Sacramento County Department of Health and Human Services, Sacramento Mental Health Treatment Center
In a first-time visit by a Sacramento County Grand Jury, on October 13, 1998, the 1998-1999 Sacramento County Grand Jury toured the Sacramento County Department of Health and Human Services, Mental Health Treatment Center, 2150 Stockton Blvd., Sacramento.
The Sacramento County Mental Health Treatment Center (SCMHTC) is a psychiatric health facility licensed by the state Department of Mental Health. The facility has been operating on this site since 1980. A new 60,000-square-foot building, designed around small courtyards to facilitate outdoor activities, opened in 1991.
The Grand Jury was informed by the director that the annual budget of the SCMHTC is $14.7 million. The per diem for an individual patient is approximately $350. There are 174 full-time staff persons and an on-call staff of 30 to 35. There are 11 beds in the crisis unit. The in-patient unit was originally designed for 82 patients; at the time of the Grand Jury's visit, however, there were 102 inpatients on the premises.
Many patients are brought to the crisis unit by law enforcement officers, although some patients walk in voluntarily for assistance and admission. More than 750 persons enter the SCMHTC each month; emergency patients enter through its crisis unit. Approximately 30 percent of those patients are admitted to the inpatient unit. The remainder are either discharged or referred to appropriate private sector facilities. According to the director, the majority (60-70 percent) of persons entering the crisis unit have substance abuse problems in addition to mental illness.
SCMHTC is primarily an adult acute care center, but it also provides temporary crisis care for children. Patients entering the crisis unit can be held voluntarily or involuntarily for periods of time defined in the California Welfare and Institutions Code. The average stay for an adult patient at SCMHTC is ten days. The maximum time that a patient can be held involuntarily at the SCMHTC is 47 days. Decisions regarding patient dispositions are made by judicial hearing offers who visit the premises daily. The Grand Jury learned that, by law, a patient's presence at the SCMHTC will not be revealed unless he or she consents.
Patients admitted to the SCMHTC inpatient unit may receive services from psychiatrists, mental health counselors, recreational therapists, mental health workers, placement team members and legal representatives. The Grand Jury was told that this multidisciplinary team approach allows thorough and effective patient evaluation and management, resulting in a low (less than 20 percent) recidivism rate.
Findings and Recommendations
Finding #1: The Grand Jury found overcrowded conditions at the SCMHTC. The Grand Jury was informed that the number of patients in the SCMHTC exceeds its design capacity almost on a daily basis.
Recommendation #1: The Grand Jury requests a written report regarding the daily head-count of patients served at the SCMHTC in fiscal years 1996-1997 and 1997-1998 in order to determine whether the SCMHTC needs to be enlarged. If, for example, space for 20 additional patients per day is needed, then implications of that expanded population should be included in the report. The report should describe how space and staffing at the SCMHTC would be modified to properly house and care for more than 100 patients at a time.
Finding #2: Staff indicated to the Grand Jury that one drawback to effective health care for mental health patients in Sacramento County is that there is no facility for patients with concomitant medical problems -- those patients who suffer from chronic or degenerative illnesses along with their mental health problems.
Recommendation #2: The Grand Jury requests data on the number of patients with concomitant medical problems seen annually at the SCMHTC who would benefit from an extended skilled-care nursing facility designed specifically for mentally ill patients. The Grand Jury requests information on how the County handles these patients at the present time.
Finding #3: The Grand Jury noted that some sections of carpets needed cleaning, wall paint was peeling, and some floorboards needed repair.
Recommendation #3: The Grand Jury recommends that steps be taken to accomplish deferred maintenance.
Finding #4: The Grand Jury was informed that because the SCMHTC does not have a formal relationship with a medical facility, it does not qualify for Medi-Cal and therefore does not receive those payments to defer patient costs.
Recommendation #4: The Grand Jury recommends that the historic association between SCMHTC and the neighboring University of California at Davis Medical Center be re-examined to determine if a new, suitable relationship can be established between the two bodies (or between the SCMHTC and another medical care facility) to allow the SCMHTC to be eligible for Medi-Cal payments.
A Response is Required
The California Penal Code requires the Sacramento County Department of Health and Human Services and the Sacramento County Board of Supervisors to respond in writing to the Grand Jury's recommendations contained in this report, and to submit their responses to the presiding judge of the Sacramento Superior Court by September 30, 1999.