Lawrence Memorial Hospital nurse coordinates mental health services for hundreds of patients each year
- on February 26, 2012
Paula Dupigny-Leigh has been a psychiatric nurse for 40 years.
“I was never real attracted to the medical aspects of nursing and so I knew mental health was going to be my niche,” the Lawrence resident said during an interview in the atrium of Lawrence Memorial Hospital. “It’s been my passion to take care of the mentally ill population.”
Dupigny-Leigh grew up in McPherson, graduated from Wichita State University and applied to work at the world-renowned Menninger Clinic in Topeka.
“I thought this was the holy grail of psychiatry and thinking as a new grad that there was probably no way I would get a job there,” she said. But, she did, and she worked there for 30 years in a variety of areas — crisis, geriatrics and outpatient care.
In 2001, when she knew the Menninger Clinic would soon be moving to Houston, she applied for a job in geriatrics in LMH’s mental health unit and was hired. Then, in 2004, LMH closed its mental health unit.
Janice Early, communications director, said there were no psychiatrists who would admit inpatient mental health patients and that’s still true today. Also, patient volumes were not sufficient to sustain a quality program. But, LMH kept Dupigny-Leigh onboard and she became the clinical coordinator of mental health.
Dupigny-Leigh said she hasn’t come across a job like hers in the hospital industry. She coordinates mental health care for inpatients and outpatients, teaches classes on suicide precaution and behavior management and provides guidance to staff. She also screens hospitalized patients to determine if they may need mental health services. For example, sometimes dementia can be mistaken as a mental health disorder among the elderly.
Dupigny-Leigh said mental health issues are common. She recently provided a report on the mental health services provided in 2011 at LMH. Among the statistics:
• 1,182 — patients came to the emergency department requiring a psychiatric assessment.
• 659 — of those patients were moved to the Crisis Stabilization Service area where patients are treated for mental health.
• 641 — patients were transported to a mental health facility.
• 103 — psychiatric consults were provided to hospitalized patients.
• 702 — nurse consults were provided by Dupigny-Leigh to patients who were hospitalized or using outpatient services such as oncology and cardiology.
She said depression and anxiety are the most common mental health issues seen in patients.
“Heart disease and depression really go hand in hand. There does seem to be a lot of depression in people who are rehabilitating from heart conditions,” she said.
Challenges in care
Dupigny-Leigh said she meets with patients once or twice, but if they need ongoing therapy or medication management, she provides them with referrals. But this can be challenging for a variety of reasons: no services, waiting lists, affordability.
She said there is a shortage of psychiatrists in Lawrence. She said most of them — three — are at Bert Nash Community Mental Health Center, which is across the street from the hospital, but there are a few who have private practices.
“To try to find adequate medication follow-up for psychiatric patients can be a real challenge. More of the primary care physicians are taking on that role,” she said.
She said they will medically detox people at LMH for drugs and alcohol and then will help them find an inpatient or outpatient program, but often there’s a wait and that’s not good because the chances of relapse are huge. She said it’s tough to find an inpatient substance abuse treatment program for men.
“Also, in my personal experience, you have to have a pretty good relationship with your therapist and not everybody matches the first time,” she said. “So, you might have to try two or three people to find the person that works for you. That can be really challenging.”
Dupigny-Leigh said there has been an increase in the number of violent and out-of-control patients who are coming into the emergency room and she said a lot of it is related to drugs and alcohol abuse.
She said when a person comes into the ER, he or she is always first evaluated from a medical aspect even if they say, “I’m suicidal,” and have no wounds. She said vitals will be taken and any appropriate testing will be done. And, she encourages people to seek mental health help at the ER.
“I don’t see mental health as being any different than appendicitis or a heart attack. So, I think when people are truly in crisis, I think that’s where they should come,” she said.
There is someone available 24/7 in the ER who can do a mental health assessment. Once a patient is medically stable and it’s determined they have mental health needs, they are moved into an area near the ER called the Crisis Stabilization Service unit. It’s a quiet area that has three rooms designed for the safety of patients. Patients transferred to the area suffer from depression, anxiety, substance abuse or have suicidal thought or intent.
In this area, further testing is done to determine whether a patient needs inpatient or outpatient treatment and then LMH will help find those services.
“We don’t have problems finding inpatient beds most of the time,” Dupigny-Leigh said. She most of the patients go to Stormont-Vail HealthCare in Topeka, but other places include Shawnee Mission Medical Center and Two Rivers Psychiatric Hospital in Kansas City, and Cushing Memorial Hospital in Leavenworth. She said most of the patients who are transported involuntarily go to Osawatomie State Hospital. She said a patient will be hospitalized if an assessment determines that the patient is dangerous to himself or herself or others.
“Unfortunately in our day and age, psychiatric hospitalization is due to self harm, suicidal, homicidal or injury to others or someone has such an acute psychosis that they can’t take care of themselves. Almost everyone else is seen on an outpatient basis,” she said.