Filling a Need for Mental Health Services

	Dr. Martin Maurer, Queens Hospital Center

Queens Hospital Center celebrated the opening of an expanded Comprehensive Psychiatric Emergency Program (CPEP) last December to help meet the growing healthcare needs caused by recent hospital closures in the borough. The new unit, which at 8,500 square feet is almost double the size of the former CPEP, is one of only two CPEPs in Queens – both run by HHC. The $9.3 million, 20-month expansion project was funded through a combination of New York State’s HEAL NY program and capital funds from HHC. HHC Today spoke with Martin Maurer, MD, Director of Psychiatry at Queens Hospital Center, to learn more about the specialized services of the new CPEP and its role in serving the mental health needs for the people of the borough of Queens.

What services does a CPEP offer and how does it differ from other psychiatric care units?

The new CPEP has a psychiatric emergency room and extended observation beds. The emergency room is where patients come when they are in psychiatric crisis and need to be served in a discrete space by an expert team of mental health professionals. Our CPEP has psychiatrists, internists, nurse practitioners, physician assistants, nurses, social workers, behavioral health officers, and activity therapists who work around the clock providing comprehensive emergency evaluations, diagnoses and treatment. We involve families and develop treatment plans that support the immediate and long-term needs of the patient. We also have extended observation beds for patients who present in crisis and staff feel can be stabilized within 72 hours and thereby avoid a more restrictive psychiatric hospitalization, which is consistent with our goal of always treating a patient in the least restrictive environment.

What's the significance of the CPEP expansion?

The new space is twice as large, bright, sun-filled and a much improved healing environment allowing greater safety for patients and staff. The new area has an open nursing station which fosters more interaction between patients and providers, and collaboration among staff members. We also have six new private extended observation rooms used for helping patients stabilize in a few days. And we have many more individual interview rooms which afford our staff and patients more privacy.

How many patients does the CPEP serve? Is there a growing need?

We’ve had a steady volume of psychiatry emergency department visits -- about 5,000 a year -- and we average about 600 admissions per year to our extended observation beds. We care for patients 18 years old and older, and we’ve even treated patients in their 90's. We've definitely seen an increase in demand for psychological consultations for patients who come to our regular medical emergency room. We're doing about 300% more of those now than we did five years ago, which indicates a growing need to support mental health care for the residents of this community.

What are the most common conditions you see in the CPEP? 

The most common conditions are psychotic disorders, bipolar and major depression, and substance abuse disorders. Some patients require hospitalization. The majority need crisis stabilization, and we connect them to a variety of outpatient support services so they can return safely to their community. All patients receive a comprehensive treatment plan which can include medication, individual and group therapy, and family therapy. When should a patient or family member of a patient seek CPEP services? The CPEP is designed to best serve individuals who are having a psychiatric crisis such as experiencing strange phenomena like hearing voices and seeing visions, feeling afraid or paranoid around people, extreme anxiety, feeling depressed, confused, or experiencing thoughts of hurting themselves or others. We always recommend that patients and families contact their mental health provider first, if they have one. But our doors are always open.

How are wait times for patients at the CPEP?

There are really no wait times. Patients are seen by a nurse within minutes and in most cases by a clinician in less than 10 minutes.

How do you measure quality performance in a CPEP and psychiatric Emergency Department? 

We have multiple performance indicators and are most proud of our ability to provide psychiatric care in a restraint-free environment. When I first started in this field, placing patients in restraints was not uncommon. But we have adopted innovative techniques and patient-centered approaches that allow us to make the need to restrain a rare occurrence. We average about one restraint per month, which is remarkable considering that many patients are brought to us in an extremely agitated state. Our staff is very skilled at engaging patients and helping patients to regain control. We now are looking at reducing our use of involuntary medication – which will indicate greater success in stabilizing patients through other interventions we’ve adopted.

June 2013