What Do Mental Health Patients Want From The ER?

Presenter: Neal Howard
Guest: Dr. Cary Gutbezahl
Guest Bio: Dr. Cary Gutbezahl is president and CEO of Compass Clinical Consulting. He has worked as interim CMO for several hospitals and health systems, where he led major change initiatives in case management, leading to reductions in length of stay and introducing a culture of safety and professional accountability. He has also served as a physician mock surveyor to prepare hospitals for regulatory surveys. While Dr. Gutbezahl was on active duty in the U.S. Navy, he was Head of the Quality Assurance Department of the Navy Medical Command, National Capital Region, in Bethesda, Md. He is board certified and completed a laboratory medicine residency and an immunohematology fellowship at Washington University in St. Louis.

Segment Overview: Dr. Cary Gutbezahl discusses the desire of Mental Health patients to able to talk with providers about their problems without stigma and without being “written off as a psych patient.” They want their right to give input on their care, to be acknowledged, especially when they are competent to make decisions.


Health Professional Radio

Neal: Hello and welcome to Health Professional Radio. I’m your host Neal Howard. So glad that you could join us today. Our guest in studio today is returning once again, Dr. Cary Gutbezahl. He’s President and CEO of Compass Clinical Consulting. He’s also got a background in hospital manage care settings as well as the skill set that is essential in redesigning work to create safer, more reliable care in hospitals and in the ERs, specifically. In addition to his consulting work, he has also worked as interim CMO for a number of hospitals and Health Systems, introducing initiatives that greatly changed and enhanced safety and professional accountability in those departments. How are you doing today Doctor?

Dr. Gutbezahl: Very well Neal. Thanks.

N: Thank you so much for returning. You know, when it comes to being treated in the emergency room, it’s already a stressful situation. There are so many questions, it is fast phased.  Things turn on a dime especially if you are the patient yourself. But for the patient that has a mental health condition being manifested in the ER, many of the staff in there – they’re not trying to recognize what’s going on inside of person’s head other than the stress or the pain that they’re undergoing based on the physical trauma. But if there’s, say, a schizophrenic patient, what are some of the attitudes that you’ve observed in your training of hospitals to deal with the mental health care patient in the ER? What are some of the attitudes of the staff and of the patient themselves that have prompted you to form Compass Clinical Consulting?

G: Patients express real concern about how they’re treated. They frequently sense that others look at them strangely, that they don’t really reach out to them. The staff doesn’t reach out to them the way they do to other patients. Staff are often afraid of dealing with mental health patients. They are not necessarily skilled and trained to be able to understand the patient; to be able to interact with the patient; to be able to identify signs of potential risks to the staff; as well as to identify the potential risks to the patient themselves. Patients brought into an emergency room because they’re acting abnormally, they may have some suicide ideation. And they can, in the emergency room, do things that are dangerous to themselves and the staff knows that they want to protect the patient from injuring themselves but they’re not necessarily well trained in order to help identify signs of escalating anxiety and also removing any potential problems – weapons, if you will – within that emergency room itself.

N: Well Doctor, as being a physician yourself, having been trained in traditional medicine – in your opinion, why do you feel that there’s a lack of training among physicians and people that are going to be literally hands-on on thousands of people a year? Why do you think there’s a lack of this education in some of the basic workings of the mind? I mean, do you just leave it to the mental healthcare professional to deal with this and the physician deals with the body?

G: You know, that’s an interesting question. I do think that there are some improvements that are being made in education today. But historically, there has been a large separation between those of us that deal with acute medical problems versus acute behavioral or mental health problems. I think in large part, those of us that are in the medical side are dealing with a well understood anatomy, physiology, and pathology that’s studied in great detail. Whereas when it comes to human behavior and mental health illness, there’s tremendous amount that’s not understood unlike a lot of medical illnesses such as managing patients who have diabetes or heart disease where there are nice clear guidelines about what is best practiced. If you look at managing schizophrenia, there are no clinical guidelines for that disease so there’s a real difference between those behavioral health illnesses and the acute medical illnesses.

N: You know, when we were in another segment, we were talking about getting everyone ‘on board’ or on the same page when it came to the safety and the best care practices in dealing with someone who has an acute behavioral problem. Wouldn’t you think that since the mental health person is being seen by a mental healthcare professional – that maybe the mental healthcare professional and the physical healthcare professional could, say, compare notes or train together? Is your firm, Compass Clinical Consulting, seeing more training being done by your company on the one hand as opposed to the other or is it a balance between mental healthcare facilities that have ER’s that are devoted to mental health?

G: We work with mental health facilities but most of the mental health facilities don’t have emergency departments…

N: Okay.

G: As we are talking about here. Mental health treatment facilities, inpatient mental health treatment facilities are often stand-alone units although a number of hospitals do have acute inpatient psychiatric units.

N: So there’s an intrinsic separation just by the fact that the person who suffers from a mental health condition is going to be in a special hospital or released from a special hospital. When you’re talking about that attitude of maybe, paranoia, on the part of the patient wanting not to be singled out in the ER or treated differently or seen as a special person in the ER – how do you breakdown some of those attitudinal barriers when it comes to how the patient is treated? How do you make that separation less of an issue in a critical ER moment?

G: In the emergency department, I think a lot of it depends upon how the staff – both nurses and physicians – interact with the patient. Do they demonstrate the same respect to that patient that they demonstrate to a person who comes in with a leg injury or arm injury? Do they listen to what the patient is saying and consider what the patient is saying as information that reflects both the history of the medical problem that they have as well as the patients’ feelings about the medical problems that they have? Or they just feel like, “Oh, I’m identified as a psychiatric patient. They’re just looking to check out my body parts to make sure that they are all okay and then I’m left in a room all by myself for an extended period of time until somebody comes in to do the mental health evaluation and others.” You know, they don’t want to feel isolated but they also don’t want to feel threatened and that, again, is part of the training that staff need to have. It is to understand what’s the right approach for this particular patient. Do they want a lot of engagement or would they prefer to be left alone with limited engagement?

N: What were you doing prior to becoming President, CEO of Compass Clinical Consulting? On a daily basis, what types of patients were you seeing? And what prompted you to take notice at how mental healthcare patients, in particular, were being treated in the ER?

G: Well a lot of our involvement with ED patients with mental health problems as well as mental health patients in mental health facilities came from the work here at Compass Clinical Consulting. Much of our work has been done to help hospitals that have accreditation issues or problems with State or CMS surveys. So, we’ve been involved with hospitals that been cited because of problems with caring for mental health patients in the emergency department or even in psychiatric hospitals where there have been concerns about the treatment planning process and goals management for patients with mental health problems.

N: Okay. Doctor, as we wrap up this segment, I’d like to ask you – how would you improve the quality of care safety of patient who are presenting with this mental health behaviors under the current system that we have in place?

G: I think there are a few things that need to be done to improve the care in the emergency department for these folks. The first one is to recognize that you have to plan how you want to care for folks. You need to look at the entire process of care in the emergency department from the time the patient presents and his triage all the way to the time that the patient’s disposition is finalized, whether they’re admitted to an inpatient psychiatric unit or discharged to outpatient care. And you need to at look at each step in the process because it is gonna be a little bit different for a behavioral health patient. Number two is you need to train the staff to understand the behavioral health patient and to develop the skills necessary to assess these patients, to interact with these patient in a way that doesn’t provoke anxiety and escalate their concerns. And then if they do demonstrate escalation, to know how to de-escalate the patient and make sure the environment remains safe.

N: Compass Clinical Consulting is involved in many aspects of training hospitals, mental healthcare facilities included, and their staff becoming knowledgeable about handling the mental healthcare issues on an emergency basis. How long has Compass been around?

G: Compass was actually started in 1979 and has been helping hospitals with these kinds of issues, really, since the 80’s. To learn more about us, you can go to our website which is www.compass-clinical.com.

N: You’ve been listening to Health Professional Radio. I’m your host Neal Howard. It’s been a pleasure talking in studio today with Dr. Cary Gutbezahl – CEO and President of Compass Clinical Consulting. And also, having been in active duty in the United States Navy where he was head of the Quality Assurance Department of the Navy Medical Command, National Capital Region in Bethesda, Maryland. It’s been great having you here with us today Doctor.

G: Thank you Neal. I’ve enjoyed this.

N: Thank you. Transcript and Audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to our podcast on iTunes.


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