EAST CAMPUS — Located at 380 Summit Ave., Steubenville, Trinity Medical Center East is home to Trinity Health System’s behavioral health unit. -- Christopher Dacanay

(Editor’s note: This is the third installment in a four-part series highlighting major Jefferson County organizations helping those with mental health issues. Friday’s story will look at Coleman Health Services and its array of services for the community.)

STEUBENVILLE — You may have heard the term behavioral health and wondered what it means, or what distinguishes it from physical health.

Behavioral health “includes the emotions and behaviors that affect your overall well-being,” according to the Centers for Medicare and Medicaid Services. It’s occasionally called mental health and encompasses substance use.

While physical health centers on the body and its functioning, behavioral health includes mental state and lifestyle choices that can impact a person’s physical health. Both spheres of health have trained providers who can help a person improve their well-being, the CMS states.

Jefferson County hosts a number of such providers, which support citizens experiencing mental health or substance use issues.

Perhaps the most prominent of those providers is Trinity Health System, which operates the only in-patient behavioral health care unit in Jefferson County. In addition to working closely with other organizations for crisis response, Trinity offers a number of services aimed at helping individuals develop positive coping habits and improve their thinking.

For the past four years, Wendy Ralston has been the director of behavioral health services for Trinity, overseeing the system’s acute inpatient unit, outpatient department, residential unit and behavioral health presence in two local school districts.

A certified psychiatric nurse who serves as Trinity’s sexual assault nurse examiner, Ralston described Trinity’s role as the bridge between 911 and getting a person to the Trinity Medical Center West emergency room in the event of a self-reported mental health crisis.

If Trinity’s 24/7 crisis response specialists are looped into a call by 911 dispatchers or the state’s 988 crisis hotline, they first determine if the subject needs an evaluation.

Often, calls result in an ER visit, Ralston said, especially if threats to oneself or others are verbalized. Specialists can provide over-the-phone crisis intervention and de-escalate until first responders arrive.

“We can offer that therapeutic communication, more so than just the standard questions that need to be asked, per se,” Ralston said. “We’ll keep them on the phone, instruct them what’s going to happen once they get to the emergency room and just reassure them that we’re here to help and they’re not doing anything wrong. A lot of times, it’s very hard for individuals to seek out help, and the last thing we want is for them to think they’re in trouble …”

Trinity only handles triage and bringing individuals to the ER, though Coleman Health Services can assist with crisis situations at a person’s residence during normal business hours.

Family members can voice concerns about a person, who can be placed on an involuntary hold if they pose a risk of self-harm or harming others. An involuntary hold must be preceded by an assessment, either by mental health professionals from Coleman or Trinity physicians, Ralston said. A transfer by law enforcement to the ER may expedite the process.

Once a person arrives in the ER and is medically cleared, physicians perform an assessment and collect collateral information from the person and associates.

If a person is deemed able to return home, Trinity works to schedule an outpatient follow-up for no later than two days. In the meantime, Ralston said, Trinity helps patients develop a safety plan, which includes three safe and accessible people they can reach out to, reasons for living and activities to bring their spirits up and promote health thinking and coping.

Someone deemed unsafe to return home will enter Trinity’s inpatient unit, located at the Trinity Medical Center East campus in Steubenville. Able to accommodate 14 patients, the unit is often at capacity but varies based on seasonal trends, averaging 10 patients per day, Ralston said.

Patients’ inpatient stay typically lasts between five and sevent days, or long enough for them to stabilize and safely return to their daily routine. That period allows patients to participate in intensive groups and individualized therapy and be monitored while starting new medications, while Trinity staff ensure they’ll return to a safe home environment.

“(The therapy) helps you reroute the way you think, thinking more positive than negative, rechanneling those thoughts,” Ralston said, adding, “(The group setting) helps individuals really connect with various people going through similar or even different situations, but they learn from each other as well. Individual therapy really focuses on what is the root cause for this one individual, and let’s work through that.”

Trinity starts individuals with counseling during their inpatient stay in hopes they continue with it in the outpatient setting, to keep the coordination of care, Ralston said.

Running three hours a day Monday through Thursday, an intensive outpatient program helps individuals transition into outpatient care if they require a higher level of care, Ralston said. Patients in Trinity’s four-bed residential unit — a 30-day inpatient step-down unit — will take part in the IOP and learn coping skills.

Also on the outpatient side, Trinity offers individual counseling — either one-on-one or marriage and family counseling — as well as medication management with a nurse practitioner. Such programs, which see about 20 total patients per day, allow Trinity to keep a closer eye on individuals and detect signs of decompensation.

“If we see that an individual is starting to spiral downward, we’re able to increase their outpatient visits more frequently or just have eyes on them, (or) maybe they need to go back into inpatient,” Ralston said. “It just helps having more individuals involved in their care for early detection. … We are that individual’s safe place or safe person that they can call …”

Separately, Trinity has therapists on site at Indian Creek and Buckeye Local schools, where students can access individualized sessions throughout the school day. All counselors are equipped for crisis intervention and de-escalation.

“The hope of this is decreasing unfortunate events where suicide is the end result,” Ralston said, noting between 30 and 40 students make use of the counselors each day, between the districts.

Like many other providers, Trinity’s behavioral health unit struggles with frequently being at capacity, while fielding staff shortages and burnout. About 16 staff members operate the unit throughout the day, Ralston said, and high patient numbers have created a demand for more outpatient service availability and acute settings.

Staffing is a challenge for implementation of a mobile crisis response team, a goal that Ralston said she’s pursuing with the Jefferson County Prevention and Recovery Board. Composed of mental health professionals, including Trinity staff, the team would respond to mental-health related calls and provide targeted support and resources in ways law enforcement can’t.

“The hurdle for that (right now) is identifying key stakeholders and getting out of a siloed way of thinking, bringing the community in to collaborate and identifying who needs to be part of the program, and getting everybody education,” Ralston said.

Despite challenges, Ralston is looking ahead with hope for Trinity’s behavioral health component. The system is looking to grow its inpatient and outpatient capacity, initiatives that may be helped by Trinity West’s recent 183,400-square-foot addition.

“We see the need for more availability for individuals seeking help,” Ralston said, adding, “Trinity East being a different building from Trinity West, we’re one entity but physically off on a different campus. The hope is to be centralized, and with the new expansion, we’ll hopefully have an inroad.”