For the second time in nearly two years, county supervisors unanimously supported a major expansion of mental health capacity at UC San Diego Health East Campus, formerly Alvarado Hospital.
Pitched as a way to quickly increase the number of metro area beds available in locked wards, the board first approved a contract with the facility’s previous owner, Prime Healthcare, in August 2022 to add about 40 beds to an unused floor in a mostly vacant high-rise building on the west side of the site. In March 2023, the move drew personal praise from Gov. Gavin Newsom, who used the facility as a backdrop to unveil the state’s $6 billion mental health infrastructure initiative, which would later become California’s Proposition 1.
However, most people believe that the project would already be started and running, especially given that it would require renovating floors in an existing licensed hospital rather than constructing an entirely new building. But the project hasn’t broken ground, despite the growing need for more behavioral health beds.
The university buys Alvarado in late 2023, voiding a previous agreement between the county and the facility’s former owner and creating the need to work out a new one. That contract isn’t ready for signing yet. The terms approved by the county commission on Tuesday call for the two organizations to negotiate and reach an agreement within 120 days.
Between 30 and 45 beds will be allocated to Medicare beneficiaries, and the additional beds will replace an existing unit at the University of California, San Diego Medical Center in Hillcrest. The center will be demolished as part of extensive reconstruction work already underway.
Taking into account the county’s bed capacity and the university’s allocation, UCSD Health CEO Patricia Macent said the total allocation could be anywhere from 62 to 92 beds.
An emergency psychiatric unit and crisis stabilization unit that would cater to short-term residents are also planned for the East Campus, and the entire operation will be run by UCSD Health and the UCSD Department of Psychiatry.
Maysent said after the meeting that he was optimistic the details could be ironed out in half of the 120-day period listed in county documents. Strengthening online mental health care capacity takes on added urgency with Senate Bill 43, a statewide law expected to increase the number of homeless residents housed under the state’s Emergency Mental Health Care Act. This change is expected to result in a flood of patients needing treatment to emergency departments.
“We’ve already discussed almost all the terms, so I think we all know what we’re going to do,” Maysent said. “Now we just have to see if we can reflect that in the document.”
The county originally planned to move inpatient beds from San Diego County Psychiatric Hospital in San Diego’s Midway neighborhood to Alvarado, but Luke Bergman, the county’s behavioral health director, said plans have changed. Currently, he said, the idea is to keep some inpatient beds, perhaps 16, at the existing hospital on Rosecrans Street.
The county’s long-term plan is to significantly reduce the number of mental health-related hospitalizations by making treatment available when symptoms are less severe, but that goal has not yet been met.
“Right now, acute psychiatry is at its capacity,” Bergman said. “We are operating many behavioral health services in the county at 90 percent to 100 percent capacity.”
He added that staffing is a bigger concern in the long term, and partnering with the region’s only medical school makes sense here. Opportunity to train more local mental health providers, from psychiatrists to nurses, by adding some 40 beds reserved for Medi-Cal beneficiaries to the UCSD-run program should increase.
And helping the university’s medical school set up a larger psychiatry unit could provide more clinical research opportunities, which in turn could help attract experts to San Diego, he added.
“That’s a really powerful part of this relationship,” Bergman said.
The Board of Supervisors delayed the implementation of SB 43 until Jan. 1, 2025, and directed all those affected by the law to study ways to increase capacity to save emergency care facilities from overflowing under the expanded definition of severe disability.
Is there any chance this modification, or any part of it, could be up and running by the new year?
Bergman said he didn’t want to make exact commitments about the project’s timing, but added that his office is looking at ways to move it along quickly.
“We’re going to leverage the (existing) infrastructure that’s here and we think it gives us the opportunity to ramp this up much faster than if we had to build it from scratch,” Bergman said.
