Dr. Stowell

Dr. Keith Stowell, Associate Chief, Psychiatric Emergency Services, UPMC Western Psychiatric Hospital, discusses the emergency mental health care available at UPMC Western Psychiatric Hospital and the steps being taken to keep patients and staff safe during COVID-19.

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Read The Full Podcast Transcript

– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.

– On the forefront of care for psychiatric emergency services: welcome to the UPMC HealthBeat Podcast. I’m Tonia Caruso, and joining us right now is Dr. Keith Stowell. He’s the associate chief of Psychiatric Emergency Services at UPMC Western Psychiatric Hospital. Doctor, thanks so much for joining us.

– Thanks for having me.

– So Western Psychiatric Hospital really is known for treating all kinds of conditions, from some very mild to very complex cases.

– That’s right. Western Psych treats ages ranging from toddlers to our older adult population, and we treat all sorts of psychiatric disorders and substance use issues as well.

– And so when it comes specifically to psychiatric emergency services, can you talk about the special programs in place?

– Sure. So, Western Psych has a special psychiatric emergency room, which is distinct from some of our medical Emergency Departments within the system. It’s located at UPMC Western Psychiatric Hospital’s Oakland campus, and it’s specifically targeted toward working with individuals and dealing with any sort of psychiatric crisis. So, just like the rest of the system, we see young children, we see the general adult population, we see older adults as well. So individuals present with all sorts of different issues: It may be a child that’s having some behavioral disturbances, it may be an adult dealing with substance use/addiction issues, it may be someone coming in with depression, anxiety, suicidal thoughts, individuals with psychosis, mania, dementia. So we really see the range of psychiatric and substance use issues.

– And so how do most of these folks make their way to you?

– So, individuals come by all sorts of different means. Most will walk in our front door either on their own, or they’ll come in with a concerned family member. Some will come via ambulance or police because maybe they’ve called 911 when they’re in the midst of a crisis, and they’ll come in that way. Others will present directly from other emergency rooms. So those are the primary routes that folks will come see us.

– So they don’t necessarily need a doctor referral or referral from anyone else for that matter.

– Not at all. In fact, most of our folks are often not involved in some sort of level of care, so they can just walk in the door and we’ll see them and work with them to come up with a plan.

– Doctor, how can people reach Psychiatric Emergency Services by phone?

– So there’s a number of ways individuals can reach Western Psych as a whole. The main number that folks should call is 624-4100, and that will route them to the main number at Western Psych, where they can either get to the Psychiatric Emergency Services, they can get connected to our resolve Crisis network, they can get connected to a number for outpatient appointments. In addition to that, we also have our resolve Crisis network that folks can contact directly, and that’s our crisis service that’s available 24/7, 365 days a year, where folks can call in and talk to a trained clinician anytime, they can request a mobile team to come out to their home, and we also have a walk-in center in the north Point Breeze area. And that number is 888-7-YOU-CAN, 888-7-Y-O-U-C-A-N.

– And so at Western Psych, really everyone there prides themselves on providing the highest level of care possible, and that really begins with understanding and really trying to de-stigmatize care. Talk a little bit about that.

– I think you’re right. And this is part of the benefit to having a psychiatric-specific emergency room. In a typical medical emergency room, they’re generally not well set up to deal with individuals that are having some sort of psychiatric crisis. The environment’s noisy, can often be a just a difficult one to be in, there’s things that folks can potentially use to injure themselves or others, and there’s not a lot of privacy. So that’s why we’ve created a separate psychiatric emergency room where we have individuals that are trained specifically in management of psychiatric issues and crises. And the setup is a lot different as well. We have larger milieus, we can bring individuals back to interview rooms. There are staff members available at all times that are observing folks — one, to make sure they maintain safety, and also just to meet any needs that they might have. So I think that’s one of the ways where it’s beneficial to have a psychiatric-specific emergency service.

– Right. And so what happens when someone does show up, when someone walks in or they’re brought in by other means? Walk through what the procedure is, who they meet with, and what is your goal as you’re looking at that patient coming through the door?

– Sure. So individuals will come in through the front door ambulance entrance of Western Psych. They’re greeted initially by a psychiatric nurse. And that nurse will do what we call a triage. They’ll assess what the issue is, get an initial understanding of the broader picture, check to see if there’s any major medical issues, or anything that might result in some sort of medical instability, check vital signs, things like your blood pressure, your heart rate, things like that. And then we escort folks back to one of our milieus. We have a separate area for adults, we have another area for children and adolescent population. So after they go through that triage process where they see the nurse, they’ll meet with typically one of our masters-trained clinicians, and they’ll get a bigger picture. They’ll do an interview, they’ll meet with a patient, further assess a bit more of the history and what’s been going on recently. They’ll potentially talk to family members as well as maybe other members involved in that team’s care. So if there’s an outpatient psychiatrist, a therapist, something like that, that clinician may reach out to them as well. And then they’ll collaborate with a physician, who will be a psychiatrist, who will then see that patient as well. And then we’ll work on coming up with what we think is the best plan of care for that patient. Now, sometimes that may be an inpatient psychiatric hospitalization. Sometimes it can be a referral to some sort of outpatient service, maybe a rehab facility. And there’s a whole bunch of different levels of care, even in between those levels that we can help folks navigate.

– And each patient’s care is individualized, and you really work with families as well.

– Absolutely. So that’s actually a big part of this because often it’s not the patient who wants to come in. It may be their family member who’s concerned. Maybe someone who has schizophrenia, who’s been off their medications and has been acting a bit bizarrely and not taking care of themselves like they used to. They may not necessarily see the need for help, but their family may say, you know, “Hey, my son isn’t doing well, he’s been off his medications, he’s been in his apartment for days. I don’t even know if he has food, so we need you to work with us to come up with a plan.” So families are often a big part of the care plan.

– And so in the middle of COVID-19, obviously emergencies did not stop. Talk about how COVID-19 impacted care.

– Yeah, so it’s interesting. Right in the beginning, especially in March when we started to see restrictions placed on movement by the government, we started to see fewer folks come in just for a brief period of time. But then soon thereafter, our volumes went back up to almost normal. Because the fact of the matter is, folks are still dealing with a lot of life stressors and other issues. They’re still dealing with underlying psychiatric or substance use issues, whether COVID is around or not. And then COVID itself has certainly brought with it its own stressors, with maybe financial stressors, anxiety about getting the illness, maybe family members who are ill with the illness. So, that’s kind of added another layer to it. We worked with our environmental services team, our administrative team, to come up with a way to create a safe environment at Western Psychiatric Hospital as a whole, and then also in our Psychiatric Emergency Services unit.

– So what are some of the safety precautions folks will experience when coming through the door in terms of keeping people safe from COVID?

– Sure, yeah. That’s a good question. So everybody going in the front door has basically a screen. Everybody is screened for temperature to see if they have a fever, and then also asked other questions related to exposure, potential exposure to COVID. Of course, if they do have an elevated temperature or they have been exposed to COVID, we will certainly provide care regardless. There are just additional precautions that we’ll take with them potentially. And then everybody that comes in is given a mask and encouraged to wear that. Our staff members are all masked. We work on socially distancing folks as best as possible during their stay in the Psychiatric Emergency Services area. Then also, should they be admitted to the inpatient unit, we work on similar precautions. And then on top of that, our team has been particularly attuned to making sure we thoroughly clean the areas, and our environmental services team comes in several times a day to clean chairs, high-touch points like doorknobs, and other things like that.

– And so, doctor, along with those safety precautions for COVID, no matter the time there are also safety precautions taken regarding every patient who comes to the hospital.

– Absolutely. So everyone coming in, either through our front door, through the ambulance entrance, goes through a safety screen. That involves a brief search with one of our safety officers. Belongings are put through a metal detector. And that’s to make sure that our patients, families, and our staff are in the safest place possible. And throughout their stay in the emergency room, we have staff that are visible and readily available. And we also have in addition to those patient care staff, safety officers that are rounding throughout the hospital and within the Psychiatric Emergency Services area itself.

– This is really the first step on a journey for these patients, but ultimately many patients do get better.

– Oh, absolutely. So you’re you’re certainly right. When individuals come in, they’re often at their lowest point. They may be feeling depressed and suicidal, or maybe this is the first onset of schizophrenia or a condition like that, so it can be a particularly difficult time for patients and their families. But certainly there are many treatments that are very effective that include medications, therapies, and we really take the initial steps here when they’re in the psychiatric emergency room to come up with plans on getting them toward their path toward recovery.

– And why is mental health care just as important as caring for our physical bodies?

– So, mental health care is really key to our overall health and well-being. Certainly our physical care is important as well, but if we’re not feeling mentally well, we may not even take good care of our physical illness. So, I think the ongoing provision of mental health care, maintaining mental health medications, therapy, those are all things to maintaining ongoing wellness.

– All right. We began by talking about you seeing a vast array of conditions and treating a vast array of patients. Can you talk a little bit about the hope that is provided, and treatments that do work, and what it’s like when you see someone getting better and getting back on track?

– Sure, sure. So, yeah, that’s often the concern of folks who come in, which is, I’m seeing my family members struggle, or maybe I’m struggling, dealing with some sort of mental illness or substance use issue. It’s a daunting prospect to even start engaging in treatment, but certainly there are many treatment options available. Some of them involve medication. A lot of them involve therapy as well, and different types of therapy, as well as all sorts of layers of support. So as an example, some individuals may have what we call service coordination. So individuals that can help provide additional support services for their care, helping them get to outpatient appointments, helping make sure that they’re scheduling those and keeping up with them or their medications. So certainly folks can and do get better.

– And take a moment, if you will, to talk about the staff at Western Psychiatric Hospital.

– Sure. So we have a great team as a whole. Certainly in the Psychiatric Emergency Services area, we have a whole cadre of nurses, clinicians, patient support techs, psychiatrists, and other levels of care as well. It’s really a dedicated team of professionals who are very invested in providing care for individuals with psychiatric illness, and they’ve really devoted their life to this area. So they certainly are very invested in working with our patients and doing the best we can to help them along their path of recovery.

– Right. So, then, as we close, what is your final message about people coming forward and seeking care?

– Sure. So I think it’s important to just say Western Psych is available 24/7. Our psychiatric emergency services among some of our other services, like our resolve Crisis network, they’re available around the clock 365 days a year. So whether COVID is here or not, it’s certainly important for individuals to maintain their mental health care, and we’ll make sure that we’re there to be able to provide that.

– Well, Dr. Keith Stowell, thank you so much for spending time with us today. We certainly do appreciate it.

– Thanks for having me.

– I’m Tonia Caruso. Thank you for joining us. Please join us again for UPMC HealthBeat.

About UPMC Western Behavioral Health

UPMC Western Psychiatric Hospital is a nationally recognized leader in mental health clinical care, research, and education. It is one of the nation’s foremost university-based psychiatric care facilities through its integration with the Department of Psychiatry of the University of Pittsburgh School of Medicine. UPMC Western Psychiatric is the hub of UPMC Western Behavioral Health, a network of nearly 60 community-based programs providing specialized mental health and addiction care for children, adolescents, adults, and seniors throughout western Pennsylvania.