County Supervisors OK New Mental Health Facility In Hillcrest

Speaker 1: 00:00 The County has taken a major step toward overhauling San Diego's mental health treatment system. On Tuesday, the County board of supervisors unanimously approved the initial funding for two new mental health hubs, plan for Hillcrest and Escondido along with moneys for two smaller mental health facilities in Oceanside and LA Mesa. The hub complex approach toward mental health treatment is the result of a year long planning and research effort, which hopes to change the county's response from crisis management to longterm patient care journey me as reporter Paul Sisson, who covers healthcare for the San Diego union Tribune. And Paul, welcome to the program. Thanks for having me. Now. Critics have accused the County four years of avoiding its responsibility to provide mental health care. What sparked this new push by the County? Speaker 2: 00:50 Uh, I think it's fair to say that, uh, there are a couple of different factors that sparked it. Uh, you have, uh, existing, uh, mental health units at a script's mercy and UCS, D, Hillcrest crest hospitals that, uh, are going to need to be closed in the, you know, mid to near future because of massive redevelopment projects that are slated for both of those medical campuses. And then, uh, more recently I think the real flashpoint was a tri city medical center up in Oceanside deciding to shutter their, uh, inpatient locked psychiatric ward and their crisis stabilization unit, uh, that they had partnered with, uh, with the County before. They said they had a lot of trouble affording to do some needed, uh, uh, upgrades that are required by federal regulations. And so that kind of got everybody thinking more, more directly about it. Oh my gosh, dude, we're, we're headed for a bed crisis here. If we, if we don't do something Speaker 1: 01:48 now, the County approved research on what kind of system they wanted to fund, who did the research, Speaker 2: 01:53 uh, you know, it was a real collaboration. You had the county's, uh, behavioral health services department under dr Luke Bergman. He is a just a, and kind of a recent hire about a year ago, uh, and he has worked with the department of, uh, of health services there at the County. Uh, and then they brought in a whole lot of experts from, you know, every type of specialty you can think of. Everything from law enforcement, uh, to healthcare, uh, to psychiatry, uh, you know, even, uh, education as well. Uh, you know, there's a lot of this affects, uh, know school students as well. Speaker 1: 02:28 So then how is this hub complex approach different from what we have now? Speaker 2: 02:33 You know, I, I think, uh, what you would say about our current system is that it is, you know, the fractured as the word a lot of people like to use. Uh, generally you will, uh, you will go on and your daily life until you have some kind of a significant symptom, uh, that will cause you to need to seek treatment. And, uh, you know, in, in the most severe cases you're talking about, uh, maybe the police being brought in. Uh, you know, if somebody believes that you're a danger to yourself or others, uh, you probably heard of the, uh, the 51 50 hold, where, where you will be kind of taking a, taken into a temporary conservatorship and, and taken to your nearest ER or, uh, or perhaps the jail lifter behavior, uh, uh, is severe enough. Uh, so, so generally that's kind of how this, uh, this entire thing, uh, rolls together is, you know, just various episodes of care and nothing really kind of linking one episode to another. Speaker 2: 03:30 Uh, so the idea of what these, um, health healthcare hubs, as I understand them anyway, uh, you know, as a new idea, uh, but the, uh, the idea is that you will have a, a clinician or other caregiver, um, directly in contact with folks who, who need help and, um, you know, checking in with them maybe even daily, but, but quite regularly to make sure that medications are being taken and, and, uh, consultations are being gone to, you know, just to head off problems before they become severe enough to end up in an ER or, or heaven forbid, a jail cell. Speaker 1: 04:07 And that's in addition to also providing some crisis stabilization areas and the kind of emergency response that we have now. Is that right? Speaker 2: 04:16 That's right. I deal with what they say is they're really trying to shift, uh, from an emergency model to a kind of a chronic care model. You know, similar to what you would do for somebody with diabetes or another, uh, chronic disease like D where you know, you're checking in regularly, uh, and you're, you're kind of in a maintenance model instead of a crisis model. Speaker 1: 04:36 Now, the first two hubs are planned for Hillcrest and Escondido are others planned? Speaker 2: 04:43 Uh, they, they have said that the indefinitely intend to have one in South County and another one in East County. Uh, they haven't said where yet. Uh, so these first two, uh, you know, that because of the, uh, the Tri-City situation up in North County, uh, Escondido and Palomar health up there, that that has been given at something of a priority. Uh, you know, and then, uh, supervisor Nathan Fletcher's, uh, work with the third Avenue side and Hillcrest kind of elevated that one to, uh, to a first priority as well. Speaker 1: 05:14 Now for County board of supervisors that has traditionally been very fiscally conservative, this is a pretty big commitment by the board in terms of cost. What is the price tag of this looking like? Speaker 2: 05:25 I don't think anybody really has a firm answer to that, which is really quite striking. Uh, and they've said that these first two hubs would cost more than a hundred million dollars, uh, taken together. So that's, you know, quite a large investment, especially if you think that they also, uh, intend to build two more. Um, they've said that a lot of the more short term changes that they've proposed for chronic contracting and such, uh, we'll add something like $15 million per year to their operating costs starting, uh, not in this fiscal year, but in the next year 2020, 20, 21. Um, and, you know, the, the, uh, what they've said to me in interviews, uh, over the last six months or, or so is, you know, we think that we can be spending our money more effectively if we're spending less money paying for acute care in emergency departments, uh, and if we have less, uh, fewer people being jailed, uh, you know, we can afford to do more of this front end care where we're consulting with people, kind of what they call upstream, uh, from those, uh, chronic, uh, I mean, uh, acute situations. Speaker 1: 06:32 And what's the timeline for getting these hubs up and running? Speaker 2: 06:35 Uh, the, the initial timeline that they've given is five to seven years. So it's a, it's a ways out. Uh, yesterday at yesterday's, a supervisor's meeting, uh, several of the supervisors seemed a little, uh, taken aback by that timeline. Uh, I, I recall a supervisor, supervisor Fletcher saying, you know, is there any way we could sharpen that timeline and, uh, and accelerate it. Uh, so I think that's still kind of an open question. You know, this hub and, uh, and Hillcrest is, is to be a collaboration between the County, uh, UCS D and Scripps health. And they really haven't quite figured out yet. You know exactly how that would have worked. So I think the timeline would be a adjusted somewhat once they get something more from, in terms of a collaborative agreement. Speaker 1: 07:19 Okay. I've been speaking with reporter appall citizen who covers healthcare for the San Diego union Tribune. Paul, thank you. No, my pleasure. Speaker 3: 07:34 [inaudible].