Margie Lyons is director of Community and Behavioral Health Services at Methodist Medical Center. Prior to her career at Methodist, Lyons worked at Zeller Mental Health Center for 12 years.
She earned a bachelor’s degree in nursing and a master’s degree in psychiatric nursing from the University of Illinois. She is a co-founder of the Central Illinois Psychiatric Nurses’ Association and chairs the IHA Steering Committee for Behavioral Health Constituency.
Lyons and her husband, Everett, have three children.
Tell us about your background, schools attended, family, etc.
I’ve lived my whole life in the Peoria area. I grew up in Washington and graduated from Washington Community High School. I went to the University of Illinois in Urbana, intending to become a history professor, but then I had two young daughters, so I put my career on hold for a while. When I was ready to get back in the job market, it was the 1970s, and there was a glut of teachers. At that point, I turned to a field where I knew there would always be a demand, and that’s nursing. I didn’t want to take too much time away from my kids, and with nursing, I could complete a two-year associates program and get my career started quickly. I also knew if I couldn’t teach, I’d like to be a counselor, and psychiatric nursing offered me a way to do something similar.
I graduated in 1975 and went to work at what is now OSF Saint Francis as a registered nurse, and then went to work at Zeller. I worked there for 12 years before coming to Methodist. I chose Methodist because of our People to People program, and I wanted an opportunity for professional growth. I’ve certainly had that here.
I have been married now for 13 years. I met my husband, Everett, when we were both working at Zeller (he’s a social worker), and between us, we have three children. One of our daughters is a family practice physician in Minneapolis, married with two children of her own, and the other is a graphic designer, married with three young children. Our son is a teacher in Chicago, coaches basketball, and is a famous skateboarder.
What or who influenced you to focus on psychiatric nursing?
I’ve had many wonderful mentors over the years, but my mind was fixed on psychiatric nursing beginning back in 1972. I wanted to be a counselor, and psychiatric nursing was a way to satisfy that need. I didn’t get my bachelor of science degree in nursing until I was 42 because I built my education one class at a time while working and raising my family. Then I wanted the skills to take on more responsibility, so I went on to get my master’s degree in psychiatric nursing through the University of Illinois at Chicago/Rockford regional program. I chose to get an advanced clinical degree rather than an administrative one because I believe a clinical background offers more options in nursing. It gave me the skills to lead a highly skilled clinical team.
Does your role as an administrator affect your role as counselor/advocate?
Absolutely. As an administrator, I more clearly see the big picture and understand the barriers to access for behavioral health services. The current and historical system of access to behavioral health services is almost like an obstacle course people have to overcome to get care. I also understand the financial and legal barriers that affect providers and patients.
How has treatment for the mentally ill changed in the last decade?
Actually, the first atypical anti-psychotic medication was introduced about 15 years ago, and that really began a significant improvement in treatment options. Many other anti-psychotic medications have been developed since then, as well as new medications that treat depression and anxiety. These new medications have dramatically improved outcomes for many mental illnesses and have enabled people to lead fuller lives—and also participate in their treatment. Community-based treatment is now much more of an option, and hospitalizations have decreased in frequency and length.
New medications called selective serotonin-reuptake inhibitors (SSRIs), which include Prozac, Zoloft, etc., have helped people with marginal dysfunction to experience happiness—sometimes for the first time in their life. In fact, these are now some of the most prescribed medications in America. The new medications have fewer negative side effects and fewer “flattening” symptoms. However, even now, some drugs have pretty severe side effects, so physicians and psychiatric nurses still have to be pharmacology experts.
There’s a great deal of anxiety and dysfunction in modern life, complicated by the fact that people’s expectations are that they should be happy. With the new medications, patients can now participate in planning for their own recovery and extend their possibilities for a full, independent life. It’s still important to receive counseling along with medications. Most people will find a deeper and more lasting benefit from a combination of counseling and medications. Cognitive behavior therapies have been around for longer than a decade, but they’re increasingly being used by counselors to assist patients in changing self-harming habits of thought and behavior.
What’s the current philosophy of treating the mentally ill today?
There isn’t a consensus. There are trends, such as going to a recovery model using evidence-based practices. Not everyone does that, but that’s the way we’re heading. But psychiatry has been hampered by a lack of uniformity. There are many reasons for this—one of which is the impact Freudian methods had on American psychiatry and the impact felt when these methods fell out of vogue.
How is Methodist Medical Center meeting the needs of the mentally ill in central Illinois?
From 1965 to 1994 we only offered inpatient care, but since 1994 we diversified to offer care in a variety of settings. We have inpatient care, but also outpatient treatment, home-based care, and partial hospitalization. We look for gaps in care that we can fill, rather than competing with other local entities, and we work to build relationships with other entities—such as Tazwood Human Service Center, the Children’s Home, and the Peoria Human Service Center—so there’s a more coordinated system of care.
We treat all ages and all diagnoses at Methodist. We’ve added children and adolescent services, and we’re serving a higher number of geriatric patients. We don’t treat dementia per se, but we do treat depression, anxiety, and agitation that can accompany dementia. We offer family educational and support meetings and try to assist nursing homes and the patients’ families in dealing with these problems more effectively.
How has the closure of Zeller Mental Health Center affected Methodist? How are you handling the increased demands on your services?
The closing of Zeller in the wake of Pekin Hospital and OSF Saint Francis closing their psychiatric units has had a significant effect on Methodist. As we’re now the only inpatient service provider for a large geographical area, access has sometimes been an issue. For example, patients come to our Emergency Department, and we don’t always have a bed readily available. So far we have always been able to find one and accommodate the needs of our patients, but it hasn’t been easy. To date, we’ve had to transfer nine or 10 patients to a state-operated facility, and 22 patients have been transferred to hospitals in other cities because we didn’t have room. Once we complete our expansion, that won’t be a problem.
But we’re handling the situation. We now have master’s-prepared clinicians in our Emergency Department 24 hours a day, seven days a week. They meet with every mentally ill patient who comes in and assist the ED team in planning for appropriate treatment—inpatient or outpatient.
On the plus side, the closing of Zeller has drawn attention to the needs of the mentally ill in our community. The misconception that people had was patients went to Zeller and lived there the rest of their lives. This, of course, is far from the truth. Almost all of the patients served at Zeller received only episodic care and were—and continue to be—living in our communities. With all of the media attention, some people are thinking about services for the mentally ill for the first time, and that’s a good thing.
How will the state grant to increase the number of psychiatric beds at Methodist help staff? How will it benefit central Illinois patients?
The grant will allow us to build 25 beds in an aesthetically pleasing, safe, behavioral health unit in a not-for-profit hospital that’s mission-driven and values-based, and where staff have the patients’ best interest at heart. Ours will be one of the only units of its kind in the state, with similar admission criteria as state facilities, but a shorter length of stay. And of course we’ll have to hire more staff.
Central Illinois patients will benefit because as a private hospital, our treatment goals have always included brief hospitalizations. Working closely with community agencies, we’ll quickly develop discharge plans that will shorten hospitalizations and decrease the need for re-hospitalizations.
Of course some people will continue to need very long-term care, which we will probably not be able to provide. And there will still be a state-operated hospital as a safety net for those individuals; it just won’t be in Peoria. Sometimes we forget Zeller served a 23-county area, so it may have been very convenient for people in the tri-county area, but not for many of those other counties served.
What, if any, are the trends you’re seeing in central Illinois in regards to demographics?
It’s definitely becoming more acceptable to receive care. People today are more likely to get treatment and to get it sooner. In that sense, I think we’ve turned a corner in demystifying mental illness.
Every time someone goes public about their own problem, it makes it that much more acceptable. In 1999, I was diagnosed with an anxiety disorder which was affecting my ability to sleep. I find that when I talk about it openly, it encourages other people to come forward, to admit they have a problem, and to seek help for it. And early and compliant treatment with medication is often the key to successful outcomes.
How important are genetics and environment to the diagnosis of mental illness?
They go hand in hand. Genetics have been shown to be extremely significant in many of the major mental illnesses, but environment plays a part as well.
We don’t know what causes schizophrenia and bipolar disorder, but the first psychotic episodes usually appear in the teens or early adulthood. We do know it’s not caused by lifestyle or weakness of character. If we could identify people at risk of developing a major mental illness (through technology) it’s possible we could intervene to prevent the illness from occurring or decrease its severity. Technology for this type of identification is definitely in our future, but it’s some years out. People often assume drugs and alcohol cause mental illness. Sometimes individuals abuse drugs and alcohol as a way of coping with what’s going on in their minds, but there’s no indication drugs and alcohol cause mental illness.
What factors differentiate depression from mental illness?
Clinical depression is a form of mental illness, but not all depression is clinical depression. All of us experience what we call “situational depression” that can be caused by something going on in your life. In severe cases it can be helped by medication or by a combination of talk therapy and medication. Clinical depression, on the other hand, comes on without warning. A diagnosis of clinical depression requires a number of indicators to be present over a period of time and it has to affect your ability to function. It’s important to know that depression, regardless of its cause, responds to treatment. If someone is experiencing depression that’s interfering with their ability to function, they should talk with their physician.
To what do you attribute the rise in depression in young people today? The rise in ADHD?
It’s hard to say if there are more emotional difficulties in children today or not. Contrary to what many people assume, statistics show there hasn’t been an increase in adolescent suicides or school shootings. I’m not sure more people are depressed today so much as our society no longer accepts “feeling bad.” More people are aware of emotional problems and seek help for their children. I do think there’s a level of stress that’s increasing in our society. Some of this stress is the result of an expectation that happiness is the norm. It goes back to Maslow’s hierarchy of needs. People used to be more concerned with food, shelter, and security. Now we’re at the top of the pyramid and everyone is seeking self-actualization. It’s normal to have difficulties in your life, and it’s normal to feel very badly about your life from time to time. Not to have difficulties or negative feelings would definitely not be normal.
As far as ADHD goes, some studies point to physical changes in the brain, but there’s no research I’m aware of that defines these changes as the cause of ADHD. What we’ve seen is a rise in the diagnosis of ADHD. In part it’s because some of the behaviors that characterize ADHD used to be accepted as a continuum of normal. We’re also saving more premature infants and there’s a correlation between premature birth and ADHD. And frankly there’s been some mislabeling of naturally rambunctious children as ADHD, as well as misdiagnosis of children who actually have other problems. At Methodist’s Center for ADHD & Related Conditions, we frequently receive patients who have been treated elsewhere without success. We investigate and find there are other things in play.
I also believe in some ways, parenting in America has lost its way. I think too many parents are less interested in helping their children develop character, and instead just want to make their children happy. Part of this might stem from parents who are so stretched for time that they want to enjoy the time they have with their children rather than spoiling the time being disciplinarians.
How are the treatment needs of young people different than adults?
Young people are struggling with developmental issues adults don’t have—issues like trying to assert their independence, breaking up with a girlfriend or boyfriend, etc. They may not have a mental illness per se, but instead may be overreacting to a life stressor. With young people, it’s important for the whole family to be involved in the treatment. We work with the parents, as well as with the child, and try to teach both parent and child how to set limits, identify triggers, and develop better forms of communication.
Adults, on the other hand, may not want family involved at all. We concentrate more on the individual. We also don’t get into behavioral modification with adults the way we do with children and adolescents. TPW