While many communities propose increasing available inpatient psychiatric hospital beds as the sole answer to the boarding issue, the STCC Steering Committee has taken a different approach and has allocated funds to create a Psychiatric Emergency Services (PES) System of Care model. A PES provides an alternative to the emergency department for patients in need of acute psychiatric care and can provide assessment and treatment that may stabilize a majority of the crisis mental health population at this level of care, thus dramatically alleviating the demand for inpatient psychiatric beds. Patients at the PES can stay up to 48 hours and are stabilized and discharged with a care plan and follow-up. If a patient’s need for additional support is identified during PES treatment, the patient may be admitted for a longer stay inpatient stay. The model not only creates the opportunity to provide 20 PES beds across 3 different facilities in Bexar County, but is intended to enhance access to outpatient services at the Local Mental Health Authority, the Center for Health Care Services (CHCS). CHCS has embedded Qualified Mental Health Professionals at each PES facility to provide aggressive assessment, linkage, and referrals to ensure the connection to ongoing outpatient treatment.
Combining the efforts of the PES System of Care and Law Enforcement Navigation, STRAC has also embedded licensed clinicians in MEDCOM 24/7 to assist in facilitating interfacility transfer requests to the identified PES facilities. Placing a licensed professional in the middle of the transfer process allows multiple treatment options to be considered. Utilizing tele-screening, the clinician can assist in determining whether the patient would benefit from PES, inpatient treatment, or potentially avoid admission all together and be connected back to an assigned treatment team for follow up. Law Enforcement Navigation is addressing the mental health crisis at the scene and the PES System of Care is addressing the mental health crisis occurring in a hospital/emergency department who may not have the service line that would best treat the patient’s conditions.
By creating the collaborative approach for these two programs to work hand in hand, for true decompression of the emergency departments can occur, as medically stable emergency detained patients are navigated directly to the closest, most appropriate mental health facility. For patients that arrive outside of law enforcement to emergency departments experiencing mental health crises, the PES System of Care provides the outlet to expedite a more specialized level of care for that individual.