Plans for a new ‘psychiatric ER’
Mental health crises in Nashville grow, prompting plans for a new ‘psychiatric ER’
Written by: Holly Fletcher, USA TODAY NETWORK – Tennessee
A “psychiatric emergency room” is planned to open in Metro Center next year as a way to more efficiently treat people in crisis and ease pressure on police who are often the first-responders in mental health emergencies.
The goal is to get people connected to help faster, especially when they come into contact with police. Police spend at least 5,000 hours a year — that’s between two and three full-time police officers — responding to someone in crisis.
It’s important to get people into treatment faster because the longer they are with a police officer the more agitated they become and the “higher your odds of doing something that gets (them) on the wrong side of the law,” said Dr. Bill Paul, director of the Metro Public Health Department.
“It’s important to think about this as Nashville’s mental health ER,” Paul said.
The $3.5 million facility will be open to anyone who walks in, or is dropped off, and needs help. The project is getting $2.6 million from the Tennessee Department Mental Health and Substance Abuse Services and $427,538 from the city. The Mental Health Cooperative is putting in $447,463. There will be 20 beds.
The Mental Health Crisis Services Center will be built on the Mental Health Cooperative’s campus in Metro Center.
It will connect to an existing facility and will make it easier for police to drop someone off and return to work. The system to get someone assessed is time consuming, and police often stay with someone for a whole shift only to be replaced by an officer coming on duty, said Metro Nashville Police Department Deputy Chief Damian Huggins.
The goal is to get the police officer back out on the street in 10 minutes.
The facility is not just a resource for people in police custody but for anyone who is having a mental health crisis.
People struggling with addiction abuse who go to the emergency room sometimes find themselves at Mental Health Cooperative because there aren’t enough beds or they can’t afford treatment.
Huggins said the new facility will allow the health and police departments to track whether treatments are working or if people are recurring through the system.
The larger Nashville gets, the more demand there is.
Mental Health Cooperative staff says the 24-hour operation is “never not busy.” Anyone can walk in and get evaluated and get mental health treatment — regardless of whether they have insurance or an ability to pay.
Mental Health Cooperative gets about 6,000 calls on its crisis line a month, does 700 face-to-face assessments and takes on about 70 drop-offs from police each month.
In a large room partitioned by glass for security, there are cubicles where people take crisis calls and a whiteboard covered in notations to track people who need in-patient care — and whether there is any space available for them.
It’s challenging for people on TennCare to find a local bed, but it’s even worse for people who don’t have any coverage.
“It’s a lot harder to get people in psychiatric hospitals. As soon as they build them, we can fill them,” said Michael Randolph, crisis supervisor at Mental Health Cooperative who works with SWAT team and helps train police.
The new facility got approval in a little over a year — a speed that impressed Paul.
Shawna Adkins said she got to the Mental Health Cooperative after she found her way into an ER because she was unable to find a rehab facility that would take her since she doesn’t have insurance.
A month ago, she decided she wanted to get kick her heroin addiction after trying to hide the problem from her family for two years.
She said she called around to area facilities but without having insurance hadn’t been able to find a spot. She wound up in an ER and after some time was transferred to the critical unit at Mental Health Cooperative where she’s getting some treatment for the side effects from detoxing.
“That’s the only way I’d get help if I went to the ER,” Adkins said.
On her third day at the cooperative’s crisis stabilization unit, she had headaches, aching bones and her skin felt like it’s burning, she said. Two years on heroin has left her 35 pounds lighter, a side effect of drug abuse that raised questions from family curious bout her weight loss, she said.
Her two kids, ages 8 and 9, are in custody of an aunt through an arrangement with the Department of Children’s Services. Adkins wants that to be temporary.
The Nashville native wants to move to Alabama where she has an uncle once she’s clean. It’d be a fresh start away from the people who might drag her into a relapse. She said she got rid of her phone and is away from the man who brought her heroin into her life.
She’ll spend about a week in two different Mental Health Cooperative units and, hopefully, find a rehab spot.
She wants her life in recovery to include culinary arts education so someday she can own a bakery.
“I’m just tired of getting high. It’s the devil’s drug,” Adkins said. “Before I lose everything, I want to get off of it. My kids are worth more than this drug.”
There’s a similar facility in Tucson, Ariz., and Knoxville is working on a diversion program, said Tom Starling, president and CEO of Mental Health America of Middle Tennessee.
Starling likes the Nashville approach because it diverts people in crisis before they make it to booking — helping keep avoidable blemishes off of people’s records. The Nashville facility is planned for a groundbreaking in February with first patients accepted in the fall.
“This means more help right here so they begin that road to recovery and treatment and hope,” Starling said.
There is often a wait in a traditional emergency room for a mental health clinician to complete a psychiatric evaluation and transfer to an in-patient or community-based facility.
The wait can range from hours to days, according to a white paper by TeamHealth, and the patient is “boarded” in an ER room.
Across the country, there’s been a decline in psychiatric beds in recent decades. It’s estimated that the available beds are only 28 percent of what’s “necessary for minimally adequate in-patient” psychiatric services, according to Treatment Advocacy Center.
The shortage is reflected in the strain on Nashville’s first responders.
But Huggins thinks the impact is larger than they know.
“We’re fairly certain we’re not capturing everything,” Huggins said.
Police receive training on how to manage people in mental health crisis but it’s a problem that needs differently trained professionals.
“You wouldn’t take someone with an appendicitis to jail. You’d take them to the ER,” said Angie Thompson, director of behavioral health services at the health department.