WEBVTT 00:00:00.445 --> 00:00:02.878 Mills: The mental health environment of care checklist 00:00:02.878 --> 00:00:06.653 is a checklist that we developed starting in 2006. 00:00:06.653 --> 00:00:13.461 We got a large group of clinicians, safety folks, engineers together to develop 00:00:13.461 --> 00:00:18.581 a checklist that people could use on an acute psych unit to check the unit, 00:00:18.581 --> 00:00:21.285 to make sure there are no environmental hazards that 00:00:21.285 --> 00:00:27.270 a patient might be able to use for self-harm or to self, to harm others. 00:00:27.270 --> 00:00:29.429 So that's how the checklist got started. 00:00:29.429 --> 00:00:35.022 We developed it, it's a very detailed checklist, about 134 questions, 00:00:35.022 --> 00:00:39.733 each one asking about specific environmental situations. 00:00:39.733 --> 00:00:45.573 So for example, are there hooks or anchor points on the walls 00:00:45.573 --> 00:00:50.102 or in the ceiling that a patient might be able to attach to and hang themselves? 00:00:50.102 --> 00:00:53.909 Are there sharp edges where a patient might be able to cut themselves 00:00:53.909 --> 00:00:56.469 if they were interested in hurting themselves? 00:00:56.469 --> 00:01:02.670 So each, so clinicians on the mental health unit and other folks at the facility 00:01:02.670 --> 00:01:07.693 form a team and go through the entire psych unit every six months 00:01:07.693 --> 00:01:12.861 and use the checklist to evaluate the unit for environmental hazards. 00:01:12.861 --> 00:01:15.477 The checklist has made care safer for veterans. 00:01:15.477 --> 00:01:20.125 Starting out, the checklist was first deployed in 2007 in VA 00:01:20.125 --> 00:01:23.462 and units would use the checklist quarterly 00:01:23.462 --> 00:01:26.069 at that time to go through their unit each quarter, 00:01:26.069 --> 00:01:29.990 using the checklist to identify hazards and more importantly, abate the hazards, 00:01:29.990 --> 00:01:34.228 really develop an action plan to get those hazards off, out of the environment. 00:01:34.228 --> 00:01:40.093 Since that time, we've gone down to doing the checklist every six months, 00:01:40.093 --> 00:01:46.605 but we've tracked the suicides in acute mental health units in VA over time 00:01:46.605 --> 00:01:52.701 and before the checklist started, the rate of completed suicide on in-patient acute 00:01:52.701 --> 00:01:57.629 psych units was about five per 100,000 admissions, which is pretty low. 00:01:57.629 --> 00:02:02.398 But now it's down to less than one per 100,000 admissions. 00:02:02.398 --> 00:02:06.853 It's come down about 82 percent, which is really a, it's a significant decrease 00:02:06.853 --> 00:02:12.029 and more importantly, every year that's five veterans that haven't 00:02:12.029 --> 00:02:14.390 killed themselves on our psych units. 00:02:14.390 --> 00:02:16.101 And that's really helpful. 00:02:16.101 --> 00:02:21.045 I get calls from private facilities asking if it's OK to use the checklist 00:02:21.045 --> 00:02:24.661 or sometimes the Joint Commission will recommend to a facility 00:02:24.661 --> 00:02:27.701 that they use our checklist on their acute mental health units. 00:02:27.701 --> 00:02:30.621 Also the Province of Alberta in Canada, 00:02:30.621 --> 00:02:33.253 we've been working together for the last couple of years 00:02:33.253 --> 00:02:36.838 to deploy the checklist throughout the entire Province of Alberta. 00:02:36.838 --> 00:02:41.309 They have about 45 acute psych units up in Alberta 00:02:41.309 --> 00:02:45.205 and they're deploying the checklist throughout the entire province. 00:02:45.205 --> 00:02:50.285 Well, the checklist is an active, iterative process. 00:02:50.285 --> 00:02:51.597 It's not stagnant. 00:02:51.597 --> 00:02:57.029 So we learn about new, new problems that happen on acute units every week. 00:02:57.029 --> 00:03:01.061 People are sending me information, so the checklist is always improving, 00:03:01.061 --> 00:03:01.893 it's getting better, 00:03:01.893 --> 00:03:05.494 it's finding problems that we didn't know existed a few years ago. 00:03:05.494 --> 00:03:07.470 So that's always changing. 00:03:07.470 --> 00:03:12.862 And for me, I think the next step would be to help more facilities throughout 00:03:12.862 --> 00:03:16.013 the United States or in other countries use the checklist, 00:03:16.013 --> 00:03:20.749 understand that it can be helpful and to help them deploy it in other areas, 00:03:20.749 --> 00:03:22.893 just like Canada's doing. 00:03:22.893 --> 00:03:26.653 Other things about the checklist, I think that are interesting is just, you know, 00:03:26.653 --> 00:03:27.981 you can develop a checklist, 00:03:27.981 --> 00:03:32.213 but it takes hundreds and hundreds of staff members throughout VA 00:03:32.213 --> 00:03:36.990 to actually use it, deploy it, take it seriously and really change things. 00:03:36.990 --> 00:03:38.461 And it's cost a lot of money. 00:03:38.461 --> 00:03:39.797 You know, you change ... 00:03:39.797 --> 00:03:44.085 mental health units, ten years ago, do not look like they look now. 00:03:44.085 --> 00:03:47.845 A lot of units in VA have been refurbished, have changed. 00:03:47.845 --> 00:03:50.838 They're safer now and also since they're being refurbished, 00:03:50.838 --> 00:03:53.637 they're also more warm and healing. 00:03:53.637 --> 00:03:56.381 So I think there's a lot that's been going on with mental health 00:03:56.381 --> 00:03:58.574 and it's not due to just us; 00:03:58.574 --> 00:04:03.062 it's all the staff out in the field, mental health staff, engineering staff, 00:04:03.062 --> 00:04:06.350 changing the environment for the mental health units. 00:04:06.350 --> 00:04:09.613 I think that's something that's important to acknowledge.