The revolving door in five numbers

If you or someone you know is in crisis, call or text 988 (Suicide & Crisis Lifeline) or call San Diego County's Access & Crisis Line at (888) 724-7240, available 24/7.

San Diego County's public behavioral health system publishes a detailed annual accounting of who it serves and how. Read closely, the FY 2023-24 adult report tells one story five different ways: the system's front door is the emergency room, and without a middle level of care, too many people cycle back through it.

51% — crisis is the front door

For the plurality of the 45,129 adults served in FY 2023-24, the most common first service was an emergency or crisis service — 51%. Half the system's clients meet it for the first time on their worst day, rather than through a referral, a screening, or a scheduled intake.

65,014 — the volume of crisis contact

17,442 clients — 39% of all adult mental health clients — used a combined 65,014 emergency/crisis services during the year. That averages nearly four crisis contacts per crisis-involved client: the same people, returning.

4,775 — hospitalizations

4,775 adult mental health clients were psychiatrically hospitalized during the year. A hospitalization is the system's most restrictive and most expensive intervention (part 3 of this series prices it against the alternatives, using the state's own rate schedule).

1,310 — the 27% who came back

Of those 4,775, 1,310 clients — 27% — were hospitalized at least once more within the same fiscal year. The county notes this was the lowest multiple-hospitalization percentage of the past five years, which is genuine progress; it is also still more than a quarter of every hospitalized cohort returning within twelve months.

159 — five or more times

Among the 1,310 rehospitalized clients, 56% were hospitalized twice, 21% three times, 10% four times — and 12%, or 159 people, five or more times in a single year. For this group the hospital is not an intervention; it is a recurring address. High-frequency utilizers are precisely the population step-down levels of care (partial hospitalization and intensive outpatient — see part 1) exist to catch.

What the report says is improving

The same report is not all bad news, and honest accounting includes it: average wait times for psychiatric assessment fell from roughly 11 days in FY 2021-22 to a little over 4 days in FY 2023-24, and the multiple-hospitalization rate is at a five-year low. The system is getting faster at the front end. The gap this series documents is at the back end — where people go after stabilization.

One more number: 57%

57% of adult mental health clients carried a co-occurring substance use disorder. Any step-down capacity that treats mental health in isolation will miss more than half of the population that needs it — a design constraint, not a footnote, for the county's new PHP/IOP programs (part 1).