The California Department of Mental Health has notified Fresno County that its only psychiatric crisis center for children does not meet state guidelines -- and now the county is fighting to keep it open.

While no decision has been made, county officials say that closing the 24-hour center would force children to wait for hours for care in ill-equipped hospital emergency rooms.

Those emergency rooms already are overwhelmed with hundreds of mentally ill adults who have nowhere else to go, advocates say, because the county closed its adult crisis center in 2009 amid a funding shortfall.

The result: Fewer children would get the intervention they need, leading to more hospitalizations. That would be costly for the taxpayer-funded mental-health service, and also harmful to the children, advocates say.

"We've turned our back on the adults in Fresno, so are we going to turn our back on children also?" asked Lauri Randle, a Clovis parent who had a daughter at the children's crisis center in 2007.

County officials already have sent the state a report and contacted state officials by telephone in their bid to keep the center open, but at least one of the state's concerns appears to be insurmountable: the center is not adjacent to a psychiatric hospital for children and adolescents, a long-standing guideline for such centers.

Until now, the state has not made that an issue. But in an e-mail message in December, state officials brought it up, along with a second concern: the center needs more staff.

While Department of Mental Health spokeswoman Jennifer Turner has characterized the concerns as just one part of a "routine process of receiving updated information from each county," county officials are worried.

"Clearly, I do not know which way they're going to go with this," said Donna Taylor, director of behavioral health for Fresno County.

A history of helping

Since September 2002, the crisis center has operated in the former Valley Children's Hospital in central Fresno.

Taylor said that to her knowledge, it's the only center of its kind in the state. Other counties respond to children in crises by sending mental-health workers to homes, she said.

The advantage of the crisis center, she said, is that it provides an alternative, short-term place for children instead of hospitalization. Of the 456 children in the center from August to October 2010, only 56 were hospitalized, Taylor said.

More than 100 children a month are brought to the crisis center -- most by law enforcement. The children can be involuntarily retained for up to 72 hours for their well-being and the public's safety, and to receive help.

Children who cannot be helped within 23 hours at the center are sent to psychiatric hospitals.

The time children stay at the center varies. Sometimes they are there for an hour or two. Some spend the night. The average length of stay is eight hours.

The center has a day room and some seclusion rooms for children who need to be isolated for care and safety. It can hold up to 12 children and adolescents at one time. A psychiatrist is available when needed, and mental-health clinicians and licensed vocational nurses are there around the clock.

The budget for the children's center is $2 million. Of that amount, $1.5 million is from realignment funds, money the county receives from sales taxes and vehicle license fees each year to pay for mental-health services. Another $500,000 is a mixture of state and federal funds and some money from private insurance.