Acute Psychiatric Care in Marin County - A Plan Fails for Lack of Leadership

In June of 2000 the Marin County Board of Supervisors approved in concept a Strategic Plan to enhance emergency and acute care services for mentally ill patients in crisis, and to establish a permanent County-owned space for a detox center. The County Mental Health Board had already endorsed The Plan in January of that year.

An increasing level of concern in the mental health community had developed around the adequacy and effectiveness of the system then in place, given the high number of psychiatric hospital admissions, and the length of patient stays. Also a factor was the significant number of patients transported to other counties for acute hospitalization.

Called Strategic Plan Phase 1: Acute Care Services, the study cost $80,000 and resulted in sixteen recommendations. The Grand Jury decided to assess the status of four of the recommendations. The four chosen centered on the use of space on the Marin General Hospital campus, and are central to providing essential treatment for the mentally ill of Marin County. They are: 1) A single point of entry system for Psychiatric Emergency Services at the Marin General Hospital Emergency Department; 2) Creation of a sub-acute Crisis Residential Facility run by the County Community Mental Health Services; 3) Expansion of the Marin General Hospital locked psychiatric unit by at least five beds to reduce out-of-county patient transfers to a minimum; 4) Transfer of the Helen Vine Detox Center to the Mental Health Center Building on the Marin General Hospital campus.

Unfortunately, there is little, if any, progress to show for this $80,000 investment, and not one of the recommendations examined by the Grand Jury is in place and working. The Grand Jury has found, instead, foot-dragging and resistance to the Strategic Plan by those who should be active, constructive participant allies, not antagonists.

The County Mental Health Board, mandated by the State of California to oversee such activities, failed to do so, nor did it report to the Board of Supervisors. And, the Board of Supervisors, either uninformed or misinformed by officials of the Department of Health & Human Services, did nothing. Although many contributed to the failure, the ultimate, essential fault rests firmly with the Board of Supervisors, which failed in its oversight and leadership responsibilities.