Search for mental health; Adolescent psychiatry

The Forest Hospital located in displaying the lanai presents the search for mental health and exploration of the newest advances in psychiatry. During this series physicians and other professional personnel working in the area of mental health at Forest Hospital a hundred bed treatment facility will discuss the latest advances in Mental Health Care Research and Education such topics as alcoholism adolescent behavior marital problems problems of the aged suicide emotional problems and others will be presented on the search for mental health. Your host for this series is Mr. Morris Squire administrators of Forest Hospital. There's more a squire and a special guest for today's Dr. Hewitt Fitz Ryan who is a psychiatrist in Colorado and the director of consultations and education at Denver Colorado at the Denver General Hospital. Dr. Rine your past interest has been in adolescence How

did you get interested in adolescence. Well I think during training that I had some experience as part of my training with adolescence and as a result. Of that experience I was quite willing to accept a job with the Department of institutions with the juvenile bureau of the departments of tuitions in the state of Colorado after I completed my residence a training does take a special kind of psychiatrist become an adolescent psychiatrist they sometimes say that in order to be an adolescent psychiatrist you have to think like an adolescent. Well I I think that. Along that line I think that it's important that people who see adolescents do see them and see a lot of them. I think that somebody who is saying out of adults primarily I may have more difficulty with adolescents than somebody who is seeing them regularly and

is really used to working with them. All right listen psychiatrist today train his speciality or are they child psychiatrist or adult psychiatrist can read into the special age group up to the present time there hasn't been any special training for people who've been working with adolescents and child psychologists have tended to get into the area of working with adolescence and I sometimes have gone on to specialize in seeing adolescents but it's also work the other way on people who have been practicing adult psychiatry become interested in adolescence and they to perhaps more than child psychologists even have tended to. End up in that area. How do you feel about the adolescent population in and around Colorado. Are they more. Denver Colorado are they more disturbed than the adolescent population was during your adolescence. Well that's I suspect I think that's a difficult question to

answer because of course the youngsters that I see in there who come to my attention are youngsters who are having difficulty and I'm really in a better position than a lay person to say what it was like in the old days. Well that's what I said in your days when you were useless and try to cope and try to bridge to that point just my own feeling is that there aren't any more sick adolescents today than they were then proportion wise and I was as well. I think what has happened and what often gets commented upon and I don't have a very firm opinion about it but there's I think a considerable feeling that adolescents are not as carefully supervised and are not expected to be as obedient to their parents as was the case a decade or two ago. I've known for example of situations in which parents were instructed by teenage youngsters to be out of

the house while they had their party a particular evening and the parents would comply with this pretty wild thing which I don't think is really providing the support which adolescents do need. What is the key to the treatment of adolescents in your opinion. That's a little tough. Well you know I think that's a difficult question I think you have to bear in mind when you talk about training how to lessons that are adolescents who have some difficulty and need some help. And who does not really require extensive treatment and may respond to a certain amount of support and perhaps not to very lengthy or prolonged treatment and that there are other adolescents who very much need treatment and need to be dealt with quite effectively by somebody who is really wanting to take charge of the

situation. Like a psychiatrist like a psychiatrist Yes instead of a mother or a father. Yes. Well shouldn't the mother or father take charge of situations that have a psychiatrist. Well I you know I think you're being you know somewhat provocative and I of course you know I think that it's really it's programmed I think that I think if that had happened in the first place that often they psychiatry's would not be necessary I would certainly agree about that. Well that is the kind of stripping the right patients. Well what comes to brings us to an important question is whether or not you involve the parents when you're working without a license. And often that is indicated as a matter of fact I make it a rule not to involve the parents with when they had a lesson so are relatively young up to about age 15 or

16 at about age shot 15 or 16. I consider seeing a youngster without seeing the parents without involving the parents directly and interviews with banks on a prolonged basis. What are your feelings regarding the people who are doing family therapy and how do you feel. These people say that you should not be seeing the individual alone every should always take into consideration and see the total family to understand that the diagnosis the family the treatment that is necessary. Well I think that's certainly a point which is. Well worth taking into consideration I think there's certainly an argument along that line and of course more and more the tendency is to involve not only the family but the extended family and the community and so forth and and treating individual patients. I think that it works. I think it's why it works

to see individual patients after a certain age I think that you can accomplish your purposes I think with children and with young adolescents that it's. Probably really necessary that the parents be seen. Your present rule is not without lessons within the Denver Colorado Hospital. It's with more with an education and consultation services and I'm curious what a wonderful time psychiatrist doing with consultation this is to other physicians to the community too. Well the kind of consultation that I've been involved with and where I'm going to be working at Denver General Hospital and General Hospital incidentally is the one in a simple hospital which serves a city and county of Denver Colorado and has an active community mental health program it's going to be the Community Mental Health Center for Denver and provide all services

under the direction of H.G. Whittington who is a man who is becoming prominent in the community mental health field and wrote a book. This has just been published called psychiatry in the American community and he's come to Donovan is providing leadership in this area in Denver. And I'm working on not hospital but not primarily in the community mental health field as such but rather you know in the hospital on the general medical and surgical floors. Working with interns and residents seeing patients for them without talking about patients helping them to deal more effectively with the people that they're saying as people rather than as a bang up in case of a particular illness which they're trading.

Certainly a very constructive kind of approach this is a guy working with the medical surgical. But on their own because it's been said I think it's been said at this meeting that often people get. I read a very reasonable training good training and a medical school in psychiatry but unless they go out into psychiatry I don't I don't continue to make use of what they've been taught and internship. They may begin not to look at the patient from the point of view of the total problems which the patient is experiencing but to limit their viewpoint and at Denver General we're very much aware of this problem. We've had the experience of. You know recognizing that about half of the interns really have had very good training in psychiatry from medical school. And the problem is to make gov has to

help them to go on using it and to make up for the United courses in the training of other people. And the internship and residency program and get them to think. More about their patients from an emotional and social logical point of view. But this takes more time Dr. How are you able to accomplish this with the residents and it was so busy. Well I've been doing what I've been doing now for only a matter of months and up to this point. I've really concentrated on providing service for the hospital stuff. And getting them used to the idea being to realize that psychiatry can be helpful and treating and managing patients. And I think that this has been well received and whereas in the beginning I was off to see people who were thought to be suicidal or who were presenting real problems in the

hospital in regard to their management were hilarious and so forth. I'm now being asked to see people who have dermatitis and. There's a feeling on the part of the intern that perhaps emotional problems are contributing to this. And I trust that this will continue. I actually have only been working on the inpatient service and now. A Denver General is going to have a program I continued Kerrick clinic for interns and residents where they see patients. Home. Have had us patients either in the emergency room or around the hospital wards and these patients will be their patients for the total hospital experience for example of thought and in turn sees a patient in the emergency room who comes in with perhaps some kind of minor trauma and is not hospitalized when the patient comes back to the hospital to a later time. This patient will become that intense patient and he will continue to see him which means that

where. Patients present who have emotional problems or somatic complaints for which there is not a physical explanation readily available who are hypo can drive call. The internal resident is going to have to figure out how to relate with that patient and how to be of service to that patient rather than referring the patient to another clinic for a continued. Medical work up so that you can make it was not his clinics. Well this is not unusual has not been unusual and of course only tends to. Make permanent whatever kind of emotional disability been reflected on patients through somatic symptoms. I the only physicians in Denver Colorado willing to accept this kind of intervention. Well the by older physicians practice looking towards or practicing medicine in the community. Yes I think that this is one

of the reasons one of the reasons I'm interested in doing what I'm doing and I think it's useful and I feel that others should be interested in this kind of work is that in the past physicians perhaps have not learned to make as much use of psychiatric consultation as they might. Dr. Ryan I wonder if you could. Tell us a little bit about the aspect of direct psychiatric services to the patients who are in Denver General. How big is the hospital first or the hospital I guess approximately 250 bed hospital inpatient psychiatric service only has approximately 18 beds at the present time. And this has been by design although eventually we expect to have two hospital wards. Until recently there were two hospital wards one of which was a closed ward and the other. One of which was an open ward. By this I mean that patients who

came into the hospital who seemed to be disturbed or were expected to cause problems would be hospitalized on the closed ward where they would not be allowed to leave the ward without permission or being accompanied and so forth. However you know we now do not have a closed ward at Denver General Hospital. Do have a day care program a partial hospitalization program which has made it possible to operate with fewer 24 hour hospital. But this is a this is the county hospital isn't it so this is the hospital which services the city and county of Denver scene is a municipal hospital it's a teaching hospital so it's a free hospital really. Well no it isn't it isn't because patients are billed or billed according to their ability to pay. They have insurance you pull a Bill in fully and if they have insurance they would be billed for all the times I

diet. Denver General Hospital on the psychiatric service. Would cost $35 service which is what a psychiatrist that includes the psych I addressed this guy just a resident attending mineral wealth we have for regular attending my we have stuff psychiatrists who head up the inpatient program director for the day care program and of course the hospital stuff is enlarged by other mental health professionals and yes we have a strong stuff of registered nurses and who are well trained and experienced in field of psychiatry and of social workers and we have. A good number of psychologists is the receiving hospital also. Now this is the receiving hospital for the psychiatric patients. Yes to all patients who come

to the state hospital therefore have to go through the receiving hospital no that's not and that's not necessarily so. I might just go on for a minute I'm sorry that the stop which we have services provides the services which are thought of when no one talks about the Community Mental Health site or emergency services partial hospitalization 24 hour hospitalization. I was a nation clinic and of course consultation and education so that. We have a style which encompasses all of those areas. But how does this compare to Fort Logan which is also in the Denver area. That is an open hospital based on the community therapy principle. This hospital with a psychiatric and 18 minutes compared to that hospital it's a different kind of solidly.

Well I think that the goals of Denver John are allowed to provide short term treatment and the patient stay on the inpatient service is approximately 18 days and the average duration of stay in the hospital. And during that time a treatment plan is worked out which includes the facilities which are available in the community that can be used useful way such as rehabilitation programs. And if it's possible to return the patient to the home then the patient will be discharged from Denver General Hospital from the inpatient service at the time the patient might go on to the day care program and to come in just during the day time or be referred to one of the mental health teams where a follow up treatment would be available if in fact the patient needs one thier hospitalization then the patient would be referred on to the Fort Logan hospital

which is the state hospital thought for the area. The four county area which is more than the area which Denver General Hospital services but is the hospital the state hospital which provides psychiatric treatment for the Denver metropolitan area. And their patients are treated at greater length. Using mill you therapy which also is used in our General Hospital about patient stays at Fort Logan hospital probably average at least four months in duration. I see it. So that the. Purposes of the two hospitals they are they. Object is different. Well due to different kinds of patients with different kinds of the CS categories and as one treat neurotics as you know in treating psychotics you treat schizophrenia said then we generally do though

the patients the patients that are seen at Denver General ordinarily have a lot of illnesses the description of the illness fits only major in the category of major psychiatric illness right. So that whether a patient goes on to Fort Logan or not really depends on whether and how accessible the patient is to treatment how quickly he compensates how able he is to use the service as a doctor general if it becomes apparent that this simply isn't going to happen right away. Then there's an arrangement are made for the farm to go out of state hospital. Is there any kind of statistics as to compare the rate of return in 18 days for Denver General Hospital to them or General Hospital or another psychiatric facility. I think that this has been done I think that I am aware of people having looked at this recently but I can't at the moment just what it would be my Dana neighbor a neighbor of 33 percent returned and returned 12 percent

richer and 15 percent return. I just I just be making a guess it's not it's not high because. The right of return is not markedly high because of the follow up which is available through the mental health teams there is a definite follow up when I was this works both ways however. Because if you're following somebody and one of the mental health teams then you're very apt to return a patient to the hospital promptly. If you become concerned about the patient group so that you wouldn't really be able to tell whether or not you are doing a better job or not such got a job it's not such a good job on the basis of the of the return. To the hospital. There are statistics that tell us that if you follow one patient out he is less likely to come back as men patients. He would you agree with that statement. Except for what I just said which is that you know there are patients who get.

A particularly high thank God when one is dealing with the social lower social economic group it's possible have a patient in the hospital and have the patient leave the hospital better and get lost to follow up and not come back to the hospital anybody ought to come back to the hospital. I see but if you are finally going to catch him in a hurry or if he's in follow a period you'll know you know the Russians and the East Europeans is said also that they would if they feel like it they can send a patient on a month's vacation how would you feel about that as the gaieties would you like to do that sometimes. I did it recently and what happened. I was in a situation in which I had to leave Denver and I had a depressed patient in the hospital who was beginning to respond and I had great difficulty persuading his family including his teenage son and even younger daughter to let him come into the hospital. And I was going to be away and I thought that when I was gone having had this great difficulty

persuading the family to let him come into the hospital that they probably would take him out of the hospital if I had another psychiatrist covering for me. And this was a man who liked to fish and I thought of all the family members were too much for him to handle. And I sent him on a fishing trip for the time that I was away out of the hospital he left directly from the hospital took his wife left the rest of the family at home. And he did very well. This of course was contrary to what many of you had to a basic principle. Which I think most psychologists embrace and. Which is that you can't make a person better or feel better by sending him on a vacation because he's only going to feel worse. It's like trying to cheer up somebody who's depressed if you say something nice to a depressed person. You can of course have a person in tears because he or she doesn't feel that he deserves to be treated.

That way since he's so great. Redden. Very interesting point thank you very much documenting it. Ryan who is the present director of consultations and education service at Denver General Hospital in Denver Colorado and this is more a square for the information regarding this program. Please write to this local radio station or deforest hospital explains online. You have just heard another in the series the search for a mental health produced by Forrest hospital in this plains Illinois in cooperation with this station. During this series decisions and other professional personnel working in the area of mental health at Forest Hospital a hundred bed treatment facility well discuss the latest advances in mental health care research and education. Other topics such as alcoholism adolescent behavior marital problems problems of the aged and others will be presented on the search for mental health.

Your host for this series is Mr. Morris Squire administrator of Forest Hospital. The search for mental health is produced and directed by Jacques Rogge our. This program was distributed by the national educational radio network.