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Summer 2016 Issue
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2016 Spring Meeting Presentation Recap

ACEs and Allies in Mental Health

By Stephen Cunningham, MD
PSV Treasurer

Stephen Cunningham, MD

Stephen Cunningham, MD (left) with
Humberto Campos / "Tito"


At the PSV Spring Conference in Richmond, Dr. Allison Jackson, PhD, discussed the effects of adverse childhood events (ACEs) on physical and mental health, based on research from Dr. Vincent Felitti. This research suggests that elevated ACE scores correspond to significant increases in comorbid medical conditions, suicide attempts and decreases in expected lifespan. Dr. Jackson related her own story as a child, adolescent and young adult, which was rife with periods of neglect, abuse, and trauma which equated to an ACE score of eight. She described her own tortuous path  through an imperfect mental health system. She eloquently portrayed herself as a patient that today would  be diagnosed with borderline personality disorder, bipolar disorder, oppositional defiant disorder and likely other diagnoses. She was viewed as a "high utilizer" of resources, having been repeatedly hospitalized.  She was likely viewed as a "difficult to deal with" patient with Axis II, Cluster B traits. She experienced physical and chemical restraints, forced medications and fought violently throughout her treatment. During her  multiple episodes and hospitalizations, Dr. Jackson (she was then known as "Cat") encountered a wide range of staff, some of whom were supportive and encouraging and some ofwhom were less than nurturing. She persevered. She finished school. She eventually obtained her PhD degree and is now an accomplished trauma therapist.

I was emotionally touched during her talk, as most of us were, as evidenced by the amount of applause at its end.  I reflected on my countless interactions with patients just like Cat, whose significant ACE scores placed them on a trajectory of struggle with the legal system, the foster care system, the medical system and the mental health system.  One of the most emotionally powerful elements of Dr. Jackson's talk was her descripton of a connection that was made with her by a mental health technician, Howard. Howard had no letters to his name and he was likely one of the most modestly paid staff in the hospital where Dr. Jackson had been hospitalized.  Yet, it was this unheralded MHT who had the greatest impact on her. It was his statement, "Please Cat, don't give up on yourself before you discover what you can become," which struck her so deeply and which helped foster a new sense of self-esteem and propelled her to continue her healing and led her to current work as a trauma specialist.

In our role as physicians in both the inpatient and outpatient realms, we treat patients like Cat everyday. At Virginia Beach Psychiatric Center (VBPC) and in any similar hospital setting, there are many factors that help determine a patient's likelihood of achieving stability and emotional balance.  Rarely are improvements seen in a patient's condition without a team approach. The treatment team cannot exist without our allies in mental health which include psychiatric nurses, social workers, utilization review staff as well as mental health technicians. Howard took time to make that meaningful connection with Dr. Jackson when she was young and emotionally fragile.  There are countless other allies in mental health across our region. One such example is an extremely valued MHT at Virginia Beach Psychiatric Center. His name is Tito.  Born Humberto Campos, Tito has worked in the mental health field for 35 years. He worked the thankless night shift for many years and now works days and evenings. He has been awarded Employee of the Month on multiple occasions. He deftly combines a sense of comical irreverence, nurturance and gentle firmness for all patients that cross his path. As Tito succinctly relayed to me, "I try to put light in dark places; I try to help them gain hope." I continue to have patients who have been hospitalized, stabilized and transitioned back to my outpatient clinic who ask, "How is Tito doing? Tell Tito how much he helped me. Tell him that I am doing better."  We have many staff who embody Tito's sense of calm, nurturance and professionalism. Without their efforts, without their attempts to connect with patients like Cat, our patients' chances of improving are proportionally diminished. I thank Tito, and all staff, who are similarly invested in the welfare of our mutual patients.

 

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