Your Turn: Pandemic innovation in mental health and addiction care must not stop Leave a comment

Kenneth Holmen and James Hereford  |  CEOs, CentraCare and Fairview Health Services

Innovation often happens when we’re faced with challenging circumstances. In healthcare, we often think of innovation as a groundbreaking trial or a rare discovery. But innovation in healthcare is also life-changing when it impacts our patients as they walk through the doors of a hospital or clinic.  

The COVID 19 pandemic laid bare the growing problem of access to and inadequacies of the mental health services. Too often, people in mental health crisis start and end their treatment in hospital emergency departments (EDs). 

Consider a young man with a panic disorder experiencing an attack. His prescription lapses and his only option is to go to the ED. There, his episode worsens as he’s triggered by the lights, sounds and activity of an ED meant to treat immediate life-threatening illness and injury. He leaves with a new prescription, but also the trauma of the environment he encountered while in emotional distress – one that was never designed for him. He loses faith and trust in the health system as a result. The cycle continues. 

Over the past 20 years ED visits by adults in mental health and addiction crisis have increased by nearly 41 percent. The increase was 57 percent for children. ED visits by people experiencing suicidal thoughts and suicide attempts have increased by 40 percent.  

In 2012, Dr. Scott Zeller, a California-based emergency psychiatrist, reimagined how an ED could be better for patients in mental health crises, their families and staff who care for them.  

His idea? Specialized units associated with EDs designed for people experiencing mental illness. He envisioned a place with calming, therapeutic spaces, staffed by licensed mental health professionals who help people experiencing a mental health crisis receive the time and support they need to reach the next step in their care. EmPATH units – short for Emergency Psychiatric Assessment, Treatment, and Healing – were born. 

MORE: CentraCare opens new space intended to improve emergency behavioral health care

In 2021, M Health Fairview Southdale Hospital and CentraCare – St. Cloud Hospital opened the first two EmPATH units in Minnesota. Since the beginning of 2021, more than 4,200 patients have received care at our EmPATH units or with our emergency psychiatry teams.  

Historically, 40% of patients who arrived in the Southdale ED with mental health symptoms were admitted to inpatient care. That rate is now less than 20%. In 2022, Fairview plans to expand EmPATH services at our largest hospital, M Health Fairview University of Minnesota Medical Center, which will ultimately serve adult and pediatric patients.   

At CentraCare’s St. Cloud and regional EDs, the implementation of an EmPATH strategy means patients have direct access to psychiatric providers for initial evaluation, immediate treatment, and a faster transition to a more appropriate setting for further healing; reduced pressure on inpatient units locally and across the state; a quicker return for patients to their communities and home environments; and the avoidance of further trauma thanks to a supportive, respectful experience. 

OUR VIEW: Emergency mental health treatment is a good start, but we must do more to help those in crisis

As regional, nonprofit health systems, we directly experience the trends and problems and feel a deep accountability for addressing them. Our commitment to innovation starts with our patients’ needs and experiences. Our EDs saw an already bad trend worsen, reflecting data nationally, and disproportionately affecting those with mental illness. With mental illness sure to increase during a pandemic, we feared what could happen to our patients, staff and communities if we reached a breaking point.  

The decision to try something new did not come without risk. In the case of EmPATH, we had the benefit of learning from a small group of hospitals around the country who had also implemented the model. We studied their data and examined their processes. Nonetheless, we had to make it work here, in our EDs, with our staff and our communities. In the middle of a pandemic, we made the leap, and nearly a year later, that risk has benefited our patients, our staff, and our communities.   

It might not be as simple next time. Healthcare is indelibly changed by a global pandemic. Health systems are arguably more fragile than ever. Healthcare workers are struggling. And healthcare is navigating through difficult circumstances largely driven by crisis level staffing shortages, a lack of public trust, and an industry functioning on a broken financing model. Our patients and our staff deserve better, and innovation can deliver it.  

— James Hereford is the president and CEO of Fairview Health Services, the largest provider of mental health services in the state of Minnesota. Dr. Kenneth Holmen is president and CEO of CentraCare, a St. Cloud-based provider of comprehensive medical care, including mental health services, to residents of Central, southwest, and west-central Minnesota. 

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