Local Lens Interview with Alex Pullen

J: Hi, welcome to Local Lens. I’m Jenni Pastusak. A nonprofit organization here in Wicomico County that provides critical services to our community is celebrating 45 years in existence. Joining me today to talk about Hudson Behavioral Health is the marketing and community outreach director, Alex Pullen.

Alex, I think that people have probably heard about Hudson Behavioral Health, but they don’t really know exactly what you do. So, can we talk a little bit about the organization? I know you’re celebrating an anniversary, but in the years that you’ve existed, what is your mission?

A: Our mission is to enrich the mind, body, and spirit by providing evidence-based clinical care and recovery support services. A lot of the programs that we implement are kind of unique in that we like to use you know music, we like to use different types of somatic therapy to get them moving and kind of healing the whole person instead of something specific with just substance treatment or or mental health. We started in in 1980 at the same campus that we’re at now right over on the Deer’s Head property.

So like you said, the anniversary is our 45th anniversary this year. As a small nonprofit, well, I don’t even know if we can consider ourselves small anymore – we’re growing a lot. So, we have about 120 employees now spread out through Salsbury and through Delaware. So, we started out with just eight beds for alcoholic men. Back then they were coming in in their suits and ties and briefcases and everything. So, it was very different. So, it’s changed throughout the years with different drugs – back then it was pretty much all alcohol and then it turned into you know, a lot of cocaine and everything through the 90s and now it’s, you know, opiates and now they’re mixing tranquilizers and fentanyl.

J: And these aren’t just men in suits. These are all different types of people.

A: It’s changed, you know, pretty dramatically. Most of the population that we serve around here is Medicaid. So it’s poverty level, a lot of homeless population. These people aren’t wearing suits anymore. A lot of them, come in with pretty much nothing.

J: They just need help functioning at life, and they have to heal to get there.

A: And life skills is a big thing that we really try to push for. Lots of people that come in have never had a bed of their own to sleep in. You know, they have a bed when they come here. So, they don’t know how to make a bed. They don’t know how to do a lot of things that somebody like me and you would probably take for granted. Some of them haven’t eaten. A lot of them don’t take care of the other things that are kind of secondary to their substance use. A lot of them have underlying medical conditions, whether that’s diabetes, high blood pressure, anything like that. And a lot of them are not on medications. And if they are, they may take it for a little while and then they just kind of stop taking them.

So, that’s one thing that we really are proud of is that we have integrated primary care. We have our doctor who’s on staff that comes in on the evenings and he meets with the person the very first day that they get in there. He’ll find out if they do have any underlying medical things going on. He’ll start them back on medication. He’ll get them started on medication if they haven’t already.

J: And full well knowing that some of these people struggle with addiction problems. So that medication may look different. I don’t know. Yeah. But it’s really looking at the whole person.

A: Exactly. Exactly. So, like I said, part of our mission is is to heal holistically and we definitely want to take care of every problem that they have while they’re there, whether that’s their medical, their social needs, obviously their addiction. We provide mental health. So that’s one thing that we’ve kind of stepped up over the last few years is just providing more mental health treatment too while they’re there. Mental health is so much more prevalent now that we’re kind of pushed in that direction.

J: And I think too I I mean I am not an expert by any sense the word, but I think that you know the addiction may have stemmed from mental health that stemmed from something else. What’s the root of the problem? You know, it might not be cocaine. It’s this over here.

A: Yeah. I don’t think that anybody really just will start using, you know, something that could easily kill them just for no reason. You know, pretty much everybody has some pretty deep rooted trauma. What that trauma is from, that’s for us to kind of do the digging, our clinicians and therapists. But I would say pretty much everybody has something deep rooted that’s causing that.

J: That’s why we need the mental health piece. So yeah, Hudson Behavioral Health is not just you know, oh we take in homeless you’re treating them medically, mentally, so that’s the difference I think between Hudson and maybe some other facilities out there.

A: Yeah. So our big goal is just to try to break down all the barriers that people face with getting treatment. One of the big ones especially around here is transportation. We have a lot of rural areas. In those rural areas there’s not many resources out there. So we have a full driving staff that that can transport, but when maybe somebody comes in late at night that a driver’s off we utilize Uber Health as well which has been a great resource for us.

 So, we’ve even implemented something where if somebody is on methadone, which is, you know, a controlled substance, so it gets a little tricky with transporting and everything. But one thing that we’ve done is we have created a vehicle where we have a lock box that is bolted into the vehicle that will transport their methodone with the patient and bring them onto our campus to get treatment.

J: That I mean, think about that’s a solution. And like you said, break down the barriers right there. You just did that, correct?

A: Yeah. So, what we used to have to do is this thing called guest dosing, which was their clinic, if they were in Baltimore, we would have to get their clinic to basically send over paperwork to a local methadone facility. But a lot of times it just wouldn’t work because we were having to rely on the patient telling the information to their home clinic to get them to send the paperwork to a local clinic and there’s just so much room for miscommunication. Plus, you know, we have a very limited time for somebody to agree to come to treatment. A lot of times it’s flash in the pan. They, you know, are ready to come to treatment and then you call them back five minutes later and they’re gone. So waiting a day or two to work on getting that set up a lot of times we would lose them.

J: That is very interesting to me. I think that, you know, people may not even realize that it’s precious time that once they commit, get them in as quickly as possible.

A: And that’s been that’s been the blessing with Uber Health as well. We don’t have to wait to send one of our drivers to Baltimore, you know, two hours up and then bring them two hours back. The Ubers that we set up are already in Baltimore. So, if we set it up, we can get a driver there within 10 or 15 minutes.

J: So, once they make the commitment, what does that look like?

A: So, if they’re referring themselves, we have a screening form that is literally just a page front and back and they can fill that out on our website. They could call into our admissions team and we can fill it out with them. But we we basically just run their insurance and we make sure that, you know, we’re the appropriate level of care for them. We’ve expanded our hours as well. So, we used to just do Monday through Friday, 8:00 to 4:00 p.m. You know, if somebody called us at 8:00, we can’t tell them, “Come in tomorrow.” No, we’re never going to see him tomorrow. And I think maybe years ago that may have worked, but not anymore. So we do 24/7 admissions now. and that’s all part of harm reduction. And I think that’s the route that substance use treatment is kind of moving towards is more harm reduction instead of kind of pushing specific treatments.

So, harm reduction can mean a whole bunch of different things. So, transportation is harm reduction. You know, providing transport for their methodone, expanding our access hours, just getting somebody’s foot in the door, maybe not physically, but even, you know, just having a contact with them and building that rapport with them where they feel comfortable reaching back out to us when they are ready to come to treatment

J: Because otherwise they would never step foot in the door. You have to make it really easy.

A: And nobody is really just like jumping out of bed one day and excited to come into treatment. You know, sometimes they need a little bit of external motivation or whatever it may be. And I think for a long time if somebody came in for a day or two and then they left against medical advice, they were kind of almost judged a little, shunned a little bit. We obviously want people to stay in treatment so they can, you know, heal. But I think with the harm reduction approach now, if they’ve stayed two days, it’s better that they’ve spent two days getting medical care and being monitored instead of out on the streets using for those two days. And it’s a step in the right direction.

J: So people literally have to detox when they enter, when they commit, right?

A: Yea. If they’re using something that their body will physically detox from then yeah we’re going to give them comfort meds and we have detox protocols for all of that. Sometimes they come in using things that they don’t physically withdraw from like you know marijuana, cocaine, something like that. They obviously wouldn’t detox.

J: That’s part of the process though if if that’s what you have to go through. You know you’re thinking that’s maybe the hardest part.

A: Yeah. And a lot of times it is for them. I mean you know the first couple days of detox is rough physically on a lot of people but you have the support. We have 247 nursing staff. Like I said, our doctor comes in every evening and we just try to keep them as comfortable as possible. And a lot of times if they can kind of get through those first few days, usually they’re different people after that. And that’s usually the hardest time for them and for us to keep them in treatment because that’s the time that they want to go. You know, they feel terrible, right? They’re not, you know, they’re not in the right mental state yet. They’re wanting to go. So that’s where we really try with our clinicians and our peer support to, you know, talk to them and keep them motivated and, you know, we try to just get them to take it a day at a time.

J: It sounds like to me too there’s a dignity piece here that through this support it is, you know, you’re worth this. So, you know, stay the track and keep going, so dignity is important.

A: Dignity is very important. Especially with the homeless population. You know, a lot of them haven’t had a shower in a while. They haven’t had a hot meal in a while. You never know what situation they’re coming from. So, when they come to us, we offer them a shower. We’ll clean their clothes. We get them food as soon as they get into our admissions department. If they don’t have any clothes with them, we have an entire clothing closet in one of our buildings that they kind of have the pick of the litter that they can choose from. And if we don’t have their size or something that they specifically need, we’ll go out and get it. And that’s one of the things that that we’re proud of that we always put on our annual report is that, you know, I believe last year we spent around $25,000 on providing clothing and things for patients. So that’s something that’s very important to us. Just restoring dignity and making them feel absolutely like they’re human.

J: That’s risk reduction too, isn’t it?

A:  Absolutely. Protecting them, you know, giving them, you know, basic necessities is absolutely crucial to getting them on the right path to a better life.

J: So you are celebrating this anniversary, 45 years. That’s big. And look at the growth. Obviously, you’ve talked about that. What do you have planned? Anything you want to talk about that Hudson Behavioral Health has planned for the future?

A: Sure. So like I said we started out with eight beds in 1980. So right now that campus that they started on has 51 beds. So we’ve expanded that much just in that one location. But we also offer pretty much a full continuum of care. So we have our campus is where most most people start. So that’s where we offer detox and you know higher levels of care, residential care. So people stay typically 30 to 60 days in that program. Our program is very unique as far as the physical setting, we’re kind of secluded in the woods, we utilize a lot of the outdoor space. There’s a walking trail that goes along. And that’s why we get a lot of referrals from, you know, Wilmington. We get them from Baltimore. People need a change of pace and they love it when they come down here. Like I said, we have we have a walking trail that goes along Johnson Lake that they can walk through. Basketball courts, volleyball courts, cornhole boards, horseshoe pits.

They do a lot of group sessions outside when the weather’s nice. We do barbecues outside. We love embracing nature and that’s part of the whole therapeutic approach with you know healing mind, body and spirit as well. So once they complete that program we have aftercare specialists that will find them placement. So, our levels of care that we have that they can step down to is our 3.1 housing. So, that’s still a residential or inpatient level of care, but it’s just in a housing setting. So, we have six of those houses here in Salisbury. There’s 59 beds throughout those, they can stay for up to a year in those houses and it’s completely covered by Maryland Medicaid.

So while they’re in those houses, the first month or so is their blackout period. What that really means is that they can’t leave the house unsupervised. They’re not allowed to work yet and they can’t have their car there. But once they’ve settled in and they’re ready to go into that next phase, we expect them to either be actively searching for a job or secure employment. So, the great thing is that there’s no rent that they pay. So, the money that they make is saving up towards their future. But they get everything still in house. So, there’s a counselor in the house, there’s case management, there’s 24/7 oversight. Okay. So, they’re still fully supported while they’re there. And we help them with any type of case management needs. So, there’s case managers in the house that will help them with, you know, if they have legal issues, we take them to, you know, any type of court. We’ll take them to primary care appointments. If they have any specialty care, we’ll take them to that. We’ll also help them with permanent housing as well.

J: So, this is full service.

A: Yeah, absolutely. And then as far as the mental health piece of that goes, we have our outpatient mental health clinic. That is our newest program, we just opened that. It’s right over on South Boulevard across from Halo, right next to Crazy Louie’s. So what we do there is primary mental health therapy. So it’s, you know, it’s speaking with a therapist. So we have our psychiatric nurse practitioner there. We have you know, we have a full staff of therapists as well. A lot of the clients that are in that program are from our housing program. So they take care of the mental health side to it, where the counselors in the houses take care of more the substance use aspect of it.

J: That is a  full-on continuum of care. It is because you’re still providing everything while they’re out in the world.

A: Absolutely. Yep. and somebody can go from, you know, our residential program down to our housing and then once they complete that housing, they can stick with our therapy. So, you know, you’re talking about a year and a half to two years of continued care and with the outpatient mental health, they can stay really as long as they need to. So we tried to expand that access to them just so they have continued support and you know studies have shown that the longer they have support and that they can stay in treatment the better the success outcomes are.

J: That makes so much sense to me. It’s not like okay you’re done congratulations bye and you shut the door and good luck. It doesn’t work that way. Because they could literally walk back out into the environment they came from. So just give them every reason not to do that and the success is going to be greater.

A: Absolutely. Yeah. And there’s a lot of studies show that people take six seven tries a lot of times on average just to you know have longer periods of sobriety resilience. And that’s another thing. You know people can’t be stigmatized because they fail. They’re going to fail and that’s part of recovery.

J: Do you have folks that have moved on and come back and said, “Thank you.”

A: Absolutely. A lot of our staff is in recovery. We love to hire people that are in recovery. We hire people that have come through our program. And one of our initiatives for the future is to restart our alumni program. Before COVID, we had a pretty thriving alumni program. So, we always did our alumni picnic that we had every year, kind of fizzled out around COVID. We’re really trying to build that up again and continue with support with our alumni and get them connected. So, you know, if somebody’s struggling, they can speak to our alumni and, you know, get them in heading in the right direction because they know what you’re going through in a sense.

J: This is a silly question, but do you throw an event for your anniversary to say, “Hey, everyone, look at what we’re doing.”

A: Yeah. So, right now the event that we’re doing in September is, we’re bringing in just our local government officials, our local partners, throwing it for our staff as well. We would love to do something for the public as well, we would love to have something for the community and that’s one of our initiatives too with the outpatient being where it is you know across from Halo. We’re looking to have kind of recurring community events at our outpatient where we can have cookouts and different things that we can do for that population that’s around there.

J: And build awareness for the surrounding population that could need your services, but also for the greater community too, to understand all that you do and how good it is for our community. Because the success stories and the recoveries that are happening, that’s amazing.

A: Yeah, absolutely. So the future is we’re going to continue to grow. We look at the trends of where everything’s going, whether that’s with the government or with trends that we see locally, and we try to adapt based off of that info that we get. One of the things that we’re seeing now is more need for medical care. We’re seeing extremely physically compromised people coming into treatment. So, you know, getting them wrapped up with a full continuum of medical care is important to us, too. We’re always looking into options of expanding the medical aspect. We’ve seen a lot more wounds as well, so that’s one thing that we’re trying to work on.

J: I’m in chronic pain, let’s say I start narcotics, I become addicted. So I started by being in pain and because I didn’t want to be in pain anymore. And as you know, maybe an addict who’s now really in some physical pain. Yeah. It’s almost like they don’t want to stop because they’re just in so much pain. So getting them that medical attention is going to attend to those needs.

A: Yeah. And we offer medication assisted treatment as well. So that’s all part of harm reduction as well. Methadone’s part of it, we can do Suboxone, Sublade, we do injectables as well. So the injectables are beneficial in that you don’t have to worry about them actually taking the dose, you can do a month injection and it lasts for a month and then they come back and get another injection. We don’t push one over the other, but injectables we feel is a little easier to monitor. That helps with their cravings, so if there’s a opiate user that detoxes, we like to get them started on whatever they choose because that’s the path.

J: It’s not just cold turkey everything.

A: Whatever will help that person is what we’re going to go with. We want them to be comfortable with what they’re doing and feel good about moving forward.

J: So, how long have you been there?

A: So, I have been there in some capacity for about probably 15 years now. I started out actually just helping out with the ground crew doing maintenance, things like that. I went into college and left for four years, and Leslie who’s our CEO who we owe a lot of the growth to, she kind of mentored me through my business program. I came out of school, got into the insurance field, wasn’t really my thing. This position opened up in 2021 and she reached out to me.

J:  Why do you do it? Where’s the passion from for you?

A: I have a lot of family that have battled addiction through the years. Some have passed away, either directly or indirectly from it. I’ve always had a passion for just wanting to help people. I wasn’t really sure what my path was going to be going through college, but I knew I wanted to do something that would impact other people. I love the job that I get to do. When I got hired, obviously I had a business background, but going out and building relationships and making those connections and being the liaison between somebody being on the streets and somebody getting into treatment, I really didn’t realize how impactful it would be until I really got into it.

The first time that you get a call of somebody that’s desperate and at their rock bottom and they’re begging you for help and you’re able to get them help, it’s a good feeling.

J: I just got the goosebumps.

A: I don’t work on campus, I work in the admin building, but I go over to campus pretty frequently. So, getting to see people when they first come in and seeing how sick they are and they need a hand. And then being able to see them maybe 30 or 60 days later and seeing the difference is very rewarding. People aren’t themselves when they they come in a lot of times. You know, you get a lot of those behaviors that come with people that are in active addiction. You’ve got to have thick skin a lot of times, but a lot of the people that I’ve come across are just the nicest people you could ever meet, but they just, like I said, they need help.

J: Well, thank you so much. For you, but for Hudson Behavioral Health for helping those people.

A: Of course. We’re happy to be here and we’re always looking to provide more services and help as many people as we can.

J: Thank you, Alex. Hudson Behavioral Health providing critical services for people right here in Wicomico County. If you need some help or you know someone who could use their services, check them out at hudsonhealth.org online.