Wednesday, February 26, 2014

Mental Health Task Force Explores System Reform

Dr. William Barker, Fauquier Hospital Emergency Department

In November of 2013, Austin Deeds, 24-year-old son of Virginia Sen. Creigh Deeds, committed suicide after stabbing his father. This was only hours after the young man underwent a psychiatric evaluation and was found to be in the midst of a mental health crisis. His emergency custody order expired while authorities were searching for a suitable mental health facility for him. No bed was found for him and he had to be released.

The tragedy highlighted problems with the mental health system in Virginia and presented an opportunity for state lawmakers and clinicians to address those issues. It also prompted Dr. William Barker, Emergency Department physician at Fauquier Hospital in Warrenton, to call Dr. William Hazel, Secretary of Health for Virginia. Dr. Hazel listened to Dr. Barker explain the mental health crisis from an emergency room doctor’s perspective; soon after, he appointed Dr. Barker to the governor’s Task Force on Improving Mental Health Services and Crisis Response. Dr. Barker pointed out that the task force was not created in response to one incident, but events like Austin Deeds’ suicide and the horrific slayings at Virginia Tech reinforce the need for reform.

Dr. Barker said, “It has become clear that we need to stop treating mental illness differently than other illnesses. In the emergency room, we wouldn’t send someone who was having a heart attack home because we didn’t have a bed available. As an ER doc who sees these cases regularly, this is something near and dear to me. It’s important because it affects patients, their families and the community.”

The 37-member task force is made up of doctors and mental health professionals, law enforcement and social services personnel, representatives from the courts and the legislature, and individuals receiving mental health services and their families. Members have been asked to “review existing services and challenges in Virginia’s mental health system and make recommendations, including legislative and budget proposals, for critical improvements to mental health procedures, programs and services.”

The task force has already made several recommendations, and on February 10 the Virginia Senate passed a bill, SB260, that would address some of these. The House of Delegates passed a similar bill, HB478, the following day.

Currently, an emergency custody order (ECO) is only good for six hours. That’s how long someone identified as being in a mental health crisis can be held involuntarily while a temporary detention order (TDO) is obtained. To obtain a TDO, a member of the community services board -- a therapist, psychiatrist or social worker -- must apply for the order, and the order must be signed by a magistrate.

Dr. Barker explained, “What we’d really like to do is create a seamless system where the ECO flows into the TCO and the times of each are not as narrowly defined. Basically, we don’t want someone who needs care to just walk away.”

Both the Senate and House bills included task force recommendations that specify -- in cases where no bed can be secured -- a place for the patient must be found in a state hospital, even if it means the move will put the facility over capacity. “It means that no one will be released if they are a danger to themselves or others,” said Dr. Barker.

Part of the problem with finding a bed for a patient is finding an appropriate facility. Dr. Barker explained, “Maybe there is a bed available, but it’s only appropriate for a male patient and the person is female. Or it could be that the opening is in a non-secure facility and the person requires a more secure placement because they may become violent or suicidal.”

The mental health task force also recommended the completion of a web-based psychiatric bed registry, to facilitate patient placement. Both bills currently up for consideration in the General Assembly include this recommendation.

The task force was specifically asked to come up with suggestions in time for legislators to act during the current General Assembly session, but Dr. Barker said that their job will go much deeper than custody order recommendations. “We need to find strategies to prevent these crises from happening. Everyone on the task force feels that we need to strengthen the system so that people who need these services -- medication and therapies -- but don’t have insurance or other options, can get them.  We need to find ways to make the mental health system better and more accessible to all. And we need to get mental health care more into the hands of clinicians and less in the hands of the courts and jails. That’s where the answer lies.”

Two New Physicians Join Fauquier Health OB/GYN

Fauquier Health OB/GYN
Dr. Wesley Hodgson, M.D.,  FACOG
Dr. Elizabeth Garreau, M.D, FACOG, FACS
Dr. Sumiya Majeed, M.D., FACOG
253 Veterans Drive, Suite 210
Warrenton, VA  20186
Phone: 540-316-5930

Dr. Elizabeth Garreau, Dr. Wesley Hodgson and Dr. Sumiya Majeed, of Fauquier Health OB/GYN.

With the addition of two new physicians, Fauquier Health OB/GYN has expanded to serve the needs of area families. Elizabeth Ann Garreau, M.D. and Sumiya Majeed, M.D., have joined Dr. Wesley Hodgson at the Medical Office Building on the Fauquier Hospital campus.

Dr. Elizabeth Garreau
With 23 years of experience, Dr. Elizabeth Ann Garreau, OB/GYN, is still enthusiastic about caring for patients. “OB/GYN is the only specialty that combines primary care -- seeing patients regularly during different phases of their lives -- with surgery, which is so satisfying because you can fix problems instead of just managing them. We can make such differences in our patients' lives!”

Dr. Garreau is a strong advocate for patients to seek care early if they notice a problem or something they don’t understand.  She says, “It is so exciting to find a disease or problem in a very early stage and treat it then, so the patient is spared from suffering from a much more serious disease.And when it comes to her pregnant patients, she emphasizes preventative care as well: maintaining a healthy weight, proper nutrition, regular exercise, and thorough prenatal care, to give the mom-to-be the best chance for a trouble-free delivery and healthy baby.

Sometimes, patients get even more than they bargained for. Dr. Garreau recalls, “We had a young woman who came in with a missed cycle. Her pregnancy test was positive and she left feeling surprised. During an early sonogram we found she was carrying twins. She left feeling really surprised. On her next visit, a sonogram showed she was actually pregnant with triplets!  She left joking, ‘I'm not coming back. Every time I come in you find another baby!’ She delivered three healthy identical boys.”

Dr. Garreau has a simple philosophy when it comes to caring for her patients. “Patients are generally smart and interested in their care, so they do better when they understand their condition and are given choices about treatments. I explain things in understandable language, and I provide lots of information.”

Dr. Sumiya Majeed
As the second new physician to join Fauquier Health OB/GYN in the last month, Sumiya Majeed, M.D., also seems to have a special calling to meet women’s specific medical needs. She says, “Women have a tendency to place their own personal health care needs at a lower priority than the other demands in life. I encourage women to take charge of their own health. To do that, they need the right information. I try to share with patients my understanding and knowledge of what is happening in ways they can understand. In fact, I am notorious for my poorly drawn pictures that I use to help them visualize things!”

Dr. Majeed has a particular enthusiasm for performing minimally invasive surgery; managing low-and high-risk obstetrics; helping women choose the best birth control choices, and providing gynecological care for young adults. “I love creating relationships with women that I get to see on a regular basis.”

A veteran of a busy city hospital, Dr. Majeed says that she appreciates the value of the patient-centered model at Fauquier Health. “I believe the women I will take care of here will recognize the effort that goes into making their care comfortable and safe.”