ER Program for Homeless Patients in Mental Distress Offers Special Care, a Chance at Housing

August 22, 2018

The man came into the emergency room at St. Joseph Hospital in Orange on a busy evening, in the throes of a full-blown panic attack.

He was delirious and suicidal. Homeless at 60, he had a long history of Parkinson’s disease. But his main issue was the state of his mental health.

He was fortunate to be at St. Joseph.

It meant he didn’t sit in a chair for long hours wrestling with his demons inside a crowded waiting room. He wasn’t put on a gurney and parked in a busy hallway inside the noisy ER, or left to linger in a bed that could be occupied by a patient in need of medical treatment.

His mental illness and need for housing made him an immediate candidate for psychiatric care in the hospital’s behavioral health Emergency Clinical Decision Unit and the social services that come with it — including a chance at supportive housing.

St. Joseph opened the ECDU in May 2015, addressing a pressing need to better accommodate patients experiencing the twin crises of acute mental distress and homelessness.

The hospital has set aside Room 53 in the emergency room for their immediate triage before moving them as soon as possible to a calmer atmosphere one floor up.

The ECDU, initiated by the hospital’s head of emergency nursing and behavioral health services, Glenn Raup, has helped free up space in the emergency room while providing specialized treatment for a troublesome population, sometimes referred to as “frequent fliers” for their multiple and costly visits to emergency rooms.

It has cut their average wait for care in half, from 24 to 12 hours.

In the softly lit quiet environment of a room that once served as an observation unit for people experiencing chest pain, eight beds are designated for ECDU patients to stay up to two days under the care of a psychiatric physician and nurses trained to treat the mentally ill.

A security guard and a psychiatric technician are always on duty. Other staff work out of a room next door. The rest of the floor is empty.

Alterations to the ECDU room prevent suicide attempts, such as sealing off all but a narrow portion of the tall windows up near the ceiling and enclosing pipes in the restroom and shower in a protective cover so a noose can’t be tied to them.

Other hospitals may have similar quiet areas designated for mentally ill patients who come into their emergency rooms. But the efforts to get patients into treatment and the housing component on the back end provide a crucial but typically absent component for future stability.

While the health needs of patients are addressed, social workers assigned to the team do their best to find those who are homeless someplace to land other than a return to the street. The ECDU averages about 430 patients a month; close to half have no housing.

“If I can get a patient placed and don’t have to see them in the emergency room for another year, I call that a success,” said Dr. Ashraf Ismail, one of two psychiatrists who are part of the ECDU team.

Reconnecting lives

So far, seven ECDU patients have been placed in permanent supportive housing or have gotten a Section 8 housing voucher through a collaboration that began a year ago with the Irvine-based affordable housing developer Jamboree Housing.

Based on their prospects of maintaining stability, Jamboree provides transitional shelter in a home it owns in Anaheim until they can be placed.

Sixteen patients have lived at the house since June 2017. One of them was a man in his early 20s who had been missing from his board and care home in Redlands, and was reunited with his family in San Bernardino County.

“The angels were watching out for him,” said Jeannine Loucks, the registered nurse who is the clinical coordinator for St. Joseph’s Behavioral Health Unit and the hands-on department manager for the ECDU.

Then there was the elderly man dying from cancer: He didn’t live long enough to move into his apartment, but a son who hadn’t seen him in years was located in time to say goodbye.

A $250,000 grant from St. Joseph underwrites the yearly cost.

There are five current residents of Anaheim House, an inviting six-bedroom ranch style home with a flagstone hearth along one wall in the den, reminiscent of the fireplace in television’s “The Brady Bunch.”

JoAnn L. Muesse, 65, finds comfort in the vegetable garden she tends in the backyard.

Muesse would bounce between living in her car and short visits to her sister in Utah. She had been sleeping in her car for several months. when she arrived at St. Joseph.

Muesse, who has congestive heart failure and major depression, only gets $660 a month in disability. She sat on the edge of her bed and talked about the change in her life, arms folded and legs crossed, her feet in a pair of pink slippers.

“It’s taken away a lot of the depression.”

The residents have assigned chores, go grocery shopping once a week, and cook for themselves. Melinda Long, the Jamboree support services coordinator that residents call their house mom, helps get them to their doctors and other appointments.

There’s no curfew, but they must respect quiet hours — and take their medications.

Katrina Laurent, 58, is disabled by cerebral palsy and wears braces on her legs. She deals with anxiety and depression. She and her service dog Rascal have been at Anaheim House for two months.

“If it weren’t for this,” she said, “I’d be sleeping in a wheelchair out on the street.”

From suicidal to secure

The challenge is finding available housing.

It could be anything from a subsidized apartment to a rented room in shared housing. The quickest turn-around at Anaheim House was 90 days; most wait six months.

Chad Ward moved in April to his neatly furnished one-bedroom at an affordable housing complex called The Depot in Santa Ana. He couldn’t have guessed the day he arrived at St. Joseph in despair how it would alter the trajectory of his life.

Ward, 48, said he was abused as a child and, as an adult, battered by his ex-spouse. The combined trauma has him battling post traumatic stress disorder and major depressive disorder. Health issues disrupted a successful investment business. Diagnosed with a brain tumor in early 2016, he underwent surgery at UCI Medical Center. He said he also spent a month in UCI’s mental health ward.

At discharge, a taxi driver deposited him in his wheelchair on the sidewalk outside the Courtyard homeless shelter in Santa Ana.

Ward credits Doris Starling, daytime operator of the Courtyard, for calming him and settling him into a bed.

But he later experienced two suicidal episodes within weeks of each other.

Ward weeps into a handkerchief recalling how he was left unattended in a hallway for more than 12 hours at UCI’s emergency room. The second time, he ended up at St. Joseph’s ECDU.

Loucks helped move him to an adult crisis residential program and then Jamboree’s Anaheim House.

Continuing support he gets from case managers — and from Loucks — helps keep him from crisis. He shares his apartment with his Maltipoo, Happy. Ward, who takes medication 29 times a day for medical and mental health issues, said it’s taken a while to feel secure.

“I thought someone would knock on the door and say you can’t live here anymore.”

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