Guest Editorial: Integrating inpatient psychiatric care


by Rachelle Schultz, president, Winona Health

Every three years all hospitals in the U.S. are required to complete a community health needs assessment. Winona Health has done this in partnership with Winona County Human Services (which shares this requirement) for our past three surveys. The top community needs have been relatively stable over this time, noting the concerns of unhealthy behaviors and other factors that contribute to overweight/obesity, health equity given the inequitable distribution of social determinants of health and improving mental health. Depending on the lens one uses to understand or evaluate these priorities, they are often interconnected and dependent. 

Winona Health, along with key community partners, has been focusing on understanding and addressing the root causes of these issues and how they impact the health status of members of our community. Not addressing root causes simply ensures the problems persist. The mission of Winona Health is to improve the health and well-being of our family, friends and neighbors and to achieve this mission, or move the dial on these community priorities, we must link together how we all care for our community members. Success does not happen in isolation. 

The topic of mental health is a top-of-mind concern across the U.S. as evidenced by the increasing number of people living with a mental illness. Twenty percent of Minnesotans live with a mental health illness. This means of every 10 people, two are dealing with a mental illness. We share similar statistics in our community. Along with other hospitals in Minnesota, Winona Health continues to fight the stigma associated with mental health and provide the most appropriate care to people with mental illnesses, substance use disorders and other related conditions. To do so, we have many relationships with mental health providers for the respective needs of patients. 

No different than advancements in medical and surgical care, for which we should all be grateful, mental health treatment has evolved. Today, the majority of mental health care is delivered in community settings just like Winona. Winona Health provides both outpatient and inpatient care to community members living with a mental health illness, just as we have for years. Recently we integrated a separate inpatient psychiatric unit into our other inpatient units to bring the focus to the whole person. The decision to integrate this unit is understandably concerning to patients who have received services in our inpatient psychiatric unit as well as their family members. This decision was not made lightly or without a lot of planning around how care and service would continue to be provided to our patients. Since this change, we have continued to admit patients in need of mental/behavioral health care to the hospital.

At Winona Health we had an average daily census of 3.4 patients in our inpatient psychiatric unit with an average length of stay of 4.8 days. Many of the patients were in the hospital for less than 24 hours. These individuals needed a safe place to stay and a psychiatric assessment with a plan of care for follow up post discharge. All of which continues to take place today. Over the past few years we have experienced approximately 50 individuals from our service area needing inpatient care from time to time – and we continue to provide this care to them, along with many other patients receiving outpatient mental/behavioral health care. The strength and beauty of a community health system is that our providers and staff know each other, they are highly collaborative, they seek each other out and most important, they are committed to doing what is best for every single patient. Without exception.

To be clear, there are some patients we are unable to care for locally, including those who are violent and aggressive, those needing long-term treatment (we are an acute care facility), or those who need detox services. That has been the case for years. However, we have long-term relationships with organizations in the region and the state who have the expertise and facilities to care for patients with these needs. And our Emergency Room providers and nurses do an outstanding job caring for them and making arrangements for their safe transfer to receive the appropriate care.

The national, state, regional and local healthcare landscape is changing. And it is changing faster than it ever has. The transition period that follows a change is often the most difficult part of change as people grieve what was, wonder about what is to come, and try to find stability again. As Winona Health continues to innovate and transform to meet these challenges, we are grounded in our mission and we respect the change process for all stakeholders. We must balance our drive to meet patient and community needs, provide high-quality care, ensure safety, and maintain financial sustainability. 

Winona Health is celebrating 125 years of serving the Winona regional community – a remarkable achievement by any standard. This milestone is a testament of the willingness to stay focused on the community, the fortitude to innovate and change the status quo, and a daily commitment to high-quality care provided by compassionate and caring providers, clinicians and support staff. It is our honor to serve you.


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