“Hospital emergency departments house homeless mental health patients for days — and sometimes weeks — while they wait for mental health bed capacity to open due to a severe shortage of inpatient and step-down unit beds.” — Sacramento County Grand Jury Investigative Report, June 2023
For California hospital leaders, the findings in a report released last week by the Sacramento County Grand Jury — “Mental Health Care for the Homeless: Who Cares?” — confirmed something they know well, that far more resources are needed to adequately deliver care to Californians in need of behavioral health services.
What’s especially notable about the findings from the grand jury, the only independent “watchdog” investigative body in Sacramento County, is that it doesn’t take a blue ribbon panel of experts to recognize that there simply aren’t enough staffed hospital beds to meet the needs of Californians — especially those in crisis — facing substance use and mental health disorders.
The report shines more light on a fragmented and inefficient system that — in addition to falling short for those in need of care for behavioral health conditions — also has a ripple effect on other people who need hospital care.
The system, in no way unique to Sacramento County, creates multiple challenges as emergency departments clog, ambulances are delayed in transferring patients, and psychiatric hospitals fill beyond capacity.
Today, Californians in nearly half of the state’s 58 counties have no local access to inpatient psychiatric care at all, and counties that do have local psychiatric beds need as much as double their current capacity to meet the growing need for crisis care.
More from the Sacramento Bee’s coverage of the report: “Even if someone has private insurance, the typical wait for a psychiatrist in the Sacramento area is about three months. Homeless men and women, who typically don’t have private insurance, often have to wait longer. That often leaves emergency rooms and jails as the only alternative for those in psychosis. Sacramento emergency departments, which are not designed for long-term stays, are sometimes housing mental health patients for as long as weeks.”
It doesn’t have to be this way. One solution is to support funding via Medi-Cal for additional psychiatric beds through the state’s budget process. Another path to improve services is found in the work of Behavioral Health Action, a coalition of more than 50 statewide organizations co-chaired by CHA and NAMI California, united to raise awareness about behavioral health issues through a blueprint for improved behavioral health care in California.
The blueprint calls for California to set and monitor goals to improve by at least 10% per year on several key indicators:
- Reduce the delay from onset of symptoms to engagement in treatment for mental health and substance use disorder needs.
- Reduce the disparities in behavioral health service utilization among racial, ethnic, and sexual orientation/gender identity populations.
- Reduce the proportion of individuals with mental health and substance use disorder needs in jails and prisons.
- Reduce the rate of re-hospitalization following a psychiatric hospitalization.
- Increase the number of children and youth receiving screening for behavioral health needs.
- Improve the satisfaction of consumers and families with the behavioral health care services they receive.
This is work that will take many years to advance and will take the partnership not only of California’s health care providers and community organizations, but state and local governments as well.
As always, hospitals stand ready to do our part.