Santa Clara County mental health system ‘fundamentally broken’

Since Santa Clara County declared a mental health crisis in January, little has changed to combat the problem, supervisors said in a pull-no-punches memo to County Executive Jeff Smith.

Local officials are frustrated with county’s lack of progress in addressing its mental health crisis, and are demanding an acceleration of several projects—including the construction of a youth psychiatric facility at Santa Clara Valley Medical Center.

Supervisors Susan Ellenberg and Otto Lee are calling for immediate progress on a number of behavioral health programs, projects and services. Since the pair declared a mental health crisis earlier this year, the county has reported 188 residents dying from drug overdoses and 106 from suicide.

“In just seven months, that’s a loss of nearly 300 of our children, siblings, parents, friends and neighbors, and they are preventable deaths,” Ellenberg said. “This is a public health crisis because our current system of care is not equipped to meet the demands.”

She said the county has to move with urgency to meet the mental health needs.

“It seems to me that everyone is working very hard, with great compassion within a system that is fundamentally broken,” Ellenberg said.

Santa Clara County’s mental health and substance use crisis has seen a record increase in suicides and drug overdoses compounded by the COVID-19 pandemic. Schools have seen an unprecedented number of youth and teens suffering from severe depression and anxiety. For adults, the issue is further exacerbated by an inadequate number of beds in behavioral health treatment facilities and the overuse of prisons to incarcerate those in need of mental health services.

Supervisors are asking county leaders to start constructing a 77-bed psychiatric facility serving children and teens within the next three months. The project, seven years in the making, would be the first county-run youth psychiatric facility. Several candidates running in the November election have criticized the $233 million project, saying it’s too expensive.

“When I hear dates of 2024 and 2025, that tells me that we’re not moving fast enough,” Lee said, referring to the estimated timelines on a number of mental health projects.

Smith said the county continues to address the issue, but there’s no easy answer to the problem. He added the county is considering four contractors to build the psychiatric hospital, with plans to report back in November. The hospital was scheduled to come online in 2023, but due to delays and cost overruns with XL Construction the contract was terminated. Construction is now scheduled for completion in December 2024.

“We have the best behavioral health system in the state certainly, and probably in the nation,” Smith said. “We clearly have problems, but given the fact that behavioral health and substance abuse problems have been emergencies for far more than a generation, we’re at a precipice where we actually can make a difference.”

Addressing the issue with urgency 

As Santa Clara County continues to report a lack of mental health beds, Ellenberg and Lee want to expand capacity to serve patients leaving acute inpatient hospitalizations or jail. The additional step down beds, which provide intermediate care, would free up spaces for others with more needs or allow patients to leave jail, the supervisors said.

They also want county officials to accelerate a renovation process at a private facility on S. Bascom Avenue to add 28 treatment beds, find funding for 20 readily available beds with a different contractor and create a timeline for a standalone long-term mental health facility—with a deadline of 90 days.

In response, Smith said the South Bascom facility will start renovation this week—with plans to finish in April 2023. Officials will update the board on the other projects at a later date.

Ellenberg and Lee are also asking the county to add 20 “social detox” beds and implement a medical detox unit in the next three months. Social detox beds support patients with substance use issues entering recovery. Medical detox beds serve those with complex medical conditions. Officials said the social detox beds are scheduled to come online next summer.

To address an ongoing worker shortage, Lee and Ellenberg asked for an action plan on how it would invest in students in the county’s pipeline and recruit new workers by December. Smith said a national shortage of psychiatrists and mental health specialists is curtailing the county’s ability to recruit.

“Funding is allocated and we’re willing to fund more,” Smith said. “The greatest difficulty is finding the specialized workers who can do this job.”

Supervisors also pointed to $100 million in leftover funding under the Mental Health Services Act as a county failure, and asked for it to be put into services.

A number of residents and advocates called in to support the direction from Lee and Ellenberg.

“I urge the board of supervisors to hold the county administration accountable for meeting the needs of people with mental disabilities,” said Sandra Asher, a member of Show Up for Racial Justice @ Sacred Heart. “Many of our neighbors are still falling through the cracks.”