Psychiatry News!
by LYNN MORRISON WILLIAMS COLUMNIST. Vero Beach 32963
Dr.Wayne Creelman, the first Eminent Scholar Chair of the new University of Florida Center for Psychiatry and Addiction Medicine in Vero Beach, is embarking on a mission to develop a satellite academic department that hopefully will both train and retain a wide range of quality psychiatric professionals in our community.
Creelman received his undergraduate degree in biology, philosophy, and theology from Boston College where he graduated Magna Cum Laude. He graduated from Georgetown University School of Medicine, finished his Internship at Hartford Hospital in Connecticut, and completed his Psychiatric Residency at The Institute of Living. While at the Institute he also worked at Yale University.
He has taught at the University of Connecticut School of Medicine, the State University of New York, Michigan State College of Medicine, and the University of Vermont College of Medicine. For eight years he directed Psychopharmacology at the Maine Medical Center.
Creelman has a lifelong commitment to patient care and scholarly activities related to ethics, research, medicine, and religion. He is currently a student in a Masters program in Divinity.
Creelman has been a member of the University of Florida College of Medicine since September 2006. Prior to being appointed the Eminent Scholastic Chair for the UF College of Medicine Center for Psychiatry and Addiction in Vero Beach, Creelman served as the Medical Executive Director at the Northeast Florida State Hospital in MacClenny, FL overseeing the clinical operations of a 600+ bed state psychiatric facility.
Dr. Creelman recently sat down with Vero Beach 32963.
Q.You have an impressive and extensive lifelong interest in biology, philosophy, and theology. How did the melding of those interests lead you to the field of psychiatry?
Creelman: From the ages of 18 to 24 I studied to be a Jesuit priest. I was in medical school and was planning on becoming a tropical medicine physician. In the summer of 1973, I was running a leper clinic in Calcutta, India. During my last week in India, I was able to spend a day with Mother Teresa. This very inspirational women serves as a constant role model regarding what is really important in life, and how each of us has to answer this question for ourselves as we figure out what ultimately defines happiness in our lives. After my experience in India, it made sense to me to go into psychiatry. Following my freshman year of medical school, I decided to leave the Jesuit order. I realized the inherent value of spending time with patients to really understand where their pain was coming from. It was also one area of medicine that was not forced by managed care to engage in numbers versus time with patients. Psychiatry was able to keep the patient– doctor relationship time more sacred.
Q.Do you feel that psychiatry today is placing a greater emphasis on incorporating more time for therapy into the treatment process?
Creelman: Psychiatry has undergone several evolutions in the 30 years that I have been in practice. The managed care phenomenon has been and continues to be the greatest threat that psychiatry faces. There is a term in psychiatry called ‘split therapy.’ This is where the psychiatrist administers medications to the patient while the psychologist or the social worker does talk therapy. Theoretically, the doctor who prescribes the medications and the therapist who does talk therapy have excellent communication together so they both know intimately what is happening with the patient, but of course that is never as good as one person running the show. I am comfortable in providing therapy and medication management alone, and at the same time I am always very comfortable with the split medicine model. The fun in the field, for me, is doing it all and watching a person arrive at a Eureka moment in therapy.
For example, the depressed person lives in the past, so without past memories there is no reason to be depressed. A person who is obsessive lives in the future because they become preoccupied with worries about what may happen tomorrow. In reality, one should “seize the day” or you miss what life is offering you in the moment.
It seems to be common sense but there is such pressure in our society to perform that it places a burden on our shoulders that at times, we feel we must become superhuman. Our perfectionistic culture has created so many layers of defense within our unconscious that these layers need to peeled off. It is through the psychotherapeutic experience and life defining moments that therapy becomes curative and does not foster dependence.
Q. What can you tell our readers with regard to the initial plans for staffing and training at the Center?
Creelman: Around November 15, 2008, Dr. Peter Gold will be joining us as our second staff member. He is a licensed clinical psychologist who has been practicing in the South Florida area. He is on staff at several South Florida hospitals and comes to us with a strong addiction medicine background. His role will be multifold and will consist of training University of Florida medical fellows, residents, and medical students about psychological processes. He will also be doing consultation/ liaison work with the local physicians in our various medical facilities.
Our third staff member will be an Addiction Medicine Fellow, who at this time must remain unnamed. However, he is highly trained and is currently applying for his Florida licensure. He comes to us from the Talbott Addiction Recovery Center in Atlanta, GA. He will be here for a one year commitment, which is a requirement of the American Society of Addiction Medicine (ASAM). We will be setting up video conferencing and supervising sessions with Scott Titelbaum, M.D., who is the Vice-Chair of the UF College of Medicine Addiction Medicine.
Our fourth staff member is Dr. Daniel Tucker. He will be arriving on January 1, 2009. He is a Board Certified Child and Adolescent Psychiatrist. One of his goals is to get our Center accredited as part of the UF College of Medicine’s satellite system for future Fellows in Medicine.
In addition, our Center will have a collaborative training/teaching relationship with the Florida State University fourth year medical students. I have met with Dr. Randall Bertolette, the Chair of the FSU satellite training program, and our plan is to have the FSU medical students rotate through our Center to meet their 4-6 week Behavioral Medicine training requirement.
The UF College of Medicine offers a community psychiatry election for fourth year General Psychiatry Residents which lasts from 1-3 months. We foresee many of our Residents in forensic, geriatric, addiction, and child psychiatry, electing to spend some time in Vero Beach. However, we still need to work out the logistics of the housing mechanism for that student population.
Vero Beach is a very viable location to bring in Psychiatric Fellows on a fulltime basis.
Hopefully, some of them will want to settle and practice in the Vero Beach area.
Q:What can you tell me about the Addiction Services component of the Center?
Creelman: It will operate from a strong medical model. We anticipate a close, collaborative relationship with Hanley Hall Inpatient Treatment Center, especially for detoxifying patients. Our treatment will be out-patient focused. Addiction Medicine is oftentimes the backbone of the recovery process. We will utilize a 12 step recovery model with our patients. We anticipate offering sobriety groups, teaching programs, psychopharmacological therapy as a deterrent for appropriate patients, and treating any underlying co-occurring mental health issues. Treating underlying mental health issues along with addiction is critical for successful addiction treatment. It is vitally important to integrate all of the pieces of the sobriety puzzle, which our Addiction Medicine Fellow will be focused on. I anticipate doing a lot of public service teaching around the addiction issue.
Q: Can you share your vision and approach to mental health treatment?
Creelman: My approach is based on there being many pieces of psychiatry that make up the field. Certainly, if there are two pillars that hold up the field of psychiatric medicine/behavioral medicine, they are the world of psychopharmacology – the use of medication for all of the biologically based illnesses in the field, and what I would characterize as psychodynamic therapy - not psychoanalysis. Psychodynamic therapy works over a longer period of time to uncover a person’s unconscious mechanisms of defense and durability, to use denial and intellectualization in all the ways that we try to skirt the truth of our lives.
My own approach is a blending approach. Any time I take on a patient, the first thing that I automatically do is decide in my mind if this a biologically based illness. I like to get a patient’s biological status in the best shape possible in order to have the patient be fully available to engage in therapy. I find this is important to assess, before we delve into relationships as to why people engage in self-defeating behaviors and why they keep getting into psychological trouble. While you are addressing the biological side, at the same time you are uncovering the psychodynamics of their behavior. It is impossible to not, at some level, raise what I will call the ‘spiritual dimension.’ I call it the ‘spiritual dimension’ not because of a religious issue, but because what I mean to do is raise life’s major questions in a psychotherapeutic event. For instance, the big questions such as: Who am I? What am I on this earth for? Why was I born? What am I looking for in relationships? How do I see the end of my life? Men and women have struggled with these questions since time began. It is impossible to care for someone in a therapy relationship without having some sense of what makes them tick. That is my global, integrative, holistic approach to life.
Oftentimes, these questions introduce patients to a whole new world that can open up a sense of joy in their lives. There is a wonderful Latin word, ‘impedimentum’, which means baggage, impediments, and signifies millstones around people’s necks. If a person is continuing to carry around this baggage, he/she is not going anywhere; it is exhausting. When you direct psychic energy into unhealthy relationships, it saps your physical, emotional, intellectual, and spiritual strength, which robs you of your creativity, ability to be fun loving, and, at the end of the day, it is all you can do to try to get to sleep.
Insomnia is another huge issue in our society. In my experience 50-60 percent of patients suffer from sleep issues, and that number growing.
I am a conventional psychiatrist who has been very well-trained, who has a great love for the unconscious mind, an expertise in psychopharmacology, and a lifelong desire to blend the spiritual life with what pain and misery comes one’s way.
Q:What type of case mix of patients do you envision the Center treating?
Creelman: I envision that approximately 80 percent of the patients who walk in the door will be in the world of depression and mood disorders or generalized anxiety disorder. Roughly 10 percent will fall into the category of psychoses such as Schizophrenia. It is my personal belief that all of us evidence some sort of personality traits, so we will be treating those persons with more severe personality traits. This would encompass the types of patients I would anticipate seeing here at the Center.
Q.How do you anticipate funding the services that the Center will be offering?
Creelman: Well, in a variety of ways. Very few people know that the $700 billion rescue bill that just passed into law by the Federal Government included the late Paul Wellstone and Peter Domenici Mental Health Parity Bill. The bottom line to this bill is essentially that any company that employs over fifty people and offers medical health care benefits will now offer benefits for psychiatry and addiction medicine. Also, there will be no stigmatized co-pays, or life-time benefit maximums. Florida is one of the nine states out of fifty that do not have a State Mental Health Parity Bill on the books. Like any law, the more stringent Bill will take precedence, so this Bill will fill in the gap for the lack of a Mental Health Parity Bill in Florida. This is very good for Mental Health Services and for our Center.
I once ran for the Michigan House of Representatives on the issue of Mental Health Parity in an effort to get the issue of Mental Health Parity into the insurance program in the state of Michigan. I ran simply to take away the stigma from an individual suffering from mental illness.
As for other funding, we have just negotiated through the Indian River Hospital District a $200,000 allocation so that we can care for the needs of the indigent and uninsured population. This is a wonderful and exciting opportunity for us to serve to this population.
Q.What are your thoughts on psychosomatic illnesses?
Creelman: What is so sad about how the mental health system has been viewed in the past is that as soon as you allow a person to access mental health services, their physical problems fall into place. This is because so many medical problems are of a psychosomatic origin – asthma, irritable bowel syndrome, Crohn’s disease, some chest pain, to name a few. Therefore, if you can nip the mental health illness in the bud, all those millions of dollars can be saved. For instance, all the cardiac thallium testing; if people took this aspect of health care as seriously as they should there would be far less people going in for bypass surgery. I believe that if people had ready access to the psychological component of overall health, people would have then made the proper life decisions about diet, calories, exercise, portion control, and weight. The statistics show how obesity is affecting our society in terms of health issues such as heart disease, cancer, metabolic conditions, etc. Psychiatry has never been more viable and intimately related to the medical problems that we all face than it is now.
Q. Can you share a little about the Continuing Medical Education Programs (CME)?
Creelman: These are continuing education programs that are offered for relicensure to physicians and nurses. I am just fine-tuning my presentation on Generalized Anxiety Disorder. Most of the anxiety disorders such as Post-Traumatic Stress Disorder (PTSD), Obsessive- Compulsive Disorder, and the Social and Phobic Anxieties are very responsive to medication intervention, but to the extent that desensitization needs to occur, that is something we will be working with Dr. Peter Gold on. We may be offering some behavioral modification groups down the road.
Florida has an enormous veteran population. The VA in Gainesville is the largest in the country. There is little appreciation for the extent of PTSD in those returning from Iraq and Afghanistan. There is an incredible elevated suicide rate among these veterans. Our CME Programs will help to better educate and familiarize the professional medical community about pertinent mental health issues with more specificity and detail.
Q.How are you planning on advertising to the public and to the professional community the services of the Center?
Creelman: There is a grand opening planned in the near future, I am not sure of the specifics or the date. We also anticipate receiving referrals from IRMC, the local medical community and other mental health professionals. To the best of our ability, we are working one-on-one with our medical colleagues to educate them about what the Center is about and how we fit into the mental health continuum.
We recognize that statistically 85 percent of psychiatric medications are prescribed by practitioners other than psychiatrists. We also are cognizant of the fact that due to the way managed care has structured health care, most physicians are not afforded the luxury of time to get to the underlying core issue of a patient who is suffering from anxiety, depression or stress. It is our hope to connect with our peers and ease some of their burden with regard to underlying mental health issues.
Q. How does the Center anticipate meeting the needing patients across the lifespan?
Creelman: I personally will be seeing patients aged eighteen and older. Dr. Daniel Tucker will be seeing children and adolescents for one week out of every four weeks, in the beginning of his practice here. As his practice grows he will be allocating more of his time in Vero.
Dr. Ray Dean, who is also a child psychiatrist, will be part of the UF College of Medicine faculty and he will be seeing patients as well as taking part in our training program.
Q. Do you anticipate having a Geriatric Fellow or Psychiatrist at the Center?
Creelman: It has not been determined at this juncture if a Geriatric Fellow will be joining our staff in the near-term. I have had many older patients in my career and I am quite comfortable working with them. That said, given the demographics of this area, it would not surprise me if in the future we end up with a Geriatric Fellow or a Geriatric Psychiatrist at this Center.
Certainly there is a condition called ‘pseudodementia’ that can be perceived and diagnosed as a form of dementia or Alzheimer’s. In reality, it is a form of depression which occurs in the elderly that is masked by cognitive symptoms. Many times these patients are started on Alzheimer’s medications when in fact if they are started on a course of appropriate anti-depressants, their memory is crystal clear again and their world brightens.
Q.Will you be introducing any innovative therapies into our community at the Center?
Creelman: Indirectly we will be referring patients to the UF College of Medicine’s Department of Psychiatry for Vagal Nerve Stimulation Therapy or Deep Brain Stimulation if we deem either of those treatment modalities to be beneficial for a patient. The equipment demands and the necessity of a large neurology department would likely preclude a direct option for patients at this Center, although I have not yet met with the neurology department that exists at IRMC.
Q.How will you be collaborating mental health care at the Center with the Behavioral Health Center at IRMC?
Creelman: Our Center is not supposed to be the ‘mental health fix’ for Indian River County. Our goal is to elevate the overall excellence of mental health care that is offered within the community. I view mental health care as a continuum. Where is the person on the continuum? If someone is in the emergency room in acute crisis do they need to be admitted as an inpatient at the Behavioral Health Center or to Hanley for detox or to us for outpatient therapy and intervention?
Dr. Ray Dean runs a top-notch inpatient treatment facility at the Behavioral Health Center for adults, adolescents, and children. I have already begun a fruitful collaborative relationship with him. We are on the same page with regard to patient care and training. I am looking forward to having him as an addition to our staff and to working with him in his capacity as Medical Director at the Behavioral Health Center.
Our hope is that the Center will be one more piece which can assist in integrating all of the mental health pieces and minimize the revolving door. We will be a highly academic, sophisticated, thriving, top-notch outpatient Center which will be interfacing with other professionals and facilities to maximize patient mental health care. Our mission is to educate our patients, the community, and other professionals while offering superb patient care along the mental health continuum.
Lynn Williams, who writes a column on integrative medicine for Vero Beach 32963, has an MS in nursing and a PsyD in clinical psychology.