Friday, October 28, 2005


In the News from Terre Haute

Read story from story here.

Staff Award winner:

This year, there were two Hamilton Staff Award winners. The first was Virgil Macke, MSW, LCSW, who works in the client support services division of Hamilton Center. Macke works as a gatekeeper to the state hospitals. One of his most notable accomplishments is his leadership of the psychiatric assertive identification and referral program, also known as PAIR. PAIR is a mental health diversion program designed to address the needs of people with mental illness who have been charged with minor criminal offenses. The nominator of this recipient put it best by saying, “His work with the PAIR program makes Hamilton Center and Vigo County enviable models for the humane treatment of the mentally ill in the judicial system.”

The second recipient of the Hamilton Staff Award was Dr. Randall L. Stevens, physician with Hamilton Center's medical services division. Stevens' career with Hamilton Center began in 1972 as a psychiatric technician. He is now providing services in the inpatient unit and addiction services. He also works as medical director at St. Ann's Medical Clinic, donating services to indigent and low-income residents of Vigo County. Stevens is currently the medical director of Vigo County Juvenile Center, clinical assistant professor of Family Medicine at IU School of Medicine, as well as medical director for the Vigo County Jail. He also works with the methamphetamine task force.

Hamilton Center Inc. is a regional behavioral health system serving central and west-central Indiana. Offices are in Clay, Greene, Hendricks, Marion, Owen, Parke, Putnam, Sullivan, Vermillion and Vigo counties. The organization provides a full continuum of behavioral health services for children, adolescents and adults. For more information about services, call Hamilton Center's Access Center at (812) 231-8200 or 1-800-742-0787.

Story created Oct 28, 2005 - 09:53:01 CDT.

Thursday, October 27, 2005


Comments of the Mayor about The PAIR Program

From a speech by the Honorable Bart Peterson, Mayor of Indianapolis, on March 2, 2005

See complete text here.

Stunning progress has been made in recent decades in the scientific treatment of the most serious mental illnesses: depression, schizophrenia and bi-polar disease. Lives that were unsalvageable just a few years ago are being turned around. We can help people reconstruct their lives and fulfill their potentials if we help them find and receive treatment. But the system for delivering and monitoring this treatment is barely functional.

We need more resources from the federal and state governments, but take a look at some of the good things started in Indianapolis recently. Community partners came together to create "Our Town," a mental health services program unique to Indiana that supports young adults from 18 to 25 with serious mental illnesses. The Crisis Intervention Team program provides training to law enforcement officials who might come in contact with those with mental illnesses. The training allows officers to avert potentially deadly confrontations and to keep those more in need of mental health treatment than jail time out of the criminal justice system. The PAIR program is focused on diversion to treatment from the criminal justice system after arrest in cases of minor offenses. And, the primary tool in the Blueprint to End Homelessness - supportive housing - is helping 40 men and women with mental illnesses and addictions in The Threshold Project.

These are examples of creative work that is making a difference in Indianapolis today. But we need to do more. We will work this year to replicate the PAIR diversion concept in other parts of the criminal justice system -- probation, for example. We will seek even earlier intervention within the system, such as at the Arrestee Processing Center. And, most importantly, we will fight for more resources for the treatment of serious mental illness. With these steps, we will improve the chances for a decent future for many people in our city, we will reduce jail overcrowding, and we will offer a broad ray of hope to the thousands of people in Indianapolis whose lives are touched by mental illness.

Mental illness is a health issue. So is obesity. The more nutritional information we print on food containers, the more data that comes out about all the diseases caused or made worse by obesity, the more we treat "carb" as a four-letter word, the heavier we get. The human consequences of this are, of course, the most important reason for us to care, but we should not ignore that dramatically rising health care costs threaten to consume all other budget priorities at all levels of government, and that American business is increasingly faced with a choice between keeping the company alive and providing adequate health care benefits to employees. More and more working Americans will become uninsured or underinsured.

Our responsibility is to make Indianapolis a healthier place. Many people are not aware that Indy Parks offers many low-cost health and fitness resources throughout Indianapolis. These include sports facilities and family centers that provide year-round recreation opportunities, including walking programs, aerobics, swimming, the greenways, and so much more. It's more fun and motivating to get in shape with other people! We have the pieces in place to help the people of our city move toward healthier lifestyles. This year, I am going to play my part to raise awareness about what resources are available and what you can do to improve your health, that of your family and of your friends and neighbors. They publish a list of the healthiest cities in America. I want Indianapolis on that list!

* * *

I stand here before you tonight as positive about the State of our city as I have ever been. We now have in place the resources and the will to fix the broken criminal justice system. Housing is now the priority in our city it needs to be. Tragedy has proven to be a catalyst to focus on our community's mental health needs. We are going to shape up together in Indianapolis and live longer, better lives! And, we have the right plan to get our fiscal house in order and complete the vision of Uni-Gov. Add to this the tower cranes sprouting across the city; economic success stories, including becoming the home of America's largest health benefits company - Wellpoint; the 2005 cultural convergence that has elevated our arts and culture; and you have one of this country's most dynamic cities refusing to rest on its laurels.

I have enjoyed my relationship with the members of the City-County Council. They are incredibly dedicated people who receive few tangible rewards for their long hours of service. They know, as I do, that beneath the headlines about the mega-deals and the blockbuster initiatives there is a more subtle, complex and ever-changing tapestry of big-city challenges and opportunities. I look forward to working with President Talley, the members of our City-County Council and the people of Indianapolis to influence the design of that tapestry. To make our city better. To leave this generation's mark on the Indianapolis success story.

Thank you and God bless you.

Wednesday, October 12, 2005


the chaplain within the mental health care team

Lorna H. Rattray, Chaplaincy
Mackinnon House, Royal Edinburgh Hospital, Edinburgh EH10 5HF

Full Link Here

In psychiatric care, where patients experience a wide range of difficulties — emotional, physical, mental, social and spiritual — care must be given to the patient as a whole person. This article is about the significance of the presence of the chaplain within the mental health care team as it seeks to offer this holistic care.

The relationship of the spiritual to the total well-being of the patient is expressed well by Nelson (1999) in her definition of spiritual needs:

‘The search for meaning may find expression in the ‘why?’ questions which are commonly asked in the context of illness, and which give voice to anxiety, anger, guilt, loneliness and other such difficult emotions. Such questions may express a need for acceptance, hope, forgiveness and love.’ (p. 77)

Although not suggesting that the chaplain is the only person concerned for patients' spiritual needs, I do argue here that acceptance of the chaplain within the mental health care team contributes significantly to holistic care. This is, I believe, for two main reasons. First, because the mental health chaplain is involved in the world of spirituality and religious belief as well as in the world of mental health care, he or she is in the unique position both of being employed by the trust as a spiritual expert or advisor and of being seen by patients and staff as a legitimate person with whom to raise issues of a spiritual, or more specifically religious, nature. Second, in a psychiatric hospital or unit where many patients have difficulties in forming healthy relationships, a care team that is seen, by its very make up, to have care of the whole person at its heart and is observed to have discussions, debates and even arguments among its members about matters physical, mental and spiritual can act as a model of a healthy relationship for the patients it seeks to help.

The care offered by the chaplain, reflecting on the example shown by Jesus, is known as ‘pastoral care’. The clearest definition of this is given by Lartey (1997):

‘Pastoral care consists of helping activities, participated in by people who recognise a transcendent dimension to human life, which by the use of verbal or non-verbal, direct or indirect, literal or symbolic modes of communication, aim at... relieving or facilitating persons coping with anxieties. Pastoral care seeks to foster people's growth as full human beings together with the development of ecologically holistic communities in which persons may live humane lives.’ (p. 9)

As a mental health chaplain, with pastoral care as my purpose, my work is to help patients to discover meaning in their lives — meaning even within their illness — and to be alongside them as they ask the questions ‘why me?’ or ‘what have I done to deserve this?’, vent anger at the God they doubt exists and reflect on their lifestyle or share past hurts.

For those experiencing acute or enduring mental health problems, pastoral care on its own may not be sufficient. The mental health chaplain, however, when accepted as a member of the care team, is able — because of his or her presence in the worlds both of spirituality and pastoral care and of mental health care — not only to contribute the pastoral care dimension to mental health care, but also to take an understanding of mental illness and mental health care into the local churches and other faith groups in which he or she is also accepted. I use the word ‘world’ deliberately because ideas and beliefs earthed in a real person, who is able to relate across the gulf often found between religious and health care professionals, can, instead of being dismissed as remote or irrelevant, be shared in earthly, practical ways for the benefit of patients in hospital and living in the community.

Two examples are relevant here. The first concerns Catriona (names and details have been changed to maintain confidentiality), a patient attending a day unit. She described herself as evil and asked me if I could arrange for an exorcism to be performed. Her psychiatrist felt that this could do no harm and might ease some of her anxieties. In discussion in the multi-disciplinary team meeting, however, I was able to highlight the potential danger: an exorcism that did not ‘make her better’ could result in her feeling extreme guilt, believing that she was so evil that even God could not help her. It was decided — with a successful outcome — to continue instead with encouragement to comply with medication.

Andrew is a middle-aged man with a schizophrenic illness who began attending a small parish church. His behaviour was experienced by some elderly people in the congregation as intimidating and the priest contacted me for advice. I was able to talk with the priest about how he might respond to any intimidating behaviour. I also spent time with the patient, both to reassure him of his welcome at that church and to help him to see what aspects of his behaviour could be perceived as frightening. With the priest feeling more confident in what was, for him, a new situation, fear was reduced within the congregation and the man was made welcome at Sunday Mass.

Not only is it important that the mental health chaplain is trained and experienced in both pastoral care and mental health care, but it is necessary also that he or she is self-aware enough to understand his or her motivation — with its personal, emotional and spiritual dimensions — and at ease with his or her own beliefs and theological understanding. The latter is essential if the chaplain is to be able to work constructively with patients of any faith, or of none, and to discuss mental health issues appropriately with members of the whole range of faith communities found in the UK today.

Such self-awareness within the chaplain is necessary to enable a continuing ‘inner dialogue’, as well as discussion with colleagues, about the relationship between the chaplain's training, experience, theological understanding and spirituality and his or her practical outworking in pastoral care. Theory and practice each influence the other, and the chaplain must be open to the influence that each has upon the other. In particular, it is likely that listening to the experiences of individuals in psychiatric care will challenge not only the theological assumptions of the chaplain but also those of religious traditions. It will be necessary, then, for the chaplain not only to reflect on, and be prepared to modify, his or her own understandings but also to challenge assumptions within faith communities. This requires courage, and the chaplain can benefit from the support and encouragement given by colleagues in the mental health care team.

Historically, chaplains have not been encouraged to seek support; in some church traditions, the acknowledgement of vulnerability within a vicar or priest is still discouraged. Support within the mental health care team, therefore, not only helps the chaplain but also enables him or her to encourage a more sharing approach to pastoral care within faith communities. Sharing and support within the team can be of benefit also to psychiatrists, who are not always encouraged to look inward and reflect on such important issues as motivation or vulnerability.

A group I worked with as chaplain in Sheffield helped me, along with registrars and senior house officers, to develop psychotherapeutic skills with patients through a study of theory and reflection on our own experiences, both professional and personal. Each of us took turns in sharing an account of our relationship with a patient with whom we were finding it difficult to work. These case studies exposed our difficulties as well as our abilities in relating to patients, and also revealed experiences from our own pasts — sometimes painful — that were getting in the way of offering positive help to a particular patient.

Such openness and honesty took courage, but as a group we helped each other to grow together: grow in our trust of each other and in our ability to make use of psychotherapeutic skills in our work with patients. My own understanding of the value of that group, as one chaplain among several psychiatrists, is that we learned also to respect one another's traditions, backgrounds and beliefs. Such respect can only benefit the patients with whom we work. Multi-disciplinary training can provide an excellent opportunity to learn together and to learn how to work together as a team.

Acceptance of the aim of working together to offer holistic care means accepting the skills and insights that each professional brings. Where the chaplain is part of the mental health care team, it becomes possible to discuss the spiritual dimension of caring in a more informed way. With the meeting of spiritual needs recognised as part of the necessarily holistic care offered to patients, such working and sharing together within the multi-disciplinary team should be welcomed and encouraged.


LARTEY, E. Y. (1997) Living Colour: An Intercultural Approach to Pastoral Care and Counselling. London: Cassell.

NELSON, G. (1999) Chaplaincy: The Church's Sector Ministries (ed. G. Legood). London: Cassell.

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