Doctors in training bring hope in fight against suicide, mental illness

Nathan Phelps
Green Bay Press-Gazette
Dr. Waqas Yasin, examines a patient Feb. 22, 2018 at the Milo C. Huempfner VA Health Care Center in Green Bay, Wis. Yasin, originally from Pakistan, is one of four residents participating in the new Northeastern Wisconsin Psychiatry Program, which includes general medical and mental health training. Sarah Kloepping/USA TODAY NETWORK-Wisconsin

It’s not quite the cavalry arriving, but Dr. Waqas Yasin’s conversation with a patient is a sign that reinforcements are on the way.

With a stethoscope around his neck and a laptop computer perched on a small stand in front of him, his questions seem unconnected to an acute shortage of psychiatrists in Wisconsin, but they’re a step toward alleviating the problem.

“In the recent past, have you been checking your blood sugars?”

Yes, the patient responds.

“How have they been?” the 30-year-old psychiatry resident asks.

Yasin is in the middle of a three-month rotation at the The Milo C. Huempfner VA Health Care Center in Green Bay as part of a new psychiatry residency program. The program launched last summer; its first classes comprise four residents in Green Bay and three in Wausau under the supervision of the Medical College of Wisconsin.

The journey from student to licensed psychiatrist takes eight years: four years of medical school and four years of residency.

The Green Bay-based Northeastern Wisconsin Psychiatry Program and a sister program in central Wisconsin were developed from studies showing doctors are likely to stay and practice where they've trained. The residents placed around the state will provide services themselves as they train, and the promise of the program is that at least some will help alleviate the state's shortage of mental health professionals by settling here.

A December report from The Henry J. Kaiser Family Foundation found Wisconsin is short some 247 mental health professionals compared to experts' recommendations.  Nationally that number was just shy of 3,400.

As Wisconsin’s youth suicide rate soared above the national average, many families report long waiting lists and trouble accessing services, especially in small cities and rural areas.

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The first class of Wisconsin residents from the new program enter the field at a time when suicides in the U.S. have been increasing dramatically growing 19 percent since 2007, according to the American Foundation for Suicide Prevention

And, perhaps contrary to expectations, the demographic group most at risk today is one that is easy to find in rural Wisconsin: white, middle-aged men.

White males accounted for 70 percent of suicides in 2016, and men between 45 and 54 were the most likely to die by suicide. By race, whites had the highest suicide rate at 15.1 per 100,000; Native Americans and Alaska natives were at 13.37. African Americans were at 6.03.

A calling to heal minds 

The residents in the Green Bay program, who come from California, Utah, Wisconsin, and Pakistan, all expressed a desire to help people with mental illness while closing the provider shortage.

Yasin, a son of a pediatrician in Pakistan, grew up in a small community in the southern part of the country before attending medical school in Karachi and, later, programs in the United States. The stigma attached to mental health issues in his native country piqued his interest in pursuing a career in the profession and making a difference in the lives of people afflicted with mental illnesses.

“There’s a big stigma associated with mental health, so it’s completely ignored,” he said. “There was no proper training in the region, so if I wanted to do psychiatry, I had to move out.”

Over the course of the first year of the program, residents train in a wide range of facilities, from the VA where they work in both general medical practice and mental health care to the Winnebago Mental Health Institute in Oshkosh, where they encounter patients with acute and long-term mental illnesses who are there because they can be a threat to themselves or others.

"The primary goal is to help people get better, but that you're compassionate and empathetic and you can help point them toward the resources that help them stay on track for long periods of time," said Dr. Andrew Kordus, a resident from Milwaukee. 

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The program includes inpatient work with adults and children and outpatient work with a heavy emphasis on use of different therapies. Residents also get a look at post-traumatic stress disorders, geriatric-related issues, and the use of telepsychiatry.

A year of elective work covers areas ranging from eating disorders to a rotation in a methadone clinic and crisis intervention.

Dr. Brooke Mastroianni said she was aware of the need for mental health providers in  Wisconsin when she applied to the northeast Wisconsin program.

“Even though there are only four of us, it still makes a huge difference in the community,” the Utah native said. “I see myself (staying) in the area because there is such a need.”

The program is partnered with Bellin Health (which operates an 80-bed psychiatric hospital near Green Bay); Brown County Community Treatment Center; The Milo C. Huempfner VA Health Care Center in Green Bay, the Winnebago Mental Health Institute; and the Wisconsin Resource Center, a program working with prisoners with mental illness.

'I'm learning something every single day'

It's a little after after 8:30 a.m. on a Thursday morning when Mastroianni sits down at a conference table at the Winnebago Mental Health Institute in Oshkosh with about 10 other people to discuss patients. The team includes a psychologist, social workers and nurses. 

It's the first step in a typical day for the native of Salt Lake City who spent the first three months of the year working at the institute. The facility generally has 150 to 240 patients and treats children and adults with acute and long-terms mental illnesses in a secure setting.

By mid-morning, she and other doctors and social workers are seeing newly arrived and longer-term patients.

"If it's a new patient, we'll see them for about an hour," Mastroianni said. "Usually I see the new patients in the morning and we'll see follow-ups in the afternoon: see how are patients are doing, any updates, any medication changes, and then writing notes."

Dr. Brooke Mastroianni, one of four residents participating in the Northeastern Wisconsin Psychiatry Program, talks on March 8, 2018 about her experiences at Winnebago Mental Health Institute in Oshkosh, Wis. Sarah Kloepping/USA TODAY NETWORK-Wisconsin

She sees patients, and makes treatment recommendations, under the guidance and instruction of doctors, but it’s very much intended to be a real-world learning experience for the residents.

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“Right now I'm seeing the acute psychotic patients, maybe patients who are suicidal," Mastroianni said."I’m learning something every single day.”

Mastroianni, who attended medical school in Cyprus and Puerto Rico, got into the field after seeing the dedication of physicians working in Puerto Rico. She wanted to find her own place where she could settle into a community and have an impact.

As part of the program, Mastroianni is working  to launch a free mental health clinic in Brown County. 

“When I was working at both Winnebago and Bellin, there were so many people coming from the U.P. and all these northern places telling me they had no access to anything up there,' she said. "Our goal is to set up a place anyone is welcome to come and we can try our best to treat them.”

Mind and body go 'hand in hand' for treatment

Behavioral health is the thrust of the program, but the training is more expansive.

While Mastroianni was working at Winnebago, Yasin was at the VA Clinic in Green Bay practicing more general medical care.

The breadth of medical education is geared toward giving the doctors the tools they need to effectively handle their own practice — including small towns where they may be the only provider of psychiatric care.

On a late February morning Yasin was busy shuttling between exam rooms and cases, including the diabetes follow up and a skin issue on another patient's leg.

“You’re still a doctor," he said, "so you’re still expected to deal with basic stuff. If someone is having a heart attack you should know how to do CPR. ... All these medical illnesses, especially diabetes and hypertension, have a psychological compliment.

“For a resident in psychiatry, it’s crucial to understand those aspects of medical health and their impact on mental health as well,” Yasin said. “They go hand in hand.”    

A three-month stint at Winnebago Mental Health Institute awaits him this spring, and Mastroianni will move to the VA.

Dr. Thomas Speech, who heads psychology at Winnebago Mental Health Institute, said less than a year into the program the residents are making a difference.

Dr. Thomas Speech

“The numbers aren’t going to be huge, but they do make a dent,” he said about the impact of the two new programs. “It’s four (residents) this year, it’ll be four more next year, then four more the year after.”

Speech said the program brings optimism for the future.

“(The residents) bring this promise: they’re are excited, enthusiastic, and they have modern information,” he said. “They take up some of the slack and it fills the gap while we’re waiting for that new batch of professionals.”   

The institute had its own psychiatry residency program in the 1990s, with many of those doctors opting to stay in the area. Many of those doctors are now reaching retirement age.

“Even if the residents don’t end up working at Winnebago, if they work in the area that will improve the resources for mental illness in the area,” Speech said. “Our goal is to not have patients come here. If they can be treated in the community instead, that’s great.”

Dr. Daniel Hoppe, a resident from California in the northeast Wisconsin program, doesn’t expect a quick fix to the gaps in mental health care around the state and nation —  nor do others. But the residency programs are important players in helping shape the future of mental health care in Wisconsin.

“It’s definitely a long-term fix, there’s no doubt about that … but I do think the problem is surmountable,” he said. “It’s been identified and is being addressed.”

Dr. Waqas Yasin, talks with Dr. Lynn Budzak after examining a patient Feb. 22, 2018 at the Milo C. Huempfner VA Health Care Center in Green Bay, Wis. Yasin, originally from Pakistan, is one of four residents participating in the new Northeastern Wisconsin Psychiatry Program, which includes general medical and mental health training. Sarah Kloepping/USA TODAY NETWORK-Wisconsin

Yasin, who interviewed for residency programs from New York City to Fargo, North Dakota, says the program, and his fellow residents, have already helped make a difference in the area and state — one he plans to continue when he enters practice.

“Even saving one life is a big, big, big deal to me,” Yasin said. “The whole point is to learn, adapt and then see what we can do for this community.”