Psychiatrist Helped Iowa Underserved Celebrate Hope and Self-Reliance

Psychiatrist Monte Bernhagen, M.D., saw a real need to help the residents of Pella, Iowa, overcome the “stigma” of acknowledging and being treated for mental illness. Some people in the conservative community in the south central part of the state “believe that mental illness is the result of sin, or if you’re depressed you must not have enough faith,” explains Bernhagen, an NHSC alumnus who worked 4 years at Pine Rest Christian Mental Health Services in Pella.

To counter some of those attitudes, Bernhagen and his wife set up a patient and family support group called “Celebrate Hope” to bring such issues out in the open. The response was overwhelming. The first weekly meeting drew over 250 people to hear and ask questions of a panel of mental health experts, including Bernhagen.

The group continued to meet, initially led by Bernhagen, and then by his wife and another therapist from Pine Rest. The emphasis, however, was to let the patients lead and support each other, he explains. “Celebrate Hope” continues meeting to this day, a legacy that Bernhagen finds very gratifying.

Bernhagen also got involved in speaking to community groups in Pella, including the local chapter of the National Alliance for the Mentally Ill (NAMI), an advocacy group organized and led by patients. “I just tried to eliminate some of the stigma that’s associated with mental health,” he notes.

Bernhagen came to medical school a little late. He completed his undergraduate degree at Dana College in Blair, Nebraska, but wasn’t able to get into medical school right away. Instead, he spent 7 years working in the construction business in Omaha, where he had grown up. But he didn’t give up on his medical career ambitions. He eventually reapplied, and was accepted at the University of Nebraska College of Medicine in 1991.

“I think it was good that I had that sabbatical after college because it changed me in a lot of ways,” Bernhagen says. “Just through my life experiences, it made me a little more compassionate towards people.”

His determination was challenged even further during his first year in med school when his wife gave birth to triplets, who were born 10 weeks premature. The incredible medical expenses, on top of his student loans, posed an almost insurmountable obstacle to the young family. “That wiped us out financially,” he recalls. It was also the first time he’d ever felt the need to seek counseling, himself, to deal with the tremendous stress. “It was an eye-opener for me,” he notes.

“Coming out of medical school, I had the biggest loans of anyone ever,” Bernhagen comments ruefully. “Loan repayment became very crucial for me.” When he initially responded to the opening at Pine Rest, the clinic hadn’t applied for NHSC approval. In typical fashion, Bernhagen took the initiative, providing the clinic with NHSC contact information, and urging them to follow up. They responded quickly, were able to apply, and received NHSC approval for the clinic within a few weeks. That enabled him to come on board in 1999 and apply successfully for NHSC’s Loan Repayment Program. He advises clinicians—who are considering the NHSC—that “if you’re interested in an underserved site, and it’s not currently an approved location, do the groundwork and it can become one.”

Bernhagen says it was a tremendous move for him and his family to come to Pella. “We fit in real quickly and became members of the community.”

Economic woes in the community also increased the need for Bernhagen’s services. In addition to farming, the community has been dependent on two major manufacturing companies: Pella Windows and Vermeer, a maker of agricultural and construction equipment. Vermeer was badly hurt by the economic downturn in recent years, he says. The plant went from 5,000 employees to 1,500, devastating the local economy.

He was the only full-time psychiatrist on staff at Pine Rest, which included two psychologists and six therapists. Bernhagen saw between 20-36 patients a day, which was a heavy load to sustain. He says that about 10 percent of his patient load was directly related to the area’s economic problems.

During his years at Pine Rest, the mental health clinic also struggled with increasing pressures from managed care insurers, which sharply curtailed its ability to provide needed care, especially referrals to inpatient facilities. As a result, he found that his patients’ problems tended to become more chronic “because there are just less services out there.” Bernhagen attempted to intervene on behalf of his patients with the insurance companies, in one case informing an insurer that they could be liable if his adolescent patient carried out her suicide threats. “That got her one day in the hospital,” he says, still frustrated by that and similar experiences.

On the lighter side, Bernhagen had to deal with the facts of small town life, such as always running into his patients as he moved about in the community. Prior to coming to Pella (population 10,000), “I never saw my patients outside of the clinic or bumped into them in the street,” he explains. “In a small town, you see your patients everywhere you go.”

Bernhagen learned to ask each of his patients privately how they preferred that he respond during such public encounters. Some wanted him to acknowledge their relationship, while others were adamant that they appear to be strangers to each other. Even so, with his large patient base, it was sometimes difficult to remember individual preferences. “Balancing all that is a challenge but also a lot of fun,” he adds.

He genuinely enjoyed most of his patient relationships and the feeling was mutual. “For many people, coming to their doctor is the highlight of their week or month,” Bernhagen explains. “They usually have a lot to say and I learned a lot from my patients listening to their life experiences and how they deal with their problems.”

Teaching medical students and residents was another opportunity Bernhagen cultivated at Pine Rest. He established an affiliation with the Des Moines University College of Osteopathic Medicine and Surgery, as well as the University of Iowa College of Medicine. “I had medical students, residents and physician assistants coming to Pine Rest from both schools, which is something I really enjoyed,” he recalls. He urges other rural-based clinicians, who are interested in teaching, to take advantage of academic institutions’ interest in providing such learning opportunities for their students. “You can incorporate teaching into your career without necessarily being involved in the academic world,” he says.

Bernhagen recently joined the Veterans Administration Medical Center in Knoxville, Tennessee. Although he relishes the opportunities in his new position, Bernhagen still looks back fondly on his time and experiences helping Pella’s underserved receive the attention and care they deserved. “I loved working at Pine Rest,” he says.