Responding to Psychiatric Crises

By Dr. James Hart

In 2017, Dr. James Hart, Rolling Hills Hospital’s medical director, sat down with David Condos, host of the Recovery Unscripted podcast, to discuss how his team stays prepared to respond to the wide range of time-sensitive psychiatric emergencies that present at their doorstep.

Dr. Hart grew up in East Tennessee before coming to Nashville to attend Vanderbilt University. He graduated with a degree in medicine and completed his psychiatry training there as well. He’d always been interested in the brain and in the mind, so psychiatry seemed to really be a good blend of those interests.

Running a 120-bed hospital can be stressful, but Dr. Hart also has a front-row seat to watch people get well. “People come into our hospital, they’re very distressed,” he says. “They’re not doing well or otherwise they wouldn’t be there. In a hospital setting with the resources that we have, you can see very rapid improvement and it’s very rewarding to see someone come in at the end of their rope and leave feeling optimistic.”

That starts the minute they walk through the door, with staff immediately springing into action to help maintain each patient’s safety. One of the first questions they often get, is, “How long will I be here?” Even the response to that says something about Rolling Hills’ approach.

Dr. Hart’s response is often, “Let’s not measure it by ‘how long do I have to be here before I leave?’ Let’s think about, ‘How long does it take to get well?’ Because when you get well, leaving takes care of itself.”

The average length of stay at Rolling Hills is actually about eight days, but each person is treated individually. Needs and situations can vary, and the illnesses being treating might vary in their average duration. That initial diagnostic work is key in helping a patient on the road to recovery.

“Why did they get to the point they’re in? What caused them to end up this way?” Dr. Hart asks. “You see an individual who presents to our hospital and then there’s detective work going on to sort out what got them to this point and what can we do to help them address that.”

Many people arrive at Rolling Hills in crisis. One example of a potential patient who may benefit from this type of acute care is someone suicidal thoughts or attempts.

“When someone who is suicidal comes into our hospital, they usually get an immediate sense of relief because they know that they no longer have to protect themselves from themselves, they know that we’re going to keep them safe,” Dr. Hart says. “That relieves an emotional burden right away and allows them to step back and reevaluate. Additionally, we’ve removed them from the stressful environment that was contributing to those thoughts and feelings … which usually gives them some immediate relief.”

Medicine has become very fragmented with individual doctors who focus on a single area. “Psychiatry is one of the few specialties in medicine where you really actually get to treat the whole person and you get to listen to people,” Dr. Hart says. At Rolling Hills, they’re able to look at the entire picture and create a wellness plan that incorporates both physical and mental health.

To find out more, you can listen to the entire Recovery Unscripted podcast or read the full transcript HERE.

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