The Santa Barbara County-run psychiatric hospital has been at the center of a flurry of policy changes and scrutiny, and county leaders got an update on the progress Tuesday.
The Psychiatric Health Facility, a county-run hospital for people with mental illness in crisis, has been the subject of just about every audit, report and other attempt to put the facility under the magnifying glass over the past two years.
A patient death — which resulted in a lawsuit that was recently settled — set off a series of events that spurred county officials to call for reforms at the hospital, which serves many of the county's most vulnerable.
The facility's changes have left it a safer place for patients and a more efficient organization, according to the changes shown in Tuesday's presentation.
On Tuesday, PHF Medical Director Dr. Leslie Lundt said the changes had created a "PHF 2.0."
Lundt gave an impressive presentation about the types of patients who use the hospital, what the financial implications are and where the hospital still needs to improve.
The patients the facility serves are a 50/50 mix between people from the north and south county, and the facility still remains woefully small for the amount of people who need services.
According to national standards, the PHF should have 30 to 60 beds for a county of Santa Barbara's size, instead of the 16 it has that are usually filled, she said.
When those beds are full, patients are sent to a similar facility in Ventura. The county has allotted $1.8 million for this year alone in out-of-county care for patients who can't be seen at the PHF. The PHF is designed for patients to stay only a few days, and anything longer than that is not ideal, she said.
Lundt took a look at the patients with the longest stays in the facility, and found that most of the patients — 75 percent of them — had placement problems, meaning they had nowhere to go when they were released, so ended up staying at the PHF longer out of necessity.
Staff will not release patients out onto the street once they are stable because "we want to have a safe place to continue receiving treatment," she said.
That's an expensive option, however, with each day at the PHF costing the county $2,000 a day per patient.
"One of my goals is to lower our length of stay," she said.
Part of that will mean finding more options for people to go if they need to stay at a long-term locked psychiatric facility, of which there are a shortage in the state. Long-term locked facilities are hard to find in the state, and patients have been shipped as far as Redding to find placement, she said. Ideally, patients will be closer to home so their families can be a part of their treatment.
Shoring up outpatient systems will be key so patients don't deteriorate to a more expensive level of acute care, said Dr. Takashi Wada, interim director of the county's Alcohol, Drug and Mental Health Services.
The county has been in talks with Cottage Hospital to look at crisis residential housing in the area, he said, and has been applying for state grants to help with the process.
The department has also made program improvements in its programs by increasing psychotherapy, supervision and staff, working to involve family members and having more recovery group options for patients.
Lundt also stated that the PHF has dramatically reduced its use of seclusion and restraint, a practice that the department had come under scrutiny for after a patient death.
Since 2008, the department has decreased its use of the practice from 10 cases per month to less than one per month, she said.
Staff will be looking at whether the amount of money the PHF receives from the feds is worth the effort of keeping the facility designated as an acute hospital.
Other challenges remain, including a lack of South County residential services and a lack of medical detox capabilities.
Officials from the department will be returning in February with more information, including more options for out-of-county placement for patients.
With the Medicare audits from recent years, "there have been improvements, and I think we are on the right track," Wada said.