If the patient is in the community, determine if they are in crisis and need immediate assistance. Refer the patient to your state’s mobile crisis unit or 911, depending on the level of need. Call for support on their behalf if necessary.

Resources for patients who have thoughts of self-harm or suicide:

• Call 911 or go to the closest emergency department

• Call 988 for the National Suicide & Crisis Life Line

• Text HOME to 741741 for the Crisis Text Line

In order to be eligible for inpatient/residential MH placement, the patient has to be medically cleared. The ED/hospital providers need to clear the patient for transfer to the MH facility. 

Once the patient is safe in the emergency room or hospitalized, the BD treatment team should work with the emergency department (ED) or hospital’s discharge planning team on next steps. Do they think this patient needs inpatient/residential MH treatment or can the patient be discharged into the community with close outpatient psychiatric follow up? Please see the section Assessing patient behavioral health needs and options for intervention for more information.

The provider (BD provider, hospital, or ED) discusses the recommendation for inpatient/residential treatment with the patient to determine any preferences regarding facilities or location. The provider conducts a bed search to identify available beds in-network with insurance. Some states have websites that display the number of beds available at each MH facility in real time.

The provider (BD provider, hospital, or ED) makes the initial outreach referral  and submits necessary admission paperwork to the facility. BD SUMHAC recommends that someone other than the BD treatment team make the initial outreach. Please see the section Considerations before making a referral to an inpatient/residential BH treatment program.

Resource Alert!

BD SUMHAC recommends that the referring provider is NOT the BD treatment team. We have found that BD treatment teams have more success in securing MH placements for their patients when they partner with other providers (ED, hospital, primary care physician, or other mental health provider). BD SUMHAC has also created a resource for ED/hospital providers to help them better understand the issue of barriers to access for people with BD and offer suggested language for them to use during the initial outreach call. Please see the section Resources for ED/ hospital-based providers.

The facility accepts or denies the patient admission. If the non-BD provider informs you that your patient has been denied access to a MH facility, ask them to explain the reason. There are many appropriate reasons that people are denied access to MH facilities that have nothing to do with BD. For example, no beds are available or the facility determined your patient does not require the level of care that they provide.

If the facility denies the patient because of their BD, that is not the end of the story. It is the beginning of the provider’s advocacy on behalf of the patient. Don’t give up and encourage your patient not to give up either. This toolkit contains significant resources that have been used successfully to secure admission for patients who had previously received denials because of their BD. Please see the section Responding to a behavioral health facility denial for more information on how to advocate for your patient.

Resource Alert!

This toolkit has numerous resources that can be used to secure placements for bleeding disorder patients after they have received a denial because of their BD. Please see the section: Responding to a behavioral health facility denial