Mills: The mental health environment of care checklist
is a checklist that we developed starting in 2006.
We got a large group of clinicians, safety folks, engineers together to develop
a checklist that people could use on an acute psych unit to check the unit,
to make sure there are no environmental hazards that
a patient might be able to use for self-harm or to self, to harm others.
So that's how the checklist got started.
We developed it, it's a very detailed checklist, about 134 questions,
each one asking about specific environmental situations.
So for example, are there hooks or anchor points on the walls
or in the ceiling that a patient might be able to attach to and hang themselves?
Are there sharp edges where a patient might be able to cut themselves
if they were interested in hurting themselves?
So each, so clinicians on the mental health unit and other folks at the facility
form a team and go through the entire psych unit every six months
and use the checklist to evaluate the unit for environmental hazards.
The checklist has made care safer for veterans.
Starting out, the checklist was first deployed in 2007 in VA
and units would use the checklist quarterly
at that time to go through their unit each quarter,
using the checklist to identify hazards and more importantly, abate the hazards,
really develop an action plan to get those hazards off, out of the environment.
Since that time, we've gone down to doing the checklist every six months,
but we've tracked the suicides in acute mental health units in VA over time
and before the checklist started, the rate of completed suicide on in-patient acute
psych units was about five per 100,000 admissions, which is pretty low.
But now it's down to less than one per 100,000 admissions.
It's come down about 82 percent, which is really a, it's a significant decrease
and more importantly, every year that's five veterans that haven't
killed themselves on our psych units.
And that's really helpful.
I get calls from private facilities asking if it's OK to use the checklist
or sometimes the Joint Commission will recommend to a facility
that they use our checklist on their acute mental health units.
Also the Province of Alberta in Canada,
we've been working together for the last couple of years
to deploy the checklist throughout the entire Province of Alberta.
They have about 45 acute psych units up in Alberta
and they're deploying the checklist throughout the entire province.
Well, the checklist is an active, iterative process.
It's not stagnant.
So we learn about new, new problems that happen on acute units every week.
People are sending me information, so the checklist is always improving,
it's getting better,
it's finding problems that we didn't know existed a few years ago.
So that's always changing.
And for me, I think the next step would be to help more facilities throughout
the United States or in other countries use the checklist,
understand that it can be helpful and to help them deploy it in other areas,
just like Canada's doing.
Other things about the checklist, I think that are interesting is just, you know,
you can develop a checklist,
but it takes hundreds and hundreds of staff members throughout VA
to actually use it, deploy it, take it seriously and really change things.
And it's cost a lot of money.
You know, you change ...
mental health units, ten years ago, do not look like they look now.
A lot of units in VA have been refurbished, have changed.
They're safer now and also since they're being refurbished,
they're also more warm and healing.
So I think there's a lot that's been going on with mental health
and it's not due to just us;
it's all the staff out in the field, mental health staff, engineering staff,
changing the environment for the mental health units.
I think that's something that's important to acknowledge.