ERs for Mental Illness

Emergency rooms are for more than treating chest pains or closing wounds. The ER is also a place where people go for mental health emergencies, such as suicidal thoughts, an anxiety attack, or the urge to self-harm. The ER is still the go-to place for these behavioral health crises, but it doesn’t have to be, researchers say.

The Living Room, a program run by the Turning Point outpatient mental health center in Skokie, Ill., provides emergency treatment for emotional issues in a calm, home-like setting. And a recent study of this model shows that people deal better with mental health emergencies when they’re in this kind of supportive environment. 

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A New Model for Mental Health Treatment?

More and more, healthcare reform efforts are focused on bringing down the skyrocketing costs of emergency room care and keeping people who have been admitted once from coming back. The authors of the new study say the outpatient model is a viable way to lower costs while keeping ERs focused on physical emergencies.

During its first year in 2011, the Living Room had 228 visits from 87 guests. For 213 of those visits, guests were diverted from ERs—a 93 percent deflection rate, which wound up saving the state about $550,000.

The environment at the Living Room is warm, with carpeted floors, comfortable furniture, soft lighting, and relaxing artwork. The private nursing area was designed not to look like a stark clinical exam room—a big anxiety-reliever for people going through a mental crisis.

Short Wait Times & Personalized Care

The center offers six slots at a time for patients as a way to avoid long waits for those in crisis. The Living Room has never had to turn anyone away.

The Living Room employs one counselor, a psychiatric registered nurse, and three peer counselors who have experience co-facilitating National Alliance on Mental Illness (NAMI) support groups and are recovering from their own mental illnesses.

Upon arrival, the counselor evaluates guests to determine whether they can be helped at the facility. At any time, the counselor can complete a petition saying that a person is at high risk for self-harm or hurting someone else, and may need an emergency psychiatric hospitalization.

Next, the psychiatric nurse takes the guest’s vital signs and performs other health screenings. The nurse provides health and medication education for guests, and assists in therapeutic interventions. Then the patient sees a peer counselor to talk about their issues and come up with solutions.

“Their ability to share their story with our trained peer counselors who themselves are dealing with mental illness is a transformative experience,” said Ann Fisher Raney, a social worker and CEO of the center. “Nearly every guest reports that their visit to The Living Room has helped them to find solutions for their distress and avoid an expensive trip to the emergency room.”

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Mona M. Shattell, Ph.D., an associate professor at DePaul University and one of the study’s authors, said The Living Room is set up specifically for people going through an emotional crisis—a big part of why the program has been so successful. In hospitals, care isn’t organized or delivered in the right way for people going through these types of events, she said.

While the service doesn’t replace ongoing psychotherapy, it can certainly complement it.

“Therapy is great for ongoing issues, but often doesn't fill the need during emergency situations,” Shattell said. “Many of The Living Room guests are not affluent; they are on Medicaid or are low-income and have to wait to see a therapist, if they have one.”

Better Care at a Lower Cost

For the past two years, The Living Room has been funded by a state grant so that patients never incur out-of-pocket costs. The Living Room bills Medicaid or the state for crisis-intervention services. Medicaid reimburses the facility for clients eligible for the program, while the state reimburses for clients without insurance.

“The ability to provide specialized treatment in a setting specifically focused on helping those with mental health crisis, combined with the significant cost savings, leads us to believe this will be the model for the future,” said Kirk Erickson, COO of Turning Point.

Mildred Frantz, M.D., a physician based in New Jersey, said the program sounds like a great idea.

“Distress caused by loneliness, anxiety, and sadness would be better suited to outpatient treatment. That is, if the treatment is quickly and readily available, which is the problem we are having in healthcare today,” she said, touting the program’s ability to deliver better service at a lower cost to insurance companies and the public.

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