County Plans Psychiatric Crisis Units : Emergency services: Officials want to revamp a system now run through two private hospitals. They say the new teams would be more highly trained.

Ventura County officials are planning to create 24-hour mobile psychiatric crisis units to replace a system that depends on two private hospitals.

Under the plan, two-member teams would answer calls from private citizens and the police and would respond anywhere in the county. Trained to intervene in crisis situations, the teams would be empowered to declare that a patient was a threat to himself or others and take him to a psychiatric hospital for up to 72 hours. During that period the person could be referred to one of several types of treatment.

The teams would include clinical social workers, mental health nurses, psychiatric technicians and doctors who would go to the scene when necessary.

In 1989, about 300 people in the county were forced into short-term psychiatric care. Typically they were exhibiting acute psychosis, the risk of suicide or other emotional crisis.

Currently, two hospitals have mobile psychiatric evaluation teams. They respond to calls from doctors, law enforcement officers, hospital emergency rooms and families of individuals who need immediate psychiatric care. The hospitals are Simi Valley Adventist Hospital and CPC Vista Del Mar Hospital in Ventura.

Their teams, however, consist of psychiatric technicians whose main job is simply to evaluate whether the individual requires admission to a psychiatric hospital. They are not trained specialists in crisis intervention, according to Randall Feltman, director of Ventura County mental health services. Nor do they have the authority to transport mentally ill patients to hospitals against their wills.

Vista Del Mar’s team has a contract with the county and under its authority may compel patients to enter the hospital involuntarily for 72 hours of psychiatric observation. It relies on the police or ambulance personnel to provide the transportation. It has one team operating countywide and deals primarily with patients who can afford to pay. Simi Valley Adventist accepts referrals from law enforcement but cannot force patients into the hospital.

“What we have currently is hospitals with psychiatric evaluation teams, essentially assessment teams that are designed to make contact with persons that are having a crisis and then decide whether they should come back to their hospitals,” Feltman said. “Their focus is on those who can pay for their service.

“What we need is a countywide, 24-hour crisis intervention service that provides individuals with access to the network of mental health services that are out there.”

The county would pay half the estimated $1-million annual cost for a staff of 21. The rest would be borne equally by the five private hospitals in the county with psychiatric units.

Patients requiring further psychiatric care and who had private insurance would be transported by the crisis teams to one of the hospitals, depending on location. Indigent patients and those with Medi-Cal coverage would be taken to the county’s inpatient unit in Ventura.

The county has money from the state for mental health crisis intervention, but it needs the cooperation of hospitals. However, the plan is being criticized by administrators of the two hospitals whose role would be reduced.

“We provide that service already,” Tom Williams, administrator of Simi Valley Adventist Hospital, said. “On the surface, it appears that it would be more costly than the returns would be.”

After receiving a letter from Feltman in June, Williams said he wrote back and said his hospital “cannot commit to participation in the program” without additional information and a meeting with other hospital administrators.

Margi Drue, administrator of CPC Vista Del Mar Hospital, an investor-owned psychiatric hospital, said she agreed in principle to the idea of partnership between the private and public sector. But the $100,000 annual cost to each individual hospital, she said, would be high: “It’s a lot of money for hospitals in these days and times to come up with.”

Hospital administrators expressed resentment over Feltman’s assertion that he would not certify hospitals that stayed out of the program to hold mentally disordered patients involuntarily.

“Blackmail?” said Monty Clark, Ventura County program director for the Hospital Council of Southern California. “It sounds like it.”

He said a copy of a June letter to hospitals in which Feltman wrote, “Hospitals choosing not to participate in this crisis service would not receive a designation to accept involuntary clients,” is being reviewed by the organization’s legal counsel.

Moreover, he said, hospitals are not convinced the service is needed. “They are asking hospitals to fund the crisis team, but hospitals have their own assessment teams,” Clark said.

Mental health and law enforcement officials and advocates for the mentally ill said the proposed teams would be much better than the present ones.

“I have been strongly in favor of that kind of unit for almost 20 years,” Oxnard Police Chief Robert Owens said. He said the current system usually leaves police officers with the job of dealing with mentally ill people.

“It’s not that they’re always going to be effective and the police are never effective,” Owens said. “But these people are trained more intensely than the police. The police are more predisposed to say, ‘Let’s get this over with and get this person turned over to someone who can deal with them.’ ”

Betty Ryerson, a board member of the Ventura County Alliance for the Mentally Ill, said she has witnessed the need for an emergency response team. During the last five years, she said, her schizophrenic son has been admitted to psychiatric hospitals 15 times. More than once, she said, he has attempted suicide.

“When your son is standing on top of a building, you call the police. And right now, police officers deal with the mentally ill and have no training,” she said. “That young man killed with a stun gun by police, or the man in Port Hueneme who set himself on fire--if acrisis team had been there, maybe they’d be alive. We desperately need this.”

Feltman said he thinks the county can negotiate a solution with the hospitals. Williams of Simi Valley Adventist said he hopes to meet with Feltman next week.