This week, Providence Sacred Heart in Spokane announced it is changing which of its employees will see emergency room patients who need mental health screenings. Providence says the goal is to improve service to those people. The changes will take effect in mid-July.
We called Tamara Sheehan, the provider’s senior director of behavioral health in Spokane, and asked her about a quote attributed to the company's Spokane chief executive in a press release.
This interview is lightly edited for clarity and length.
DN: Susan Stacey's quoted as saying, behavioral health needs in our community have changed and it's our responsibility to adapt. How have they changed?
Tamara Sheehan: I think in a couple of different ways. First, you know, in the emergency room, when people first are having initial presentations in the emergency room, we have an increase in the serious mental illness, as well as increase in the substance use, not only in the acuity of the patients compared to 10 years ago or longer, but also in the age groups as well. We're starting to see people with serious mental illness that have suffered from those illnesses or substance use for many, many years, and so we're seeing medically fragile, more elderly individuals, which actually rolls into what we're seeing in our inpatient psychiatric units.
They're aging. They just need more direct, hands-on patient care compared to years before when we had a lot, lot less acuity.
DN: We blame a lot of stuff on the COVID pandemic these days. Is this one of these things we can blame on the COVID pandemic?
TS: No, it doesn't have anything to do with the COVID pandemic.
It's just the natural progression in our community. We're getting a more elderly population, more medically fragile population, and remembering that the brain is part of a part of our body. We're seeing more and more people with issues from a medical perspective. Now we're seeing it with their brain as well.
DN: For somebody who walks into the hospital right now, maybe the emergency room, tell me what the procedure is right now, and does that change under the new regime?
TS: I would say that no processes or protocols are changing. Everything should look seamless to the patients who walk into our doors in that perspective.
People bring themselves in, family brings them in, police, ambulance, and maybe it's for a mental health or substance use or medical issue. We end up evaluating based on some of their answers to some of our routine questions around depression and suicidal thoughts. And then once our emergency room attending physicians or ARMPs do their assessment, both medical and work to address those issues.
They may determine that their patient needs another evaluation, further evaluation around their mental health and the severity of whether they're safe to go home, whether maybe they need to be evaluated by a psychiatrist, or they're for sure somebody who is willing or unwilling to stay to receive inpatient psychiatric care. So none of that changes. That's exactly the same process that we've always had in place.
What changes is now we're having people who are trained in the emergency room. They've had the education, they can diagnose, they can create treatment plans based on that, those diagnostics and provide accurate recommendations to partner with the ED physician in a more educated way than we have before.
DN: Are the people who are going to be doing this work, is it much more extensive education that they need?
TS: There were a variety of levels of past education for the individuals that are currently in the department. But yes, there's much more education involved with the current group. It will be mandatory. They have a master's degree in a social science that allows them to get experience and education in the things I talked about, diagnostics and treatment plans and so forth. So they will, at minimum, have a master's degree from an accredited college.
DN: Is Providence having to go out then and find these people? And are there enough people out there to be able to do this work?
TS: Definitely we're going to have to recruit. We're not reducing positions. We'll be recruiting for the same number of positions that are currently in that department. I guess we'll see, there's people that really love to work in the hospital and they have those licenses and we actually have the same model of care at Holy Family Hospital and their emergency room and we've been able to staff that. They will have to have some experience in crisis. So they're not going to be fresh out of college. They may work for another organization like Frontier Behavioral Health or Lutheran Services, other community partners that have had that type of work in the community.
DN: How does Providence decide how much it needs in order to satisfy the demand?
TS: Actually, I think our volumes have remained very steady and we've been able to meet that demand with that process.
Evaluations take a little bit longer in this new model, but not significantly longer than they take now. So I don't think there's going to be a problem with meeting the needs of our emergency room or the people who enter it based on this model of change.
DN: Beyond the Providence system, is this something that a lot of other health systems are finding themselves having to do?
TS: Oh yeah. What I found is I've got partners in Providence and partners outside of Providence within Washington state and Oregon, specifically, and I've done reviews of what they do in their emergency rooms and everybody, this is what we're moving to as industry standard.
DN: And in terms of the amount of resources that Providence is able to, will have to put toward this, is it a significant investment? You're spending the same amount of money in a different way?
TS: Yeah, the new model of care is likely to cost more than we currently have. This is not a financial savings project that we're doing. This is really just righting the kind of care we need to provide for our patients with the individuals who can do that work.
DN: In terms of the personnel, you're communicating with the folks who are going to be affected by this. Can you give me sort of down the line, what's the next few months look like?
TS: We've provided a 60 day notice. So we'll continue business as usual for the individuals. They'll continue to come to work and continue to have their schedule. It would be business as usual for those individuals, unless they find another position prior to that 60 days notice coming up. And then we would follow our normal processes for that. As we work with them and their union, we'll determine what next steps and pathways may be available to them. Obviously we want to keep them in the Providence family. A lot of these people have had a significant time with us in our organization and we care about them as people and we want to hopefully keep them in Providence and try to provide what pathways we can to do so.
DN: As you look six months, a year or two down the road and you evaluate whether or not this has been successful, what are the things you're going to be looking for?
TS: I think we're going to continually, at the very beginning, start looking for, are we getting the recommendations to the physicians as they would like and partnering so that they feel supported? This helps our emergency room physicians and advanced practitioners help make determinations on what the level of care should be for the next steps of the patient. So really we're going to see patient satisfaction and we're going to hopefully see continued throughput, if we can do this work up front and we see lower workloads on our psychiatrists when they come in so that we have experts making those decisions along with the emergency room, instead of waiting for psychiatrists to come in and try to make that determination.
