An epiphany last year on the status of the state’s commitment to mental health convinced Karen Shumate that Lawrence Memorial Hospital had to take another direction in the care of those with behavioral and mental health issues.
The epiphany: The state wasn't going to fix its own mental health hospital.
Up until that time, Shumate, LMH chief operating officer, said she thought the state would seek to rectify Osawatomie State Hospital’s loss in December 2015 of federal certification needed to receive Medicaid funding. She was also under the belief the hospital would once again have beds available for those who were occupying LMH’s emergency rooms for extended stays.
“The crisis in Osawatomie forced the question,” she said. “That happened in the fall of 2015, and I really thought until early last summer that they were going to get their beds up, they were going to get their accreditation and everything would go back to the way it was. I remember I was at a meeting, and I thought ‘this is not going to get any better.’ They did not take the steps they needed to get their accreditation back. They did not get the expertise they needed to get it done.”
The Osawatomie crisis forced the hospital and others in the community to take a critical look at the state of mental health care and admit that the conditions before the state hospital’s loss of accreditation “weren’t all that great,” said LMH President Russ Johnson, who started his job at the hospital in August 2016, a few month’s after Shumate’s epiphany.
For the hospital, the re-evaluation was an acknowledgement LMH had a role in the community’s mental health continuum of care and needed to improve that care in consort with community partners, Johnson said.
The hospital doesn't believe it can provide all the mental health care needs in the community, but Johnson confirmed the hospital is still committed to building a small crisis stabilization center inside the hospital. Shumate said the hospital is currently working with architects on the plans, and hopes to start construction by the fall.
The hospital does see a significant number of people who are in mental health crisis. LMH has as many as eight to 10 patients a day in behavioral or mental health crisis. Those numbers aren't much different than before the problems began at Osawatomie, however the severity of cases dealt with by LMH has changed. Assessments performed soon after admissions indicated those admitted to LMH were experiencing more severe conditions, and records show they are staying up to 30 hours longer, she said.
Shumate characterizes the care mental health patients receive at the hospital emergency room as a “holding pattern.” They are placed in calm environments, either in three dedicated behavioral-health safe rooms or in traditional emergency rooms, and receive psychiatric medication when appropriate, she said.
After their admissions, a social worker visits to determine whether patients have improved enough to return to their homes, be transferred to other inpatient facilities or are a danger to themselves or others. For involuntarily admitted patients, that latter determination could eventually lead to admission to Osawatomie, she said.
The hospital’s reappraisal of its mental health care service came as Douglas County was reviewing with community partners the mental health care needs in the county as part of its planning for a mental health crisis intervention center it looks to build in partnership with Bert Nash Community Mental Health Center.
The net consequences of the county review, coupled with the Osawatomie State Hospital crisis, were that the hospital and other partners would need to — in Johnson’s words — break out of their “silos” and start exploring ways to create a comprehensive approach to mental health care.
It was a conversation that involved the county, LMH, Bert Nash, Heartland Community Health Center, DCCCA, the Lawrence-Douglas County Health Department, the Lawrence Police Department and other stakeholders.
That large group was broken into four subcommittees, two of which directly involved LHM. One explored what measures the hospital could take to provide a crisis stabilization center and the second looked at what staffing and services such a facility would need, Shumate said.
At a March 1 Douglas County Commission meeting, Johnson and Shumate revealed how LMH planned to improve its mental health care within the context of those community discussions when they shared plans for a mental health crisis stabilization center to be built in 1,000 square feet of currently unused space adjacent to the hospital’s emergency department.
The hospital also found it could add another 400 square feet by knocking out an exterior wall, Johnson said. Although that would increase the center’s cost, it would provide a significant increase in space.
The two LMH officials told commissioners the center was intended to provide a better experience for behavioral- and mental-health patients. It would have beds for extended stays and recliners for those undergoing less severe issues, they said.
They also emphasized with Bert Nash CEO David Johnson that the plan was not only to start active therapy at the hospital, but to assist patients in establishing contacts for continued treatment and services in the community, which would help prevent them from falling back into crisis.
The plan Treanor Architects is creating for the crisis stabilization center is progressing, Johnson and Shumate said. Its evolution has benefited from tours of Kansas City metropolitan area crisis centers and online reviews of other facilities and best practices, they said.
At the March meeting, Johnson and Shumate said the center would have four private rooms, in addition to a common calming area with recliners in which patients could receive medication or recover from less severe issues. Johnson said it since was discovered private rooms weren’t best for patients in mental-health crises, which eliminated the need for some walls, while potentially increasing the number of beds available and cutting costs.
As for staffing the stabilization center, LMH is looking to hire case managers and “peer support specialists” in partnership with Bert Nash and Heartland Health, Shumate said.
“Those are traditional roles,” she said. “Peer support specialists are people who had behavioral health issues themselves but have been stable for a number of years and have had training in how to be supportive of someone else. What Bert Nash has taught us is what people in crisis need most is companionship.”
The county is asking LMH to provide its staffing expectations for the stabilization center within a month, Shumate said.
LMH’s emergency department would continue to have a role in the treatment of behavioral/mental-health patients, Shumate said. Those who are found to be a danger to themselves or others, are unable to take an active role in their treatment and require more intensive monitoring would continue to be treated there until stabilized, she said.
LMH hopes to have preliminary plans completed soon, which will allow construction cost estimates to be developed, Shumate said. It was her expectation that would start a process that could get construction started on the center by fall.
“Once you start involving architects and permits, it does get lengthy,” she said. “I’d really like to get started on this by the end of the summer. I think everybody is moving on it as fast as we can, but we want to do it right.”
Johnson, too, said the hospital was making progress on the crisis stabilization center. If it was acting on its own without the input of community partners, it could move faster, he said. But he said the end product would benefit from the more comprehensive approach.
“We’re making progress as a community,” Johnson said. “There’s no way Lawrence Memorial Hospital is going to resolve the mental/behavioral health issues in this community. It takes a community of people, but most of those partners are now sitting around talking, sharing ideas and solving problems. We think this is really the time to get information and consensus from our partners, rather than hurry something through.”