RWJBH eager to see effects of bringing mental health resources into medical-surgical ward

RWJBarnabas Health is inviting mental health associates into the standard medical-surgical hospital ward. And it’s inviting other hospitals to do the same.

The new model the hospital system is adopting — and, its leaders hope, showcasing — at one of its facilities is a department that combines mental health and psychiatric resources with nurses and clinical care staff in one dedicated eight-bed unit.

The Medical Behavioral Specialty Unit, as it’s called, is about two months into operating at RWJBarnabas Health’s Monmouth Medical Center Southern Campus, where Mabel LaForgia serves as chief nursing officer.

“So, it’s fairly new, but the feedback so far has been great, and we’ve had some success stories,” she said. “I can say we’ve had patients who were known to us, such as one who didn’t usually adhere to medical regimens who in this unit had surgery, took all his medicines and had no incidence of violence. It was such a great stay with the care and expertise in the unit.”

Positive feedback from staff has been important, too. LaForgia said patients who could benefit from the care of behavioral health specialists can sometimes present scary situations for standard medical staff, who aren’t as accustomed to agitated or potentially combative patients.

“A lot of times this can lead to workplace violence events toward a nursing team,” she said. “The intention might be just to provide medical care, but the patient can escalate things. If you don’t have the behavioral health expertise to pick up on those signs early, you’re almost in a more reactionary role and not as proactive in managing that.”

The design of Monmouth’s unit, which is in a limited-access area of the hospital, ensures an added level of safety for patients and staff, LaForgia said. Cameras are set up around the unit and each of the rooms has windows with sightlines that allow staff to keep an eye on patients, she explained. Psychiatric resources also are available there around the clock.

In the past, behavioral health patients requiring medical care would have received care from a regular nursing team that wouldn’t be able to attend to that cohort of patients in the way they might need, LaForgia said. Under this new model, even the standard nursing team would have additional training in behavioral health.

As LaForgia points out: There’s nothing infrequent about encountering patients who are dealing with some form of psychiatric distress.

At a rate of 1-in-5 adults suffering from mental illnesses, psychiatric conditions actually rank among the most common health issues in the U.S., according to the Centers for Disease Control and Prevention.

So, it’s no surprise that upwards of half of patients have psychiatric co-morbid conditions in medical-surgical hospital wards, according to a review published in a 2022 American Psychiatric Association journal. Those conditions are associated with increased hospital length of stay, medical costs and rehospitalizations.

“It’s more prevalent than people think,” LaForgia said. “We need to start being more creative in how we’re looking at and managing these patients. And I think this is a great way to do it.”

This new medical-surgical unit is one of the first of its types in the region. Where behavioral health teams are not already integrated with other medical departments in hospitals, LaForgia anticipates change.

And she expects their hospital could serve as a catalyst for that.

“I would love to get some great results and be able to let people know about it,” she said. “I would also love to have people see what we’re doing and adopt it, because I believe it’s important and necessary for patients.”