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Supervisors approve Tri-City mental health agreement

San Diego Union-Tribune - 1/14/2020

With little further discussion, county supervisors swiftly approved a $17 million budget allocation that will build a 16-bed behavioral health unit on land owned by Tri-City Medical Center in Oceanside.

Tri-City's governing board approved the essential documents for the unit, which replaces one it shut down in 2018, during a special meeting Monday.

The pair of approvals ends 18 months of uncertainty regarding how Tri-City's sidelined psychiatric capacity will be replaced, though doing so will not happen overnight. Now that the shape of the deal has coalesced, experts estimate it will take between two and three years to design, permit and build the unit, which will be detached from Tri-City's sprawling main structure.

By the time the new facility is online, three to four years will have passed since Tri-City stopped admitting psychiatric inpatients, meaning that other facilities in San Diego County, especially Palomar Medical Center in Escondido, have quite a long way to go before their current patient volumes begin to decrease.

The county has said it intends to add a crisis stabilization center in Oceanside at its Live Well Center on Mission Avenue. Initial plans announced in 2018 to contract for a similar center in Vista never moved forward.

Dr. Luke Bergmann, the county's director of behavioral health services, said Monday that plans to build out the facility are moving forward and the crisis-stabilization center should be able to open in 2020. Once open, law enforcement would be able to deliver many who are detained on 5150 psychiatric assessment holds because they are deemed a danger to themselves or others directly to the center, sparing a trip to an accepting emergency department, generally in Escondido or San Diego.

The developments voted on Monday and Tuesday represent the first in what are expected to be a long chain of actions that attempt to take a more proactive approach to mental health care, extending access to counseling and care coordination that planners hope will result in fewer hospitalizations and fewer law enforcement holds.

Nick Macchione, director of the county Health and Human Services Agency, said that experience in prevention for heart disease and obesity, which have achieved results that have garnered the county nationwide attention for their success, convince him and others that aggressive prevention strategies can work without breaking the budget.

"We're taking the blueprint we've done on all of these other chronic conditions and applying it to behavioral health," Macchione said.

Those whose family members have long fought mental illnesses seem, for the moment, to have had a positive response to the plans as they've been laid out so far, especially to the idea of creating several county-run mental health "hubs" that would provide crisis stabilization and regular follow-up counseling on a walk-in basis.

Mike Bagby, a long-time member of the National Alliance on Mental Illnesses, said the Tri-City deal does seem to signal a new era and new thinking about how best to handle the region's mental health needs. But he knows that well-laid plans can still crash and sink upon the rocks of implementation.

"We are going to watch it closely but, hopefully, we have turned a corner," Bagby said.

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