Del Mar Times |

County, UCSD Health start negotiations on East Campus mental health unit

For the second time in nearly two years, county supervisors unanimously supported significantly expanding mental health capacity at UC San Diego Health East Campus, formerly known as Alvarado Hospital.

Pitched as a way to quickly increase the number of metro-area beds available in locked hospital units, the board first approved a contract with Prime Healthcare, the property’s former owner, in August 2022 to add about 40 beds on unused floors of a mostly empty multi-story building on the west portion of the property. In March 2023, the move drew in-person praise from Gov. Gavin Newsom, who used the facility as a backdrop to announce what later became California’s Proposition 1, the state’s $6 billion mental health infrastructure initiative.

But, while most thought the project would be up and running by now, especially given that it requires remodeling existing licensed hospital floors rather than building entirely new structures, the project has not broken ground even as the need for more behavioral health beds has increased.

The university purchased Alvarado in late 2023, invalidating the county’s previous deal with the facility’s former owner, and making it necessary to create a new agreement. That agreement is not yet ready for signatures. The item that the county board approved Tuesday calls for the two organizations to negotiate and return with a pact within 120 days or less.

Between 30 and 45 beds would be allocated to Medi-Cal beneficiaries, with additional beds replacing an existing unit at UC San Diego Medical Center in Hillcrest, which will be demolished as part of a massive reconstruction effort that is already under way there.

Accounting for the county’s beds and the university’s allocation, Patricia Maysent, chief executive officer of UCSD Health, said the total allocation could be as low as 62 or as high as 92.

An emergency psychiatric unit and a crisis stabilization unit to handle short-term stays is also planned for the East Campus, with the entire operation run by UCSD Health and the UCSD Department of Psychiatry.

Maysent said after the meeting that she is optimistic that the particulars can be ironed out in half of the 120-day time frame referenced in county documents. Getting more mental health care capacity online is made even more urgent by Senate Bill 43, the statewide law that is expected to increase the number of unhoused residents brought in under the state’s emergency mental health care laws, a change that is expected to flood emergency departments with patients who need treatment.

“We’ve already talked about pretty much all of the terms back and forth, so I think we all know what we’re trying to do,” Maysent said. “We just have to make sure that we can reflect it in the documents.”

Initially, the county planned to move its inpatient beds from the San Diego County Psychiatric Hospital in San Diego’s Midway district to Alvarado, but Luke Bergmann, director of behavioral health for the county, said that plan has been modified. Now, he said, the idea is to keep some inpatient beds, probably about 16, at the existing hospital on Rosecrans Street.

While the county’s long-term plan is to significantly reduce the number of mental health-related hospital stays by increasing the availability of therapy when symptoms are less severe, that goal has not yet been met.

“Presently, the acute psychiatric capacity is maxed out,” Bergmann said. “We are running many behavioral health services across our county at 90 percent to 100 percent capacity.”

Long term, he added, staffing is the greater concern, and here, he said, partnering with the region’s only medical school makes sense. Adding 40 or so beds reserved for Medi-Cal beneficiaries in a program run by UCSD should provide more opportunities to train more local mental health care providers, everything from psychiatrists to nurse practitioners.

And, he added, helping the university medical school build a bigger psych unit also should provide more opportunities for clinical research which, in turn, could help draw experts to San Diego.

“That’s a very powerful part of this relationship,” Bergmann said.

The Board of Supervisors delayed implementation of SB43 until Jan. 1, 2025, directing everyone affected by the law to research ways that capacity might be increased to help keep those picked up under an expanded definition of what constitutes grave disability from flooding emergency departments.

Is it possible that this remodel, or some part of it, might be able to be up and running by the new year?

While he said that he didn’t want to make any hard-and-fast promises on project timing, Bergmann added that his office is working to find ways to move quickly.

“We will be working with (existing) infrastructure here, and we think that gives us an opportunity to stand this up much faster than we would anything that we would have to build from the ground up,” Bergmann said.