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24-hour behavioral health crisis support available in ER

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Over the past three years, there has been a steady increase in the number of patients requiring behavioral health services in the Emergency Department at Dignity Health Sierra Nevada Memorial Hospital (SNMH).

Thanks to a three-year grant, 24-hour support is now available at the hospital for patients in the midst of mental health crises.

The program is funded by California Senate Bill 82, the Investment in Mental Health Wellness Act of 2013, according to Michael Heggarty, MFT, director of health for Nevada County.



The grant, which was competitive, funded three components of care, including on-site crisis workers (licensed psychotherapists) for the emergency department, specially trained on-call peer counselors, and a peer-staffed respite center where up to four people can stay for as long as three weeks.

“Our overall goals are to enhance, expand, and improve psychiatric emergency services,” Heggarty explained. “Through this program we are trying to move patients out of the emergency room faster, reduce transfers to inpatient psychiatric facilities, provide training for ED staff, treat patients in a less restrictive lower level of care, improve follow up of released patients, and reduce readmissions.”




The program is working, according to Joseph Britton, MD, director of emergency services at SNMH.

“Having a crisis worker stationed in the ED has resulted in more timely care for patients who present to our hospital with acute psychiatric issues,” Dr. Britton said. “Their assistance in getting patients managed and triaged so that they can receive definitive psychiatric care is invaluable.”

Karin Zink, RN, nursing director for the ED, said the volume of behavioral health visits has risen steadily over recent years.

“Having a crisis worker here to assist and facilitate intervention has been very helpful,” she said. “Patients can be assessed and directed to outpatient services, transferred to another facility, or provided with appropriate intervention services.”

The program was launched in February and staffed for 16 hours a day for the first two months, Heggarty said. Since May it has been operating seven days a week, 24 hours a day.

“We’ve treated an average of 95 patients a month through the ED crisis staff and peer counselors,” Heggarty said.

Zink said that a new Crisis Stabilization Unit is not yet available but should be operational next year. It will be located somewhere on the hospital campus.

Additionally, Sierra Nevada Memorial Hospital Foundation received a multi-year grant to assist with tele-psychiatric care. The resulting program allows patients in the ED to access psychiatric services during a crisis, day or night. Utilizing the Dignity Health tele-health system, psychiatrists provide early evaluation and psychiatric intervention via remote consultations with patients, improving patient care, decreasing the need for some transfers, and providing a safer environment for staff members and patients.

Although local figures were not available, one national study estimated that about one in eight emergency room visits are related to mental health disorders or substance abuse.

“The mission of our hospital is to partner with local community services in order to meet the health care needs of our community. I am proud of this team and the rapid action they have taken to provide greater access to behavioral health care,” shared Katherine A. Medeiros, president and CEO at SNMH.

Emergency departments have served as safety nets for communities lacking mental health crisis intervention facilities, even though emergency rooms are typically geared toward treating physical, rather than mental trauma.

Heggarty said the grant funding the new program is only good for three years, but added, “We intend to sustain the program indefinitely.”

He added, “Feedback from patients, families, and staff has been all positive.”

All physicians providing care for patients at SNMH are members of the medical staff and are independent practitioners, not employees of the hospital.


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