The PRMS Blog

Guest Blog: We are needed


As a part of PRMS’ ongoing commitment to behavioral health, we invited James Bouknight, MD, PhD, in Charleston, SC, to be featured as one of our guest bloggers this month. 

The growth in the geriatric population both in the United States and worldwide presents issues and opportunities for the medical community in general and psychiatry in particular.  According to the National Institutes of Health (NIH) the percentage of people 65 and older worldwide is expected to double to 1.6 billion by 2050.  In the United States the numbers reflect the global trend with a population of 88 million geriatric individuals by 2050. Even more remarkable is the world growth in the “oldest old,” people age 80 and over, which is expected to triple to almost 447 million by 2050. The reasons for the dramatic growth in the geriatric population are multiple: extended lifetimes, decreases in risk behaviors such as tobacco use and advances in controlling infectious diseases all contribute to the growth of the geriatric population. 

In the United States, a major contributor to the growth of the geriatric population is the aging of the Baby Boomers, that group born between approximately 1946 and 1964. Living longer is not necessarily synonymous with living better. With increasing age cardiovascular, endocrine, renal, orthopedic and pulmonary conditions tend to worsen.  In my work, I observe increases in mood disorders and, most particularly, with neurocognitive disorders caused by Alzheimer’s disease, vascular dementia, Lewy Body Dementia, Parkinson’s Disease and other less common causes of neurocognitive disorders.  An often neglected aspect of psychiatry in the aging population is substance abuse which is becoming more prevalent in the geriatric population as the Baby Boomers age.

As a former program director of a geriatric psychiatry fellowship program and teacher to our general psychiatry residents and medical students, I was often asked “Why become a geriatric psychiatrist?” Many people both in and out of medicine see treating geriatric patients as more of a burden than an opportunity. I have had my students say that geriatric psychiatry is depressing “because your patients die.”  It then became incumbent upon me to point out that ALL of our patients die, it’s only a question of when. My response to the question of why become a geriatric psychiatrist is multiple:

1. Every part of our patients’ lives has value and the privilege of being a participant in their lives is an honor. Children and middle aged adults are not necessarily less challenging than geriatric patients.

2. In geriatric psychiatry, the patient’s family and caregivers are usually a part of the treatment. This gives us the opportunity to be a part of the environment in which the patient lives rather than a 55 minute session once every three months as is often the case with adults.

3. We are needed. The American Association for Geriatric Psychiatry estimates that an additional 2,500 geriatric psychiatrists will be needed by 2030. Geriatric patients received most of their psychiatric care from primary care providers, physicians, nurse practitioners or physicians’ assistants. While these non-psychiatrist providers do their best to treat their geriatric patients, they are not specialists and suboptimal care is often the result.

4. Financial security is guaranteed in a field with such a dramatic shortage of physicians. Medicare is the primary payer for geriatric patients but many physicians choose to “opt out” of Medicare and only accept cash payment. In either case, incomes are reasonable and above those of many medical specialties.

5. There are innovative ways of delivering medical care to geriatric patients which are outside of the usual office based practice. One of the most effective ways of distributing our expertise in geriatric psychiatry is through Telepsychiatry which is especially important in rural, underserved areas.

6. Career satisfaction should rank high in the reasons to choose a specialty. The data indicate that geriatric psychiatrists report high rates of career satisfaction than many other subspecialties.

7. Research into neurocognitive disorders and treatments is very active with new approaches to these illnesses being developed on many fronts. This gives the geriatric psychiatrist the opportunity to participate in research which could benefit our patients.

8. Finally, the satisfaction of being a part of a patient’s life makes geriatric psychiatry particularly rewarding. These patients have experienced aspects of life that we may never experience.  I have had the honor of treating members of “The Greatest Generation” and they have taught me about life and resilience.

Although I am “semi-retired” now, I am still active in geriatric psychiatry.  I serve as an expert witness for both defense and plaintiff in legal proceeding.  I also participate in evaluations of geriatric patients for the probate court system.  These are usually determinations of the need for a guardian and/or conservator to protect the interests of the geriatric patient.  Physical, emotional and financial abuse of older individuals is rampant in our society and we as geriatric psychiatrists are the advocates for our patients.  I can truly say that geriatric psychiatry provided me with career satisfaction that I don’t believe I would have received from another medical specialty. 

 

James Bouknight, MD, PhD

Dr. James Bouknight earned a doctor of medicine from the Medical University of South Carolina, Charleston, South Carolina. Prior to his medical degree, he received a bachelor of arts in economics from Wofford College, Spartanburg, South Carolina; a master of arts in economics from Duke University, Durham, North Carolina; and a Ph.D. in economics from the University of South Carolina, Columbia, South Carolina.

After serving a residency at William S. Hall Psychiatric Institute, Columbia, South Carolina, Dr. Bouknight was employed by the Columbia Area Mental Health Center and WJB Dorn Department of Veterans Affairs Medical Center, Columbia, South Carolina; and Charter Rivers Hospital, West Columbia, South Carolina. During five years at Charter Rivers Hospital he served as Director of the Partial Hospitalization Program, Director of the Geriatric Psychiatry Service and president of the medical staff. Dr. Bouknight joined the faculty of the USC School of Medicine in 1993, and was named Director of Geriatric Psychiatry in 2004.

Board certified in psychiatry and geriatric psychiatry, Dr. Bouknight has added qualifications in geriatric psychiatry. His special interests are in the treatment of dementias and mood disorders.

Posted in PRMS Blog | Comments Off on Guest Blog: We are needed



Guest Blog: Psychiatric Outreach Program (POP) in Jackson, MS


As a part of PRMS’ ongoing commitment to behavioral health we invited Dr. Chasity Torrence, Assistant Professor in the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center (UMMC) and a staff psychiatrist at the Mississippi State Hospital, to be featured as one of our guest bloggers this month. In 2016, Dr. Torrence received the PRMS Resident Achievement Travel Award and the 2016 Draper Award at the UMMC resident graduation.

What is homelessness? Homelessness is defined as “having no place to live” or “having no home or permanent place of residence.” Thirty percent of those suffering from chronic homelessness have a serious mental illness and two-thirds have a primary substance use disorder or other chronic health condition.

In recent years, homelessness has become an epidemic. Annually, 1.56 million individuals (0.5% of the U.S. population) use emergency shelters or transitional housing. The majority of homeless individuals lack health insurance, a public provision for healthcare, or a primary care provider. Emergency departments are not equipped to meet the psychosocial needs of homeless patients and do not have the capacity to assist with housing, substance use treatment, or mental healthcare.

The Psychiatric Outreach Program (POP) is a volunteer physician-based outreach program founded in July 2016 by Dr. Chasity Torrence, assistant professor of psychiatry in the Department of Psychiatry and Human Behavior and a staff psychiatrist at the Mississippi State Hospital, along with Dr. Charles Richardson and Dr. Matthew Walker, psychiatry residents at the University of Mississippi Medical Center. The thrust of POP was inspired by Dr. Sheryl Fleisch from Vanderbilt University who founded a similar program in Nashville, Tennessee. Last summer, amid $8.3 million in legislative budget cuts to mental health in Mississippi, POP was founded to offset those affected who could not otherwise afford mental health services.

Dr. Chasity Torrence, right, and fourth-year medical student Jonathan Baker review a case on October 15 in the POP clinic at the Jackson Free Clinic. Photo courtesy: Gary Pettus

The POP clinic is available every third Saturday at the Jackson Free Clinic, a medical-student-run free clinic in Jackson, MS. The number of patients has tripled since POP opened its doors seven months ago, and the volunteers are looking to partner with other outreach programs and homeless shelters in the area to meet the growing demand. POP’s goals are to:
– provide accessible mental healthcare to the underserved, homeless, and uninsured residents of Jackson, MS
– reduce the volume of non-emergent care placed on emergency departments of local hospitals
– build strong relationships with the community

The POP clinic uses an interdisciplinary team of volunteer social workers, recreational therapists, occupational therapists, and physical therapists who also volunteer at the Jackson Free Clinic.

Staff members of the Psychiatry Outreach Program are, front row, from left, row, co-founders Dr. Matthew Walker, a third-year resident; Dr. Chasity Torrence, assistant professor of psychiatry; and fourth-year resident Dr. Charles Richardson; back row, from left, volunteers Yolonda Ross, a fourth-year medical student; Dr. Jon Jackson, assistant professor of psychiatry; and Jonathan Baker, a fourth-year medical student.

Posted in PRMS Blog | Comments Off on Guest Blog: Psychiatric Outreach Program (POP) in Jackson, MS



Mississippi Psychiatric Association Celebrates Its 50th Anniversary


Make no mistake, religion and spirituality can help some people struggling with mental health conditions and often plays a big role in recovery. Inclusive and welcoming congregations often have outreach programs for people with mental health conditions or mental health ministries. But some – particularly in the South – view mental illness as a moral failing. 

In its 50th anniversary year, the Mississippi Psychiatric Association (MPA) plans to do something about this. In May, the Association is announcing the launch of an ambitious campaign designed to encourage faith-based communities to be welcoming and supportive of people and family members affected by mental illness from October 7th to October 14th 2018.

The initiative will focus on fostering dialogue and reducing stigma that addresses the medical and spiritual dimensions of people seeking care. The goal is to have every major faith-based organization in the state present a program, sermon or bulletin write-up addressing the connection between faith and mental health.

“We want to help banish stigma – when bad things happen on the news, that gives a lot of people a really negative impression of mental illness, but a lot of times it’s really not what is going on and that’s a terrible thing because patients are further ostracized,” said Maxie Gordon, MD, a psychiatrist and MPA president. “We think by reaching out to churches we will be able to have a big impact in the lives of people who suffer from mental illness.”

MPA, incorporated in 1967, is a District Branch of the American Psychiatric Association (APA). MPA hopes to partner with Southern Baptist, Catholic, Protestant, and Jewish congregations, as well as Hindu and Muslim organizations. Although outreach is just beginning, Gordon, former Director of Medical Student Education at the University of Mississippi School of Medicine, who now works at East Mississippi State Hospital and G.V. (Sonny) Montgomery Veterans Affairs Medical Center, said the idea has met little resistance.

The goal is to provide a better understanding of science and evidence-based treatments for mental illness and to highlight how for many, support and reinforcement from faith-based leaders in recovery can be key to successful outcomes.

“We are in the South and it is very much a faith-based bunch of people who feel like it’s extremely important to have their medical team and their faith team on the same plane,” said Angela Ladner, Executive Director of MPA. “We don’t determine who the higher power is – we just want the dialogue to occur.”

As part of its outreach, MPA plans to provide faith-based leaders “Mental Health: A Guide for Faith Leaders,” a guide developed by the APA. If successful, MPA hopes to build a tradition that is recognized annually during Mental Health Awareness Week.

MPA has a long history of successful lobbying, thanks in large part to Ladner, who began working with the Association in 1999 as its contract lobbyist.

Capitol Screening Initiative

Since 2005, MPA has partnered with the Mississippi State Medical Association on a Capitol Screening Initiative (CSI). Ladner launched the initiative because she wanted elected officials to better understand what physicians do each day. The program brings free health screenings to members of the legislature and staff once a year in January. MPA also has psychiatrists onsite to advocate for the profession and talk to legislators about issues affecting the practice.

“We find that often our elected officials don’t take the time to monitor their health, especially during the legislative session,” said Ladner. Since CSI began, cases of male and female breast cancer and an imminent heart attack have been detected, she added.

Legislature

Ladner spends three months a year at the legislature when it is in session. When she began working for MPA, the Association fought for the ability to hold people who were a danger to themselves or others with a so-called “72-hour hold statute,” which passed in 2000.

MPA is now focused on promoting mental health courts. Last year, it helped pass statutes that allowed for pilot programs in certain areas of the state. Legislation this year would allow such courts to be set up statewide and also provide funding. Gordon said the group also hopes to get legislation adopted surrounding mental health parity to make sure that companies are identifying and paying for issues and treatment related to mental health.

50th Celebration and Growth

This year’s MPA annual meeting in March included a 50th anniversary celebration. MPA celebrated achievements, honored past leadership and highlighted milestones.

Retired psychiatrist June Powell, MD, MPA President from 1997 to 1999, who later was a member of the Tulane University School of Medicine faculty before returning to the state more than two decades later, was key in getting recognition for Mississippi at the national meetings of the APA.

In addition to working to change laws, Powell said one of the most important things about MPA’s impact in a rural state such as Mississippi “is meeting colleagues and knowing then who to refer patients to while building your practice. It really helps to see what other people are doing particularly because many people are very isolated. It gives a feeling of community and that was extremely valuable for me coming back because I was away 25 years.”

Psychiatrist Vincent Liberto, MD, of the G.V. (Sonny) Montgomery Veterans Affairs Medical Center, served as President of MPA for two terms and noted that in addition to its lobbying impact, the Association also helped secure better staffing and more continuity at community mental health centers and worked to address regions of the state that had low ratios of psychiatrists to the population.

In nearly 20 years with the Association, Ladner said she has seen it become more diverse. Gordon is MPA’s first African-American President. But it has grown in other ways, in part a reflection on the profession.

“There are many more female physicians. The Association also is more culturally diverse and its membership has broadened, helping bring in different perspectives and ideas,” Ladner said.

MPA’s 50th anniversary celebration is co-sponsored by PRMS, MPA’s Platinum Partner.

“Our longstanding relationship with PRMS truly allows us to accomplish our mission every day,” Ladner said. She sends MPA members a weekly electronic newsletter with information from PRMS about risk management and other issues that reinforce “everything our people need to be thinking about.” PRMS also presents MPA members a half-day of CME seminars at no cost during the annual meeting.

“MPA is a strong and effective advocate for psychiatrists and their patients,” said Stephen Sills, PRMS President and Chief Executive Officer. “It is our privilege to have worked together through the decades and we look forward to many more decades to come.”

For more on MPA, visit http://www.msmpa.com.

Charles D Cash presented a CME seminar during the Annual Meeting in March.

Sign at the 50th Anniversary celebration.

To learn more about the superior insurance program and comprehensive services offered by PRMS, click here.

Posted in Events, PRMS "Gives a Hoot!", PRMS Blog | Tagged , | Comments Off on Mississippi Psychiatric Association Celebrates Its 50th Anniversary



Psychiatry-Specific Excess Risk Management Courses


PRMS is pleased to announce that it is making its psychiatry-specific Excess Risk Management courses available online – at no charge – to all New York psychiatrists, including those not insured through the PRMS program.  Our risk managers are experts in psychiatric malpractice risk management and we are sharing our expertise with the entire New York psychiatric community as part of our strong commitment to behavioral healthcare.

Both the Basic and Follow-Up online courses will be offered.  These have been approved by the New York State Medical Society and the New York State Insurance Department (with special approval to focus solely on psychiatry).

Psychiatrists may need to take one of these courses for any of the following reasons:

-If doctors in the New York Excess Insurance Program are required to take the Excess Risk Management course this year for continued participation in the Excess Insurance Program.

-Doctors may want to earn a Risk Management Premium Credit on their medical malpractice insurance.  In New York, completion of an approved Excess Risk Management course is required to earn this premium credit.

-Doctors may want to take the course for CME purposes.

About the courses:

-The Follow-Up Course is three hours and focuses on psychiatrists’ greatest liability exposures – psychopharmacology and treating suicidal patients, with special focus on the suicide risk assessment.

-The Basic Course is six hours and covers confidentiality, communication, psychopharmacology, treating suicidal patients, and more!

If doctors are insured through PRMS in The Psychiatrists’ Program, they can access the courses here (log in required).  If doctors are not insured through PRMS, they can simply send an email requesting access to Seminars@prms.com.  Upon receipt, we will email the course link.

To learn more about the superior insurance program and comprehensive services offered by PRMS, click here.

Posted in PRMS Blog | Tagged | Comments Off on Psychiatry-Specific Excess Risk Management Courses



New York, New York…


Will you be in New York City for the Annual Meeting later this week?  If so, join PRMS at these upcoming events:

Telepsychiatry: What You Need To Know 
Friday, May 4
7:30 am – 12:15 pm OR 12:30 pm – 5:15 pm
New York Hilton Midtown (1335 Avenue of the Americas, New York City) 
Click here for more details and to register today!

Manfred S. Guttmacher Award Presentation 
Saturday, May 5
8:00 am
Javits Center (655 W. 34th St, New York City) Please check directory for exact location

“Suicide and Suicide Risk Assessment: A Core Competence”
APA Annual Meeting (registration required)
Panel with Lisa Gold, MD, Cheryl Wills, MD, Richard Frierson, MD, Kaustubh Joshi, MD, Donna Vanderpool, JD, MBA, PRMS VP Risk Management
Monday, May 7
1:00 pm – 4:00 pm
Liberty, Marriott Marquis (1535 Broadway, New York City)

PRMS is pleased to support many organizations that will be meeting in New York City this May, such as:

  • American Association of Community Psychiatrists (AACP)
  • American Association of Psychiatric Administrators (AAPA)
  • Association of LGBTQ+ Psychiatrists (AGLP)
  • Association of Women Psychiatrists (AWP)
  • Indo-American Psychiatric Association (IAPA)
  • Senior Psychiatrists
  • Society of Uniformed Services Psychiatrists (SUSP)
  • Southern Psychiatric Association (SPA)
  • And more

 

The PRMS team will be out and about and we hope to run into as many friendly faces as possible.

Thanks to all of you for your support of PRMS.  It is an honor to have you as a client.

To learn more about the superior insurance program and comprehensive services offered by PRMS, click here.

Posted in Events, PRMS Blog | Tagged | Comments Off on New York, New York…



About the Author