OAHHS Spring Summer 2019

7 Spring/Summer 2019 Garth Ellefson said his son has attempted suicide eight times and has boarded in the ED several times. Garth praised the changes at St. Charles, calling the improvements “remarkable” for both the hospital staff and the contract counselors who work with Erik. For that they are grateful, as well as to all the people at St. Charles who have worked so hard for them in difficult circumstances. Even though the family can only hope that one day there will be better in-patient mental health care options for Erik and others facing similar challenges, they do know this: they will never stop fighting for their son. “It’s busy and chaotic, not the best place for someone suffering from mental illness,” said Brenholdt. Another problem: the path from crisis to stabilization takes time—often several days. But those patients are not admitted to the hospital unless there is a medical need. Instead, they stay in the emergency department in a kind of limbo that has come to be known as “ED boarding.” After Erik’s near overdose in 2016, Garth Ellefson said his son had “a couple of suicide attempts” before he spent several days in the ED at St. Charles Bend (Ellefson works in IT at the hospital). Garth said the counselor for the outside agency managing youth mental health cases at St. Charles told them that Erik needed to go home since he was no longer suicidal. His parents did not agree. “It was a pretty terrible experience,” said Ellefson. The closest in-patient pediatric psychiatric facility is in the Portland area, and there is often a waiting list for available beds. Erik was admitted to one of the facilities, but “it didn’t go well,” according to his father. In the meantime, Brenholdt and her St. Charles team have worked hard to improve the patient experience for Erik and others like him. “We have told him he can stay (in the ED) as long as he needs,” Brenholdt said, and the hospital provides a “safety sitter” for ED boarders. But she knows it’s not the best situation. “We can have pediatric patients in the ED for 7–10 days,” said Brenholdt. “In rural areas, there is even less access to pediatric psychiatry services. In Redmond, we’ve had a patient in the ED for 19 days. He didn’t meet the criteria for admission.” When patients are discharged, the hospital now provides a strong network of wraparound services, including diligent follow-up and caring contacts. Brenholdt said there’s a critical need for beds in the community for crisis stabilization. Ellefson agrees. “We’ve seen an astronomical growth in the number of teenagers suffering from depression and who are suicidal,” said Brenholdt. With increased awareness of the ED boarding problem, there is now momentum building to search for solutions. OAHHS introduced SB 140 in the current legislative session. The bill seeks to set up a pilot project with stakeholders looking for answers in the community. Many Oregonians struggle with mental health challenges and substance use disorders every day. Demands for behavioral health services have been growing at an alarming rate, both in Oregon and nationally. State and federal lawmakers, as well as policy makers, community and social service agencies and healthcare providers are working together to define the problem and implement solutions to mitigate it. Out of the 1,280,555 emergency department visits in 2017 from Oregon patients to our state’s 60 acute care hospitals, 23.7% of these were behavioral health related. While the high volumes for behavioral health-related emergency department visits are in urban areas, when measured by visits per 1,000, the top five counties are all in more rural areas: Jefferson, Crook, Klamath, Douglas and Lincoln counties. Each of the five counties had rates from 69.42 visits per 1,000 to 141.92 visits per 1,000, higher than Oregon’s overall behavioral health visits rate of 75.48 per 1000. Among the counties showing a sharp increase is Harney, where the number of visits jumped from 461 visits to 798. Also, Coos County rose from 3,705 to 5,936, and Malheur County jumped from 1,981 to 3,106 over a 3 year period (2015–2017). To read the details of this analysis from Apprise Health Insights, please visit our new website, which is now integrated as a part of the Oregon Association of Hospitals and Health Systems website, www.oahhs.org RURAL OREGON SHOWS SHARP INCREASE IN BEHAVIORAL HEALTH ED VISITS