Can proactive mental health care actually shorten hospital stays and enhance recovery? Join us as we unravel this intriguing question with Drew White, a dedicated psychiatric Nurse Practitioner at Centra's Psychiatry and Behavioral Health Services. We tackle the critical rise in mental health issues like anxiety, depression, and substance use since, spotlight the pioneering emPATH unit at Lynchburg General Hospital, designed for emergency psychiatric care and confront the urgent topic of suicide awareness and prevention.
Drew offers a deep dive into how clinicians assess suicide risk and provides essential tips for non-clinicians on recognizing warning signs in loved ones. We emphasize the lifesaving importance of human connection and vigilance, along with sharing crucial resources like the national 988 suicide hotline.
This episode is a must-listen for anyone interested in the vital intersections of mental health and medical care, and in learning how to play a part in suicide prevention.
Speaker 1:
Hi and welcome to, and so Much More. I am here with Drew White, who is a psychiatric nurse practitioner here at Central Health over in Lynchburg General Hospital and he is within this larger service line that we call Psychiatry Behavioral Services.
Speaker 2:
Yeah, Psychiatry and Behavioral Health.
Speaker 1:
And Behavioral Health. So first of all, thank you so much for being here. I know you have a very busy day, very busy week, but I would also, I would love for you to just let us know who is Drew White and what brought you to Centra.
Speaker 2:
Okay, yeah, so I've been with Centra since 2009. And I've occupied many roles in that time. In 2012, I started working on our inpatient child and adolescent psychiatric unit and that's for kids between five and 17 years old and that's at Virginia Baptist Hospital, and when I was there, I was a counselor or a mental health counselor, and the nurses and the doctors looked like they were having all the fun, so I initially thought I was going to be a therapist and then I started working in the hospital and so, like I said, the nurses and the doctors I really liked what they were doing. It seemed fascinating. So I went back to school for nursing, went to and adolescent unit as a nurse, while I went to grad school at UVA for my master's and my psychiatric nurse practitioner degree.
Speaker 1:
Wow. And so here you are.
Speaker 2:
This is.
Speaker 1:
I mean, all of our service lines are so vitally important. But when I we just finished our community health needs assessment at the end of March and we talked about it constantly because of how important it is to learn what are the top needs within our community and mental health has been identified year after year after year after year, and so we are primarily going to have a conversation around suicide awareness, are primarily going to have a conversation around suicide awareness, but I also see how mental health and we were kind of pre-gaming a little bit before we started talking mental health touches everything, and I think that that can be almost a common misconception. So why don't you tell us a little bit about that from a really like, take a step back and look at the big picture.
Speaker 2:
Yeah, so you're right. You know, the community health needs assessment continually points out the need for mental health services in our community and I feel like that. That was just likely, well, certainly exacerbated by the pandemic. By the pandemic, you know, across the board we have seen increases in anxiety, depression, substance use over the last few years, across the life, across all age groups, and so that's very important. And as far as of what we were talking a little bit, I'm sure.
Speaker 2:
And then, as well as the inpatient medical floors, when people are admitted to the Lynchburg General Hospital or are outlying sites for a primary medical issue but also have a mental health or psychiatric need, I'm following those patients while they're in the hospital too, and what we see is when your mental health and your psychiatric needs are being met and addressed proactively, you heal quicker.
Speaker 2:
While you're in the hospital, the length of stay is decreased and, additionally, tied into that is when your mental health is not being well managed. We see patients and people in the community have more medical issues related to that. So an example I used earlier was like if someone has a severe mental illness like bipolar disorder or schizophrenia, as well as a medical issue like diabetes, if their schizophrenia or bipolar disorder is not well managed and they're not staying on top of that, then they're likely not going to be taking their insulin correctly or checking their blood sugars, and so then you see that person in the hospital more frequently for medical needs. And so what we're trying to do with my service that we have here with the service it's called Consultation, liaison Psychiatry, that's when you're in the medical setting practicing psychiatry is we're trying to be more proactively managing the acute and subacute mental health needs of that population to help them heal quicker. Okay, Wow.
Speaker 1:
So day in and day out, you're sitting down with many patients and you're called in as a. You know either it's chronic, you're seeing patients over and over, or you know this. There's just something there going on here.
Speaker 2:
And a lot of times when people are medically admitted, there's a certain level of psychological stress that accompanies that.
Speaker 2:
But also too, there are acute psychiatric issues that arise when someone is admitted medically, like delirium, you know, a lot of times in the elderly there may be an underlying neurocognitive disorder like dementia.
Speaker 2:
There may be an underlying neurocognitive disorder like dementia, and then that person comes into the hospital for a surgery, a procedure, and they get given anesthesia and other kind of medications that can cause disorientation and they don't recover from that like you or I would. You know they're older, it takes them a little while to bounce back from that, and so there may be a period of time where they're in the hospital and they are confused, disoriented, can sometimes become agitated, you know, sometimes combative, and so in those cases I'm called in to kind of help manage their medications and look to make sure there's no, you know, interaction between the medications they're on that could be exacerbating the issue and those sorts of things. And then, additionally, we've got patients, you know, severely mentally ill. Patients, like I said, also become physically ill and they end up in the hospital for things. And while they're in the hospital the primary medical team who's managing their care appreciates, you know, us kind of helping along to make sure that there's no decompensation of their psychiatric mental health while they're in the hospital.
Speaker 1:
Wow, so the whole body is considered, from your mind to the physical aspect yeah, and so important. You did mention empath and I'm very curious. Empath has been well. I'll let you explain what empath is right now over at General.
Speaker 2:
So empath stands for emergency psychiatric treatment and healing and it is a model of care emergency psychiatric care that was started in California by a emergency psychiatrist named Dr Scott Zeller. He's been a champion of this model of care and it's starting to catch on across the country. We were actually the first empath unit I know in Virginia and I want to say on the East Coast.
Speaker 2:
Very cool, and the goal or the objective for empath units in our unit is we used to have two options. When somebody would come into the emergency room with a mental health crisis, we had two options we could admit them to an inpatient psychiatric unit or we could discharge them. And what studies have shown? Multiple studies over the years have shown that approximately 75 to 80 percent of patients who arrive to an emergency room in a mental health crisis could avoid inpatient hospitalization. 75 to 80 percent of people who are admitted across the country to inpatient psychiatric units could have avoided that had there been an alternative level of care in place in that community. And so what Empath essentially is is it's observation. You know, now we have a third choice. You know, we can admit a patient to inpatient psychiatric treatment. We can discharge them. Or if we're not quite sure what needs to happen say we don't have enough data yet we don't, you know, we don't have enough information we can keep them. And so that's where empath comes in, and we don't just observe and keep them in a holding pattern, we start treatment. And so what we do the goal is to. You know, emergency rooms are not equipped to really manage mental health crises. They're equipped to manage physical crises, you know, but really if you're in a mental health crisis and you arrive in an emergency room and you know you're told you need inpatient treatment and then sometimes the length of stay while you're waiting for a bed could be four or five, six days, historically those patients would just sit there in the ER for four or five or six days, not really receive any treatment. What we're doing now with Empath is, as soon as the patient comes through and it's determined they need mental health treatment, we're trying to get them over to the Empath unit. We're evaluating them, determining kind of to the empath unit. We're evaluating them, determining kind of what their needs are. We're adjusting medication, starting medication, and what we're finding is, within 24 to 48, sometimes 72 hours, that patient who previously would have needed inpatient treatment were able to discharge to the community. A big part of that is case management. We have a case manager on the unit who, the minute the patients come over from the main ER, she's working on getting them follow-up appointments and getting them connected to resources in the community. We have group therapy sessions on the unit. We have individual therapy, so we're starting treatment quicker and we're stabilizing patients quicker. And what the data is showing right now. We've been open seven months and about 88% of the patients who have come through empath have been able to be discharged to the community without an inpatient hospitalization.
Speaker 2:
And that's not to say that there isn't a role for inpatient psychiatric hospitalization. But it can be disruptive being in the hospital, whether it's for a medical reason or for a mental health reason. It can be disruptive to your job. You miss work, you're away from your family. You could, you know, theoretically miss paying your bills. You could be. You miss work for a week, you could be short on rent on the first and then that just compounds your anxiety and your stress. So if we can stabilize people in 48 hours and we get them connected to services and we avoid an inpatient hospitalization, that does two things is it helps them get back to their life and addressing the things they need to address, and it also we have eight beds on empath. So that now means we have eight beds on our inpatient unit for higher acuity, sicker patients who previously wouldn't have had anywhere to go.
Speaker 1:
Yeah, so it has spread things out more evenly, but also more appropriately Right, so that not any particular people group is waiting obscene amounts of time which on some level in the emergency room is common and normal.
Speaker 2:
Yeah, it's just the nature of you know. I could talk for a few hours probably about the state of the mental health care system across the country, but I think it's important to emphasize what we're seeing here as far as boarding and length of stay. Oh, another point Let me hop back to the results of empath Sure Is the length of stay for behavioral health patients in our LGHED has, since Empath opened, has decreased by 20%. So we're because we're moving things along quicker, we're getting people where they need to go quicker, they're not waiting as long. But ED boarding for mental health patients across the country has been increasing exponentially over the last decade, 10 to 15 years, and it's because there's less. You know, there's a lot of state-funded psychiatric programs. Hospitals across the country have closed for various reasons, and so that has put the onus of managing this crisis kind of on the private health care system. And so that's where Empath comes in.
Speaker 2:
Everybody's trying to figure out ways to better address the needs of this population, and this is one way to do that.
Speaker 1:
Yeah.
Speaker 2:
Yeah.
Speaker 1:
I love how passionate you are about this. Clearly, this is.
Speaker 2:
I tell people all the time, especially students, when I have students come through or we've had several people interviewing, where you know we're trying to build up our service and I wouldn't. There's nothing else I'd rather be doing, it's just it's really been. This subspecialty of psychiatry is really kind of where I'm meant to be for sure.
Speaker 1:
Yeah, that's really incredible. I do want to touch on suicide awareness. In your particular role, how often do you come into contact with someone who is having an episode that you are seeing? This could potentially be a concern.
Speaker 2:
Yeah, daily, multiple times a day.
Speaker 2:
That's pretty so there's.
Speaker 2:
You know I touched a little bit on kind of the role of psychiatry in the inpatient medical world and as a consultant and helping the medical team manage the needs of patients that are admitted medically.
Speaker 2:
But as far as the ER my work in the ER is pretty much every patient I see there's some risk of suicide or self-harm as a component in their presentation, and so emergency psychiatry is a sub-specialty of psychiatry and that's really a big part of one of the biggest parts of what we do is assessing the risk for suicide and there is a whole, you know, field of science behind suicide prevention, suicide risk assessment, and you know this. You know wouldn't have enough time here today to explain all the nuances of how we do that, but it is a large part of what we do on a daily basis is talking to patients and evaluating their risk factors and their current. You know what they're currently telling us about their mental state and you know, is that person in need of a higher level of care or could they potentially be managed in a lower level of care like the outpatient setting? So that's 90% of what I do in the ER I would say is assessing suicide risk.
Speaker 1:
Okay, so first I had no idea that it was that prevalent and I think that that, you know, really highlights the importance of this prevention, and you were even talking about the science that's behind it. So from a clinical perspective, you are so equipped to be doing this work. What about those of us who, you know, have people we love, we care about in our lives? How do we notice those symptoms? To maybe be that one step ahead of, you know, keeping them out of a clinical setting, if at all possible, to prevent, you know, sometimes the need is to go into, but, you know, what can we look for? What difference can we make?
Speaker 2:
I think you know there's lots of things to look out for, but if this is one thing that we one of the biggest risk factors that we look at, one of the things that is a one of the largest red flags for us is a prior history of self-harming or a prior history of suicide attempts. So if you have a loved one or a friend that you're aware of in the past you know it could be 15, 20 years ago, but you're aware that they struggled with suicidal thoughts and at one point may have even attempted to end their life that is one of the biggest predictors of future suicidal behavior. Okay, so if you know that that is in someone's history and in their past not that you wouldn't take their statements seriously to begin with, but any time any change in behavior or concerning statements, you need to kind far as like what to look out for. You know concern. You know, of course, concerning statements people stating things like I just wish I wasn't around anymore or this would be life would be so much easier for everyone around me if I wasn't here those types of things are concerning, also, people that you know a lot of times, if they're considering, you know, suicide, there may be attempts to reach out to people they haven't spoken to in a long time and saying goodbye, things like that, yeah so. Or selling their belongings, those sorts of things, giving away items that maybe you would expect would hold special significance to them they're giving those away to loved ones, that sort of thing.
Speaker 2:
That's a very concerning, you know red flag and, of course, just overall shift in demeanor and mood. You know, if they seem very withdrawn, isolating, that's cause for concern and I think a lot of people shy away from this topic. It's still very stigmatized and taboo in a lot of settings. But asking somebody how they're feeling, like where are you at right now, yeah, like that can go a long way.
Speaker 2:
A lot of people feel a lot of people with you know suicidal thoughts and suicidal behaviors, feel alone and as though they're a burden on others. And showing someone that you love or that you care about that they're not can go a long way. That you love or that you care about that they're not can go a long way. Another thing I think is important to note is that suicide and suicidal behavior is a crisis-driven act and if you can interrupt the crisis long enough, you can kind of steer things in a different direction and this is backed up by research. There was a study done on survivors of suicide attempts from the Golden Gate Bridge. There was about they studied.
Speaker 2:
I read this yeah, and so they studied, I think, 300 people that had either had a suicide attempt interrupted on the Golden Gate Bridge or had even attempted and then survived. And they did a longitudinal study and they followed these people and 20 years later 94% of them were still alive. And so what that shows you is you interrupt the crisis, the individual's plans, long enough, and you can get them the help they need and you can funnel them into the appropriate resources. The chances for long-term survival are huge, so yeah.
Speaker 1:
So it's attention. It is just paying attention, really seeing the people that you love and, honestly, the people that you're around a lot. I think of how often you think of a workday, how often are you around your coworkers and we get to know them and you get to know their quirks and how they tick and how they interact, and even that I think you know. If that changes, that would be a major red flag. This is so helpful and I love how tangible some of these things are, how really practical they are. To be able to do your work is so important. I really appreciate you coming here. I do want to ask is there anything I haven't asked that you would like to speak?
Speaker 2:
to. I would just say that if you have concerns about um a co-worker, a friend, a loved one and you're worried that they um, either you have suspicions or you know for a fact that they are planning something to harm themselves. There are ways to get um people in to help um and you know, additionally, if you yourself are having thoughts of um that are concerning for thoughts of wanting to end your life or to harm yourself, there's the last year or year and a half or so ago, the 988, the suicide hotline. That's a national number now that you can call and they can get you into the appropriate setting to be evaluated. And they can get you into the appropriate setting to be evaluated. Also, our emergency department. You know if you have concerns for someone, you can ask them to come into our emergency department to be evaluated. Don't suffer in silence. There is lots of help available is what I would say.
Speaker 1:
Thank you so much, and thank you all for joining us on and so Much More.
