The psychiatric unit at Sutter Medical Center in Santa Rosa, a crisis center for those so mentally disturbed that they are a threat to themselves or others, is set to close at the end of 2008.
Sonoma County now must decide on an alternative to the 30-bed Norton Center psychiatric unit, formerly Oakcrest, that for almost four decades has kept the most troubled patients under locked care.
Sutter is bowing out because its agreement with the county to shelter the psychiatric program ends in 2008, and psychiatric inpatient care is not compatible with its long-term plans, a spokesman said.
In response, county officials are developing community programs for less-dangerous patients, while searching for a hospital in Sonoma County or elsewhere in Northern California to care for those with more serious mental problems.
"It's imperative we provide services to this population," said Supervisor Mike Kerns, a former police officer who serves as the board's liaison with county health services. "Coming from a law enforcement background, I'm very much aware of the necessity for this kind of a facility."
Concerns are being raised that some people who need treatment could fall between the cracks, winding up on the streets or in jail.
"If there is no acute care inpatient facility, you're going to see an unwarranted stress on the criminal justice system with people put in jail who don't belong there or, if intervention is not pursued, people participating in crimes," said Chris Andrian, a criminal defense attorney in Santa Rosa.
Kaiser Permanente and Santa Rosa Memorial Hospital also operate psychiatric units but accept only a limited number of patient.
Sutter, which took responsibility for Community Hospital's programs when it took over the county-run facility in 1996, is re-evaluating many of the hospital's services.
The Sacramento-based health system also is considering cutting the budget of its family practice residency program and seeking community financial support to sustain the program, which treats the poor and has brought many physicians to practice in the county for more than 70 years.
The psychiatric inpatient facility at Norton Center, which has operated since 1969, originally was part of Community Hospital. It's a locked unit, meaning patients are there involuntarily and cannot leave when they choose.
Most of the hundreds of patients who pass through its doors each year are sent by the legal system or their families because they threatened suicide or homicide, are incompetent to stand trial or are gravely mentally disturbed.
They stay for short periods, usually less than 30 days, until they can be released into the community or transferred to another care facility.
The psychiatric unit loses money each year, but it is the county, not Sutter, that takes the hit. Sutter pays the county about $8 million a year to manage the unit, then collects reimbursement from Medi-Cal, Medicare or other insurers. If those reimbursements don't total $8 million, the county pays Sutter the difference, said Mitch Proaps, a Sutter spokesman.
"It was never our intention to maintain the inpatient psychiatric unit," he said. "It just isn't one of our core services. Sutter Health facilities throughout the system traditionally do not have psychiatric units."
The county will be responsible for providing the psychiatric services when the agreement with Sutter ends Dec. 31, 2008. But when the county turned over Community Hospital to Sutter, it also relinquished the license to operate an acute care facility.
The county can't operate the Norton psychiatric unit without the license, so it will have to find another hospital to take the patients, Supervisor Mike Reilly said.
"We're going to need to find alternatives," he said. "The question is, what alternatives are available and where are they? There are probably more than 20 counties operating without psychiatric inpatient facilities, so other people are doing it."
Finding a hospital within the county to accept the psychiatric patients is critical, Assistant Sheriff Gary Zanolini said.
Some of the smaller cities have only a few police officers on duty at a time, and the time it takes to transport a patient to another county would pose a substantial hardship, he said.
County health officials expect to present some of their strategies for psychiatric care to the Board of Supervisors at the end of March.
"We can't abandon this population," said Art Ewart, head of the county's Mental Health Services Division. "We are looking at alternative levels of care and how to treat the population in another way."
"Right now, it's one size fits all. But if someone is depressed, not psychotic, they don't need to be here," Ewart said.
The closure of the Norton Center follows a series of closures of psychiatric health facilities around the state, including in Redding and Nevada and Siskiyou counties, said Randall Hagar, a director with the California Psychiatric Association in Sacramento.
"We've lost 500 acute-care beds for psychiatric patients in the last four to five years," Hagar said, referring to patients who are considered dangerous to themselves or others. "Reimbursement is very, very poor for psychiatric facilities."