Jail may become 'de facto' mental unit: Loss of hospital facility would put patients under county care, sheriff says



Sonoma County Sheriff Bill Cogbill said Thursday that closure of Santa Rosa Memorial Hospital's inpatient psychiatric unit could result in more mental health patients ending up in jail.

"There's not enough mental health services right now," Cogbill said, adding that jails are becoming "de facto secure mental health facilities."

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

St. Joseph Health System officials said closure of the psychiatric unit, planned for 60 days from now, was a difficult decision but that the operation had been losing millions of dollars over the past several years.

Supervisor Mike Kerns echoed Cogbill's concern and noted that the county eliminated 16 positions in mental health services last year and closed its inpatient facility, the Norton Center, because of state cutbacks.

"We were counting on some of these other facilities to provide that service within the county," said Kerns, adding that Cogbill is "exactly right" about the implications.

"And the cost of putting people in jail is a lot more than treatment facilities," he said.

Kerns said the planned closure is further cause for concern because it comes at a time when Memorial is negotiating with Sutter Health to take over Sutter's contracted county health care obligation.

"How are they going to pick up the needed services that Sutter is now providing if they're reducing their personnel by 212 people?" Kerns asked. "That is a concern."

The Fulton Road psychiatric unit is a secure facility that employs 55 people and, its director said, provides mental health services to those who are either a danger to themselves or others; in some cases, they can no longer feed or clothe themselves.

About 80 percent of the patients have either contemplated or attempted suicide, said Barbara Roush, the program director. They receive psychiatric counseling on a daily basis, as-needed one-on-one therapy, and intensive therapy through a minimum of 35 hours a week of support groups.

Jo Sandersfeld, vice president of mission integration for St. Joseph Health Systems, which runs Memorial Hospital, said the hospital had been in negotiations to expand services at the mental health unit since 2006. Talks included the contractor that runs the unit, Horizon Mental Health Management, the county and the property owner.

These plans included expanding services and staff to fully utilize the 38 beds licensed at the mental health unit. It currently is staffed to handle 18 patients with two psychiatrists on duty, Roush said.

But expansion plans fell through because of "barriers with this piece of property," Sandersfeld said.

Sandersfeld said closing the unit became necessary after years of financial losses. According to St. Joseph Health System officials, the psychiatric unit lost $7 million in 2005, $6.9 million in 2006 and $7.8 million in 2007. The losses represent the gap between the cost of patient care and the reimbursement from various sources for that care.

Nancy Dobbs, a member of Sonoma County's Health Action Council, a group formed to come up with solutions to local health system problems, said low reimbursement for mental health service is a chronic problem affecting providers across the country.

Dobbs, who also is on the board of directors of Palm Drive Hospital, said the closure will force mental health patients to seek inpatient psychiatric services outside the county and in emergency rooms, which can provide brief care.

"The staff in regular emergency rooms aren't trained to handle mental health, by and large," Dobbs said. "It really puts mental health patients and their families in an unfortunate and underserved situation."

Training also has been an issue for law enforcement, which is frequently called to assist people having mental health problems. Advocacy groups have complained that law enforcement personnel are ill prepared.

Last summer, as law enforcement and advocacy groups met on mental health issues, Cogbill announced a five-year, $360,000 program to improve deputies' crisis intervention skills. He said the closure of local mental health facilities was the catalyst for the plan.

On Thursday, several employees at Memorial's Fulton Road facility said they were told a day earlier that they would be losing their jobs. They said the loss will be felt hard because the facility serves not only Sonoma County, but families and patients all the way to the Oregon border.

They also were worried about their job prospects.

"There are no more services in Sonoma County," said one employee, who asked that her name not be used. "So unless you're going to work for private practice, there are no jobs here."

You can reach Staff Writer Martin Espinoza at 521-5213 or