However, the number of beds available at psychiatric hospitals in the state are severely limited — leaving individuals in need and community organizations in limbo.
When a patient arrives at Newman Regional Health experiencing a psychiatric emergency, they are immediately assessed.
“We have order sets and those patients need to be cleared medically first,” emergency room director Damian O’Keefe said. “Then, if they don’t have a medical issue that needs to be addressed, it is at that point in time that the doctor will put in a request for a mental health screening, at which time the folks from CrossWinds will come over and do an assessment of the patient.”
CrossWinds Counseling and Wellness staff and hospital personnel work together to establish a safe discharge plan for each patient. Discharge planning can involve several different options.
“The physician and mental health provider will huddle together and make sure they go over a safe discharge plan with that patient,” O’Keefe said. “It can be inpatient hospitalization, it can be outpatient — but that plan has to be agreed upon by everybody.”
If it is determined the patient needs inpatient psychiatric hospitalization, it is unlikely they will be admitted to the hospital immediately. More often than not, patients will have to wait anywhere from several hours to several days for a bed to become available. During the waiting period, hospital staff attempts to balance the needs of the patient and the safety of their staff.
Due to the increase in the number of patients in need of psychiatric care and the increase in wait times, the hospital has developed new plans to ensure all parties are cared for appropriately. During the last year, the hospital has seen a marked increase in the number of patients in need of hospitalization and the wait for transfer.
“The number of transfers are overall higher this year through the 11 months, so I suspect we are going to end up perhaps as much as 150 higher then we were last year, total,” CEO Bob Wright said in late December. “The most significant increase was in psych detox patients. Last year they represented 5 percent of our transfers — there were 41 of them. For the first 11 months of this year we have had 122, so we will probably end the year with something around 135. They now represent 13 percent of the transfers.”
Maintaining safety and compassionate care
While individuals wait for beds for inpatient psychiatric treatment, Newman Regional Health is left to wait as well. During that wait, hospital staff attempts a delicate balance — providing compassionate and effective care while also maintaining staff safety.
“As a community hospital we get it and we care,” Cathy Pimple, chief quality officer with Newman Regional Health said. “There are two perspectives to consider. First, providing care for this vulnerable population. Can we provide the care that these individuals with behavioral health psychiatric disorder have? Can we do it in a compassionate and safe manner for them? As well as, can we keep our staff safe?”
Maintaining that balance has required the hospital staffers to change the way they do things and create alternate options. Those include working in close partnership with CrossWinds staff, utilizing patient safety officers and providing ongoing nursing care in the observation unit. Additional training and environmental trainings have also occurred throughout the hospital.
“Those changes have occurred so we can provide the type of care these individuals have the right to, but we can also keep our staff safe,” Pimple said.
Julia Pyle, chief operating officer with Newman Regional Health, said one of the biggest changes the hospital has made is to develop a behavioral emergency response team. Anytime staff, patients or family members feel unsafe, the team will respond bedside to assist in developing a plan of care for the patient.
Education, including CPI training, have been provided to staff. CPI focuses on de-escalating the situation. It is commonly used in school districts as well as psychiatric hospitals. A safe room has also been created in the emergency department, which provides a low-stimulation environment for patients to remain safe. Additionally, staff support has increased with debriefing as necessary.
“We are also doing education around the medications that are frequently prescribed to these patients,” Pyle said.
Newman Regional Health does not employ a psychiatrist. While patients are waiting for a bed at a psychiatric hospital they can wait at Newman Regional Health in a safe environment, but they do not have access to a physician that can treat their specific condition. This is in direct contrast to the way all other medical emergencies are treated.
“If you think about if somebody has a need for a higher level of care for a heart condition or a lung condition, we can transfer them immediately — but not mental health or behavioral health,” Pimple said. “Again there, is such a shortage of beds and services.”
Newman Regional Health is not the only community organization that has been impacted by mental health funding cuts. CrossWinds, the court system, law enforcement and area school districts are all feeling the fallout from lack of funding.
“It has gotten worse,” Pyle said. “When funding decreased for mental health, that correlates very closely to an increase in the need for inpatient hospitalizations.”
Community partners have come together to form a mental health task force. Each agency is facing limited resources and the task force allows them to collaborate. In working together, the hope is that agencies will be able to share resources.
With the state facing a budget shortfall of more than $300 million this fiscal year, it is unlikely funding for mental health services will increase anytime soon.