Thursday, July 03, 2014
Doctor's Perspective
Proper care needed for the mentally ill

By Dr. Anthony Policastro
One of the issues frequently discussed in relation to gun violence is the mental health status of the individuals involved. A point that is not often made is the fact that our country does a terrible job of taking care of mentally ill patients. With the work I do involving children with behavioral problems in school, there is often a need to refer patients to mental health professionals. The need is clear cut. Accessing that care is another story. Patients that I refer face multiple obstacles. The first and most important issue is availability of mental health professionals. There are not enough mental health professionals in the State of Delaware. I sat on a panel chaired by then Lt. Governor Carney. We ran the numbers. Delaware is woefully underserved. Sussex County is significantly below the national average in number of mental health providers. The second major issue is payment. Health care insurance does a fairly good job of paying for medical problems. It does a pretty poor job of paying for mental health issues. The people who need mental health care the most, very often do not have insurance coverage to pay for it. The combination of these two issues makes the wait to get into mental health services a long one. It is often months before a child can see a child psychiatrist. In the meantime, the illness continues to worsen which makes it harder to treat when the patient is ultimately seen. A third major issue is the disappearance of psychiatric inpatient facilities. In the past the solution to major mental health issues was to institutionalize the individual. We later were able to avoid that with the proper use of medications to treat individuals on an outpatient basis. Once we were able to get most patients out, the insurance companies took the next step. They limited inpatient stays to 28 days. It did not matter how sick the individual was, they had to be released in 28 days or payment would not be provided. That ultimately led to the closure of many psychiatric units. Now hospitalization for mental health issues requires someone to be homicidal or suicidal. Then the insurer may pay for a few days to a week. The result has been to place the burden of care on the primary care physician. The evaluation and treatment of a psychiatric illness is complex. There is not a lot of time for doing that kind of workup in a busy physician's office. Patients will get a diagnosis and they will get treatment for that diagnosis. However, they may not be able to get follow up and a more complex evaluation with a mental health professional. The last issue is related to patient compliance. Medications only work if the patient takes them. The mentally ill patient is not liable to take medications as prescribed. A good example of that comes from recent studies. There was some publicity that antidepressants sometimes had a side effect of making patients suicidal. That side effect was very rare. However, many patients stopped taking their antidepressants. Depressed people commit suicide. The study showed that there were many more suicides from depressed patients failing to take their medication than there were as a side effect of the medication. The right way to deal with the issue of mentally ill individuals going on rampages is to provide them with the medical care that they need in the first place. That is not likely to happen with our current system of providing care to these individuals. If you have comments about this column or suggestions for other topics, send an email to Dr. Anthony Policastro at

How to prevent heat exhaustion Heat illness occurs whenever the body cannot compensate for excessive heat. When temperatures and humidity are high, sweat ceases to evaporate and the body's natural cooling system slows down, in some cases shutting down completely. Very hot weather can cause heat exhaustion and heat stroke, which can be fatal. DPH recommends:
  • Limiting outdoor activity, especially midday when the sun is hottest.
  • Wearing and reapplying sunscreen as indicated on the package.
  • Scheduling workouts and practices earlier or later in the day when the temperature is cooler.
  • Pacing activity. Starting activities slow and picking up the pace gradually.
  • Drinking more water than usual and not waiting until you're thirsty to drink more. Muscle cramping may be an early sign of heat-related illness.
  • Monitoring a teammate's condition, and having someone do the same for you.
  • Wearing loose, lightweight, light-colored clothing.
  • Seeking medical care immediately if you or a teammate has symptoms of heat-related illness.
  • Learning more by participating in a CDC course for coaches, athletic trainers, students, school nurses, parents and teachers on preventing heat-related illness. Heat exhaustion occurs when a person is overheated along with reduced or unbalanced intake of fluids. Symptoms include dehydration, fatigue, weakness, clammy skin, headache, nausea and/or vomiting, rapid breathing, irritability and fainting.
Take these steps to reduce heat exhaustion:
  • Move the person indoors or into shade.
  • Loosen or remove the person's clothing.
  • Encourage the heat exhaustion victim to eat and drink.
  • Get the person to a cool shower or bath.
  • Call your doctor for further advice.
Heat stroke occurs when the body can no longer cool itself, and can be a life-threatening event. Prompt medical treatment is required. Symptoms include: flushed, hot and dry skin with no sweating; high body temperature (above 103 F, taken orally); severe, throbbing headache; weakness, dizziness, or confusion; sluggishness or fatigue; decreased responsiveness; and loss of consciousness.

If heat stroke occurs, take these steps:
  • Call 9-1-1 immediately. This is a medical emergency.
  • Get the heat stroke victim indoors or into shade.
  • Get the person into a cool shower or bath, or wipe them down continually with soaked cool washcloths while awaiting emergency responders.

Keep kids safe from heatstroke Two young children in other states have died as a result of heatstroke related symptoms. This happens more than you would think. Every 10 days in the United States a child dies when left alone in a hot car. Both incidents, one in Florida and one in Georgia, occurred when the babies' parents forgot to drop them at daycare and instead left them locked in their vehicles when they went in to work. These types of tragedies can happen to anyone, and most of the cases are to loving, caring parents. It's easy for parents to become distracted when their routine is disrupted, like when 'the other parent' drops the child off at daycare. Data has shown that heatstroke tragedies happen more often when the daily routine is changed. In other cases, parents choose to leave them in a car 'just for a minute' while they run into a store for a forgotten or needed item. "These tragedies are absolutely heartbreaking, and a reminder for all of us to be aware of what can happen when children are left alone in a car," said Jennifer McCue, chair of Safe Kids Delaware and injury prevention coordinator at Nemours/Alfred I. duPont Hospital for Children. National statistics show Delaware has experienced one heatstroke related death in a vehicle in the last 10 years. "It could happen again. We must continue talk about injury prevention and to educate and raise awareness about heatstroke so all parents have the information and resources they need to keep their kids safe." Many parents are shocked to learn how hot the inside of a car can get. Even with seemingly mild temperatures outside, the temperatures inside a car can rise 20 degrees in as little as 10 minutes; and cracking the window doesn't help. A child's body heats up three to five times faster than an adult's, making them more susceptible to heatstroke. Once a child's body temperature reaches 104 degrees, internal organs begin to shut down. Safe Kids Delaware is asking everyone to help protect kids by never leaving a child alone in a car, not even for a minute, and to share this information on how to ACT: A: Avoid heatstroke-related injury and death by never leaving your child alone in a car, not even for a minute. Also, make sure to keep your car locked when you're not in it so kids don't get in on their own. C: Create reminders by putting something on the backseat of your car next to your child such as a briefcase, a purse or a cell phone that is needed at your final destination. This is especially important if you're not following your normal routine. T: Take action. If you see a child alone in a car, call 911. Emergency personnel want you to call. They are trained to respond to these situations. One call could save a life. Additional prevention information can be found at For ongoing updates about child injury prevention in Delaware, follow Safe Kids Delaware on Facebook at and on Twitter @SafeKidsDE.

Diabetes education program Nanticoke Memorial Hospital, Seaford, will hold a four-session diabetes education program on July 16, 23, 30 and Aug. 6, from 5 to 7 p.m. at the hospital. Registration is required. The cost of the four-session program may be reimbursable by insurance. This four-session program includes weekly education sessions and individualized meal planning for diabetes self-management. The goal is to give you the self-management skills to control your diabetes. Family members/significant others are welcome to attend the weekly sessions. For more information and to register, contact Nanticoke Memorial Hospital's Diabetes Education department at 629-6611, ext. 2446.

Hospice 5K Run & Family Fun walk Join the fun with hundreds of runners and walkers as Delaware Hospice holds the 6th annual Delaware Hospice 5K on Wednesday, July 9, at the Delaware Hospice Center in Milford. Registration opens at 5:30 p.m., the race begins at 6:30, and the post-event cookout and party will go on until evening. Individual entries are $20, and the team rate for a group of four or family rate for a group of four or more from the same household is $50. Register online at or contact Peggy Dolby, assistant director of development, at or 746-4666.

Diabetes support group Nanticoke Memorial Hospital will hold a free diabetes support group from 5 to 6 p.m. on Monday, July 21, at the hospital. As a person with diabetes, are you struggling to make positive behavior changes in your life or would just like to share with others coping with diabetes? Come join our free support group for individuals with diabetes. A demonstration on "Seasonal Produce in Diabetic Cooking" will be presented by Nanticoke's Executive Chef, David Eanes. There will also be a question and answer period. Registration is required. To register and for more information, contact Nanticoke Memorial Hospital's Diabetes Education department at 629-6611, ext. 2446.

Stroke support group Nanticoke Memorial Hospital's next Stroke Support Group meeting is Tuesday, July 15 at 1:30 p.m. at the Seaford Library. The support group is designed for individuals who have survived a stroke as well as their families and caregivers. The two-hour support group meetings will consist of guest speakers and breakaway sessions, in which caregivers and stroke survivors will meet in two groups to discuss concerns, provide support and allow for networking. Refreshments will be provided. Pre-registration is not required for this free support group. For more information, contact Nanticoke Memorial Hospital at 629-6611, ext. 8626.