Behavioral healthcare professionals have more tools than ever to diagnose and treat mental health and addiction, yet societal barriers and a shortage of healthcare workers remain a concern for many in the field.
Despite those challenges, improvements in patient and physician safety and collaborative care and advancements in medications and therapies during the last decade have led to breakthroughs in diagnosis and treatment for patients, according to one Mid-South physician and several local healthcare leaders.
“It’s a great time to train in psychiatry,” said Paul B. Hill, MD, assistant professor of psychiatry at the University of Tennessee Health Science Center. “There has been an explosion in treatments in the last decade, and there is more focus on patient and physician safety in a variety of settings.”
Jep Stokes, CEO of Crestwyn Behavioral Health, agrees.
Crestwyn Behavioral Health is a 60-bed acute inpatient and outpatient behavioral health facility that opened in May of this year in Germantown. The facility provides care for adolescents, adults and geriatric patients with mental health and substance use disorders.
According to Stokes, outpatient treatment at Crestwyn began operations in late September. Patients who are in an outpatient treatment program enter the facility through a separate entrance and do not come in contact with patients who are in inpatient treatment there.
“The level of safety at mental health facilities has improved immensely,” Stokes said. “Our new facility is state of the art. A big concern is protecting patients who are trying to hurt themselves. We want to protect them, and we can do that better than ever before.”
Additionally, Hill said physicians and residents are working in a safer environment.
“Our residents work in a variety of settings, including inpatient, outpatient and geriatrics,” he said. “The setting is very important because different issues can arise even though the diagnosis may be the same. Facilities are safer now for them as well as the patients.”
In addition to safer environments, there have been improvements in collaborative care, according to Heidi Hillery, director of behavioral health services at Saint Francis Hospital.
The Behavioral Health Center at Saint Francis is a short-term inpatient mental health treatment unit that treats children, adolescents, adults and senior citizens. The unit consists of two floors that can house up to 40 adults and 30 children at one time, each in a private room.
One unique aspect is that the center can treat mental health patients with other medical conditions and ailments. According to Hillery, psychiatrists, other physicians and the medical team assigned to the patient collaborate to treat the patient.
“For instance, we can service a pregnant woman inside the hospital,” Hillery said.
Stokes said it’s challenging to treat behavioral health patients with other medical issues.
“Cases have become more medically complicated, especially with baby boomers aging,” Stokes said. “Patients have psychological issues and other medical conditions, and it is tough to treat both at the same time.”
All three experts agree that numerous improvements in treatments and therapies during the last decade benefit patients today.
According to Hill and Stokes, one particular treatment, which is the latest innovation in treating patients with depression and post-traumatic stress disorder, is transcranial magnetic stimulation (TMS).
TMS is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.
“Typically, this treatment is given to patients who haven’t responded to certain medications, and it’s given without anesthesia,” Hill said.
Stokes said this treatment is performed on an outpatient basis at Crestwyn.
“It re-energizes the brain without medication,” he said. “This is cutting edge in the field. We were not doing this treatment 10 years ago.”
Additionally, Lakeside Behavioral Health System, a 305-bed inpatient and outpatient facility which specializes in behavioral health and addictive disease services for children, adolescents, adults and seniors in the Mid-South, began providing TMS for the treatment of depression as recently as five years ago, according to the facility’s website.
The procedure is done on an outpatient basis under the supervision of an attending psychiatrist while the patient is awake and alert. The treatment regimens last from four to six weeks, the website reports.
Another treatment, which has improved over the past several decades, is electroconvulsive therapy (ECT).
ECT is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. According to the Mayo Clinic, ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health disorders such as depression.
ECT is performed at Saint Francis Hospital on an inpatient and outpatient basis, Hillery said.
According to Lakeside, ECT remains the most effective, fastest and safest treatment in many cases.
Additionally, Hill and Hillery affirm that there now are more new antidepressants and
antipsychotic medications available for patients than ever before. Both agree that medications are longer acting and help patients who are chronically ill.
“When I was in residency in 1989, there were only 20 or so drugs which treated these conditions,” Hill said. “Now there are 150.”
Hill said two medications, buprenorphine and naltrexone, are making an impact in treating patients with opioid addiction.
Buprenorphine is an opioid medication that acts on the receptor targets of heroin and morphine but does not produce the same intense high or dangerous side effects.
“This medication is addressing the opiate crisis in our state and county,” Hill said.
Naltrexone is given to opiate dependent patients after detoxification to help prevent relapse. Patients take it daily by mouth or monthly as an injection. Hill said the length of treatment is usually one year.
Even though there are numerous advancements in the field of behavioral health, medical professionals still face challenges. All three experts agree that the biggest challenge is the negative societal stigma that is associated with people who have mental health conditions.
“People don’t like to admit that they may have depression,” Stokes said. “Huge profile cases such as Robin Williams’ suicide help shed light on a subject that people don’t like to discuss. When a tragedy like that happens, we see more assessments.”
According to Mental Health America, a non-profit advocacy organization, six in 10 adults with a mental health issue receive no treatment, and 18.5 percent of Americans experience a mental health condition.
Stokes, Hill and Hillery agree that behavioral health faces the same challenge as other fields of medicine, a shortage of healthcare workers.
“Patients have trouble getting in to see a psychiatrist because there is a shortage of providers,” Hill said. “Psychiatry is on the low end of the pay scale.”
Stokes cited a need for more nurses.
“Nurses don’t see psychiatry as an option,” he said. “There is a big need in this field of medicine for compassionate care.”
As a result of the shortage of medical professionals, telepsychiatry is on the rise, according to Hill and Jason McCown, manager of the clinical assessment center at Saint Francis.
“Psychiatrists can see more patients, especially in more rural locations through telepsychiatry,” Hill said. “The future of psychiatry will be telemedicine.”
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