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Mental Health Care and Emergency Medicine Unite in the ED

Kaiser Permanente South Sacramento’s Emergency Department demonstrates innovation and efficiency in its approach to mental health care.

As a designated Level II trauma center, the Kaiser Permanente South Sacramento Emergency Department provides emergency care 24 hours a day, 7 days a week to KP members and community.

It is also staffed with a behavioral health manager, 15 therapists, including licensed clinical social workers and marriage and family therapists, and a full-time psychiatrist — a response beginning in 2015 to the increased number of patients presenting with behavioral health issues in the emergency department.

The hospital recently applied with the city to build a 41,525-square-foot building addition for the emergency department. Last year, it saw more patients than any other local hospital, reporting over 127,000 visits and admissions. According to Brian Jensen, a regional vice president at the Hospital Council of Northern and Central California, there is a dramatic rise in the need for behavioral health services in the Sacramento region.

“That includes both mental health and substance abuse services,” he said. “There are probably a lot of societal factors driving that, but the end result is that there are not enough behavioral health care facilities and providers — individuals who actually do the work — for the needs of this population, so where do they go? They go to the emergency department.”

Coming to the ED

All ED patients are evaluated by a medical doctor, and part of that evaluation is a mental health screening.

“If, during that process, a patient is clearly having delusions or hallucinations or showing signs of an altered mental status, then the physician will consult with the psychiatry team here in the ED,” said Okeema Polite, PSW, MFT, the ED’s behavioral health manager.

Having behavioral health teams devoted to emergency medicine is not necessarily the norm — although a number of Kaiser Permanente hospitals do, including those in Roseville and Sacramento. According to Polite, it certainly has its benefits.

“Our staff psychiatrist, Dr. Arlene Burton, is able to immediately restart the medications of patients who have gone off theirs or run out.” That kind of quick action can prevent the patient from having his or her condition deteriorate.

Once the patient has been medically cleared by the attending physician, the appropriate next step is determined.

Rich in Resources

“Here at Kaiser Permanente, we have an amazing array of outpatient therapy services that we can provide, from intensive outpatient treatment to crisis residential services to partial hospitalization,” said Polite.

And for those who meet 5150 criteria — the Welfare and Institutions Code that allows for the 72-hour detainment of those determined to be a danger to self, to others, or gravely disabled — the team initiates the process for transferring the person to an inpatient psychiatric facility for further stabilization and treatment.

Having mental health staff on hand also enables the ED to administer some in-house interventions.

“Whether it’s a pre-psycho-social intervention with the family or getting collateral information or providing crisis intervention, we have the tools and skills to address the immediate needs of many of these patients,” said Polite, “And that timing can make a big difference.”

Speed Saves

Because a swift response is often called for, the ED initiated a process last January called PARTE, which stands for Psychiatric Assessment Rapid Triage Evaluation.

It is employed when an initial assessment by nurses reveals mental health symptoms but no medical indications in a patient. A therapist and a physician may then go into the treatment room together and perform their assessments simultaneously. This allows them to gather and respond to clinical and psychiatric information at the same time.

“This helps us respond more rapidly than with the usual first-come-first-serve intake process,” said Polite. “We want to provide relief and get people back to their communities and their natural support systems as soon as possible.”

The PARTE process was created with the intent of decreasing patients’ overall length of stay, and it has shown dramatic results. Patients are discharged from the South Sacramento ED under PARTE in fewer than 3 hours, versus 9-10 hours for non-PARTE patient discharge.