Naval Medical Center Portsmouth's Crisis Stabilization Program has successfully completed its pilot phase and now continues to help patients as a permanent program as of April 1. Within the Directorate of Mental Health, the program saved more than $200,000 during the pilot.

The program provides six days of intense outpatient therapy for active-duty service members. Those who are eligible have presented to the emergency room with suicidal ideations, or they have been hospitalized with an acute psychiatric crisis, but are now well enough to be discharged from the Inpatient Mental Health Ward and would benefit from continued therapy.

Program manager Lt. Cmdr. Beth-ann Vealey considers the program a step up from ER care and a step down from hospitalization, helping patients recover from a psychiatric crisis immediately and improve their ability to stabilize in a short time.

"I developed the program specific to NMCP because we frequently have patients with psychiatric crisis presenting to the emergency department, and the inpatient ward is consistently full," Vealey said. "This program offers patients who have an acute psychiatric crisis immediate access to high-quality psychiatric care and related services."

The program offers daily clinical oversight and ongoing support for six days. Multiple therapeutic interventions decreases isolation and behaviorally activates the patients, which results in the improved safety and well-being of program participants.

Data from the pilot shows the program's positive impact on patients. There was a dramatic 75 percent increase in resiliency to stress, a 55 percent decrease in functional impairment, a 30 percent decrease in depression symptoms, a 22 percent decrease in anxiety symptoms, and a 13 percent improvement in quality of sleep.

Program staff consists of five psychiatric technicians, a clinical psychologist, the program manager and a psychiatrist for five to 10 hours a week for patients who need medication. Changes during the pilot phase included the addition of art and recreation therapy, and increasing patient involvement for the psych techs.
They also streamlined the screening process for patients coming into the program after their discharge from the inpatient ward.

"They are not going through discharge and then separately screened to be in the program - we do it at the same time," Vealey said. "It creates a 'warm handoff' and coordination of care, and develops a better rapport with patients."

While half of the patients are referred by the ER and half by the inpatient ward, Vealey said the program currently has a capacity of eight patients per day, and they manage the numbers as enrollment and discharge is continuous. Prior to discharge, she sets up patients with outpatient services for continued care and to avert future crises.

"In the after-care program, patients can attend Wednesday meetings and receive ongoing support as they continue to maintain stabilization on their own," Vealey said. "We also correspond with them weekly through email for 90 days to support and encourage them to use healthy coping skills."

As Vealey developed program materials and trained technicians, she stressed the importance of treating these patients in a way that shows appreciation for those who wear the uniform. She wanted to look at fitness issues and their work environment while trying to work with people and empathize in a non-judgmental way about what it's like to be in acute psychiatric state and ask for help.

"I'm excited for the patients," Vealey said. "Within a week, they can go from being suicidal to feeling so much better, understanding how they began to develop those ideations, resolving feelings and being excited to go back to a work environment."

During the pilot, Mental Health Directorate staff supported Vealey's vision for the program.

"They have just been remarkable; they are open to learning and they ask questions," Vealey said. "I've had good input from staff on ways we can modify based on experiences in the ward."

To Vealey, it was exciting to conceptualize this program in theory, develop a standard operating procedure, and then watch it come to fruition.

"I am so incredibly fortunate to be given the opportunity to design and implement the program and to work with such a great team," Vealey said. "Staff has stepped up to the plate for the program, and the quality of clinical services we've been providing is really remarkable."

She credits part of the program's success with trying to see things from the viewpoint of patients.

"I developed and worked the program with the thought that if I were the person on the other side of the table needing services, how would I want to be treated and what would benefit me most," she said. "I don't think people choose to be in a crisis state. Being in the military, it can be difficult to ask for help, because we want to feel like we can take care of own problems and focus on the job at hand. It takes a lot of courage to ask for help, and we try to honor our patients by how we work with them."

The Directorate of Mental Health won NMCP's Vikki Garner Memorial Award for Excellence in Quality Improvement March 19 for the Crisis Stabilization Program.

The Vikki Garner Memorial Award for Excellence in Quality Improvement is awarded annually to an individual or a team that identifies a significant quality improvement opportunity and implements an innovative solution which improves the quality of care. The award recognizes achievements that will have a long-lasting impact on reaching the goal of improving the quality of care and promoting a culture of patient safety throughout the command.

For more news from Naval Medical Center Portsmouth, visit www.navy.mil/local/NMCP/.