Thu August 16, 2012
Urgent mental health services slowly returning to St. Louis
In 2010, the slumping state budget forced the Missouri Department of Mental Health to close the emergency room and 50 short-term beds at the Metropolitan Psychiatric Center.
The move saved $16 million. But it also forced those in need of immediate mental health treatment into local hospitals, which are not designed for those in crisis.
With the help of the area’s two largest hospital systems and some state support, there are now 16 beds available for patients with psychiatric needs who have already been screened at other hospital emergency rooms. Beginning this fall, patients needing urgent mental health care should be able to go straight to the new Psychiatric Stabilization Center.
The PSC is a temporary fix - but its creators are also hoping it helps shift the treatment paradigm.
At first glance, there’s nothing unique about the call center for Behavioral Health Response. Employees in headsets sit in cubicles in front of computers. A monitor at the front of the room gives the important metrics - number of calls, how long each call took, how many people hung up.
But the men and women answering these phones aren't helping individuals cancel a credit card or sort through a newspaper delivery problem. They are directing people with immediate mental health needs to what could be life-saving resources.
Filling a gap
BHR lead counselor Sarah Mulholland says the old Metropolitan Psychiatric Center on Delmar Blvd. was a crucial cog in the machine. Many of the hotline's callers, she said, needed emergency medication, which isn't always available at community emergency rooms.
"Also, the MPC would do longer-term mental health inpatient treatment than the hospital can do," she said. "So with that being shut down, you've got people who are put back out into their homes, or onto the streets if they're homeless without being completely stable."
Mulholland says she and her colleagues are excited to see those services gradually returning to the St. Louis region. And she says patients are also ready for that to happen.
"We've had several calls from people who say, 'I went to the MPC the last time, how do I get back there,'" she said. "They must have gotten the help they need."
Under federal law, all patients who enter the emergency room at a local hospital must be treated. But Dr. Rob Porier, the clinical operations chief of the Barnes-Jewish emergency department, says the chaos makes them difficult places for people in mental distress.
"We do the best we can, but we're limited by what we have," he said. "And we know that at times, all the lights and the sounds and the busyness that goes on in an emergency department can cause mental health patients to become more agitated."
Porier says the Barnes-Jewish ER saw a 30 percent increase in patients needing treatment for mental health issues after the MPC closed, though he says the bad economy may have contributed to that number. And he says the hospital had to spend hundreds of thousands of dollars to make more rooms in the ER safe for mental health patients.
"We needed to put in video equipment and audio equipment, we had to redesign the rooms so that people would not have access to some of the supplies, such as syringes, IV equipment supplies, blood drawing equipment supplies, lab testing supplies, which are important when we're dealing with true emergencies," Porier said.
As soon as the MPC was shuttered, he and many other medical, mental health and law enforcement professionals sat down to find a solution. They found it in the Psychiatric Stabilization Center - a public-private partnership at the same site as the old facility.
A new paradigm
The center is already being viewed as a national model, says Robert Fruend, the president of the Regional Health Commission, which coordinated the two-year planning effort and provided some seed money. And the return of specialized emergency mental health care isn't the only benefit that emerged.
"It’s the capacity we don’t have right now, as well as coordinated services to link them to long-term options all under one roof," Fruend said. "Our providers are learning new ways to work together, and really prioritizing who needs what kind of treatment to make sure that it’s delivered in the right spot."
The state of Missouri is providing $1 million a year in funding. BJC and SSM are chipping in another $1 million a year. But that's only enough to open 16 of the 50 short-term beds that closed two years ago - a quirk in federal law means that stand-alone psychiatric hospitals cannot receive Medicaid dollars.
Missouri was accepted into a pilot project that changes the rules for three years, which will eventually provide enough money to replace all 50 beds. But it will take an act of Congress to extend the federal dollars beyond 2015, says the Psychiatric Stabilization Center's president, John Eiler.
"If the long-term viability of Medicaid funding does not stay in place for us, then we would be looking at trying to find other sources, whether it would be other hospitals in our community, but it’s up to us to really show that it’s really a critical service and demonstrate the value," Eiler said.
He suspects it won't be a hard case to make.
Making the PSC financially stable will take a lot of work, Eiler says, but he's excited about the opportunity. Even if it fails, the cooperation that led to the center's creation will improve mental health care in the region.
Follow Rachel Lippmann on Twitter: @rlippmann
Emergency psychiatric care
Department of Mental Health Audit