More than three years after the need became acute in coastal North County, local law enforcement officers now have a new place to take those they pick up on mental health calls, allowing them to quickly transfer custody and get back on their beats, skipping the often hours-long emergency department waits that such work usually entails.
A crowd gathered at a nondescript shopping center in Vista Thursday to celebrate the opening of the Vista Crisis Stabilization Unit, a newly remodeled space to be operated by Exodus Recovery Inc. and offering short-term assessment and treatment to those with immediate behavioral health needs. By law, such units can offer just under 24 hours of care, providing a quiet and calming place where trained staff can determine whether longer-term treatment is necessary.
Traditionally in San Diego County, stabilization units have been part of hospital-based psychiatric units. Vista’s location is the first stand-alone unit in the region, though the county is nearly ready to open a second stand-alone unit on the ground floor of its Oceanside Live Well center in the coming weeks.
Dr. Luke Bergmann, the county’s director of behavioral health, said the two North County units are early signs of sweeping changes to the basic philosophy of mental health care. Additional similar units — the next is likely to pop up in East County — will be part of service hubs designed to provide more locations for early treatment, hopefully reducing the need for long-term stays in locked hospital-based psychiatric facilities.
“We see this as a linchpin in the regional distribution of care and direction of people needing care,” Bergmann said. “We aim to proliferate this kind of service pretty dramatically.”
Tri-City Medical Center in Oceanside provided the spark that ignited the county’s current mental health rethink in 2018 when its leaders announced they would close the public hospital district’s inpatient mental health unit and crisis stabilization center, citing the need for significant safety upgrades and ongoing financial and staffing issues.
Today, the hospital’s inpatient mental health capacity remains shuttered. In early 2020, the county gave Tri-City $17 million to build a new 16-bed behavioral health hospital on vacant land on the western side of the hospital campus.
Though a completion date for the Tri-City facility was not available Thursday, records show that plans were submitted to the Office of Statewide Health Planning and Development in June.
The Tri-City shutdown in 2018 put additional pressure on other area hospitals — especially Palomar Medical Center in Escondido — to take up the slack.
There were 1,109 people picked up on “5150" holds in Oceanside alone in 2020, according to city records. 5150 refers to the section of legal code that allows law enforcement to restrain and detain those who, in their judgment, may be a danger to themselves or others. Though the most-severe cases will still need to be taken to hospitals, a significant percentage is expected to be dropped off at the Vista center, which opened at 9 a.m. Friday.
Because they are not located in hospitals and are not connected to general-purpose emergency departments, stand-alone crisis-stabilization centers offer a more streamlined arrival process. There is no chance that patients with more immediate life-threatening health care problems from heart attacks to strokes will continually push mental health patients lower on the triage list.
Undersheriff Kelly Martinez of the San Diego County Sheriff’s Department noted during Thursday’s opening ceremony in Vista that law enforcement officers tend to keep those brought in on 5150 calls restrained until they can be transferred to the custody of health care providers.
“Spending eight hours with a deputy sheriff in handcuffs in an emergency room is just not acceptable,” Martinez said. “It’s not the way that it should be.”
The problem has been that patients too often get treatment only when they reach crisis, cycling in and out of facilities month after month, year after year. The key to breaking that cycle, studies have shown, is getting patients enrolled in the long-term resources they need after they are stabilized and discharged.
Luana Murphy, president and chief executive of Exodus Recovery, said the Vista location was chosen in large part due to its proximity to the office of the area’s mobile crisis response team. That rapid-reaction force of mental health clinicians, peer support specialists and other non-law-enforcement personnel are sent on crisis calls that do not involve known threats of violence or other medical emergencies. Agencies that help residents with developmental disabilities and substance abuse problems are also nearby as is an outpatient mental health provider operated by Tri-City.
“The partners we need to work with are already here,” Murphy said.
Though mere proximity, and the fact that Exodus was already operating a walk-up mental health unit out of the same complex, seemed to make the location a no-brainer, creating the stabilization center still took years due to opposition from local leaders.
County supervisor Jim Desmond, whose district includes Vista, said Thursday that it took some time to persuade city council members and others that the county did not intend to simply deliver all local mental health cases to Vista. He applauded the fact that consensus was eventually reached.
“I say this with no exaggeration; this is going to save lives,” Desmond said.
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