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Bill Klaproth (Host): Mental health conditions as well as alcohol and drug addictions are complex issues that require dedicated and specially trained healthcare professionals. At ECMC, there is a center dedicated to helping these individuals with a variety of issues. Here to tell us more about the regional center of excellence for behavioral health at ECMC is Dr. Michael Cummings, associate medical director at the ECMC corporation. Dr. Cummings, thanks for your time today.

Michael R. Cummings, MD (Guest): Thank you so much for having me.

Host: So Dr. Cummings, can you tell us more about the regional center of excellence for behavioral health? Why is a center like this needed?

Dr. Cummings: Well, mental health diagnoses are prevalent in all walks of life, all socioeconomic statuses throughout this country. Just to give you some reference for comparison. If you take all of the disability associated with cancer and heart disease in the entire country, it is less than the disability associated with major depression alone, which is only one of the main diagnoses that we treat. There is a lot of modern talk about suicidality and the [dality ph?] risks in the modern media as well as in the scientific journal and medical research now. If you are an adolescent female aged 10 to 14, you have the same chance of committing suicide as you do dying in a motor vehicle accident. So clearly these are issues that everyone faces in everyday life. The Center of Excellence is here to help families and individuals through these processes and to achieve their best self.

Host: Well that certainly helps explain why a center like this is needed. You were just mentioning as one of the major conditions you treat. What are some of the other conditions and diseases that you treat?

Dr. Cummings: So we treat pretty much everything under the sun both in respect to mental health conditions as well as chemical dependency conditions. So all the major psychiatric disorders—schizophrenia, bipolar disorder, anxiety disorders, trauma, PTSD, depression to name a few. All realms of chemical dependency both on an inpatient and outpatient status. We’re starting to build a little niche for becoming a center of excellence for treating those with developmental disabilities, both within the psychiatric community as well as within the medical/surgical community within ECMC.

Host: This covers all ages. Is that correct?

Dr. Cummings: That’s exactly right. From 0 to 100 and anything above and below that if we can find them. We are really the major center in western New York and starting to become one of the major centers in the entire country for what we do.

Host: And ECMC is the only Buffalo area hospital that offers a psychiatrist in the emergency room and chemical dependency evaluations 24 hours a day, 7 days a week. Can you tell us more about that?

Dr. Cummings: That’s exactly right. So we have a psychiatric emergency room called CPEP. C-P-E-P. It stands for comprehensive psychiatric emergency program. There’s about 20 of them in New York state. We typically have the busiest one in the entire state. Once in a while New York City beats us. So we see individuals 24/7 in our psychiatric emergency room. Last year we saw almost 13,000 individuals throughout the year. We also have chemical dependency counselors within our emergency room. So that’s a 24 hour, 7 day a week service. People walk in all day long, get assessments, get evaluated for the needs for outpatient treatment, or, if necessary, inpatient detox and rehab treatment.

Host: So let’s talk a little bit more about the inpatient and outpatient care. How do you separate that? How does that work?

Dr. Cummings: So inpatient, we’re one of the largest providers of inpatient care throughout the state. We have 136 beds. 16 for those are for adolescents. We have a geriatric unit. We have a first onset psychosis statement, a chronic psychosis unit, and then some more general psychiatric units. We do about 3,500 admissions a year. So it’s a very robust service. Then we have an enormous outpatient behavioral health system. So between our four outpatient sites for psychiatry throughout the Buffalo area, we see approximately 35,000 visits a year. We have an additional three outpatient chemical dependency sites, which sees about 42,000 to 45,000 a year. So all totaled, we’re approaching 80,000 visits a year between chemical dependency outpatient care as well as the outpatient mental health care.

Host: Wow. That’s a lot of people. Dr. Cummings, do you think in this country we’re coming to grips with mental health where people aren’t hiding it as much? They're not taking it on themselves as much where they're saying, “I can just get through this. I'm just feeling down today.” Do you think we’re getting to the point where people are going, “You know what? I may have a problem and I do need help.” Hopefully we are. What do you think about that?

Dr. Cummings: Well, I think it is… We’re approaching that in the right direction. Certainly you see more public service announcements by athletes, by actors, et cetera. In the social media realm, there is a lot more open conversation about mental illness. Far different than it was even 10 years ago. In Erie County, we have a wonderful coalition made up of 16 stakeholders. The Erie County Anti-stigma Coalition, which it’s entire mission is to kind of get the word out about mental illness. Start the conversation. Have people feel comfortable talking about it, very similar to how they would be comfortable talking about their diabetes or their heart disease in everyday conversation. So we’re moving in that direction. I’d be hesitant to say we’re close to the comfort level that people have talking about other medical conditions, but we’re definitely moving in the right direction.

Host: Well, that is good news and I hope that we are certainly moving in that direction. So if somebody needs your services or wants your services, do they just check themselves in? Does a parent just bring a child in? Tell us about that.

Dr. Cummings: Well, so the emergency room, as I said, is open 24 hours, 7 days a week. We have all of our outpatient sites. Probably the best way, because they all have different phone numbers, is to call the Erie County Medical Center direct line, which is 898-3000. Then ask for psychiatric outpatient, chemical dependency outpatient. We have a great set of operators. They’ll get you to the right number. One of the new services that we developed within the last year that we’re really excited about is what we have called our help center. Our help center is approaching, it’s about 12 hours a day now. We’re working to get it closer and closer to 24 hours a day. It’s basically a walk in center where someone can come in, get an evaluation, get setup for an appointment within the next couple days. If they do need more intensive treatment immediately then they’ll be walked up to our psychiatric emergency room. It’s a growing program right now. We’re seeing about 140 new cases each month presently, but it literally is growing each and every month.

The goal for the help center is really to give people an alternative between waiting for a very long time for an outpatient appointment, which would be the status quo within our community, and having to utilize an emergency room. So this is to bridge that. So people who have urgent concerns can be seen that same day, and then be triaged to the right level of care that meets their and their family’s needs.

Host: That sounds great. So then after someone is checked in or receives a service, how do you transition these patients back to the community?

Dr. Cummings: So that is really… We have a whole team of discharge planners and social workers within the inpatient services as well as our psychiatric emergency room. They’re sole goal is to do just that. We certainly hand a lot of cases off to our own outpatient services, which is fairly seamless. But we’ve been working very closely with the local community mental health stakeholders, primary care physicians, the medical community at large to have what we would term these warm handoffs so that the care that is occurring on inpatient translates to the care that will be occurring on outpatient. Likewise in the other direction. There are many outside agencies that will send their high risk individuals to us for inpatient evaluation. The seamless communication between these two sites is invaluable. It’s a process. We’re getting closer and closer to where it works in the way that is in the patient’s best interest, but, you know, it’s obviously a bunch of different systems trying to talk to each other in real time. We have a lot of very good community partners in the Buffalo area as well as within the Erie County government, the Erie County Department of Mental Health to name the major one that is really facilitating this process in western New York.

Host: Right. If you could wrap it up for us, Dr. Cummings. Is there anything else we should know about mental health or addictions and about the regional center of excellence for behavioral health?

Dr. Cummings: Well, the reality of it is if someone is not struggling with some type of mental health difficulty— maybe not a pure disorder, but a difficulty—they certainly have a very close friend or relative who is. Just as if you started to have a numb arm or left sided chest pain, you’d rush to the emergency room. We may not need to rush to the emergency room, but these things should not be ignored. There are treatments that help people get over and recover from these conditions and even very serious mental health conditions every single day. People who reestablish their life, reestablish their developmental trajectory, really learn how to live their best lives with the help of trained professionals. Within the western New York region, the Erie County Medical Center’s Center for Excellence for Behavioral Health is the site to start with if you don’t know where else to go.

Host: Dr. Cummings, thank you so much for your time. I think that perfectly wraps it up. These things should not be ignored and there is help certainly at the regional Center of Excellence for Behavioral Health. Thank you, again, for your time. For more information, please visit ecmc.edu. That’s ecmc.edu. This is the True Care health cast from Erie County Medical Center. I'm Bill Klaproth. Thanks for listening.