Dr. Amador, CEO of #SunriseVistaBehavioralHealth, shares about #psychiatric hospitalization–when it’s appropriate, how to benefit from inpatient care, and what the alternatives are. Pricey retreat centers and the “Troubled Teen Industry” came up as we always delve into the price of care on this show. We discussed avoiding ketamine, Transcranial Magnetic Stimulation (TMS), and ElectroConvulsive Therapy (ECT) in favor of small, sustainable habit changes. We also explain IOP, PHP, and other options that require more commitment than weekly therapy appointments, but may be beneficial for patients in crisis.
Transcript:
welcome to the Ascend Health show I’m your host Nick Angelis I’m a nurse anesthetist and one of the owners of Ascend Health Center and I’m here with Dr Michael Amador from Sunrise Vista Behavioral Health
it’s a pleasure to be here sir
yeah and we’ve already started our conversation so this is just a part that we recording we’re halfway through so we were just talking about baby steps which may sound surprising being the CEO of a a psychiatric hospital that instead of saying quick get your person to the hospital we’re like well no sometimes you have to get better little by little and take a measured approach
well you know it’s those it’s that process of baby steps as we talked about earlier that has the long-term positive effect and so patients for example when they come into a psychiatric facility uh we begin that baby step process We Begin by evaluating their medications we We Begin by putting them on 6 hours a day of therapy you know as mentioned we we we have a short amount of time to do quite a bit bit right uh 5 to 7 days is what we have to put the patients on the steps that they need to so they can follow that after they leave the facility yeah
you you were saying that for one thing no one wants to be there exactly which I think is and we’re already off topic so this is going to be a great show which I think is fascinating because uh we already talked a little bit again before the cameras rolled about the troubled teen industry and the fact that you can pay $20,000 and go to this camp where they’ll deal with your mental health needs and so are specialized like they’ll do EMDR there’s yoga but the other side which is okay your insurance will pay for a psychiatric uh Hospital state and one was like no absolutely not but what you’re saying is if the patient can kind of get themselves into the mindset of well this is sort of a vacation for one thing you said you all don’t use restraints there which is no we don’t which is a huge risk for someone going to a psychiatric facility like yeah it sounds great and I’m going to end up strapped to a bed for 4 days we actually try to do the best we can again in the short amount of time time so from day one we begin the discharge planning process the after care process and we we evaluate all the medications that the patients on to ensure that the medications that they’re on are appropriate you know a lot of hospitals they’ll uh delit a patient and just continue meds what we do is we try to evaluate what meds that patient is on because what worked for them last month may not work for them this month and so we checked their medication we do a complete history and physical we have 6 hours of programming per day 2 hours of Rec therapy 2 hours of Social Services 2 hours of nursing so we try our best to do as much as we can in a short amount of time so it’s kind of a crisis intervention but also putting them on that baby step process so they can continue on after they get discharged that makes sense because it’s a stressful situation of course for the patient so you’re not like here’s everything you need to change immediately it’s more like okay while you’re here we’re going to move quickly get you out of crisis at the same time here is the steps and we’ll start this process here but you have to continue it afterwards our goal is to get them out of Crisis get them stable ready for outpatient or for partial hospitalization or for IOP our goal is mainly crisis stabilization sure and you a lot of my patients at a cent Health Center know IOP and PHP and uh many patients who because we get a lot of patients with treatment resistant depression they know all the lingo and uh alar realizing I do have a patient that should go to your IOP especially since you all are in Stark County U but can you explain the differences between those because what you said too is some patients don’t quite need the hospitalization don’t quite want it so what are other Alternatives rather than you know just having therapy weekly or well partial hospitalization is a lot more intensive than for example IOP uh partial hospitalization is the step right below inpatient so normally it works as an alternative to inpatient the patient is in a crisis but not severe enough to be impatient but severe enough where they need an intensive following where it’s about 4 to 6 hours a day Monday through Friday okay whereas IOP serves as a step down uh you know especially if you have a short stay in a hospital IOP Works real well because it’s intensive out patient they have group and they have a a therapist there three times a week so it’s less less intensive but yet more intensive than once a week counseling or once a month counseling right no that makes sense and at our facility the most intens we can do is okay you can see the nurse practitioner or the psychiatrist once every few weeks and then we have group therapy once a week on Wednesdays and then individual therapy but often it’s that case where okay you need you don’t necessarily need hospitalization but you need a little bit more than what we can provide exactly and so you have all these different steps you have inpatient you have PHP you have IOP and then you have counseling and the least restriced one is counseling which is once a week or once a month but most patients especially after uh an inpatient uh stay they require either PHP which is a partial hospitalization or the IOP okay and do you think some of the stigma of a psychiatric hospital is that loss of control where it’s it may start out as oh you just need to come in here for a day or two and then before you know it the patient’s there for a week or two because I think sometimes there’s a book I like called this won’t hurt a bit in healthcare often we we do have to fight the temptation to sugar coat things believe it or not our our greatest challenge in getting their patients discharge is not the patient is placement issues uh so often times the family don’t want them back or the nursing home don’t want them back so we don’t have a place to send them to and so we end up keeping them longer than we really want to because we have placement issues uh but you know most cases we’re able to get them out within four to seven days uh and again it’s it it’s very intensive but psychiatry in itself has a stigma associated with it so when you get into a hospital especially if it’s your first time in an inpatient facility it’s scary because it’s a lock facility you feel like your rights have been taken away although you have many rights that we still try to protect but it is a lock facility for your safety and for your confidentiality but it’s scary for a lot of patients when they first enter a psychiatric facility and of course immediately they want to get out because they’re afraid they’re they’re nervous anxious about being impatient uh the mental health facility once they come in and they meet the therapist the doctor they’re able to get involved in group that fear uh decreases quite a bit okay so what are the benefits of that impatient care because we’ve already mentioned and there’s a stigma with it sometimes patients can be scared there’s a fear of will I lose my rights so what are the good things that can happen being in as you said a locked facility as opposed to just coming and going of of what you need or what the patient feels they need in psychiat ha well focus is extremely important and when a patient comes into a psychiatric facility they’re focused on themselves they’re focused on their on their uh their treatment um they focus on their mental health whereas if you’re outside there’s so many things that are distractions when you’re in a psychiatric facility you’re focusing on that exact mental health problem that led you to a place of Crisis and so what’s positive about it is that you’re able to get a Crisis Intervention in in a short amount of time to help you deal with the pressures outside the facility you know as you know all of us deal with extreme pressures outside the hospital and there are so many distractions when you go into facility like ours you focus on your mental health and we’re able to put all of the all of our attention all of our energies toward trying to get you to a place of stabilization so you’re able to go back into the community okay no that makes sense and you’re in a safe environment you know it’s locked so you’re in a safe environment where you don’t have folks coming in MH or folks going out and so it it it keeps you focused on your treatment well you can think of it too because you know every drug has that blackbox warning of this could make you feel worse correct so it it gives you a chance to try some of these medicines in an inpatient way where uh there might be side effects or risk but because those are taken care of we can actually move the envelope cuz there’s a lot of our patients at asent Health Center that will say well I want to try this but I’m worried about this side effect or what if this happens so and that’s a good thing about being in an impatient facility is that you’re able to try new meds uh uh or even a new strength and and have observation and you there’re being observed 24 hours a day so again it it it allows you to focus 100% on your mental health problem that led you to a crisis I mean I’m thinking of it more as a retreat center at this point well know it it is it is different because in a ret Treet Center you’re more in a relaxed setting in an impatient facility you deal with issues that have been you’ve been harboring for years right you deal with with sensitive issues that a lot of times you don’t want to in therapy and you’re having to uh also deal with other patients that are in a milu with uh either the same or more severe problems that you have so it’s a little more intensive than a retreat but it’s definitely good for you because it allows you to focus again on the crisis that led you to be in in the first place and sometimes just being separated from your environment does help because regardless that environment is at least part of the reason that brought you to the psychiatric facility we tend to you know as you know as human beings we tend to ignore things and think we can just put them just put them under the floor right if you don’t pay your light bill eventually you’ll have your lights cut off MH you cannot ignore things so you cannot ignore your mental health if if you ignore your mental health you eventually you will deteriorate to a level of Crisis right and so we what we do is we focus on that Mental Health crisis that led you there in the first place get you stabilized and get you back in the community as quickly as possible Right asend Health Center that’s what we say about the ketamine infusions a lot of times it know just strip all the protections that you’ve the maladaptive protections we should say that you’ve formed and it’s almost like talking to a blunt therapist for days that okay this might be you might end up being more irritable at first you might even have increased anxiety as you start the treatments because it does sort of act as a mirror of letting you see okay what’s actually going on so you can focus on the root causes instead of like oh let’s just focus on this easy symptom instead of really addressing what’s going on ins it’s a look it’s a huge challenge not only for the patient but for the staff and for the Physicians to be able to uh do as much as you can in a short amount of time and so our staff of Sunrise I’m very proud of them I mean our nursing staff our our clinical staff staff all our ancillary staff they work for one purpose patient care one of my biggest pet peeves and passions is that let’s make a difference in these patients lives even if it’s that their stay is 5 to seven days let’s make a positive difference let’s make an impact I always believe that if you sew a good seed you reap a good harvest and so we try to sew as many good seeds in these patients as possible now we may not see it while they’re while they’re with us but that good seed will come to fruition after towards and our goal is really the highest patient care that we can possibly provide each patient deserves our respect and that’s another thing that is a pep in a belief system in our hospital is that every patient should be respected I I tell our staff all the time respect you give to everyone trust you earn you don’t trust everyone you earn that trust but respect should be given to everyone especially our patients they’re they’re in a vulnerable state they’re in a weakened State and they need our help need a respect as well right no absolutely and I like that idea of the seed I mean you know it’s a it’s a spiritual thing and I think that’s sometimes something that we don’t see in our cold Western Medical Health Care system that a lot of times if you don’t nurture the spirit you can give all the meds you want yeah it’s a holistic approach yeah uh we all have three sides to us and so we are mental health or physical or spiritual side and we try our best to uh do the holistic approach if we can but make a make a positive impact on all patients and sometimes unfortunately patients are there against their will if they get P slipped they’re not happy they’re there and they want to get out and and we’re we’re in a catch 22 because we want we want to do right by these patients so we’re not able to discharge them in one day or two so we try to get them uh to buy into their treatment at least for the next few days it’s difficult sometimes that’s why you got patients leaving and sometimes they’re unhappy because they they felt they stayed too long but we fail you didn’t stay long enough right that that is interesting so uh what’s the process of getting admitted to the hospital because I know a lot of times patients will call us at a s say do I need to go to the ER I really don’t want to sometimes they’ll turn me away sometimes I’m waiting there for 12 24 hours so what’s the process if someone feels okay I do need the next step for my mental health well look you know I tell folks all the time if there’s an emergency you always call 911 but of course we take walk-ins and so we’re able to we have an aeing office that’s open 24 hours a day 7 days a week and we have nurses we have licensed uh clinicians in there and so we’re able to assess patients and see what level of treatment they may require so if they need to come directly to the hospital is not a problem they don’t have to go to the ER okay the ER is good if they have an emergency if they think it may be medical is good to go to the ER but if it’s strictly a mental health crisis you can come straight to the hospital okay no that’s really because it’s similar to what we said about uh restraints that a lot of times the interventions that we do in healthcare cause their own trauma exactly so for our patients when they’ve been seen by our physician tell them okay you’re our patient now if you need anything you call us first and we’ll see if we can help you or send you along because other times you’re trying to repair what someone else did not saying that they’re incompetent but it is it’s a different mindset of it’s a challenge because for us that we don’t do restraints we don’t tie folks down again it it can be very traumatic to be in a situation where you get tied down and so we don’t do that at all we try to verbally deescalate the patient and we try to medicate them if they if if they are in need of it uh but we think it’s it it’s the most Humane and therapeutic way to handle the patient is without restraints sure and then what do you do for treatment resistant depression and I also know you you all tackle addiction as well well we we treat dual diagnosis so patients have to have a primary uh you know a mental health problem but sometimes you don’t know who came first chicken or the egg uh but U when we have patients who are resistant to a certain medication we meet as a treatment team every day so every day you have all these different uh departments nursing clinicians the provider the doctor the pharmacist and we meet every day to discuss the patient’s well-being if the patient’s medication is not working then we change it or we modify it right okay and that’s honestly part of why I do this show is I think this is probably our 45th episode when a patient ask for resource I’m like well watch this video see if you connect with what they’re saying and if so call them if not here’s another video or here’s somebody else you can call Cuz and I know it sounds silly to say like does this inpatient psychiatric facility Vibe with you but there is a kernel truth to that of see if their philosophy and their approach is something that you’re thinking oh I think they could help me well there’s a lack of Education out in the community that’s one of the reasons I I had shared with you earlier that that we started a community Workshop every month uh to educate the Community and Mental Health and try to decrease that stigma and so you know I believe a hospital should be a resource for that community and so for example in December Christmas is supposed to be and and of course uh New Year is supposed to be a happy time uh but for a lot of folks it’s very depressing if you’ve gone through a divorce you’ve lost a loved one uh you’re you’re not financially able to buy those gifts you go through what I call it could be seasonal depression onsight depression right we want to do a workshop in December overcoming grief during the holidays because that that’s that’s extremely important for the community uh we want to be able to teach on o uh signs and symptoms of mental health signs and symptoms of depression uh how to deescalate a family member who is in crisis all those are areas is what we’re going to be touching on and offering for the community on a monthly basis okay for free will those be held inside the hospital okay yes well they’ll be in a hospital and and we’ll be able to even have as much as about 100 folks if they want to come so we’re not going to have a uh problem in space sure so someone can just Google Sunrise Vista or Sunrise Vista Behavioral Health and then the information will be on the web well I’m not sure yet since it’s so new it’s not going to be on there but they can call the facility okay and and they’ll be able to you know immediately know what what workshop and sure and uh you know what time and what day right and what the resources are exactly cuz you’re right it’s quite something to go from nothing to okay now I’m impatient but if you’re already used to the resources and you’ve seen the staff around then if you do have a crisis it’s a little bit of an easier transition for sure well you know I think every every facility uh you know especially dealing with people’s lives as in mental health it it should be more than just inpatient facil faity they should be a Community Asset and so for example we’re we’re trying to put together a coat drive and a blanket Drive uh for the for the homeless there’s a severe problem with homeless uh folks in you know in Canton and so we’re trying to do our best to be able to support those Folks by even doing a a C drive a blanket drive and and uh again trying to make positive change sure and sometimes that is a challenge between safety and this quality of life that we talk about all the time that we want you to be in this unit where safe but uh a lot of times you think well wait what’s what’s the end game here like are we just keeping you from killing yourself like is that the only goal here how can we restore some quality of life and that’s see that’s our passion you touched on what our our passion is and that is when the patient admitted our first goal and our primary goal is to make a difference in that patient’s life uh if they’re suicidal we want them to leave with knowing that there’s a worthwhile reason to to keep living right if uh if you know if they’re if they’re going through a difficult time we want to be able to help them maybe not resolve it but put them on the track to resolve it right and that way they can also make their own decisions exactly we’re talking earlier about ECT that uh we see that a lot at Ascend Health Center because we have patients who nothing else has worked we’ll do ketamine infusions spva which is a nasal spray TMS and then sometimes actually I think three different times in the last 5 years you’ve been like you know what none of this is working for you let talk about ECT but sometimes that can cause memory issues i’ I’ve done the anesthesia for ECT so I know how that goes as well um so it just comes down to okay what are we trying to what goal are we trying to reach what are we willing to do for it and are they realistic goals yeah and honestly I think one of the most freeing things for a patient is to say you know what if I do this and this I’ll F this perc better and it’s not worth it for me it’s it’s almost like a the analogy I use is there’s a chocolate cake in your fridge and you’re not on a die so if you want to go have a slice you will but there’s no fixation on it exactly we do that a lot actually with aamine infusions where some patients the mental health will deteriorate back after they stop them but because they know they can come here if they need to they’re like actually I’m going to work through this this is fine because I have a safety net now good point and I think what you’re saying too is that Sunrise Vista can be that safety net yes and it could be a support system safety net it can be uh a resource for you so you’re able to make better choices and decisions concerning your mental health right because if you’re living in fear all the time then you you can’t get better it’s like it’s always like oh am I going to have another psychotic break you not experiencing quality of life right exactly so and I think that is the most important thing we could remove that fear if patients realize okay someone has my back then they can do things they can take risks and they can know that okay I’m I’m not here all by myself and that really reduces the chance of spiraling especially as you said during the holidays and it mental health affects all the areas of of your life and so if your mental health is not um healthy it it will affect all the areas of your life it will affect your family your interactions it will affect your job that’s why it’s so important to make sure that you have a healthy mental health and most of us take it for granted we go through traumas we go through childhood traumas we go through there are women who have been raped who have been abandoned who have lost loved ones lost husbands after 40 years of marriage right all this affects your mental health that’s why I believe in counseling I believe in you know if if you’ve suffered a trauma go to counseling get that trauma resolved because it doesn’t go away by itself right you have to face it and so whether it being counseling whether it be an IOP PHP or impatient you cannot ignore your mental health yeah I had one patient who said well I’m depressed and here’s the reason why correct and I told her like this is great because before you were just depressed but now it’s like something bad happened I’m having the appropriate human response to it but I can sort of see okay one day I’ll get over this thing that happened and then I’ll move on correct I was like that’s exactly what we want we don’t want you to be so numbed with the medicines that you’re you know going through things and just tolerating them we want you to have the typical ups and downs of life and that’s why way medication management is extremely important especially if you going into a hospital to evaluate a person’s medication even in the past is extremely important because again what worked for a patient last month last year may not work for a patient today and we don’t want to overd drug them either we want to make sure that they still keep that quality of life in the room to make choices and eventually decrease that medication if we can right the ability to make a choice of exactly not being in a survival mode all the time makes a huge difference correct and what you said about counseling too it is almost that that helps pinpoint what we should work on uh one analogy and you should be careful cuz I I make up these analogies all the time and they don’t always make sense I make them up on the spot but if you’re complaining of oh my my feet are numb or I can’t see that well right now it’s like well no if you’re a diabetic we need to get your blood sugar under control we shouldn’t worry about the neuropathy as a primary focus or these other symptoms like in the root cause right exactly and and that’s that’s what counseling impatient that’s what it does it actually goes down to the root cause not just the symptoms CU if you treat the symptoms the cause will still be there symptoms will come back right you’ve got to treat the root cause and we we try again as much as we can within 5 to seven days and that’s why after care is so very important the IOP the the PHP so we can continue to tackle that root cause right that caused you to be in this situation and like you said it’s you know when you involve the patient in that process when you’re saying okay together we’ll find the root cause and then you’re going to be the primary driver cuz again your mental health exactly it is still everyone’s own responsib ability we can come alongside we can help as we can but apart from 24-hour care it’s like we’ll help you find that root cause and then here’s some as we started the show with here some baby steps of how we can start addressing it and it’s your it’s your mentality is your unseen challenge M that can materialize in a negative or positive way but it’s an unseen challenge because we don’t see it right we feel it and sometimes even our own feelings betray us absolutely so again if you have been watching and you feel that any of it’s useful we usually have the medical disclaimer that this isn’t medical advice really nothing you watch on the internet should be but still if any of this resonates with you: ascend health centers in Akron we see patients all over Ohio we do Psychiatry counseling uh aot treatment resistant depression treatments such as ketamine , transcranial magnetic stimulation and why you just talk for the last minute about uh how to reach Sunrise Vista Behavioral Health if someone has any problem or any know this like I said resonates with them
well they can reach the hospital directly we have both 1800 number and a local number we’re open 24 hours a day 7 days a week uh you and again we have a hospital that uh I would consider a great place to have treatment uh We’ve made so many positive changes you know in a hospital you never get to a place where you feel comfortable you always want to continue to improve and make changes that will be uh beneficial for the patient so our biggest challenge our biggest goal is quality patient care and so by all means you know if if you do have any mental health needs if you feel that uh that you have any questions call us we want to be a community resource to you as well
absolutely well thanks for being on the show today
it was my pleasure thank you so much for having me
absolutely
#TMS #ECT #akron #canton #Spravato #troubledteenindustry #depression #anxiety #treatmentresistant