San Diego County supervisors on Tuesday unanimously approved a $32 million long-term loan to UC San Diego Health, funding the establishment of 30 additional beds in San Diego for Medicare-covered patients who need mental health care.
The vote has big implications for San Diego County’s entire behavioral health system, which has long recognized the need for more psychiatric beds. UC San Diego Health CEO Patricia Macent said at Tuesday’s meeting that there have long been talks about the university and the county working together to expand those resources.
“It’s been a long journey. Eight years ago we started having conversations (with the county) about a regional plan and improving (behavioral health) services,” Maysent said.
The original idea was for the university’s health system to operate a county psychiatric hospital in San Diego’s Midway neighborhood, but the original goals slowly changed: Plans to build a psychiatric hospital on vacant county-owned land on Third Avenue in Hillcrest were replaced by renovations to Alvarado Hospital, which had vacant space in its westernmost building.
Officials say refurbishing the Alvarado floors would be much quicker and less expensive than building a new facility on Third Avenue. Such a pivot could provide new beds by late 2023, officials said in August 2022.
But construction never broke ground, even though plans were drawn up by the county and the land’s former owner, Prime Healthcare. The stalemate continued, but with patient volumes soaring at its main hospitals in La Jolla and Hillcrest, UC San Diego Health stepped in, purchased Alvarado, and renamed it UC San Diego Medical Center East Campus.
The original plan was for UCSD to run the psychiatric unit planned for Alvarado, but the university is now taking the lead.
Macent said in an interview Monday that plans for Prime remain unchanged. A 30-bed unit dedicated to mentally ill seniors on the building’s third floor will be expanded to accommodate seniors ages 15 and older, and 30 more beds will be added to the building’s currently vacant fourth floor. Half of the overall capacity will be for people on Medicare.
“We’re going to take the existing design and build it as is,” Maycent said. “Hopefully, if we can get it through the state and work with the county and us, we can get it done in probably 20 months,” Maycent said.
While 20 months may seem short to planners familiar with the slow pace of hospital development in California, it may come as a shock to those who followed the plan in 2022, when then-County Supervisor Nathan Fletcher pitched Alvarado as a near-term project that could be operational by the end of 2023.
After all, many reasoned at the time that the hospital building already existed and was licensed by the state, and this would be merely a renovation rather than new construction, so advanced hospital infrastructure like medical gas lines would not be needed.
Macent did not go into detail about the various factors that would extend the timeline for the renovations to 20 months, other than to indicate the renovations require multiple approvals.
But it’s clear that getting more treatment beds online as quickly as possible is more urgent than ever, as San Diego County is set to implement Senate Bill 43, a new law that will expand the definition of severely disabled to include people suffering from substance use-related illnesses, on January 1, 2024. This law is expected to significantly increase the number of residents placed on mental health holds and sent to local emergency departments.
And Josh Bohannan, director of government relations for Father Joe’s Village, a well-respected San Diego nonprofit that serves homeless residents, noted that the need for more mental health treatment beds was already acute even without the impact of SB 43.
The lack of available hospital beds is already a bottleneck for the organization’s federally qualified health centers.
“We have behavioral health support. We have psychiatric counselors, peer support specialists, behavioral health staff,” Bohannan said.
But he said there are limitations to the types of services local clinics can provide.
“After we help stabilize someone, they have nowhere to go. Our shelter beds are not suitable for people who are experiencing a serious behavioral health crisis or issue.”
Accelerating the buildout of mental health care infrastructure is a key goal of Gov. Gavin Newsom’s administration. “California is full steam ahead, getting funding out faster and implementing important reforms faster to better support Californians,” the governor said during a visit to a Northern California medical center in May.
And indeed, Governor Newsom is clear that he believes a quick renovation of Alvarado fits into his vision for fast action. In March 2023, the Governor used Alvarado as a backdrop to announce Proposition 1, a $6 billion bond referendum for the construction of a mental health facility, which voters narrowly passed in March.
Officials said Tuesday they intend to seek Proposition 1 funding for some of the renovations, but also made clear they would move forward with the project regardless of the funding source.
But is there a way to help the state get this project built more quickly?
The question was posed Tuesday morning, but the governor’s media office did not immediately respond.
SB 43 was also on the agenda, with supervisors unanimously agreeing to Supervisor Jim Desmond’s request to ask the governor for an additional $51 million per year in revenue to cover the projected costs of additional transports to local emergency departments that would result from the legislation starting in 2025.
