The nation’s first emergency medicine behavioral health fellowship has its first fellow, Dr. Austin MacKenzie, who is practicing medicine in Grand Rapids.
The fellowship is sponsored by Emergency Care Specialists (ECS), a physician-owned and -governed private practice specializing in all aspects of emergency care medicine. ECS is an independent group of more than 250 physicians and advanced care providers, established and operating out of Spectrum Health Butterworth Hospital.
ECS emergency medicine behavioral health fellowship program director Dr. Craig Bilbrey, M.D., said the fellowship is a new approach to emergency behavioral health care. While most emergency mental health fellowships are psychiatry-based, Bilbrey said this fellowship is a way to “get better” at behavioral health care in an emergency setting.
He said instead of a psychiatric focus, this fellowship is based on finding ways to offer immediate help and care to a behavioral or mental health crisis in the emergency room, by viewing the crisis through an emergency medicine lens.
He said the idea for the fellowship was born out of the steady increase in individuals suffering from behavioral health crises who come to emergency rooms for help, as one in every eight emergency room visits are related to behavioral health, and the need for medicine to evolve in its ability to care for them.
“The mental health population that shows up to the emergency department continues to increase every year,” Bilbrey said. “We’re trying to do stuff with the outpatient resources, but it just isn’t keeping up with demand.
“Patients are often told to come to the emergency department by 911 or whoever, and then they get here and historically we’ve said, ‘Well, I see you’re in crisis, but you know, this isn’t really the place. We can’t really fix what’s going on for you.’ So, we tried to recognize that, and over the past few years, we’ve changed some of our practice, adapting how we take care of the patients; how we deescalate them.”
Bilbrey, who practices emergency medicine himself, said this fellowship is attempting to meet the problem head-on. Its first fellow, MacKenzie, who started with the program in July of this year, is currently in uncharted territory. So far, Bilbrey said, the new fellowship is going well.
“I’ll say it’s quite a leap of faith for him to jump in and do this,” Bilbrey said. “This was the first program of this kind (and) we came up with an academic calendar that we thought would work and achieve the end result for him, but there are very few like-model physicians for him.
“He’ll quickly become better than I am at this, just because he’ll be doing it a lot more. It’s not like other fellowships where if you’re going to be this type of surgeon, you just work with that type of surgeon all day long and you pretty much get where they’re at. This one is kind of building it as we go and learning as we go.”
MacKenzie, originally from Illinois, earned a bachelor’s degree in psychology from the University of Wisconsin-La Crosse. He attended medical school at University of Illinois-Chicago, graduating in 2018. He came to Grand Rapids from an emergency medicine residency at Eastern Carolina University, which he graduated in June. This gave him a solid foundation for the work he is doing in ECS’ fellowship program.
Bilbrey praised MacKenzie’s willingness and ability to work with the new fellowship.
“It takes someone like him,” he said, “who’s very interested in it and passionate about it, and also self-motivated. Because every day is a little bit different, you really have to care about the population to figure out how we can serve them better. It’s constantly evolving.
“We’re very excited that we found someone that fits what we want to do and has so far been a great (addition) to our team.”
Rather than specializing in one area of medicine, as many fellowships do, MacKenzie is being exposed to a wide variety of topics and aspects of emergency behavioral medicine.
About half of MacKenzie’s time is currently spent as an emergency department attending physician, working with patients at Spectrum Health Butterworth’s emergency unit. The other half of his time is spent doing work in his fellowship role. Right now, that means taking charge of the hospital’s emPATH unit. The emPATH unit, or “emergency psychiatric assessment, treatment and healing unit,” is an empathetic space for those suffering from an emergency behavioral health crisis to find help outside of the stressful confines of an emergency room.
The emPATH unit, according to Bilbrey, is like an observational space between in- and outpatient care. Patients who come to the emergency department for behavioral health care are brought to the emPATH unit, where they are able to be cared for in a slower, calmer environment. Patients are free in the unit, rather than being confined in a bed in a hospital room, and are with specialists who can determine if they need to be sent to inpatient care at a local hospital such as Pine Rest.
Most patients at the emPATH unit are suffering from anxiety and depression, or suicidal thoughts. The unit also cares for those with schizophrenia or bipolar disorders, people in crisis due to mania or other circumstances.
MacKenzie currently coordinates the care at the unit, directing social workers, nurses and psychiatrists who help patients there.
In addition to his work with Spectrum’s emPATH unit, MacKenzie also will do a rotation at Cherry Health, where he will focus on buprenorphine and outpatient addiction management.
MacKenzie also will spend some time at the Sanford West Behavioral Health Campus in Marne, which has a dual diagnosis unit caring for patients with substance use and mental health illnesses. He also is expected to do inpatient psychiatry work with the Spectrum Health medical group and spend some time in care coordination with Grand Rapids mental health service provider Network180.
Bilbrey said he hopes the new fellowship will be the start to a new model of emergency behavioral health care, finding ways to create better protocols for emergency physicians dealing with patients in behavioral health crises.
“None of us went into emergency medicine to take care of behavioral health, that’s not the draw historically,” he said. “But it’s becoming more and more of our population, so we need to get good at it. Even if it’s not our primary desire, it’s in everybody’s best interest for us to be good at it.”