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.

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