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Round up: A look
at inpatient psychiatry
in New England
RHODE ISLAND
(May 2006
Issue)
Rhode Island, with its small population and land area, appears
to be a place with a fair amount of sensible and collaborative health
care.
For example, Louis A. Cerbo, Ed.D, Eleanor Slater Hospital's administrator
of adult psychiatric services and director of psychological services,
speaks of the state's response to the recent increase in younger
(21 and 22-year-old) psychiatric patients with significant behavioral,
substance abuse and psychiatric problems. Eleanor Slater clinicians
have in the past year forged a collaboration with clinicians in
the community mental health centers. Together, they were trained
in dialectical behavioral therapy and now they meet regularly to
consult on patient care. "This has been very helpful with regard
to consistency," says Cerbo, which is especially important in treating
this patient population.
Richard Wagner, M.D., Eleanor Slater's chief of psychiatric services,
explains that Rhode Island patients are assigned to community health
centers based on geographic area, so patients are always discharged
to treatment, minimizing relapses. Additionally, Wagner runs a state
program providing a particularly long list of psychotropic medications
for the poor and indigent. Pharmaceutical companies cover the first
two months' supply, but the state pays for the rest, although some
are very expensive. Wagner tells how the funding for hospital care,
community health services and medications are treated as one budget,
which makes the administrator more cognizant of where savings really
exist. Even expensive medications cost less than hospital care (a
lesson not practiced by many other states).
Other new programs include Rhode Island Hospital's participation
in a national study to explore how to stop the progression of mild
cognitive impairment and Alzheimer's disease and another study focusing
on the quality of life for caregivers of Alzheimer's patients.
Also at Rhode Island Hospital, psychiatrist Lowell McRoberts, M.D.,
is working at the oncology clinic to treat patients with depression
and anxiety and to reassure other patients that their feelings are
normal reactions to a stressful illness. McRoberts is also working
with the transplant unit, helping to determine the appropriateness
of particular donors, as well as the willingness of potential recipients
to commit to a lifetime of healthy living and anti-rejection medications.
At present, he is referring patients needing therapy out to psychologists
in the community.
Harry Sax, M.D., chief of surgery at Miriam Hospital, speaks of
psychological screenings and treatment offered to patients seeking
bariatric surgery. "We need to know if these folks have the emotional
insight into whether they can make the long-term behavioral changes
necessary for long-term weight loss," Sax says. Patients may be
referred to psychologists and psychiatrists with training in obesity
and weight loss.
Elinor Nelson
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