‘This should be a wakeup call’: South Bay inpatient psychiatric care unit to close

Alexis Crase calls Mission Oaks her “safe place.”

The 32-year-old San Jose resident has been admitted to the inpatient psychiatric facility in Los Gatos more than 20 times over the last five years for treatment of bipolar disorder, obsessive-compulsive disorder and suicidal thoughts. When she heard that Mission Oaks is closing its doors in August, she was rattled.

“At this point, I’m doing a lot better, and I was kind of hoping I wouldn’t ever need to go back there,” said Crase, who is active in the mental health advocacy field and is forthcoming about her own struggles. “There’s just something about knowing it’s there when I need it, and knowing it’s not going to be there is a little frightening.”

Santa Clara County has 211 beds for inpatient psychiatric care, a number experts say is alarmingly low even without the loss of the 18 beds at Mission Oaks. A 2018 report from the California Hospital Association recommends at least one public psychiatric bed for every 2,000 residents. Santa Clara County has just 0.26 beds per 2,000, meaning it needs to nearly quadruple the number of beds — adding around 960 — to fully serve the population.

Its closure could not only force patients such as Crase to travel outside the county for the critical care they need but overwhelm emergency departments and push some patients who are diverted to treatment centers from jail back into the prison system, altering their life course and hope for successful treatment.

“This should be a wakeup call to the community that we need quality mental health care and acute care, and losing these beds has a significant impact on the community,” said consultant Michael Fitzgerald, former executive director of El Camino’s Behavioral Health Hospital in Mountain View.

HCA Healthcare, which operates Mission Oaks at Good Samaritan Hospital, cited staffing shortages as its main reason for closing the facility and its pediatric intensive care unit. In a statement, the Nashville-based for-profit company said it had made “extraordinary efforts” during the COVID-19 pandemic to maintain its existing services despite serious staffing challenges.

“Unfortunately, in the post-pandemic healthcare ecosystem, we can’t find qualified staffing for this unit. Staffing shortages are not unique to Good Samaritan and are a national problem,” HCA said.

The Los Gatos facility’s closure comes in the midst of a national mental health crisis. Mental health cases have been on the rise since the pandemic, and Santa Clara County officials declared a mental health crisis in 2022.

Globally, the prevalence of anxiety and depression rose 25% in the first year of the COVID-19 pandemic, the World Health Organization reported. Four in 10 adults in the U.S. have faced high levels of psychological distress since the start of the pandemic, the Pew Research Center found.

“COVID closed a lot of (inpatient facilities) down, and COVID increased the number of people with mental health problems. So the number of people who need help is growing, and the number of resources has shrunk,” Crase said.

In addition, nearly a quarter of the county’s inmate population has a diagnosed mental illness, some 687 of 2,988 inmates as of January 2022. Of those inmates, 107 are currently waiting to be released from jail into a psychiatric treatment facility, but there aren’t enough beds for them, said Santa Clara County Superior Court Judge Stephen Manley, who has been a longtime advocate of mental health treatment over prison time.

These patients must meet a “high standard” for admission, Manley said, including an in-depth medical and psychological evaluation, but still often wait for months in jail before receiving treatment.

“Every bed we lose makes it more challenging to try and get help for people,” Manley said. ”I see that every day, just a dramatic increase in the number of people who need treatment at the highest levels. This is the highest I’ve seen it in many, many years.”

The longer treatment is delayed, the worse the inmates’ conditions become, Manley said. Some end up being released without treatment only to end up back in court again.

Emergency rooms are also at risk of overcrowding and turning into waiting rooms for inpatient care centers, where some patients already spend days waiting for a bed to open up, Fitzgerald said.

If someone attempts suicide or is having suicidal thoughts and is admitted to the emergency room, doctors will determine if they need to be placed in an inpatient facility, which are among the most intensive forms of mental health care and offer patients therapy sessions, treatment plans and 24-hour monitoring. With fewer inpatient beds available, these patients don’t have anywhere to go, which could leave even more people waiting in emergency departments or put patients at risk for being sent home rather than to a center where they could get the help they need.

Crase said she was once released from the emergency room after seeking care for suicidal thoughts because there weren’t any available beds in the Bay Area or even as far away as Sacramento.

“They sent me home suicidal when I wanted help,” she said.

Tracey Wetherell, a former nurse at Mission Oaks, said the lower nurse-to-patient ratio at the facility led to more personalized care and a higher-quality treatment. “It’s guaranteed when you have a 1:6 ratio that at least once a day someone’s going to sit down with this person if they are able.”

What set Mission Oaks above other facilities was its nurse-to-patient ratio, Crase said.

“That was the one place I trusted. Most of their nurses are so kind, they don’t ignore you,” she said. “If they see you’re upset about something, they talk to you, try to get to know you. To listen. They’ll sit down and have a conversation with you and try to see what’s going on.”

The loss of that quality care when a place such as Mission Oaks closes is something that goes beyond statistics, said retired state Sen. Jim Beall, who authored several mental health reform bills. As more patients who need acute care flood outpatient treatment centers that are not equipped for their needs, there will be a ripple effect across the system.

“This is more than just the number of beds and the number of patients,” Beall said. “It won’t be just 18 people, it’ll be hundreds of people pushed into different levels of care.”

If you or someone you know is struggling with feelings of depression or suicidal thoughts, the National Suicide Prevention Lifeline offers free round-the-clock support, information and resources for help. Reach the lifeline at 800-273-8255 or see the SuicidePreventionLifeline.org website.