Despite a rash of teen suicides and hundreds of children in need of emergency mental health care each year, Northern California’s most populous county does not have a single inpatient psychiatric bed for young people.
But now, with overwhelmed community agencies and desperate parents seeking crisis care as far away as Concord, Vallejo and even Sacramento, Santa Clara County supervisors have vowed to fund a new psychiatric facility for children by June. The move comes as epidemiologists from the U.S. Centers for Disease Control and Prevention head to Palo Alto this month on an urgent mission to study suicide “clusters” near two local high schools.
“There is no question” the inpatient facility is needed, said child psychiatrist Thomas Tarshis, echoing a broad consensus of local mental health professionals. “No child should be denied access to the best scientific treatment for whatever illness they have, and right now Santa Clara County is missing a significant piece.”
As a result, as many as 20 county youths are in far-flung psychiatric hospitals on any given day suffering from deep depression, excessive anxiety, self-harming behaviors and other episodes of psychosis. More than 600 of the county’s children seek inpatient treatment outside of the county each year, since the only local facility shut down about 20 years ago.
And because hospital stays typically last about a week, parents struggle to visit while caring for other children, maintaining jobs and traveling for hours each day if they cannot afford to rent hotel rooms.
In recent months, a group of mothers has lobbied county supervisors to solve the problem, which has persisted for years but was not acted upon by county officials until Supervisor Joe Simitian took up the cause a year ago.
Proposals for an inpatient unit serving 5- to 17-year-olds will be solicited in the coming weeks, with a provider selected by May. So far, no details about possible locations or cost are available.
Sarah Gentile, of Los Altos, scrambled to get crisis care for her teenage son to get him through his severe depressive episodes. In 2014, when the 17-year-old revealed to his psychiatrist that he had a suicide plan, a doctor at El Camino Hospital’s emergency room in Mountain View had some troubling advice.
“The first thing he said to me was: ‘We need to call around and find a place that will take your son,'” Gentile recounted. “I said, ‘What are you talking about?’ And he said, ‘We don’t have any psychiatric beds for children here.'”
There is one program, run by the nonprofit EMQ FamiliesFirst, offering seven emergency beds for psychiatric patients in a county that is home to more than 430,000 young people age 17 and younger. But the EMQ beds can be used for only 24 hours.
At Gunn and Palo Alto high schools alone, teens were hospitalized 50 times last year for being a threat to themselves or others. In 2014 and 2015, one former and three current students took their own lives. Those deaths followed six similar cases in 2009 and 2010 — tragedies that mostly occurred on the Caltrain tracks by the two schools and have terrified local residents.
Hoping to reach youth in crisis who display early warning signs, county officials and community-based providers say a hospital unit would enhance other prevention efforts underway. “Mental diseases and disorders” are by far the number one reason California children are hospitalized, according to the Lucile Packard Foundation for Children’s Health — well above fractures, viruses, seizures and asthma. Nearly 40,000 Californians ages 5 through 19 were hospitalized for mental health reasons in 2014 alone.
In Santa Clara County, youths are initially brought to hospital emergency rooms. But when inpatient care is needed — if youth have overdosed on pills or carved their arms so deeply they need stitches, for example — caregivers and families must find bed space elsewhere.
The lucky ones find room at Mills-Peninsula Medical Center in San Mateo or Fremont Hospital in the East Bay. Still others have to transport deeply troubled kids as far away as Bakersfield, hundreds of miles away.
“This is just hell on kids and their families at one of the toughest times in their lives,” Simitian said. “It’s a challenging problem but a solvable one.”
Some parents have testified in public meetings about choosing not to hospitalize their kids because the only available facilities were too far away. And some teens say the time it takes to be assessed and then transferred to an out-of-county hospital in the middle of a crisis is simply too much to handle, said Christine Tam, a director with the school-based Adolescent Counseling Services in Palo Alto.
“They worry that they’re going to get into this messy bureaucratic-type experience,” Tam said. “It’s dangerous for kids to have the perception that we’re not going to serve them in a caring way that’s efficient because then they’re resistant to share with an adult that they may be depressed or having suicidal thoughts.”
The reasons for psychiatric crises in young people are complex, with explanations that can vary by socioeconomic status, said Laura Champion, EMQ’s executive director — from the stress of poverty, foster care and homelessness in low-income communities to “debilitating and pervasive cyberbullying” and “unrelenting expectations” in wealthier areas.
Ideally, a new inpatient facility would stabilize distraught kids in a safe and secure environment for as long as is needed. Experts say successful hospital interventions rely on close family involvement, with visits as often as twice daily. Most essentially, after-care planning should begin upon admission, with a discharge plan providing seamless links to at-home support. That critical piece is difficult to ensure across multiple county lines.
Tarshis, who teaches at Stanford and runs a nonprofit mental health agency with hundreds on the waiting list in San Jose, said the new facility must also protect children from excessive prescribing of psychiatric drugs. Tarshis said he took a job in the adolescent unit at Mills-Peninsula because his agency’s clients were being inappropriately treated there by psychiatrists who normally treat adults — “overmedicated, misdiagnosed, and sent out of the hospital with no real care.”
“Yes, we need our own hospital, but we have to do it properly, or we’re just going to propagate the problem,” he said. “Anything is better than what we have now.”
A group of parents whose children have particularly complex physical, behavioral and emotional challenges have urged the county to create a psychiatric unit attached to a full-scale hospital.
Stanford law professor Alison Morantz, whose mildly autistic and severely aggressive son was first hospitalized at age 8 when he developed severe psychosis, says crisis help is needed for young children like her son, whom she calls “my polka-dotted swan.”
“It’s not that he needs a hospital for polka-dotted swans,” Morantz said. “But the basic characteristics of a hospital should support a child with any needs — including my swan.”
Contact Karen de Sá at 408-920-5781.