For years, the county’s Psychiatric Health Facility — better known as the PHF (pronounced “The Puff”) — has been the subject of numerous exasperated Grand Jury reports mostly about the lack of needed bed space for people so mentally ill they posed a threat to themselves or others.
But this week, the supervisors heard a different story.
For the past two years in a row, inspectors with the State Department of Health Care Services have given the PHF the onceover and concluded there were no clinical deficiencies to report. According to Behavioral Wellness Director Toni Navarro, the two inspectors said they’d never experienced that before, not even once, let alone twice.
When asked directly by Supervisor Joan Hartmann whether the 16-bed facility was “big enough,” Navarro sidestepped, saying a more telling index was “flow” and “capacity.” Based on this year’s numbers thus far, the PHF is on pace to experience a 30 percent increase in the number of admissions — from 328 to 436 — but is doing a better job at freeing up limited bed space for those in acute crises, patients so sick as to warrant involuntary, or 5150, holds. They’ve done this by releasing patients with less severe diagnoses who are categorized as “administrative” rather than “acute” to step down facilities elsewhere.
Based on the numbers released to the supervisors, this shuffle appears to be working. In the previous two years, only 30 percent of the PHF patients were classified as “acute” at any given time. This year, 50 percent of the patients are classified as acute.
In years past, patients would stay for longer periods in the PHF, and the facility’s limited bed space would find itself be dominated by patients deemed less in need of acute care. This, in turn, created a log jam for emergency room doctors, who found themselves frustrated by the lack of options for the billowing number of acute-care mental-health patients confronting them.
In response, ER doctors started issuing their own 5150 holds. So, too, did local law enforcement agencies. This may sound rudimentary, but for decades, there was an ironclad but unwritten understanding that only the county’s Department of Behavioral Wellness could issue 5150 findings. For the ER doctors and law enforcement agencies to break with that tradition reflected the intense degree of frustration caused by the PHF’s limited number of acute-care beds.
After many years of intense political lobbying at the state and federal levels, the federal authorities governing mental-health facilities that receive Medicare reimbursements agreed to allow the 16-bed PHF to expand — but only by two. Again, this sounds like nothing, but given the strenuous and sustained political effort involved, it constituted a major accomplishment. The federal regulations stem from the dark days of mental health warehouses and the county had to jump through many hoops to get approval for just those two additional beds.
When Supervisor Hartmann asked Behavioral Wellness director Navarro whether she intended to add those two new beds, Navarro replied she wasn’t sure. It was a surprising answer given this history. Navarro added that the department has until 2027 to act.
Explaining this diminished sense of urgency, departmental spokesperson Suzanne Grimmesey noted the growing availability of suitable step-down beds to which PHF patients determined to not pose a potential threat to themselves or others could be released. This capacity, she explained, created the “flow” to which Navarro frequently alludes.
Behavioral Wellness currently has access to 44 step-down beds in the Crestwood mental-health rehab facility in Lompoc. Another 32 mental-health beds are slated to be built on the North County Jail property in the next several years. And Ventura County is about to start construction on a 110-bed mental health rehab facility for its own population. All this, Grimmesey said, should free up some of the space Ventura County now contracts for at Crestwood.
Tuesday’s discussion was an informational briefing only. Perhaps most striking was the absence of any of the mental-health advocates who have been relentlessly making the case for more PHF beds. No member of the public spoke.
The last question also went to Supervisor Hartmann. How many 5150 patients had to be readmitted? she wondered. It turns out 53 of this year’s 344 total admissions were admitted more than once this year. No one asked how many of those admitted reported having no home. It turns out that 87 reported being unhoused at the time of their admission.
