Behavioral health leaders are increasingly being asked to balance safety, access, staffing pressures and financial realities, often all at the same time.
Sarah Hollins, director of behavioral health services at WVU Medicine Camden Clark Medical Center in Parkersburg, W.Va., recently joined Becker’s “Behavioral Health Podcast” to share how her approach to crisis leadership relies heavily on front-line relationships, rapid communication and data-informed decision-making.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: From your experience building and leading crisis services, where are the biggest gaps today in the continuum of care, and what needs to change to better connect patients to the right level of support?
Sarah Hollins: One of the biggest gaps in the behavioral health continuum is that too many patients still enter at the point of crisis instead of earlier in the process. We’ve improved awareness, and demand for services has really increased, but access to timely outpatient care, therapy, substance abuse treatment and community support still hasn’t caught up. I really feel like that creates those bottlenecks everywhere else in the system.
Transitions between levels of care remain one of the weakest points in that continuum. Patients may stabilize in the ED, inpatient care or even a crisis setting like a crisis stabilization unit, but if the follow-up services aren’t available quickly or communication between those providers is fragmented, that risk of readmission or relapse increases significantly.
Too often, patients and families are really left trying to navigate a still very complicated system on their own.
Another major gap is the lack of consistency in crisis response models across communities. Some areas have strong mobile crisis programs, crisis stabilization services and partnerships with law enforcement and EMS. Thankfully, we do here in our community, but other communities still rely heavily on emergency departments and inpatient admissions as a default solution.
That’s not always the right level of care for the patient, and it puts additional strain on an already overwhelmed hospital system.
What needs to change is better integration and coordination across that continuum. Behavioral health can’t function in silos. Health systems, outpatient providers, crisis teams, community organizations, EMS and payers all really need to be more aligned around shared goals and smoother handoffs.
We need to continue to expand alternatives to hospitalization — things like crisis stabilization units, EmPATH units, peer support services and mobile crisis response. Not every behavioral health crisis requires inpatient admission, but patients do need rapid access to the right level of support before things really escalate further.
Ultimately, the goal should really be building a continuum that’s easier to access, easier to navigate and more responsive in real time so patients can receive the right care at the right time instead of cycling through the system during repeat crises.
Q: Behavioral health leaders are constantly navigating competing priorities from access and safety to financial pressures. How do you approach problem-solving in high-stakes environments?
SH: I typically approach those high-stakes problem-solving issues by trying to get really clear on what actually matters at that moment. Not everything can be top priority at the same time, and in behavioral health it almost always comes back to safety first, then access, then sustainability.
If safety is at risk, that drives the decision. From there, I look at how we preserve access without creating downstream risk, and then we have to make it financially viable.
I also try to be very data-informed. I don’t like to wait for perfect data to act. So I use what we have. I’m looking at throughput metrics, incident trends and staffing patterns, and I try to pair that with real-time front-line input.
I make a point to engage my nurses, mental health specialists and providers early in the process. Our behavioral health unit and our ED leadership actually meet weekly to look at some of those problem-solving issues.
I also try to simplify the problem. In high-pressure situations, complexity can slow us down. I have to look at what’s urgent versus important, what’s controllable versus not, and then try to make those high-impact changes quickly and align my team around an actual plan.
Communication is a big part of it. I try to be transparent about any trade-offs that need to be made, especially when decisions affect access or workload, so staff understand the why and patients understand the why. That helps with trust and execution.
I also build rapid feedback loops because behavioral health things shift quickly. I try to reassess often and adjust as needed. That way we can keep communication flowing between departments, staff and patients.
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
