WVUA: Health Matters – Anxiety (May 3, 2017)

May is Mental Health Awareness Month, and this week dean of the University of Alabama College of Community Health Sciences Dr. Rick Streiffer is highlighting anxiety.

According to the National Alliance on Mental Illness, one in five people in the U.S. will develop some kind of temporary or permanent mental health condition in their lifetime.

Social work and mental health specialist Bob McKinney said even though it feels harmful, not all anxiety is bad.

“Anxiety is a perfectly normal part of life,” McKinney said. “It’s the way our bodies react to stress and stressful situations. Anxiety can kind of hone your focus into the task at hand.”

College’s Transitional Care Clinic reducing re-hospitalizations

Dr. Tamer Elsayed, assistant professor of Family Medicine for the College of Community Health Sciences and assistant director of its Family Medicine Residency provided an overview of the College’s Transitional Care Clinic at University Medical Center during a lecture April 24 as part of the Mini Medical School lecture series hosted by then College and UA’s OLLI program.

The lecture was titled “Transitional Care Management Clinic: Discoveries made with Inter-Professional Collaboration.”

The clinic, located in University Medical Center, which is operated by the College, opened in November 2015 and is designed to assist patients with the transition from the inpatient hospital care setting to home or a community (assisted living) setting.

“The problem is that many patients have multiple chronic problems who require extra care and have been readmitted multiple times to the hospital,” said Elsayed. “We decided that we wanted to have the extra care to these patients as soon as possible, as soon as they get out of the hospital, and see what kind of services they need.”

At the clinic there is a large team of 8 different positions and a lot of resources available including nursing, pharmacology, social services, a dietician and family medicine. Each service does what they can to help the patient. For example, during the visit, a PharmD takes a look at the patient’s medications, notes changes and calls the pharmacy to make sure the patient has the correct medications.
“At the end of the visit, the patient receives a printed list of the medications they need for clarity,” said Elsayed.

Bringing attention to a mental health crisis in jails

In a mental health crisis, people are more likely to encounter police than get medical help, according to the National Alliance on Mental Health. As a result, more than 2 million people with mental illness are booked into jails each year, and the vast majority of these individuals are not violent criminals.

“They get arrested instead of getting into treatment,” said Dr. Marisa Giggie, associate professor of psychiatry and behavioral medicine at the College of Community Health Sciences and chief psychiatrist for the Tuscaloosa County Jail.

“The correctional system becomes the safety net.”

Once in jail, however, these individuals might not receive the treatment they need and might end up getting worse.

The College hosted a presentation and panel discussion April 25 to bring attention to the mental health crisis in jails. “Mental Health in Correctional Settings in Tuscaloosa” was held at DCH Regional Medical Center in Tuscaloosa. In addition to Giggie, presenters included Tuscaloosa County Sheriff Ron Abernathy and the Honorable M. Bradley Almond, presiding judge of Tuscaloosa’s Mental Health Court.

Giggie provided stark statistics about the mental health crisis in jails. She said there are 10 times more people with mental illness in jail than in state-funded mental health facilities. She said 30 percent of the 9 million inmates in Cook County Jail in Chicago have mental illnesses making the jail “the largest provider of mental health services in the country.”

Giggie said the mental illness inmates experience can include drug addiction, depression, Bipolar disorder, schizophrenia and post-traumatic stress disorder. She said confinement to jail cells can increase the symptoms of these inmates.

She sees approximately 30 percent of the total Tuscaloosa County Jail population, a daily average of 536 inmates, for a variety of mental health issues.

The issue of mental illness among offenders in the criminal justice system is not new, but now there is better information about the scope of the issue. The rise in inmates with mental disorders began decades ago when policies were enacted nationwide that moved mentally ill people out of state institutions in an attempt to allow them to return to their families and live independently.

To try to deal with the influx of mentally ill inmates, Tuscaloosa County, in 2012, implemented a mental health court that was established by Almond, Abernathy and Indian Rivers Mental Health Facility in Tuscaloosa. The Tuscaloosa County Mental Health Court is a jail diversion program for nonviolent mentally ill offenders.

Almond said to date, a total of 440 inmates have been assessed by the mental health court and of those, 140 have received mental health treatment and 81 have graduated, averting jail time.

“The last place a person with mental illness needs to be at is the county jail,” Abernathy said.

He and Almond estimate the mental health court keeps 30 to 40 inmates out of the system annually. “That’s saved us hundreds of thousands of dollars, but the most important issue is that these people don’t need to be there,” Abernathy said.

A jail diversion program for the mentally ill in Massachusetts has saved that state $1.3 million in health services costs, Giggie said. “A jail diversion program is less costly and more humane.”

In addition to Giggie, the Tuscaloosa County Jail also employs a full-time social worker and recently hired a health officer with the authority to seek mental health care for an individual rather than making an arrest.

McKinney to advise student group

Dr. Robert McKinney, assistant professor of Social Work for the College, was tapped as the faculty advisor for the Carl A. Elliott Society, a student-led, community service based organization at UA that works to better society through social justice and community service.

The Elliott Society is named in honor of the late Carl Atwood Elliott, a former UA Student Government Association president who later became an Alabama congressman in the US House of Representatives. His political principles were based on assisting the needy, racial tolerance and educational opportunities. His efforts in Congress focused on education and he co-authored The Library Services Act of 1956 and the National Defense Education Act of 1958.

Avery honored by medical association

Dr. Dan Avery, director of Medical Student Recruitment and Scholarship for the College and a professor of Community Medicine and Population Health, received a Distinguished Service Award from the Medical Association of the State of Alabama earlier this month.

Avery received the honor for his work with MASA’s Council on Medical Education Committee. The council reviews, evaluates and approves hospitals and other health care institutions in Alabama to provide continuing medical education courses and credits.

At the College, Avery also serves as medical director and medical review officer for the Laboratory and X-ray Department at University Medical Center, which the College operates. He is professor and division chief of Pathology, and is medical director for the College’s Institute for Rural Health Research. He is a professor and former chair of the College’s Department of Obstetrics and Gynecology.

Weida completes fellowship, elected to Council on Medical Education

Dr. Jane Weida, associate professor of Family Medicine for the College and associate director of its Family Medicine Residency, completed a fellowship with the National Institute for Program Director Development in March. The fellowship is awarded by the Association of Family Medicine Residency Directors.

As part of the program, fellows engage with and learn from seasoned program directors and family medicine educators and leaders. The NIPDD fellowship model seeks to enhance knowledge and skills and to mentor fellows to become effective residency directors.

In addition, Weida was elected the District 7 representative to the Council on Medical Education. The council recommends educational policies to the American Medical Association House of Delegates, and recommends to the AMA Board of Trustees the appointment of representatives to medical education organization, accrediting bodies and certification boards.

The Council on Medical Education focuses on issues and initiatives related to undergraduate medical education, graduate medical education, continuing medical education and professional development.

Payne-Foster receives UA scholar award

Dr. Pamela Payne-Foster, associate professor of Community Medicine and Population Health for the College, received a 2017 Distinguished Community-Engaged Scholar Award from UA’s Council on Community-Based Partnerships.

Each spring semester, the council recognizes students, faculty, staff and their community partners for excellence in community-based research. The Distinguished Community-Engaged Scholar Award recognizes a faculty member, student and community partner for public service and engagement efforts that have improved the quality of life in Alabama over an extended period.

Payne-Foster, who is also deputy director of the College’s Institute for Rural Health Research, was the faculty recipient. The student recipient was Joon Yea Lee, a doctoral student in the College of Communication and Information Sciences, and Dr. Billy Kirkpatrick, executive director of West Alabama AIDS Outreach, was the community partner recipient.

Payne-Foster studies the spread of HIV in the South. Her current research focuses on developing an anti-stigma curriculum for African-American churches in rural Alabama. She hopes her work will educate congregations about HIV/AIDS and reduce the stigma around the disease.

Lessons learned from three decades of medical practice

The practice of medicine has experienced many changes over the years, but one thing that has stayed consistent over time is the importance of physician-patient communication, said Dr. Dan Avery, an obstetrician-gynecologist who has practiced in Alabama for more than 30 years.

He shared key takeaways from his years in practice in a presentation April 17 as part of the Mini Medical School lecture series hosted by the College and UA’s OLLI program.

Avery practiced privately for more than 20 years before joining the College, where he was professor and chair of the Department of Obstetrics and Gynecology. He is currently director of Medical Student Recruitment and Scholarship at the College and a professor of Community Medicine and Population Health. He is also medical director for the College’s Institute for Rural Health Research.

Avery began his presentation, “Lessons learned from three decades of ob/gyn and medical practice,” by comparing differences in medical education from the time he was a medical student to today. He said differences include the medical school application process, the cost of medical school, and the length of residencies and how those training programs are now structured.

“The reduction of work hours for residents has decreased the number of procedures they are able to do,” Avery said. “The years of residency may be lengthened due to changing hour requirements.”

An increase in the use of technology has also changed medicine, he said.

The importance of communication between physician and patient, however, has remained a constant over the years, Avery said. “The relationship with the patient is everything.”

In some ways, technology has helped communication, Avery said, noting that he will text patients if they have medical concerns that don’t require an in-person visit.

Communication extends across all specialties in medicine and is particularly important in obstetrics, Avery said, not only because obstetrics is a high-risk specialty for malpractice but because many women want to choose when they deliver their babies.

“You’ve got to have a good reason to [electively] deliver a baby preterm,” he said. And, this needs to be discussed with an obstetrician before a decision is made. The closer to term a baby is delivered, the better the change of the baby being born healthy.

Avery said while many women deliver in hospitals, home deliveries are on the rise, so it’s vital to communicate with a physician if a home delivery is planned.

While communication between doctors and patients is important, it often doesn’t get the attention it deserves in medical school, he said.

“If you listen to a patient long enough, they will tell you what is wrong with them,” Avery said, quoting Dr. Tinsley Harrison, a long-time physician and educator at the University of Alabama School of Medicine.

UA News: Presentation Seeks to Raise Awareness About Mental Health Crisis in Jails

The University of Alabama’s Dr. Marisa Giggie hopes to bring attention to the mental health crisis in jails and prisons during a presentation and panel discussion. The session is titled, “Mental Health in Correctional Settings in Tuscaloosa” and will begin at 12:15 p.m. Tuesday, April 25, in Willard Auditorium at DCH Regional Medical Center in Tuscaloosa.

Geno, Robinson selected for emerging leaders fellowships

Dr. Ed Geno, an assistant professor in the Department of Family Medicine at the College of Community Health Sciences, and Dr. Cecil Robinson, an associate professor and director of Learning Resources and Evaluation for the College, were among faculty chosen nationwide for the Society of Teachers in Family Medicine’s Emerging Leaders Class of 2018.

The competitive STFM fellowship provides training, tools and support to new faculty and those transitioning to leadership roles. During the yearlong fellowship, participants take on leadership roles and connect with accomplished leaders who share tips on motivating others and handling difficult people and situations. Participants also lead a team in completion of a leadership project and present the results at the 2018 STFM Annual Spring Conference.

Geno, works with the College’s family medicine residents in minor surgery and hospital medicine. He attended medical school at the University of Oklahoma School of Medicine and completed residencies in general surgery and family medicine at Ochsner Foundation Hospital in New Orleans. He also taught in the Ochsner Family Medicine Residency.

Geno has practiced obstetrics as well as minor procedures and clinic and hospital medicine. He serves as a national advisory faculty member for the Advanced Life Support in Obstetrics.

Robinson works with undergraduate and graduate medical educators and administrators at the College to examine, assess and improve educational practices, processes and outcomes. He also works to advance interprofessional education among health faculty and professionals at UA.

Robinson earned a bachelor’s degree from Northwestern University and a doctorate in educational psychology certificate in cognitive science from the University of Colorado, Boulder. Robinson previously was an associate professor of educational psychology for the Department of Educational Studies in Psychology, Research Methodology, and Counseling at UA’s College of Education.