Nov 18, 2022 | Adolescent Health, Inside Mount Sinai Psychiatry, Mental Health, Psychiatry
“We’re not bound by the traditional therapeutic framework where you meet in an office for a scheduled appointment,” Dr. Weller says. “We literally meet them where they’re at.”
By the time students reach New York City’s Judith S. Kaye High School (JSK), multiple systems have failed them. As a public transfer school for students with significant barriers to their education, many of JSK’s students have faced significant adversity.
“All of our students have been disconnected from school at some point and many have experienced some trauma,” says school principal Andrew Brown. Mental health disorders and substance use problems are common, but linking students to traditional mental health services is nearly impossible. “Even for students who are ready to meet with someone, once they leave the building, the obstacles are frequently insurmountable,” Brown says.
Thanks to Mount Sinai’s UPRISE (Use Prevention Recovery Intervention Services & Education) program, students no longer have to leave school to get the care they need. “Rather than trying to get students to come to us, we provide services on-site,” says Rachel Weller, PsyD, an assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai and project manager and clinical supervisor for UPRISE.
The partnership, launched just before the COVID-19 pandemic, is helping students address their mental health problems and substance use, often for the first time. “Having access to this high-quality care, within the school building, is a game changer,” Brown says.
Youth Mental Health: An Unmet Need
JSK, which serves about 145 students at their Manhattan site, is co-located within the School of Cooperative Technical Education (Coop Tech), a career and technical school that serves about 1,500 students. Students from both schools are offered access to mental health and substance use treatment through the UPRISE program.
UPRISE is an offshoot of the Comprehensive Adolescent Rehabilitation and Education Service (CARES), a program of the Addiction Institute of Mount Sinai that has served adolescents and young adults for more than 20 years. CARES provides a therapeutic high school environment that includes a range of targeted services for youth with complex mental health, substance use, and educational problems. While CARES has seen great success, the need for services among New York City youth remains significant. UPRISE is a new model that shows how mental health services can be integrated into a public school setting.
Both Coop Tech and JSK serve historically marginalized populations who have long been subject to systemic racism and discrimination, says Shilpa R. Taufique, PhD, director of the psychology division for the Mount Sinai Health System and director of CARES. “These students and their families have all had the experience of not being seen or heard, and of having institutions impose what they think is best for them,” she says. “There’s such a deep mistrust of the systems that are supposed to be helping them.”
As a result, students have often struggled for years with mental health problems — even before the COVID-19 pandemic made youth mental health a national crisis. “We see many kids present with PTSD, complex trauma, major depression, anxiety, and difficulty with substance use,” Dr. Weller says. “What’s most striking is the number of students who have a longstanding history of mental health difficulties, yet have never received any type of treatment.”
A New Model of School Mental Health
UPRISE aims to give adolescents the tools to help them develop into healthy, functioning young adults. The clinical team is small but mighty: Dr. Weller is on-site in the school most days, along with part-time clinical staff including two postdoctoral fellows and a graduate student extern. They currently provide services for about 30 students, but Weller and her colleagues hope to double that number in early 2023.
UPRISE offers a range of services, including:
- Psychoeducation
- Individual therapy
- Group therapy
- Family therapy
- Milieu therapy
- Substance use treatment
- Medication management
In addition to counseling and therapy services, the team helps students connect with prescribing providers via telehealth for medication management. All of these services are billed to students’ insurance companies, making it a model that is both sustainable and replicable, Dr. Taufique says.
Flexible Approaches to Teen Mental Health
Plenty of schools have experimented with embedding social workers or mental health providers in school settings. But UPRISE goes further. Before launching the program, the team spent a year learning about the schools and their students’ unique needs. “People make a lot of assumptions about teenagers, especially young people who have been disconnected from school or who are in treatment,” Brown says. “[The UPRISE team] didn’t come in with any expectations about who these kids are.”
That open-minded attitude has led to several innovations. URPISE takes a novel approach to family therapy, incorporating school staff into students’ treatment plans much like parents or other family members might be included. “The school setting is a surrogate family for most of these students. The teachers, guidance counselors, and social workers are very involved in their students’ lives — these are the people students call in the middle of the night if they’re in crisis,” Dr. Taufique says. “We want to highlight the roles they play in students’ lives and also give school staff some therapeutic framework to draw on so they don’t get burned out.”
Clinicians provide services to students in school during the school day, but they also reach out to them in the community. If a student has a phobia of the subway or anxiety about coming to school, for instance, providers might arrange to travel to school with them to provide a form of exposure therapy. “We’re not bound by the traditional therapeutic framework where you meet in an office for a scheduled appointment,” Dr. Weller says. “We literally meet them where they’re at.”
Services Without Stigma
In addition to services for patients, UPRISE offers psychoeducation and outreach to the entire school community, such as school-wide presentations on topics related to substance use and mental health. The program is also open for a drop-in hour five days a week, so any student in either school can come in to talk whenever they need. “With the drop-in hour, we discuss things that are going on in students’ lives, provide some psychoeducation, and sometimes link students to services or provide referrals,” Weller says. “We want to make this accessible, even to kids we’re not directly serving.”
At a time when most of the news about teen mental health is bleak, UPRISE is making a positive difference in his students’ lives, Brown says. “We have students who are seeing counselors for the first time. They’re showing up to appointments, connecting with counselors. They’re more connected to school.”
“Students look at this as a tool to help them get better and help them transition into adulthood. There’s no stigma attached to it,” he adds. “It’s just become a part of our community.”
Learn more about The Comprehensive Adolescent Rehabilitation and Education Service (CARES) program at Mount Sinai.
Updated on Nov 18, 2022 | Inside Mount Sinai Psychiatry, Mental Health, Psychiatry
“Many patients think that being hospitalized is the worst thing that can happen to them,” Dr. Vora says. “But sometimes it actually ends up being the thing that turns their life around.”
Stigma remains a big problem for psychiatry. Inpatient psychiatric care, in particular, has long suffered from unfair portrayal. The mere mention of an inpatient psychiatric unit conjures up images of Jack Nicholson in One Flew Over the Cuckoo’s Nest. This stigma is present not only among the public, but also among many doctors and medical providers. “There’s a certain amount of stigma and fear around the idea of being hospitalized in a psychiatric unit, but it’s a very different quality of care and treatment than what is typically portrayed in the media,” says Rajvee Vora, MD, MS, Associate Professor and Vice Chair of Clinical Affairs for the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai.
Forget the stereotypes, Dr. Vora says. The inpatient psychiatric facilities at The Mount Sinai Hospital are bright, welcoming, and beautifully designed, and patients receive high-quality care. “Patients are up and walking around, encouraged to be up and about, attend groups and sessions, and play basketball in our indoor court.”
Above all, hospitalized patients receive a range of evidence-based treatments to help them manage their mental illnesses. “Many patients think that being hospitalized is the worst thing that can happen to them,” Dr. Vora says. “But sometimes it actually ends up being the thing that turns their life around.”
An Interdisciplinary Approach to Inpatient Mental Health
In recent years, the field of psychiatry has moved most treatments to outpatient settings. Yet for some patients with severe mental illness and acute psychiatric needs, inpatient care remains critical. In fact, the need for such care has increased recently. “During COVID, many outpatient providers switched to remote services, which aren’t always accessible to people with serious mental illness,” says Danielle Campisi, LCSW, director of social work for the inpatient psychiatry service. “Now we’re seeing a big uptick in the number of patients that had been chronically well-managed, but lost access to care during the pandemic.”
The team at Mount Sinai’s inpatient behavioral health unit treats a variety of psychiatric illnesses, including:
- Mood and anxiety disorders
- Personality disorders
- Psychotic illness
“Treatment isn’t something that happens to the patient. It happens with the patient,” says Dr. Rosenthal.
Patients don’t need to be severely incapacitated to benefit from hospitalization, says Blake Rosenthal, MD, Assistant Professor of Psychiatry and Inpatient Unit Chief at The Mount Sinai Hospital. “Sometimes our patients have developed psychotic symptoms for the first time. They may have a change in their ability to perceive reality or are developing hallucinations,” Dr. Rosenthal says. “They can come in without having a complete decompensation and loss of function, and we’re able to meet those needs really well.”
Cutting-Edge Psychiatric Treatments
Inpatient treatments typically include medications and intense psychotherapy, including individual, group, and milieu therapy. As a cutting-edge research institution, Mount Sinai offers access to new and emerging treatments, including interventions such as electroconvulsive therapy (ECT) and esketamine for treatment-resistant depression. Patients also receive additional services such as art therapy, music therapy, dance/movement therapy, and substance abuse counseling. “Inpatient treatment is so much more than medication management,” Dr. Vora says. “The core of the work we do is ‘milieu therapy’ — what being in this environment does for patients.”
Patients are treated by an interdisciplinary team that includes an attending psychiatrist, psychiatric residents, nursing staff, creative arts therapists, assistive staff, and social workers. The team develops a comprehensive treatment plan for each patient, which describes the interventions and services they will receive as well as the plan for transitioning to outpatient care. That transition is important, since patients typically stay in the hospital just a week or two before being discharged to outpatient services or to higher levels of care, such as assertive community treatment (ACT).
Social workers work closely with patients to understand their psychosocial needs, connect them with appropriate services, and teach them about their illnesses. “When patients come in, they’re sometimes resistant to being treated. We do a lot of psychoeducation to improve patients’ understanding of their illness, the potential need for medications, and the importance of outpatient follow-up,” she says.
It’s a collaborative effort, Rosenthal adds. “Treatment isn’t something that happens to the patient. It happens with the patient,” he says.
Inpatient Mental Health at Mount Sinai
While Mount Sinai provides access to the latest evidence-based treatments, its biggest asset is the people delivering those therapies, Dr. Rosenthal says. “What really distinguishes Mount Sinai’s inpatient program is our team. Our treatment team almost functions as a single provider,” he says. “It sounds cliché, but everyone on the unit cares deeply about how patients are doing.”
Mount Sinai has leading experts in schizophrenia, depression, and other psychiatric illnesses, who often consult on treatment. The team mentality extends to treating a patient’s non-psychiatric medical conditions as well. The inpatient psychiatry team collaborates closely with other service lines such as OBGYN and neurology to ensure all of a patient’s healthcare needs are met during their inpatient stay.
While caring for patients is a top priority, Mount Sinai’s inpatient behavioral health team is also committed to reducing stigma and improving care for all patients with psychiatric illness. Experts from the department recently held a symposium to discuss the management of clinical challenges in inpatient psychiatry.
Most psychiatric inpatients are transferred from the emergency department, but individual cases are considered. Learn more about Mount Sinai’s Inpatient Behavioral Health Services, or contact the inpatient behavioral health admissions coordinator at 212-241-5675.
