Glens Falls Hospital’s new Crisis Unit aims to better serve mental health patients young & adult

By Cathy DeDe, Chronicle Managing Editor

We’ve heard the stories, especially since COVID, of patients in mental health crisis languishing for weeks in the Emergency Department at Glens Falls Hospital — especially young people, even children, who had nowhere else to go for treatment.

The former Crisis Stabilization Unit (CSU), may have had private rooms, not just curtains between beds, but offered limited care, the Hospital decided.

One young patient awaiting a residential treatment program spent 117 days in the Emergency Department, The Chronicle was told. That’s close to four months, kept safe and being fed, but with little if any therapeutic service.

Glens Falls Hospital last week debuted its new Crisis Stabilization Unit, or CSU, the part of the Emergency Department that serves people who are experiencing mental health crisis.

This expanded area will function more as a preliminary treatment provider than simply a “holding area,” especially for adolescents and children who cannot transition to or be treated in the hospital’s adult-only Behavioral Health Unit.

Quick note: The Emergency Department is an “ER” no longer. It’s more than a room, and hospital staff refer to the suite in shorthand as the “ED” — though in talking, they do slip back to the old “ER.”

Michell Kilmer, RN, is nursing director of the Emergency Department and Behavioral Health at GFH. She led The Chronicle and others on a tour last Wednesday of the new Crisis Unit, a day before it was to open for its first patients.

The space was carved from offices and a meeting room behind the current ED. Rather than “an island” of isolated rooms, it’s connected on its far side to the hospital’s inpatient Behavioral Health Unit, Ms. Kilmer said .

That makes it easier to share resources and ease crisis intervention by behavioral health staff, for instance, if a patient becomes agitated, Ms. Kilmer said.

It has separate, connected sides, with five adult rooms and eight for adolescents and children — up from seven total.

Perhaps the biggest shift, she says: “We hired a social worker who’s going to focus on the adolescents, so that they’re actually getting treatment while they’re here, instead of just waiting to be transferred.”

Some young patients linger for weeks — or much longer, awaiting placement, hospital CEO Paul Scimeca confirmed.

“We don’t let anybody go until we know that they have a safe plan for where they go next, whether it’s home, to another facility, to a higher level of care, maybe to residential.”

“There’s such a shortage,” Mr. Scimeca says, “especially for adolescents needing longer-term residential treatment.” When they do find a place, it may be as far as Massachusetts or New York City, he said.

Ms. Kilmer says, “Kids that are sitting here for two weeks waiting to get into an inpatient facility, they don’t get better if we don’t give them some therapy and medication management.”

Still, Mr. Scimeca said, the new CSU is technically considered part of the emergency department. What that means for the hospital is insurance treats it as a single service. “Whether they’re here for six hours or 100 days, we get paid one ED visit. That’s it,” Mr. Scimeca said.

How much? “Typically a few hundred dollars,” he says. “But this is for our community, and it’s the right thing to do.”

Getting state approval for the new unit was a challenge, Mr. Scimeca said, in part because there’s wasn’t a road map.

“There aren’t hospitals wanting to build spaces like this, because they don’t make any money…

“The one message I tried really, really hard to portray in Albany to make sure people hear, that our hospital is the safety net” for more than 100 miles going north.

How it works: After being medically cleared by the Emergency Department, patients enter the Crisis Stabilization Unit through a “sally port,” a secure room where their belongings are checked and initial evaluation takes place.

Adults go to the left; children and adolescents go to the right.

Both sides have activity space, bathrooms with showers, consulting rooms for meetings with therapists or where youths can be tutored, even wide halls where children and teens can play or toss a ball, Ms. Kilmer said. Some patients are young as five or six years old, Ms. Kilmer said, though most are older.

Furnishings are designed for safety.

A nursing station at the center has large windows to overlook both sides, and “significantly more” monitors to oversee all than the prior CSU.

Down one hall is the unit’s new dining area, brightly painted and with a wall of windows — where the old space had no natural light, Ms. Kilmer said.

The new dining area serves three populations at different times — adults in the CSU, adults in the BHU and children/teens in the CSU. It can also be used for group activities, even movies.

The $3 million project was funded in part through Warren County’s ARPA (American Rescue Plan Act ) grant, as well as “very generous donations from individuals and from the business community…who really just wanted to support this,” Mr. Scimeca said.

“We really tried to get this program going as quick as we can. The more that we can do, the better their experience and outcome will be.”

Mr. Scimeca said the hospital’s original goal was to fully fund both the CSU and the $25 million Sheridan Emergency Department project, which is now in the capital campaign phase, seeking $15 million.

“We really don’t want to incur any additional debt on the hospital. Not that I don’t love my banking colleagues,” Mr. Scimeca laughed, with several bankers in the room, “but we have enough loans, so we have to really rely upon the community, and frankly, the state.”

In the case of the planned new Emergency Department, he added, “The state has to play a role. It’s to their benefit that we’re here, and healthy.”

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