Skyland Trail News

Skyland Trail Employment Opportunities

2010-08-20T14:22:00.000-07:00

Opportunities for employment are now available at Skyland Trail. We believe that the success of our programs can be traced to a caring staff of psychiatrists, psychologists, licensed clinicians, and professionals holding master's degrees trained in specialty areas such as counseling, psychology, social work, recreation, and horticulture therapy. Check out the open positions at Skyland Trail's website, or follow the links below for more information.

Available Positions

August Lunch and Learn: Real Men Do Cry

2010-08-13T06:35:00.000-07:00

Join Skyland Trail for this month’s Lunch-and-Learn in the Dorothy C. Fuqua Training Center, August 20th at 11AM, featuring Michael E. Walsh, MS, CAP, BRI I, director of Admissions & Business Development for the Hanley Center in West Palm Beach.

This month’s topic is “Real Men Do Cry: Age Specific Intervention and Treatment Approaches for Baby Boomers and Older Adults.” Walsh’s presentation will enable participants to be able to: review a complex Boomer addiction profile and challenges for health care and treatment; explore how men’s issues in midlife and beyond affect risk and protector factors and how related therapies can engage the individual in treatment. It will also review the inter-relationship of barriers to men’s recovery and how new research is identifying effective treatment interventions and relapse prevention.

As Director of Admissions and Business Development at Hanley Center since 2008, Walsh’s goal is to provide excellence and consistency in a seamless continuum of care. He has lectured nationally and internationally, and is a member of professional organizations including NAADAC, NAATP, and the Association of Intervention Specialists. A graduate of Boston College, he received a Masters degree in Substance Abuse Counseling from Nova Southeastern University, and is a Board Registered Interventionist and is CAP-certified.

The fee for this Lunch-and-Learn is $20. Mental health professionals receive continuing education credits for attending the event. Check back for updates at Skyland Trail.

Skyland Trail's "Benefits of Laughter" Transcript Part 2

2010-08-04T08:56:00.000-07:00

The following is the second part in a series of posts containing transcripts of a presentation given by Skyland Trail's medical director, Ray Kotwicki, MD.

The criteria for a major depressive episode (if you have more than one episode in your lifetime you have major depressive disorder) fits this pneumonic that we call SIGECAPS, so here are the criteria for major depression: You have to feel sad, the I is for interest – you have to have decreased interest in things you used to enjoy, the G is for guilt, people who are depressed often feel guilty or worthless, decreased energy, problems concentrating, change in appetite, P is for psychomotor changes – it means that either your body doesn’t want to move or it can’t sit still, either way. Then the final S is for sleep problems. Either for increased sleep, which we call hyper-somnia or decreased, sleep which we call insomnia. If you have most of these, at least 5 out of the 8 most of the day, every day for two weeks in a row, you meet the criteria for having a major depressive episode. If you have more than one of those periods in your lifetime you have major depressive disorder. We call it the kindling effect. So kindling is small wood that you use to build a fire. Every next episode of depression that you have makes it more likely that you will have another one. So people who have had their first episode of depression have roughly between 35 and 40% chance of having a second episode at some point in their life. By the time you get up to having 4 or 5 episodes of depression it is almost a certainty that you will have a 6th or a 7th because it is harder to treat as more of them occur. So let me finish with the mood disorder and I’ll go back to Schizophrenia.

When you think about bipolar disorder, we often call that manic depression in the general media. It’s this – having the depressive episode, and then at least one point in your life you have a manic episode, which is sort of like the opposite of depression, and the pneumonic for a manic episode is DIGFAST. So, people who are manic are distractible, irritable, grandiose, they have flight of ideas, their thoughts go so fast that their mouth can’t keep up with it, increased goal-directed activities, which is the A, so they have multiple projects going on at the same time and can’t finish any of them. They are sleepless, they don’t sleep but they don’t feel tired the next day, and they had thoughtless behaviors. The most common thoughtless behaviors in this order of likelihood are having increased sexual activity that you regret with multiple partners, spending money you don’t have causing bankruptcy or financial ruin in your family and having impulsive travel. So people who get on a plane and fly to Paris for the day without having booked a hotel, without knowing what they are going to do when they get there or they want to go because they want to watch the sunrise – that would be considered a thoughtless behavior in a potentially manic episode. Again, if you have the majority of these things for a certain period of time, that would be criteria for a manic episode. And again, if they have ever had one manic episode in their life, even if every other episode in their life has been depression, they have bipolar disorder. So together we call depression and mania mood disorders. That is different than thought disorders of which schizophrenia is the most common. So schizophrenia is an illness that is really misunderstood. And you see a lot of wrong portrayals of what schizophrenia is in the movies. A great example of positive symptoms of schizophrenia is in the movie A Beautiful Mind with Russell Crowe. So John Nash, the character who had schizophrenia that was played by Russell Crowe, was actually a Nobel Laureate in Physics – a very smart man so he didn’t have any cognitive problems. He was so intensely focused on his work that everything else around him didn’t matter. He heard voices that other people couldn’t hear – we call those audio hallucinations. He believed that he was working for the government and he was getting special messages out of magazines. He would cut out these words and paste them up. He had a fixed false idea that we call a delusion. So together, delusions and hallucinations are the positive symptoms of schizophrenia. They are the “movie” symptoms – the symptoms people like to watch and can be scary. When you look at outcome data, positive symptoms actually are not the best indicator of whether or not somebody can get better if they have schizophrenia. It’s the negative symptoms. So positive symptoms are the things that somebody with schizophrenia experiences that we wish was not there. The negative symptoms are things somebody with schizophrenia is missing. So negative symptoms include a-motivtion, - the desire to get out of bed and do something every day, alosia – being able to organize thinking and speech so that they can communicate with others, affective flattening – not showing any emotion on your face when you are inter-relating with others, asocial – not caring whether they have social relationships with others, lack of attention to hygiene and how somebody is portraying themselves physically. Those are the things that make it harder to have relationships. They are the better predictor of whether or not somebody can get better, and we call those negative symptoms. So, in programs that specialize in treating the positive symptoms and getting rid of the scary movie symptoms, but they neglect the negative symptoms – it is not actually helping somebody with schizophrenia recover from their illness. It is stabilizing somebody perhaps, but it is not using the maximum benefit of evidence-based medicine to help somebody live a productive life.

My definition of mental health is that when people have a very diverse set of ways to get through things in life that they can use at the appropriate time – so they have a battery or arsenal of unique things that will help somebody be okay – requiring them to pick one of those things to use at the right time – to me is what mental health is. Let me give you an example. I make a joke out of everything and that works 50 % of the time just to laugh something off. But if I make a joke out of going to a funeral when I’m sad rather than sort of experiencing that sadness, being there for the family, participating in what’s going on, that’s probably a mistake. And that might produce a disability for me and problems with my relationship with that group of people in the long run. This would suggest to me that it wasn’t the best strategy I could have used. You can kind of think about that in the more serious mental illnesses as well. People who have had traumas, who dissociate, they say I’m not going to experience what is going on in body right now because that is what I need to do in order to survive. That’s very functional if you are in the middle of being raped – you are not going to get killed, but if you use that strategy in other situations where you are not at imminent risk for trauma or abuse, that is not helpful. So we can kind of take that same situation and that analogy of what to use when for all the mental illnesses.

Let’s take a look at who comes to Skyland Trail and I’ll try to match the program that we offer with our patient’s needs. So between the years 2007, 2008, 2009, we’ve had a real spike in the number of people between the ages of 18 and 25 who are admitted into our services. I love that because we catch people early in the course of their illness and it means that we are more likely to ensure they are treated in a holistic way and maybe prevent the next episode in their illness – which means we might make a bigger difference in their lives. We work with adults of any age and have people in their 60’s and even 1 person in his early 70’s. But I’m happy to see this spike in our young adult census because it really gives us an opportunity to help people have a good experience in the mental health system earlier.

When you look at what the admission diagnoses are of our new patients in the years of 2007, 2008 and 2009 we lump these two together – bipolar disorder and major depressive disorder as mood disorders and we lump together schizophrenia and schizo-affective disorder – schizo-affective disorder is a combination of schizophrenia plus a mood disorder – but we call it a primary psychotic disorder. So when we lump these things together in 2009, 8 out of 10 newly admitted patients had a mood disorder. This is really important because I think that Skyland Trail has a reputation in the community of being a treatment facility for people with schizophrenia, and while we are expert at helping people with schizophrenia recover, we actually work much more frequently with people who have a mood disorder. We do a great job there as well. Most people with anxiety disorders don’t come to get treatment and then the other category is sort of – when we get to know a patient when after they have lived in our program for 45 days and gotten to know our staff and we understand they don’t have a psychotic disorder or a mood disorder but they in fact have a substance abuse disorder or they have a personality disorder. So those are the three categories of mental illnesses – mood disorders, psychotic disorders and anxiety disorders.

We know that people with bipolar disorder – manic depression – about 85% have some kind of substance mis-use problem and the most common one is alcohol abuse. It makes sense if you think about it. If someone is manic they are kind of revved up, using a depressant like alcohol sort of brings you back down and it makes a lot of sense to me. If you are depressed people might use alcohol because it feels like you can kind of get out of your body for a while, or stimulants, which makes more sense to bring people back up. So there is a high co-morbidity between substance misuse problems and mental illnesses. We work very well with people who have both. The problem is if the substance misuse disorder precedes any of the symptoms of the mental illness, we might actually be looking at a substance abuse problem that looks like a mood disorder or psychotic disorder rather than both of them occurring at the same time. So for that group of people we would refer them to a substance abuse treatment facility.

A guy by the name of George Valiant out of Harvard says that you cannot make the diagnosis of a primary mental illness outside of substance abuse until somebody is clean and sober for 6 months. So that is sort of the party line. We don’t use 6 months as our cutoff, but we want to make sure that the substance abuse is followed by the symptoms rather than precede it.

What we’ve seen, and particularly in 2010 is younger people are being admitted earlier, but are staying for shorter periods of time because of the economy. We had more admissions in the first half of 2010 up until the middle of June. We had more admissions in that period of time than in any other year. That creates some challenges for the program, and we hope that people still benefit even though their length of stay is shorter, but we are trying to maintain fidelity to what we have to offer so that people maximally benefit from our program.

The people with whom we work are smart people. And I know that the party line for people with mental illnesses have cognitive problems. That is partially something we want to prevent. A researcher by the name of Jeff Lieberman, who happens to be on our National Advisory Board, did a great study that showed – every next day of NOT having treatment when somebody is actively in the middle of a psychotic episode or a manic episode produces cognitive decline, so that is bad. We want to make sure that people get treated early and get treated assertively so that we can prevent the cognitive ramifications. However, our patients come to us with a lot of education and a lot of capacity to be able to learn new things and learn new coping strategies, so they can apply the things that we teach them during group therapy to their own personal life. About 8% of the clients who came to Skyland Trail in 2009 have at least some college experience if they didn’t graduate from college. So that is really a benefit for our program.

There are the social determinates of illness – if you start off at a higher socio-economic level – if you have decline you are still sort of above. Whereas if you start off with the same illness and you have psychosocial problems such as no money, no housing, no ability to go to college, no food or whatever, the illness will make a bigger difference in your life.

So when we developed the Skyland Trail Integrated Medical Recovery model we did a comprehensive literature search about what is considered to be or what are considered to be the best practices in psychiatry. What we found is that this idea of recovery is really important. It is really the idea that people with mental illnesses can get better and lead functional, happy, productive lives just like any of the rest of us. There are two variables that predict whether or not somebody with a mental illness such as schizophrenia will get better. The first one is having a good social support system such as family involvement; a spouse or somebody the patient can rely on. The second variable is having a staff work with that patient who has high expectations. So we expect that people will recover from their mental illness when they are here. And that is what we work on. We call it the N+1 philosophy. If you are at level N that is great, but what is next for you? What is N+1? The second thing is engagement. We work really, really hard to get people to buy into their recovery. We know that not taking medications is a real part of what happens with people who have mental illness such as schizophrenia or bipolar disorder. In the Katy trial again, 18 months after a patient with schizophrenia was started on medication 76% of all of those patients 18 months after that initial day were off all medications. And the number one reason is because of patient preference. People don’t like having the sexual side effects, people don’t like having to remind themselves that they are sick and have to take a medication every day, and people don’t necessarily like how it makes them feel, especially if they are used to being manic, because being manic feels really good. So we work hard to engage people not only to take their medication but through our adjunctive therapy programs so people will want to come here and learn what we have to teach.

Third, we have a holistic program, and this is a word that I think is misused a lot, and what we mean by holistic is that we provide services and encourage people to think about their recovery from soup to nuts. It is not just about the symptoms of your mental illness, it is about your physical health. About having healthy eating and active living lifestyle. It is about making sure you feel connected to something bigger than yourself. All of those things are important and things that we work on during the time somebody is at Skyland Trail.

Finally, we know that this model is useful. We measure what happens. There is a durf of evidence in mental health that what people do and the money that people pay for treatment produces good results and we have data to support that – that what we do is actually very effective.

The model that we developed is called the Recovery Community Model, and I want to show you a visual of what this looks like. So in this wheel each one of the concentric circles represents an individual staff person or an individual function – so the patient of course is at the center and he or she drives the treatment based on what they say they want to do with their life. We have case managers; we have vocational services counselors, residential counselors, adjunctive therapy counselors, a nurse practitioner, primary care counselors, pastoral counselor, psychiatrists, etc. And once a week each slice of this pie gets together to talk about every patient enrolled in that recovery community. It is between 10-15 patients, all of whom have the same diagnosis and work with the same kind of psychotherapeutic modality. So let me give you an example. If somebody comes to Skyland Trail and they are in the middle of a major depressive episode, we know from the research literature that cognitive behavioral therapy is the best treatment for that in addition to medications. So we have cognitive behavioral therapy or a CBT track for people who have depression. And every day everybody who is on the CBT track will get together and have a core group with their primary counselor and learn from one another based on their homework, the manual that we give them to study, and the things that we teach them that are based on Cognitive Behavioral Therapy. We have an analogy to all those other kinds of recovery communities. We have Personality Disorder community with DBT, we have a dual diagnosis recovery community for people who have substance abuse problems and another mental illness, schizophrenia first episode recovery community, and together this can be very individualized and targeted interventions for people with specific needs. This is a new model and we are one of the only places in the country that uses this kind of targeted psychotherapy. Everybody on the team, or everybody in one of the wedges of the pie is versed in using the kind of psychotherapeutic interventions that have been shown to be the best for those patients.

To work in some redundancy to this model, we have what we call a flex track, and the flex track is meant for people who don’t necessarily fit in only one of these wedges of the pie. It gives us some capacity to provide this kind of modality or a combination of the modalities to people who need that combination. That has been a very useful kind of way to make sure we can accommodate the individual needs of everybody who comes for admission.

Before this model was instituted, primary counselors were assigned patients based on census. So I might be a really good primary counselor but I have no idea what CBT is, but if I’m up for an admission, I’d get the next person to be on my caseload even though I don’t know the kind of psychotherapy that would be best suited for that person. The second thing is that the staff used to meet once a week together and you can’t talk about every person’s recovery plan when you meet for one hour and you have 90 patients. You talk about the problems. And what that did was – it made us focus on how to make sure people were not getting into trouble rather than pushing patients to the next level of their recovery process.

We have a very robust vocational, educational and volunteer program. Thinking again about the negative symptoms of schizophrenia – that is a key component of what we do and what I think every recovery facility should do. It is the thing that is most often left out of treatment facility’s models, but we teach people how to socialize, how to interview, how to put together a resume, how to take care of their hygiene and their physical appearance so people will not make assumptions about them. We think this is a real component of recovery. We also have an on-sight primary care clinic so we don’t let patients with mental illnesses not get the same kind of excellent care that you and I get when we go to see our internal medicine doctor. We have a pastoral counseling program and we try to encourage people to think spiritually about their recovery. Our pastoral counselor can be helpful in understanding what that means in somebody’s life and he will gladly participate in somebody’s recovery. Again, this is a very different model, and in a system of mental health services where they don’t provide all this array of services, these are the things that tend to get left out. But these are probably the more important things, if you think about it, that helps somebody live a healthier, happy, productive life.

We have lots of collaborations in the community. We have collaboration with the School of Medicine at Emory, the School of Public Health, the School of Theology and other Universities, and we have a very robust way of making sure we are providing services to professionals in our community that they want. We have a Professional Advisory Board where we caucus Atlanta physicians and clinicians, we have a national Advisory Board where the thought leaders in psychiatry convene every other year and talk about the next best thing in psychiatry. We use all of those as springboards for further developing our model of care.

We actually measure outcomes and I want to share this with you because I think you can really get a sense of what we do. The Basis 32 is a 32 item survey that the patient himself/herself reports- it measures things about symptoms and functionality as well as social relationships. On this graph – higher is worse – it means you have more symptoms and lower is better. You and I would be somewhere between 0 and 1 based on what is going on is our work life or social life. So we can see that when people are admitted to Skyland Trail – and these are the years 2007, 2008 and 2009, they have a significant amount of dysfunction as well as symptoms. It is roughly an average of 1.93 or 1.94.

At the time of discharge, their basis 32 score falls off significantly, and in 2009 the disparity between 1.93 and 0.55 was roughly 72% improvement in their functionality and social relationships and symptom control. So this is not only a statistically significant finding to a P-value of <. 05, which means that this change can be no greater than 5% due to chance – there is something causing that change. That drop-off is a clinically significant change in how somebody is appearing. So I can tell the difference between somebody who had a Basis 32 score of .5 and somebody who had a score of 2. That would be a very obvious change.

Sponsors for 2010 Skyland Trail's Benefits of Laughter

2010-07-27T14:00:00.001-07:00

We would like to take a moment to thank in advance the corporations who have already signed on as sponsors for 2010 Benefits of Laughter! Your support of Skyland Trail’s Financial Aid Program assists clients and families who could not otherwise access or continue treatment. We are very grateful to you!

As of July 27, 2010 – Many thanks to:

Gold Sponsors: Alston & Bird; BNY Mellon Wealth Management; First Beacon Investments, Inc.; Robert W. Baird & Co. Incorporated

Silver Sponsors: Blue Cross Blue Shield of South Carolina; Georgia Commerce Bank; Goldman Sachs & Co.; Holder Construction Foundation; Piedmont Healthcare; Printpack, Inc.; Russell Reynolds Associates; St. Joseph’s Hospital

Bronze Sponsors: Smith & Howard P.C.; Wells Fargo

Other businesses who have committed to supporting the 2010 gala are: Empire Distributors; Epps Aviation; Gardner Spencer Smith Tench & Jarbeau, P.C.; Genuine Parts Company; Peachtree Orthopaedic Clinic; Pugmire Lincoln-Mercury, Inc.

Stay tuned for transcripts from a presentation given by Skyland Trail's medical director!

Skyland Trail's "Benefits of Laughter" Transcript Part 1

2010-07-21T11:05:00.000-07:00

The following is the first part in a series of posts consisting of transcripts of a presentation given by Skyland Trail's medical director, Ray Kotwicki, MD.

I’m going to talk with you about mental illness in general, making a couple points that illustrate why Skyland Trail is such a unique treatment facility, and I really think it is crucial to back up and try to understand what it might be like for somebody dealing with a mental illnesses and how our unique recovery program here at Skyland Trail can help someone recover and live happy, productive lives. When we think of mental illness we talk about the origin of symptoms using this term called a stress diathesis model. In Latin, diathesis refers to a genetic predisposition. So we know there are certain mental illnesses, when somebody has the genes that are responsible for producing these mental illnesses – it is much more likely that they will have those genes become active at some point in their life and develop the signs and symptoms of things like schizophrenia or bipolar disorder.

However, it is not a 100% certainty, so there are some individuals who have the genes but never develop the mental illness. So we think that on top of having the genetic predisposition, it is important to determine whether or not somebody has been exposed to stress. And what stress can refer to can be all sorts of different things. Early use of marijuana and other substances of abuse actually make it much more likely that the genes will turn on and develop mental illnesses later in somebody’s life. Early childhood neglect and abuse, whether it is physical, sexual, emotional, whatever – that stress makes it more likely that the genes will turn on. And then thinking about social stressors – so somebody might not have the symptoms of a mental illness until they are 18 and then leave the home of their parents and go to college and have to do things on their own, or the breakup of a significant relationship. All these things could make the genes become active. So in any of those situations the slings and arrows of life make it more likely that somebody’s genes will kick into gear and develop the symptoms of mental illnesses. So together we call that the stress diathesis model.

It looks like people who have the genes for mental illness also have different tissues in the rest of their body. So we know from a trial called the “Catie Trial” that was done in the early 2000’s that even before people with mental illnesses are treated with psychotropic medications they have twice the rate of heart disease, twice the rate of pulmonary disease and almost 3 times the rate of diabetes than anybody else in the population that does not have a mental illness.

There is a recent article that came out this summer that suggests that it looks like there is an increased inflammatory response in people who have schizophrenia, so that somebody who has almost a revved up inflammation process that is going on in their body and in their brain and they have the genes and the stress that leads to the development of this mental illness. To that end, they think it might now be important to consider using anti-inflammatory medication such as Aspirin to try and treat people who have mental illnesses such as schizophrenia. Up until this year there was no indication that this was something that scientifically made sense. So the thing that I like about this idea is that it is becoming easier to understand the biologic etiology of mental illness rather than thinking historically that they did something bad or that you are being punished for something and there was no way to understand the biologic origin of these mental illnesses.

So now that we know that, hopefully it will make it easier to de-stigmatize mental illness because we can demonstrate very clearly that this is a group of illnesses that originates in tissues just like any other medical illness.

Let’s now talk a little bit about prevalence. We know that there are certain mental illnesses that have the same prevalence in all countries across the world, and the classic example of that is schizophrenia. 1% of the world’s population has schizophrenia and it does not vary between who is making the diagnosis, what country somebody is living in, what their culture is like, what language they speak or whatever. Another example of that is Bipolar I Disorder. I’ll talk about the difference between Bipolar I, II, and other things in a minute, but roughly 1 % of the world’s population has Bipolar Disorder. So this is a great example epidemiologically of how the genetic type of disposition plays out in populations of people. For other illnesses such as depression, we know that is not true. So we know that in America, if you are a woman, you have a 25% chance – 1 out of 4 – of at least one point in your life of meeting the diagnostic criteria for having a major depressive episode. If you are a man, you have a 12 % chance in a lifetime of having a major depressive episode. I am suspicious of some of this prevalence data. Does anyone have ideas why?

The way that I think about it is that men stay home and suffer, and oftentimes don’t get help at all unfortunately because they don’t go to the doctor. So, if you are a depressed man and you don’t go in to get diagnosed – it is very likely that we are under diagnosing depression in men. The second reason is men doctors are making the diagnoses although that is changing every year because more and more women are going into psychiatry. A gender diagnostic bias may also contribute to these prevalence data. But there certainly is a gender bias against being emotional or having some kind of activity that is typical of depression.

So when you look at annual prevalence of any mood disorder in American, roughly 10% or one out of every 10 Americans at some point during one year have a mood disorder. There is a very common diagnosis and it has significant implications not only for the person that is affected by depression, but we know that in disability statistics if you have depression you are 500% more likely to be on Disability income, which of course is a huge economic burden for our country and our society.

The most common class of any kind of psychiatric diagnoses is anxiety disorders, and if you think about specific phobias as an anxiety disorder which is actually considered to be one, roughly 40% of all of us at some point or another will meet the criteria for some anxiety disorder. Paramount to understanding what the diagnostic criteria are is the idea that it has to produce some kind of disability in your life. For example, I hate snakes and I wouldn’t every want to pet a snake, I would never want to go into the reptile exhibit at the zoo, but it doesn’t keep me from going outside and mowing my lawn, it doesn’t keep me from walking to my car or keep me from doing things that are important in my life, so that wouldn’t necessarily be an anxiety disorder. On the other hand, imagine if someone were afraid of elevators and worked on the 51st floor of a building. Every day they had to walk up 51 flights of stairs, or had a lunch appointment had to walk down those stairs and this took too many hours of out their work week. In this case, the fear of elevators would meet the criteria for an anxiety disorder because it caused significant disability.

When you look at the economic impact of mental illnesses, particularly schizophrenia, the economic impact on our culture is great. Annually it cost about 32 ½ billion dollars to treat, medicate or prevent the hospitalization of people with schizophrenia. Remember, 1% of the world’s population has schizophrenia. But people in American with schizophrenia account for the consumption of roughly 90% of all the mental health dollars. It is a very serious illness and one we know that people can get much better when they get treatment in a holistic program like the one offered at Skyland Trail. I’ll described what we do that is different compared to other treatment facilities. The Catie trial also demonstrated that when you look at people with schizophrenia, on average they have a 33-year life decrease in expectancy. So people who are born today who actually will develop schizophrenia – if the an average life expectancy of a man is 76 ½ yrs, their life expectancy would be 76 ½ years minus 33. So why do you think people with mental illnesses such as schizophrenia have such an increase in mortality? Suicide is not factored into that and we know that a quarter of people with schizophrenia will probably have a serious suicide attempt that will lead to some kind of disability. But that is not considered in the data that I just shared with you. Part of it is the function of the patient and we call those negative symptoms and I’m going to talk about them in a future discussion.

The other piece of it is what happens from the biased care that physicians and other health care providers provide when a patient with bipolar disorder or schizophrenia comes into see them. So a great example is – in an emergency room – if a patient comes in with crushing chest pain that radiates to their shoulder and jaw, they are sweating, their heart is beating fast and they feel like they are dying – for anybody else it would be a myocardial infarction or a heart attack and so you rule it out. If you have the same symptoms in a patient with schizophrenia, doctors might say – oh, this person is having delusions, or this person is experiencing something that is not real and they will pick up the phone and call psychiatry rather than cardiology. So, I think there is a disparity in the excellence of medical care that people with schizophrenia and other mental illnesses expect and are provided in addition to their potential lack of insight that they need that kind of care.

Major depression is slated to become the second most costly illness worldwide by 2020, only surpassed by heart disease. So, this is a real problem in terms of absenteeism. People with depression actually perceive more physical pain than those who do not have depression. There is that commercial on TV for Duloxetine and it says –“ Where does depression hurt – everywhere. Who does depression hurt – everyone.” Well, it is cheesy, but it’s true. So, I like to think about people who have depression as not making up physical symptoms, but it is sort of like their hyper-aware of what is going on in their body. If you have a headache and you are not depressed, you can continue to function and do what you have to do during the daytime. If you have the same headache and you are depressed, it will make more of a difference in terms of what your disability is, and so you might not be able to do what you are supposed to do during that day. So, there is a huge inter-link between somebody’s physical health and somebody’s emotional health, and sort of a sense of spiritual existential well being. A treatment program that is good and designed to help somebody recover from mental illness will take all of those variables into consideration, and that is what we try to do at Skyland Trail.

Skyland Trail’s 13th Benefits of Laughter will be held in Buckhead

2010-05-25T07:34:00.000-07:00

Skyland Trail’s 13th annual Benefits of Laughter gala will be held October 21 at the beautiful St. Regis Atlanta in the heart of Buckhead. This ‘Seriously Funny Night’ has helped Skyland Trail clients recover from mental illness and has played a key role in raising mental health awareness in the Atlanta community since 1998.

The Honorary Chairs for Benefits of Laughter 2010 are community leaders and long-time friends of Skyland Trail, Amy and Cecil Conlee. Comedy entertainment for the evening will be John Heffron, the winner of the popular television series Last Comic Standing who is seen often on Comedy Central, and promises to be cleanly hilarious.

Skyland Trail is grateful to Event Chairs Leslie Wierman and Anne Hennessy, who are ably assisted by a dedicated team of community and business volunteers.

Skyland Trail Partners with Blue Cross Blue Shield of Georgia

2010-05-24T12:44:00.000-07:00

Skyland Trail is pleased to announce that effective May 1, 2010 it has contracted with Blue Cross Blue Shield of Georgia. Skyland Trail will accept Blue Cross Blue Shield coverage for:
• Residential services
• Partial Hospitalization services
• Intensive Outpatient services

“We are excited to now accept Blue Cross Blue Shield,” said Skyland Trail President Beth Finnerty. “This will enable more of our clients to access timely, affordable treatment.”

Other insurance accepted by Skyland Trail include: Aetna Behavioral Health; Cigna Behavioral Health; Cameron and Associates; Magellan Behavioral Health; United Behavioral Health; and Value Options.

Skyland Trail's Arts in the Garden Reminder

2010-05-11T07:11:00.000-07:00

This originally was a post on the Skyland Trail Facebook page on Thursday, 06 May 2010 at 15:20

Make sure to drop by Skyland Trail tomorrow between 9:30am and 3pm for Arts in the Garden. We are offering lunch for $5. Parking for the event is at the Health and Education Center, the Dorothy C. Fuqua Center, and some extra spaces will be provided at the Hampton Inn.

We're excited to see all of you!

Blue Cross Blue Shield and Skyland Trail

2010-05-04T08:44:00.000-07:00

Skyland Trail is pleased to announce that effective May 1, 2010 we have contracted with Blue Cross Blue Shield of Georgia.

Skyland Trail will accept Blue Cross Blue Shield of Georgia Insurance for our Residential services, Partial Hospitalization services (RHP), and our Intensive Outpatient services (IOP).

Arts in the Garden This Week at Skyland Trail!

2010-05-04T08:37:00.000-07:00

Just a quick reminder: 'Arts in the Garden' (AITG) is just a few days away! The event this year themed Honoring Our Journey and is set to take place on May 7. The theme of Honoring Our Journey is so very appropriate as AITG is one of the ways each year we celebrate the strength and perseverance of our clients.

AITG is held each May during Mental Health Awareness Month and serves as an opportunity to celebrate the many talents and abilities of consumers of mental health services. It's a great place for consumers, family members, mental health professionals and the Atlanta community to gather and network. The day is filled with festivities throughout the Skyland Trail gardens for everyone to enjoy. Attendees experience hands-on workshops, make & take classes, demonstrations, art exhibits, music and dance performances, plant and art sales, a silent auction, and mental health education. AITG also aims to educate the public about mental illness in order to reduce stigma.

Please come out and support, empower, and become educated on those with mental illnesses. This is one of our favorite events each year, and everyone is invited! Please see a few pictures from past AITG events...see you all there!

Skyland Trail Announces New 2010 Board of Directors Members

2010-05-04T08:36:00.000-07:00

Skyland Trail announced new members of the Board of Directors elected for terms beginning in 2010. Skyland Trail is a non-profit organization serving adults with mental illness.

New members elected to the board are David Flint of Schreeder, Wheeler & Flint, LLP; Jackie Montag of A. Montag & Associates; and Michelle Sullivan, Senior Vice President of Wells Fargo Insurance Services.

The foundation’s Board of Directors is a corporate entity that oversees a professional management team. Their responsibilities include fulfilling the organization’s mission, maintaining its financial health, and ensuring quality care for Skyland Trail clients.
About Skyland Trail

Skyland Trail is a community-based non-profit organization that offers hope to adults with mental illness by teaching them the skills they need to lead productive and independent lives. We provide a unique curriculum of innovative services, tailored to the individual client, to improve mental, physical and social well-being. Programs are offered in Atlanta on three campus-like settings and are led by a team of caring professionals who are specialists in their fields.

Skyland Trail Clients Honored at 24th Annual Southeastern Flower Show

2010-04-26T07:30:00.000-07:00

Wednesday, 17 March 2010 at 16:21

Atlanta philanthropist and gardener Virginia Almand helped Skyland Trail’s clients enjoy a successful day at February's Southeastern Flower Show, which was held February 4-6 at the Cobb Galleria. Two Skyland Trail entries took home honors in the forced bulbs division, including a blue ribbon for “Best in Show” and Tulip Bulbs. Congrats to Heath K. and Kathleen T.!

Almand, who serves as a judge for similar shows around the country, has been volunteering in the Skyland Trail greenhouse for the past 10 years. Her guidance in forcing bulbs during the winter months has provided a soothing outlet for many clients, and Skyland Trail horticultural therapist Libba Shortridge said forcing bulbs has become a metaphor of sorts for clients as they learn to manage their mental illnesses.

“We always take advantage of the recovery metaphor of the bulb,” she said. “Energy and beauty are stored within the bulb, and that beauty is released at an opportune moment. We can all relate to seeing that growth as individuals, and many of our clients have been inspired by the evolution they facilitate in these flowers.”

Horticulture therapy is a popular aspect of Skyland Trail’s adjunctive therapy program, which also includes woodworking, arts, recreation, and music therapies. These programs are intertwined with more traditional therapies to give Skyland Trail clients a holistic continuum of treatment options. The adjunctive therapies combine with a vocational program to give clients skills that can be useful in day-to-day life when they discharge from the facility and return to their lives and communities.

Skyland Trail Announces New 2010 Board of Directors Members

2010-04-26T07:11:00.000-07:00

This update was originally posted on Skyland Trail's Facebook page.

Atlanta April 15, 2010– Skyland Trail, a project of the George West Mental Health Foundation, announced new members of the Board of Directors elected for terms beginning in 2010. Skyland Trail is a non-profit organization serving adults with mental illness.

New members elected to the board are David Flint of Schreeder, Wheeler & Flint, LLP; Jackie Montag of A. Montag & Associates; and Michelle Sullivan, Senior Vice President of Wells Fargo Insurance Services.

The foundation’s Board of Directors is a corporate entity that oversees a professional management team. Their responsibilities include fulfilling the organization’s mission, maintaining its financial health, and ensuring quality care for Skyland Trail clients.
About Skyland Trail

Skyland Trail is a community-based non-profit organization that offers hope to adults with mental illness by teaching them the skills they need to lead productive and independent lives. We provide a unique curriculum of innovative services, tailored to the individual client, to improve mental, physical and social well-being. Programs are offered in Atlanta on three campus-like settings and are led by a team of caring professionals who are specialists in their fields.

Skyland Trail to Host 12th ‘Annual Arts in the Garden’ May 7

2010-04-20T09:45:00.000-07:00

this post originally came from Skyland Trail's community forum page.

Hello everyone,

It’s hard to believe that we’re just under three months away from Arts in the Garden 2010! This year’s event will take place Friday, May 7 on the Skyland Trail campus, and the theme is ‘Honoring Our Journey’. For those of you unfamiliar with Arts in the Garden (AITG), I’d like to provide you with some details about what has become one of our favorite days of the year at Skyland Trail.

This will be our 12th annual Arts in the Garden, and with each passing year, the event continues to grow in popularity! Held each May during Mental Health Awareness Month, AITG serves as an opportunity to celebrate the many talents and abilities of consumers of mental health services, and is a great place for consumers, family members, mental health professionals and the Atlanta community to gather and network. The day is filled with festivities throughout the Skyland Trail gardens for everyone to enjoy. Attendees experience hands-on workshops, make & take classes, demonstrations, art exhibits, music and dance performances, plant and art sales, a silent auction, and mental health education. AITG also aims to educate the public about mental illness in order to reduce stigma.

Skyland Trail clients, as well as community organizations and consumers of mental health services in the Atlanta area, have an opportunity to show their creative talents through visual and performing arts. This very special day has 500-plus participants and is recognized by the mental health community. We invite anyone interested to come experience this wonderful day with us at Skyland Trail!

-Shelley Danser

Skyland Trail to be Honored at 11-Alive Community Service Awards

2010-04-20T09:42:00.000-07:00

Skyland Trail is honored to be the non-profit recipient for this year’s 11Alive Community Service Awards.

FOR IMMEDIATE RELEASE
PR Log (Press Release) – Apr 16, 2010 – Atlanta (April 13, 2010) – Skyland Trail is honored to be the non-profit recipient for this year’s 11Alive Community Service Awards. Hosted by 11Alive News Anchors Brenda Wood and Ted Hall, the 35th Annual 11Alive Community Service Awards will be broadcast Saturday, April 24th at 7:30 p.m. on WXIA and Sunday, April 25th at 12:30 p.m. on WATL. Television taping will take place Tuesday, April 20th at the Marriott Marquis Hotel as the awards are presented.

An 11Alive tradition, the Community Service Awards annually honors members of our society who generously give their time and resources to improving the lives of others. This year’s recipients have given back to the community in many and varied ways, which include providing foster homes for children, fund-raising for childhood cancer and disease research, the development of a Holocaust program for schools, flying Angel Flight volunteer missions, establishing educational and recreational programs for at risk youth, donating veterinary services to animal shelters, and providing emotional support for sick children and their families. Proud sponsors include The Coca-Cola Company and United Parcel Service.

At this year’s 11Alive Community Service Awards, 11Alive will proudly recognize twelve outstanding community leaders who embody these qualities and whose dedication and service has changed people’s lives.

Award Recipients

Ryan Cameron, whose Ryan Cameron Foundation, in service since 1991, invests 100% of the proceeds from its yearly fund-raising events to supporting post-secondary educational opportunities for young adults.
Doug Ellis, a volunteer pilot for 14 years with Angel Flight, has donated his time, his plane and the cost of fuel to fly seriously ill patients to and from the hospital.
Julius Erving, as the Honorary Chair of the Salvation Army Booth Society, organized the first Julius Erving Biddy Basketball Tournament in Atlanta, and served as spokesperson for the Salvation Army’s Metro Atlanta holiday efforts.
Jon Kleinberg is nominated for his volunteer fund raising and organizational efforts on behalf of the Mary Hall Freedom House, a shelter for homeless women and children.
Herbert Kohn is nominated for over 30 years of volunteer work with the Jewish Family & Career Services, Bremen Jewish Heritage and Holocaust Museum, much of his time dedicated to educating people about the Holocaust.
Keith and Victoria Ledford decided 14 years ago to become foster parents. They presently provide a loving home for 24 children, some of whom have learning disabilities and other challenges.
Tommy Owens is the first coach of Team in Training, an endurance training program of the Leukemia and Lymphoma Society, which helps to raise millions of dollars for blood cancers research by training runners to run marathons.
Dr. Karen Thomas has been donating her veterinary services to local animal rescue shelters Noah’s Ark and Praying for Paws for 14 years. Proceeds from her clinic have helped fund numerous programs at the shelters.
Jacqueline Viener has donated almost 700 volunteer hours since 2005 to brightening the lives of young patients at Children’s Healthcare of Atlanta. As a volunteer Fairy Godmother, she reads, tells stories and visits children who need a special “lift.” She also volunteers as a Family Support Volunteer at the Shepherd Center.
Darius Weems, who suffers from Duchennes Muscular Dystrophy, is nominated for devoting the last five years of his life to raising over 2 million dollars for research and awareness of this debilitating and often fatal disease.

The Boisfeuillet Jones Award Recipient: Warrick Dunn, who in 1997 established Homes for the Holidays, a program of the Warrick Dunn Foundation, as a tribute to his late mother. The Warrick Dunn Foundation’s mission is to provide opportunities to economically-disadvantaged single parents and their children who have demonstrated a commitment to achieve financial independence and stability. In Atlanta, Homes for the Holidays has helped to provide 24 mothers and 58 children and dependents with homes of their own.

# # #

Skyland Trail is a community-based non-profit organization that offers hope to adults with mental illness by teaching them the skills they need to lead productive and independent lives. We provide a unique curriculum of innovative services, tailored to the individual client, to improve mental, physical and social well-being. Programs are offered in Atlanta on three campus-like settings and are led by a team of caring professionals who are specialists in their fields.

Looking Back on 2009

2009-12-29T12:20:00.000-08:00

As we here at Skyland Trail look back on 2009, there is a lot to be proud of. From receiving the 'Heroes in the Fight' award for 2009 by Mental Health America of Georgia, to the success of the Benefits of Laughter event, to seeing our clients go on to help others in need - it has been a truly great year. Of course celebrating our 20th anniversary only made things that much better.

We look forward to 2010 and all it has to bring Skyland Trail and its clients.

Happy Holidays

2009-12-22T10:06:00.000-08:00

Skyland Trail would like to wish all employees, patients, and families, past and present all the best this holiday season.

To a safe and healthy new year!

VALERO article: Skyland Trail Press

2009-12-16T14:07:00.000-08:00

VALERO Study aims to provide new outcomes assessments for Skyland Trail Clients

The lack of rigorous research data has been a challenge in the world of psychiatry and mental health treatment for many years. This is an issue Skyland Trail hopes to help rectify by taking a supporting role in researching and testing the most effective treatment options for people with mental illness.

In May, Skyland Trail’s clinical team began working on the VALERO Study, an innovative research initiative aimed at developing assessments to quantify and VALidate the Everyday, Real-life Outcomes of people with serious mental illness.

The program, which is sponsored by the National Institute for Mental Health (NIMH) in conjunction with Emory University’s Department of Psychiatry and Behavioral Sciences, began in May with a series of tests on 30 clients who volunteered for the study at the Skyland Trail testing site. The same tests are being conducted at the University of California, San Diego with the same number of clients who were recruited from that site. Both Skyland Trail and UC San Diego will repeat the tests with 30 new volunteers next year at each testing site.

The VALERO Study assessments began with a series of interviews and questionnaires for the patient volunteers including: a structured assessment of their current and previous symptoms of illness, an assessment of the volunteers’ concentration, attention, memory, problem-solving abilities, and tests of everyday living and social skills. Finally, the volunteers are asked to provide some self-ratings of their ability to perform everyday living skills, like cooking, cleaning, transportation and work. Principal Investigator for VALERO and Emory psychiatry professor Philip D. Harvey, PhD, explained the importance of having the volunteers provide the self-assessments.

“The study stems from when I was in New York and we asked a large sampling of patients with schizophrenia to perform a self-assessment of everyday living skills,” he said. “What we kept finding was that the patients’ assessments were not consistent with those of their case managers. They were not seeing those abilities to perform basic skills in the same way. And it wasn’t that the perceptions of the patients were over or under those of the case managers, but the two just did not correlate.

“The idea is that people with schizophrenia have a hard time establishing how ill they are,” continued Harvey. “So, this study is about finding out how to most effectively evaluate real-world functionality, and we use performance in these assessments as a reference point for how to measure that.”

In the past, Skyland Trail has used the ‘Basis 32,’ an outcomes measure consisting of a 32-item, self-administered (or structured interview) questionnaire developed to assess outcomes of mental health treatment for patients undergoing psychiatric care for a wide range of disorders. The five domains measured by the Basis 32 are psychosis, daily living/role functioning skills, relation to self/others, impulsive addictive behavior, and depression.

“With the Basis 32, you are asking people to tell you how they are doing,” said Harvey. “It’s important to keep in mind that how a person is feeling and how they might actually be doing in reality are two different things in some cases. Our argument is that both are important, but the two should not be confused with one another.”

The tests themselves measure cognitive capacity for people with schizophrenia, giving clinicians a better sense of what people with schizophrenia might be able to accomplish once they are back in the community.

“It goes right back to our overall philosophy of reintegrating clients back into the community to lead productive lives,” said Skyland Trail Medical Director Ray Kotwicki, M.D. “We want to take a close look at what people diagnosed with serious mental illnesses such as schizophrenia can accomplish and what their capabilities are.”

In the future, Harvey said he is hopeful that the VALERO Study can transcend measuring not only outcomes for schizophrenia, but for other mental illnesses as well.

“Our goal is to move this beyond just looking at schizophrenia,” he said. “It would be beneficial to patients in the sense that clinicians have this whole new skill-set for the future. We are hopeful to see it open up new doors in the psychiatric world.”

Skyland Trail Press

2009-12-16T14:02:00.000-08:00

Published in our own Journeys magazine this year is an article on our 20th anniversary. A video on the same subject can be found at the Skyland Trail YouTube channel.

Skyland Trail opened its doors May 1, 1989. Twenty years and thousands of clients later, we are stronger than ever. In turn, so too is the Atlanta community.

The early years

Charles West founded the George West Mental Health Foundation, named for his father, in 1982. At the time, West was retiring from a lifetime of work in the lumber business, and was looking for his next challenge. Through the need of a family friend, West learned that adults with mental illness in Atlanta faced a void as they tried to bridge the gap between hospitalization and returning to normal community life. Seeing the opportunity to deliver help where the need was great but resources were few, Mr. West undertook the Journey that would lead to Skyland Trail as we know it today.

In the year before its first facility opened, Charles West’s son, Mark, embraced the cause and joined the organization as its volunteer president, working tirelessly with his father and the Skyland Trail Advisory Board to give form to their vision. His first order of business was finding a suitable place for Skyland Trail to run its day-to-day operations. Mark West and the board of directors purchased a 1960 sera apartment complex located on four acres of land in northeast DeKalb County. It was to become the first residential complex, now called Skyland Trail North.

“Our board spent years looking at various real estate options only to be turned away when our mission was disclosed,” he said. “We found these apartments nestled on the edge of a stable community and slid in under the radar.”

With the wheels in motion, the West family and the board began to soul-search for what would set Skyland Trail apart from the rest of the mental health community. It would be the vision and foresight of one man, according to West, that would leave the most indelible handprint on the direction of Skyland Trail: the late Bernard Holland, M.D..

“Dr. Holland had the dream that the founding board embraced,” said West. “He and I toured a half-dozen facilities around the country and we took the best aspects of each to create Skyland Trail.”

Along with Holland, board members from the early days—Allison Williams, M.D., Bob Scherer, Bart Miller, Dorothy C. Fuqua, Edward Noble, Jim Wilson and Alvin Barge would continue to mold the ideals by which Skyland Trial would solidify itself as a health care leader in the Atlanta community.

With a talented board committed to the Skyland Trail philosophy, West turned his attention to staffing. Within six months he had identified Beth Finnerty as Skyland Trail’s executive director. She and three clinicians comprised the entire staff. Now, 20 years later, Finnerty is still the engine behind Skyland Trail.

“We were just one big, happy family; all four of us, and the board wore a lot of different hats during those days,” said a laughing Finnerty. “We mowed the grass and cleaned the toilets together. It was truly a labor a love.”

And the labor slowly began to pay off.

“Our board was so committed and thoughtful—they approached Skyland Trail with a collective savvy,” she said. “We all dedicated to the mission, and our name started getting out there in the community; we began to see admissions take off.”

The Next Steps

In 1991, Skyland Trail received its first big shot in the arm when Vivian Dubose and the Noble Foundation awarded the program a $500,000 challenge grant. This would allow the purchase of a duplex in close proximity to the apartments, allowing Skyland Trail to expand its continuum of care to include independent living and case management.

“That $500,000 was a really big deal for us,” said Finnerty. “It got us well on our way to expansion—and offering a much needed service to the adults we were serving.”

Even with the expansion, Skyland Trail was still a young program in the Atlanta community, and West remembers a crossroads in early 1992.

“We were continuing to refine our programs and we believed in what we were doing, but we came to a juncture where we had to make some tough decisions,” he said.

Longtime Skyland Trail advocate and board member John Gordon was serving on the board in 1992 and remembers it well.

“One of my first recollections of Skyland Trail was sitting around that board table—which was actually a kitchen table—and rubbing elbows with some of Atlanta’s giants in the business world,” said Gordon. “Times then were pretty tough. We counted every penny. I can remember one of the board members wrote a check to cover the next week’s payroll. I got to see firsthand what long-term dedication really means.”

Gordon learned under Skyland Trail’s first Finance Committee Chairman, Alvin Barge, before taking the reigns in 1992. The two men played a vital role in helping move Skyland Trail to the financially stable program it is today.

“Alvin Barge gets most of the credit for that,” said Gordon. “He’s a man who stands tall and was a great role model for me. And Beth always came to the meetings well prepared. We never spent a dime we didn’t have. We were judicious, and more importantly, we were the beneficiaries of this terrific Atlanta philanthropic community.”

With the future in mind, Finnerty, West and the board sat down to kick off its first long-range strategic planning effort. By 1993, that long-range plan had been adopted by the board of directors and included three primary initiatives that focused on continued growth in services to meet the increasing need:

• To build a free-standing day treatment center
• To add residential capacity
• To expand the aftercare and case management programs

In order to fulfill these lofty aspirations, Finnerty and the board launched Skyland Trail’s first capital campaign. The campaign, dubbed ‘Securing the Promise,’ sought to raise $12.5 million.

“That forward thinking and long-term planning have defined us over the years,” said West.

The campaign kicked off in 1995, the same year Skyland Trial achieved another milestone: Accreditation with commendation from Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). The next few years would be spent fine-tuning Skyland Trail’s programs, adding staff, searching for land to build a day treatment center, and working tirelessly to raise the capital needed to meet the campaign’s goal.

“That was a busy period,” remembers Finnerty. “We were working every day to build a model program that met all the needs of our clients and one that was viable financially.

“Layered on top of that was our capital campaign and the planning and development process for the new facilities,” continued Finnerty. “It was an exciting time in our growth and truly a pleasure to watch Skyland bud and blossom during those years.”

Land for the new Health and Education Center was purchased in 1997 on North Druid Hills Road near I-85. By 1998, Skyland Trail celebrated its first capital campaign victory when the $12.5 million goal was met, and plans for building the new state-of-the-art Health and Education Center were well on their way. Former board members and longtime Skyland Trail donors Dorothy Fuqua and Vivian Dubose lent their time and energy to help design the building.

“I think the most critical thing was probably the site selection, and Skyland Trail did a great job tapping its resources to make the right decision. I have seen Skyland Trail grow exponentially over the years, and the Health and Education Center was a major component of that,” said Dubose. “We wanted to provide a place that was uplifting and gave us the best opportunity to facilitate the treatment Skyland Trail’s clients needed.”

A New Decade

Skyland Trail cut the ribbon at the Health and Education Center in September of 1999. West remembers the reaction of clients upon seeing the new facility for the first time.

“This is for us? That was their collective reaction,” remembers West. “Our clients had not had the opportunity to be a part of a first-class facility like the one we have now. That will always be a very touching memory for me.”

Additionally in 1999, a second facility was identified on Clairmont Road that was deemed suitable for expanding residential capacity. The purchase was approved by the board and another of Skyland Trail’s long-range initiatives was within reach. The Clairmont Road facility, now named Skyland Trail South, opened in October 2000. With two residential facilities, and with bed capacity expanded, Skyland Trail could now tailor its services to short and longer-stay clients .

In 2002, Skyland Trial received the Rosalynn Carter/Johnson & Johnson Caregiver Award for excellence in its family therapy programs, along with the Community Foundation for Greater Atlanta ‘Managing for Excellence’ Award. The following two years would see the Professional Advisory Board and the National Advisory Board created to further Skyland Trail’s expertise and reach. Many new services, including the pastoral care and family education programs were added to the continuum of care. In 2004, Skyland Trail was awarded the American Psychiatric Association’s Gold Achievement Award for excellence and innovation in psychiatric service and delivery. With the prestigious honor, Skyland Trail was recognized as a leader in innovation and effectiveness.

Today—Reducing Stigma

Skyland Trail recently celebrated the completion of its third capital campaign, an $11.5 million endeavor that was coined “Initiatives for Program and Campus Expansion.” Through the continued support of friends in the Atlanta community, the campaign has enabled Skyland Trail to expand its education and training program and all support services to the new annex—the Dorothy C. Fuqua Center—and expand clinical services within the Health and Education Center, including a full-time primary care clinic.

“I saw the need for Skyland Trail’s services from the beginning,” said Fuqua. “It’s been such a pleasure to watch it grow over the years.”

One of the many challenges Skyland Trail and people with mental illnesses face is the stigma associated with it.

“It’s interesting how when a well know person has a mental illness it becomes more accepted,” said Fuqua. “People begin to become aware of the fact that it’s an illness just like anything else.

“I told Charles [West] that he has given me one of the greatest pleasures of my life by asking me to serve on the Skyland Trail board,” continued Fuqua.

Bobbi Cleveland, executive director of the JM Tull Charitable Foundation, a supporting foundation from the beginning, said Skyland Trial has served as a voice for Atlantans with mental illnesses.

“What Skyland Trail has done to reduce stigma of mental illness in the Atlanta community is really remarkable,” she said. “They have put a new face on mental illness. It’s no longer the faces of others; now, it’s a face with which we can all relate. People in our community are no longer hesitant to support this cause or turn a blind eye to it.”

The stigma Cleveland referred to is an issue people with mental illnesses and mental health providers struggle with everyday. John Stephenson of the Campbell Foundation talked from a donor’s perspective towards mental illness in the early 1990s.

“Honestly, Skyland Trail wasn’t on our radar initially—the community was a little unsure about how to approach an organization like this at the time,” said Stephenson. “But Skyland Trail has demonstrated over the years that what they do is effective and meets a vital need. No one else does this type of work as completely and effectively as Skyland Trail.”

Skyland Trail works to reduce stigma through events like Benefits of Laughter and Arts in the Garden. Its Community Education Series seeks to educate Atlantans on mental health awareness. As an advocate for clients, Skyland Trail offers need-based financial aid and has distributed close to $4 million in assistance to hundreds of adults since the inception of this program in 1999.

“The thing about Skyland Trail that makes it unique is that it sees true needs in this arena of mental health and it seeks to fill those needs,” said Dubose. “The community has been happy to support Skyland because it provides such a useful service.”

Looking Towards the Future

As great as the first 20 years have been, Skyland Trail has its collective eye focused squarely on the next 20 years.

“Obviously, we’re living in a different world than we were five years ago, even one year ago” said Finnerty. “We have to adjust with the times and keep our clients’ well-being at the forefront.”

Skyland Trail is currently focused on further developing its wellness program, in particular the on-site primary care clinic, as well as enhancing the vocational service programs. As it continues to enhance its model of care, Skyland Trail clinical leadership is developing a sophisticated outcomes research program to track and analyze the success of its clients longitudinally once back in the community.

“I am so proud of all the people who have made Skyland Trail what it is today and honored to have been a small part of this success story. It has been a real privilege to work with the boards, our staff, the Atlanta community and beyond,” Finnerty added. “But there is still so much work to do.”

As West thought back over the past two decades, he took a moment to reflect on how Skyland Trail has impacted him and his family.

“We have gotten a lot more out of Skyland Trail than we’ve given,” he said. “The relationships built over time with the staff, boards and clients have enriched our lives.

“From a personal standpoint, Skyland Trail was an opportunity in my life at truly making a difference,” he said. “This place is a dream realized.”

Skyland Trail in the News

2009-12-16T13:58:00.000-08:00

Below is an article published in Behavioral Healthcare earlier this year:

Atlanta’s Skyland Trail Opens Primary Care Clinic

Skyland Trail, an Atlanta-based mental health treatment center specializing in the treatment of depression, schizophrenia and bipolar disorder, has become one of the first of its kind to open an on-site, full-time primary care clinic.

Skyland Trail is a community-based, nonprofit organization that offers hope to adults with mental illness by teaching them the practical skills they need to lead productive and independent lives. Providing a unique range of innovative services tailored to the individual, Skyland Trail strives to reintegrate patients into the community and improve their mental, physical and social well-being. Since opening its doors in 1989, Skyland Trail has served over 2,000 clients across three campus-like settings.

In 2007, the National Association of State Mental Health Program Directors published a report indicating adults with serious mental illness who are treated in public systems have a life expectancy that is about 25 years less than average Americans.

Additionally, according to the National Institute for Mental Health’s [NIMH] CATIE Study, conducted by Jeffrey A. Lieberman, M.D., Columbia University, from 2002-2005, patients with schizophrenia have an inherent predisposition towards metabolic syndrome [MS], which is worsened by their sedentary lifestyles, poor dietary habits, and medication-induced side effects. Subsequently, patients with schizophrenia experience a higher risk of morbidity and mortality than the general population.

Despite that data, there has been a divide between primary and mental health care over the years, something Ray Kotwicki, M.D., MPH, Medical Director at Skyland Trail, said may partially be a consequence of fundamental biases by both primary and mental health care professionals.

“On the mental health side, we tend to focus on our own area of expertise in a very systematic approach, and the same is true for primary care clinicians,” said Kotwicki. “Oftentimes patients’ mental concerns are so complex that we just don’t have the resources to cover soup to nuts.

“Additionally, when certain healthcare providers see a serious mental illness, their biases may indirectly cause them not to ask thorough questions,” continued Kotwicki. “For instance, if a physician sees a patient who is schizophrenic and complaining of chest pains, many times they assume that patient is delusional. In reality, the patient could actually be having a cardiovascular symptom or some other physical source to their complaint. Even well-intentioned physicians may ‘write-off’ physical symptoms in individuals with mental illnesses to only being part of their mental illness.”

The idea for Skyland Trail’s primary care clinic was spawned during a 2004 strategic planning retreat of its National Advisory Board, a group of leading psychiatrists representing major academic institutes throughout the country. The model of care at Skyland Trail, as with many psychiatric facilities around the country, focused on the mental health needs of its patients with medical care being provided by their own general practitioner in the community. The National Advisory Board saw an opportunity to do something that was unique.

“When the National Advisory Board met in 2004, one of the emerging trends echoed by many was the integration of medicine and psychiatry,” said Skyland Trail President Beth Finnerty, who has been with the organization since its inception in 1989. “The data backed up the fact that people with major mental illnesses have a shorter life expectancy, and the idea of primary health care at Skyland Trail really resonated throughout the group.”

With the primary care clinic officially part of Skyland Trail’s next strategic plan, a task force of staff and board members was formed to see it through to implementation. Just one hurdle remained: Funding. The task force decided to start small and think big. The clinic was opened part-time in 2006 with one exam room and one part-time nurse practitioner. In June 2008, it opened full-time with funding from private Atlanta foundations, growing from a one-room office into a 1,500-square-foot facility that includes a pharmacy, two exam rooms, an infirmary, a laboratory, a waiting and reception area, a medical director’s office, a research area and additional office space.

“As it turned out, there were several foundations in the Atlanta area with a similar interest in and focus on this intersection of medicine and psychiatry,” said Finnerty. “We are fortunate and grateful for the early support from these foundations with start-up and renovation expenses.”

While Finnerty and the Skyland Trail development team sought funding for building purposes, the clinical staff went to work strategizing a new wellness initiative that would be at the heart of the primary care clinic. They would eventually develop three primary care tracks into which each patient is grouped:

• A Cardio-Metabolic Track for the control of blood pressure, coronary artery disease or congestive heart failure in patients with a family history of risk factors. This track also focuses on patients who are at a higher risk of developing cardiovascular and metabolic abnormalities related to the use of psychotropic drugs or family risk factors.
• A Wellness Track for health promotion and disease prevention efforts. This track runs the gamut of general health concerns, from broken bones to thyroid issues, and is crucial to the younger patients who are early in their recovery process.
• A Follow-Up Track through which patients follow a previously developed individual treatment plan based on a pre-existing medical condition. Individuals with chronic illnesses like asthma as well as acute illnesses such as infections receive timely attention from respectful physicians who are well versed with patients who have mental illnesses.

“Because the merging of primary and mental health care is still a relatively new concept, we are at the cutting edge for implementing these processes,” said Kotwicki. “It’s a dynamic process. As we’ve thought about it over time and measured what has worked and what hasn’t, the ideas and recommendations for the wellness tracks have changed.”

Along with the primary care tracks, the clinic provides patients with basic primary care starting with their admission, including:

• Medical history and physical exam on the date of admission
• Thorough family medical history assessment
• Assessment of current and past medical problems
• Check of the patient’s body mass index
• Check and review of patients’ metabolic panels, blood counts, thyroid functioning, HIV or other infectious diseases, and other individualized tests. Based on those assessments, clients are placed in one of the three wellness tracks.

Additionally, Skyland Trail provides its patients with education about lifestyle changes that promote wellness, such as cessation of smoking, healthy eating, exercise, avoiding diabetes, and the dangers of higher-risk drug use and sexual behavior. Patients are encouraged to exercise and take part in recreational therapy as part of their everyday life.

“The clinic is one piece of our overall wellness initiative. Educating our clients on primary care is very important as well,” said Finnerty. “The bottom line is that good physical health goes hand-in-hand with good mental health.”

Many patients at Skyland Trail have seen the immediate effect of the primary care clinic. Former patient Paul S., who suffers from diabetes, found the support to properly treat himself. “I’d let the diabetes go,” said Paul. “I lost track of monitoring myself.”

According to Kotwicki, this is a relatively common problem with many of his patients who suffer from both mental illness and primary health concerns.

“I’ve found with some of my patients the gravity of preventive medicine just doesn’t register,” he said. “People can be disorganized. Think about the general public and how many people don’t get their recommended preventive medical or primary care. From a patients’ point of view, preventive medical care is even tougher: imagine experiencing auditory hallucinations every minute of every day. In a situation like that, scheduling a mammogram may seem less important.”

That’s where the primary care staff can lend a helping hand at facilities like Skyland Trail. In Paul’s case, Skyland Trail diagnosed the problem and referred him to a specialist for treatment. The primary care staff also helped him obtain a glucose monitor. Such solutions may sound obvious on the surface, but with many cases like Paul’s, simple primary health solutions fall through the cracks.

“They set up the appointment for me, and got me in touch with the right people,” said Paul. “The nurse practitioner was able to help me obtain a glucose meter, which has been very helpful for me, and Skyland Trail kept in touch with me after I left just to keep tabs on how I was feeling.”

Kotwicki also mentioned the importance of having infirmary rooms on-site at Skyland Trail. As a residential facility providing transportation for patients to the day treatment facility and main campus, Kotwicki said many patients who are ill do not travel to the main campus, which creates a domino effect.

“What you see are patients getting sick and staying in their rooms, which weighs on their minds and prompts them to be even more sick,” he said. “We want people to come to the clinic on campus so that we can make sure they are getting the proper help they need, both from a physical and mental standpoint.”

Along with tangible examples of how the clinic helps certain patients with particular primary health disorders, the clinic has also improved efficiency in the admissions process. Before a patient can be admitted to Skyland Trail, he or she must undergo a history and physical examination. Prior to the primary care clinic’s existence, Skyland Trail referred prospective patients to general practitioners in the community before admittance, a time-consuming process.

“We can schedule and perform physicals quickly now and patients are admitted in a timelier fashion,” said Skyland Trail Admissions Director Chris Cline. “We also know a great deal more about each patient. When you look through that medical lens, you build a greater relationship right from the start.”

Cline said patients have responded very positively to having the clinic at their disposal.

“Some people come in with medical issues that have been troubling them for some time,” said Cline. “I think it’s very comforting for them to know that we have a place right here where they can ask questions about problems that have been on their minds.”

While the primary care clinic has been advantageous at Skyland Trail, there are obstacles other mental health treatment centers should keep in mind. One of the biggest challenges has been with insurance reimbursement.

“The insurance companies are still one of the primary challenges for us,” said Finnerty. “Their systems don’t recognize the fact that primary care can be successfully delivered at the same place psychiatric care is being delivered. As a result, charges are often denied.”

Additionally, Kotwicki voiced concern that patients who form a strong bond with staff in the clinic may not feel as comfortable seeing a new general health care provider in the community. For that reason, Skyland Trail recently decided to open the primary care clinic to its alumni.

“When patients develop that trust, generally they would like to keep seeing the same provider,” said Kotwicki. “This also gives us a way to stay in touch with our former patients. It’s similar to an ‘after-care’ program.”

Moving forward, Kotwicki and rest of the Skyland Trail clinical team have even larger plans for primary care services.

“We would really like to open our services to people around the [Atlanta] community who have mental illnesses,” he said. “We want this to be a place where they will receive respectful, quality care. Sometimes general providers can’t get past the stigma of mental disorders. This is a place where they can feel comfortable.”

And despite the advances Skyland Trail has made over the last three years in seeking to bridge the gap between mental and primary health care, Kotwicki hopes this is only the beginning.

“This is certainly innovative in that primary care services are interlinked with the excellent mental health care provided at Skyland Trail,” said Kotwicki. “As far as research is concerned, I think this is just the tip of the iceberg. We know that patients with mental health disorders have higher likelihoods of experiencing general health problems, but I think the more sophisticated question is, ‘how are the two related?’ That’s a very complicated question at this mind-body interface.”

Whatever the answer, Skyland Trail is lifting the rock on an issue that has remained unresolved for too long, and opening the door for patients who once fell through the cracks to receive proper health care they deserve.

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