Five Questions With: Christopher Harrigan

"Most prominent medical diagnoses are likely cardiovascular diseases."

Christopher Harrigan was recently named program manager of psychiatric skilled nursing services at Pinnacle Home Care. Harrigan, will also head Pinnacle Home Care’s Behavioral Health Program. The program delivers crisis intervention, stabilization and disease management services at home for those unable to access community behavioral health services.
Harrigan has experience as a registered nurse and clinician in the area of behavioral health and is a qualified mental health professional (QMHP) certified by the R.I. Department of Behavioral Health, Developmental Disabilities and Hospitals. He graduated with a double major in nursing and psychology from Rhode Island College with departmental honors in psychiatric mental health nursing. He also received a Master of Science in Health Care Administration and Management from Salve Regina University.

PBN: Behavioral health issues can dramatically worsen chronic diseases. How early in your career did you become aware of that, and was there one patient or situation that really brought the point home to you?
HARRIGAN:
First, I must clarify that behavioral health issues, are for many individuals, chronic diseases themselves. I believe we must look at individuals as a whole, and not specific diagnoses, because in most cases, diseases go hand in hand.
Getting back to your question, I remember as a nursing student early on at one of the community mental health centers in this state, a client with end-stage liver disease and very close to death selling his money for food for half its worth in order to buy alcohol, which would bring him even closer to death. The extent of his alcoholism, which is a disease, though many do not believe that, and his self-medicating with the substance due to his severe, persistent, and uncontrolled depressive disorder, clearly brought my attention to the medical neglect due to behavioral health.

PBN: What is the single most common dual diagnosis combining a behavioral health problem and a chronic disease?
HARRIGAN:
Most prominent medical diagnoses are likely cardiovascular diseases. Individuals with behavioral health disorders, often do not have access or insight to appropriate foods that lower likelihood for cardiovascular disease. Cigarette smoking is also common. Although 25 percent of the U.S. adult population have a mental illness, these individuals smoke 40 percent of all the cigarettes in the United States, also increasing likelihood for cardiovascular diseases.

However, when the term “dual diagnosis” is mentioned with “chronic disease,” I truly find it to be substance abuse disorders with co-morbid psychiatric diagnoses. Approximately 4 million Americans suffer from both and the chronic diseases that can be developed as a result are limitless; HIV, and Hepatitis C from intravenous drug users, chronic obstructive pulmonary disease, and lung cancer in smokers, alcoholic cirrhosis and liver disease in those with alcoholism, and myocardial infarctions among stimulant abusers.

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PBN: How soon should people in Rhode Island expect the goals of parity for mental health care to be achieved?
HARRIGAN:
I would love to say in the next five years. However, the political and financial agendas in the state seem to be pitting different services against each other that as a whole could make it a possible achievement. All of the community mental health providers need to come together, and bring their strengths as a team to target the issue, and the medical community. The general population needs to remove their stigmatization of mental health patients as well; it is too common to be stigmatized. The issue is very multifaceted, and insurers, providers, and policymakers need to get on the same page to allow for mental health clients to get the parity they are afforded by law, and deserve.

PBN: In what ways do you see your work as being suicide prevention? Is suicide a lot more prevalent than most people think?
HARRIGAN:
One of the services my program provides is following client’s post-acute psychiatric hospitalization, for medication management, monitoring of efficacy, and teaching coping techniques.
These clients are often admitted for a mood disorder exacerbation, started on a new anti-depressant that will take several weeks to truly take effect, and given a follow up appointment with a psychiatrist. This period of post-discharge with a new drug is critical, and is the time where clients are likely to be (1) re-hospitalized, (2) stop taking the new medication due to side-effects, or (3) the most severe and critical, take their lives. Our work in the home with these clients, rather than them waiting weeks to see a clinician, I do believe greatly reduces the chance of adverse events.
As far a suicide being more prevalent than most perceived, yes, and it crosses all socioeconomic, psychosocial, and age-related borders that I feel the population at large generally associates the incidence with.

PBN: Is there one patient whose dramatically improved quality of life is something that you reflect on sometimes to keep you engaged and optimistic in your work?
HARRIGAN:
Honestly, there is not one patient specifically. On a daily basis, I find the most minor improvements in the quality of one of my client’s lives to keep myself engaged and motivated, those changes that may seem minute to most, I feel as a clinician, build on each other and are the building blocks to stabilization or recovery. So the little positive changes are the most influential factors at keeping me engaged as a change agent in a much needed gap in health care.

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