The vision: What will the psychiatric unit expect as standard?

We began this series by shining a light on inpatient psychiatric care; an often overlooked but vital part of healthcare, where those who are most vulnerable go in the hope of getting better, of becoming mentally healthier.

And by looking more closely at how these settings operate, we have seen how hard the work is. How important, and yet how disruptive, Q15s are. How the largest controllable cost hides in plain sight on the P&L, what we call PLGL (Patient Liability & Grievous Loss). How innovation could change the operating model. And how heavy a toll the setting takes on patients and staff alike, where a lack of sleep can worsen the very illness a patient came to heal, and every tough moment further strains a workforce already stretched thin.

The pressure from three angles

Manual observation is the backbone of inpatient mental health safety, a practice largely unchanged for more than 60 years. It is meant to keep patients safe, and it is written into the accreditation process. Yet it is fraught, and it leaves gaps: even generously, a patient on Q15s is directly observed under 7% of the day.

Consider the pressure the system is under, from three closely related angles:

• Acuity is rising: state psychiatric capacity has fallen to a historic low of 10.8 beds per 100,000 people, and a majority of what remains is now given over to forensic patients. When the beds are full, the sickest arrivals wait in emergency departments that boarded roughly a third of behavioral health visits in 2020 and nearly half by 2024. And a sad consequence: violent-injury rates on psychiatric units now run about eight times those of a typical acute hospital, up more than 70% in a decade.
• Staffing, meanwhile, is scarce and getting scarcer: behavioral health nursing carries the highest turnover of any specialty, at 22.5%, and 93% of the professionals surveyed report burnout.
• And the cost of simply watching is enormous: a single continuous one-to-one observation runs about $561 a day, and across US behavioral health the sitter line runs into the billions.

Sicker patients, fewer hands to care for them, and ever-rising costs for a model that cannot hold. That is the equation every inpatient leader I have spoken with is now trying to solve.

So what is the answer? How do we fix a critical part of healthcare that only seems to make headlines when something goes wrong? My argument is simple: we embrace innovation. We move from asking tired, burnt-out staff to watch harder to letting technology support the watch.

Think of vital-sign monitoring in an acute hospital. It was once optional; today it is simply assumed. That same shift is now visible in the market: over the past 18 months, Stryker acquired care.ai, an ambient and virtual-care platform, and AvaSure, a leader in virtual sitting and nursing, acquired Nurse Disrupted. The direction of travel is clear.

But inpatient mental health is the most demanding environment in all of healthcare, and solutions here must be purpose-built. That is why we exist, and why we are ready to take the next step with our partners in the US and the UK.

So when does the same shift reach mental health? My answer is now.

The future of behavioral health: Continuous ambient patient monitoring

The technology exists to move from the periodic check to continuous, ambient monitoring. Picture a unit where vital signs are captured without a wearable, where staff is supported by a solution that never gets tired rather than a flashlight and a clipboard in a dark room, and where the platform is moving toward surfacing change earlier, in the very gaps a 15-minute rounding routine is designed to leave open. No one sits on a hard plastic chair for hours; no one walks into a room unaware.

Five years from now, the Q15 as we know it should be obsolete, with ambient monitoring the baseline infrastructure of the unit. Patients should expect to recover in a calmer, safer place, with staff free to focus on therapeutic care rather than managing risk, outcomes improving, and liability costs contained.

Staff are no longer sitting still and watching; they are interacting and caring. In the morning, patients wake not to a flashlight, but because they are rested. The dangerous time between the checks does not shrink; it disappears. The 7% becomes 100%, with dignity and safety finally operating as one.

Partnering to build the inpatient psychiatric unit of the future

So let us go there today. The technology is ready; the question is who moves first. If you run an inpatient facility and you want to help shape the unit of the future and the hospital of the future, reach out to me. Let us build it in partnership together.

‍Author: Todd Haedrich, CEO, LIO