January 24, 2011

St. Vincent Charity Medical Center doctor shines light on mental illness and its treatments

Recently published in The Plain Dealer, the following op/ed by Leslie Koblentz, M.D. of St. Vincent Charity Medical Center shines light on mental illness and its treatment in response to the tragedy in Tucson, Arizona.

Shining light on mental illness, its treatment: Leslie Koblentz, M.D.

By Leslie Koblentz, M.D.
Published by The Plain Dealer, Sunday, January 23, 2011

While our nation is reeling from the impact of the tragic shootings in Tucson, Ariz., and the issue of mental illness is once again thrust into the national spotlight, we must remember certain truths about mental illness.

It's a fact that a very small number of mentally ill persons are violent. They are more apt to be victims of crime and have antisocial behaviors than to exhibit violence. And yet when they do exhibit violence, it can have horrific consequences. But what can we do to prevent such outbursts?

Adequate funding: Following the Virginia Tech shootings in 2007, the state of Virginia expanded its funding of mental health services. However, the reality of state budgets in Virginia and Ohio and across the country has meant deep cuts in mental health funding. In Cuyahoga County, we are fortunate to have the strong financial and programmatic support of the Alcohol, Drug Addiction and Mental Health Services Board. As the state of Ohio prepares its next biennial budget, we need to remember that mental illness is just that -- an illness that requires treatment.

Access to care: The city of Cleveland is a mega-center for psychiatry. We are very fortunate to have not only the psychiatric services provided by the likes of St. Vincent Charity Medical Center, University Hospitals, the Cleveland Clinic and MetroHealth Medical Center, but we also have three psychiatry residency programs to train future psychiatrists. A number of mental health agencies also provide critical outpatient psychiatric services on an ongoing basis.

Even with all of these resources, there are still many gaps in the delivery system.

Role of emergency care: The Psychiatric Emergency Department at St. Vincent Charity Medical Center is one of only two such dedicated psychiatric emergency departments in the state and one of only a handful in the country. We are in a unique position to positively identify risks of violence in mentally ill persons that otherwise might be missed before they reach the level of the Arizona tragedy.

When people arrive at the Psychiatric Emergency Department, we assess whether or not they are a danger to themselves or to others. We perform a vital and unique service for the community that seeks to identify and treat patients as well as protect society from those who do pose a risk.

Prior to discharge, we conduct another risk assessment that evaluates a person's access to weapons, what kind of support services are available to the individual, whether he or she should be observed in a safe environment or admitted to an appropriate hospital. We work closely with Mobile Crisis, Mental Health Services, the Alcohol, Drug Addiction and Mental Health Services Board and all community mental health providers.

Coordination among providers: One of the existing challenges to care is the inability of mental health providers to share information about patients. Many mentally ill patients have difficulty caring for themselves. But a coordinated system of care would allow providers to know who has seen a patient last, what medications that person is supposed to be taking and where he or she is supposed to receive care. Those kinds of initiatives should become an imperative for improving care.

Dispelling myths: The reality is that mental illness knows no financial, racial, religious, geographic or gender boundaries. It affects people from rural areas and suburbs to people in the city's urban core. But it can and must be treated with a coordinated plan to include comprehensive psychosocial and medical services.

When you have a heart attack or break your arm, you seek care at an emergency department. Mental illness deserves the same access to emergency assessment and treatment as a broken arm or a heart attack. Because, when left untreated, mental illness can have catastrophic impact.


Koblentz is acting chairperson of the Department of Behavioral Health and medical director of Psychiatric Emergency Medicine at St. Vincent Charity Medical Center and director of Emergency Psychiatric Services at University Hospitals.

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