Mental Health Proposal Deserves Some Thought

San Diego County is at a crossroads in its plans for the Hillcrest mental hospital, the only public hospital in the county treating the impoverished and the violent mentally ill.

Serious problems at the hospital prompted administrators to reduce the number of beds to 60 from 92 to improve the quality of care, which had deteriorated to the point that federal health officials had revoked the hospital’s Medicare eligibility and its Medi-Cal funding was threatened as well.

The psychiatric community objected to the cutback. Other hospitals, especially nearby UC San Diego Medical Center and Mercy Hospital, say that, as a result of the reduction in beds at Hillcrest, they have had to treat many indigent patients when the county hospital is full--and some patients who need hospitalization are being released.

Although no doubt it was a difficult decision, the reduction in patients is accomplishing its goal. A recent state inspection found that care has improved.

Now the county is faced with longer-term decisions. The Board of Supervisors is considering a proposal to build a 110-bed hospital on Sports Arena Boulevard.

Last week, another promising idea was proffered by UCSD. Dr. Lewis Judd, chairman of the university’s department of psychiatry, proposed that the university’s medical school establish a center for psychiatric treatment, training and research, funded by the state, to care for the county’s poor. The university connection would make it easier to recruit and to keep psychiatrists, which the county hospital has had difficulty doing because of low pay, difficult patients and low prestige.

Granted, the county also could improve care if it had the $12 million that UC would pump into the center under this proposal. But that wouldn’t solve the recruitment problem.

As long as treatment does not take a back seat to research and training, we think the trade-off could benefit the county and the university, as well as the patients.

This proposal has additional promise. It provides an opportunity for the county to reverse its history of allowing health problems to fester until state and federal agencies threaten amputation. It would provide the county the chance to become a leader in psychiatric care for the indigent.

We urge the county to give serious consideration to the UCSD proposal.