Hospitals work to get mentally ill out of Emergency Rooms

New Hampshire Union Leader

Concord Hospital has had a separate area in its emergency department for taking care of behavioral health patients since 2007.

But back then, they were just consult rooms, according to Camille Kennedy, the hospital’s director of behavioral health services. About eight years ago, they started seeing more patients having to stay overnight in those rooms, she said, and hospital leaders decided that had to change.

Today, Concord Hospital’s “yellow pod” has six rooms for patients with more acute illness; and a common room that can house four lower-acuity patients, where therapy and group activities can be held. There’s a dedicated nurses station, behavioral health staff and security.

Kennedy said Elliot Hospital’s behavioral health staff toured the yellow pod before they created their newly expanded Psychiatric Evaluation Program (PEP) unit.

Heidi St. Hilaire, nurse manager of adult behavioral health at Elliot Hospital, said the hospital’s six-room PEP is staffed with behavioral health nurses trained in violence prevention and de-escalation techniques. Nurses will work 12-hour shifts, working individually with patients to help resolve the issues that brought them to the hospital.

St. Hilaire said the goal was to get these patients out of the chaos of the emergency department. “If you come into the ER and you’re anxious, we want to put you in a quieter place that’s going to be conducive to helping resolve that anxiety,” she said.

All patients who come in to the PEP unit are evaluated by clinicians from the Mental Health Center of Greater Manchester (MHCGM). And any patient who stays more than 24 hours is seen by a psychiatrist.

Mark Bodwell, coordinator of emergency and interim care services for MHCGM, said Elliot’s new PEP unit will offer “a better atmosphere” for such evaluations. But at the same time, he said, providers know that the ER is not the best place to treat these patients.

He’s hoping resources such as the state’s three mobile crisis response teams will get people the help they need before they end up in emergency rooms. “We’re trying to get the word out there that there’s lots of other options,” he said.

Anna Pousland, director of emergency and interim care services for MHCGM, said her agency also just created a new “intensive transition team” that will go to emergency departments to meet with patients and connect them with resources and community services that can help ease a crisis. “So we’re really hopeful that that team will impact the number of people in the E.D.s because people will hopefully be stabilized in a sustainable way,” she said.

There’s some evidence that’s starting to happen.

Pousland said MHCGM did clinical evaluations for 3,261 patients in emergency rooms in the fiscal year that ended June 30. That was 351 fewer individuals than were seen during the prior fiscal year.

It’s the first time those numbers have declined since 2009, she said.

Kennedy said if she could create the ideal space from the ground up, “It would not be in the E.D. but on campus close to the E.D. so that they could go directly to that area.

“And it would be a bright, comfortable, calming area with rooms for family meetings and more comfortable, spacious rooms for the patient,”she said.