It’s a well-known phenomenon: Depressives who drink or do drugs to ease their pain; addicts who shoot up to take the edge off; anxious and severely distraught people who pop every pill they can get their hands on instead of seeking the psychiatric help they need.
Doctors call these “co-occurring” mental health and substance abuse problems. One study in the Journal of the American Medical Association found 29 percent of people diagnosed as mentally ill abused either alcohol or drugs, and 37 percent of alcohol abusers and 53 percent of drug abusers had at least one serious mental health illness.
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Now, to better serve those patients, Roger Williams Medical Center is opening a new, 12-bed “dual diagnosis” unit, adding to an already unique array of mental health and substance abuse services for a community hospital. Roger Williams also has a 15-bed alcohol detoxification unit, a day treatment program and a geriatric psychiatry unit.
For this new unit, carved out of long-unused research space, Roger Williams hired 18 new staffers, including a clinical nurse manager, an occupational therapist, a utilization review coordinator, a social worker, seven registered nurses and seven mental health workers.
Psychiatric facilities can provide similar care, but Susan Kimper, director of behavioral medicine for the hospital, said one of the benefits of having a dual diagnosis unit within an acute-care hospital is that many of these patients have medical conditions as well.
“If our patients start getting into difficulty with other issues, we have immediately a code team, and they can be transferred to a medical bed of the ICU,” she said. Diagnostic imaging and other services are also close by, she noted, making it easier to care for patients.
In 2002, the R.I. Department of Health has reported, nearly 35,000 patients were discharged from Rhode Island hospitals in 2002 with a mental health or substance abuse diagnosis, but for nearly 22,000 of them, it was a secondary diagnosis, after some kind of physical illness or injury. All but four were treated at non-psychiatric hospitals.
Earlier this year, a Rhode Island SHAPE Foundation report on behavioral health in the state specifically cited the lack of coordination between mental health, substance abuse and medical services as a major problem, given the multiple needs of many patients.
The SHAPE report also specifically said providers should be encouraged to create programs with integrated services for people with co-occurring disorders.
The new Roger Williams unit has six double rooms, including two medical beds with all the equipment to support a sicker patient, as well as a group therapy room and a dining area.
Most of the unit is decorated in sea-foam and mauve tones – chosen for their soothing properties – and the group spaces are light-filled and “invigorating,” as Kimper put it. Architects Robinson Green & Beretta Corp. did the renovation, which cost $800,000.
To get the word out about the new facility, Roger Williams hosted an open house Sept. 9 and invited a wide range of potential referrers: doctors, mental-health centers, even other hospitals – since they all get their share of dual diagnosis patients in their emergency rooms.
The R.I. Department of Mental Health, Retardation and Hospitals had some final inspections to do last week; Kimper said she expects the first patients to be admitted this week, and at that point, another mailing will go out alerting providers to the fact that the unit is open.
Given the shortage of mental health and substance abuse beds statewide, Kimper said, she’s anticipating a lot of referrals from other institutions.
“I know right now on Friday, going into the weekend, there were no beds for any psychiatric or substance abuse issues in the whole state,” she said. “We expect that we’re going to be pretty full on a daily basis.”
