California offers little for young people with mental health issues

Dr. Deborah Thurber sometimes uses this chart to see how a child is feeling. She is a child psychiatrist overseeing county medical services for children with mental issues. The number of kids being placed on involuntary mental health holds has doubled in the county and they often must wait for days to get into a psychiatric hospital. Juan Carlo/THE STAR

This story originally appeared in the Ventura County Star.

Ventura County is on the front line of a statewide trend: increasing numbers of children and teenagers are being hospitalized for mental health emergencies, while the crisis services that might prevent those hospitalizations too often are unavailable.

Mental health crisis services can range from mobile response units to short-term residential facilities. Many counties offer few or no such services for children.

In 2013, the number of Californians 21 and under landing in the hospital in crisis was up 43 percent compared to 2007 - from a little more than 34,000 hospitalizations to almost 49,000. In Ventura County, such hospitalizations were up 26 percent.

A statewide shortage of psychiatric beds means that children in crisis can end up waiting for days in the emergency room before a bed becomes available - and even then, may be transferred to hospitals hundreds of miles away from their families.

In 2014, the state legislature set aside $200 million to create new mental health crisis facilities and services, but advocates say little of that money has gone specifically to help children and teenagers.

Rusty Selix, executive director of the state Mental Health Association said children’s services are generally not viewed as a big priority because the need for adult mental health services is ten times as big.

Even in those counties that do decide to offer services to children, including Ventura County, the array of what they offer is generally incomplete, advocates say. Ventura County has a mobile crisis response team that can help children experiencing psychiatric emergencies in their homes and schools, for example, but has struggled to figure out where to send young people who need a place to stay.

Earlier this year, Assemblymember Das Williams (D-Carpinteria) introduced legislation to license crisis residential services, an alternative to hospitalization that exists for adults but not for children. Ventura County is working to create such a facility.

Currently, Williams said, 47 out of 58 counties in the state have no psychiatric hospital beds for children under the age of 12. Without local crisis residential facilities, he said, young children who have attempted suicide are often shipped across the state — away from their families — to one of the few counties that do have available hospital beds.

“It’s just a perverse system,” he said.

Melinda Bird, an attorney with Disability Rights California, said a lawsuit against the state is possible if counties don’t start providing more comprehensive children’s crisis services.

“But the best would be if counties did it on their own,” she said, “and some have.”

“We’re in this enviable position where we actually know what works,” she added.

Attorneys from six legal services organizations signed a letter to the director of the state’s Department of Health Care Services in May, calling upon the state to require counties to provide children’s crisis services.

“DHCS has failed to ensure that counties actually provide children’s crisis care, including mobile crisis intervention, and that the care that they do provide is adequate to meet the need of children in the county,” the letter stated, stating that the provision of such services is mandatory under federal law.

Norman Williams, a DHCS spokesman, said in an email that the department takes the concerns outlined in the letter “very seriously” and is surveying county mental health plans to better assess the scope, capacity, and availability of crisis services for Medi-Cal-eligible children.

Pat Ryan, interim executive director of the County Behavioral Health Directors Association of California, said requiring all counties — large and small — to have the same array of crisis services is unrealistic, both because of the expense involved, and because of the shortage of mental health professionals in many areas of the state.

“When I query our members about whether there is a crisis in the availability of crisis services, they don’t believe that there is,” she said.

As it is with other mental health services, the storyline differs greatly depending on where you live.

“It really varies from county to county,” said Carroll Schroeder, executive director of the California Alliance of Child and Family Services. “You have some counties that are terrific and doing a lot of great stuff, and other counties that are doing the minimum to get by.”

While advocates, providers and families say the need for better crisis services is acute, some counties say providing them is simply too expensive.

“It has to be based on the community to some extent, because you cannot provide all of these things to everybody in every community, because the resources just aren’t there to do it,” said Ryan, of CBHDA.

Even Alameda County, which has a number of innovative crisis services, recently shut down its children’s mobile crisis unit.

Jeff Rackmil, director of the county’s children’s system of care, said the mobile response unit was simply too expensive to sustain given how few children it served.

“That jury’s out,” he said, on whether it will eventually be reinstated. The county already has a crisis stabilization unit for adolescents, he said, and is applying for funding to build a crisis residential unit for young people.

“Crisis residential is without a doubt needed,” he said. “That’s very clear. Unequivocally, it’s a hole in our system. You have kids who turn up (in the hospital) over and over again.”

More Stories from This Project

California launches audit of mental health services in schools

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The first time Emily tried to kill herself, at age 15, she swallowed the entire contents of a bottle of Prozac, along with some Sudafed and Claritin she found in the medicine cabinet.

Hospitalizations way up for California’s youngest residents

In recent years, Dr. Jason Bynum has seen the churn: teens in crisis cycling through his south Sacramento psychiatric hospital, admitted, released, and just a few months down the road, back with another breakdown.

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