contracts, there is a significant deficit in the county’s system of care.

The PHF or Psychiatric Health Facility in Santa Barbara has 16 acute beds, officially. This number based on federal funding; however, this number leaves clients out in the cold.

In an informal survey of the 32 PHF units or Psychiatric Care Units in California, only two take Cen-Cal.

Cen-Cal, California’s Medicaid program, is a joint federal and state program that finances both acute and primary care services for low-income families. However, Medicaid’s Institutions for Mental Disease (IMD) Exclusion was passed in 1965, amended in 1988 to 16 beds or fewer to receive state funding.

There have been times when this was less troubling. There are exceptions such as inpatient hospital services and nursing facilities for the aged 65 and older in an IMD or receiving PHF services for individuals under 21.

Vista Del Mar served both inpatient and outpatient clients. Despite being a private hospital outside of the county, they held 30 beds for Cen-Cal only patients, before the fire, according to James. “They only take children’s Cen-Cal now. Santa Barbara used to be more flexible too. They would double up beds when necessary.”

A significant factor depends on how acute the patient presents and if they have the correct insurance. The people most likely to be placed can get assistance elsewhere with Medicare and Cen-Cal due to social security or private insurance. Of the 447,000 people who live in Santa Barbara County, around 193,000 people have Cen-Cal insurance.

The board of supervisors has acknowledged this shortage as recently as last year. As quoted in an article by Nick Welsh of the Santa Barbara Independent, “this shortage has not been a limit of physical space so much as it’s been federal rules designed to prevent the warehousing of people with mental illnesses in large institutions.”

Susanne Grimmesy works in Administration for Mental Health in Santa Barbara County and does not believe there is a shortage.

When reached for comment, Suzanne Grimmesey, MFT Quality Care and Strategy Care Officer stated, “She is unaware of a shortage. We have other contracts with hospitals outside of the county and a co-response team to mitigate the necessity for beds.”

When asked about Cen-Cal only beds, Grimmesey stated Medi/Medi beds were more expensive.

An informal survey conducted, and all 32 PHF units in California accept both Medi/Medi funding.

County of Santa Barbara Supervisor Das Williams has worked intimately with the County budget. When reached for comment, he stated that the need is not there for more beds.

“I personally believe we are not there yet and will need to continue to expand our system. When the 16 beds at the PHF you speak of are full, our new contracted beds are elsewhere in the state. However, there is some demand that fell off as soon as Vista burned down, even though that too was a private, out-of-county facility.”

Lynne Gibbs, a spokesperson for NAMI, is frequently the voice of the most vulnerable people in the community. An advocate for more beds in the PHF county system has lobbied for HB 2611, a federal bill that would allow more beds in PHF hospitals.

A report released by Lynne Gibbs, NAMI SBCO Public Policy Committee, shows a different outlook. “From May 2020 to May 2021, the number doubled. Cottage staff predicts the number has not plateaued. They expect it to continue to grow throughout the summer. There are now more persons in psychiatric crisis (both voluntary and involuntary) at any given time at the Cottage ER than all other medical emergencies combined. Marian Hospital reports a similar trend.” According to Gibbs report.

The report goes on to state, “An increased number of involuntary patients were discharged from the Cottage ER/ED directly to their homes, from 13 in April to 31 in May. And, an increased number (13) saw their holds simply expire. Due to the limited number of inpatient beds statewide, there is an increasingly keen competition among counties for beds.”

Lynne Gibbs’s informational report given to the Board of supervisors was entered into the minutes of the Board of Supervisors meeting.

Nick Welsh of The Santa Barbara Independent previously reported on this just a week ago, June 22, 2021,

More data is necessary to understand why the private sector has doubled while the patients with state insurance have stayed static in numbers.

At the end of Jame’s shift, five clients were still waiting in the ER’s on 51/50 holds, according to the nurses on duty still waiting for a bed. All five had Cen-Cal. Santa Barbara’s PHF ward was only at a capacity of ten according to their census.

• Name has been changed in order to protect source.