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Psychiatric stabilization center set to open in January

The St. Louis Metropolitan Psychiatric Center
Missouri Department of Mental Health
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After overcoming some delays, operators hope to open a short-term facility next year to accommodate people needing help for a mental-health crisis.

Initially, the St. Louis Regional Psychiatric Stabilization Center was expected to open before the end of this year. But the facility's president, John Eiler, says some steps took longer than expected to complete. These included recruiting physicians and setting up electronic health records. Roughly 100 people will work at the facility, 5351 Delmar Blvd., inside the St. Louis Metropolitan Psychiatric Center.

The next big test is the initial state inspection, expected during the first week of January. In the meantime, all staffers are undergoing training, which began on Dec. 19. The facility initially will have 16 beds, with the hope of expanding later. Eiler stressed that not all of those beds will be filled immediately:

"The main thing folks need to understand is that we won't have a full house. We have to start with a couple of patients to make sure that the state does our survey (inspection) and we're all appropriate. Then we'll add a few more patients and go through another survey. A new hospital has to come on line with a gradual number of patients during the first two inspections."

Read the Beacon's earlier story below:

Work crews are busy hammering, painting, pulling up carpet and laying vinyl flooring for a new emergency mental health unit inside of St. Louis Metropolitan Psychiatric Center. Though these activities are a little noisy at times, they sound like music to some core administrative staff members working on the new program in nearby offices. To them, the sounds are a pleasant reminder that St. Louis is closer to reviving an important mental health service that was lost when state budget cuts took effect at about this time last year.

On Delmar about a block west of Union, MPC became a rallying point among mental health advocates when the state decided to close the facility's emergency department and the beds that had been used for the short-term stabilization of patients. In these times of recession and dwindling state resources, such services are usually lost permanently once the budget ax falls. But not this time.

Robert Fruend
Credit St. Louis Regional Health Commission
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Robert Fruend

"What we were able to do was design a new system, which is going live in a couple of months with brand new services back at MPC," says Robert Fruend, chief executive of the Regional Health Commission. "They are using (the old emergency room) for storage now. But we're going to put psychiatrists, nurses, social workers back in the emergency room, and we expect about 25 people will be served there each day."

When the emergency assistance was discontinued, the Department of Mental Health and Gov. Jay Nixon's office appealed to the commission to spearhead an effort to find an alternative. Fruend says the effort could not have succeeded without strong support from the public, local government agencies and health care executives.

"A lot of times in St. Louis, things don't break that way," Fruend says of the outcome. "But the community was strong in saying that the services needed to be replaced. And the hospitals came to the table and, to their credit, said this (new program) was medically a better way to take care of people, and they wanted to be part of the solution. Not only that, they put their money where their mouths were."

The Regional Health Commission made a one-time contribution of $1.5 million to help the process. Ongoing funding is coming from the state and from BJC and SSM Healthcare. Both hospital systems have made a commitment to help keep the program afloat financially once it opens in late fall.

The new program will be called the St. Louis Regional Psychiatric Stabilization Center. Its president, John Eiler, admits the name is a mouthful. He expects the public to refer to it simply as PSC. He estimates 25 people will visit daily, seeking help for a mental health crisis. He expects about half of them won't have to be admitted. Their conditions will be stabilized. They will get medications, if needed. Then they will be referred to community mental health providers, their psychiatrists or released to families. Eiler says the number of patients accommodated daily will exceed the number who were served before, particularly those who need not be admitted.

A 16-bed unit will be available for some of those who need admission. These are mainly patients who have suicidal or homicidal thoughts and are considered dangerous to themselves or others. Eiler says the limited number of beds means that the unit will accommodate only a third of those needing hospitalization.

"That means (some individuals) will have to go back to a hospital in-patient program," he says. "So we still are going to be providing a lot of placement services."

The choice to open only 16 beds, along with the decision to set up an independent nonprofit company to run PSC, was influenced largely by federal Medicaid rules.

"Frankly, it's impossible to make this work without Medicaid," he says. "But when you are a free-standing psychiatric facility, you can't receive adult Medicaid funding. The one way of receiving the funding is if (the program) has 16 or fewer beds. Because of this long standing federal rule, we're stuck with 16 beds."

The program might have a way to get around the 16-bed limitation. A provision of the Affordable Care Act includes a pilot project granting waivers to extend Medicaid to certain free-standing psychiatric facilities that are not state-operated. PSC might qualify because it is set up as an independent, not-for-profit company leasing an emergency department and an in-patient unit inside a state mental health facility. Eiler says PSC has been working with the state Department of Mental Health to get the waiver, which could come by late fall.

"But we don't want to count our chickens until they hatch," he cautions.

The new facility will take some of the load off area hospital emergency rooms. On any given day, Eiler estimates that 80 people seeking help for psychiatric ailments either visit or are taken to hospital emergency rooms.

"We're opening a psychiatric emergency room, which will be a more appropriate place for someone who has a psychiatric crisis," Eiler says. "Emergency rooms are doing a good job, but we are trying to emphasize that we have a specialized service that will be a better place as long as people don't require acute medical care."

He says PSC, which will have about 75 workers, is working with EMS, police, health providers and consumers to ensure coordination on directing patients to appropriate treatment.

"Ideally, we'd like to operate up to 50 beds. That's the ultimate vision. We have to find a way to get there."

Eiler formerly was an executive vice president at SSM Healthcare in charge of behavioral health and senior services. The PSC's eight-person board includes representatives from BJC and SSM, St. Louis city's Human Services Department and its EMS Bureau, a consumer voice and an ex-officio, non-voting member from the Department of Mental Health. The board's chair is Richard J. Liekweg, president of Barnes-Jewish Hospital and Barnes-Jewish West County Hospital. Eiler says he expects PSC's website to be available soon at www.stlpsc.org.

Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.

This article originally appeared in the St. Louis Beacon.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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