Editor’s Note: A version of this post was previously published in the Puget Sound Business Journal.
The United States faces a mental health crisis, with 26% of people nationwide suffering from psychological illness or addiction. When these patients are at their most vulnerable, our communities’ emergency departments (EDs) are used as dumping grounds and holding areas due to the shortage of appropriate resources.
While any treatment is better than none, EDs are often unequipped to treat these specific patients, especially in smaller cities that are challenged by less capacity and staffing or by fewer specialized facilities. Treatment in the ED often comes with loud noises, bright lights, chaos and seclusion — which can aggravate and trigger complications for a behavioral health patient. EDs are also an expensive treatment option, increasing the cost of care for the patient and the public.
The trend of patients seeking care in EDs instead of psychiatric institutions is not new. In 1963 Congress passed the Community Mental Health Centers Act to deinstitutionalize the mentally ill. The goal was to stop “quarantining” the mentally ill and provide voluntary humane treatment. Unfortunately, this act has not been successful; the deinstitutionalization movement has been called the trans-institutional movement, with patients instead filling EDs, jails, prisons, and homeless shelters.
A Healthy Path Forward
Luckily, healthcare organizations are working with partners in their communities to overcome these challenges. For example, Kaiser Permanente and MultiCare are actively participating in programs to provide appropriate treatment for behavioral health patients — from better training of emergency responders, to preventive health measures, to better funding models.
Another solution is to redesign our treatment facilities. In Portland, Oregon, is Unity Health, envisioned by the Randall Charitable Trust. Together with a series of healthcare institutions, the trust remodeled a shuttered hospital into an inpatient behavioral health hospital with a psychiatric emergency services department. Several architectural firms came together to design appropriate spaces for care and treatment, not just stabilization until a patient is “good enough” to be released.
For example, at Unity, the typical ED exam room allows patients to dim, brighten or turn off lighting completely. While a seemingly benign solution, there is conclusive evidence on the power light has to hinder or support healing, especially with those suffering from anxiety attacks.
The project also focuses on reducing noise. When sound becomes too acute in healthcare settings, it can raise stress levels, boost blood pressure levels and require additional medication. These side effects work against providers as they seek to support their patients. The new design focuses on creating quieter spaces — using sound-absorbing materials, sliding doors and acoustical tiles to decrease noise levels.
In addition, behavioral health patients often react to each other’s outbursts, so the design relies on patient monitoring for safety. Not only does this allow for patient privacy, it also prevents patients from being put in windowless, isolated rooms.
A Call to Action
Despite the best efforts of the Affordable Care Act, the cost to treat behavioral health patients is skyrocketing. To counter the cost impact, we need to create programs for understanding, rehabilitation and prevention to ensure behavioral health patients find wellness and stay well. Studies show that for every 10% increase in mental health spending, the prison population is reduced by 1.5%. It’s clearly better to spend our resources on creating a well-balanced environment — through programs, assistance and facility design — than incarceration.
While the nation grapples with the uncertainty of healthcare under a new administration, we can take steps now to ensure patients suffering from behavioral health issues are given the tools and resources necessary to lead healthier, happier lives.
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