Asante Rogue Regional Medical Center creating sanctuary for mentally ill

April 13--Laurel Nickels lifted a weighted blanket from a couch and held it up.

"You know how when you're at the dentist getting an X-ray and they put the lead apron on you? It feels comforting," said Nickels, the clinical manager for Asante Rogue Regional Medical Center Behavioral Health Services. "This feels like that."

Anxious mental health patients in the hospital's psychiatric Behavioral Health Unit can come into the unit's comfort room, sit on the couch or in a gliding rocking chair and cover themselves with the blanket. A flat screen television plays nature videos while soothing music fills the gently lit room.

A box of Kleenex is at the ready, along with art supplies for patients who want to express themselves.

Patients who use the comfort room fill out questionnaires. On average, they report their stress levels dropping by 55 percent. The unit has been able to reduce its use of medication for anxiety, Nickels said.

Nickels wants the entire 18-bed unit to feel more like the comfort room. The unit already has nature art on the walls, and patients can stroll the hallway, sit in armchairs near an aquarium filled with goldfish or enjoy fresh air on a screened patio. Patients dress in their own clothes, and staff members don't wear uniforms.

But Nickels believes more can be done to make the unit seem more comforting and less institutional -- like a sanctuary for the people in crisis who are brought to the only hospital-based inpatient psychiatric stabilization center in nine counties.

The unit is adopting a Sanctuary Model of care. The model recognizes many of the patients are actually showing symptoms of trauma.

The old model of acute psychiatric care across the nation emphasized controlling the patient, said Nickels, who started as a nurse in the unit 11 years ago.

"Trauma-informed care doesn't ask, 'What's wrong with you?' but 'What has happened in your life to bring you to this?' Why does a man scream and throw his tray if he doesn't get what he wants on his tray? For people with a high trauma load, simple things can be highly activating," Nickels said.

To help the hospital adopt the Sanctuary Model, renovate the Behavioral Health Unit and form deeper community partnerships with local police departments, mental health professionals and organizations, the Asante Foundation has launched a three-year, $1.5 million fundraising campaign, said Asante Foundation Development Director C.J. McPhail.

That commitment is unusual at a time when many hospitals across America are closing their psychiatric units, which are costly to run. Asante Rogue Regional Medical Center has operated its unit since the 1970s, Nickels said.

McPhail said it wouldn't be right to close the unit, especially since the Medford Police Department is responding to more calls involving mental illness, including attempted suicides.

Last year, the unit treated about 725 patients. It's on track to treat 800 patients this year, Nickels said.

The unit is often overflowing, with mental health patients held in the emergency room or other spaces while they wait for psychiatric beds to open up. McPhail said early architectural drawings show there is room to add some beds, but a decision has not been made yet whether to boost the unit's capacity. Factors such as staffing, costs and impacts on other resources have to be considered, he said.

People brought to the unit are at risk of suicide or are suffering from extreme depression, schizophrenia, bipolar disorder, personality disorders and other mental illnesses. Cases can be complex, with substance abuse issues or medical problems also present, Nickels said.

Using the Sanctuary Model helps staff members better treat patients who've experienced trauma, she said.

The New York-based Sanctuary Institute defines trauma as an experience in which a person's internal resources are not adequate to cope with external events. What people see as bad behaviors are actually misapplied survival skills -- often seen as "fight or flight" reactions.

A physically abused child, for example, may lash out and fight a classmate who is teasing him.

From listening to patients' stories, Nickels said staff members have learned many patients brought to the unit have had unusually high numbers of traumatic childhood experiences.

The Adverse Childhood Experiences scoring system asks 10 questions about childhood trauma, including whether you were ever hit by a parent or adult in the household so hard you had marks or were injured, if you lived with a problem drinker or alcoholic, if a household member went to prison and if you were sexually abused by a person at least five years older than you.

People with scores of four or more have much higher rates of a variety of problems, from depression, suicide and violent interactions to heart disease, diabetes, hepatitis and lung disease, according to the ACES Too High website devoted to news and education on adverse childhood experiences research.

Nickels said childhood trauma can occur to anyone and happens across all socioeconomic groups.

To better help patients, Behavioral Health Unit staff members are committing to nonviolence, both in their actions at work and in teaching patients about nonviolence.

"A lot of our folks live in a very violent world," Nickels said of patients who come to the unit.

Staff members are also creating more democratic situations, for example by involving patients in the creation of their discharge plans and in consulting them about medications. Many patients have experience with different mental health medications and have a good idea of what works and what doesn't work for them, she said.

"We want to give them an opportunity to have a voice in a positive way and have a say in what happens to them," Nickels said.

Another Sanctuary Model principle is open communication, which includes avoiding sarcasm. For a patient suffering delusions, sarcasm can be deeply confusing and troubling, Nickels pointed out.

"It would be like a physician joking about your cancer diagnosis when you're already really nervous," McPhail said.

Research has shown psychiatric treatment units that adopt the Sanctuary Model have increased patient satisfaction levels and patients are able to leave earlier. Meanwhile, there is less staff turnover, Nickels said.

She said the staff members at the unit long have provided loving, compassionate, professional care.

"We do good work," Nickels said. "We want to do even better work."

Staff reporter Vickie Aldous can be reached at 541-776-4486 or valdous@mailtribune.com. Follow her on Twitter at www.twitter.com/VickieAldous.

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