Walk-In Center Offers Acute Care. (Treatment, Referrals 24/7)

By Bates, Betsy | Clinical Psychiatry News, February 2003 | Go to article overview

Walk-In Center Offers Acute Care. (Treatment, Referrals 24/7)


Bates, Betsy, Clinical Psychiatry News


Barbara Kelly was nearly frantic when she pulled into the parking lot of Los Angeles County's Mental Health Urgent Care Center on a windy, Tuesday afternoon, her agitated brother, Larry, in the passenger's seat.

After a checkerboard history of time spent in state and county hospitals, and a board-and-care home, Larry recently had been discharged from a group home. Barbara first heard about it when she got a call from the Ontario, Calif., jail. Larry had been picked up but was ready to be released. And she was next of kin.

For a week, Barbara made him comfortable in the two-bedroom house she shares with her husband and teenage son. Her brother spent his days watching TV or smoking on the patio. He also gained a bit of much-needed weight eating her meals.

But without medication, Larry became increasingly upset, vociferous, and disruptive. She feared that he might become violent because of the auditory hallucinations Larry was experiencing.

One day last year, Barbara had seen a sign go up about a walk-in mental health center, and when Larry's condition deteriorated, it occurred to her that it just might be an option. Indeed, it was.

The Mental Health Urgent Care Center at Long Beach offers the same immediate care as a "Doc in the Box," an urgent care center for medical ailments, But instead of sore throats, cut chins, and dog bites, the center in Long Beach treats mental illnesses 24 hours a day, 365 days a year.

A second such center has opened in Alameda, Calif., and proponents think that they may serve as models to meet gaps in mental health care nationwide.

"We see patients who can't wait 2 weeks to see their regular doctor but don't really need to go to the emergency room, says Ed Bienkowski, Ph.D., administrator of the Long Beach center run for Los Angeles County by Telecare Corp.

Some patients drive up themselves. Others are brought by caseworkers, relatives, or police officers. If a person in crisis calls, "we'll send a cab to pick them up," he says.

A metal detector wand--the type used in airports--provides a quick search for weapons to ensure the safety of patients and staff members. A full-time nurse takes the patient's vital signs. The comprehensive, five-page medical, psychiatric, and social history might be taken by the nurse, a licensed clinical social worker, a crisis intervention specialist, or a marriage and family therapist.

A psychiatrist is either on site or arrives within 30 minutes to make a formal diagnosis, check the patient's records obtained from a county database, and prescribe whatever medications are needed.

The crisis is diffused; the patient's condition stabilized. If she's homeless, there's a shower. If he's hungry, there's a meal. There are crayons for patients' children, a garden patio for a smoke, comfortable easy chairs that fold into beds for a quiet night's sleep.

People can stay for 23 hours, 59 minutes, and sometimes they do. But many cases are handled in far less time.

"If someone gets into a fight at a board-and-care, and they want him out for the night, we'll keep him here and talk to him and calm him down," Dr. Bienkowski says.

The program serves voluntary patients over 18. It's designed, technically, for patients who are already in county-supported mental health programs, but "no one is turned away."

People may see the sign and enter the mental health care system for the first time. If they have private insurance, they are assisted in finding a private psychiatrist and a place to go. …

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