Head Inside Mental Health
Todd Weatherly, Therapeutic Consultant and mental health professional hosts #Head-Inside Mental Health featuring conversations about mental health and substance use treatment with experts from across the country sharing their thoughts and insights on the world of behavioral health care.
Head Inside Mental Health
Healing Beyond Symptoms: Eating Disorder and Mental Health with Dr. Wendy Oliver-Pyatt
Discover the transformative journey of Dr. Wendy Oliver-Pyatt, a trailblazer in mental health and eating disorder treatment. From her formative training at NYU Bellevue Hospital to her influential role as Nevada's Medical Director for Mental Health and Disability Services, Dr. Oliver-Pyatt's career is a masterclass in pioneering compassionate care. We explore how her unique blend of psychodynamic therapy and community psychiatry has revolutionized treatment approaches at centers like Galen Hope and Within Health. Her story is one of innovation, resilience, and a deep commitment to holistic healing.
This episode promises to reshape your understanding of eating disorder recovery by emphasizing the crucial need for addressing psychological dynamics beyond behavioral symptoms. Dr. Oliver-Pyatt sheds light on the power of incorporating trauma history and relational insights into treatment plans. We critically examine the flaws in existing mental health care models, focusing on the tumultuous transition from residential to outpatient care. Highlighting the benefits Assertive Community Treatment programs, we discuss how integrating these principles can improve patient outcomes and reduce healthcare costs. Join us as Wendy and I advocate for systemic change in mental health reimbursement, pushing for fair allocation of funds to enhance care quality.
Hello folks, thanks for joining us on Head Inside Mental Health, featuring conversations about mental health and substance use treatment and co-occurring disorders, with experts from across the country sharing their thoughts, insights and practice perspectives on the world of behavioral health care. Broadcasting on WPVM 1037, the voice of Asheville independent commercial-free radio. I'm Todd Weatherly, your host, your therapeutic consultant and behavioral health expert. Today I have the privilege of being joined by Dr Wendy Oliver-Pyatt, founder of multiple eating disorder and mental health treatment centers across the country, including Within Health, galen Hope, oliver-pyatt Centers, clementine Embrace Treatment Program for Binge Eating Disorder and the Center for Hope of the Sierras.
Speaker 1:Dr Oliver Pyatt completed her training as a psychiatrist at NYU Bellevue Hospital. That is a place to get trained, where she served as a chief resident. Her training and experience involved direct patient care and leadership across multiple levels of care and treatment modalities, including inpatient psychiatry, residential addiction programs, pac teams, emergency room psychiatry and public and private outpatient care. In 2001, she became the State of Nevada Division of Mental Health and Disability Services Medical Director. That's no small feat there, the first woman and the youngest person ever to be in the role receiving senatorial recognition. In 2003, dr Oliver Pyatt founded her first residential eating disorder treatment program, the Center for Hope of the Sierras. Later, in 2008, she went on to found Oliver Pyatt Center in Clementine, both nationally and internationally recognized top programs in their field of eating disorders.
Speaker 1:She authored Questions and Answers on Binge Eating Disorder, a guide for clinicians, and named by USA Today as a top healthcare entrepreneur, 2024 and beyond, recently elected as a fellow of the American Psychiatric Association. Congratulations, thank you. Wendy. Carries her work with an unwavering belief in compassion and scientifically sound treatment. I also know her as just kind of a cool lady that I like hanging out with, who I send very difficult clients to, and she says yes, thank you, dr Oliver Pyatt. Wendy, thank you and welcome to the show.
Speaker 2:Oh, thank you so much, Todd. I really am so happy that you invited me. I look forward to our conversation and continuing to spend more time with you.
Speaker 1:Absolutely Well. You know we kind of hit the we. We hit a little bit beforehand, right, but the I, when we place the individuals in the families that we work with, it's very often that there's a, there's a very significant presenting eating disorder. For the clients that suffer from that we end up calling it a co-occurring condition because we know that behind it is this very significant primary mental health condition that they are struggling with Maybe bipolar disorder, maybe it's borderline personality disorder or other personality disorder kind of features, and that makes them very challenging behaviorally to deal with. So we work with you and your centers and specifically down there in Galen Hope. We've had several clients go down there because when a person is struggling with both conditions you actually have both tracks at your center there and do a job.
Speaker 1:That many kind of neglect, which is they do really good at the eating disorder side but they're not paying the kind of attention that we need to pay to the mental health side. And you and the programs that you've created do an exceptional job of kind of bringing that art and science together. How, what brought you to that? I mean you've got this distinguished career and I you know a lot of. It's like public sector, private sector and and you've just got to see the the kind of gaps and failings that happened in both of those systems and brought that experience and like, created something where tell me how you got there, please. Like what? What is it that like?
Speaker 2:Hey, we got to do this better and brought you to the place where you are now. Oh, todd, thank you so much for all those kind words and generous thoughts. Um, how did I get here? I mean, sometimes people kind of talk with me and they figure, oh, did you have this planned out? Did you know you wanted to be an eating disorder psychiatrist? Because I did have an eating disorder early in my life. And so people think, oh, did you become a psychiatrist because you wanted to treat eating disorders and all that? Absolutely not. I had no preconceived notion, you know, of my plan here. I didn't really have a plan.
Speaker 2:I think one of the things that I try to tell my patients too is that if we get in touch with our authentic self and we are like more organic about how we let our life unfold, rather than feel like we have to have some exact plan of what we're going to do, a lot of times the path we get on can be much more anchored in, like our soul and what really drives us or excites us or that we feel passionate about.
Speaker 2:I've been incredibly lucky because I love what I do first and foremost, and that's kind of how the process unfolded For me. My first love in going into psychiatry was really a fascination with the mind and a commitment to helping those with severe mental illnesses. That was why I did my residency at NYU. I really wanted to focus on community mental health. At NYU. I really wanted to focus on community mental health and through that experience I had really extensive training on, you know, the full gamut of psychiatric conditions and how we treat them. And I'm very lucky as well because even though at NYU it wasn't necessarily thought out this way, but it was an interesting blend of community psychiatry and also many of our supervisors were psychodynamic oriented Freudian analysts, believe it or not.
Speaker 1:So I got a little day right.
Speaker 2:Back in the day, that's kind of who they had as our supervisors. So I had this incredible mix and I, I believe, like I first, you know, kind of fell into doing the higher level of care work really out of my own, my own, like frustration with like what I was being expected to do as a psychiatrist, which was sort of become a prescription pad, because the field of psychiatry sort of got marginalized into oh, you do, you write the medication orders and everybody else does the therapy, and what I saw is just a lot of like bifurcated healthcare, like mental health over here and medication over here, and therapy over there and medical conditions over here, and even the medical conditions. So people are this one, you know, we're one human being and we have a multitude of different things happening with us, and the care itself being so fragmented just drove me absolutely nuts.
Speaker 1:Well, in siloed care, the silos don't talk to one another. I get why specialty has to exist, right. But and being in Bellevue, you know the one of the like, you know one of the busiest psychiatric centers in the emergency psychiatric centers in the freaking country.
Speaker 2:Yeah.
Speaker 1:You know you're just. You're writing scripts and getting them out the door, right?
Speaker 2:Yeah, but at the same time I had these patients, I also got to do therapy and I had these analytic supervisors. So that was kind of the background. But I really just didn't want to become a prescription pad and I just decided, if I'm going to do this work, I'm going to stick my neck out. That's when I started my first treatment center. I'm going to do it the way that I want to do it, which is not not BSing, like truly integrated, holistic care where there's a medical personnel, there's a psychiatrist that can do therapy, there's therapists, there's dietitians, there's recovery coaches, there's all of that in one place so that a person can truly be treated in this integrated fashion. So that was really, you know how it came about.
Speaker 2:And the field of eating disorders is very interesting because it's a really vivid example of probably the most vivid example of the importance of using that biopsychosocial model. And Hilda Brooke, who was one of the first clinicians to really write in contemporary times about anorexia nervosa, really revived that concept of the biopsychosocial foundation. It was already came about by another physician, but she kind of brought it into life with her writings about anorexia nervosa and there really is. I mean, any disease process has a biopsychosocial foundation. Whether it's diabetes or lung cancer, heart failure, whatever, there's always that biopsychosocial piece. But in eating disorders, if you don't really pay attention to all, then you're not going to get anywhere. And also the same is true for primary mental health. We do actually treat primary mental health, with or without the eating disorder. So using that foundation is really the anchor to being sure that you're leaving no stone unturned and you're hitting all those domains of care.
Speaker 2:And you mentioned about how eating disorder treatment can be very focused on just the food and the eating and all of that.
Speaker 2:Well, that's a very behavioral thing, like eat the food, weight restore, blah, blah, blah. I believe that when you only focus on behavior and food, you really are hurting potentially the patient, because the psychodynamics and the healing process like also has to happen. So I really believe that behavioral is important, like it is important to put containment on behaviors and expectations and have very clear process there. That's not punitive, it's natural consequences. So the behavior, we don't go punitive, we go natural consequence, we can talk about that. But at the same time we always lead with compassionate curiosity and a psychodynamic foundation, and so we really need to understand our patients in the psychodynamic way as well and in a relational way because it's the relationship where a lot of that healing is going to happen and understanding the trauma history, the psychodynamics within family, psychosocial reality that the person's experiencing. If we don't also include that, then just changing behavior when a person's in a higher level of care will have no lasting impact.
Speaker 1:Well, as soon as the behavior mod goes away, right the modification. You know they're receiving support on eating. Somebody's watching their calories for them. They're doing all these things and then they go out on the street.
Speaker 2:Yeah.
Speaker 2:And goes away all of it goes away. It doesn't generalize and also, if it's just punitive, it also just doesn't go like. The patients, our patients or the clients, whatever you want to call it I call them both, um are intelligent people that understand like, are capable of understanding, like the process. So if we explain to the person this is exposure therapy, this is how it works, it's gonna feel harder and then it's gonna feel easier. You explain, I'm not just shoving you down this road for no reason. This is called exposure therapy. This is how it works and we explain what's happening to the patient and we and when we use natural consequences right, we're helping the patient see and experience the ramifications of their behavior.
Speaker 2:We're not just putting a protocol in place. We're helping the person see like. Well, you know the reason you're not doing high cardio in our movement program right now is that you actually have orthostatic vital sign changes, so you're going to be dizzy, or your blood sugar has been really low, so of course, we're not going to strain your body on a treadmill and it's going to tank, you know, yeah, so we we use this process of natural consequences, like, oh, you're purged in the program, like we're probably not going to be okay with you going on a pass right now, and so things like this are very, very important.
Speaker 2:A lot of times also, families don't understand how to implement this attuned care where there's the natural consequences. The natural consequences is akin to what Maria Montessori talks about freedom and responsibility. I don't know. My kids went to Montessori and one of the most powerful kind of mock papers I read that they made you read like Montessori work was this concept that talked about freedom and responsibility being intertwined. Well, when we are gradual and attuned in what freedoms we give to our patients, that's tied to what they can responsibly manage. That actually imposes upon them the demand, if you will, to heal, and that is how we grow. It's really honestly, it's a common sense developmental process.
Speaker 1:Well, I mean it's a parallel to being an experiential ed nerd Wilderness approach is the same principle.
Speaker 2:Oh, really Tell me.
Speaker 1:Well, I mean, you know it's like hey, it's raining, you might want to put a raincoat on and if you don't put a raincoat on, you're gonna be wet. You know, it's real simple. It gets real basic really quickly. Um, but it, you know, like you say, it's informative. It's, it's something that provides a person with education, but in addition to that agency where they like hey, I understand.
Speaker 1:That's right. I I understand what's going on. I'm making choices because I know that there are consequences to my behavior and consequences. They may be good, they may be bad, but you're like, you're making active and engaged choices about what you do in your behavior so that you get the outcome that you want, right, um, but the? You know the thing that you're talking about here. That interests me a lot as well, and I know that you're also a very experienced addictionologist, a person who understands addiction at its core principle. You've got individuals coming in there not only suffering from mental health disorders eating disorders, but also substance misuse disorder as well and helping them manage those things as well, and helping them manage those things, but the not being punitive because, there's a.
Speaker 1:There's a lot of the. You've got this. Let's call it a subsegment of the treatment community that it's confrontive. I don't know if we might go as far as to call it punitive, but it's like the whole concept that you're defective at your core, or or that you, or that you relapse.
Speaker 1:you got to get kicked out Until you decide you can do something better. Don't come back to us until you're ready, that kind of thing. And I think that there are programs that are successful in this approach and maybe they modify it or they use it in a different way. What is your approach Like? Give me the nitty gritty of your thoughts, yeah, please.
Speaker 2:I think that I start with the premise that in the essence, within the essence, in all of us, is this like whole person, and we want to. So I think we all kind of want to love. What do we want? We want to give love, we want to receive love. These are the things we want to give love. We want to receive love Right, we want to be accepted for who we are, on some level, like who we are, like we want to feel like we can be who we are. We may not consciously think that, but we're more at ease when we can be loved and connected with and be a part of some kind of culture or grouping where we are accepted for who we are Right.
Speaker 2:Yeah where we are accepted for who we are, along, right, yeah, and there is that part of us that has a need to manifest something about ourself for which we are passionate or we are drawn to or whatever, like we want to manifest some love. Goodness, I think most of us are really, we're born into the world with these basic kind of aspects of our essence I just called our essence. I think our essence of who we are is a beautiful. We're beautiful. We're beautiful little babies born into this world and we just want to feel safe, protected, love.
Speaker 2:So if we kind of start with like that's who each one of us really is at our core, and then things happen in life and we build defenses or we have a medical condition or a psychiatric condition that gives us, you know, barriers to manifesting that in a full way, we encounter trauma. A lot of things can happen to us that make us, you know, more guarded or defended or unable to kind of just manifest what we're capable of manifesting. So, whether it's SUD or mental health or eating disorder or whatever, I think if you kind of walk into the space with a patient believing that about the other human being sitting there before you and also walking in with that humility of like. You know that the true one of the definitions of humility is like you know, I'm no better or worse than anybody else. Like we're, we're on an equal playing field.
Speaker 2:I'm not some authoritative, I know, you know I mean it's important to have conviction about how somebody gets treatment Right and saying, ok, I can guide you, let me hold your hand. But to say I'm a superior being to you in some way, shape or form through your behavior, overt or covert, is really, I think, a shaming thing. So I don't really believe in shaming people into behavior. I think calling people out for behavior that's hurtful to others or short-sighted, like you can do that, you know, in a loving way, no-transcript trauma, anxiety or whatever that makes it harder for the person to operate or function. So giving them supports and tools. You know sorry, a cat just jumped on me.
Speaker 1:No worries, sorry, a cat just jumped on me.
Speaker 2:No worries, I told you before I have a foster cat, but helping people manifest that essence, whatever their primary various conditions, are Within that, though, I think that when you're working with an SUD folks, you really have to give consideration. Now, with eating disorders, what's their psychosocial experience going to be when they leave? Are they going to be in a kind of pro-recovery?
Speaker 1:environment.
Speaker 2:Because I mean really being conscientious about what's surrounding that person is very, very important when it comes to SUD and helping them make choices where they're not going to get exposed to things that are triggering them or inviting them. Or maybe they're in a toxic relationship, or maybe they're in an environment that's reinforcing the use of substance. So really you have to be very practical with SUDs, so I think that's also, and with eating disorder too, but that's one of the things, I think, Todd, that comes into play. So, getting into the underlying dynamics, the family, the family, family, family dynamics, where there's sometimes intergenerational trauma, intergenerational SUD and addictions and mental health problems. That all played a part in the evolution of the various defense mechanisms the person may have, or or adaptations to life, or or the worldview, our cognitive scheme of like, how do we see the world? Or what do we expect out of relationships? I expect relationships to hurt, like I need to be defended against that, or whatever the schema may be. That's where the true, you know, psychotherapy comes into play.
Speaker 2:So, again going back to the biopsychosocial piece, getting the medical piece sorted out a lot of folks haven't been doing great self care and nutrition, getting that sorted out. And then, last but not least, on the STD side, there are some medications that a person can use that are helpful. I think, you know, using something like Antabuse is not you know, it's not unheard of, I think it's there's so much stigma around it but it's a very helpful tool for folks with or naltrexone substance, you know, or the various ways that it can be delivered. So I think these are. I mean, the research shows that these are underutilized tools as well, and so I think it's. You know, I just don't take that view of somebody being defective. I more take the view that they're struggling and they need healing, whatever the primary conditions really are. Well, and I think that you're struggling and they need healing, whatever the primary conditions really are.
Speaker 1:Well, and I think that you're saying something that's really key here and you're naming something else that is you haven't overtly said, but it's why the work that you're doing, I believe, is innovative and effective and something that a lot of the world misses out on trying to bridge. How do we bridge this piece? But first of all, treating them like human being yeah um, and a whole person.
Speaker 1:Right, you know they're not a number, they're not a script. They're, yeah, this person. We need to look at the whole scenario. But the other piece is this long like where are they going to be a year from now? We're two years from now. I've got to think about their life in a long-term scenario and I think that that's the trap that the hospitalists say, for example, can fall into. It's like I don't know where this person's going. Now I'm going to script them as best I can to manage symptoms and hope that that works out, but the truth is is they're going out into an environment that's not very supportive. They fall over.
Speaker 1:You've been involved with PAC teams. You know assertive community treatment. You've seen where it lands on the ground, where it falls over, where people run into their stumbling box and end up repeating the cycles and everything else. Some of your programming is also it's got. You know PHP and IOP aspects of it and you've done a lot of outpatient care when you know, know for you, where does the rubber meet the road out there? Well, that's after treatment. You know what I mean.
Speaker 2:Yeah, that's residential I mean, I really believe that the model that we generally have in our culture is flawed, and you're you're alluding to that, yeah, you think flawed and and so, sadly and tragically, people who go into a higher level of care and then struggle, they lose hope, they internalize shame, they hear that they're treatment refractory or treatment resistant and what I say is like, are they treatment refractory or did they just not get good treatment? That's the question that we have to pose here, I think, because whether it's like they didn't get good psychiatric management, which you alluded to, they really have bipolar disorder. Nobody treated that. They really have trauma. They never had EMDR, they really have depression. They've only been on 20 milligrams of Prozac for three years or something like that.
Speaker 1:They went to the hospital, they put them on the velvet hammer and sent them out the door.
Speaker 2:Yeah, so what happens? The model is you mentioned this with the hospital, so it's this model that, because we're cheap and we're a society that wants to get everything done fast, so it's like, oh my God, the person's symptomatic Put them in a 24-hour care, put them in a hospital, glue them up to where they just okay, they're not about to die tomorrow, right, okay, they're not going to die tomorrow. Boom, there you go.
Speaker 1:Better job die tomorrow, right Okay.
Speaker 2:They're not going to die tomorrow. Boom, there you go. And even if you think about this, is this is mind boggling when you really think about the traditional model, residential care being 24 hour care, php being six hours. So that model of residential to PHP is completely insane.
Speaker 1:It's upside down.
Speaker 2:It's insane. And so our model allows or a smooth transition from that 24-hour care, which right now we do it under the model of PHP, with supported housing. We will have actual residential care as well, because we've just recognized the need for that. But the 24, 24 hour care, we can gradually taper down that clinical programming from 12 hours to eight hours, et cetera. So we take a really serious look at patients before they go from 24 hour care to having the eight hours or six hours of PHP, because that is when they are first. Now they're out in the world on their own. So we, one of our little rules of thumb is that they don't move down to the lower level of care until they've demonstrate an ability to like, manage that freedom. It's just like if your kid is learning to drive, you're not, you're, I'm in Miami, we're just going down the street on on, you know, 57th Avenue or something I'm not going to be like. Okay, we drove in the parking lot here, go, drive up I-95.
Speaker 1:Well, Gen Xers, that's the way we did it. We decided that that was not a good way.
Speaker 2:Yeah, it's like, no, that's not going to work. So I think that this whole model is just flawed and this tapering down of care that's really attuned to where the person's at, and it's like, oh, they struggled a little bit, we moved them down to PHP eight and now in that little window of time they, you know, drank or something like that, and then when you have the relationship, they can talk about the behavior too. Right.
Speaker 1:They come to you about it, yeah.
Speaker 2:They can tell you, tell you more about it. So I think that is really nice. And then also we keep that stable housing and the stable treatment team all through all those levels of care. So as they're moving around, that team is with them. They're not switching, They've got the same team. They still have a stable place to live all the way down to IOP. But you mentioned PACT. That's where this focus on acute care and then just turn your back on the patient in a sense at the IOP level is so wrong. It's so flawed, because people have to get integrated into the community. They have to have that life worth living. I mean, loneliness is a big issue for folks like the surgeon general named loneliness, a big problem in our society. It is Loneliness and having meaning, having a routine. We all need it. Look what happened to us when we lost our routine during COVID the depression rates skyrocketed. I mean, for me, even working remotely, a lot of times sometimes I'm like I need to go in and be with my team in person.
Speaker 1:Well, we run into this with our clients all the time as well, and it's and to really say positive things about the kind of the model you're referring to, especially the treatment model that you designed down. There is hey, I want to come out of this emergency level, this kind of 24 hour supervision level of care, and just go into outpatient without any supported housing, without any other components that are going into my, the support that I need it's like. So let me get this straight You're going to come right out of this 24 hour environment. You're going to go spend I don't know six hours, six hours a day, five days a week, doing some intensive clinical work, and then you're going to go home to be alone at night.
Speaker 2:It's insane, todd, are you?
Speaker 1:kidding me.
Speaker 2:Isn't it insane that we actually expect people to heal and do well in that model and a lot of them don't even get that PHP. They might just go straight to outpatient or to IOP and it's like how can you expect somebody? And look, our patients are very complex and by the time somebody makes the decision to go into 24-hour care, you know them because you're taking them. You know you're figuring out what to do. Their lives are really in a state of major disarray. So they're coming to us with really serious things happening for them and those things are not solved in 30 days in a 24-hour care setting.
Speaker 1:Your PHP. I mean, I think that to call it a PHP is almost a disservice, because they're in a supported housing, they've got coaches with them all the time. They're in a highly structured environment. There's never really eyes off of them, so they're really in what most would refer to as a residential treatment environment, even though there's some really eyes off of them. So they're really in a what most would refer to as a residential treatment environment, even though there's some space that exists between where they live and where they get treatment.
Speaker 2:You know it's we were referring to, you know commonly the Florida model, right, and it's like well, we want to get the licensure and bill, but yeah, I mean back in the day when, when I first started at like Santa Barbara this year is, we didn't need 24 hour nursing to be residential. That just kind of came into the field that residential needed 24 hour nursing and honestly, that was an insurance company ploy to try to get rid of residential programs, put them out of business, because most people with eating disorders some need 24 hour care, but most people at the residential don't need 24 hour nursing. They need 24 hour monitoring and they may need nursing throughout the week. But it was really not something that it it really wasn't something that actually made clinical sense. So you know, they needed the 24 hour monitoring more than anything and that's what. And then we that's what's so important to block the behaviors and give them the support, and then the tapering down and the building the connections in the community that uses. That's where that PACT model comes to play.
Speaker 1:So I got a question that I ask a lot of the folks that come on the show that are doing innovative work in the private sector, have worked in the public sector, and the question I have is what's the divide? You know where? Where do we bridge this gap?
Speaker 2:What do you think where?
Speaker 1:where do you think? How? How do we? Is there a chance at it? Where do we start? Like what's your answer?
Speaker 2:to that. I am so glad you asked this. Okay, here I go. Okay, so this is this is something that bothers me so much, like, first of all, the first thing we're talking about here is the separation between acute care and then dumping people, dropping people off. Of course patients want to leave and they want to be in the lowest level of care. That's normal. But so that's the first problem we have. And then the second problem is this use of this model of pact and sort of community treatment that kind of follows the acute treatment, and the way we do it is really not widely done. It's done. Pact is done in two groups pact model it's done in some places with really wealthy folks who can pay cash for these kinds of services, right, we have some of those programs. Right and great, those people get great care. And you also see that it's done in some public mental health programs, because some of these programs realize, oh, this actually saves us money, which it does. I started a PAC program.
Speaker 1:Little blips of good stuff in the country right I started a PAC program in Nevada and we brought people out of the hospital.
Speaker 2:We reduced recidivism. It does actually save money to do PAC programs. Is my cat distracting you?
Speaker 1:Oh no, not at all.
Speaker 2:Okay. So, by the way, that's my meaning. I'm a foster mommy for cats, I'm a cat lady and I'm a big believer in just say yes when it comes to fostering, if you want meaning in your life. So, anyway, that's my plug for my one of the ways.
Speaker 1:I do, there you go.
Speaker 2:Okay.
Speaker 1:You're carrying across the board, you know.
Speaker 2:Across the board. Yeah, my, yeah, okay. So as long as it's not distracting, todd, I'll just not make my cat get down. But so the one thing we talked about is this bifurcation where you've got the private high cash places doing PAC and then you've got some hospital systems public, like Medicaid, medicare population doing PAC because they realize, oh, this actually saves money, people aren't going in and out of the hospital and that's for the people that don't know.
Speaker 2:Pac stands for Assertive Community Treatment or Program for Assertive Community Treatment, and it's sort of this hospital without walls concept that was really derived from taking all the staff that was in a hospital and planting them in the community and doing a lot of work in the community and doing a lot of work in the community.
Speaker 2:It started in like, I think, the seventies in a public system in Wisconsin, if I'm not mistaken. But so it's this public. Certain public systems have packed and then the high count. So what I want to do, what my hope and goal and vision, is to bring this model that blends that acute phase that we're able to do with that integrated you know the principles of PACT so that people are getting into their life in a meaningful way, and we've got that blended together and deliver that into the commercial space so that I can work with programs. You know that, you know where the mom or the dad is the teacher, or the mom or the dad is the janitor, whatever and they have health insurance with X payer or Y payer, so that this cause, this model, is really people with mental illness and eating disorders.
Speaker 2:They're owed a better model of care and it shouldn't just be if you have the cash to go pay for a packed program, or it shouldn't just be okay. The person is so debilitated now that they have no functional life and they're just on Medicaid and Medicare and they've ended up in the public sector and they really haven't been able to heal because they haven't ever got the care that they want. Because every one of us, we deserve a chance. People deserve a chance to get to that essence, to get to that place where they can manifest what they're meant to be. And the integration of the pact with acute care is really my passion and my hope is that I can convince the payers and the commercial insurance industry that this is so beneficial that it reduces the trauma on the patient, on the family, reduces recidivism, it makes people have better outcomes and it ultimately Cost less money it does cost less money.
Speaker 2:It does cost less money. You know what, even if it costs more, it should still be okay, but it does actually cost less because, I mean, acute hospitalization is a crazy amount of money. Don't forget, when you're doing this assertive community treatment, you're making sure they're going to their doctor appointment and getting their preventive screenings done, and so you're doing you're not just making sure the mental health is taken care of, you're making sure they're getting their pap smear, they're getting their colonoscopy and mammogram and all that preventive stuff, and you're saving money along those lines of going to the dentist. You know things like that.
Speaker 1:I mean it's a very similar analogy. It's a very similar analogy. I was recently in Connecticut. Dr Rocky Murata was on the show recently, dr Andrew Gerber, ceo of Silver Hill Hospital. They were doing a presentation. It was a conference Virgil got to present at it and everything else, but one of the things that we ended up talking about because they did a panel at the end was this subject and I said, look, insurance companies are going to save a lot more money If they just go ahead and pay for what we call well, you and I would call actual care.
Speaker 2:Yeah.
Speaker 1:Long enough at all the levels and allow a person to progress and everything else like pay for it.
Speaker 2:Yeah.
Speaker 1:And you're going to get better outcomes out of the people. Dr Gerber said look, insurance companies are never going to do that. You're going to force them into it because the average payer, the average subscriber, rather, only stays with their company for two years. Yeah, I said well, yeah, but if they all did it, then they would all say, yeah, they would all benefit. It was universal yeah what is the argument? What's the argument that you would make to an insurance company with all that kind of?
Speaker 2:I mean that does that whole piece of what that person said about the. The lifetime like the. The risk to the payer is like oh, I've got this patient, I got the subscriber for two years, so why should I pay for this longer length of stay? Right, I would say a couple of things. One is, even if you pay for a longer length of stay, if these patients are getting out, you know three, you know two, three weeks into higher level or a week in the hospital, whatever, they still cost the house, the system a lot more money Cause of also the medical visits they end up in the emergency room and they end up having these patients end up having recurrent hospitalizations a lot of the time.
Speaker 1:The revolving door.
Speaker 2:Yeah. And then I think the other piece of it that gets really missed is the impact on the family and the people. You know it's like your kid has a major mental illness. Like you're not going to be at work. You know you're not, you're going to be calling in sick, you're going to get sick. You're going to have not, you're going to be calling in sick, you're going to get sick. You're going to have more. You're going to be less productive, you're going to be less happy, you're going to have. Your concentration is going to be impaired. So I think if payers thought about the whole system too, that would really help.
Speaker 2:Another, another barrier to this model is and it's beginning to change with some payers but when the behavioral health and the medical are split off, so that's a big problem. So the behavioral health side is like, well, if it's saving money on the medical side, I don't get the credit for that. It's just my P&L is behavioral, and then there's over there is the medical. So the psychiatric care saved money on the medical side, but the behavioral side didn't get any credit for that because it's a separate organization literally, which is completely ridiculous. So I think moving in the direction of these models going to be more integrated is really, really important and you do see that more and more and it is absolutely silly that they aren't more integrated, but it's really just the way the models were derived.
Speaker 1:Well, it's almost like you know. This just occurred to me. I don't know why, but there's this dyad going on where healthcare is sickness-incentivized. You know, the longer a person stays in care, the longer a doctor gets paid to monitor, the longer drugs get used for that. You know, longer a person stays in care, the longer a doctor gets paid to monitor, longer drugs get used for that. You know lifetime drug, lifetime prescriptions for. You know, managing a medical condition say it's diabetes it's like, well, you're going to be on this medication for the rest of your life. So you have this healthcare system that's that's aimed at sickness. You know, either it's sickness in seven lives or it's just we don't do anything until sickness occurs and then there's a problem and it's emergency care kind of stuff.
Speaker 2:That's not the big issue, right there, right.
Speaker 1:Then you've got the other side. You've got insurance companies that are paying for health care and they're denials oriented. You know what I mean. Yeah, they're trying every way they can not to pay for this person's long-term care or big medical need or expensive psychiatric need in this particular case. If we could split this script and just say let's incentivize health care, let's incentivize wellness, right, aren't in the hole on paying for long-term conditions for which there's not a lot of really good outcomes, versus going ahead and paying for care people need, including preventative care, and getting far better outcomes. It's almost like the Monsters, the Monsters Inc thing Laughter is 10 times more powerful than scream.
Speaker 2:Health is 10 times more powerful than scream. Health is 10 times less expensive than sickness. Yeah, absolutely. I think we all have a tendency to sort of underreact, I think, to our own health, healthcare needs, right. But then it's like break our leg, like we're going to go to the emergency room but we might not have thought about what you know, stretching or exercise or whatever that might've made us had better balance or whatever you know we're.
Speaker 2:I remember you're making me remember that book, seven habits of highly effective people, and he had like yeah, and I don't know if you remember the grid where it was like things that are unimportant that require urgent attention versus things that are important that don't require urgent attention. Like the things that are important that don't require urgent attention, those just like they're important but they're not urgent and so they just get like falling off the way to the background.
Speaker 1:What?
Speaker 2:was the background. So you're, you're managing things that are urgent and important, like the broken leg, and you're also managing these that are urgent and unimportant, like checking your phone and all of this instead of taking care of yourself. So where our, our priorities get really you know where we put our time and how we, you know how we use our time is, like, really important. And so with the, I think in the insurance space, it just naturally sort of happens of like, okay, we just got to handle the acute stuff, but the other stuff I do think that you know, when I talk to some of the insurance companies, another thing that has happened is that there's a little bit of like, I think, cynicism sometimes around mental health care, because there's such a huge variability of the quality of that care.
Speaker 2:And so I've talked to some of the payers who they don't want to pay for care that they don't feel is going to be effective. Or they see the fact that, yeah, when you just go to residential and then you go out and then you go back, it costs them a lot of money to pay for residential care. That doesn't really work because the model again is flawed, because it's lack of follow through on the other side, or the or the other thing that happens is, you know, and I and I hate to say this, but I think to the lay person if they have a loved one with a mental health problem or a needy disorder, they're not necessarily discerning between different residential care. They're just like my kid went to residential care, my kid went to PHP. They don't understand. There's a whole bunch of different kinds of programs, different quality, different skill of the teams, like different philosophies. So the insurance payer, like the family, maybe just be like residential care and like it doesn't work.
Speaker 1:Yeah, it just goes in and out because I've been to three places and it didn't work right, yeah, and so the insurance companies also get cynical too um and they they need a therapeutic consultant they do if they, if they decide that they, when they sign on and bringing you with me, we, we're going together. Why don't?
Speaker 2:I bring you to my next meeting with my next major. I'm going to bring you Todd. I'll be like you know what. I want Todd to join my meeting to talk with you a little bit about it.
Speaker 1:I'm just a guy, you know.
Speaker 2:You're just a guy that knows what's happening out there, right?
Speaker 1:Well, you know, honestly, I don't think it's that hard to look at and see what the problem is and what the solution is. I don't think this is rocket science.
Speaker 2:Honestly I've said this so many times Like what we're doing is not rocket science. Like sometimes people are like, oh my gosh, your program is so innovative.
Speaker 1:I'm like this is literally common sense. Well, I think that not to diminish what I think is a truly accomplished clinician and somebody who knows how to provide real care to people, that's a skill and an art and let's not diminish that. But if we take the 10,000 foot view, we look at what the system's supposed to look like. I agree it's not really all that complicated. The trick is time We've got to give people enough time to heal and the right modality that matches their condition. You know those are your principles. If we can start sticking to those, we're going to get somewhere, I promise you. You know what I mean.
Speaker 2:I couldn't agree. And then the other third thing that you said the time, the modalities, right, and I'm confident you're going to agree with me is like the quality of the human being that are there with the person, those people also understanding the modalities care system, if you will get a lot of a beating because there has been a lot of turmoil and turnover in the space and much of that is tied into low reimbursement because that's right. Quality.
Speaker 1:There you go.
Speaker 2:Quality of those, and I'm not saying that somebody with less experience is less quality, because you can have a brand new person, be a freaking, a plus clinician.
Speaker 1:But you need their investment.
Speaker 2:Yeah, but it's like people aren't going to keep. I mean, look, working in these programs a higher level of care. It's like you know the machine. You know it's just firing, firing, firing, firing at all times. So this is the kind of work that takes stamina and passion and conviction and all that. You know if people aren't getting reimbursed or excuse me paid for their services and you know getting raises.
Speaker 1:They're getting niggled and dimed.
Speaker 2:Yeah, and it's very difficult and I've found that to be true myself. One of my struggles is just, hey, the cost of doing this has gone up and up and up and across all domains and it's very hard to tell very hardworking clinicians like I don't have enough money to give you a raise right now, and we run into that a lot. And that's very connected with now we're talking about again the insurance industry, where, if you really think about it, we're paying all this money to insurance companies and how much of the money that we're paying and their budget is actually going to administrative functions and paying for these systems of denying or not denying care. It's not actually going to actual care.
Speaker 1:Putting bonuses in executive pockets?
Speaker 2:Yeah, it's not actually for the therapist that's doing the therapy, and so that's a little bit of a predicament or a pickle, but I find personally that's something I'm going through right now is just having so many deserving staff that I want to give more money to to keep them and to incentivize them because they deserve it, but finding it difficult to do that based on you know what our reimbursement rates really are.
Speaker 1:I don't think. I don't think you're alone. I don't think you're alone.
Speaker 2:Yeah.
Speaker 1:Wendy, it has been. I've had such a good time just talking with you. It's been really great. Thanks for being on the show with me. This has been Head Inside Mental Health broadcasting on WPVM 1037, the voice of Asheville Dr Wendy Oliver-Pine on the show. Wendy, thank you so much for being with us today and I will look forward to seeing you when I get down to Florida here in a few months.
Speaker 2:I am so happy about that, todd, thank you very, very much for.