Milwaukee VA Medical Center

The team at the Milwaukee VA Medical Center's Immediate Mental Health Access Clinic stands ready to help Veterans suffering from urgent mental health problems. From left are psychologist Dr. Angela Zapata, psychiatrist Dr. Jason Burns, psychiatrist Dr. Lisa Henriksen and social worker Sarah Flayter.

The term “urgent care” typically invokes thoughts of broken bones, high fevers, physical pain and life-threatening medical conditions. We have countless clinics for this kind of urgent care.

But mental health also requires urgent care at times, but you won’t find many urgent care mental health clinics.

A notable exception is the Milwaukee VA Medical Center.

Not only is the Emergency Department at the hospital staffed full time with a mental health specialist, but there’s also the Immediate Mental Health Access Clinic, which stands ready to provide mental health services on a walk-in basis.

“We are a crisis clinic,” said clinic psychologist Dr. Angela Zapata. “Any patients who come in who are in crisis, we’re the ones working with those patients.”

On the severe side, this can include patients who are suicidal, homicidal, having a PTSD flare up, experiencing a psychotic episode or working through drug/alcohol withdrawal.

But it also includes less critical patients, such as those dealing with stress, anxiety and mild depression, Zapata said.

“It’s great access to mental health care that I as a civilian probably don’t have in the community,” said clinic psychiatrist Dr. Lisa Henriksen. “If I wanted to see a psychiatrist (in the community), it could take weeks or months. But here the patients can just come in … and be seen the same day. It’s pretty nice.”

“Friends in private practice are often jealous that we have a facility like IMHAC,” said fellow clinic psychiatrist Dr. Jason Burns. “The veterans are really taken care of.”

Team approach

Also making the clinic unique is its team approach: It is staffed full time with a psychologist, psychiatrist, social worker and specially trained nurses.

“When someone comes in in crisis, not just one person is there to help them; we have a whole team, and we can work together to figure out the best plan.” Dr. Lisa Henriksen, IMHAC psychiatrist

That team approach greatly benefits patients, especially those who may have complicating issues.

“When someone comes in in crisis, not just one person is there to help them; we have a whole team, and we can work together to figure out the best plan,” Henriksen said. “That’s the best part of the job.”

“Sometimes people come in and say, ‘I don’t know what to do,’” Zapata said, and that requires some exploration for the staff as they try to get to the root of the problem.

“We try to connect with the person … working collaboratively to figure out what’s going on and what they need.”

For example, a Veteran on the verge of becoming homeless may start having suicidal thoughts and may be struggling with his/medications.

In that case, the psychologist might do an initial assessment, bring in the psychiatrist regarding the medication and include the social worker to address the housing problem.

“What I love about our clinic is we really function as a team here,” social worker Sarah Flayter said. “We’re dealing with some pretty high-stress situations, and it’s wonderful to have another person … to work through these situations.

“We don’t know who’s going to walk through that door, which can be intimidating … but you’re never on your own when it comes to making decisions.”

Making a plan

Because the clinic is often a first stop for those in need, in does its fair share of referrals as the staff helps develop the best plan for the patient.

“We see people who are just getting established with mental health care,” Zapata said. “A lot of time we’re doing assessments to see what level of care a person needs.”

“One way to look at this clinic is our main focus is emergency and urgent care, but we’re also an outpatient consultation clinic. If anybody in any specialty in the hospital has a question about a mental health issue, we'll work with them.” Dr. Jason Burns, IMHAC psychiatrist

That could mean admission to the acute inpatient unit or referral to a therapist, an outpatient service or a psychiatrist.

“One way to look at this clinic is our main focus is emergency and urgent care, but we’re also an outpatient consultation clinic,” Burns said. “If anybody in any specialty in the hospital has a question about a mental health issue, we’ll work with them”

“We get lots of calls from different clinics … and work collaboratively with the social workers, doctors and nurses, trying to come up with a plan of what to do,” Zapata said. “So I think we’re valued in lots of different kinds of ways.”

That includes working with the police, she said, responding to situations where a patient may have become agitated.

In recent years, more attention has been paid to police tactics in dealing with people in mental health crisis, and Zapata praised the VA police for their ability to recognize and handle those situations.

“The police here do a lot to de-escalate things,” Zapata said. “We have a really good police force that works collaboratively with mental health, which is really nice.”

Pandemic stress

Before the COVID pandemic, the clinic saw about 15 to 20 people a day, Zapata said. Those numbers dropped at the pandemic’s height, as people were afraid to come to the hospital.

As the hospital has slowly reopened, the numbers have been rising, getting near the pre-pandemic level.

“The pandemic has been extremely stressful for people, with all the social distancing and isolation. And a lot of Veterans are struggling with the political and racial environment.” Dr. Angela Zapata, IMHAC psychologist

And those coming in are showing the stress of isolation, fear and being unable to meet with therapists and others as regularly as they did pre-pandemic.

“The pandemic has been extremely stressful for people, with all the social distancing and isolation,” Zapata said. “And a lot of Veterans are struggling with the political and racial environment.”

“We’re definitely seeing an uptick in substance use, because it’s stressful and people are isolated,” Burns said.

“It’s almost like they were waiting to come in until things got really, really bad,” Zapata said, noting that connecting via telephone or video doesn’t always fulfills patients’ needs.

“It’s been a struggle for a lot of our Veterans,” she said. “They don’t feel very connected over the phone. … We’ve had lot of people come in here in crisis because they just don’t feel like those long-distance services are as effective.”

Burn noted that pre-pandemic, the hospital was a safe, gathering place for some Veterans dealing with chronic mental illness. But once pandemic restrictions were put in place, they couldn’t get together here.

“We’ve had to kind of patch up some of those folks,” he said.

Destigmatizing mental health

As more attention has been paid in recent years to the importance of mental health, clinic staff said more Veterans are recognizing when they need help.

“Going to see a psychiatrist or psychologist is no different than going to see your primary care doctor, or endocrinologist or any other specialist. It's nothing to be ashamed of.” Dr. Lisa Henriksen, IMHAC psychiatrist

“I think that mental health services are more valued throughout the community,” Zapata said. “Mental health is starting to be viewed differently.”

“Going to see a psychiatrist or psychologist is no different than going to see your primary care doctor, or endocrinologist or any other specialist,” Henriksen said. “It’s nothing to be ashamed of.”

While many Veterans in need come to the clinic on their own, spouses, caregivers and other Veterans often are the ones to give them a push, clinic staff said.

“It’s really positive when that happens because it further destigmatizes mental health when a fellow Veterans says, ‘Hey, it’s OK to ask for help,’” Zapata said. “It takes a lot of courage to ask for help.”

Serving Veterans’ unique needs

And Veterans can take heart in knowing that clinic staff are well-versed in treating Veterans, who may have unique circumstances related to their military service.

Flayter said a Veteran who recently transferred to VA from a community-based care provider said he felt VA care was more “specialized” and looked at “the big picture.”

“He said, ‘No other community provider completely understands what we’ve been through as far as combat Veterans,’ she said.

Burns agreed.

“I think for many Vets who struggle with chronic mental illness or PTSD … this is a safe place for them where they know they will get support.” he said.

 

The Immediate Mental Health Access Clinic is open 8 a.m. to 4 p.m. weekday (except federal holidays) and is located in Room 1252 of the Milwaukee VA Medical Center (Building 111). Telephone: 414-384-2000 or 888-469-6614, ext. 45760.

On evenings, weekends and holidays, those in crisis can contact the Emergency Department at ext. 41885 or call the Nurse Advice Line at ext. 46345.

Or call the Veterans Crisis Line at 1-800-273-825, text 838255 or chat at www.VeteransCrisisLine.net.