Caring for the Mind, Emotions, Relationships, Meaning, and the Whole Person
Hospitals Without Walls™ recognizes that physical health, emotional well-being, behavior, relationships, personal values, meaning, and spiritual concerns may influence how a person experiences illness and participates in care.
Our model may connect patients with qualified behavioral-health professionals and, when desired by the patient, respectful PsychoSpiritual support consistent with the patient's own beliefs, values, culture, and preferences.
Whole Person Health
Physical and Behavioral Health Are Connected
Medical illness may affect mood, sleep, cognition, relationships, independence, and quality of life. Behavioral health conditions may also affect symptom management, medication use, nutrition, activity, healthcare engagement, and a person's ability to carry out a care plan.
Whole-person assessment may consider:
- Emotional distress
- Depression or anxiety symptoms
- Grief and loss
- Stress and coping
- Sleep concerns
- Cognitive or behavioral changes
- Substance-use concerns
- Social isolation
- Family and caregiver strain
- Adjustment to illness or disability
- Meaning, purpose, hope, and personal values
- Spiritual or existential concerns identified by the patient
Screening identifies possible needs; it does not by itself establish a diagnosis.
Behavioral-Health Services
Care Delivered by Appropriately Qualified Professionals
Depending on availability, clinical need, professional qualifications, and applicable law, behavioral-health services may include:
- Behavioral health screening
- Diagnostic assessment
- Individual psychotherapy
- Family or caregiver consultation
- Psychiatric evaluation
- Medication evaluation and management
- Substance-use assessment and referral
- Grief and bereavement support
- Health behavior interventions
- Crisis assessment and safety planning
- Coordination with medical professionals
- Referral to an appropriate level of care
Each service must be provided by a professional who is appropriately licensed, credentialed, trained, and authorized to perform it.
PsychoSpiritual Health
Respecting the Patient's Search for Meaning, Connection, and Inner Well Being
Within the Hospitals Without Walls™ model, PsychoSpiritual health refers to the emotional, psychological, relational, existential, and spiritual dimensions through which a person may understand illness, suffering, healing, identity, hope, meaning, and purpose.
PsychoSpiritual support may help a willing patient explore:
- Personal sources of meaning and purpose
- Hope, dignity, and inner strength
- Emotional responses to illness
- Grief, loss, fear, guilt, or uncertainty
- Relationships and reconciliation
- Values that influence healthcare decisions
- Spiritual or religious concerns
- Nonreligious sources of connection and meaning
- Legacy and life reflection
- Goals for living with serious illness
- Preferences concerning spiritual care resources
PsychoSpiritual support is guided by the patient. It is not imposed on the patient and does not require belief in any religion, spiritual tradition, or philosophy.
Patient Choice and Freedom of Belief
Support Without Pressure, Judgment, or Proselytizing
Every patient has the right to accept, decline, begin, or discontinue spiritual or PsychoSpiritual support.
Services should:
- Respect the patient's stated beliefs and values
- Respect atheistic, agnostic, secular, religious, and spiritual perspectives
- Avoid imposing the beliefs of a professional or organization
- Avoid coercion, manipulation, or proselytizing
- Use qualified interpreters when needed
- Respect cultural and family preferences
- Protect privacy and confidentiality
- Obtain permission before involving clergy, chaplains, faith communities, or family members
A patient's acceptance or refusal of PsychoSpiritual support must not determine access to medically necessary care.
PsychoSpiritual Support Is Not a Substitute for Treatment
Clear Professional and Clinical Boundaries
PsychoSpiritual support does not replace:
- Medical evaluation or treatment
- Psychiatric assessment
- Psychotherapy
- Substance use treatment
- Medication management
- Crisis intervention
- Emergency services
- Protection from abuse, neglect, or exploitation
- Mandatory reporting required by law
When a concern requires clinical behavioral-health evaluation, the patient should be referred to an appropriately qualified professional.
Clergy members, chaplains, spiritual-care providers, peers, coaches, and community supporters may have valuable roles, but they must not represent themselves as licensed behavioral health professionals unless they hold the required credentials and are acting within their lawful scope.
Who May Benefit?
Support Based on the Patient's Needs and Preferences
Behavioral or PsychoSpiritual support may be considered for patients experiencing:
- Chronic or serious illness
- Major changes in health or function
- Depression, anxiety, or persistent distress
- Grief or bereavement
- Cognitive or behavioral changes
- Loneliness or social isolation
- Difficulty adjusting to disability
- Caregiver or family conflict
- Fear concerning illness, death, or the future
- Loss of meaning, purpose, identity, or hope
- Questions involving values or goals of care
- Substance use concerns
- Difficulty following or engaging with a medical care plan
The appropriate response depends on the nature, severity, urgency, and cause of the concern.
Our Integrated Process
Connecting Behavioral, Medical, and Supportive Care
- 1
Identification of Need
A patient, caregiver, healthcare professional, or organization may identify a behavioral, emotional, social, or spiritual concern.
- 2
Consent and Initial Review
The patient or authorized representative is informed about available services and provides any consent required for assessment, communication, or referral.
- 3
Screening or Assessment
An appropriately qualified professional evaluates the concern using methods suitable for the patient's age, language, culture, cognition, condition, and care setting.
- 4
Safety Evaluation
Urgent risks—including possible self-harm, harm to others, abuse, neglect, exploitation, severe withdrawal, psychosis, or inability to meet basic needs—are addressed through established escalation procedures.
- 5
Individualized Plan
The plan may include behavioral health treatment, medical evaluation, caregiver support, social services, PsychoSpiritual support, or referral to another level of care.
- 6
Coordination
With appropriate authorization, relevant information may be shared with the patient's treating professionals and other participants involved in the care plan.
- 7
Follow-Up and Reassessment
The responsible team evaluates engagement, symptoms, safety, goals, barriers, and whether the care plan should continue or change.
Behavioral and Physical Health Integration
One Patient—Not Separate Conditions in Separate Systems
When authorized and clinically appropriate, coordination may connect behavioral-health professionals with:
- Primary care practitioners
- Medical specialists
- Palliative care professionals
- Pharmacists
- Home health agencies
- Rehabilitation providers
- Hospitals and post acute facilities
- Residential communities
- Socialservice organizations
- Authorized caregivers
Integrated care may address behavioral symptoms, medical conditions, medications, treatment adherence, social barriers, caregiver needs, and patient goals within one coordinated plan.
No professional may direct or alter another professional's treatment without appropriate authority and communication.
Serious Illness, Palliative Care, and Grief
Supporting the Person and Family Through Difficult Experiences
Patients with serious illness may experience fear, sadness, uncertainty, changes in identity, loss of independence, family strain, or questions about meaning and purpose.
Depending on patient preference, support may include:
- Emotional assessment
- Symptom related coping strategies
- Communication about goals and values
- Family meetings
- Grief and anticipatory-grief support
- Life review and legacy activities
- Chaplain or spiritual care referral
- Connection with the patient's chosen faith or community resources
- Nonreligious meaning centered support
- Coordination with palliative or hospice services
Palliative care may be provided alongside disease-directed treatment. Hospice is a separate benefit with distinct eligibility and coverage requirements.
Older Adults and Cognitive Change
Behavioral Symptoms Require Careful Evaluation
Changes in mood, behavior, sleep, memory, attention, or judgment may have psychiatric, neurologic, medical, medication related, environmental, or social causes.
Assessment may consider:
- Depression and anxiety
- Delirium
- Dementia or other cognitive impairment
- Medication effects
- Pain or untreated symptoms
- Sleep disturbance
- Infection or other acute illness
- Sensory impairment
- Substance use
- Isolation, grief, or environmental stress
- Caregiver observations and capacity
New confusion, sudden behavioral change, or altered consciousness may require urgent medical evaluation and should not automatically be attributed to aging, dementia, or a psychiatric condition.
Caregiver and Family Support
Supporting Those Who Help Carry the Care Plan
Caregivers may experience stress, grief, exhaustion, role changes, financial pressure, or difficulty managing behavioral symptoms.
Support may include:
- Education about the patient's condition
- Communication and coping strategies
- Identification of caregiver strain
- Family meetings
- Safety and escalation planning
- Community resource referral
- Respite resource information
- Grief and bereavement support
- Referral for the caregiver's own professional care
The patient's privacy, consent, decision-making authority, and preferences remain central when family or caregivers are involved.
Telehealth and Mobile Support
Extending Access Beyond the Traditional Office
When appropriate and legally permitted, behavioral or PsychoSpiritual services may be supported through:
- Secure video visits
- Audio only services when permitted
- Mobile professional visits
- Virtual family meetings
- Remote screening and follow-up
- Coordinated care conferences
- Secure patient messaging
The professional must determine whether the technology provides sufficient privacy, safety, and clinical information. An in person or higher level of care may be required when a virtual encounter is insufficient.
Crisis and Emergency Support
Immediate Help for Urgent Safety Concerns
Hospitals Without Walls™ is not a crisis-response center or emergency service unless a specific program expressly establishes that function.
In the United States:
- Call or text 988 for the Suicide & Crisis Lifeline
- Call 911 when there is immediate danger or a medical emergency
- Go to the nearest emergency department when urgent in person evaluation is needed
Patients should not wait for a routine appointment, portal response, email, or monitoring review when immediate safety is at risk.
If abuse, neglect, exploitation, or violence is suspected, contact the appropriate emergency, protective services, or law enforcement resource as required by the circumstances and applicable law.
Privacy and Information Sharing
Protecting Sensitive Behavioral and Spiritual Information
Behavioral health, substance use, and spiritual information may be particularly sensitive.
Programs should address:
- Patient authorization
- Permitted uses and disclosures
- Role based access
- Secure communication
- Documentation standards
- Additional protections applicable to certain substance use records
- Mandatory reporting
- Duty to protect or similar requirements where applicable
- Patient access and amendment rights
- Information sharing during emergencies
Information should be shared only as permitted by applicable law and as necessary for authorized care, safety, payment, healthcare operations, or another lawful purpose.
Medicare and Insurance Coverage
Coverage Depends on the Service and the Professional Providing It
Medicare and other payers may cover qualifying behavioral health and behavioral health integration services when current eligibility, medical-necessity, practitioner, setting, consent, documentation, coding, and billing requirements are satisfied.
PsychoSpiritual support, chaplain services, community support, or other nonclinical services may not be separately covered by a patient's health plan.
Participation does not guarantee insurance authorization, coverage, or reimbursement. Each billing provider remains responsible for determining whether the service qualifies for payment and for submitting an accurate claim supported by the record.
Organizational Partnerships
Building Integrated Programs Around Defined Needs
Hospitals Without Walls™ may develop behavioral and PsychoSpiritual health arrangements with:
- Hospitals and health systems
- Health plans and insurance companies
- Government and military healthcare programs
- Physician groups and medical practices
- Skilled nursing and post-acute facilities
- Assisted living and senior communities
- Home health and community healthcare organizations
- Palliative and hospice organizations
- Qualified behavioral health organizations
- Other appropriate community partners
Written agreements should define the population, services, professional qualifications, clinical responsibilities, consent, privacy, crisis response, referrals, documentation, billing, quality measures, and governance.
Quality and Performance Measurement
Responsible Evaluation Without Overstatement
Depending on the program and reliable data availability, measures may include:
- Screening and assessment completion
- Timely access to qualified professionals
- Referral and follow up completion
- Changes in validated symptom measures
- Patient defined goals
- Patient and caregiver experience
- Crisis escalation and safety plan completion
- Coordination with medical care
- Treatment engagement and continuity
- Healthcare utilization
- Access and equity measures
Measures should define:
- The population
- Tools
- Data sources
- Baseline
- Exclusions
- Reporting period
- Analytical method
- Limitations
Evidence concerning behavioral health integration and spiritual care interventions varies by population, condition, intervention, and outcome. Associations between spirituality and health do not establish that a particular spiritual intervention will improve health. No clinical, spiritual, utilization, or financial outcome is guaranteed.
Request Behavioral or PsychoSpiritual Support
Care That Respects the Entire Person
Patients, caregivers, clinicians, and organizations may contact Hospitals Without Walls™ to discuss available behavioral health and patient directed PsychoSpiritual support.
Organizations seeking a contract should be prepared to describe:
- The population to be served
- Requested clinical and supportive services
- Professional staffing and qualifications
- Crisis response capabilities
- Medical and behavioral health partnerships
- Cultural, language, and accessibility needs
- Privacy and information sharing requirements
- Payer and billing arrangements
- Desired quality and outcome measures
Important Notice
Behavioral and PsychoSpiritual services vary by location, patient need, professional availability, licensure, consent, program design, payer authorization, contractual terms, and applicable law.
PsychoSpiritual support is voluntary and does not replace medical, psychiatric, psychological, substance use, crisis, or emergency care. Participation does not guarantee a diagnosis, treatment, prescription, coverage, reimbursement, or improvement in clinical or financial outcomes.
This page provides general information and does not constitute individualized medical, psychiatric, psychological, spiritual, legal, billing, or reimbursement advice.
If there is immediate danger or a medical emergency, call 911. In the United States, call or text 988 for suicide, mental health, or substance use crisis support.