Reimagining Behavioral Emergency Environments

In 2022, Mental Health America ranked Washington State #32 in the nation in terms of prevalence of mental illness and rates of access to care for adults. In recent years, the state has committed to investing significantly in inpatient mental health beds, but many gaps remain in the community safety net. Often developed at the county level, Crisis Stabilization Units (CSUs) can begin to fill some of those gaps by providing urgent care for mental illness and/or substance abuse disorders. Unlike standard urgent cares or emergency departments, these facilities are designed specifically for mental illness, and programs are designed to help staff quickly stabilize patients, connect them to resources, and then get them back into the community.

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The session began with former patients and current patient advocates describing their personal experiences in a similar environment, allowing each participant to build empathy and a deeper understanding of specific challenges faced with this facility type. Through process mapping exercises, they prioritized the issue of the “one size fits all” nature of many units, developing a unit that ensures the right level of care for each patient and empowering them to maintain individual autonomy and a sense of control.

Once they identified this primary goal, the team rapidly identified, prototyped, and tested ways to address that challenge. Focusing on the emPATH unit concept and using Human Centered Design principles, Lori’s team developed diagrammatic concepts that allowed the facility to flexibly subdivide by diagnosis, age, locked vs. unlocked units, and other factors. The group also identified firmwide peer advocates as a key and often missing part of the care team, and found multiple ways to incorporate advocates into the facility’s workflow.

The below final product depicts an emPATH unit located adjacent to an existing emergency department. Walk-in patients are assigned peers or navigators upon check-in, while other patients arrive through a centralized, secure sallyport. After the triage process, patients may be escorted into the treatment area. These large spaces can be subdivided into multiple separate units that have been flexibly designed. Each sub-unit would accommodate different age groups and acuity/ security levels, allowing each unit’s census to ebb and flow as needed based on the patient population.

The workshop’s goal was to further the discussion of ways to improve the Crisis Stabilization Model to incorporate empathy and the patient experience. SRG Partnership is using what Lori learned to discuss, imagine, and design what this type of unit could be. SRG has committed to continuing the conversation through an upcoming series of design discussions and work sessions firmwide.