Hospitals in Action

Getting ER patients the support, drug treatment they need

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LaToya Mitchell and Rebecca Bartley were drawn to become Substance Use Navigators (SUNs) after addiction tangled their lives. SUNs support emergency room patients with substance use disorders, which includes sharing safer drug use techniques, connecting patients with drug treatment programs, and serving as a liaison between patients and the treatment team.

LaToya, who works at Bakersfield Memorial Hospital, grew up with a mom addicted to methamphetamine. The addiction led to LaToya and her siblings being placed in foster care. Rebecca, who works at St. Mary Medical Center in Apple Valley, had struggled in the past with addiction to opioids following a back injury, repeatedly falling into its trap. They both know what it’s like to overcome feeling alone, hopeless, and ashamed. 

Finding peace and support was the key for both to take back their lives. After LaToya’s mother completed drug treatment, the two developed a deep and loving relationship. Rebecca never sought treatment because clinical resources were difficult to access, instead she drew strength from her family. She uses her lived experience in recovery to help motivate her clients.

But for many Californians, recovery programs are out of reach. 

Substance Use Navigators help break the cycle

People who experience substance use disorders often seek help in a hospital’s emergency department. People with an opioid overdose can be saved with drugs like naloxone that quickly reverse the powerful effects of opioids. But it’s not enough. 

While these measures save lives, they do not address the complexities of substance use disorder, which can stem from a combination of factors, such as chronic pain, behavioral health disorders, trauma, and a family history of addiction. Hospital emergency department staff juggle case management, follow-up appointments, and connecting patients to drug treatment services between their other duties. Unfortunately, many patients with substance use disorder repeat the cycle over and over.

Here’s how SUNs make a difference.

Dr. Aimee Moulin is an ER physician and Director/Co-Principal Investigator for CA Bridge, which trains and supports behavioral health navigators. She knows people with substance use disorders have a greater chance of getting into treatment if they are treated with compassion, dignity, and immediate access to treatment in the critical hours after overdose.

“What we’re doing is trying to take advantage of that moment as an opportunity to aggressively and respectfully link them into treatment,” Dr. Moulin said. “The key to success is hospital emergency departments are strategically located across the state, they’re always open, and people know where we are.”

SUNs support their clients in whatever capacity needed. Sometimes it’s a phone call or text message. Other times, Rebecca takes a hands-on approach.

“Withdrawal can be really scary and really difficult, so it’s important to have someone there to help throughout that entire experience,” she said. “I use that opportunity to share my lived experience, I know the local system, and I can help with the entire process, from the first call to going in to treatment and what comes after — I’m there no matter what.”

Another key to success is the work SUNs do to remove the stigma associated with substance use disorders. It’s especially personal to LaToya.

“When I was a child, everyone around me, even my own family members, would bad mouth my mom. I loved her and never wanted to hear anyone talk bad about her,” she said. “I see it all the time, people talk about others. ‘Pill popper’ or ‘addict’ gets thrown around a lot. Even if they do have a past addiction or past criminal history, somebody has to give them a chance to get their lives back in order.”

Empathy, kindness, and hope are powerful weapons against the barriers to success many people struggling with substance use disorder experience.

SUNs share successes

LaToya recalls a 24-year-old male patient whose alcohol use disorder was so severe, he drank hand sanitizer. Doctors believed he’d need a liver transplant. Each time he tried to quit drinking, he’d endure severe seizures. When LaToya first met him, he was resistant to her help, implying someone dressed up and in a lab coat couldn’t understand where he was coming from. 

“Just because I have this pretty dress and lab coat doesn’t mean I don’t know what it’s like to struggle,” she said and shared her story. “That seemed to change his attitude.”

Soon he entered a 30-day detox, followed by a 45-day residential treatment program. More than 6 months later, he was still sober. When he tried to get on a liver transplant list, he learned his liver was repairing itself. His 15-year-old sister also stopped drinking. 

“It wasn’t just him, his whole family benefitted,” LaToya said. That Christmas, she received their family photo. “It was one of the most beautiful things I’ve ever seen.”

Rebecca remembers a female patient, 20, who lost custody of her 5-year-old son and came to the ER with severe methadone withdrawal, blacking out and hallucinating. A skilled clinician administered buprenorphine and in a few hours, she was back to normal. Rebecca coached her into treatment. 

“She had every hoop and hardship to jump through,” Rebecca said. “Everything that could have gone wrong went wrong, from insurance to transportation.”

But she persisted. 

She has since given birth to a healthy baby and is seeking to restore custody of her son. She sometimes texts or calls to remind Rebecca that she helped when even family had given up, often saying, “you’ll never know how much you mean to me.”

“But the truth is, she’ll never know how much she means to me,” Rebecca said. “Because people like her and outcomes like that are the reason I keep doing this work.”

SUNs needed now more than ever

Hospitals across California are dedicated to ensuring all of their patients receive the care they need.

The SUNs project started with 12 hospitals in 2018 and quickly grew to 52 sites. The pilot was so successful, SUNs now support ER patients in more than 200 hospitals across California. These behavioral health counselors help people with substance use disorder get into treatment and move towards recovery.

This successful Behavioral Health Pilot Project (BHPP) saves lives, decreases police engagement, and reduces return visits to hospital emergency departments. 

Advancing behavioral health care has never been more critical – more Californians died of drug overdose during the pandemic than ever before. Your support means we can stand together for better behavioral health care for all because substance use and mental health challenges know no boundaries.