26 MONTEREY COUNTY WEEKLY APRIL 6-12, 2023 www.montereycountyweekly.com around that.” The workaround Singh describes sounds a bit like playing a game of Tetris, moving the sickest patients with other ailments to beds upstairs so that more patients—like those with mental health needs—have a place in the ER. “We’re always ready with a bed for that really sick patient but we have to be somewhat flexible,” Singh says. It’s a process that is played out at the other two large hospitals in the county, Natividad, a public hospital, and CHOMP in Monterey, a private nonprofit hospital like SVH. (The fourth hospital located in the county, Mee Memorial in King City, is a rural hospital which refers patients in mental health crises to Natividad.) The fact that Natividad and CHOMP have in-house psychiatric beds make them different from SVH. The two are designated for what are known as “5150” holds; a law that allows psychiatric patients who are a danger to themselves or others to be held for 72 hours in a psychiatric hospital. Even with psychiatric beds inside their hospitals, CHOMP’s Garden Pavilion secure psychiatric unit and Natividad still reach times when all their psychiatric beds are full, leaving patients waiting in ERs. Doctors and nurses will locate patients in quieter corners of ER rooms, but they agree it doesn’t replace a dedicated psychiatric bed where patients are getting targeted care and a chance to rest. Finding themselves with no way to fix the larger issue of not enough beds at the state level, staff at two local hospitals decided they had to figure out their own ways to alleviate the pressure. At CHOMP, the relief came first in the form of carving out space in eight rooms in the ER where patients in a mental health crisis would find respite. “It was over five years ago we noticed a significant increase in behavioral health patients where we felt we needed to section off a portion of the emergency department,” says Christy Soboleski, interim director of the department. The average length of stay for patients in CHOMP’s ED on crisis evaluation orders varies. In January, they saw 120 patients who stayed for an average of 19.8 hours before being released or transferred to a psychiatric treatment facility. The high was June 2022, when they saw 122 patients for an average of 39.6 hours. In August 2022, 162 patients with crisis evaluation orders who stayed an average of 25.7 hours. “It’s very important that we keep an environment that is calm, as quiet as possible,” as well as control the light and pipe calming music into the rooms, Soboleski says. Staff members are trained in de-escalation techniques, and there are opportunities to begin individual or family therapy in the rooms. Still, it’s hard on patients who are waiting for psychiatric beds to open up, sometimes for days. “Our emergency department doesn’t have windows so patients go without sunlight or being outside for a significant amount of time,” she says. CHOMP’s emergency beds were sometimes occupied by patients in a more temporary crisis, which is what led to the creation of the Crisis Stabilization Unit, located across the hall from the ER. The unit opened its doors on March 20 to patients aged 18 and older. A separate area for those aged 17 and younger is set to open in late May. Stays will last no longer than about 24 hours for adults, with children expected to stay a bit longer. It will not be available to patients who need hospitalization, are violent or who have advanced dementia. The goal, says Searles Quick, is to get patients into a therapeutic space rapidly, where they can receive consultations and begin group or family therapy before being released for outpatient care. CHOMP reported that in January, a typical month, there were 146 ER patients who needed mental health assistance or evaluation. Alexandra Keller, director of behavioral health services for CHOMP, said in an announcement about the opening that many of those patients could have been helped by the crisis unit. That in turn would have relieved stress on all of CHOMP’s emergency beds. At SVH, the staff turned to technolMonterey County currently has no psychiatric beds for children or adolescents, but that’s set to change by next year. Montage Health is building Ohana, an outpatient and inpatient behavioral health center in Ryan Ranch, Monterey. The outpatient portion is expected to open in fall of 2023, and the 16-bed inpatient section in 2024. 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