Two-fifths of admissions to mental hospitals can be prevented.

That’s the conclusion of a new report, filed Tuesday with the county board of overseers, that provides the most detailed report yet on how the region’s overwhelmed behavioral health system can be reshaped. Information is provided.

The plan, dubbed the county’s “optimal care pathway model,” avoids significantly increasing the number of hospital beds dedicated to mental health care across the region, instead limiting facilities such as nursing homes and “respite centers.” We anticipate an increase in investment in locations with less It is more effective in solving the current mental health crisis in the long term.

Overall, the report suggests that increasing the modest resources available to people in the early stages of the disease can significantly reduce the need for the most restrictive types of care. In other words, significantly increasing hospital-level resources is a bad investment. .

“Many of the systemic pressures we’re feeling right now don’t reflect the dramatic increase in the prevalence of serious mental illness,” said planner and San Diego County Behavioral Health Coordinator. “This reflects the fact that there is no continuum of care designed based on what we know about behavioral health,” said director Luke Bergman.

After reading the document, Poway resident Linda Mims, vice chair of the Schizophrenia and Psychosis Action Network, an advocacy group active in Southern California, said she appreciates the big picture, but the details. He said he was concerned about

Too often, today, people suffering from severe mental illnesses such as schizophrenia cycle to and from hospital units due to the lack of beds, she said. A long-term plan to fix the mental health system that doesn’t promise to increase it feels like it doesn’t fully address the needs facing communities today.

“I really care about the sickest people who don’t even know they’re sick, those who have been left out of the line of care and are on our streets and in prisons. “We really need to dedicate significant resources to that population.”

Bergman said he agreed that more beds are needed here and now, pointing to ongoing projects such as increasing capacity at Tri-City Medical Center in Oceanside and Alvarado Hospital in La Mesa. requirement.

But he added that research shows that a long-term mindset shift is also needed.

“Right now we really have a system defined largely by iterations of crisis management, but I think those dominance can be reshaped and recalibrated,” Bergman said. There is still an absolute need for inpatient psychiatric treatment, as well as a carefully applied guardianship system.”

new road

The county worked with Public Consulting Group, a national firm specializing in public sector process improvement, to build a model and analyze data on current patterns of care.

Bergman believes the effort is comprehensive enough to pinpoint what needs to change, with a core belief that more preventative strategies could work. left to him.

“This is a very rigorous analytical exercise, and what we’re saying is that we believe we can prevent 40% of the use of inpatient care,” Bergmann said. “If these sound like bold statements, they should, because the changes needed for behavioral health are dramatic.”

The biggest new investment will come in the part of the system designed to work pre- and post-hospital.

On the front end, the model is a “crisis rest” center that provides up to a week of low-intensity treatment for people who may initially be brought to one of the region’s growing number of crisis stabilization centers. Seeking creation. You can sit in a reclining chair and stay under psychiatric supervision for up to 24 hours.

Respite centers offer a longer route, perhaps operating in housing or other modest “warm and welcoming environments”, with a mix of peer workers and clinicians trained to provide higher levels of care. increase.

The model predicts that approximately 126,000 days of respite care will be required to meet local demand. The number of bed days represents the amount of time the patient receives treatment. For example, 7 days in hospital is equivalent to 7 days in bed.

peer support worker

Adding new categories of residential resources is a particularly ambitious goal given the current shortage of mental health workers. A recent report from the San Diego Workforce Partnership puts the community at: We need an additional 8,000 talented people to meet current demand, and nearly double our size to meet future demand.

The respite plan will take advantage of upcoming state-level changes that will formalize a commonly trusted category of mental health workers called peer support specialists. It’s especially effective for working with people who have recovered from an episode and are in the process of dealing with a similar situation.

Whether leading peer support groups, encouraging people you work with to take prescribed medications, or ensuring counseling appointments, peer support is increasingly accepted as a fundamental resource that underpins mental health care systems. It is

In California, the job has always had an informal connotation, but that changed in 2020 with the passing of a bill allowing peer support workers to take state proficiency exams and become certified. started. A full testing system is not yet operational, but it is expected to soon provide a path to better salaries and Medi-Cal reimbursement.

Bergman has seen certified peer support workers greatly expand the reach of the mental health workforce in Detroit and New York, where he worked before returning to San Diego. He said that outreach is particularly effective in treating people with substance abuse disorders that are causing symptoms of psychosis.

“Peer support has been demonstrated in rigorous research to be particularly effective in keeping people engaged in care and preventing future crisis episodes,” Bergman said.

At this time, many people who could have been better served at respite centers received little or no treatment until someone called 911, forcing hospitalizations that could have been avoided. he said.

long term treatment

The county’s plan suggests investing more in skilled nursing centers for those who need more intensive support due to mental illness. Currently, there are not enough “step-down” beds to handle the demand for long-term care some patients require, resulting in many patients spending months or years in the ward.

A particularly significant increase is recommended for skilled nursing facilities specializing in neurobehavioral therapy. The region is said to currently provide approximately 4,000 beddays of care per year, but modeling predicts that this resource will need to increase 13-fold to provide approximately 55,000 beddays per year. doing.

Another category concerns places where people who have recovered from severe mental illness can live after receiving treatment. In recent years, the region has seen a sharp decline in “board and care” and other adult residential facilities, as well as residential care facilities for the elderly. A good number for this category is about 233,000 bed-days, nearly three times the 88,000 currently available, according to county research.

Mimms said she sees a strong need for both long-term care and places for people who spend months or years in mental health facilities to be discharged and returned to their communities. But she remains skeptical that skilled nursing centers can serve patients who often have trouble recognizing their need for treatment.

“I don’t think putting someone in an unlocked facility will do anything for someone who has a severe mental illness and can’t be stabilized quickly.

Bergmann said neurodevelopmental skilled nursing centers can operate locked units but don’t have to.

The plan supervisors will discuss Tuesday is a roadmap that doesn’t go all the way to specific initiatives in specific locations with specific numbers of beds.

Cost is also a big open question, but the roadmap suggests that reducing mental health-related hospitalizations would save money and free up resources that could be put into proposed community-level resources.

The county’s latest behavioral health update also indicates that the region’s next crisis stabilization hub will be built in El Cajon, though no specific location is listed.