March 31, 2025 • 40 mins
Dr. John Santopietro never planned to become a leader in mental healthcare transformation, but after witnessing systemic failures firsthand, he couldn't stay on the sidelines.
From his unique beginnings working in a family fish market where he observed countless personality types, through his Quaker education emphasizing introspection – Dr. Santopietro's path to psychiatry reveals how personal experiences shape professional passions. Today, as Senior Vice President at Hartford HealthCare and Physician-in-Chief of their Behavioral Health Network overseeing 3,000 employees, he's implementing bold solutions to fix a fractured system, including The Ridge Recovery Center.
The conversation delves into a troubling shift in psychiatric care – from an earlier model focused 80% on understanding patients to today's approach emphasizing 80% management of symptoms. Dr. Santopietro shares how integrating mental health into primary care dramatically improves both psychiatric and medical outcomes, with diabetic patients seeing A1C levels drop a full point when receiving comprehensive care. His team-based approach, embedding psychologists across medical specialties from orthopedics to cancer treatment, demonstrates how breaking down silos between providers elevates patient care.
Join us for a conversation that offers both practical wisdom for clinicians and hope for patients navigating a complex system, reminding us that at its heart, healing comes from human connection.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Hello folks, thanks for joining us again on Head
Inside Mental Health, featuringconversations about mental
health and substance usetreatment, with experts across
the country sharing theirthoughts and insights on the
world of behavioral health care.
Broadcasting on WPBM 1037, thevoice of Asheville Independent
Commercial Free Radio.
I'm Todd Weatherly, your host,therapeutic consultant and
(00:23):
behavioral health expert.
Joining us today is ourdistinguished guest and friend
of mine, dr John Santopietro.
Dr Santopietro is the SeniorVice President at Hartford
HealthCare andPhysician-in-Chief at their
Behavioral Health Network therein Hartford, connecticut.
Assistant Clinical Professor ofPsychiatry at the Yale School
of Medicine, assistant Professorof Psychiatry at the University
(00:44):
of Connecticut School ofMedicine and Assistant Professor
at the Frank H Netter MD Schoolof Medicine, quinnipiac
University.
John got his BA at Yale, but hewent on to get his MD from
Northwestern Medical School inChicago.
He did his internship andresidency at Cambridge Hospital
with that little school up therein Mass.
What's the name of it?
Harvard?
Yeah, that's the one.
The little school up there inMass, what's the name of it?
Harvard?
Yeah, that's the one.
(01:05):
He also did a fellowship withAustin Riggs Center, a
residential therapeuticcommunity up in Stockbridge,
mass, probably the place wherehe and Virgil crossed paths at
one point.
Dr Santo Pietro is a 2001diplomat with the American Board
of Psychiatry and Neurology andhe retains his certification
and license in multiple statesthere in the Northeast but keeps
(01:26):
it up in North Carolina as well, having been former chief
clinical officer and chair ofDepartment of Psychiatry at the
Carolinas Healthcare System inCharlotte.
But we will hold that againsthim.
John has many such leadershipappointments across the
Northeast, including formerpresident and medical director
at Silver Hill Hospital.
Over there with our friends inNew Canaan Just had Dr Murata on
(01:46):
the show.
Dr Santo Pietro is adistinguished fellow with the
American Psychiatric Association, member of the Connecticut
Psychiatric Society and theAmerican Medical Association
foreign board.
Member at the AmericanAssociation of Community
Psychiatrists, also member ofthe group for the advancement of
psychiatry and the AmericanAssociation of Psychiatric
Administrators.
Doc, welcome to the show.
Speaker 2 (02:09):
Wow, that was way too long.
You know, I'm like who is thatguy?
Speaker 1 (02:14):
Who's this guy we're talking about?
Well, you know, the thing thatI like to say is he's also just
like a nice guy and I likehanging out with him.
Speaker 2 (02:20):
Well, it's kind of like imagine like those, if you
know you're about to like uh,you know they say your life
flashes before your eyes whenyou're like get in a car
accident or something likethat's what I'm like.
Who?
Speaker 1 (02:31):
is that guy, and?
Speaker 2 (02:33):
and actually the I just recently um, since that bio
, uh, my uh, apa AmericanAssociation status has moved to
Distinguished Life Fellow, whichmeans that I'm old, which means
that you're old.
No, that's the only.
The qualification is.
You've been in it for 30 years,oh wow.
(02:55):
Well, anyway, I don't think ofmyself that old.
So I am.
You know, it's a total honorhere, todd, to be, you know,
able to have a conversation withyou.
It's a total honor here, todd,to be able to have a
conversation with you for avariety of reasons.
Most importantly, I think weget up every day and have a that
(03:36):
many of us kind of get bittenby a bug that really changes our
life.
So I thought maybe I don't knowif it's okay just saying a
little bit about how I ended upgetting into the.
Speaker 1 (03:41):
Well, that's a story I haven't heard.
I'd love to hear story likewhere you know what, where did
the bug bite you?
You know?
I guess is the question welland it's.
Speaker 2 (03:49):
I don't know if I would have been able to ask that
, like you know, 20 years ago.
But looking back, um, here'show I, here's how I think of it.
So I grew up in rhode island,which is a very small state,
obviously, and I'm all italian.
If people that have been inrhode island might know, there
are a lot of italian people inin rhode island.
So I uh, nobody's not italianin in my family until me.
(04:13):
My wife is actually all irishand, um, I uh, and it was a very
tight family, and when I say itwas a close family, three of
the brothers one, two, two,three married.
Three sisters One, two, threesisters no kidding, from across
the street.
Speaker 1 (04:32):
Right.
And so, Because that's how itwas in the old country you know,
essentially that's how it was.
Speaker 2 (04:37):
That's how it was and what they did was they had a
fish market and that was thefamily business that they
started.
And so I grew up working in afish market, since I was like a
little kid and so I was alwaysaround a lot of people and
people were always talking andkind of in each other's business
and we'd have big gatheringsand holidays and stuff.
(04:59):
So I was interested in how andyou meet a lot of interesting
people working in a fish market.
If you want a lot of differentpersonality types to observe,
it's a great way.
And so then my mother, myparents, were both teachers.
They were the first generationto go to college and they
believed in education, and so mymother taught at a private
(05:20):
school so we could go for freeback in the day, and that was a
Quaker school, and I don't knowif people know much about
Quakers, but they're very inwardlooking.
So and I went to this school,the one school from kindergarten
through high school, so 13years in one school, and there
we would have silent meetingonce a month, even when you're
(05:42):
just a little kid, like inkindergarten.
Speaker 1 (05:45):
I'm a big fan of Parker Palmer, who's you know
kind of takes the Quaker methodand uses it as a you know this
introspective way of doingdevelopment work.
It's cool stuff, but I'm veryfamiliar with the Quaker method.
Yeah, neat stuff.
Speaker 2 (05:58):
I'm going to have to check that out.
Like meaning in the work, likein our work.
Speaker 1 (06:03):
Yeah, with educators and with, you know, care
providers.
You can imagine that he alignsto folks that are in care and
teaching professions.
Courage to teach, courage toheal.
You know Parker Palmer's neatstuff, but the method that he
uses is the Quaker method and Ithink it's really cool.
It's neat that you grew up thatway, yeah.
Speaker 2 (06:26):
Yeah, and literally.
So you know these silentmeetings for an hour and however
many that added up to my wholeeducation, and you're in a room
with you know, I don't know 50people, maybe sometimes 100,
more than that 100 people, andnobody's in charge of the
meeting.
Anybody can speak, so it's avery intense sort of it's sort
(06:53):
of like group therapy.
So you know, I was sort ofprimed to do something in mental
health.
And then I, when I was incollege, I took a course on
Sigmund Freud, you know, in whenI was a sophomore, and that was
it.
I was just blown away and I'mlike, wow, there's an
unconscious and you can helppeople by talking to them.
And and then I went to medicalschool and all that stuff,
always thinking I'd be apsychiatrist or do something in
(07:17):
mental health, and finished allthat training that you described
in 2000.
And my first job job.
Speaker 1 (07:25):
I left the dates out because I didn't want to date
you too bad.
Speaker 2 (07:27):
You know it's like I can't believe what's going
anyway.
Um, yeah, I mean, we have threeboys and the two one's about to
graduate from college and one'sa freshman in college and one's
in high school.
So, um, so am I, and I was justjust planning on being a
clinician, which I just is inquotations, because that is, to
(07:50):
this day, my favorite thing todo.
It's what brings me the most,in a sense, joy and satisfaction
.
But what happened was my firstjob was in an inner city
hospital just outside of Boston,in Dorchester, and I basically
couldn't believe how broken thesystem was and I couldn't unsee
(08:11):
that.
And so I was the way Idescribed it is.
I was just afflicted with.
I couldn't stay out of thefight to make things better,
meaning getting involved inleadership, and so I'm kind of a
reluctant leader in a sense,like it was not my first thing
that I wanted to do, but everyday that I feel like I can make
a difference as a leader andhelp move things incrementally
(08:33):
forward.
And so that's been it for 25years now, and I've been in, I
really worked in like 12 systemsand um, which is a whole other
story, but at the end of the day, uh, community mental health
state hospital, inner cityhospital, community hospital,
silver Hill.
You mentioned um, northCarolina, maine, massachusetts,
(08:55):
connecticut.
So I have a pretty good senseof the system and what's out
there.
And right now, the role thatI'm in, which I've been in for
over six years, which is a totalrecord for me, is this leading
behavioral health at HartfordHealthCare, which is a
not-for-profit health system inConnecticut, we have 47,000
(09:17):
employees in the wholeorganization, 3,000 in
behavioral health, which isreally unusual to and to have
that many in a big system, in ain a big healthcare system.
Speaker 1 (09:27):
And a nonprofit system that maintains its
nonprofit and it hasn't beenbought by some other system,
which has happened to our systemas well.
You know, here here inAsheville.
But, um, I mean, I think thatsome of the other things that
you're doing some prettyinnovative stuff around
community mental health.
You've got a new recoverycenter that just opened, the
Ridge Recovery Center.
You've, you know, got your gotyour iron.
(09:48):
You know, irons in a lot offires, or or a lot of irons in
the fire, some of which havecome out and are serving the
community in ways that arereally incredible.
I was responding to something.
I was somebody asked a seriesof questions and I was
responding I think it was onLinkedIn or somewhere but I said
you know the thing that we needto do.
People talk about a brokensystem.
(10:09):
I'm like I'm not sure when itwas functional, but we do have
these pockets.
I don't know what state offunctionality we came from,
where we would say that it wasbroken, but we do have these
pockets.
There are these places and Iwould say that you and your role
and the work that you're doingis one of them where there is
exceptional work being done,where there's real solid
(10:30):
community work and solidtreatment that's happening in a
format that is welcoming andmakes people feel a part of
something and causes them tostay invested and engaged, and
causes them to stay invested andengaged in the country little
spots here and there, and Ithink we just need to find those
models and do more of them inplaces where we can plant them.
(10:55):
In your mind, you've always hadthis you wanted to be a
clinician and you went and gotan education and everything.
It sounds to me like the bugbit you when you got inside of
the system and saw how broken itwas and decided to make some
changes.
That's where the bug bit you,and then you can't let it go.
(11:16):
So in your mind, what work haveyou done that you think that we
need more of, and or what doyou see for the future in terms
of bringing our mental healthand behavioral health care
system back into a place wherewe feel like it serves the
people that are in greatest need?
Speaker 2 (11:31):
Yeah, that's really a fantastic question, honestly,
and we could probably spend aweek talking about it.
Speaker 1 (11:39):
It's been a long time .
Give me the highlights you know.
Speaker 2 (11:45):
Well, my mind goes in two directions on that.
You know, one is sort of thethe rocket science side and one
is the not rocket science side.
(12:05):
So I'll start start with thenon who get how important it is
to connect with other humanbeings in this work.
I mean, I can't overstate that,at the end of the day, as of
today, there is no blood test,there is no head scan, there is
nothing that says this personhas bipolar disorder or this
(12:29):
person has PTSD, in terms of anactual physical, you know lab
value, right, which is amazing,right.
If you have pneumonia, you knowwe get a sputum sample.
We find out what bacteria it is.
We can tell within.
You know a couple percent.
Speaker 1 (12:44):
We can see your white blood cell count, we know that
you're, et cetera et cetera,right, genes, you know, cancer,
all this stuff.
Speaker 2 (12:50):
So at the end of the day, what we do is imprecise.
You know it doesn't haveprecision, but it doesn't mean
we're not good at it.
We can be really good at it.
And you know you know this aswell as I do that there's a
difference between when it'sbeing done really well and when
it's not being done so well.
And I think about that in termsof, like, clinical soul.
(13:14):
You can sort of tell thatthere's sort of clinical soul in
an organization and inindividuals.
I would say, actually the ironyand I've been doing this for a
long time, I probably, you know,I mean I have 3,000 people here
.
I don't know how many peopleacross the years I've had on my
teams, but it's thousands, right, I can't think of almost any of
(13:36):
them that didn't start out aslike caring, you know, loving
you, loving bright people thatwant to make a difference and
help other people.
So where it goes wrong isusually in the system, like they
start that way but it's withina system that starts for
(13:57):
whatever and again, the systemdoesn't intend to do this, but
for whatever reason there's toomuch emphasis on throughput and
productivity or all thispaperwork or caseload.
Now the other side of it is wedo have access issues.
So I'm definitely a fan and Ido see as many patients still as
I actually can because I loveit.
(14:19):
But on the other side of it isthis is is again all in a
non-rocket science bucket, andthe other way I would describe
this is basically there's twothings we do when people come
into our services.
We either are trying tounderstand them or we're trying
to manage stuff right right,right right manage stuff is you
(14:43):
come in with a symptom, we give,give you medicine.
You come in, you know, and Iwork.
We have 337 inpatient beds.
You know, you, you're, you havean aggressive behavior and you
get a shot of medication andmaybe put in restraints.
That's management, rightUnderstanding is, like why are
you here today?
Like, why are you asking forhelp?
(15:03):
What's going on?
Who?
Every single person is totallyunique.
Why are you back here today?
Why are you back here today?
What's going on?
You know?
And when I trained, which wasages ago, mid to late 90s right,
I would say it was like 80understanding, 20 management,
which is, which is astonishingbecause it's reversed now, you
(15:26):
know it's people are coming outof training and it's 80%
management.
And it just takes psychiatristshow many psychiatrists are just
like given a pill?
Right, like 80% management, 20%understanding.
So when, when you're askinglike if I could wave a magic
wand, you know, and and fixsomething, that's that's thing
(15:47):
is that we would shift theemphasis back to understanding,
being human with each other.
Engagement, like you're anengagement, you know, savant,
like you know, and what you doin the world and your work is in
the top echelon of engagementand not everyone can reach that,
but we can certainly do a lotbetter than we're doing.
Then there is the rocketscience stuff.
Speaker 1 (16:09):
Yeah.
Speaker 2 (16:09):
Which is like how do you?
You know, because what I'mtrying to do in my leadership
career is work within a systemto bring the best care to the
most people.
The best care side is hard tobalance with the most people
side, right.
So when I was at silver hill,you mentioned which is a
(16:30):
fantastic, high, high um youknow highly expert staff, um,
and they provide excellenttreatment to about 500 people a
year 600 a year.
Speaker 1 (16:41):
High cost, you know high cost for many, you know,
for many of the programs they dobut um, but they do a great
career, live in a world whereyou know insurance doesn't pay
for this stuff the way it should.
Speaker 2 (16:54):
I hope.
I hope in the next life we'llwake up.
Yeah, the opposite where it getspaid for because it should,
where it's our brain and allthat uh stuff.
Where I work now, we do um 500000 outpatient visits a year.
We do a hundred thousandinpatient days a year.
(17:16):
We serve 30 40 000 people ayear, so, um.
So there's the access issue.
This is more rocket sciencestuff.
So what do we really have to doin the coming years so that we
can treat, you know, of all thepeople that have mental illness?
You know, I mean Substance useissues are both right and
(17:43):
substance use.
We're missing even more.
So we have to start thinkingabout innovation.
We have to start thinking, anda lot of people are doing this.
I don't think anyone's totallyhit it out of the park yet, but
you know there's virtual care ingeneral.
There's like app based stuff.
There's, you know, ai peopleare even thinking about, which
(18:05):
is controversial and I'm notsure how that's going to fit
into things.
I think we've got to be carefulwith it, but yeah, yeah, yeah
and I mean you as the engagementexpert.
Be interesting what you thinkabout whether AI would ever
substitute for connecting, youknow, with a human or connecting
(18:34):
, you know, with a human.
Speaker 1 (18:34):
I I think it can make you know there's a part of the
thing that you run into and I Imean I haven't worked with lots
of clinicians and you know beenin startup and and managing
programs paperwork anddocumentation is just
everybody's, you know, bugaboochasing after people who need to
document so you can getinsurance.
Billing or coding or any ofthose other kinds of things are
not always very good at thataspect of the care.
(18:55):
Make their job easier so theycan really focus their attention
on what you and I are talkingabout, which is the connection
piece, because you know thethere's a there's a piece of
(19:16):
research out there that's fairlyold but it's still relevant,
that you know.
Uh, it doesn't matter.
The methodology that you uselargely is not as impactful
across methodologies as thetherapeutic connection, as the
therapeutic alliance that thecare provider has with the
person that they're serving.
If the therapeutic alliance isstrong, chances are good you're
(19:39):
going to get pretty goodoutcomes with your care,
regardless of the method thatyou use.
Now you know we've got somepretty sophisticated
methodologies and clinical workout there, including some
technology that's helping uswith the brain and all those
other pieces, right, but I stillthink that it takes a person to
connect with a person.
(19:59):
They need to feel like they'renot alone, and you can't just
screen your way through tobetter mental health.
It can be a tool and it can beused.
You know daily meditation, youknow you've got somebody who's
immediately available to you ona platform virtual platform that
can respond to a text messageor do a quick video meeting with
you.
Those are cool things, but Ithink that and I'd like to get
(20:24):
your idea about this betweeninsurance companies not paying
for it and the stigma thatexists both around mental health
and addictions issues, you'vegot you've got people don't seek
care, right, you've got a lotof people who don't seek care.
And then then you, if you stackon top of that this, the
(20:45):
complement of there's a lot ofcare out there that is
insufficient to the task.
You know people are getting.
They're walking into a hospital.
It's a revolving door.
They're not getting the carethey need because there's no
management on the other side.
There's no place for them to go.
So you end up with these verycomplicated conditions as a
result of poor care donerepeatedly Yep, as a result of
(21:06):
poor care done repeatedly.
So you end up with this muchgreater need and I wonder if
it's a matter of getting toeverybody early enough before we
get into this sticky wicket ofcomplicated didn't seek care for
years and years and years, andnow is the psychiatric condition
(21:26):
they have to go to the hospitalfor Like.
Ideally they would have startedmanaging this mental health
much earlier.
How do we get?
How do we get to that Like?
What's the path there?
Speaker 2 (21:36):
Yeah, that's a great question.
That goes on my rocket sciencelist and I don't mean to say
it's really hard, but more justa systems issue.
For sure, systems issues betterway to say it.
So there are a variety of waysto do that.
Obviously, you know, workingwith kids and and getting
working on, you know,psychological resilience, right.
(21:56):
Like we always talk about thebad side of things, like when
you're you have a mental illness, we talk about mental illness.
We don't talk about mentalhealth a lot like really, and
there's some good programs outthere where they're working with
kids even in college, likegiving courses for credit that
you can take on how to bepsychologically resilient.
But at scale, I would sayprobably in my mind, one of the
(22:18):
most impactful things is to getmental health into primary care,
because everybody almost has aprimary care provider and they
are overwhelmed, they're workingsuper hard, they don't have a
lot of time with patients, theyneed a lot of support, and I've
been involved in my career,including where I am now we have
very robust integration intoprimary care.
(22:39):
I did this when I was down inNorth Carolina as well, and one
of the nice things aboutbehavioral health into primary
care, connecting them is.
You can be virtual right.
So you can have, because youknow a person comes in and see
their primary care doc, you canscreen them.
Even if you don't screen them,you know the behavioral health
team can get a report of all ofthe patients that are on
(23:01):
psychiatric medications, forinstance, and then they can
reach out.
Hey, here's your behavioralteam, you know just how's it
going.
And that doesn't have to be inperson, it can be over video, it
could be on the phone, it canbe through the chart and lots of
studies show this and this isconsistent with when I've done
it in systems.
(23:22):
When you integrate behavioralhealth into primary care, your
well, first of all, your mentalhealth outcomes are better.
So generally your depressionscores fall and your anxiety
scores fall, but also yourmedical conditions get better.
You're in one, that's right.
(23:43):
I'm going to walk hand in hand.
Your A1Cs came down a fullpoint for the diabetic
population.
So it's good that you're ontothat, because we're just seeing
people downstream when they'refalling out of the river down
there.
We should really look at themwhen they fall into the river.
You know, way back, way back.
Speaker 1 (24:05):
And you've got maybe a couple years on me not a ton
of years, but a couple of yearson me.
I I can.
I can say I can remember andI've seen the shift and I don't
remember exactly when it was.
I would say it's probably inthe 2000s.
When you walk into the dock andthey give you the sheet, it's
like where you're havingproblems.
What's your thing today?
(24:26):
Fill out this tick list of theconditions that you might have a
history of or suffering from oryou're concerned about, and the
category that got added werepsychiatric symptoms, depression
, anxiety, are you havingdisturbed thoughts or you know
sleep, etc.
Etc.
Etc.
There's a section that is thatis there now, that was not there
(24:48):
very early on at the primarycare physician's office where
you might list something whereyou're experiencing depressive
symptoms or you're experiencingwhatever it is that's in the
psychiatric realm, and then theyhave to ask about it.
Now they're still gun shy ontreating you or you're getting
(25:08):
referred out often because it'snot their wheelhouse.
That's fair.
I think that the other piece andI'd like to hear the ways in
which you're doing this now,because I know that you are is
when we go into concierge, whenpeople go into concierge level
care, especially withindividuals who might be
suffering from co-occurringmedical conditions, co-occurring
(25:30):
substance use in addition tomental health, et cetera.
You've got a team that'stalking to one another.
Yeah, uh, and I think that thethe one of the things that the
rest of the world experiences asa deficit is none of their
providers talk to one another.
Yeah, they're all, you know,they're all expertly.
You know, my favorite is, uh,expertly hitting, uh, or hitting
(25:54):
expert tennis shots fromseparate courts.
Oh, interesting, yeah, yeah,and it's, you know, they're,
they're, they're hitting into a,they're not.
They don't have anybody to playoff of.
Yeah, and you're getting thesesiloed kinds of treatment
results yeah out of serving thegreater public.
(26:14):
and I wonder what the systemsyou know, how are you trying,
how are you seeing and how areyou managing integrating the
medical with the psychiatric,with et cetera?
Like, how is that happening foryou there at Harvard?
Speaker 2 (26:30):
Yeah.
So a number of things.
One is just very concretelywe're very lucky.
We got about 60, 70psychologists in our system,
which is really unusual.
You may know just the trends inthe field for no good reason.
When I trained there were a lotof psychologists in big systems
(26:51):
, even on inpatient units, andthen over the subsequent 10, 20,
30 years it changed.
But we have a psychologydepartment, we have training
program on health psychology.
So we have about 30, you know,maybe even 40 psychologists that
(27:11):
are embedded in medicalpractices.
This is different than theintegration into primary care.
This is specialty practices.
So this is, you know, livertransplant service.
This is movement disorders, thisis cancer, this is actually
even orthopedics.
We have, like a psychologistthat works in orthopedics.
(27:34):
So there's a growing andthere's a growing understanding
that the mind, you know, plays arole in Huge role.
Huge role Weight loss, surgery,stuff like that.
But at a more basic level, todd, this is the stuff that still,
I want to say, bothers me alittle bit.
You know, like I, cause I dothe work and it is so fun, I
(27:56):
would never want to do the workin isolation.
It's no fun, like it's muchmore fun to pick up the phone,
which I do every time, and, andyou know, get a release and talk
with a therapist and talk withthe primary care doc and bring,
by the way, the family in to thenext.
I've gotten a couple of thosecalls Right.
Well, I mean, and this to me,this is when I and it's my own
(28:20):
failing that I haven't moved theneedle further on this, maybe
even nationally, because itseems so obvious to me how can
you do the work unless you'regetting all that data right?
Because right now we don't havean MRI machine, but we are the
MRI machine, so the more datayou have, the more accurately
(28:41):
you can figure out what's goingon with someone.
But it's just fun.
It's challenging to put thingstogether.
I mean people come into usbecause they haven't been able
to put things together and it'sjust fun.
It's challenging to put thingstogether.
I mean people come into usbecause they haven't been able
to put things together and it'scomplicated or else they
wouldn't come in.
So what we also do, here atleast, is we emphasize it is a
team sport Like.
(29:02):
Team-based care is a termyou'll hear getting thrown
around, but it is for real andagain, lots of studies show that
team-based care is better, isbetter care.
So we do.
We do a lot of that as as wellyeah, man, that's just a.
Speaker 1 (29:21):
I think that simple.
You know, team-based care.
It's simple.
I mean, I think it leads tothings that are profound in
terms of quality of care.
Yeah, but it's also something.
The thing that carries peoplethe most, whether it's
professionals or you're on theground workers or you're direct
(29:43):
care, I mean the thing thatcarries people the most are
these kinds of simple things.
It's like I'm part of a team oryou know communities, the
solution, or there are theseprinciples that kind of carry a
person and I, yeah, I'm not, youknow, like you.
I have the, I have the heartthat wants to make it the
national issue and solve theproblem.
(30:05):
Yeah, I, I, I.
I have not yet accomplishedthat.
I'm not going to saddle youwith failure and I'm not giving
it up just yet either.
So we're going to keep workingRight, we're not giving up.
Speaker 2 (30:18):
Well, I mean cause it just seems so obvious.
You know, sometimes I think ofus, I I love.
One of the reasons I went intothe field is I love hanging out
with clinicians.
They're so.
You learn from every one ofthem.
You know everyone does things alittle bit differently.
They have different methods ortricks.
You know, in a sense and how toengage with people, and one of
(30:40):
the things that is reallyimpactful is case conferences,
which is something I alwaysbring in wherever I am.
They used to be around 30 yearsago, not so much anymore.
All this productivity stuff andalso bringing the patient into
that right, and it's alwaysimpactful to the patient First
(31:02):
of all.
See all these caring, smartpeople that care about them,
that are putting their headstogether to try to figure out
what's going on with them, andthen you learn stuff you know
from each other.
One of the other things I'mdoing is we have two times this
year once at a big conferencethat we had on patient
experience and then one recentlywe had a summit for our interns
(31:25):
.
We have like a social workinterns and there's a particular
patient of mine I've beenworking with for two years who
struggles with a lot of reallytough stuff and she's
extraordinarily bright andarticulate and, um, and really
wants to give back.
She's always like when she getshospitalized, you know we, you
know you can bring residents andinterns in and she'll talk with
(31:47):
them about, um, what's going onwith her, and, and so I've had
a conversation with her in inthe, at the big conference right
, with all kinds ofadministrators and everything
that has never seen apsychiatric interview, um, and
then we were invited to go tothis intern, uh, so, and so what
it does?
First of all, it normalizestalking with patients, and when
(32:08):
I say patients, I mean a humanbeing who's in the patient role.
Speaker 1 (32:11):
A shocking concept really.
Speaker 2 (32:13):
Well, it's just someone in the patient role.
In that sense I'm in the doctorrole, but that could switch.
I mean, we're all patients atsome point, so it normalizes it.
It's also like I think of usand I don't know if this makes
any sense to you, but, like youknow, I, when I look at so, the
way the work that our people do,including you I'm like these
(32:36):
are like star athletes.
It's imagine we were like aprofessional, we were playing
like professional baseball,right, like that's how good
people are at this, and yet werarely get to see each other do
it.
You know, inspired by it tolearn things, to actually even
critique each other too at times, like yeah, I don't know, like,
like should, I might want toconsider this or do it this way,
or I've done it this, yeahexactly which is just I mean the
(32:58):
value in that.
Speaker 1 (33:00):
I mean to me just the opportunity, even with the show
.
That's part of what the show isabout.
Actually.
It's like getting with peoplelike you and just you know,
let's take 30 or 40 minutes andjust hear this person's wisdom
of decades worth of care and Idon't think people understand
the value of it and the factthat you know, in many ways,
(33:23):
somebody like you with as manycredentials as you have and all
the things hanging on the walland everything else.
I think one thing that peoplemight not know at first glance
is that you're also, like this,really nice person that's fun to
hang out with well, I mean it'snot, you know, that's my
opinion yeah, I mean to mean tome part of that is, you know,
(33:46):
it's not rocket science.
Speaker 2 (33:47):
I grew up working in a fish market.
This is not and partly I saythat for people to know that you
can learn this stuff Like Istill literally use lines from
when I was in training and I sawI used to observe the way that
people would.
We'd had a lot of that back inthe day.
You would observe how peopleinterview and I still literally
(34:08):
use lines today.
I have a couple of them come tomind that are really good.
One is especially with somebodythat is kind of depressed.
It's what keeps you going.
Speaker 1 (34:20):
Yeah, like very simple.
Speaker 2 (34:22):
You know it's a very simple and there's usually only
a few categories of things.
You know or you don't get ananswer.
You know it's a very simple andthere's usually only a few
categories of things you know,or you don't get an answer you
know, or another one is do youhave anyone out there?
You can lean on Right,literally like.
I heard that 30 years ago andI've used it every.
Speaker 1 (34:43):
Every year You've got techniques like motivational
interviewing and all thesethings.
I'm like like, hey, you know, alot of this is socratic method,
you know what I mean.
Like it's socratic methodthat's been distilled and and
and refined and everything else,but asking somebody a good
question that causes them tofocus on what are the resources
you have?
Like, how are you keepingyourself well, right, right,
(35:04):
they haven't.
They have an you know asopposed to you know.
Are you feeling terrible?
Have you had any suicidalthoughts?
I mean, those can be importantquestions and I'm not
discounting them.
Right, having a person focus onthe ways in which they're
maintaining a well-being RightIs a shift.
I think many of our you know,provider networks need to make a
little bit.
Speaker 2 (35:25):
Yeah, and I think our folks don't get nearly enough
credit for what they do.
They they, you know and to makeit perverse like they get a lot
of attention when somethinggoes wrong.
Speaker 1 (35:35):
Right, yeah, oh yeah.
Speaker 2 (35:36):
Yeah, but no one gets how incredible, like it's, a
little bit of what we do is sortof like a trade.
It's like becoming a reallygood plumber, Like you know.
I think you said you have toapprentice, you know and watch
people and get better and makesome mistakes too.
You know, like that's how youknow, you, you learn.
But I want to get back tostigma, because you did use that
(35:57):
word and I don't want to.
I know we don't have too muchtime left and I want to.
I think that's critical.
I mean that would be the otherthing if I could wave.
Wave a magic wand is, um, there,there is so much stigma still.
I mean the good news is theyounger generations, I think,
are doing better.
But it is embedded in a lot ofwhat we do.
(36:19):
It's embedded in our systemsand, um, you know, to give a
shout out to the system I'm inand all my places have been good
.
I mean, they've had great luckin finding good places to work.
But as big systems go again,this is, you know, it's a 47,000
(36:40):
person, $7 billionnot-for-profit system, which
these days is not huge.
Seven billion dollarnot-for-profit system, which
these days is not huge.
Um and uh, behavioral health isbig here, but it's not as big
as the rest of what we do, right, we have acute care hospitals
and orthopedics and surgery andprimary care and emergency rooms
, right, um, but one of thereasons I'm still here after six
(37:04):
more than six is that there isless stigma here around mental
health than I've ever seen inany other system, and I think
that's a function of the culture, you know, of an organization
and the culture of ourorganization.
They've been working on it for15 years officially.
(37:26):
You know they really work hardon it.
We have leadership behaviorsincluding be curious, not
judgmental.
That's literally a leadershipbehavior.
And so you had mentioned thisprogram that we started and I do
want to, you know, let peopleknow about it, not only because
it's a great program.
It's called the Ridge RecoveryCenter.
(37:47):
It's in Northeastern uh,connecticut.
Speaker 1 (37:50):
Opened last year, is that?
Speaker 2 (37:51):
right.
Exactly a year ago.
In fact, we had just had aevent one year event and two of
the two of the former patientsthat came were were.
One of them was the firstpatient.
Speaker 1 (38:04):
Oh wow.
Speaker 2 (38:05):
The other one was like the fifth patient or
something, and they told theirstories of recovery, you know,
and and what so?
Um, what's extraordinary aboutthis program which shouldn't be
extraordinary but it is is that,um, and you know the field well
, so there's a lot of smallprivate you.
You know residential rehab, soit's like 60 beds and we've got
(38:29):
some are withdrawal managementor used to call them detox, some
are residential rehab and thena few of them are extended stay.
You can, it's like a soberliving kind of thing.
So most of the, a lot of thepeople that do that do them in
small private organizationswhich you know, to make a living
, to make it work, to sustain aplace, it has to be out of
(38:51):
pocket.
This is not that way.
This is insurance-based andit's part of a large health
system and the fact that ahealth system during the
pandemic you know how bad thatwas for health systems, I mean
you know, hundreds of millionsof dollars lost, billions really
across the country.
(39:12):
During that period our systeminvested in starting this
program, which is, you know,again like.
It's sort of a heartwarmingfeeling to me, because they
treat behavioral health as asany other thing, as orthopedics,
as surgery, as cancer.
But on the other side you'relike why should you?
Why should that be so unusual?
(39:33):
Like why yeah?
Speaker 1 (39:35):
exactly.
Speaker 2 (39:36):
Right, and especially because every one of us has in
our family, somewhere, ourfriends, people who struggle
with this stuff.
Speaker 1 (39:48):
If you stand with a person on either side of you,
one of them struggling with oneof you struggling with a
condition.
Speaker 2 (39:54):
That's right.
But anyway, I know we're kindof winding down, but I don't
know.
Speaker 1 (39:59):
Well, you know, I think you and I could wind up
several times to be my guest,which is exactly why I was.
I was really grateful that youwanted to come on the show and
hang out with me today.
This has been Dr John SantoPietro with Hartford healthcare
there up in Connecticut.
Speaker 2 (40:19):
Thank you, you're very welcome.
Speaker 1 (40:22):
It's so glad to have you on the show.
This has been Headed SideMental Health.
We'll see you all next time.
Bye-bye.
Hello folks, thanks for joining us again on Head
Inside Mental Health, featuringconversations about mental
health and substance usetreatment, with experts across
the country sharing theirthoughts and insights on the
world of behavioral health care.
Broadcasting on WPBM 1037, thevoice of Asheville Independent
Commercial Free Radio.
I'm Todd Weatherly, your host,therapeutic consultant and
(00:23):
behavioral health expert.
Joining us today is ourdistinguished guest and friend
of mine, dr John Santopietro.
Dr Santopietro is the SeniorVice President at Hartford
HealthCare andPhysician-in-Chief at their
Behavioral Health Network therein Hartford, connecticut.
Assistant Clinical Professor ofPsychiatry at the Yale School
of Medicine, assistant Professorof Psychiatry at the University
(00:44):
of Connecticut School ofMedicine and Assistant Professor
at the Frank H Netter MD Schoolof Medicine, quinnipiac
University.
John got his BA at Yale, but hewent on to get his MD from
Northwestern Medical School inChicago.
He did his internship andresidency at Cambridge Hospital
with that little school up therein Mass.
What's the name of it?
Harvard?
Yeah, that's the one.
The little school up there inMass, what's the name of it?
Harvard?
Yeah, that's the one.
(01:05):
He also did a fellowship withAustin Riggs Center, a
residential therapeuticcommunity up in Stockbridge,
mass, probably the place wherehe and Virgil crossed paths at
one point.
Dr Santo Pietro is a 2001diplomat with the American Board
of Psychiatry and Neurology andhe retains his certification
and license in multiple statesthere in the Northeast but keeps
(01:26):
it up in North Carolina as well, having been former chief
clinical officer and chair ofDepartment of Psychiatry at the
Carolinas Healthcare System inCharlotte.
But we will hold that againsthim.
John has many such leadershipappointments across the
Northeast, including formerpresident and medical director
at Silver Hill Hospital.
Over there with our friends inNew Canaan Just had Dr Murata on
(01:46):
the show.
Dr Santo Pietro is adistinguished fellow with the
American Psychiatric Association, member of the Connecticut
Psychiatric Society and theAmerican Medical Association
foreign board.
Member at the AmericanAssociation of Community
Psychiatrists, also member ofthe group for the advancement of
psychiatry and the AmericanAssociation of Psychiatric
Administrators.
Doc, welcome to the show.
Speaker 2 (02:09):
Wow, that was way too long.
You know, I'm like who is thatguy?
Speaker 1 (02:14):
Who's this guy we're talking about?
Well, you know, the thing thatI like to say is he's also just
like a nice guy and I likehanging out with him.
Speaker 2 (02:20):
Well, it's kind of like imagine like those, if you
know you're about to like uh,you know they say your life
flashes before your eyes whenyou're like get in a car
accident or something likethat's what I'm like.
Who?
Speaker 1 (02:31):
is that guy, and?
Speaker 2 (02:33):
and actually the I just recently um, since that bio
, uh, my uh, apa AmericanAssociation status has moved to
Distinguished Life Fellow, whichmeans that I'm old, which means
that you're old.
No, that's the only.
The qualification is.
You've been in it for 30 years,oh wow.
(02:55):
Well, anyway, I don't think ofmyself that old.
So I am.
You know, it's a total honorhere, todd, to be, you know,
able to have a conversation withyou.
It's a total honor here, todd,to be able to have a
conversation with you for avariety of reasons.
Most importantly, I think weget up every day and have a that
(03:36):
many of us kind of get bittenby a bug that really changes our
life.
So I thought maybe I don't knowif it's okay just saying a
little bit about how I ended upgetting into the.
Speaker 1 (03:41):
Well, that's a story I haven't heard.
I'd love to hear story likewhere you know what, where did
the bug bite you?
You know?
I guess is the question welland it's.
Speaker 2 (03:49):
I don't know if I would have been able to ask that
, like you know, 20 years ago.
But looking back, um, here'show I, here's how I think of it.
So I grew up in rhode island,which is a very small state,
obviously, and I'm all italian.
If people that have been inrhode island might know, there
are a lot of italian people inin rhode island.
So I uh, nobody's not italianin in my family until me.
(04:13):
My wife is actually all irishand, um, I uh, and it was a very
tight family, and when I say itwas a close family, three of
the brothers one, two, two,three married.
Three sisters One, two, threesisters no kidding, from across
the street.
Speaker 1 (04:32):
Right.
And so, Because that's how itwas in the old country you know,
essentially that's how it was.
Speaker 2 (04:37):
That's how it was and what they did was they had a
fish market and that was thefamily business that they
started.
And so I grew up working in afish market, since I was like a
little kid and so I was alwaysaround a lot of people and
people were always talking andkind of in each other's business
and we'd have big gatheringsand holidays and stuff.
(04:59):
So I was interested in how andyou meet a lot of interesting
people working in a fish market.
If you want a lot of differentpersonality types to observe,
it's a great way.
And so then my mother, myparents, were both teachers.
They were the first generationto go to college and they
believed in education, and so mymother taught at a private
(05:20):
school so we could go for freeback in the day, and that was a
Quaker school, and I don't knowif people know much about
Quakers, but they're very inwardlooking.
So and I went to this school,the one school from kindergarten
through high school, so 13years in one school, and there
we would have silent meetingonce a month, even when you're
(05:42):
just a little kid, like inkindergarten.
Speaker 1 (05:45):
I'm a big fan of Parker Palmer, who's you know
kind of takes the Quaker methodand uses it as a you know this
introspective way of doingdevelopment work.
It's cool stuff, but I'm veryfamiliar with the Quaker method.
Yeah, neat stuff.
Speaker 2 (05:58):
I'm going to have to check that out.
Like meaning in the work, likein our work.
Speaker 1 (06:03):
Yeah, with educators and with, you know, care
providers.
You can imagine that he alignsto folks that are in care and
teaching professions.
Courage to teach, courage toheal.
You know Parker Palmer's neatstuff, but the method that he
uses is the Quaker method and Ithink it's really cool.
It's neat that you grew up thatway, yeah.
Speaker 2 (06:26):
Yeah, and literally.
So you know these silentmeetings for an hour and however
many that added up to my wholeeducation, and you're in a room
with you know, I don't know 50people, maybe sometimes 100,
more than that 100 people, andnobody's in charge of the
meeting.
Anybody can speak, so it's avery intense sort of it's sort
(06:53):
of like group therapy.
So you know, I was sort ofprimed to do something in mental
health.
And then I, when I was incollege, I took a course on
Sigmund Freud, you know, in whenI was a sophomore, and that was
it.
I was just blown away and I'mlike, wow, there's an
unconscious and you can helppeople by talking to them.
And and then I went to medicalschool and all that stuff,
always thinking I'd be apsychiatrist or do something in
(07:17):
mental health, and finished allthat training that you described
in 2000.
And my first job job.
Speaker 1 (07:25):
I left the dates out because I didn't want to date
you too bad.
Speaker 2 (07:27):
You know it's like I can't believe what's going
anyway.
Um, yeah, I mean, we have threeboys and the two one's about to
graduate from college and one'sa freshman in college and one's
in high school.
So, um, so am I, and I was justjust planning on being a
clinician, which I just is inquotations, because that is, to
(07:50):
this day, my favorite thing todo.
It's what brings me the most,in a sense, joy and satisfaction
.
But what happened was my firstjob was in an inner city
hospital just outside of Boston,in Dorchester, and I basically
couldn't believe how broken thesystem was and I couldn't unsee
(08:11):
that.
And so I was the way Idescribed it is.
I was just afflicted with.
I couldn't stay out of thefight to make things better,
meaning getting involved inleadership, and so I'm kind of a
reluctant leader in a sense,like it was not my first thing
that I wanted to do, but everyday that I feel like I can make
a difference as a leader andhelp move things incrementally
(08:33):
forward.
And so that's been it for 25years now, and I've been in, I
really worked in like 12 systemsand um, which is a whole other
story, but at the end of the day, uh, community mental health
state hospital, inner cityhospital, community hospital,
silver Hill.
You mentioned um, northCarolina, maine, massachusetts,
(08:55):
connecticut.
So I have a pretty good senseof the system and what's out
there.
And right now, the role thatI'm in, which I've been in for
over six years, which is a totalrecord for me, is this leading
behavioral health at HartfordHealthCare, which is a
not-for-profit health system inConnecticut, we have 47,000
(09:17):
employees in the wholeorganization, 3,000 in
behavioral health, which isreally unusual to and to have
that many in a big system, in ain a big healthcare system.
Speaker 1 (09:27):
And a nonprofit system that maintains its
nonprofit and it hasn't beenbought by some other system,
which has happened to our systemas well.
You know, here here inAsheville.
But, um, I mean, I think thatsome of the other things that
you're doing some prettyinnovative stuff around
community mental health.
You've got a new recoverycenter that just opened, the
Ridge Recovery Center.
You've, you know, got your gotyour iron.
(09:48):
You know, irons in a lot offires, or or a lot of irons in
the fire, some of which havecome out and are serving the
community in ways that arereally incredible.
I was responding to something.
I was somebody asked a seriesof questions and I was
responding I think it was onLinkedIn or somewhere but I said
you know the thing that we needto do.
People talk about a brokensystem.
(10:09):
I'm like I'm not sure when itwas functional, but we do have
these pockets.
I don't know what state offunctionality we came from,
where we would say that it wasbroken, but we do have these
pockets.
There are these places and Iwould say that you and your role
and the work that you're doingis one of them where there is
exceptional work being done,where there's real solid
(10:30):
community work and solidtreatment that's happening in a
format that is welcoming andmakes people feel a part of
something and causes them tostay invested and engaged, and
causes them to stay invested andengaged in the country little
spots here and there, and Ithink we just need to find those
models and do more of them inplaces where we can plant them.
(10:55):
In your mind, you've always hadthis you wanted to be a
clinician and you went and gotan education and everything.
It sounds to me like the bugbit you when you got inside of
the system and saw how broken itwas and decided to make some
changes.
That's where the bug bit you,and then you can't let it go.
(11:16):
So in your mind, what work haveyou done that you think that we
need more of, and or what doyou see for the future in terms
of bringing our mental healthand behavioral health care
system back into a place wherewe feel like it serves the
people that are in greatest need?
Speaker 2 (11:31):
Yeah, that's really a fantastic question, honestly,
and we could probably spend aweek talking about it.
Speaker 1 (11:39):
It's been a long time .
Give me the highlights you know.
Speaker 2 (11:45):
Well, my mind goes in two directions on that.
You know, one is sort of thethe rocket science side and one
is the not rocket science side.
(12:05):
So I'll start start with thenon who get how important it is
to connect with other humanbeings in this work.
I mean, I can't overstate that,at the end of the day, as of
today, there is no blood test,there is no head scan, there is
nothing that says this personhas bipolar disorder or this
(12:29):
person has PTSD, in terms of anactual physical, you know lab
value, right, which is amazing,right.
If you have pneumonia, you knowwe get a sputum sample.
We find out what bacteria it is.
We can tell within.
You know a couple percent.
Speaker 1 (12:44):
We can see your white blood cell count, we know that
you're, et cetera et cetera,right, genes, you know, cancer,
all this stuff.
Speaker 2 (12:50):
So at the end of the day, what we do is imprecise.
You know it doesn't haveprecision, but it doesn't mean
we're not good at it.
We can be really good at it.
And you know you know this aswell as I do that there's a
difference between when it'sbeing done really well and when
it's not being done so well.
And I think about that in termsof, like, clinical soul.
(13:14):
You can sort of tell thatthere's sort of clinical soul in
an organization and inindividuals.
I would say, actually the ironyand I've been doing this for a
long time, I probably, you know,I mean I have 3,000 people here
.
I don't know how many peopleacross the years I've had on my
teams, but it's thousands, right, I can't think of almost any of
(13:36):
them that didn't start out aslike caring, you know, loving
you, loving bright people thatwant to make a difference and
help other people.
So where it goes wrong isusually in the system, like they
start that way but it's withina system that starts for
(13:57):
whatever and again, the systemdoesn't intend to do this, but
for whatever reason there's toomuch emphasis on throughput and
productivity or all thispaperwork or caseload.
Now the other side of it is wedo have access issues.
So I'm definitely a fan and Ido see as many patients still as
I actually can because I loveit.
(14:19):
But on the other side of it isthis is is again all in a
non-rocket science bucket, andthe other way I would describe
this is basically there's twothings we do when people come
into our services.
We either are trying tounderstand them or we're trying
to manage stuff right right,right right manage stuff is you
(14:43):
come in with a symptom, we give,give you medicine.
You come in, you know, and Iwork.
We have 337 inpatient beds.
You know, you, you're, you havean aggressive behavior and you
get a shot of medication andmaybe put in restraints.
That's management, rightUnderstanding is, like why are
you here today?
Like, why are you asking forhelp?
(15:03):
What's going on?
Who?
Every single person is totallyunique.
Why are you back here today?
Why are you back here today?
What's going on?
You know?
And when I trained, which wasages ago, mid to late 90s right,
I would say it was like 80understanding, 20 management,
which is, which is astonishingbecause it's reversed now, you
(15:26):
know it's people are coming outof training and it's 80%
management.
And it just takes psychiatristshow many psychiatrists are just
like given a pill?
Right, like 80% management, 20%understanding.
So when, when you're askinglike if I could wave a magic
wand, you know, and and fixsomething, that's that's thing
(15:47):
is that we would shift theemphasis back to understanding,
being human with each other.
Engagement, like you're anengagement, you know, savant,
like you know, and what you doin the world and your work is in
the top echelon of engagementand not everyone can reach that,
but we can certainly do a lotbetter than we're doing.
Then there is the rocketscience stuff.
Speaker 1 (16:09):
Yeah.
Speaker 2 (16:09):
Which is like how do you?
You know, because what I'mtrying to do in my leadership
career is work within a systemto bring the best care to the
most people.
The best care side is hard tobalance with the most people
side, right.
So when I was at silver hill,you mentioned which is a
(16:30):
fantastic, high, high um youknow highly expert staff, um,
and they provide excellenttreatment to about 500 people a
year 600 a year.
Speaker 1 (16:41):
High cost, you know high cost for many, you know,
for many of the programs they dobut um, but they do a great
career, live in a world whereyou know insurance doesn't pay
for this stuff the way it should.
Speaker 2 (16:54):
I hope.
I hope in the next life we'llwake up.
Yeah, the opposite where it getspaid for because it should,
where it's our brain and allthat uh stuff.
Where I work now, we do um 500000 outpatient visits a year.
We do a hundred thousandinpatient days a year.
(17:16):
We serve 30 40 000 people ayear, so, um.
So there's the access issue.
This is more rocket sciencestuff.
So what do we really have to doin the coming years so that we
can treat, you know, of all thepeople that have mental illness?
You know, I mean Substance useissues are both right and
(17:43):
substance use.
We're missing even more.
So we have to start thinkingabout innovation.
We have to start thinking, anda lot of people are doing this.
I don't think anyone's totallyhit it out of the park yet, but
you know there's virtual care ingeneral.
There's like app based stuff.
There's, you know, ai peopleare even thinking about, which
(18:05):
is controversial and I'm notsure how that's going to fit
into things.
I think we've got to be carefulwith it, but yeah, yeah, yeah
and I mean you as the engagementexpert.
Be interesting what you thinkabout whether AI would ever
substitute for connecting, youknow, with a human or connecting
(18:34):
, you know, with a human.
Speaker 1 (18:34):
I I think it can make you know there's a part of the
thing that you run into and I Imean I haven't worked with lots
of clinicians and you know beenin startup and and managing
programs paperwork anddocumentation is just
everybody's, you know, bugaboochasing after people who need to
document so you can getinsurance.
Billing or coding or any ofthose other kinds of things are
not always very good at thataspect of the care.
(18:55):
Make their job easier so theycan really focus their attention
on what you and I are talkingabout, which is the connection
piece, because you know thethere's a there's a piece of
(19:16):
research out there that's fairlyold but it's still relevant,
that you know.
Uh, it doesn't matter.
The methodology that you uselargely is not as impactful
across methodologies as thetherapeutic connection, as the
therapeutic alliance that thecare provider has with the
person that they're serving.
If the therapeutic alliance isstrong, chances are good you're
(19:39):
going to get pretty goodoutcomes with your care,
regardless of the method thatyou use.
Now you know we've got somepretty sophisticated
methodologies and clinical workout there, including some
technology that's helping uswith the brain and all those
other pieces, right, but I stillthink that it takes a person to
connect with a person.
(19:59):
They need to feel like they'renot alone, and you can't just
screen your way through tobetter mental health.
It can be a tool and it can beused.
You know daily meditation, youknow you've got somebody who's
immediately available to you ona platform virtual platform that
can respond to a text messageor do a quick video meeting with
you.
Those are cool things, but Ithink that and I'd like to get
(20:24):
your idea about this betweeninsurance companies not paying
for it and the stigma thatexists both around mental health
and addictions issues, you'vegot you've got people don't seek
care, right, you've got a lotof people who don't seek care.
And then then you, if you stackon top of that this, the
(20:45):
complement of there's a lot ofcare out there that is
insufficient to the task.
You know people are getting.
They're walking into a hospital.
It's a revolving door.
They're not getting the carethey need because there's no
management on the other side.
There's no place for them to go.
So you end up with these verycomplicated conditions as a
result of poor care donerepeatedly Yep, as a result of
(21:06):
poor care done repeatedly.
So you end up with this muchgreater need and I wonder if
it's a matter of getting toeverybody early enough before we
get into this sticky wicket ofcomplicated didn't seek care for
years and years and years, andnow is the psychiatric condition
(21:26):
they have to go to the hospitalfor Like.
Ideally they would have startedmanaging this mental health
much earlier.
How do we get?
How do we get to that Like?
What's the path there?
Speaker 2 (21:36):
Yeah, that's a great question.
That goes on my rocket sciencelist and I don't mean to say
it's really hard, but more justa systems issue.
For sure, systems issues betterway to say it.
So there are a variety of waysto do that.
Obviously, you know, workingwith kids and and getting
working on, you know,psychological resilience, right.
(21:56):
Like we always talk about thebad side of things, like when
you're you have a mental illness, we talk about mental illness.
We don't talk about mentalhealth a lot like really, and
there's some good programs outthere where they're working with
kids even in college, likegiving courses for credit that
you can take on how to bepsychologically resilient.
But at scale, I would sayprobably in my mind, one of the
(22:18):
most impactful things is to getmental health into primary care,
because everybody almost has aprimary care provider and they
are overwhelmed, they're workingsuper hard, they don't have a
lot of time with patients, theyneed a lot of support, and I've
been involved in my career,including where I am now we have
very robust integration intoprimary care.
(22:39):
I did this when I was down inNorth Carolina as well, and one
of the nice things aboutbehavioral health into primary
care, connecting them is.
You can be virtual right.
So you can have, because youknow a person comes in and see
their primary care doc, you canscreen them.
Even if you don't screen them,you know the behavioral health
team can get a report of all ofthe patients that are on
(23:01):
psychiatric medications, forinstance, and then they can
reach out.
Hey, here's your behavioralteam, you know just how's it
going.
And that doesn't have to be inperson, it can be over video, it
could be on the phone, it canbe through the chart and lots of
studies show this and this isconsistent with when I've done
it in systems.
(23:22):
When you integrate behavioralhealth into primary care, your
well, first of all, your mentalhealth outcomes are better.
So generally your depressionscores fall and your anxiety
scores fall, but also yourmedical conditions get better.
You're in one, that's right.
(23:43):
I'm going to walk hand in hand.
Your A1Cs came down a fullpoint for the diabetic
population.
So it's good that you're ontothat, because we're just seeing
people downstream when they'refalling out of the river down
there.
We should really look at themwhen they fall into the river.
You know, way back, way back.
Speaker 1 (24:05):
And you've got maybe a couple years on me not a ton
of years, but a couple of yearson me.
I I can.
I can say I can remember andI've seen the shift and I don't
remember exactly when it was.
I would say it's probably inthe 2000s.
When you walk into the dock andthey give you the sheet, it's
like where you're havingproblems.
What's your thing today?
(24:26):
Fill out this tick list of theconditions that you might have a
history of or suffering from oryou're concerned about, and the
category that got added werepsychiatric symptoms, depression
, anxiety, are you havingdisturbed thoughts or you know
sleep, etc.
Etc.
Etc.
There's a section that is thatis there now, that was not there
(24:48):
very early on at the primarycare physician's office where
you might list something whereyou're experiencing depressive
symptoms or you're experiencingwhatever it is that's in the
psychiatric realm, and then theyhave to ask about it.
Now they're still gun shy ontreating you or you're getting
(25:08):
referred out often because it'snot their wheelhouse.
That's fair.
I think that the other piece andI'd like to hear the ways in
which you're doing this now,because I know that you are is
when we go into concierge, whenpeople go into concierge level
care, especially withindividuals who might be
suffering from co-occurringmedical conditions, co-occurring
(25:30):
substance use in addition tomental health, et cetera.
You've got a team that'stalking to one another.
Yeah, uh, and I think that thethe one of the things that the
rest of the world experiences asa deficit is none of their
providers talk to one another.
Yeah, they're all, you know,they're all expertly.
You know, my favorite is, uh,expertly hitting, uh, or hitting
(25:54):
expert tennis shots fromseparate courts.
Oh, interesting, yeah, yeah,and it's, you know, they're,
they're, they're hitting into a,they're not.
They don't have anybody to playoff of.
Yeah, and you're getting thesesiloed kinds of treatment
results yeah out of serving thegreater public.
(26:14):
and I wonder what the systemsyou know, how are you trying,
how are you seeing and how areyou managing integrating the
medical with the psychiatric,with et cetera?
Like, how is that happening foryou there at Harvard?
Speaker 2 (26:30):
Yeah.
So a number of things.
One is just very concretelywe're very lucky.
We got about 60, 70psychologists in our system,
which is really unusual.
You may know just the trends inthe field for no good reason.
When I trained there were a lotof psychologists in big systems
(26:51):
, even on inpatient units, andthen over the subsequent 10, 20,
30 years it changed.
But we have a psychologydepartment, we have training
program on health psychology.
So we have about 30, you know,maybe even 40 psychologists that
(27:11):
are embedded in medicalpractices.
This is different than theintegration into primary care.
This is specialty practices.
So this is, you know, livertransplant service.
This is movement disorders, thisis cancer, this is actually
even orthopedics.
We have, like a psychologistthat works in orthopedics.
(27:34):
So there's a growing andthere's a growing understanding
that the mind, you know, plays arole in Huge role.
Huge role Weight loss, surgery,stuff like that.
But at a more basic level, todd, this is the stuff that still,
I want to say, bothers me alittle bit.
You know, like I, cause I dothe work and it is so fun, I
(27:56):
would never want to do the workin isolation.
It's no fun, like it's muchmore fun to pick up the phone,
which I do every time, and, andyou know, get a release and talk
with a therapist and talk withthe primary care doc and bring,
by the way, the family in to thenext.
I've gotten a couple of thosecalls Right.
Well, I mean, and this to me,this is when I and it's my own
(28:20):
failing that I haven't moved theneedle further on this, maybe
even nationally, because itseems so obvious to me how can
you do the work unless you'regetting all that data right?
Because right now we don't havean MRI machine, but we are the
MRI machine, so the more datayou have, the more accurately
(28:41):
you can figure out what's goingon with someone.
But it's just fun.
It's challenging to put thingstogether.
I mean people come into usbecause they haven't been able
to put things together and it'sjust fun.
It's challenging to put thingstogether.
I mean people come into usbecause they haven't been able
to put things together and it'scomplicated or else they
wouldn't come in.
So what we also do, here atleast, is we emphasize it is a
team sport Like.
(29:02):
Team-based care is a termyou'll hear getting thrown
around, but it is for real andagain, lots of studies show that
team-based care is better, isbetter care.
So we do.
We do a lot of that as as wellyeah, man, that's just a.
Speaker 1 (29:21):
I think that simple.
You know, team-based care.
It's simple.
I mean, I think it leads tothings that are profound in
terms of quality of care.
Yeah, but it's also something.
The thing that carries peoplethe most, whether it's
professionals or you're on theground workers or you're direct
(29:43):
care, I mean the thing thatcarries people the most are
these kinds of simple things.
It's like I'm part of a team oryou know communities, the
solution, or there are theseprinciples that kind of carry a
person and I, yeah, I'm not, youknow, like you.
I have the, I have the heartthat wants to make it the
national issue and solve theproblem.
(30:05):
Yeah, I, I, I.
I have not yet accomplishedthat.
I'm not going to saddle youwith failure and I'm not giving
it up just yet either.
So we're going to keep workingRight, we're not giving up.
Speaker 2 (30:18):
Well, I mean cause it just seems so obvious.
You know, sometimes I think ofus, I I love.
One of the reasons I went intothe field is I love hanging out
with clinicians.
They're so.
You learn from every one ofthem.
You know everyone does things alittle bit differently.
They have different methods ortricks.
You know, in a sense and how toengage with people, and one of
(30:40):
the things that is reallyimpactful is case conferences,
which is something I alwaysbring in wherever I am.
They used to be around 30 yearsago, not so much anymore.
All this productivity stuff andalso bringing the patient into
that right, and it's alwaysimpactful to the patient First
(31:02):
of all.
See all these caring, smartpeople that care about them,
that are putting their headstogether to try to figure out
what's going on with them, andthen you learn stuff you know
from each other.
One of the other things I'mdoing is we have two times this
year once at a big conferencethat we had on patient
experience and then one recentlywe had a summit for our interns
(31:25):
.
We have like a social workinterns and there's a particular
patient of mine I've beenworking with for two years who
struggles with a lot of reallytough stuff and she's
extraordinarily bright andarticulate and, um, and really
wants to give back.
She's always like when she getshospitalized, you know we, you
know you can bring residents andinterns in and she'll talk with
(31:47):
them about, um, what's going onwith her, and, and so I've had
a conversation with her in inthe, at the big conference right
, with all kinds ofadministrators and everything
that has never seen apsychiatric interview, um, and
then we were invited to go tothis intern, uh, so, and so what
it does?
First of all, it normalizestalking with patients, and when
(32:08):
I say patients, I mean a humanbeing who's in the patient role.
Speaker 1 (32:11):
A shocking concept really.
Speaker 2 (32:13):
Well, it's just someone in the patient role.
In that sense I'm in the doctorrole, but that could switch.
I mean, we're all patients atsome point, so it normalizes it.
It's also like I think of usand I don't know if this makes
any sense to you, but, like youknow, I, when I look at so, the
way the work that our people do,including you I'm like these
(32:36):
are like star athletes.
It's imagine we were like aprofessional, we were playing
like professional baseball,right, like that's how good
people are at this, and yet werarely get to see each other do
it.
You know, inspired by it tolearn things, to actually even
critique each other too at times, like yeah, I don't know, like,
like should, I might want toconsider this or do it this way,
or I've done it this, yeahexactly which is just I mean the
(32:58):
value in that.
Speaker 1 (33:00):
I mean to me just the opportunity, even with the show
.
That's part of what the show isabout.
Actually.
It's like getting with peoplelike you and just you know,
let's take 30 or 40 minutes andjust hear this person's wisdom
of decades worth of care and Idon't think people understand
the value of it and the factthat you know, in many ways,
(33:23):
somebody like you with as manycredentials as you have and all
the things hanging on the walland everything else.
I think one thing that peoplemight not know at first glance
is that you're also, like this,really nice person that's fun to
hang out with well, I mean it'snot, you know, that's my
opinion yeah, I mean to mean tome part of that is, you know,
(33:46):
it's not rocket science.
Speaker 2 (33:47):
I grew up working in a fish market.
This is not and partly I saythat for people to know that you
can learn this stuff Like Istill literally use lines from
when I was in training and I sawI used to observe the way that
people would.
We'd had a lot of that back inthe day.
You would observe how peopleinterview and I still literally
(34:08):
use lines today.
I have a couple of them come tomind that are really good.
One is especially with somebodythat is kind of depressed.
It's what keeps you going.
Speaker 1 (34:20):
Yeah, like very simple.
Speaker 2 (34:22):
You know it's a very simple and there's usually only
a few categories of things.
You know or you don't get ananswer.
You know it's a very simple andthere's usually only a few
categories of things you know,or you don't get an answer you
know, or another one is do youhave anyone out there?
You can lean on Right,literally like.
I heard that 30 years ago andI've used it every.
Speaker 1 (34:43):
Every year You've got techniques like motivational
interviewing and all thesethings.
I'm like like, hey, you know, alot of this is socratic method,
you know what I mean.
Like it's socratic methodthat's been distilled and and
and refined and everything else,but asking somebody a good
question that causes them tofocus on what are the resources
you have?
Like, how are you keepingyourself well, right, right,
(35:04):
they haven't.
They have an you know asopposed to you know.
Are you feeling terrible?
Have you had any suicidalthoughts?
I mean, those can be importantquestions and I'm not
discounting them.
Right, having a person focus onthe ways in which they're
maintaining a well-being RightIs a shift.
I think many of our you know,provider networks need to make a
little bit.
Speaker 2 (35:25):
Yeah, and I think our folks don't get nearly enough
credit for what they do.
They they, you know and to makeit perverse like they get a lot
of attention when somethinggoes wrong.
Speaker 1 (35:35):
Right, yeah, oh yeah.
Speaker 2 (35:36):
Yeah, but no one gets how incredible, like it's, a
little bit of what we do is sortof like a trade.
It's like becoming a reallygood plumber, Like you know.
I think you said you have toapprentice, you know and watch
people and get better and makesome mistakes too.
You know, like that's how youknow, you, you learn.
But I want to get back tostigma, because you did use that
(35:57):
word and I don't want to.
I know we don't have too muchtime left and I want to.
I think that's critical.
I mean that would be the otherthing if I could wave.
Wave a magic wand is, um, there,there is so much stigma still.
I mean the good news is theyounger generations, I think,
are doing better.
But it is embedded in a lot ofwhat we do.
(36:19):
It's embedded in our systemsand, um, you know, to give a
shout out to the system I'm inand all my places have been good
.
I mean, they've had great luckin finding good places to work.
But as big systems go again,this is, you know, it's a 47,000
(36:40):
person, $7 billionnot-for-profit system, which
these days is not huge.
Seven billion dollarnot-for-profit system, which
these days is not huge.
Um and uh, behavioral health isbig here, but it's not as big
as the rest of what we do, right, we have acute care hospitals
and orthopedics and surgery andprimary care and emergency rooms
, right, um, but one of thereasons I'm still here after six
(37:04):
more than six is that there isless stigma here around mental
health than I've ever seen inany other system, and I think
that's a function of the culture, you know, of an organization
and the culture of ourorganization.
They've been working on it for15 years officially.
(37:26):
You know they really work hardon it.
We have leadership behaviorsincluding be curious, not
judgmental.
That's literally a leadershipbehavior.
And so you had mentioned thisprogram that we started and I do
want to, you know, let peopleknow about it, not only because
it's a great program.
It's called the Ridge RecoveryCenter.
(37:47):
It's in Northeastern uh,connecticut.
Speaker 1 (37:50):
Opened last year, is that?
Speaker 2 (37:51):
right.
Exactly a year ago.
In fact, we had just had aevent one year event and two of
the two of the former patientsthat came were were.
One of them was the firstpatient.
Speaker 1 (38:04):
Oh wow.
Speaker 2 (38:05):
The other one was like the fifth patient or
something, and they told theirstories of recovery, you know,
and and what so?
Um, what's extraordinary aboutthis program which shouldn't be
extraordinary but it is is that,um, and you know the field well
, so there's a lot of smallprivate you.
You know residential rehab, soit's like 60 beds and we've got
(38:29):
some are withdrawal managementor used to call them detox, some
are residential rehab and thena few of them are extended stay.
You can, it's like a soberliving kind of thing.
So most of the, a lot of thepeople that do that do them in
small private organizationswhich you know, to make a living
, to make it work, to sustain aplace, it has to be out of
(38:51):
pocket.
This is not that way.
This is insurance-based andit's part of a large health
system and the fact that ahealth system during the
pandemic you know how bad thatwas for health systems, I mean
you know, hundreds of millionsof dollars lost, billions really
across the country.
(39:12):
During that period our systeminvested in starting this
program, which is, you know,again like.
It's sort of a heartwarmingfeeling to me, because they
treat behavioral health as asany other thing, as orthopedics,
as surgery, as cancer.
But on the other side you'relike why should you?
Why should that be so unusual?
(39:33):
Like why yeah?
Speaker 1 (39:35):
exactly.
Speaker 2 (39:36):
Right, and especially because every one of us has in
our family, somewhere, ourfriends, people who struggle
with this stuff.
Speaker 1 (39:48):
If you stand with a person on either side of you,
one of them struggling with oneof you struggling with a
condition.
Speaker 2 (39:54):
That's right.
But anyway, I know we're kindof winding down, but I don't
know.
Speaker 1 (39:59):
Well, you know, I think you and I could wind up
several times to be my guest,which is exactly why I was.
I was really grateful that youwanted to come on the show and
hang out with me today.
This has been Dr John SantoPietro with Hartford healthcare
there up in Connecticut.
Speaker 2 (40:19):
Thank you, you're very welcome.
Speaker 1 (40:22):
It's so glad to have you on the show.
This has been Headed SideMental Health.
We'll see you all next time.
Bye-bye.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.