No wellness package is complete without a look into behavioral health, but some unique challenges in New Mexico have made the issue difficult for many area residents.
A wave of investigations into the billing practices of some state providers ultimately resulted in turmoil for many of the state’s most vulnerable citizens.
Thankfully, a number of agencies, including Artesia General Hospital (AGH), have stepped up to fill the void that resulted. In 2014, AGH greatly added to its behavioral health services to expand outpatient mental health care for area residents as well as dementia and depression services at the special Senior Care Unit at the hospital.
As part of that effort, AGH brought in two talented local professionals in psychiatry: Ron Haugen and Susan Caley. The two rotate between serving at a clinic in Carlsbad and the Memorial Family Practice in Artesia.
Caley and Haugen are both board-certified nurse practitioners who specialize in psychiatric issues, which includes dealing with any mental health disorder, including screening for someone concerned about a potential disorder, substance abuse issues and elderly care. There’s a shortage of these services in Southeastern New Mexico, so to say that the two keep busy would be a gross understatement.
Dr. Ron Haugen received his doctorate in nursing practice in forensics from the University of Tennessee. He received both his Master of Science and Bachelor of Science degrees in nursing from New Mexico State University. In his free time, he enjoys spending time with his family and playing the drums. Oh yeah, and he was awarded the Excellence in Advanced Practice Nursing award at the 2015 New Mexico Nursing Excellence Awards.
Caley has a bachelor’s degree in nursing from Graceland College in Iowa and a master’s in nursing with an emphasis in adult psychiatric mental health from New Mexico State University. She is board certified by the American Nurse Credentialing Center as a Psychiatric Nurse Practitioner. Her personal interests are reading, travel and spending time with her granddaughter.
Carlsbad resident Haugen, who began his practice in Southeastern New Mexico in 2007, said he’d worked with AGH for several years as a contractor and then on a part-time basis, but the hospital entered into a full partnership with him and Caley in November 2014. While hospitals in large cities often have behavioral health components to their portfolio, it is rare for hospitals in smaller communities to do so. “This was basically a new idea for them,” he acknowledged.
“There were lots of surveys about what the community felt was needed,” added Caley, who has been an Artesia resident for several decades now. She is a well-known psychiatric nurse practitioner in the area, and among other assignments, she recently served in that capacity at the corrections center in Roswell.
Richard Gibson, Executive Director of Behavioral Health Services with Artesia General Hospital, elaborated on the decision.
“Our hospital’s own Community Health Needs Assessment, the Eddy County Health Council Assessment and visits to the ER (emergency room) have attested to the community’s need for behavioral health service. This global need was acknowledged in the Accountable Care Act that mandated behavioral health treatment to be addressed by insurers in parity with physical health treatment, offering citizens more financial support in seeking treatment to restore their mental health.”
About half of Haugen and Caley’s patients are referred by a primary care provider or specialist, but the other half are self-referred. They only see and treat patients age 14 and older, with an emphasis on those over 18.
Because the brain is such a complex body part, psychiatric diagnosis is extremely difficult. Where do you begin with someone who comes in concerned about a potential disorder?
“The interviewing process is very important,” Caley explained. “We’re looking at the thought process and how they present that, but we’re also looking back at their history of how they’ve responded to different medications.”
Other issues to consider include family history and whether or not there are any current substance dependencies.
“When we started school, there was a ‘nature vs. nurture’ discussion, but now I think it is more clear that it is nature and nurture,” Haugen stressed. “It’s people’s experiences along with underlying medical issues.”
In the case of an addict, therefore, a psychiatrist will have to attempt to navigate the extremely complicated human mind to try to determine whether the drug caused the psychological issue, or was an outcome of the issue, or (most likely) some overlapping combination of the two. Haugen and Caley may also order diagnostic tests, if they feel they are needed.
“It’s all considered together,” Haugen continued. “We’re always having to look at interactions and potential risk.”
Medication is a part of the package, but by no means the only treatment. While some people express hesitancy toward the idea of any medication for a behavioral health issue, the reality is there are chemical imbalances that serve as the platform for so many different issues labeled as mental illnesses. Much like a diabetic might need insulin, Caley explained, someone with a mental health issue might need medicine to balance out what his or her body is not doing on its own.
An anti-medicine philosophy presents some unique challenges. For example, some rehabilitation centers demand that patients not be taking any psychotropic drugs, but those drugs are often needed to stabilize chemical imbalances needed to make rehabilitation effective.
“As nurse practitioners, we prescribe medication,” Caley pointed out. “We also do some therapy and counseling, but we don’t have a lot of time.” Therefore, the practitioner will often recommend additional counseling or therapy from a psychologist or other expert in the area.
Psychiatrists are sometimes accused of handing out multiple pills when they could just prescribe one, Caley noted, but that isn’t the case. Mental medication is extremely complicated, and it is often a matter of finding the right recipe, not just the right medicine. Sometimes that recipe needs to be refined over time.
“And that recipe always includes lifestyle changes,” Haugen added. “People do significantly better with therapy and lifestyle changes in combination with medicines.”
Caley and Haugen also play an important role with Artesia General Hospital by supporting psychiatry needs related to the hospital’s Senior Care Unit. There, they assist with mental health issues that focus on the elderly, such as Alzheimer’s and dementia.
“The majority of our patients there have dementia,” Caley continued, noting that end of life issues can be even more complicated. “It’s very complicated when you have dementia plus pre-existing mood problems.”
The state mental health shakeup was disruptive, and especially so to a group of vulnerable individuals, Haugen revealed. Some services switched providers multiple times, which resulted in employee turnover. Many behavioral health services, such as the Crossroads program in Carlsbad (a rehab center for women with children), no longer exist. Consequently, psychiatric services have been in very high demand in the area.
“While we are a separate entity from some of them, we do work with everybody,” Haugen assured. “It’s been a big transition for patients, and every time there is a corporate change (with one of the area’s other behavioral health providers), we’ve had an influx of very frustrated patients.”
Haugen’s clinic in Carlsbad, which operated in the same location prior to his affiliation with AGH, has been a source of stability for some. Employees such as Yvette Leos recognize many of the region’s patients and can rely on past experiences.
“The reality is that most patients want to establish consistency with someone and develop a relationship,” according to Caley. “That’s true with all health providers, but a relationship with a mental health provider is one of the most important relationships you can have.”
And diversity also helps, since one patient may relate better to Caley or Haugen, or to someone else. “You also need to feel like you have a choice,” she concluded.
Make no mistake about it, Southeastern New Mexico still needs more behavioral health employees.
“We’re actively looking for more clinicians and therapists,” Haugen declared. “We’d really like to see the hospital expand to where we’re offering more traditional therapy.”
What Southeastern New Mexico has done well is develop volunteer and faith-based programs that complement professional services, Haugen and Caley agreed.
Historically, there has often been a stigma against individuals with mental health problems, in that some people have often been less understanding of those problems than they are of purely physical ailments.
Haugen observed that over the past nine years in the profession, he has gradually seen more and more acceptance in terms of people willing to seek mental health treatment for themselves or recommend it for family members.
“The stigma is still there, but it is getting better,” he shared.
“There are very few families who can look at themselves and say there’s not somebody who has had a challenge,” confided Caley. “And life is stressful!”
In the information age, there’s also a lot of access to information online, but there’s some drawback there. Who hasn’t decided they are dying of 12 diseases after looking something up online? But Haugen and Caley say the benefit is a positive.
“If they are doing a self-diagnosis and then coming in, they are recognizing that something is affecting their functioning,” Caley observed.
With mental or behavioral health being increasingly seen as the linchpin to overall physical health, professionals such as Dr. Ron Haugen and Susan Caley will become increasingly valued.
The Memorial Family Practice in Artesia is located at 702 North 13th Street and can be reached at 575-746-3119. The Carlsbad office is located at 1101 W. Pierce Street and can be reached at 575-725-5562.www.ArtesiaGeneral.com
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