Even before Pennsylvania Hospital (PAH) opened its doors in 1751, Dr. Thomas Bond and Benjamin Franklin had already expressed their dedication to serving the community’s most vulnerable individuals, including those struggling with mental illness. This commitment to providing high-quality care to those with physical illnesses and behavioral health disorders alike has remained unchanged over the past 268 years. Nevertheless, in keeping with the innovative spirit of the hospital’s pioneering founders, PAH has always sought to set new standards, provide the most advanced, patient-centered treatments, and develop accessible, stigma-free support services.

Whether individuals with psychiatric conditions are in need of emergency intervention at the recently relocated and upgraded Crisis Response Center (CRC), or community members with intersecting behavioral health and psychosocial issues require access to the outpatient services provided by Hall-Mercer Community Behavioral Health Center, PAH is committed to connecting patients with the specific resources they need — not just to recover, but to thrive.

Design with Dignified Care in Mind

pah crc rendering 2019

For more than 20 years, PAH’s CRC operated out of Hall-Mercer, half a block away from the main hospital entrance. This 24/7 psychiatric emergency room provided a safe environment where individuals experiencing behavioral health crises like severe depression or anxiety, episodes of psychosis or self-harm, suicidal ideation, or substance use could stabilize and get connected to treatment. But while the CRC provided community members with much-needed services, the mere 500 feet separating Hall-Mercer from the main hospital created a number of barriers to care.

Movement between the hospital and CRC required costly ambulance transport that delayed patient care, and staff regularly needed to head across the street to work with the ancillary service teams. And as patient volume steadily increased, the outdated space couldn’t expand to keep up. In 2015, PAH Chief Executive Officer Theresa Larivee, and psychiatric leadership decided that the time had come to find the CRC a new home. The Spruce Building — which conveniently houses PAH’s two inpatient psychiatric units — was chosen, and earlier this summer, the state-of-the-art center officially began welcoming patients.

“Designing within the confines of a historic space was challenging, but being physically connected to the hospital has allowed us to improve the scope of our practice,” said Juliette Galbraith, MD, medical director for Emergency Psychiatry Services and attending psychiatrist at the CRC. “Safety is paramount, so we made many upgrades to minimize risk — low-profile metal detectors and cameras, patient lockers in our vestibules, and sally port doors that open on a delay to prevent elopement [leaving without authorization] — but just like any other patient, patients who come to the CRC deserve a therapeutic space that’s appealing and dignified.”

pah crc rendering 2019

In addition to the center’s soothing color palette and the natural light that brightens the treatment rooms, the inclusion of two entrances help to maintain a therapeutic environment. Separate entrances — one for walk-in patients and another for patients who arrive by ambulance or police — improve traffic flow through the unit while also preventing the presence of police or distressed individuals from triggering other patients.

“For someone experiencing a worsening of their psychiatric condition, busy areas can be very upsetting — and what’s more hectic than an emergency room?” said Maria A. Oquendo, MD, PhD, chair of Psychiatry. “The CRC’s layout really sets it apart. We have a new quiet area with reclining chairs and a TV where patients who don’t need to be monitored closely can go to relax between interviews so they aren’t upset by the activity around the general waiting room.” This reduced-stimulus “respite room” has received extremely positive feedback from patients and staff alike.

The added square footage also created storage areas for equipment and medications, as well as comfortable spaces that support the needs of staff and residents. “This is a very high-pressure job, and it’s important to have a dedicated area where staff can actually take a break and rest,” Galbraith said.

Establishing an Entry Point for Treatment

Regardless of when or how they arrive, each patient is greeted warmly by a security officer and clinician who explain what patients can expect in a clear and non-intimidating way. The CRC sees an average of 22 patients daily, and the creation of additional interview rooms has ensured they can speak with the CRC coordinator, nurses, crisis clinicians, physicians, and advanced practice providers quickly and get connected with the best resources for their circumstances.

While the assessment process is standardized, the CRC serves as a gateway to individualized care based on the severity of a patient’s condition. For example, someone struggling with moderate anxiety exacerbated by a psychosocial crisis like homelessness may be referred to outpatient counseling, while someone whose major depression has led them to stop eating will likely be referred to an inpatient unit either upstairs in the Spruce Building or at Penn Presbyterian Medical Center or another facility. The split between inpatient and outpatient referrals is about 50/50. After sharing their recommendations with the patient, staff set up appointments, track down open beds, work with insurance companies and coordinate transport to reduce stress and prevent delays or interruptions as patients move on to the next phase of their care.

Patients experiencing behavioral health crises and physical illness simultaneously will also be referred to medical treatment — a process that is now far easier given the CRC’s proximity to the main hospital. As Oquendo noted, creating “a seamless transition between levels of care wherein psychiatry is integrated with the rest of medicine” is the ultimate goal given that improved mental health often leads to better outcomes overall.

“For Pennsylvania Hospital, the CRC represents an investment in psychiatry, in behavioral health care, and in the community,” said Jody Foster, MD, MBA, chair of Psychiatry at PAH. “We’re always open, and we’re always here to help.”

Spreading the Word (and the Love)

While the CRC is no longer attached to Hall-Mercer, the relocation hasn’t affected the relationship between the two centers; CRC staff members regularly refer patients to Hall-Mercer’s outpatient services, and Hall-Mercer’s outreach teams consistently accompany at-risk individuals to the CRC for evaluation.

One of these outreach teams is led by senior outreach and engagement specialist Helena Boyle, who spends her weekdays (and frequently her weekends) engaging with homeless individuals. While she still approaches people on the streets, her focus has shifted recently to the individuals living in the underground concourse areas of Jefferson and Suburban train stations. As part of a new pilot program — developed by Patty Inacker, DSW, MBA, director of Operations for Hall-Mercer, and supported by Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services — Boyle has teamed up with SEPTA to train their police officers to engage more compassionately with the homeless population in and around the stations. During her shifts, Boyle demonstrates effective conversation tactics and provides tips to officers on how to assess whether an individual is in crisis or is under the influence of a substance.

“If you think about it, we’re really in the same business — social work,” Boyle said. “We want people to feel comfortable enough to say, ‘Hi, Sergeant Matt. When you see Helena, can you tell her to meet me here tomorrow morning? I need a pair of socks.’”

But Boyle can offer more than socks. She has Wawa gift cards for those who can’t afford food, and train and bus tickets for those who have a home or family to return to, but need support to get there. She has access to community organizations that provide IDs, free haircuts, and new glasses, and she can connect individuals to the CRC or Hall-Mercer’s plethora of services — counseling, drug and alcohol treatment, laundry facilities, showers, a safe place to stay during extreme weather Code Reds and Blues — to get them back on track. Perhaps most importantly, she has the time and willingness to listen.

“We all have our gifts, and mine’s talking homelessness. Maybe they don’t want to stop drinking. Maybe they’re not interested in treatment yet. That’s okay. I’m meeting them where they are. And as we talk, they pick up information just like the SEPTA officers I’m training,” Boyle said. Starting conversations over a sandwich, building relationships through repeated interactions, and showing what options are available via walks down to the PAH campus allow her and Hall-Mercer’s other outreach staff to help individuals get into treatment and housing.

“Even if they don’t need emergency care at the CRC right now, they know it exists. Maybe they agree to come with me for a shower, but as they wait, they’ll see others coming in for appointments or leaving with bus tickets,” she continued. “We’re breaking down barriers and making connections — and it’s working.”

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