September 22, 2018
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Missing Peace

Community-based and private practice mental health services expand level of patient care
View the full feature in the July/August 2013 issue of Evansville Living.

Cognitive disabilities weren’t just a concept for President John F. Kennedy. His eldest sister, Rosemary, was mentally disabled, and she later underwent a prefrontal lobotomy. It was a time when mental health and developmental disabilities weren’t widely understood.

Kennedy created a study panel that authored one of the most comprehensive, multifaceted, and well-researched reports in the disability field, according to the Association of University Centers on Disabilities. The report led to Kennedy’s decision to sign two public laws that restructured the mental health system to include community based care.

The new laws led to substantial changes and reflected a growing shift in the way the public viewed the mentally ill. In 1890, for instance, the Southern Indiana Hospital for the Insane (now known as the Evansville State Hospital) was built on the corner of Lincoln and Vann avenues to care for the mentally ill in “a tranquil setting with activities to keep them busy and in an environment that was self-contained,” according to John K. Browning, the former president/CEO of Southwestern Healthcare Inc. The hospital was roughly five miles from Downtown Evansville, the heart of the city, and “it was the thinking of that era that individuals with a mental illness could better recover far away from society,” Browning adds.

The two public laws signed by Kennedy changed that.

“JFK recognized that services were extremely limited for all in the country via his own personal family experiences,” says Dennis Moran, the current president/CEO of Southwestern Behavioral Healthcare. “Most that was available was either too expensive or was available as inpatient care only (as in state hospitals). A significant number of state hospital patients should have been receiving community based services, and JFK opened the door for this to take place.”

Fifty years later, those laws have led to the wide range of community-based and private practice mental health resources available today in Evansville.

Southwestern Behavioral Healthcare, which opened its headquarters in 1971, provides programs and services ranging from outpatient to consultation and education for youth to the elderly in 14 locations in Vanderburgh, Warrick, Gibson, and Posey counties in Indiana. Its services include acute psychiatric care for all age groups, 24-hour emergency services, and a full range of outpatient services and addiction treatments. It also provides care for older adults with serious and persistent mental illnesses.

Statistically, one in four people will be diagnosed with a mental health disorder in their lifetime, according to Rick Paul, director of clinical practice at Southwestern Behavioral Healthcare.

The following group of stories point to ways local readers can work to experience good mental health.

Playing in the Sand

New expressive therapy can be effective   By Julie Bellamy, LCSW, and Caron Leader, LCS

Talk therapy can be helpful, but sometimes clients need additional therapies to assist them further. When that happens, two local psychotherapists at Within Sight LLC turn to a form of expressive therapy called Sandtray-Wordplay.

The approach is unique in that it asks clients to express themselves through sand. Clients can touch the sand, manipulate the sand, or build their own sand world. To further enhance their world, they can use miniature images or other items as a psychotherapist witnesses their newly created world.

Sandtray-Wordplay was developed by Gisela Schubach De Domenico, Ph.D., in the 1980s. Her practice is in California. This method, which also is used by psychotherapists at Within Sight, entails the use of various colors of sand in blue trays. The trays measure roughly two-feet-by-two-feet and three-to-five inches in depth. This blue tray transforms into a world for clients to express their inner experience.

The theoretical premise is that there is a “builder” of the sandtray world and a “witness” to the building. The process allows the builder of the world to choose whatever draws or repels them. They peruse a variety of miniature images depicting all aspects of human life, including elements from nature, fictional characters, and anything else the psyche needs.

The builder is in charge of the world and the psychotherapist is the silent but attentive witness. After the building of the world is complete, there usually is a shared experiencing of the sandtray. The world in the limited space of the sandtray reflects aspects of the builder’s life experience in a specific, concentrated, and illuminating manner.

The builder’s world is to be witnessed and experienced, not interpreted or directed. Something powerful happens in this therapeutic process as a psychotherapist joins with a client and actually experiences their world with them. Clients can freely express whatever is needed to produce the change they are seeking. This shared experience further integrates the change.

This type of expressive therapy can be helpful when talk therapy is not because words do not always suffice. Clients who create images and scenes using Sandtray-Wordplay are invited to think differently, often times using the sand to portray and experience scenes and emotions that their words may only hint at. It’s also very important for the client to know that their psychotherapist is sharing their experience. In these moments, the psychotherapist is able to better understand how the client feels and why they feel that way.

The building process might be completed in one or more sessions. Photographs are used to chronicle the world. Psychotherapists at Within Sight use Sandtray-Wordplay as the sole therapy technique or as an adjunct to traditional talk therapy. Having an experiential tool that can be adapted to individuals, couples, and groups is therapeutically valuable. It becomes a creative vehicle that can produce dramatic results.

Sandtray-Wordplay therapy at Within Sight takes place in a special room, but therapists can use the trays in their offices, as well. Therapists certified in this method can be trained in seven levels of Sandtray-Wordplay therapy.

For more information about Sandtray-Wordplay, contact psychotherapists Caron Leader and Julie Bellamy at Within Sight LLC at 812-402-8333 or visit iamwithinsight.com.

What Do They Do?

There are a variety of mental health professionals in Evansville   By Victoria Grabner

Psychiatrist (M.D. or D.O.): These physicians specialize in the diagnosis, treatment, and prevention of mental health and emotional problems. They can prescribe medication.

Psychologist (Ph.D., Ed.D., or Psy.D.): These licensed mental health professionals specialize in the diagnosis and treatment of mental and emotional disorders. They generally cannot prescribe medications. They must attend continuing education programs to maintain their license.

Marriage and Family Therapist: These individuals are trained to provide services to couples and families. They have completed a master’s level/graduate program. They are eligible for licensure through the State of Indiana with the LMFT designation.

Mental Health Counselor: These mental health professionals provide flexible therapy combining traditional psychotherapy with a practical, problem-solving approach to help patients change and resolve their problems. They must have received at least a master’s degree in an area related to mental health counseling. Their Indiana state licensure designation is the LMHC.

Master in Social Work: These individuals help people manage their everyday lives and have completed at least a master’s level/graduate program. They are eligible for licensure through the State of Indiana with the designation of LCSW (licensed clinical social worker).

A Child’s Place

Hillcrest offers emergency care for children taken from their homes   By Victoria Grabner

These days, Hillcrest Washington Youth Home Inc. is a private, not-for-profit, community-based residential facility for both males and females ages 10 to 21 who have become wards of the court or are in need of services through the Department of Child Services. Hillcrest is staffed 24 hours a day every day, and it provides residential services to children from any county in Indiana.

Yet in 1871, Hillcrest was a private residence that was then deeded to Vanderburgh County for use as an orphanage. In 1952, the county constructed the new Hillcrest and Washington buildings to be used as residential care facilities for youth, according to the organization’s website. They were operated by the Vanderburgh County Department of Public Welfare.

In 1986, Indiana law required that all county welfare departments were to become part of the State Welfare Department. Since the State Welfare Department did not operate facilities, the Vanderburgh County Commissioners began asking the community for agencies that would be interested in operating the Hillcrest and Washington facilities, the website says.

In 1987, the Southwestern Indiana Mental Health Foundation Inc. began operating the facilities. Hillcrest began operating as a residential and emergency shelter facility for all children and became Hillcrest Washington Youth Home Inc.

Now, the average age of children admitted to Hillcrest is 14. During the 2013 fiscal year, the average time a child stayed in the residential program was 45 days. Most children who live at Hillcrest attend schools in the Evansville Vanderburgh School Corp., while some may take part in GED services.

Hillcrest Washington Youth Home Inc. also offers emergency shelter services, independent living, Strengthening Our Family Ties (SOFT), motivators, and a teen matrix substance abuse program.

The facility has seen more than 2,500 children since it was acquired by Southwestern Healthcare Inc. in 1987, according to Becky Glines, communications manager for Southwestern Healthcare Inc. Hillcrest sees an average of 127 children in any given year. It is located at 2700 W. Indiana St. in Evansville.

To refer a child to Hillcrest, call 812-428-0698 to contact the admissions coordinator. For more information, visit hillcrestyouthhome.org. Hillcrest is part of Southwestern Healthcare Inc.

Addiction Specialists

Variety of programs offered at Stepping Stone   By Victoria Grabner

Stepping Stone offers a variety of programs for people struggling with addictions and co-occurring mental illness. Services are offered in one building that is part of Southwestern Behavioral Healthcare Inc. Among the programs are:

» Social detoxification: This residential program is for those who need a safe, structured environment during the first five-to-seven days of abstinence. Patients are medically supervised with a nursing staff and a physician who is present during the day. Non-medical staff are on site 24 hours a day. This service is generally offered to those addicted to opiates, methamphetamine, marijuana, synthetic drugs, cocaine, and, in some cases, alcohol.

» Residential: This is the most intensive program. It provides patients with structured programming using the best evidence-based practices while offering patients a safe, supportive environment. Those in this program stay between three to four weeks and attend all programming.

» Transitional: Those who have completed the residential treatment program are allowed to stay in the transitional wing for up to six months. These residents are required to work, make payment toward their fees, attend community 12-step meetings, and attend required programming.

» Intensive Outpatient Program and Matrix Program: These are the two most intensive outpatient programs that meet three times a week. Both of these programs use evidence-based curricula to assist those early in recovery with developing life skills, early recovery skills, relapse prevention skills, and orientation to the 12-step program.

» Outpatient Specialty Groups: These are always evolving to meet the needs of the community. These groups typically meet once per week and are designed for those who have some period of sobriety and have already completed an intensive program.

Stepping Stone is located at 4001 John St. in Evansville. Those interested in outpatient services are asked to call 812-473-3144. For residential services, call 812-473-3104.

For Every Need

Mulberry Center offers marriage, ADHD help   By Victoria Grabner

Mulberry Center has a long history in our community of providing quality, accessible, professional, and confidential services in an outpatient setting for individuals and families in need of treatment for emotional problems.

Therapy sessions are geared toward problems associated with marriage, family conflicts, anxiety and depression, alcohol and drug abuse, child and adolescent behaviors, attention deficit hyperactivity disorders, critical incident debriefing, post-traumatic stress disorder, and anger.

Mulberry Center also provides treatment for people struggling with alcohol and drug issues through individual, group, and family therapy.

A new initiative at Mulberry Center is responding to the community’s needs through the First Responder program for those who are first to help others but face trauma on a daily basis. In addition, Mulberry Center is quick to respond when a company has a crisis, a major accident occurs, or when other needs arise to provide this assistance. Its members will stay as long as they are needed.

Mulberry Center is located at 414 SE Fourth St. For more information, call 812-423-4700 or visit mulberrycenter.org.

Treating Trauma

aha! counseling works with PTSD patients   By Kate Rosenmeier, LCSW, ACSW

Post-traumatic stress disorder is the body’s and mind’s reaction to a traumatic event. A trauma can be defined as any stressful occurrence that is outside the range of usual human experience and would be distressing to almost everyone. This would include serious threats of harm to one’s self, children, spouse, or home; seeing another person who has been seriously injured or killed; being a victim of a crime; living through a combat experience; living through a natural disaster; being a victim of domestic violence; or having experienced childhood sexual or physical abuse.

Some people can live through a traumatic event and find that, with time, they begin to feel better with little evidence of distress. For others, the body’s and mind’s reaction to the stressful event can persist for years and can affect their ability to enjoy life. Generally, symptoms of PTSD include increased anxiety and/or depression; an increased startle response; a fixation on the traumatic event; intrusive thoughts; the occurrence of flashbacks and nightmares; a proclivity to explosive outbursts; and sometimes a numbing response or emotional constriction.

Bessel A. van der Kolk is a leading researcher in the area of PTSD who is the medical director of the Trauma Center at Justice Resource Institute in Brookline, Mass. Through his use of positron emission tomography (PET) scans and brain imaging, he has discovered that there are very few neural pathways between the amygdala, which controls instinctive responses, and the cerebral cortex areas of the brain. The cerebral cortex controls language, memory, and abstract reasoning functions. He believes it is not helpful for PTSD patients merely to talk about a trauma as that can sometimes re-trigger the associated anxiety. Yet there are ways to reach and help PTSD patients.

aha! counseling uses EMDR (Eye Movement, Desensitization, and Reprocessing) along with process therapy and medication management to target and lower the anxiety associated with PTSD. This form of therapy starts with the old memory and stimulates the brain to route through neural pathways in the mid-brain to the cerebral cortex. It is very efficient and can generally help a person to feel significantly better in one or two sessions.

Meanwhile, the study of PTSD is a fairly recent science. Veterans of World Wars I and II were known to have “shell shock.” Little was known about PTSD until soldiers started returning from Vietnam and their experiences became an area of scientific study and interest. The U.S. Department of Veterans Affairs does a commendable job of identifying and treating PTSD.

aha! counseling primarily treats non-combat related PTSD. Its patients generally come from the Tri-State area. Treatment varies with the individual, although some people can be helped in one to three sessions. The most important thing for people to understand is that if they have lived through a trauma and are having a difficult emotional response, they should seek treatment. Treatment is highly effective and is best when started as soon after the event as possible.

Kate Rosenmeier, LCSW, ACSW, has been in the social work field for 35 years. For more information about aha! Counseling, call 812-479-1242 or visit ahacounseling.com.

Help is Out There

Suicide is real in Vanderburgh County   By Victoria Grabner

The statistics include both genders and cut across most age groups, from pre-teens to the elderly. The message? Suicide is real, especially here in Vanderburgh County.

A total of 42 people killed themselves in this county in 2012, according to the county coroner’s office. In 2011, that number was 44. In 2010, there were 54 suicides, and in 2009, a total 49 people ended their lives. In 2008, 38 people committed suicide. In 2007, it was 40. And in 2006, the number was 29.
Janie Chappell, the manager of community services and business development for Deaconess Cross Pointe and chairperson of the Southwestern Indiana Suicide Prevention Coalition, says more men than women die by suicide, though more women than men attempt suicide. Additionally, 90 percent of the people who die by suicide have a diagnosable mental illness.

“Suicide is not really about death,” she says. “It is about ending emotional or psychological pain. Most suicidal people do not want to die. They want to end their pain.”

Chappell says the best way to ask someone if they are suicidal is to ask them directly, as in “Are you thinking about killing yourself?”

She adds that friends and relatives will not plant the idea of suicide by asking or by educating people about suicide. Chappell says family members who lose a loved one by suicide have a six times higher risk of themselves dying by suicide.

There is help for people who feel helpless, hopeless, depressed, out of control, or ready to give up. Those who are considering suicide are encouraged to all the Suicide Prevention Line at 812-422-1100.

The Suicide Awareness Initiative is a community-wide marketing campaign that uses TV, radio, print, billboards, magazine advertisements, and bus benches to let people know they can talk about their feelings and seek help if they are considering suicide.

For more information about suicide prevention and education, call Janie Chappell at 812-471-4521 or visit southwestern.org/suicide.

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