Confluence Health’s mental health unit is shutting down, expert says it was a matter of time

WENATCHEE – Confluence Health plans to shut down a medical unit meant to care for medical patients with psychiatric diseases or behavioral issues in March , citing declining census numbers.

The 11-member Medical Unit 1, or MU1, composed of all registered nurses, first opened in 2014 to some fanfare and a visit from Gov. Jay Inslee several years later in 2018.

Although not a licensed psychiatric unit, MU1 could help “facilitate the special care needs associated with patients who had these concerns,” according to Adam MacDonald, Confluence Health spokesperson.

Dr. Julie Rickard, who took part in training the unit’s staff on protocol, said the unit felt “revolutionary” at the time. Rickard is a consulting psychologist and Director of Suicide Prevention Coalition of NCW

“It felt exciting to be part of something that we felt at the time was outside of the norm, for sure,” she said. “There really weren’t a lot of programs that were happening around mental health at that time.”

Before MU1, any person who was experiencing a mental crisis and had to be retained would often go to the hospital until they got moved to an inpatient facility, Rickard said. A staff member would have to stay with them, 24 hours a day, until they got moved.

With MU1, “the people that needed care were put with staff that were trained specifically in mental health and could have a greater understanding of what the patients were potentially suffering with,” Rickard said. “Not just a random floor that had a bed that was available. It just was less intrusive to the patient. It was more friendly, and it helped them recover sooner.”

Confluence Health cites a “steady decrease” of patients to the unit for the unit’s closure with only five patients a day on account of the American Behavioral Health Systems facility, often called Parkside, opening in 2016, according to MacDonald.

The unit itself is shutting down, but MacDonald said the staff is being “dispersed” to other medical floors where patients will “receive the same level of care.”

Affected staff will be moved to “other areas of need at Confluence Health.”

“In short, this change is happening because patient needs can still be met in other units without the need to keep open a wholly separate unit which no longer has the patient census level to necessitate being a separate unit,” he said.

To Rickard, the unit’s closure was likely inevitable – only a matter of when. Since the unit’s arrival in 2014, several other entities have arrived and offer crisis stabilization services like Parkside.

She stressed the landscape for mental health has radically changed since MU1 opened. Rickard recalled being among the few psychologists when she first moved to the area around 18 years ago.

“Our four-county, regional area has done an amazing job at coming together and creating services for mental health patients that were not available when MU1 was opened,” Rickard said.

Designated crisis responders call every facility, like Parkside, in the area with certified evaluation and treatment facility beds before they will place them at Confluence Health, per state law.

Rickard said the unit and Confluence Health’s mental health services are likely not financially profitable.

“If it’s not penciling out, I don’t want Confluence to go under,” she said. “I definitely don’t want them to be bought out by someone else.”

In general, mental health as a field is not a “great field for businesses,” an issue legislators need to address, Rickard said. Medicaid rates are still low and Confluence Health, and the rest of the hospital industry in the state, has been struggling.

But patients will still have access at Confluence Health to psychologists and psychiatry onsite even after MU1 shuts down. Confluence Health Hospital is “good at managing mental health,” Rickard said. “Not all hospitals across the state are good at that.”

Issues from the closure

But with the closure of MU1 may come with its share of issues, Rickard said, adding that it’s a “community problem” that needs to be addressed together given that the mental health landscape has “changed so much since MU1 opened.”

One issue is a lack of inpatient facilities like MU1 that can treat patients with developmental disabilities, like autism, and with mental health or behavioral problems.

“It’s such a specialized population that no one really specializes in it and is afraid of touching it,” she said.

“The state put some special rules around care and management of autistic people and getting them diagnosed which made it even fewer people that were able to go in.

“So unless you specialize, you’re not really doing therapy with that group.”

Another gap in service, a growing problem in recent years, concerns senior patients with dementia and other behavioral issues.

“When a resident of a long-term care facility says they’re suicidal, they get sent to a hospital because staff feels so uncomfortable with the idea that they potentially could do something,” she said. “They are concerned and it makes them anxious to manage them. So they pitch them off to the hospital for management. It’s one way that they can dump them as a resident … and then not take the patient back.”

The other issue is that many inpatient units cannot take someone with mental health and medical issues.

But once the unit shuts down, the mental health entities around the four-county area will be there to see what needs to be addressed given the area has historically been working well together, Rickard said.

“We aren’t as competitive as we are collaborative, unlike potentially other communities,” she said. “It provides this atmosphere where we can say, ‘Hey, we’re willing to look at this gap and put service in place,’ and then other people then go, instead of duplicating, ‘We’ll pick up the pieces over here.’

“The truth is, is that we have an enormous network of providers that are very patient centric, including the hospital, which is a very good partner.”