Balancing Safety and Compassion (Oregon Business Magazine)
In 2017, four organizations merged together to address Portland’s dire mental health crisis. It was called Unity Center for Behavioral Health.
Within its first year, this model posed major challenges. Health of patients and nurses was compromised, the OHA launched an investigation…all of this made big headlines.
As Unity was in “recovery mode”, they booked a story in Oregon Business Magazine to show how they were cleaning up and rectifying their mistakes.
The article had two goals: communicate transparency and ownership of mistakes; and, show the positive side, a patient “success story”.
Full article printed below, with digital version linked here.
A family member of Brenna Legaard was diagnosed with Obsessive Compulsive Disorder ten years ago. In that span, his symptoms had flared with different intensities. He lived out of state and visited Brenna periodically. During his last stay, he was undergoing an episode so severe he called Brenna with the thought of taking his life.
The family member needed immediate psychiatric care. Brenna’s husband knew a clinician at Unity Center for Behavioral Health—Portland’s first comprehensive 24/7 behavioral health center—and recommended taking the family member in for treatment.
Having visited three behavioral health centers before, the family member was almost completely resistant to going.
Behavioral centers have a reputation: often, staff immediately assume the patient as dangerous, and treat him or her as a “threat to be neutralized”. They take away shoelaces, belt, etc., and immediately put the patient into isolation. “When they do that, it reinforces all the stigmas in your head,” said Brenna. “It’s horribly degrading—it strips you of your humanity, your agency, your dignity. Truth is, my [family member] is a sensitive, intelligent, caring person who wouldn’t hurt a fly.”
Unity, however, was different. A nurse immediately walked up, placed her hand on the family member’s arm, and gently walked him back for treatment. The receptionist was kind and empathetic towards Brenna and her husband. A social worker gave regular updates, eventually sharing that the family member was reading a novel in a comfortable recliner with access to fresh, hot food (an uncommon amenity in acute treatment centers).
Ten hours later, the family member came out as calm as Brenna had ever seen him. He was carrying a prescription for a medication which he had never tried before, and which, according to Brenna, has since changed his life. Before he left, a nurse addressed each of his concerns.
“When he left, he believed he could manage his illness and realize his goals,” said Brenna. The family member is applying to trade schools, cooking regularly, and maintaining a social life. “He’ll continue with therapy, but there’s finally a hope that he’s living the life he wants to live, something he hasn’t been able to do in decades.”
In its first year, Unity Center has seen many success stories like Brenna’s family member, where patients flourish under Unity’s patient-centric model of care, but there have been challenges as well. This past May, Unity Center for Behavioral Health went under investigation by the Oregon Health Authority for issues regarding patient and staff safety.
Unity opened in January 2017, the collaboration between Legacy Health, Kaiser Permanente, Adventist Health, and OHSU. The four healthcare organizations agreed that, individually, their models of mental health treatment were inadequate in addressing Portland’s growing mental health crisis. Instead, they could best serve the community by pooling resources and supporting Portland’s mental health needs together.
Unity’s 107-bed inpatient facility provides acute psychiatric treatment for emergency cases, the first of its kind in Portland. A major intention was not only to reduce time before patients see a psychiatrist—which before could typically take 40-60 hours—but to treat every single patient as a human being, not as a potential threat.
While treating patients with such a diverse needs and conditions that range from mild to severe, Unity needs to strike the right balance between providing compassionate care and safety. Challenges in doing so have caused safety and health issues for both patients and staff that are at the root of the OHA’s ensuing investigation. Unity’s leadership has since taken full responsibility.
“We created Unity Center to dramatically raise the bar on the quality of care provided to those in our community suffering from mental illness,” said Trent Green, president of Legacy Emanuel Medical Center and Unity Center. “Despite the collective depth of experience of our hospital partners in treating patients with mental health issues, there have been unforeseen challenges in adapting our policies and procedures to an environment that serves the volume of severely ill psychiatric patients that we have at Unity Center. Nonetheless, we are unwavering in our commitment to the success of Unity Center and focused intensely on fixing the problems at hand.”
Unity employs trauma-informed healthcare, a form of mental health treatment which involves understanding, recognizing, and responding to the effects of all types of trauma. It’s designed to not further traumatize the individual—such as what Brenna’s family member had previously experienced—which could re-aggravate the patient’s condition and cause further damage.
“We’re trying to de-institutionalize behavioral healthcare,” said Green. “Our model is focused on meeting each patient where they are and not generalizing as if every patient is a violent individual. But there are times when you must implement aggressive safety measures. And it’s certainly an evolutionary process for how this gets applied.”
While evolution is often gradual and iterative—especially in new and revolutionary models—the process has been spurred by the OHA’s investigation. To address the investigation, Unity’s plan of action includes five key areas: improving physical environment of care; addressing patient monitoring; applying rigorous and consistent patient documentation; implementing new mobile technology and medication confirmation checks; and incorporating widespread changes to culture of safety, such as maintaining strict adherence to policies and promoting constant encouragement for staff to report all safety concerns.
Though the investigation is still underway, Green feels confident in Unity’s ability to remedy past issues. “We’ve made significant improvements to the environment and overall culture,” said Green. “Already, its far superior to what existed 18 months ago.”
This has been a busy and challenging time for Unity, yet Green acknowledged his staff are what’s kept him inspired. “Our staff are extremely dedicated professionals who feel very deeply about the mission we’re working towards,” he said. “I have hosted a series of town halls for staff over the past several weeks, and the passion is palpable. I know that if we can serve our staff and attend to their needs, then they will do amazing things.”
Moving forward, Unity will still greet patients with compassion, empathy, and care. Yet now, with new lessons learned, they will have the right measures in place to provide that care while ensuring a safe, physical environment. But regardless of what changes, the goal remains the same: treat patients as human beings. “For anyone who hasn’t stood in the patient’s shoes before, you don’t know how important that compassion and dignity is,” said Brenna. “When you’re at your most vulnerable, you can feel like you’re nothing but your illness. For someone to reach in and speak to your humanity, it’s life saving.”