Head Inside Mental Health
Todd Weatherly, Therapeutic Consultant and behavioral health expert 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
Treatment Without Walls, Community Within
What if the mental health system focused on continuity over fragmentation, dignity over coercion, and a practical blend of medicine, lifestyle, and belonging that actually changes outcomes. Our default model is more emergency care than health care: ten-minute psychiatrist visits, revolving-door hospitalizations, and poor aftercare often worsen psychiatric health.
We talk about alternatives that work: home-based ACT with true collaboration, campus-style therapeutic communities that provide structure without pressure, and metabolic psychiatry that treats weight gain, sleep, and insulin resistance as central to mental health—not an afterthought. You’ll hear how autonomy, harm reduction, and everyday connection turn “noncompliance” into engagement. The result isn’t just fewer ER visits; it’s a return to roles, relationships, and purpose.
We also spotlight the principle of starting treatment at the first call, include families from day one, keep the same team across phases, and protect a person’s social role in school or work. Medicines can quiet voices; community rebuilds a life. When funding models pay for coordination and continuity, extended care becomes not only humane but cost-effective compared to incarceration and repeated hospital stays. The takeaway is simple and challenging: meet people where they are, stay long enough to matter, and make belonging part of the treatment plan.
If this resonates, share the episode with someone who needs a more hopeful map of care, follow the show for more expert conversations, and leave a review with your biggest takeaway—what would you change first in your community?
Hello, folks. Thanks for joining us on Head Inside Mental Health, featuring conversations about mental health and substance use treatment with experts, advocates, and professionals from around the country sharing their thoughts and insights on the world of behavioral health care. Broadcasting on WPVM 1037, The Voice of Asheville, independent commercial free radio. I am Todd Weatherly, your host, therapeutic consultant, and behavioral health expert. We have a star-sted star-studded guest list on the show today, which I'm excited about. It is my pleasure to welcome back to the show Dr. Ross Ellenhorn, founder of Allenhorn Assertive Community Treatment and Community Integration Programs in LA, New York, and Boston, as well as founding partner of Accord, a holistic treatment program embracing metabolic psychiatry, bridging the gap between mental and physical well-being left out by traditional psychiatric med management, and author of a few books, um, How We Change. I I uploaded, I got my I got my book set done. I need signatures from you, Dr. Ross. Uh, and uh more more recently, Purple Crayons. Uh, how we The Art of Drawing Life, which uh when he told me about this book, I thought he was actually the purple crayon kids book author and was very was about to be even more impressed. But um, this is a lot about uh how people can draw a life for themselves, especially if they're suffering from mental and emotional conditions. So we also welcome back to the show Sarah Summe, doctoral candidate in public health administration at the University of Texas and executive director of the Lakewood Center, a therapeutic community designed for long-term care, enhancing the lives of adults with serious mental illness. Along with her, we welcome to the show Lakewood Medical Director, Lakewood Center Medical Director and Psychiatrist Dr. John Stevens, leader in personalized mental health care, board certified in child and adolescent and adult psychiatry and obesity medicine medicine. Um, Sarah and Dr. Ross, welcome back to the show. Dr. Stevens, thanks for joining us. Thanks, Todd. Absolutely.
SPEAKER_00:I did have to say, so my mother doesn't disown me. It's the University of Tennessee, the original UT.
SPEAKER_03:Right. Um, not far from still disown me.
SPEAKER_00:Right.
SPEAKER_03:Right. Those UT folks, they're pretty serious about their school. That's that's some school pride out there.
SPEAKER_00:Yeah. Um thanks for having us, Todd. We we're happy to be here.
SPEAKER_03:You're most welcome. And you know, uh um Dr. John, we're we're getting to know each other, and and uh, but you've worked with some of the clients that we've had down there at the Lakewood Center. Um, I've known Dr. Ellen Horn here for quite a while, and Sarah for quite a while. She's actually from our area. And uh just looking at everything, I thought like there's kind of three places that we could spend time talking about. One is is um part of the new program that that Ross helped start recently, which is the metabolic psychiatry, um, and kind of where traditional psychiatry leaves out the metabolics, the the diet, the things that you're putting into body and what kind of impact they have on the brain. Um, because a lot of our psychiatry is driven ultimately by emergency psychiatry. You go in and they dump you full of meds and they stabilize you enough, and then you go out and you feel like a space cadet, and it's no wonder people go off their meds a lot because they feel weird and they don't like it, and it comes with a lot of metabolic and you know, gut problems and uh attention problems, sleep problems, all the other things. And so some of this approach, especially for people, and this goes into the category for you, Dr. Stevens and Sarah, is the long-term care aspect. It's like it's one thing to get a person into emergency care and get them out on the street and get them so that they're not, you know, having a psychotic break or not endanger themselves or others and those kinds of things. That's really a it's a pretty low bar in terms of a person's care. And then what do they do after that? As therapeutic consultants, we get involved a lot at a time when the emergency care is needed, the residential care is needed, and getting them through kind of this how well let's figure out whether what what is the ideal medication level, what are these places that we get to, um, and what is it going to look like long term? And then, you know, ideally we'll either find a program like Sarah's or we'll find a program like Dr. Ellenhorn's, and where they can receive this a community approach to care. So that's the other piece is like long-term care, but a community approaches to care, community integration for people as a treatment modality, is this kind of the thrust of the therapeutic approach is to have connection with others. And so something uh that the front end of of mental health care and a lot of community mental health care misses, or if they've designed act teams, like you know, Ellen Horn is an act team, the act teams are not managed very well. So, you know, what is it? I think the big question, and um, I pose it to all of you, is like, where did you start and how did you come to realize that models of care that you're now engaged in are a better way to go? Like, where did the shift happen for you guys? You want to start, Dr. Ross? I know that you Act Team is a big Act Team is a big thing. You're you you know, you're kind of one of the pioneers of an Act Team from very very long ago. So why don't you hit that first and then we'll work our way?
SPEAKER_01:Yeah, I mean, I I think there's a there's a few influences on my own thinking about that. Um one influence is you know the fact that my own functioning as a kid was most disrupted by being diagnosed as having um a severe learning disability. Um and that the effect of that diagnosis was just just much more powerful than whatever this thing was that uh this guy who's written three books and has a PhD had or has, right? So so the the the the event itself, the social event of that injury, um um made me think differently about how we think and approach uh events of mind and mood and thought. Um and then I'm trained as a sociologist, so we're we're always looking for kind of the social elements um within behavior. And so those things sort of came together on a public pack team. And then the third thing is it what we did isn't anything new. This is exactly what they created. Programs that are oriented towards people integrating back in the world that they created at the point of deinstitutionalization when they created community mental health programs, they've never been funded right, but their brilliance lies in how do you get people to recover socially, what's called psychosocial rehabilitation. That's just this model that's underappreciated, but it's actually what most people in this country get. Not in the private sector, but most people are getting some poorly funded version of what they invented when they came up with community integration. So all those things sort of came together and kind of my belief and in the idea that the even the most acute experiences can be treated outside of institutions, possibly, and that you're doing some good when you do that because you're protecting the person's social being.
SPEAKER_03:Well, and I you know, I know Sarah's visited um Cooperese before, uh a program that their second campus is uh licensed and opened, was managing director for their campus, but it sits, it sits in the old um Brouwer Hall, like the the old psychiatric, you know, it's renowned to have had um or Ep Scott Fitzgerald's wife um there, and she was one of the women who died in the fire and so on. So there's so there's a lot of this history there, but they rebuilt this building out of the strongest fire brick that you can build, so you couldn't burn that building down if you tried now. Um and if you go, having spent a lot of time there, the model that they used, and we're talking about back in the 60s, was this you've got uh a hospital, and the hospital was connected to a wing that was a step down, and that was connected to a wing that was adjacent to an outpatient. And it was like there was a continuum of care located on campus. And it's almost like the model that they came up with, like you're saying, uh Ross, is the was brilliant. And if we had embraced it thoroughly at the time, I don't think that we'd be in the space that we're in in now ultimately in in community mental health circles. But you know, the to kind of go and and talk about Sarah's end of the world, which is that's great that we get them out of the hospital, maybe we get them through residential care and they get on the right meds, and maybe they start getting a job and everything else. But then they turn 40 and 50 and 60 and 70, and you've got this long-term care, Dr. Stevens. You have these folks from a psychiatric standpoint or the psychiatry standpoint, and you're serving these individuals, individuals that have got decades worth of time on mixed levels of meds, trying to figure all that out. You know, walking into the world, you certainly cross through areas of care where it was probably done poorly and people, you know, reacted poorly, or they they fell off the map somewhere along the way, and you've landed in a care model that I really appreciate personally, um, but I think we need a lot more of. What is it that what what brought you there? Like what was the what was the epiphany moment for either one of you?
SPEAKER_04:I mean, I'm just speaking for myself, you know, as you know, now about 20 years of experience. I had good training. I'm very proud of that training, good experiences early on, but you start getting into the the working world as a psychiatrist. And I've worked from inpatient, outpatient, and in between, you know, things called day treatment, residential treatment, IOP, all these alphabet stupids that we have taught. But you kind of realize that we have not built like a healthcare system as much as a crisis management system. It's not a recovery system, whether it's 10-minute med checks, revolving door hospitalizations, I mean, unfortunately, incarceration, which costs us billions of dollars a year and yet doesn't change lives for the positive. You kind of see that the system is broken in terms of treating symptoms, but really not outcomes or futures. Talking about sociology with Ross. So sitting here with Ross and Sarah, two of my influences for years, you see, I mean, they'll call themselves different things. I'll use the term extended care. It's not acute care. Um and and Lakewood uh center and and certainly Ellenhorn are very different. But what they were, and there's others out there, uh Gould Farm, which I had the pleasure of visiting, you mentioned other places, they really flip the script on uh the warehousing of patients uh, you know, or the the revolving door, as I said, so they provide continuity, dignity, community, and recovery. We talked about the metabolic side of, you know, how you know the the nourishment, both in terms of food activity, um, mental activity, physical activity, these are how they get better outcomes. And I'm I've witnessed both, both at Ellen Horn and these other places with present, they get better outcomes because it's a holistic approach. And it doesn't waste$60,000 a year incarcerating someone with a severe and persistent mental illness or just shuttling them ERs, uh it which is wastes tremendous care and doesn't serve the the personal benefit of the patient or society's benefit whatsoever.
SPEAKER_03:Completely agree. The other, you know, the other part that you know, the outcomes are better for these people, but it's also sustainable. You you you know, when they land into what you're talking about, an environment like you're talking about, you can keep it going.
SPEAKER_00:As a young clinician, I would get, and I worked in community mental health and then private residential as well. One of the most heartbreaking notifications I would get is someone was being added back to my caseload who had already been on the caseload and who had been set up with an aftercare plan to move on. And they were either right back in jail or right back in the hospital or right back in the very same situation that brought them to me to begin with. And so um, when I first learned of Lakewood, especially for this population for serious and persistent mental illness, I was so ecstatically excited because it was like, this is what we're talking about. This is the way it can be for people. And I I felt the same way, Ross, when I visited your Boston program. You had a group of, I don't know what you call your participants, but that were listening to the talking heads record. Like they're just sitting around talking about this record, hanging out on a sofa, chilling, which is what I do on the weekend, right? Like, and so they're safe, they're contained, they're they're on medications if that's right for them. There's harm reduction in place, and there's not this pressure cooker model of we got to go to eight groups a day, you got to do this, you got to do this, and and this burden of do all of this or you're gonna be back in jail. And so that for me, from the clinical perspective, was there is a better way to give people an opportunity at a high quality and dignifying life that breaks them out of this cycle that's as a society we built for them. Like it's they're built, it's destined to fail otherwise in the current systems that we have in place.
SPEAKER_03:I mean, I we talk about Lakewood Center specifically, and it's a nonprofit, but that's a pretty affordable rate. If you think about long-term care, what you're gonna pay for a person who suffers from fairly significant um, you know, mental illness and conditions of that of that kind. And what would I do with that person if they're living in community chasing after them in hospitals and prisons and things like that, and the cost of that, just like Dr. Stevens is talking about, versus, you know, five to seven thousand dollars a month over a year's time. You're gonna spend uh incredible amounts of money less doing doing that here, right?
SPEAKER_00:State hospital in the state of Florida is twelve hundred and fifty dollars a day for state hospital, and that's where about 70% of our state budget for mental health goes to is state hospital.
SPEAKER_03:Ours is 25.
SPEAKER_00:Yeah.
SPEAKER_03:That's the billable rate. Well, and even you know, even Ellenhorn, which is, you know, I I and this is something that I I run into with people all the time. It's like, well, that's really expensive. I'm like, no, it's not, actually. Um I mean, I think that for a person who is out in the world having to pay for what I would call adequate care, um, if as Dr. Ross is saying, the, you know, if these if these act teams were properly funded in the first place, if we had started, if we had funded our model, the idea that we had in the beginning, and kept that going and made it, you know, kept stuck with it and made it work, we we'd see a whole, we'd see a very different world, I think, personally. But it but it also goes to the you guys have created these programs, you've created them in environments where, you know, either you know, people who can private pay for the care are coming in there with part of your clientele, or you know, as with Lakewood Center, there's a nonprofit attached to it. So there's some there's funding that's supplementing some of the way the operations happen so that it can be can become affordable. Um what do you think causes this solution, this whole thing to turn? Like what is it? How can how can we how can the models that people experience in the community, the ones that we're talking about that don't work, start to bridge, how do we bridge the gap and be like, hey, look over here, it works. Where do you think that turn happens?
SPEAKER_01:Well, most of the research says they work, you know. I mean, most of the best practice research on how to organize and deliver care, which by the way is kind of better research on best practice in some technique, right? How how is it actually delivered? Um, you know, so how how flexible is it? How in the home is it? How responsive is it? How much can it change depending on the person's symptoms while keeping the person within the same system? All those things. I mean, we have this crazy system where crisis teams are typically not connected to the treatment. Community mental health, the crisis team is part of the community mental health center, right? And so there's a complete fluidity to that. That those kind of models are really the most researched, best practice models for long-term psychiatric events. But the problem is uh we we keep talking about um um uh is it cost efficient? Uh it's not cost efficient, it costs a lot of money to care for people in a way that actually helps them recover. Um, and it typically means a kind of revenue stream that isn't uh event focused. In other words, every session is where I make the money because so much of it has to do with coordination, things that we can't bill insurance companies for. And so it really should be it should be this grant-based thing that where you know a community mental health center gets a certain amount of money, they're not reporting all their contacts, they're reporting, you know, kind of recovery and stuff. Um, and that that's not that's not cheap. But it's like works, you know. Um, and it it it it really is what they really can have brilliant ideas about how to make this work.
SPEAKER_03:Well, and yours is a model where you're taking it to people where they live, you know. Yeah, that you're having to be out in the world with uh a form of containment that's mobile. Whereas Sarah's Sarah's got this built community, you know, it exists within the parameters of a of a place. Um what's the what's the you know, when you talk about and I was mentioning this before, like the therapeutic use of community. And I and and I think what Ross is also talking about here is it's it's hard to care for people in this way because you've got people who traditionally as a symptom isolate and disconnect. And what you're bringing to them, even though sometimes it's professional and paid for, is connection. Um, you guys do that really well. We could talk, we could talk about a shared case if we wanted to. Um, somebody who was not inclined to connect and you really had to work to help him connect. But you know eventually he kind of accepted the invitation and and warmed up a little bit. Um, Dr. Stevens, you probably worked with this client before. How do you how do you build that into uh uh an intentional community, as it were?
SPEAKER_04:I you build it, like Ross saying, not being event focused, especially in a potentially traumatic setting like an ER or an interaction with police, uh, or where, you know, sometimes I think the idea of a sort of community treatment, certainly psychiatric or packed, we'll use that, is well-meaning. But I think in many places the actual rollout is big brotherish, where it's it's it's more of protecting, or oddly enough, protecting the community from the client. So how does that Todd connect? You know, is that how can you reconcile that with connection? I think where Ross is such a pioneer, and you know, and in you know, other places we've we've copied his model. He let it be copied, just flat out, you know, or some of the people I work with, you know, embedded and copied it for here in Texas, is it's fundamentally different. The the focus is on the patient, where the patient's at and what the patient needs. And that personalization, I think, is starting to resonate, Todd. I think there's some awakening that, at least in mental health care, a population management or and certainly psychiatry, treatment algorithms leave too many people falling through the cracks. What I mean by that is like if if you treat psychosis or schizophrenia like you would high blood pressure or cholesterol, it fundamentally leaves people uh unwell, not connected, stigmatized in a way that's fundamentally different. So that's why uh that kind of approach, I think there is this now with the technology we're seeing, which is really advancing rapidly, allows the personalization of mental health care to reach those 6 million Americans who have severe and persistent mental illness, who will, on average, require 10 psychiatric hospitalizations in their lifetime. A third of those 6 million will have a period of homelessness, will have significant malnutrition, uh, and are incredibly vulnerable. This it's the to me, the question is not whether we could afford to do this. It's that we can no longer afford to do it the traditional way, which is colossally broken, as you've heard. So I'm not sure it's either Lakewood or Ellen Horne's way. I think these are the early pioneers, the first kind of dawn on a realization that we need to do it this way to restore the dignity, to end the hospitalizations and the criminalization of mental health care problems. Because when it comes to things like psychosis, Todd, I think you're aware of this. Uh, high potency THC, what we saw after the isolation of COVID-19, the frankly, too easy prescription of stimulants for people probably with not ADHD and all of that, and conferring in our young or youth, uh, and the rates of psychosis of hospitalizations for this are going up. And I think you know, we're we're gonna have to face this sooner rather than later.
SPEAKER_01:Yeah, I I I really appreciate that. I I I think that um I think you're absolutely right. Like, you know, our program is called the hospital without walls. There's nothing more terrifying than a hospital without walls, right? It's sort of police state, right? So so it depends on how it's delivered. But I I want to point out something about community and also about about how we sort of approach these psychiatric events. And I'm I'm gonna I'm gonna make a big distinction between us four and the rest of the world who's mentally ill. And that is that us four, whenever there's a problem in our life, we can solve it immediately if we just find the right technique, right? It's just a piece of cake. You just say, like, I gotta lose weight, and the next day you're losing weight, and it's just like that, it's easy. You have some sort of psychiatric thing bugging you, and you just go, Well, if that technique works, then I'm fine. The rest of the world struggles with change. They actually change is hard for them. And the problem is the struggle over the change, not the technique. So we live in a system that's just offering them one mode of technique after the other and calling them disengaged or in denial or anything when they don't accept it. In that group, the group that has a struggle with how to take in care are the poorly treated group. They're called difficult to engage. And we need programs that actually work with them and aren't working necessarily on fixing the psychiatric issue, but fixing their struggle over change, their struggle of how am I gonna make my life work. Those can go together. So if you don't take care of that problem of metabolizing help, bringing it into your life and doing something with it, you can't get to the other. And you can't get to community that way either. That's what the loneliness epidemic's proving is that loneliness is mobile. That until you build a sense of your own value and your own worth to people, you'll stay lonely. And so just giving somebody a community doesn't make the thing happen. It's pride that makes it happen. It's sense that I'm worth being in this community that makes it happen. Um, and so all of these things we talk about, sort of delivering instead of how do we get the person to that place where they actually can engage in that way. And that's really the poorly treated group. They're just completely neglected in ways. They're just told, like, if you can't show up to this clinic, you can't do this and that, something's wrong with you because we've got the perfect solution for you.
SPEAKER_03:Well, it's reflected by how my practice works. Most of the most of my clients are not the person who needs the care. They're a person who's the parent or the associate, you know, like I'm working for them, helping them find help that person realize they need care, get to it, and find their way through to a better, more independent life. And that that's where that's indicated. I'm sorry, Sarah, go ahead.
SPEAKER_00:I was just gonna say, let Ross, you're like bringing to mind a term that I really don't like to use, which is treatment resistant. And we we s throw that around a lot as clinicians of, well, Johnny's treatment resistant. Well, Johnny can't sit in groups six hours a day. Like, and Johnny doesn't understand the medication that you're presenting to him. Um, we have clinicians who, or my I've been. I mean, I'll go. If the person's mad at their clinician and they have an appointment with Dr. Stevens at two o'clock, I like he was here the other day and one of them just stopped me in the middle of the hall and I'm really mad at her today. Can you go to my psych appointment with me? But we we go with them so that we can advocate for them and help them to identify what's being said to them and be that extra voice in the room if that's necessary, but it's also not a requirement. There's people who I don't want anybody in my psych appointment. And so um they they go on their own. But I I think, you know, one of the my favorite swag items that I've gotten Ross is Airmen for Christmas sent me a bag that says meet people where they are. My team hated that I got that for Christmas because there's signs everywhere all over Lakewood that says meet people where they are. And I point to them quite a lot when my team will want to be like, oh, but the rules are, and I'm like, nope, we got to meet people where they are. And so your bag was a pretty funny joke around Lakewood for a few days because I carried it everywhere I went. But I think it's meeting people where they are. It's you know, putting a garden in if somebody won't come out of their room, but we know that they like to work in a in a community garden. You know, we we've done those things and I've seen um programs like Ellenhorn get really creative with that too. And it's okay, well, you know, we're just gonna come to you until you're ready to come to us, if you're ever ready to come to us, right? Like I think removing that boundary and that pressure of what a positive outcome looks like is really important in these care models and in these conversations as well, is um, you know, we have one client who's here right now who had over 125 hospitalizations in a two-year time period. And John and I were talking last night, and I'm gonna knock on something, but I mean, he's been here two years and hasn't required much of anything in terms of emergency urgent support. But there's also been a lot of unlearning for his family that yeah, he's probably not gonna use that bachelor's degree that he went and got. We're proud of him for having that. But for right now, he hasn't been in the hospital in two years, and we haven't had to, you know, he also hasn't like taken off on foot. He's happy to be here. He's found a community, he's found purpose. To to your point, Ross, like it's finding that purpose and that reason for existing in a community to get someone to engage in it to begin with.
SPEAKER_01:Yeah, I mean the person says to you, you're a traitor, and the person says to you, uh, I don't know if I want to take that pill. I don't really know if that's gonna there's I gotta look into that. I don't know. I I've taken medications before, I don't know if I really want to do that. Or a person says, Uh, okay, I'll take the pill. Give me the pill, give it give it to me right now. I don't I don't even want to know anything about it. I just just give it to me, I'll put it in my mouth and I'll take it. Uh that's a non-treatment resistant client. Seems a much less sane version of how to approach medical care. Yeah, and I just give me some medicine, I'll put it in my mouth. Yeah, I mean, I don't know about this. Uh doesn't I want to make sure this is gonna work this time? It's uh it's the logical consumer approach that can get illogical and get kind of crazy, but it is it leans much more towards sanity than to just just pop it in my mouth, I'm taking it, right? John, you're you're look you're looking you're looking for collaborations, right? You're looking for collaborations. It's the collaborative collaborative event, is the event.
SPEAKER_04:Collaborative, and and and I'm I'm pro-medicine, everyone you guys know that. And yeah, you know, when it comes to psychosis, antipsychotics are are are necessary for the large miracle, you know. They are, yeah, they're they're necessary, but they're not okay.
SPEAKER_03:But yeah, you know, we we we'll go there.
SPEAKER_04:Well, you gotta you you know you're gonna have some sparks. We have different, you know, but I think we all hear antipsychotics quiet, the voices they they help melt away the delusions or the paranoia, but they don't rebuild a life. And that's what we're all talking about here is to me, medicines are foundational, but these versions of extended care uh, you know, uh they're not new, but these have been around, but both people you're talking about represent, you know, what people doing things away for a long time. But it's to me the foundations are structure, community, uh therapies. That's that's the house we build on that that foundation of medicine. I I think it has to be there. I know that sometimes you know there's the rare case, you know, whether one out of ten, probably closer to one out of a hundred, that could be off medicines and and do well. Functionally and achieve goals, but the large majority, it's it's not either or it's both end.
SPEAKER_02:Yeah.
SPEAKER_03:Well, and I, you know, I'll I'll I'll give um Dr. Ellenor here a little credit. And he's like, I don't know about this miracle thing, Todd. I you know, if a person walks into a hospital or walks into a care a facility of any kind, and what they're having is psychosis and they're hearing voices and they're having hallucinations and everything else, and you give them a medication, and those things dissipate and even go away, that feels like a miracle. Now, kind of the way the medical profession approaches things, like we've already said, is like, great, problem solved. And they it is overused, it is it is seen as the kind of the only medium of care in a lot of emergency settings. Like, great, they're no longer a danger to themselves or others. You can hit the street, just take this medication, and it's not a miracle then. What it is is a management issue, and it makes the patient feel horrible, and there's lots of long-term side effects, and there's all these other things that that are complicated about it. And again, uh, you know, for I run into a lot of people, and medications are going to be one of the mediums of care that they need to achieve a sustainable recovery. That's true, at least for now it is. It's not the only way. Um, like, say, if people could pay for it, sometimes they can find another way. The number of people who suffer from these conditions who've been able to stay off of medications and manage it through diet and exercise and everything else, they are very few number of people. Um, and they are some of the most dedicated and disciplined people I've ever met in my life. Um, but it's been done. So to kind of go to this, and you're you you work with folks, Dr. Stevens, who you know suffer from obesity and you're engaged in that level of medicine. Dr. Ross is also, you know, the metabolic psychiatry. We we all know that people on a lot of these long-term uh psychiatric medications, they experience metabolic syndrome, they get very unhealthy, or they gain a lot of weight, they have problems with the sun, and vitamin D deficiencies, the whole nine yards. It's like there are all these complications and issues. And then there's also the other side of it is like, can we manage some of this without this heavy medication, but actually engaging in some kind of dietary practice or exercise or any of these other pieces that are lifestyle-based? So it emergency medicine has doesn't have the time, right? They don't have that time to assess any of this stuff, to look at it. It's I need to get them in, I need to get them out, I got beds. I got beds that there's there's people lined up at the door. I need to, we need to keep this thing rolling. Where's the bridge? Like, where's the bridge for people? Obviously, seeing one of you or coming to a program that that features these kinds of practices is one way, but where's the bridge for the average person who's maybe suffering from a condition or family with a family member that's suffering a condition uh to find their way towards this kind of better model of care when it comes to what you put in your body? Where's the bridge to that?
SPEAKER_04:I think that you said it a lot there, but that would be news to most people. Most people or families do not have all those elements in place, like you just went through. Uh the weaker to the crisis intervention, the event, as Ross said earlier, a week or two in the hospital might help you survive that event, but you're not going to thrive. I think six months in any of these programs we're talking about, that's how you thrive. I've that's what I've seen. I've had my own patients in my private practice. Um, I've seen countless times that it's the consistency, it's the implementation of all those things. In these fragmented models, you don't get all those things. So what you just said, cut, paste that. You know, there's your your reels clip. That is news that most families, when they look at, it's not, they don't have the prescriber that's listening, they don't have the therapist, they don't have the community, they don't have the support, um, they have far too much stigma, they have insurance that's not covering this or that, and uh certainly don't have the the majority don't have the exercise lifestyle and nutritional interventions. And that's why people with severe and persistent mental illness, depending on your die eight to ten years sooner. Most of the time, not from suicide or or interactions with the place, they die from boring things like heart disease and stroke and diabetes.
SPEAKER_01:Yeah, I mean I think that if you were to study the physiological effects of what are called uh social resources, psychosocial resources when you don't have them, you would see these same um physiological responses independent of what you put in your mouth. Because of course, because these are called stress buffers, a sense of social support, a sense of purpose, self-efficacy, uh self-esteem, a sense of your value in the community. Without those things, social psychology is really proven. You go straight into a stress mode and a chronic one. And we're focused on metabolic stuff, which is awesome. It's great, I believe in it. But we're doing it again, we're not looking at the social experience of these people. Because our brains just move towards the body and to the physique and all those sorts of things. And I believe that the underlying thing that's killing them is years of stress. Because they don't have these resources. You cannot survive a life. If you don't this is what the loneliness epidemic's showing us on some level, you cannot survive loneliness is ties with cholesterol and smoking for heart disease because of the cortisol. You're talking about lonely lives. You're talking about lives even if they're in a program, even if they're not isolated, where they don't have the sense of value and pride to make them feel like they belong. And so not belonging this is a killer. Maybe it's not the only thing, it's the meds, it's the metabolism, it's all those sorts of things, but we keep extracting it. As the most obvious killer in all this. Well, we'll give it to ourselves. We'll talk about the loneliness epidemic affecting non-mentally ill clients, but we don't give it to the most lonely people, which is the mentally ill clients, and allow them to be also uh uh part of this idea that that it's a killer, that it's a danger, it's an epidemic, you know.
SPEAKER_04:But it's addressable. Sarah, I mean, you want to talk about you sometimes I feel like you're an events coordinator there for all the events that you do. Uh I I'm gonna let you talk about that. How to combat long.
SPEAKER_00:Yeah, so one one of the things that comes to mind here when we're talking about medications or or any of this, any of these things any of our programs offer, um is I I think one of the bridges, Todd, kind of circling back to your question, is that dignity and autonomy is is one of the most important pieces. And you know, I have had to seek out care for a loved one. And if I said to him, um, hey, you didn't take your medication today, so now you have to discharge and go home. Or, you know, you didn't do this thing, so now we're gonna remove care and support from you. That never made sense to me. But rather, as a clinician, taking that responsibility of, okay, this person's not engaging, this person is, then it's finding out what Ross just said. Okay, this is a loneliness issue, this is a social support issue, this is a person not having opportunity to engage in a way that they feel safe and comfortable. So, you know, I mean, I could just speak for Lakewood alone. We we find ways. They went to SeaWorld yesterday. That wasn't for everyone, but it was for about eight people, right? And they went and they came back and they told me what a great time they had at SeaWorld. But here on campus, we also made bracelets. And we made bracelets because this one particular resident had a bracelet-making kit and was Sarah, do you want to make bracelets with us? And I had everything in the world to do yesterday except time to make a bracelet. But I sat down on the sidewalk with them and and and made a bracelet because that was they engaged me, they probed me for I'd like some connection and you're who I'd like the connection with. So I think it comes back down to being able to get creative and and being able to find opportunity for people to combat that loneliness, which is easy to do in a program like mine, um, or or a program in general like like Alan Horn. I mean, I mean, I don't want to say it's easy, but to Russ's point, that costs money. It's not cheap. Um, you know, I have to we have to pay people a livable wage, we have to have resources and supplies and things like that. But in in the community, in terms of of that, it's it it is the point, you know. I think that that is where it's no, it's it's definitely not. I mean, inpatient hospitalization, unemployment costs us all money. Um, all of these things cost society money. So being able to plug in that loneliness element and find connection for people. But I think a lot of that comes down to acceptance. You know, um, with my late brother, when we finally accepted what he was willing to um receive in terms of care and support, he started to accept the care and support. But when we're forcing on someone, when you're telling someone what they need and being prescriptive with things, um you know, I like to say that everything's optional here as long as we can keep you safe, you know. When we have people who, well, we have person who is not on an antipsychotic, and I think he might be that one of 100 that that John's talking about. But um, you know, he has suffering, but he also has support and and choice. And I think that that piece is really important when we start bridging things. But when the legislation that's passed is if you're homeless or mentally ill, you're going to jail or um the hospital, well, who's going to reach out then? Like why why wouldn't I reach out if the if jail or psychiatric incarceration are my two options?
SPEAKER_03:Yeah, and I think that the the piece about this is like, okay, where does this problem begin? Does it begin in isolation? Does it begin with stigma, you know, because they can't find community and and isolation becomes the the natural thing that they do. Um but I what I notice a lot for folks that we work with is that um, and I said this the other day in a presentation I was doing with a local bar, and I said, you know, they were like, what do you do with a person who might need some care but is not really willing to accept it, but they're a professional and they're working and all this other thing. I was like, well, it's very difficult to realize that you need help when you need help. And it's not something that people will often readily accept. There's a there's a like, nope, it's fine, put it over here. Um but I also think that the the the stigma and all the other things, what what I see with the clients that we serve is this has gone on way too long. It's gotten so bad because it didn't get attention way back there when it could have, when you know, more socialization and some good therapy and possibly some dietary approaches and some of these other things, which at that moment would not have been that expensive, could have had an impact, and that person wouldn't have reached a level of acuity in their condition that required all these major innovative strat interventive strategies to get them to a place of wellness. Um, and so you know, maybe it's maybe it's a thing of education to the community as a whole. It's like, look, you know, I there are probably there are several medical conditions we could pull out where it's like, hey, do this early. Brush your teeth, you know, eat greens. Like the the education is like, you know, don't think of mint don't think of mental distress as something you shouldn't address. Think of it as something that's as critical to your health as anything else.
SPEAKER_01:Yeah, I mean, I think that some good stuff's being done about first break psychosis right now, where they're thinking more and more about on the unit trying to figure out how to keep the person in school or work. Um, and how to get them back to their social role as much as possible. To me, that's preventative medicine.
SPEAKER_03:Yeah. Are you seeing that in New York or down in South Carolina?
SPEAKER_01:It's it's a big deal in New York right now. Um, and I think that that kind of model, but there's other places too, where they really kind of think about this thing at the point of crisis, is this how do we kind of keep that that that that stress buffer around you as much as possible? Um and and that puts a buffer to an extreme event for the person, too. Because the worst place for a person who's psychotic to be is in an emergency room for 48 hours on a stretcher with their hands bound and then on a unit. That's the worst moment for someone in the middle of psychosis. And so it's also trying to kind of think about that and how do we kind of soothe that element too. And so there is some good work in that area as far as how to kind of create those buffers, you know? Yeah.
SPEAKER_04:Someone have a center of excellence for that. And that's something on for psychosis. You know, you you see now for you, obviously here in Houston, MD Anderson is a center of excellence for cancer. You see places for autism, uh, you even have some small programs for mood disorders or OCD or eating disorders. How many treatment centers? And Todd could probably tell us, do you have for substance use disorders ranging from the usual 30-day or the laundry balance?
SPEAKER_03:I can't tell you there's too many.
SPEAKER_04:Tell me, though, a place where you could go for first break psychosis to truly for diagnosis, for vocational, for for again to involve family, to to have realistic expectations, to maybe get a waiver from college so it's not just all Fs or a medical withdrawal. I mean, there's we need there's it sounds so basic. Yeah, there are really no either funding mechanisms, or I think the the will, there's no walk, there's walk for breast cancer and and and and autism awareness. Where's the schizophrenia walk?
SPEAKER_03:It's just so um Dr. Stevens is starting a nonprofit for months.
SPEAKER_00:We're gonna be walking this time next year for schizophrenia. John, so we're gonna just not in Houston. I maybe talk a little bit about it. We can go to we can go to New York.
SPEAKER_01:Can we talk a little bit about this model that we use the technique from it, but not the model necessarily. Uh called Open Dialogue from Finland. And this this hospital called Caraputus Hospital in in Tor at uh in Finland, the town around it, uh the the psychosis, the the the the experience of psychosis has dropped. The functioning if you're psychotic has gone way up. Right? So even if they're psychotic, they're able to kind of get on with life on some level. And when you call there in crisis, I don't know how they do this, because it could never be done in the United States. Whoever answers the phone becomes your case manager. Basically, your care begins the minute you call in. And now that place is following you from beginning to end, to the point when you don't need them anymore. It's not like you're coming in.
SPEAKER_03:You need a therapeutic consultant the moment you call.
SPEAKER_01:You get yeah, you get well, you get you get a team because they start doing this process called over dialogue too. This way of saying treatment is your treatment doesn't begin after in the hospital, or it's not segmented in the acute phase and then the next phase. Your treatment begins now. It starts now, and we'll figure it out with you. And all treatment planning is a therapeutic event, it's not a bureaucratic event where we meet without the person in another room and decide what they need. It's a conversation that begins the minute they walk through that door, with their family typically, with the network that's been affected. And their model says that the best medication at that point isn't an antipsychotic, but possibly a benzone. You're just calming the person down because psychosis is kind of this stressful event, this stress-created event of isolation, because they want to actually hear what's going on for the person on some level. And then they might introduce antipsychotics, so it's not like they don't do them at all. But the point is, is how do we kind of create this continuity of care from beginning to end? And John, what you're describing is exactly right. Because these things are siloed, crisis events are siloed, the treatment just gets disorganized, you know, in a way where it doesn't match what this disorder needs, which is this lot of continuity.
SPEAKER_04:And it's crazy making the fragmentation.
SPEAKER_01:Exactly. It's crazy making. So much of psychosis is is iatrogenic. It is created by systems that give people the opposite of what they need when they're in psychosis. It it creates stress, it creates isolation, which are the two main non-biological triggers of psychosis. That's it's insane. I agree that we have a system that does that. Yeah.
SPEAKER_03:Yeah. Well, and that's kind of our, you know, as a consultant, our our continuity of care is our biggest, our biggest role. Yeah. Like that's right. We're we're drawing the line between it's like, okay, they've ended up in the hospital. This is not where the care happens. Let's get them in. And one of the biggest hurdles that that I ever have to cross uh or jump is this person having been in models of care in the past, deciding that that's the only model there is out there, and they don't want to go do that again because it sucks. So I'm coming in here going, Hey, why don't you think consider this place? It's like, well, it's all the same, isn't it? It's like, it's actually not. I'm sorry that you've had the experience that you've had, but there are places that actually care about you. You're probably gonna feel valued and like you have a community and connection. Let's give it a shot, shall we? Like, that's one of the biggest things I have to talk people into. And I I don't blame them for being resistant to it, quote unquote. There's that word again, right? But um, you know, I I I think that um we've we've formed now the board for this nonprofit that Dr. Stevens is starting. We just need the donor or the right. You know, there's probably some we probably got some traction out there. We could we could get something together. We've uh we've already got a nonprofit. I mean, we got so we got sitting right there, right? Um, but uh I think that uh you know there's a I I tell people all the time we actually know how to do pretty good mental health care. We actually do. It exists, it's out there. We've got people who are dedicated to doing it, we're providing it for some. If we could put it in places where everybody it was accessible to everybody, we'd see a whole kind of different world. Um, and I'm I'm really grateful to this group as people who are pioneering what that idea actually means. So um I we could spend probably hours just talking about this. I know that I could for certain, especially with this group of star-studded professionals in the field. Thank you all for being here with me today. Dr. Ross Ellen Horn, Dr. John Stevens, and Sarah Summe, thank you for being who you are in the world and helping us, you know, provide something like community and care for the folks who really need it. Um this has been head inside the middle health on weather late. We'll be with you next time. Thanks, guys, very much.
SPEAKER_00:Thank you. Thank you. Great, pin, I've not beaten beat on it, not beat the beat, fill, I've not beaten a beat and pen, not beat the beat, fell, I've not beaten a fit of pen.
SPEAKER_02:I'll be so lonely and last in the eye, need to fly my way home. I'll feel so lonely last in here, I scalp me, need to find our way home. I want I feel so lonely, the last in here, I need to fly my way home, I'll find our way home.