College Provides AED Training

The presence and proper use of an Automatic External Defibrillator can make the difference between life and death in a cardiac emergency. An AED can determine if a person in cardiac distress needs an electric shock, and then deliver that shock.

Efforts to place AEDs in buildings across The University of Alabama campus began last year and as awareness of the AED grows, so are the number of faculty and staff being trained to use the devices.

The idea for placing AEDs on campus came about as the University critiqued itself on the Chain of Survival set forth by the American Heart Association’s Emergency Cardiovascular Care Committee. The chain has five steps: call 911, perform CPR, use an AED, have paramedics close enough to respond quickly and be near a hospital. After reviewing these steps, it was determined that the only step lacking was the AED.

The first installment of AEDs on campus began in July 2009 when the College’s Capstone Foundation and EMPACT West Alabama, a non-profit organization that provides emergency medical and community training programs, provided financial support to purchase 75 AEDs to install in high-traffic buildings on campus.

The installation of AEDs in existing buildings is a continuing effort. New construction bids must include an AED to ensure that all new buildings will have them.

Each building with an AED has a minimum of four people who have been trained to use the device. Although only four people per building are required to be trained, there are sometimes 12 to 20 who come for training.

Glenn Davis

Glenn Davis, EMT-P, director of the EMS program in the College’s Institute for Rural Health Research and who assists EMPACT West Alabama, says he recently held a training session for Gorgas Library and 25 people showed up. “People in the buildings have enthusiastically adopted the AED and the training that comes with it,” Davis says.

To date, there have only been two instances on campus when an AED has been used on a person in cardiac arrest, and both were successful in saving those people’s lives.

The University works in compliance with the guidelines of the Emergency Cardiovascular Care Committee for the Public Access AED Program. The environmental health safety program sends inspectors to check AEDs in conjunction with their other annual safety checks across campus. All AEDs are located within public view in buildings.

“It has been a team effort to get the AEDs in buildings on campus, and it is great to see people on campus gather around something that can save a life,” Davis says.

Alice McLean Stewart Endowed Lecture on Addiction

The Alice McLean Stewart Endowed Lecture on Addiction will be Tuesday November 8th in the Willard Auditorium of DCH Regional Medical Center. Dr. Lori L. Davis will present “Does Concurrent Substance Use Disorder Reduce the Effectiveness of Antidepressant Medication Treatment of Major Depression?”. Dr. Davis is Associate Chief of Staff, Research and Development Services, Staff Physician at the VA Medical Center. She is also Clinical Professor in the Department of Psychiatry and Behavioral Medicine at the University of Alabama School of Medicine – Birmingham and Tuscaloosa Campus.

Dr. Rebecca Pauly – September 20, 2011

O'Neal Lecture – Dr. Cassandra Simon

The Dr. Joe W. and Virginia Hursey O’Neal Endowed Lecture will be Tuesday October 25th in the Willard Auditorium of DCH Regional Medical Center.  Dr. Cassandra Simon will present “Each Life Matters: Saving Families from Grief Through Breast Cancer Early Detection.”

Telepsychiatry: Moving Mental Health Care Closer to Rural Patients

by Leslie Zganjar

In Alabama, 42 percent of the population lives in a federally designated mental health professional shortage area. In the state’s rural communities, mental health services are in even shorter supply.

Thaddeus Ulzen, MD, a psychiatrist and interim dean of the College, knows these statistics all too well. Not only is there tremendous need for mental health services in rural areas, he says, but mental health challenges there are often greater because, with less access to care, patients may present later with more complications. In addition, rural residents often have no choice but to seek help from their primary care physicians, who are already overwhelmed with heavy patient loads, he says.

Ulzen says for rural populations that are geographically isolated or financially unable to travel long distances to urban areas for care, moving mental health services closer through telepsychiatry is invaluable to improving access.

The College began work on a telepsychiatry program in 2007 when it partnered with the Alabama Department of Mental Health, West Alabama Mental Health Center and others on a $1.2 million grant awarded by the Bristol-Meyers Squibb Foundation to improve mental health services in Alabama’s rural and impoverished Black Belt region. The grant enabled the College to begin providing telepsychiatry services to assist the Demopolis- based West Alabama Mental Health Center, which has facilities in five rural West Alabama counties.

Two years later, the College’s Institute for Rural Health Research was awarded a $99,800 grant from the U.S. Department of Agriculture’s Distance Learning and Telemedicine Grant Program to purchase cameras, monitors and other equipment to bring telepsychiatry services to rural Alabama clinics that parterned with the Institute on the  grant. The clinics include Capstone Rural Health Center in Walker County, Carrollton Primary Care in Pickens County, Cahaba Medical Care in Bibb County and Monroeville Primary Care in Monroe County.

Last year, the College began providing telepsychiatry services to DeKalb County Youth Services.

Today, the College continues efforts to expand its telepsychiatry program with plans to provide services to additional sites in DeKalb County and sites in Etowah and Cherokee counties, to Northwest Alabama Mental Health Center and to other mental health centers, county jails and youth services facilities in Alabama that have asked the College to provide adult and child telepsychiatry to their clients.

Lloyda Williamson, MD, a psychiatrist and assistant professor in the College’s Department of Psychiatry and Behavioral Medicine, currently provides telepsychiatry services to Dekalb County Youth Services. In the past, she has provided telepsychiatry services to patients of West Alabama Mental Health Center. She says with fewer medical students choosing psychiatry as a specialty, and with the recognized need for mental health care, particularly in rural communities, “we are going to have to think outside the box and telepsychiatry is one way to do this.”

A Growing Need

Telepsychiatry is a growing trend in mental health care and regarded as one of the most promising telehealth applications. Telepsychiatry allows qualified mental health providers  to remotely deliver mental health services to individuals with limited access to care,  including those living in rural or underserved communities.

Mental health providers use video conferencing over a broadband network connection to conduct virtual sessions with patients located at remote sites. Patients and providers are connected through the use of computer cameras and microphones. Treatment is up close and personal. “You can talk back and forth in real time,” Williamson says.

The rise in telepsychiatry has come largely out of need. Mental illness is common problem in the United States. According to the National Institute of Mental Health, one in every four American adults aged 18 and older (58 million people) experiences a mental illness or substance-related disorder each year. Approximately 10 percent suffer severe, chronic and debilitating conditions, including schizophrenia, bipolar disorder, depression, anxiety and drug addition, the NIMH says.

Children are also affected. The American Academy of Child and Adolescent Psychiatry says between 7 million and 12 million youths suffer from mental, behavioral or developmental disorders. A recent survey funded in part by NIMH indicates that 50 percent of children in the United States who have certain mental issues, such as generalized anxiety disorder and depression, are not being treated by a psychiatrist or other mental health professional.

The picture is grim in rural areas. According to the U.S. Department of Health and Human Services, 60 percent of rural Americans live in a designated mental health professional shortage area where many communities have limited or no access to psychiatrists, psychologists and social workers. Frequently, rural Americans suffering from mental illness go untreated.

Children in rural areas are at greatest risk, Ulzen says. Prevalence estimates of childhood psychiatric disorders are generally about 20 percent, and nearly three-quarters of 21-year-olds with a psychiatric issue had problems as children, he says.

Zelia Baugh, MSW, LCSW, leads the Alabama Department of Mental Health. She says more than half of Alabama’s 4.5 million residents are in need of some mental health services but ongoing state budget shortfalls are leaving thousands of citizens without access to mental health services.

“There is a psychiatrist shortage in Alabama. The average wait to see a psychiatrist is three months. And we have a strained public health system that only provides services for 33 percent of adults with serious mental illness,” Baugh says. “There are other challenges, especially in rural Alabama where people, if they are able, have to travel long distances to have their mental health needs met.”

Enhancing the Mission

The College was founded nearly 40 years ago with a mission to train primary care physicians to practice in rural communities and to support them in their efforts. The telepsychiatry program is helping the College enhance and expand this mission, Ulzen says.

Several days each week, Elaine Leynes, MD, the College’s Rural Public Psychiatry fellow, sees patients at West Alabama Mental Health Center in Demopolis, which has facilities in five surrounding rural counties – Choctaw, Greene, Hale, Marengo and Sumter. Using telepsychiatry, Leynes can consult directly with psychiatrists at University Medical Center, which the College operates.

Last year, the College began offering telepsychiatry services to DeKalb County Youth Services and hopes to soon provide telepsychiatry services to the DeKalb County Jail, the DeKalb County Juvenile Court and to Northwest Mental Health Center, which has locations in Fayette, Lamar, Marion, Walker and Winston counties. Plans are underway to bring telepsychiatry services to Capstone Rural Health Center, Carrollton Primary Care, Cahaba Medical Care and Monroeville Primary Care. The clinics also serve as rural health training sites for the College’s medical students and residents.

In addition, the College is working to integrate its Behavioral Health in Family Medicine Fellowship and Rural Public Psychiatry Fellowship with its telepsychiatry program. Williamson says telepsychiatry needs to be introduced into the medical curriculum and needs to be a priority in medical education.

“Telepsychiatry needs to be integrated into the general medical curriculum from the very beginning,” adds Marisa Giggie, MD, a psychiatrist and assistant professor in the Department of Psychiatry and Behavioral Medicine. “We need to expose students early in their training and their residencies.”

Giggie, who specializes in child, adolescent and forensic psychiatry, also works with county jails in Alabama to conduct psychiatric assessments and evaluations of juvenile offenders using telepsychiatry. She hopes the College’s telepsychiatry efforts will eventually reach all rural and underserved areas throughout the state.

“Telepsychiatry truly does help improve their access to care,” she says. And for medical students and resident physicians, “they receive exposure to a technology that is expected to be used more widely in the future.”

There are a few barriers to providing telepsychiatry services. Reimbursement is sometimes difficult to receive, especially from third-party payers. But those involved with telepsychiatry say both patients and providers are satisfied with the care they are receiving and giving.

Giggie says she was apprehensive at first about telepsychiatry. “You observe much through eye contact and body language, but I was surprised at how satisfying it was. I am glad I can provide treatment to someone who might not otherwise get treatment.”

Dr. Rick Streiffer

Part One

Part Two