New Psychiatric Consult Services Available
January 6, 2016 - It’s no secret that the Merrimack Valley, and in fact the state and the northeast region, have a shortage of mental health services available for patients in need. Thanks to the leadership of Dr. Jose Ribas, our very busy employed psychiatrist, working with hospital leadership, we now have a new full time Psychiatry Consultation service for inpatients at Lawrence General.
Recognizing the dire need for services in our region, Lawrence General has hired a psychiatric nurse practitioner who will work with Dr. Ribas to provide psychiatric consultations for our inpatients. Whitney Gibson will allow us to have a full time presence working with patients and providing better psych services, not just to patients, but eventually to caregivers too, through things like educational programming, crisis debriefing mindfulness training, etc.
“It speaks well of this hospital administration’s commitment to very badly needed psychiatric services,” comments Dr. Ribas. “They recognized this as a critical need for the patients of our region, and within a few months of my arrival here at Lawrence General, leadership encouraged and supported me in taking the next step towards expanding mental health services for our patients.”
Whitney is a psychiatric nurse practitioner, specializing in the adult mental health. After completing her BSN at the University of Florida, she worked around the country as an RN in cardiac and critical care, as well as home, school and community care settings, eventually settling down near family in Massachusetts, and completing her MSN nurse practitioner program in psychiatry at UMass Lowell.
Having worked in the north shore in acute inpatient psychiatric care as well as partial hospitalization and dual diagnosis programs, Whitney is looking forward to managing the psychiatric sequelae and origins of our complex medically admitted patients at Lawrence General. Whitney’s particular interests include psychotic disorders, coping with death and dying, and mood disorders through the child bearing years in women.
Population at Risk and Case Identification
In the general medical setting, as many as 30% of patients have a psychiatric disorder.13–15
Delirium is detected in 10% of all medical inpatients 16
and is detected in over 30% in some high-risk groups. Two-thirds of patients who are high users of medical care have a psychiatric disturbance: 23% have depression, 22% have anxiety, and 20% have somatization.17,18
Clearly, psychiatric comorbidity has an impact on health care economics.19–23
The presence of a psychiatric disturbance has repeatedly been shown to be a robust predictor of increased hospital length of stay.24, 27
Nearly 90% of 26 studies have demonstrated either an increased length of stay or an increased medical readmission rate in patients with psychiatric comorbidity.28
Only a small subset of the population at risk is currently being adequately identified. The percentage of patient admissions receiving psychiatric consultation varies from institution to institution,29
ranging from 1% to 10%.29–32
Intervention studies have suggested that elderly patients with hip fractures benefit from psychiatric consultation; they have shorter length of hospital stays and are more often discharged home, rather than to a nursing home.33–34
A liaison approach with increased case identification and earlier psychiatric intervention and treatment resulted in a marked decrease in the need for transfer to inpatient psychiatric facilities.35