Veterans needing acute psychiatric services can get that care again at the Mann-Grandstaff VA Medical Center, which reopened its 12-bed inpatient unit Tuesday after a more than two-year remodel.
Paid for by Veteran Health Administration, the $3.5 million project includes upgrades such as reinforced security windows and room designs following national standards to prevent self-harm, harm to others and suicide attempts.
“When they come here, they’re at their highest acute crisis, and the goal is to remove them from an environment that might be causing triggers, so it’s to put them in a safe environment,” said Laramie Zent, the unit’s nurse manager.
An average patient stay in the unit is seven to 10 days. A few veterans might stay up to 14 days. When patients first arrive to the unit, many are suicidal, Zent said.
“Our goal is to get them engaged through treatment here. Our goal is to have them continue with outpatient services.”
Veterans have a 57% higher rate of suicide than adults who aren’t veterans, according to the VA.
While the unit was closed for remodeling, Frontier Behavioral Health and Inland Northwest Behavioral Health provided much of the inpatient psychiatric services the past two years for area veterans, said Patrick Metoyer, acting chief of VA behavioral health service.
“They did a tremendous amount of work for our veterans,” Metoyer said.
The VA unit’s reopening coincided with a Department of Veterans Affairs announcement that as of Tuesday, U.S. military veterans in an “acute suicidal crisis” can receive free treatment, including inpatient care up to 30 days and outpatient care for up to 90 days.
The expanded care was announced Friday to “prevent veteran suicide by guaranteeing no cost, world-class care to veterans in times of crisis.” Veterans who are seeking that care can go to any VA or non-VA health care facility, a news release said, and they do not have to be enrolled in the VA system to receive care.
The VA reported 6,146 deaths from suicide among veterans in 2020, the most recent year with data. That figure was 343 fewer than in 2019, a recent National Veteran Suicide Prevention annual report cited. The agency’s estimate for Washington state in 2020 lists some 181 deaths; Idaho, 57.
The report also said from 2018 to 2020, the adjusted rate for suicides among veterans fell by 9.7%. Some suicide prevention advocates have argued that might not include unexplained or accidental deaths, or record-keeping mistakes.
The local VA hospital unit’s remodel took longer than expected with pandemic-related delays and supply issues.
“It’s been a little over two years; we shut down to do safety upgrades,” Zent said. “Unfortunately, as soon as it was in motion, the pandemic was in motion, and supply line issues became a challenge.
“The whole project was all safety-oriented.”
The number of inpatient beds didn’t change with the remodel. The upgrades included additional cameras, heavier and safer furniture, and construction to remove hanging risks, such as pipes. Patient rooms include new technology for sensors on doors, as well as better designs for cabinets.
“The old cabinets had laminates that could peel off if you use a sharp object, and they could cut themselves or use it to harm staff or other patients,” Zent said. “This now is a hard surface that you can’t peel off. There are shatterproof mirrors, break-away hooks in the bathrooms, cameras.”
The overhead door alarms are crucial if someone is trying to create a ligature over the door, he said. The previous sensors were pressure-sensitive, but the upgraded technology uses a light bar sensor that works better.
“There’s a sensor that sends off an alarm in the nurses’ station, if a person were to take a piece of clothing or bedding over the door.”
The unit has double and single rooms. In the back, a large activity room with tables offers a space for eating, playing cards and attending group meetings and classes. Near the activity room, patients can spend time on an enclosed balcony.
The unit has about 30 staff members, and patients are checked on every 15 minutes around the clock, he said.
“Typically, we see a lot of mood disorders, depression, PTSD, anxiety,” Zent said. “We see suicidal ideations. Quite a few of our patients who come in have suicidal ideations, and that’s the reason they’re here.”
Metoyer said all of the unit’s patients voluntarily enter treatment. However, he said they often do so because of potential harm to self or others, while suffering from depression, PTSD, chronic pain or other mental health issues. He added that mental health providers are handling a significant number of calls after the launch of the 988 Suicide & Crisis Lifeline phone number.
The veteran population tends to have higher rates of trauma, in some cases from combat, Metoyer said.
The remodel followed a ceiling-to-floor, end-to-end review. “Many of the upgrades came out of national VA and national mental health suicide prevention on any kind of risks.”
Spokane’s VA hospital serves veterans from a region that stretches from Libby, Mont., across Idaho and to Wenatchee, along with a corridor from the Canadian border down to the Moscow-Pullman area.
The unit includes a room used by a doctor to do exams and treat patients, who may have neglected health issues or chronic pain, Zent said. Other spaces are used by a psychologist, social worker and for classes.
The unit is designed so patients can freely move around, he said. They can leave a room, walk around the hallway and go to programs, such as classes on sleep hygiene and coping skills for anxiety.
“Our patients who are veterans often prefer care here,” Zent said. “It’s targeted toward the veteran demographic, which is a unique demographic. They have unique experiences, and a lot of our staff are veterans.
“In mental health, you can’t simply grab a blood pressure cuff. In the world of psychiatric care, you have to have them offer what they’re feeling and thinking, and the only way you can do that is build a therapeutic professional relationship with them and build trust.”
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