Ready in a Crisis
Emergency rooms conjure images of people who are severely physically ill or injured with doctors and nurses scurrying to see to those with the greatest need. And that need can take many forms, including substance use and mental health emergencies that may overlap a physical issue. At times like that it’s important to have a mental health crisis worker, like Kate Hobbs available at a moment’s notice.
Hobbs is one of 60 crisis workers embedded within emergency rooms at all MaineHealth hospitals, including Southern Maine Health Care (SMHC), where she has worked for 19 years. The SMHC Emergency Department Acute Psychiatry unit (EDAP) alone consists of 30 crisis workers with four workers on each shift. This allows the EDAP to be ready 24/7 when a patient is brought to the emergency room and presents with a significant mental health issue that could pose a safety risk. The emergency doctor or attending physician will make the decision to bring in a crisis worker, like Hobbs, for an assessment.
“The most important part of my job is to meet the patient at that moment, where they are in their crisis, and truly listen to them,” said Hobbs. “I have to look closely at each patient and truly hear them, because often what we can see will differ from what they’re saying.”
The crisis assessment is a series of questions to get to know the patient and understand their current state. The assessment may also include reaching out to anyone who knows the person well. That may include a boss, coworker, neighbor, pastor, friend or family member, as well as any health professional such as any case managers, psychiatrists or treating physicians. Crisis workers collaborate with everyone to determine if the behavior is a deviation from their usual behavior. Being able to quickly connect with a patient’s network means being able to build strong, trusting relationships with everyone.
“It’s no different than calling in a specialist,” Hobbs explained. “If the patient is presenting with heart issues, they call in a cardiac specialist. If the patient is presenting with any mental health issues, they call in crisis.”
Once Hobbs has gathered her information, she consults with her clinical supervisor to ensure recommended treatment plans are solid and nothing has been missed. Once everyone agrees on the plan, Hobbs connects with the emergency room doctor, sharing the suggested treatment plan and it is ultimately up to the doctor to make the decision.
“We have to connect as many dots as we can to get the patient to the appropriate level of care, with the ultimate goal of getting them back into the community with good support in place. There are so many factors when putting together a recommendation plan for a patient in crisis. For new patients, you have to work hard to establish a rapport where they feel more comfortable sharing with you. With patients we are familiar with, the focus shifts to what’s going on currently because we have some foundational knowledge already.”
In an emergency room of 30 beds, including four designated for EDAP, shifts can get very hectic. Some days, 20 or more beds will hold crisis patients.
“Kate is so balanced and calm,” said Clinical Supervisor Danielle Loring. “No matter how chaotic the ED gets, Kate is focused and not running around, which helps everyone around her.”
“This job feels made for me,” Hobbs said. “I have a ‘helper’ mentality and this job is perfect for that. No matter how hard the day is, there is peace at the end of each shift because you know you did your best to make a positive difference in someone’s life.”