nView Mental Healthcare Today | Guests -Dr. Nikki King and Lindsey Gessendorf
[Music] welcome to mental health care today i’m jim saperski and we are so fortunate to have some wonderful guests today to speak to us nikki king and lindsey gessendorf and theirs is a good and very powerful story of treating behavioral health and substance use in rural america nikki king is the manager of behavioral health and addiction at margaret mary hospital in batesville indiana lindsay gessendorf is a licensed clinical social worker and director clinical director of substance use services at margaret mary health and also the creator of the addiction and drug program at the ripley county indiana courthouse for some quick background i first came across nikki about a year ago when i was reading through an mit publication under mit technology and it was really a tale of two cities one about an addiction program that was being created in california that was raising millions of dollars through venture capital and the other was really a story about nikki and her team in rural america and what they were doing in their community and building in their community and serving their communities early was a very powerful story i was so impressed by it so with a little bit of background like that also by the way for those who haven’t heard it nikki can be found on uh she did a a t publication or a tv broadcast with emma curran company on top of that and i would highly recommend both of those to anybody who is interested in finding that um without further ado nikki i know you grew up in eastern kentucky you grew up in rural appalachia uh you went to university of kentucky and now you’re in indiana and as a someone who grew up in north carolina i feel like we should be talking basketball but since this is probably not a very good year for any of those states we can skip over that i suppose so can you tell me can you maybe uh just start with you nikki and lindsey can you tell me a little about the work you’re doing um at margaret mary and some of the challenges and maybe contrast those challenges of rural addiction treatment versus urban addiction treatment or urban substance disorder treatment um because i perceive at least from some of the things i’ve read that there are some differences there yeah so i’ll speak a little bit about um you know margaret mary and her community and then i’ll turn it over to lindsay to talk about her passion which is substance use um so basically yeah we’re uh from we’re part of margaret mary health center which is a newly minted not-for-profit clinic we are serving um batesville indiana so it’s a town of about 6 000 people but we also serve a lot of the communities around batesville most of which are significantly more rural than batesville itself in fact lindsay is headquartered out of brookville indiana which is a lot smaller than batesville um so our um our organization serves two entirely rural communities franklin and ripley county indiana for anybody’s familiar with that part of the world we’re about halfway between cincinnati and indianapolis um batesville is known for uh for hill-rom which makes hospital beds and also known for the baseville casket company i think like 70 to 80 percent of the caskets in the country are made here in batesville our program’s better than that would imply but you know such as it is um so yeah um i’ll turn it over to lindsay to talk a little bit more about the specifics about substance abuse in rural communities so i will start with the fact that i’m from ohio cincinnati and so going into indiana was much different than what i’ve seen in the past if you go to cincinnati you can find treatment centers anywhere you can find silver living housing anywhere and that’s not what i ran into and i started working in indiana and so the difference for me is a the level of trauma we’re seeing is it’s skyrocket and unfortunately for so long we took the stance of mental health and substance use existing in bubbles we didn’t put them together and they do they exist together so 80 of people with a substance use disorder have a co-occurring mental health diagnosis and oftentimes it’s going untreated and when you’re in indiana and you’re lacking access to psychiatrists and providers you have this unique circumstance where you’ve got to find a way to make this work this person is struggling with a substance use disorder they’ve been incarcerated they have ptsd they also have an untreated bipolar disorder that we have to treat all of those things to make this person successful and for so long all these programs came out and they would treat one so they would say you can’t come into our substance use clinic if you have a major mental health diagnosis okay well you just got rid of 80 of people with a substance use disorder and so we took a different approach these things don’t exist in a vacuum we’re going to treat your substance use disorder your mental health disorder your trauma the factors in your life that are making it difficult for you to maintain sobriety because if we want to be successful and we want to be a top-of-the-line program i can’t just treat you like you exist in a vacuum and so we took limited resources and with nikki’s amazing grant writing skills and our team’s dedication to working non-stop we’ve been able to treat the whole person and it to me it’s amazing because what we’re seeing is patients that have been through six seven eight treatment programs have been incarcerated multiple times spent years in prison and they’re coming out and they’re able to have successful lives and so i’m just amazed with what we’re able to do with limited resources and really give these people the help that they need i mean that is interesting because um our our chief medical officer who also serves as a medical director for a substance use disorder clinic in boise idaho has a comment and you just you just hit it on the head he said everybody has a secondary diagnosis who comes into our place you know we we tend to think of in terms of substance use disorder but in fact there is generally some underlying cause whether it’s ptsd or it’s adhd or something underlying and then really until we can get to that we really can’t get to the heart of the problem so it’s wonderful to hear you say that lindsey that’s that’s uh confirming for me ever after having heard that a number of times uh over the past several years uh you know one of the mickey when we i first reached out to you um we were talking about the pandemic and the impact of the pandemic a little bit just in our messaging and you had a quote and i pulled out the pandemic is unleashed pandora’s box of mental health issues and it’s hard to keep up so maybe you know would you address that first lindsay then i’d love to get nikki’s view on that as well as i mean the impact of that i mean we see it everywhere but i’d love to see how you’re seeing it in your community when you said pandemic my eyes lit up because it’s been such a difficult challenge people are isolated and so one of the biggest things i think we’ve seen is domestic violence has skyrocketed we have had patients lose friends to domestic violence through this pandemic when you create this sense of isolation lack of access to services you’re essentially you’re setting people up to have significant mental health struggles and so you have somebody with depression that you’re saying okay for the next year you can’t really leave your house you can’t see your family you’re already on probation you’re already on house arrest now your n a and your aaa is gone all in purses all in-person services are disconnected and so the overdose rate is skyrocketing the relapse rate is skyrocketing because people can’t exist alone we’re social we’re meant to be together an addiction in itself is a very isolating secretive illness and so is ptsd and then you add the ability to take away all in-person access and you’ve created this perfect cocktail of severe mental illness just as a follow-up with that how are you able to treat them are you able to do phone support or any type of video or telehealth capabilities or how are how are you handling it absolutely so we’re doing telehealth we also have myself and our peer recovery coach have a work phone on us 24 7. patients have access to us that doesn’t necessarily mean they’re going to get a hold of us right away but we’ll respond to them even on the weekends we’re doing in-person one-on-one sessions so we’re offering that more frequently to people we’re trying to utilize the resources we have we’re currently connected with probation so one of the things we’ve asked is increase in home visits and so any contact you can get with somebody face-to-face because unfortunately you can see me on a computer and i might present very well but you don’t know what’s going on in my life when you can’t access my body language you can’t see the day-to-day things that have fallen apart because of the isolation but we’re doing our best to make sure they have access to services even if it is virtually right now interesting nikki and maybe to that addressing kind of that same issue what what is that done to the resources you’ve had available because i i imagine that’s puts an incredible strain on the people the dollars the funds that you have to support these programs maybe you could talk to that for a second uh we’ve seen our referrals go up 200 percent i’m gonna be honest with you everybody is at the breaking point everybody in healthcare is at their breaking point i mean that you know when you talk about that you talk about a lot of the acute care workers who you know they were putting themselves directly in harm’s way their family in harm’s way for months to take care of people who you know were coronavirus positive people who were volunteering to work in you know conjunction with those patients that normally wouldn’t be in those settings and then you know you kind of have mental health who’s over here just sort of quietly plodding along you know and it’s not the same kind of risk as you know like the people who work in med surg and the people who work in icu and things like that but there’s almost a secondhand trauma so it’s almost like a survivor’s guilt because you’re not up there working directly with it and then on top of that then you get hit with the backwash of you know these just huge numbers of patients and then you know and i think that people forget that you know healthcare providers are people too we’re struggling with the same things everybody else is in the pandemic and on top of that our jobs have now been made exponentially harder and there’s no end in sight you know i think every week lindsey will laugh every week i try to give a little bit of hope oh maybe we’ll get another provider or maybe it’ll slow down or the vaccines you know look at our vaccine rate and then every week we get more and more referrals and so it’s like no no it’s just more dirt just keep shoveling it’s great at this point it’s easier to just dig down than it is to dig up you know you bring up a really good point you know there’s one of my favorite phrases that i stole from someone who’s a doctor out west uh one time was mental healthcare is healthcare you
nView Mental Healthcare Today | Guests -Dr. Nikki King and Lindsey Gessendorf – Treating Mental Health and Substance Use in Rural America
Dr. King and Lindsey Gessendorf join nView CEO Jim Szyperski, and discuss the challenges of treating mental health and substance use in rural America as well as the programs that they have developed to treat these issues. Dr. King’s work has received national coverage in the MIT Technology Review as well as by Amanpour & Company on PBS.
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