Joining Forces in Support of Mental and Behavioral Health

00:00:00:18 - 00:00:39:00
Tom Haederle
With similar missions, psychiatric hospitals and community mental health centers sound like they should be two peas in a pod. But in reality they're often siloed, working independently and not coordinating their efforts to meet patients needs. Butler, a renowned psychiatric hospital in Rhode Island, decided to change the equation - forging a close and cooperative relationship with the Providence Center, a community mental health center, and resulting in patient satisfaction rates that are off the charts.

00:00:39:02 - 00:01:06:03
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. For people experiencing severe and persistent mental illness, the goal is to treat and support them in their communities of choice. That's not necessarily a hospital. By closely coordinating their services and resources, Butler Hospital and the Providence Center are able to accommodate that objective and provide a more seamless continuum of services for patients.

00:01:06:06 - 00:01:29:10
Tom Haederle
In this podcast hosted by Rebecca Chickey, senior director of Behavioral health, Clinical Affairs and Workforce with AHA, Mary Marran, president and CEO of Butler Hospital, describes how the enhanced partnership between two mental health service providers has made a big difference. This podcast was recorded at the American Hospital Association's Annual Membership meeting in Washington, DC.

00:01:29:12 - 00:02:00:04
Rebecca Chickey
Thank you, Tom. And Mary, thank you for joining me today here at the American Hospital Association's 2024 Annual Meeting. So far, it has been just a phenomenal event, and we're going to add to it today with learning about Butler Hospital and its relationship with the Providence Center, a community mental health center. So, if I may, I want to start with asking you to describe what is that relationship between Butler, an internationally renowned psychiatric hospital, and the Providence Center?

00:02:00:07 - 00:02:02:11
Rebecca Chickey
Can you share and what was the journey to get there?

00:02:02:12 - 00:02:26:19
Mary Marran
Sure. Thanks. First, let me thank you for the opportunity to talk about our great work in Rhode Island. And it's an interesting story, quite frankly. The Providence Center joined Care New England, which is our health system that includes Butler Hospital - the psychiatric hospital I ran - about 5 or 6 years ago. At that time, they had their own CEO and president, and we moved them into the corporate shared services structure.

00:02:26:19 - 00:02:49:29
Mary Marran
It was a great way to support the great work of the Providence Center. Along the way, the president resigned, and ultimately I ended up stepping in as an interim to run the Providence Center. We tried to recruit a president for a period of time. We weren't really successful. So we decided for essentially now that I would run both the hospital and the center.

00:02:50:02 - 00:03:13:24
Mary Marran
And boy, what a privilege it's been. Because historically, and I think most people know this and it's not a bad thing, but community mental health centers hospitalization is a failure. The center is about days in the community. It's about supporting people with severe and persistent illness in their communities of choice. So when someone has to go into the hospital, truly that's considered a failure.

00:03:13:26 - 00:03:38:23
Mary Marran
I think what we've learned from the pandemic is there's so much need in our communities for the treatment of behavioral health services and our ability to partner and support each other with the unique services we bring, and combine those in a way that we fill the gaps, quite frankly, we're doing a great job with the transitions of care, particularly for the severe and persistently ill.

00:03:38:25 - 00:03:50:21
Mary Marran
So my ability to run both organizations and really connect the people that do this work, elbow to elbow, really does result in some tremendous outcomes, which I'll be happy to share with you.

00:03:50:23 - 00:04:07:10
Rebecca Chickey
Yeah, you teed that up so nicely because that's exactly where I was going to go next. As you say, there historically has been a silo or a big wall, often between community mental health centers and hospitals and sort of peering over the wall every now and then and going, what are you doing? And are you playing in my sandbox

00:04:07:10 - 00:04:40:11
Rebecca Chickey
sometimes. But more and more, I would say I've seen over the last 15 years or so, hospitals and community mental health centers coming together and specifically to have a full continuum of care because discharging patients from an inpatient setting can also be challenging, and that transition of care is a pain point often. So tell me what you have been able to do in care transitions that has really, I think based on the tone in your voice, strengthened the relationship between Butler and Providence.

00:04:40:14 - 00:05:06:04
Mary Marran
So, many things. But let me start with probably our first, most significant move, which was we've located one of our Act model integrated health home teams. So it's a sort of community treatment. We have a team that actually lives within the hospital, in offices that are, you know, maybe 50 yards from the inpatient units. What I love about this, it was my Providence Center staff who'd named the team.

00:05:06:10 - 00:05:38:13
Mary Marran
It's called Unity. It speaks to that coming in they understood that this is a job we need to do together. And actually, from people who meet the requirements for a sort of community treatment, there's about 300 people now served within that hospital based function. We actually are going to add a second team because the caseloads have increased. What it allows for is really both early identification of individuals who need this intensive community treatment and a warm handoff.

00:05:38:15 - 00:06:13:00
Mary Marran
Our staff can go...I should say my staff at the Providence Center because I have staff at the hospital as well...they can go right to the unit, meet the patient, talk to the patient about what the transition is going to look like, and move the patient right to the community services, keeping in mind that within the health home team, there are peer services, wraparound services that they will then plug in to, increasing the likelihood that the transition to the community will be successful, decreasing the likelihood that a readmission will follow, which is really important to all of us.

00:06:13:03 - 00:06:34:20
Mary Marran
So one example. The other example is we actually have a 24/7 call center at the hospital, and we cover the emergency line for the Providence Center. So if a client has a crisis in the community, they call Butler, we're able to engage the staff at the Providence Center, work first to divert, if possible, safely divert the patient.

00:06:34:20 - 00:06:54:21
Mary Marran
But if the patient needs to come in for any reason, we can get them into the emergency room, admit them if we need to, hold them till morning. Really connect them to the people they know at the Providence Center. Another great example is recently we were really struggling with folks who suffer from addiction. Come to our detox unit.

00:06:54:23 - 00:07:19:03
Mary Marran
Typically it's for alcohol use disorders, but they're our most frequent readmissions, are highest utilized hours. We were having trouble breaking that cycle. And this is what's changed at the hospital, is when we think of these transition issues, we first think about our partners at the Providence Center. What might we do with the Providence Center that can help with these transitions?

00:07:19:03 - 00:07:56:00
Mary Marran
Well, the Providence Center has a network of recovery centers, anchor recovery centers, and they have peers who help us in the EDs. They help us throughout the community. But at Butler, what we asked is, could you potentially bring peers to our unit before we try to discharge and see if we can't make that connection there? So it's only been about six months now, but we're starting to introduce peers on the detox unit to help navigate that transition by someone who has lived experience, which is one of our most powerful tools in the community.

00:07:56:00 - 00:08:26:03
Mary Marran
So that's another great example of the work that we're doing. The Providence Center has a huge challenge with individuals who are discharged from the hospital. We set up intake appointments yet high no show rate. So first intake at the Providence Center and it's not always people who are coming from Butler. The folks coming from Butler now, we do the intake right at Butler with the Unity team. Even if they may not need at level services

00:08:26:03 - 00:08:51:29
Mary Marran
we get them connected. They might need outpatient, they might need something else in the Center. But we're able to tie that handoff so that you do that quickly. You don't give opportunity for that person to leave and, you know, not be able to engage them in whatever service they need. So working with Butler to make sure that anybody coming from Butler, we try to increase the likelihood that they're going to engage and start treatment. Again,

00:08:51:29 - 00:09:17:06
Mary Marran
that unity relationship helps with that. We also work with the social service staff at Butler around individuals that they're sending that aren't necessarily going to go to Unity. And we really try to understand is the appointment time convenient? Transportation, all of those social drivers that might interfere and that tight relationship with Butler. We have a better rate of first appointment show rates.

00:09:17:09 - 00:09:35:29
Mary Marran
We struggle with some of the other hospitals. We're doing things to try to engage some of the other hospitals that refer. But with Butler, because of that tight relationship, we're really able to impact that no-show rate. It was pretty high. It was almost half, and we're overbooking, but still that miss. But it's that collaborative work where we brought that down.

00:09:35:29 - 00:09:43:10
Mary Marran
Now last week it looked like it was down to like 20% no show, which is, believe it or not, a pretty good no show rate for the community.

00:09:43:13 - 00:10:07:06
Rebecca Chickey
And that is incredibly significant. You shared so much. One of the things I want to compliment you on is everything you described seems like it is trying to treat the whole person. We were reminded yesterday in one of the sessions that only 20% of health can be managed or influenced by hospitalization, and that leaves a significant part for those of you who are not the math person, that leaves 80%

00:10:07:06 - 00:10:34:10
Rebecca Chickey
that's influenced by everything else that impact human beings on a daily basis. And so this partnership with the Providence Center helps you be able to better address that 80% and treat what's influencing their health. And it also sounds like, particularly those last two examples, that you provided relationships. The Surgeon General recently, within the last year or so, released a report on loneliness and how loneliness it really is becoming an epidemic

00:10:34:10 - 00:10:54:14
Rebecca Chickey
in many ways. It existed before the pandemic, but the pandemic has influenced it. And bringing those peers from the Providence Center into the detox unit, that allows them to have a relationship. And instead of when they're already going through a transition after discharge, trying to establish that relationship. So how brilliant. Thank you.

00:10:54:17 - 00:11:15:06
Mary Marran
Well, and I think that quickly, the other thing that we've learned as a hospital, we've adopted service design from the Providence Center. We actually have an integrated health, an Act model team that we run at the hospital for the commercially insured who suffer from severe and persistent mental illness. We largely serve the Medicaid population from the mental health center.

00:11:15:06 - 00:11:38:28
Mary Marran
We modeled our service after the Providence Center and a lot of our transitional services with case management. These are lessons we've learned from the Providence Center. Social drivers. If we really want to appreciate social drivers, our community mental health centers have been doing this work forever, understanding that in order to actually get to care, you really need to help the individual with those challenges.

00:11:38:28 - 00:11:49:21
Mary Marran
Housing, transportation, food, insecurities, things that are barriers to care, and our mental health centers - and the one I have the privilege to run - have great expertise in that area.

00:11:49:26 - 00:11:56:07
Rebecca Chickey
Yeah, it's so important. Have you been able to track as a part of this any impact on patient satisfaction?

00:11:56:10 - 00:12:20:07
Mary Marran
In terms of the clients at the Providence Center, the patient satisfaction rates are off the charts. The connection to our staff, and quite frankly, our staff are so tightly tied to each other that experience for our clients is really highly regarded. So, absolutely, for those folks who are working with in transition, we're getting great satisfaction results.

00:12:20:08 - 00:12:21:10
Mary Marran
Yes.

00:12:21:12 - 00:12:22:19
Rebecca Chickey
How about the staff?

00:12:22:22 - 00:12:42:03
Mary Marran
Yeah. So it's interesting more and more. And it's a matter of routine now that when we're trying to solve a problem, I bring the teams from both the Providence Center and Butler together. And so at first you're sort of bumping around the table and it's Butler. It's the Providence Center. But now they do it themselves. They have a question.

00:12:42:06 - 00:12:54:12
Mary Marran
Workforce development. Another area where we're at the hospital mimicking some of the ladders, the professional ladders that we've developed at the Providence Center. And those things now are fluid, which is just wonderful.

00:12:54:14 - 00:13:14:11
Rebecca Chickey
That's so great. I had the opportunity last week to interview a community health worker, and I asked her why she chose that career, and at first she was hesitant. And then I said, well, what do you love about what you do? And she said, working with the people when they contact me and they say, you have a really helped me turn my life around.

00:13:14:13 - 00:13:21:01
Rebecca Chickey
And that's something that is invaluable. And she just got this big beam. So I expect that you see that as well.

00:13:21:01 - 00:13:49:27
Mary Marran
And it's not uncommon for me to receive an email sometimes through a staff member, sometimes directly from a client, from a patient at the hospital. And they're appreciative and delighted with the experience. And some of the best stories you're going to hear are from the folks who feel compelled to tell us about it, which is wonderful. And yes, we share that with our staff, and it's a moment where you can really underline how significant the work is that we're doing in this space in behavioral health.

00:13:49:29 - 00:14:08:24
Rebecca Chickey
So I'm going to ask the question around funding, because we all know that hospitals and health systems are being asked to do more and more with less and less. That's how it feels, particularly given Covid and the financial impact that that had. What have you seen in terms of the financial impact of this collaboration?

00:14:08:27 - 00:14:42:28
Mary Marran
I would say that what we're seeing is recognition that we cannot ignore this behavioral health crisis in front of us. So why forget when we did the podcast about the behavioral health short stay unit that I'm opening - entirely publicly funded. State/federal dollars, $12 million to permit me to open up this unit. The hospital has never seen that, but I believe people really understand that if we don't address this problem, it's going to affect us all in our economy, in the overall health of the population.

00:14:43:00 - 00:15:13:02
Mary Marran
The Providence Center is working right now with the state of Rhode Island, who has given us grant funds for workforce stabilization. So we did receive several million dollars to actually pay our staff market competitive rates, because everybody needs the talents of the folks doing the most difficult work in the community. So investment recognition by the state. Right now, the entire state is working on all of the mental health centers becoming CBHCs, so certified behavioral health clinics.

00:15:13:06 - 00:15:31:00
Mary Marran
And there's been a fair bit of grant funding from the state of Rhode Island to support us through that process. If all goes well, by October 1st, all of the community mental health centers that are licensed in Rhode Island will be CBHCs, and a couple other agencies are being added to that list. So in Rhode Island, could we use more?

00:15:31:02 - 00:15:43:28
Mary Marran
Absolutely. Are we struggling financially through this transition to CBHCs? Yes. But the state is, I think, really trying to do their part in helping us through that transition. We're very fortunate.

00:15:44:01 - 00:15:54:11
Rebecca Chickey
Now that's phenomenal. And it sounds like your state leadership has really gotten behind this and acknowledged the problem and not just talked about it, but actually stepped up and said, here's some funding.

00:15:54:15 - 00:15:59:07
Mary Marran
State and our federal delegation has been really active in helping us through this work.

00:15:59:10 - 00:16:05:19
Rebecca Chickey
That's great. Since we're here in D.C., yes, you may be going to the Hill to thank them or inform them.

00:16:05:20 - 00:16:13:17
Mary Marran
A nice thing about Rhode Island is they come visit us often. You know, we're small, 40 square miles. We do see our delegation. Awesome. And they've been wonderful to us.

00:16:13:19 - 00:16:38:01
Rebecca Chickey
That's phenomenal. So as I'm looking at time and wrapping up, you have shared a number of reasons for hospitals and health systems to be inspired by this community partnership. As you and I have talked about many times, there's not one solution to improving access to care. There's integration. There's reducing the stigma, there's technology, digital solutions. But community partnerships

00:16:38:01 - 00:17:06:04
Rebecca Chickey
I truly feel hit so many sweet spots because we're all caring for the same patients. And if you can coordinate that care across the continuum, particularly for individuals with chronic severe mental illness, it's just common sense. Although my son once said, mom, common sense is not that common anymore, and he has some common sense just by saying that, I'll say. But are there particularly 2 or 3 things you would say to inspire other hospital or health system leaders, too.

00:17:06:07 - 00:17:27:27
Mary Marran
I would say one, it's a great investment in terms of the time we put into these partnerships with our community providers. It quite frankly makes good sense clinically and good sense economically to really support those partnerships. I would also say there's a lot of work for us all to do, and the degree that we can collaborate together to get it done.

00:17:27:29 - 00:17:53:02
Mary Marran
And it's a rewarding process that quite frankly, we have to remind ourselves it's not competitive, it's cooperative. And the more we do that, the more patients we serve, the healthier they're going to be. And again, investment in behavioral health is really an investment in the overall health and well-being of your population. And lastly, there's a lot to learn from our community agencies and providers, health and human services providers like the Providence Center.

00:17:53:08 - 00:18:10:20
Mary Marran
They've been doing the work that we're talking about, being so important. Social drivers, taking care of those things that disrupt care, they know how to do it. We have a lot to learn from our community providers, and we should all lock arms with agencies like the Providence Center. The outcomes are pretty special.

00:18:10:23 - 00:18:33:16
Rebecca Chickey
Mary, thank you so much. Thank you for joining us here today. Really appreciate it. I'll let the listeners know there is a website on AHA.org/behavioral health. And if you scroll down on that page you'll see an icon and the words Community Partnerships. So if you click there you can listen and learn and read about other community partnerships.

00:18:33:23 - 00:18:45:19
Rebecca Chickey
Because this one is unique and each one has their own unique journey. But we can learn from all of them. So please consider taking a look at those resources. And Mary, just keep up the great work.

00:18:45:20 - 00:18:48:21
Mary Marran
Oh thank you. Thanks for the opportunity to talk about it.

00:18:48:23 - 00:18:57:05
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.