Alternates to the ED

1. Alternates to the ED • Subcommittee Chair: Linda Simoneaux MA RN • HCRS Residential Services Program manager • lsimonea@hcrs.org "There is no health without mental health."

2. Alternates to the ED - Overview • Why are we doing this? • Who are the people that will be served? • What are the requirements for an Alternative Space? • What are current models that exist that might serve this need? "There is no health without mental health."

3. Alternates to the ED - Why • We believe: • - all persons in need of psychiatric emergency care and support need access to services on an emergent basis. • - Hospital Emergency Departments are only one possible avenue for meeting this need. • Our goal: • - Make recommendations to DMH for ways to divert people from getting “stuck” in emergency departments while waiting for inpatient hospital beds and to alleviate the strain on EDs as the “Go To Place” for after hours emotional/mental support and intervention. • -Recommendations will further the practice of the State of Vermont to provide compassionate, effective and innovative person centered care. • - We do not want to replicate services or put services in place that will not be accessed to the maximum capacity. "There is no health without mental health."

4. Alternates to the ED – Who will be Served • All people in need of emergent psychiatric support. This may include people who are also adults, children, elders, with development challenges, acute or chronic mental health issues, homeless, who have resources, have limited resources, or with substance issues. The common factor ? VT residents with need for emergent psychiatric support. "There is no health without mental health."

5. Alternates to the ED – Requirements Must have Capabilities "There is no health without mental health."

6. Alternates to the ED – Requirements Must have Capabilities "There is no health without mental health."

7. Alternates to the ED – Requirements Must have Capabilities "There is no health without mental health."

8. Alternates to the ED – Requirements Nice to have Capabilities "There is no health without mental health."

9. Alternates to the ED – Models Living Room • The overarching goal of The Living Room is to decrease the use of emergency departments for mental health crisis and provide guests with support resources to be used long-term in order to minimize their need of further visits. • The Living Room is a comfortable space that is designed and furnished to have a home-like feeling with common areas and personal rooms for relaxation; strives to feel less clinical • Staffing- Peer specialists, licensed counselor/social worker, medical (psychiatric nurse) • Triage can occur as necessary • Optimally would be 24/7 but could be operated during times known to be peak crisis services utilization periods "There is no health without mental health."

10. Alternates to the ED – Models Living Room • The Living Room model has been used in at least six states to provide alternatives to ED (citation: Peer Services in a Crisis Setting; The Living Room, Lori Ashcroft, META Services Inc, March 2006). (http://www.recoveryinnovations.org/pdf/LivingRoom.pdf) • The original Living Room located in Illinois, in its first year, had 228 visits from 87 unique individuals, most of them diverted from the ED, which saved the State of Illinois approximately $550,000 (citation: Heyland, M., Emery, C., & Shattell, M. (2013). • The Living Room, a Community Crisis Respite Program: Offering People in Crisis an Alternative to Emergency Departments. Global Journal of Community Psychology Practice, 4(3), 1-8. Retrieved 8/8/17, from (http://www.gjcpp.org/). "There is no health without mental health."

11. Alternates to the ED – Models Living Room – What People Want • A study of focus groups by Recovery Innovations (formerly META) with people who had either used one of their crisis programs (including Living Room), or had been hospitalized for psychiatric care found that people expressed needing: • • A place that looks and feels more like a home than like a clinic or hospital. • • A place that feels natural and has a friendly, accepting and supportive environment. • • A place where I will be treated with respect and dignity that is non-judgmental about my condition or situation. A place where I feel safe and valued. • • A normal mode of transportation not involving law enforcement, which makes us feel like we’ve broken the law by being ill. If you would come and pick us up, we’ll go voluntarily. • • We want a continuation of META’s policy of not using restraints or seclusion. We also don’t want chemical restraint. These approaches set back our recovery process. • • A place with lots of peer staff on board who can give us hope and remind us who we really are. "There is no health without mental health."

12. Alternates to the ED – Models Living Room – What People Want • What people want from a Living Room Model (Continued) • • A place where we can be in contact with our friends, families and children; where they can come and be with us during our hard times. • • A place where we can access food and snacks. We’d like to make a sandwich, or get someone else a cup of coffee. • • A place with outside space so we can be outdoors if we feel like it. • • A place that provides interesting things to do, activities that will promote our recovery process. • • A place that offers medication education and choices. • • A place that offers lots of help with recovery – recovery planning, recovery options, and good solid plan for recovery when we leave. • • A place we can come back to if we start to slip, and not worry about being locked up. "There is no health without mental health."

13. Alternates to the ED – Models 72 Hour Hold Bed • 72 hour beds would be beds located on Inpatient Psychiatric units. These would be at hospitals that agree to provide this level of care. • These beds would either be new or existing beds whose sole purpose is to house, assess and treat persons on 72 hour holds. • 72 hour beds would get a reimbursement from the state or be able to bill for EE. (I don't know enough about this to explain how) • Once the 72 hours is up, the person is either admitted to a unit voluntarily or involuntarily, or discharged to a lower level of care such as crisis bed, living room, or home with supports or home without intensive supports, depending on the persons needs at the time the 72 hold is up. When it's over, it's over. "There is no health without mental health."

14. Alternates to the ED – Models 72 Hour Hold Bed • Pros: Incentivizes hospitals to provide immediate care and rapid disposition, rather than it being somebody else’s responsibility. • Allows patients to be in an environment of care designed to meet specialized needs, with specialized staff and environments. No need to create entire mini milieus in EDs • Speeds up access to hospitalization on parity with medical access. • Cons: Hospitals must agree to time limited beds and to potential for having empty beds if there are no 72 hour holds. How many beds would we need? Cost? Now the EDs carry the cost. "There is no health without mental health."