Genesis Expands Behavioral Health Unit

Mental health in the U.S. is facing a perfect storm of adverse conditions from declining funding levels, poor reimbursements for providers and too few psychiatrists to care for the number of people who could benefit from treatment.

Meanwhile, the number of people needing mental health care is rising.

Kicking the mental health can down the road to some other entity has increasingly seemed to be viewed as a mental health solution. But instead of following the path of some hospitals, which have shut down inpatient behavioral health units permanently, Genesis is adding inpatient beds as the next step in a turnaround of the Genesis Behavioral Health Unit.

This month, Genesis is opening seven more staffed behavioral health beds at Genesis Medical Center, West Central Park, for a total of 24.

The transformation of behavioral health at Genesis Medical Center, Davenport has required a commitment by psychiatrists, specialized staff and the administration of Genesis Health System.

Only a year ago, the Behavioral Health Unit was only hours from being temporarily closed.

“Management made the decision that expanding the services was what we needed to do to best serve the community,’’ said Doug Cropper, President and CEO, Genesis Health System, in explaining the commitment of leadership. “We are seeing an increasing need for this care.

“This expansion of beds is an example of Genesis living our mission ‘to provide compassionate, quality health care for all those in need.’ The expansion certainly isn’t profit-focused. The entire focus is on community need. This decision to expand requires a Genesis commitment to financially subsidize the expansion. That is how important we consider this care to be for the region.”

In the last year, Genesis Medical Center, Davenport has found a solution to an issue that health care providers across the country are facing.

Dr. Jeffrey Weyeneth and Dr. Rickey Wilson have joined Genesis in the past year as psychiatric hospitalists to treat behavioral health inpatients. The psychiatrists only provide treatment for patients in the behavioral health unit and do not treat patients in a clinic setting.

Patients admitted to the acute unit often stabilize after a day or two and are ready for a less intensive level of care. The recent expansion provides additional “step-down” beds, which opens up more acute beds to serve the hospital’s emergency departments and outside hospitals who refer patients to Genesis, Dr. Weyeneth said.

“Even with all the budgetary cuts and reductions in mental health services elsewhere, Genesis has decided it’s important to expand these services,” Dr. Weyeneth said. “We know this area is underserved. It’s significant that Genesis is willing to take that chance and offer these services to a community that’s starved for them.”

Hours away from shutting down

It was the lack of psychiatric coverage that nearly forced Genesis to temporarily close the inpatient unit in March 2011.

One of the worst days Heidi Bradley has had during a long career in nursing and management at Genesis started with a phone call last March.

Bradley, MSN, RN and Manager of Behavioral Health, had just returned as manager of behavioral health services when a Genesis administrator called to tell her the inpatient unit would have to close the next day. There weren’t psychiatrists available to provide care to hospitalized patients.

“I had 40 employees in the unit at the time, and they had done everything they could to get us through the period when we didn’t have psychiatry coverage. They had taken paid time off, unpaid time off ... everything they needed to do,’’ Bradley said. “Now I was going to have to tell them they wouldn’t be working for the next several weeks until we could find psychiatrists.

“We were literally a day away from closing because we had no coverage available. We had plenty of patients, but no doctors.’’

Bradley was able to find a temporary solution in the disappearing hours before a forced closure. Psychiatrist Dr. Ronee Aaron, who was leaving the area for Kentucky, agreed under extreme emotional coercion from Bradley to stay a few more weeks.

“Dr. Aaron already had the moving van scheduled for later that week. I did everything I could to convince Dr. Aaron to stay. I was calling her all day. I begged, pleaded, cried. She said I was like a dog nipping at her heels,’’ Bradley said. “The night before we were going to have to close, Dr. Aaron called and said she couldn’t put up with any more begging and crying from me and she would stay temporarily.”

Psychiatric hospitalists join Genesis

The first step toward a solution was to find permanent psychiatry coverage. Dr. Weyeneth had already been hired as the first psychiatric hospitalist at Genesis when the unit was about to close.

However Dr. Weyeneth, a Commander in the U.S. Naval Reserves, was on a deployment to Japan. Highly experienced with mental health issues in the military, he was weeks away from returning from deployment.

The return of Dr. Weyeneth, who already lived in the Quad Cities and had been with Vera French Community Mental Health Center, relieved some of the pressure to find psychiatric coverage.

Last August, Genesis was able to recruit Dr. Wilson as a second psychiatric hospitalist. The availability of two psychiatrists made the expansion of the inpatient unit possible.

“It was never a question of having enough beds. Beds we have. The issue faced by hospitals across the country is having enough psychiatric coverage,’’ Bradley explained. “A lot of hospitals are scrambling to place patients who need inpatient treatment.

“We’ve had to send patients to Cedar Rapids, Iowa City and as far away as Sioux City. It has become difficult to find mental health patients the treatment they need. At the same time, we are taking patients from other areas. We’ve had patients from as far away as Kirksville, Mo., and we have had times when we’ve held patients in the Emergency Department for up to 18 hours until we had a bed open for them.”

Having two psychiatric hospitalists has made an impact.

“It increases the number of patients who can receive care,” Dr. Weyeneth said. “It expands the number of services we can offer other areas of the hospital in terms of consults. It improves the quality of care because it gives me and Dr. Wilson more time to spend with our patients. Sometimes we get two different perspectives, which helps.”

Cropper explained that financial considerations are a reason other hospitals are struggling to continue services.

Reimbursements from Medicaid are low, private health insurance often has limitations on mental health coverage and funding from state and local governments is declining.

“What we found out was that if we had coverage available from psychiatrists, it doesn’t increase costs significantly to have 24 beds in the unit instead of 17 beds,’’ Cropper said. “And the need certainly exists.’’

Bradley, recently named a Great Iowa Nurse, has taken her advocacy for the mental health unit at Genesis one step further. Instead of just talking about the shortage of providers, “whining about it,’’ as she would say, she is doing something on a personal basis.

She is enrolled in college again working on becoming a psychiatric nurse practitioner. She hopes to graduate in December 2013.