Behavioral Health

We’re focused on healing the whole person—body, mind and spirit. That means we value your emotional and mental health just as much as your physical health.

Our skilled professional team has specialized training to care for people with all types of mental health conditions and substance use disorders. We bring together experts from several disciplines, including:

• Psychiatrists and other psychiatric providers
• Registered nurses
• Mental Health Associates
• Social Workers
• Chaplains
• Activity therapists

We care for people with many short-term and chronic behavioral health conditions, including:

• Anxiety
• Bipolar disorder
• Depression
• Personality disorders
• Post traumatic stress disorder
• Psychosis
• Schizoaffective disorder
• Schizophrenia
• Other psychiatric conditions

We offer the following inpatient behavioral health services:

• Psychiatric consultation for diagnosis and treatment
• Short-term therapeutic interventions for specific goals
• Group classes on a variety of behavioral health topics
• Treatment Planning and goals conferences
• Discharge Planning

It is the policy of Mercy Medical Center that patients presenting in a behavioral health crisis in the emergency department and all inpatient units receive comprehensive crisis assessment/safety planning when being discharged to the community.

Discharge planning begins at the time of admission and will consider emotional, social, financial and physical needs. This is a process of working cooperatively with the patient, their significant other(s), members of their health care team, and community support systems. We want to help the patient develop a plan that will help ensure they receive continuing medical and social services that support stability, recovery and wellbeing.

Instructions or training provided to the patient and lay caregiver will help to provide the information a comprehensive discharge plan:

• Discharge risk assessment,
• Long term needs assessment
• Treatment and/or medications instructions.
• Care coordination including transition to outpatient care.
• We will attempt to schedule your first outpatient appointment after discharge within seven days.

We are unable to talk with family members or lay caregivers without the patient’s permission. The patient will need to sign an authorization form so that we can communicate with lay caregiver/s. We will need an authorization so that caregivers can participate in discharge planning.

PURPOSE

Pursuant to HB 3900, OAR 333-520-0070 and ORS 441.053-4, a hospital must include certain elements of transition and discharge planning care that help support patients who are admitted to the emergency department or inpatient unit for a behavioral health crisis. This policy describes those elements and support we are required to provide for patients.

POLICY

1. Emergency Department and/or Inpatient units: Emergency Department and/or Hospital Medical Floor patients who have presented to the emergency department or have been admitted to an inpatient unit due to a behavioral health crisis will receive a behavioral health assessment that includes care management and long-term needs assessment to ensure the discharge plan is appropriate to the needs and acuity of the patient and the abilities of the lay caregiver. For the purpose of this policy, the following defines a patient in behavioral health crisis:
   1. Admission to a hospital medical or behavioral health inpatient unit for whom admission occurred because of a behavioral health crisis.
   2. Patients receiving care while in the emergency department as a result of a behavioral health crisis and resulting QMHP order for consultation.
2. Requirements for Patients Being Seen: The following elements are required for patients being seen or admitted for a behavioral health crisis when discharging from an emergency department or inpatient unit:
   1. Behavioral health assessment conducted by a mental health professional that includes: a best practice suicide risk assessment, homicide/violence risk assessment and if indicated develop a safety plan and lethal means counseling with the patient and designated lay caregiver (as available) as well as any other collateral contacts. Providers may accept unsolicited information from family and friends not authorized for disclosure.
   2. Be offered and encouraged to designate a lay caregiver/support person to aid in safety and discharge planning.
      1. If a lay caregiver is designated, request patient to sign authorization form for Mercy Medical Center to speak with designated lay caregiver. Inform patient that they can revoke the release of information at any time, the hospital does not require disclosure without patient permission and that only the minimal information necessary will be shared.
      2. The lay caregiver and their relationship to the patient should be noted in the patient’s medical record.
      3. If the minor is 14 or older and does not to designate the legal guardian or parent as a lay caregiver due to cause, the reasons for that determination should be noted in the medical record.
   3. Information on Benefits: Provide information on benefits of involving lay caregiver and disclosing information to him/her, as well as limits to disclosure as outlined within the patient summarization given during admission and at discharge and noted on the release of information disclosure form.
   4. Patient Long-Term Needs Assessment: Patient long-term needs assessment that includes, but is not limited to:
      1. Capacity for self-care including but not limited to risk of self-harm, available support network at the location of anticipated discharge and resources available to access prescribed medications or travel to follow-up appointments,
      2. Need for community-based services, and
      3. To the extent possible, whether the patient may return to the place from which they resided prior to hospital admission or emergency department visit or if step-down resources are needed.
      4. Care coordination transitioning to outpatient treatment that includes one or more of the following: primary care provider, community-based providers, peer support, lay caregivers or others who can implement the patient’s plan of care.
      5. Schedule follow-up appointment(s) that occurs within 7 days of discharge with a provider that is appropriate to address crisis follow up and ensure the next provider of care receives adequate documentation of the crisis visit. If a follow-up appointment cannot be scheduled within 7 days, document the applicable barriers in the patient’s medical record. Provide documentation if follow up is not applicable due to patient transfer to another inpatient/residential facility.
      6. Case management that includes clinical review of the patient record and interview of patient and/or lay caregiver, if available, to determine and address any medical, functional and/or psychosocial barriers to safe discharge, recommend resources and supports, and agreed upon by the patient.
      7. Educate lay caregiver(s) (if available) on diagnosis, treatment recommendations, outstanding safety issues, discharge criteria as well as inform lay caregiver(s) of patient discharge prior to discharge.
      8. This policy will be publicly available on the hospital’s website and provided to each patient and patient’s lay caregiver (as available) in written form upon admission/discharge from the hospital or release from the emergency department.
      9. For patients presenting with a suicide attempt or suicidal ideation, a caring contact must be attempted within 48 hours of discharge. Caring contacts may be conducted in person, via telemedicine or by phone. B
   5. Discharge Plans: All elements must be completed promptly so as not to delay discharge or transfer to another facility. Completing a behavioral health assessment that includes care management and long-term needs assessment helps ensure the discharge plan is appropriate to the patient’s needs and acuity and the abilities of the lay caregiver. If at any time a patient refuses resources or support, safety plan and/or discharge plan/ instructions, the physician will be consulted to reassess readiness for discharge, to include suicide risk.

Help

For questions about this policy, or assistance with understanding your obligations under this policy, please contact the manager of Behavioral Health Services.

References:

Department of Health and Human Services: Centers for Medicare and Medicaid Services Regulation 42 CFR 412.27(c); 482.61(e) Discharge Planning and Discharge Summary and 482.43

Oregon Health Authority: Discharge planning for patients presenting with behavioral health crisis or hospitalized for mental health treatment fact sheet (Revised 10/18/2022)

ORS 441.053, 441.054

Oregon Administrative Rules: 333-500-0010;333-505-0030, 0050, and 0055; 333-520-0070 and 333-535-0000

Oregon House bill 3900

Approvals

Initial Approval: 2/2024

CNO: 2/2024

BHU Specialist: 2/24

The Inpatient Behavioral Health Unit is located in a remodeled space on the campus of CHI Mercy Health in Roseburg. This acute psychiatric unit provides a safe and healing environment in which to treat people experiencing psychiatric crises.

Treatment involves medical, psychological and social services, and is specific to each patient. The amount of time a patient stays on the Unit is generally brief, usually less than a week. Each patient is encouraged to participate in his or her own care, and the patient and family help make decisions about treatment. Care is provided in the least restrictive environment that will assure both safe and effective treatment of patients.

Psychiatric Inpatient services are provided at Mercy Medical Center’s Behavioral Health Unit. This is a 12 bed, short-term, stabilization unit for adults 18 years and older. Services include:

• Mental health assessments
• Stabilization of acute symptoms
• Medication Management
• Group Therapy
• Discharge planning
• Referrals

Visiting Information

• There will be daily visiting hours for people over 18 years old.
• Family members who wish to visit, with the patient’s consent, can call the nurses station to request a time during those hours to visit.
• Zoom can be used for those younger than 18 to connect with their parent or caregiver.
• On the weekends, visiting hours will be for a longer duration.
• Patients are not allowed to leave the unit for any reason until they are discharged.

Patient Belongings and Storage

It is common to want to bring things to a loved one in the hospital, however, on this unit we are limited. Patients and family members are encouraged to leave any unneeded items at home or send them back home. We have limited storage and limited items allowed on the unit to promote safety. If you are coming to visit a patient, please leave these items at home:

• Patient’s purse or wallet
• Items of significant value
• Electronics
• Jewelry
• Any clothing in excess of 3 outfits
• Clothing with strings, political, drug substances, or otherwise offensive slogans or pictures
• Perfume, cologne, nail clippers, razors, tweezers, hair dryers
• Weapons or any items that are sharp
• Art and craft items are not allowed with the exception of paper or cardboard items.
• Medications (unless we are unable to provide a certain medication)?
• Food and beverage items

Items that are allowed

• Books, magazines, crossword, word search, or coloring books, jigsaw puzzles, sticker art books, origami
• Hygiene items in small containers (about 8 ounces or less) such as shampoo, conditioner, soap, deodorant, lotion, toothpaste, floss
• Clothing items up to 3 outfits

Other things to know about

• Phones:
  Patients will have access to cordless phones anytime except when groups are being held to provide them the opportunity to fully participate in their treatment program. Cell phone use will not be allowed on the unit. Phone use is discouraged after 10 pm to allow all a peaceful, quiet sleep.

• Washer and dryer:
  There is a washer and dryer on the unit so there is no need to take clothing home to be laundered.

• National Alliance for the Mentally Ill, NAMI:
  NAMI is a group of consumers and their family and friends. They hold meetings and educational opportunities to learn more about mental health conditions and how to support your loved one.

Get help in a crisis

If you’re thinking about harming yourself or others, please call 911 or go to the nearest emergency room.

If you or a loved one is experiencing a behavioral health issue that interferes with daily functioning, help is available.