By the time the Washington State Supreme Court ruled psychiatric boarding as illegal in 2014, Sound Mental Health (SMH) was already developing a program that would bring relief to hundreds of mentally ill people who found themselves held indefinitely in hospital emergency rooms. SMH’s Transition Support Program designed and operated in partnership with King County successfully addresses this challenging issue.
Boarding was a phenomenon that occurred with greater frequency as mental health funding decreased. Often, hospital emergency rooms had little choice but to become the de facto point of entry into the mental health system. According to statistics from King County, there were less than 500 individuals boarded in hospitals in 2007. By 2013, there were nearly 2,500 boarded in hospitals annually. The number of people unable to access services and being housed in hospitals was increasing, creating higher costs for tax payers without any real improvements in clients’ well-being.
Beth Anderson, manager of SMH’s Transition Support Program (TSP), explains that individuals were held for indefi nite periods, often unable to see a psychiatrist or receive a mental health evaluation. Upon discharge from the hospital, they frequently lacked the direct one-on-one support needed to be successful in their communities and avoid returning to the emergency room. The program’s stated goals, then, are to: reduce the number of visits and length of stay of people detained at King county hospitals; help people successfully transition back into their community and supports; connect to long-term care and reduce/prevent more acute illnesses that result in costly hospital readmissions.
Take the example of Danielle*, a woman who became a frequent presence in emergency rooms in three King County hospitals over the years, often detained for up to an entire week. Danielle’s troubles included losing her job and the threat of losing her home. Worse still, her surging money problems meant she could not afford medication to manage her bipolar disorder and depression. By the time she was discharged from her last hospitalization, however, SMH staff had already engaged her, eventually connecting her with a payee and writing her a prescription. TSP also consulted with her bank to get her finances in order and apply for mortgage forbearance. Importantly, TSP staff taught communication skills so that she would work more closely with her husband in the future. This support on housing and finances helped to strengthen Dianelle’s focus on recovery and her long-term success.
“These are people who might be coming to emergency departments 10 times a year or more,” says Anderson. “They are usually not enrolled in benefits, are not engaged with any kind of mental health agency and often do not have community support. We are working with people who truly do not have the resources or connections yet to make it on their own out in their community.”
To achieve these goals, SMH’s program empowers these individuals with tools, education and appropriate guidance to make life-changing connections to resources, feel a responsibility to maintain their wellness and, hopefully, end the cycle.
“Our goal is to teach and not take over,” Anderson emphasizes.
Sustainable Effort
Katrina Egner, director of SMH’s Sound Response, best illustrates the mission of the program: “From your first day with the client, you are teaching them how to be successful without you.”
While there are only a handful of other similar programs in the area, SMH is distinctive from them in a few key ways.
First, SMH utilizes a multidisciplinary approach to provide comprehensive care for people with complex issues. TSP’s eight-person team consists of licensed mental health clinicians and social workers, a psychiatric advanced registered nurse practitioner to prescribe medications, registered nurses and certified peer support specialists. The multidisciplinary model draws from various competencies, in real-time, to address the complex needs of the client.
Second, the program is specifically built to dedicate quality time to these individuals. Working with clients from 30 to 90 days, the program averages 95 people at any one time. This enables a level of thoroughness and connection that other programs cannot offer. Since the program’s inception in July 2014, they have served more than 800 clients.
“What makes our program special is that we have the time and ability to work in depth with clients, to teach them to take their own medications, get to their own appointments and empower them to be able to take care of themselves fully,” states Anderson. “We are able to address a broader spectrum of needs for the client. We’re able to offer specialty care around medical needs as well as a clinical component. All of those pieces combined are what make us unique and different.”
Staff utilize proven clinical practices to maximum effect. All are certified in the Care Transitions Model, a medical methodology adapted to behavioral health, that engages clients with specific tools and education to learn self-management skills. They primarily utilize the evidence based APIC Model and Motivational Interviewing practices, as well as other tailored models that meet specific client needs.
TSP supports the client first and foremost, providing program services where ever needed—primarily serving hospitals throughout King County, including the Swedish Health system, Evergreen, Virginia Mason, UW Medical, Overlake, Highline, Auburn Multicare, Valley Medical Center and Fairfax among others. If that client lives in another county, but engages SMH in a King County hospital, they’ll get the care they need, too.
Meeting County Goals
The program initially was formed to address the boarding issue. Though the Supreme Court ruled thepractice as illegal, new psychiatric beds were not being provided quickly, making the program absolutely critical. Even as more beds are being made available, TSP occupies a much needed niche in the community.
“Since the inception of our program, we have consistently met and exceeded our program goals,” says Anderson. “Clients are making successful connections to services, reducing or eliminating their need for hospitalization and if they do end up needing future hospital services, their length of stay is reduced.”
The Future
In terms of positive human engagement and supporting the simplest of personal triumphs, TSP is a success.
“There are such tiny things that we can do to help our clients that have such a high impact in their lives. We are planting seeds for their success and while we may not get to see the final results of their accomplishments (because they are only with us for 30 to 90 days), I’m absolutely confident that months from now, that seed will start to grow and blossom based upon the work we begin with them.”
Beyond the individual human impact, however, the program has not only been a success in meeting the county’s objectives over the past year and a half, it also presents a promising model of care for future effect.
“Our goal for Transition Support,” says Anderson, “is that the county would expand upon our program. My hope for it is that we would expand our staff and the ability to serve all of the clients who have been involuntarily held in King County.”
* Names changed for privacy.