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WHAT HAPPENED: Memorial Hospital announced this week it would close the only inpatient psychiatric care unit in Sonoma County in 60 days.

WHERE WILL PATIENTS GO: Patients with acute mental health crises may be sent out of the county for treatment; if there are no beds available elsewhere, they could end up at the county jail.

WHAT'S AHEAD: County officials say they are trying to set up an alternative, non-hospital facility.

A treatment crisis in Sonoma County could worsen when Santa Rosa Memorial Hospital closes its acute inpatient psychiatric unit, forcing patients to travel out of county for care, therapists and mental health professionals warned Friday.

Dr. Terry Scannell, clinical director of Creekside Mental Health Program in Santa Rosa, said the planned shutdown makes it even more difficult to respond to the closure in June of the county's own acute inpatient psychiatric facility.

"Shutting things down is not the answer," said Scannell. "When somebody is ill, they're not just a danger to themselves, they can be a danger to other people."

She and others said the closure likely will put greater pressures on local emergency room personnel, as well as law enforcement officials who often come into contact with patients with severe mental problems.

Art Ewart, the county's mental health director, said such concerns are overstated and that the county is trying to find ways to set up an alternative 16-bed, nonhospital psychiatric health facility.

Ewart acknowledged that closure of Memorial's Fulton Road facility could create severe inconveniences for patients and their families because they could be forced to go outside the county for care.

Scannell and other mental health professionals said relying on outside facilities, including hospitals with secure psychiatric units in Napa, Marin and San Francisco counties, as well as in Vallejo and Berkeley, is a poor solution and more inpatient beds are needed.

"If you're sitting in your emergency room, and you call down to Marin General and they don't have any beds, and then you call San Francisco to St. Luke's and they're full, you don't have any choice but to patch the person together and put them into the community," said Scannell.

She said "patching" someone up usually means an aggressive use of medication and setting up an outpatient appointment as soon as possible, which may not be for 72 hours.

Memorial Hospital announced Wednesday that it would close the psychiatric unit within 60 days as part of a cost-cutting plan that includes closing two other off-site patient care units and laying off 212 employees.

Officials at St. Joseph Health System, which runs Memorial Hospital, said closing the psychiatric unit was necessary because the operation has lost almost $22 million in the past three years, largely because of the cost of providing unreimbursed care.

St. Joseph Health officials said closing the facility will not undermine Memorial Hospital's ability to take over Sutter's health care access agreement with the county.

The impending shutdown of the acute care facility, however, drew expressions of deep concern from mental health professionals.

"It's a disaster for all segments of society; we're not just talking about people living under a bridge," said Dr. Richard Kirk, a practicing psychiatrist in Sonoma.

Kirk said that about half of the population will experience some sort of depression at some point in their lives; about 1 percent to 2 percent has manic depression and about 1 percent has schizophrenia.

Kirk said that relying on facilities outside the county is "irresponsible," because psychiatric facilities such as the one at Marin General are "experiencing the same problems we are."

Michael Fraga, clinical director of Ananda Institute, a nonprofit organization that provides psychological services in Santa Rosa, agreed.

Fraga, a psychologist who said he's also on staff at Marin General, said budget constraints have forced the local mental health system to resort to "case management."

"We've been having to go outside the county for years," Fraga said. "When you have to place somebody, it's bed-shopping time."

Dr. Jain Fairfax, a Santa Rosa psychotherapist, said sending people out of the county would be "disastrous."

"They're going to be far from their families, far from their support group, and then it makes the way back much more difficult," Fairfax said.

Ewart conceded that sending people out of the county creates a burden for families and patients. But he said local alternatives to hospitalization have lessened the need for acute inpatient care.

"Do we think the impact is going to be severe on the community? No," he said. But there will be problems. "There are going to be times where our psychiatric services are backed up with an inability to find a bed in Northern California."

Gary Bravo, medical director of Sonoma County Mental Health, said losing the Memorial facility would be "a shame," but that the the county has sufficient resources to deal with local mental health issues.

He said the county still operates psychiatric emergency services at a temporary holding facility at the otherwise closed Norton Center, where patients can be stabilized and can stay for up to 23 hours. The county has residential crisis units that offer an alternative to hospitalization for people undergoing psychiatric emergencies, he said.

Bravo and Ewart both said the county is trying to find a location for its planned psychiatric health facility.

But several mental health professionals said Friday that much more is needed.

Guy Gullion is a psychiatrist who worked for the Marin County mental health program for 13 years and for 10 years was also a doctor at Norton, formerly known as Oakcrest. Practicing psychiatrists are facing a "diminishing" safety net for their patients, Gullion said.

"Someone with a new onset of bipolar mania needs at least a week in a good psychiatric hospital," said Gullion. "That was frequently done at Fulton and Oakcrest. When you're manic, you tend to do things that are against the law or are publicly disruptive. You wind up in jail. It's a public safety issue. It's a public safety issue that the private sector hospitals don't find it profitable."

You can reach Staff Writer Martin Espinoza at 521-5213 or martin.espinoza@pressdemocrat.com.

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