Behavioral health staff and leaders said Wednesday no one needing help would be turned away once the Treatment and Recovery Center of Douglas County opens, but they offered up scenarios explaining how inpatient access would be limited, at least for some.
Representatives of the TRC gave an update to the Douglas County Commission on Wednesday. Although they didn’t provide a date the center would launch a proposed three-phase opening plan, they shared protocol for how those experiencing crises involving mental illness and chemical use would be able to access the center’s services.
“We’ll be open 24/7, 365. It’s that we won’t have a full-blown outpatient clinic open 24/7, 365,” said Stephen O’Neill, chief operations officer for Bert Nash Community Mental Health Center, in response to a question from Commissioner Patrick Kelly about hourly requirements. Kelly said the public’s expectation was the center would operate around-the-clock.
O’Neill told commissioners that expectation would be met.
“We will have the full range of staff 24/7, 365 and if you show up at night, we would have a different entrance for you, but we would still meet with you and work with you,” O’Neill said.
Referring to the center’s after-hours door on the west side of the building, O’Neill likened the TRC’s Access Center to an urgent-care type of service but for people experiencing crises involving mental illnesses, substance use and addiction.
“It’s really about walk-in access to outpatient services, but we will have all of the staff,” O’Neill said. “We don’t staff as high overnight as we do during the day, but we have social workers, nurse practitioners, all of the staff are there and we probably need to do a better job of communicating and articulating that. But from Day One, it will be open 24/7, 365.”
O’Neill, however, pointed out a caveat after intake and evaluation within the TRC Access Center. Those under 18 can’t be admitted to the TRC’s Observation and Stabilization units. State licensing restricts those units to adults only.
“I will say, what we can do for someone under 18 after hours is going to be different than what we can do for someone over 18 after hours,” O’Neill said.
In that case, staff would still meet with a minor and their parent or guardian but would refer them to outside facilities or community services before they left the TRC. A minor who needed to be admitted to an inpatient facility could receive help from TRC staff to locate that facility.
Likewise, once the Observation and Stabilization units have reached capacity, staff will still perform intake and assessment services for all who enter the TRC. But instead of being admitted to the TRC for observation, a calm-down period, detox or other services, they’d receive help from TRC staff to locate a bed in another treatment facility or receive services at LMH Health’s Emergency Department. With 40 TRC employees already on board, these services already are provided by staff nearby at Bert Nash and LMH Health, staff said.
In the TRC’s Observation Unit, recliners will provide inpatient adults a place to rest for up to 23 hours before they’re discharged back into the community or referred to another facility. During stabilization, up to 72 hours are allotted before an adult patient would return to the community or go to another facility for continued care. Beds within the Stabilization Unit are provided two-to-a-room.
Space-wise, the Observation and Stabilization Units can accommodate up to 16 adults each, but that doesn’t mean the center would serve 32 patients, staff said.
In figures that were adjusted by Bert Nash staff since the agenda had been posted online the previous week, numbers of potential inpatients in each phase had increased due to budget adjustments, according to O’Neill. He said he used a first-phase opening date of February for estimation purposes only within the TRC’s $7.6 million draft budget for 2023.
New figures proposed staffing for up to 10 adult inpatients within the Observation and Stabilization units and front-door Access Center hours of 8 a.m. to 8 p.m. Monday through Friday for youth and adults when the TRC’s doors open.
By the proposed phase two, the Access Center would add front-door weekend hours of 8 a.m. to noon Saturday and Sunday, and accommodate up to 16 inpatients. In the third and final opening phase, the center could serve up to 24 inpatients.
“However, when I did the four-year look back on data from LMH (Health) and Bert Nash and who we’re sending to the hospital, it is a very unlikely scenario anytime in the near future that we would even hit the 24,” O’Neill said.
“I could be wrong when we open, because opening something new could bring in people we’re not aware of, but I think we should take this incrementally and see what’s happening and make adjustments and pivots along the way.”
O’Neill said there would be flexibility in how those 24 patients could be served altogether between the Observation and Stabilization units, and it could be viewed “as one pot” from a staffing standpoint.
Commissioners talked with staff members about the proposed phasing levels and their corresponding patient acuity levels. Higher levels of acuity translate to patients with higher needs.
In the proposed phase one, for example, the TRC only would accept adult inpatients who’ve already been medically cleared by LMH Health. In phase two, voluntary self-referrals would be accepted as inpatients. Referrals from law enforcement and emergency medical services wouldn’t be admitted as inpatients until the third phase.
“In all candor, because prior to the TRC opening, people have experienced being rejected for services and turned away due to acuity,” Commission Chair Shannon Reid said. “I have a significant concern about that trend continuing and not changing and evolving as I expect it to, so I just, I ask those questions, to put a point on really wanting to know that we are not turning people away, that there is no wrong door, and people even with high acuity are going to get their needs met.”
O’Neill said the faster the TRC could hire staff, the faster the center could serve as many as 24 inpatients and reach the highest level of acuity. At the same time, staff members said they needed tiered services within the three phases in order to help them recognize service gaps and identify needs for improvement before accepting those patients with the highest levels of need.
That being said, O’Neill clarified the center could still initiate an involuntary hold with an inpatient, if necessary, as soon as the center opened its doors.
“There will be folks Day One that we would still prefer law enforcement bring to the (Emergency Department),” he said. “The other thing is, I think we will see, if we think about involuntary care and treatment, that represents a very small percentage of people in acute psychiatric crisis.”
Reid, who works in social services, said the TRC is a “project that has always been envisioned as one of true inclusion and being able to serve all people in our community no matter the level of, that need of care.”
Commissioner Karen Willey told Bert Nash CEO Patrick Schmitz she wasn’t bothered by the phased-in levels of care but said TRC staff and community members would need to receive adequate communication on how calls would be handled during transitions from one phase to another.
Wednesday’s presentation to commissioners was made by O’Neill, Schmitz and TRC staff members, who are transitioning to employment under Bert Nash.
Nancy Thellman, board member of Behavioral Health Partners, announced near the end of the presentation the nonprofit board wished to withdraw from consideration to operate the TRC. Instead, Thellman said, the BHP board supported the county handing over that responsibility to Bert Nash.
Commissioners didn’t vote on any proposals Wednesday. A ribbon-cutting for the center was held in June. County leaders had anticipated an opening in July.