PRSRT STD U.S. POSTAGE
PAID
PERMIT #22 Palmer, MA 01069
Change Service Requested P.O. Box 5464 Bradford, MA 01835
MAY 2018
AN INDEPENDENT VOICE FOR THE REGION’S PSYCHOLOGISTS
VOL. 26, NO. 4
Psychologists weigh benefits, challenges of Should states bring back asylums? working in inpatient hospital settings By Phyllis Hanlon sychologists today have opportunities to pursue several different professional career paths. New England Psychologist spoke to psychologists who practice in inpatient settings and found that this venue offers both rewards and challenges. Before retiring, Robert J. Kamman, Ph.D, of Raymond, Maine, spent 32 years working at the Buffalo Psychiatric Center in New York, where he conducted initial screenings on every admission and determined the necessity for assessments. His responsibilities also included administering tests, running group therapy sessions, collaborating with the art and music therapist, occasionally treating patients on an individual basis and frequently working with families.
David Prescott, Ph.D has held several positions at Acadia Hospital over the years.
In spite of these challenges, he would encourage early stage psychologists to consider inpatient work for this underserved population. Kamman emphasized the importance though of finding a supportive supervisor and
“If psychiatrists support psychologists, life is good.” David Prescott, Ph.D, consultant, inpatient department, Acadia Hospital Throughout his career, the hospital provided a collegial setting and enabled Kamman to serve as mentor and supervisor to interns. Inpatient work also served as a learning experience as he was invited to take part in grand rounds and seminars. “I also had the freedom to take a position as an adjunct faculty and maintain a small private practice,” Kamman said. Although Kamman would follow the same career path given the chance, he pointed out that by the time he retired, the hospital environment had become more restrictive, governed by federal mandates and managed care.
engaging in activities outside the hospital to maintain your energy. When David Prescott, Ph.D, moved from Indiana to Maine in 1994, his timing was perfect, career-wise; the state was building Acadia Hospital and he landed a job as director of the day treatment program. Through the years, he has held a number of positions that involved inpatient and outpatient care and also worked in the quality and performance improvement departments. To be effective in an inpatient setting, Prescott said that experience working with patients who have severe, persistent mental illness, such as
schizophrenia, bipolar disease, severe depression or a diagnosis on the autism spectrum, is very helpful. Experience and comfort conducting group therapy are also key qualities. On a personal level, Prescott indicated that psychologists working in an inpatient setting must be comfortable “not being at the top of the hierarchy” as therapy has to be directed by physicians. Moreover, good relationships between psychologists and psychiatrists are critical. “If psychiatrists support psychologists, life is good,” he said. However, Prescott pointed out that while hospitals are mandated to hire physicians, nurses, social workers and other professionals, they do not have to staff the facility with psychologists. “The psychologist has an uphill battle of showing value in a hospital setting,” he said. Working in an inpatient setting can be a valuable learning experience, according to Prescott. He explained that you have a chance to interact with smart, talented people who can teach you things you wouldn’t otherwise learn. “You are exposed to other disciplines and can see new techniques in action,” he said. The fast-pace, rewarding environment and opportunity to work with a multi-disciplinary team in a hospital setting drew Alysha Thompson, Ph.D, to inpatient work. She is the attending psychologist in the Adolescent Inpatient Unit at Bradley Hospital in Providence, Rhode Island. Although patients are usually at their most acute state, the chance to manage and treat aggressive behavior, suicidal tendencies and other psychologically challenging behaviors can be professionally satisfying, she said. At the same time, dealing Continued on Page 11
By Janine Weisman resident Donald Trump has acknowledged what once might have been done about the volatile behavior of the 19-year-old suspect before the Feb. 14 mass shooting at a Parkland, Florida high school that left 17 people dead: “In the old days,” Trump told state governors attending a meeting on gun safety at the White House on Feb. 26, “you would put him into a mental institution.” The old days would have been 1953 when the number of state psychiatric hospital beds in the United States peaked at 559,000. That was before new antipsychotic medications and the rise of the civil rights movement led to a shift toward communitybased outpatient treatment for individuals previously considered lifelong hospital cases. Today, there are only an estimated 40,000 state and county psychiatric hospital beds, according to a 2017 report by the National Association of State Mental Health Program Directors. Deinstitutionalization emptied hospitals but ultimately filled prisons, jails, and the streets with people with serious mental illness when adequate funding for community mental health care never materialized. Trump’s public comments mirror renewed interest in the role of mental institutions in American society, despite the
history of abuses like those portrayed in the classic film, “The Snake Pit.” Among those advocating for a rethinking of asylums is Dominic Sisti, Ph.D., an assistant professor in the Department of Medical Ethics & Health Policy at the University of Pennsylvania where he directs the Scattergood Program for Applied Ethics in Behavioral Health Care. Sisti published a paper in JAMA in 2015 titled “Improving Long-term Psychiatric Care: Bring Back the Asylum” arguing that “safe, modern and humane” psychiatric asylums make both financial and moral sense. The original meaning of asylum was a place of refuge where people with mental illness could live and heal and receive humane treatment, Sisti said. “The idea isn’t to rebuild Willowbrook or the awful snake pits that were in documentary films in the 1950s and ‘60s at all,” Sisti said in a recent phone interview. “It would be extraordinarily foolish for anyone to say we should go back to those places. They were not asylums. They were snake pits.” Initial reaction to the paper was negative as people got hung up on the subtitle, Sisti said. Then he started hearing from others who were more favorable. “People didn’t really read the paper. They saw screenshots and tweets and things Continued on Page 11
INSIDE
Brattleboro Retreat expands telepsychiatry services .............................Page 7 Vermont searches for solutions to increase bed capacity................................Page 8 CE listings.................................................Page 13