Psychiatric unit staffers prepare for closing of ward today

Sad faces, some holding back tears, could be seen among staffers Tuesday at the soon-to-close Tuolumne County psychiatric unit, two days before the facility’s scheduled closure.

Just four patients, all set to be released into the public come the closing day, remained within the 16-bed facility. The closure of is designed to save the county money.

“I’m very saddened,” said Darlene Hieb, the unit’s director of nurses. “This has been a big family. To see people leave, it’s hard.”
  

Unit Manager Mary Swann said the plan was to leave the unit’s offices largely intact until the last minute. That way, the reality that the closure was coming would take awhile to sink in.

Judging by the sad faces, it didn’t work.

In all, the psychiatric unit employs 26 people, mostly nurses. Most have found employment elsewhere or in other capacities for county government, but not all of them.

Some, like Swann, are heading into the unknown and hoping for the best. She’s going back to her home state of Virginia after working in the unit for nearly eight years. When asked what she’s going to do for work, she said, “I don’t know yet.”

The unit, located on the third floor of the largely empty former county hospital, has treated psychiatric patients, most of whom have been committed involuntarily for fear that they are a threat to themselves or others, for more than 25 years.

Depending on a patient’s level of need, he or she would stay in the unit for a night, or a month or more. Those with special medical needs that couldn’t be met were sent out of the county to other facilities.

In the spring of 2007, when the county Board of Supervisors voted to close Tuolumne General Hospital, the board agreed to give the psychiatric unit up to three years to continue operations. But when this year’s budget was formulated, supervisors thought closing the unit down was the way to go in order to save the county money in a time of decreasing tax revenue and increasing medical costs.

The county has since adopted a new “crisis intervention” model for mental patients that looks to keep people out of acute care settings by attempting to treat them before their mental health deteriorates to the point that they need acute care. Those who do will be sent to other counties.

Running the psychiatric unit has cost the county about $1.5 million annually to operate, while costs under the new model are estimated at $635,000. That assumes the county can be successful in reducing the number of long-term commitments, which can cost hundreds of dollars per day. 

TGH’s closure, in June 2007, was a harbinger of things to come for the psychiatric unit. Hieb said it was tough for the unit’s employees, who remained as fixtures at the former hospital amid an exodus of fellow employees.

“It was like your family was going on vacation and leaving you behind,” Swann said.

“It was hard,” added Hieb. “It felt like death.”

It’s a scenario that Hieb is undoubtedly going to live again by the end of today, as she’s one of the unit’s 17 employees remaining with the county.

She will extend her 26-year county career by overseeing nurses in the county’s long-term care nursing home unit, one of the few services remaining on the hospital campus.

Hieb and Swann want the public to know that the unit’s closure is not a signal that its mission failed.
 

They recalled treating people with methamphetamine-induced psychosis, people who were suicidal, and those so detached from reality that working with them was like dealing with a feral animal.

The unit also provided friendship, according to Swann, who said staff members often became attached to patients and sincerely cared for their well-being when they left the facility. Some even provided money to the patients, many of whom were indigent.

Though county officials say that the county’s new model of psychiatric care is designed to not only save money, but to provide better service, Swann remains skeptical.

“We worry what’s going to happen to our patients,” she said, noting that the number of mentally ill people walking the streets in Tuolumne County could increase as people are steered away from costly acute-inpatient settings.

But, she added, “I don’t think it’s going to be an increased danger to the community. Not everybody walking down the street hearing voices is going to attack somebody.”