Psychiatric Boarding: One State’s Journey to Recovery

hospital bedsAsk any group of behavioral health leaders about their recent personal experiences with Emergency Departments (EDs), and you will invariably hear complaints about waiting. I have queried audiences a number of times and the common word uniting their complaints is always “hours.” We can all empathize. Over the years my wife and/or I have been in the ED on numerous occasions with one of our two boys, and an hours-long wait in a waiting room with a sick child is painful. Several hours can seem like an eternity.

By stark contrast, individuals with mental health and addiction issues in EDs across the country do not wait hours. They wait days, a fact that is somehow continuously overlooked and minimized. Some counter that these stories are mere anecdotes or outliers. In October 2013, an investigation by the Seattle Times reported, “The patients wait on average three days [emphasis mine] — and in some cases months — in chaotic hospital EDs and ill-equipped medical rooms. They are frequently parked in hallways or bound to beds, usually given medication, but otherwise no psychiatric care.”

In 2013, ten individuals from Pierce County collectively filed suit contesting their petitions due to the waits they experienced for appropriate evaluation and care. Last August, the Washington State Supreme Court ruled on the case, finding that the practice of ED “psychiatric boarding” until an appropriate bed is available is unconstitutional and therefore unlawful (see Forbes article). Hospitals and the Department of Social and Health Services (DSHS) were given until December 26, 2014 to comply.

The investment was immediate. The Puget Sound Business Journal described the state’s rapid response in an article, “Washington care providers race to expand services.” The day following the Supreme Court ruling, the Regional Service Network for Pierce County, Optum Health, approached Recovery Innovations to fast-track the opening of a new Evaluation and Treatment (E&T) program on the campus of Western State Hospital, co-located with a similar program operated by Telecare Corporation, to quickly expand important capacity for those individuals in need.

Optum Health has been a nationally recognized leader for its innovative recovery and crisis service system of care in Pierce County, led by CEO Cheri Dolezal. Through a strong focus on community collaboration, measured accountability, and enhanced service and peer capacity, Optum Health has increased the overall number of people served by 32% (see PowerPoint presentation). So, it’s no surprise that Cheri’s team acted quickly to take advantage of an opportunity to further improve the system with additional E&T capacity.

On December 8, 2014, RI opened the Lakewood Recovery Pathway. It’s a 16-bed inpatient Evaluation and Treatment program, serving individuals with mental illness under 72-hour involuntary detention and/or 14-day commitment in accordance with the Washington State Involuntary Treatment Act, RCW 71.05. It’s a formal, legal process, which could be cold and distant. But, I’m very proud of the progress being made by the RI team in partnership with Optum Health to bring the strongest possible recovery experience and healing space for individuals in crisis.

Cheri has been an inspiration throughout the implementation. She wrote to me early on about starting an E&T in Clark County when she was Director for the Regional Service Network and working to incorporate a welcome and positive recovery environment. Individuals most frequently come into involuntary care after interaction with family, community, and/or law enforcement has resulted in an assessment and referral to an E&T by a Designated Mental Health Professional (DMHP). The individual may be very frightened by what they are experiencing and/or the process itself. Compassion, respect, and human dignity make all the difference in whether the experience is an important step towards recovery or a traumatic experience that ultimately doesn’t help, but does harm.

In her email, Cheri described creating a comfort room in the E&T for the “guests,” complete with a recliner and very soft, cuddly, warm blankets. Calm music played in the background, and the psychiatrist ate lunch with the group every day, integrating staff and those on petition. The strong nursing leadership, who directed the program, helped weave the recovery, clinical, and medical together.

This hands-on support by Cheri and the entire Optum Health team has been terrific. I’m also extremely grateful to RI senior leaders from Phoenix who have spent weeks on the ground supporting the new team in Lakewood. These include Leon Boyko, Dr. Vernon Barksdale, Marie Gagnon, Kathleen Miner, and Andrew Terech. Dr. Joshua Shemon has also been phenomenal as the administrator for the E&T and the RI Recovery Response Center (Crisis Stabilization Program) in Fife. His calm and steady leadership has been vital in supporting new staff and reinforcing a recovery space.

I also wish to thank Eleanor Owen, a member of RI’s Board of Directors and a cornerstone in behavioral health, family advocacy, and the recovery movement for nearly 40 years, for touring the new space, meeting with community leaders and supporting the staff during this launch.

velvet elvis awardOn Friday, I visited the Lakewood facility to recognize the entire team for going above and beyond, and we recognized Liz Timko with the Velvet Elvis* award. Liz has been a senior leader at the RI flagship facility in Peoria, Arizona, and we are so proud and appreciative of her efforts in Washington State. She has spent nearly two months providing hands-on support to new staff, showing them firsthand how to interact and create recovery partnerships. Her expertise as a Certified Therapeutic Options and CPI trainer, her ability to handle and manage crisis situations, and her knowledge of RI’s internal systems have been invaluable.

I’m also excited to announce two important new hires. Beth Hammonds joins the RI senior team as the new Regional Director for the Washington State and California programs, starting today. Beth helped launch the Lakewood E&T and brings a rich experience from her years as Adult Outpatient Director for King County-based Valley Cities. In addition to the Fife RRC and Lakewood E&T, Recovery Innovations also operates the Peer Bridger and Community Building program. Beth will oversee these programs as well as the operations in California, and be responsible for the Customer relationships with RI’s funders.

On March 23rd, Rivers Carpenter will start as the administrator for the Lakewood E&T and will report to Joshua, alongside Gretchen McClelland who leads the Recovery Response Center in Fife. She is an LCSW with a strong background in managing clinical and residential programs.

RI News Flash

Beth Hammonds joins Recovery Innovations as Regional Director for California and Washington State. Rivers Carpenter will be the Lakewood E&T Administrator.

Velvet Elvis Update: Liz is the second individual at Recovery Innovations to join the ranks of Velvet Elvis recipient. After a 1,200 mile journey, the king transitions to her from Sarah Blanka who held the award in Peoria, Arizona for 30 days.

Igniting Hope with Recovery Education

recoveryNelson Mandela believed the catalyst for a better future was learning. “Education is the most powerful weapon which you can use to change the world.” Equipped with the right tools, the disenfranchised and disabled become engaged and empowered. Hope is ignited.

In behavioral health, recovery education opens an individual’s eyes to recognize potential beyond the despair of a limited life; giving courage and creating possibilities. Perhaps this is seen most strongly in those who have transitioned from a disability check to meaningful employment.

But recovery education creates more than personal development; it’s the stuff of social movements. While token voice and limited participation may previously have been seen as laudable for a person wanting to be involved in a community mental health center or mental health system, suddenly active leadership and action are required.

For the past 15 years, Recovery Innovations (RI) has engaged in changing the world through recovery education, focusing their efforts on three different target populations:

  • Individuals with Serious Mental Illness
  • Behavioral healthcare leaders/administrators
  • Recovery Innovations employees

Three departments within RI are responsible for delivering this education.

Recovery Opportunity Center (ROC)

Founded in 2005 as an RI subsidiary, the Recovery Opportunity Center has graduated more than 6,000 individuals from Peer Employment Training, certifying them to serve in Peer Support roles. As a result, RI has boasted one of the largest peer supports workforces in the world, and has used this experience in recruitment, training, support, management and retention of peer workers to create trainings that support other organizations in making similar transformations.

Lisa St. George leads the Recovery Opportunity Center and its group of six master recovery trainers who have delivered recovery consultation to behavioral health leaders around the world. In addition to trainings that guide people who supervise peer workers about how to develop a resilient, effective, and viable peer workforce, the ROC has also developed numerous training tools, books, and workbooks that support the recovery of the people RI serves.

Recovery Education Center (REC)

Author Malcolm Gladwell’s Ted Talk on Capitalizing Human Potential focuses on two key drivers: what others expect of us and what we are trained to achieve. Often, individuals with serious mental illness are told that they have a disabling illness, and as a result they will not be able to work.

Since 2002, the Company has offered alternatives to historic day programs, including vocational certificates and personal growth workshops, bringing an important “Peer Career Ladder” to thousands of individuals served by RI’s Wellness City. This empowers individuals to choose career options beyond Certified Peer Supports.

Arrow Foster leads the Recovery Education Center, which is licensed as a private post-secondary vocational school in Arizona. The program equips individuals for roles as wellness coaches, crisis navigators, case managers, and supervisors and/or administrators.  The master’s level instructors also introduce students to work roles outside of behavioral health.

RI Learning Team

Chris Martin leads the Learning Team of three master learning specialists and an education coordinator, which supports RI sites and programs across the US and in Auckland, New Zealand. They also focus on the professional and career development of staff and the advancement of the four balanced score card areas of the company.

Those who join RI’s nearly 800 strong workforce onboard through “New Employee Celebration” week, and receive ongoing support and skill-building through strong, interactive face-to-face and virtual trainings. This preparation is vital for all employees to help maintain the exceptionally strong connection to the RI core mission and to a service approach that is “irresistible” to those who experience it.

Integrating Efforts and Collective Impact

shanna galdysIn 2015, RI is aligning these three important departments under a new role to integrate and elevate their outcomes. Effective March 9, Shanna Galdys will join the RI executive team as Chief Recovery and Clinical Officer. Her team will include the learning department leaders Lisa St. George (ROC), Arrow Foster (REC) and Chris Martin (Learning Team).

Shanna previously led the learning efforts at two prior Maricopa County Regional Behavioral Health Authorities (Magellan Health and Value Options), and is a recognized leader in behavioral health in Maricopa County with a demonstrated and enduring commitment to positively impact the lives of individuals with serious mental illness.

Her prior successes include an outcomes-based workforce development model that continuously engaged participants in the practical application of recovery principles, utilized a blended learning model, and incorporated licensing and credentialing requirements. The RBHA facilitated tens of thousands of “learning events” per year, supporting new employees, behavioral health provider staff, and community members with both face-to-face and online training.

Shanna’s credentials align strongly with RI’s mission and values. She is a family member of an individual with a serious mental illness, an active member of NAMI, has a Masters of Social Work (MSW) degree and is also a Certified Psychiatric Rehabilitation Practitioner (CPRP).

In addition to working closely with the three learning departments, Shanna will partner with the RI operations leaders to strengthen the clinical foundation of the Company’s recovery programs. This includes creating strategies to improve the central focus on the individual, the health and safety of staff and guests/citizens, and the measurement of effectiveness. Shanna will also be interviewing and surveying RI staff about what they need to better serve individuals, including those with co-occurring addiction use, serious medical complications, and/or suicide risk.

“My career path has afforded me the opportunity to make changes that introduced recovery into large systems of care,” Shanna said. “Recovery Innovations represents a unique opportunity to engage in truly mission-driven practices, and together with our leadership team to back up recovery with data-driven outcomes showing the proof in people’s lives where they live, work and play every day.”

RI News Flash

Shanna Galdys joins Recovery Innovations as Chief Recovery and Clinical Officer.