The Burke Mental Health Emergency Center (MHEC) is the first free-standing Psychiatric Emergency Center fully served only by emergency telepsychiatrists. Previously, any patients in psychiatric crisis in rural and remote areas of America faced lengthy drives, sometimes handcuffed in the back of police vehicles…sometimes driving hundreds of miles to the nearest hospital or crisis center.
The MHEC model includes a single, free-standing facility which includes a Psychiatric Emergency Service (PES), a voluntary Crisis Residential Unit (CRU) of 16 beds, a 6 bed Extended Observation Unit (EOU) for consumers on emergency detention, and Mobile Crisis Outreach Teams (MCOT). All psychiatric services are provided 24/7/365 by a team of dedicated emergency telepsychiatrists.
Consumers presenting to the PES are seen via telemedicine within 20 minutes of arrival. Consumers on the CRU and EOU are seen on rounds by telepsychiatrists up to three times per day. Upon discharge from PES, CRU, or EOU, consumers can be seen by the same group of telepsychiatrists upon transitioning to the MCOT teams for linkage to outpatient care.
MHEC represents improved access for consumers and their families in crisis … in a humane, coercion free facility which emphasizes recovery, improved community functioning, and integrated physical and mental healthcare.
Using Emergency Telepsychiatry at MHECs is a new innovation which maximizes community resources:
· For Cost Savings: Paying for psychiatric services on demand, when and where they are needed
· For Emergency Departments(EDs): EDs no longer need to go on diversion because of mental health consumers boarding in the ED
· For Police: Decreased time to transport consumers over vast distances and/or wait with mental health consumers in EDs
· For Consumers and Families: A more welcoming and less coercive atmosphere versus EDs or inpatient hospitals; no waiting for days at a time in an emergency room for an inpatient bed
· For the Legal system: An alternative to putting consumers in jail
· For the Overcrowded Inpatient Hospital System: a community based alternative to inpatient hospitalization
· For Dual Disorders: Access to Emergency Psychiatrists comfortable with medical treatment, substance abuse and detoxification, ages 3-100, and consumers with developmental disabilities.
JSA Health Telepsychiatry and The Burke Center provide free consulting to institutions … local and national … interested in building their own MHEC. Methods and materials are provided to assist with:
• Coordinating efforts between local agencies to raise interest and operating capital
• Implementing telepsychiatry into clinical operations to decrease cost and increase access to care
• Developing least restrictive interventions including verbal de-escalation and other non-coercive techniques for assessing and treating suicidal and homicidal consumers
• Providing excellent psychiatric and medical care at MHEC facilities to address among others presenting problems hypertension, seizure disorders, diabetes, chronic pain, community acquired infections, metabolic problems, obesity and cigarette smoking. The result - 92% of presenting consumers do not need medical clearance in local emergency departments.
• Architectural design to create light, open and inviting facilities for consumers in crisis
Complete policy and procedure manuals and implementation schedules are provided upon request.
The Burke MHEC came together through a massive and creative strategy to get diverse agencies to see the need for a regional psychiatric emergency center including:
• Emergency Medical Response
• Judicial Courts
• Emergency Departments
• Community Mental Health Centers
• Advocates for the Mentally Ill and more
Exemplary leadership was shown by the following:
• Obtain a HRSA Network Development Planning Grant
• Perform a needs assessment for the region done by a local university
• Form 12 county advisory boards
• Consensus build with State Legislators and Judges representing all 12 counties
• Obtain matching cash contributions from area medical hospitals to build and maintain MHEC
• Obtain funding from each county Commissioner’s Court
• Obtain matching funding from the Local Temple Foundation
• Lobby the Texas State Department of Health Services to put up $1.6 million dollars in annual grant funding
JSA Health Telepsychiatry has replicated the MHEC model at eleven additional sites using telepsychiatry for crisis care:
1. Bluebonnet Trails Crisis – Georgetown and Seguine, Texas
2. Emergence EOU – El Paso, Texas
3. Heart of Texas Crisis Treatment Center – Waco, Texas
4. Camino Real Crisis Program – Pearsall, Texas
5. StarCare EOU – Lubbock, Texas
6. Texana Crisis Center – Rosenberg, Texas
7. Community HealthCore Regional Crisis Centers – Marshal, Atlanta and Kilgore, Texas
8. Gulf Bend EOU – Victoria, Texas
Currently under development
1. Spindletop Crisis Unit – Beaumont, Texas
2. Austin Travis County Mental Health Emergency Center – Austin, Texas
3. TriCounty EOU – Conroe, Texas
JSA Health Telepsychiatry maintains a secure DropBox folder for al MHEC facilities with documents including policies and procedures, quality management and outcome measurement, necessary forms and Clinical Service Plans. This shared folder assists in replication from site to site.
JSA Health Telepsychiatry and Burke MHEC track outcomes related to cost and utilization as follows:
Total Admissions since November 2008: > 5100
Cost data 2014:
- State Hospital Stay: $11,629.00
- Mental Health Jail Stay: $10,960.00
- Emergency Department Visit: $1265.00
- Burke MHEC 3 day stay: $2399.00
- Annual savings per year from ED/Hospital/Jail Diversion: ~ $9,930,000
Performance Data 2014:
· Admissions per Month: 90
· Readmitted < 30 days: 8%
· Transferred to Inpatient Psychiatric Hospital: 17%
· Sent for Medical Clearance after Arrival at MHEC: 2%
· Requests for Medical Clearance Prior to Arrival: 3%
· Consumers Reporting Improvement: 88%
· Consumers Satisfied with Telepsychiatry: 82%
Heart of Texas MHEC reported State Psychiatric Bed Day Usage declined from 59 beds per day in May 2013 when HOT-MHEC opened to an inpatient bed day census of 9 in February 2015 - an 85% reduction in hospital bed day usage saving ~ $6,843,000 annually.