Mental illness hits closer to home than you might think

By Kim Eaton

Did you know?

In an average US city with 20,000 people, 840 will have been diagnosed with depression. That is an average of 13.3 million people in the US with diagnosed depression.

Mental illness does not discriminate. It can impact anyone and everyone, not just in Tuscaloosa or Alabama, but nationally and internationally.

“Depression has increased by 18 percent since 2005 and is now the leading cause of ill-health and disability worldwide, with more than 300 million people suffering,” said Dr. John Burkhardt, an assistant professor of Psychiatry and Behavioral Medicine for the College of Community Health Sciences and a practicing clinical health psychologist at University Medical Center, which the College operates.

That number is only those diagnosed with depression, Burkhardt added. There are many people suffering from undiagnosed mental illness. Depression also puts people at risk for other medical conditions, like increased risk of cardiovascular disease, diabetes, stroke and Alzheimer’s disease.

May is Mental Health Awareness Month, and to raise awareness of this health issue, faculty from the College’s Department of Psychiatry and Behavioral Medicine provided, throughout the month, media interviews and patient information about various mental health topics – depression, anxiety, substance abuse, ADHD and healthy lifestyles – as well as weekly mindfulness segments for College employees.

So, what is mental health?

Mental health ultimately has to do with how someone functions in his or her world.

“All of us will go through periods when we may experience depression or anxiety,” Burkhardt said. “And for some of us, we will experience more problems functioning in one or multiple areas, whether it be work, home or interpersonally. Being in good mental health means having the resources and coping skills to manage these times, but most importantly to remain functional, which means being able to manage the various areas of your life successfully, such as work, parenting, play, relationships, exercise, home, etc.”

Since Burkhardt moved to Tuscaloosa two years ago, he has seen a broad range of mental illness in his clinic at University Medical Center. He sees a lot of depression and anxiety, but said Alabama as a whole has problems with drug abuse, either prescribed or non-prescribed. He also sees many people trying to cope with some form of trauma in their life.

“There is not one common problem,” Burkhardt said. “Mental illness exists in many forms and is closer to home than we think.”

Despite the prevalence of mental illness, access to care and being able to afford care are two of the biggest challenges for individuals. When looking at mental health provider ratios, top US providers have a 360:1 patient-to-provider ratio; Alabama is 1,260:1; and Tuscaloosa is 890:1. This is the ratio of the county population to the number of mental health providers, including psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists, mental health providers who treat alcohol and other drug abuse and advanced practice nurses specializing in mental health care. About 30 percent of Alabama’s population lives in a county designated as a Mental Health Professional Shortage area.

To help fill in the gap, The University of Alabama and the College offer multiple resources to students, faculty and staff, as well as the community. These include the Betty Shirley Clinic at University Medical Center, Student Health Center, Counseling Center, Psychology Clinic, Employee Assistance Program and the Capstone Family Therapy Clinic.

Another challenge is the stigma surrounding mental illness, which might prevent someone from seeking help. There are several misconceptions, the most common being that it does not happen to “everyday or regular people” and if someone gets diagnosed then there is something severely wrong with them.

“Stigma plays a big role in this,” Burkhardt said. “Negative emotions and reactions are apparent when the topic of mental illness arises. People get these negative pictures in their head whether it be from movies they have seen or their own perceptions of what people with poor mental health present like. They don’t understand that the severity can range from mild to severe, so they always assume it’s severe. We are now just getting to a point where people can talk about mental illness without feeling like they have been hiding a dirty secret.”

Another misconception is that people should just be able to “get over it” because life is not easy. While it is true life is full of challenges, having poor mental health does not mean they are a failure or cannot manage their life. But it also doesn’t mean they can do it themselves.

“There is help for you,” Burkhardt said. “Just because you have a diagnosis does not mean your life has to stop. Many individuals live a full life managing their mental illness.”


Leeper, Paxon join College

Dr. Connie Leeper joined the College of Community Health Sciences as an assistant professor in the Department of Family, Internal, and Rural Medicine.

Leeper graduated cum laude from Duke University with a bachelor’s degree in Biology. She earned her medical degree and a Master’s of Public Health from the University of Alabama at Birmingham.

She completed a family medicine residency at the Ventura Family Medicine Residency in Ventura, California, where she served as a chief resident. Leeper also completed an obstetric fellowship at Natividad Medical Center in Salinas, California.

Dr. Raheem Paxton joined the College of Community Health Sciences as an associate professor in the Department of Community Medicine and Population Health and as an investigator for the College’s Institute for Rural Health Research.

Previously, Paxton was an assistant professor in the School of Public Health at The University of North Texas Health Science Center in Fort Worth, Texas, with a joint appointment at the university’s Center for Alzheimer’s and Neurodegenerative Research in the Institute of Aging.

Paxton graduated cum laude from Morehouse College in Atlanta with a bachelor’s degree in Psychology. He earned a master’s degree in Kinesiology from Kansas State University in Manhattan, Kansas, and a PhD in Public Health/Health Promotion, Education, and Behavior from the University of South Carolina in Columbia, South Carolina.

His post-graduate training includes a research fellowship in Intervention Development/Dissemination Research at the Cancer Research Center of Hawaii in Honolulu, Hawaii, and a research fellowship in Health Disparities in Cancer Survivorship at The University of Texas MD Anderson Cancer Center in Houston, Texas.

Rural Medical Scholars recognized at convocation

Ten students who want to become physicians and practice in rural communities were recognized April 23 at a convocation for the Rural Medical Scholars Program, which is operated by the College of Community Health Sciences.

The program is exclusively for rural Alabama students and includes a year of study, after students receive their undergraduate degree, that leads to a master’s degree in Rural Community Health and early admission to the University of Alabama School of Medicine. Rural medical Scholars spend the first two years of medical school at the School of Medicine’s main campus in Birmingham and then return to the College for their final two years of clinical education. The 10 graduates begin medical school this summer.

“Our mission is to produce physicians for rural Alabama who are leaders in their communities,” said Dr. John Wheat, founder and director of the Rural Medical Scholars Program.

State Sen. Gerald Dial of Lineville, Alabama, a former chair of the Senate Health Committee, provided the keynote address. He stressed to the student how important they will be to the communities where they will one day practice.

“In addition to providing medical services, a rural physician opens economic opportunities for communities. You can’t put a value on a rural physician, it means everything. You provide life to a community.”

Also during the convocation, the Rural Medical Scholars Program Distinguished Service Award was presented to Dr. Nathan Smith, who served as an assistant dean for Students and Admissions at the School of Medicine for many years and who is now a professor and vice chairman of the Department of Psychiatry there.

“Rural is close to my heart,” he said, noting that he was raised in Rockledge, Alabama. “Of all that I did as assistant dean of admissions, I am most proud of my involvement with the Rural Medical Scholars Program, and I am grateful for all that has been accomplished through these programs.”

Emily Sutton, a junior at UA majoring in Biology who has participated in other Rural Pipeline programs, received the Rural Alabama Health Alliance Student Award. “I love this program – its mission and purpose. I’m thankful for the program investing in me.”

Partners of the Rural Medical Scholars Program were also recognized: Dr. Charles Nash, vice chancellor for Academic and Student Affairs for the UA System; Dr. James Jackson, professor emeritus of Education in Medicine in the Department of Medical Education at the School of Medicine; and the Alabama Farmer’s Federation Women’s Leadership Division.

The convocation was held at the Hotel Capstone on the UA campus.

Graduating Rural Medical Scholars:

  • Veronica Coleman of Butler
  • Rebecca England of Demopolis
  • Andrew Seth Griffin of Centre
  • Jessica Luker of Camden
  • Dustin Marshall of Coaling
  • Colby James of Empire
  • Brionna McMeans of Fort Deposit
  • Johnny Pate, Jr. of Moundville
  • Madison Peoples of Hamilton
  • Madilyn Tomaso of Barnwell

Chief residents named for 2017-18 academic year

Three resident physicians in the College’s Family Medicine Residency were selected chief residents for the 2017-2018 academic year. They are Drs. Steven Kelton, Brianna Kendrick and Natalie Kuijpers.

Residency Director Dr. Richard Friend says the three have demonstrated academic and clinical excellence as well as an ability to work well with team members. They were selected by their peers.

The College’s residency is a three-year program that provides specialized training in the discipline of family medicine. The residency is the second largest family medicine residency in the nation and one of the oldest.

Kelton received his bachelor’s degree from the University of Waterloo in Ontario, Canada. He earned a master’s degree in Adolescent Education from D’Youville College in Buffalo, New York. He earned his medical degree from the Medical University of the Americas in Nevis, West Indies.

Kendrick received her bachelor’s degree in Psychology from the University of Louisville in Kentucky. She completed medical school at the Kentucky College of Osteopathic Medicine at the University of Pikeville.

Kuijpers received her bachelor’s degree from Queen’s University in Kingston Ontario, Canada, and a degree in X-ray technology from Eastern Ontario School of X-ray Technology. She earned her medical degree from St. George’s University in Granada, West Indies.

The three will replace current chief residents Drs. Shawanda Agnew, Carrie Coxwell and Blake DeWitt.

College’s fourth-year medical students match into residencies

Fourth-year medical students from the University of Alabama School of Medicine Tuscaloosa Regional Campus learned earlier this month where they will train for the next three to seven years for their graduate medical education.

Twenty-nine students from the Tuscaloosa Regional Campus, which is operated by UA’s College of Community Health Sciences, were among thousands nationwide who learned of their residency placements through the National Resident Matching Program, which coordinates the residency match process.

Three Tuscaloosa campus students – William Lee, Jessica Powell and Amanda Shaw – matched into the College’s Family Medicine Residency, the second oldest and one of the largest family medicine residencies in the country.

The largest number of students matched into pediatric residencies at six, followed by four in family medicine, four in emergency medicine and three in general surgery. Students also matched in other medical specialties, including two in surgery-preliminary, two in transitional-ophthalmology, and one each in internal medicine, obstetrics-gynecology, neurology, anesthesiology, orthopaedic surgery, radiology-diagnostic, medicine-pediatrics, transitional-dermatology and medicine-preliminary-dermatology.

Altogether, Tuscaloosa campus students placed into residencies across 18 different states.


2017 Match Results

Steven Allon, Internal Medicine, UAB Medical Center (Birmingham, AL)

Jonathan Antonetti, General Surgery, Brookwood Baptist Health (Birmingham, AL)

Roshmi Bhattacharya, Surgery-Preliminary, Einstein Healthcare Network (Philadelphia, PA)

Reaves Crabtree, Orthopaedic Surgery, University Hospitals (Jackson, MS)

Ariana Diamond, Transitional-Ophthalmology, Brookwood Baptist Health-St. Louis University School of Medicine (St. Louis, MO)

Carter Elliott, Anesthesiology, UAB Medical Center (Birmingham, AL)

Danielle Fincher, Family Medicine, University of California Davis Medical Center (Sacramento, CA)

Maria Gulas, Pediatrics, Carolinas Medical Center (Charlotte, NC)

Samantha Haggerty, Pediatrics, Baystate Medical Center (Springfield, MA)

Andrew Headrick, Pediatrics, Baylor College of Medicine (Houston, TX)

Chase Henderson, General Surgery, Brookwood Baptist Health (Birmingham, AL)

Katelynn Hillman, Pediatrics, Virginia Commonwealth (Richmond, VA)

Adam Jacobs, Surgery-Preliminary, Brookwood Baptist Health-UAB Medical Center (Birmingham, AL)

Caroline Kennemer, Medicine-Preliminary, University Hospitals (Jackson, MS)

Joshua Koplon, Emergency Medicine, Orlando Health (Orland, FL)

William Lee, Family Medicine, The University of Alabama Family Medicine Residence (Tuscaloosa, AL)

Kayln Mulhern, General Surgery, University of Tennessee College of Medicine (Memphis, TN)

Courtney Newsome, Emergency Medicine, University of Arkansas (Little Rock AR)

Jessica Powell, Family Medicine, The University of Alabama Family Medicine Residency (Tuscaloosa, AL)

Amanda Shaw, Family Medicine, The University of Alabama Family Medicine Residency (Tuscaloosa, AL)

Nathan Sherrer, Medicine-Pediatrics, Ohio State University Medical Center (Columbus, OH)

Daniel Stanley, Emergency Medicine, University of Virginia (Charlottesville, VA)

Julia Steigler, Transitional-Dermatology, Resurrection Medical Center-University of Rochester/Strong Memorial (Rochester, NY)

Scott Thomas, Neurology, UAB Medical Center (Birmingham, AL)

Caitlin Tidwell, Emergency Medicine, Palmetto Health Richland (Columbia SC)

Chelsea Turgeon, Obstetrics-Gynecology, University of Pittsburgh medical Center (Pittsburgh, PA)

Chaniece Wallace, Pediatrics, Indiana University School of Medicine (Indianapolis, IN)

James Watson, Pediatrics, UAB Medical Center (Birmingham, AL)

Caroline Watson, Transitional-Ophthalmology, Brookwood Baptist Health (Birmingham, AL)-Tulane University School of Medicine (New Orleans, LA)

College receives grant to provide colonoscopy training to faculty and residents

By Kimberly Florence

The College of Community Health Sciences wants to increase the number of colonoscopy procedures performed by family medicine physicians in underserved communities of rural Alabama, and it plans to accomplish this goal through a grant from the American Cancer Society.

Dr. Richard Friend, director of the College’s Family Medicine Residency, applied for the grant in early 2016. In June 2016, the College received an endowment of $70,000 that matched an additional $70,000 from CCHS.

The money will be used to fund colonoscopy training for the Family Medicine faculty and residents, said Friend.

“The purpose of this grant is to train more providers to do colonoscopies throughout the state,” he said. “The way we are approaching that is by training more faculty who will in turn train more residents.”

The grant will fund the purchase of a high-fidelity simulator that faculty and residents will use to learn. The simulator uses computerized manikins to guide providers through performing the procedure and records proficiency. Once providers have met certain requirements, they can to move on to assisted cases in surgery with live patients. Friend says the simulator will be purchased in about a month.

Residents will begin their training under the direction of Friend. Dr. Drake Lavender, associate professor of Family Medicine.

Two faculty members will also receive training: Dr. Jared Ellis, associate director of the Residency, and Dr. Ed Geno, associate professor of Family Medicine. Once they complete their training, they will join Friend and Lavender in training residents.

The majority of residencies across the country do not provide colonoscopy training and family medicine physicians perform only 8 percent of colonoscopies in the state, said Friend. By training more family physicians to perform the procedure, the College hopes to provide greater access to patients in rural areas who may not be able to get to an urban setting where the majority of colonoscopies are performed, said Friend.

“There are people in our region who can’t get to the larger metropolitan areas like Tuscaloosa and Birmingham,” Friend said. “We hope to provide these services in smaller rural medical centers where they’re needed the most.”

The College’s mission is to improve and promote the health of individuals and communities in Alabama and the region through the provision of high quality, accessible healthcare, and one of the ways it does that is by sending its trained physicians into Alabama’s rural and underserved communities.

McKinney Selected for Fellowship

Robert McKinney, assistant professor of social work in the department of Psychiatry and Behavioral Medicine at The University of Alabama’s College of Community Health Sciences, was among 16 faculty nationwide chosen for the 2018 class of the Society of Teachers in Family Medicine’s Behavioral Science/Family Systems Educator Fellowship.

Med students practice tai chi, learn health benefits

Medical students learned about the health benefits of tai chi along with a few basic movements on Jan. 13 at Dean’s Hour at The University of Alabama College of Community Health Sciences.

Madeleine Hill, a longtime friend of the College and a member of its Board of Visitors, spoke about the benefits of tai chi, and introduced students to a few basic movements of sun, one of the five basic styles of the Chinese martial art.

The Dean’s Hour Lecture Series is a monthly forum for medical students created by the College to raise students’ awareness of community health issues.

Hill has taught tai chi for more than 10 years. Her late husband, Dr. William Winternitz, was a faculty member at CCHS for many years, and they both have supported the College’s Geriatrics Initiative.

Tai chi helps to reduce stress, promote relaxation and enhance peace of mind, Hill said. She has seen first hand through her teaching of tai chi how it has helped to reduce pain for some of her students. It also improves concentration and memory.

Another benefit of tai chi is that it helps to improve balance. According to the CDC, older Americans experienced 29 million falls in 2014, causing 7 million injuries and costing about $31 billion in annual Medicare costs. More than 27,000 older adults died from a fall in 2014.

“There’s a good reason to improve our balance,” Hill said.

One of the College’s functions is to serve as the Tuscaloosa Regional Campus for the University of Alabama School of Medicine, providing clinical education for a cohort of third- and fourth-year students.

“How could this come into play in your own practices?” Hill asked students. “It starts with you. You’re the best example to your patients of how you maintain your own lives and take care of yourselves.”

Alumnus, antivenin developer speaks to med students about snakebites

Resident speaks about hypertension at Mini Medical School

One in three adults in America has hypertension, according to the US Centers for Disease Control and Prevention. However, hypertension can be treated with lifestyle modifications and medications, said Dr. Brittney Anderson, a third-year resident physician at The University of Alabama Family Medicine Residency.

Dr. Brittney Anderson, third-year resident at The University of Alabama Family Medicine Residency

Dr. Brittney Anderson, third-year resident at The University of Alabama Family Medicine Residency

Anderson provided a presentation on hypertension on Nov. 3 as part of the Mini Medical School program conducted by the UA College of Community Health Sciences in collaboration with UA’s OLLI program.

Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and residents provide information about issues and advances in medicine and research. OLLI, short for the Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel.

Anderson started her presentation by illustrating hypertension, or high blood pressure.

“Think of it the way you would think of pressure from a water hose. What would alter that pressure? The size of the hose, and what the fluid in the hose is having to overcome,” she said.

Cholesterol buildup, for instance, can inhibit blood from moving at a normal pressure through blood vessels, she said.

Diagnosing hypertension starts with an accurate blood pressure reading, which can sometimes be challenging due to faulty or inaccurate measuring cuffs or other factors with the patient and environment, Anderson said.

She offered tips for an accurate blood pressure reading. First, be at your calmest—don’t worry about engaging in conversation. Second, support your back and feet, and keep your legs uncrossed. Third, empty your bladder so that it doesn’t affect your body’s stress level. And fourth, keep your arm supported at your heart level and make sure the cuff is over your bare arm (and not your clothes).

If patients are using an automated cuff for measuring blood pressure at home, the physician may ask that it be brought in for the exam to compare, Anderson said.

Normal blood pressure less than 120 mm Hg systolic and less than 80 mm Hg diastolic. Prehypertension is between 120-139 mm Hg systolic and 80-89 mm Hg diastolic. When the systolic reads 140-159 mm Hg, and diastolic reads 90-99 mm Hg, the patient may be diagnosed as Hypertension Stage 1. Hypertension Stage 2 is when the systolic is 160 mm Hg or higher, and the diastolic reading is 100 mm Hg or higher. A Hypertensive Crisis, which requires emergency intervention, is when the systolic is read at higher than 180 mm Hg and higher than 110 mm Hg diastolic.

If a patient has an elevated blood pressure reading of greater than or equal to 180/110 mm Hg, then the diagnosis is clearly hypertension, Anderson says.

“But if not, then we have to do some more digging,” she said. It could be that the patient suffers from “white coat hypertension,” which means the patient is nervous simply from being in the doctor’s office. Patients in that case would be asked to wear an ambulatory blood pressure cuff 24 hours a day for a few days for an accurate measurement.

Or, if a patient is diabetic, it causes damage to blood vessels. That means that if a reading is greater than 130/80 mm Hg and the patient is diabetic, then it is a diagnosis of hypertension.

There are risk factors that lead to hypertension, Anderson said. Primary risk factors include age, obesity, family history, race, diet and exercise and alcohol use. Secondary risk factors include medicines (like decongestants, birth control and steroids), illicit drugs, sleep apnea and renal disease.

Hypertension can be treated through lifestyle modifications, like weight loss, adopting an eating plan, adding physical activity and reducing alcohol and sodium intake, Anderson said. There are many medications, too. Thiazides, ACE inhibitors and calcium channel blockers are some of the most common.