Helping Practitioners Bridge the Mental Healthcare Gap for Their Patients

Practitioners who work with individuals with amputations recognize that many of their patients face emotional issues as well as physical challenges in dealing with their limb loss, but they may not have the tools to help. A new program that helps prosthetists recognize the emotional well-being of their patients seeks to change that. The program, Improving the Well-Being of People with Limb Loss, will soon be expanding thanks to a growing coalition of companies, organizations, researchers, and prosthetic practices. Mahesh Mansukhani, former president of Össur Americas, Foothill Ranch, California, says the program is absolutely needed to help patients in the orthotic and prosthetic community. "The rehabilitation of an amputee, especially early on, is very contingent on how they are feeling from the neck upward," he says. "If their heads are in the game and you can give them confidence, that is much more important than anything you put on them." [caption id="" align="alignnone" width="180"] Mansukhani[/caption] [caption id="" align="alignnone" width="180"] Wegener[/caption] [caption id="" align="alignnone" width="180"] Cummings[/caption] Össur believes so strongly in the program that it funded its pilot phase, which launched in 2011. That phase was conducted through a partnership between the Amputee Coalition and Johns Hopkins University (JHU), Baltimore, Maryland. It was trialed at five prosthetic practices: Dankmeyer, Baltimore; Wright & Filippis, headquartered in Rochester Hills, Michigan; Next Step Bionics & Prosthetics, Manchester, New Hampshire; Maryland Orthotics & Prosthetics, Baltimore; and Bulow Biotech, headquartered in Nashville, Tennessee. While general concern for the well-being of individuals with amputations was a factor, a driving force behind establishing the program was that research has long shown that people with amputations suffer higher rates of depression than the general population and they are less likely to use mental health services or seek a referral to address the issue, according to George Gondo, director of research and grants for the Amputee Coalition. Researchers thought that prosthetists, who often have close relationships with their patients, would be a good fit to help identify patients who may need mental health services and to provide resources. But first they had to establish whether the prosthetists were on board. In focus groups, prosthetists told researchers that they wanted to help their patients but often felt uncomfortable with the topic of mental health. "We found that...[prosthetists] do find themselves engaged in these issues but, quite frankly, they didn't have any tools to do anything about it," Gondo says. "So they were apprehensive and felt uncomfortable in the discussion. As a whole, they just felt that they did not have the training to serve in that function." Mansukhani says that is just the point of the program—not for prosthetists to be counselors, but rather to point their patients in the direction of qualified help. "We want to give them the tools to identify, not diagnose, when patients are in need," Mansukhani says. "Ideally we want to give them tools for when they think there is an issue." Researchers soon got to work developing a program that prosthetists would feel comfortable with and would allow them to encourage patients in need to seek additional help. The program includes a self-assessment for patients to determine if they might need help and whether they feel they are living life to the fullest. Patients who may need help are given a list of local and national resources that includes mental healthcare providers in their area and local support groups, says Stephen T. Wegener, PhD, ABPP, associate professor and director of rehabilitation psychology at JHU, who is leading the research side of the program. Prosthetists are also trained how to bring up the issues with their patients and weave the conversation into their normal appointment, Wegener says. Data from the pilot program show that patients and prosthetists overall felt the program was helpful and effective, he adds. Scott Cummings, PT, CPO, FAAOP, was part of the pilot program through his practice, Next Step Bionics & Prosthetics. He says he took part in the program because he has long felt that the psychological and emotional needs of people with amputations have been overlooked. He explains that while the subject of mental health comes up often in sessions he has with patients, it could still be a sticky subject. "Usually I did not directly address a person's mental health needs unless it was obvious that this person was struggling," Cummings says. "In these instances, our conversations led to an opportunity for me to suggest that he or she should talk to a counselor or caseworker." Now, after being trained in the program, he is armed with specific local and national resources for clients. The program, he says, makes it "incredibly comfortable" to broach the subject. "It lays out a process that gets the appropriate information to those clients who would benefit from it." He has already seen successes. One of the first times Next Step Bionics & Prosthetics used the program involved a traumatic amputee. The patient filled out the self-assessment after being introduced to the program by a practitioner. In the end, the patient sought additional help. "Now when we see him, the topic is open for discussion," Cummings says. "It seems as though this has helped remove a barrier that otherwise would have limited his progress." Össur Americas will continue to help fund the second phase of the program, but an additional partner has recently lent its support as well. Hanger, Austin, Texas, announced that it is also contributing to the cause and has awarded the Amputee Coalition a $100,000 educational grant for the program. Hanger President and CEO Vinit Asar says the program aligns well with the company's focus on the total patient. "This is a long overdue program, especially in our industry, where a lot of our patients come to us having already suffered some sort of trauma and likely having multiple comorbidities," Asar says. Due to the success of the first phase, training for prosthetists will soon be available on a larger scale, according to Gondo. The program's second phase will help train more prosthetists by offering trainings at local and national O&P industry meetings, Wegener explains. The Amputee Coalition will appoint a person whose job will be to seek out local resources for participating prosthetists. Many prosthetists are unaware of all of the mental health resources in their communities, and the resource person will help them come up with a comprehensive list for their areas. Throughout the second phase of the program, researchers will collect data to help determine the effectiveness of the program. They will want to know if patients seek treatment once it's recommended and if prosthetists feel comfortable bringing up the issue. If the data show that the program is effective for patients and prosthetists, the program could eventually be used nationwide and included in school curriculum for prosthetists, Wegener adds. Asar says that although the program has a lot of potential, it should be studied carefully. "While this program has the potential for widespread distribution, we should first ensure we get through this second phase to understand the data. Once we gather and understand the data, we can incorporate it into our approach and then begin to distribute it nationally." Cummings, who now uses the program in his office, said he hopes the program continues to expand and helps prosthetists get resources to address all of the needs of their patients. "I think the profession needs a paradigm shift away from providers of devices," he says. "We need to view ourselves as providers of amputee care, which includes mental health." Maria St. Louis-Sanchez can be reached at msantray@yahoo.com

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Spillover Effects

Recipe for a Master’s Degree from Scratch

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We’re Currently Seeking Certified Prosthetist/Orthotists (CPOs) for Opportunities Throughout Several States

Certified Prosthetist Orthotist or Board Eligible Prosthetist Orthotist

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