Maine program aims to lower ED visits for psychiatric crisis patients

PORTLAND, ME - Amistad, a non-profit corporation that provides peer support to individuals with serious life challenges in Portland, Maine, has launched a new program to provide alternative solutions for those who frequently use the emergency department for psychiatric crisis.

Amistad Executive Director Peter Driscoll and Program Coordinator Christopher Monahan presented the new Peer Coaching Initiative, which launched in November 2011, at the 2012 Maine Quality Counts conference in Augusta, Maine, in March.

Amistad started out as a peer social club, a safe place that people could come to, said Driscoll, and has expanded into a full peer center with trained peers placed in the emergency rooms of both Maine Medical Center and Riverview Psychiatric Center.

Monahan said the Peer Coaching Initiative, which is funded with private dollars, encourages those who tend to end up in the emergency department frequently to meet with trained peers in a community setting, like a coffee shop, on a regular basis to expand their options and help lessen their dependence on the emergency room.

“The Peer Coaching Initiative is intended to work intensively with individuals identified by the hospital as ‘frequent visitors’ to the psych ED. It is a relatively small cohort of patients who tend to be in the ED very frequently, and are sent home in the great majority of cases,” said Driscoll.

Driscoll said Amistad has also operated a peer support program for about seven years, which is funded by the state’s Department of Health and Human Services.

“We have a peer placed in the emergency rooms seven nights a week from 5 to 11 p.m., the busiest times for those coming in with a psychiatric crisis. We can make the visit more comfortable and provide someone to talk to that’s been there or just help them pass the time in the waiting room, which can sometimes be really scary. They’ll also help the individuals once released from the emergency room by sharing resources,” he said. “As the result of this approach, we believe that their needs will be more effectively met, they will eventually reduce their use of the ED, and there will be dramatic savings to the current system. In general, we see peer services as a complement to traditional services, not as a replacement.”

Monahan said the first seven participants in the Peer Coaching Initiative had an average of 17 emergency room visits in three months prior to the program. After the first three months of involvement with the program, those same individuals averaged nine visits.

“An average emergency room visit costs $875 to $1,700, whereas a peer intervention costs $19. More than half of those visiting the emergency room for a psychiatric crisis go home that night, which means they probably didn’t need to be there in the first place,” said Driscoll. “One person in our program has visited the emergency department 1,100 times in seven years. It’s a small number of people using an enormous amount of resources.”

Monahan agrees. “By providing support in non-traditional settings,” said Monahan, “we think we can really decrease ED use and improve a person’s ability to manage their own health.”