News Article Details

Crossroads provides mental health crisis treatment

Sun Journal - 3/9/2017

March 09--CarolinaEast Medical Center provides not only medical assistance for physical problems, but also for mental health issues.

Crossroads has been in existence for 28 years, providing residents in the region with an adult mental health unit that has an intensive in-patient component, as well as a partial hospitalization program for people who don't need to stay overnight, and an intensive out-patient program.

Crossroads has a track record of success, the latest being named the Horizon Management winner for best patient satisfaction. Horizon manages 90 mental health units across the nation.

Ron England, Crossroads director, oversees a 48-person staff, consisting of employees from Horizon, the contract manager, along with hospital nursing and tech staff. The therapy and director jobs are Horizon, based in Texas.

"It has actually been a somewhat hidden secret in the community," he said of Crossroads.

England said the goal of Crossroads is to stabilize a crisis, not perform long-term treatment. The work includes referrals to a community agency where the extended treatment is available.

One of the Crossroads programs is intensive in-patient care, where people come to for crisis stabilization, and once they are stabilized they return to the community to continue doing the work that will be able to help them stay emotionally healthy. The average length of stay is three-to-five days, with some isolated cases as much as several months to stabilize.

There is a combination of ways people enter that program -- about 46 percent are involuntary commitments, which involves a magistrate.

"It can be the police identify the individual as in distress, or it can come from a family member, or the individual can come into the emergency department or from another community provider, where someone has identified that they are not safe," England said.

That can include thoughts of harming themselves or others or they are experiencing hallucinations or delusions and perhaps hearing voices.

By-products of the mental problems often include alcohol and substance abuse, although England said that Crossroads is predominantly involved in physiatrists.

The majority of individuals who go through Crossroads programs are having mood disorders, frequently suicidal thoughts, along with manic-depressive illnesses and schizophrenia.

Those issues within the brain of the patient can include "seeing things, hearing things and delusions that people are after them."

England said that in some cases, people with manic-depressive or bi-polar issues often shun the thoughts of taking medications to stabilize the chemical imbalance in their brain.

"At times when they are manic, they are experiencing no need for sleep and everything that they are doing is the most amazing thing that has ever been done," he said. "The thoughts of taking medication every day is not the most wonderful day, I am not going to have any more energy than anyone else."

When they stop medication, they often feel everything is wonderful -- for a time.

"There is fear there that it will control them, change who they are," England said.

"In fact, the purpose of medication is not to numb them out. It is to make them the best person they can be and be able to use all of their resources, all of their assets -- to think the most clearly and make the best decisions."

The problems can mount when individuals make bad decisions, resulting in financial and emotional consequences.

One of the challenges with a condition such as schizophrenia is that it's an illness that tells the person they do not have an illness.

For friends of anyone who has a mood disorder, England has advice, since friends have no legal recourse in helping.

"The first and foremost thing is continue being their friend and listening to them," England said. "There will be the opportunity in all likelihood that because you are willing to listen, you can say 'I am really worried about you. Are you willing to see someone? We can find someone.' It is just those first steps of listening."

Substance abuse naturally comes into play with Crossroads, because in many cases individuals with major mental issues will self-medicate with street drugs and alcohol.

England describes two other programs as being for individuals "who are not at the status of being a train wreck, but are in acute crisis."

One is partial hospitalization, which has been around 21 years. It is intensive out-patient, referred to as a "hospital without walls." The patients return home on a daily basis, for 20 hours a week.

"One of the unique things about our partial program is currently, it is almost exclusively active-duty military," England said. "They go back to the base and those who are retired to home."

He said there is a two-fold role for Crossroads.

"We are trying to save their life and two, we are trying to save their career," he said.

The third program is intensive out-patient, which began last spring.

"With that program, we are able to tailor what the needs are," he said, adding that visits to Crossroads can range from a few to multiple treatments and group sessions -- based on the best way to help move through a crisis.

The age range of patients in the various programs in the past year was from 18 to 85. Of that number, 51 percent were female. There was a large grouping of ages 19- to 40-year-olds and another from 49 to 61.

The hospital emergency department provides 66 percent of patients, 17 percent from other hospitals, 10 percent from community-based providers and 7 percent are from primary care physicians.

"Individuals who have the awareness are the ones that it is easier to work with because they want to change," England said.

There appears to no longer be a simple formula of youth experimenting and finding their way, a grace period of stable adult-hood and family, followed by later stages of mid-life crisis.

"With the stresses of the world currently, no longer is there that lull that takes place," he said.

England said that the bottom line of treatment is "our patients are doing the hard work. We are a service station. We will walk the path with them, providing support, but it is a matter of the things they accomplish -- the heavy lifting."

One Crossroads patient talked with the Sun Journal about her journey and treatment, on the condition of anonymity.

"I have had a history with mental illness for over two decades and I can say that I have been blessed with some wonderful practitioners," she said. "I know myself well enough to know when I am getting out of balance, when I need a med adjustment."

She said before coming to Crossroads, she was "brushed aside" by former medical help when she told them she needed a change in medications.

"I thought this is not going to work out, so I drove myself right here to CarolinaEast and was fortunate enough to have people that listened to me," she said.

"Knowing herself" was not always the case, such as early in her condition, with depression in 1999, influenced by being a self-described workaholic.

"A manic-depressive person can continue in a manic phase for quite some time," the woman said. "When you crash into a depression, you know it."

Her condition continued into the early 2000s and she was stabilized on medication.

"I was determined to have a child, so I came off medication and went pretty well up until 2009," she continued. "That is when my world tanked again."

She was not formally diagnosed until 2014, which created added confusion to her false sense of being "Superwoman."

"It is not just the depression that sets in. It is almost self-guilt. I was not good enough to get all of this done," she said.

She is now feeling "wonderful" again, with coping skills and plans to go to intensive outpatient treatment.

Her advice to anyone with potential mental health problems is simple.

"Get into see a health-care provider," she said. "It needs to be looked at both from a medical perspective and then also from a therapeutic perspective."

Charlie Hall can be reached at 252-635-5667 or 252-259-7585, or charlie.hall@newbernsj.com. Follow him on Twitter @CharlieHallNBSJ

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