The Q&A below is transcribed from a phone interview with Mary Leveillee, senior vice president of Patient Care Services and chief nursing officer at Butler Hospital, for Honest Conversations.
How would you describe Butler’s clinical staff?
I really do admire our staff. They have a difficult job, and some days are even harder than others. But they face the challenges, they look for opportunities for improvement, and they work together, all in the best interest of our patients. Our front line staff are the heroes of our clinical care. They take care of our patients and support them through the most raw and vulnerable phases of their illness. They focus on the individuals but they also pull back and look at the larger scope of managing the whole unit as well, working to create the most therapeutic environment. Their knowledge and understanding is impressive—it has to be. They have to know the various diagnoses, the presentations, and the signs and symptoms that are associated with those diagnoses, so that they know how to respond to the needs of each individual. Honestly, our staff is very creative and equally committed to finding solutions to care for our patients.
With the Affordable Care Act, we had people coming in who had not had treatment in many years. Just like the medical hospitals were seeing people with pretty advanced illnesses that had gone untreated, we were also seeing people who had not been successfully treated in any psychiatric setting before, and who also had complicated co-morbid medical issues—it’s two diagnoses that are together, like having depression and a cardiac condition. Traditionally, we hadn’t had as much medical management here, so our staff had to adapt and grow in new ways.
Inpatient programs at Butler are typically short term. Why?
Each person’s needs are different, but I think for many of our patients, getting them back to their environment, where they’re actually going to be healing and living, and back to their everyday life is much more helpful than taking people out of their environment for a very long time. It helps not only to heal, but it helps them with coping at the same time where, if we extract people from their environment for too long, the ability to transition with effective coping becomes very difficult.
How has the field of psychiatry evolved?
Psychiatry has come a long way since I began my career. I do think that our medications have improved over the years; there are more options for medication treatment. Managing these illnesses has become much more sophisticated, so that has been of tremendous benefit. I think there have been great strides in understanding that these are biologically-based illnesses, so like any acute flare-up of an illness, there’s time for hospitalization and then people do more rehabilitation at home. So, we’re seeing the same thing in terms of psychiatric care as well. There’s an acute episode and then the continuation of betterment happens at home.
What do you think are the biggest myths out there that we need to shatter?
Stigma is still a huge issue for us. It’s such a huge issue and I think if we can get out there and talk about the fact that these are illnesses that any one of us could encounter, the conversation will change around this. In all my years of teaching, that was always one of my first lessons: know that this could be any one of us. These illnesses do not discriminate. We know that anything, like sudden loss and grief, can propel people into a depression as well. Eliminating stigma around mental illness is such an important piece of the puzzle. It’s the first step in how we get people to access treatment earlier and help them have a different life trajectory.
What does the clinical care team look like on an inpatient unit?
We have team nursing where one nurse oversees a team of patients associated with one doctor. On that team is also a mental health worker. So the nurse and mental health worker divide and conquer. The mental health worker becomes the eyes and ears of the nurse, bringing information back to help prioritize where the nurse needs to focus. They work as a team, whereas the nurse very much relies on the mental health worker for constant feedback on the state of the patients. We also have mental health workers that are certified nursing assistants, and so most of those folks work on our geriatric unit and they help much more intensely with the physical care of patients. Then we have quite a large group of mental health workers who are activities therapists. They have some more specialized training to work closely with our Occupational Therapy Department, conducting group sessions on the units.
How do you handle when people return to Butler for a treatment?
We do see patients for repeated admissions. It is never looked at as a failure. We say, “You’re in a new phase of moving forward. There is work that needs to be done, an adjustment needs to be made in medication, another kind of coping skill needs to be developed and, most importantly, you’re never back where you started. You’re moving forward, toward health, and that’s an accomplishment.”
What makes Butler special?
Well, I really do think it’s our historical mission of humane care that we really still embody to this day. We are very much looking at the best evidence-based treatments, therapies and practices. We are always asking, how do we continue to improve? I think that’s such an important piece of what we do here at Butler. We’re not just sitting on a reputation; we’re focused on how we continue to expand our knowledge of care and create a better avenue for our patients in order to truly live up to our reputation.
Butler Hospital’s Programs and Services
Butler Hospital is Rhode Island’s psychiatric hospital focused on treatments, teaching and research for behavioral health. Learn about our inpatient, outpatient and partial hospital programs.View Our Programs