Whole-Person Care Decreases ER Visits When Incorporated into the Community Mental Health Setting

Severely mentally ill patients lack access to medical care and tend to die 25 years earlier compared with the general population. The health care complications and emergency room visits associated with mental illness increase overall health care costs.

During a presentation at the American Psychiatric Nurses Association 28th Annual Conference, held October 22-25, 2014, in Indianapolis, IN, Laura Sidlinger, DNP, APRN-C, psychiatric nurse practitioner at St. Francis Primary Care at Valeo in Topeka, KS, said that “it just makes sense to combine primary care with mental health service in a community mental health center clinic.”

Patients with severe mental illness are not considered “good” patients in a primary care setting by primary care standards, Sidlinger said. “These patients often forget to show up for appointments. Sometimes, they don’t take the medications exactly as you prescribe, so primary care terminates them.” Sidlinger said her clinic made a rule that no one with mental illness would be terminated, unless violence was involved.

She said the staff at her facility conducted a needs assessment with the community to see if people would actually come for treatment. After they established the need, they opened with sliding-scale fees. They started offering just 12 hours a week and have now expanded to a full-time clinic.

• Sidlinger said there have been several lessons learned:
• Two rooms are much better than one
• The longer a patient has to wait for a visit, the more likely they’ll choose the ER instead
• Leave a few appointments each day for urgent care/walk-ins

“Many of these consumers had never been taught how to be a patient in a clinic. They either showed up or they didn’t,” Sidlinger said. She tried to teach them to become more active in their care and to maintain a schedule. Even something as simple as “if you don’t think you’re going to make it, call and let us know because we have people who can come in right away,” she said.

The staff also double-booked and saved some time each day for call-ins or urgent care, then saw a significant decrease in ER visits. Sidlinger said one time she saw a man as a same-day appointment and asked what he would have done if he couldn’t have seen her. “He said he would have gone to the ER because he could get the same care there. When they have a problem, they want it taken care of right now!” she said. Her facility’s current goal is to have everyone seen within 72 hours.

Some patients don’t trust doctors or have previously had problems with health care workers understanding their mental illness. Others just need more time than most doctors can typically give.

“When you can spend the time to explain things so that patients understand, they are more likely to be compliant and have more successful outcomes,” she said.