After opening quietly in early October, the new adult psychiatric emergency services unit at the Nebraska Medical Center saw nearly 400 patients during its first three months of operation.
The long-envisioned center was intended to address a significant increase in recent years in the number of people coming to the hospital’s emergency room with problems related to mental health and substance abuse.
And the pandemic has only added to the need.
Dr. Howard Liu, chair of psychiatry at the University of Nebraska Medical Center, said 40% of Americans responding to a June survey reported that they were struggling with mental health or substance abuse problems.
In November, Nebraska data indicated that about one in four households had a loved one taking medications for mental health problems or receiving therapy, and about one in 10 said they needed therapy but didn’t get it.
“So certainly there is a gap out there, and we need to build a strong safety net for mental health in every community,” Liu said in a recent video interview.
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While the medical center and other mental health providers offer telehealth consultations, such care isn’t always comprehensive, he said. In addition, crises continue to occur, and people need a safe place to bring loved ones for help.
David Cates, Nebraska Medicine’s director of behavioral health, said the need for such a unit in the community was identified in a 2015 needs assessment.
The hospital sought input from many sources — from first responders to Region 6 Behavioral Healthcare — in developing the center, which is based on a University of Michigan model. Liu has credited Region 6 Behavioral Healthcare for carrying the torch for the project.
Dr. James Linder, Nebraska Medicine’s CEO, said the $4.8 million in renovations needed to create the center on the ground floor of Clarkson Tower was covered by a combination of philanthropic support and the health system’s capital budget. Clarkson Tower is near 42nd Street and Dewey Avenue.
By Jan. 3, the new center had recorded 381 visits since it opened on Oct. 5.
Patients still arrive in the emergency room as they have in the past. They are cleared for medical concerns first, Liu said, a step requested by other mental health providers in the community so they don’t have to repeat it if patients later are transferred. Nebraska Medicine does not have its own inpatient psychiatric beds.
Once cleared medically, patients can go to the new center and begin treatment right away. Unlike most traditional emergency rooms, the center is staffed 24 hours a day with a psychiatrist, advanced practice professionals, psychiatrically trained nurses and licensed mental health practitioners.
Linder said one of the medical center’s next priorities will be to develop a medical and psychiatric unit where people can be treated for both mental health and physical conditions at the same time.
The space where that unit would be situated now is being used to provide beds during the COVID-19 surge, he said. The project can move forward once that space becomes available and the health system has secured a portion of the estimated $8 million cost from donors.
With the addition of the psychiatric emergency center, Liu said, the hospital already has been able to decrease the amount of time mental health patients spend in the ER and get them more quickly to a place where they feel safe and supported.
Currently, one in eight visits to an emergency room in the United States involves a patient with a psychiatric or substance abuse problem. Nebraska Medicine alone saw a nearly 80% increase in people with a psychiatric crisis in its ER from 2015 to 2019, with more than 3,000 such visits just last year.
Liu said the unit is designed to operate like a train station, with patients stopping briefly and then moving on to the next phase of their care, whether that is an admission to an inpatient mental health unit or a referral to a community-based behavioral health organization.
Ideally, patients stay less than 24 hours. But those who need an inpatient bed may stay a couple of days until the right space becomes available. In the meantime, they can begin treatment.
The unit’s staff has been forging alliances with organizations in the community that work with people with behavioral health problems in order to help patients who are discharged make those connections.
Cates said the staff hopes providers from those community programs eventually will come to the unit to meet with patients.
The unit also is staffed seven days a week by trained and certified peer-support specialists, who also had input into the unit’s design.
Peer-support workers are people who have experienced mental health and substance abuse problems. Because of those experiences, they can be particularly helpful to first-time patients and those trying to get into recovery, as well as their families.
Havalynn Russell, one of the peer-support specialists, said she once thought she would never work again. She thought she didn’t have anything to offer. But she now feels that everything she went through was job training for her new position.
“Everything I went through was not a failure,” she said. “It was leading me to the success I get to experience now.”
The new unit is designed to be calm and quiet and features nature-based art. It includes four interview and triage rooms where patients can be assessed, as well as an open observation area with capacity for 12 moderate-risk patients. Those could include patients with suicidal thoughts or manic symptoms from bipolar disorder.
In addition, the unit includes a secure-care area with six private rooms where providers can stabilize patients at high risk of harming themselves or others or who are too agitated to be around other patients while they await transfer to an appropriate facility.
Russell said having a calm space is important. A chaotic space creates more chaos.
Joe Chambers, another peer specialist, said the space allows for small, hospitable touches, such as the option to offer a cup of coffee and a warm blanket, that make patients feel welcome.
Chambers said he suffered a major manic episode about 10 years ago. Not a lot of people knew what to do. If he had been able to have a conversation with someone like Russell, he said, “what a tremendous difference it could have (made) in the trajectory of my recovery and my well-being.”