On the fifth floor of a new University of Colorado hospital tower, the rooms have no furniture to move or handles or faucets to hang a ligature from.
The new 40-bed psychiatric unit was designed with the most up-to-date safety measures in existence, some invented mid-construction.
A nurse standing in the hallway can see the whole room, even her feet in the shower. Natural light filters through large windows protected by a sophisticated locking system. And the door opens on both the right and left sides so that if a patient uses their body as a barricade, hospital staff can adjust the hinges and avoid a face-to-face confrontation when opening the door.
When UCHealth’s new psychiatric unit accepts its first patients this summer, it will make a small dent in Colorado’s acute shortage of inpatient psychiatric beds. But while mental health advocates laud the effort, they say it’s not enough to make up for years of psychiatric bed closures in hospitals across Colorado.
However, 40 fewer people will have to sit in emergency departments because state psychiatric beds are full.
New unit on Aurora’s Anschutz campus represents a turnaround in health care, a move by some hospital systems to incorporate mental health care after decades of downsizing or outright elimination, at least that’s the hope of mental health advocates . In 2009, the teaching hospital closed its psychiatric unit because, at the time, the hospital didn’t have enough room for people needing surgery and other medical care, hospital officials said.
It was a time when psychiatric units were disappearing rapidly in Colorado and across the country as hospitals complained that the cost of operating them was not affordable. Colorado lost 186 beds as it closed four psychiatric hospitals from 2014 to 2020, according to the state health department.
But recently, some hospitals are returning to behavioral health care. HealthONE, with hospitals in Denver, Aurora and other suburbs, now has 120 inpatient psychiatric beds at its Behavioral Health & Wellness Center, recently adding 20 in 2021. The center opened in Aurora in 2012.
Denver Health has 21 adolescent psychiatric beds and 42 adult psychiatric beds, with plans to add an additional 15 adult psychiatric beds.
Colorado’s two state psychiatric hospitals also expanded, although understaffing prevented their full utilization. Pueblo State Hospital has grown to 516 beds from 451 beds a decade ago, yet is only staffed to handle 422 beds. Colorado Mental Health Hospital in Fort Logan has 138 beds, but only 106 are usable due to staff shortages.
The university has not had any inpatient psychiatric beds since 2009
For the teaching hospital, it took 14 years to open a new psychiatric unit after closing the last one on the Aurora medical campus.
The decision to close the old 18-bed psychiatric unit was strategic to the overall needs of the community, said Anne Felton, director of inpatient behavioral health for UCHealth. There were patients waiting in corridor beds for medical and surgical needs throughout the hospital, she said. Their intent was always to reopen hospital psychiatry. I think if they could have predicted the future, they could have made different decisions.
Federal and state equality laws that have sought to force insurance companies to reimburse mental health care at a level comparable to physical care have had some impact, but not enough, say hospital officials and mental health advocates.
Certainly, concerns about the level of reimbursement for behavioral health services persist, but we know this type of care is needed now more than ever, said Elicia Bunch, vice president of behavioral health services at UCHealth.
The hospital system announced a five-year, $100 million behavioral health plan in 2019, which included placing therapists in primary care clinics and expanding virtual mental health appointments. The goal, Bunch said, is to deliver services in a way that destigmatizes and normalizes access as an essential part of health care for the whole person. It also serves to provide varying levels of care so that patients can get help before they end up in crisis and in the psychiatric inpatient unit.
UCHealth also plans to add nine adult and adolescent psychiatric beds to Fort Collins over the next two years, increasing the number of beds to 50 from 41. It will move to Poudre Valley Hospital next year.
Colorado Mental Health President Vincent Atchity said while Colorado desperately needs mental health beds, what it needs most are supportive housing programs that help people before they end up on a ward. closed psychiatric. The programs work, but Colorado hasn’t had the political will to invest enough in them to solve the mental health crisis, he said. One example is the Sanderson Apartments, a program run by Denver’s community mental health center WellPower that moves people off the streets and into accommodations that focus on trauma treatment.
Forty berths is nice to see and that’s double what they closed, Atchity said. But inpatient psychiatric care is a last resort for someone’s health. We are inevitably fixated on beds. There are other questions we should ask ourselves.
We are unable to develop the political will to recognize that there is a significant portion of any human population that will need persistent, high-quality hospital care that allows for some mobility. We do none of that. We make people live in tents and under bridges.
Atchity also suggested that every hospital should have a certain number of psychiatric beds.
The psychiatric unit has a circular walkway, as well as a clinic for ketamine, electroconvulsive therapy
The new unit of the University Hospital consists of two wings with 20 beds each. One side is for patients who are severely depressed and possibly suicidal, but who can engage in group and individual therapy and follow directions. The other side is for patients who are disorganized, delusional, or in such a manic state that they have difficulty interacting with others.
Ideally, a patient who starts on the sharper side of the unit would move to the other side as his condition improves, Felton said.
Patients, on average, would need to stay three to 12 days before leaving for a descending outpatient program or possibly an assisted living community where they would receive ongoing counseling.
The lower-gravity patient side of the unit includes a fitness room, a community space where patients can talk while eating meals from the cafeteria, and a track that goes full circle around the wing, for those who like to walk . The walls display giant artwork, wildflower and mountain scenes. This was a way to create that kind of nature walk feel and feel a little less enclosed, said Catherine Reeves, a registered nurse and project manager on the construction team.
The nurse stations in both wings are not protected by a glass screen. Instead, the counter that separates nurses from patients is higher than normal and angles outward towards the patient, making it difficult for a patient to reach the counter. The bench was designed according to trauma-informed care best practices, also to feel less like a prison.
By the time someone stood up and if they really meant to, there would have been enough time for someone to step in and verbally engage with them, Felton said. Many of your mental hospitals will have glass or a barrier going all the way up to the ceiling. We didn’t do it intentionally.
Adjacent to the unit is the hospital’s new interventional psychiatric clinic, where patients will receive electroconvulsive therapy and ketamine treatment. Electroconvulsive therapy sends an electric current into the brain, causing a seizure and reprogramming the brain to reduce mental health symptoms. Ketamine, a sedative, is used to treat depression by allowing the patient to dissociate from the pain and see themselves as separate from the mental illness.
Approximately a quarter of the clinic’s patients are expected to come from the inpatient psychiatric unit, with the remainder to be from the community.
The psychiatric unit, which is expected to open in late June or early July, will take in patients mostly from emergency departments after they arrive in mental health crises. Right now, teaching hospital emergency rooms have to call around the city and state trying to find available psychiatric beds for patients who, because they pose a danger to themselves or others, cannot go home.
The team of behavioral health professionals who work in the community and emergency departments spend a lot of time trying to find beds all over Colorado, Felton said. Forty sleeps is great.
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