The Cass County Health System (CCHS) Board of Trustees voted on September 23, 2020, to close the Behavioral Health Unit (BHU) and repurpose the space as a permanent location for AMC Rapid Care.

“On the matter of closing the BHU, the board had a lot of factors to weigh: the pandemic likely lasting throughout 2021, the work longevity of our psychiatrist, the availability of inpatient beds increasing across the state, and the statistics of how many local residents we were actually serving, just to name a few. Looking holistically at that data, we were able to unanimously and confidently say that this is the right decision,” said Chairman Ned Brown.

Initially, COVID-19 played a role in ceasing services in the BHU. “As the pandemic started ramping up across Iowa, we looked at our own operations in the BHU. It’s a congregate care setting with four patient rooms and a common living area that is shared with staff 24/7/365. There was no way that we could responsibly keep the unit open with coronavirus cases climbing. We would have been jeopardizing the health of our patients and staff, some of whom are high risk. Many experts anticipate this pandemic to persist at least an additional 12 to 18 months, and we did not foresee a time in the near future when we could responsibly reopen the BHU,” said CCHS Chief Nursing Officer Amanda Bireline. “We found ourselves forced into a position where we had to suspend services in the BHU back in early May, but the looming question was, ‘How do we still help people during a mental health crisis without a BHU?’”

CCHS Director of Acute Care Operations Amanda Rynearson, RN said that the pandemic provided staff with time to more deeply examine how CCHS was delivering crisis mental health care. “In some ways, it has been a blessing to have this opportunity to step back and evaluate this service. In our 4-bed unit, which was the smallest in Iowa, we were usually only half-full. One of our core goals is to provide more services locally, and the BHU is an area in which, quite frankly, we struggled to do that. In fact, nearly 75% of our patients last year came from outside of Cass County,” said “In total, we served less than 40 local patients last year. We know we can do better for our local citizens – and we need to do better.”

The solution was to create a crisis stabilization model, which has been in place since June. CCHS psychiatrist, Dr. Ivan Delgado, M.D., and a team of staff work to provide urgent one-on-one mental health crisis care to adolescents and adults. The goal is to then safely transfer the patient to the care of a mental health provider as appropriate.

“In this new model of care, I consult for patients needing psychiatric care while in the emergency room or on the inpatient floor.  I am able to assess the patient and advise on immediate needs such as medication adjustments, specialized inpatient placement, or a safe outpatient plan of care,” said Dr. Delgado.

Overall, Dr. Delgado says the new model is working well, and it was the right time to make this change. “By the time this pandemic ends, I will likely be closer to my retirement window, and the likelihood of CCHS recruiting another dually board certified psychiatrist for a 4-bed unit is slim to none so now is a good time to start planning for the future,” said Dr. Delgado.

Thanks to great collaboration with Southwest Iowa Mental Health Center, CCHS staff adopted the new process over the summer months and can already see its benefits.

“It seemed like closing the BHU could have caused some challenges in the emergency room, but since we transitioned to this new approach of caring for patients one-on-one, making sure they’re safe, and quickly connecting them to their next care provider, we honestly haven’t had any problems – the process has gone very smoothly,” said CCHS Emergency Department Manager Darci Young, RN.

Prior to the new crisis stabilization model, patients seen in the emergency department for behavioral health issues sometimes had to wait 2-3 weeks before being seen by a mental health professional on an outpatient basis. That delay prompted admissions that may not have been necessary if an outpatient appointment could have been rapidly facilitated. The new model allows Dr. Delgado to quickly assess and care for patients in times of crisis and more quickly arrange outpatient therapy with Southwest Iowa Mental Health Center— within 2-4 days or, if needed, to transfer a patient to a larger, more robust inpatient facility.

CCHS works closely with both Jennie Edmundson Hospital and Mercy in Council Bluffs to transfer patients. Additionally, there are two new, large facilities that focus on inpatient mental health needs. Eagle View Behavioral Health is a 72-bed inpatient acute psychiatric hospital in Bettendorf, Iowa, that opened in June. Closer to Cass County, Clive Behavioral Health will open in February 2021 and is a brand-new 100-bed facility that spans more than 83,000 square feet that includes a three-story unit for inpatient and outpatient services. Both facilities provide care to children and adults.

“Knowing that there were two new inpatient units of substantial size with far more resources than we can provide that are being added in Iowa helped extinguish some of our anxiety about transitioning our small four-bed unit to the AMC Rapid Care clinic that will serve thousands more citizens,” said Rynearson.

In addition to these new hospitals, CCHS also looked more deeply into other resources that could be utilized to improve access to mental health care. “We know that the county pays more than $320,000 annually to the Southwest Iowa Mental Health & Disabilities Services Region. That’s a large investment, and we have not vigorously tapped into those resources to work together with our region to improve mental health services in our county. One example is their mobile crisis teams, which we are now beginning to access,” stated Rynearson.

At the same time, CCHS is investing in a major remodeling project that includes quadrupling the space for its outpatient behavioral health program, Senior Life Solutions (SLS).  SLS is an intensive outpatient behavioral health program intended primarily for seniors, which provides individual and group counseling services three days per week.  The successful program began three years ago and now has a waiting list, and they will move into their new offices in January 2021.

“With the BHU services suspended due to the ongoing pandemic, CCHS was able to repurpose the space to reopen AMC Rapid Care in July with amazing results due to high patient demand. With Rapid Care, now conveniently located across from the Emergency Department, we are on track to provide over 5,000 patient encounters per year. It enables us to provide patients with an appropriate and more affordable level of care than they may incur with an emergency room visit.  AMC Rapid Care is a walk-in clinic accessed just inside the emergency department entrance on the south side of the hospital with no appointments necessary, open Monday-Friday 8 a.m. to 8 p.m. and Saturday-Sunday 10 a.m. to 6 p.m.,” said Chief Clinic Administrator Tammy Bireline.

“At the end of the day, we always do what is best for our patients, community, staff, and organization. After looking at this from every angle, we all feel that we are making the right decision to move in this direction to serve more people with quality care. Mental health services are crucial, and we have and will continue to invest in our community’s needs in this area.  By redesigning our processes, adopting an enhanced outpatient model that expedites access to care, and working more closely with regional partners, we believe we can help prevent the need for unnecessary BHU hospitalizations while providing more access to outpatient care,” said CCHS CEO Brett Altman.