Chronic medical and substance use conditions of patients at a community-based residential Crisis Stabilization Unit

A 16-bed residential Crisis Stabilization Unit (CSU), established on-site at a large, urban, Mid-Atlantic community behavioral health center in November of 2009 provides a lower-cost, community-based response alternative for individuals experiencing psychiatric emergencies. The CSU provides a sub-acute, semi-secure environment for observation, evaluation, and stabilization in support of an individual's pathway to wellness and recovery from serious mental illness and co-occurring substance use disorder. The therapeutic milieu includes recovery support groups, individual and group counseling, medical screening, medically-assisted detoxification, psychiatric evaluation, medication management, and care coordination. The program is staffed by a part-time psychiatrist, a full-time program director/licensed psychiatric nurse practitioner, a variety of qualified mental health clinical and case management staff, peer support specialists, and 24-hour nursing services. Primary medical and substance abuse screening are performed routinely, at admission, in addition to the psychiatric assessment, with staff obtaining vital statistics and a basic laboratory workup as well as the Fagerstrom Nicotine Dependence Scale, Clinical Institute Withdrawal Assessment (CIWA), and Clinical Opiate Withdrawal Scale (COWS). Analyses of these data is ongoing, but initial results from a sub-set of 150 patients indicate that a majority have one or more of the following chronic medical conditions: hypertension, diabetes, overweight or obesity, nicotine dependence, and/or co-occurring substance use disorder, in addition to a serious mental illness. Further, a substantial number (X > 30%) of clients have clinically significant asthma. CSU staff will continue to track these data and staff will use this information to improve the delivery of services within the CSU. These data also help inform the larger, parent organization on how to better meet the overall health care needs of its primary behavioral health populations by addressing the other, co-occurring chronic medical conditions of its patients as the organization prepares to become a health home for chronic behavioral health consumers.