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Published in Health Care

Health systems build capacity for ‘rapidly growing’ mental health needs

BY Sunday, October 10, 2021 05:15pm

The number of people going to Holland Hospital’s emergency room with a mental health condition grew 50 percent from 2010 to 2017.

That increase led the hospital to examine ways to expand access to mental health care, an issue that regularly tops needs assessments in many communities. By late 2019, Holland Hospital opened an area adjacent to the emergency room specifically designed for the growing volume of patients with severe depression, anxiety, suicidal thoughts, psychotic symptoms, substance use disorder and other mental health conditions.

COURTESY PHOTO

In opening the six-bed unit, Holland Hospital recognized that the emergency room was an integral part of the mental health system and sought to provide a better setting to assess and treat those patients, said Joe Bonello, Holland Hospital’s vice president of nursing.

“Those patients were already coming to the emergency department and coming in increasing numbers. We were lacking a space that was well designed both to be therapeutic for those patients and to provide a safe environment for the patients and for the staff,” Bonello said. “It really was the first step for us toward expanding our behavioral health services, and it was in response to a rapidly growing need in the community.”

When first opened in November 2019, Holland Hospital’s mental health emergency room served about 140 to 150 patients a month. Today, the unit averages 200 patients monthly, Bonello said.

The unit shows how health care providers have sought to address the rising number of patients who need treatment for a mental health condition.

In Grand Rapids, Spectrum Health and Pine Rest Christian Mental Health Services partnered in November 2020 to open a unit known as EmPATH — short for Emergency Psychiatric Assessment Treatment and Healing — adjacent to the Butterworth Hospital emergency room for patients seeking help for a mental health condition.

The Butterworth and Holland units operate with the same goal: Providing a specialized setting to care for people with a mental health condition who come into an emergency room, which Bonello said is “probably about the worst environment you could be in when you’re in a behavioral health crisis.”

Alternative sites

In the last 12 months, Holland’s mental health emergency room treated 3,350 patients, about a quarter of whom required admission for their condition, either to the hospital’s inpatient unit or to another psychiatric facility, Bonello said.

The units at Holland and Butterworth are each designed with a soothing aesthetic and low-stimulation, quiet environment that’s intended to calm a patient in the middle of a mental health episode.

“ERs are chaotic and a lot of our patients are in significant turmoil in their life,” said Dr. Subodh Jain, division chief of psychiatry and behavioral medicine at Spectrum Health. “The emergency room is non-conducive to their immediate treatment.”

Staffed with social workers, nurses and mental health professionals, the Butterworth and Holland units gave both hospitals a better setting to evaluate and treat mental health patients. That also frees up needed beds in an ER where medical staff are often not adequately equipped to properly assess and treat mental health patients.

In forming the six-bed EmPATH unit that sees about 100 patients a month, Spectrum Health and Pine Rest also sought to reduce hospitalizations by getting patients into treatment immediately, Jain said. That can sometimes alleviate the need for their transfer to an inpatient psychiatric facility.

Between 65 percent and 70 percent of EmPATH patients are discharged home within 24 hours with plans for follow-up care, Jain said.

Capacity shortage, crisis worsening

The mental health crisis and need for increased access to care exists on both the outpatient and inpatient levels, care providers say.

Quite often a mental health patient who needs inpatient care in a psychiatric facility will wait hours, and sometimes days, in an ER bed until they are transferred to an appropriate setting.

Holland Hospital recently had a patient wait four days in the mental health emergency room before they were transferred to an inpatient psychiatric unit, “and that’s certainly not the first time that’s happened,” Bonello said. 

The situation reflects the inpatient capacity shortage that stems from a need for more beds and a shortage of mental health care professionals.

“We can’t do this on our own. We really need more providers who can help with this. We’re doing everything we can to meet the needs of the community, and still the demand far outweighs the resources that we have available,” Bonello said.

The Holland Hospital mental health emergency room and the EmPATH unit at Butterworth Hospital offer new settings for care in a crisis that providers say has worsened in the COVID-19 pandemic.

Care providers say they’re seeing more people than ever with anxiety and depression brought on by the pandemic.

“We all have limits on our coping abilities,” Bonello said. “We’re just seeing that everybody’s been pushed to the brink and then one more thing happens and it pushes them beyond the ability to cope. The baseline stress is higher for everybody, and so as a result we’re seeing more.”

Spectrum Health and Pine Rest began discussing the EmPATH unit just prior to the pandemic’s onset, Jain said. He describes the present demand for mental health care as “humongous.”

The COVID-19 pandemic has at least created greater awareness about the mental health care crisis, he said.

“The pandemic just highlighted the problem to the extent that I think it was a call on all of us to do something about it, especially with the (emergency departments) being flooded by other patients,” said Jain, who questions how well care providers can sustain new mental health programs without higher reimbursements from insurers.

New facilities planned

To address the mental health crisis, care providers plan to develop a number of new inpatient psychiatric facilities across the state, including in Grand Rapids and Kalamazoo.

Kalamazoo-based Bronson Healthcare has partnered with Franklin, Tenn.-based Acadia Healthcare Co. to develop a new 96-bed psychiatric hospital in Battle Creek. Construction was to start this fall on the $35 million facility planned at Glenn Cross Road and M-66 that will integrate physical and mental health care. When opened in early 2023, the new facility would provide inpatient behavioral health care for adults from the aging Fieldstone Center in Battle Creek.

Mercy Health and an Auburn Hills-based operator of psychiatric hospitals plan to build a new facility in Kent County through a joint venture. Havenwyck Hospital Inc. — an affiliate of Pennsylvania-based Universal Health Services Inc. — received tentative state approval in the spring for a 60-bed adult inpatient psychiatric hospital.

That project’s approval has been appealed by Pine Rest Christian Mental Health Services, which had a competing project denied by the state.

Pine Rest last week did get temporary approval from the Michigan Department of Health and Human Services for an emergency request for a 40-bed inpatient psychiatric unit that could transition between serving adults, children and adolescents.

Pine Rest this month also filed an application with the state to add 16 beds to an existing 162-bed inpatient unit at the Van Andel Center on its 68th Street campus in Gaines Township that would flex between adult and adolescent needs.

The mental health care provider wants to add inpatient capacity as demand for care increases, said Harmony Gould, Pine Rest’s vice president for hospital and residential services. Pine Rest has been running occupancy rates about 80 percent since July 2020. The number of people turned away when inpatient units are full has doubled in the pandemic, Gould said.

“As we’re seeing occupancy go up over the last 20 months, we’re just trying to respond to community needs,” she said. “We’re just busy all of the time.

Read 1006 times Last modified on Friday, 08 October 2021 13:49
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