Hillcrest’s Action Brings Mental Health Care Problems Into Public Focus

When Dr. Harold Mavritte decided last year to eliminate 32 beds at the county’s Hillcrest mental hospital, his primary goal was to improve care for the 60 patients who would fill the remaining beds at San Diego’s only public hospital for the mentally ill.

But Mavritte, the hospital’s clinical director, concedes that the move had another effect not entirely unplanned: It forced the county’s private and academic medical community to recognize what had been a longstanding but politely ignored shortage in the number of beds available for the area’s impoverished mental patients.

Mavritte said he realized in the spring of 1985 that the Hillcrest hospital, then coming under what would be almost a year of criticism for providing substandard care, would be faced with a serious crisis when its staff of five full-time psychiatrists dwindled to just three because he couldn’t recruit replacements to work at the troubled facility. He called a meeting of about a dozen hospital officials and asked what they could do to help.

“I was hoping the private sector might take some of these people,” Mavritte said in an interview. “But instead they said, ‘Gee, you’ve got a problem there. You ought to solve it.’ ”

He solved it by cutting 32 beds, a move that reduced to an acceptable level the number of patients seen by the remaining psychiatrists on Hillcrest’s staff.

As a result, local hospital officials, private psychiatrists and police say they have found it increasingly difficult to get disturbed patients admitted to the county-run hospital, the county’s largest for mental patients. Now these groups are calling on elected county officials to address the problem in part by more than tripling the number of beds available.

Psychiatrists at UC San Diego Medical Center and Mercy Hospital, Hillcrest’s two closest neighbors, acknowledge that the change in county policy has made them and other area doctors more outspoken about a problem they had been reluctant to discuss publicly.

Dr. David Braff, chief of inpatient care for UCSD’s mental health unit, said county health officials should fight harder for the money they need to provide adequate care in the community. But he said that private physicians have not always been as aggressive as they could be.

“We don’t have in this community a sense of moral outrage on the part of the professionals who should be leading the fight for better mental health,” Braff said.

Braff has expressed his concerns to Hillcrest officials and has alerted the Board of Supervisors. Dr. Lawrence Thum, his counterpart at Mercy, has also written the county board. The county Emergency Room Nurses Assn. and the San Diego Psychiatric Society have similarly made their views known.

“It’s a tricky thing,” said Dr. Charles Marsh, president of the Psychiatric Society. “I believe they did the right thing in reducing the number of beds. Ninety-two was too many, and 60 makes things significantly better in terms of care. But there still exists a population of patients going untreated. . . . The only real solution is for the county to bite the bullet and go ahead and build an appropriate sized facility.”

County supervisors have already approved plans to build a new mental hospital in the Sports Arena area, but that building will have only 110 beds--compared to the 300 most psychiatric care experts say are needed here. County officials say the rest should be provided through contracts with private hospitals and other care centers--an expansion of the very system medical officials say is not working now.

Mavritte and Karenlee Robinson, the hospital administrator at Hillcrest, said they welcome the new activism from the psychiatric community. They say an outcry from doctors in the private sector will carry more political punch than anything county health officials could say.

“If we go to the board and say we need 60 more beds, we will be accused of feathering our own nests and building empires,” Robinson said. “The community has to say we need more beds.”

Mavritte added that he believes it is the community’s responsibility to insist that the county provide not only high quality care for the poor but enough of that care to go around.

“For me to say it, people will just think I’m trying to protect my job, that if there are not enough crazy people then I’d lose my job,” he said.