Listen, Mental Health Matters: James Corbett, Initium Health

In the fourth episode of “Listen, Mental Health Matters,” Brian Giebink, HDR’s behavioral and mental health practice lead, speaks with James Corbett, founder and principal at Initium Health in Denver. Their unguarded conversation dives into the top challenges and opportunities that communities face regarding behavioral and mental health — and why local efforts and community-informed decisions are so critical for the future. Hear about the roots of Corbett’s ambitious career path from law school to divinity school to the founding of Initium Health, and how he found his calling in the advancement of behavioral and mental healthcare in the U.S.

Episode Transcript

(00:04):
I'm John Torek, and I'm Danny Sullivan, and
you're listening to Speaking of Design, bringing you
the stories of the engineers and architects
who are transforming
the world one project at a time. Today,
we bring you another episode of a special
podcast series on behavioral and mental health called
Listen, Mental Health Matters.

(00:24):
As part of this series, Brian Geebink, behavioral
and mental health practice leader at HDR,
visits some of the world's leading health care
providers for candid conversations
about the challenges they face and the opportunities
to transform the patient and caregiver experience.
I'm Brian Giebink, and I hope that by
listening, this series helps us consider new perspectives

(00:46):
in our quest to create transformational mental health
facilities that improve the quality of life for
individuals and families and promote a shared sense
of community.
And now, Brian's
conversation with James Corbett, principal at Inetium Health
in Denver, Colorado.

(01:06):
Welcome. My name is Brian Gebink. I'm the
behavioral practice leader for HDR. I'm an architect
and planner and really engaged in the design
and behavioral health space. Here with me today
is James Corbett. He is the founder and
principal of Inetium Health based out of Denver,
Colorado. James, welcome. Thank you for the opportunity,
Brian. Really glad to have you here. If
you don't mind, just maybe share a little
bit about yourself

(01:27):
and your background and how you ended up
where you are today. Yeah. Thanks, Brian. It's
kind of the unique story. I went to
law school and then divinity school. And whenever
I tell people that, they get a few
chuckles and they say, well, what happened? Who
are you? Why'd you do that? And the
next question they ask is, did you go
to divinity school first or law school first?
So they said, if they could peer into
my soul. So I always say, I went
to law school first, then divinity school. I'll

(01:47):
leave it to you to decide if I've
been ruined or reformed.
So probably into some unique spaces. I've been
working in Catholic health care for maybe fifteen
years.
I actually replaced a lot of the nuns,
coincidentally. So I had with the law degree
of master divinity, as nuns were retiring and
moving into
other fields, they needed somebody to come in
and make sure that the mission of that

(02:08):
hospital, that Catholic hospital, that care for the
poor, that healing ministry was lived out. So
they trained what's called the laity, people who
aren't ordained to come in and take over
those roles. So I was a mission leader
in hospitals in Massachusetts
and Colorado and in other states. And in
that role, I was in charge of community
health, the community benefit, care of the poor.
I was also in charge of things such

(02:29):
as behavioral health. And in Massachusetts, I found
myself taking care of more psych and substitute
beds than anybody in the state. I was
doing that on behalf of a Catholic health
system that had a footprint in some underserved
areas. As you know, often in underserved areas,
there's more need for behavioral health and more
services. So after that,
six years ago, I started a company, a
law of the partner, Elise Plocky, and we

(02:51):
started Netium Health. And it's a marketing
and consulting company. And we consult with health
care companies. We consult with governmental entities.
And we do a lot in both the
built environment, architecture alike, but also in the
processes. So in the era with so much
opioid settlement funding coming down the pike, how
do governments and municipalities spend it in a

(03:11):
way that makes the most sense, that has
the most impact? And you're based in Denver,
Colorado, but you're consulting everywhere. I currently work
in about 12 states, and we have employees
in different states as well. Our base is
in Denver, but the majority of my work
is actually outside. Okay. Is your consulting base
just in behavioral health care? You do all
types of of health care. Yeah. We love
behavioral health, and we do that probably about
70%, but we also have a strong footprint

(03:32):
in community health. So for the city of
Lubbock, we're doing their community health efforts. We
work with the public health department, doing a
needs assessment, helping them understand a community health
improvement plan. Sometimes that does involve the built
environment as well. Like one of the things
we're looking for in that community is better
safety in our biking lanes. So as we
do a needs assessment, one thing that might
come out out of that is better biking

(03:53):
lanes and things like that. Too early in
the process to say and I don't get
to decide, but that's like a word we
do. So thinking about the behavioral health space,
can you elaborate a little bit more on
some of the challenges that some of the
communities are facing and what you, as Initiative
Health, are doing to help overcome some of
those challenges? Yeah. So I'll start by saying
that even the term behavioral health needs some
unpacking. So behavioral health is really a term

(04:13):
of convenience. It covers both substance use disorder
and mental health. And substance use disorder is
actually a form of mental health illness. So
we really should be using the term mental
health, but the very fact that I often
have to unpack that highlights the lack of
clarity and the lack of advancement that's happened
in the behavioral health space, and that's largely
because the funding wasn't there. We don't have
these conversations with orthopedics. When you say orthopedics,

(04:35):
people know what we're talking about. We say
neurologic, people know we're talking about. So that's
the starting challenge. The second challenge I alluded
to is the fact that it's been so
underfunded for so long. That means there's a
dearth of funding in the space, so there's
more need. But there's also a dearth of
expertise in the space. It's fascinating because the
money wasn't there that a lot of people
didn't grow up saying, hey. I'm gonna be
a behavioral health employee. Right? And then the

(04:56):
physicians who worked in that space were largely,
you know, psychiatrists lead that space. And I
think of really recently that their salaries have
exploded. So behavioral health is now starting to
explode. The need is great. The cost is
great. There's not enough behavioral health employees.
And at the same time, there's funding that
is still at its highest level for behavioral
health, mostly driven by the opioid settlement funding.

(05:19):
So it's almost like a perfect storm to
address what you could consider a very imperfect
profession of behavioral health. Absolutely. And it's getting
better every day slowly, but surely, you're seeing
a lot of progress with the the clients
that you're working with. James, I was fortunate
to hear you speak at Med Talks earlier,
and you had a very powerful story that
you opened with. And I think that's important

(05:39):
for listeners to hear that because I think
it really highlights the need for very thoughtfully
creative behavioral health, communities of care, environments of
care, both the physical environment and the community
really embracing. Like, Kara, do you mind sharing
that story or similar stories with the audience
listening? Yeah. I was really honored to do
that. Second year now doing the face to
the art then. The topic was somewhere to

(06:00):
go. And I started by telling a story
of a gentleman who was in his twenties
who walked into an emergency room, and he
had been there before. He's what we call,
frequent utilize or VR services.
As was well known to the staff, and
on this fateful day, he was discharged and
he was found in a ditch two days
later. And his mom wrote us the executives

(06:20):
of the health system a letter and she
said she dictated all the reasons why he
probably shouldn't have been discharged, discharged on his
own particularly.
And she said, you know, I don't wanna
sue you, but I want you to know
that he had a mom and that the
next person that comes in the yard in
a similar situation has a mom and that
we would do anything just to spend one
more day with that person. So that stuck
with me. I still carry the letter along.

(06:42):
It's kinda like an inspiring force. And it's
my hope that with new funding and new
opportunities, we will not have as many stories
like that. But I will tell you sadly,
it's happening across the country right now. Mhmm.
That's such a such a sad story, and
I
imagine it's happening everywhere. Yeah. I mean, as
I see, this classic story written on it
by Malcolm Gladwell, it was written in the

(07:03):
New Yorker and the story is called, Million
Dollar Murray. So it's a gentleman named Murray.
He was experiencing homelessness. He was experiencing
substance use disorder,
and he would drink every day and end
up in the hospital in the emergency room.
So they started to track him, and they
studied him. And he was in the ER
so much that he cost one health system
a million dollars, thus the moniker million dollar

(07:23):
Murray. Though, sadly, we have a lot of
million dollar Murrays. And in Denver, they're actually
starting to track not only those who are
coming in and out of the ER, but
those who are inordinately
using a a variety of city services, social
services, prison services, jail services.
And if you can look at those top
users of the system and the spend and
think of more creative, financially viable ways to

(07:43):
serve them, we can save money and provide
better care. So I think behavioral health really
spends much much beyond behavioral health. Unmet behavioral
health needs leads to a lot larger health
care spend in general. So if we can
fix behavioral health, we can reduce
the overall spend in in health. And we
know it's at about 19% of our GDP,
so we need to do something.

(08:04):
19% of the GDP. Yes. Wow. Wow. That's
pretty significant.
So as you approach communities
to try to help them solve some of
these challenges, you're working with a lot of
communities,
and there are probably certain things that communities
need more than other things. What do you
think are the top issues that communities are
facing right now, and and how are you

(08:24):
helping those communities fill those gaps in the
services
as they recognize them or as you help
them recognize? I wanna start by taking a
step back and take a little bit more
of my background, which kinda drives my concern
for community good. So I was gonna be
the first failed lawyer. I did math with
my parents, hold me every day gonna be
the first failed lawyer, and I did it,
but I knew in law school I didn't
wanna do. And so, yeah, I kinda do
these things for your parents. I'm glad I

(08:45):
did it. It's a very valuable and flexible
degree. But then I went back to divinity
school, and they said, what you doing? They
said, you have your degree already. I said,
I went to law school for you and
won the divinity school for me. It was
a premise that the law alum has very
powerful opportunities to shape society, but I felt
like I needed a little bit more on
the ethics, the the why and the how.
And there is this connection between law and

(09:05):
theology. Theoretically, we have a Judeo Christian basis
on the law that shape our society.
And I just wanted to do more in
the community. So I went to Beth's divinity
school, and I took a job in a
nursing home. I was in charge of the
community benefit of a nursing home in Biddeford,
Maine. And I'll never forget, had two graduate
degrees and I was making less than 30,000
a year. And I was eating Robin Doodles
thinking this plan of mine is not working.

(09:27):
But it happened pretty quickly after that. And
I think it's a story of chasing your
dreams. And I have three years as a
vice president of a health system in Maine
and I was doing community health fair. Two
years later, I was a vice president of
a large,
for profit health system in Massachusetts where I
learned behavioral health, and then I came out
to Colorado where I was also a senior
vice president. So I've always had this passion
to serve communities, and I can tell you,

(09:47):
as we sat inside hospitals in charge of
community benefit,
hospitals could do more to live up to
what it means to be an anchor institution.
So but I get it. There are challenges.
And as I said today in the talk,
health is a hairball in the financial realities
and strategic realities, why they're not doing as
much as they can. But what I'm happy
about today is in the era where we
have the opioid settlement funding, $50,000,000,000

(10:09):
coming out in the next twenty years across
the country. That's an opportunity for counties and
municipalities to step into a space that hospitals
are reluctant to do. So I could give
that background to say that it's the counties
and municipalities and cities that hold the most
promise for addressing our behavioral health needs. They're
the ones who have EMS and fire and
police in order to at least serving

(10:29):
populations that could at best be served in
a health care setting. Now the type of
setting is the crisis care facility. That's the
future. In patient care emergency rooms are hospital
based, privately owned or publicly owned if you're
for profit.
But
the institutions at cities, they're the ones who
are dealing with the most vulnerable. They're the
ones who are focusing on crisis care. And
they're the ones, I believe, have the largest

(10:50):
opportunity for behavioral health in the future to
set up a model of care that supports
patients the best. How might somebody start this
process? A community anywhere. Let's let's pick a
state, a community in Arizona, for example. How
might somebody start the process if there's an
individual or a community member or a health
system that knows there are gaps in behavioral
health care in the community? What's the process
for starting that? Well, I like to say

(11:11):
that it should be community informed solutions for
behavioral health. Right? So the muckety muck will
tell you this is what we need to
do, but there's people with lived experience who
might have a different story. So we'll generally
come in. We'll get hired by a municipality
or a city. And your example would be
Arizona. And then we'll come in and we'll
do a needs assessment or a feasibility study.
And we'll highlight all the behavioral health needs

(11:31):
in that community. We'll start with what the
quantifiable data is, the public health data. But
then we'll do qualitative data interviews and interviews
with people. Then we'll do listening sessions. We
like to call them ideas exchange. Community listening
sessions can sound
but that ideas exchange, you bring people from
other cities, you bring people from that community,
and it's an exchange of ideas. We then

(11:51):
take that data. We put it in a
report to a city or county. And then
with that data, inevitably, unfortunately, because we're so
much unmet need, shows us unmet need, and
then we help them determine what those solutions
could be. The solutions generally fall into the
three buckets of what crisis care standards are
in this country now. Someone to call, someone
to respond, and some place to go. So

(12:12):
we generally help there a lot of those
three areas. We have a marketing arm of
our company. We are both a marketing agency
and a consulting company. So sometimes we'll do
campaigns to raise awareness of services.
Other times we'll help with a strategy around
developing mobile crisis teams in partnership with law
enforcement. And then thirdly, what brings us together
today will help with the built environment. Now
we're doing the building. I'll leave that to

(12:33):
the architects like you who will come in
talking about design principles,
architectural recovery,
the importance of a certain flow for patients
and employees. So it's enjoyable work. It's meaningful
work. In this process, where do you see
your other typical roadblocks that a community might
face in this process? And how have you
been able to help them through these initiatives?
Sadly, I'll start with the most depressing impediment

(12:54):
is those that are profiting off the status
quo. In any improvement, there's someone working and
doing pretty well on the dysfunction. And sadly,
across the country, there are those who are
pretty happy with the status quo. So the
first thing that happens is I get attacked
and I get told that my data's wrong.
It's public health data. I get told that
my plan doesn't make sense. It's not my
plan. I always say it's not the James
Goring plan, it's the Samsung plan. I'll just

(13:16):
wait those guys. And, inevitably, we can get
past that. And it's really about building trust
with that community,
and you do that by making sure they
know that you're taking their opinion seriously. It
goes back to the importance of those community
informed solutions for behavioral health and these ideas
exchanges in different ZIP codes. I don't go
to the wealthy ZIP code alone and saying,
what do you need to have done? I
go to the variety of ZIP codes. We

(13:36):
collect that data in a meaningful way, illustrate
it in ways that are easier to digest
and read, sometimes in videos and others. And
then we build community consensus. It's the question
is a great one because the first thing
that I go, I meet with on behalf
of cities and counties because that's generally what
I'm doing. So first, all the people in
the community will tell me why the city
is doing it wrong and what the county
could be doing differently. But I always say,
you know what? I'm hired to do this

(13:57):
needs assessment to determine the what this community
needs.
And I said, but my unofficial goal is
to build consensus. So you tell me two
or three things we can agree on. Because
I know there's lots of things we disagree
on. But there are two or three things
we can agree on, and then I use
those two or three to find consensus in
other circles. By the end of the report,
there are only things we can agree on.
Well, behavioral health will divide it in so
many ways. Behavioral health is the one thing

(14:19):
across the country been able to come to
terms with across the aisle, if you will.
That's really great. Do you have a maybe
an example of a community that you worked
with that has done it very well that
maybe other listeners and other organizations couldn't learn
from that experience? Yeah. I mean, maybe they've
overcome certain challenges or overcome a funding barrier
or something. Yeah. I'll get you two different
examples. So one is in Palm Beach, Florida.

(14:39):
So the health care district of Palm Beach
hired us to do a feasibility
assessment for them about the needs of behavioral
health, unmet need, and to build a crosswalk
to address those gaps in services. But they
were really clear early on that they wanted
to follow
SAMHSA's guidelines, the national guidelines for crisis care.
So their goal was to come in and
to adhere to those guidelines and then score

(15:00):
their community across those measures, figure out what
the gaps are, and figure out what would
be needed to address those gaps. So that
was a great client because they had known
about the guidelines already, and they wanted fidelity
to the guidelines in their community. The hard
part is to go into Florida and tell
them about these national guidelines and hear about,
oh, we did things differently in Florida. Right?
And so, you know, but we're able to
get past that. We're making great progress there.

(15:22):
A different story is in a rural community
such as in Clovis, New Mexico.
And in Clovis, New Mexico, a town of
about 30,000 people, they had a big challenge.
The money's going to Albuquerque. And I understand
that for a population health approach, there's more
people in Albuquerque, a lot more than 30,000
in Clovis. But Clovis has real leads. They're
driving outside of their state to Lubbock or
Amarillo to get care for behavioral health. They

(15:43):
were also wise enough to know that 30,000
residents
weren't gonna get funding alone because of their
size comparative to Albuquerque. So they partnered with
six other municipalities,
very small. Together, they totaled a hundred thousand
people. Because they were able to combine with
those hundred thousand people, we were able to
give a needs assessment that took into account
not just Clovis but whole of Eastern New

(16:05):
Mexico. We were able to go to that
state, and they got a $10,000,000
award to build a crisis facility in their
community. So it's a great story, and I
think that's gonna be a story that is
gonna be a kind of a beacon for
rural communities across the country. It was like
the collective voice is stronger than the individual.
Absolutely. But, you know, there's a lot of
councils and commissioners at each of these cities,

(16:26):
at each of these. So bringing them together
was one of the hardest things, but I
was so happy to hear that
they came together for the first time last
summer, and they wanted me to moderate for
the first time when all these different councils
had what they call a joint session. They
all drove from rural communities across Eastern New
Mexico, and they came together. And it wasn't
easy, but we left with consensus of what
the next steps would be. Because decisions have

(16:48):
to be made, we have six small communities
with large
diversity in terms of their scope and their
geography in the distance.
It has to be built in one place.
So all the first questions we got asked
was why is it being built in closed?
What about this community or that community? But
they got past that, and they decided to
put their money together to build one facility
they can all work on. It's such a
beacon of collaboration, and sadly, not as common

(17:09):
as you would think. But, James, what are
we not talking about that you feel like
is important for advancing behavior health and community?
Yeah. I just think it's this collaboration
across city and county and state lines. So
while the feds came up with a great
concept, it is a theory, and I always
separate the theory from the practice. So the
theory of these national guidelines
and how they can work across the country.

(17:30):
The reality and practice is that Los Angeles
is very different than Clovis, New Mexico. So
how do you take those guidelines and then
translate them to local communities?
And then how do you share
those learnings of those local communities so that
the closest of the world can inform other
local communities and that the Palm Beaches of
the world can inform
other Palm Beaches of the world? Palm Beach

(17:50):
County is one of the largest geographic counties
in the country.
And it's so diverse from downtown, Marrero, Largo's
down there to, you know, the Sugar Plantations
way up north. So I just think we
have such a great country and great diversity
that there should be a way for us
to share these learnings a little quicker. And
I feel like that's the biggest gap because
it's happening. The money's there, but the pathway

(18:12):
in different communities and the sausage making, if
you will, have to hard fire. Absolutely. Yeah.
Do you think there's anything that we can
do as whether it's designers or architects or
community members to help? Is it advocacy? How
how do we help with the guidelines and
not make a challenge? So I'm gonna give
you a answer that you might not predict
for this question, but it's really about what

(18:32):
we've done to professionalize
health at the expense of the community, understand
their role in health. So what I say
that to say that the professionalism of health,
the doctors,
the hospital industry, the medical industrial complex, has
been great in many ways. At the same
time, it's de empowered individuals' role in health.
They think health is at the hospital. Well,
that's why I go to health. I go

(18:53):
to the emergency room. The hospital's gonna take
care of us. And I would argue that
there's so much that can happen in the
community
that they can be empowered to have community
informed solutions for behavioral health. And this is
what I believe the builders and the designers
and the creative class can help because you
guys have great creativity, great ideas about what
can be built in older buildings and others.

(19:15):
And guess what? The hospitals aren't charged anymore.
So all the bureaucracy, the golf playing, the
doctors and CEOs to get the business, those
days are in the past in the space
of crisis care. Put in a request for
proposal, you are chosen not only in relationship
but in your skill set. You can bring
your great ideas to bear in a way
you can shape communities across the country. Do
you have any other thoughts?
Just that I'll close with a question around

(19:35):
the concept of a quote. One of my
favorite quotes is it, you can test the
morality of the society by its treatment of
the poor and underserved.
And I think that not a lot of
people would argue that those suffering from behavioral
health are very vulnerable and that they deserve
better care. So let's bind together and make
the society more immoral, at least of that
test, by focusing on behavioral health with renewed

(19:56):
emphasis. That's really great. Well, James, thank you
so much for your time today. It was
really great chatting with you, and I've learned
a lot. And I'm sure our listeners have
learned a lot too. So thank you very
much. Thank you, as an alumni.
For more information on our listen mental health
matters series, please visit hdrinc.com/listen.

(20:17):
There, you'll find more on HDR's approach to
behavioral and mental health design, meet our team,
and see samples of our work.
If you like what you heard, be sure
to rate us or leave a comment on
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