UAMC South offers emergency rooms for psychiatric patients

The University of Arizona Medical Center South Behavioral Health Pavilion on Tucson's South Side has new emergency department with a separate area built just for psychiatric patients. It also has more inpatient beds for psychiatric patients.

"We're the largest inpatient psychiatric services in Pima County," said Patricia Harrison-Monroe, Ph.D., chief of behavioral health services at UAMC South. "We have 48 general psychiatric beds and 14 for geriatric psychiatric patients 55 and older. It's the only place specifically for them, though we're looking forward to St. Mary's opening up some (geriatric) beds."

The emergency department at the facility, 2800 E. Ajo Way, was expanded a year ago to 42 treatment rooms – nine of them designated specifically for psychiatric patients. Those rooms are separate from rest of emergency department. The idea is to minimize the trauma for patients brought to the emergency room, keep the mentally ill from being exposed to people screaming in pain, or an agitated psychiatric patient.

"We make an effort to make sure people are safe," Harrison-Monroe said. "The psychiatric area of the emergency room is built with safety glass, hardened ceilings, no protruding medical equipment. All the equipment is brought into the room, to protect the patient who may be homicidal. There are no gases, nothing they can use to harm themselves. And the rooms are separately staffed with personnel trained to interact with patients who are having a psychiatric emergency."

Harrison-Monroe said the Crisis Response Center is located across the pathway. Patients who come there in a mental health crisis may be transferred to the ED if they have medical as well. Some may need admission to inpatient services.

"The UA Department of Psychiatry staffs the CRC 24 hours, covering its adult and juvenile sections." she said.

A crisis stay there has a 24-hour limit. If appropriate community referrals can't be made in 24 hours, there is a short-stay unit for 3- to 5-day says, only for adults. "That unit is unfortunately often full. If an adult requires more than 24 hours, we'll make a transfer into a psychiatric hospital, Sonora Behavioral Health for children and Palo Verde Hospital for adults," she said.

The CRC primarily takes walk-ins and individuals brought to the facility by law enforcement, she said.

"We work very collaboratively together."

Before the new facilities were built, law enforcement brought mentally ill individuals in crisis to area hospital emergency rooms where they would wait for hours for the person to be evaluated.

"Now, law enforcement doesn't have to wait. The minimal paperwork is completed (at the new facilities) and law enforcement is on their way. It's a benefit to the other emergency rooms as well," said Harrison-Monroe. She is also clinical assistant professor in the Department of Psychiatry at the College of Medicine at the University of Arizona.

"We get patients brought in by Immigration and Customs Enforcement, police, sheriff's deputies and emergency medical services providers.

"Before we opened, we had open houses for law enforcement so they would be aware of access issues and have a chance to tour the ED and CRC."

Geriatric patients are very difficult to place, she said. "They have so many medical and psychiatric issues. "They may have multiple psychotic symptoms, may be suicidal and have depression."

"At some point they need to come back into the community and there are limited community resources for geriatric psychiatric patients. They end up staying in our unit for longer periods of time than they would if there were beds for them. We always have geriatric patients waiting in our emergency room, waiting for a room."

Inpatient services at the South Campus Behavioral Health Pavilion provide care for individuals with acute psychiatric disorders, anxiety, depression, psychoses, those who are a danger to themselves or others, and those with withdrawn behavior.

There are more crisis services available in the system because of the CRC but ongoing services are limited for people who have dropped off AHCCS.

It is very challenging, she said, to serve those who have lost their benefits and will need psychiatric services once they leave the facility.

When AHCCC (Arizona's version of Medicaid) cuts came through last July, she said," it significantly impacted the level of psychiatric services available in the community for people who are underinsured and uninsured."

"And when these individuals do have access to psychiatric medication and are eligible for public benefits, the formulary is limited and they can't take the latest and maybe the most effective drugs. They are very costly," Harrison-Monroe said.

It's a challenge for the mentally ill to get benefits so they can take the medication that can control their symptoms, she said.

"It's not easy to apply for any kind of benefits. If you have all your faculties, it's difficult but if you have difficulty concentrating or are hearing voices, it's difficult to be persistent enough to get services.

"Most of the seriously mentally ill can't do this. They can't remember when their next appointment is. They can't just get on a bus to get over here. They're brought here because of their bizarre behavior by friends, family members, emergency medical workers and police."

It's important to get the word out, she said, so people in trouble who need psychiatric services know where they can go.

Harrison-Monroe said UAMC South's ED is now a trauma level 3 facility, complementing UAMC-University Campus's trauma level 1 ED, at 1501 North Campbell Avenue. There is a helipad at UAMC South than can accommodate two helicopters and provide easy access to the facility's emergency room.

For those not in an immediate crisis, outpatient psychiatric services are offered through UAMC's Department of Psychiatry clinic by its faculty and advanced trainees. Consultation, evaluation, medication and couples and individual therapy are available.

Anyone may call 874-7500 to make an appointment.

There is also an outpatient treatment program called Epicenter for individuals with psychotic illness, including schizophrenia and bipolar disorder with psychotic features.