Newsletter - Bartlett Regional Hospital

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Rich in Resources “We are blessed with a high number of psychiatrists,” says Dr. Robert Schults, referring to the strong quality of professional resources immediately available to the residents of Bartlett Regional Hospital’s service area. “We have five psychiatrists here at the hospital, and another four in private practice.” According to Dr. Schults, four of the nine local psychiatrists are trained in childhood/adolescent psychiatry. Psychiatrists are physicians who specialize in the diagnosis and treatment of mental disorders. About a dozen masters level or higher psychologists and as many similarly credentialed Licensed Professional Counselors also provide counseling services in the Juneau area. Bartlett Service Area Resources: The Juneau Alliance for Mental Health, Inc. (JAMHI) provides emergency response 24/7, as well as rehabilitation, psychiatric and nursing care, general mental health, a drop-in center, and enhanced residential services. NAMI—the National Alliance on Mental Illness—is a nationwide support network that provides technical assistance to local mental health affiliates. It also advocates for the mentally ill and their families, and provides community education to combat the stigma frequently associated with mental illness. The Juneau Community Suicide Prevention Task Force, a coalition of community resources, hosts a website that provides links to services available for those with thoughts of suicide, or their family and friends. See: www.juneausuicideprevention.org A person cannot be admitted to the MHU, voluntarily or involuntarily, without meeting basic criteria. Occasionally, a homeless person may act out, hoping for a few days of shelter. But even if someone appears to be falsifying symptoms, he or she is still taken seriously. The underlying concern is that even those who have threatened suicide or homicide for spurious reasons might at some point become serious. “We want to err on the side of caution,” says Burgess. The underlying concern is that even those who have threatened suicide or homicide for spurious reasons might at some point become serious. Burgess admits the process of assessment can be frustrating for family, friends, or advocates for the mentally ill, especially when a person with mental illness refuses treatment. “The family may not understand the strict criteria,” he says, “and not understand how it could be that we would not admit an obviously mentally ill person.” “It is a civil rights issue,” says Pam Watts, head of JAMHI. “Sometimes the situation gets tense. To family members it may seem like a no-brainer. They become indignant, concerned that the mentally ill person is vulnerable. But we can’t just lock somebody up because someone else thinks they should be locked up. There has to be a medical necessity; before admission, that person has to meet the statutory risk requirements.” The determination of medical necessity is made by a psychiatrist. Dr. Robert Schults, MD, a psychiatrist at Bartlett for over 11 years, has practiced in Alaska since 1985. “A clinician will call HouseCalls — 4
me and describe the situation,” he says of a typical discussion that precedes a request of the court for an ex parte decision on commitment. If the psychiatrist confirms the clinician’s assessment that an involuntary admission is justified, then the court is petitioned. If the court accepts the ex parte petition, a person can be involuntarily admitted for psychiatric care, without a hearing, for up to 72 hours. (The 72-hour hold is defined in state law as three working days.) In addition to the mental state of the person being assessed, Dr. Schults says he and the clinician will also discuss the patient’s medical history and physical condition. District Court Judge Keith Levy routinely handles ex parte cases. “Most of the time, the petitions are granted,” he says. “The conditions under which ex parte requests are considered are set out in statutes and are well defined.” Extending the hold beyond 72 hours requires a court hearing. Patients then have the right to counsel. “This becomes a formal, recorded proceeding that usually involves a psychiatrist, an assistant attorney general representing the state, and a publicly appointed attorney representing the patient,” Judge Levy explains. For those with acute mental illnesses, such as people who present with symptoms of schizophrenia, are not uncommon, more typically patients admitted for treatment at the Mental Health Unit are suffering from anxiety disorders (often due to an underlying physical problem like diabetes or low oxygen levels caused by such conditions as emphysema) or profound depression. “There are more suicides due to depression than other causes,” says Schults. “Sometimes sadness and depression come on without cause. Often, the brain chemicals that allow us to enjoy life are depleted,” he says. Schizophrenia is of a different order than depression or anxiety, but these conditions all respond to pharmaceutical treatments. “These days, medications are usually well tolerated,” says Dr. Schults. “We work to get the right combination—we don’t give up. We can usually dial in the dosage and combination, and some people can stay on the medication for years. Unfortunately, the all too common response is that when people begin feeling good they stop the medication.” “We work to get the right combination— we don’t give up. We can usually dial in the dosage and combination, and some people can stay on the medication for years.” —Dr. Robert Schults Even if a person meets the criteria and is admitted to the MHU, he or she might be treated and within a day or two discharged. If not yet stabilized, some patients will volunteer to stay longer, thereby avoiding a court hearing. “Most people wind up cooperating,” says Eddie Jones, discharge planner for the MHU. “A 30-day extension doesn’t have to be 30 days. Might just be a couple of extra days. Sometimes, if there is no sign of improvement, a stay might be extended to 90 days.” It is Jones’ responsibility to make certain that a patient has a safe living situation following discharge. “Many are homeless, living on the street,” says Jones, who comes to his role at MHU with a 20-year background in similar positions, most recently with REACH, a local agency that provides developmental disability services. “It can be difficult to plan around those situations. Typically, we try to connect with JAMHI services or other mental health agencies that can follow them once they are back out in the community.” For those people who stop using their meds, the cycle can repeat itself and the police may be called. The police officers will do their best to contain the situation, get the person back to a place of safety, and avoid the necessity of yet another visit to the Emergency Department. Eddie Jones confirms Lt. Kris Sell’s description of police officers as empathetic. Over his career, he has observed a steady increase in the Juneau Police Department’s capabilities in dealing with the mentally ill. “Police are the front line assessors of people’s behavior,” says Jones. “I know many of these police officers. They are very astute, highly competent, and know what their role is.” As with any complex system involving institutions like the police department, the courts, the medical and mental health professions, and social services, improvements are part of the ongoing process. “There are always bumps in the road,” says clinician Lee Burgess, “but by working together to iron out those bumps, we are able to help each other maintain a high standard of care. We spend a lot of time improving what is already a highly functional system.” 5 — Fall 2011
Page 1 and 2: HouseCalls Fall We bring healthcare
Page 3: Caring for the Mentally Ill A highl
Page 7 and 8: earning a Bachelor of Science Nursi
Page 9 and 10: Heart Attack Care We achieved a 100
Page 11 and 12: New Diagnostic Imaging Director: Ro
Page 13 and 14: wait for home health services to be
Page 15 and 16: and assisted Bill Palmer in finishi
Page 17 and 18: approved an operating budget— tha
Page 19 and 20: Profile: Dr. Saltzman, from page 10

Newsletter - Bartlett Regional Hospital

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