Chapter 04: A Role as Psychiatric Services Liaison and Reflections on Justice and Care of the Mentally Ill

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Chapter 04: A Role as Psychiatric Services Liaison and Reflections on Justice and Care of the Mentally Ill

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In this chapter, Dr. Baile talks about his first position as Director, Consultation/Liaison Service, Department of Psychiatry, Johns Hopkins Bayview Hospital, Baltimore (1978-1983), where he also served as Director of Psychiatric Education in the General Internal Medicine Residency Program (1980-1983). He notes the “steep learning curve” and his enthusiasm for applying what he had learned about group dynamics and systems theory as he educated the staff about the need for mental health treatment. Next Dr. Baile talks about attitudes toward treatment of mentally ill patients (particularly those in prison) and compares general treatment practices with the excellent community treatment and support offered at that time through Bayview Hospital. He notes that the question, What is justice, “guides my heart” and approach to psychotherapy. He talks about his commitment to helping people who have been disadvantaged by their life experiences.

Identifier

BaileW_01_20160823_C04

Publication Date

8-23-2016

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Professional Path; Personal Background; Professional Path; Formative Experiences; Professional Values, Ethics, Purpose; The History of Health Care, Patient Care; Politics and Cancer/Science/Care; Cultural/Social Influences; Ethics; Critical Perspectives; Definitions, Explanations, Translations

Transcript

T.A. Rosolowski, PhD:

So you said, let me just take a look here—so you became—it was director of the Consultation Liaison Service at Johns Hopkins hospital. That was ’78 to ’83.

Walter F. Baile, MD:

Actually, it’s now called Bayview Medical Center.

T.A. Rosolowski, PhD:

Bayview Medical Center.

Walter F. Baile, MD:

But it used to be called—it wasn’t at Hopkins, it was an affiliated hospital.

T.A. Rosolowski, PhD:

Oh, OK. OK.

Walter F. Baile, MD:

It was Baltimore City Hospital at that time.

T.A. Rosolowski, PhD:

Baltimore City Hospital. OK. So what did you do as—what did they hire you to do at that point?

Walter F. Baile, MD:

Well, they hired me to run this Consultation Liaison Service, which was dedicated to providing psychiatric consultations and care to patients on the medical and surgical wards.

T.A. Rosolowski, PhD:

So—

Walter F. Baile, MD:

So they would request us to come and see them.

T.A. Rosolowski, PhD:

So show up and discover, I mean, that’s—

Walter F. Baile, MD:

Yeah. Help us out. This patient doesn’t want to get out of bed.

T.A. Rosolowski, PhD:

Oh, wow.

Walter F. Baile, MD:

So, things of that sort.

T.A. Rosolowski, PhD:

Interesting.

Walter F. Baile, MD:

Yeah.

T.A. Rosolowski, PhD:

So you were in that position for five years?

Walter F. Baile, MD:

Right.

T.A. Rosolowski, PhD:

And you must have seen a lot. What was the learning curve? And what were your big takeaways from that experience?

Walter F. Baile, MD:

Well, it was a very steep learning curve. You had to be extremely efficient, because you didn’t have a lot of time, with people going into the hospital. You had to figure out what was going on with them. So it required a lot of intuition, and it required a lot of rapport building, and getting people to talk about themselves very quickly. It required a knowledge of what you could and couldn’t do with people. Plus there was a lot of opportunity to educate the staff about how to manage people who were on the units, because patients, they felt helpless to do anything. They felt often angry at the patients because they wouldn’t get out of bed, or did other things to annoy them. They needed to be consistent at taking care of patients, and to recognize that their own reactions to the patients were often part of the problem. So you had this complex system to deal with. My residency at Hopkins was strongly influenced by a guy who was a social psychiatrist named Kenneth Artis. He had us reading all sorts of sociology books that understand systems.

T.A. Rosolowski, PhD:

OK.

Walter F. Baile, MD:

And have you ever heard of Tavistock?

T.A. Rosolowski, PhD:

Yes.

Walter F. Baile, MD:

He was educated with David Rioch in Tavistock. He was influenced very heavily by groups and how groups behave, and how groups behave in systems. So it was very interesting. We had a resident meeting every week with him, and we used our experiences on the inpatient service to understand the dynamics of what was going on. So it was a job that was well-suited to me, because you look around and you’d understand the interplay between different systems. I can look at this place here and begin to think about how all the dynamics of leadership and finances and faculty rights, and all they interact. It’s just a big system.

T.A. Rosolowski, PhD:

Yeah, I was actually really glad you went into that place, because I was going to ask you if you were discovering new problem areas in this first job. But it sounds as though it was giving you the opportunity to apply what you had already gathered from this previous training, which was great.

Walter F. Baile, MD:

Yeah, the training well-prepared me.

T.A. Rosolowski, PhD:

Yeah. So it really refined you. I mean, were there some things that you encountered that really surprised you or made you rethink some assumptions you had made? Or what you expected to find?

Walter F. Baile, MD:

Well, I’ll tell you, one thing I discovered. Now, you know that half the people in jail are mentally ill probably, right?

T.A. Rosolowski, PhD:

Mm-hmm.

Walter F. Baile, MD:

And why is that?

T.A. Rosolowski, PhD:

Well, first of all, bad behavior often comes from some kind of poor preparation, and police are not exactly trained well to interface with people who have mental issues.

Walter F. Baile, MD:

Right. Can you name one community mental health center here in Houston?

T.A. Rosolowski, PhD:

No.

Walter F. Baile, MD:

So when I was at Baltimore City Hospital, Judy Carter had given a number of block grants to fund community mental health centers. Now, I don’t know what the history behind that is. But we had, for Baltimore, we had four state hospitals that were outlying areas. And we could send mentally ill patients to one of these hospitals to get treatment. And then they would come back to us and we would see them as part of the community. So there was a system in place to capture people who were discharged from these centers, and keep them functioning in the community, often with the help of their parents. What we have now is a tragedy. The mentally ill people are treated by criminals. Our jails are full of them. You know, I have to say I’m ashamed of my own profession of not doing more to really promote—I mean, I don’t know what the American Psychiatric Association has really done. But it’s really very, very said to think that we have closed and cut off the resources for these people. And so people are sent to jail, they’re discharged. Then came the law. So the law now says that you can’t hold somebody for more than 24 hours if they’re not homicidal or suicidal. So what does “suicidal” mean? If you go on the street and you don’t eat and you don’t take care of yourself, and you live in a mosquito-ridden area, and you get the Zika virus or some other kind of thing and get sick and die, OK, that’s one way for the state to abrogate its obligation toward the mentally ill. Just make a law that says you have no responsibility unless a person is suicidal or homicidal. Well, what does “suicidal” mean? And so we have this revolving door system. We have the lawyers who’ve gotten involved in determining whether someone is certifiable or not. And they call it under the guise of “patient rights,” we’ve abrogated our responsibility to the mentally ill. And that’s the biggest thing. So having worked in a community mental health center where it really, really worked, and there were halfway houses and things of that sort, it’s tragic to see what happens today. And how—it’s very interesting, because there’s an old saying. You can tell the strength of a country and its character about how they take care of their youngest and their oldest.

T.A. Rosolowski, PhD:

Their oldest, yeah.

Walter F. Baile, MD:

And I would add that, and their mentally ill. And in that sense, I think we’re doing a terrible job. I don’t think we take care of our elderly very well. And I don’t know, youngsters, I don’t know. It depends where you look. We cut back on the CHIP programs; we cut back on Medicaid funding, dental program for young people. You know, we’re becoming heartless. Not that our politicians have any heart anyway, especially in this state where I live, having come from the Northeast. We’re probably more heart bleeders than anything else. But it’s very sad and very discouraging to see this happening.

T.A. Rosolowski, PhD:

And it sounds like you have some issues with your own profession, too, and the way they’ve stepped up to the—

Walter F. Baile, MD:

Well, I’m not sure. I shouldn’t really blame them. I mean, I’m not sure whether—how much time they’ve spent on it. I haven’t been a member of the American Psychiatric Association for many years. I’m not sure how much lobbying that they do in this area. But you can bet that with the state refusing to fund Medicaid that probably would have covered a lot of people who had mental illness.

T.A. Rosolowski, PhD:

Yeah, exactly. Exactly.

Walter F. Baile, MD:

You know? So I’m happy to see that the state funds cancer care, and for indigent people, and that we have a big presence at LBJ, which I think is wonderful, because it provides expertise there to people who have cancer illnesses, but can’t afford insurance. But I feel bitter, because of the fact that we’ve got a country that’s so wealthy, and we can’t afford to take care of our mentally ill and our poor people. And one thing I learned from Europe, now, they have a socialized medicine system. It isn’t perfect. But the cost to them of taking care of people is so much less than it is here. And if you’re privileged, like I am, to have Blue Cross/Blue Shield coverage, and to be able to have my daughter on my insurance, things are hunky dory. But if you’re not—do you know the number one cause of bankruptcies in this country are medical bills?

T.A. Rosolowski, PhD:

Medical bills, yeah.

Walter F. Baile, MD:

How can that be? I mean, how could any politician look themselves in the eye, in the mirror, and say, “I’m doing a job.” So I’m very much discouraged by the issue. And what’s the first thing that they do here? Where do you go for—what’s your insurance?

T.A. Rosolowski, PhD:

[Intake?]—yeah, absolutely.

Walter F. Baile, MD:

Right? You know?

T.A. Rosolowski, PhD:

You can’t even get an appointment if you don’t have insurance.

Walter F. Baile, MD:

You can’t even get an appointment. That’s right!

T.A. Rosolowski, PhD:

Not unless they—yeah.

Walter F. Baile, MD:

That’s right.

T.A. Rosolowski, PhD:

Yeah, I know, it’s the issue.

Walter F. Baile, MD:

Is that just? So if you kind of really take a Jesuit approach to all this—and you might remember that the Berrigan Brothers were very strong anti-war advocates. One just died recently. But this idea of justice and what it is, is one that is very dear to my heart. And in a way, you know, it guides my sense of psychotherapy in that I strongly believe that helping people who have been disadvantaged by their life experiences is a mission. Helping people get whole. Even if not completely whole, a little bit so. So that’s been interesting. And I think, you know—I was reflecting the other day. When I retire in 2018, you know, what am I going to do that can make a difference? I saw something very interesting on the news last night, in which people have gotten restaurants to pack up their unused food and then someone picks it up and distributes it.

T.A. Rosolowski, PhD:

Yeah.

Walter F. Baile, MD:

And I’m glad you reminded me, because I’m going to—(cell phone rings) I’m going to—

T.A. Rosolowski, PhD:

Do we need to pause?

Walter F. Baile, MD:

No. I keep on getting these phone calls from different places that—it’s this scam that you get up, and it’s a credit card thing.

T.A. Rosolowski, PhD:

Oh, that’s whacky.

Walter F. Baile, MD:

So they capture numbers from all over the country, they use those numbers to call. This is the second one.

T.A. Rosolowski, PhD:

Yikes.

Walter F. Baile, MD:

This is the second one. The earlier one was that, too. Even though I reported them, it’s—anyway. So where was I going with that?

T.A. Rosolowski, PhD:

Yeah, there are some very interesting things going on, sort of social justice, creating—ordinary folks creating social support.

Walter F. Baile, MD:

So you know what I’m going to do? I’m going to call up the director of our food services and say, “What are you doing with your leftover food?”

T.A. Rosolowski, PhD:

Yeah, good idea. Good idea.

Walter F. Baile, MD:

Because we’re a big place.

T.A. Rosolowski, PhD:

Yep.

Walter F. Baile, MD:

We see a lot of people in the cafeteria.

T.A. Rosolowski, PhD:

I used to work with a soup kitchen when I lived in Buffalo, New York, and it was amazing the food that came from—they had partnerships with supermarkets that would send stuff.

Walter F. Baile, MD:

Supermarkets, yeah, that’s an idea. But how about all the restaurants?

T.A. Rosolowski, PhD:

Yeah.

Walter F. Baile, MD:

You know how many restaurants we have here in Houston?

T.A. Rosolowski, PhD:

I think there are more restaurants per capita in Houston than anywhere.

Walter F. Baile, MD:

Than many, many other places.

T.A. Rosolowski, PhD:

There was this (inaudible)—

Walter F. Baile, MD:

So that’s really—that’s when I thought that, you know.

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Chapter 04: A Role as Psychiatric Services Liaison and Reflections on Justice and Care of the Mentally Ill

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