SHRINKING SPACE FOR TROUBLED KIDS

Locked Facilities Are Still Needed Despite Advances In Treatment

SANTA Clara County's shortage of places to treat severely disturbed
children just got worse. The only mental hospital in the county where
children could be locked in if they were suicidal or a danger to others has
closed its doors.

County health officials' first response was to find similar hospitals in
other counties that will take these children. But they know that's not
enough. The board of supervisors and the community need to take a hard look
at the shortage of help available for mentally disturbed children and
youth, and make a commitment to fill the gaps.

Twenty years ago, children in the county who were considered suicidal or
dangerous were shipped off to the state mental hospital in Napa, locked up
for their own protection.

Since then, institutional care for the mentally ill has fallen into
disfavor. Today, instead of sending children away for treatment, the county
sends the treatment to them. A team of mental health professionals
coordinated by Eastfield Ming Quong is dispatched to the family's home to
provide ``wraparound'' care -- around-the-clock, on-site treatment that
keeps the child from being separated from family and familiar surroundings.
This is actually cheaper than hospitalization, as well as being better for
children.

Still, a few children are so disturbed that they need to be "in a secure
environment"(locked up) until they can be "stabilized" (calmed down and
possibly medicated). The county had been sending four or five such children
a week to Charter Behavioral Health Systems, once known as Oak Creek
Hospital, a private psychiatric hospital in San Jose for adults and
children. On Nov. 12, faced with mounting financial pressures from its new
owners and the threat of lost federal and state funding because of alleged
deficiencies, Charter shut down.

County Mental Health Director Allan Rawland insists there were no problems
with the treatment children received at Charter, despite unfavorable
reports by federal inspectors. And he insists there will be no interruption
of care. With Charter gone, the county can send children to hospitals in
Fremont, San Mateo or San Francisco.

But he is quick to acknowledge that there is a shortage of overall care for
disturbed children, and that it's not enough to simply plug the hole left
by Charter.

"Is this a crisis? Yes," Rawland said. "We do need an acute level of care
in the county. But I see it as an opportunity, too."

It's an opportunity to evaluate where we fail troubled kids in our midst.
Despite the success of the wraparound program, every week children who need
mental health services wind up at the county children's shelter or, worse,
in juvenile hall. Those aren't appropriate places to treat them.

We need more group homes for troubled kids. We need in-patient treatment
for teens with serious addictions to alcohol or drugs. Currently, the
closest residential substance abuse center for kids is in Scotts Valley.
For that matter, we also need more substance abuse treatment for adults.
Too often, a parent's alcohol or drug addiction is a factor in the child's
emotional problem.

Next week, when the county supervisors discuss how to spend our $22 million
share of the nationwide tobacco settlement, drug and alcohol treatment
should be considered.

As for replacing Charter, those who treat kids in the county aren't sure we
need another psychiatric hospital. There just aren't that many young people
who need care that intensive. And, under managed care, such hospitals have
a tough time surviving because insurance companies limit hospital stays.
That was one of the reasons Charter closed.

One possible solution to the loss of Charter would be to create a small
community treatment facility - perhaps 30 beds - that could be locked, but
would be more inviting and less confining than a hospital. The county had
hoped to lease space from Charter to create such a facility.

Now another location will have to be found, but the idea must not be
dropped.