Focus is on outpatient crisis intervention and transitioning people from hospitalization

BHICTo close gaps in the continuum of care for people requiring behavioral health services, The Ohio State University Wexner Medical Center has initiated a Behavioral Health Immediate Care Program. The program seeks to assist two groups of patients particularly in need of continuous access to care:

People discharged from an inpatient hospitalization and waiting to see a provider. This group may have to wait months before seeing a clinician at a time when they are most likely to decompensate or be at risk for suicide. Their diagnoses cover a whole range of severe mental illnesses.

“We try to meet them while they are still in the hospital and let them know about our services prior to discharge,” says Daniel Lee, MD, a collaborating psychiatrist in the Immediate Care Program.

Staff members initiate routine phone calls to check in with patients. They're available to monitor blood levels and medication side effects and provide counseling as needed. They also provide case management services, such as coordination of non-psychiatric medical issues and facilitation of community outpatient follow-up.  

Important goals are to make sure an individual takes prescribed medicine as directed and shows up for the first outpatient visit. Services are provided up to eight weeks after hospital discharge. 

People under outpatient care who are in crisis. With outpatient behavioral health treatment, patients often go three or six months between visits with their provider. People in crisis who don’t meet the criteria for hospitalization benefit from a bridging service to provide care when they need it. The Immediate Care Program provides that bridge to the next appointment with phone counseling, video visits, and medication adjustments or refills. 

Same-day appointments are available, and patients can seek care once or several times. 

Dr. Lee wants this program to provide an effective alternative to coming to the Emergency Department for a medication adjustment or other issue that doesn’t require hospitalization. 

Staffing and resources

The Immediate Care Program team includes two psychiatrists, nurse practitioners, a social worker and a nurse. They staff phone lines five days a week. Although currently providing services remotely, the program has a dedicated space to see patients in person once the dangers of COVID-19 have passed.

Close to 250 patients have been served since the program began in spring 2020. The staff is tracking data to confirm that services provided are meaningful to patients.

“Investing the time, resources and energy to fill in these access gaps of care for the most ill of our patient population is fairly unique,” says Dr. Lee, who recently joined the Psychiatry faculty at the Ohio State Wexner Medical Center. “Getting the right care to people at the right time is a reflection of our priorities and values.”

For more information, call 614-293-8295.

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