Profiles of three who are leaving their individualized marks on behavioral healthcare by THE STAFF OF BEHAVIORAL HEALTH MANAGEMENTPeople who work in behavioral healthcare certainly do so because of a special calling to serve those who are in deep distress. But working with people with mental illnesses and substance abuse problems can be difficult, and it isn’t made any easier by limited funding, regulatory paperwork, and constant questions about treatment effectiveness from both outside and inside the field. Many in the field have risen to meet these challenges, to the benefit of millions of people with behavioral health disorders, and some have even excelled to the point of leaving a significant mark on the wider practice of behavioral healthcare.
In this issue of Behavioral Health Management, we profile the accomplishments of three such “champions” of the field—a patient, a researcher, and a provider. We hope you find their stories interesting and inspiring as you go about your daily task of meeting your call to serve. We hope, too, that you will be inspired to share your own stories of champions in behavioral healthcare. E-mail us at email@example.com.
Relying on Cultural—and Personal—Experiences
“My first exposure to serious mental illness came personally, not through the medical world,” recalls Alex Kopelowicz, MD, who recently was honored by the American Psychiatric Foundation (APF) with an Award for Advancing Minority Mental Health.
A friend suffered with schizophrenia when the two were teenagers. His friend was able to stabilize his illness with the help of medication by his early 20s and is now married, has two kids, and works full time. “When I first went into medicine, my expectations for people with illnesses like schizophrenia were not pessimistic because my first experience was very optimistic,” he says.
It was from this experience that Dr. Kopelowicz became interested in the recovery model of treating mental illness. “The recovery model is really focused more on trying to improve people’s overall functional outcome. It’s not just focused on symptoms,” he explains.
Born in Buenos Aires, Argentina, Dr. Kopelowicz and his family moved to the United States when he was a young child. Growing up, Dr. Kopelowicz spoke English and Spanish, which helped him when he completed his residency in heavily Latino-populated Los Angeles, where he remains today. Dr. Kopelowicz is medical director at the San Fernando Mental Health Center, which treats 1,800 patients, half of whom are Hispanic. When he started at the center, he was the only clinician on the staff who spoke Spanish; of the clinic’s roughly 900 Hispanic patients, half speak only Spanish. “I basically became the doctor for the Spanish-speaking people. That’s where I started using my Spanish for day-to-day work,” he says. Now, four of the seven doctors at the clinic speak Spanish.
At the second annual APF Awards for Advancing Minority Mental Health (supported by Otsuka America Pharmaceutical, Inc.), formerly known as the Minority Mental Health Awards, Dr. Kopelowicz received an award based on his incorporation of cultural differences into his research at the center. “One of the things that struck me was how many of the patients, even the ones with serious illnesses, lived with their families,” he says. “The Hispanic family was particularly interested in maintaining their ill relative and not putting him or her in a facility.”
Dr. Kopelowicz initiated a program to teach family members how to help their relatives with social skills training, as well as to help adhere to medication regimens, report medication side effects, and monitor symptoms. “If we could teach them how to help the ill relative rather than do it for them, then we were much more likely to be successful,” he says.
Patients whose family members received training were less likely to present to a hospital, had fewer symptoms, and were more likely to take their medications, the study found (Kopelowicz A, Zarate R, Gonzalez Smith V, et al. Disease management in Latinos with schizophrenia: A family-assisted, skills training approach. Schizophr Bull 2003;29:211-27). However, while patients in the study got better, the families didn’t feel less burdened. “We were asking the families to sort of serve as case managers,” Dr. Kopelowicz notes. “We were asking them to do work!” A new study currently under way is aimed at enhancing the program by focusing on multiple-family groups incorporating several patients and their families. The groups attempt to identify and fix through problem solving the most difficult issues facing both the patients and the families. “We’re in the middle of it now—it’s going really well,” he says.
Along with his duties at the San Fernando Mental Health Center, Dr. Kopelowicz is an associate professor of psychiatry at UCLA, president-elect of the American Society of Hispanic Psychiatry, and vice-president in charge of programs for the Latino Behavioral Health Institute, whose annual conference will be held September 20-22 in Los Angeles.
And what about the friend who personally brought mental illness to Dr. Kopelowicz’s attention? “I’m in touch with him every week—he’s still my best friend,” he says.
—Michael Peltier, Assistant Editor