Sustaining a public mental health clinic

I operate 3 public mental health clinics, 3 school mental health programs, and 1 prevention program on Maryland’s rural Eastern Shore. I was raised here and I love being here. The good news is that I get to do what I love in a place I love every day of the week; the bad news is that it is nearly 7 days and nights a week. (It’s a good thing I love it.)

In our clinics we have seen thousands of clients and we have done some very good work in multiple counties. We have sites on Talbot, Wicomico, and Somerset Counties. Several years ago we moved into Talbot and Somerset counties when other clinics closed down. (What were we thinking?) Managing sites in 3 counties is a major challenge, but I have excellent managers. Problems such as an “us and them” mentality crop up and we have to work against that. Communication can be tricky and sometimes difficult among sites. On the other hand, we have economy of scale for benefits for employees and other goods and services. Psychological testing is located in one site, but can be offered in other sites, as well. Consequently, we have contracts that cover many counties on the Shore.

Being in a rural area and serving an economically disadvantaged population, client transportation to services has been a major hurdle. We have had several used vehicles that sites have shared so that children can be picked up for services. This is a necessary, but not reimbursed service. We bought our first new van after 10 years of providing services. Employees also transport children in their private cars, which means that we have had to have policies and insurance for employee use of vehicles. In ten years we have had one van break down with children in it. It was because employees “forgot” to put oil and water in it and killed the engine, so we needed a system and policy for that.

In the present day environment, mental health has to be run as a business. It has been a paradigm shift for those of us who have believed that we are here to help others whether we get paid or not. So, we have had to learn and to teach others how to balance clinical with fiscal responsibility. It has been a shift for me as well. My first mission statement read, “the highest quality services for everyone regardless of their ability to pay.” Now, employees have minimum productivity requirements. They must see 25 clients per week for a full time position. Additionally, I must make payroll regardless of whether the state pays me on time or not. Managers must ensure that expenses do not exceed income. This has been difficult especially since we have grown from 5 to 80 employees in 10 years and we were under capitalized.

Therapists and PRP (Psychiatric Rehabilitation Program) workers must have excellent paperwork skills. Public mental health paperwork is massive and very specific. Some people have not been able to keep up with the paperwork and have had to undergo disciplinary action. Some have not been able to meet the paperwork standards even after supervision and training and we have had to dismiss them. (Now there’s a joyful time for all.)

We maintain the highest quality of clinical services through supervision, clinical meetings, training, and grand rounds. Employees can use paid time off to attend training and we offer free training on site. I have tried to maintain that the most complex cases require the most intensive and complex interventions, but this has been a difficult concept for some to understand, as well. We serve a forensic population and the therapy for them is different than for those with no forensic issues. Working with Court ordered clients requires training and a paradigm shift. It is not for everyone. Some have tried it and found they are not suited to it.

We have maintained our business through multiple streams of funding, such as fee for services, contracts, consultation, and grants of all kinds. It has been our survival and our vitality. We have a contract with the department of Juvenile Services for psychological testing and contracts with State and Federal Parole and Probation. Healthy Families is our prevention program and it is funded through a grant. We will be expanding our grant funding for research in the future.

Some examples of situations a public mental health clinic faces may make the picture clearer. Several years ago I had a phone call on the emergency pager from a desperate father of three. His wife was severely mentally ill. He had no health insurance. He made $10 an hour, too much for his wife to qualify for medical assistance. He could not afford medical appointments for his wife or medication. She could not take care of her three children. I stayed on the phone with him to help him figure out some options that might work and told him to call back if they didn’t work. He didn’t call back, so I am hoping something worked. These are the types of dilemmas we face in public mental health.

Funding has been cut back severely for public mental health in these tough economic times. Clinic directors were told recently to prepare for another $23 million in cuts, which turned out to be $11 million in cuts. Still a lot of money, and we tightened our belts one more time. The Upper Shore Hospital Center closed and RICA lost more beds. Many people lost jobs.
Plato said “the true creator is necessity, who is the mother of invention, while Nietzsche said, “That which does not kill us makes us stronger. So, I think they are both right. I certainly am stronger for the experience of creating and maintaining this public mental health clinic and it has not killed me. I have created many new things (programs, books, assessments) out of the necessity of meeting the mental health needs of Eastern Shore people. In conclusion, running 3 public mental health clinics is the toughest thing I have ever done in my life, but it was well worth it.

Ways to Make Someone Smile

20 Different Ways To Make Someone Smile

In todays world we simply dont smile enough. By making someone smile you will make a good friend.

Do you want to put a smile on someone's face today? Maybe make their day a little better. It won't cost you a single penny or much time to do just that. And because smiling is contagious, it probably won't just be one person you make smile today.

Here are 20 ways to turn that frown upside down.

1. Send some flowers to your partner at work.
2. Compliment a friend or work colleague on their appearance.
3. Donate something to charity.
4. Take a friend out to lunch.
5. Let someone know you miss them.
6. Make a surprise telephone call to your partner at work, just to say hi.
7. Hold a door open for someone walking behind you.
8. Hug your partner for no reason.
9. Leave a joke on a friends answer machine.
10. Send a card to a friend letting them know what a good friend they are.
11. Give up your seat on the train to someone when there aren't any left.
12. Share your umbrella on a rainy day.
13. Ask a friend if they need anything while you're out shopping.
14. When it's raining, plan an indoor picnic with your children.
15. Leave a love letter somewhere where your partner will find it.
16. Send someone an unusual and unexpected gift like chocolate, or flowers.
17. Tell your child you're proud of them.
18. Tell someone you thought about them the other day.
19. Cook a surprise meal for your partner one night, especially if they normally do the cooking.
20. Tell your partner you love them.

Did you know it takes only 17 muscles to smile, but 43 to frown. Why waste all that energy frowning when you could just smile.

Here are 5 more facts about smiling.

1. Women smile more than men.
2. Smiling releases endorphins that make us feel better.
3. We are all born with the ability to smile, it's not something we learn from others.
4. A smile is a universal expression of happiness.
5. A smiling person is thought to be a more pleasant, attractive, sociable, sincere and competent than a non-smiling person.

Just remember, smiling is the easiest and cheapest way of improving your looks.

Content Source: Bukisa - 20 Different Ways To Make Someone Smile

FDA recommends that Gardasil be used with males

The FDA has now recommended that Gardasil now be given to boys ages 9 to 26 to prevent genital warts caused by HVP. HVP is now believed to be responsible for 70% of anal and cervical cancers and is preventable by giving girls and now boys the drug gardasil.

Famous Quotes

Stephen Covey
Strength lies in differences, not in similarities.

Kenneth Hildebrand
Strong lives are motivated by dynamic purposes.

Vincent Lombardi
Success demands singleness of purpose.

Booker T. Washington
Success is to be measured not so much by the position that one has reached in life as by the obstacles which he has overcome.

Health news - Teen Pregnancy and New Health Screening Guidelines

Teen pregnancy is on the rise. 435,000 in 2006. Top states are Mississippi, Texas and New Mexico. Teens tend to have children with more health and behavior problems. It is believed that we are failing to properly educate our young people about human sexuality.

New mammography guideline state that women do not need regular mammograms until age 50 and them only every other year. PAP tests do not need to begin until 21 with re-screens every two years until age 30. with 3 negative screens, women can be screened every 3 years after age 30. with no abnormal results in 10 years, women over 65 can stop getting PAP tests altogether. The rest of the world apparently has gone to PAP tests every 5-6 years.

Well this flies in the face of what we have heard for many years. what are we to think? It is reported that fewer screenings will not increase our risk of cancer. It is just different than what we have had drummed in our heads for so long. I hate having those tests anyhow. So, I am good with this.
Dr. kathy

Video for Support of Breast Cancer Awareness Very Cool!!

Today's famous quotes.

Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.
Franklin D. Roosevelt


Love and compassion are necessities, not luxuries. Without them humanity cannot survive.
The Dalai Lama

CNN Hero of the year

Check out CNN's hero of the year, a educator in the Philippines. We hear plenty of bad news, here's some good news for a change. Yeah CNN, for this project. Goto Cnn.com

Affirmation

Everything is as it should be and I am grateful for this day.
---Joan Boryshenko

ESPS Celebrates 10 Years

Salisbury, MD. July 1, 2009 marked the tenth anniversary of Eastern Shore Psychological Services, LLC (ESPS) providing quality mental health care. ESPS has grown from five employees in a single location in Salisbury, MD to three locations. Currently ESPS provides services to Wicomico, Somerset, Southern Worcester, Dorchester, and Talbot counties in Maryland with over eighty employees.

Services provided include traditional mental health therapy, group therapy, psychiatric evaluations and medication management. ESPS also provides psychological testing and evaluations and engages in ongoing research to help identify the risk of violence in youth and adults. Mid Shore Mental Health Systems recently presented the founder, Dr. Kathryn Seifert, with an award for innovative mental health programming, as well. ESPS was also named one of Maryland's Top Woman Owned Businesses by Diversity Business in 2009. ESPS will be having 10th Anniversary open houses at each of their locations in October.

Dr. Kathryn Seifert, founder and CEO of ESPS, speaks nationally and internationally on topics of violence prevention. Her book, How Children Become Violent won the 2007 Independent Publishers Award. She has also authored a parent version of this book to provide practical advice for caregivers. While researching the book, Dr. Seifert also developed a risk and needs assessment tool, The CARE 2: Chronic Violence Risk and Need Assessment, which helps therapists determine the appropriate level and type of services needed for individuals and their families. This tool is gaining acceptance both nationally and internationally. Dr. Seifert has authored several other books and CD's including RELAX: Your Life May Depend on It and Pathways to Inner Peace. . Dr. Seifert will be presenting information on her research and books this fall at:

• National Conference of Juvenile and Family Court Judges in Chicago in July 2009,

• SHIP: School Health Interdisciplinary Program at Turf Valley, MD in August 2009

• International Children and the Law Conference in Prato, Italy in September 2009

• National Workshop on Juvenile and Adult Female offenders in Jackson, MS in October 2009

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If you would like to arrange an interview with Dr. Seifert, you may contact Melissa Wright at 410-334-6961 ext. 104 or email your request to m.wright@espsmd.com.

Health Care Debate will begin in the Senate

The senate voted tonight to begin debate on the health reform bill after Thanksgiving. Do you feel some form of bill should be eventually passed? Answer my poll.
Dr. Kathy

Welcome

This is a new blog about relaxation, wellness, and health. I will be adding articles and news.

My husband heard a news article on NPR that 4000 IU of vitamin D3 daily has been proven to help the symptoms of arthritis. I didn't hear the report, but i am willing to try it out and let you know.
Dr. Kathy