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A Psychiatric Emergency in Contra Costa County

For years, Contra Costa County has ignored problems at its once-groundbreaking psychiatric unit.  Now the violence and aggression have reached a breaking point.

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Children's advocate Kathleen "Kathi" McLaughlin addressed the Contra Costa County Board of Supervisors last summer about an ongoing issue that the county has kept largely hidden, the poor and dangerous conditions for children and adolescents at the county's emergency psych ward.

McLaughlin, a Martinez school board member and former Mental Health Commissioner, recounted a story about a suicidal 14-year-old girl who sought emergency treatment at the facility. She and her mother waited hours at the grim, outdoor waiting area, which is immediately adjacent to a busy roadway. When the teenage girl was finally admitted the following day, a nurse took her to an exam room to check her heart rate. Just as the nurse lifted the girl's shirt, a male patient who had been committed to the facility on an involuntary psychiatric hold barged into the examination room.

"That would be hard for an adult, for a 14-year-old girl, it's really hard," said McLaughlin who has advocated for change at the facility for years.

The Board of Supervisors had just been served with a grand jury report that for a second time outlined problems at the facility, which is known by its oddly truncated name, Psychiatric Emergency Services (PES). The scathing report contained no new information for the supervisors, who have been aware for years of the serious issues at PES: overcrowding, chaos, violence, staffing shortages, little to no access for families, patients regularly sleeping on the hallway floors, and emotionally vulnerable children sharing hallways and waiting areas with volatile adults.

"This report is an opportunity to actually do something about PES," McLaughlin told the board.

What the grand jury report did not note is that Psychiatric Emergency Services has seen a 68 percent rise in aggressive incidents including physical violence and property damage during 2019. And aggression among youth in the facility has more than doubled. Most worrisome for children and adolescents is that the violence, including kicking, punching, hair-pulling, and throwing heavy objects, occurs suddenly in common areas, like hallways, that children and teens regularly share with adults who have been placed in the facility on an involuntary psychiatric hold because they present a danger to themselves or others.  

There has been no investigation into the sudden rise in aggression, but hospital officials suggest the increase is due to more aggressive acts by minors and overlong detentions of minors who, by law, should not be confined for more than 23 hours. In some cases, according to the report, they are kept for five and six days. But advocates such as McLaughlin claim the problem is due to overcrowded conditions and minors being forced to stay in windowless, confined areas in an outdated building for days without proper treatment for their conditions.

"It's illegal and inappropriate to keep children and adolescents in an emergency psychiatric facility for more than 23 hours," McLaughlin said. "They are meant to be stabilized, assessed and then, if necessary, sent on to a long-term inpatient facility or released to caretakers for outpatient treatment."

The conditions McLaughlin described were not missed by the grand jury. Psychiatric Emergency Services saw a monthly average of 848 patients during 2018, according to the report. Almost 16 percent of those patients, or an average of 134 per month, were children 7 to 12 or adolescents 13 to 17.  

There are only four "beds" for minors at Psychiatric Emergency Services, but the beds are really reclining chairs crammed, two each, into two very small rooms. When there are fewer beds than children, they are given mats to sleep on the floor.

The hidden factor of these poor conditions is the psychological impact on vulnerable and agitated youth who are confined in an overcrowded, chaotic environment of spit guards, restraints and narcotic stares.  

"Upon arrival at PES, and when they leave, children and adolescents must pass through the adult area to reach the assessment rooms," the report said. "Distressed children and adolescents are exposed to adult patients needing psychiatric help. PES staff state this could cause additional trauma to the children and adolescents."

In fact, Psychiatric Emergency Services has become so dysfunctional that at least two staff members regularly and openly warn people to NOT allow their children and teens to be checked into the facility, according to county mental health workers.

Ange Cottone, a registered nurse and union rep for the California Nurses Association, said violence is a problem at Psychiatric Emergency Services and other county hospital departments. "Contra Costa County is required by state law to produce a workplace violence-prevention plan," Cottone said. "We are overwhelmingly disappointed that the county has lingered with a deficient plan and they have neglected any input from frontline employees. They have left hospitals, clinics, detention facilities, and offices unsafe for both staff and patients."

The lack of attention to these issues also lies with the Contra Costa County Board of Supervisors. The grand jury report chided supervisors for not addressing the hospital's problems , which have been neglected for years. "The Contra Costa Mental Health Commission recommended changes to PES to improve treatment space for children and adolescents," the report reads. "The grand jury did not find any evidence that the commission's recommendations had been implemented."  

McLaughlin said she has been frustrated trying to get supervisors and hospital administrators to take action regarding Psychiatric Emergency Services and that many other activists who had over the years worked hard to create change at the facility have simply given up — just like the supervisors. "At one time, the Board of Supervisors was interested in fixing this problem," McLaughlin said, "but it seems like they've given up for some reason."

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