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The Norton Center this week ends four decades as Sonoma County's primary hospital for the mentally ill.

Emergency psychiatric services will be offered at the Chanate Road facility in Santa Rosa, but starting Tuesday patients who need more than an overnight stay will be transferred to other facilities, most of them out of the county.

In some ways it marks the end of one era and the beginning of another.

Since passage of Proposition 63 in 2004, California's money and energy has turned away from acute, inpatient treatment of mental illness and toward outpatient, community-based treatment.

The closure of Norton, once known as Oakcrest, is part of that shift.

"It's good in that it shows belief in the recovery model, but it negates the fact that there are still psychotic breaks happening that need acute care," said Jennifer Hedgpeth, president of the Sonoma County branch of the National Alliance on Mental Illness.

Art Ewart, director of mental health services for the county, said the change does mark a milestone, but stressed that people needing help will continue to get it in Sonoma County.

"For clients requiring hospitalization, that can be arranged at any hour," Ewart said. "And as far as our emergency services, nothing is changing."

The county hopes to open a 16-bed inpatient facility to replace Norton, but neither a site nor an operator has been identified. Ewart said it will be a public-private partnership.

As part of the shift away from acute care, the county increased capacity in its Crisis Residential Program facility on Montgomery Drive in Santa Rosa. The six-bed transitional program accepts voluntary clients and offers psychiatric treatment in a non-hospital setting and is staffed 24 hours a day, seven days a week.

Norton's closure has been anticipated since March 2006, but the timing originally was to coincide with the end of a lease with Sutter Health in 2008.

For the next several months, maybe longer, mental patients needing hospitalization will be referred to other facilities: Memorial Hospital's Behavioral Health unit on Fulton Road in Santa Rosa, St. Helena Behavioral Health in Angwin or Vallejo and the Solano County Psychiatric Health Facility in Fairfield.

However, Santa Rosa Memorial Hospital earlier this month laid off staffers and reduced the size of its psychiatric facility from 30 beds to 18 beds. Memorial also recently closed an outpatient mental clinic in Petaluma.

"I think the big players are hunkering down and trying to maximize profits and the community is suffering for it," said Dick Kirk, a Sonoma Valley psychiatrist and veteran of the county's mental health system.

"So far the other players at the county and state level have not stepped up to the plate yet to help offset the impacts and, as usually happens, the people who are poor or chronically ill will be affected most," Kirk said.

Norton's closure comes amid heightened scrutiny of how Sonoma County deals with its mentally ill. Law enforcement agencies have had three fatal encounters with mental health patients in recent months.

In March, Sebastopol teenager Jeremiah Chass, who appeared to be having a psychotic episode, was shot and killed by sheriff's deputies. In April, Jeanne Hoyt was killed by her paranoid schizophrenic son in Rohnert Park. Later in April, Santa Rosa police shot and killed Richard DeSantis, a man with bipolar disorder who reportedly stopped taking his medication.

This month, Sonoma County Sheriff Bill Cogbill proposed a five-year, $360,000 program to improve deputies' crisis-intervention skills when they confront mentally disturbed people.

Although the proposal came after a call for more law enforcement training in the wake of the shootings, Cogbill said his main motivation was to prepare for cutbacks in services for mentally ill homeless people.

Before a training program or a new county mental health facility is up and running, it's business as usual for Santa Rosa police and Sonoma County sheriff's deputies.

"Our officers will still take 5150s (police code for mentally unstable suspects) to the same facility, we'll still file the same paperwork, the same insurance forms, everything," Santa Rosa Police Capt. Tom Schwedhelm said.

"The psych emergency services will still be fully functional, so, from our perspective, nothing is changing," Assistant Sheriff Sean McDermott said.

Others say losing Norton as an inpatient option will change the landscape of care in Sonoma County.

"For anyone in the midst of a psychotic break needing some inpatient hospitalization, there will be a scramble for beds and it could lead to destinations like Oakland, Vallejo, St. Helena or Solano County," Hedgpeth said. "Then there is the possibility of going to the jail, where at this time there are 70 mentally ill people detained."

Oakcrest opened in 1969 as a locked unit of the county-run Community Hospital, since taken over by Sutter Health. Patients usually are not admitted voluntarily to locked units and they are not free to leave.

Many of the estimated 45,000 people who have passed through Norton were sent by the legal system or their families because they threatened suicide or homicide, weren't competent for trial or were gravely mentally disturbed.

They stayed for short periods, usually less than 30 days, until they could be released into the community or transferred to another care facility.

Norton's daily average of patients has been steadily dropping for years.

"In the last six months, we've gone down from an average census of 12 to about five," Ewart said. "Years ago, the average was usually 24 to 27."

Although costs declined along with the number of patients, the county was paying Sutter millions of dollars a year to make up the difference between the cost of patient care at Norton and the reimbursement Sutter gets from insurers. Over the past five years, the county has paid Sutter about $10 million, Ewart estimated.

If the center remained open through December 2008, the county would pay out a projected $18 million, Ewart said. The health department's annual budget is $144 million.

Most of the 49 employees in Norton's inpatient facility found other jobs in the county or private industry. Six county employees were laid off and 14 per diem workers were dismissed.

Memorial laid off 14 in its reduction of the psychiatric unit on Fulton Road.

You can reach Staff Writer George Lauer at 521-5220 or george.lauer@pressdemocrat.com.