The Chester County Hospital Behavioral Health Team
The 2022 Southeastern Pennsylvania Community Health Needs Assessment only confirmed what had become clear during the COVID-19 pandemic: the Greater Philadelphia area, much like the rest of the country, was in the midst of a mental health crisis.
The assessment, which not-for-profit hospitals and health systems are required to undertake every three years by the Affordable Care Act (ACA), identifies the unmet health needs of local communities. "By better understanding the service needs and gaps in a community,” the report says, “an organization can develop implementation plans – which are also mandated by the ACA – that more effectively respond to high-priority needs."
"Mental health conditions" were identified in the 2022 Southeastern Pennsylvania assessment as the number one community health need. The pandemic added urgency to the concern, but it wasn’t the lone cause of it. In the prior assessment, published in 2019, "behavioral health diagnosis and treatment” was the second-ranked community health need. "Substance/opioid use and abuse" was the first.
Michele Francis, MS, RD, CDCES, LDN, Director of Community Health and Wellness for Chester County Hospital, and her department began collaborating with the Chester County Suicide Prevention Task Force in the wake of the 2019 assessment. Those efforts increased dramatically in response to the 2022 assessment.
The hospital now sponsors Youth Mental Health First Aid USA, a free, in-person, day-long training session presented by the task force that helps adults identify, understand, and respond to signs of mental illness and substance use disorders in children and adolescents.
The hospital also offers QPR (Question, Persuade, Refer): Suicide Prevention Training, an evidence-based protocol that's taught by the Community Health Education Coordinator, Chad Thomas, MPH, PMP, and two other instructors from the hospital, Christina Gamez, MSN, RN-BC, EBPC, and Aneesha Dhargalkar, MD. Upon completing the two-hour class, participants are certified as "Gatekeepers".
"Many people are touched personally by mental health challenges and suicide,” Thomas says. "Some people in the QPR classes have already lost someone to suicide. I've heard them say, 'I wish I would have had this training back then. I could have saved their life or helped more.'"
Last fall, Thomas also represented the department at a mental health fair hosted by the Coatesville Youth Initiative, a nonprofit "committed to youth-led, transformational community change."
Chelsea Melrath, a trauma specialist with the Chester County Health Department, leads a free virtual training session, Promoting Resiliency and Developing Connections, which is sponsored and hosted by the Community Health and Wellness Department.
Francis says she's also been in talks with the National Alliance for Mental Illness to cohost some programs with its new Chester County chapter once it opens later this year.
A need of this magnitude called for structural changes, too. Chester County Hospital established a behavioral health service line in February 2020. Initially, the fledgling program was strained by the sudden, overwhelming demands of the pandemic.
"We've seen fluctuations in our census because of COVID-19, but for different reasons," says Kim Joffe, CRNP, PMHNP, a psychiatric nurse practitioner in the CCH Behavioral Health program. "At first, many stayed away from the hospital. Then there was a tremendous uptick in substance and alcohol use, kids with suicidal thoughts, and geriatric individuals in complete isolation who experienced a loss of drive to live anymore. And then there were complications that we didn’t understand initially."
The surge was compounded by the closure of two nearby hospitals in early 2022.
"The impact was immediate and overwhelming," says Kyle Finucane, MSW, Director of the Chester County Hospital Behavioral Health Program. Compared to March 2021, Finucane says the Chester County Hospital Emergency Department saw a 75 percent increase in behavioral health patients in March 2022. Others, he adds, were admitted medically for "days or weeks" because they couldn't be placed in an inpatient psychiatric facility.
Finucane says the hospital's leadership "sensed a significant need for boots on the ground regarding our psychiatric services" at least two years prior. Since then, several new hires and appointments have been added. Today, the Chester County Hospital Behavioral Health team comprises 12 full-time and four part-time staff members, including 11 social workers and four treating behavioral health clinicians.
In addition to Joffe, two additional nurse practitioners were hired in 2022. A licensed behavioral health counselor, Samantha Dawson was also hired last year. She provides brief therapeutic interventions to patients experiencing a behavioral health crisis.
"The hospital's leadership, right on up to [President and CEO] Michael Duncan, has been a huge advocate for meeting the needs of patients experiencing any form of a behavioral health crisis," Finucane says. "The executive leadership team provided the necessary services and resources to better meet the needs of those in our community coming to the hospital and seeking our help."