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Imperial County Supervisor Ryan Kelley listens to county Behavioral Health’s Leticia Plancarte-Garcia as she presents information on Casa Serena before he abstained from voting to accept a $5 million grant for the project on Oct. 19. The vote, or lack of vote, was Kelley’s silent protest and effort to raise awareness about the lack of psychiatric beds in Imperial County. | MARCIE LANDEROS PHOTO

Need for Local Psych Beds Prompts ‘Silent’ Protest

$5 Million Casa Serena Project Grant for Behavioral Health Gets 4-0-1 Vote by Board of Supervisors

EL CENTRO — One county elected official long familiar with the struggles to provide local psychiatric treatment for individuals in crisis made his voice heard recently by remaining silent, so to speak.

As the Imperial County Board of Supervisors voted to accept a $5 million grant that looks to provide services on the front and back end of involuntary psychiatric holds initiated by medical officials or law enforcement, District 4 Supervisor Ryan Kelley abstained as a form of raising awareness.

At issue for Kelley is the county’s lack of more robust in-house psychiatric treatment, either by developing a behavioral health hospital or a dedicated mental health wing at an existing medical center rather than seeing Imperial County patients shipped outside the area.

The southern facing doors on Imperial County Behavioral Health’s main building will serve as the entrance for Casa Serna, keeping the grant-funded program close to the department’s crisis center for easy transitions between programs. | MARCIE LANDEROS PHOTO

“I don’t want to make the behavioral health staff or director feel like they’re not doing good work. This (issue) has existed for quite a long time. And my time as a fireman, as an (emergency medical services) administrator and as a board member, it continually gets talked about, and we don’t move anything forward on it,” Kelley said during a phone interview on Thursday, Oct. 21.

“I’m talking about a psychiatric hold facility in this valley,” he said. “Right now, we have to wait for beds in San Diego or San Bernardino, and that can be very problematic for law enforcement, first responders, hospitals, and behavioral health.”

The county board accepted a $5 million state Department of Health and Human Services’ Substance Abuse and Mental Health Service Administration grant for county Behavioral Health Services for the development of Casa Serena, a two-year program that is meant to both provide services before the point of an involuntary 72-hour hold, commonly referred to as a 5150 hold after the number of the section of the Welfare and Institutions Code, or just after release.

Imperial County averages 1,016 individuals a year placed in involuntary holds, yet only 166 of those individuals require long-term hospitalization, making a dedicated psychiatric hospital, even a small one, unsustainable, said Leticia Plancarte-Garcia, director of Behavioral Health Services, in an interview Oct. 21, two days after the county board voted 4-0-1 to accept the grant.

“Those facilities are very costly because of the level of staffing that they require. We have had discussions about opening certain facilities, but our numbers wouldn’t sustain those facilities because of the level of staffing, like having a doctor, a psychiatrist available,” she said during an interview.

To address such issues brought by Kelley, Behavioral Health has developed what Plancarte referred to as a “continuum of care,” or a network of programs and services the county offers to support the treatment of mental health issues before hospitalization is required. The continuum includes outpatient clinics, crisis teams who go with law enforcement on mental health calls, education and outreach programs, and Jackson House, a 16-bed voluntary crisis residential facility.

Casa Serena now becomes part of that continuum, she said.

Casa Serena falls under the prevention portion of the continuum, providing some level of in-patient services for those who are having a mental health crisis before they are placed in a mental health hold.

“We want to offer a level before they start feeling they’re going to have a psychotic crisis, but once they develop a psychotic crisis, that’s when we are providing the crisis intervention, then the de-escalation and trying to work with the individual to manage their crisis,” Plancarte-Garcia said.

Leticia Plancarte-Garcia, director of Imperial County Behavioral Health Department, seeks approval to begin the Casa Serna pilot project from the Imperial County Board of Supervisors during its regular meeting on Oct. 19. | MARCIE LANDEROS PHOTO

Casa Serena will service like relaxation rooms aimed to different age groups, crisis interventions, individual treatment plans, and assistance in accessing resources to improve mental help. In addition to helping before an involuntary hold occurs, Casa Serena will also serve the almost 80 percent of individuals who are released after their holds to prevent the reoccurrence of the psychiatric crisis they experienced. 

“The goal is to educate the community about resources available so they can access services without the need to be calling law enforcement. So, the client or the individual might be identifying that they might have a crisis, so they can reach up to us instead of calling law enforcement,” Maria Ruiz, deputy director for the mental health triage and engagement services at Behavioral Health, said during an interview on Oct. 19. “So that’s the main goal in the reduction of 5150.”

A portion of Imperial County Behavioral Health Department’s main building will be remodeled to house its new program, Casa Serena, which will work to prevent involuntary mental health holds on individuals in crisis as well as prevent additional hospitalization after a hold. The county Board of Supervisors voted 4-0-1 on Oct. 19 to accept a $5 million grant for the project. | MARCIE LANDEROS PHOTO

The competitive grant is to develop and implement Casa Serena for the first two years. It will pay for 18 individuals, two passenger vans, and the remodel of a portion of the main Behavioral Health building at 202 N. 8th St. in El Centro. At the end of the two years, the program will be covered by California’s Realignment Funds dedicated to counties to pay for specific health programs and federal Medi-Cal funds.

Casa Serena staff will include a psychiatric social worker, mental health rehabilitation technicians, mental health workers, and community service workers who will work as peer support specialists, according to a county press release. During the two-year project period, Casa Serena is projected to serve 1,000 (unduplicated) individuals.

“This is a monumental step forward in addressing the mental health needs of our community, especially as we continue in our collective recovery from the impacts of COVID-19, and the county commends Mrs. Plancarte-Garcia and ICBHS on obtaining and securing this funding,” stated Chairman of the Board of Supervisors Michael W. Kelley in a press release. “In addition, we also are aware that this project will provide much needed additional employment opportunities for our community.”