Let’s Talk About Empath

Cami Smith:                      Hi, and welcome to Centra Scripts. My name is Cami Smith and I am your host today here. We're going to be talking about the emPATH unit that is coming to the Centra Health system, which is a direct answer to some needs that have been growing in our community. If you can't tell, I'm excited about this. This is going to be such an incredible resource. This is going to be a life-changing resource that is available to our health system.

                                           So I'm here today and I am with James Bryant, who is the vice president of Emergency Services, as well as is my Ismael Gama, who is the vice president of Psychiatry and Behavioral Health Services here at Centra. I'm excited to hear your perspective on this because this is something that both of you have been a part of since day one, since the inception of the idea, since bringing it to this area. And it has been this convergence of... I think you were saying earlier, it's almost like fate. It's like this convergence of different things that have been happening within the last few years really that have led to this obvious next step of an impact unit.

                                           But before we get into that, because it's a very cool story, I want to hear a little bit about both of you. So we'll start with you, James. Why don't you tell us a little bit about yourself, how you came to Centra and you can just take it away.

James Bryant:                  Great. So I'm James Bryant and I have been doing emergency medicine for almost 40 years. So I have started as a nursing assistant many, many years ago in Mount Area, North Carolina. I've had various leadership roles at Wake Forest University, Baptist Medical Center, the Cleveland Clinic, New Hanover Regional Medical Center in Wilmington and most recently here at Centra. I came to Centra because of a great community, but also because of a great need to grow our health system to meet the community needs. So that's really what I hope to do here in the next few years.

Cami Smith:                      Yes. You bring such a joy to the environment here at Centra Health. There's just this passion when you talk about the impact unit and when you talk about just your unit in general. And so I thank you for that because it's rare, but it's also a light. And so thank you for explaining a little bit about your background. And then Ismael, why don't you share with us your perspective.

Ismael Gama:                   Yeah, sure. With pleasure. Been in healthcare for about 25 years and really behavioral health has been my passion. I have a background in counseling and it's really where my heart is. I came to Centra just because of that. I heard this great service line that we have and usually the best way I describe, we serve people from two years old to 102. So the full spectrum of life and behavioral health has been my passion and just to come here and make a difference in the community.

Cami Smith:                      So how long have the two of you been working together?

James Bryant:                  Since late January. So I joined Centra in January and the emergency department was in the middle of our COVID surge. And so we were seeing an increase in the number of emergency department patients. And unfortunately it was also a number of behavioral health patients. So we were working very closely together to make sure that those patients needs were met.

Cami Smith:                      So would you say in that season, and you were new to Centra at that time, so Ismael, maybe this could be something that you could speak to, but in that season, were there more mental health cases than we have had in past history or is that just something that we have seen slowly increasing over time?

Ismael Gama:                   So in many ways since COVID that became such a major issue. So healthcare in general has been an issue, right? But behavioral health with COVID, with isolation tripled the numbers in our EDs across the country, especially here for Centra as well. So yes, since COVID we can see the numbers increasing. Used to be more adults. Now, you have folks from all kinds of types of not only crisis, but age as well.

                                           So it has been a crisis since COVID really. It has been dabbling. Every Monday when you look at the numbers, you see how many folks came over the weekend and seeking medical help, but also behavioral health as well.

Cami Smith:                      It's interesting, and I'm no expert in the clinical setting, but it seems to me that things that people have been sustaining just below the surface for years and years and years, COVID was like a match that just blew the top. It's like the floodgates have opened. So in a lot of ways it has shy, it has shown a light on what was already there maybe. But also I think it has been a catalyst for destigmatizing care, mental healthcare specifically, which is great news.

                                           I wish I had come about in a different way, but great news that people are seeking the care that they need, but now there's a need to meet that because it's just severely lacking really across the country. So something that we do here at Centra that we have talked about in our newsletters that we've tried to explain and show to our community because it's exciting really is the Community Health Needs Assessment.

                                           So every three years I believe we do the Community Health Needs Assessment. We do that in all areas of our health system to help identify what are the greatest needs. One thing that we saw in every single community is this increase in mental health. Whether it's from COVID, whether it's from your everyday stress, whether it's from, I don't know, the economy, I have no idea, it's there. So this need came to the surface. How did Centra go about beginning to get that ball rolling to meet this need?

Ismael Gama:                   Well, there's so many areas of need in our communities like you said, but especially top three, always for the last couple needs assessment, behavioral health is on top of that. So there's child care. There's homelessness, but behavioral health has been on top three for the last couple assessments. It takes a team. Healthcare is a team sport when it comes to that.

                                           But the behavioral health piece, like you mentioned, has been increasing year by year and the isolation that you feel not being able to go to your work perhaps, having to stay home, all that increases. And guess what? Where do they go? They go to the emergency room, right? The appropriate place. The front door of our life is healthcare.

James Bryant:                  And we embrace that. Emergency departments, that's what we do. That safety net for our community. Unfortunately we've been strained a bit as more and more people come in, and as you said, there just aren't the resources in our community where we're all struggling to get help. Everyone sees the help wanted signs. It's no different for mental health agencies, for hospitals. We're all struggling to get qualified professionals and to meet the demand.

Cami Smith:                      Yeah. So the emergency room can be a stressful place. I'm sure that many of you watching have maybe had an experience where you have gone to the emergency department here within the Centra Health system or maybe back where wherever you live across the country. It is the front door to so many hospitals, but also, it can be a scary place. And it also can be a crowded place or sensory overload type of place. So why don't you explain to us what is an emPATH unit and how does the emPATH unit kind of meet the craziness that an emergency department tends to have?

Ismael Gama:                   Yeah. I mean the emPATH unit is a response to exactly what you're describing. When you have a mental health crisis, if you go to an emergency room, there are so many distractions, people in pain, family members. The emergency room is really not appropriate space for behavioral health patients to be. They need a more dedicated space, more separate that brings the anxiety down a little bit. So emPATH is a direct response to that to try to mitigate some of these elements that really makes you even more hyper anxious. And if you come already to the emergency room with that, guess what, James? People may begin to have other conflicts right there in the waiting area.

James Bryant:                  They can then become very agitated or even hostile or violent and we try to avoid that. So emPATH takes that. It stands for emergency psychiatric treatment.

Ismael Gama:                   Assessment.

James Bryant:                  Assessment and healing space. So that emPATH, sort of that psychic... I better start over again. emPATH which is for emergency psychiatric assessment treatment and healing space. And I think what resonated for all of us is when you put the word healing in.

Cami Smith:                      Yes. That is definitely what's resonated with me.

James Bryant:                  That's different because normally when people come into the emergency department, what you see is chaos a lot of times. There are people coming in. To us, that's my life. I live that. I see that every day. I consider that normal. But for 99% of the public when they come in, they see lots of people. It's crowded, it's noisy. You hear people crying or you're hearing people that are upset.

                                           So when you're in the behavioral health crisis, that just adds to that. And so what we want to do is assess patients and then move them to a quieter space where we can address their individual needs. And our goal is not to keep people in the hospital, not to transfer them to a psychiatric facility, but to actually discharge them back home to community resources we have right here in Lynchburg and other communities to take care of them.

Cami Smith:                      So what you said, I find so interesting because we've been doing a series of articles within the Center Today Newsletter just to help the community wrap their minds around... And to help us wrap our minds around what an emPATH unit does and how it is such a great resource. And so some things that we have found is it actually decreased the admittance of inpatient psychiatric care. So exactly to your point, were not having to admit these patients who are coming in sometimes for something not related to mental health, but because the environment is not conducive to mental health.

                                           Then they end up getting admitted and prolonging that whole treatment system. So another thing and decreased time spent in the ED. So help me understand that one before I go onto my last one, because I imagine if I was overwhelmed with an environment, I mean I might just leave and not wait to get the care no matter how necessary that care may be in the moment, just because it's too much and you can't take it in. But how does it decrease the time spent in the emergency department?

James Bryant:                  So I think for the most part, there are some patients who can't leave. They've been actually brought in by law enforcement under a court order for services.

Cami Smith:                      Oh, I see.

James Bryant:                  So those patients can be a little bit more complex. But for all of our patients coming into the emergency department, there's an emergency department assessment. So we want to rule out to make sure that you aren't a diabetic who's blood sugar is just affected or you don't have some other medical condition. Once we've determined that it's more psychological or behavioral health related, then we bring in our mental health professionals and they work really closely with us in the emergency department.

                                           But sometimes then the recommendation is to be placed in another facility. And so what happens then is we have to look for a bed. And you've probably read in other newspaper articles or heard on the news that many of those facilities are full every day. So unfortunately they're not able to take our patients. So some people can wait several days to get placed in one of those facilities for additional treatment.

Cami Smith:                      Okay. That's so interesting. Just further, the need is so deep. It runs very deep. The following thing I wanted to ask about was the emPATH unit has increased followup appointments by over 20%. So I imagine, and maybe this is ignorance on my part, but if a doctor says, "Let's set up your next appointment," I set up my next appointment. But that's not always the case. How has the emPATH unit increase those statistics in areas where this has been implemented?

Ismael Gama:                   It helps to almost like a bridge. Some folks that come to the emergency room seeking mental health, they want help right away. But if you don't have anything in the community to the next appointment, you need some treatment. You need some group therapy. And if you don't have that, emPATH comes and bridges that. You receive healing immediately. As soon as you go to emPATH, the healthcare professionals are there, the psychiatrists, the therapists.

                                           They're all there to start treatment with you right away. But at the same time, we're looking for a more appropriate treatment for you in the community. So emPATH is this transition into outside the hospital where more appropriate care will be provided to you? So there are things, clinics. There will be PHP, Partial Hospitalization Programs, IOP, Intensive Outpatient Programs where folks can receive their care outside the hospital in a more appropriate space.

                                           And the emergency room is always going to be there. If you have a moment of crisis, you need to go to the emergency room. But the emPATH will help that transition into an outpatient community care.

Cami Smith:                      So let's talk about this real practically. So let's say I have my son, and let's say he needs to be in an environment where his mental needs can be addressed before his physical needs can be addressed. And that's something that we know even ahead of time. Would we go to the emergency department first and then we would be rerouted to the emPATH unit? Or do we go straight to the emPATH unit? What is this practically going to look like for the community?

James Bryant:                  So really it is you come to the emergency department and you're assessed by an emergency department provider first, because again, we want to rule out any of those medical conditions that you have. Once we've done that then you would transition to the emPATH area and that's where the remainder of your care would take place unless you have another medical issue that comes up.

                                           Sometimes starting people on new medications could spark a seizure. Sometimes it could affect your blood pressure. There may be a reason to move you back to the emergency department. We would do that for a couple of reasons. One, because those folks in the emergency room are more prepared for that type of care, but also because we want to protect that emPATH unit to be that healing treatment space and not turn into an emergency department. It's a portion, but it's different from the emergency department.

Cami Smith:                      So if you do have an emergency, you find yourself headed to the emergency department and maybe think that the emPATH unit would be a better fit. Go to the emergency department first and there are going to be team members who are going... They're there to help find the best place for you at that time.

                                           Okay. That's a good answer. That helps a little bit more with the understanding. I think as people are hearing about this for the first time, it sounds so wonderful. And I think on some level, everyone is going to want to sit, but in a place where it's like, "Oh, I want to go there too." But I think the other side of this is, this is going to also help the emergency department because it's going to separate from the emergency department, those who need a different type of care.

                                           So each of these environments are going to be specifically for those who our clinical staff is going to place where they need to be. So that's huge. So you mentioned that as the patients come into the emergency department and as they come into the emPATH unit that finding the best place for them is a logical next step. And sometimes that is with community partners that Centra Health has. So what does that look like? Who are these community partners and what can someone expect when having interactions there?

Ismael Gama:                   We have several partners in the community. Obviously, when it comes to behavioral health, everyone is booked. If you look today and try to get an appointment with one of the psychiatrists in a community or for Centra, it takes several months. Unfortunately, I hate to say that, but that's the reality we face. So we depend on those partners. And we have internal partners as well. Foundation has play a big role in the emPATH effort.

Cami Smith:                      Okay. So now the foundation, those of you may be wondering, look, what is that? So we have what we call the Centra Foundation, and they actually received a very generous donation that is making the emPATH possible. And so tell us a little bit about that.

James Bryant:                  So that was very interesting. I'd only been at Centra for a few weeks, and I was approached by my boss, Dr. Matt Foster, that there was this potential donation. And so it really was a catalyst to say, "Well, what could we do in partnership with behavioral health that would meet patients' needs?" And so Shannon Miles, who is the senior director for Behavioral Health and Psychiatry, she had read about emPATH. I had some experiences in North Carolina and so we started looking at this.

                                           Again, healing really resonated with this. So we were able to take and say, "You know what? We want to try to use this $1 million gift." But then our partners at the Centra Foundation decided that they really wanted to help us a little more. So then they came forward and offered to not only help fund the complete construction of it, but the first year's operating expenses to ensure its success.

                                           So it really turned into a $4.5 million gift from the community to make a difference. I mean, this is, like you said earlier, is a life changing. We believe this will be a life changing event for our community.

Cami Smith:                      What an incredible way to see how as a health system, Centra really does give back and put first this community that we're serving. And it is just this circle because so many of our caregivers are from our community. And so it's just this constant cycle of giving and just standing in the balance for each other, which is a really beautiful thing. And to think that this Community Health Needs Assessment identified a need and there was already someone thinking of giving toward a great need.

                                           Everything just came together in such a beautiful way. So we're looking at early 2023. Is that correct? So when this emPATH unit does open, what does that look like? I mean, it's going to drastically change an environment of care within the emergency department, but what does the timeline look like at this point?

James Bryant:                  So we are working... Like everyone, we're a little bit challenged by supply chain, so COVID has impacted a lot. So there were certain things that we wanted and really liked. I really loved a particular fencing product from the UK, but they were saying it would be 18 months to have that delivered.

Cami Smith:                      Oh, wow.

James Bryant:                  So unfortunately we could not wait 18 months. What we're looking at is a groundbreaking the end of September, and then no later than June 1st of next year. So just depending on when things come in and how we're able to put things together with our construction team. But it will be about 3,500 square feet, a beautiful facility. We'll have some additional information coming forward where people can get a look at what a computer believes the space is going to look like.

                                           But it's a calming area. It really is designed to support our patients, but also the staff that are in there too, to give them some room, some private consult areas and things like that. But I really wanted to build too that a lot of this is also getting people to our own Centra facilities. We have a lot of tremendous programs here where our inpatient operations at the Virginia Baptist Hospital. We also have the PACE program.

                                           We have partial hospital programs. So we have so many programs we offer through Centra, but we also have Horizons and Johnson Help, and many other partners that we work with too. So our goal with emPATH is to get them transitioned back to those to continue their care and hopefully reduce the number of times that they have to come back to the emergency department.

Cami Smith:                      Yeah. I think that's really going to help us community walk forward together. Some unity across the board. Well, is there anything that we haven't touched on that I haven't asked you about, but that you would like for our viewers to know about the emPATH unit or about the behavior of health environment that we're currently in?

Ismael Gama:                   Well, one of the things that I want our audience to be assured that we have a space for you. If you're going through a mental health crisis at some point in your life, first thing, come to the emergency room. We have the professionals there to assess you, making sure that you are okay, and then we transfer you immediately if appropriate to emPATH a more appropriate space.

                                           Behavioral health affects everyone in your family. It affects your core workers, your neighbors, family members, really. Sometimes they don't know what to do, right? So Centra is here for you. We want you to come and we will find appropriate space for you to receive care. And really, like James said, with our partners in the community, making sure that you can receive treatment away from the hospital, not necessarily... But certain times you might need an inpatient. Right?

Cami Smith:                      Mm-hmm.

Ismael Gama:                   And we're there for you as well.

Cami Smith:                      Okay.

James Bryant:                  I think too for emergency departments, I know that many people have self-care in our emergency departments, not just here at Lynchburg, but across our network. They've had waits in the emergency department. And part of that's because everyone is busy. Physicians' offices are overcrowded. Urgent care centers have not been able to get some help. And we've seen some closures in our community of urgent care centers. So everyone right now is struggling, but we are here to take care of you. We're always going to prioritize those patients, have that immediate need first, and we're going to take care of everyone as they come through.

                                           So please do not let a waiting room stand between you and care because it's that important to you and your family. And that this is often a lifelong illness. So it's really about getting started, getting treatment, getting better. And you will always have issues, just like diabetics or congestive heart failure. Patients have a time when they have to come back to the hospital. We stabilize you and get you back on track because we want you to have your best life. And that's really important to us, so we're here for you.

Cami Smith:                      And that's such a great message that prioritizing your health is, it's such a great choice to make. We've talked about that in various episodes of our podcast to just make the choice to take the first step, make the call, go to the emergency department, start your care. We can't stress it enough because it does. We want you to live your best life, and it does ensure that you are headed in that direction. And so thank you guys so much for joining me today.

                                           I want to encourage those of you who are listening, we have been doing a series and it's on centratoday.com. It has been a part of our newsletter, but it's also called a Did You Know series. We have talked specifically about the Community Health Needs Assessment and those results. We've talked about the emPATH unit starting in July. Introducing it, but then also really breaking down what is the need? How does it help? And so there are very detailed explanations for those of you who are interested in learning more. So I encourage you to check that out and we'll hope that you'll join us next time on Centra Scripts.