A person with a mental health emergency will tell you that going to an emergency room of a hospital is to be avoided at all costs unless you have already undertaken a violent action like attempting suicide. Being bloody, vomiting, or violently striking out – then most likely you will be in the clutches of the police — will get you immediate help. Otherwise if you look reasonably rational, you sit and stew for hours until finally called to begin emergency room routines of filling out the paper work before the standard procedures of temperature, pulse, EKG, and perhaps even blood collecting are imposed. After this you have a long wait for the results in the institutional environment of many chairs in rows or facing each other under the attentive eye of a security guard. Finally you get to meet an ER doctor or a nurse, who will begin the questioning. ER personnel are trained to deal with triage. They often appear bored, since the mental health patient may not look like an emergency — no bleeding, no peculiarly bent appendages, no gasping for breath.
These medical emergency practitioners are usually not trained for mental health emergencies and the questions they ask can border on the inane. “What brings you here tonight?” the nurse asks while flipping through your new chart. “Is what you are feeling really an emergency?” Her tone might be suspicious of your intent. “Well, I was feeling extremely depressed.” “Are you anxious about something? Can you name it?” “No! I just feel life is not worth living?” “And why is that? Are you afraid of something?” “Well I was in my apartment alone in the dark.” “Ah, do shadows bother you?” “No, but I didn’t want to turn on the lights. I just wanted the world to disappear.” “Does the Emergency Room scare you?” “Yeah a little, but my girlfriend thought you could help me out.” “Are you hearing voices?” “No, but I am thinking about death.” “Are you actively planning to kill yourself or someone else?” “No, but the thought crosses my mind I would be better off dead.”
The questions are myriad and different from facility to facility, but they never fail to make person questioned diminished. Up against the institution of a hospital, the mental patient feels as if his or her problem isn’t grand enough to gain the attention of the staff. Each person experiencing this kind of treatment feels a little less human and a little less important. If the questions don’t lead to a person admitting he or she is planning to kill himself or herself or someone else, which is the ticket to the mental ward, a person seeking mental health help will often be dismissed from the hospital. Perhaps if he or she is lucky, there might be a prescription to get through this moment of trouble, along with the “there, there pat” that everything will be all right.
The whole process is inefficient and extremely costly because a mental health emergency is treated like any other emergency, initiating tests and procedures, which are unnecessary. If the patient is poor then the cost is born by the state. It doesn’t have to be this way, and progressive mental health providers like Skokie, Illinois’ Turning Point, a behavioral health center serving the North Side of Chicago, have done something about it. They have started a program and dedicated a space to a program they call “The Living Room.” Here a person suffering a mental health emergency can come and find a safe and caring haven. The space looks like a living room with couches, chairs, tables, and lamps in a residential style. One can come and get help or can just “cool out.” There is no pressure. There is an intake person, who signs someone in and gets the basic information on what is troubling them. There is a psychologist available if the person wants to talk and a nurse, otherwise the walk-in is left alone unless unruly in behavior. The police in Skokie and surrounding town now bring the mental health cases to Turning Point instead of going to emergency rooms.
The Living Room at Turning Point opened in September2011. The Living Room offers people experiencing psychiatric emergencies a welcoming, comfortable, and non-clinical space. Unfortunately, because of budget limitations the Living Room is not open five days a week nor on weekends. Despite this, the Living Room handled 228 visits, which resulted in only 15 emergency room referrals. According to Ann Raney, CEO of Turning Point, this is a deflection rate of 93% that saved the state of Illinois an estimated $500,000 in Medicaid health care costs.
In December 2011, Turning Point received a $1.2 million grant from the North Suburban Healthcare Foundation in Chicago. The grant has allowed Turning Point to purchase a neighboring building to expand its facility and house other mental health organizations. It is hoped that some of this money will be used to expand the hours of operation of the Living Room.
The Living Room model is an idea that should be embraced across the country by many mental health providers. This kind of compassionate and caring space provides those in psychiatric crisis a place to take refuge, take stock of their situation, and find the appropriate help without the formality and impersonality of the Emergency Room. As Turning Point has already demonstrated this idea is not only appropriate, it is cost effective. In a time of dwindling mental health care dollars, channeling funds to organizations with facilities like the Living Room make fiscal sense. Let the politicians know we need more mental health Living Rooms.