Host Dr. Wayne Tuckson welcomes guests Lindsey Jasinski, PhD, and Marc Woods, DNP. Here are three takeaways from the episode:
- 1. Approximately 15.4 million adults in the U.S. have a mental illness, according to 2022 data. This includes more common diagnoses such as depression and anxiety, and serious conditions such as schizophrenia and bipolar disorder.
“In Kentucky, we tend to be higher than the national average in terms of individuals who have any mental illness or have high levels of mental distress,” says Lindsey Jasinski, PhD, chief administrative officer for Eastern State Hospital/UK Healthcare in Lexington. “We have many counties in Kentucky where nearly 40 percent of the population says that they’ve had more difficult days in the last month than good days.”
While nearly everyone goes through periods of depression or bouts of anxiety, those with serious, persistent mental illness may lack awareness of their condition, Jasinski says.
“What we know is that because of stigma, many times people don’t seek support and they may actually meet the criteria for one of those diagnoses,” she explains. “We know that in many places, Kentucky especially, we have deserts where there are fewer mental health professionals available.” This means that diagnoses of mental illness are often made by primary care physicians or other medical staff.
While Jasinski says Kentucky needs about 200 more mental health providers, there are some positive developments. Marc Woods, DNP, RN, chief nursing officer for Eastern State Hospital/UK Healthcare, says telehealth services have helped expand access to mental health care in underserved areas. He adds that substance abuse treatment facilities provide important mental health services as well, since addiction often correlates with psychological issues.
- 2. Too often, persons with long-term mental illness end up in correctional facilities, where they don’t get the treatment they need.
According to Woods, inmates in jails and prisons have a higher rate of serious mental illness than the overall population, up to 30 percent. “Why is that a problem? It’s because people aren’t being treated,” he says. “There’s very little resources provided to jails and prisons for the treatment of mental illness.”
He continues that there are more people with serious mental illness in Kentucky’s prisons and jails than there are in the state’s hospitals, which is due to a national trend of hospital closings. Because of this, he says many patients at Eastern State are admitted after spending time in correctional facilities and are in significant mental health crises due to lack of treatment.
“With the (mental health) deserts we talked about, there’s just not a lot of places for people to go to get care,” Woods says. “So they find themselves in jails and prisons because they’re not getting treatment, and they get picked up for some of these smaller crimes, or maybe they’re involved in larger crimes because they don’t have that support system.”
Jasinski says television and movies often portray mentally ill people as dangerous and to be feared – stereotypes that are not supported by research. She says only about 4 percent of violent acts are connected to mental illness. In fact, Jasinski and Woods explain that persons with mental illness are more likely to be victims of crimes rather than perpetrators.
“We don’t see some of these healing stories, the recovery stories, the things that show us that mental illness looks different,” Jasinski says. “Mental illness can look like someone going to work every day, taking care of their family, owning their home, and (being) successful in recovery and engaged in treatment.”
Woods adds that the best way to combat the stigma surrounding mental illness is for people to share their personal stories about their own struggles with depression, anxiety, or other burdens, or relate stories about loved ones doing the same. “It can be very normalizing to people,” he says.
- 3. The EmPATH program (Emergency Psychiatric Assessment Treatment Healing) is transforming the way professionals treat persons with mental illness. There are around 30 programs in the United States, and Eastern State Hospital in Lexington hosts the first one in Kentucky.
Eastern State Hospital’s EmPATH unit, operated by UK Healthcare, is an in-person program that is open to patients at any time and without scheduling. “You don’t have to call or get an appointment or whatever, you just drive up, show up, and within 30 minutes you’re in front of a provider that’s sitting down and trying to create a plan of care with you,” Woods explains.
The program is specifically designed to treat persons in an acute mental health crisis, which Jasinski says can be different for each individual. For some, it will be an escalation of substance use disorder. For others, it manifests in a withdrawal from work and social activities into isolation. Persons who develop suicidal thoughts with the intent to act on them need urgent attention, she says. And then there are those who have psychosis and an altered perception of reality.
“It can be any of those things,” Jasinski says. “With EmPATH, we’ve really designed a program that is available 24-7, 365 days a year, because we can’t define when someone’s crisis happens but we can address all of those concerns.”
The availability of EmPATH means those experiencing a mental health crisis can avoid visiting an emergency room, where they might not receive immediate treatment and could be misdiagnosed. Jasinski says the staff at Eastern State work with community partners such as the police, fire department, and EMS to ensure that persons experiencing a mental health crisis don’t go to jail but instead are taken to the EmPATH center. “We’ve tried to make it simple and easy. This is the destination where we do behavioral health care,” she says.
Treatment options at EmPATH are varied and are provided according to each individual’s needs, Jasinski says. They include medications, therapeutic interactions, and even consultations with peer support specialists. “These are adults who have lived experience, they’ve been through some of these things,” she says. “What they bring is hope. And we know hope is a major antidote to suicidal thoughts and depression.
“The idea is that we’re not just evaluating someone and saying, ‘You’re going to inpatient or you’re going to these outpatient services,’” Jasinski continues. “We’re treating that person for up to 23 hours. On average people are with us for about 15 hours, and all 15 hours are active treatment.” This treatment is developed with input from the patient and can include assistance with food, shelter, or other social services after they depart the EmPATH center.
“I can’t talk enough about the actual environment itself and how therapeutic it is,” Woods says. “When (a patient) is in an (emergency department), they’re in their little cubbyhole or they may even be in a hallway, right? But at EmPATH, they’re assigned a very comfortable chair that they’re able to recline fully so they can sleep, and they can move this chair to the position on the unit that they want to be in. We have open snacks and food that they can (get) with their own agency and choose how much to eat and drink. It’s a very open, warm, welcoming sort of environment.”
The EmPATH treatment process begins by stabilizing the acute mental health crisis for each patient, Jasinski says. That is followed by connecting each individual to outpatient services in the community that can help them once they leave. Those services come from long-term care facilities that are aligned with EmPATH’s mission, such as New Vista Community Mental Health Center and The Ridge in Lexington.
The EmPATH staff also arranges follow-up services for patients, which Woods says usually occurs within 24 to 48 hours after departure. For those whose mental health crisis is connected to substance use disorder, the EmPATH staff will contact residential facilities and even drive them directly there to sign up and continue receiving treatment.
Jasinski says that EmPATH is largely funded by insurance reimbursement, and that the staff works with persons that don’t have insurance to set up a payment plan based on their income. According to both Jasinski and Woods, EmPATH is a more successful and less expensive option than emergency rooms for persons experiencing a mental health crisis. “Of those that come to EmPATH, only 25 percent require hospitalization when they leave,” Jasinski says.
