Crisis Stabilization: Along the Behavioral Health Continuum

Crisis Stabilization Along the Behavioral Health Continuum

Expertise Introduction Case Study References

01 Expertise

E X PE RTISE

Your Trusted Healthcare Design Partner Stacy has more than 20 years of experience working in and around healthcare. Starting as a nurse, she has been able to be a part of the full functions of the hospital which helps her work with clients to plan and operate their new and existing facilities efficiently. For the last six years she has been the director of surgical services and nursing for hospitals across West Michigan.

Putting People at the Heart of Everything We Do. Just Like You. Stacy Mockridge, RN, MSN Clinician/Healthcare Planner mockridges@progressiveae.com

Phone: 616.365.3427

The healthcare sector is an ever-evolving industry often riddled with unique challenges — especially with the pandemic’s impact on systems across the United States. And if fighting to keep patients at the center of care isn’t difficult enough, now healthcare systems are juggling reimbursement issues, supply chain issues, staff shortages, and delivering financially sustainable projects. You don’t need to go it alone.

We care about people. In fact, they’re our ‘why’. Let’s work together to advance your mission by designing exceptional healing environments where people can thrive.

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OF EXPERIENCE

DESIGN AWARDS

LOCATIONS= 3 03

Expertise Introduction Case Study References

02 Introduction

IN TR OD U CTION

More than 1 in 5 adults and over 1 in 5 adolescents either currently or at some point during their life, have had a seriously debilitating mental illness (Mayo Clinic, 2022). Mental health is our emotional, psychological, and social well-being. It affects how we think, feel and act. It also determines how we handle stress, relate to others, and make choices. In contrast, mental illness refers to disorders that affect your mood, thinking, and behavior. As individuals navigating the complex terrain of mental well-being, we invariably encounter fluctuations in mood and varying levels of anxiety stemming from the challenges of life. It is constructive to perceive these fluctuations as part of a continuum, acknowledging the dynamic nature of our mental health journey. When we talk about mental health, we often use words loosely and interchangeably and they start to lose their true meaning. It is imperative we are careful of our words.

For example: Depression is not the same as having a bad day, a panic attack is not the same as feeling afraid, OCD is not being organized, ADHD is not hyperactive, and PTSD is not the same as feeling upset or stressed about an exam. The use of generalizations contributes greatly to the stigma associated with mental illness. Suicide is a leading cause of death in the United States and was responsible for 48,183 deaths in 2021, that is one death by suicide every 11 minutes and rising. More than half of the people with mental illness don’t receive help, often avoiding or delaying treatment for fear of prejudice or discrimination.

Mental Health verse Behavioral Health and the Continuum of Care?

The phrase “behavioral health” was first used about 40 years ago and the definition has evolved since.

According to StarMed, behavioral health refers to the way your habits affect your mental and physical health and wellness (Hatton, 2023). Behavioral health disorders are a pattern of disruptive and destructive behaviors that last several weeks or longer. In contrast, mental health is a person’s emotional, social, and psychological well-being. It affects how we think, feel, relate to others, and handle stress. Mental health is a component of behavioral health and should be managed as part of behavioral health treatment.

The behavioral health continuum of care refers to a range of services designed to address the varied behavioral health needs of individuals. The services range from early intervention to intensive treatment and recovery (Public Sector Consultants Inc., 2021). The continuum can be seen as a series of escalating steps based on the severity of the condition being experienced and the level of care necessary to address the needs of the patient. Providers utilize the continuum of care to follow patients from preventative care through diagnosis, therapy, and aftercare.

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Expertise Introduction Case Study References

03 Case Study

CASE STU DY

CONTINUUM OF CARE

The Need for Innovation The delivery of behavioral health care is at a crucial juncture where efficiency and quality must hold the spotlight. Coordination of services must be maximized and focused on the changing needs of those seeking treatment. Underinvestment in mental health is a global phenomenon, despite the apparent significant need for people to access behavioral health services (Fitton, 2018). Historically, mental health and substance use treatment in the United States were developed locally, based on community need and availability. Work has been done to integrate services; however, fragmentation of services and programs continues to be a problem and is a serious obstacle for providers seeking treatment for their patients. In 2020, less than half of adults and youth with behavioral health conditions, and less than 10% with substance use disorders received treatment. Provider shortages and wait times for services can be weeks or months. Individuals in need of urgent care for behavioral health issues spend days waiting in the emergency department before services become available. Rising inpatient care costs have dramatically decreased funds available for early intervention and prevention services funded by the community.

Background and Rationale Like so many communities in the United States and throughout the world, Kent County, Michigan has a critical gap in behavioral health crisis services. Too many people with urgent behavioral health needs present to the emergency department or a correctional facility. Emergency departments in the community reported nearly 10% of all visits are for behavioral health crises. The average cost per episode of care in the emergency room that concludes in an inpatient setting exceeds $15,000.00. Preliminary data showed that approximately 100 individuals with a serious mental illness are booked in the Kent County Jail each month. Neither the emergency department nor county jail are designed for behavioral health treatment, and both can exacerbate a crisis. These events mean that individuals do not receive appropriate care while further burdening a challenged healthcare industry. Network180, Kent County's Mental Health Authority, being responsible for providing adequate behavioral health crisis treatment began an investigation into ways to overcome barriers, more efficiently manage resources, and improve access to care for individuals in their community. Network180 organized an independent task force dedicated to exploring a behavioral health crisis center model of care to both improve treatment and maximize funding for behavioral health patients in Kent County.

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CASE STU DY

Who Bears the Cost for Each Step Typical Steps in the Process of Seeking Emergency Psychiatric Hospitalization with Medicaid

Mcaid Health Plan

ED/ Health System

Ambulance Co.

CMH

Total

1. Call 911. Ambulance Ride to Emergency Room.

$ $$.$$

2. Evaluation in Emergency Department (ED). Determination that presenting issue is a mental health or substance use disorder (SUD) crisis.

$ $$.$$

$ $$.$$

$ $$.$$

3. Tests are completed for all patients even though some facilities do not require tests because the facility with an open bed is not yet found. It will delay placement if the required tests are not complete when a bed is found.

$ $$.$$

$ $$.$$

$ $$.$$

$ $$.$$

$ $$.$$

4. CMH completes required screening and authorization for inpatient. Wait for open psychiatric bed for hours or days. This waiting, called "psychiatric boarding" lasts over seven hours on average and costs the ED, because it cannot help other patients.

Individuals from Kent County are hospitalized locally, regionally, and out of state- wherever a bed can be found. This is estimated lost revenue from three patients the ED could not serve at a rate of $1,917/patient.

5. Bed is identified. Ambulance ride from ED to local psychiatric hospital.

$ $$.$$

$ $$.$$

$ $$.$$

6. Average nine day stay in Psychiatric Inpatient Hospital- Actual Rate.

Average Costs for Typical Emergency Psychiatric Inpatient Process.

$ $$.$$

$ $$.$$

$ $$.$$

$ $$.$$

$ $$.$$ $ $$.$$

$ $$.$$

$ $$.$$

$ 15,000.00 +

The National Guidelines for Behavioral Health Crisis Care define essential elements for effective, modern, and comprehensive crisis care to include: • Regional Crisis Call Center • Crisis Mobile Team Response • Crisis Receiving and Stabilization Facilities The focus of this study will be the creation of a crisis stabilization unit. Crisis stabilization services offer the community “no-wrong-door” access to mental health and substance use care. Operating much like an emergency department that accepts all walk-in, ambulance, and authority drop-offs. In a 2014 report, SAMHSA defines crisis stabilization as: A direct service that assists with deescalating the severity of a person’s level of distress and/or need for urgent care associated with a substance use or mental disorder. Crisis stabilization services are designed to prevent or ameliorate a behavioral health crisis and/or reduce acute symptoms of mental illness by providing continuous 24-hour observation and supervision of persons who do not require inpatient services (SAMHSA, 2020).

To accomplish their goal and align with the SAMHSA crisis continuum, Network180 partnered with Trinity Health Grand Rapids to construct a new Behavioral Health Crisis Center in Kent County.

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CASE STU DY

The heart of the new Behavioral Health Crisis Center (BHCC) is a Crisis Stabilization Unit, which will allow for rapidly accessible intensive treatment that can stabilize most behavioral health crises within 24 hours.

Funding Securing startup funding for a crisis stabilization unit posed a significant challenge as the regional public behavioral health budget saw an unexpected reduction. However, this did not stop the partnership from moving forward.

A crisis care task force consisting of community stakeholders and feasibility study participants was formed to solicit feedback on the crisis center concept, analyze and validate financing needs, and recommend a financial plan to develop the CSU. Findings of the task force demonstrated that nationally 55%- 88% of individuals who would otherwise need inpatient psychiatric hospitalization can be effectively treated in less than 24 hours with immediate psychiatric and crisis intervention services. This model of care provides appropriate treatment at a lower cost for both patients and health systems.

Network 180 was pleased to receive a grant for the construction of their new behavioral health crisis center because of Michigan Legislature to encourage participation and creation of crisis stabilization units (CSUs). Michigan Legislature designated funding in the FY2023 budget to account for at least this CSU and others. Included in the budget is $625 million in new investments for behavioral health and the healthcare workforce. $30 million to establish crisis stabilization units for mental and behavioral healthcare along with $10 million to fund the essential health provider loan repayment program to cover behavioral and mental health professionals (Michigan Legislature, 2023).

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CASE STU DY

Design Principles Trinity Health Grand Rapids and Network180 partnered with consultant (Enviah) for planning, strategy, and operational development of the Behavioral Health Crisis Center. Together they established the objective of the project: to design a space that is safe, flexible, and integrated with a multi-disciplinary team approach, and a therapeutic space for the patients. To accomplish this the team, including Progressive AE, established principles to follow throughout the design process.

Common Design Principles The design of the behavioral health crisis center, both in terms of its physical layout and operational procedures, prioritized safety, therapeutic intervention, and a patient-centered approach. Design principles used for the development of a crisis stabilization unit are as follows:

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Design Principles 1

Safety First

2

Therapeutic Environment

DESIGN PRINCIPLES

3

Patient-Centered Design

4

Flexibility

5

Staff Needs & Safety

FLEXIBILITY

PATIENT CENTERED DESIGN SAFETY FIRST

STAFF NEEDS AND SAFETY

THERAPEUTIC ENVIRONMENT

VESTIBULE

2

PATIENT ROOM 1

TD

PATIENT ROOM 2

CORRIDOR

CONSULT / OFFICE 1

CONSULT / OFFICE 2

CONSULT / OFFICE 3

CONSULT / OFFICE 4

1

HALLWAY

CONSULT / OFFICE 5

1

2 HALLWAY

3

PT TOILET

PATIENT ROOM 3

PT SHWR

CONSULT 6

LIVING ROOM

PASSAGE

CONSULT 7

TRIAGE

MED NOURISH

PT SHWR

1

SALLYPORT

2

PATIENT ROOM 7

REGISTRATION

PT TOILET

5

CLEAN STORAGE

5 OFFICE

ELEC.

PASSAGE

5

SALLYPORT

STORAGE

CORRIDOR

TD

PATIENT ROOM 6

3

STAFF CORRIDOR

5

4

PATIENT ROOM 5

WAITING

STORAGE

STAFF WORK

PATIENT ROOM 4

4

SECURITY

5

PATIENT STORAGE

SOILED HOLDING

5 IT

STAFF CORRIDOR

TD

EQUIPMENT STORAGE

5 5

5

ST TOILET

STAFF BREAK

PATIENT ROOM 8

PATIENT ROOM 9

PATIENT ROOM 10

PATIENT ROOM 11

PATIENT ROOM 12

PATIENT ROOM 13

PATIENT ROOM 14

PATIENT ROOM 15

PATIENT ROOM 16

LAUNDRY

FIRST FLOOR PLAN - DESIGN PRINCIPLES 3/32" = 1'-0"

THE INFORMATION IN THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF PROGRESSIVE AE. IT IS INTENDED SOLELY FOR USE BY THE INDIVIDUAL OWNER. REPRODUCTION OF ANY PORTION OF THIS DOCUMENT FOR ANY PURPOSE IS STRICTLY PROHIBITED.

TRINITY HEALTH GRAND RAPIDS | CRISIS STABILIZATION UNIT | 260 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503 59846137 | FIRST FLOOR PLAN - DESIGN PRINCIPLES

PROGRESSIVE AE | HEALTH AND WELLNESS

A02

10

CASE STU DY

NUMBER FROM FLOOR PLAN

1

2

3

4

DESIGN PRINCIPLES

SAFETY FIRST

THERAPEUTIC ENVIRONMENT

PATIENT-CENTERED DESIGN

FLEXIBILITY

PROGRESSIVE AE | HEALTH AND WELLNESS

FEATURES

•

Physical Safety: ensure the environment is free from items or structures that might be used for self-harm

•

Surveillance: use unobtrusive cameras and/or one-way mirrors to allow staff to monitor patients without being overly invasive.

•

Secure Entrances/ Exits: limited access to ensure the safety of both staff and patients

•

Natural Light: research suggests that natural light can have a positive impact on mental health

•

Comfortable Furnishings: comfortable seating, soothing colors, and non-institutional furnishings can promote a calming environment

•

Quiet Spaces: provide areas where patients can retreat and have quiet reflection or private conversations

•

Privacy: while maintaining safety, offer spaces where patients can have privacy, especially for personal conversations or therapy

•

Personal Control: allow patients some control over their environment, such as adjustable lighting or room temperature

•

Adaptable Spaces: design spaces that can be used for multiple purposes group therapy, individual therapy, recreational activities, etc.

11

CASE STU DY

5

STAFF NEEDS & SAFETY

ENVIRONMENTAL CONSIDERATIONS

ITEMS TO BE CONSIDERED

ENGAGING ACTIVITIES

STAKEHOLDER INPUT

PROGRESSIVE AE | HEALTH AND WELLNESS

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Observation Points: design spaces that allow staff to easily observe and monitor patients

•

Safe Rooms: for staff to retreat to in case a patient becomes aggressive

•

Ergonomic Design: consider the needs of the staff in terms of workstation design, staff respite areas, etc.

•

Sensory Rooms: some CSUs incorporate sensory rooms with items that help soothe patients, like weighted blankets, soft lighting, and calming sounds

•

Outdoor Spaces: if feasible, provide secure outdoor spaces where patients can get fresh air and natural sunlight

•

Activity Rooms: spaces for art therapy, music therapy, or other recreational therapies can be beneficial for patient well-being

•

Involvement: engage patients, families, staff, and other stakeholders in the design process to ensure the facility meets the needs of all users

•

It was essential to identify key stakeholders early in this project due to the new partnership, ensuring optimal collaboration.

Key stakeholder work groups were established to be sure all voices were heard in a structured manner

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CASE STU DY

Location and Site Selection There are several factors to consider when choosing a site for the development of a behavioral health crisis center (BHCC). The first step is to perform a needs assessment to evaluate the population size and behavioral health needs in the region through stakeholder input. Stakeholders should include community members, behavioral health professionals practicing in the area as well as first responders. Once the need has been established the focus shifts to accessibility; is it centrally located where transportation is available and ample parking is easy to navigate. Also consider the proximity to other healthcare facilities, such as hospitals, outpatient clinics, and psychiatric services. This allows for seamless transfer of patients when necessary. The goal is to select a site that provides effective, safe, and compassionate care for individuals in crisis while ensuring the safety and well-being of staff and the surrounding community.

Attempts should be made to provide privacy to patients upon entering the facility to reduce the potential stigma attached to accessing care.

The new behavioral health crisis center in Kent County will be located on the Trinity Health Grand Rapids' campus. The location of the BHCC was very intentionally chosen, to provide separation from the main hospital and emergency department while remaining close enough that patients can easily be transferred to the emergency department or to inpatient departments when deemed medically necessary. During planning it was important to the stakeholders that signage be prominent to attract patients to the BHCC with the hope of deterring them from seeking treatment for their mental health condition in the emergency department.

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CASE STU DY

Architectural Design Designing behavioral health facilities requires a deep understanding of the unique needs of the patient population to be served. The CSU is designed to provide short term care and stabilization to individuals experiencing acute mental health crises, potentially avoiding inpatient hospitalizations. We used evidence based design principles to create an effective crisis treatment center is multi-faceted and includes knowledge of the population to be served, physical environment needs to promote healing, the team’s approach to healing, staff training, evidence based therapies, feedback through data collection on patient outcomes, incidents and satisfaction for continuous improvement.

FGI provides minimum design requirements for behavioral health care units, beginning with the development of a functional program and safety risk assessment to capture the owner’s intent, guide design, support staff safety, and provide standards and guidance to authorities having jurisdiction (AHJs) (Facility Guidelines Institute, 2022).

The behavioral health crisis center will include both a brief intervention and crisis stabilization unit for those needing more intense treatment to deescalate what they are experiencing. Visioning exercises were performed, and it was established that the brief intervention area will consist mainly of consultation rooms while in contrast the CSU will provide a residential feel to allow patients a safe and secure environment to heal. The initial building design and layout of our case study was drafted through an exploratory exercise that helped to determine how the team envisioned the spaces and operational workflows. Throughout the exercise, common themes were identified and later developed into spaces.

The team desired to be the premier patient care facility in the area, that provides patients and employees with a safe, flexible, therapeutic, and integrated experience. Entry / check-in / triage spaces were designed to minimize distance to maximize staff efficiency and visibility. Treatment spaces such as patient rooms and community areas will be supportive, quiet, comforting and inviting. Staff dedicated work areas are designed to provide the least accessible barrier between staff and patients while maintaining visual connectedness and safety. Key stakeholder feedback was sought, and a list of desires was created for inside the building. A few highlights included onsite security 24/7, private entrance for EMS and Law Enforcement drop-offs, and common areas for family integration.

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CASE STU DY Relationship Diagram

Clinical Spaces Physical layout of clinical spaces can be a useful tool in the treatment of patients experiencing a mental illness. It is imperative to consider aspects of the environment that could evoke stress and suffering for the patient, for example, lighting, noise, smells, and temperature are items the patient could control to ensure they feel involved in the space. Aesthetically the environment can play a significant role in recovery and stabilization. Interior design should aim for calming colors, natural light, plants, and artwork that evoke a sense of calm and healing. Areas identified as vital to providing exceptional care in the behavioral health environment include: • Reception Area: welcoming and non-threatening area where patients are received, assessed, and wait if necessary.

• Triage (assessment) Rooms: private ligature free rooms where mental health professionals conduct initial evaluations. The triage room is the primary point of contact and should be designed to exude safety and comfort to patients as they enter.

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CASE STU DY

• Observation Area (living room): space where clients can be observed without feeling restricted. This should be open, with comfortable seating and a calming atmosphere. The living room plays a key role in allowing patients to feel supported by other patients and staff while also being able to connect and recharge independently.

• Private Rooms (patient room): a place for rest and restoring for the patient, customizable lighting and temperature provide a soothing warm and inviting environment without a clinical feel. Creating a modifiable patient room that allows the patient to customize environmental controls increases their feeling of independence and control over their situation.

• Consult Rooms: supportive spaces that allow the patient to meet with the multi-disciplinary team.

The room should be designed with intent to support and comfort the patient, allowing them to feel at ease and part of the care team in this collaborative space.

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CASE STU DY

Sustainability and Operations The behavioral health crisis center serves as an essential hub for individuals experiencing acute mental health or substance use crises. Sustainability and effective operations are crucial for long term viability and the well-being of the community it serves. Operations will often dictate the design as was the case with the BHCC in Kent County. When orchestrating operational planning for a new concept without concrete rules and regulations it is imperative to establish a strategy that aligns with what is known, and to document with rationale the case for all aspects of the operation. Here is a breakdown of tools used to assist in operational development: • Needs assessment: estimate the volume of patients based on regional data and identify prevalent mental health disorders in the community • Operational flow diagram: diagram of the steps in a process and a sequence of activities in an organization that shows how the work will be accomplished; common flows include staffing, patient, supplies, billing • Risk assessment: uses; pre-design, capture space requirements to support or improve the environment of care, establish expectations with stakeholders on liability associated with risk

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CASE STU DY

What does good look like is an important question to ask when thinking of how the space will operate.

In the design of the BHCC stakeholders were asked what process flow issues need to be considered to achieve efficient and effective crisis treatment with the fewest steps possible for those individuals in crisis. This is what good looks like for the team in Kent County: • Have enough staff to meet demand • Shared access to clinical records with live data • Reduced wait times with streamlined triage • Assessment, authorization, and referral in one location • Setting up safe and secure transportation to the facility • Accepting all patients regardless of insurance • Connecting to families in timely fashion and continuing communication after discharge • Medical clearance, or medical assessment onsite

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• Collaboration and good communication with other agencies

Safety Risk Assessment

SAFETY RISK ASSESSMENT

Level 1

LEVEL 1 LEVEL 3

Level 3

LEVEL 4

Level 4 VESTIBULE PATIENT ROOM 1

TD

CONSULT / OFFICE 1

PATIENT ROOM 2

PATIENT ROOM 3

CONSULT / OFFICE 3

CONSULT / OFFICE 2

CONSULT / OFFICE 4

CONSULT / OFFICE 5

WAITING

HALLWAY

HALLWAY

STORAGE

PT TOILET

CORRIDOR

SECURITY

PT SHWR

CONSULT 6

PASSAGE

CONSULT 7

TRIAGE

PT TOILET

STAFF CORRIDOR

STAFF WORK

PATIENT ROOM 4

REGISTRATION

PATIENT STORAGE

ELEC.

LIVING ROOM MED

PATIENT ROOM 5

NOURISH

CLEAN STORAGE

OFFICE

PASSAGE

SALLYPORT

PT SHWR STORAGE

IT

SOILED HOLDING STAFF CORRIDOR

CORRIDOR

PATIENT ROOM 6

ST TOILET TD

TD

SALLYPORT

PATIENT ROOM 7

PATIENT ROOM 8

PATIENT ROOM 9

PATIENT ROOM 10

PATIENT ROOM 11

PATIENT ROOM 12

PATIENT ROOM 13

EQUIPMENT STORAGE

PATIENT ROOM 14

STAFF BREAK PATIENT ROOM 15

PATIENT ROOM 16

LAUNDRY

FIRST FLOOR PLAN - SAFETY RISK ASSESSMENT 3/32" = 1'-0"

THE INFORMATION IN THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF PROGRESSIVE AE. IT IS INTENDED SOLELY FOR USE BY THE INDIVIDUAL OWNER. REPRODUCTION OF ANY PORTION OF THIS DOCUMENT FOR ANY PURPOSE IS STRICTLY PROHIBITED.

TRINITY HEALTH GRAND RAPIDS | CRISIS STABILIZATION UNIT | 260 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503 59846137 | FIRST FLOOR PLAN - SAFETY RISK ASSESSMENT

PROGRESSIVE AE | HEALTH AND WELLNESS

A01

18

CASE STU DY Planning

What types of services need to be offered?

63 Responses

What needs to be considered in the physical space?

58 Responses

•

• • • • • • • • • • •

• • • • • • • • • • • • • • •

Crisis Intervention & Stabilization Peer/Group Support Medical Evaluations/Clearance Referral/Resource Services Detox Medication Dispensing Temporary Beds Counseling Triage Services Therapy Psychological Evaluations Long-term Planning Education 23 Hour Observation Telephone Services ER/Jail Diversion

Safe Space Design Security Welcoming Private Meeting Rooms Privacy (Entrances) Trauma Sensitive Environment Easily Accessible Beds Waiting /Family Area Food and Drinks Classrooms

What else needs to be considered to meet the needs of individuals experiencing a crisis?

51 Responses • • • • • • • • •

Referral Services Translation Services Discharge Short and Long-Term Care Plans Health Insurance • Medicare Case Management Support for Family and Significant Others Accommodating Ambulance and Police Drop Offs Education to Outside Agencies Transportation for Additional Services

Operations Workflow

Developed by Enviah PROGRESSIVE AE | HEALTH AND WELLNESS

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CASE STU DY Staffing and Training There is a need for more specialized staff on hand. Not only psychiatrist to assist with intake evaluations but for medication administration as well. All staff, including peer support and resource coordinators, should be trained in crisis response if they do not have experience with trauma-informed care. A mix of professionals and support staff with a vast array of education and training are necessary for the success of the behavioral health crisis center.

What type of staff should be available and how should they be trained?

61 responses TRAINING • • • • • • • • • • •

Master's Degrees Preferred Trauma Informed Care Emergency Procedures Medication Management Forensic Investigation Verbal & Physical De-escalation DBT & CBT Domestic Violence Response Community Resources Diversity Substance Abuse

STAFF • • • • • • • • • • • •

Peer Support Nurses (RN & LPN) Psychologist (Neuropsychologist) Security Direct Care Psychiatrist (Medication Dispensing) Social Workers Counselors Clinicians Case Managers Administration Maintenance & Janitorial

Key Takeaways Behavioral health crisis care represents a crucial component of mental health services. Properly addressing crises can save lives, facilitate recovery, and reduce overall costs of care. Best practices noted focus on immediate access to care, deescalation, trauma-informed care, safety, least restrictive setting, person-centered care, peer support, and continuity of care. It is the challenge of the design team to enable the care team to accomplish best practice, safely and efficiently within the space created.

Throughout the design of the behavioral health crisis center in Kent County unique challenges presented themselves with the majority stemming from the lack of clear guidelines in Michigan for the development of this type of establishment.

Occupancy BHCC was designed for an existing building that was a business occupancy. This created concern in relation to the patient’s length of stay. If the patients occupy the space for greater than 24 hours the building must adhere to an I-2 occupancy which greatly increases cost. Without clear regulations it made sense to take this to our local jurisdiction for input. The building was able to remain business occupancy, as long as the floor was protected with an automatic fire protection system.

PROGRESSIVE AE | HEALTH AND WELLNESS

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CASE STU DY

Renovation As is so often the case, many health systems find themselves re-purposing existing spaces on their campuses. Things to consider when renovating a space to a crisis stabilization unit: •

Anti-ligature design is costly in an older building not previously designed for behavioral health environments.

•

Exterior windows proved to be a challenge, it was imperative to ensure the windows could sustain force to prevent breakage.

•

Recommended ceiling heights of 9 feet are important to limit the vandalization of ceiling mounted fixtures. Consider the floor to floor height of your proposed behavioral health environments.

•

Consideration for privacy of patients is important when dealing with main floor environments.

Conclusion In order to establish a sustainable and effective Behavioral Health Crisis Center, a comprehensive strategy is essential. This involves active engagement with stakeholders, a commitment to continuous improvement, and a keen focus on meeting the community's specific needs. The center must cultivate a welcoming and safe environment, distinct from the institutional feel of an emergency room, with the objective of being more attractive to individuals in crisis. Recognizing the interconnectedness of mental and physical health, healthcare design should prioritize principles that support both aspects.

The commitment to addressing diverse mental health conditions is evident in the design team's understanding of the profound impact the environment has on mental well-being. Their empathetic approach acknowledges the unique challenges faced by those with mental health issues, shaping a philosophy centered on creating spaces conducive to healing through calmness, upliftment, and respect.

The design emphasizes tailoring environments to the varied needs of behavioral health patients, ensuring privacy, positive social interaction, safety, and control. Despite resource constraints, the team prioritizes elements such as visibility for safety, moments of respite, and opportunities for positive engagement to support the well-being of dedicated professionals in these settings.

PROGRESSIVE AE | HEALTH AND WELLNESS

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Expertise Introduction Case Study References

04 References

R E FE R E N CE S Definitions Behavioral Health Crisis Center (BHCC): a facility dedicated to providing immediate care, intervention, and stabilization for individuals experiencing a behavioral health crisis.

Crisis Stabilization unit (CSU): short-term alternative to emergency department and psychiatric inpatient admission for people who can be stabilized through treatment and recovery coaching within 72hours

References: Butland, S., Pena, R. de la, Gill, J., Glubke, M., Hillman, M., LaMarre, S., Schmitz, R., Zheng, K., UBC Student Health and Wellbeing Staff, Gillies, J., Johnston, B., Warwick, L., Devine, D., Guild, J., Hsu, A., Islam, H., Kaur, M., Mokhovikova, M., Nicholls, J. M., & Smith, C. (2021, December 15). 3. the language of mental health.

Starting A Conversation About Mental Health Foundational Training for Students. https://opentextbc.ca/ studentmentalhealth/chapter/the-language-of-mental-health/ Centers for Disease Control and Prevention. (2023, April 25). About mental health. Centers for Disease Control and Prevention. https://www.cdc.gov/mentalhealth/learn/ Crisis Stabilization Units - MHA: Michigan Health & Hospital Association. MHA. (2023, August 23). https:// www.mha.org/newsroom/tag/crisis-stabilization-units/ FGI. (n.d.). Home - Facility Guidelines Institute. https://fgiguidelines.org/wp-content/uploads/2022/06/FGIDesign-of-BHCUs_2022-06.pdf Fitton, S., Reagan E. (2018). Behavior Health Crisis Services- Models and Issues. Health Management Associates. https://mihealthfund.org/wp-content/uploads/2018/10/HealthFund_BehavioralHealthCrisisServices.pdf Hatton, T. (2023, January 9). Behavioral health vs mental health: What’s the difference? StarMed Healthcare. https://starmed.care/behavioral-health-vs-mental-health-whats-the-difference/ Health Policy Ways and Means, Health Policy and Human Services (2020). House Bill 5832. Senate Fiscal Agency. https://www.legislature.mi.gov/(S(myete0rd4y3jik3wvvhmxr2i))/mileg.aspx?page=GetObject&objectna me=2020-HB-5832 Mayo Foundation for Medical Education and Research. (2022, December 13). Mental illness. Mayo Clinic. https:// www.mayoclinic.org/diseases-conditions/mental-illness/symptoms-causes/syc-20374968 Mi Psychiatric Care Improvement Project. SOM - State of Michigan. (n.d.). https://www.michigan.gov/mdhhs/ keep-mi-healthy/mentalhealth/mi-behavioral-health-crisis-service Michigan Legislature (2023). Mental Health Code (Excerpt) Act 258 of 1974 Chapter 9A Crisis Stabilization Units. Michigan.gov. https://www.legislature.mi.gov/(S(gtuajgunc01g0swkp5oz1p4g))/mileg.aspx?page=GetObje ct&objectname=mcl-act-258-of-1974

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REFE R E N CE M ATE R IA L References Continued: Public Sector Consultants Inc. (2021). Crisis Stabilization Units in Michigan Concept Paper. Michigan.gov. https://www.michigan.gov/mdhhs/-/media/Project/Websites/ mdhhs/Keeping-Michigan-Healthy/BH-DD/CSU-Concept-Paper-for-Children-and-Adults. pdf?rev=c02a6beed50d46fa98b5b5f59d9efa50&hash=97F30199B109FDCC05A45253812B0707 SAMHSA (2020). National Guidelines for Behavioral Health Crisis Care Best Practice Toolkit. Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf

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