Transitions program reduces psychiatric hospital admissions, fills gaps in care

In Minnesota, as elsewhere, mental health services are strained. Escalating demand and dwindling resources have led to a shortage of psychiatric beds and overburdened emergency departments (EDs), leaving acute care patients waiting days or weeks for treatment. Patients discharged from acute hospitalization often endure equally long waits to see a new therapist or enter a program.

Mayo Clinic Psychiatric Hospital in Rochester, Minn., under Timothy W. Lineberry, M.D., medical director, is finding innovative ways to address these problems. One is the new Transitions Program, an intensive outpatient program for adults leaving acute hospitalization or needing additional care after an emergency department visit.

Bruce Sutor, M.D., program founder and chair of the clinical practice committee in the Department of Psychiatry and Psychology at Mayo Clinic in Minnesota, explains, "Transitions is a structured, multidisciplinary program designed to meet the different needs of different patients. The main populations we want to serve are people who have chemical dependency issues along with psychiatric issues and those with parasuicidality or significant life stressors. These patients have the greatest need for services when they leave the hospital."

Dr. Sutor says the idea for Transitions was prompted by the suicides of two young men awaiting treatment for chemical dependency. "There was a long gap from the time they left the hospital until they successfully completed suicide, and that really struck a chord," he explains. "I realized that people's lives were on the line and we needed to do something."

Transitions has two main goals:

  • To get patients out of the hospital sooner — typically two to three days earlier than normal — and provide them with immediate outpatient treatment
  • To prevent unnecessary hospitalizations by diverting ED patients who don't require inpatient care into the program

In both cases, hospital beds become available for people experiencing significant mental health crises, and all patients receive seamless and appropriate care.

Dr. Sutor tells the story of a young woman contemplating suicide who called for help late one evening. "Normally she would have been admitted to the hospital," he says. "But because she asked for help, had structure and support at home, and could do an intake with Transitions in the morning, we let her spend the night with her family. That would not have been possible if she had to wait weeks to get an appointment with a therapist. But I felt comfortable knowing she would be seeing experienced clinicians the next morning."

Transitions operates five days a week, with two sessions running simultaneously in the early and late afternoon. Patients can participate in various groups, including skills building, stress management and dialectical behavioral therapy for those in significant distress. A psychiatric nurse practitioner, licensed alcohol and drug counselor, registered nurse, and other staff provide treatment under the medical direction of Brian A. Palmer, M.D.