As a full-time child and adolescent psychiatrist in Sonoma County, I find working here like practicing in the Australian Outback. Except there are probably more resources available to patients and families living in the Outback.
When the Memorial Hospital Fulton Campus inpatient unit closes, the situation for adults in need of acute behavioral health care will be just as bleak as it is now for kids and teens in crisis.
I became a psychiatrist because mental pain and anguish are often worse than physical pain and suffering. At least with physical pain, one has a pretty good idea where it is coming from and what to do about it. When emotional and psychic pain become overwhelming, the situation can be more dangerous than physical illness. That's where a locally accessible inpatient psychiatric hospital can be a lifesaver.
When I needed to hospitalize one of my patients, immediate access to the Memorial Hospital inpatient unit as a local resource helped save her life. Struggling with severe depression, she held on bravely for weeks until her psychotherapy and medication could kick in. Unfortunately, it wasn't enough, and the depression worsened to the point where she had made up her mind that living was more painful than the alternative.
Her family had been exceptionally supportive through the process, and they were doing everything they could to hold on. But, at this point of crisis, the Memorial Hospital inpatient unit and staff provided a safe haven where her healing and recovery process truly began.
I worked at another local psychiatric inpatient unit, Ross Hospital in Marin, which served countless kids and adults from Sonoma County until it was closed in 2000. This has left a huge hole that has not been filled: Vallejo is the closest venue for inpatient child and adolescent inpatient psychiatric care.
The only remaining inpatient psychiatric units in the area are in San Francisco, Berkeley, Sacramento and Concord.
While distance alone presents an undue barrier to care for our patients and families, these remaining inpatient units are often full and unable for days to accept our local patients in crisis.
Without any local inpatient resources, emergency rooms and hospitals provide patients with costly care as they wait for a bed to open up.
One of my patients sat for days at the county's Psychiatric Emergency Services unit because no local hospital beds were available.
He was ultimately sent by ambulance to a hospital in San Bernardino, while others are sent to Sacramento on a routine basis. Imagine what these ambulance rides cost our taxpayers.
Herein lays the paradox of our broken mental health system. Doctors understand the most about mental illness and how to help individual patients, but they are powerless over the design and implementation of the mental health "system of care." Mental health administrators understand the most about the system, yet they know very little about what individual patients need.
The Southern Californian owners of Memorial Hospital, Sisters of St. Joseph of Orange, can't be blamed for pulling the plug on the Fulton Campus inpatient psychiatric unit.
As with the closure of Ross Hospital and multiple psych hospitals across the country, inpatient units have been falling like dominoes for over 10 years in Northern California and nationwide.
These are financial decisions.
In Memorial's case, the unit was losing money due to the high cost of staffing, personnel and overhead.
In the 12 years I have practiced in Sonoma County, our community mental health system has closed or restricted access to: the County Mental Health Resource team on Farmers Lane, the Norton (Oakcrest) Inpatient Unit, the FACT team for jail and offender aftercare and now the Orenda Center. Psychiatric Emergency Services remains open because it is a mandated service.
Our chronic mentally ill patients and other community members in psychiatric crisis are unlikely to burden San Francisco or other Bay Area counties. They may not make it that far to evaluation.
The burden of care for major mental illness will fall upon families, police and sheriff's departments, community support agencies or local hospitals, emergency rooms and, of course, the mental health unit of last resort: the jail.
I worked in the jail for three years with dedicated correction officers and mental health workers.
But, it is a sad commentary on our society that we are funding jail and forensic mental health care as more mentally ill wind up in jail.
An inpatient psychiatric service is a vital safety net that saves lives.
Perhaps some kind of an arrangement between Kaiser, St. Joseph's, Sutter and the county of Sonoma will be the only way to piece together a framework for a sustainable local inpatient unit.
In the meantime, we as a community will suffer the consequences of more mentally ill on the streets and in jail without the safety net of local access and expertise of an inpatient psychiatric hospital.
This column is a weekly opportunity for a voice from the community to make real-life experience relevant to an issue of the day. If you are interested in contributing, contact Senior Editor Chuck Buxton at 521-5246 or chuck.buxton@ pressdemocrat.com
