Unlock the transformative power of mental health care in this episode 2 of Emergency Care & so much more, featuring James Bryant, Vice President for Emergency Services at Centra. Together, we shed light on the pressing issue of mental health accessibility, and discover how Centra is pioneering a "no wrong door" approach to mental health support by collaborating with key partners in each of our health-system communities.
Our discussion also highlights how Centra is breaking new ground with their mental health urgent care, providing immediate support for adults. Mental health is a priority and appropriate and urgent care is essential, especially during crises. Learn where to go and what to expect in this episode of & so much more.
Transcript:
Cami Smith:
Hi and welcome to, and so Much More. My name is Cami Smith and I am here once again with James Bryant from our Centra Emergency Department, and we have already had a conversation about emergency care, what to expect, where to go, all of the things that you need to know telehealth, urgent care and we want to explain that conversation in this. I guess part two, if you will, for emergency care to expand upon mental health. So, and once again for the third time, maybe more you know that's just where my knowledge ends Mental health has been identified as one of the most emergent needs in our community, and that's according to the CHNA report that has just published.
Cami Smith:
And so developing care, developing appropriate care and timely care for mental health is just crucial, absolutely crucial. And so, when you are living in our central health system, we want you to know when and where to go for a mental health need. And so, james, um, for those of you who didn't catch the first one, let me have you introduce yourself and kind of share a little bit about sure sir, I'm james bryan.
James Bryant:
I'm the vice president for emergency services here at centra and I am so happy to talk about mental health and all the efforts that centra and the community have done to really address that need, because it is severe. After COVID, many of us are hurting and people are struggling with that, and that affects your physical care. So mental health care really does affect all aspects of your life. So us being there and ready to help you and direct you to the right care within Centra and our community is just crucial.
Cami Smith:
Yes, and something that we talked about briefly before we started filming is the community network that exists in our area, and not even just how unique that is because it is, it's pretty unique but also how, how carefully put together that was and all that that entails, and we probably won't go super into detail about that. But what can you share? Just high level.
James Bryant:
So I can share that. We've really been partnering, especially here in the Lynchburg area, with Horizon, and Horizon is our CSB, which is our community service board, so they are responsible for mental health care in this space, and so they've really been partnering with Lynchburg Police Department now, where they actually have a team that rides along.
James Bryant:
So, if they have a patient who's having a mental health crisis, then police have been called. They've got professionals right there with them. We've started the empath unit here at Centra, which has been great for patients who need, like, an observation or very short stay to help stabilize their condition. We also have our inpatient areas, and then Horizon is building a new crisis stabilization unit with a residential space which is going to be available in 2025.
James Bryant:
All of these things can really I like to say there's no wrong door anymore at Centra. There are places to go. You can go to primary care and be linked to services. You can come to the emergency department, you can go to Horizons, you can call 911. All of these things are going to get you to care and our goal is to have a community network that wraps around our patients and supports them, because that is essential to your well-being. It's a good mental health framework.
James Bryant:
And so we want to make sure that we're here to support that, and we can't do that alone. So we've got partnerships not just with Horizons, but many, many other private providers in our community.
Cami Smith:
So, to begin, where should a patient go if they're having a mental health crisis? You mentioned no wrong door, but what's the right door?
James Bryant:
And that depends on what's going on. So some people who have had a mental health history they may already have established with a primary care mental health provider, so they may have a counselor or a physician that they already see and they can call or see that just like they would a normal provider. They just call and get that appointment. But if you are having suicidal thoughts, homicidal thoughts, you're hearing voices, that's not normal for you. You're just really depressed, you just do not feel like you can get out of that bed, then that is always a medical emergency and you can come to the emergency department and we will assess you. We go through the same triage process for someone who has a sore throat or a heart attack and we assess that patient. We try to move them out of that waiting room fairly quickly because being in a space with a lot of people around you can be challenging. So we do try to move them into an area in the back for a rapid assessment and treatment and then our mental health team takes a look and does a thorough evaluation and decides what level of care do you need? Sometimes it's just stabilization and you can be discharged home, or maybe you need to stay a short stay in our empath unit or an inpatient hospitalization. So all of those are options for the provider once you've been thoroughly evaluated, but all of those end up with you being referred and connected to someone in our community for ongoing care.
James Bryant:
Mental health care, I try to tell folks are really just like being a diabetic or having high blood pressure. This is a lifelong illness. Depression just doesn't go away. Psychotic feelings don doesn't go away. Yes, you know psychotic feelings don't always go away. You know those things are going to be with you for life. So there's usually lifelong medications, there's lifelong checks that you have to have, just like you would for any other chronic illness, and that's the way I like for us to treat them, because it's it's okay. People need to seek that care and they need to be stabilized. Without it, you will get worse, you will not live your best life and you will never be in a place that we want you to be, which is healthy, healthy, happy and really living that best life.
Cami Smith:
Yes, so you are central to this, to the Lynchburg ED For our other service areas. Is there anything you can share? Is the process similar, or should they go somewhere else? Or what does that look like?
James Bryant:
No. So across the state of Virginia these community services boards are in each area. So for our facility at Gretna, that's the Danville Pennsylvania County, there's a network there.
James Bryant:
We also have a Crossroads, which is our Southside facility. So everyone in Bedford is also covered by Horizons. So we work with these community partners to get you connected and we also can transfer patients between our facilities. So if we have a patient at Bedford who would benefit from empath, we transfer that patient to Lynchburg General and our empath unit. If we have someone at Southside who needs inpatient care, we can transfer that patient to our inpatient care at Virginia Baptist. So Centra works as a network to get you to the right care, Dr.
Cami Smith:
Amy Moore yes, and we talked about this briefly, and if you haven't watched the previous podcast specifically about ED and urgent care, I encourage you to do that. But something that we did talk about was the fact that you know Centra is a large print and a lot of our patients have that perspective of Bedford as its own organization and Lynchburg as its own organization, and so I love that you are saying this network, because it truly is this larger connection point and, regardless of where you go, it's all working together to get you to that right place where you need to end up to receive the best care. And so just I think knowing where to start is huge, and knowing that a mental health episode is an emergency. Some people may not think that this is something warranting going to the emergency room or the urgent care or or any kind of facility, and they're just kind of wondering what do I do? I'm in crisis and I don't know where to start, and that is what we want to avoid if at all possible.
James Bryant:
And that's really important because one in seven patients that we see in the emergency department are there for a mental health issue.
James Bryant:
And that's just not here at Centra, that's nationwide. So I want people to understand that that is a need that's out there and we want to get you connected to care. And Centra has done an amazing job because we actually have a mental health team that's based here in Lynchburg but that mental health team actually connects every day to all of our Centra sites and we're saying who's in the hospital, who has some mental health needs? What are we doing to get them the best care possible? And we're looking at that 24 hours a day of what these patients need to minimize their wait time in the emergency department. With all of the help here at Centra and really it's been an amazing team effort We've reduced our length of stay for behavioral health patients by about 50 percent. So the statewide average is 41 hours for patients to spend in emergency departments.
Cami Smith:
If you can believe that that's a long time.
James Bryant:
We do it in about 14 hours. So it's because we do have, I think, a very, very tight process and that we have those community partners that we're able to work with to get people to those resources quickly.
Cami Smith:
Yes, yes, and that's something that I try to keep into perspective, because waiting is not easy, no matter who you are, and I always try to remind myself and this is the example and tell me if you think this is ridiculous and that's okay. I grew up in Jersey and you are in your car for 40 minutes to an hour, no matter where you're going. Traffic is horrible. It's just a lot of people in a small space. And now, living here in Virginia, if I have to drive longer than 20 minutes, I'm like annoyed. Virginia, if I have to drive longer than 20 minutes, I'm like annoyed, and it's so. I mean, it's such a blessing to be able to have that time, but it's perspective.
Cami Smith:
You know, waiting is waiting and nobody likes to do it, and so I think having the understanding and the expectation that you are going to wait, and and it doesn't help to know that people are waiting nationwide, because they're waiting too and they're probably just annoyed too, but we're all on this together, and so, no matter where you're going, um, I think having an expectation of what you're going to experience, um, and so I love that we're doing so much work to reduce that time, um, because I think that is crucial, especially in a mental health situation, when you waiting is just one more thing on top of a large list of things that need to be taken care of, and so if you're coming in for a mental health episode, no matter where you're going, what can you expect, dr Randall?
James Bryant:
Bell MD. So you can expect to come in and be triaged. So we'll ask you some questions about how you're feeling. We'll take your blood pressures. The other thing that we do in the emergency department is make sure that there's not a medical reason that you're having some of these feelings, because you know you can be a diabetic and your blood sugar be off.
James Bryant:
You could be having a brain aneurysm there's a lot of reasons people can, you know, feel differently or be confused or be out of you know their, their normal circumstances, and so we want to make sure that you're not experiencing that. Once we've cleared you medically, then that's where the decision becomes. Can you be safely discharged with a plant home? Yeah, can you be placed in our empath area for a day or two for it to stabilize? Do you need inpatient care or does that care need to be someplace other than Centra, because we do have a network of behavioral health facilities across the state of Virginia. So that decision is made and then you move into that space.
James Bryant:
You know, during those periods of time when you're waiting, we do try to keep people in a quiet environment. You know. Oftentimes, though, some of these patients do have, you know, desires to hurt themselves or hurt other people, and so we do remove some of their, their belongings, just for safety of the patient and our staff, and that can be uncomfortable for some patients. Yeah, but that does happen, and so I don't want people to be surprised if we ask for that. We also can limit visitors sometimes, because oftentimes visitors can trigger, so we do make an assessment of that. You know, maybe that person is really a great support for you, but not right now and we don't want to damage that relationship, so we'll maybe ask them to step away for a bit. We do let you speak by phone. Patients are always, always in control. They're the ones that we're listening to, and then we help make decisions with them as we go through this process yeah um.
James Bryant:
The other thing is we get. We start people on medications, oftentimes in the emergency department, for behavioral health needs. Those medications can take days to weeks to work it's not something that's simple, so you may not leave the emergency room completely better. So we always have a plan for your safety and plan for follow-up, because that's the most important part is how are we going to keep you safe and what are the next steps for you and your care.
Cami Smith:
So that's been another exciting part that we've been working with those community partners to ensure yeah, and I hope that's what you're hearing, if you're listening we have a plan, there is a plan in place and decisions are made always in the best interest of the patient, for whatever reason. You mentioned empath. Can you tell me I mean, there's so much to know about empath, but just kind of high level for those who haven't heard about it or who maybe just want to know more what is empath and then how does that work?
James Bryant:
This has been really exciting. So empath is emergency psychiatric assessment, treatment and healing, and it was developed by dr scott zeller on the west west coast in 2016. It has, over the last year and a half, become an international phenomenon. There are units opening every day and what what other people are finding is what centra found a year ago is that this concept works sometimes. Sometimes people just need a day or two, an observation stay. They don't need seven to ten days in a mental health facility, but that short stay of very intense therapy and getting medications begun if appropriate really does help that patient in a crisis and gets them connected to community services.
James Bryant:
So empath is really just a different way of thinking. It is an open unit where everyone is working together. Everyone can talk. There's a lot of one-on-one interactions with staff. There's an outdoor area. It is not confining, but it's really meant to be a supportive environment where people can see that others are having the same challenges, they're not alone and that we're going to take and get them connected to that services. And what we've really been proud is, even if we have difficulty getting them to an appointment, we've developed a bridge clinic. A virtual clinic will actually go online and follow up with those patients who've been through our empath program to ensure that they are safe, that they are doing well, until they can get connected to a community provider.
James Bryant:
So, we really are trying to make sure that everyone is successful. We've seen good results from that. Those results are driving the expansion of this. Dr Zeller has actually taken this to Saudi Arabia, to Canada, to Scotland, and that's all just in the last year. So Suntra was really on the cutting edge of this concept and we're very proud. He's been very complimentary of the work that we've done here, and so you know we are just excited to continue that development of that program and people ask are we going to put it in other sites? If the volume is there, if we have a need, we would look at the potential of putting this concept in other places. Right now we're able to meet that need at Virginia for our campus right here at Central Lynchburg.
Cami Smith:
Okay, and again that speaks to the network, the larger network. If there is a need within the health system, there is a facility to meet that need, but knowing that, should the need arise for another one, that you know we see it, it's working. So those are the decisions that are happening.
James Bryant:
And I want to put a plug in for our Centra Foundation, because they were instrumental in really helping us get this started. They had the faith in that and we also had an anonymous donor who made a significant contribution and really has changed mental health care. Empath has really linked a lot of services together, so I think it's just helped all of us see what the potential is for mental health care.
Cami Smith:
Yeah, and I'm glad that you brought that up, because the Centra Foundation has addressed so many needs at Centra by providing resources, by raising the funds, and so for those of you who are hearing this and it's changed your life or you want to be a part of this, you can get more information at CentraFoundationcom and you can give through the foundation to benefit this local health system. And that even kind of leads us to like there's so much that's happening now that's new and so much that's still coming. So we have PPAUC, so psychiatry and behavioral health, it's an urgent care for mental health needs and I don't want to just throw that out there and leave it, because urgent care is something that I think at least I default to. I default to urgent care very often, and so for a mental health need, I think it's important to know what a mental health urgent care is before you just, you know, pack yourself in a car and head that way, hope for the best, because that might be where you need to go. But what can you tell us about that?
James Bryant:
So mental health urgent care this is another exciting concept here at Centra. Tell us about that. So mental health urgent care this is another exciting concept here at Centra is that we really saw that there was a need for that immediate care. So sometimes you can't get into your primary care provider or your primary mental health provider, so psychiatric emergency services developed this option where you can present without an appointment or you can call and be scheduled for that same day. They have a limited number of appointments available, so it's just like any other urgent care. There are some limits to that. You may have to wait a little bit longer, but their goal is to see you as soon as possible same day and give you that immediacy that you need to get you through that little crisis that you're having at that time. And so, and if that's not available, again you've got emergency departments, you've got your primary care provider, but that urgent care for mental health is just an exciting concept it started again.
James Bryant:
It's very new out in the healthcare arena but I'm glad to see that Centra is really on the cutting edge of that and really bringing that concept here, and I will share too that we're also exploring the potential to look at an option for pediatrics in the future.
Cami Smith:
Yes, and I'm glad you said that, because this current mental health urgent care is an adult urgent care and so it's encouraging to hear that there is something coming for children. To hear that there is something coming for children, because I think that's where a lot of our community is at a loss and feeling maybe even desperate of how and where to get this need met for their children.
James Bryant:
I think that, if you'll look around too, that what you're seeing is Centra is making a significant investment in our community with the Simons Run Campus, with our new behavioral health hospital That'll also include a rehab facility. We have the new building that's coming up for our primary care and also specialty care at the Holt, and then we've also got the modernization at Lynchburg General and also projects across center, at all of our sites to improve health care for our community and give us the absolute state-of-the-art care.
James Bryant:
It's exciting to see what we're designing for the new building at Lynchburg General and we hope that we can share that soon with the community.
Cami Smith:
Oh, I'm sure you're bursting. There's so much coming, and I think the encouraging thing is for those who are listening to take away is things like the CHNA, these identified needs that we're learning about our community. That is what is driving these decisions about additional care, additional facilities and these programs that are coming into place. It's to meet these identified needs, and so, for those of you who have participated, thank you, thank you for telling us what these needs are and then also stay tuned, because there's just so much. There's so much that's coming.
James Bryant:
Absolutely. I'm just excited. It makes my job very exciting every day to see what's coming and also to work with so many professionals across Centra and our communities that are just dedicated to this. We can't do it alone.
Cami Smith:
We need our patients.
James Bryant:
We need our partners, we need Centra to all come together to meet that community health need, because this is a great place to live and it's a little bit of a drive to some of these other sites for care. We have those same options. We have that same great care right here, moments from your home where you can still be surrounded by family and friends to support your recovery.
Cami Smith:
Yeah, and I think you said this in the previous episode but just always come with that grace and that patience and that understanding that we are all in this together and your needs are our priority. And so, is there anything? Is there any information that you want to leave our patients with before we close?
James Bryant:
I think that you know, I think that, since we were really focused on mental health care, is that mental health care is just as important as physical health. Yes, and so that, if you're having challenges is make sure that you get those needs addressed. Also, because that is the core, that feeling, that love, that connections that we all have to each other is so critical. You don't ever want to live without that, so we want to help you make sure you have all those connections.
Cami Smith:
Yes, thank you so much, James, and thank you all for you for joining us and so much more All right, thank you.
