On the fifth floor of a new tower at University of Colorado Hospital, the rooms have no furniture that moves and no handles or faucets from which to hang a ligature.
The new 40-bed psychiatric unit was designed with the most up-to-date safety measures that exist, some that were invented mid-construction.
A nurse standing in the hallway can see the entire room, even feet in the shower. Natural light filters in through large windows secured by a sophisticated locking system. And the door opens on both the right and left sides so that if a patient is using their body as a barricade, hospital staff can adjust the hinges and avoid a face-to-face confrontation when they push open the door.
When UCHealth’s new psychiatric unit accepts its first patients this summer, it will make a small dent in Colorado’s severe shortage of in-patient psychiatric beds. But while mental health advocates are praising the effort, they say it’s not nearly enough to make up for years of psychiatric bed closures at hospitals throughout Colorado.
Still, it’s 40 fewer people who will have to sit in emergency departments because the state’s psychiatric beds are full.
The new unit on the Anschutz campus in Aurora represents a turnabout in health care, a move by some hospital systems to incorporate mental health care after decades of downsizing or cutting it out completely — at least that is the hope of mental health advocates. In 2009, University Hospital closed its psychiatric unit because, at the time, the hospital didn’t have enough space for people in need of surgeries and other medical care, hospital officials said.
It was an era when psychiatric units were disappearing at a rapid pace in Colorado and around the country, as hospitals complained that the cost of operating them was not sustainable. Colorado lost 186 beds with the closure of four psychiatric hospitals from 2014 to 2020, according to the state health department.
But recently, some hospitals are returning to behavioral health care. HealthONE, with hospitals in Denver, Aurora and other suburbs, now has 120 in-patient psychiatric beds at its Behavioral Health & Wellness Center, most recently adding 20 in 2021. The center opened in Aurora in 2012.
Denver Health has 21 adolescent psychiatric beds and 42 adult psychiatric beds, with plans to add 15 more adult beds.
Colorado’s two state-run psychiatric hospitals also have expanded, though staffing shortages have prevented them from full use. The state hospital in Pueblo has grown to 516 beds from 451 beds a decade ago, yet there is only enough staff to operate 422 beds. The Colorado Mental Health Hospital at Fort Logan has 138 beds, yet only 106 are usable because of lack of staff.
University hasn’t had in-patient psychiatric beds since 2009
For University Hospital, it’s taken 14 years to open a new psychiatric unit after closing its last one on the Aurora medical campus.
The decision to close the old psychiatric unit, which had 18 beds, “was strategic around the overall needs of the community,” said Anne Felton, director of in-patient behavioral health for UCHealth. “There were patients waiting in hallway beds for medical and surgical needs throughout the hospital,” she said. “Their intent was always to reopen in-patient psych. I think if they could have predicted the future, they might have made some different decisions.”
Federal and state “parity” laws that have tried to force insurance companies to reimburse for mental health care at a level comparable to physical care have had some impact, but not enough, say hospital officials and mental health advocates.
“Certainly, those concerns about the level of reimbursement for behavioral health services persist, but we know this type of care is needed now more than ever,” said Elicia Bunch, UCHealth vice president of behavioral health services.
The hospital system announced a $100 million, five-year plan for behavioral health in 2019, which included placing therapists in primary care clinics and expanding virtual mental health appointments. The goal, Bunch said, is to provide services “in a way that destigmatizes and normalizes access as an essential part of whole-person health care.” It’s also to provide various levels of care so patients can get help before they end up in crisis and in the in-patient psychiatric unit.
UCHealth also plans in the next couple of years to add nine psychiatric beds for adults and adolescents in Fort Collins, raising the bed count to 50 from 41. Currently, the health system’s only psychiatric beds are at Mountain Crest Behavioral Health Center, and that unit will move to Poudre Valley Hospital next year.
Mental Health Colorado president Vincent Atchity said that while Colorado desperately needs mental health beds, what it needs more are supportive housing programs that help people before they end up in a locked psychiatric ward. The programs work, but Colorado has not had the political will to invest enough in them to solve the mental health crisis, he said. One example is the Sanderson Apartments, a program run by Denver’s community mental health center, WellPower, that moves people off the streets and into housing that focuses on treating trauma.
“Forty beds is great to see and that’s double what they closed,” Atchity said. But “in-patient psychiatric care is the last resort for somebody’s health. We are inevitably fixated on the beds. There are other questions we should be asking.
“We aren’t able to develop the political will to acknowledge that there is a significant portion of any human population that is going to need a persistent, high-quality, in-patient care that allows some mobility. We don’t do any of that. We let people live in tents and under bridges.”
Atchity also suggested that every hospital should be required to have a certain number of psychiatric beds.
Psych unit has circular walking track, plus a clinic for ketamine, electro-convulsive therapy
The new University Hospital unit has two wings, each with 20 beds. One side is for patients who are severely depressed and possibly suicidal, but who can engage in group and individual therapy and follow directions. The other side is for patients who are disorganized, delusional or in such a manic state that they have trouble interacting with others.
Ideally, a patient who starts on the more acute side of the unit would move to the other side when their condition improves, Felton said.
Patients, on average, are expected to stay for three to 12 days before leaving for a step-down outpatient program or possibly a supported housing community where they would receive ongoing counseling.
The side of the unit for lower-acuity patients includes a fitness room, community space where patients could talk while eating cafeteria meals, and a track that makes a complete circle around the wing, for those who like to pace. The walls display giant artwork, scenes of wildflowers and mountains. “This was a way to create that walk-in-nature type of feeling and feeling a little bit less enclosed,” said Catherine Reeves, a registered nurse and project manager of the construction team.
The nurses’ stations in both wings aren’t protected by a shield of glass. Instead, the counter that separates nurses from patients is taller than normal and slopes outward toward the patient, making it hard for a patient to reach over the counter. The counter was designed according to best practices of “trauma-informed” care, including to look less like a jail.
“By the time somebody got up and over if they were really intent on doing it, there would be enough time for somebody to intervene and to verbally engage with them,” Felton said. “A lot of your psychiatric hospitals will put in glass or a barrier that goes all the way up to the ceiling. We intentionally did not do that.”
Adjacent to the unit is the hospital’s new interventional psychiatry clinic, where patients will receive electro-convulsive therapy and ketamine treatment. Electro-convulsive therapy sends electric current into the brain, causing a seizure and reprogramming the brain in a way that could decrease mental health symptoms. Ketamine, a sedative, is used to treat depression by allowing the patient to dissociate from pain and view themselves separately from mental illness.
About one-quarter of the clinic’s patients are expected to come from the in-patient psychiatric unit, while the rest will come from the community.
The psychiatric unit, on target to open at the end of June or beginning of July, will take patients mainly from emergency departments after they’ve arrived in mental health crises. Right now, University Hospital’s emergency department has to call around the city and state trying to find available psychiatric beds for patients who, because they are a danger to themselves or others, cannot go home.
“The team of behavioral health professionals working in the community and in emergency departments spends a great deal of time trying to find beds throughout Colorado,” Felton said. “Forty beds is amazing.”