San Diego jails have become 'de facto behavioral health hospitals,' Scripps CEO says

San Diego County in California has about half the beds it needs to care for patients with mental illnesses. As a result, jails and prisons are picking up hospitals' "slack," according to Chris Van Gorder, CEO of Scripps Health. 

Mr. Van Gorder, who helms the nonprofit system based in San Diego, expressed concern about the region's behavioral care shortage in a June 19 opinion piece for The San Diego Union-Tribune

In any given year, Scripps serves "tens of thousands" of patients with co-occuring health issues from combinations of mental health diagnoses, substance misuse and homelessness, Mr. Van Gorder wrote. Behavioral health patients then wait two to six months for beds at long-term care facilities and two to five years for spots in state hospitals. 

When patients cannot transfer out of the emergency room efficiently, it creates care delays for others, including acute cases. When they are released back into the community without the proper follow-up services to support them, they frequently "boomerang" back into emergency rooms and jails — where they are subject to poor outcomes including death, according to Mr. Van Gorder. 

"Jails and prisons have become de facto behavioral health hospitals, but they are not built nor staffed to provide the level of care needed," Mr. Van Gorder wrote.

It is not just a lack of behavioral health facilities causing the problem, according to Mr. Van Gorder. Healthcare workforce shortages, insufficient drug and alcohol treatment programs, and deficiencies in other post-acute long-term care placements compound the issue. 

"What would help is an increase in Medi-Cal reimbursements — which haven't been raised in 10 years — to a level that covers the cost of care for hospitals, as well as for other care like home health, skilled nursing facilities and behavioral health so patients have a better chance of being accepted elsewhere when they no longer need to be in an acute care hospital. Or so they can get the level of care they need in the first place that could keep them out of the acute care setting altogether," Mr. Van Gorder wrote.

He also suggested developing more behavioral health hospitals and an appropriate network of resources to support people with mental illnesses in the community. 

"But if we do not do what has to be done, the suffering will just get worse," Mr. Van Gorder wrote.

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