Donna Markham OP, PhD, vice president of behavioral health services for Ohio- and Kentucky-based Catholic Health Partners (CHP), is convinced that over the past 20 years, the quality of effective treatment for the severely and persistently mentally ill has been steadily declining.
“Many healthcare facilities have closed acute care behavioral health units or cut back staffing to the extent that care is largely custodial,” she told Vision. “Private, state and federal funding for mental illness has been drastically reduced. This has resulted in behavioral health being a loss leader in the healthcare industry and, as a consequence, caused many hospitals to discontinue serving this population. Many persons suffering from mental illness have thus been left to fend for themselves, often homeless and in critical need for care.”
Sister Markham, an Adrian Dominican sister and board certified clinical psychologist, is leading the transformation of behavioral health services across the continuum of care in the seven regions of the system. In November 2012, she held a training program for CHP chaplains, “Leading Spirituality Groups with Those Who are Emotionally Fragile.”
Prior to coming to CHP, Donna was president of the Southdown Institute in Ontario, Canada, and prioress general of her religious congregation. She is an internationally known author and speaker in areas related to transformational change, leadership formation and group psychotherapeutic treatment of the mentally ill. She answered the following questions for Vision readers.
Q Catholic Health Partners has begun a comprehensive program for the care of behavioral health patients. What is the vision and mission of this program? How will the process unfold?
A The president and CEO of CHP, Michael D. Connelly, with the support of the Board of Directors, made a bold commitment to address the needs of this underserved population. I was invited to join CHP with the mandate to effect the transformation of the delivery of behavioral health services to serve the health of the population encompassed by the regions of CHP. This includes initiating evidence-based treatment procedures in acute care, partial hospitalization and intensive outpatient services. It also involved embedding behavioral health clinicians in primary care physician practices.
Rather than treating mentally ill persons as pariahs who are kept out of sight and out of proximity to our healthcare facilities, CHP committed to a comprehensive plan that involves capital improvements, staff training and development, the initiation of treatment outcome measures and the expansion of services designed to assist patients in their process of healing. It is expected that this process of transformation will take at least three years to fully implement. This year’s focus is on the acute care treatment program and involves staffing realignment and training in best practices.
Q You advocate conducting spirituality groups rather than individual pastoral interventions. Can you share why this is a preferred pastoral practice? What are some of the guidelines for conducting a spiritual care group?
A Comprehensive research in psychotherapy has shown that groups are as effective as individual therapy when those groups are led by trained therapists. In the acute care setting, patients struggle with isolation and fear. Oftentimes they are responding to internal stimuli in the form of delusions or hallucinations. Structured, small group processes have been shown to be far more effective in breaking through isolation and instilling hope in persons struggling with mental illness.
Chaplains are of greatest assistance to this population when they are able to steer away from diagnoses and counseling and rather assist patients in focusing on their relationship with God and family in a supportive, interactive group setting.
Q What are some of the core principles of pastoral care when working with emotionally fragile persons?
- Do not focus on pathology, but rather on the strengths of individuals in their capacity to relate with God.
- Redirect and reframe interactions that are confused or disorganized.
- Do not sermonize! Listen and facilitate!
- Assist patients in engaging with one another in the small group rather than focusing on the chaplain.
- Always remember that the instillation of hope and the breaking through of isolation are key to the healing process.
Q What do you see as some of the challenges, or training needed for chaplains, when working with behavioral health patients? What isn’t needed or helpful?
A Chaplains are not needed to be therapists in the acute care setting but rather are important conduits of the care and compassion of God. Training in small group best practices is really essential for chaplains who are working in acute behavioral health units. Individual counseling can place the chaplain in an uncomfortable situation should delusional material surface. My bias is that chaplains should work with patients in groups as a general practice and, of course, be available should an individual patient request a visit or a time to pray personally with the chaplain.
Q Any additional thoughts you’d like to share?
A Thanks for the opportunity to share a few thoughts with you. I realize it is far beyond the scope of this interchange to address the detailed processes involved in the preparation of chaplains to serve in behavioral health acute care facilities, but hopefully this will spur more conversation and underscore the need for specialized training.
Sandra Lucas is regional director of spiritual care for Humility of Mary Health Partners in Youngstown, OH, and a member of the NACC’s Editorial Advisory Panel.