How to Improve Access for Mental Health Patients in Crisis

Last year, 5,492 adults were treated at Intermountain Health's Behavioral Health Access Centers.

Intermountain Health has improved access to services for mental health patients by opening 24/7 outpatient centers.

With a nationwide shortage of psychiatrists, access is one of the biggest challenges in behavioral health. More than half of U.S. adults with mental illness do not receive treatment, according to Mental Health America.

Intermountain has opened Behavioral Health Access Centers at three hospitals in Utah. "Prior to the access centers, the only place someone in a mental health crisis would go to was the emergency department. The ED was the gateway for behavioral health screenings and determining whether someone needed to be admitted to a behavioral health unit or discharged," Clint Thurgood, crisis services director at Intermountain, told HealthLeaders.

The Behavioral Health Access Centers are an alternative to the ED for mental health patients who are not at risk of harming themselves or others, he says. "The access centers are built in close proximity to the EDs. When patients come to the ED, the triage nurse in the ED asks a couple of questions related to their immediate safety and whether they are at risk of harming themselves, which would constitute a medical emergency. If the patient does not have a medical emergency, they are physically escorted to the access center to be triaged and registered similar to the procedure in the ED."

The access centers are staffed with a psychiatrist during the day, along with several other psychiatric care providers, Thurgood says. "We have crisis workers who could be a mental health social worker or licensed family therapist. We also have psychiatric nurses and psychiatric technicians. The access centers are designed to ensure that the patients who are in need of psychiatric care are meeting with the right providers at the right time."

With the access centers in place, mental health patients in crisis do not have to go to the ED, he says. "Patients do not need to go to the ED to be screened. As we have seen at our three locations, more and more people are self-presenting to the access centers, which have community-facing doors. So, the public can access them. The police can access them if they have patients who are appropriate to be seen in the access center. We are open for walk-ins."

The access centers have reduced the number of mental health patients seeking care in the EDs at the three hospitals as well as decreased the number of these patients who are admitted to the hospitals, Thurgood says. "One of the successes we have seen with the access centers is that at our EDs about 55% of all adults who come to our hospitals needing a psychiatric crisis evaluation end up being admitted to the hospital. But for patients who are seen at the access centers, the rate of admission goes from 55% down to 39%. More patients can successfully discharge to home."

Last year, 5,492 adults were treated in the three access centers.

Patients receive a thorough evaluation in the access centers, he says. "There are psychiatric consults provided by the psychiatrists. Crisis evaluation consults are provided the crisis workers. There are standardized screening tools such as the Columbia Suicide Severity Rating Scale to determine a patient's suicidality."

The access centers are a lower cost setting for treating mental health patients than EDs, Thurgood says. "Over the past five years at the hospitals with access centers, about 80% of adults with mental health crises have been seen in the access centers rather than the ED. We know that the most expensive place to receive care is the ED. So, by shifting the volume of patients away from the ED to the access centers, costs are much lower for Intermountain as well as the cost impact on the patients. It is about a third to a quarter of the cost to receive care in an access center compared to an ED."

Patients seen in the access centers receive a care plan and are connected to outpatient services in the community, he says. "By coming to the access center, patients as needed can stay in the access center for as many as 23 hours of observation. This gives us time to assess their needs and to connect them with formal and informal resources to create a care plan, including a plan for discharge from the hospital and a follow-up plan in the community."

Patients who are prescribed medication by access center psychiatrists are targeted for follow-up care, Thurgood says. "There is a concern about starting a patient on medication if they do not have follow-up care. So, a key component of the access centers is having case management workers who can connect with the patient following their discharge from the access center to make sure they have ongoing care. So, if the psychiatrist starts a patient on a medication at the access center, a case manager needs to call them the next day and say, 'Let's set you up with an outpatient provider who can continue monitoring you, so you have somewhere to go for the next seven to 14 days.'"

Related: Physician Groups Call for Behavioral Health Integration in Primary Care Practices