October 25, 2017

The simple approach helping Sinai's Holy Cross Hospital 'decriminalize' mental health issues

Daily Briefing

    Sinai Health System's Holy Cross Hospital has launched Chicago's first 24/7 crisis stabilization unit (CSU) for patients experiencing a mental health emergency, improving care for patients while helping the city "decriminalize" mental health issues, Leo Vartorella reports for Becker's Hospital Review.

    Get 3 innovative ways to better manage behavioral health patients

    How it works

    Holy Cross Hospital's CSU aims to "help the most vulnerable people in Chicago" by improving access to mental health care, reducing the amount of time patients spend in the ED, and avoiding unnecessary inpatient stays, Sinai CEO Karen Teitelbaum tells Vartorella.

    To do this, Teitelbaum said the hospital integrated the CSU into its ED triaging processes. Under the new process, patients who come to the ED experiencing a behavioral health crisis are "triaged in the [ED] as is appropriate," and those who require care but are determined not to require inpatient care are directed to the CSU.

    Once patients arrive, Teitelbaum said they are observed, treated, and counseled by a dedicated care team consisting of psychiatrists, psychiatric nurses, nurse practitioners, social workers, and others. The team also coordinates any medications or needed follow-up appointments before a patient leaves. She described the CSU as "a quiet place that has recliners" instead of beds and gurneys.

    Improving patient care

    Since opening the CSU, Teitelbaum said Holy Cross Hospital has reduced the amount of time behavioral health patients stay in the ED. "A lot of the people are getting in and out in less than three hours, instead of a full day to as many as three days in an ED."

    Further, she said the CSU has given hospital officials more insight into the types of care patients with behavioral health conditions may need. She said, "Clearly if someone is in such an acute state that they need to be hospitalized then we do that." But she said they have found that a majority of patients "are taken care of with a far less intense level of services."

    Teitelbaum said, "Seventy-two percent of the people we see in the CSU aren't admitted," adding, "That's terrific for the patients, it's safer, and they don't get mired in an intense inpatient stay that they really don't need."

    A safe haven

    The CSU also plays a key role in how law enforcement officers approach individuals with mental health conditions, Teitelbaum said.

    The CSU is working with the Cook County Sheriff's Office and the Chicago Police Department to divert individuals struggling with mental health conditions who might otherwise end up in the criminal justice system. According to Vartorella, 76,400 people were admitted to the Cook County Jail between 2009 and 2012, of which 45,840 suffered from some form of mental health issues.

    Lessons learned

    Teitelbaum said they have seen a great demand for the CSU's services and have nearly finished expanding the number of recliners from 12 to 34. She said the process for building the CSU "went pretty quickly" and noted that it is "not that capital intensive." She said, "It took 6 months for the pilot, and now that the larger unit is under construction, we just have typical hospital construction duration."

    Teitelbaum recommended that other hospital leaders interested in establishing CSUs focus on developing strong community partners to ensure patients have a follow-up appointment lined up when they leave the CSU, "whether it's for substance abuse or counseling or safe housing or medications."

    Ultimately, the end goal for the CSU, according to Teitelbaum, is this: "We want the people who should not be in the prisons to get the right type of care, be safe and be well" (Vartorella, Becker's Hospital Review, 10/11).

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