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Bob Lewis (Host): And good evening, I'm Bob Lewis. We're continuing our series now with the experts from Summa Health about the offices and the expertise being offered by Summa Health for our community today. We're talking about Summa Health and the things they offer through their wide range of mental health services. Joining us today is Dr. John Kasper. He's the Vice Chair of Psychiatry and Director of Outpatient Psychiatry at the Summa Health Behavioral Health Institute. Dr. Kasper specializes in outpatient psychiatry programs for behavioral mental health. Dr. Kasper, first of all, thank you for joining us on this beautiful Sunday evening.

Dr. John Kasper: Yes, you're welcome, and nice to be here.

Host: Take us through the different levels of mental healthcare available at Summa, starting with this inpatient psychiatric care. Tell us what it involves and what level of the care might be needed.

Dr. John Kasper: Our inpatient psychiatric care represents the most intensive care that we provide. Usually, one of the major considerations for patients who are referred for inpatient psychiatric care is safety. At times, our patients will have symptoms to the point that they're a risk to themselves, possibly a risk to others, or unable to care for themselves outside of a supervised environment with a lot of support and structure. And so, we offer inpatient care for those patients in those situations. Generally, those admissions, those stays in the hospital are brief. And that's because we offer a wide array of other services that are available that are less intensive. And we'll continue to allow the patient to recover and then return back to family and friends and work.

Host: Tell us exactly who should seek out inpatient psychiatric care. How do you describe that patient?

Dr. John Kasper: These are patients usually who have a psychiatric condition that oftentimes requires medication. And we have specialized medications in psychiatry to treat a wide array of psychiatric diagnoses including schizophrenia, depression, bipolar disorder, and significant anxiety disorders, panic disorder. In the inpatient setting, we can make changes in medication rather quickly because we're having the assistance of our great nursing staff who can monitor both for improvement, but also can be aware of any difficulties patients may be experiencing with their medications so that we can address those as quickly as possible. This is also a place where patients who have co-occurring medical concerns can also be treated and followed by the many consultants that we have available across the many different specialties, including Internal medicine, family medicine, OB-GYN, surgery. Now, that we are actually on the campus of Akron City Hospital, we have the opportunity to have a more comprehensive care for our patients while they're admitted to any of our four psychiatry units.

Host: Now, what are some of the goals of inpatient psychiatric care?

Dr. John Kasper: So, the main goal is to address those safety concerns and to provide that support and supervision while patients may be experiencing, for example, an increase in thoughts of self-harm, suicidal thoughts. With treatment and the support and the medication provided in one of our psychiatry units, the risk decreases over time, and generally our average length of stay in the hospital now is somewhere between five and seven days. In the past, these hospitalizations were much longer. But because of better medication, better treatment programming, better facilities, to be quite honest, we are able to be more effective in our treatments and have patients improve to the point that they no longer require hospitalization and can move on to the next level of care.

Host: So, tell us, Dr. Kasper, what happens after an inpatient stay? What services are then available as their next step?

Dr. John Kasper: Yeah. It's a great question. One of the most important things in medicine in general, but especially for psychiatry, is what we call transitions of care. So when patients have improved after treatment at a more intensive level of care, we need to make sure that they have continued support and treatment after, in this particular case, discharged from the hospital. So, Summa offers a number of programs, including a partial hospital program and several intensive outpatient programs specific to different needs that patients may present with.

Host: Now, tell us about these programs. What do they actually require the patient to do?

Dr. John Kasper: Our partial hospital program is an all-day program. It is five days a week, generally lasts anywhere from one to two weeks. Again, Monday through Friday. There's a morning session. Patients have lunch and then an afternoon session.

Partial hospital is particularly helpful for patients after they have been discharged from an inpatient stay. It continues to provide support. There's a psychiatrist available to see the patients daily if that's what is necessary. I'm actually that psychiatrist. I'm the medical Director for our Partial Hospital Intensive Outpatient Programs. And it provides specific types of therapies that are helpful while patients transition again from the hospital back to family, work, school, back to their lives.

Just to distinguish the partial hospital program from our intensive outpatient programs, our intensive outpatient programs are half day programs. They're three days a week. The sessions are usually around three hours long. We offer morning, afternoon and, at some of our satellite offices, an evening program. Lots of flexibility so that if patients would like to continue working, or would like to continue with school, or just being involved with family and life in general, they can choose an intensive outpatient program schedule that works best for them. And we have intensive outpatient programs that specialize in behavioral health, in chemical dependency, and also in traumatic stress.

Host: Now, what kind of symptoms and behaviors can lead you to recommend a partial hospitalization program?

Dr. John Kasper: Many of our patients are referred from their outpatient mental health provider. During the course of their treatment, they may see an increase in symptoms that are interfering with their patient's ability to do their activities of daily living, again, including work and school, and the other things that they would like to do. The treatment providers are concerned that without a more intensive level of care and treatment, they may end up needing to be hospitalized at some point.

So, this partial hospital program is a space between the outpatient office where patients are seen anywhere from weekly to monthly to a program where patients are seen daily for treatment. And it is with the intention of providing more support and more intensive treatment to, again, stabilize symptoms and return the patient back to their outpatient treatment provider.

So, patients with an increase in psychiatric symptoms, concern about potential risk developing are referred to our program. They're also referred to our program from our emergency rooms where they may present in crisis and are determined to be in need of an increased level of care other than being followed in an office setting. And our partial hospital program is also extremely helpful, as I mentioned a little earlier, for our patients who are discharging after an inpatient stay. We can be more comfortable with the patient safely discharging to a partial hospital program, because we know that they'll have that attention from psychiatry, from the therapist. And we also have a full time nurse associated with our program.

Host: Now, how can programs like these, how can they prevent more severe symptoms or relapse to the patient was suffering from it?

Dr. John Kasper: One of the ways is we do a thorough psychiatric evaluation. We make a diagnosis. Based on that diagnosis, certain medications are helpful. So, we can start those medications in the program. And similar to the inpatient stay, we can monitor patients' response to medication, seeing whether the particular medication we choose is a benefit. Initially, there may be some side effects that would cause some concern for the patients. We can readily address those and be available to provide support and reassurance. And with that treatment, the symptoms begin to remit, that's in addition to the group therapy that they receive for essentially six hours out of the day. And during that programming, they learn different skills to help manage their stress. They learn about their particular psychiatric condition. They learn about the medications that are prescribed. All of this information is critical. The more patients are aware of what the particular diagnosis means in regards to symptoms and kind of signs and indications of exacerbation the better that they will do on down the road.

Host: Now, the intensive and outpatient program also includes a weekly family program. What is that involving and why would that be important for the patient and the family?

Dr. John Kasper: It's an excellent question. When we treat our patients, we're actually not just treating the patient, but we're treating their whole microcosm, so to speak. So, their family becomes very important, their friends become very important. Educating family and friends to the extent that patients are comfortable with family and friends being involved is very important, because family is a source of support. And a lot of what is being experienced by our patients may be the first time that they've been through anything similar, and that would include their families.

Being as educated and informed as possible is critical. And so, we welcome family involvement. And actually, it's helpful for us too, because patients often will not be able to tell us whether they are actually doing better or not. But family and friends can definitely provide that collateral information. And that's important in regards to any need to change treatment plan, whether that be medication or any of the other treatment programs that we're providing.

Host: We're talking today with Dr. John Kasper. He is the Vice Chair of Psychiatry and Director of Outpatient Psychiatry at the Summa Health Behavioral Health Institute, specializing in outpatient psychiatry programs for behavioral health.

Now, the inpatient mental health treatment partial hospitalization programs for behavioral health, they're all perceived as pretty intensive and extreme. And unfortunately, they often come with a lot of stigma still in society today. What would you like the people to understand about this type of treatment?

Dr. John Kasper: I agree with the assessment of the stigma being attached to psychiatric disorders. Fortunately, I've been doing this for about 30 years now. And I've watched that change significantly over time. I think we're learning more about psychiatric disorders. It's becoming more freely discussed in the media. Obviously, programs like this are important in getting information out about mental health in general.

I think It became a significant topic of discussion over the last three years with the pandemic. And I know that at all different levels, whether it be in the work environment, in the school environment, mental health, and essentially well-being, it has become very important and we realize that our mental health contributes to our physical health and vice versa. All of those things, I feel, have helped decrease the stigma associated with psychiatric diagnoses and psychiatric treatment. And that education that I mentioned earlier that we provide in our programs, both to the patients themselves and to families, we hope that will continue to destigmatize psychiatric disorders, which are medical, biological conditions that do respond quite well to treatment. I think there's been some thought that change is not possible, but that's absolutely not true. We treat, we effectively treat and patients respond well and then can go on with their lives knowing that they have that ongoing support provided now by either a psychiatrist, a therapist or the combination of both of those.

Host: Does it help when celebrities and other people of note come forward and talk about their wrestling with these types of problems to beat these stigmas down?

Dr. John Kasper: Excellent point. And as I said, the media, people who are stars, both athletes, movie, television, those out in the public eye who speak out about their own struggles and their successes with mental health issues goes a very long way to decreasing stigma and encouraging others to seek treatment.

Host: Now, there's a lot of commitment to time and individuals have to have frequent encounters with these programs. So, are they an option for folks who are still wishing to continue to work or for folks who are going to school?

Dr. John Kasper: Yes. So, we do want to make sure that patients have time to participate in our treatment programs so that they can get better and, again, be successful back at school, back at work, back at home with their families. For example, for our partial hospital programs, they are all day. They are one to two weeks in length usually. We will support our patients by filling out whatever necessary family medical leave forms or short-term disability forms, whatever is required by their employer to allow them to have the time available without the stress of either going to work or knowing that they have the ability to be away from work so that they can be as involved in their treatment and not have that added stress. So, we do support them in that way.

And then, as I mentioned, our intensive outpatient programs, because they're half day and we have morning, afternoon, and evening options, patients can at times still continue even maybe at a reduced level to participate in work and/or school. So, it just depends on what the patient is comfortable with doing. We will support them in any way we can. If they want to continue while in treatment in school or work, or we will help them have that time available to them so they can focus on their treatment and their recovery.

Host: So once someone completes an intensive outpatient program or a partial hospitalization, what types of ongoing care and treatment do they have available to them?

Dr. John Kasper: So ,many of our patients are referred from outpatient behavioral health providers. So, they would return to their individual therapists, to their psychiatrists, to both. Again, there's another transition of care. So, we make sure that they're ready to go to that next level of care. Make sure we have the followup appointments in place for them. There are patients who come to our programs. And we are the first, we are the front door for behavioral health treatment. We're the first behavioral health professionals that patients interact with. So, we assess their needs during the programming. And if they are wanting to participate in and we feel it would be helpful for them to have individual psychotherapy, we make those referrals. And if we've started psychiatric medications especially some of the more complicated psychiatric medications, then we make sure that we have ongoing psychiatric care scheduled for them as well. And that could be with a psychiatrist, or we also have advanced practice providers who specialize in psychiatry that work within our Summa Health Medical Group Behavioral Health Outpatient Practice.

Bob Lewis (Host): Now, with the increased awareness of mental health issues, there is also a growing demand for mental health services. Now, Dr. Kasper, can you talk about where you are seeing increased demand for mental health support?

Dr. John Kasper: Yes. Another excellent question. I know that we have need in kind of all across the lifespan. But particularly, one of the areas that I see an increased need for mental health services is actually in those young adults who are transitioning from adolescence into young adulthood. And whether that's simply going out into the job market or going off to college, that change at times is very stressful and can result in if someone is already in treatment for some type of mental health condition, an increase in symptoms at that time, or sometimes that's the first episode of a psychiatric disorder. So, a lot of the bigger universities realize this and have incorporated mental health services into their student health clinics, specifically to address that need.

And then, another patient population and demographic that we see increased psychiatric need is our older adults. And we have specific treatment at Summa for our geriatric population. And older adults who may be experiencing depression, may be experiencing some of the cognitive disorders that we're aware of, different dementias. So, those areas, we're seeing increased demand, as well as our chemical dependency patients who, again, are presenting more and more for treatment. And we have programs that are helpful for them as well.

Host: You mentioned earlier, Dr. Kasper, the pandemic and the effects the pandemic has had on increasing the need for mental health services for many reasons, not just for people who suffered from the disease itself, but just for the entire experience, the entire three years of living in a very stressful time. What are some of the most common problems that people have had in dealing with the pandemic?

Dr. John Kasper: I think a number of patients have experienced a significant increase in anxiety. And anxiety is a part of the human condition, but in the extreme can be very debilitating and can interfere with family, with school, with work. And the pandemic with the concerns about your physical health because of COVID-19, but also the fact that people were isolated and a lot of the supports that were available to them were for a period of time taken away, the ability to go to school, live in classroom, to engage in the work environment. We transitioned to remote work and also being isolated from family, depending on the age of a particular individual. Someone may have felt someone would be at risk if they were visiting because of concerns about the virus and all of that. So, there's a lot of social isolation. And as a result of that, depression and anxiety both, I think, increased significantly over the last three years.

Host: Now, the services we talked about, the essential mental health services are all available now at Summa Health. They have a brand new family behavioral health pavilion. So Dr. Kasper, tell us about your new building and the other services available.

Dr. John Kasper: Yes. The Juve Family Behavioral Health Pavilion, we're very grateful to Sharon and Rick Juve for their kind gift that has supported our brand new seven-storey behavioral health pavilion. As I mentioned earlier, we are now on the Akron City Campus, the Summa Health Akron City Hospital Campus.

Our services had previously been at Summa St. Thomas Hospital, had been there for many years. And that building became somewhat of a challenge as it was getting older and older. Summa Health and the board committed to building the new behavioral health pavilion and it was completed in December, and we moved all of our services there in January. It includes four inpatient psychiatry units. The fourth floor is our geropsych unit for older adults. Our fifth floor is for more acute, more symptomatic patients. Our sixth floor is actually what we call a dual diagnosis unit for those patients suffering from co-occurring psychiatric disorders and substance use disorders. And then, our seventh floor is a unit where folks with depression, anxiety, panic. Those conditions that are obviously still very debilitating, but present lower risk at times, that's our seventh floor. We have a all of our outpatient services are on our second floor. That includes the Summa Health Medical Group, Outpatient Practice, and our Traumatic Stress Center. And on the ground floor is the Heritage Center, which it was constructed to honor the legacy of St. Thomas Hospital and Sister Ignatia and Dr. Bob and Alcoholics Anonymous. And right outside the Heritage Center is our Serenity Garden.

And the important thing that I think people also need to realize is that there's a ground floor and a second floor. There's no first floor. We have a vaulted ground floor, and that's so we can connect to Akron City Hospital by a walking bridge on the second floor. And that's very symbolic, because we want to make sure that everyone knows that the mental health services are integrated into all of the care that is provided at Akron City Hospital .And so, that bridge is a nice physical reminder of that connection. So, we're very pleased to be in the new building. I love my new office. My patients love the space and we look forward to treating patients there for many years.

Host: Excellent. To learn more about Summa Health's mental health services, you can visit summahealth.org/mentalhealth or call 330-379-8190, 330-379-8190. Dr. John Kasper, Vice Chair of Psychiatry and Director of Outpatient Psychiatry at Summa Health Behavioral Health Institute.

Thank you for being with us here on WNIR Kent Akron. And again, continued good luck in your very wonderful work.

Dr. John Kasper: Thank you, sir.

Host: I'm Bob Lewis.