Housing Is The Treatment with Sarah Summey

You can’t “therapy” your way out of a housing crisis, and you can’t build recovery on top of benefits rules that punish stability. Todd Weatherly sits down with returning guest Sarah Summy, CEO of Lakewood Center in Greater Orlando, to pull apart the real-world mechanics that keep people with chronic mental illness and substance use needs stuck in cycles of homelessness, hospitalization, and incarceration.

We start with a sharp example from pop culture: the Hulu film Patrice and the disability benefits “marriage penalty” that forces couples to choose between love and survival. From there, we follow the money and the incentives, from corporate wage practices that lean on public assistance to insurance policies that will fund “treatment” while refusing to cover the housing that makes treatment work. Sarah makes the case plainly: for many people with severe and persistent mental illness, housing is the care. Community is the intervention. We also dig into the barriers that show up outside psychiatry, including denials of skilled nursing care over drug screens and the ripple effects of opioid-era pain management policies, even in hospice.

If you care about mental health care access, supportive housing, Medicaid and Medicare policy, or what a functional continuum of care should look like, this conversation will give you both language and leverage. Subscribe, share this with someone who works in health care or policy, and leave a review so more people can find it.

Transcript

Welcome And A Benefits Trap

SPEAKER_01 0:00

Hello, folks. Thanks again for joining us on Head Inside Mental Health, featuring conversations about mental health and substance use treatment with experts, advocates, and professionals from across 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'm Todd Weatherly, your host, therapeutic consultant, and behavioral health expert. With me today and returning to the show is my good friend, Sarah Summy. The Chief Executive Officer of Lakewood Center, a therapeutic community to enhance the quality of life for adults living with chronic mental illness based in Greater Orlando. Sarah has an impressive background that spans various pivotal roles in the behavioral health care sector, including executive officer, senior director, and direct care clinical roles. Her extensive experience encompasses operational strategy, service recovery, and multifacility oversight, leading groundbreaking initiatives in assisted living programming and forging partnerships with esteemed institutions like the University of Central Florida and Rollins College. Beyond her professional achievements, Sarah is a passionate advocate for mental health and is actively involved in organizations such as the National Alliance for Mental Illness, NAMI, and the American Foundation for Suicide Prevention, with a Master of Science in Healthcare Administration and certifications that underline her expertise. Sarah combines her professional knowledge with personal experiences that fuel her mission to enhance the access to mental health care for all, which is why I like her. Um, have you seen this? Have you seen the movie Patrice on Hulu?

SPEAKER_05 1:36

No.

SPEAKER_01 1:38

Check it out.

SPEAKER_05 1:39

What's it about?

SPEAKER_01 1:40

So Patrice is uh a person with differ disabilities, and she lives um with her partner, or they kind of live together with her partner because they can't get married, because if they get married, they lose their benefits. Oh which is a huge issue, of course, in the Which really happens. Yep, in the Medicaid, Medicare benefits world. And we see, you know, we're seeing a bunch of that, of course, right now, especially with housing. If they got if they got limited resources, they got limited income, you know, through through disability, and they're truly disabled. And then of course, what's the next thing they're talking about? They're they're talking about people who are disabled, and I don't know the parameters on this. I assume, you know, they're talking about uh, well, you need to work a small amount of time, you know, part-time or something, some amount of hours in order to continue to get your benefits. It's like, so does that mean that my 84-year-old mother needs to go back to work? Like, is that is that what we're talking about? Because she's not going, she's not going back to work.

SPEAKER_05 2:57

And no offense, but like as an employer, and you want to keep like we're talking about like economic hardship and why things cost so much. It's expensive to make all these special accommodations. And so we're like expecting it, we're expecting companies and employers to subsidize disability benefits. Like that's so all the accommodations I have to make for someone, which I can and I and I do. Um, but that's someone has to pay for that. So you're it's the consumer's gonna pay for the expense of that, and I'm now subsidizing what should be provided, anyways.

SPEAKER_01 3:39

It's like it's like Walmart, you know. Yeah, percentage, what very high percentage of their their employees are on assistance. And that's basically they're making the government subsidize their employees.

SPEAKER_05 3:52

Paying to give people a livable wage, yeah.

SPEAKER_01 3:54

Right. And so is that what the government's supposed to do? Because those are the dollars that I'd like to see. I want Walmart to be paying its people a livable wage, and then I want people with disabilities who deserve to have support from the government be accommodated at the level of their need.

SPEAKER_05 4:16

Yeah.

SPEAKER_01 4:19

And we I mean we see it with insurance.

SPEAKER_05 4:21

Because if Walmart paid their livable wage, then there would be plenty of money for disability benefits.

SPEAKER_01 4:29

I mean, technically speaking, there's plenty of money already. Yeah. We don't really have to take from one disenfranchised group. I mean, that technically isn't. That's taking from someone who puts it all in three or four people's pocket. So that, you know, Bezos is the same way. You know, if he one less yacht and Bezos could pay, you know, not only could they have bathroom breaks, but they could have health insurance. Go figure.

SPEAKER_00 4:56

Yeah.

SPEAKER_01 4:57

So I don't, you know, the the perpetual model of we always have to make a profit and we always have to make more profit than we did last year. Uh I I'm just not sure how long that model will can be sustained.

SPEAKER_05 5:09

Um like can't and Amazon's notorious in Walmart too for not having full-time employees. Oh yeah, because then they don't have to be able to do the other obligations.

SPEAKER_01 5:20

Correct.

SPEAKER_05 5:20

Yeah.

unknown 5:21

Yeah.

SPEAKER_01 5:22

Dodge all the other benefits stuff and you know, under the essentially out of the table, you know.

SPEAKER_03 5:28

Yeah.

SPEAKER_01 5:29

Um but and then you know it insurance, we can't get insurance. It's like I'm not sure where it came from. That insurance companies, if you go into like say PHP level of care, they don't pay room board because it's not quote unquote residential. The truth is, is you could make a really good program you could make some really good programming out of resident, you know, for a care model with uh with a room and board PHP style programming. And in Arizona, they're doing a model that's really working this way. They're shortening residential stays and they're putting people at the PHP and really doing the clinical work there. But they, you know, people still have to come up with the with the extra for housing. But for the people that you serve, like housing is is like it's 100% essential. Like these people can't get the care they need without the housing. Housing is the care.

SPEAKER_05 6:32

Even our community-based program that we're working on rolling out later in the year, the housing's the key component there. Like the housing is everything's centered around stable housing, and for the population we work with, like everything's centered around stable housing with that. So there's really no way it never made sense to me why insurance companies well, insurance companies have never made sense to me. Why is someone who's never met me determining my health progress and what treatments I'm gonna receive? Um and and that are not an active care provider or no, and there's most of them are not physicians, most of them are like paraprofessionals um who are yeah, who are like reading off of a thing, saying, Okay, well, I'm gonna um I'm just going off this criteria based on this criteria. Here's the coverage you're allowed to have, rather than looking at the individual and the physician recommendation, um, especially in pharmaceutical, like especially in medications. But like how how does an insurance company get to just say, well, housing's not necessary for this level of care? When housing is a large component of what care is being provided, like without the housing piece, the rest of it is you can't do it.

SPEAKER_01 7:58

And it's largely the same way for most of the levels of care after residential, even for people who are not doing long-term care environments.

Housing As Mental Health Treatment

SPEAKER_05 8:06

Yeah, even if you're doing like going yeah, if you're going into their houses and taking the care to them, like a packed model, insurance doesn't cover that either. So, like if it's not talk therapy, um, or psychiatry, like pr prescribing or group, yeah, or group, which for the folks that I work with, as you know, um talk therapy is not indicated, it's not an effective or an evidence-based tool. Groups are usually the same way, it's psychosocial rehabilitation that they need the most of structure and support. Um structure support and community, yeah, and community. That's the biggest piece is community of people.

SPEAKER_01 8:53

Um they get better about being with people when they're with people.

SPEAKER_05 8:57

Yeah.

SPEAKER_01 8:58

Go fix it.

SPEAKER_05 8:59

That's the biggest piece. I mean, I just mentioned music and mocktails, and you hear something like that, and it's like, well, where's the psychotherapy? And that there is no psychotherapy, but you take a suicidal person, put some really good music on, and put them in a room with other people who understand them, who look like them, who get it. And they leave there being like, I think I will just hang on till tomorrow, because that was a good time.

SPEAKER_01 9:23

Right. Because I don't feel awful now.

SPEAKER_05 9:25

Yeah, I feel a lot better. Yeah.

SPEAKER_01 9:29

Yeah, I well, and you little little prop to Lakewood here. Um are getting ready. Let's see, hold on. I think I have it here. The um The Legacy Gala.

SPEAKER_04 9:44

Yes.

SPEAKER_01 9:45

It's coming up.

SPEAKER_04 9:47

October 3rd in North Florida.

SPEAKER_01 9:49

No, it says Friday, October 2nd. Oh my god.

SPEAKER_05 9:53

No, it's the second. You're right.

SPEAKER_01 9:55

It's the second. Well, you gotta go erase that. You can be wrong, but if the paper's wrong, that becomes a problem.

SPEAKER_05 10:01

No, the paper's right. But you know, I think last year it was fell in the third.

SPEAKER_01 10:08

Why are you having a gala? Because you're a nonprofit. Yes. Why are you a nonprofit? Because, you know, it very often by the time a person reaches anywhere from three to six months to a year's worth of year care, they're running out of their resources and they need you to subsidize their ability to make it into a long-term stay.

SPEAKER_00 10:30

Yeah.

SPEAKER_01 10:30

There's another program with similar features out in Texas. And, you know, you've got people who are living in recovery from severe and persistent mental illness and even addictions issues for five and 10 and 15 years, and they're not going to the hospital. And they're, you know, they're taking their meds routinely, and they're getting the amount of care that they need to support them at the level of independence they've they've achieved. And instead of like being in jail, being in the hospital repeatedly, you know, 18 times a year or whatever it is, sometimes more, or, you know, uh needing lawyers and public defenders and everything else to handle the stuff in addition to whatever damage they may be causing to people and properties and everything else, like the math after a period of time is really a no-brainer.

SPEAKER_05 11:26

Yeah. So according to um our impact study in the state of Florida, to house or incarcerate and hospitalize repeatedly someone with let's say schizophrenia. So SPMI, pick your choice, I'll say schizophrenia. Um, it's about$360,000 per year. And that's taxpayer funded, right? So for one individual. Um, and I don't have the numbers, so I won't throw them out there about how many of those that we have each year. So even if someone paid full rate at Lakewood Center with no anything, it would be right around$1,200, or I'm sorry,$120,000 a year. Um, and I have a client here now who prior to coming to us in one year, he had 96 inpatient hospitalizations.

SPEAKER_01 12:21

Like that takes that's a record. That's the record.

SPEAKER_05 12:23

I I don't have 90 96 times he was involuntarily admitted to the hospital. So he spent over a quarter of his year in a hospital. Um, and he would get out in, and there were a couple of arrests in there as well. And so he would get out of the hospital, have some adverse event, come off of his medications, wander off from family, was sleeping on the streets, all of these same things that you and I in our worlds hear all the time.

SPEAKER_01 12:52

Using using shelters who are also nonprofits, you know.

SPEAKER_05 12:56

Yes. Um, has been here for three years with no hospitalization, um, and obviously no incarceration either. And that was the missing piece was stable housing, community, um, a level of, to your point, a level of independence he was able to achieve and now is maintaining with our support and gets to be um, he has a therapeutic job, he has a job in our therapeutic work program here on campus, so he's making a little bit of money. Um sister just had a child, so he gets to visit and be an uncle now. Whereas before it was, well, I'm the guy that 96 times my family got the call that I'm back in the hospital because I pick whatever it was for that time. And so I think that the way that you know, we when we look at public health, especially around mental health, we want to jump straight to these evidence-based things when the evidence just shows us that basic needs have to be met first and accommodate those basic needs, and then we can move forward with addressing all of these other things if it's indicated for that person.

Lakewood’s Model And The Real Math

SPEAKER_01 14:09

And you know, the other thing I I keep asking this question, but it's like, well, what's the where's the barrier here? It's like so in insurance companies and and and state funded agencies that are providing you know licensure and funding and everything else for for entities like this. We you know, you exist on what I would call, say, the frenches of the private pay industry. A lot of you folks are private pay, they can afford it and twenty thousand dollars a year for their individual to be to stay in your care. Um, but they might ask for you know a break somewhere in that that year stay and need a break ongoing, and you're a nonprofit, so you're prepared to provide some of that. If we go to the if we go to the community mental health system, you know, it's it's kind of the same thing as what the insurance are doing. Insurance does to what we see in residential care and private pay care and everything else, or insurance build care. They are underfunding, understaffing, under training, under serving their communities that they are bidden to serve. They don't have enough room because they don't have enough staff, and even the people that are in the in their care are not receiving their care. I've got a client right now. He was in he was in uh the care of the local man at the LME here, and they uh, you know, had a lot of problems, got arrested a bunch, was in the hospital, up and down, homeless for weeks and months on end. All the things that happened to people with severe and persistent mental illness, inconsistent on meds, and finally was able to get him into a sober home. And he's been sober now for a year.

SPEAKER_05 16:03

That's amazing.

SPEAKER_01 16:04

He has a trust. Trust is able to cover it's you know, it's not an expensive sober home, but it's more than the average person can afford that's in that situation. And you know, with people around him to support him, he stays stable, he stays on his meds, he's not in the hospital, hadn't been in the hospital a long time, hasn't been incarcerated. We got all of his charges dismissed.

SPEAKER_05 16:28

That's amazing.

SPEAKER_01 16:29

So, you know, on the other side of that, we've got this person who's walking around, and even though they got the money, they can't they can't get the services. When we went back and we said, hey, this person's doing well, they've been sober, etc. etc. Wondering if they could, you know, reengage and be assigned housing, etc. They wrote back, this is a direct quote from the LME. You look up who they are in our area in Asheville, North Carolina, and you'll know exactly who I'm talking about. They said, This person is no longer, nor is he, nor is he ever to be a client of ours. It's like, how can you be licensed and contracted by the state to provide care to individuals that meet this criteria and refuse care to a person that's in that criteria? I really didn't I did not respond with this comment, which was so you're telling me that you're prepared to give him the same level of services that you gave him when he was in your care. Is that right? Yeah, because that's what they gave him, which was nothing. Yeah, nothing. Well, he could do virtual IOP. He's on the street, man.

SPEAKER_05 17:41

I I think I you know, I think access to care, I think telehealth really improved a lot for access to care.

SPEAKER_01 17:47

Um you know, I'm not a there's not a ditch on uh virtual care.

Public System Gaps And Telehealth Limits

SPEAKER_05 17:53

Well, so I I um you know I'm from East Tennessee, so there's like uh I think two psychiatrists in in the town I'm from. And so over a million people for for two psychiatrists to manage that. I mean, I think that telehealth has really improved access to care, but I do think that payers, specifically Medicare, Medicaid, and private insurance, has landed in this space that they know it is way more cost effective for them. And so that's always the solution. They can do virtual insert that here. And that's not always possible. So to your point, there is if how's a homeless person gonna have access to working internet and somewhere to sit for three hours? You gotta keep it moving. You can't sit somewhere for three hours if you're a homeless person. And that's kind of my um, I think the clubhouse model is fantastic. I don't understand why the unhoused people can't join and attend a clubhouse model. Um, I won't say which one that I visited, but that I was my mind was blown because it's a city where homelessness is uh really rampant rampant. And so we say that homelessness and mental illness go hand in hand, or at least that's you know, the narrative. But you can't go to the state-funded clubhouse if you're homeless, and you can't be homeless if you're you know, you're not gonna come out of homelessness if you have mental illness because you don't have the support you need. So it's just a broken system across the board. I know for our um, you know, there is a program that is long-term residential for people um right here in Central Florida, and it's our local LME basically. Um, but it has the three-year max. So after three years, then what am I to do? Then where am I to go? On average, you could be waiting months to see a psychiatrist. So if I get bakeracted, or that's our involuntary um hospitalization here. So if I go in in under an involuntary hospitalization because I'm suicidal, and they determine okay, we're gonna put you on antidepressants, we're gonna put you on a mood stabilizer, um, we're gonna give you 30 days worth. And then you need to follow up with an outpatient psychiatrist. And I don't know about um what do you got there? Mission hospital. I don't know how mission does it, but um, our local hospital is in here's your piece of paper, call one. And you can call, you can call all of those things on the piece of paper, and on average, you're gonna be waiting three months. So I have 30 days of meds, and I'm gonna wait 90 days to see a provider to refill my medications. So, what am I really gonna do? Is probably not even take the medications to begin with, or I'm gonna run out in 30 days and end up back in the hospital again. I'm gonna be right back there because I still haven't been able to see my provider.

When Drug Tests Block Care

SPEAKER_01 20:55

You know, the we can talk about this other case that we just got through working with. This is this is the other great thing. Yeah. Is that uh you got a person with advanced medical needs and um you know a lot of complicated kind of medical stuff and needs there's a lot of medications, there's wound care, there's all these things, um uh mobility challenges, and needs a s needs a uh skilled nursing respite essentially, you know, needs a couple of weeks in skilled nursing to make sure these things heal up and they can kind of literally, in this case, get back on their feet at least a little bit. And um they got a they got a um a drug test back that said this person had methamphetamines in their system, which may or may not be true. Sometimes you can get a false positive on methamphetamines, if says especially if if you got a lot of polypharma going on.

unknown 21:53

Yeah.

SPEAKER_01 21:59

Right. They were taking pseudophed. You're going to get a methamphetamine read. What you need is a blood test so you can detect levels and determine and look at the meds that that person is taking to say, oh, this is why that read is there because of this and everything else. But they don't do that. All they do is they look at methamphetamine or amphetamine on the registry of the of the of the drugs that have been tested and showed positive. And they refused her across the state to be in a skilled nursing facility. Now, did her medical needs go away? No, they didn't. So who do we sue for that? You know, who do we who is refusing, you know, who with a duty to care is refusing to fulfill their duty to care? Um, and I, you know, we were in a they were discharging, we didn't have time to turn around, but I swear I said, like, we could sue the state because I think we should. Or one of these facilities.

SPEAKER_05 22:57

And the responsibility is, well, let's put it back on a Lakewood center who doesn't even have nursing care except once a week. Right. You solve it for this person. And it's like, well, you know, unless let's say the methamphetamine, let's say it is positive for for for drug abuse reasons, right? Let's say that this person is using methamphetamine. Um and do you have meth dealers in your skilled nursing facilities?

SPEAKER_01 23:26

I mean, you absolutely do.

SPEAKER_05 23:30

But you you know what I mean? Like, do you have a market where she can go purchase these things? Because we're telling you this person quite literally cannot get about. That's why we need you for seven to ten days.

SPEAKER_01 23:42

So are they gonna they're gonna leave and get their meth somewhere? They're gonna have a hard time.

SPEAKER_05 23:47

And and you know, people who use drugs need care still. I I don't, you know, it's um just because you do something that's not legal doesn't make you any more in need of care and and and support. I don't I was really surprised to hear that. That was something I didn't know and something new to add to my soapbox for later when it downloads. But um I don't I and it's very disparaging and discouraging for people in that situation because it's why bother? You don't believe me. Like, why bother?

SPEAKER_01 24:26

Why what did you think me no place to go?

SPEAKER_05 24:28

Yeah, no place to go. Of course I'm gonna be angry and bitter because now what?

SPEAKER_01 24:32

Like Might as well do meth again.

SPEAKER_05 24:36

Yeah, but I mean, at least the meth dealers helped me out when I needed something.

SPEAKER_01 24:41

They're very ready to take your money and help you out.

SPEAKER_05 24:44

Yes, good customer service at the meth house.

SPEAKER_01 24:47

Right. They uh you know, the because of a of a family friend that we had who passed um now several now, uh gosh, a decade ago. Um it is it is the same in hospice. Like you can't drug determination. Yeah, we're gonna drug test you and you can't, and or you've got an addictions issue, and we're not gonna give you any of this particular painkiller because you've got an addictions issue in hospice.

SPEAKER_05 25:15

So that's the other piece. And I um, you know, I'm getting my doctorate, and so I've been doing a lot of things, been doing a lot of research.

SPEAKER_01 25:24

Because I like I keep I hear about this doctorate, but I don't like I don't where are the results? I'm just gonna talk about it. You don't sound any smarter to me. In fact, I think it's going the other way.

SPEAKER_05 25:32

I think it's making me a lot less smart. My ability to analyze and reason is so exhausted that I just don't do it anymore.

SPEAKER_03 25:41

I just stopped.

unknown 25:42

I just stopped.

SPEAKER_05 25:45

They used to be like Sarah's so analytical, and now it's like Sarah shows up, she arrives. We can depend on her to show up.

SPEAKER_00 25:52

She's she's got the she's got the dark circles under her eyes. It's like I can see through her.

SPEAKER_05 25:58

Well, I interviewed um nine different medical doctors that were not in psychiatry because I was especially interested to see how that these things are impacting providers who don't live in our world. And um, you know, I had a couple providers, like one was a gynecologist, and it was like, you know, outside of your common, like occasional mother who's using drugs, like my prescribing and things like that have not been impacted. Like my patients haven't really been impacted by the opioid epidemic. And I'm like, has it not? Let's talk that let's unpack that. If I have an ectopic pregnancy, one of the most painful things to happen, especially if a tube ruptures, um, and I have to have abdominal surgery, which is three incisions across my abdominal across my abdomen, similarly to a um C-section, and for not that it matters, I haven't had this, but I know people who have. Um I go home with seven hydrocodones. That's enough to get me a day and a half. But you tell me that I have to be essentially bedridden for about four days. And then you also tell me I have to take this other medication that's gonna cause my uterus to cramp and have contra basically you're gonna put me in active labor for a few days. And I get seven hydrocodone tablets. And I've never used drugs before. I I'm I'm not a drug addict, I've I've never even used an illicit drug. So don't say that the opioid epidemic doesn't impact you. Like just because you're not addicted to it, prescribing practices have changed so much because pain management now is like people saying I'm in pain is no longer a reliable indicator of pain or a reason to treat pain. It's just well, no, sorry. And so the same could be said for what you're describing. So I use I was a drug user and now I'm in hospice, and you're afraid I'm gonna relapse. I have a week left to live.

unknown 28:01

Right.

SPEAKER_01 28:02

I I mean well, or it's the other way, and the prescriber, you get a hundred hydrocodone. Yes, they're like, Yeah, you're gonna need this till the cows come home. Just take it.

SPEAKER_05 28:11

You need this for three days. Yeah, like, okay, I really just needed pain management around the clock for the four days you told me I'm not gonna be able to get out of bed because it's gonna hurt so bad. But you give me a hundred.

SPEAKER_01 28:22

Right. The this doctor says that there's no problems. It's like, how often do you serve the clients after they're through with the pain? Because you're you're serving them for pregnancy. You may go in, you're doing the incisions and everything else. Like their OBGYN might have a different answer to this question. Yeah, but they might they might not even know because I bet they're finding all kinds of ways to get their script filled, and it might be illicit. In fact, my uh um one story that just kind of blew my mind was um uh and this this in particular is in Florida, as you might imagine. But there's a playground, and a certain time of day, not when the kids are out of school, but when they're still in school, you'll see a lot of vans lining up in the parking lot near this playground, not far from the school. Because why? Because the mommies are exchanging pharmaceuticals, they're exchanging pharmaceuticals and they're getting dealt opiates, they're getting heroin off the street in the soccer, in the in in the you know, soccer van, the mom van, um, and and then going home and finishing out their day and going picking up kids. Like it's you the person you think of as an addict, there's no common picture anymore. It doesn't exist. But we still keep treating it like it's a you know a pariah, and that you know, i if you do this, then you're you're excluded from other care. It's like just because I mean, just because a person's an addict doesn't mean they don't need the other care that they need, including their pain and your profession and your attention, or in pain management.

SPEAKER_05 30:02

It doesn't mean they're painful.

SPEAKER_01 30:03

And pain management, yeah.

SPEAKER_05 30:05

Um and I don't know the statistics on this. I I would really like to know like how many people are really still going to the doctor to get their opiates.

SPEAKER_00 30:15

Right.

SPEAKER_05 30:16

I mean, that's like a big problem. I mean, fentanyl is a huge problem here in Florida, and I mean, every vehicle that's registered. No, every vehicle that's registered in my name has a box of Narcan in it. And you know, because the parking lot, to your point, because the mommy's in their vans and it's always someone you don't expect. The parking lot is usually the number one people place people overdose and in grocery stores. Um that that was a study I'd read from a few years ago. And so, yeah, we we carry Narcan. I've I don't know if I've ever had an opiate. I had to think back about it. Someone asked me the other day. I'm like, I'm not sure. But we carry that because you never know. Um that they're pain, like, I don't know that anybody's like rolling up to the family doctor to like fulfill their heroin addiction.

SPEAKER_01 31:08

Well, and I think you're talking you're naming the problem. He went and interviewed a doc, and the doc's like, well, there's no problem, you know.

SPEAKER_05 31:15

Yeah, it doesn't impact me one way or the next.

SPEAKER_01 31:17

Right. So this doc lives in this silo and he gets to think he's right. He's not. But you know, in his experience, in his narrow little worldview of his patients, the no more than he sees them for the time that he sees them and for the condition that he sees them, he's he might be accurate. Well, it doesn't impact me, it doesn't impact my my patients that I know of. Right. Because I don't look any further than when I'm talking to them for 15 minutes. And so you get these silos, and I'm a doctor, so I know things.

SPEAKER_04 31:51

Yeah.

SPEAKER_01 31:52

In fact, I know all the things, and that generally applies everywhere. I mean, if you go into a hospital, it's like, well, we don't need to know any of the history about the person. We're the doctor, we'll know things. It's like, did you know that they were allergic to the med that you prescribed them to, actually?

SPEAKER_05 32:04

Because that happened to the thing.

SPEAKER_01 32:05

Maybe it was worth looking at something because it wasn't on their, you know.

SPEAKER_05 32:09

Yeah, that happened to the two of us as well recently.

SPEAKER_01 32:12

Oh my gosh, right?

SPEAKER_05 32:13

Like, oh, we didn't know she was allergic. Really, because it was on the 10 page packet I sent with her.

SPEAKER_01 32:19

Didn't look at that, did you? No.

SPEAKER_05 32:21

Not closely. We don't need their thing. They're just that little program over in Fern Park. We don't need we don't need their feedback.

SPEAKER_01 32:28

Right. So that's the problem that we have. I mean, we've got fragmented hair.

SPEAKER_05 32:34

Yeah.

SPEAKER_01 32:36

So how do we fix it?

SPEAKER_05 32:39

We've fixed it. We've fixed it for 53 people, 52 people now. Um here at Lakewood, we fixed it for 52 people.

SPEAKER_01 32:48

So more Lakewoods, is that what you're telling me?

SPEAKER_05 32:51

I think more lake.

SPEAKER_01 32:51

We have one up here. We need one up here.

SPEAKER_05 32:53

We do that golf course, you know. If you're listening to this and you happen to have a um a uh property, give me a call. Todd will give you my number, right?

SPEAKER_00 33:05

Um, I think we can find just a property.

SPEAKER_05 33:08

So I, you know, I think you know, the one thing that we try really hard to do, and I think that's missing is it's one this one size fits all attitude, or like this is indicated for this condition. I know I keep saying this, and I'm not hating on evidence-based principles because those are so important. We have to have somewhere to start, but that's where you start, not where you stay. And, you know, we have essentially in our extended care model adapted each person to whatever that needs to look like for them. So, you know, we we may have somebody who never has talk therapy, but we may have somebody who has it every day. We have a podiatrist that comes out. Not everybody here sees the podiatrist, um, but I've worked at other programs where it was everybody has to have diabetes education. Well, only three people have diabetes. Why is everybody having diabetes education? And so if we could find a way to disenfranchise one size fits all care, um, and yes, more extended care models that are affordable, that are funded.

SPEAKER_01 34:13

Well, and crisis response care. I mean, I'm not saying that people don't get in crisis, but like all of our care is to intervene on a crisis and then not do a whole lot after that. No, because the person's gotten to a place where they got in crisis, they're with that.

SPEAKER_05 34:32

Yeah, it did they didn't just wake up in crisis. There were things that led up to that. And I also think that when I say funded, like we need more extended care models that are funded. We don't need to take the fund, the fun out of it either, or the quality, because that's a lot of the reason that we haven't been incredibly eager to accept state or federal funding, is because there's a lot of things that it would be, oh, you can't take them on a boat ride. They don't need a boat ride. You know what I mean? So, like you have to really compromise your quality if you are receiving those dollars. And so I think that it, you know, the providing needs to be left up to the providers so that that way um we can be impactful in in creating these models. But I would love to see a Lakewood in every community, not just um you know, the Florida states that I love. But you know, every community needs them. I think it is the solution. I think community integration is um the solution for sure.

SPEAKER_01 35:41

Well, and you know, we were really we were really pretty close to it in the 70s. I mean, we were doing it in the 70s. Yes, we were doing it, you know, in the 70s and even in the 80s, then so then the 90s came around, and people who are working for insurance companies who are not who are not professionals, not medical and or or uh mental health professionals, starting dictating what care should be. We're gonna do it, we're gonna do it in this time frame, you're gonna have these periods, etc. etc. I remember when it came down and it could it really, really, really threw mental health for a loop. And mental health has never been true, mental health care has never been truly functional on the on the on the um public pay side.

SPEAKER_03 36:22

Yeah.

SPEAKER_01 36:22

But we were closer, we were closer, and this is we were closer 50 years ago than we are today. Which is just a nutty thing for me to think about and say. On the private side, you got plenty of really good care and we know what to do. So we got a lot of sophisticated clinical models that already exist that have already been proven that they're using regularly now.

SPEAKER_05 36:44

So you can you can insert a lot of like really fresh blood to a model that actually worked back in the 70s, and it is cost effective, it's gonna be way less than homelessness and incarceration.

SPEAKER_01 36:56

Yeah, yeah. I mean, you know, at Cooperese, the the the grounds that the second campus for Cooperese sits on is the Highland Center. Yeah. And it had it had a hospital and two faces of step down on campus. Yeah. And then an outpatient doctor's office at the end that that they could get their scripts from. And it's like they had a complete model right there on campus, 1967, I believe.

SPEAKER_04 37:23

Yeah.

SPEAKER_01 37:25

And you know, it eventually shut down because well, in this case, their main building burned out Zelda Fitzgerald. But but but more importantly, entities came in and they said, no, this is too expensive.

SPEAKER_05 37:40

We don't want to still look at an example.

SPEAKER_01 37:42

Right.

Paying For Care And Calling Leaders

SPEAKER_05 37:44

Yeah, well, I I think that that's the biggest the biggest barrier. I there's nothing more heartbreaking, heartbreaking to me than having to tell someone I don't know. And we'll get calls sometimes, I'll fill in sometimes for admissions and families. How do people afford this? Because one thing that we never want to do here at Lakewood is part of our expensive. No, and part of our nonprofit, part of our model today, and I hope that you know people donate and we can fundraise huge dollars and we can bring people in on the front end with financial aid. But our model today is we never want finances to be the reason someone has to leave here. So we reserve those funds for after someone's been here for a period of time. And so, you know, you have people who will ask me, How do people afford this? What do I do? I don't have any money. And uh my answer to them is I don't know because I don't. I don't know how people are are managing and um they're going homeless or they're going to jail.

SPEAKER_01 38:44

I mean, we know how they're getting we know how they're treating the city. I know the people come.

SPEAKER_05 38:48

I don't have the outside of I mean, I do have the solution, I don't know how to uh make rubber stamp what we're doing here and make people pay for it, make right those that be pay for it. Because the truth is is society, we're all paying for it anyways. And you know, you have people. Um, I live in a um suburb here in Orlando, and I'm on like the community pages on the internet, right? Like on Facebook or whatever, and it'll be like, Gasp, there's a homeless man on 1792, not in our town. This is getting ridiculous. They're like migrating from Orlando into our little suburb. And these people like because of one unhoused person who may or may not be unhoused, because true story, I was training for a backpacking trip and had all my gear on and was stopped by law enforcement in my neighborhood.

SPEAKER_01 39:40

They were calling in, right?

SPEAKER_05 39:41

They were like, What where do you live, ma'am? What are you doing? And I'm like, gosh, I got like$7,000 worth of gear on my back right now. Do I look over? Right.

SPEAKER_00 39:50

Read the room.

SPEAKER_05 39:53

But I was happy to answer their questions and whatnot. But you know, they it's it's like, well, that's unsightly. We don't want to see these people, we don't want them in our communities. We will well, there's this you're paying for it anyways. But then the same group, which unfortunately are usually the ones making the decisions, are the same ones who are gonna say, I don't want to be able to do that. Yeah, I don't want to pay for that. Like, that's their problem. I I don't I don't want to pay for people who use drugs. I don't want my money going to people who use drugs. I don't know anyone um that I've met, and you tell me if you have, but I've never met anyone who when they were little and they're like filling out what do you want to be when you grow up, wrote drug addict.

SPEAKER_03 40:38

Right.

SPEAKER_05 40:39

Like that's not something that someone was just like, This is how I'm gonna be.

SPEAKER_01 40:44

Things have to count on one hand the number of people I know who have never used drugs.

SPEAKER_05 40:50

Right. So for us to say, I don't want my money going to that, and you know, we'll have people that these people stand out here and beg, and I'm not giving them money because they may go buy drugs with it. Well, what else are they gonna do? They can't go get an H apartment to rent or with your two dollars that you're gonna give them, they can't get housing, or I mean, what you know, but you shouldn't have to give them money. We should have communities and rent control and things like that so that they don't have to be there.

SPEAKER_01 41:22

Tell you what, don't give them any money. Um, just pay your taxes, would you?

SPEAKER_05 41:28

Just write your election.

SPEAKER_01 41:32

Just to pay your taxes.

SPEAKER_05 41:34

Yeah, can you call your elected officials and say, hey, uh when those people pay their taxes, I want it to go to the person I don't want to give my two dollars to his drugs.

SPEAKER_01 41:44

There you go. Problem solved. See?

SPEAKER_05 41:47

We did it in this podcast.

Final Thanks And Sign Off

SPEAKER_01 41:49

We just solved the world's problem. Three minutes, like we got it done. What's everyone else doing? I don't know. Well, Sarah, thank you um for being a small slice of the solution to all of this. Um love and appreciate your work. Know that you know, I'm glad you're out there in the world, and um, I will look forward to seeing you at the gala. I hope to attend again this year.

SPEAKER_04 42:13

So on October 2nd. Right, not the third.

SPEAKER_01 42:18

Thanks, folks. This has been Todd Weatherly on Head Inside Mental Health. Sorry, Summy with Liquid Center's been our guest. We look forward to seeing you next time.

unknown 42:46

I've not been the Peter Pen off, the beat the laptop, I've not been the Peter Pen.

SPEAKER_02 44:13

I'll feel so lonely last in the Ashkin. I need to find my way home. Oh, Fam our way home.