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Unity Center for Behavioral Health offers calm alternative to noisy, high-volume emergency departments

Inside Unity Center
A walking stick insect is used as part of a mindfulness exercises in the classroom at Unity Center for Behavioral Health. (OHSU/Kristyna Wentz-Graff)

In a serene, naturally lit classroom equipped with digital technology, sets of novels, math books, games and craft supplies, lives a creature of comfort for the students here.

Ben White, a teacher through Multnomah Education Service District, takes the walking stick insect out of his terrarium and lets him crawl up his arm on impossibly spindly legs. White and his co-teacher’s students enjoy sitting on the floor and letting the walking stick traverse them as part of a mindfulness exercise.

Inside Unity Center
Ben White, a teacher through Multnomah Education Service District, in the classroom at Unity Center for Behavioral Heatlh. (OHSU/Kristyna Wentz-Graff)

Therapeutically tailored classroom instruction for adolescent inpatients is an example of the holistic range of patient-centered care offered at Unity Center for Behavioral Health. Legacy Health, OHSU, Kaiser Permanente and Adventist Health opened the 24-hour behavioral and mental health services center Jan. 31, 2017, to provide immediate psychiatric care and recovery services for adults and adolescents experiencing a mental health crisis.

George Keepers, M.D.
George Keepers, M.D.(OHSU)

“I can tell you that when I first went there after staff were working with patients, I was very moved,” said George Keepers, M.D., professor and chair of psychiatry, OHSU School of Medicine, who serves on the three-member Unity Board of Managers and oversees the Unity faculty and residents. “The staff and the atmosphere is calm, reassuring and humane. It’s extremely moving for anyone who has seen the evolution of patients held in restraints in ERs for days because there was nothing available to this entirely different way of treating people.”

Indeed, from police to health care providers, the experience of confronting the extreme lack of appropriate services for people with serious mental illness helped forge the relationships and the will to envision and build this revolutionary alternative as one step toward meeting the significant need.

Keepers and Chris Farentinos, M.D., M.P.H., vice president of Unity Center for Behavioral Health, credit the police, emergency medical services and community mental health agencies and advocates, as well as Legacy, OHSU, Kaiser and Adventist for, as Keepers said, “coming together in this way to produce a result that is fantastic and so needed for so long.”

Another key piece was money.

In a state that ranks among the very worst in funding for mental health services nationally, it took a philanthropist like Marcia Randall, after whom the Randall Children’s Hospital is named, and her anchor gift of $20 million to jumpstart the project. Another factor was a favorable Medicaid reimbursement rate from the state negotiated by the Unity planning team.

Greg Miller, M.D., M.B.A., chief medical officer for Unity and associate professor of psychiatry, OHSU School of Medicine, said that contrary to his observations back east, the Portland philanthropic community is interested in giving to mental health.

“That speaks to wanting to make this city a more humane place for people,” Miller said.

And then there was the available building, the former Holladay Park Medical Center, centrally located in the Lloyd District and formally occupied by the Portland branch of the Oregon State Hospital. The state hospital moved out in March 2014. The campus is still shared with Legacy Research Institute. 

Inside Unity Center
Dr. Sruthi Chunduri meets with a patient at the Unity Center for Behavioral Health. Unity is operated through a partnership between four regional health care providers, with OHSU providing all the medical staff at the center. (OHSU/Kristyna Wentz-Graff) 

Now when patients arrive at Unity, they enter a quiet, clean, secure and uncluttered environment with beautiful watercolor and landscape photography on the walls and comfortable furniture in soothing colors. Staff and providers – from the reception desk to the intake centers to the treatment floors – lead with kindness and a deep knowledge of their patients’ needs.

Unity can accommodate 50 patients in the adult psychiatric emergency service and has 80 adult and 22 adolescent inpatient beds. The center offers a full range of services, including crisis stabilization and intervention, medication management, crisis counseling, inpatient care, social work and family support.

Providers use a range of complementary practices from art and music therapy to yoga, as well as peer support, where patients are paired with others who live with mental illness. Unity also has a hearing room where a judge assists with such matters as civil commitments on site so that a patients and families don’t have to leave to go to a courthouse.

One of the two care environments in the psychiatric emergency service is called the Living Room and lined with recliners. Unity’s main conference room is called The Retreat. Patient areas boast built-in shelves lined with paperback books. Posters on office walls promote an employee morale program called Kudos where employees win prizes for getting and giving praise.

OHSU’s involvement in Unity has contributed to its uniqueness.

In addition to providing psychiatric care, the center is a teaching and research facility. OHSU recruited a high-caliber team of experienced adult and child psychiatrists locally and, in the case of such faculty as Miller, nationally, creating hybrid opportunities involving patient care, teaching and research that drew top talent.

All were credentialed through OHSU in what Keepers calls “a heroic effort” by the credentialing department working across health systems to get the job done.

Inside Unity Center
(Left to right) Third-year medical student Ishak Elkhal, first-year psychiatry resident Andrew Hughes, M.D. and Tom Veeder, M.D., Unity Inpatient Rotation Director meet to discuss a patient's case. (OHSU/Kristyna Wentz-Graff)

Off one hallway, Tom Veeder, M.D., assistant professor of psychiatry, OHSU School of Medicine, and Unity Inpatient Rotation Director meets with first-year psychiatry resident Andrew Hughes, M.D., and third-year medical student Ishak Elkhal in a softly lit, artistically decorated office.

Hughes, who is on a three-month rotation at Unity, said the opportunity to be part of something new and experimental was “one of the reasons OHSU went to the top of my list” for residency.

Elkhal said he values learning the full range of mental health care, from emergency psychiatric services to recovery care using a trauma-informed model, under one roof.

And patients appreciate that range of services too.

“A lot of patients are leaving here saying ‘thank you,’ and that’s not normally what patients say,” Veeder said.

Unity has also already become a crucial vantage point from which to grasp the magnitude of the still unmet need for mental health care.

With only 22 beds in the child and adolescent psychiatric service, for example, Unity is only able to take the kids with the most serious mental health problems, including depression, mania and, increasingly, the kinds of psychosis once seen only in adults. The waiting list for adolescent services is routinely 20 patients and higher.

Keith Cheng, M.D.
Keith Cheng, M.D. (OHSU/Kristyna Wentz-Graff) 

“It breaks my heart that I can’t admit someone who may have overdosed on Tylenol because I need to admit a child who thinks the FBI is spying on them,” said Keith Cheng, M.D., clinical associate professor of psychiatry (child and adolescent psychiatry), OHSU School of Medicine, and interim child and adolescent medical director at Unity. “There are a lot of great cases where kids have done really well as a result of being here, but it is the tip of the iceberg.”

Everyone involved with Unity hopes that its most powerful impact will be as an example of what’s possible, catalyzing development of far more services.

Said Dr. Farentinos, “I believe Unity will become a model for the country regarding collaboration toward mission-driven services that may be a burden on one system alone but can flourish and serve the community well when many stakeholders come together.”

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