Three health care providers based in Roanoke and Lynchburg are launching new efforts to better address mental and behavioral health treatment as the nation continues to grapple with an ongoing mental health crisis.
Carilion Clinic is preparing to open a new, expanded space for outpatient services this fall at Roanoke’s Tanglewood Mall, on the heels of rebranding its Psychiatric and Behavioral Medicine Department to Carilion Mental Health.
Centra Health has opened a new emPATH unit, which aims to provide some behavioral health patients with a faster, yet less stressful, flow of care compared to Lynchburg General Hospital’s emergency department.
Also in Lynchburg, Horizon Behavioral Health plans to begin construction next year on a new crisis receiving center for mental health patients.
Goals of the various efforts include offering new care options, reducing the strain on hospital emergency departments and reducing the stigma around seeking treatment for mental health issues.
“For the last 20-plus years, people have had to deal with more managed care, restricting access to health care in a lot of ways, even for those of us who are insured,” said Dr. Robert Trestman, chair of psychiatry and behavioral medicine at Carilion.
“Funding for psychiatric care, for mental health care broadly, has not kept pace with the growing pressures. Many people suffered through the Great Recession in 2008. With COVID, many, many became despondent, lost their jobs, lost their social connections.”
That, Trestman said, occurred alongside a nationwide decrease in ease of access to care plus increasing costs.
Nonetheless, Trestman said, as rates of distress, anxiety and risk of suicidal behavior have increased, people are simultaneously growing more comfortable talking about mental illness and addiction.
“The stigma associated with addiction is decreasing,” he said. “We’re not talking about depression, anxiety, addiction as moral failings the way we did a decade or two ago. We’re talking about it more and more as an illness that can be treated.”
[Disclosure: Carilion is one of our donors but donors have no say in news decisions; see our policy.]
Carilion Mental Health moving outpatient services to mall
In Roanoke, Carilion Clinic is finishing an $11 million project to move outpatient services under its recently rebranded Carilion Mental Health department to the Tanglewood Mall, setting up shop in 40,000 square feet of space alongside the health system’s pediatric medicine department.
A growing mental health concern
About 1 in 5 American adults had some form of mental illness as of 2021, while about 1 in 20 had a “serious” mental illness, according to the National Institutes for Health.
Between 2011 and 2020, emergency department visits for young people with mental health conditions doubled, and the proportion of visits for suicide-related symptoms increased fivefold, according to a study published in May the Journal of the American Medical Association.
Despite a growing need for services, most localities in Virginia suffer from a shortage of mental health professionals, according to data from the U.S. Health Resources and Services Administration. Nationwide, more than 8,000 mental health practitioners would be needed to fill the shortages.
Experts anticipate that if such workforce shortages continue, wait times for care will increase. According to the American Psychological Association, 60% of psychologists surveyed nationwide late last year had no openings for new patients and more than 40% had waiting lists of 10 or more patients. Many providers feel burned out.
Centra’s 2021 Community Health Needs Assessment showed that mental health ranks among the top health concerns across the communities that the health system covers.
(If you are experiencing anxiety, depression, or any other mental illness or disorder, talk to your health care professionals to work together to address your symptoms. If it’s an emergency, call 911, or call or text the 988 Suicide & Crisis Lifeline.)
— Matt Busse
Inpatient services, emergency programs and high-intensity addiction treatment services will remain at Carilion Mental Health’s current Jefferson Street location in Roanoke, Trestman said.
Choosing the mall for the expansion is a deliberate public statement aimed at erasing stigma, Trestman said.
“We want people to be able to access this openly and comfortably,” he said.
The nonprofit health system has seven hospitals and more than 250 clinics, serving 1 million patients each year across western Virginia.
The Carilion Mental Health moniker encompasses inpatient and outpatient care; addiction services; child, adolescent and geriatric psychiatry; women’s mental health services; emergency psychiatry; the health system’s Center for Grief and Healing; and more.
“People have all sorts of ideas, images and stigma around institutionalization and medical care, certainly psychiatry — some are good, some are bad — but when people actually look up care for a problem with depression, anxiety, or other disorders, what we’ve found was, nationally and locally, when people do an internet search, they type ‘mental health,’” Trestman said.
“We thought it would really make sense for Carilion, in our community-facing appearance and branding, to acknowledge that. That’s what people think of and talk about. They talk about their mental health, their need to improve it, their need to address challenges they’re facing.”
The Tanglewood Mall facility initially will be open Mondays through Fridays, and Trestman said he hopes the hours will expand to include Saturdays.
Trestman said it’s difficult to forecast how many patients it will end up serving but estimated it could be a couple hundred people a day. Carilion also will continue to serve patients through telehealth services.
Carilion Mental Health is tied in with the health system’s Bridge to Treatment program for opioid use disorder patients, which began at Carilion in 2018 and now is expanding statewide thanks to a $1.9 million grant from the Virginia Department of Health Injury and Violence Prevention Program, announced in March.
Under the Bridge to Treatment model, patients who have a non-fatal overdose, experience withdrawal symptoms or ask for treatment are started on medication-assisted treatment and then move to an outpatient-based opioid treatment program in what Trestman called a “warm handoff.”
Carilion says that creating the “bridge” between the initial care and follow-up outpatient treatment has increased the percentage of patients who ultimately receive that follow-up care compared to before the program was enacted.
Figures provided by Carilion show that 55% of relevant patients seen in Carilion’s emergency departments enter into treatment within 30 days, though that share is down from the program’s first year, when more than 80% did so.
And 78% still remain in treatment after 30 days, down from 92% in the program’s first year.
The new state grant will allow Carilion to assist seven hospitals around Virginia as they build their own programs similar to Bridge to Treatment, Carilion said.
“Perhaps most exciting is that this expansion will allow our work to benefit patients far beyond our immediate community. It is the untreated patient who overdoses; getting more persons with an opioid use disorder into treatment saves lives,” Cheri Hartman, project director for Carilion, said in a March news release.
Centra’s emPATH unit to offer alternative to emergency department
Based in Lynchburg, Centra Health is a nonprofit health care provider serving more than 500,000 patients each year at more than 50 locations in the Lynchburg, Bedford, Danville and Farmville regions.
Last week, officials cut the ribbon on Centra’s new emPATH (short for “emergency psychiatric assessment, treatment and healing”) unit next to Lynchburg General Hospital’s emergency department.
The unit aims to offer behavioral health patients an alternative to potentially stressful traditional emergency department visits.
The 2,800-square-foot area features a main room with eight chairs — officials noted that the emPATH space is an “eight-recliner” unit, not an “eight-bed” unit — arranged in a horseshoe shape by a nurses’ station.
A smaller “reflection” room, a consult room and an outdoor seating area are also available for use.
Once patients begin being seen in the unit this week, they’ll be able to walk around, get a snack, look out a window or even talk to other patients. The space is designed to eliminate isolation and provide more room to move around.
A key goal is to help patients feel more comfortable and return them home more quickly, with appropriate follow-up care, thereby reducing inpatient admissions and extended emergency department stays, according to Centra.
“It’s a different way of taking care of these patients,” said James Bryant, Centra’s vice president for emergency services. “Typically in emergency departments, we bring patients in, we evaluate them, we determine that they need care beyond the emergency department, and then they just wait. Waiting time is really kind of wasted time.”
Officials estimate that Centra’s emPATH unit will serve an average of six patients per day. Currently, Lynchburg General’s 52-bed emergency department sees an average of 14 behavioral health patients per day.
“That’s six rooms we give back to the emergency department,” Bryant noted.
The Centra Foundation — a nonprofit that supports Centra’s programs — paid $4.5 million to build the unit and fund its first year of operation; that budget included a $1 million gift from an anonymous donor.
Providing care at the emPATH unit will take a team-based approach, with doctors, behavioral health experts, case managers and patients themselves taking a more active role in their own care, Centra said.
The emPATH unit will only be for patients entering voluntarily, noted Ismael Gama, Centra’s vice president of psychiatry and behavioral health.
Those with a temporary detention order — in which patients experiencing more severe crises are required by law to be held pending a commitment hearing — will be held elsewhere more securely.
Gama called the new unit a “brilliant partnership” between behavioral health services and emergency department services.
“Many systems around the country are trying to find solutions to address the behavioral health needs across our nation. So emPATH is part of the puzzle,” Gama said. “It provides a more appropriate environment for behavioral health patients to be taken care of very quickly.”
The emPATH model was developed by Dr. Scott Zeller, who now is vice president of acute psychiatry at Emeryville, California-based Vituity, a multispecialty, physician-owned health care firm with a national footprint.
A 2021 study conducted at an unnamed Midwestern health care facility showed that the emPATH model reduced hospital admissions and improved follow-up care for suicidal patients.
Centra said its emPATH unit is the first in Virginia, among approximately 100 such units in the United States.
“Health care needs are changing and we need to change with them,” Centra CEO Amy Carrier said at the ribbon-cutting event.
Del. Wendell Walker, R-Lynchburg, said in an interview that the unit represents Lynchburg providing an example of care for the rest of Virginia to follow.
“We are going to be the role model now going forward,” said Walker, who serves on the House of Delegates’ Health, Welfare and Institutions committee.
New crisis receiving center slated for Lynchburg
Lynchburg-based Horizon Behavioral Health offers case management, emergency services, addiction treatment and more. Last year it served more than 11,700 clients.
Now, it’s planning a new crisis receiving center with 16 beds for residential crisis stabilization and detox services, a 23-hour observation service that can serve up to 16 clients at a time, plus walk-in mental health evaluations, said Horizon spokesperson Gabriella Smith.
Construction is set to begin next year with an opening planned for 2025.
Horizon said its center will provide services that complement Centra’s emPATH unit, and some patients could transition from emPATH to the crisis receiving center’s stabilization service.
Unlike the emPATH unit, Horizon’s center will serve patients brought in under emergency custody orders or temporary detention orders, in addition to patients who arrive voluntarily.
But like the emPATH unit, the center is designed to provide a shorter wait time than Lynchburg General’s emergency department.
It also could help reduce the burden on police officers, who must stay with patients brought in under ECOs and TDOs.
“The primary goal of the crisis receiving center is to process clients faster and get them the appropriate level of care they need sooner. When this is accomplished, law enforcement officers are able to be released back to the community quicker,” Smith said in an email.
To house the new facility, Horizon purchased a 50,000-square-foot property on Fenwick Drive in Lynchburg from Centra for $1.2 million, according to city records available online.
The property is assessed for tax purposes at $2.7 million. Horizon said in a news release that Centra sold the property “at a reduced purchase price, as a community contribution, to address this significant need.”
When the center first opens, it will use the entire property, but Horizon will later explore options for moving other Horizon services to that building, Smith said.
Horizon plans to have 108 staff on site.
Horizon’s crisis receiving center also will be funded by the city of Lynchburg, the state Department of Behavioral Health and Developmental Services and the Virginia Opioid Abatement Authority.
“Now having access to these services 24/7, individuals will be presented with more options to remain in the community and close to their natural support systems and receive needed treatment faster than they would otherwise,” Smith said.
“Data shows that early intervention leads to better outcomes and individuals who maintain access to natural support systems in their community experience improved treatment outcomes. The [crisis receiving center] provides an alternative path for treatment/care for individuals experiencing a mental health emergency than the state hospital or local emergency room.”