Dr. Patricia Wold, 56 years of service in psychiatry

Contributed by Ed Allard, FHR Communications Representative

Dr. Patricia Wold, M.D.

This past September, after 16 years of distinguished service, Patricia Wold, M.D. concluded her work with Fellowship Health Resources. Throughout her years of service, Dr. Wold never wavered from her focus on the client as an individual. A tireless consulting psychiatrist for Fellowship consumers, she never lost sight of the unique potential for each individual to recover.

Graduating from medical school in 1952, Dr. Wold began a rotating internship, which led to a permanent position at the Massachusetts Mental Health Center. She later began a private practice in Providence, Rhode Island.  When asked why she chose the field of psychiatry, she pointed to “an interest in psychology and what made people do what they did.” Among the first to prescribe Thorazine, an antipsychotic drug of low-potency used to treat schizophrenia, Dr. Wold remarked that, with this treatment, “many patients who had been diagnosed psychotic for years came back to themselves and were able to go home as a result of it.”

Ed Allard, FHR Communications Representative in the Administration office, had the opportunity to interview Dr. Wold earlier this spring. “As a previous patient of hers, I was curious about the challenges and rewards she’d found throughout her over five-decade career in psychiatry.” He continued, “I also felt certain that our readers would find her insights on mental health care, and on society’s perception of mental illness, to be valuable.”

Always humble, Dr. Wold praised the individual’s ability to take control of their recovery process. Her goal has always been “to assist people in achieving their goals and coming to themselves.” She continued, “The challenge for me has been watching people who are not able to make use of their treatment plans. I’ve had a couple of cases when I thought, ‘boy, whatever I did, it wasn’t enough.’ However, there are times, years later, that I heard from those same individuals and learned that they had gotten something out of it…it had been more useful than it had seemed. It’s so rewarding when that happens.”

Over her decades of service, Dr. Wold has witnessed many milestones in the mental health care system. The John D. and Catherine T. MacArthur Foundation notes that “advances in service delivery, including evidence-based practices such as partial hospitalization, supportive housing, and supported employment have helped people, even with serious mental illness, to live, work, and participate in their communities.”

Other changes over the years include the elimination of treatments that were ineffective and harmful. Recent innovations in treatment have made it much easier for doctors to prescribe, and patients to adhere to, treatments involving psychotropic medications. “There is a lot of new evidence that mental illness is a brain disorder,” Dr. Wold explained. “Mental illness is treatable,” she continued, “although it is still a struggle for many people who feel that, in order to be normal, they have to not be taking pills. And that, in turn, is a struggle for mental health service providers.”
While many changes have improved the overall quality of life for those in recovery, Dr. Wold was quick to comment that these changes were “probably not enough.” She expressed frustration with a “system” that encourages individuals not to work. Under current regulations, a person on a disability pension for a mental illness stands to lose both the pension and their health insurance if their earnings and/or assets go above certain restrictive limits. The sudden loss of a pension and the cessation of Medicaid (the primary health insurance for people on disability), can make it nearly impossible for people to continue in recovery.

“These regulations make it very difficult for people to work,” Dr. Wold explained. “The whole idea of OSO is to encourage employment, but when people get to a point where they are employable, there are all kinds of problems with the insurance and the basic grant is threatened. They then have the great privilege of buying into Medicare for $500 a month,” she continued with sarcasm. “Well, who has that to spend?” Every six months there is a reevaluation of Medicaid eligibility. At that time, the system can deny benefits to an individual receiving care until he/she supplies qualifying evidence. “That’s just inane!” Dr. Wold exclaimed. “And then it can take months to get benefits back. This kind of thing should just absolutely not happen.”

When asked about health care reform, Dr. Wold expressed feelings that the present state of mental health insurance is “obscene.” Recent statutes, the Patient Protection and Affordable Care Act (PPACA), along with the Health Care and Education Reconciliation Act, will require people to have health insurance, or pay a penalty of $700. This fine becomes effective in 2014. The thought is that the state would then be responsible for penalty fees if they precipitously remove someone from the Medicaid rolls. Furthermore, people with low incomes will become eligible for a subsidy to pay for health insurance should they migrate off Medicaid when earnings exceed Medicaid limits. As long as this insurance is acceptable to the mental health provider, the individual would be able to continue in treatment with less difficulty. “I don’t know what this new health bill is ultimately going to do,” Dr. Wold said. “Maybe if you’re always required to have insurance, the state will suddenly find that they might save some money if they stop taking people off of it.”

As to what is most helpful to people with mental illness, Dr. Wold focused on families and family-like scenarios. “People who have families that stand by them are blessed,” she began. “However, when you don’t have a family that is able to function in that way, individuals need the ability to make a substitute support system. This is where organizations such as Fellowship Health Resources, and programs like OSO, are so necessary,” she explained. “These are their homes, their family, and their lifelines.”