Unfettered by health insurance company demands or cost, Austen Riggs provides 100 years of maverick mental health care - Berkshire Eagle

By Kristin Palpini , The Berkshire Eagle

For a whole generation of people living in Stockbridge, the Austen Riggs Center on Main Street was the place where parents threatened to send their misbehaving children.

From the outside, the romantic white brick inn imposed on the serene, Main Street campus is mysterious.

Austen Riggs Center psychiatric hospital and residential treatment facility has been and continues to be protective of patient privacy — a necessary component of American health care that preserves client autonomy, but keeps the public at a distance. Also keeping most people off campus is the hefty price of treatment. The first six weeks of intake and treatment starts at around $60,000. In Berkshire County, the median household income is a little over $55,000.

Now, the mental health care facility is celebrating 100 years in business and is using the occasion to create a better public understanding of the center and the importance of a peaceful mind.

"It's an exciting, premier institute, but people drive by and don't know exactly what we do," said Jane Tillman, P.h.D., director of the Austen Riggs Center Erikson Institute.

Tillman first heard that parents would try to use the threat of a trip to the mental health hospital to provoke good behavior from their children during a summertime ribbon-cutting for an Austen Riggs historical exhibit at the Old Corner House, 48 Main St.

"It lets us know that, that's one way people are thinking about [Riggs] in the community," she said with a laugh. "But there's so much else to say. We have something important to say about human dignity and mental health; we want to tell our story."

Founded in 1919 by Austen Fox Riggs, the Austen Riggs Center was a place where professionals could recuperate following panic attacks and long-term frayed nerves. The psychiatric hospital now treats patients with a range of ailments including psychotic disorders, bipolar disorder, obsessive compulsive disorder and depression.

The center has a unique approach to patient personal responsibility, understanding a person's life story and environment as contributing to mental health illnesses, community engagement and providing a campus where clients are free to come and go as they please.

The center isn't for everyone — something reviewers ding the hospital for in online statements to sites such as Yelp, Google and RehabReviews.com. People have been critical of the cost of the treatment and the lack of more robust addiction services there — 45 percent of center patients have a substance abuse disorder in their history. Tillman said over the course of a four- to six-week interview and admission process, the center strives to only admit people staff believe they can help. People actively battling addiction might not do well in the voluntary environment at Riggs, she said.

The patient "has to agree to accept the risk and responsibility of being a patient here," Tillman said. "We ask you to be sober here and that can be a challenge. If someone is actively suicidal, this is not a great place for you at the moment."

Austen Riggs has become one of the few intermediate, residential treatment programs in the country for people with "treatment-resistant" mental health issues. Staff turn up their noses at the phrase, but it's all over the hospital's literature and website. Too often when a patient has a "treatment-resistant" problem, it is the patient who is seen as resistant. At Austen Riggs, Medical Director/CEO Eric Plakun said "treatment resistant" refers to the failure of methods, not people.

"Treatment resistance is not in the patient, but in the limits of our treatments," he said.

RAISING MENTAL HEALTH AWARENESS

The timing of this centennial and call for awareness could not be more perfect. As mental health care has become a more common topic in the media and 2020 presidential primary debates, it's important for mental health care professionals to speak up, Plakun said, because afflicted people are not always accurately represented.

Not that the Austen Riggs Center has been quiet over the past century. The center has made important contributions to psychological practice and education through its research center and attracted some of the nation's leading minds in the field. It also holds guest lecture series and trains future psychoanalysts through its fellowship program.

Seeking an outlet to provide free and low-cost consultation services and therapy to Berkshire County, in 1920 The Riggs Clinic opened in Pittsfield, helmed by Anna King. The clinic laid the groundwork for what would become The Brien Center today.

"We've done a lot out in the world, but we want to make more of a difference on the local community," Tillman said.

To mark 100 years of mental health services, Austen Riggs has packed 2019 with celebrations, art and understanding. A gallery display of the center's history went up this summer at the Old Corner House. The Lavender Door Gallery is open at 37 Main St. and features work by patients as well as outside artists. The center has also packed this year's annual fall psychology conference with mental health rock stars. The Sept. 21-22 conference is being called, "The Mental Health Crisis in America: Recognizing problems, working toward solutions."

"There are two kinds of problems," Plakun said. "It's too narrow a focus on a biomedical model [for treatment] and access to care."

Still most of Riggs accomplishments and contributions to psychology aren't well known by local lay-folk and the story of how Riggs was able to weather 100 years — a fete for any business — is one full of more risk than a person might expect to find at a luxury hospital.

THE AUSTEN RIGGS DIFFERENCE

Throughout its long history, the Austen Riggs Center has had a variety of make-or-break moments: The most dynamic of which may have occurred in the 1990s when insurance-managed health care had become de rigueur. Center leadership made a conscious decision to develop patient treatment methods outside of what health insurance providers may or may not cover.

The risk of providing mental health care services at full price to people with insurance carriers unwilling to cover much outside of standard methods and crisis stabilization meant the center's clientele could disappear.

That didn't happen.

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"What insurance companies said, went. All they had to say was jump," Plakun said. "We made the important decision not to be a short-term, locked setting. We wanted to keep the system at Riggs open. We were going to figure this out or we were going to go out of business."

People seeking treatment at Austen Riggs are often put on a waiting list. The facility treats about 59 people at a time through residential, outpatient and other programs. Typically, a patient stays anywhere from several months to years.

The center's annual revenues typically outpace its $16 million to $17 million annual operating expenses by at least $1 million, according to the nonprofit's taxes from 2011 to 2017. The hospital's endowment was more than $23 million in 2017, the most recent information available, and Austen Riggs spent more than $2 million that year on patient financial aid and benefits to the community.

Money coming in isn't lining the pockets of hospital leadership — though many in upper management earn six-figure salaries — but you can see it all over the gorgeous campus, including a state-of-the-art community center constructed in 2007 and individualized patient treatment options.

Austen Riggs employs 29 doctors, seven clinical social workers and 31 nursing staff members. Each patient attends four one-on-one therapy sessions per week. The center also hires professional artists to teach their skills to residents in one of the tenets of Austen Riggs treatment: it is important for a patient to identify as something more than a mental health illness, and engaging in positive activities is a pathway to well-being. Artistic pursuits offered at Riggs include sculpture, painting, acting and pottery.

"It's very powerful not to be defined by just this one thing, it brings person-hood to Riggs," said Michael McCarthy, Riggs' pottery instructor.

McCarthy is careful to note that he is an artist, not an art therapist.

"It's a connection to your life outside [Riggs]," he said. "We try to make this a warm and welcoming space where people can feel comfortable taking risks and be comfortable with failing."

WHERE IT ALL BEGAN

After contracting tuberculosis, Austen Fox Riggs moved from the New York City area to his father-in-law's Stockbridge farm in 1904 thinking that the cold winter air and sunshine would be good for his recovery. During his convalescence, Riggs had time to nurture his lifelong interest in psychology.

Riggs developed an approach to addressing mental health illnesses that seeks to understand an individual's personality and unique life situations that contributed to their ailments. He also believed that physical ills could be caused by poor mental health and that recovery required developing a regiment of meaningful daily activities.

The Stockbridge Institute for the Study and Treatment of Psychoneuroses was founded in 1919 and was soon renamed for its founder. The center developed side-by-side with modern psychology having opened just 40 years after the University of Leipzig, Germany, launched what is often considered the world's first experimental psychology lab.

The organization weathered changes in leadership, paradigm shifts in the health industry and national economic downturns. The key to staying open for Riggs has been to maintain standards for treatment and invite patients to be independent and influence the hospital's programs. Consumer buy-in is important for any institution.

In psychology's nascent days, mental health advocates and professionals debated the effectiveness of biological and "talking cures" for mental illness. Riggs was firmly in the "talking cures" camp and in 1912 wrote "Talks to Patients."

Throughout its history Riggs has stood apart from standard mental health care — a move that could have tanked the agency many times over. When the world embraced the Oedipal theories of Sigmund Freud, Riggs questioned the narrow focus on sex. When electroshock, insulin comas and lobotomies were common mental health care treatments, the center avoided them in favor of talk therapy and engagement programs.

Riggs died from cancer in 1940 and it was the first time the center was thrown into a time of uncertainty and change.

Austen Riggs' next storied leader was Robert Knight, who was the medical director 1947-1966. Knight attracted many mental health heavyweights to the center: Margaret Brenman-Gibson, Cyrus Friedman and David Rapaport, but the most impactful were psychoanalyst Erik Erikson and his wife Joan.

The Eriksons arrived at Riggs in 1951. Erik Erikson, who coined the phrase "identity crisis," is studied in just about every American psychology class. He was dedicated to the then-novel idea that a person cannot be understood outside their social and historical context. Joan, meanwhile, formalized the center's arts and activities programs, which now include horticulture and assisting a local nursery school.

The Austen Riggs method of talk therapy and patient past experiences may have seemed a little outdated in the 1980s when the American Psychiatric Association shifted to a more biological understanding of mental health illness. It is around this time that the center integrated medication into patient care.

The 1990s were a time of growth for Austen Riggs. In 1991 Ed Shapiro became medical director and expanded the center's social work department to include a "step down" program to help patients reacclimate to life outside of Riggs. Three years later, the center founded the Erikson Institute for Education and Research. Today, the institute is studying suicide prevention and patients' relationships to their medications.

Health care has been a roller coaster ride since the 2000s with the passage of some radical legislation: the Mental Health Parity and Addiction Equity Act in 2008 and former President Barack Obama's Affordable Care Act in 2010. Republican attempts to deconstruct the ACA have weakened the law's effectiveness and the mental health parity act hasn't been fully realized, much to the chagrin of the Austen Riggs Center, care professionals and people suffering with mental health illnesses everywhere.

In an attempt to rectify this, U.S. Sen. Chris Murphy, D-Conn., introduced the Mental Health Parity Compliance Act to Congress in June.

At this potential turning point for American mental health care, Austen Riggs is now working to advocate for patients and be a resource for mental health truth. Organizers of Riggs' September conference will be asking what's wrong with health care, but Plakun said that part is becoming well defined: limited access, emphasis on crisis and stabilization, over-reliance on medication and oversimplification of diagnosis and treatment. What can be done to address these issues is less clear.

"We get these top-down solutions from the government, but it's time for the bottom-up piece," Plakun said. "The goal in the field should not just be stabilization, but recovery."

Kristin Palpini can be reached at kpalpini@berkshireeagle.com, @kristinpalpini on Twitter.

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