Rex Hospital’s ER may soon have fewer mentally ill patients. Here’s why.

The rooms are under 24-hour video surveillance. The chairs are weighted with metal plates to discourage patients from flinging them. Even the small window cranks, which could be turned into weapons, are removable and kept by nurses.

The $2.5 million behavioral health zone, funded by an anonymous donor, is UNC Rex Healthcare’s attempt to keep mentally ill patients out of emergency rooms. The facility allows patients to be quickly moved from the ER and into sunlit, private rooms until space becomes available at a psychiatric hospital or they are stable enough to go home.

Rex officials provided a tour of the facility Tuesday, demonstrating features such as the virtually indestructible metal soap dispensers, and airtight paper towel dispensers that won’t burn if deliberately set on fire. The safety features are based on best practices recommended by consultants and also used in psychiatric hospitals. The facility is undergoing finishing touches and will be ready for patients this month.

The eight individual rooms are bathed in natural lighting, offset in gentle green and blue hues that are believed to induce a calming effect, said Jennifer Sollami, Rex’s emergency department manager. A common area is available for socializing, playing games and relaxing. She said it’s the first facility of its type in the state, and several other hospitals are now planning their own.

“The first thing you’ll notice is the natural light,” Sollami said. “You’re here in a calm, therapeutic, safe environment.”

Because of a shortage of psychiatric facilities, mentally ill patients often end up in hospital emergency rooms when they are suicidal, homicidal, psychotic or otherwise unstable. They arrive in police cars, in ambulances and on their own seeking help. For years they’ve been shunted to hospital ERs, confined to a bed or a chair in a narrow stall behind a sliding curtain.

In the noisy, chaotic ER setting, behavioral patients compete for doctors and beds with conventional emergency cases, such as heart attacks, strokes and accident victims.

Statewide, behavioral patients last year waited an average of five days in a hospital to gain admittance to a state mental health facility, and 2.5 days to get into a private facility that typically only accepts patients with health insurance. At Rex, mentally ill patients wait an average of 30 hours – though some wait longer than a week – for a slot to become available at a psychiatric hospital.

Those who pose a physical danger to themselves or to others require a personal guard to control violent outbreaks. The guards are equipped with panic buttons and whistles for their own protection.

Rex officials hope the guards will no longer be necessary in the new behavioral health zone, where video cameras will monitor patient rooms and hallways around the clock. A hospital psychiatrist and mental health aides will make regular rounds, attending to the needs of the patients. Liaisons will coordinate with family members, social service providers and psychiatric hospitals.

“There will be staffing that will at least begin to transition into the treatment that would be available in an inpatient hospital,” said Gerry Akland, the former president of the Wake County chapter of the National Alliance on Mental Illness. “This is also remarkable.”

But Akland said that Rex’s more humane approach is not a long-term solution to the nation’s shortage of resources for the mentally ill. The patients will have to be moved at least one more time during a challenging period when they may be experiencing extreme stress, confusion, panic and anger.

“It is very hard for a person in mental health crisis to cope with moving all over the place and facing a different treatment team,” Akland said by email. “This also probably means that the person will be transported by our law enforcement folks who will likely use hand restraints (or other techniques), adding more trauma to the individual.

“So all in all, something better, but only a stop-gap step that has its drawbacks,” Akland said.

On any given day, an average of four behavioral health patients are hospitalized at Rex, which is on track to log nearly 1,200 psychiatric patients this year, up 11 percent from 2016.

Mixing psychiatric patients with other emergency cases has long posed a security risk at hospitals. The logistics of “boarding” mentally ill patients at community hospitals and regional medical centers is a hot topic in the health care field, Sollami said.

“We are not a jail,” Sollami said. “We are not equipped to take care of these patients. Every hospital in the nation had to learn how to deal with violent patients.”

This story was originally published December 12, 2017 at 5:14 PM with the headline "Rex Hospital’s ER may soon have fewer mentally ill patients. Here’s why.."