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Sentara opens clinics for mental health, substance abuse care / November 14, 2018
With Southside Virginia communities experiencing rising opioid use, one local hospital is doing its part to reduce the number of victims caught up in the crisis.

Sentara Behavioral Health Services, part of Sentara Halifax Regional Health, has opened two clinics for chemically dependent individuals who may also have mental health issues: an intensive outpatient program and a partial hospitalization program. Both programs are a less intrusive and intensive means of helping people beset by behavioral health issues and mental illness to cope with substance abuse or achieve a substance-free life.

The aim is to prevent or reduce the frequency and severity of relapses and find better ways to address the multiple aspects of everyday life.

Before discussing either program, Substance Abuse Coordinator Catherine Wright and PHP Coordinator Laura Castle say it is important to get past the misconception that opioids are the sum total of the country’s and region’s drug problem.

“Many of the people we see here are functional addicts. They’re speed-balling a combination of crystal meth and opioids or heroin,” says Wright. She points out that crystal meth was and continues to be a problem, but since opioids were declared a national health crisis, that has become the focus of the latest war on drugs. No matter the drug, the need for treatment does not change.

Working in tandem, Wright and Castle, both licensed professional counselors, help individuals suffering from substance abuse and mental health issues to find the motivation to overcome their addiction while also addressing the behavioral issues that may have led to problems in the first place.

Wright describes her role as helping those with substance abuse issues find a reason to get off and stay off drugs — child custody or reconnection with family among the motivations. Castle’s role is to help people find alternatives to effectively manage everyday living with all its stresses and temptations, from therapy to meditation.

Castle said her partial hospitalization program, or PHP, is also available to people living with mental health issues, post-traumatic stress disorder, depression, anxiety or even chronic pain, but who do not abuse drugs or alcohol. They, like substance abusers, may need a structured and protective environment, but not 24-hour care.

People who cannot, for financial or other reasons, drop everything and move into a residential setting for an extended period can benefit from Sentara’s partial hospitalization program. “It is the most intense program before inpatient treatment,” she says.

Her patients are referred by psychiatrists, healthcare professionals, the Southside Community Services Board, employers and even clergy. They spend between 5-6 hours at the Behavioral Health Center, five days a week for at least a week. So far, no one has needed the PHP program, which began in August, for more than three weeks

Each session can include a mix of therapy, lessons in medication management, nutrition counseling, relaxation and stress management training, anger management, and grief and loss counseling, depending on an individual’s needs. There is also a psychiatric evaluation to assess the nature and extent of the patient’s mental health issues.

The Intensive Outpatient Program (IOP) was created to help chemicall- dependent individuals begin the recovery process. Wright equates her job to that of a gardener: “It’s my job to plant the seeds of recovery and to help them grow. It is up to each person to find their own motivation for wanting [sobriety].”

Like the PHP program, patients can be referred to the IOP by a psychiatrist, healthcare professional or the local community services board. Unlike the PHP program, IOP patients can also self-refer or be referred by family members. They will spend about three hours per day, three days per week working with professionals at Sentara’s Behavioral Health Center. The duration of their time in the program varies based on need.

Currently, Sentara does not offer medication-assisted treatment (MAT) such as Suboxone through either program, but Wright said she believes MAT will likely be in place by the end of the year. Just recently Sentara Behavioral Health Center added a licensed psychiatrist, Dr. Gregory Weiss, to their team, whose philosophy is to foster lasting improvements in each patient’s mental health and wellness with medication and therapy.

Many of Wright’s substance abuse patients struggle with issues of loneliness. Those who began abusing drugs at an early age never took the time to learn “who I am. Their normal development process never happened,” according to Wright.

Hence an important part of her program is the mental health aspects of personal growth and development. According to Castle, there’s another reason for combining both mental health and substance abuse services under one umbrella. It stems from their knowledge that between 50 and 75 percent of substance abusers have undiagnosed or untreated mental health issues. The drugs help them “feel more normal.”

Wright explained how she first came to understand the connection between substance abuse and mental health. She was working with a patient addicted to cocaine. What she did not know and did not see was that the same patient was living with undiagnosed attention deficit, hyperactivity disorder.

“He kept telling me, it makes me feel normal [using cocaine].” Once he was sober, the ADHD symptoms became obvious, Wright notes. It was then she understood what her patient had been trying to communicate.

Most people addicted to cocaine get agitated or lose focus when they get high, but her patient who also lived with ADHD became calmer. It took her witnessing the behavior of this patient with undiagnosed ADHD after he became sober to fully understand how and why the drug was so important.

“It sounds counter-intuitive, I know,” she says.

Castle adds, that is why it is important to treat both the obvious issues and those that may be masked by the drug abuse.

While work experience and personal observation may give Castle and Wright a better understanding of the need to combine their two areas of expertise, they say the real impetus for Sentara’s PHP and IOP programs is the lack of resources available to people living in the rural area.

The nearest inpatient treatment facility is in Lynchburg, according to Castle.

“Our biggest obstacle right now is lack of transportation and available childcare services,” says Castle.

Many of their patients lack access to vehicles or are no longer allowed to drive. Still others are solely responsible for raising young children. They cannot bring the youngster with them while at the program but have no one willing or able to care for the children in their absence.

On a positive note, the profession’s views on the best treatment methods for chemically dependent individuals and those living with mental health issues are evolving, both providers note.

Even crime prosecutors are “moving toward a treatment modality” away from punishment, according to Wright. She and Castle see the programs offered through Sentara as helping to shift that view.

Still, Castle says, patients who are also in the criminal justice system — most likely because of their substance abuse or mental health issues — must come to understand that there are consequences for their actions.

There is evidence to support those who argue that incarceration, then treatment produces better results in helping people overcome their addictions.

That’s for others to argue. Castle and Wright focus instead on services that help people move away from their past and stop punishing themselves for their mistakes.

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