Posted on June 12, 2018
Removing the barriers that stand in the way of providing appropriate care to people with behavioral health needs – including mental illness and substance abuse disorders – is a dominant concern across Michigan hospitals.
Behavioral health patients who enter through the emergency department (ED) at our hospitals may remain in the acute care hospital for days or even weeks as they await placement in a facility that can provide the care they need, and Michigan is working to address this huge challenge to our healthcare system.
At a recent meeting of physicians on this subject, Leslie Zun, MD, chair of Emergency Medicine at Sinai Health System, Chicago, who specializes in behavioral emergencies in acute care settings, shared these statistics, which help demonstrate the prevalence of behavioral health need in hospital emergency departments:
- The literature on ED and behavioral health shows 12.5 percent of all ED visits were related to mental health and/or substance use disorder.
- 41 percent of those visits resulted in hospital admission.
- That admission rate is over two and a half times that for ED visits related to other conditions.
While we continue to work with advocates to develop short-term solutions, the MHA and several member hospitals participated in an effort with the Michigan Department of Health and Human Services (MDHHS) to identify the root causes that prevent timely access to inpatient psychiatric hospital care last fall. The Michigan Inpatient Psychiatric Access Discussion, known as MIPAD, published a long list of recommendations this year.
Underpinning many of the recommendations was the need for establishing common general standards and language for clearing psychiatric patients as medically ready to leave the emergency department and move to the inpatient psychiatric hospital setting. Informally known as medical clearance, several states have already attempted implementing requirements or standards to ensure ED physicians and inpatient psychiatric psychiatrists use one common set of tests and evaluations to determine a person’s medical status prior to transfer.
Together with MDHHS, we at the MHA have brought together a group of physicians to make initial recommendations for standards for medical clearance. The group has representatives from emergency medicine, psychiatry, psychology, academic medicine, the Michigan State Medical Society, and east, west and northern Michigan.
With a goal of finalizing its recommendations before the end of 2018, the workgroup will consult with many interest groups before establishing standards and advancing to the implementation phase. These groups include:
- Constituency associations.
- Academic experts.
- Clinicians who are managing behavioral health patients and the inpatient psychiatric placement.
- Inpatient hospital counterparts.
The MIPAD effort and the medical clearance workgroup are helping to move the focus toward improving the effectiveness of the behavioral health resources we have in Michigan and the amount of funding the state of Michigan is directing toward this need. Although the MIPAD recommendations may not yield changes for several years, we are encouraged by the initial steps being taken to address inpatient psychiatric care for behavioral health patients.
Laura Appel is senior vice president and chief innovation officer at the Michigan Health & Hospital Association. In her current role, she focuses on healthcare policy, hospital finance, legislation and governance. At the federal level, she represents the interests of Michigan hospitals and health systems in both the legislative and regulatory arenas on key issues, including federal healthcare reform and Medicare.
Posted in: MHA Rounds