{"id":57088,"date":"2022-10-27T09:00:34","date_gmt":"2022-10-27T13:00:34","guid":{"rendered":"https:\/\/healthcaredesignmagazine.com\/?p=57088"},"modified":"2022-10-24T15:20:52","modified_gmt":"2022-10-24T19:20:52","slug":"spreading-the-news-on-behavioral-health-crisis-units","status":"publish","type":"post","link":"https:\/\/healthcaredesignmagazine.com\/trends\/operations-facility-management\/spreading-the-news-on-behavioral-health-crisis-units\/","title":{"rendered":"Spreading The News On Behavioral Health Crisis Units"},"content":{"rendered":"

Here\u2019s the good news: Spending on much-needed behavioral and mental healthcare in the U.S. has increased more than 50 percent in the past decade, reaching $225 billion in 2019, according to an Open Minds Market Intelligence Report<\/a>.<\/p>\n

Today that figure is set to expand even more following this summer\u2019s passage of a federal gun safety bill that includes $8.6 billion to support the buildout of certified community behavioral health clinics in all 50 states.<\/p>\n

Now the bad news: Even as behavioral and mental health conditions have become better funded and less stigmatized, trips to the hospital for behavioral health emergencies are on the upswing.<\/p>\n

Between 2007 and 2016, emergency department (ED) visits for behavioral health services in the U.S. increased from 6.6 percent to 10.9 percent, according to the article \u201cIncreasing Emergency Department Visits for Mental Health Conditions in the United States,\u201d published in the Journal of Clinical Psychiatry<\/em><\/a>.<\/p>\n

Recent stressors like COVID-19, polarizing politics, and economic instability have made matters worse. It\u2019s now estimated that one in seven people arriving at an ED is there for a behavioral health issue or underlying mental or substance-abuse condition.<\/p>\n

Challenges to behavioral health care<\/h2>\n

Although behavioral health services<\/a> have expanded, EDs are often the only option for patients experiencing acute behavioral crises such as profound psychosis, aggressive or agitated behavior, intoxication, and\/or suicidal tendencies.<\/p>\n

Unfortunately, many EDs lack appropriate treatment spaces for these patients. Most EDs either hold these patients for extended periods or transfer them to an inpatient bed\u2014neither of which are ideal from an operational, financial, or treatment perspective.<\/p>\n

Another challenge facing hospitals is that behavioral health visits to the ED are often less profitable than other medical emergencies and can actually result in financial losses. This is because behavioral health patients are commonly held in the ED for long periods without receiving billable treatment while also occupying beds that could be used for other patients.<\/p>\n

A 2011 study, \u201cThe Impact of Psychiatric Patient Boarding in Emergency Departments\u201d by Wake Forest University<\/a>, found that behavioral health\u00a0 patients stayed in the ED an average of three times longer than traditional medical patients, resulting in 2.2 fewer bed turnovers and a financial loss of $2,264 per patient.<\/p>\n

A more recent study, \u201cEconomic Evaluation of the Emergency Department After Implementation of an Emergency Psychiatric Assessment, Treatment, and Healing Unit\u201d published in the journal Academic Emergency Medicine<\/em><\/a>, found that 75 to 80 percent of behavioral health patients in the ED could have been discharged within 24 hours had they received prompt evaluation and treatment in a calming, therapeutic environment.<\/p>\n

Defining a behavioral health crisis unit (BHCU)<\/h2>\n

Behavioral health crisis units (BHCUs) embedded within hospitals offer such an environment. These specialized, calming spaces accommodate the safe and efficient assessment and stabilization of behavioral health patients.<\/p>\n

BHCUs complement the continuum of care for behavioral and mental health patients<\/a> and support the \u201ctriple aim\u201d of healthcare: enhancing the patient experience, improving population health, and reducing costs.<\/p>\n

Another benefit to the BHCU model is that it provides a specialized space that can accommodate many behavioral health patients at once and allow for expedited and reimbursable treatment.<\/p>\n

Approximately 100 BHCUs are currently in use in the U.S. The reason more haven\u2019t been built is due, in part, to unfamiliarity with the facility type and the lack of planning and design standards.<\/p>\n

Hoping to clear up both issues, the Facility Guidelines Institute (FGI) convened a topic group of healthcare designers and behavioral health experts (including this author) to identify best practices and establish BHCU planning and design guidance that others could use.<\/p>\n

The topic group\u2019s work resulted in the addition of minimum design requirements for BHCUs in the 2022 edition of\u00a0 FGI\u2019s Guidelines for Design and Construction of Hospitals and Guidelines for Design and Construction of Outpatient Facilities<\/em>.<\/p>\n

Information of these standards also are now available in a newly released FGI white paper, \u201cDesign of Behavioral Health Crisis Units,\u201d which offers valuable insights for both healthcare providers and designers looking to provide hospitals and patients with a better and more compassionate model of care.<\/p>\n

This article discusses some key points from the white paper, including how to best introduce a BHCU into an existing facility so it aligns with other services and how to design and program spaces for effective treatment.<\/p>\n

Space considerations for BHCUs<\/h2>\n

The FGI white paper offers a broad outline for planning and designing BHCUs, beginning with location. The Guidelines<\/em> documents require that BHCUs be placed adjacent to\u2014or in close proximity to\u2014a hospital\u2019s emergency department or freestanding emergency care facility.<\/p>\n

Coupling the two departments allows for the sharing of clinical support services and spaces, including medical triage, equipment and supply storage, and support areas for staff and families.<\/p>\n

At the core of the BHCU is a multiple-patient observation area often called a milieu. As opposed to individual patient rooms, which can feel like \u201ccells\u201d for many people experiencing a behavioral health crisis, the milieu gives patients room to move about to help reduce anxiety.<\/p>\n

Patients in the milieu typically use recliners to rest or recuperate, and tables are available for small group conversation. A self-serve snack or nourishment area can further give patients a sense of control over their situation.<\/p>\n

Patients also interact with clinicians in the milieu. To encourage this connection, the white paper authors recommend integrating nurses\u2019 stations into this space rather than positioning them behind a separated \u201cfishbowl\u201d of protective glass, which can\u00a0 limit engagement and can foster patient distrust.<\/p>\n

In addition to the milieu, BHCUs may include single-patient observation rooms and secure holding rooms for de-escalation in the rare instances where coercive interventions are needed. The FGI Guidelines<\/em> documents require an intake room or area, an exam\/treatment room, and a quiet room for respite. The total number of patient care areas will be determined and documented in the functional program developed by the healthcare organization and its planning and design team.<\/p>\n

Design in these spaces should focus on calming the patient by including\u2014where possible\u2014natural light, views of nature via windows or wall art, and furnishings and building materials that mitigate noise.<\/p>\n

A soothing interior design approach with comfortable furnishings, relaxing and muted colors , and dimmable artificial lighting that can reinforce circadian rhythms is also recommended.<\/p>\n

Safety and circulation within a behavioral health unit<\/h2>\n

While the design and programming of BHCUs prioritize open and calming environments, the authors of the white paper also lay out several suggestions for making these spaces as safe and secure as possible.<\/p>\n

These include tactical design and technology solutions\u2014such as ligature-resistant products, electronic badging for staff, duress alarms, and surveillance cameras\u2014as well as organizational\u00a0 approaches that include training staff on how to de-escalate patients exhibiting aggression.<\/p>\n

When locating a BHCU near an ED, planners and administrators should analyze travel distances between any\u00a0 shared support spaces to confirm efficient travel time for BHCU staff.<\/p>\n

Furthermore, circulation paths for behavioral health patients\u2014particularly those in crisis\u2014should be organized to avoid intersecting with spaces dedicated to support services, staff-only zones, or other diagnostic\/clinical service areas serving a broader patient census. BHCUs with projected high volumes may also benefit from a dedicated exterior entrance near the ED entrance.<\/p>\n

Next steps for mental health care <\/strong><\/h2>\n

Previous FGI Guidelines<\/em> editions included an option for a secure holding room in EDs and freestanding emergency facilities. To address increased patient numbers, the 2022 documents for hospitals and outpatient facilities include standards for additional behavioral health spaces in EDs, including flexible secure treatment rooms and behavioral and mental health treatment rooms.<\/p>\n

Yet even these additional spaces may not be sufficient to deal with the growing number of patients requiring emergency behavioral health care.<\/p>\n

One reason emergency behavioral health care hasn\u2019t kept pace with demand is that hospitals and the authorities having jurisdiction that approve their construction have lacked a clear understanding of the unique needs of these patient types.<\/p>\n

FGI\u2019s BHCU white paper provides clarity and insight into the operational and care benefits of having a separate treatment space specifically designed for behavioral health care.<\/p>\n

When to consider a BHCU<\/h2>\n

Hospitals wishing to improve their care of emergency behavioral health patients\u2014while also improving their bottom line\u2014should ask themselves the following questions:<\/p>\n

    \n
  1. What type of emergency treatment spaces are we providing for emergency behavioral health patients?<\/li>\n
  2. What is their average length of stay?<\/li>\n
  3. What is their health outcome?<\/li>\n
  4. What impact does the care and treatment of behavioral health patients have on our operations and finances?<\/li>\n<\/ol>\n

    If the answer to one or more of these questions leaves room for improvement, it could be time to explore the opportunities offered by a BHCU.<\/p>\n

    For more information on this subject, download the \u201cDesign of Behavioral Health Crisis Units\u201d white paper at https:\/\/fgiguidelines.org\/resources<\/a>.<\/em><\/p>\n

     <\/p>\n

    Virginia Pankey, AIA, EDAC, LEED AP, is principal and senior medical planner at HOK and served as the chair of FGI\u2019s Behavioral Health Crisis Unit topic group. She can be reached at virginia.r.pankey@hok.com<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

    A recent FGI white paper outlines design guidelines for specialized BHCU units to address the growing need for behavioral and mental health care.<\/p>\n","protected":false},"author":13604,"featured_media":57098,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[534,536],"tags":[],"acf":[],"aioseo_notices":[],"parsely":{"version":"1.1.0","meta":{"@context":"https:\/\/schema.org","@type":"NewsArticle","headline":"Spreading The News On Behavioral Health Crisis Units","url":"http:\/\/healthcaredesignmagazine.com\/trends\/operations-facility-management\/spreading-the-news-on-behavioral-health-crisis-units\/","mainEntityOfPage":{"@type":"WebPage","@id":"http:\/\/healthcaredesignmagazine.com\/trends\/operations-facility-management\/spreading-the-news-on-behavioral-health-crisis-units\/"},"thumbnailUrl":"https:\/\/healthcaredesignmagazine.com\/wp-content\/uploads\/2022\/10\/HCD-October-2022-150x92.jpg","image":{"@type":"ImageObject","url":"https:\/\/healthcaredesignmagazine.com\/wp-content\/uploads\/2022\/10\/HCD-October-2022.jpg"},"articleSection":"Operations and Facility Management","author":[{"@type":"Person","name":"Tracey Walker"}],"creator":["Tracey Walker"],"publisher":{"@type":"Organization","name":"HCD Magazine","logo":""},"keywords":[],"dateCreated":"2022-10-27T13:00:34Z","datePublished":"2022-10-27T13:00:34Z","dateModified":"2022-10-27T13:00:34Z"},"rendered":"