www.montereycountyweekly.com APRIL 6-12, 2023 MONTEREY COUNTY WEEKLY 23 N ewly homeless and frightened, Regina Lebel felt a tug inside that made her think about ending her life. Resisting that urge, she dialed 911 from a 7-11 and asked for an ambulance. One came and soon she was inside the emergency room at Community Hospital of the Monterey Peninsula on a bed and waiting to be transferred to a psychiatric bed, she hoped inside the Garden Pavillion at CHOMP. Hours went by, and still no transfer. “I was waiting a day-and-a-half and it was fraught with anxiety and trepidation and insecurity,” says Lebel, remembering back to that day in 2017. “Hearing the sounds in the emergency room and all the true emergencies—I would get more insecure about even being there to be assessed by a psychiatrist or someone on staff there. I felt like I needed to make way for the true emergencies, even though I was a true emergency myself.” Today Lebel is doing well and feeling grateful to be in a clean, safe, subsidized apartment. Back then in 2017 hers was indeed a true emergency, even as she fought to believe it herself. Every person who shows up in emergency rooms in a mental health crisis is treated as such, according to doctors who work in the ERs of Monterey County’s largest hospitals. They also readily acknowledge that waiting in an ER for a day-and-a-half—patients like Lebel can sometimes wait up to three days in an ER—is not ideal. “The emergency department is not a very therapeutic place for a patient in a psychiatric crisis,” says Dr. Veronica Searles Quick, director of crisis psychiatry for CHOMP. “It’s hard for our patients and it’s hard for us to be a witness to that, knowing they are not getting the care they really need.” The problem is there just aren’t enough psychiatric beds available in California. And on any given day, case workers at hospitals in Monterey County are performing a Sisyphean task, making call after call to psychiatric facilities up and down California looking for an open bed. If they’re lucky there might be a bed in San Jose, or Oakland, Davis or maybe San Luis Obispo, ready in a couple of hours. It’s not just a problem for the patients, it’s also a serious issue for local emergency rooms with limited capacity that keep the patients in crisis safe until they can be transferred. It can mean patients with other emergencies will have a longer wait to get into an ER bed. “It’s a national issue, something we very much wrestle with in Monterey County,” says Dr. Rakesh Singh, an emergency room doctor and vice head of staff at Salinas Valley Health, formerly Salinas Valley Memorial Hospital. One study puts the shortage of beds in California at just over 4,700. In March, Gov. Gavin Newsom stated there was a shortage of approximately 6,000 psychiatric beds. It’s an intractable problem for patients and staff at the three large hospitals located in Monterey County. All agree that a bustling emergency room is not the best place for patients in mental distress. And for every ER bed that’s occupied by psychiatric patients waiting for transfer, it means other patients may have to wait. The reasons for the shortage of psychiatric beds are complicated, and root causes go back decades. With pressure building on the system, California legislators are taking notice and creating legislation hoping to fix the problem. Hospitals in Monterey County can’t wait for large-scale, systemic changes, however, so instead they are finding creative ways to serve patients, either through technology, or by crafting entirely new spaces where those in crisis can get care during the wait. The need for psychiatric beds at all levels in California is stark, according to a 2021 study by the RAND Corporation. The 4,700-bed shortage includes a need for 1,971 acute beds for emergency situations where a short-term stay is needed and nearly 2,800 sub-acute beds for longer stays. An emergency room bed at Salinas Valley Health. Dr. Singh on his way to see a patient in the Salinas Valley Health emergency room. A LACK OF PSYCHIATRIC TREATMENT BEDS IN CALIFORNIA PUTS AN ENORMOUS STRAIN ON PATIENTS, STAFF AND THE COMMUNITY. By Pam Marino Dr. Rakesh Singh, an emergency physician, in a connection hallway of the emergency department at Salinas Valley Health. He’s seen an increase in people in psychiatric crises over the years for an array of reasons. He says some of this comes from an explosion of opioid use, some of it more recently is due to isolation during the Covid-19 pandemic. DANIEL DREIFUSS DANIEL DREIFUSS DANIEL DREIFUSS
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