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Bill Klaproth (Host): So, what is the Comprehensive Psychiatric Emergency Program or CPEP Program at ECMC and what do you need to know about it? Here to give us a nursing director’s perspective on CPEP is Donna Gatti, a Registered Nurse and Director of the Comprehensive Psychiatric Emergency Program at ECMC. Donna thanks for your time. Tell me what role you play and your CPEP plays in the community.

Donna Gatti, RN (Guest): Well my role as Director, Nursing Director of CPEP is to make sure that all patients are well-served in the community. Our patients come in. We are an extension of the Medical Emergency Department. And we serve patients that are in psychiatric crisis 24 hours a day, seven days a week.

Host: And how do people come to CPEP?

Donna: Patients often come in voluntarily by themselves or they are accompanied by family or friends. In certain cases, patients might be brought to CPEP by officials appointed to take them into custody because of risk to them – of harm to themselves or others. We work with Crisis Services of Erie County. They do mobile outreach. They often get the calls and go out to people’s homes and evaluate them and they are brought to CPEP. There’re times that the police have to be involved and they do bring patients in when there’s concern for safety, whether it’s safety to themselves or safety of others.

Host: So, what is the CPEP process regarding clinical assessments?

Donna: So, every patient is evaluated by a registered nurse, a clinical social worker, and a psychiatrist. We look at the clinical symptoms. We look at why they were brought in and what we can do that day for them to manage their crisis. We assess every patient for safety. We always contact patient’s loved ones to include them and also ask them why they feel that their loved one was brought here and to address any safety concerns. After the completion of the assessment; the psychiatrist will determine if they are safe enough to go home or they will need an inpatient stay.

Host: So, if the assessment says they need an inpatient stay; do you admit them right away?

Donna: Yes. So, they will be admitted. We have 160 beds here at ECMC and we also have an extended observation unit which is right in CPEP. It’s a six-bed unit and it’s for patients that require three days or less of acute stabilization of their psychiatric symptoms. It’s a nice alternative to an inpatient stay which is often longer.

Host: Yeah, that makes sense. So, you have an extended observation unit. So, exactly what purpose does that serve again? Can you explain that to us?

Donna: Sure. So, it’s a smaller unit. Patients are seen by the physician daily. We have nursing groups and social work groups. We have occupational therapy. It’s a very structured program and we can make some quick medication changes, help patients to gain some coping skills and work with their families and get them linked into the community so they are discharged within three days of coming into CPEP.

Host: So, speaking of discharge; are there certain things that have to be met before a CPEP patient is discharged?

Donna: Absolutely. All of our patients, first of all, if there are any safety concerns, we have to address those, and we look at safety – we have an interdisciplinary team here that looks at all the aspects. So, if a patient is able to be discharged; we always make sure the patients have a mental health linkage and they also have safe housing. Housing is often a significant issue with a lot of our patients. So, social workers work very, very hard to make sure that when they leave there’s a roof over their head.

Host: So, you’ve been mentioning safety throughout this and you just talk about someone making sure they have a roof over their head; so, when it comes to safety, this is for people who may not be safe to themselves as well as not having a safe place to stay?

Donna: Yes. Patients often come in – either they want to hurt themselves or others or their clinical symptoms are so distressing that they can be – there could be safety concerns for themselves or others. So, all that has to be taken into account before someone is discharged.

Host: So, people that are not safe to themselves; we are talking about people who are potentially suicidal?

Donna: Yes.

Host: And you said you contact the family members as well to let them know that they have been admitted into the CPEP program?

Donna: Not only that, but we include them in their care. It’s very important that we get some information about what’s been happening at home. Because sometimes it’s not always the same clinical picture that a patient will give us. So, we need to find out what’s been going on at home, what their concerns are, because they are with their loved ones all the time. They know their patients so much better than we do. We see them for a little snippet of time. And often this is the worst day of someone’s life when they come in. So, we really need to make sure that we are looking at the patient as a whole and making sure we are making good decisions.

Host: Right. And how do you follow up with these people once they are discharged?

Donna: So, all patients are referred for a mental health linkage. Certainly, you have to be willing to do that. The majority of people will accept treatment. They get followed up with a counselor. Once they leave; we don’t really have a lot to do with their care. But if in the future there’s a crisis, we certainly are available, and we do contact patients’ outside mental health counselors and physicians.

Host: I could see where CPEP really does play an important role in the community. Is that right?

Donna: It does. It does. Our community really has – really struggles on so many levels. Not only do we see people that come in in mental health crises, but we see a lot of alcohol and substance abuse. So, our patients are very complex that we have to take care of because sometimes if someone presents intoxicated; you are not getting a clear clinical presentation of why they are here. Once their clinically sober; we have to reevaluate them and see what the needs are. So, our patients are so much more complex than ever.

Host: I could understand that. I could see where your expertise definitely helps them. So, overall, how does CPEP fit in with the Center of Excellence at ECMC?

Donna: So, we have a – we play a few different roles. First of all, we are often the first point of entry for mental health treatment. A lot of patients aren’t linked out in the community, so they come here when they are in crisis. And then our role is really – we are here if once they are out and they’re working on their recovery and their symptoms get high again, we will have them come back into the hospital and reevaluate them and take a look to see what they need and often their needs change. So, we really are here as their safety net.

Host: And that safety net is important, and you certainly do play a vital role in the community. Donna thank you so much for your time today. For more information on the CPEP program, visit the ECMC website at www.ecmc.edu, that’s www.ecmc.edu. This is the True Care Healthcast from Erie County Medical Center. I’m Bill Klaproth. Thanks for listening.