Bill Klaproth (Host): If you or someone you know is experiencing symptoms that cause either severe difficulty in daily living or present a danger to themselves or others; inpatient hospitalization may be the best treatment. Here to talk with us about inpatient voluntary admission is Dr. Philip Sullivan, the Psychiatric Medical Director at Southern New Hampshire Health. Dr. Sullivan, it’s a pleasure to talk with you today. So, what types of patients do you see or who benefits from the inpatient Behavioral Health Unit or BHU as it’s called?

Philip Sullivan, MD (Guest): Hi Bill. Thank you for inviting me to be interviewed. It’s a pleasure for me too. So, our psychiatric inpatient unit is an 18-bed unit that takes voluntary patients, which means that people who come here are signing in because they want to come, and they are looking for care. They are willing to be here. So, we take the full array of psychiatric conditions that require inpatient care, from severe mood disorders like bipolar disorder and severe depression to disorders where people lose touch with reality like schizophrenia. We treat severe anxiety disorders where people are so overwhelmed by anxiety that they are unable to function normally in their lives. And we treat a fair amount of post-traumatic stress disorder- people who have trauma histories in their lives and the trauma continues to affect their stability and ability to function in their lives.

As a voluntary unit; we do not take people who are unwilling to be here or are presenting with such dangerous behaviors that we cannot manage them. But we do take people who are actively suicidal and in need of a safe environment to get better.

Host: So, voluntary admission means people check themselves in? Is that right? They want to be there? Is that correct?

Dr. Sullivan: Exactly. Yes. For instance, if somebody was unwilling to be admitted, say their family was insisting that they come to a hospital, but they say no; then we can’t admit them. But there is a process for involuntary admission, not at our hospital, but at other hospitals.

Host: Okay so what does this process look like then? How does somebody basically admit themselves? What is that process? Can you explain that to us?

Dr. Sullivan: Absolutely. So, the entry to our hospital setting is through the Emergency Room as it is for almost all medical admissions. We have a dedicated psychiatric assessment team in our Emergency Room, there 24 hours a day. So, people check into the Emergency Room, let the admission personnel know that they are there for a psychiatric crisis, and then one of our psychiatric assessors interviews them, evaluates them, and works on a plan with them about their needs and whether they meet the criteria for being on an inpatient unit.

Host: So, why is the voluntary admission option important for patients and families?

Dr. Sullivan: Well, it’s the most preferable option, and the vast majority of psychiatric admissions are voluntary. It’s actually fairly rare that people need to go the involuntary route. Most people come looking for inpatient treatment because they know that they are in distress. They know that they are having trouble functioning, or they know that they are in a state where they are unsafe and are actively looking for this and willing to accept an admission.

Host: So, how are families involved? How do you work with a family?

Dr. Sullivan: So, we work with families in the Emergency Room, and then we work with families once the person is on the inpatient unit. We have a dedicated social work staff who are trained to work with families. Families are as involved as they want to be, and I have to say also as involved as the person who is admitted allows them to be. People have a right to limit their family’s involvement if they want to do that. Most people do not. Most people see their families as supportive and as part of their treatment team. So, we have regular family meetings on the Behavioral Health Unit with our social work staff, our physicians, and family, along with the patient himself or herself, to include the family in the treatment team.

Host: So, Dr. Sullivan, can you tell us about the typical stay at the BHU? Generally, how many days, and what’s an average day like, etc.?

Dr. Sullivan: Absolutely. So, the average length of stay on our unit is five to seven days. We are a crisis-oriented unit, and we try to treat people rapidly and get them back to their families and their homes as quickly as we can. So, that being said, there are some people who stay longer if their illness and symptoms are more severe. So, sometimes we have people who are very ill who stay for a couple of weeks, but for most people, the average is five to seven days.

The typical day on the Behavioral Health Unit is a mixture of meetings with the treating psychiatrist, our internal medicine consultant if there are any ongoing physical medical issues, and meeting with the primary nurse, and then a series of group sessions that are focused on understanding of illness and learning about more adaptive coping strategies to help people function once they return home and not need to be readmitted. It’s a pretty full day we schedule.

Host: So, you were just talking about giving them coping strategies, working with them etc. What types of treatments or therapeutic services are available as well?

Dr. Sullivan: So, most of our therapy is group-based on the Behavioral Health Unit. Each – so there is a series of four or five groups throughout the day to help people understand themselves better and develop strategies to help them improve their daily functioning. In addition to that, we have – each person is assigned a specific staff person and meets individually with that staff person at some point during the day for an individual session, and then there is also a daily individual session with the treating psychiatrist to review the entire treatment and psychiatrists as medical doctors, as physicians are those who are in charge of treating with medications. In most cases, people who come to our unit have a level of illness where medication is helpful, so it can include antidepressants, mood-stabilizing medications, anti-anxiety medications, and medicines that are helpful for treating illnesses where people lose touch with reality, what we refer to as psychosis.

Host: So, when they are done with their stay; what comes next for the patients? How are they supported upon leaving the unit to ensure that they maintain their mental health?

Dr. Sullivan: So, we feel very strongly that a good, solid, supportive discharge plan is essential to an individual being successful in returning to their home, work, and family. So, we begin working on discharge planning literally the day that the person arrives. We have a – as I mentioned earlier, we have a dedicated social work staff who is in touch with all of the community resources that are available to support a person once they leave the hospital, and they work actively with the patient and their family on setting up those outpatient resources which can include transitioning into our day program which is usually those seven to ten days, two-thirds day program which provides many of the same therapeutic resources that our inpatient unit provides; but people are able to go home at night. Then, referrals to individual psychotherapists, individual psychiatric medication prescribers, and, for those who are most affected by their illness, case management services to help with providing help negotiating day-to-day stressors and events.

Host: Well, it’s very easy to see how the inpatient voluntary admission program at the BHU is very valuable, and thank you so much for talking to us about this today, Dr. Sullivan. And if you would like more information, please visit www.snhhealth.org, that’s www.snhhealth.org. This is Simply Healthy, a podcast by Southern New Hampshire Health. I’m Bill Klaproth. Thanks for listening.