Residential Treatment

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Rogers is a comprehensive psychiatric hospital, nationally recognized for specialty residential treatment programs for eating disorders, addiction, obsessive-compulsive disorder and anxiety disorders for children, teens and adults.

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January 16, 2014 - 12:13pm

Jerry HalversonDepression and other mood disorders in young adults is the FOCUS of a new residential program at Rogers. With intensive psychiatric evaluations and medication management, the program builds on the strong foundation set by Rogers other residential treatment programs and strong evidence-based care.

Jerry Halverson, MD medical director of adult services at Rogers will lead the program.

Read what Dr. Halverson had to say to the Milwaukee Business Journal.

January 16, 2014 - 8:50am

New residential program FOCUS builds on clinical expertise

Losing interest in activities, withdrawal from family and friends, and sadness can be part of the daily struggle when fighting severe depression or other mood disorders. Behavioral activation – a major component of treatment in a new residential program at Rogers -- addresses these struggles.

Building on Rogers’s foundation of evidence-based care through cognitive behavioral therapy (CBT), on February 10, Rogers opens FOCUS, a residential program for young adults with depression and other mood disorders. For these patients experiencing a difficult transition to adulthood, behavioral activation is one key building block toward recovery.

But what exactly is behavioral activation?

As a treatment for depression and other mood disorders, behavioral activation is based on the theory that, as individuals become depressed, they tend to engage in increasing avoidance and isolation, which serves to maintain or worsen their symptoms. The goal of treatment, therefore, is to work with depressed individuals to gradually decrease their avoidance and isolation and increase their engagement in activities that have been shown to improve mood. Many times, this includes activities that they enjoyed before becoming depressed, activities related to their values or even everyday items that get pushed aside such as:

  • Exercising 
  • Going out to dinner 
  • Improving relationships with their family members 
  • Working toward specific work-related goals 
  • Learning new skills and activities 
  • Showering regularly 
  • Completing household chores

It is also important to examine sleep routines and eating habits and work toward normalizing these, as sleep and diet often change when individuals become depressed.

To assist with learning about how an individual’s activities affect his or her mood, with behavioral activation individuals are often asked to complete activity monitoring. This involves having the individual write down which activities he or she completes throughout the day (or week), with mood ratings for each activity. This allows the treatment provider to identify patterns in behavior, including avoidance, and to help increase engagement in behaviors that are related to improvements in mood. Often, additional strategies are needed to help individuals remember to complete assignments, gain the necessary skills to do various assignments and work toward their goals, while at the same time managing the uncomfortable emotions that may arise during different activities when one feels depressed.

Throughout treatment, increasingly challenging activities are assigned as the individual experiences improvements in mood and engagement in specific types of activities.

Watch for more information on the new FOCUS residential program. For a free screening for any of Rogers programs, call
1-800-767-4411.

January 2, 2014 - 12:54pm

Child and Adolescent PsychiatryThe fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, commonly referred to as DSM-5, helps clinicians diagnose mental disorders that aren’t as easily identified by symptoms like many other health conditions, e.g., a broken arm or case of pneumonia. Plus, the new manual offers greater insight into many of these disorders.

The DSM-5 revisions aim to capture children’s experiences and symptoms more precisely. Rather than isolating childhood conditions, the new manual underscores how they might manifest throughout a patient’s life span. Each disorder is now set within a framework that recognizes age-related aspects, chronologically listing diagnoses that are most applicable to infancy and childhood first, followed by diagnoses that are more common to adolescence and early adulthood, and ending with those that are often diagnosed later in life.

A New Diagnosis

Erik Ulland, M.D., the medical director of Rogers’ child and adolescent inpatient services, says the DSM-5 changes help clinicians look at what disorders may look like as children grow older, rather than just as the result of behavioral problems that may be occurring right now. He says many children and adolescents may be affected by a new diagnosis – disruptive mood dysregulation disorder (DMDD) – that will in turn affect other diagnostic categories.

DMDD is described as intense outbursts and irritability beyond normal temper tantrums in young children. The new diagnosis is needed as more children under the age of 12 years old have been diagnosed with pediatric bipolar disorder over the past decade (since DSM-IV), which often led to prescriptions for antipsychotic medications at a very young age. In addition, hospital stays for this disorder rose significantly.

“Instead of having a separate chapter for childhood illness, each chapter of the DSM-5 is written more in the context of development, this is a big improvement” Dr. Ulland explains. “Illnesses that were often diagnosed earlier in life are reviewed first. DMDD is meant to describe children who were previously identified as bipolar, but did not show up as bipolar adults. That was puzzling for many clinicians. Many pediatric specialists believe the discrepancy is due to many of those kids being incorrectly identified as bipolar."

Why Diagnosis is Important

What is most critical about the DMDD diagnosis, Dr. Ulland says, is that it’s a step that suggests “umbrella” diagnoses are inadequate to describe children and adolescents. “Meds rarely ever fix developmental issues, which is the way many behavioral disorders have been addressed in the past. Accurately described mental illness leads to better treatment. Specific, accurate diagnosis leads to children being referred to treatments that will assist development rather than a reliance on medications as the only answer.” In other words, awareness of the complexity of children is heightened. Shorter medical checks and evaluations are not sufficient to properly diagnose them.

“DSM-5 changes are meant to recognize developmental, emotional and behavioral alignment, rather than simply a collection of symptoms and behaviors. The new guide helps to show more of the natural progression of mental illnesses. With the removal of the section on childhood disorders, practitioners are forced to recognize that disorders that were previously diagnosed in children may be seen in other age groups, and even increase risk for development of other psychiatric illnesses at a later age. Age-relevant examples help clinicians consider the diagnosis within the entire life cycle. Many disorders have a natural history within the person which before probably had not been recognized enough by practitioners,” he continues.

There are many effective treatments for disorders in children and adolescents. Dr. Ulland states that the spectrum of anxiety disorders, depression and attention deficit hyperactivity disorder (ADHD) are among the most common and treatable illnesses. All of these may cause behavioral problems that are rather severe if left untreated, but it’s important that clinicians continue to be as sophisticated as possible in diagnosis, since this informs the most effective treatments. DMDD and the new categories were ultimately made to assist in better treatment of mental illness, while removing part of the divide between current research and treatment.

If you believe a child or adolescent is living with a mental disorder, call Rogers at 800-767-4411 for a free screening or request one online.

December 18, 2013 - 10:32am

Sarah Biskobing is a registered and certified dietitian specializing in the nutritional treatment of eating disorders at Rogers Memorial Hospital.

It’s that time of the year, the holiday season. For those overcoming years of disordered eating, such as anorexia, bulimia, or even those that struggle with body image the holidays can be a real struggle. Food is at the forefront of almost every holiday celebration and the bounty of calorie-rich foods often triggers a fear of weight gain during the holiday season. As a result, some make a hasty retreat back to their familiar disordered eating behaviors.

However, the holiday season does not have to equate to diets and deprivation. In fact, your holiday season can be healthy, Here are some how-to’s for a healthy holiday season:

  • Give yourself permission to eat and to enjoy what you eat.
  • Take the judgment out of the food and take yourself off the hook. Your values, and the person you are, are not affected by the food you just ate.
  • Do not starve yourself beforehand in an attempt to save up the day’s allotment of food for the holiday celebration. Doing so may trigger you to overindulge, which may in turn produce feelings of guilt and shame and start a cycle of disordered eating behaviors. Instead, nourish yourself with a balance of food throughout the day.
  • Slow down, settle in, and socialize first. Stand more than an arm’s length away from the munchies so that you can focus on the good company and festivities.
  • Have a support person available (in person or on the phone) who can help you work through momentary struggles and difficult situations. Anticipate some of the possible triggers in advance so that you can have a game plan for how to positively cope when you encounter them.
  • Plan ahead, assess your hunger and fullness level and evaluate your options. Consider portion size and moderation. Mindfully consider the foods you enjoy. Decide which foods you’ll definitely eat, which ones you will sample, and which ones you will skip.
  • Make a decision and stick with it. Do not play a back and forth game of this is good/bad for me, but this is better for me. The back and forth choices can cause confusion, frustration, anxiety and can trigger the cycle of disordered eating behaviors.
  • Slow down and become mindful while you eat. Enjoy the taste, texture, and smell. Breathe and assess your fullness (and/or your meal plan) while you are eating. It takes at least 20 minutes for fullness cues to arrive and signal us to stop eating. Therefore, instead of heaping your plate full right from the start, moderately fill your plate and remember that you can go back for seconds if you are still hungry.
  • Legalize the holiday yumminess! Deprivation, chronic dieting, cutting back, or labeling food as good or bad can lead to cravings, overeating (or binges), and poor nutrition.
  • Focus on moderation versus deprivation. When foods are forbidden, they take on a magical quality that is difficult to resist. Research shows that the more you legalize a food, the more in control you will be when eating that particular food. If you try to restrict yourself from all holiday treats, you may be more likely to overindulge at some point.

By following some of these tips and tricks, you can be healthy and enjoy your holiday season. And it’s ok to lean on family and friends, by talking about what you are experiencing.

December 16, 2013 - 10:40am

Believe it or not, the first attempt to gather information about mental health was done to collect statistical information for the 1840 census. In fact, it was these early census recordings that distinguished early categories of mental health. It was not until post-World War II that the first edition of the DSM or Diagnostic and Statistical Manual of Mental Disorders (DSM) was published. It was then this clinical and diagnostic tool, published by the American Psychiatric Association, provided description and diagnostic categories for clinicians working with mental disorders. Today, the DSM is still considered the authoritative guide by behavioral health professionals throughout the country, providing the common language and standard criteria for the classification of mental disorders.

Why This Matters

Mental illness cannot be determined by a traditional, physical test. A blood test won’t tell you if you are depressed or anxious. Broken arms and pneumonia have physical symptoms. Mental illness is not as easily identified, leading to a need for a clear set of guidelines to help clinicians diagnose a condition. As we gain insight into these mental disorders, the DSM helps providers prescribe more effective treatment and acquire more accurate statistics and research. In addition, the handbook is used by researchers and health insurance companies. All in all, the changes may mean the difference between gaining access to treatment… or not.

2013 saw publication of the fifth edition of the DSM, culminating in a 14-year revision process. While the new edition has changes, it is important to realize that it is more about clarifying and looking at some of the disorders in a new way, due to research and feedback from mental health professionals.

For example, in DSM-5, the symptoms for diagnosing post-traumatic stress disorder (PTSD) were revised to allow those who have experienced different forms of trauma to get treatment. Previously a PTSD diagnosis was attributed more to those who had been in combat; the new edition is far more inclusive. In fact, it is also more explicit about what can be defined as a “traumatic” event. The previous edition included three major symptom clusters for PTSD, whereas the DSM-5 has four with more distinct criteria. In addition, children and adolescents can now be diagnosed with PTSD, and there is a subtype with separate criteria for preschool children.

Easier to Get Treatment

The DSM-5 takes into consideration the many years of experience that different clinicians and researchers have had with mental illness, using new language that makes it easier to identify conditions like PTSD. The updated guidelines may even help patients get insurance coverage for syndromes that looked and acted like a particular condition, but did not meet criteria in the previous edition. That means more patients can get treatment to recover from their symptoms and live a more meaningful, enjoyable life.

In addition, the DSM-5 neither hinders – nor addresses specific plans for – treatment. Everyone who had a diagnosis before DSM-5 will still have a diagnosis, and many who need care will find it easier to get treatment. If anything, the new classifications will lead to more specific diagnoses that open new pathways to treatment. As before, clinicians can continue working with patients to determine what’s best.

If you or someone you know needs treatment, call Rogers at 800-767-4411 for a free screening or request one online.

December 13, 2013 - 9:24am

By Jennifer B. Wilcox, M.A.

Obsessive-compulsive disorder (OCD) is characterized by obsessions or compulsions leading to distress, thereby interfering with overall functioning. Although a diagnosis of OCD only requires the presence of obsessions or compulsions, the majority of children usually experience both. OCD can appear any time between preschool and adulthood, but most commonly surfaces between ages 8 and 12 or between the late teens and adulthood. It is estimated that approximately 1 in 200 children and adolescents has OCD.

Obsessions are unwanted and intrusive thoughts, urges, or images that are recurrent and persistent, causing marked anxiety and distress. They are not simply worries about real life problems, but rather originate within the mind. Examples of common obsessions include:

  • Fear of contamination or germs
  • Fear of harm or danger
  • Fear of loss
  • Need for symmetry
  • Need for perfection

An attempt to suppress or neutralize these obsessions occurs in OCD through distraction, by avoiding triggers, or engaging in behavior or mental rituals that reduce distress. This action or unwelcome thought or action is a compulsion.

Compulsions are behaviors, rituals, or mental acts that a person feels driven to perform (often repeatedly) in response to an obsession, or according to rules that have rigidly been applied to his or her life. Compulsions may be directly associated with the obsession in an obvious way or seem completely unrelated. Examples of common compulsions include:

  • Washing and cleaning
  • Checking
  • Hoarding
  • Ordering and arranging
  • Repeating rituals

Research has shown that it is common for everyone to have occasional unwanted and intrusive thoughts or mental images, and most people do not place much importance on them. In people with OCD, the thoughts are considered highly important. This causes the person experiencing them to feel compelled to neutralize or suppress them in an attempt to deflect their anxiety and discomfort. Despite having somewhat limited insight--in comparison to adults--children and adolescents are often able to recognize their compulsions as being excessive, unreasonable, and even senseless. However, their anxiety still obliges them to engage in the activity.

Because everyone has these types of experiences, it is important to ask the following questions to help determine whether your child may need professional help:

  • Do the symptoms cause distress for the child?
    OCD is ego-dystonic, meaning it differs from the person’s beliefs and values, and is therefore quite upsetting. He or she does not want to have these thoughts or engage in these activities. It is important to determine whether this behavior is unwanted. For example, if the child gets a new game or toy and appears to be “obsessed” with it, ask yourself: Is this an unwanted behavior by the child?
  • How often is the child engaging in these symptoms? How much time does he or she spend engaged in them? Is it more than one hour per day?
    Children with OCD often spend one to several hours per day of their time preoccupied with the symptoms of OCD.
  • Do the symptoms interfere with normal activities such as getting ready in the morning, schoolwork, socialization with friends, family activities, and other enjoyable activities?
    In a child with OCD, the stress of day-to-day life tends to become overwhelming and even unmanageable for him and his family.

If these descriptions seem to describe your child, he or she may have OCD and it will likely be beneficial to consult a mental health professional.

At Rogers, OCD treatment includes personalized treatment plans. Through evidence-based treatment for teens and children, our OCD programs help alleviate symptoms and learn effective therapy strategies they can use the rest of their lives. For a free screening, call us at 800-767-4411.

References
Anxiety and Depression Association of America (ADAA) http://www.adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd
Baer, L. (2000). Getting Control: Overcoming Your Obsessions and Compulsions.New York, NY: Penguin Putnam Inc.
International Obsessive Compulsive Disorder Foundation (IOCDF) http://www.ocfoundation.org/ocdinkids/
Johnston, H.F., & Fruehling, J.J. (2002). Obsessive Compulsive Disorder in Children and Adolescents: A Guide. Madison, WI: The Progressive Press.
March, J. , & Benton, C. (2007). Talking Back to OCD. New York, NY: The Guilford Press.
March, J.S., & Mulle, K. (1998). OCD in Children and Adolescents: A Cognitive-Behavioral Treatment Manual. New York, NY: The Guilford Press.

October 15, 2013 - 12:54pm

By Mary Jo Wiegratz, Manager of National Outreach

This year the annual National Eating Disorders Conference was held in Washington, D.C., so members could participate in a Federal Lobby Day, which focused on bringing awareness and support for eating disorders. Rogers’ Medical Director of Eating Disorders Services, Theodore Weltzin, MD, FAED, FAPA, national outreach representative Jean Corrao and I took advantage of that opportunity.

This year’s focus was on increasing access to mental health treatment and strengthening research funding. A recent poll showed cost of care and insurance coverage are top factors impeding successful recovery. And research funding for eating disorders lags other conditions. In 2011, the National Institutes of Health (NIH) provided funding research for Alzheimer’s of which88 dollars was spent per affected individual; for schizophrenia, 81 dollars, and for autism, 44 dollars. However, for eating disorders it was only 93 cents per affected individual.

Working with NEDA, we were able to meet with aides of Wisconsin’s Congressional representatives or aides from Jim Sensenbrenner, Gwen Moor and Mark Pocan and U.S. Sen. Tammy Baldwin’s offices. We encouraged their support of the Federal Response to Eliminate Eating Disorders (FREED) Act of 2013, which addresses additional research, improved training for health and school professionals and improved insurance reimbursement for eating disorders. And, we invited them to join and support the National Eating Disorders Awareness Caucus and support a key initiative seeking further federal research.

We also sought their support or sponsorship of the House and Senate versions of the Mental Health Improvement Act, which can help with access and coverage. Part of this bill would allow for Medicare coverage of treatment provided by marriage and family therapists (MFTs) and mental health counselors (MHCs) n addition to the licensed certified social workers (LCSWs) currently covered. Training is comparable for these professionals, but MFTs and MHCs – often the only resource in rural communities – are not recognized as providers by Medicare.

We had a good response from everyone we met. Sen.Baldwin previously played an important role in supporting the FREED Act.

It was certainly an interesting time to be on Capitol Hill, given the government shutdown. It was pretty quiet. But it did give us a sense of being at the center of the government and doing our small part to encourage these initiatives.

September 26, 2013 - 2:42pm

As parents, friends and family members, we’re consistently reminded to keep our medications out of sight and reach. For many, the assumption is that this step is meant to keep small children safe. In reality, however, young children are not the only ones in danger—adolescents and adults are also at risk, as they have access to unsupervised medicine cabinets. In fact, reports indicate that thousands of teens use a prescription drug intended for someone else every day.

Consider the Dangers

Although you may not think about protecting unused prescriptions from wandering eyes and hands during social occasions, you may want to consider that – for many who find these drugs – a party isn’t really a party without a “random drug spin,” i.e., raiding the medicine cabinet and taking something with unknown effects. The fun, they say, is in not knowing what they’re about to experience.

Unfortunately, the effects of taking these drugs may be worse than they realize. The American College of Preventive Medicine warns that our country is in the midst of an epidemic – widespread prescription drug abuse. Prescription and over-the-counter medications account for eight of the 14 most frequently abused drugs by high school seniors. Plus, adolescents say prescription drugs are much easier to obtain than illicit drugs. Even more shocking: The abuse of prescription drugs is higher than cocaine, hallucinogens, inhalants and heroin for those over the age of 12. The sad truth is that many prescription medications are forgotten in medicine cabinets and can become the “entertainment” some adults and adolescents seek.

Immediate and Long-Term Dangers

When adolescents and adults seek entertainment in pills, often mixing them with alcohol in efforts to get drunk faster, they put themselves at risk in the present and future. In addition to immediate effects like reduced ability to pay attention, impotence, potential brain damage, heart attack, stroke and even death, they become exponentially more likely to become chemically dependent. In fact, statistics indicate that the number of adolescents entering treatment for addiction to prescription pain relievers has increased by more than 300% over the last 10 years. And other reports reveal that one in four adolescents questioned in 2012 admit to abusing prescription drugs at least once, which represents a dramatic increase of 33% in just four years. In total, 7 million people abuse or misuse prescription drugs every month.

What Can You Do?

Locking your medicine cabinet and disposing of unused prescriptions can help. Safe medication disposal can mean bringing your unused medication supplies to a “drop-off” site such as a local police department. Otherwise, to discard expired and unused prescription drugs safely, remove tablets/capsules from their original containers and mix them with undesirable substances, such as cat litter or used coffee grounds, before placing them in a container with a lid or sealed bag for disposal. Flushing them down the toilet is not recommended due to chemicals entering the water supply.

Visit dispose my meds for a listing of approved drug disposal sites.

If you or someone you love is abusing prescription drugs, Rogers offers a wide variety of addiction treatment options including withdrawal management and long term stabilization at the Herrington Recovery Center. Request a free screening online or call us at 800-767-4411.

September 20, 2013 - 9:57am

Dual-Diagnosis in AddictionAddiction and mental illness: a circular relationship where one often feeds the other. There are cravings, obsessions and addictions that initially seem to solve issues with self-esteem, body image, family or work problems. Studies show that nearly one-third of alcohol abusers and one-half of drug abusers also battle a mental illness. This makes it difficult to determine if the addiction half of the relationship occurred before, or as a consequence of, the disease.

Michael Miller, MD, director of the Herrington Recovery Center and addiction treatment at Rogers, says, “For too long addiction and mental illness have been treated as separate disorders. The success of treating the addiction is often rooted in simultaneously addressing mental health disorders that increase a patient’s tendency to provide inadequate self-care and use drugs and alcohol.”

At Rogers, our doctors and therapists are trained to assess and treat the entire person – mind, body and spirit, not just the addiction. Each patient works with a treatment team to develop a plan that allows them to take care of themselves and learn healthy ways to manage their anxiety and depression. Recovery is difficult, but, with integrated treatment, patients learn strategies to change the feelings and behaviors that led to substance misuse.

August 5, 2013 - 8:59am

The following post is part of a letter presented by Jerry Halverson, MD, FAPA, to members of the Speaker’s Taskforce on Mental Health during a public hearing for the state of Wisconsin. He was asked to provide an overview of mental illness and the challenges faced by those that suffer, as well as the professionals the treat them. Part one:

Anxiety and Depression TreatmentWhat is Mental Illness?

By Jerry Halverson, MD, FAPA Medical Director of Adult Services at Rogers Memorial Hospital

I will start with what a mental illness is not. It is not a choice. It is not a weakness. A mental illness is a physical and/or emotional manifestation of diseases of the brain. Caused by too much or too little of certain chemical actions in one part of the brain, this hyper/hypo activity is used to communicate and transmit messages within the brain. This may lead to symptoms that present as changes in thoughts, moods, or behaviors. Associated with distress and impaired functioning, these thoughts can have minor or dire effects that could include disruptions of daily functions, incapacitating personal, social, and occupational impairment or even premature death. The most common mental illnesses in adults are anxiety and mood disorders.

The term mental illness refers collectively to all diagnosable mental disorders. These brain diseases can be caused by genetics or external events/agents thus, altering the chemicals our brains produce and changing the brain behavior.

Mental illnesses are found in all races, genders and socioeconomic classes. They are found throughout our state, our country and our world. According to the World Health Organization, mental illness results in more disability in developed countries than any other group of illnesses, including cancer and heart disease. Published studies report that about 25 percent of all U.S. adults have a mental illness and that nearly 50% of U.S. adults will develop at least one mental illness during their lifetime.

Mental illness is an important public health problem in itself, but also because it is often associated with chronic medical issues such as dementia, cardiovascular disease and diabetes. Data from the Wisconsin Health Information Organization (WHIO) shows behavioral health ranks third in illnesses most costly to treat. Unfortunately the data most likely underreports these costs as it does not include substance use disorders, patients being treated for the wrong diagnosis or for under-diagnosed patients whose illness may lead to additional unhealthy behaviors.

We know mental illness tends to worsen outcomes in medical illnesses, in turn leading to increased costs and complications, higher death rates, longer hospital stays and less control over chronic health issues. Mental illness is also associated with use of tobacco and abuse of alcohol.

Making an accurate diagnosis and treatment options are additional challenges facing mental illness. Dr. Halverson addressed this with the task force as well, his thoughts shared in an upcoming blog.

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