by Kirby Lindsay Laney, posted 13 March 2017
Swedish Ballard is Fremont’s hospital, being our closest Emergency Room and the obvious choice for Fremonsters seeking care. Fortunately, for us, last year Swedish chose to give over space within the hospital in service to addressing a desperate need in our community, and city.
The Behavioral Health Unit at Swedish Ballard has 22 beds currently in use for voluntary and involuntary treatment of patients, age 18 and over, in need of crisis care with their mental health. Board-certified psychiatrists, specialty trained nurses, social workers, occupational therapists, and the medical services of the hospital (sub-specialists, imaging, surgical services, etc.) can be put to work helping patients stabilize and return to our community, better prepared with the resources and tools they need to continue on their paths to wellness.
“The community needs it,” Brian Livingston, M.D., MBA, FACEP, acknowledged, “you see it on the streets.” Dr. Livingston serves as Chief Executive and Vice-President of Medical Affairs for Swedish Ballard. He believes in this commitment shown by Swedish to serving those struggling with mental and behavioral health problems, and providing them with quality care that assists them immediately, and long-term.
Dr. Livingston and Pam Wagner, Nurse Manager for the Behavioral Health Unit gave a discreet tour of the new unit to Fremocentrist, although the Unit is already operational. A video tour can be seen on-line (click here) on the Swedish.org website, with Wagner pointing out several special details of the design and treatment.
As Wagner explains, the Unit, “serves the community and the patient,” by providing patients, their families, law enforcement and our community with a safe, healthy place dedicated to their wellness.
Dedicated To Mental Health
The Behavioral Health Unit opened in February of 2016. “The ER used to be used,” Dr. Livingston observed, with patients entering the emergency room or languishing on medical-surgical floors, awaiting treatment. Now, they get focused attention on their mental illness just as they would with physical illness.
A big part of the Unit is its holistic approach to care. For many patients, mental or emotional issues may not be the only problem. “We can take patients with medical conditions,” Dr. Livingston explained. Within the Unit, care can be coordinated for those suffering from more than one chronic illness. They’ve also got a few bariatric beds, and rooms, for those fighting obesity. “It comes up,” Livingston admitted. “We try to take only ambulatory patients,” Wagner explained, “but we have taken everyone,” and will do so, whether they need a full hospital bed or administration of oxygen.
Most patients, when experiencing a full blown mental health crisis, will arrive at Swedish Ballard – or any hospital – without information, or any ability to share their complete medical history. “They are not coming in with their medical charts,” Dr. Livingston observed. This problem can be easier to address in the Behavioral Health Unit, with its trained caregivers, access to diagnosticians, and the ability to treat many different medical conditions – all in a calm, safe setting.
The Behavioral Health Unit is part a larger emphasis within Swedish, on giving more attention to the mental health of its patients. Like physical illness, mental illness is a medical condition, and can be treated when acknowledged.
The Behavioral Health Unit At Swedish Ballard
It is not possible to wander in, or out, of the Behavioral Health Unit. The Unit is locked, with a vestibule between the security doors, to keep patients safe. Within the Unit, patients have their own rooms and they can choose to stay in them. However, as Wagner points out, patients, both voluntary and involuntary, are encouraged to be out in the many common areas of the Unit, interacting, and working on healing.
In fact, Wagner helped with the design of the Unit and a great deal of attention was given to making people inside it not feel trapped or enclosed. Months and months of effort was put in to the design of the Unit, with the architect researching what has worked and what has not, in creating a calming space where patients can heal.
The Unit deliberately “looks very different,” from the rest of the hospital, Wagner observed, and this is obvious from the first step inside. “We wanted it not to look like a hospital,” she explained. Rather than sterile and even slightly cold, “We wanted it to look healing, while making it as safe as possible.”
In the Unit, they use different fabrics, paint, and lighting, with a water theme in the décor, and paid attention to sensory therapy methods. A variety of textures give different spaces different tactile definitions, and circadian lighting throughout (it dims in the evenings and brightens in the mornings) makes the Unit feel more natural. The design also includes sound dampening elements, and a music system that can be change in each room.
Within the comforting surroundings of the Behavioral Health Unit patients are less likely to act out, yet staff do have access to seclusion rooms and a restraint bed, “but our goal is to never use those,” acknowledged Wagner. The seclusion room meets every regulatory standard, and still it manages to look less restrictive and more caring. It is a small room, painted in warm, calming colors, with little more than a bed (and blankets.) The anteroom has less in it, providing a place where staff can monitor the patient through a large window, and a bathroom.
The seclusion room has no windows on the outside world, but most of the Unit does have plenty of windows that allow natural light into patient rooms, along with many of the group rooms. Patients cannot go outside while staying in the Behavioral Health Unit, but they do have an exercise room with workout equipment and yoga supplies.
Patients have access to occupational therapy, group therapy, and a chaplain who can help with grief. Most patients are encouraged to give structure to their days, while in the Unit, and once they transition back home. They are also taught coping skills in group sessions.
One way coping method is the Reflection Room where patients can voluntarily go to escape the world, and to self-soothe when feeling agitated. “We teach patients to take themselves out of situations that upset them,” Wagner explained. The Reflection Room has programmable lighting and sound to change the room’s color, sounds, and sense of warmth. The quiet, soothing space also has weighted blankets and warmed quilts for patients who want to wrap themselves in comfort.
When patients have free time, the large common area has a television and multiple work tables, for group gatherings or spacious solitary activities. The tables are square, based on patient input, to make it easier to join them together and invite others into activities. The adjacent Resource Room is stocked with books and games, along with computers connected to the internet. “We do take their phones away,” Wagner acknowledged, but computer access is only semi-restricted. Patients are encouraged to use the computers to learn new skills and to find ways to cope with the outside world.
As for patient rooms, each one has its own bathroom, desk, bed, clock and shelves. The rooms are spacious and comfortable, and visitors will likely miss the careful details that make them safe for those seeking self-harm. All doors throughout the Unit can be opened either way, to avoid barricading. The doors in patient rooms are ‘anti-ligature.’ The faucets, light fixtures, clocks, etc. were chosen for their safety and yet harmonious design.
Yet, for all the safety efforts, when patients are not in group or at specific scheduled activities, they get checked on every 15 minutes by staff. They can have visitors, during certain hours, and the well-appointed visitor’s room provides a place where family and friends can gather for meetings before or after visits, and cubbies where they can store belongings that should not be brought into the Unit.
In time, Wagner explained, they hope to have one group room appointed and approved for meetings between patients, their lawyers and a judge. An involuntary patient can be committed to the Behavioral Health Unit for three judicial days, and the courts can be asked to extend that stay for up to 14 days. Providing a place where a patient can meet with their lawyer, and speak to the judge, within the Unit, respects their rights while providing more continuity of care.
According to Wagner, right now the average stay at the Behavioral Health Unit for involuntary patients is 14 days, and the average voluntary stay is seven.
Meeting A Community Need
Ultimately, within the Behavioral Health Unit, “our model is focused on recovery,” Wagner explained, “to help [the patients] find their way.” Here patients can stabilize with new medications, find non-medicinal treatments and identify resources they can use to heal.
As both Dr. Livingston and Nurse Wagner agreed, the community needs this facility – and the facts bear them out. Since it opened, the Behavioral Health Unit has been at maximum capacity. “It was the right thing to do,” Dr. Livingston said, of dedicating the space and the staff of Swedish Ballard to this kind of care. However, he also acknowledged, “It’s not a money maker.”
According to Dr. Livingston, Washington State contributed significantly to the cost of building out the Unit, and giving Swedish the confidence to commit to this project. “Speaker [Frank] Chopp is very helpful,” Dr. Livingston observed, about getting them the initial funding, and potentially more state support.
Yet, unlike maternity care or other types of medical care, many patients in the Behavioral Health Unit come without insurance or an ability to pay. It will be necessary for our community to donate to the Swedish Medical Center Foundation to support this Unit. In addition, Swedish is actively recruiting specially trained staff, to seek more nurses skilled in psychiatric care, with a heart for this challenging work.
For more information about the Behavioral Health Unit, visit the Swedish.org website – or read a news item from the website with even more details about this exciting and triumphant commitment to better mental health for our community!
- Fremont’s Swedish/Ballard Hospital
- by Kirby Lindsay, January 30, 2013
- A Fremont Guide To Resources For Aid
- by Kirby Lindsay, November 28, 2012
- Hope For Those Feeling Depression
- by Kirby Lindsay Laney, February 20, 2017
©2017 Kirby Laney. This column is protected by intellectual property laws, including U.S. copyright laws. Reproduction, adaptation or distribution without permission is prohibited.