Two doctors talking together in the hallway of a medical facility would seem quite ordinary, but when the doctors are Brian Sheitman and Beat Steiner and the facility is WakeBrook Recovery Center the communication is extraordinary.
Why? Because Sheitman, WakeBrook’s medical director, is a psychiatrist and Steiner is a primary care physician. And throughout the world of health care those two fields rarely work together. But at WakeBrook they are and the cooperation represents a ray of hope for progress in the nation’s dismal record of caring for the mentally ill.
Sheitman and Steiner, both clinical professors at the UNC School of Medicine, deliver and oversee care at WakeBrook that treats the whole person, body and mind.
WakeBrook is a former Wake County facility now run by UNC Hospitals. The hospital system agreed to take over WakeBrook and build two psychiatric residential units as part of a 2012 agreement to help WakeMed care for those who are indigent and mentally ill.
“We take the people who fall through the cracks,” says Sheitman.
The facility, located close to WakeMed’s Raleigh campus, can serve only a fraction of the Wake County population with serious mental illness. Its crisis unit sometimes fills, and WakeBrook must turn away people having psychotic episodes who are brought in by the police.
But WakeBrook is making a difference in a broken mental health care system in which people having a mental health crisis can usually be taken only to an emergency room or to jail.
“I suspect that without this place, it would be a disaster,” Sheitman says.
I visited the hospital two years ago when construction was nearing completion on phase one. I went back last week and found the new 16-bed residential building full and construction crews at work on the second and final phase that will add 12 more beds.
But this isn’t a return to institutionalization. The residential beds are there for people in crisis, but not for long-term stays. Most patients are stabilized and move out within a few weeks.
What’s happening at WakeBrook is an approach that follows one of the rarest qualities in the United States’ history of mental health care – common sense.
WakeBrook is providing psychiatric treatment and detox to thousands of patients on an inpatient and outpatient basis, but also primary heath care for hundreds of patients.
The holistic approach brings together care that’s been split for political and cultural reasons rather than medical ones. Physical illness is seen and covered as real illness. Mental illness is seen as affecting few people and is often underfunded in government budgets.
Of the divide between physical and mental health care, Sheitman says, “It’s striking how isolated the two are.”
WakeBrook breaks down the barriers, and the approach saves money and improves the quality of life and the longevity of the seriously mentally ill, who on average die 25 years earlier than Americans without mental illness.
On the subject of savings, Sheitman tells of one patient who used to regularly arrive at a hospital complaining of abdominal pain, and the emergency room doctor, erring on the side of caution, inevitably ordered an expensive CT scan. When the patient comes to WakeBrook with the same complaint, there’s a different response.
“Here, we know him,” Sheitman says. “No scans.”
The medical director estimates that care at WakeBrook is 90 percent less expensive than care in an emergency room.
It is a misconception that the mentally ill tend to be violent. The great majority are afraid, or confused, or depressed. Many are in physical pain because of untreated ailments, including dental problems.
Steiner, director of the primary care clinic at WakeBrook, says having a regular doctor helps the mentally ill physically, but also provides “a sense of connection” to someone who is interested in their wellbeing rather than simply processing them through a clinic or emergency room. Steiner says one patient recently told him during an exam, “This is the first time I’ve been listened to.”
WakeBrook is doing what should be done everywhere. Its holistic approach got a boost recently from a $1.6 million federal grant. The money will allow it to expand its primary care treatment, including dental care. That will meet an urgent but neglected need. Mental health experts estimate that 4 percent of the U.S. population suffers from serious mental illness, but many lack a regular primary care doctor.
While WakeBrook’s approach is impressive, what matters more is whether it can demonstrate results and savings that will help bring mental and physical health care together across the state and nation. Closing that gap will mean fewer people falling though the cracks.
Barnett: firstname.lastname@example.org, 919-829-4512