Clint Thurgood, LCSW at Intermountain Health talks about a new system to better help mental health patients.
Interview conducted by Ivanhoe Broadcast News in 2023.
When someone arrives at the access center, what’s the process?
Thurgood: When someone arrives at the access center, they are greeted by a receptionist on registration and the caregiver asks them to make sure that they are at the location. We are co-located in a hospital with emergency departments, so we want to make sure that we are receiving the patients that intend to be in the access center. Upon meeting with the registration individuals, they meet with- after that, they meet with the triage nurse or the access center nurse to understand what they are there to be seen for. Then they are moved to a location where they are moved to an observation space where they will receive crisis evaluation. They’ll have the opportunity to meet with a psychiatrist, receive a medical screening exam, and then as needed a psychiatric consult.
Is this an emergency department for behavioral health?
Thurgood: Yes. It’s been said that psychiatry at that time was a psychiatrist’s best friend. The MO in an emergency department is, we need to clear up beds, we need to triage patients, we need to treat them, we need to discharge them to make room for the next person who might be coming through medical emergency. The access center allows individuals additional time to receive a more robust assessment with the hopes that having that additional time will allow crisis workers and the physician, the psychiatrist, to create a solid discharge plan with the patient, as well as their formal and informal supports in their home, with really the hope to return the individual to their home environment and not to be admitted to the hospital.
What other reasons would an access center be needed? You touched on it for the patient, but can you talk about several cases?
Thurgood: Sure. Traditionally, for individuals who were feeling suicidal or having a mental health crisis, and that can be anything from somebody who’s experiencing mania or psychosis, to a drug overdose, the traditional area where they would receive the treatment would be an emergency department. In an emergency department, they’re not normally staffed with behavioral health specialists. The access center diverts patients from that level of care if they do not need a medical emergency, it diverts them to a location where they can be seen at the right place, at the right time, by the right type of provider.
Do emergency personnel know where to take them?
Thurgood: Yes. As individuals come into the emergency department, the triage nurse will ask a few questions to determine if that patient is there for a medical emergency or if they’re there for a behavioral health concern. If they don’t have a medical emergency, then they will do a physical handoff to the access center team, walk the patient to the right location, and have them registered there.
How has it been in the years that it’s been open?
Thurgood: The access centers started in 2017, but all three that we have currently in existence were operational by 2018. We see roughly seven thousand individuals a year in our access centers, and it’s been very successful. It provides that level of psychiatric care at a third of the price of what is normally charged for a patient who’s seen in the emergency department. Another benefit of the access center is folks who come to the access center are less likely to need that higher level of care in an inpatient behavioral health unit. As we look at averages across the country, more than 50 percent of individuals who go to the emergency department for psychiatric care end up being admitted to a behavioral health unit. But with our access centers, we see that the admission rate is much lower. Sometimes between 28 and 40 percent. Less patients are admitted when they are treated by behavioral health personnel in the access centers.
Can you talk about how that impacts the emergency department?
Thurgood: It allows the emergency department to have those beds to meet and manage the next patient who is experiencing a medical emergency or a life-and-death situation.
Is there anything else that you want to talk about that I didn’t ask?
Thurgood: The access centers that we have at Intermountain right now are at St. George Hospital down in St. George Regional, LDS Hospital, and up in Ogden at McKay Dee Hospital. The access centers are for adults, 18 and older. I think that’s an important distinction. There are some plans in the future to have some pediatric type of services in our pediatric-based hospitals. Another reason why the access centers have been so effective and needed is because there’s an access situation affecting the entire country. If an individual calls to get a first appointment with a psychiatrist or a therapist, they may be scheduled out several weeks or several months. The access centers allow individuals who are at that level of crisis or even before the crisis, we want to move that care upstream. It allows them to meet with a psychiatrist or psychiatric provider and have those needs met before a crisis occurs.
Can you talk about how this is a sign that it’s going in that direction?
Thurgood: I think it is a sign that’s going in this direction. The access center is just one of many different cogs in this will. There’s been a lot of attention given to what can be done in the community. A lot of county mental health partners coordinate care with a hospital. We’ve seen our crisis volumes over the last five years in the state be relatively stable. We know the population has increased, but there are other opportunities for patients to receive that care outside of a hospital. I think we’re just one of those, again, spokes in that will of the continuum of care. There’s a lot more community resources and a lot of attention being placed on mental health because it is a growing need in our community.
It’s a really good idea that this was since COVID, I heard that more people are showing signs.
Thurgood: What we saw is that, again, our crisis numbers have been relatively stable, but we know that with the additional resources that’s in the community, a lot of individuals who are at lower risk or who are a lower acuity are being managed in the community. What we’ve seen in the hospital setting is the acuity has gone up a little bit. And I think this is a sign that some folks have not had the right opportunity to engage with providers or engage with interventions that can help them manage their mental health outside of the hospital system.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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Erin Goff Brad Gillman
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