This week, I sat down with Dr. Martin Buxton, chief of psychiatry and medical director of child & adolescent program at Chippenham Hospital’s Tucker Pavilion. The Pavilion is our 137 bed psychiatric hospital embedded within the Chippenham campus serving inpatient and outpatient patients as young 5 years old all the way through geriatrics adult services. Dr. Buxton and his psychiatric partners at Insight Physicians have been instrumental in leading the clinical services in the area of behavioral health in the Richmond market.
Tim: How long have you been at Chippenham Hospital’s Tucker Pavilion?
Dr. Buxton: I have worked at Chippenham for 20 years and been a child psychiatrist for almost 40. I came to Chippenham because they had an adolescent (13-17 years old) inpatient program and they wanted to expand it to child (5-12 years old).
Tim: Recently, there has been concern raised around behavioral health services both regionally and nationally. What is driving that change?
Dr. Buxton: The spotlight has been both positive and negative. Today, there is greater awareness of mental health wellness. Unfortunately, we often hear sound bites of both the problems and the answers and they don’t tell the whole truth of the story. With that being said, the number of high acuity complex cases has increased. I think in the past mental health issues were more hidden and not as broadly discussed or treated.
Tim: There has been a lot of public discussion about the increased use of psychiatric medication in both children and adults. Some people believe psychiatrist are pushing medications and not getting at the root of the issue. What is your take on the issue?
Dr. Buxton: The scientific evidence supports the increased use of medication in the population. Today we have better medications available than before. However, we still don’t have the quality of medications we need. The efficacy is very good but the significant side effects and tolerability still remains a challenge. On a positive note, we are able to use dual agent drugs that can impact multiple neurotransmitters. In effect this allows us the capability of dealing with multiple parts of the brain at one time with one medicine. There is some truth to the perception about the frequency of prescription writing in the field. However, part of what drives that perception is there are more non-physician therapist so the practicality of the need in the community has forced psychiatrist to write prescriptions and not to focus only on therapy.
Tim: Tucker Pavilion recently opened a state-of-the-art $5M Child and Adolescent unit and are about to open an intensive outpatient facility to serve children with acute mental health needs. Why was this important?
Dr. Buxton: We know there is an unmet need for children to stabilize acute psychiatric emergencies. By expanding the beds and constructing it in a way to meet the varied needs of the population we are able to have a greater impact in a setting that supports the latest evidence based treatment.
Tim: Your son Dr. David Buxton is joining your group, Insight Physicians, as a child and adolescent doctor in September. Tell me about that.
Dr. Buxton: It is more complex than I thought it would be. I am not just his father, I am a colleague. I always envisioned him becoming a physician and psychiatrist but I didn’t know he would join me. It expands our personal relationship and allows us come to understand each other better. At the same time, we have to see each other as colleagues and not father and son, it is an adjustment and needs to be no different from any other psychiatrist on staff.
Tim: We often talk about partnerships as being the key to the success. What your take on the CJW-Insight Physician partnership?
Dr. Buxton: It is a win-win. We are devoted to providing inpatient and outpatient psychiatric care and HCA is a system that has recognized the need for behavioral health outreach. Our goals are aligned. The open and collaborative dialogue has allowed us to improve together.
Tim: What keeps you up at night?
Dr. Buxton: Challenging patients keep me up many nights. I think about what I need to do to help specific patients get better. I often question whether I have run out of options. I feel like there are high expectations of my skills and abilities in the community and that can be a lot to live up to. I do better when people have never heard of me without expectations. I put additional pressure on myself to help when I hear from families that I am the last resort.
Tim: What is the biggest misconception about psychiatry?
Dr. Buxton: People often have a lack of understanding about behavioral health. Mental wellness isn’t usually a simple black or white issue but rather somewhere on a spectrum. What makes people healthier is understanding their particular challenges and customizing the care. Patient can’t operate under the notion that they don’t have any mental health issues. The reality is everyone has some degree of mental health challenges. The question is how incapacitated are they and how much do they want to expand themselves. There has historically been a lot of prejudice against mental health patients because people assume they aren’t affected. The opportunity for us is to gently educate the public that being healthy is like walking up a down escalator. If you don’t work at it you will continue to drift downward towards poor mental health.
Tim: I have been in your office and there is no couch to lie down on. Is that only in the movies?
Dr. Buxton: (laughs) I was psychoanalytically trained early in my career. At the time they used a couch. I have a small sofa in my office and sometimes patient arrive and wonder if they should lie down. I have to tell them we aren’t doing that kind of therapy. That is one helpful technique but it isn’t for everyone.
Tim: What is your vision and hope for Tucker in 10 years?
Dr. Buxton: To be the premier mental health site in Virginia and beyond. We have an extraordinary opportunity that is unmatched. With our recent expansion into outpatient care at Tucker we can do more than ever. There are very few sites with our current abilities and our future potential. I have had the opportunity to practice at nationally recognized elite psychiatric centers like Yale, University of Michigan, Medical College of Ohio, and NJ Medical School and have never seen as such a caring, competent staff with an eagerness to learn and stay updated and to try new innovative treatments.