Florida's Lee Memorial Health System is using several strategies to connect emergency department patients with mental health and/or substance abuse problems to the outpatient care they need.

The system is part of a multiagency collaboration supporting the Bob Janes Triage Center & Low Demand Shelter in Fort Myers, which serves homeless people with mental health or substance abuse disorders. The voluntary shelter, opened in 2008, also provides an alternative to jail for people whose behavioral health condition or substance abuse puts them at risk of being arrested for low-level, nonviolent offenses.

The bulk of shelter admissions, 71 percent, are pre-arrest diversions by law enforcement. But the second largest admission source, at 19 percent, is Lee Memorial. The 58-bed shelter is housed on the Fort Myers campus of SalusCare, a mental health and substance abuse service provider that offers treatment and social services to shelter patients.

Emergency patients who would benefit from the triage center are identified by ED nurses or physicians, who alert a social worker or case manager, explains Heidi A. Shoriak, R.N., Lee Memorial's director of care management. After eligible patients are medically evaluated and cleared, the social worker or case manager checks whether a shelter bed is open and arranges patient transportation.

"You're doing the right thing by helping someone to get off the streets," says Chris Nesheim, R.N., vice president of care management. "It can be life-changing."

The shelter helps to relieve ED overcrowding by offering an option for nonemergency behavioral health or substance abuse patients. "It's not just helping them to get in the right place, but it's also helping us as a health system to provide health care for people who really need an acute care hospital," Shoriak says.

Flexible Support

Two years ago, Lee Memorial launched a program for people who frequently come to the system's EDs for nonemergency problems. Most of the patients have similar problems with mental health and substance abuse as the triage center patients, but they typically aren't homeless.

Emergency Care Helping Others is run by a social worker, a case manager and a community health worker. Shoriak is in the process of hiring a second community health worker. Potential participants are identified by social workers and case managers in the health system's four EDs.

The first piece of the program is getting to know the patients and determining their medical and social needs. "It's really about individualizing a care plan based on what we identify as the barriers and the problems," Shoriak says.

The team conducts home visits, checks on patients over the phone, accompanies patients to doctor's visits, sets up transportation to appointments, and connects patients with community social services. Some patients don't need intensive help, while others require intensive support during a crisis, Shoriak says. For treatment, patients typically are referred to Lee Memorial's outpatient behavioral health center or to SalusCare, depending on their needs.

The program encountered bumps at the start. The first 25 patients were selected because they were the biggest overutilizers, but they kept returning to the ED regardless of the amount of intervention they received. "We needed to look at the next group of people, those who we could influence and catch before [overuse] became such an ingrained habit," Shoriak says.

Now before enrolling patients, a team member interviews them and obtains feedback from hospital case managers and social workers. Eligible patients are sent a letter and must agree to participate. "We're here to help them, but they have to buy into it and be willing to accept the support," Shoriak says.

To learn how other health care organizations are improving care and access for behavioral health patients, read "Three Ways Hospitals are Improving Behavioral Health Care."

Geri Aston is a freelance writer in Chicago.