A 5150 success! Now what?

John Taylor: December 14, 20120 Comments

First the good news: The mental health crisis center that reopened last May is a success – praised by clients and their families and welcomed by hospitals in Fresno County, particularly Community Regional Medical Center, as it’s helped ease the logjam of behaviorally challenged patients coming to emergency departments.

The Fresno County Board of Supervisors got a December 11 update from the leadership of Exodus Recovery, Inc., the private contractor that was hired to reopen the center on the old University Medical Center campus. It treats adults who are a danger to themselves, others or are disabled by a mental disorder – holding them for as long as 72 hours, on an outpatient basis.

“They’re a great partner,” said Donna Taylor, R.N., director of the county’s behavioral health department.

“Exodus has closed a huge gap in mental health services in Fresno County,” said Carolyn Evans, chairman of the Mental Health Board, a public advisory panel appointed by the supervisors. Clients are treated with compassion and respect, said Evans.

Exodus leadership praised both Community Regional’s emergency department staff and its security personnel, who also provide security at the crisis center. (Kudos to Brenda Diel, Garth Wade, Kevin Weaver and their staffs.) Exodus said it has room to accommodate more clients – it was budgeted to see 12 a day, is currently seeing 14 and expects that number to rise.

Now, a bit of perspective on the good news.

Until 2007, the county maintained trained staff at Community Regional to evaluate so-called 5150 patients. That year, the Board of Supervisors scrapped the staff and Regional’s status as a designated receiving facility. Every hospital in the county that had an ED became a receiving facility for behavioral patients.

In July 2009, in a budget-cutting move that was decried by hospitals and community activists, the county closed its crisis intervention center.

What happened next was a meltdown – EDs were overwhelmed. Community Regional’s 5150 volumes went from 250-300 a month to more than 600; Clovis Community saw its 5150 volumes increase 3-4 times. Community Behavioral Health Center saw a 20-25% increase in its average daily census. Length of stays in the EDs went through the roof.

As the meltdown was occurring, so too was a coming together. Facilitated by the Hospital Council’s Lynne Ashbeck, hospitals huddled with each other, law enforcement, emergency medical services, community activists and others to find new pathways to serve behavioral patients and to strenuously advocate for reopening of the center.

In January 2011, the supervisors acknowledged they’d made an error, and promised to “fast track” reopening of the center. Roughly 16 months later, the center reopened under contract with Exodus, which also runs centers in Los Angeles and San Diego counties.

That “ancient history” wasn’t formally recollected at the December 11 board meeting.

But the public wasn’t shy about raising other mental health needs – services for adolescents, integrating electronic health records among the various providers. There are a number of others – a statewide shortage of inpatient care beds, a shortage of beds for those on temporary conservatorship.

The reopening of the crisis center deals with the tip of the iceberg. It’s created some hope. Now comes the “what’s next and when?”
 

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