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Four Ways Hospitals Are Improving Behavioral Health Care

Behavioral health strategies take pressure off emergency departments

The hectic, stressful nature of the typical emergency department (ED) makes it a less-than-ideal setting for mental health care. Nevertheless, hospital EDs have become a major component of the nation’s de facto behavioral health system, according to an article in Hospitals & Health Networks.

The reasons include years of funding cuts to public mental health organizations and the resulting loss of thousands of inpatient beds at state and county facilities, coupled with an increased demand for services, H&HN says. Mental illness and substance abuse account for 4% of ED visits, or nearly 5.5 million visits a year.

To address the problem, many hospitals are embarking on strategies to increase access to mental health screening and outpatient services, to improve behavioral health care within the ED, and to connect patients with medical and social services in the community. H&HN describes four innovative approaches that hospitals have taken to improve care and access for patients with behavioral health concerns.

Integrating Psychiatry Into Primary Care

At New York’s Montefiore Health System, requests by primary care physicians for help in treating patients with behavioral health issues sparked an initiative to begin embedding social workers and psychiatrists in each of its 23 primary care sites, according to the article. All primary care clinics now have a social worker, and half have a psychiatrist. The new care model includes universal depression screening for patients at the primary care clinics at least once annually.

Most patients receive therapy, often focused on problem solving, from the social worker. The primary care physician handles prescriptions for common, less-severe mental health problems. The psychiatrists spend about half their time consulting with the social workers and primary care physicians and the other half working directly with patients with the most severe mental illnesses.

Building a Continuum of Behavioral Health

Over the years, Atlantic Health System in New Jersey has built a continuum of behavioral health care that encompasses inpatient mental health and ED services, outpatient therapy, and even partial hospitalization and residential care. Now it’s working to fold behavioral health into its hospital-owned, community-based practices, according to the article.

Atlantic has embedded psychologists in many departments, such as diabetes, pain management, oncology, cardiology, and bariatrics, and has geropsychiatric units at three of its hospitals.

Linking All Providers

The 2010 closure of a state mental-health hospital caused alarm in the St. Louis, Missouri-area health care community over the increased demands it would place on an already-overburdened system. To come up with solutions to the problem, local hospitals and community mental-health centers partnered to create the Behavioral Health Network of Greater St. Louis.

The organization developed the Hospital-Community Linkages Project, which facilitates referrals from hospitals to community mental-health centers and improves care coordination between them. The project is funded primarily by the state and also by an annual fee paid by participating hospitals. It targets patients who are uninsured or on traditional Medicaid, who aren’t already linked with a service provider, and who have a serious mental illness.

Helping ED Patients Obtain Outpatient Services

Florida’s Lee Memorial Health System is taking several approaches to connecting ED patients with mental health and/or substance abuse problems to the outpatient care they need, H&HN says.

The system is part of a multiagency collaboration supporting the Bob Janes Triage Center & Low Demand Shelter, which serves homeless people with mental health or substance-abuse disorders. The voluntary shelter, opened in 2008, also provides an alternative to jail for people whose behavioral health condition or substance abuse puts them at risk of being arrested for low-level, nonviolent offenses.

Emergency patients who would benefit from the triage center are identified by ED nurses or physicians, who alert a social worker or case manager. After eligible patients are medically evaluated and cleared, the social worker or case manager checks whether a shelter bed is open and arranges patient transportation.

Source: H&HN; May 11, 2015.

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