The words “urgent care” conjure up images of crowded waiting rooms filled with sick, slumping patients. Add the words “mental health” to “urgent care,” and you might imagine a place where things could get out of hand pretty quickly.
On a recent Tuesday morning, however, the waiting room in the Urgent Care for Adult Mental Health on University Avenue in St. Paul felt quiet and calm.
A receptionist, seated behind a large counter, answered phones and spoke with patients. Two or three people lingered in the center’s sunny front waiting area. To the right of the receptionist was another, larger space called the “Living Room,” filled with cozy chairs and couches arranged in clusters and separated by movable dividers that looked a little bit like large palm fronds. A family with children sat on one of the couches, the kids reading quietly while one adult filled out paperwork.
On this morning, anyway, the mood in the Urgent Care for Adult Mental Health felt anything but urgent.
“That’s just the way we want this place to feel,” said Roger Meyer, project director for the Mental Health Crisis Alliance, a coalition of East Metro mental health providers that worked with Ramsey County to create, fund and develop the Mental Health Urgent Care. “We designed the Living Room to be a place that is clearly not an emergency room. It is clearly not a doctor’s waiting room, either. It’s something different.”
Intended to provide an alternative to a hospital emergency rooms for people over age 18 experiencing a mental health crisis in Ramsey, Dakota and Washington Counties, the Mental Health Urgent Care is designed to feel non-threatening, approachable and user friendly. The hope is that adults with mental illness — many of whom may have negative associations with doctors and hospitals — will find it a comfortable place to seek help for their concerns. The Living Room is intentionally designed to be a welcoming introduction to the mental health services the center provides.
“This room can be used for conversations with family members, for conversations with other individuals, for relaxation,” Meyer said. “Oftentimes you’ll come in and you’ll see people sitting here getting resources lined up, using the telephone. It’s just a comfortable spot.”
In the four years since the building opened, it’s also become an informal gathering place for people with mental illness who want to learn more about available services and meet others with similar diagnoses, said Alyssa Conducy, MSW, LICSW, human services manager for Ramsey County’s chemical and adult mental health services.
“The thing that is really cool is that this space has ended up being a place for engagement. It’s not uncommon for us to have visitors who will come here many times, to use the phone, look at resources, put their toe in the water. It’s a step toward the person being able to ask for help. Sometimes our staff will notice someone who’s been hanging around, and we’ll say, ‘We’ve been seeing you around. Can we help you with anything?’” Some visitors make their way to the center from downtown St. Paul, Conducy said: “We have people stop by from Union Gospel Mission, Dorothy Day, a bunch of different places.”
Creating an environment where people feel comfortable seeking treatment for their mental health concerns was central to the Urgent Care’s creation, but another motivator was reducing health care costs.
“We do believe it is a more cost effective service than the emergency room,” Meyer explained. Because the Urgent Care’s staff is trained to work with people with mental illness and understand the mental health care system, he added, ”It is a better service for the consumer than the ER and the police. Needs are met here in a way they aren’t in other locations.”
Many people in mental health crisis head to an emergency room, Conducy said, and that seems like a natural response: When you or a loved one is experiencing acute symptoms of mental illness, it does feel like an emergency, but even though they see many such cases, hospital emergency rooms are not really the best place to go for a mental health crisis.
“The emergency room’s goal is to see if they need to get you into an inpatient room or not,” Meyer said. They are not designed to assess individuals’ mental illness. “They are very high volume. They have very limited time to deal with individuals. They are great partners and they do what they do very well, but emergency rooms are not a great spot to go to if you don’t need an inpatient bed. When you come here, you are going to get more conversation, more focus on, ‘What can we do for you right now?’ And then you are going to get plugged into post-assessment care.”
Whom the center serves
Unlike a walk-in counseling center or a therapist’s office, the Urgent Care for Adult Mental Health is intended for people experiencing an acute mental health crisis, not for those seeking ongoing therapy.
“Almost everything in this building is focused on a moment-in-time crisis,” Meyer explained. While staff often help patients set up ongoing follow-up treatment at different locations, “We don’t want to see people coming back here over and over for appointments.”
There are a few small, private interview rooms just off the Living Room where staff can speak with patients to assess their needs and explain available services, but most business tends to take place out in the open.
“We do have formal interview rooms, Conducy said, “but a lot of times people feel more comfortable in a more open space when they’re talking with the crisis staff.”
Sometimes staff determines that a visitor is in immediate danger to his or herself and needs to be admitted to a hospital. In those cases, an ambulance is called.
“That doesn’t happen very often,” Meyer said. “It’s much more common that we can manage the situation here, we can plug into services.”
The goal is to keep people out of the hospital as much as possible, to plug them into services based the community, and, even better, for staff to go out of the building and meet patients where they are most comfortable.
“Our staff goes out and sees people in their homes, their place of employment, at a family member’s house,” Conducy said. “Wherever a person is we’ll go there. People do come here, of course, but we actually prefer going to them.”
Beyond the Living Room, the Urgent Care building is also home to the county’s 24-hour crisis line (651-266-7900), a call line staffed by mental health professionals who support people in mental health crisis. The same group of people also make up Ramsey County’s Mobile Crisis Team
“The number has been around for 20-30 years so it’s established in the community,” Conducy said. “People call from the community, from individuals themselves, from family members, from providers. It’s a full range of things, from people needing help with resource identification to really serious situations, where it is a crisis. Sometimes we need to get the police involved right away, or we need to send out the Crisis Team and assess the situation.”
Staffers sit at desks arranged around the edges of the room. They speak on the phone and then turn to consult with each other. “We typically have six or seven staff on during the day,” Conducy said. “This is the bull-pen model where staff can easily consult with each other.”
Stabilization staff is housed in the next room, Conducy said. The room, as it usually is, was mostly empty. “It’s their job to go out and work with people in the community,” she said. “They are hardly ever here. This is basically just a place to put a desk.”
Certified peer counselors, people with mental illness who are trained to provide peer support to others, also share space in the building, as well as psychiatrists and clinical nurse practitioners who can provide short-term psychiatric services. The county’s detox center, which was moved from 160 East Kellogg Boulevard, is located upstairs.
Commitment to community wellness
Meyer believes that the construction of the Urgent Care building represents a commitment on the part of Ramsey County to support the mental health needs of all members of the community.
“The county was very bold and right in the middle of a recession plunked down a bunch of money on mental health services,” Meyer said, explaining that planning began on the project in 2009. “Kudos to Ramsey County: They built a brand-new $9 million building and they got it done. No other counties were doing that at the time.” During the planning process, Meyer explained, “The county also said, ‘We have this thing called the Alliance, where we have all these other partners. Let’s work with them to see how the Urgent Care should work.’”
The resulting building, which opened in September 2011, is a hive of activity, with a clear focus on mental wellness. Meyer and Conducy are proud of space and what it represents.
“Overall, Ramsey County really values recovery, and we believe that everybody is capable of achieving recovery and wellness,” Conducy said. “As the building was designed, that was the question we kept asking ourselves: ‘How do we facilitate people being well in our community?’ We wanted to create a place that could be a central part of the journey toward overall health.”