Karen Teitelbaum has been president and CEO of Chicago-based Sinai Health System since 2014, and under her leadership the system became home to the city's first ever crisis stabilization unit.
The psychiatric observation CSU at Sinai's Holy Cross Hospital opened in 2016 and started off accommodating up to 12 patients at a time. The unit plays a unique role in Chicago's healthcare and criminal justice ecosystem, as it diverts patients with behavioral health problems from the emergency department into a setting more amenable to their unique needs. The unit is staffed with psychiatrists, psychiatric nurses and nurse practitioners, licensed social workers and other mental health workers.
Not only does the CSU allow patients with behavioral health needs to access treatment more quickly, but it serves as a vital safe haven. Law enforcement officers can divert those struggling with mental health issues to Sinai's unit, sparing them from unnecessary entry into the criminal justice system.
Between 2009 and 2012 alone, Illinois cut $113.7 million dollars from mental health services, leaving many suffering from conditions untreated and misunderstood, according to statistics from the Chicago Tribune. In that same time frame, 45,840 of the 76,400 people admitted to Cook County Jail suffered from some type of mental illness. In 2015 alone, 80,000 patients sought treatment for behavioral health problems at Sinai system hospitals, up 46 percent.
The effective criminalization of mental illness and the lack of accessibility to mental healthcare is what prompted Ms. Teitelbaum to institute the CSU.
Ms. Teitelbaum spoke with Becker's about the process of creating the CSU, what it offers the community and how executives can implement similar initiatives.
Question: Why did you decide to create the CSU and how does it operate?
Karen Teitelbaum: At Holy Cross Hospital, which is where the crisis stabilization unit is now, we used to have patients waiting anywhere between 18 to 36 hours to get a final disposition for treatment if they were going to get admitted some place. At our crisis stabilization unit, patients who come into the emergency department with some sort of behavioral health crisis are triaged in the emergency department as is appropriate, and normally they're in the emergency department somewhere between 1.5 to 3 hours at most, so you see a big difference in the emergency department experience. If they do not need to be admitted but still need treatment, they're sent to the CSU.
The CSU is a quiet place that has recliners, not beds or gurneys, and patients have the entire care team come to them. Patients are observed, treated, counseled and, when they're ready to leave, they are given whatever medications they need and follow-up appointments. Then we make sure they leave to a safe place.
Q: How do you decide who should be sent to the CSU?
KT: Clearly if someone is in such an acute state that they need to be hospitalized then we do that. But what we found through the CSU is more than 70 percent of the patients we've seen, and at this point we've seen well over 2,000 since it opened last year, are taken care of with a far less intense level of services.
That's terrific for the patients — it's safer and they don't get mired in an intense inpatient stay that they really don't need. We see 70 percent Medicaid patients and 20 percent are on Medicare, so it's better for the government payer patients; it's a much less expensive mode of treatment, though that's never our driving factor, and it's better quality care. We've already seen great outcomes from that.
Q: What was the process like creating and growing the program?
KT: It went pretty quickly. You know, you think about it and it's not that capital intensive. It took 6 months for the pilot and now that the larger unit is under construction, we just have typical hospital construction duration. We started with 12 recliners, and the demand is so great that we are 90 percent of the way through an expansion to 34 recliners. I can guarantee those are going to be filled up.
A lot of what we're doing at Sinai is helping Chicago decriminalize mental illness. It's a huge problem across the country, but we're looking to help the most vulnerable people in Chicago, so the CSU has been very exciting. We have plans to open one on our north campus, at Mount Sinai Hospital, but first we're going to finish the expansion down south [at Holy Cross].
Q: What kinds of partnerships do you have?
KT: We work with Cook County Sheriff Tom Dart and his office, because so many people are arrested not because of criminal or illegal activity but because they are an undiagnosed behavioral health patient. The county jail is the nation's largest psych hospital. We're going to be a drop-off site for the Chicago Police Department, and the sheriff's department has said the work we're doing in behavioral health is a Christmas present.
Seventy-two percent of the people we see in the CSU aren't admitted; that in itself is a success. A lot of the people are getting in and out in less than three hours, instead of a full day to as many as three days in an ED. That is a success.
Q: What advice do you have for hospital leaders looking to create their own CSU?
KT: I think the most important thing is to have the partners for collaboration, because one of the key benefits for this model is that patients leave with their follow-up appointments, whether it's for substance abuse or counseling or safe housing or medications. I don't know many organizations that can go it alone with every care need and every social need. So we have very tight relationships in the community to make sure we can give people ready and reliable access to these services.
We all have the same end goal: We want the people who should not be in the prisons to get the right type of care, be safe and be well. Everybody is focused on that. People getting out after having served their time are frequently referred to us, and we want to make sure the next chapter is productive for the patients, for their families and for Chicago.