Plans are taking shape for a much-needed psychiatric hospital for central San Joaquin Valley teens, with five counties trying to persuade Community Medical Centers to get on board.
At stake is the quality of health care for hundreds of teens who need intensive mental-health treatment, but who now must travel across the state for care.
County mental-health directors are treading carefully, however, because a similar proposal with Kaweah Delta Hospital in Visalia fell apart two years ago.
Since the last Valley adolescent psychiatric unit closed in 2002, the closest hospitals for the teens are in Bakersfield and Sacramento. When those fill up, counties often send patients to Los Angeles or the Bay Area.
"Every time a child is placed out of town, not only is that child's life disrupted, but the whole family's life is being disrupted," said Brenda Leue, co-director of the National Alliance on Mental Illness in Fresno.
And that's not a good way to care for patients, said Giang Nguyen, Fresno County's director of behavioral health. The county places about 100 children a year in hospitals out of the Valley.
Fresno, Madera, Merced, Kings and Tulare counties are collaborating to create a nine-bed adolescent psychiatric unit at Community Behavioral Health Center, a 61-bed locked psychiatric hospital in Fresno operated by Community Medical Centers. The nonprofit hospital system bought the former Cedar Vista Hospital in 2002.
Nguyen said she wants to have an agreement by July.
But the counties have yet to negotiate rates with Community, and hospital officials said last week it was too early to make a commitment.
"The counties have to come up with a model that is both viable and sustainable before anyone would look at offering to be the provider of those services," said Dawan Haubursin, chief executive officer at the Community psychiatric hospital.
Tulare County supports moving ahead with negotiations, said Cheryl Duerksen, director of the county's mental health services. "But I don't think anything has solidified at this point," she said.
Community in the past has not shown an interest in providing psychiatric care to children and adolescents. When it bought the then-Cedar Vista Hospital, it closed the adolescent unit to focus on adult psychiatric services, which are less expensive to provide.
Psychiatric hospital programs for children and adolescents have closed in the past decade statewide because of financial problems. Cedar Vista was the last hospital with psychiatric beds for adolescents in the Valley.
Community has space for nine adolescents at the Behavioral Center. One of four units would be available, Haubursin said.
Parents say a solution is long overdue. Sending teens out of the Valley for care is traumatic and costly for families, they say.
The three weeks that Stacey Rystad's son spent at a UCLA adolescent psychiatric hospital were horrendous for her family.
Doctors recommended that Spencer Rystad, 13, be hospitalized in September 2006 when he became dangerous during a manic episode. Spencer has a bipolar and pervasive development disorder, his mother said.
Rystad, 44, of Fresno stayed at an aunt and uncle's Los Angeles home to be near Spencer. Her husband, Eric Rystad, a computer systems operator, stayed home with Spencer's younger brother and sister.
"No way could we have afforded food and hotels for all that time," Stacey Rystad said. "We were lucky we had family there."
Nguyen said a recent analysis showed that a nine-bed unit would be large enough to avoid sending most of the Valley's adolescent patients out of town.
Three years ago, the counties considered an agreement with Kaweah Delta Hospital for a 16-bed adolescent psychiatric unit. But the Kaweah proposal died after a lukewarm response from counties. Only three -- Fresno, Madera and Merced -- agreed to send letters of interest.
There were many factors in the proposal's failure, including the cost and the location.
"We had the facility and the board with the will to do it," said Lindsay Mann, Kaweah Delta Healthcare District chief executive officer. "I think perhaps one reason was maybe there was a sense that it needed to happen in Fresno."
An adolescent psychiatric unit can break even financially only if counties keep it full, Mann said. "It was critical from our analysis that there be multicounty participation," he said.
A mental-health consultant said at the time that counties were balking at paying Kaweah administrative costs to oversee the program.
Cost remains a concern for counties this time around.
"There's good will among the counties to work together to make this happen, and I think there's good will among the provider," said Janice Melton, director of mental health services for Madera County. "But it's just tough economic times."
Most of the children and adolescents receive Medi-Cal, the state-federal insurance for the poor. Medi-Cal picks up a substantial part of the costs. But counties are responsible for half the per-day bill in a hospital.
Fresno County has paid about $185,000 to hospitalize adolescents with mental illnesses so far this fiscal year, Nguyen said.
It's likely the counties could save money by hospitalizing teens close to home, but there's no guarantee, because rates are still up in the air.
Under the nine-bed proposal, the counties would negotiate a per-day rate with Community Behavioral Center. Each county would have a contract that specifies how many beds it would fill.
Community may be able to offer lower rates than hospitals in Los Angeles and the Bay Area, where the cost of living drives up health-care prices.
But some are concerned that opening a local psychiatric hospital could increase the demand for hospital care. Doctors might be more inclined to hospitalize adolescents if a psychiatric hospital were available in the Valley, Melton said.
Even so, Nguyen said she's optimistic that rates and other details can be worked out between Community and county mental health directors.
The directors are behind the plan, she said.
They especially like a proposal for training child and adolescent psychiatrists at Community Behavioral. Child psychiatrists are in short supply throughout the Valley. The doctors would be trained through the UCSF-Fresno psychiatry residency program.
"They have the ability to recruit the child psychiatrists here," said Melton.
The site also would be used for training psychologists, social workers and psychiatric nurse practitioners, among other medical professionals who work with children.
For families like the Rystads, a psychiatric hospital in Fresno would make a huge difference, Stacey Rystad said. Mental illness can be a lifelong battle.
"I'm sure it won't be our last time in the hospital," she said.