This column was originally featured on Newportri.com.
More people are turning to the Emergency Department (ED) because it’s the only safe place where they know they can find help. Over the past several decades, key social safety nets have weakened or disappeared. Affordable and supportive housing has dwindled, social welfare programs have been tightened, and access to substance use treatment remains limited. Add to this the shortage of primary care providers, an increasingly complex healthcare system, and rising income inequality, and the result is a persistently overcrowded ED.
Hospital Emergency Departments frequently see the same patients cycling through their doors with crisis after crisis. Many are homeless, struggling with mental health or substance use disorders, and unable to make lasting progress due to the absence of ongoing support systems after they leave the ED.
The situation in our own local Emergency Department at Newport Hospital is like so many others, with one exception – the compassion of the Newport Hospital providers and their desire to help these patients beyond what is medically needed. This exception is turning the tide on an endless and frustrating cycle, and a partnership between Newport Mental Health and the Newport Hospital ED is making a difference for patients.
How Did We Get Here?
The ED is always open and available, and hospitals in the U.S. can’t turn people away because of the Emergency Medical Treatment and Labor Act (EMTALA), passed in 1986. This federal law, however, only guarantees emergency care and stabilization, not long-term treatment or follow-up care after people are discharged. This gap is why so many patients keep returning to the ED, even if they don’t have a medical issue.
The use of the ED for behavioral health and social problems, like seeking a warm place because you are homeless, has a profound effect on both patients and providers.
“As a frontline clinician,” says Dr. Alexis C. Lawrence, medical director and chair of Newport Hospital’s Emergency Department, “I hear frustrations from patients saying that they don’t have access to certain resources, like mental health care, primary care, stable housing, or substance-based care. I hear from nurses and other providers who get so frustrated because we hear those concerns and as healthcare providers, we want to do more.”
Data Helps Pave a Path Forward
Dr. Lawrence and her team turned desire into action and began tracking observational data about patients fitting the profile. The numbers revealed that patients in Newport Hospital’s ED who were referred to Newport Mental Health and subsequently received stable housing and comprehensive support services experienced dramatically improved outcomes, making fewer repeat visits to the ED and showing more overall stability.
This past fall, Newport Mental Health provided permanent supportive housing for 20 clients who were known to the ED. The hospital team noticed that in the months following housing placement, the clients had a substantial reduction in ED visits and inpatient and psychiatric hospital admissions.
“Clearly this is observational data,” Dr. Lawrence notes, “but it certainly supports the work Newport Mental Health is doing.”
Newport Mental Health follows the Housing First model. This is a proven approach where individuals go directly from the street or hospital into permanent supportive housing, bypassing shelters or transitional housing. Once housed, they receive wraparound support: a housing stability plan, case management, and, if needed, services from Newport Mental Health clinicians to ensure their well-being.
A Pilot Program Grown from Synergy
This success sparked a further collaboration between the ED and Newport Mental Health. “We have another group of patients that we can help,” says Dr. Lawrence, referring to frequent visitors to the ED who aren’t yet connected with Newport Mental Health.
Newport Hospital and Newport Mental Health have launched a pilot program targeting this group. Still in its early “proof-of-concept” phase, the program places Newport Mental Health behavioral health clinicians on-site near the hospital. After patients are medically cleared in the ED, they’re offered the opportunity to engage with a Newport Mental Health clinician. The program is currently limited in hours, but already it’s showing promise; patients who had previously resisted behavioral health care are starting to engage with Newport Mental Health.
Healing for Patients and Staff
“The impact is not just to the patients, but for the frontline staff,” says Dr. Lawrence of the new collaboration. “People in healthcare want to help. When you give them the tools and have these systems in place such that we can bridge people to services, it makes a difference.”
Acknowledging barriers to care and working to bridge that gap through this collaborative effort has already revealed meaningful patient impact based on these early interventions. In addition, the collaboration has fostered new energy and commitment across both organizations.
There is some magic in the work that the two organizations are doing because it’s driven from a place of need. There’s a whole group of people coming together to learn each other’s systems, focusing on how to do more for the individuals we serve. It’s not just about data. It’s not just about programs. It’s about people—helping them live better lives and helping healthcare workers find meaning in their mission.
The pilot program is being closely tracked to evaluate outcomes and refine the model. The hope is for the pilot program to become permanent; the goal is to ensure that people in need, no matter where they are, can access the services and support they deserve. We’ll provide periodic updates as we learn more. In the meantime, community support is always welcome. To learn more about our organizations, visit Newport Mental Health at newportmentalhealth.org or Newport Hospital by visiting brownhealth.org/locations/newport-hospital.