Episode Transcript
[00:00:13] Speaker A: Hi, everybody, and welcome to another edition of the Southern Fried Podcast, a production of the Arkansas Democrat Gazette. I'm Rex Nelson, Democrat Gazette Senior editor. And you know, every once in a while, probably need to do it more often. I love to have guests from uam.
It is such an important institution to our entire state, in addition to being a giant economic engine for Arkansas. Brilliant people all over the place. And it's always fun for me to learn a little bit about a new area, era area, something I haven't thought about. And we're going to try to do that in the next 30 minutes or so.
Like to welcome Dr. Jessica Coker, Associate Professor, Psychiatry OB GYN at UAMS. Dr. Shauna Ray Griffith, Associate Professor, Ambulatory Director of the Women's Mental Health Program.
Shawna, I guess I will just start with you. I'm not going to assume anybody knows anything that's listening right now. So outline very simply what the Women's Mental Health Program is.
[00:01:32] Speaker B: Okay. So the Women's Mental Health Program is a program at uams. We have outpatient and inpatient care and the out. I'm the director of the outpatient and the outpatient. We primarily take care of pregnant and postpartum women, and that simply means women who are currently pregnant or women a year after they give birth.
Or we also see patients who are planning to become pregnant and they may have a history of mental health issues or substance use disorders, and we help them plan for their pregnancy.
[00:02:09] Speaker C: Yeah.
[00:02:10] Speaker A: Jessica could talk a little bit, if you will, about the importance of maternal mental health.
You know, we talk about physical health.
You know, we rate low in a lot of categories when it comes to maternal health in Arkansas. But I don't hear as much about the mental health part. So the importance of that and why it matters to the overall picture.
[00:02:38] Speaker C: Yeah. Thank you so much. So you probably are well aware the maternal mortality is high in Arkansas.
[00:02:44] Speaker A: We we right near the bottom. Yeah.
[00:02:46] Speaker C: Yeah. And it's become a huge topic of conversation.
And fortunately, the government are putting resources into that.
And a lot of a lot of work is going on in maternal mortality and maternal health overall at uams.
I think we play a key component to that because we know that rates of postpartum depression, rates of postpartum illness or illness, depression, anxiety during pregnancy contribute to overall maternal health.
Arkansas is near the top as far as the amount of women who have mental health conditions during pregnancy and postpartum. Around 20% of women in Arkansas will have postpartum depression. So that's one in five women could experience that.
And we also know that psychiatric conditions lead to a lot of maternal death.
So if you look at overall rate of maternal mortality, suicide and drug overdoses are actually the number the leading causes of maternal mortality. I think it's also important because it impacts families.
I always say. And one of the reasons why I'm passionate about doing this work is that I think moms kind of run households. They run.
[00:04:01] Speaker A: Absolutely.
[00:04:02] Speaker C: They run family.
[00:04:03] Speaker A: They've always run my household. I'll just put it that way.
[00:04:06] Speaker C: Mine too, I'll say that about myself.
But I also think that women have huge impacts in our communities.
They help our communities thrive. They help all the way to the top. Without women, I think we are not as well off.
And I think having healthy women is the most important.
And we know that depression, anxiety, not only impacts the household and their children, but then ultimately impacts our communities when women are not feeling well or not being their best moms that they could be and struggling with depression, anxiety. And so I get a lot of, I guess a lot of passion in that area, and I think we all do in the women's mental health program is a big reason why we do this is not only for the women that we take care of, but for their families, too.
[00:04:54] Speaker A: Absolutely. Give me a sense, both of you, if you will, of the. Of the kind of services that you provide.
[00:05:01] Speaker B: So in the outpatient setting, it's just like going to your regular doctor. But usually it's for a issue such as depression or anxiety is a common issue that we see, or unfortunately, a history of trauma.
So something bad happening to someone, and they're coming to see us. And many of our patients have never experienced this before, and they're like, I was pregnant. Pregnancy was great.
Then all of a sudden, I like, you know, I can't function. I'm crying all the time. I'm. I'm not taking care of myself. I'm barely taking care of my baby. I'm just doing what I need. I'm not doing anything in the house. I can't sleep at night, even though I'm really tired.
I'm so exhausted, but I can't sleep at night. What is wrong? What is wrong with me?
And then we kind of, you know, finish talking and ask a bunch of questions, and then they, you know, we come up with a plan. Usually at that, I say, you know, I think this is what I described is very typical of postpartum depression. And then we discuss treatment options. And that can be medications or therapy or both or nothing. If they elect to do Nothing.
And sometimes people do, you know, they say, okay, well, I want to give it a little bit longer and see if it gets better. I'm not sleeping right now, but the baby's starting to sleep throughout the night. Maybe if I sleep a little bit better, I'll feel better and. And I'll say, okay, well, come back and see me then.
[00:06:35] Speaker C: And I would. On. That's the outpatient side. On the inpatient side, we do have an inpatient women's unit, which I'm really proud to say that we're only one of five units in the whole country that has a psychiatric unit dedicated to women.
So it's a very low acute unit, meaning there's not a lot of aggression or things that people get really scared about about going to a psychiatric it.
And we focus on acute care. So I always describe it as like the ICU of mental health care. Someone may have suicidal thoughts. They may be so depressed that they cannot function at all and need help, or they just need a different plan. And maybe the outpatient plan isn't working, and they need to come in the hospital to have more wraparound care.
So the average length of stay of that is around five days. And we have a lot of group therapy, individual therapy, medication management, and then get people kind of stable a lot faster than you can on the outpatient side.
[00:07:34] Speaker A: So we are talking about both outpatient and inpatient services being offered.
[00:07:38] Speaker C: And I would also add that if you deliver your baby at UAMS on our obstetrical floors, we also provide consult services. So if you're over in labor and delivery and things aren't going well, one of our psychiatrists can go see you on that floor as well to make sure things go well for the.
[00:07:56] Speaker A: For the inpatient. Is there any kind of average of the average length of stay?
[00:08:02] Speaker C: Yeah, it's around five days.
[00:08:04] Speaker A: Five. Okay. Okay. I was interested in that. Now, for a lot of layman, which I am, walk me through the differences between psychiatry and therapy.
[00:08:19] Speaker B: Okay. That's a great question.
[00:08:20] Speaker A: Yeah.
One I want to hear. I want to hear both your answers on that, too. I'm not so sure I can answer that.
[00:08:27] Speaker B: Well, I think in medical school, I don't think I knew the difference either.
And so psychiatrists are medical doctors. They have gone to medical school and they have training in medications, and they have a large experience with mental and medical issues.
Then when you say the word therapist, you're encompassing a large group of professionals, from psychologists to licensed counselors to licensed clinical social workers to masters in social workers. There's lots of professional degrees that do counseling.
Let's go back to psychiatrists. So after you do medical school and you go to a psychiatry residency, you do get some training in therapy. Gotcha.
It's not a lot of training, but you do get some.
Some psychiatrists, when they grow up and become, you know, whatever, they're going to come in the outpatient realm. They do a combination of medication management and therapy. So they prescribe medicines and do therapy.
At the Women's Mental Health Program, we do a little bit of that, but not a lot.
We have a lot of therapists that we can refer to. So we actually refer out for therapy and then you refer out to therapy. Therapy is more of what you consider talk therapy. So people talking about things, you know, maybe even suggesting there's all type of therapy, but just listening or even suggesting of like, hey, what are you doing all day?
Let's get you moving. Let's talk about what can we do to get you out and out of the house and moving. Because you feel a lot better when you get up and move.
[00:10:16] Speaker A: Exactly.
[00:10:18] Speaker B: And not sit at home all day. Inside, go outside, go see the sun, go for a walk. Sometimes it's simple as that. Sometimes it's, hey, what are you, you know, who's surrounding yourself when you're sad. This is a prime example I give everyone when they come see me, my patients, is when you're sad, do you watch a sad movie or do you watch a comedy?
That's a simple tool right there. Don't go watch the sad movie. You're going to stay sad.
Go watch the comedy. That's one way you can change your mood, especially if you don't like feeling sad. Go watch the comedy. It'll lighten you up. Go call a friend, go make a plan. Go do something. And that's type of stuff you can really work through in therapy.
And therapy tends to be more often. So like once a week or once every couple of weeks, medication management is probably going to be more like monthly.
[00:11:10] Speaker A: Gotcha. Did you want to add to that?
[00:11:12] Speaker C: The only thing I would add is psychiatrists also can determine differences between psychiatric conditions and then maybe medical conditions that can manifest with psychiatric conditions.
So especially if you have very complicated diagnoses like bipolar disorder, schizophrenia, or medical complications that mimic psychiatric conditions, Psychiatrists, medical doctors are better at diagnosing those conditions and coming up with treatment plans. But yeah, our main focus is. Is on medications compared to therapy.
[00:11:44] Speaker A: All right, let me ask, are our medications safe during pregnancy and how do you determine that?
[00:11:51] Speaker B: Okay. So safe. When you use the word safe in pregnancy, I cringe.
[00:11:55] Speaker A: Okay.
[00:11:57] Speaker B: Nothing is ever safe in pregnancy.
[00:11:59] Speaker A: I like to make my guests gr.
Part of the show.
[00:12:03] Speaker B: But, you know, that's what everyone comes to you and asks, well, you know, is this safe? Yes. And as we know from the media, Tylenol or acetaminophen, is it safe anymore? You know, that's been a big, huge question. And that's exactly. That's been a medicine that's been safe for many years in pregnancy for many people. So I like the terms. We need to talk about the risk and benefits of using medication in pregnancy as well as the risk and benefits of not using medications in pregnancy. So if you have a serious mental disorder like bipolar disorder, should we be treating it in pregnancy or should we not with medications which are often the best treatment we have for that disorder?
Same thing with depression. If you're not taking care of yourself and you're pregnant, you're not taking care of your unborn child. Now you gotta be eating.
[00:12:56] Speaker A: Exactly.
[00:12:56] Speaker B: You need to be sleeping. So then the risk of the medicine may be overweight by the benefits.
You know, so we always have to have that conversation of what are the benefits of the medicine? What are the risk?
And weigh those two.
[00:13:12] Speaker C: And I think that that's where we come in, and that's where it's really important to see somebody instead of just cold turkey stopping your medications. Because we have a lot of women who come in and just cold turkey stop them because they get scared. And that's very reasonable.
But that can also cause a lot of problems. And so we are experts in talking to you about, like, here are your options, here are your. Here are what we know about the medications. Here's what we don't know about the medications. Here's what can happen if you do stop them. Here's what could happen if you stay on them. And I think having that. That discussion helps women make an informed decision. And that's what we want. We want all of our women that we see to have all the best information so that they can make the best decisions for themselves.
And it's not just black and white. Is it safe or not safe? And I think that's really important because we see a lot of women who struggle with that decision, and. And we can help with that.
[00:14:07] Speaker A: Do a number of the women that you treat, do they have substance abuse problems?
[00:14:13] Speaker B: So for me, yes. So one of the other titles I hold is I am a board certified addiction medicine.
[00:14:19] Speaker A: Gotcha. Because it's such a Huge issue across Arkansas. I had ask. Yeah.
[00:14:23] Speaker B: Yes. So we do have one day a week. We have a specialized program in the Women's Mental health program that does treat pregnant and postpartum women with dual diagnosis. So they have mental health disorders and substance use disorders.
And that program is more, it's more intensive.
So these patients, some of them even come every week to see us or every couple of weeks and they get group therapy, they may even get some individual therapy and they see the doctor every week. So we keep a pretty close eye on those patients while we help them navigate this. And pregnancy is a great time for many people with substance use disorders to seek treatment. It can often be the reason that they come to treatment. They never really had a reason before to stalk now that they're pregnant. That's a great reason to stalk.
[00:15:16] Speaker A: I know the, the ultimate answer to making sure that your mental health is good during a pregnancy is to come seek treatment if you think you've got problems. But for those who may be listening, let's talk about ways that you can improve your mental health during, during pregnancy and during postpartum. Just, you know, there may be a maybe pregnant woman or a new mother out there listening right now and could, could learn something just from this podcast.
[00:15:49] Speaker C: Yeah.
So I think I always say pregnancy is hard. It is not, it is not an easy time for women.
So one, I think it's just recognizing that pregnancy is hard and it's challenging and it has its ups and downs.
[00:16:03] Speaker A: An easy pregnancy is a misnomer, right? Yes, no such thing.
[00:16:07] Speaker C: Yeah, it is hard. So like, let's be honest about that first. And, and so one, don't, don't have these expectations that things are not going to be hard and that it isn't a difficult time. And I think that can help because you don't have as much pressure on yourself to make everything well.
Some things don't go well during pregnancy.
I think exercise is very important as long as your doctor is allowing you to exercise, which is usually the case.
But continuing to exercise. There are some women who believe that you can't exercise in pregnanc and for the most part that's not true.
And that can be simple as going on a walk. 30 minutes a day of walking has shown to decrease depression, anxiety. I'm not asking people to go to the gym and lift heavy weights or go on a two mile run. Like just moderate walking for 30 minutes makes a difference.
Eating well, plenty of sunshine, being around positive people, keeping in contact with your friends is good. And just taking Care of yourself, Resting when you feel like you need to rest.
I know a lot of working moms who might have multiple children. It's hard to rest.
But making time for yourself to do that I think is also helpful.
[00:17:19] Speaker A: Did you want to add to that?
[00:17:22] Speaker B: You know, I think this is also the time when you become a mom and if you have other children at home, you become so busy and you think, I don't have time. And one of the things I started telling patients recently is you're the only person who's going to make time for you.
Everyone else needs or wants something from you. So you have to make your own time. And so you're the only one who's going to take care of yourself.
So, right, like, let's do it. Like, reach out to your friends.
Don't wait for them to call you. Reach out to them. Plan something.
Accept help from those who want to help you as well. You don't have to do it all, and it's okay to accept help.
[00:18:07] Speaker A: What are the warning signs that tell you it's time to seek psychiatric help at this point?
[00:18:16] Speaker C: One thing that I like to preach about right now is sleep.
I think that women can get some really bad messaging around sleep when they deliver a baby. So I hear, I've heard things like, oh, you're never going to sleep again. Like, good luck. Yeah, yeah. And that's actually not true at all.
And it is bad messaging.
So you, you will have broken sleep.
But sleep is one of the, the biggest warning signs of having a mental health condition. Across all mental health conditions, sleep is disrupted.
And so what I want to, to preach to, to women who are having a baby is that if your baby is sleeping, you should be able to sleep if you are staying up watching your baby, if it is hard to fall asleep after you get done feeding, or, you know, you should be so tired that when you lay down, you're sleeping.
And I think a lot of women don't recognize that it's a problem because they're told you're not going to sleep anymore, which isn't true. And so if you are having trouble sleeping after delivery and you cannot find your a way to shut your brain down and get some rest.
That is, it's, that is, I think one of the first signs to get help.
[00:19:30] Speaker B: Other signs, I think other signs are the biggest risk factors we see is any thoughts of harming yourself or others, what we call suicidal thoughts or homicidal thoughts. Any of those kind of scary thoughts that you're either having for the first time or you've had them before, but they seem to be stronger.
Those definitely need to be. You need to see someone for that and possibly even go to the emergency room.
And then lastly, is any, any kind of what we call psychotic thoughts? So, you know, hearing things that other people aren't hearing, Seeing things that other people aren't seeing. If you're really concerned about cleanliness or someone harming your unborn child and everyone else around you is saying, that's not happening, everything's okay, you're fine, that may be a time for you to seek help as well.
And those would be big, big, big, major warning signs.
[00:20:35] Speaker A: Gotcha. If you're joining us in progress, we're visiting with Dr. Shawna Ray Griffith and Dr. Jessica Coker from the UAMS Women's Health Clinic.
So if you're out there and if you're thinking, okay, I really do need professional help, do you need a referral? Do you just call up the clinic?
What's the next step?
[00:21:01] Speaker B: At this point, we make it really easy. We are one of the, probably the only places at uams.
I shouldn't say that because I don't know, but we're a self referral.
[00:21:11] Speaker A: Okay, you just need your primary care physician to give you a referral.
[00:21:15] Speaker B: No, you just need to call and get an appointment.
And if we don't answer the phone, leave a message. We have a great program manager and nurse of our clinic who checks that religiously and will reach out to you and get you scheduled. And you simply call the numbers 501-526-8201.
[00:21:38] Speaker A: Give that one more time. Speaking of a pen right now.
[00:21:41] Speaker B: 501-526-8201.
[00:21:45] Speaker A: Okay.
[00:21:46] Speaker B: The other option would be if you're like, well, I don't want to go see a psychiatrist. I'm not. I don't feel comfortable doing that. Is to go to your OB gyn.
So the doctor who cared for you while you were pregnant, you can also go see them. And if they don't know how to assist, most of those in the central Arkansas area and even throughout the state know who we are and can get you to us as well.
[00:22:12] Speaker C: And then I would say if you are having dangerous thoughts, you can always come to the UAMS emergency room.
That is a way to get admitted to the inpatient unit. If you do need inpatient care is to go through the UAMS emergency room or make an appointment with us. And that can, that can facilitate it as well. But the emergency room is always open, always staffed by psychiatry, and they can get you help quickly if it's needed.
[00:22:37] Speaker A: Yeah. You know, we've got about five minutes left. And I wanted to go just a little bit more big picture, because as I said at the outset, UAMS is such a wonderful economic engine for our state, such a wonderful health care provider.
And again, I just don't think most Arkansans know what all is sitting on that campus right now.
For instance, the Women's Health Clinic is on the fourth floor of the UAMS Psychiatric Research Institute. What is the Psychiatric Research Institute?
[00:23:15] Speaker B: Okay, so the Psychiatric Research Institute is a fancy name for the psychiatry department.
[00:23:20] Speaker A: Gotcha.
[00:23:21] Speaker B: Okay. It's the building that the Department of Psychiatry is in. That is where our inpatient and outpatient clinics are located. So the outpatient clinics are on the third and fourth floor, and the inpatient units are on the fifth and sixth floor. All right.
[00:23:36] Speaker A: All right.
And, you know, we were talking before the program.
Dr. Ray Griffith is a Texas native, but has been here long enough that, unlike my wife, she no longer says, I'm from Texas. My wife's been here 37 years. She's a Texan. Not anymore.
Dr. Coker is an Arkansas native from Bologna. But again, big picture. I'm not sure the average Arkansas again fully recognizes the diversity and the intellectual capital that UAMS brings to our state. For such a small state. I mean, literally, we have people from all over the world that are working at uams, and some of them are just some of the top experts in their field in the world. Is that. Is that not the case?
[00:24:35] Speaker C: Well, I would like to say one thing, because I think you bring up a good point. And due to some other things and other positions that I hold, I'm one of the chief medical officers who serves at uams. And what that means is every few weeks, I'm kind of the. The person who takes care of any issues that happen at uams.
[00:24:56] Speaker A: Gotcha.
[00:24:57] Speaker C: What I have learned, I've been doing this for about two years now, is that when anything is going wrong with somebody in Arkansas, they are brought to uams. So most of what I deal with in that role is helping people get to UAMS that need UMS care because we're the only place in the state that can provide that service.
Unfortunately, a lot of the times our hospital is full. The hospitals are always full.
And. But we try our hardest to get every single patient who needs UAMS care to uams.
And we work really hard behind the scenes to make that happen, even if we don't have any beds right then available, because we Know that we are the only place in the state that can help some conditions. We're the only place that, for example, has ophthalmological coverage 24, 7, hand orthopedic surgery coverage 24, 7. We manage a lot of vascular conditions that no other place can, can accommodate. And so it is a very valuable resource for our state in a lot of ways.
But for patient care, it's really important that we can get as many patients from other hospitals too, that need that specialized care. And then of course, all the research and education that's going on.
Majority of the doctors who practice at in Arkansas and even rural communities probably trained at UMS at some point.
And so we provide that really valuable service to get doctors out into the community.
We have increased medical schools in the state, so that will also help get more providers out. But, you know, in psychiatry, we know that there's an access problem. We know that there's not as many mental health providers as needed, but we want to try to fill the gaps in when we can. And UMS is continuing to grow. The psychiatry department has hired four new psychiatrists just coming on for this year.
So we are working on that. I'll also add from what Dr. Ray said about, we do have our clinic here. We also have a women's mental health program in northwest Arkansas. Dr. Aaron Jefferson is seeing patients there who are pregnant or postpartum. So any listeners who are in that area can also get help. In northwest Arkansas, we also see patients be virtually through telemedicine.
And we just started this year seeing patients for even their new patient appointment can be via telemedicine. So we heard people in other areas of the state. So we really want to send you people, but they can't get there. We can't. They can't get their transportation all the way to Little Rock. So please reach out to us even in those cases, because we do have options to see people completely virtual. So we really want to try. UAMS in general is expanding, growing, and we want to get more services throughout the state.
[00:27:48] Speaker A: You know, I don't want to get too far afield. We are running out of time. But I think I have to mention, because I've been writing about this, among other things, we live in a rural state, and yet one that is becoming more urbanized. So our rural areas, most rural counties, continue to lose population.
You combine those population losses with the federal funding cuts that we have seen, and I hate to say this, but I think it's inevitable that we're going to see more rural Hospitals closed. Camden declared chapter 11 just recently.
I fear we're going to see more of that.
And what that does, in essence, is it puts more pressure on UAMS as a provider.
[00:28:33] Speaker B: Yeah. Yes. And the birthing hospitals have already drastically declined.
Yeah. Are in Arkansas. And that's something that our colleagues in the Department of OB are working to address.
And Family Medicine.
[00:28:48] Speaker A: Yeah.
[00:28:48] Speaker B: They're both trying to help with that issue. But I, I learned something probably not too long ago that was really interesting is to keep a birthing hospital open, it requires a minimum of four OB GYNs.
Because of the 24. Yeah, yeah. The 24. Seven.
[00:29:07] Speaker A: You have to have four OBGYNs there to operate one. Yeah, yeah. Interesting.
[00:29:12] Speaker C: High number.
[00:29:13] Speaker A: And there's a high hurdle to clear for a rural area, which again, puts more pressure on UAMs. And you touched on it. But I guess, I guess telehealth becomes a more important part of what you do with each passing year.
[00:29:27] Speaker C: Yeah. And we're partnering right now with the OB department and some people on especially helping patients in Ashley county and in the Delta, like Magnolia, Camden area, El Dorado, because that's where real need is right now in our state, especially with the recent closing of another birthing hospital down there. So like I said at the, I think at the very top, luckily the, the government is taking some of the federal dollars that are coming down and, and, and working in maternal health, which is such a needed area for our state.
Kind of going back full circle of like, if we don't help our women, then we're not helping our communities at whole and, and our families and our children of the state.
[00:30:12] Speaker A: Absolutely. I'm going to have to get you back for an update. I knew this would go quickly. Thank you so much. And thank you for the work that the Women's Health Clinic does at UAMS for our entire state.
[00:30:24] Speaker B: Well, thank you for having us.
[00:30:26] Speaker A: Our guests have been Dr. Shawna Ray Griffith and Dr. Jessica Coker from the University of Arkansas for Medical Sciences. You've been listening to another edition of the Southern Fried Podcast, a production of the Arkansas Democrat Gazette.
[00:30:50] Speaker B: Sa.
