photo by: Journal-World file photos

Shown clockwise from left in these Journal-World file photos are the Community Health Facility, 200 Maine St.; a sign at the entrance to Bert Nash Community Mental Health Center; and the center's CEO, Patrick Schmitz.

Monday will mark two weeks since seven specialized therapists simultaneously submitted letters of resignation at Bert Nash Community Mental Health Center, and 17 days until their last day, Aug. 15.

As the Journal-World has reported, the seven are practitioners in the center’s dialectical behavior therapy program, or DBT. The treatment targets those who “struggle with a variety of emotional and behavioral problems and feel out of control,” according to the center’s website. Among others, those who have severe mood disorders, anger issues and suicidal or self-harming thoughts may benefit from DBT.

The departure will leave just four of the center’s current DBT team in place. Bert Nash CEO Patrick Schmitz has told the Journal-World that some current staff members who previously worked in the DBT program will be helping out and consulting on clients.

The center is also hiring, but Schmitz did not say whether all seven positions would be filled. When asked, he said that providing a vague timeline of that hiring process — days, weeks or months — was “impossible.”

The Journal-World asked Schmitz about the concern of stability for patients as new therapists are hired.

“We operate as a team-based approach to care,” he said. “So a lot of our clients are served by a multitude of providers, and we see our clients as clients of the center, not of a specific individual.”

Schmitz said Friday that the case-by-case review of the seven therapists’ clients, to determine how to continue their care, is going “great, absolutely.” But depending on what those seven plan to do after Aug. 15, patients might have a different option.

Patients’ choice

In some professions, such as sales, employment contracts may include a clause that bars salespeople from soliciting clients to follow them to a new firm upon their departure.

In psychotherapy, it works differently. Informed consent dictates that patients must be given all the information they need to make decisions about their treatment.

Hypothetically, if the seven therapists were to join other practices or otherwise make themselves available here in town, it could spare a lot of high-risk clients the emotional shakeup of being transferred to other programs or practitioners at Bert Nash.

Wes Crenshaw is board certified in couple and family psychology. He has practiced for 26 years, in Lawrence since 2000.

“If the therapist is reasonably available in another practice, the therapist needs to share that at the point of disclosure and suggest the pros and cons of continuing versus staying at the former practice and seeing a different therapist,” Crenshaw said.

In the case of Bert Nash, he said there are many issues to consider, including continuity of team care, medication management, crisis management and so on, “but one has to really sit down and talk that through with the client and literally have them sign off that they understand.”

As the sole owner of Family Psychological Services in Lawrence since 2012, Crenshaw has dealt multiple times with hiring practitioners from other agencies. He said he’s had varying experiences hiring staff from community mental health centers, Bert Nash included, in the past — sometimes it’s gone smoothly and other times it’s been “messy.”

He said one “leaver” was told not to tell any clients they were going to a different practice, but the problem was resolved when he objected to that as a matter of professional ethics.

“Everyone understands the importance of the relationship between client and therapist and also balancing that against some larger treatment needs that maybe only (Bert Nash) can supply,” he said. “But that discussion must be had.”

Based on what Schmitz has told the Journal-World, it doesn’t seem as though that would come up as an issue.

“Since I don’t know what those seven are planning to do, I really can’t comment on (whether patients would be able to continue with their current practitioner),” he said Friday. “But, as we talked on the phone the other day, we work with clients to pick out the best choice of treatment that’s available to them, and so we collaborate with providers every day.”

The patients’ treatment records currently belong to the center, but they could be released to a new practice with a signed HIPAA (Health Insurance Portability and Accountability Act) waiver, or to the patients themselves. So essentially, all confidentiality and legal privilege of mental health records belong to the client.

‘Easily digestible’ materials?

Given the nature of the clientele that qualify for DBT and knowledge of the program’s intensity — some clients spend 15 hours per week in group therapy alone, according to the center’s website — the Journal-World asked Schmitz last week about training new hires in the protocol. He said the materials are “very easily digestible for most clinicians.”

Crenshaw said he has trained for two days with the creator of DBT, Marsha Linehan, and two more days with her certified staff. He said he found it to be a very complex program and protocol.

“It’s good, but it’s best when it’s all-in,” he said. “That’s why I chose not to offer it specifically in my office.”

He said the programmatic and supervision issues of DBT are intricate.

“It involves meditation and becoming good at that takes time and practice,” Crenshaw said. “I’m not good at it and I work at it. So yes, it’s very learnable, but one only really can implement it through experience and oversight in order to do it well.”

Linehan and her staff could not be reached for comment last week, but for reference, the current DBT team leader became a licensed clinical psychotherapist in 2001 and has been with the center’s DBT program since it was started in 1995, according to Bert Nash’s website, bertnash.org. She became a Linehan-certified clinician in October of 2017, and she is one of 189 worldwide.

Asked again Friday about the training, Schmitz reiterated the center’s team-based approach to care.

“We have a number of staff within the DBT program and within the agency that have that skill and expertise and experience, and the materials,” he said. “The staff go through regular training and consultation to help them continue to learn. Quite honestly, even a very skilled practitioner is still in the learning process through the DBT. You never finish learning the skills of DBT.”

About Healthy Outlook

Healthy Outlook is a column written by Journal-World reporter and Health section editor Mackenzie Clark, in hopes of helping readers make their lives a little bit happier, healthier and more active.

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