A look inside one of the rooms in Children’s of Alabama’s Nature Hall, a behavioral health unit within the emergency department.
Two years after opening a behavioral health safe area within its emergency department (ED), Children’s of Alabama is already seeing dramatic improvements to the way children in mental health crises are treated. It’s the fruition of a vision the hospital’s behavioral health team began developing several years ago.
The Children’s of Alabama Nature Hall opened in March 2023 as an expansion of the ED designed to provide 24/7 services to children and adolescents who arrive in need of mental health evaluation. With 16 beds, it quadrupled the hospital’s capacity to treat children with mental health needs in the ED. Children’s developed it in response to a record surge in mental health patients that began around 2019.
Marked improvement
Already, the Nature Hall’s impact is clear. Since it opened, the average length of stay for patients discharged from the ED has decreased from 9.46 hours to 4.55 hours. The number of patients who left without being seen dropped all the way to zero in 2024, compared to 47 in 2022, the year before the Nature Hall opened. “These are incredible outcomes that reflect the dedication of our staff and the importance of having the right resources in place,” said Bonnie Moore, director of Inpatient Behavioral Health Services at Children’s.
Moore attributes the Nature Hall’s success in part to the team’s decision to staff the unit with trained behavioral health professionals, including nurses, behavioral associates and psychiatric providers. “This ensures children receive care from experts who understand their unique needs, which has greatly enhanced patient outcomes,” she said.
Some of the staff who serve the unit are part of the Psychiatric Intake Response Center (PIRC), which is a phone response center for adults seeking mental health resources for their children or adolescents. The PIRC team is made up of licensed mental health professionals who, in addition to answering calls, provide behavioral health consultation services within the ED. In the Nature Hall, PIRC therapists provide evaluations, Alabama Department of Human Resources reporting, discharge planning, and transfers to outside hospitals. With the PIRC’s robust database of more than 1,900 providers, team members are also able to offer mental health resources for patients and their families.
“The PIRC program bridges a critical gap in mental health care by providing both in-person and phone-based resources,” PIRC director Cindy Jones, MA, LPC-S, NCC, said.
The idea behind the Nature Hall
The need for a behavioral health safe area like the Nature Hall became evident in 2019 when the hospital faced an record surge in emergency mental health cases. Behavioral health patients began occupying up to half of the ED’s beds, far exceeding the capacity of its original four-bed, behavioral-health-safe “pod.” This crisis prompted Children’s to repurpose an underutilized space within the ED, culminating in the creation of Nature Hall. Now, children and providers both benefit from this state-of-the-art area dedicated to pediatric behavioral health patients.
Both Moore and Jones attribute the rising demand for children’s mental health services to several factors, including social media influences, exposure to inappropriate content online, and increased societal stressors. While these challenges existed prior to the pandemic, COVID-19 exacerbated the crisis. “People are now more willing to seek mental health care due to reduced stigma, but this has created additional pressure on resources,” Jones explained. “However, part of the PIRC’s mission is assist caregivers by helping them navigate what behavioral health services are available, match them with the appropriate services and resources in their communities, and educate them on what to expect.”
Children’s of Alabama continues to refine its approach to managing pediatric mental health demands, demonstrating how targeted efforts address urgent public health issues. Moore says the improvements Children’s has seen since opening Nature Hall highlight the impact of investing in specialized care for the most vulnerable patients.
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