The Growing Role of Emergency Departments in Behavioral Health Services

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Speaker 1
Over the past five years, there's been a documented rise in the number of people who turn to their local emergency departments to provide behavioral health services. The pandemic has only amplified the demand. To meet the growing need, hospitals and health systems are creatively addressing this challenge and expanding their offerings. Welcome to Advancing Health, a podcast from the American Hospital Association.

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Speaker 1
I'm Tom Haederle with AHA Communications. Headquartered in Minnesota, M Health Fairview has responded to the rising demand for ED-based behavioral health services with its "Empath" unit. That stands for Emergency Psychiatric Assessment, Treatment and Healing. Introduced in 2021, the model offers patients fast effective care in a calming environment, and that's already making a big difference in the community.

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Speaker 1
In this podcast, Jordan Steiger, senior program manager of Clinical Affairs and Workforce of the AHA explores how Empath delivers the care patients need with Beth Hines, an executive with a mental health and addiction services and Women and children service lines at mHealth, Fairview. And now, to Jordan and Beth.

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Steiger
Thanks so much, Tom. Beth, thank you for being here today with us. Before we start, I was wondering if you could tell us just a little bit about you and your role at mHealth, Fairview?

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Hines
Sure. I am the senior executive accountable for mental health and addiction services for M Health Fairview, which is a partnership with the University of Minnesota rate.

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Steiger
So what we're here to talk about today is your Empath unit, which is a really unique way to provide mental health care to your patients and the population that you serve. So I was wondering if you could just explain what an Empath unit is.

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Hines
Sure. An impact unit is an emergency psychiatric assessment, treatment and healing area. So it's similar to an emergency department. But the entire unit is completely designed and dedicated for any type of crisis regarding mental health or addiction.

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Steiger
Great. And tell us a little bit about what your unit looks like. Like, what does that patient experience when somebody comes in?

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Hines
Yeah. So we wanted our Empath unit to be very, very different than a medical emergency room. So if you think of a medical emergency room, you are hearing sirens, usually loud noises. Your I.V. beeping that goes on. It can be a very loud and chaotic environment, which we know is not therapeutic when you're in a mental health crisis and so our Empath is designed.

00;02;54;10 - 00;03;37;23
Hines
One of the things that we really wanted to hold as a guiding principle was a very open milieu, very relaxing environment. We have outside light, so making sure that we have access to natural sunlight. So anyone who is receiving care in the Empath is able to know if it's daytime or nighttime. We've got freedom of movement throughout the the whole entire space, and it's a very open space so people can get coffee or get drinks, make decisions for themselves in a way that you don't necessarily have the ability and agency to do in a medical E.R..

00;03;38;06 - 00;04;08;15
Hines
We have about 15 recliners that are circular around the outside of our impasse with, like I said, natural light coming in. And then we've got an area that we've got water and beverages. We have a sensory room that any individual could access if they want. Just a little bit of quiet time. We have a very open nursing station that's kind of central to the unit, but yet part of that unit. 

00;04;08;15 - 00;04;16;12
Hines
We also have the ability we've got a shower room. So if somebody wants to go and take a shower, they have the ability to do that, grab a blanket or grab snacks.

00;04;16;27 - 00;04;26;02
Steiger
That sounds like an environment that is really conducive to healing and just being comfortable in a situation that can be really scary for patients coming into the hospital.

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Hines
Exactly. It's really wellness and recovery orientated. So really focused on that approach. And again, our patients have the ability to kind of continue to take care of themselves in that space as well.

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Steiger
It sounds like it. And tell me a little bit more about the types of psychiatric services you provide.

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Hines
We pretty much see anybody who would normally present to an emergency department in a crisis. And so our Empath is actually for individuals who are 18 and older and we see pretty close to 95% of any of the individuals presenting to an emergency room. So if they're medically cleared and they can walk and talk and eat, you can come in to to the Empath and receive services there.

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Steiger
That sounds like a really productive way to keep people out of the ED, which we know can be really stressful for people that are needing psychiatric services. What happens after somebody comes to your unit?

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Hines
Our unit is staffed by a multidisciplinary team with constant observation. And so they actually come in and we've got a licensed mental health professional. It could be a master's level social worker. It could be a Ph.D psychologist who actually does an initial evaluation. And then there's opportunities for reevaluation. And then we actually are able to access psychiatry services immediately.

00;05;54;29 - 00;06;40;10
Hines
So if meds need to be started or changed, that can also happen immediately. We also offer groups, so therapeutic groups that we have open invitations to individuals to be able to come in and do some of that processing and therapeutic work right away in that Empath unit. Our average length of stay is about 24 to 26 hours. And so it's kind of almost borderline an observation stay, but it gives us enough time oftentimes to start that treatment and we're able to de-escalate and help our patients actually start on that wellness journey so that we can actually do some diagnosis and discharge planning with our patients and the families that present.

00;06;40;24 - 00;06;52;14
Steiger
That sounds great. I mean, it sounds like that's a really productive way to to make sure that the patient gets to the right place after they come to see you. So how did this journey start for you and how did you launch this unit?

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Hines
So that's a great question. I do a lot of work with the University of Minnesota Masters in Health Care Administration program, and we actually had a student group of second year MHA students who needed a project to do to complete for graduation. And I asked them to try to tackle the problem of ED boarding, which is which is a pretty big problem to tackle.

00;07;17;21 - 00;07;40;24
Hines
But it was a great group who came with a lot of research and came with one of the recommendations for us to consider actually starting an Empath. Our Empath was the first one that was opened in the state of Minnesota, so it was very innovative in in the suggestion and in the research that they actually presented. And we just took it and ran with it, which was great.

00;07;41;11 - 00;07;59;24
Hines
My organization was very supportive of looking at how do we solve the ED boarding and how do we give just a different level of care that meets the needs of our patients who have a mental health diagnosis and is in crisis. So it was kind of an exciting way to start.

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Steiger
Absolutely. And how long has the unit been open?

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Hines
Been open about 18 months.

00;08;05;26 - 00;08;12;28
Steiger
18 months. So still pretty new. Is this something that is financially viable for your organization to continue?

00;08;13;21 - 00;08;40;08
Hines
That's a great question. We still are actually getting paid as if it's an emergency department visit. And so we are working actually with our payers to help demonstrate some of the outcomes that we've been able to demonstrate with that first 18 months of the Empath and looking for our payers to actually pay us more appropriately for the type of care that's actually given in in our Empath units.

00;08;40;21 - 00;08;43;12
Steiger
I'm sure that can be a challenging discussion sometimes.

00;08;43;12 - 00;08;45;22
Hines
Yes.

00;08;45;28 - 00;08;51;11
Steiger
What are some of the other barriers that you've encountered as you've launched and started to grow this unit?

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Hines
I would say the payer issues are probably the most significant and in the long term support of this program. Minnesota is known for not having enough psychiatry support, so we're a little challenged with making sure that we're hiring enough providers to make sure we're providing that 24 seven ability and access. We've been able to do that, but that that is a little bit challenging.

00;09;21;01 - 00;09;41;04
Hines
However, on the flip side, doing something innovative is very attractive to providers and to staff. And so we've had we've had a lot of ability to attract really some great talent who are very interested in changing how we look at treatment of mental health in crisis.

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Steiger
You bring up an interesting point about workforce and, you know, attracting talent, I think is that's top of mind for so many organizations across the country right now. Thinking about how to be innovative sounds like it has really paid off for you.

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Hines
It has in that area. It has. Yeah.

00;09;57;08 - 00;10;12;12
Steiger
So, Beth, you know, after learning about this program, it sounds like you're doing a lot of really innovative work that pays off for both your workforce and your patient population. But I'd love to know from your perspective why is this so important to you? Why does this work matter so personally?

00;10;12;13 - 00;10;41;14
Hines
It matters to me because I started my entire career in providing psychiatric ER social work services, and so it's very near and dear to my heart. However, in a broader sense, we know that we're in a mental health crisis, and I think we have to really look at what the care model actually is. And I hear so often that the the answer is we need more inpatient mental health beds.

00;10;42;00 - 00;11;12;00
Hines
I want to challenge that. I want to challenge that on the local level and on the national level. I think it's looking at the care very differently. And I think that providing care like this, an Empath unit, it's such a different experience for the patients going through the Empath versus going through a medical emergency department. This is incredibly patient focused and our results are speaking for themselves.

00;11;12;13 - 00;11;36;20
Hines
But really, if if an individual, we can meet individuals where they're at with the care that they need to get better quicker and to avoid an inpatient mental health stay. Because we all know an inpatient mental health stay can be a very traumatic experience on the individual and on the family. And it can have lasting impact on individuals lives.

00;11;36;28 - 00;12;04;20
Hines
And if you can avoid that, there's always going to be a certain amount of patients who flat out need an inpatient mental health stay. That's not the group that I'm talking about. There's another very large group that needs just stabilization, needs immediate treatment and intervention, and they need wraparound, very intensive discharge planning around programmatic care, like an intensive outpatient or a partial hospitalization.

00;12;05;00 - 00;12;30;02
Hines
But it keeps them in the community and it keeps them able to be as independent as possible, yet getting the help that they need. And I think that's what really drives the work that I do and really the satisfaction to be a part of actually opening this first Empath for Minnesota. And for my organization, I can say it's reduced length of stay, it's reduced boarding hours.

00;12;30;02 - 00;12;56;08
Hines
It's actually freed up medical beds for medical patients. So our mental health patients are getting appropriate care in a different unit. It's really actually decreased costs associated with psychiatric patient boarding. We had originally in that hospital where we opened our Empath, 42% of all patients who presented in that ED with mental health issues were actually admitted. Going through the Empath, we've reduced that down to 11%.

00;12;56;09 - 00;13;06;01
Hines
Significant outcomes. And it's it's really the right treatment to help our patients become well.

00;13;06;22 - 00;13;21;06
Steiger
But I think those results speak for themselves as to why this has been a great investment for your organization and something that I think a lot of other organizations could consider. As we wrap up here, are there any other things you'd like our listeners to know about your Empath unit?

00;13;21;22 - 00;13;46;18
Hines
I would say it's a risk, but I would just encourage health care systems to consider very different ways of meeting their patients where they're at, particularly around mental health needs. And it's worth the risk. And the more health care systems that are actually providing a different care model, the better we all can band together to make sure that the right payment is also in place for that appropriate care.

00;13;47;00 - 00;14;07;08
Steiger
Wonderful. Thank you so much. And thank you for your time today. I think this has been a really valuable discussion and something that our listeners are going to be able to take a lot away from. If you are interested in learning more about this program, we have a written case study on our website that goes into a lot more detail about the Empath unit at M Health Fairview.

00;14;07;16 - 00;14;16;14
Steiger
You can access that by visiting www.aha.org/behavioral health. And Beth, thank you so much for your time today.

00;14;17;00 - 00;14;21;10
Hines
Thank you, Jordan. It's just really exciting to talk about this care model. So thanks for your interest.