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Mental health crisis center coming to Sacramento County. Mercy San Juan gives an early look.

Sacramento Bee - 7/9/2019

Jul. 9--Sacramento County and Dignity Health are undertaking an $18.7 million effort to relieve pressure on the region's psychiatric hospitals by opening a facility at Mercy San Juan Medical Center that will treat patients in behavioral health crisis for up to 23 hours.

Roughly 4,000 patients a year come to the emergency room at Carmichael's Mercy San Juan with a behavioral health crisis, said Rosemary Younts, senior director of behavioral health for Dignity Health, and that kind of volume is tough to match or beat in Sacramento County. Both Dignity and county officials, she said, recognized the region served by the hospital needed intensive crisis services.

"Most emergency departments are not the most appropriate places for patients in a mental health crisis," Younts said. "They're noisy. They're loud. They're very crowded. It often makes it worse for someone suffering from mental illness."

People often end up in the emergency room because they're a danger to themselves or others, said Ryan Quist, director of the Division of Behavioral Health Services at Sacramento County. Many come to Mercy San Juan because someone called 911, and an ambulance or law enforcement brought them into the emergency room. Others come on their own, Younts said, because they are suffering from extreme depression or anxiety.

"There is a huge psychiatry shortage where individuals aren't able to get their medication services, and so individuals often will go into crisis because their prescription has ended," Quist said. "This is another opportunity for us to help support people in those situations to keep them from moving to a higher level (of crisis)."

Quist, Younts and other officials planned to show off the new unit Tuesday morning to visiting dignitaries and Mercy San Juan staff. Quist, who has been in his position for only two months, credited Younts and his predecessor, Uma Zykofsky, with seeing how a crisis stabilization unit at Mercy San Juan would help Sacramento County residents and applying for the funding to fill the need there.

The lion's share of the 3,400-square-foot facility's cost -- $13.9 million -- comes from Proposition 63, now known as the Mental Health Services Act, which levied a 1 percent income tax on personal income above $1 million. The initiative was approved in 2004, and much of its funding goes to counties to do work in prevention, early intervention, infrastructure, technology and training.

Sacramento County leaders could have put other projects forward for a share of the funds, but after feedback from community members, they decided that the crisis stabilization unit at Mercy San Juan should be a priority. They sought the money from a pool of funding in the Mental Health Services Act set aside for innovation, and they won approval from the group that holds the purse strings, the Mental Health Oversight and Accountability Commission.

Quist and Younts said they felt the new crisis stabilization unit would secure innovation funding because psychiatric professionals have more time to evaluate the severity of each patient's condition, the unit offers a resource center where patients and their families get help with re-entry into their lives, and the project elicited both both public and private funding.

Dignity is kicking in $2.8 million for the modular structure where the crisis stabilization unit will be located and for its maintenance and upkeep, and Mercy San Juan will pay staff and contract out for psychiatric services. In addition to the Proposition 63 funds secured by Sacramento County, Placer County is providing some funding for its residents who seek care there. And, roughly $2 million in federal dollars is expected to be allotted toward the unit.

"It's not an easy thing to do, getting collaborations up and going," Quist said. "It took a lot of hard work from the county and Dignity to put this together. It took a lot of work from the community, and this is what the community has said they need."

Younts said that she and officials at Sacramento County looked at the best practices for running a crisis stabilization unit when determining what to include in the proposal.

For instance, psychiatric workers will have more time to provide trauma-informed care there after the emergency team has ensured the patient is medically stable, reducing the odds that patients will have to be detained for a psychiatric hold.

"Often these individuals are not necessarily in need of such intensive service, but they don't have some place to go to stabilize," Quist said. "Rather than requiring transportation all over Sacramento County for these individuals to get to the right level of service, we've co-located behavioral health services at this site. They're able to immediately connect to crisis stabilization services, which is ... probably the right level of care for most individuals."

And, if patients do need to be placed in a psychiatric hospital, he said, the crisis stabilization staff will have time to get them a bed in an appropriate setting.

"The big benefit is that this puts in another level of care for these individuals where we get to prevent unnecessary hospitalization," Quist said. "It's a benefit to the emergency department, in that they have the services right there on site. It's also a benefit to the behavioral health system because we're getting individuals to the right level of care. ... And, it's the right thing for the consumer because the consumer is being treated at the right level of care in the least restrictive environment."

If the psychiatric team clears a patient for release, Quist and Younts said, they can introduce them to peer and family navigators in the resource center to help them find resources to prevent a return to the emergency room.

Mercy San Juan has found that roughly half of the patients seeking the emergency department team's help for a behavioral health crisis get their health care covered through Medi-Cal, Younts said, and the resource center can provide them with more help connecting with the resources they need for care.

The resource center is separate from the common room where patients will receive treatment, Younts said. The treatment room will have reclining chairs where up to 12 patients can be treated at a time, she said, and the psychiatric team will be able to intervene to stabilize individuals, do psychiatric assessments, evaluate and manage medications, and perform alcohol and drug screenings.

"We're demonstrating a model that provides both medical and mental health care in one location and providing real-time intervention at the point of entry for individuals," Quist said. "It's timely care in the right environment."


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