The New York City Health and Hospitals Corporation marked the opening of the new $153 million psychiatric center at Kings County Hospital, introduced new senior leadership and unveiled a series of significant reforms completed or underway across the behavioral health programs at the hospital. HHC President Alan D. Aviles outlined an eight-point plan to continue to transform mental health services, improve quality of care and radically change the patient experience for the 12,000 New Yorkers served by the psychiatric program every year. The essential elements of the blueprint for reform, as well as some of the steps already taken or underway, are outlined below.

Ensure the safety and security of both patients and staff

• Further relief of overcrowding and the expansion of therapeutic activity space with completion of the $153 million, 300,000 square foot Behavioral Health Center Pavilion, which will house the Comprehensive Psychiatric Emergency Program (CPEP), the 230 inpatient beds and the outpatient services that are now spread out over seven hospital buildings.
• Better coordination with EMS and other components of the mental health system, adequate staffing ratios, more expeditious triage, assessment and treatment that have led to a dramatic reduction in overcrowding in the psychiatric emergency room. The average number of patients in the psychiatric emergency room generally does not exceed 25 patients at any given time. Patient census before these changes went as high as 50 or more. The average length of time patients stay in the CPEP - which includes triage, evaluation, treatment and disposition to the next level of care -- is down to less than 8 hours compared to an average of 27 hours one year ago.
• Reduced reliance on hospital police to manage patients in crisis with deployment of new specially trained personnel who have crisis intervention and security skills.
• Expand training in crisis intervention techniques to all front-line staff to better manage care and treatment of agitated patients and patients at high risk for violent behavior.
• Build more psych emergency service capacity by creating a new Comprehensive Psychiatric Emergency Program (CPEP) at Woodhull Hospital.
• A further reduction of overcrowding and capacity expansion with priority access to 24 crisis beds at Kingsborough Psychiatric Center (KPC), jointly developed and staffed by Kings County and KPC.
• Adopt best-practice assessment tools to better identify and curtail risk of violent behavior.
• Adopt principles of, and provide staff training to support, a restraint-free environment.

Establish a reform-minded leadership team, build staff expertise and accountability

• New Kings County Hospital Executive Director appointed effective February 2.
• New Director of Behavioral Health appointed February 2.
• New Director of Nursing appointed July, 2008.
• Added more than 200 new doctors, nurses, psychologists, social workers and other staff; more planned.
• Actively searching for new CPEP Director and Director of Inpatient Services.
• Actively recruited skilled, culturally diverse individuals in nursing, psychiatry, psychology, social work, activity therapy.
• Expanded training to develop leadership skills among managers and front-line supervisors.
• Expanded training to develop culture that supports recovery and rehabilitation model of care focused on empowering patients to actively participate in sustainable recovery.

Radically change the psychiatric emergency room experience

• Ensure patients in Emergency Service are triaged promptly, seen by a psychiatrist within one hour and fully evaluated within 6 hours.
• Use Peer Counselors - full-time employees who have been mental health patients themselves and now serve as mentors - to help engage patients and support assessment team.
• Maintain the average patient length of stay in the Psychiatric Emergency Department to the lowest feasible time consistent with appropriate triage, evaluation, treatment and disposition -- currently at an average of less than 8 hours, down from 27 hours in December 2007.
• Use dedicated staff to check on patients in Psychiatric Emergency Service every 15 minutes to determine if patients require any immediate assistance.

Provide quality, patient-centered mental health care focused on recovery and rehabilitation

• Expand the Peer Counselor Program, full time staff who been mental health patients themselves and will now serve as patient navigators, mentors and patient advocates.
• Continue to prohibit the use of seclusion and chemical restraints.
• Expand Therapeutic Group Program.
• Create new specialized team to guide the care of the developmentally disabled mentally-ill.
• Strengthen the integration of substance use disorder treatment into the care of mentally ill patients with co-occurring substance abuse.
• Enhance services for mental health patients who are victims of physical and sexual abuse.

Strengthen chronic disease care and address underlying medical conditions

• Link psychiatric patients to a primary care doctor and better manage chronic conditions like asthma, diabetes, and heart disease, which often go untreated among this population.
• Assign senior physician to regularly assess proper medication regimen used to treat mental illness and avoid unnecessary exacerbation of underlying chronic medical conditions.
• Arrange for home care consultations focused on chronic disease management and/or connect patients to specialty medical services as needed.

Involve patients and their families more directly in the design of care

• Expand Peer Counseling Program into the inpatient units.
• Create Consumer and Family Behavioral Health Advisory Council to formally engage mental health advocates, patients, families, and members of the local Central Brooklyn community.
• Host family support groups.

Increase accountability and transparency

• Publicly report performance measures in behavioral health for Kings County and entire HHC system. Post such data on HHC's transparency webpages, www.nyc.gov/hhc .
• Adopt a patient and staff satisfaction survey
• Distribute quarterly progress reports to patients, families, community leaders, advocates and staff.

Assist and support patients as they make the transition back into the community

• Continue to work with state and city agencies to help prioritize access to specialized supportive housing, community crisis beds, and case management.
• Call on the state to better align Medicaid reimbursement formulas to support an improved model of psychiatric services.
• Coordinate with New York City Fire Department EMS to manage patient volume and ensure patients in need of psychiatric emergency care can be properly redirected to other healthcare facilities if needed.
• Ensure families have access to and are referred to available services that support their role as partners in recovery.

Kings County Hospital Center is a member of the New York City Health and Hospitals Corporation (HHC) and is an affiliate of the SUNY-Downstate Medical School. HHC, the largest municipal hospital and health care system in the country, is a $5.4 billion public benefit corporation that serves 1.3 million New Yorkers and nearly 450,000 who are uninsured. HHC provides medical, mental health and substance abuse services through its 11 acute care hospitals, four skilled nursing facilities, six large diagnostic and treatment centers and more than 80 community based clinics. HHC has its own managed care health plan, MetroPlus and a home care agency, Health and Home Care, that provides health services at home for New Yorkers. For more information visit www.nyc.gov/hhc.