The living room alternative to ER visits for mentally ill patients in crisis

The Living Room concept has been used in Illinois for several years now, the first one established at Turning Point Behavioral Health in Skokie. Just as it sounds, the space is set up like a living room. There is a television set, comfortable chairs, a couch, and a separate, darker room with a couch, where a person can just go lie down and relax, with no outside stimuli.

Those who visit the Living Room are offered a snack. After being evaluated by a psychiatric nurse to make sure the guest is not experiencing a medical emergency, such as an adverse reaction to medication, the guest then meets with a trained peer counselor. The peer counselor is someone who has a mental illness, but is doing well in his or her recovery. There are also therapists available, if necessary, because the Living Room is open at a time that Turning Point is also open.

Patients in a mental health crisis, who present to an Emergency Department (ED) at a hospital, are often kept there for hours, if not days. It is a sterile, unfriendly, and often frightening environment. The patient is not truly free to leave, and could even be restrained. Plus, this visit costs thousands of dollars, while not accomplishing much most of the time.

The Living Room model has many advantages over a hospital ED. It is easier to convince someone to go to the Living Room, because it is a much less threatening and much more pleasant environment. The guest is always free to go. The cost savings is not only to the guest, but also to the hospital, where this guest would likely end up otherwise, and ultimately to the taxpayers, as often the guest is a Medicaid recipient.

The Living Room in Skokie is funded by the State of Illinois, Division of Mental Health, but they have started billing Medicaid for some services. While there are many advantages, on the down side, their hours are limited. They are not open every day, and when they are, the hours are only from 3:00 - 8:00 p.m. Additionally, they are not really close to any hospital, in the event of a true medical emergency, or for referrals.

Lutheran Social Services of Illinois has opened a “Welcoming Center” in Chicago, across from Swedish Covenant Hospital. It is open Monday through Friday, 8:00 a.m. – 8:00 p.m. It has the benefit of case management services, which offer the guest up to 90 days of assistance in accessing housing, food, outpatient mental health treatment, public benefits applications, employment services, etc. They also do follow-ups with the guests, whereas the Living Room at Turning Point in Skokie does not. Because they do not do any follow-ups with their guests, it is hard to know if the number of patients they claim to have diverted from the EDs and the millions of dollars they claim to have saved everyone are really accurate. They may have prevented someone from going to the ED or a psychiatric inpatient hospitalization that day, but there is insufficient data to determine whether the guest ended up needing those services in the days that followed.

Another group in the near western suburbs of Chicago has been meeting to discuss opening a Living Room in the area of Oak Park, River Forest, Forest Park, or Berwyn. The principals in this discussion include MacNeal Hospital, Riveredge Hospital, NAMI Metro Suburban, Oak Park/River Forest Township, Pillars, and Thrive. Location and funding seem to be the biggest hurdles.

As lawyers, we should be interested in the Living Room concept because it potentially represents the most humane and least restrictive means of defusing a mental health crisis. 

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Susan O’Neal is a part-time Assistant Public Defender in Juvenile Court in a Peoria County and has a private practice devoted to representing persons with disabilities.  She is also certified to teach and does teach the NAMI Family-to-Family Class.