How to Access Mental Health Services

For numerous reasons, mental health issues are on the increase. At Lehigh Valley Health Network (LVHN), part of Jefferson Health, internal referrals to behavioral health services have risen nearly 300% since 2020. 

Not only are mental health issues prevalent, but they can be difficult to pin down. When you have a broken leg or a sinus infection, you know where to go for help. However, what if someone is in an anxious or threatening state? Or distressed but not responding to anything you ask them? How do you know where to start?

If someone is showing serious symptoms, experts advise getting the person to the nearest emergency room (ER). These symptoms may include suicidal thoughts or behaviors, thoughts of harming others, an inability to care for oneself, psychosis, mania, or severe anxiety.

“We have a psychiatric emergency service staffed by social workers and psychiatrists 24/7, ready to evaluate patients,” says Zeeshan Javid, MD, Associate Medical Director and Vice Chair, Quality and Patient Safety, Department of Psychiatry. The evaluation includes screening for any underlying medical conditions that may be contributing to their symptoms, followed by a comprehensive psychiatric assessment. The psychiatric evaluation assesses the individual's symptoms, safety, level of functioning, and treatment needs to determine the most appropriate level of care.

This initial exam serves to assess the individual's symptoms, safety, and treatment needs, as well as see whether an inpatient admission is justified. (It also applies if the person requires hospitalization against their will.) 

From there, staff members and a psychiatrist collaborate with the patient – either in person or via video – to decide what level of care would be the best next step. The patient might be referred to LVHN’s inpatient unit at Lehigh Valley Hospital–Muhlenberg, or possibly to Hanover Hill Behavioral Health, an inpatient psychiatric hospital, also in Bethlehem.  

“We are fortunate to have Hanover Hill close by,” Dr. Javid says. “Previously, if we had no available beds, patients would transfer to facilities as far as Montgomery County or Berks County. Now there’s a better chance of getting care here in the Lehigh Valley.” 

If someone is not threatening their own safety or others but there is a mental health concern, they should visit their primary care clinician, who has several options at hand. Dr. Javid outlines the possibilities:

• The clinician may refer someone for psychotherapy or initiate a medication trial. Hopefully, this will be successful. If not, a second trial might follow, or the clinician will request a chart review by a psychiatrist for additional suggestions.
• Another possibility is to request a one-time outpatient psychiatric consultation, by way of a video visit. The psychiatrist will clarify the diagnosis and make recommendations, but the patient will return to their primary care clinician to continue treatment. 
• If resources through the patient’s primary care clinician were to become exhausted, LVHN has a range of behavioral health programs – including inpatient units, outpatient offices and a partial hospitalization program for adults and adolescents. The partial hospitalization program provides intensive treatment for patients during the day and allows them to return home for the night.  

LVHN also has 53 therapists embedded throughout the network, including some at Valley Health Partners, a community healthcare organization in the Lehigh Valley and Poconos. “We have about 35 therapists specifically supporting LVPG primary and specialty care practices,” Dr. Javid says.  

Many people are familiar with the heartbreaking signs of mental health problems. Here is a summary of some and where to go for help.

• Excessive anger or violence: Dial 911 or go to the ER.
• Talking about suicide: Go to the ER. 
• Isolating oneself or sleeping a lot: See your primary care clinician.
• Lack of interest in activities or not going to school or work: See your primary care clinician. They may refer you to the Partial Behavioral Health program. 
• Not able to function: See your primary care clinician. (For example, if the patient has no energy, is gaining weight and has no appetite, they could have a thyroid problem. Situations like this call for testing before a decision can be made.) 
• Risky behavior: This depends on the nature of the behavior. Start with the ER for behavior that is uncharacteristic or dangerous such as driving recklessly. 
• Suspicion about substance use: See your primary care clinician for treatment options. They may refer you to the ER, if there is an urgent need for an assessment. Toxicology specialists may evaluate the patient for clinical assistance. 

Dr. Javid points out there are also non-LVHN help numbers loved ones can call:

• Check here for county crisis lines. A local mobile team or phone support can help determine whether you can safely remain at home or need a higher level of care.
• Call or text 988, the national mental health hotline, to discuss symptoms and get emotional support.
• Call 911 if someone is an immediate risk to safety and you need help right away. 

“Regardless of how patients come into the system, we offer guidance to get to the right point,” Dr. Javid says. “We triage based on severity of symptoms, then refer patients to the appropriate level of care.”