“I want people to know that we are working to make ourselves available to the community and that makes for good business. We want to be good community partners.” - Jim Harris, VP of Operations at Oglethorpe Inc. and Springbrook Interim Administrator
New leadership has arrived at Springbrook Hospital in Brooksville and that leadership is working to improve community relations and outreach as well as expand programs in order to provide valuable mental health resources to Hernando County.
In March 2018, Jim Harris, VP of Operations at Oglethorpe Inc., stepped in to manage Springbrook as Interim Hospital Administrator. Since that time Harris has made it a point to get involved in the various mental health committees within Hernando County made up of organizations such as Lutheran Services Florida, The Hernando County Sheriff’s Office and the Hernando County Community Anti-Drug Coalition.
“A primary interest for Springbrook is to be a productive member of this community, we want to become more engaged with the community, we want the community to know about our services, and we want to ensure we are supporting the community with mental health and substance abuse treatment services that meet its needs. And there are plenty of needs,” Harris remarked.
Dan Coggins, former Nursing Home Executive Director was brought on board about three months ago and has made great strides in developing a mental health treatment program for older adults. He says that Springbrook’s community involvement is crucial “so that we can provide the resources to solve some of those mental health issues.”
“Dan has brought a lot of evidence based research, best practices to define the direction we’re going in and improve the service we provide,” remarked Harris.
Springbrook Hospital was established in Hernando County in 1990, but was originally called Greenbrier. Today, it is owned by Oglethorpe Inc., which was founded by Bob Cohen in 1999. Oglethorpe’s mission is to “breathe new life into failed or failing psychiatric health centers, to restore their places in their neighborhoods.” Oglethorpe has over 1,200 employees, with offices and facilities in 4 states.
Springbrook is a 66 bed facility and one of two behavioral health hospitals in the county. They are the only behavioral health hospital in the county to handle Baker Acts following the end of BayCare’s program in January of 2012.
Baker Acts are one element of their general adult program which addresses primary mental health needs. All of their treatment programs are for adults.
They have three inpatient treatment programs: the voluntary, co-occurring disorder program, the general adult program which takes both voluntary and involuntary patients and the older adult program which also has both voluntary and involuntary patients. Outpatient Partial Hospital Programming is also provided at two sites, across the street from the hospital on Grove Road and a new site opening in Holiday, Florida.
The Co-Occurring or Dual Diagnosis Program, called The Eclipse Program, is a 28 bed, voluntary unit that provides both detox and a 28 day rehab. A co-occurring disorder involves both mental health and substance abuse. “Co-occurring essentially means that two illnesses are interrelated, they co-exist and in the case of mental health and addiction, the two illnesses feed each other,” explained Harris.
He said that in the past, treatment programs would attempt to “fix” one problem before the other- depending on which was the more prominent issue. There is a different approach now he explained.
“The direction the field has taken is toward an integrated treatment approach. A good treatment program is capable of addressing both the mental health and the substance abuse simultaneously. Being flexible enough to manage what the priorities are for each patient is necessary, often having to initially address severe symptoms such as psychosis or withdrawal. The bulk of the treatment, however, is focused on helping the patient understand the interwoven nature of their mental health and addiction, and developing individualized coping and relapse prevention strategies while they regain their often depleted physical health.”
Recently, Springbrook had an open house for its Older Adult Program also known as the Bridges program which, Harris reports, “has undergone major programmatic restructuring to meet current, evidence-based, best practice standards.” Harris added, “Dan Coggins, former Nursing Home Executive Director, was brought on board about three months ago and has made great strides in developing the programming for the older adults.” Coggins agrees that “Springbrook’s community involvement is crucial so that we can provide the resources to address some of those mental health issues.”
Coggins further explained, “The older adult program typically treats people over 60 who are physical feeble or medically fragile. This would include dementia with behavior changes such as a flare up of a mental health issue that they’ve had for most of their lives.” For example, with someone who develops dementia and has had depression or bipolar disorder in their lifetime, Harris said, in the earlier stages of dementia, the depression can re-emerge. “With the new programming, we’ll help them deal with these and other mental health issues as a whole,” said Harris.
During the Open House, Medical Director and Psychiatrist Dr. Leo Yason who has worked at the hospital since 1992 explained that people with mental illness are living longer. “The lifespan of patients with chronic psychiatric illness is longer. In the past, people with schizophrenia died earlier, often in their mid 50’s. Now because of improvements in psychotropic medication, they can live into their 70’s.” With the additional stressors of aging, these mental issues become exacerbated.
“We wanted to design a program that, figuratively, wraps its arms around the patient, from the time they get up in the morning until they go to sleep at night, a structured program offering nursing and therapeutic groups that address health and wellness, self-care, stress reduction, medication compliance, the aging process and life stage changes, the importance of hydration and more.”
Coggins stressed that a variety of medical professionals are involved with patients throughout the day including a psychiatrist, nurses, CNA’s, physical therapist and recreational therapists. He also emphasized that exercising the mind and body are essential to successful treatment.
To that end, they brought in a culinary expert to change the meal plan and to train the dietary staff to improve the nutritional value and taste of the meals. They’ve created a shaded courtyard, reserved for the older adult unit patients where they can experience their outdoor environment through various activities depending on their physical condition. Plans are also in the works for a naturewalk.
Being active is very important with geriatrics who often experience sundowning or agitated behaviors as a result of dementia. Sundowners Syndrome while not completely understood is thought to be a confusion of night and day leading to sleeplessness and agitation towards the end of the day or around ‘sundown.’
“If we’re better at getting them outside, getting them active, doing crafts, physical activity earlier in the day, then they get physically tired and will in turn sleep better- not necessarily relying on medications all the time. And hopefully will do better in their acceptance of treatment,” said Coggins.
Regarding medications, “older adults are being prescribed and taking double digit medications every day and you really have to watch how those medications interact with each other.” Coggins said it is their goal to assess the medication interactions for adverse reactions and reduce those medications where applicable.
Treatment also includes discussion topics such as relationships and family, loss of independence, feeling of abandonment and self-worth - being a burden to their family and friends, holidays, late life anxiety and depression- what it can look like- sadness and hopelessness. “All of these take over for these individuals and this is what we are trying to address with this older adult population,” Coggins remarked.
He said, “My view, from a 30 year career as an Assisted Living Executive Director, Nursing Home Administrator, and a Regional Vice President of Operations for a senior living company is that many of them are kind of passed over. We wanted to have a separate unit, we wanted to be able to intensely engage them, and we wanted to give them the best supportive experience that they could possibly have.”
Dr. Yason also remarked, “I’ve experienced the changes and transformations of this hospital over the years. At least for the past couple of years, I’ve really seen very positive, very good changes and improvements. The most recent and exciting changes are happening now with the older adult unit.”
In coordination with county-wide mental healthcare groups, Springbrook is currently exploring their options for a child-adolescent treatment unit. While Springbrook does not have a treatment program for children at this time, they do receive Baker Acted minors. Developing a treatment unit for children would alleviate the need to send these children to treatment centers outside of the county. Consideration for such a unit is under strong consideration however is not guaranteed,” Harris reports.
Harris notes that when these minors are sent out of the county, the ‘continuum of care’ they recieve and outcome success is jeopardized.
“Currently when we send a child out, that child can go anywhere- Tampa, Manatee, Miami- it all depends on where there is a bed. Unfortunately there are not that many beds around. So that child can end up a long ways away. What does that mean? That means the parents aren’t going to be involved in their child’s treatment because we don’t send the parents down there with them… They’re in the hospital for three days to make sure that they’re no longer ready to kill somebody or themselves or do dramatic damage to their environment. Then they get sent back to the family. In this process, typically what has happened to them often gets lost or it’s not necessarily connected firmly or solidly with the next level of care. The continuum of care for adolescents in this community is kind of broken in essence. And it’s hit or miss on what happens when they get back with regard to the follow-up.”
Another solution they are considering is a partial hospitalization program for adolescents which would be 5 days a week and 4 to 5 hours a day with a basic educational component, although it wouldn’t be school based.
Harris explained, “It’s a step down - intermediate place between community and in-patient acute level care - so it works in two directions. One is if you’re coming out of acute care you could step down to that level of care to be integrated back into the community. You educate the child and family on the identified problems, you help them navigate and negotiate those issues. The other way it works is that you’ve identified a kid in the community that is in early crisis and doesn’t necessarily need acute level care, but we know if we don’t do something now- keep a daily eye on this child- that they’re going to end up being put in handcuffs and brought to Springbrook.”
“The child comes to the partial-hospital program- has a psychiatrist to review the children’s behavioral health needs, a nurse who looks at the medical issues and therapists who provide the therapy for the kids and basic creative activities (to channel their energy away from the negative).”
While Springbrook is assessing the specialized treatment needs for the county’s minors, the regulatory guidelines and the financial impact, Harris reiterates that Springbrook cannot guarantee the opening of such a unit. Treatment for this population is particularly resource intensive as patients require a lot of supervision.
“You need to put a lot of resources into helping them with their needs but also protecting them and keeping them safe from one another and themselves. It’s expensive in that sense. We need to weigh that component as well- is it a viable program for us? We know that the community needs it,” Harris remarked.
With Springbrook receiving at least several hundred baker acts a year from Hernando County alone, Harris said,
“I want people to know that we are working to make ourselves available to the community and that makes for good business. We want to be good community partners.”