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Dual Diagnosis: The delicate balance of mental and physical health in young adults
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Hartford HealthCare’s Steve Coates talks with Dr. David Bendor, Clinical Coordinator of the Young Adult Medical Track at Hartford HealthCare’s Institute of Living.
They discuss the challenges faced by youth with a dual diagnosis of behavioral and physical health conditions, and the most effective strategies to manage this unique situation - for both the patient and their families.
The Young Adult Medical Track is taking referrals at 860.545.7008. To learn more and to meet the team, go to InstituteOfLiving.org/YoungAdultMedical
Related topic: When Medical Illness Causes Mental Health Problems in Youths
These are young adults who, for example, the college freshman who went off and because of his severe GI distress never left his dorm. He was too frightened to get sick in public or too much distress in public. So we dealt with the anxiety and depression that's related to that. But unlike others who might then venture out to get treatment, because of the GI distress, he was in too much physical pain and too much discomfort to leave. So he had that was an experience of like an entire freshman year, for example.
SPEAKER_00Welcome to More Light. In this episode, Hartford Healthcare's Deep Coach talks with Dr. David Bendor, clinical coordinator of the Young Adult Medical Track at Hartford Healthcare's Institute of Living. They discussed the challenges faced by youth with a dual diagnosis of behavioral and physical health conditions and the most effective strategies to manage this unique situation for both the patient and for their families. Here's Steve Coffee.
SPEAKER_04So we talk a lot about holistic care and coordinated care and health care, and whether it's treating comorbidities of certain conditions, connecting people to specialists, subspecialists. I have to be honest with you, until we spoke, I never really thought about that intrinsic connection between some physical conditions and behavioral health, especially for young adults. Fill us in on what the young adult medical track program is doing.
SPEAKER_01Sure. So in a nutshell, we're working with young adults ages between 18 and 26, I'd say. And these are young adults who are struggling with concurrently both chronic medical conditions, such as asthma or cystic fibrosis, you know, chronic pain, heart disease, so chronic medical conditions, as well as psychiatric conditions, you know, behavioral health conditions. Depression, anxiety, PTSD, bipolar disorder, to name a few. And so, you know, they're obviously uniquely challenged in having to deal with both and deal with caring for both and treating both. And so it's a very unique population, one that um you'll hear today. I'm very excited that we're able to serve the way we are.
SPEAKER_04So give me a snapshot of the typical patient and the pathway to get to you. Are they patients with behavioral health conditions brought on by the physical conditions, or can it be the flip side of that?
SPEAKER_01Right. So my short answer to what you just said is well, yeah, yeah, all the above. I mean, if I may, because this is part I get excited about, so feel free to kind of slow me down or pace me. But you know, so so this came about. So I've been in in here at the institute, you know, we have this young adult division essentially, where we're we realize that 18 to 26 year olds, they're too old to be grouped with teenagers, you know, young adolescents. They're still, though, too young, we thought, to be grouped with folks in their 30s, 40s, 50s who've been dealing with these uh emotional struggles for quite some time. So we have this really nice carve-out of a young adult division. And I've been in it, I'd say, for about eight years myself. And in this young adult division, we've treated and continue to treat young adults struggling with mental health conditions. That's what we do. We're a behavioral health program here at the institute and as part of the Hartford Healthcare system. And what we noticed though, Steve, throughout my time is that every admission cycle, every time we brought in new young adults, we would see at least 10% of them or so seem to have a concurrent medical condition. There would be the young adult who came to us with depression or anxiety, which we know how to treat, but they also had really severe GI problems. They had Crohn's disease or gastroparesis. And what that meant was that we could address the mental health, but their physical health, right, was still a real struggle for them. So to give you, as I said, in a nutshell, these are young adults who, for example, the college freshman who went off and because of his severe GI distress never left his dorm. He was too frightened to get sick in public or have too much distress in public. So he dealt with the anxiety and depression that related to that. But unlike others who might then venture out to get treatment, because of the GI distress, he was in too much physical pain and too much discomfort to leave it. So he had that was his experience of like an entire freshman year, for example. Or another, another young person I'm thinking of who had cancer, beak cancer, but due to the aggressive treatment, he was left with a lot of physical pain that just wasn't going to go away. So, unlike his father and grandfather, who were firemen, and that was his dream all along, that was just robbed from him. For nothing he did wrong, he could treat his mental health as aggressively as anyone else, but he just couldn't do it. So it's just real losses that other young adults typically just don't have to face.
SPEAKER_04For so many young adults these days, it's you know a really difficult transition time. They might be living at home with their parents, they might still be under their parents' insurance or maybe have no insurance at all. How do they connect with the program? Is it through the primary care provider?
SPEAKER_01Because so many of these young people, or all these young people, are involved medically, we had to branch out in a way that we never normally would for behavioral health, right? We were now reaching out to these medical providers and saying, some of your folks may have never had any kind of mental health treatment, but if you're finding these patients of yours are struggling, struggling to adhere with their treatment, struggling to adhere with their recommendations, if you're hearing they're isolating too much or they're sad too often, let us talk to them. Maybe they might be a good fit for what we've got going over here. And and we launched this, I should mention, back in uh September of 2019, a mere six months before a certain uh pandemic changed things dramatically to Then I'm guessing being part of a large coordinated healthcare system has advantages for a program like this. Yeah, I I'd be even so bold to say I don't think we could have done it without being a part of this system. I would say actually one of the few silver linings of COVID in doing so much telehealth and telemedicine and emailing and texting is that you know I've networked in a way that I don't think I would have otherwise. And very much you mentioned digestive health and bone and join and all the others that we have connections with. We have easier and easier ways to network with them and talk to their nursing staff, talk to their mental health people in bed, and talk to the providers themselves about what we've got going on and how easy we can make the referral process.
SPEAKER_04And before there was a program like this, what how were these patients addressing some of these issues?
SPEAKER_01One of the people I met before this program launched, you know, years before, you know, it was this young man who played hockey at uh you know at the high school level and bad freak injury, and boom, the the hockey career was over, the scholar athletic scholarship for college over, and mom said he got amazing care at CCMC, but we're still at a loss of what he should do with his life. You know, the injury was treated and addressed uh aggressively and correctly, but he was just left with, as you're as we're talking about, you know, those chronic lingering injuries. He just could not do what he did, what he had done before, what he dreamed of doing. So at 18, you're just told what you thought you'd be doing is just gone. And so he did go into you know depressive, and and that's just one story, but you're absolutely right. Bone and joint, chronic pain, you know. I have some young person in the program right now, she was a class A athlete, and a freak injury is just took it just robbed that from her. Those are huge losses. And that's why I mentioned to you not only depression and anxiety, but also traumatic experiences a lot of these young people have.
SPEAKER_04So the patient or the provider wants to connect with you, or maybe a a parent wants to make a recommendation. Uh, what are the steps? What are the next steps?
SPEAKER_01So, what I'll do is and I and I'll tell people this all the time, you know, in my role of coordinator of this program, so I I really put myself up out there and I want anyone to call me directly. You know, I just, you know, my direct direct line is on the website, it's ever, you'll feel free to give it out. I'm kind of, I see myself as a screener. I'm the first encounter. And so whether it's a provider who thinks he may he or she may have a patient or a patient, him or herself, or a family member of a patient, I have them call me. We just do a very quick phone screen. Uh, we talk a little bit about the program and talk about what's been going on for this young adult and how we might help them. What we're very clear to say is, you know, we are we are behavioral health, you know, we are mental health providers, uh, but we have kind of, if you will, an ear for and a focus on those who are struggling with chronic medical conditions as well, recognizing that we can get a lot of the mental health aspects uh go into remission in terms of depression or anxiety, really, you know, but recognize that chronic medical piece will likely still be there, perhaps not as acute, but it'll it'll be there, it'll linger. So a lot of what we do is not only address the mental health, but also really work with them to start to develop what a plan B of life will look like. That life doesn't have to stop when there's that injury or something like that, but but it will look different. You need time to grieve that loss. Uh, and we'll give you a space to do that. We have space to do that, and you'll be doing that alongside peers who know exactly what you're going through. So there's no longer that thing idea of being alone, which is what we hear all the time. Oh, I didn't know others had what I had or feel what I feel.
SPEAKER_04This is a really difficult time to be a young adult balancing school, maybe a new job, paying rent if they're not living with a parent. Might be hard for them time-wise to invest in and enroll. What are the nuts and bolts of the program? Talk a little bit about the patient's commitment.
SPEAKER_01Most patients will attend three to four days a week. Uh, we start late morning, 10 a.m., and the young adults always have jokes about how early, quote unquote, I'm starting the program. So I apologize, of course, for starting at the crack of dawn of 10 a.m. So we go from 10 to 1, but three to four days a week going from 10 to 1. So that's a pretty intense schedule because again, we want to aggressively treat the mental health component. You know, when COVID hit, we switched the whole thing, we just shut the whole thing down and we were all telehealth, we're all virtual. And and I think one of this is actually one of the nice things that we picked up. Now that the numbers are going down and staff is vaccinated, more and more young adults are vaccinated. You know, we're we're doing more in-person treatment now, which is what it used to be, and it's what's preferred. So right now, the typical young adult who say would join us next week, would come join us uh up to two days virtually and two days in person. And again, the beauty of it, you think about the people who were now pulling in from you know Fairfield County and the shoreline, if they choose to, they only have to drive in for one in-person day a week and come twice virtually, and they're still meeting that three-day minimum that we have for an IOP experience. And so that's right here at the Iowa campus. And some have really liked that because there's no way I would have gotten people from Fairfield County or the shoreline necessarily driving to our place four times a week, three to four times a week. And so we're reaching, we're actually reaching patients we thought we would not have reached otherwise. And they come in. A typical day is three group therapy sessions, and each group is different. We give them a schedule, there's skills groups and educational groups to help them learn, for example, what their brains are doing and uh what's going on when they have traumatic responses and how best to manage their pain. We also have these discussion groups we call process groups, where we really delve into stuff like what's it like trying to relate to medical providers who just aren't hearing you, they think, or or family members who are just telling you to hurry up and get better already, and what it's like to have these illnesses that just prohibit you from joining all other 20-somethings in normal activity. So we have a lot of group discussions, and that's where the real connections made to their peers, and that, like you said, you know, realizing you're not alone in this. But in addition to the groups, you know, we have the psychiatrist component. That's a psychiatrist. She's Dr. Salmira Solomon, she just does a wonderful job coordinating with these young adults, medical and mental health providers out there in the community to really do this in a collaborative way. They have opportunities for individual therapy check-ins as well as family sessions with our lead health psychologists and Dr. Rosenberg, she just runs terrific family meetings for our young adults. Um, and those family meetings are often critical because you really need that support system buy-in to best help the young adult. And then lastly, they have an opportunity to work with Lorraine, who's our nurse and case manager. She helps them manage medical appointments. They might have coordinate appointments. But as I mentioned before, perhaps as importantly, she helps them with all the other young adult matters, such as looking for first jobs, getting back to work, preparing for interviews, securing accommodations in college. So we want to really focus on not just the mental health by the book stuff, but really the importance of doing life. That's as important as anything else we offer. And, you know, as I mentioned to you, you know, the people who come back who have the success stories not only tell us their mental health is better, but their mental health is in remission and their medical concerns are in remission enough that they can do life. One of the things I like to say is on discharge, tell me where you are in your satisfaction meter, your life satisfaction meter. That's really what uh what their experience would be like in our program.
SPEAKER_04Maybe this is simplifying things, but I would think, you know, good mental health leads to better healing.
SPEAKER_01Absolutely. And you'll see that folks who, you know, when their mental health is stronger and they become more resilient, lo and behold, you'll see a lot of those medical symptoms abate to a degree and lessen. What you'll also see, and this is really significant, especially for the you know the medical providers, is their compliance with treatment improves when their mental health improves because they're feeling more hopeful and positive and resilient. And so, you know, we've talked a lot about GI, but also in endocrinology, you know, we get a lot of folks who refer to us who have had diabetes and often diabetes since birth, you know, type one. These are folks who they've had pain associated and loss associated with it. And at times they come to us and they're just so despondent. They're like, I cannot imagine a life of having to, you know, deal with diabetes and the insulin, and and they're just frankly, they're exhausted. And none of their friends are going through it, so it's not like they have a shoulder to cry on, they believe. But as they go through our program, if we help them with their mental health and they feel more resilient and feel like they're not alone, lo and behold, to no surprise, uh we hear from their providers wow, so-and-so is doing so much better with her blood sugar. So-and-so is doing so much better staying out of the hospital, frankly.
SPEAKER_04Doctor, thanks so much for joining us, and thanks to you and to the program for all the great work you're doing.
SPEAKER_01Thank you so much. Thank you so much for having me.
SPEAKER_00Thank you. Steve Coates and Dr. Bendor. The Young Adult Medical Track is taking referrals, and that direct line that Dr. Bendor mentioned is 860-545-7008. For more information, just go to instituteofliving.org slash young adult medical or check the notes for the number and link in this episode. For Hartford Healthcare, I'm Enron DePierre. Thanks for listening to More Life.
SPEAKER_03I'm ready for the stuff.