Normally, the auditorium at Butler Hospital in Providence is a gathering spot for conferences and panel discussions on behavioral health issues. But in early 2022, the space was filled with beds for patients.
The makeshift setup was needed to help relieve the state’s emergency rooms that had become overwhelmed with the surge in demand for behavioral health care in the wake of the COVID-19 pandemic, said Mary Marran, Butler’s president and chief operating officer.
That surge was causing people in need of behavioral care to wait in emergency rooms for long periods of time, tying up emergency resources for other people with urgent medical needs.
The temporary beds in Butler’s Ray Conference Center at the psychiatric and substance abuse hospital’s East Side campus eased that problem.
“What it allowed us to do was move folks who were boarding in emergency rooms to Butler and then from there to the next available bed,” said Marran, who is also president of The Providence Center and senior vice president of Care New England Health System. “Or we were able to step most of these folks down to outpatient and other ambulatory behavioral health services.”
Now Butler is in the process of building something permanent.
In September, the hospital started construction on a 25-bed short-stay unit that will allow patients from across the state who enter an emergency room with behavioral health issues to be transferred to the Butler unit for up to three days. Then patients will be moved to an inpatient facility or transition to a lower level of care.
The unit will be on the second floor of the Riverview Building at the southeast end of the hospital campus and is being paid for by $8 million from the State Fiscal Recovery Fund, part of the state’s American Rescue Plan federal relief money. Another $4 million in federal funds will be used, too.
Marran says behavioral health care providers across the state plan to collaborate to ensure patients receive appropriate care during and after their time in the short-stay unit.
This type of coordination is not new. Since the end of 2021, representatives from the emergency departments at local hospitals who see behavioral health patients have been participating in daily virtual meetings with providers, according to Louis Cerbo, interim director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities & Hospitals.
The virtual meetings, dubbed “bed huddles,” are meant to provide a snapshot of the daily demand for behavioral health services.
While demand has tapered since the huddles began, there are approximately 40 to 50 patients seeking behavioral health care in Rhode Island’s emergency departments on any given day, according to health leaders.
“These [short-stay units] will help many people who need a safe place,” Cerbo said. “We’ve got to use all of the tools in our toolbox to develop a continuum of care.”
Shortening the time patients must wait to receive care is crucial, says Laurie-Marie Pisciotta, executive director of the Mental Health Association of Rhode Island.
“Any investment from the state and private sector will likely have a positive effect,” she said. “Early intervention is necessary because it improves patient outcomes and saves money long term.”
Pisciotta says Rhode Island patients still find themselves on waitlists, and a shortage of behavioral health professionals persists. The lack of providers is partly because Medicaid reimbursement rates have been too low for too long, causing professionals to close practices or move out of state, Pisciotta says.
“We still have waitlists, which is not acceptable,” she said. “If we value behavioral health care, we must value behavioral health professionals.”
Dr. Daniel J. Shanin, medical director of the Andrew F. Anderson Emergency Center at Rhode Island Hospital, says care can be delayed when doctors need more time to diagnose a patient with behavioral health issues because compounding substance use disorders or housing insecurity are involved. For example, doctors may need to wait for a patient to get sober before they can determine the best course of treatment.
Sometimes behavioral health patients in ERs may even require 24-hour observation that might not be necessary at an inpatient facility, Shanin says. This means a hospital staff member must be pulled from their daily duties to watch a patient.
Shanin says the short-stay beds at Butler could be especially helpful not only in treating these patients but also in relieving emergency departments.
“It’s a great opportunity to get patients out of the ED to the right level of care and therapy,” Shanin said.
The new short-stay unit at Butler will be flexible and designed to accommodate different types of patients. For example, isolation rooms can be provided, and the number of beds for adolescents can fluctuate, depending on the needs of a given day.
While the short-stay unit at Butler is not a complete solution, Marran says it could serve as a model for improving the state’s behavioral health system.
“It really is focusing on getting as many people out of the emergency rooms as possible who are sitting waiting for treatment, so that we can begin treatment earlier and return them to the community,” she said.
