February 17, 2025 • 46 mins
Discover the transformative journey of Dr. Wendy Oliver-Pyatt, a trailblazer in mental health and eating disorder treatment. From her formative training at NYU Bellevue Hospital to her influential role as Nevada's Medical Director for Mental Health and Disability Services, Dr. Oliver-Pyatt's career is a masterclass in pioneering compassionate care. We explore how her unique blend of psychodynamic therapy and community psychiatry has revolutionized treatment approaches at centers like Galen Hope and Within Health. Her story is one of innovation, resilience, and a deep commitment to holistic healing.
This episode promises to reshape your understanding of eating disorder recovery by emphasizing the crucial need for addressing psychological dynamics beyond behavioral symptoms. Dr. Oliver-Pyatt sheds light on the power of incorporating trauma history and relational insights into treatment plans. We critically examine the flaws in existing mental health care models, focusing on the tumultuous transition from residential to outpatient care. Highlighting the benefits Assertive Community Treatment programs, we discuss how integrating these principles can improve patient outcomes and reduce healthcare costs. Join us as Wendy and I advocate for systemic change in mental health reimbursement, pushing for fair allocation of funds to enhance care quality.
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Episode Transcript
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Speaker 1 (00:00):
Hello folks, thanks for joining us on Head Inside
Mental Health, featuringconversations about mental
health and substance usetreatment and co-occurring
disorders, with experts fromacross the country sharing their
thoughts, insights and practiceperspectives on the world of
behavioral health care.
Broadcasting on WPVM 1037, thevoice of Asheville independent
(00:20):
commercial-free radio.
I'm Todd Weatherly, your host,your therapeutic consultant and
behavioral health expert.
Today I have the privilege ofbeing joined by Dr Wendy
Oliver-Pyatt, founder ofmultiple eating disorder and
mental health treatment centersacross the country, including
Within Health, galen Hope,oliver-pyatt Centers, clementine
(00:42):
Embrace Treatment Program forBinge Eating Disorder and the
Center for Hope of the Sierras.
Dr Oliver Pyatt completed hertraining as a psychiatrist at
NYU Bellevue Hospital.
That is a place to get trained,where she served as a chief
resident.
Her training and experienceinvolved direct patient care and
(01:03):
leadership across multiplelevels of care and treatment
modalities, including inpatientpsychiatry, residential
addiction programs, pac teams,emergency room psychiatry and
public and private outpatientcare.
In 2001, she became the Stateof Nevada Division of Mental
Health and Disability ServicesMedical Director.
That's no small feat there, thefirst woman and the youngest
(01:23):
person ever to be in the rolereceiving senatorial recognition
.
In 2003, dr Oliver Pyattfounded her first residential
eating disorder treatmentprogram, the Center for Hope of
the Sierras.
Later, in 2008, she went on tofound Oliver Pyatt Center in
Clementine, both nationally andinternationally recognized top
programs in their field ofeating disorders.
She authored Questions andAnswers on Binge Eating Disorder
(01:46):
, a guide for clinicians, andnamed by USA Today as a top
healthcare entrepreneur, 2024and beyond, recently elected as
a fellow of the AmericanPsychiatric Association.
Congratulations, thank you.
Wendy.
Carries her work with anunwavering belief in compassion
and scientifically soundtreatment.
I also know her as just kind ofa cool lady that I like hanging
(02:06):
out with, who I send verydifficult clients to, and she
says yes, thank you, dr OliverPyatt.
Wendy, thank you and welcome tothe show.
Speaker 2 (02:17):
Oh, thank you so much , Todd.
I really am so happy that youinvited me.
I look forward to ourconversation and continuing to
spend more time with you.
Speaker 1 (02:25):
Absolutely Well.
You know we kind of hit the we.
We hit a little bit beforehand,right, but the I, when we place
the individuals in the familiesthat we work with, it's very
often that there's a, there's avery significant presenting
eating disorder.
For the clients that sufferfrom that we end up calling it a
(02:46):
co-occurring condition becausewe know that behind it is this
very significant primary mentalhealth condition that they are
struggling with Maybe bipolardisorder, maybe it's borderline
personality disorder or otherpersonality disorder kind of
features, and that makes themvery challenging behaviorally to
(03:08):
deal with.
So we work with you and yourcenters and specifically down
there in Galen Hope.
We've had several clients godown there because when a person
is struggling with bothconditions you actually have
both tracks at your center thereand do a job.
That many kind of neglect, whichis they do really good at the
(03:30):
eating disorder side but they'renot paying the kind of
attention that we need to pay tothe mental health side.
And you and the programs thatyou've created do an exceptional
job of kind of bringing thatart and science together.
How, what brought you to that?
I mean you've got thisdistinguished career and I you
know a lot of.
It's like public sector,private sector and and you've
(03:55):
just got to see the the kind ofgaps and failings that happened
in both of those systems andbrought that experience and like
, created something where tellme how you got there, please.
Like what?
What is it that like?
Speaker 2 (04:09):
Hey, we got to do this better and brought you to
the place where you are now.
Oh, todd, thank you so much forall those kind words and
generous thoughts.
Um, how did I get here?
I mean, sometimes people kindof talk with me and they figure,
oh, did you have this plannedout?
Did you know you wanted to bean eating disorder psychiatrist?
Because I did have an eatingdisorder early in my life.
(04:30):
And so people think, oh, didyou become a psychiatrist
because you wanted to treateating disorders and all that?
Absolutely not.
I had no preconceived notion,you know, of my plan here.
I didn't really have a plan.
I think one of the things that Itry to tell my patients too is
that if we get in touch with ourauthentic self and we are like
more organic about how we letour life unfold, rather than
feel like we have to have someexact plan of what we're going
(04:51):
to do, a lot of times the pathwe get on can be much more
anchored in, like our soul andwhat really drives us or excites
us or that we feel passionateabout.
I've been incredibly luckybecause I love what I do first
and foremost, and that's kind ofhow the process unfolded For me
.
My first love in going intopsychiatry was really a
(05:13):
fascination with the mind and acommitment to helping those with
severe mental illnesses.
That was why I did my residencyat NYU.
I really wanted to focus oncommunity mental health.
At NYU.
I really wanted to focus oncommunity mental health and
through that experience I hadreally extensive training on,
you know, the full gamut ofpsychiatric conditions and how
we treat them.
And I'm very lucky as wellbecause even though at NYU it
(05:37):
wasn't necessarily thought outthis way, but it was an
interesting blend of communitypsychiatry and also many of our
supervisors were psychodynamicoriented Freudian analysts,
believe it or not.
Speaker 1 (05:49):
So I got a little day right.
Speaker 2 (05:51):
Back in the day, that's kind of who they had as
our supervisors.
So I had this incredible mixand I, I believe, like I first,
you know, kind of fell intodoing the higher level of care
work really out of my own, myown, like frustration with like
what I was being expected to doas a psychiatrist, which was
sort of become a prescriptionpad, because the field of
(06:14):
psychiatry sort of gotmarginalized into oh, you do,
you write the medication ordersand everybody else does the
therapy, and what I saw is justa lot of like bifurcated
healthcare, like mental healthover here and medication over
here, and therapy over there andmedical conditions over here,
and even the medical conditions.
So people are this one, youknow, we're one human being and
(06:38):
we have a multitude of differentthings happening with us, and
the care itself being sofragmented just drove me
absolutely nuts.
Speaker 1 (06:47):
Well, in siloed care, the silos don't talk to one
another.
I get why specialty has toexist, right.
But and being in Bellevue, youknow the one of the like, you
know one of the busiestpsychiatric centers in the
emergency psychiatric centers inthe freaking country.
Speaker 2 (07:01):
Yeah.
Speaker 1 (07:02):
You know you're just.
You're writing scripts andgetting them out the door, right
?
Speaker 2 (07:05):
Yeah, but at the same time I had these patients, I
also got to do therapy and I hadthese analytic supervisors.
So that was kind of thebackground.
But I really just didn't wantto become a prescription pad and
I just decided, if I'm going todo this work, I'm going to
stick my neck out.
That's when I started my firsttreatment center.
I'm going to do it the way thatI want to do it, which is not
(07:26):
not BSing, like truly integrated, holistic care where there's a
medical personnel, there's apsychiatrist that can do therapy
, there's therapists, there'sdietitians, there's recovery
coaches, there's all of that inone place so that a person can
truly be treated in thisintegrated fashion.
So that was really, you knowhow it came about.
(07:46):
And the field of eatingdisorders is very interesting
because it's a really vividexample of probably the most
vivid example of the importanceof using that biopsychosocial
model.
And Hilda Brooke, who was oneof the first clinicians to
really write in contemporarytimes about anorexia nervosa,
(08:06):
really revived that concept ofthe biopsychosocial foundation.
It was already came about byanother physician, but she kind
of brought it into life with herwritings about anorexia nervosa
and there really is.
I mean, any disease process hasa biopsychosocial foundation.
Whether it's diabetes or lungcancer, heart failure, whatever,
(08:29):
there's always thatbiopsychosocial piece.
But in eating disorders, if youdon't really pay attention to
all, then you're not going toget anywhere.
And also the same is true forprimary mental health.
We do actually treat primarymental health, with or without
the eating disorder.
So using that foundation isreally the anchor to being sure
(08:49):
that you're leaving no stoneunturned and you're hitting all
those domains of care.
And you mentioned about howeating disorder treatment can be
very focused on just the foodand the eating and all of that.
Well, that's a very behavioralthing, like eat the food, weight
restore, blah, blah, blah.
I believe that when you onlyfocus on behavior and food, you
really are hurting potentiallythe patient, because the
(09:12):
psychodynamics and the healingprocess like also has to happen.
So I really believe thatbehavioral is important, like it
is important to put containmenton behaviors and expectations
and have very clear processthere.
That's not punitive, it'snatural consequences.
So the behavior, we don't gopunitive, we go natural
(09:35):
consequence, we can talk aboutthat.
But at the same time we alwayslead with compassionate
curiosity and a psychodynamicfoundation, and so we really
need to understand our patientsin the psychodynamic way as well
and in a relational way becauseit's the relationship where a
(09:56):
lot of that healing is going tohappen and understanding the
trauma history, thepsychodynamics within family,
psychosocial reality that theperson's experiencing.
If we don't also include that,then just changing behavior when
a person's in a higher level ofcare will have no lasting
impact.
Speaker 1 (10:11):
Well, as soon as the behavior mod goes away, right
the modification.
You know they're receivingsupport on eating.
Somebody's watching theircalories for them.
They're doing all these thingsand then they go out on the
street.
Speaker 2 (10:26):
Yeah.
And goes away all of it goesaway.
It doesn't generalize and also,if it's just punitive, it also
just doesn't go like.
The patients, our patients orthe clients, whatever you want
to call it I call them both, umare intelligent people that
understand like, are capable ofunderstanding, like the process.
So if we explain to the personthis is exposure therapy, this
(10:49):
is how it works, it's gonna feelharder and then it's gonna feel
easier.
You explain, I'm not justshoving you down this road for
no reason.
This is called exposure therapy.
This is how it works and weexplain what's happening to the
patient and we and when we usenatural consequences right,
we're helping the patient seeand experience the ramifications
(11:10):
of their behavior.
We're not just putting aprotocol in place.
We're helping the person seelike.
Well, you know the reasonyou're not doing high cardio in
our movement program right nowis that you actually have
orthostatic vital sign changes,so you're going to be dizzy, or
your blood sugar has been reallylow, so of course, we're not
going to strain your body on atreadmill and it's going to tank
(11:32):
, you know, yeah, so we we usethis process of natural
consequences, like, oh, you'repurged in the program, like
we're probably not going to beokay with you going on a pass
right now, and so things likethis are very, very important.
A lot of times also, familiesdon't understand how to
implement this attuned carewhere there's the natural
(11:53):
consequences.
The natural consequences isakin to what Maria Montessori
talks about freedom andresponsibility.
I don't know.
My kids went to Montessori andone of the most powerful kind of
mock papers I read that theymade you read like Montessori
work was this concept thattalked about freedom and
responsibility being intertwined.
(12:13):
Well, when we are gradual andattuned in what freedoms we give
to our patients, that's tied towhat they can responsibly
manage.
That actually imposes upon themthe demand, if you will, to
heal, and that is how we grow.
It's really honestly, it's acommon sense developmental
process.
Speaker 1 (12:33):
Well, I mean it's a parallel to being an
experiential ed nerd Wildernessapproach is the same principle.
Speaker 2 (12:40):
Oh, really Tell me.
Speaker 1 (12:42):
Well, I mean, you know it's like hey, it's raining
, you might want to put araincoat on and if you don't put
a raincoat on, you're gonna bewet.
You know, it's real simple.
It gets real basic reallyquickly.
Um, but it, you know, like yousay, it's informative.
It's, it's something thatprovides a person with education
, but in addition to that agencywhere they like hey, I
understand.
(13:03):
That's right.
I I understand what's going on.
I'm making choices because Iknow that there are consequences
to my behavior and consequences.
They may be good, they may bebad, but you're like, you're
making active and engagedchoices about what you do in
your behavior so that you getthe outcome that you want, right
, um, but the?
You know the thing that you'retalking about here.
That interests me a lot as well, and I know that you're also a
(13:27):
very experiencedaddictionologist, a person who
understands addiction at itscore principle.
You've got individuals comingin there not only suffering from
mental health disorders eatingdisorders, but also substance
misuse disorder as well andhelping them manage those things
as well, and helping themmanage those things, but the not
being punitive because, there'sa.
(13:47):
There's a lot of the.
You've got this.
Let's call it a subsegment ofthe treatment community that
it's confrontive.
I don't know if we might go asfar as to call it punitive, but
it's like the whole concept thatyou're defective at your core,
or or that you, or that yourelapse.
you got to get kicked out Untilyou decide you can do something
(14:09):
better.
Don't come back to us untilyou're ready, that kind of thing
.
And I think that there areprograms that are successful in
this approach and maybe theymodify it or they use it in a
different way.
What is your approach Like?
Give me the nitty gritty ofyour thoughts, yeah, please.
Speaker 2 (14:30):
I think that I start with the premise that in the
essence, within the essence, inall of us, is this like whole
person, and we want to.
So I think we all kind of wantto love.
What do we want?
We want to give love, we wantto receive love.
(14:52):
These are the things we want togive love.
We want to receive love Right,we want to be accepted for who
we are, on some level, like whowe are, like we want to feel
like we can be who we are.
We may not consciously thinkthat, but we're more at ease
when we can be loved andconnected with and be a part of
(15:13):
some kind of culture or groupingwhere we are accepted for who
we are Right.
Yeah where we are accepted forwho we are, along, right, yeah,
and there is that part of usthat has a need to manifest
something about ourself forwhich we are passionate or we
are drawn to or whatever, likewe want to manifest some love.
Goodness, I think most of usare really, we're born into the
(15:35):
world with these basic kind ofaspects of our essence I just
called our essence.
I think our essence of who weare is a beautiful.
We're beautiful.
We're beautiful little babiesborn into this world and we just
want to feel safe, protected,love.
So if we kind of start with likethat's who each one of us
really is at our core, and thenthings happen in life and we
(15:58):
build defenses or we have amedical condition or a
psychiatric condition that givesus, you know, barriers to
manifesting that in a full way,we encounter trauma.
A lot of things can happen tous that make us, you know, more
guarded or defended or unable tokind of just manifest what
we're capable of manifesting.
(16:19):
So, whether it's SUD or mentalhealth or eating disorder or
whatever, I think if you kind ofwalk into the space with a
patient believing that about theother human being sitting there
before you and also walking inwith that humility of like.
You know that the true one ofthe definitions of humility is
like you know, I'm no better orworse than anybody else.
(16:41):
Like we're, we're on an equalplaying field.
I'm not some authoritative, Iknow, you know I mean it's
important to have convictionabout how somebody gets
treatment Right and saying, ok,I can guide you, let me hold
your hand.
But to say I'm a superior beingto you in some way, shape or
form through your behavior,overt or covert, is really, I
(17:02):
think, a shaming thing.
So I don't really believe inshaming people into behavior.
I think calling people out forbehavior that's hurtful to
others or short-sighted, likeyou can do that, you know, in a
loving way, no-transcript trauma, anxiety or whatever that makes
(17:50):
it harder for the person tooperate or function.
So giving them supports andtools.
You know sorry, a cat justjumped on me.
Speaker 1 (17:57):
No worries, sorry, a cat just jumped on me.
Speaker 2 (17:59):
No worries, I told you before I have a foster cat,
but helping people manifest thatessence, whatever their primary
various conditions, are Withinthat, though, I think that when
you're working with an SUD folks, you really have to give
consideration.
Now, with eating disorders,what's their psychosocial
(18:22):
experience going to be when theyleave?
Are they going to be in a kindof pro-recovery?
Speaker 1 (18:25):
environment.
Speaker 2 (18:25):
Because I mean really being conscientious about
what's surrounding that personis very, very important when it
comes to SUD and helping themmake choices where they're not
going to get exposed to thingsthat are triggering them or
inviting them.
Or maybe they're in a toxicrelationship, or maybe they're
in an environment that'sreinforcing the use of substance
.
So really you have to be verypractical with SUDs, so I think
(18:50):
that's also, and with eatingdisorder too, but that's one of
the things, I think, Todd, thatcomes into play.
So, getting into the underlyingdynamics, the family, the
family, family, family dynamics,where there's sometimes
intergenerational trauma,intergenerational SUD and
addictions and mental healthproblems.
That all played a part in theevolution of the various defense
(19:10):
mechanisms the person may have,or or adaptations to life, or
or the worldview, our cognitivescheme of like, how do we see
the world?
Or what do we expect out ofrelationships?
I expect relationships to hurt,like I need to be defended
against that, or whatever theschema may be.
That's where the true, you know, psychotherapy comes into play.
So, again going back to thebiopsychosocial piece, getting
(19:32):
the medical piece sorted out alot of folks haven't been doing
great self care and nutrition,getting that sorted out.
And then, last but not least,on the STD side, there are some
medications that a person canuse that are helpful.
I think, you know, usingsomething like Antabuse is not
you know, it's not unheard of, Ithink it's there's so much
(19:53):
stigma around it but it's a veryhelpful tool for folks with or
naltrexone substance, you know,or the various ways that it can
be delivered.
So I think these are.
I mean, the research shows thatthese are underutilized tools
as well, and so I think it's.
You know, I just don't takethat view of somebody being
(20:13):
defective.
I more take the view thatthey're struggling and they need
healing, whatever the primaryconditions really are.
Well, and I think that you'restruggling and they need healing
, whatever the primaryconditions really are.
Speaker 1 (20:21):
Well, and I think that you're saying something
that's really key here andyou're naming something else
that is you haven't overtly said, but it's why the work that
you're doing, I believe, isinnovative and effective and
something that a lot of theworld misses out on trying to
bridge.
How do we bridge this piece?
But first of all, treating themlike human being yeah um, and a
(20:42):
whole person.
Right, you know they're not anumber, they're not a script.
They're, yeah, this person.
We need to look at the wholescenario.
But the other piece is thislong like where are they going
to be a year from now?
We're two years from now.
I've got to think about theirlife in a long-term scenario and
I think that that's the trapthat the hospitalists say, for
(21:03):
example, can fall into.
It's like I don't know wherethis person's going.
Now I'm going to script them asbest I can to manage symptoms
and hope that that works out,but the truth is is they're
going out into an environmentthat's not very supportive.
They fall over.
You've been involved with PACteams.
You know assertive communitytreatment.
You've seen where it lands onthe ground, where it falls over,
(21:29):
where people run into theirstumbling box and end up
repeating the cycles andeverything else.
Some of your programming isalso it's got.
You know PHP and IOP aspects ofit and you've done a lot of
outpatient care when you know,know for you, where does the
rubber meet the road out there?
Well, that's after treatment.
You know what I mean.
Speaker 2 (21:42):
Yeah, that's residential I mean, I really
believe that the model that wegenerally have in our culture is
flawed, and you're you'realluding to that, yeah, you
think flawed and and so, sadlyand tragically, people who go
into a higher level of care andthen struggle, they lose hope,
they internalize shame, theyhear that they're treatment
(22:05):
refractory or treatmentresistant and what I say is like
, are they treatment refractoryor did they just not get good
treatment?
That's the question that wehave to pose here, I think,
because whether it's like theydidn't get good psychiatric
management, which you alluded to, they really have bipolar
disorder.
Nobody treated that.
They really have trauma.
They never had EMDR, theyreally have depression.
(22:27):
They've only been on 20milligrams of Prozac for three
years or something like that.
Speaker 1 (22:31):
They went to the hospital, they put them on the
velvet hammer and sent them outthe door.
Speaker 2 (22:35):
Yeah, so what happens ?
The model is you mentioned thiswith the hospital, so it's this
model that, because we're cheapand we're a society that wants
to get everything done fast, soit's like, oh my God, the
person's symptomatic Put them ina 24-hour care, put them in a
hospital, glue them up to wherethey just okay, they're not
about to die tomorrow, right,okay, they're not going to die
(22:57):
tomorrow.
Boom, there you go.
Speaker 1 (22:59):
Better job die tomorrow, right Okay.
Speaker 2 (23:00):
They're not going to die tomorrow.
Boom, there you go.
And even if you think aboutthis, is this is mind boggling
when you really think about thetraditional model, residential
care being 24 hour care, phpbeing six hours.
So that model of residential toPHP is completely insane.
Speaker 1 (23:18):
It's upside down.
Speaker 2 (23:19):
It's insane.
And so our model allows or asmooth transition from that
24-hour care, which right now wedo it under the model of PHP,
with supported housing.
We will have actual residentialcare as well, because we've
just recognized the need forthat.
But the 24, 24 hour care, wecan gradually taper down that
(23:42):
clinical programming from 12hours to eight hours, et cetera.
So we take a really seriouslook at patients before they go
from 24 hour care to having theeight hours or six hours of PHP,
because that is when they arefirst.
Now they're out in the world ontheir own.
So we, one of our little rulesof thumb is that they don't move
(24:04):
down to the lower level of careuntil they've demonstrate an
ability to like, manage thatfreedom.
It's just like if your kid islearning to drive, you're not,
you're, I'm in Miami, we're justgoing down the street on on,
you know, 57th Avenue orsomething I'm not going to be
like.
Okay, we drove in the parkinglot here, go, drive up I-95.
Speaker 1 (24:23):
Well, Gen Xers, that's the way we did it.
We decided that that was not agood way.
Speaker 2 (24:28):
Yeah, it's like, no, that's not going to work.
So I think that this wholemodel is just flawed and this
tapering down of care that'sreally attuned to where the
person's at, and it's like, oh,they struggled a little bit, we
moved them down to PHP eight andnow in that little window of
time they, you know, drank orsomething like that, and then
when you have the relationship,they can talk about the behavior
(24:51):
too.
Right.
Speaker 1 (24:52):
They come to you about it, yeah.
Speaker 2 (24:53):
They can tell you, tell you more about it.
So I think that is really nice.
And then also we keep thatstable housing and the stable
treatment team all through allthose levels of care.
So as they're moving around,that team is with them.
They're not switching, They'vegot the same team.
They still have a stable placeto live all the way down to IOP.
But you mentioned PACT.
That's where this focus onacute care and then just turn
(25:17):
your back on the patient in asense at the IOP level is so
wrong.
It's so flawed, because peoplehave to get integrated into the
community.
They have to have that lifeworth living.
I mean, loneliness is a bigissue for folks like the surgeon
general named loneliness, a bigproblem in our society.
(25:38):
It is Loneliness and havingmeaning, having a routine.
We all need it.
Look what happened to us whenwe lost our routine during COVID
the depression ratesskyrocketed.
I mean, for me, even workingremotely, a lot of times
sometimes I'm like I need to goin and be with my team in person
.
Speaker 1 (25:59):
Well, we run into this with our clients all the
time as well, and it's and toreally say positive things about
the kind of the model you'rereferring to, especially the
treatment model that youdesigned down.
There is hey, I want to comeout of this emergency level,
this kind of 24 hour supervisionlevel of care, and just go into
outpatient without anysupported housing, without any
(26:21):
other components that are goinginto my, the support that I need
it's like.
So let me get this straightYou're going to come right out
of this 24 hour environment.
You're going to go spend Idon't know six hours, six hours
a day, five days a week, doingsome intensive clinical work,
and then you're going to go hometo be alone at night.
Speaker 2 (26:39):
It's insane, todd, are you?
Speaker 1 (26:40):
kidding me.
Speaker 2 (26:41):
Isn't it insane that we actually expect people to
heal and do well in that modeland a lot of them don't even get
that PHP.
They might just go straight tooutpatient or to IOP and it's
like how can you expect somebody?
And look, our patients are verycomplex and by the time
somebody makes the decision togo into 24-hour care, you know
(27:02):
them because you're taking them.
You know you're figuring outwhat to do.
Their lives are really in astate of major disarray.
So they're coming to us withreally serious things happening
for them and those things arenot solved in 30 days in a
24-hour care setting.
Speaker 1 (27:23):
Your PHP.
I mean, I think that to call ita PHP is almost a disservice,
because they're in a supportedhousing, they've got coaches
with them all the time.
They're in a highly structuredenvironment.
There's never really eyes offof them, so they're really in
what most would refer to as aresidential treatment
environment, even though there'ssome really eyes off of them.
So they're really in a whatmost would refer to as a
residential treatmentenvironment, even though there's
some space that exists betweenwhere they live and where they
(27:45):
get treatment.
Speaker 2 (27:46):
You know it's we were referring to, you know commonly
the Florida model, right, andit's like well, we want to get
the licensure and bill, but yeah, I mean back in the day when,
when I first started at likeSanta Barbara this year is, we
didn't need 24 hour nursing tobe residential.
That just kind of came into thefield that residential needed
24 hour nursing and honestly,that was an insurance company
(28:09):
ploy to try to get rid ofresidential programs, put them
out of business, because mostpeople with eating disorders
some need 24 hour care, but mostpeople at the residential don't
need 24 hour nursing.
They need 24 hour monitoringand they may need nursing
throughout the week.
But it was really not somethingthat it it really wasn't
something that actually madeclinical sense.
(28:29):
So you know, they needed the 24hour monitoring more than
anything and that's what.
And then we that's what's soimportant to block the behaviors
and give them the support, andthen the tapering down and the
building the connections in thecommunity that uses.
That's where that PACT modelcomes to play.
Speaker 1 (28:47):
So I got a question that I ask a lot of the folks
that come on the show that aredoing innovative work in the
private sector, have worked inthe public sector, and the
question I have is what's thedivide?
You know where?
Where do we bridge this gap?
Speaker 2 (29:05):
What do you think where?
Speaker 1 (29:07):
where do you think?
How?
How do we?
Is there a chance at it?
Where do we start?
Like what's your answer?
Speaker 2 (29:12):
to that.
I am so glad you asked this.
Okay, here I go.
Okay, so this is this issomething that bothers me so
much, like, first of all, thefirst thing we're talking about
here is the separation betweenacute care and then dumping
people, dropping people off.
Of course patients want toleave and they want to be in the
lowest level of care.
(29:33):
That's normal.
But so that's the first problemwe have.
And then the second problem isthis use of this model of pact
and sort of community treatmentthat kind of follows the acute
treatment, and the way we do itis really not widely done.
It's done.
Pact is done in two groups pactmodel it's done in some places
(29:55):
with really wealthy folks whocan pay cash for these kinds of
services, right, we have some ofthose programs.
Right and great, those peopleget great care.
And you also see that it's donein some public mental health
programs, because some of theseprograms realize, oh, this
(30:16):
actually saves us money, whichit does.
I started a PAC program.
Speaker 1 (30:18):
Little blips of good stuff in the country right I
started a PAC program in Nevadaand we brought people out of the
hospital.
Speaker 2 (30:25):
We reduced recidivism .
It does actually save money todo PAC programs.
Is my cat distracting you?
Speaker 1 (30:32):
Oh no, not at all.
Speaker 2 (30:33):
Okay.
So, by the way, that's mymeaning.
I'm a foster mommy for cats,I'm a cat lady and I'm a big
believer in just say yes when itcomes to fostering, if you want
meaning in your life.
So, anyway, that's my plug formy one of the ways.
Speaker 1 (30:51):
I do, there you go.
Speaker 2 (30:52):
Okay.
Speaker 1 (30:52):
You're carrying across the board, you know.
Speaker 2 (30:54):
Across the board.
Yeah, my, yeah, okay.
So as long as it's notdistracting, todd, I'll just not
make my cat get down.
But so the one thing we talkedabout is this bifurcation where
you've got the private high cashplaces doing PAC and then
you've got some hospital systemspublic, like Medicaid, medicare
(31:17):
population doing PAC becausethey realize, oh, this actually
saves money, people aren't goingin and out of the hospital and
that's for the people that don'tknow.
Pac stands for AssertiveCommunity Treatment or Program
for Assertive CommunityTreatment, and it's sort of this
hospital without walls conceptthat was really derived from
taking all the staff that was ina hospital and planting them in
the community and doing a lotof work in the community and
(31:39):
doing a lot of work in thecommunity.
It started in like, I think, theseventies in a public system in
Wisconsin, if I'm not mistaken.
But so it's this public.
Certain public systems havepacked and then the high count.
So what I want to do, what myhope and goal and vision, is to
(31:59):
bring this model that blendsthat acute phase that we're able
to do with that integrated youknow the principles of PACT so
that people are getting intotheir life in a meaningful way,
and we've got that blendedtogether and deliver that into
the commercial space so that Ican work with programs.
(32:19):
You know that, you know wherethe mom or the dad is the
teacher, or the mom or the dadis the janitor, whatever and
they have health insurance withX payer or Y payer, so that this
cause, this model, is reallypeople with mental illness and
eating disorders.
They're owed a better model ofcare and it shouldn't just be if
(32:42):
you have the cash to go pay fora packed program, or it
shouldn't just be okay.
The person is so debilitatednow that they have no functional
life and they're just onMedicaid and Medicare and
they've ended up in the publicsector and they really haven't
been able to heal because theyhaven't ever got the care that
they want.
(33:02):
Because every one of us, wedeserve a chance.
People deserve a chance to getto that essence, to get to that
place where they can manifestwhat they're meant to be.
And the integration of the pactwith acute care is really my
passion and my hope is that Ican convince the payers and the
(33:23):
commercial insurance industrythat this is so beneficial that
it reduces the trauma on thepatient, on the family, reduces
recidivism, it makes people havebetter outcomes and it
ultimately Cost less money itdoes cost less money.
It does cost less money.
You know what, even if it costsmore, it should still be okay,
(33:45):
but it does actually cost lessbecause, I mean, acute
hospitalization is a crazyamount of money.
Don't forget, when you're doingthis assertive community
treatment, you're making surethey're going to their doctor
appointment and getting theirpreventive screenings done, and
so you're doing you're not justmaking sure the mental health is
taken care of, you're makingsure they're getting their pap
(34:05):
smear, they're getting theircolonoscopy and mammogram and
all that preventive stuff, andyou're saving money along those
lines of going to the dentist.
You know things like that.
Speaker 1 (34:15):
I mean it's a very similar analogy.
It's a very similar analogy.
I was recently in Connecticut.
Dr Rocky Murata was on the showrecently, dr Andrew Gerber, ceo
of Silver Hill Hospital.
They were doing a presentation.
It was a conference Virgil gotto present at it and everything
else, but one of the things thatwe ended up talking about
(34:36):
because they did a panel at theend was this subject and I said,
look, insurance companies aregoing to save a lot more money
If they just go ahead and payfor what we call well, you and I
would call actual care.
Speaker 2 (34:50):
Yeah.
Speaker 1 (34:51):
Long enough at all the levels and allow a person to
progress and everything elselike pay for it.
Speaker 2 (34:56):
Yeah.
Speaker 1 (34:56):
And you're going to get better outcomes out of the
people.
Dr Gerber said look, insurancecompanies are never going to do
that.
You're going to force them intoit because the average payer,
the average subscriber, rather,only stays with their company
for two years.
Yeah, I said well, yeah, but ifthey all did it, then they
would all say, yeah, they wouldall benefit.
(35:18):
It was universal yeah what isthe argument?
What's the argument that youwould make to an insurance
company with all that kind of?
Speaker 2 (35:26):
I mean that does that whole piece of what that person
said about the.
The lifetime like the.
The risk to the payer is likeoh, I've got this patient, I got
the subscriber for two years,so why should I pay for this
longer length of stay?
Right, I would say a couple ofthings.
One is, even if you pay for alonger length of stay, if these
(35:50):
patients are getting out, youknow three, you know two, three
weeks into higher level or aweek in the hospital, whatever,
they still cost the house, thesystem a lot more money Cause of
also the medical visits theyend up in the emergency room and
they end up having thesepatients end up having recurrent
hospitalizations a lot of thetime.
Speaker 1 (36:10):
The revolving door.
Speaker 2 (36:11):
Yeah.
And then I think the otherpiece of it that gets really
missed is the impact on thefamily and the people.
You know it's like your kid hasa major mental illness.
Like you're not going to be atwork.
You know you're not, you'regoing to be calling in sick,
you're going to get sick.
You're going to have not,you're going to be calling in
sick, you're going to get sick.
You're going to have more.
You're going to be lessproductive, you're going to be
(36:33):
less happy, you're going to have.
Your concentration is going tobe impaired.
So I think if payers thoughtabout the whole system too, that
would really help.
Another, another barrier to thismodel is and it's beginning to
change with some payers but whenthe behavioral health and the
medical are split off, so that'sa big problem.
So the behavioral health sideis like, well, if it's saving
(36:56):
money on the medical side, Idon't get the credit for that.
It's just my P&L is behavioral,and then there's over there is
the medical.
So the psychiatric care savedmoney on the medical side, but
the behavioral side didn't getany credit for that because it's
a separate organizationliterally, which is completely
ridiculous.
So I think moving in thedirection of these models going
(37:22):
to be more integrated is really,really important and you do see
that more and more and it isabsolutely silly that they
aren't more integrated, but it'sreally just the way the models
were derived.
Speaker 1 (37:34):
Well, it's almost like you know.
This just occurred to me.
I don't know why, but there'sthis dyad going on where
healthcare issickness-incentivized.
You know, the longer a personstays in care, the longer a
doctor gets paid to monitor, thelonger drugs get used for that.
You know, longer a person staysin care, the longer a doctor
gets paid to monitor, longerdrugs get used for that.
You know lifetime drug,lifetime prescriptions for.
(37:55):
You know, managing a medicalcondition say it's diabetes it's
like, well, you're going to beon this medication for the rest
of your life.
So you have this healthcaresystem that's that's aimed at
sickness.
You know, either it's sicknessin seven lives or it's just we
don't do anything until sicknessoccurs and then there's a
problem and it's emergency carekind of stuff.
Speaker 2 (38:13):
That's not the big issue, right there, right.
Speaker 1 (38:15):
Then you've got the other side.
You've got insurance companiesthat are paying for health care
and they're denials oriented.
You know what I mean.
Yeah, they're trying every waythey can not to pay for this
person's long-term care or bigmedical need or expensive
psychiatric need in thisparticular case.
If we could split this scriptand just say let's incentivize
(38:39):
health care, let's incentivizewellness, right, aren't in the
hole on paying for long-termconditions for which there's not
a lot of really good outcomes,versus going ahead and paying
for care people need, includingpreventative care, and getting
far better outcomes.
(38:59):
It's almost like the Monsters,the Monsters Inc thing Laughter
is 10 times more powerful thanscream.
Speaker 2 (39:14):
Health is 10 times more powerful than scream.
Health is 10 times lessexpensive than sickness.
Yeah, absolutely.
I think we all have a tendencyto sort of underreact, I think,
to our own health, healthcareneeds, right.
But then it's like break ourleg, like we're going to go to
the emergency room but we mightnot have thought about what you
know, stretching or exercise orwhatever that might've made us
(39:35):
had better balance or whateveryou know we're.
I remember you're making meremember that book, seven habits
of highly effective people, andhe had like yeah, and I don't
know if you remember the gridwhere it was like things that
are unimportant that requireurgent attention versus things
that are important that don'trequire urgent attention.
(39:56):
Like the things that areimportant that don't require
urgent attention, those justlike they're important but
they're not urgent and so theyjust get like falling off the
way to the background.
Speaker 1 (40:06):
What?
Speaker 2 (40:07):
was the background.
So you're, you're managingthings that are urgent and
important, like the broken leg,and you're also managing these
that are urgent and unimportant,like checking your phone and
all of this instead of takingcare of yourself.
So where our, our prioritiesget really you know where we put
our time and how we, you knowhow we use our time is, like,
really important.
And so with the, I think in theinsurance space, it just
(40:31):
naturally sort of happens oflike, okay, we just got to
handle the acute stuff, but theother stuff I do think that you
know, when I talk to some of theinsurance companies, another
thing that has happened is thatthere's a little bit of like, I
think, cynicism sometimes aroundmental health care, because
there's such a huge variabilityof the quality of that care.
(40:54):
And so I've talked to some ofthe payers who they don't want
to pay for care that they don'tfeel is going to be effective.
Or they see the fact that, yeah, when you just go to
residential and then you go outand then you go back, it costs
them a lot of money to pay forresidential care.
That doesn't really workbecause the model again is
flawed, because it's lack offollow through on the other side
(41:16):
, or the or the other thing thathappens is, you know, and I and
I hate to say this, but I thinkto the lay person if they have
a loved one with a mental healthproblem or a needy disorder,
they're not necessarilydiscerning between different
residential care.
They're just like my kid wentto residential care, my kid went
to PHP.
They don't understand.
(41:37):
There's a whole bunch ofdifferent kinds of programs,
different quality, differentskill of the teams, like
different philosophies.
So the insurance payer, likethe family, maybe just be like
residential care and like itdoesn't work.
Speaker 1 (41:52):
Yeah, it just goes in and out because I've been to
three places and it didn't workright, yeah, and so the
insurance companies also getcynical too um and they they
need a therapeutic consultantthey do if they, if they decide
that they, when they sign on andbringing you with me, we, we're
going together.
Why don't?
Speaker 2 (42:09):
I bring you to my next meeting with my next major.
I'm going to bring you Todd.
I'll be like you know what.
I want Todd to join my meetingto talk with you a little bit
about it.
Speaker 1 (42:18):
I'm just a guy, you know.
Speaker 2 (42:20):
You're just a guy that knows what's happening out
there, right?
Speaker 1 (42:24):
Well, you know, honestly, I don't think it's
that hard to look at and seewhat the problem is and what the
solution is.
I don't think this is rocketscience.
Speaker 2 (42:35):
Honestly I've said this so many times Like what
we're doing is not rocketscience.
Like sometimes people are like,oh my gosh, your program is so
innovative.
Speaker 1 (42:45):
I'm like this is literally common sense.
Well, I think that not todiminish what I think is a truly
accomplished clinician andsomebody who knows how to
provide real care to people,that's a skill and an art and
let's not diminish that.
But if we take the 10,000 footview, we look at what the
system's supposed to look like.
I agree it's not really allthat complicated.
(43:08):
The trick is time We've got togive people enough time to heal
and the right modality thatmatches their condition.
You know those are yourprinciples.
If we can start sticking tothose, we're going to get
somewhere, I promise you.
You know what I mean.
Speaker 2 (43:24):
I couldn't agree.
And then the other third thingthat you said the time, the
modalities, right, and I'mconfident you're going to agree
with me is like the quality ofthe human being that are there
with the person, those peoplealso understanding the
modalities care system, if youwill get a lot of a beating
(43:47):
because there has been a lot ofturmoil and turnover in the
space and much of that is tiedinto low reimbursement because
that's right.
Quality.
Speaker 1 (44:01):
There you go.
Speaker 2 (44:02):
Quality of those, and I'm not saying that somebody
with less experience is lessquality, because you can have a
brand new person, be a freaking,a plus clinician.
Speaker 1 (44:11):
But you need their investment.
Speaker 2 (44:13):
Yeah, but it's like people aren't going to keep.
I mean, look, working in theseprograms a higher level of care.
It's like you know the machine.
You know it's just firing,firing, firing, firing at all
times.
So this is the kind of workthat takes stamina and passion
and conviction and all that.
You know if people aren'tgetting reimbursed or excuse me
(44:33):
paid for their services and youknow getting raises.
Speaker 1 (44:37):
They're getting niggled and dimed.
Speaker 2 (44:39):
Yeah, and it's very difficult and I've found that to
be true myself.
One of my struggles is just,hey, the cost of doing this has
gone up and up and up and acrossall domains and it's very hard
to tell very hardworkingclinicians like I don't have
enough money to give you a raiseright now, and we run into that
a lot.
And that's very connected withnow we're talking about again
(45:02):
the insurance industry, where,if you really think about it,
we're paying all this money toinsurance companies and how much
of the money that we're payingand their budget is actually
going to administrativefunctions and paying for these
systems of denying or notdenying care.
(45:23):
It's not actually going toactual care.
Speaker 1 (45:27):
Putting bonuses in executive pockets?
Speaker 2 (45:29):
Yeah, it's not actually for the therapist
that's doing the therapy, and sothat's a little bit of a
predicament or a pickle, but Ifind personally that's something
I'm going through right now isjust having so many deserving
staff that I want to give moremoney to to keep them and to
incentivize them because theydeserve it, but finding it
(45:51):
difficult to do that based onyou know what our reimbursement
rates really are.
Speaker 1 (45:57):
I don't think.
I don't think you're alone.
I don't think you're alone.
Speaker 2 (46:01):
Yeah.
Speaker 1 (46:02):
Wendy, it has been.
I've had such a good time justtalking with you.
It's been really great.
Thanks for being on the showwith me.
This has been Head InsideMental Health broadcasting on
WPVM 1037, the voice ofAsheville Dr Wendy Oliver-Pine
on the show.
Wendy, thank you so much forbeing with us today and I will
look forward to seeing you whenI get down to Florida here in a
(46:22):
few months.
Speaker 2 (46:23):
I am so happy about that, todd, thank you very, very
much for.
Hello folks, thanks for joining us on Head Inside
Mental Health, featuringconversations about mental
health and substance usetreatment and co-occurring
disorders, with experts fromacross the country sharing their
thoughts, insights and practiceperspectives on the world of
behavioral health care.
Broadcasting on WPVM 1037, thevoice of Asheville independent
(00:20):
commercial-free radio.
I'm Todd Weatherly, your host,your therapeutic consultant and
behavioral health expert.
Today I have the privilege ofbeing joined by Dr Wendy
Oliver-Pyatt, founder ofmultiple eating disorder and
mental health treatment centersacross the country, including
Within Health, galen Hope,oliver-pyatt Centers, clementine
(00:42):
Embrace Treatment Program forBinge Eating Disorder and the
Center for Hope of the Sierras.
Dr Oliver Pyatt completed hertraining as a psychiatrist at
NYU Bellevue Hospital.
That is a place to get trained,where she served as a chief
resident.
Her training and experienceinvolved direct patient care and
(01:03):
leadership across multiplelevels of care and treatment
modalities, including inpatientpsychiatry, residential
addiction programs, pac teams,emergency room psychiatry and
public and private outpatientcare.
In 2001, she became the Stateof Nevada Division of Mental
Health and Disability ServicesMedical Director.
That's no small feat there, thefirst woman and the youngest
(01:23):
person ever to be in the rolereceiving senatorial recognition
.
In 2003, dr Oliver Pyattfounded her first residential
eating disorder treatmentprogram, the Center for Hope of
the Sierras.
Later, in 2008, she went on tofound Oliver Pyatt Center in
Clementine, both nationally andinternationally recognized top
programs in their field ofeating disorders.
She authored Questions andAnswers on Binge Eating Disorder
(01:46):
, a guide for clinicians, andnamed by USA Today as a top
healthcare entrepreneur, 2024and beyond, recently elected as
a fellow of the AmericanPsychiatric Association.
Congratulations, thank you.
Wendy.
Carries her work with anunwavering belief in compassion
and scientifically soundtreatment.
I also know her as just kind ofa cool lady that I like hanging
(02:06):
out with, who I send verydifficult clients to, and she
says yes, thank you, dr OliverPyatt.
Wendy, thank you and welcome tothe show.
Speaker 2 (02:17):
Oh, thank you so much , Todd.
I really am so happy that youinvited me.
I look forward to ourconversation and continuing to
spend more time with you.
Speaker 1 (02:25):
Absolutely Well.
You know we kind of hit the we.
We hit a little bit beforehand,right, but the I, when we place
the individuals in the familiesthat we work with, it's very
often that there's a, there's avery significant presenting
eating disorder.
For the clients that sufferfrom that we end up calling it a
(02:46):
co-occurring condition becausewe know that behind it is this
very significant primary mentalhealth condition that they are
struggling with Maybe bipolardisorder, maybe it's borderline
personality disorder or otherpersonality disorder kind of
features, and that makes themvery challenging behaviorally to
(03:08):
deal with.
So we work with you and yourcenters and specifically down
there in Galen Hope.
We've had several clients godown there because when a person
is struggling with bothconditions you actually have
both tracks at your center thereand do a job.
That many kind of neglect, whichis they do really good at the
(03:30):
eating disorder side but they'renot paying the kind of
attention that we need to pay tothe mental health side.
And you and the programs thatyou've created do an exceptional
job of kind of bringing thatart and science together.
How, what brought you to that?
I mean you've got thisdistinguished career and I you
know a lot of.
It's like public sector,private sector and and you've
(03:55):
just got to see the the kind ofgaps and failings that happened
in both of those systems andbrought that experience and like
, created something where tellme how you got there, please.
Like what?
What is it that like?
Speaker 2 (04:09):
Hey, we got to do this better and brought you to
the place where you are now.
Oh, todd, thank you so much forall those kind words and
generous thoughts.
Um, how did I get here?
I mean, sometimes people kindof talk with me and they figure,
oh, did you have this plannedout?
Did you know you wanted to bean eating disorder psychiatrist?
Because I did have an eatingdisorder early in my life.
(04:30):
And so people think, oh, didyou become a psychiatrist
because you wanted to treateating disorders and all that?
Absolutely not.
I had no preconceived notion,you know, of my plan here.
I didn't really have a plan.
I think one of the things that Itry to tell my patients too is
that if we get in touch with ourauthentic self and we are like
more organic about how we letour life unfold, rather than
feel like we have to have someexact plan of what we're going
(04:51):
to do, a lot of times the pathwe get on can be much more
anchored in, like our soul andwhat really drives us or excites
us or that we feel passionateabout.
I've been incredibly luckybecause I love what I do first
and foremost, and that's kind ofhow the process unfolded For me
.
My first love in going intopsychiatry was really a
(05:13):
fascination with the mind and acommitment to helping those with
severe mental illnesses.
That was why I did my residencyat NYU.
I really wanted to focus oncommunity mental health.
At NYU.
I really wanted to focus oncommunity mental health and
through that experience I hadreally extensive training on,
you know, the full gamut ofpsychiatric conditions and how
we treat them.
And I'm very lucky as wellbecause even though at NYU it
(05:37):
wasn't necessarily thought outthis way, but it was an
interesting blend of communitypsychiatry and also many of our
supervisors were psychodynamicoriented Freudian analysts,
believe it or not.
Speaker 1 (05:49):
So I got a little day right.
Speaker 2 (05:51):
Back in the day, that's kind of who they had as
our supervisors.
So I had this incredible mixand I, I believe, like I first,
you know, kind of fell intodoing the higher level of care
work really out of my own, myown, like frustration with like
what I was being expected to doas a psychiatrist, which was
sort of become a prescriptionpad, because the field of
(06:14):
psychiatry sort of gotmarginalized into oh, you do,
you write the medication ordersand everybody else does the
therapy, and what I saw is justa lot of like bifurcated
healthcare, like mental healthover here and medication over
here, and therapy over there andmedical conditions over here,
and even the medical conditions.
So people are this one, youknow, we're one human being and
(06:38):
we have a multitude of differentthings happening with us, and
the care itself being sofragmented just drove me
absolutely nuts.
Speaker 1 (06:47):
Well, in siloed care, the silos don't talk to one
another.
I get why specialty has toexist, right.
But and being in Bellevue, youknow the one of the like, you
know one of the busiestpsychiatric centers in the
emergency psychiatric centers inthe freaking country.
Speaker 2 (07:01):
Yeah.
Speaker 1 (07:02):
You know you're just.
You're writing scripts andgetting them out the door, right
?
Speaker 2 (07:05):
Yeah, but at the same time I had these patients, I
also got to do therapy and I hadthese analytic supervisors.
So that was kind of thebackground.
But I really just didn't wantto become a prescription pad and
I just decided, if I'm going todo this work, I'm going to
stick my neck out.
That's when I started my firsttreatment center.
I'm going to do it the way thatI want to do it, which is not
(07:26):
not BSing, like truly integrated, holistic care where there's a
medical personnel, there's apsychiatrist that can do therapy
, there's therapists, there'sdietitians, there's recovery
coaches, there's all of that inone place so that a person can
truly be treated in thisintegrated fashion.
So that was really, you knowhow it came about.
(07:46):
And the field of eatingdisorders is very interesting
because it's a really vividexample of probably the most
vivid example of the importanceof using that biopsychosocial
model.
And Hilda Brooke, who was oneof the first clinicians to
really write in contemporarytimes about anorexia nervosa,
(08:06):
really revived that concept ofthe biopsychosocial foundation.
It was already came about byanother physician, but she kind
of brought it into life with herwritings about anorexia nervosa
and there really is.
I mean, any disease process hasa biopsychosocial foundation.
Whether it's diabetes or lungcancer, heart failure, whatever,
(08:29):
there's always thatbiopsychosocial piece.
But in eating disorders, if youdon't really pay attention to
all, then you're not going toget anywhere.
And also the same is true forprimary mental health.
We do actually treat primarymental health, with or without
the eating disorder.
So using that foundation isreally the anchor to being sure
(08:49):
that you're leaving no stoneunturned and you're hitting all
those domains of care.
And you mentioned about howeating disorder treatment can be
very focused on just the foodand the eating and all of that.
Well, that's a very behavioralthing, like eat the food, weight
restore, blah, blah, blah.
I believe that when you onlyfocus on behavior and food, you
really are hurting potentiallythe patient, because the
(09:12):
psychodynamics and the healingprocess like also has to happen.
So I really believe thatbehavioral is important, like it
is important to put containmenton behaviors and expectations
and have very clear processthere.
That's not punitive, it'snatural consequences.
So the behavior, we don't gopunitive, we go natural
(09:35):
consequence, we can talk aboutthat.
But at the same time we alwayslead with compassionate
curiosity and a psychodynamicfoundation, and so we really
need to understand our patientsin the psychodynamic way as well
and in a relational way becauseit's the relationship where a
(09:56):
lot of that healing is going tohappen and understanding the
trauma history, thepsychodynamics within family,
psychosocial reality that theperson's experiencing.
If we don't also include that,then just changing behavior when
a person's in a higher level ofcare will have no lasting
impact.
Speaker 1 (10:11):
Well, as soon as the behavior mod goes away, right
the modification.
You know they're receivingsupport on eating.
Somebody's watching theircalories for them.
They're doing all these thingsand then they go out on the
street.
Speaker 2 (10:26):
Yeah.
And goes away all of it goesaway.
It doesn't generalize and also,if it's just punitive, it also
just doesn't go like.
The patients, our patients orthe clients, whatever you want
to call it I call them both, umare intelligent people that
understand like, are capable ofunderstanding, like the process.
So if we explain to the personthis is exposure therapy, this
(10:49):
is how it works, it's gonna feelharder and then it's gonna feel
easier.
You explain, I'm not justshoving you down this road for
no reason.
This is called exposure therapy.
This is how it works and weexplain what's happening to the
patient and we and when we usenatural consequences right,
we're helping the patient seeand experience the ramifications
(11:10):
of their behavior.
We're not just putting aprotocol in place.
We're helping the person seelike.
Well, you know the reasonyou're not doing high cardio in
our movement program right nowis that you actually have
orthostatic vital sign changes,so you're going to be dizzy, or
your blood sugar has been reallylow, so of course, we're not
going to strain your body on atreadmill and it's going to tank
(11:32):
, you know, yeah, so we we usethis process of natural
consequences, like, oh, you'repurged in the program, like
we're probably not going to beokay with you going on a pass
right now, and so things likethis are very, very important.
A lot of times also, familiesdon't understand how to
implement this attuned carewhere there's the natural
(11:53):
consequences.
The natural consequences isakin to what Maria Montessori
talks about freedom andresponsibility.
I don't know.
My kids went to Montessori andone of the most powerful kind of
mock papers I read that theymade you read like Montessori
work was this concept thattalked about freedom and
responsibility being intertwined.
(12:13):
Well, when we are gradual andattuned in what freedoms we give
to our patients, that's tied towhat they can responsibly
manage.
That actually imposes upon themthe demand, if you will, to
heal, and that is how we grow.
It's really honestly, it's acommon sense developmental
process.
Speaker 1 (12:33):
Well, I mean it's a parallel to being an
experiential ed nerd Wildernessapproach is the same principle.
Speaker 2 (12:40):
Oh, really Tell me.
Speaker 1 (12:42):
Well, I mean, you know it's like hey, it's raining
, you might want to put araincoat on and if you don't put
a raincoat on, you're gonna bewet.
You know, it's real simple.
It gets real basic reallyquickly.
Um, but it, you know, like yousay, it's informative.
It's, it's something thatprovides a person with education
, but in addition to that agencywhere they like hey, I
understand.
(13:03):
That's right.
I I understand what's going on.
I'm making choices because Iknow that there are consequences
to my behavior and consequences.
They may be good, they may bebad, but you're like, you're
making active and engagedchoices about what you do in
your behavior so that you getthe outcome that you want, right
, um, but the?
You know the thing that you'retalking about here.
That interests me a lot as well, and I know that you're also a
(13:27):
very experiencedaddictionologist, a person who
understands addiction at itscore principle.
You've got individuals comingin there not only suffering from
mental health disorders eatingdisorders, but also substance
misuse disorder as well andhelping them manage those things
as well, and helping themmanage those things, but the not
being punitive because, there'sa.
(13:47):
There's a lot of the.
You've got this.
Let's call it a subsegment ofthe treatment community that
it's confrontive.
I don't know if we might go asfar as to call it punitive, but
it's like the whole concept thatyou're defective at your core,
or or that you, or that yourelapse.
you got to get kicked out Untilyou decide you can do something
(14:09):
better.
Don't come back to us untilyou're ready, that kind of thing
.
And I think that there areprograms that are successful in
this approach and maybe theymodify it or they use it in a
different way.
What is your approach Like?
Give me the nitty gritty ofyour thoughts, yeah, please.
Speaker 2 (14:30):
I think that I start with the premise that in the
essence, within the essence, inall of us, is this like whole
person, and we want to.
So I think we all kind of wantto love.
What do we want?
We want to give love, we wantto receive love.
(14:52):
These are the things we want togive love.
We want to receive love Right,we want to be accepted for who
we are, on some level, like whowe are, like we want to feel
like we can be who we are.
We may not consciously thinkthat, but we're more at ease
when we can be loved andconnected with and be a part of
(15:13):
some kind of culture or groupingwhere we are accepted for who
we are Right.
Yeah where we are accepted forwho we are, along, right, yeah,
and there is that part of usthat has a need to manifest
something about ourself forwhich we are passionate or we
are drawn to or whatever, likewe want to manifest some love.
Goodness, I think most of usare really, we're born into the
(15:35):
world with these basic kind ofaspects of our essence I just
called our essence.
I think our essence of who weare is a beautiful.
We're beautiful.
We're beautiful little babiesborn into this world and we just
want to feel safe, protected,love.
So if we kind of start with likethat's who each one of us
really is at our core, and thenthings happen in life and we
(15:58):
build defenses or we have amedical condition or a
psychiatric condition that givesus, you know, barriers to
manifesting that in a full way,we encounter trauma.
A lot of things can happen tous that make us, you know, more
guarded or defended or unable tokind of just manifest what
we're capable of manifesting.
(16:19):
So, whether it's SUD or mentalhealth or eating disorder or
whatever, I think if you kind ofwalk into the space with a
patient believing that about theother human being sitting there
before you and also walking inwith that humility of like.
You know that the true one ofthe definitions of humility is
like you know, I'm no better orworse than anybody else.
(16:41):
Like we're, we're on an equalplaying field.
I'm not some authoritative, Iknow, you know I mean it's
important to have convictionabout how somebody gets
treatment Right and saying, ok,I can guide you, let me hold
your hand.
But to say I'm a superior beingto you in some way, shape or
form through your behavior,overt or covert, is really, I
(17:02):
think, a shaming thing.
So I don't really believe inshaming people into behavior.
I think calling people out forbehavior that's hurtful to
others or short-sighted, likeyou can do that, you know, in a
loving way, no-transcript trauma, anxiety or whatever that makes
(17:50):
it harder for the person tooperate or function.
So giving them supports andtools.
You know sorry, a cat justjumped on me.
Speaker 1 (17:57):
No worries, sorry, a cat just jumped on me.
Speaker 2 (17:59):
No worries, I told you before I have a foster cat,
but helping people manifest thatessence, whatever their primary
various conditions, are Withinthat, though, I think that when
you're working with an SUD folks, you really have to give
consideration.
Now, with eating disorders,what's their psychosocial
(18:22):
experience going to be when theyleave?
Are they going to be in a kindof pro-recovery?
Speaker 1 (18:25):
environment.
Speaker 2 (18:25):
Because I mean really being conscientious about
what's surrounding that personis very, very important when it
comes to SUD and helping themmake choices where they're not
going to get exposed to thingsthat are triggering them or
inviting them.
Or maybe they're in a toxicrelationship, or maybe they're
in an environment that'sreinforcing the use of substance
.
So really you have to be verypractical with SUDs, so I think
(18:50):
that's also, and with eatingdisorder too, but that's one of
the things, I think, Todd, thatcomes into play.
So, getting into the underlyingdynamics, the family, the
family, family, family dynamics,where there's sometimes
intergenerational trauma,intergenerational SUD and
addictions and mental healthproblems.
That all played a part in theevolution of the various defense
(19:10):
mechanisms the person may have,or or adaptations to life, or
or the worldview, our cognitivescheme of like, how do we see
the world?
Or what do we expect out ofrelationships?
I expect relationships to hurt,like I need to be defended
against that, or whatever theschema may be.
That's where the true, you know, psychotherapy comes into play.
So, again going back to thebiopsychosocial piece, getting
(19:32):
the medical piece sorted out alot of folks haven't been doing
great self care and nutrition,getting that sorted out.
And then, last but not least,on the STD side, there are some
medications that a person canuse that are helpful.
I think, you know, usingsomething like Antabuse is not
you know, it's not unheard of, Ithink it's there's so much
(19:53):
stigma around it but it's a veryhelpful tool for folks with or
naltrexone substance, you know,or the various ways that it can
be delivered.
So I think these are.
I mean, the research shows thatthese are underutilized tools
as well, and so I think it's.
You know, I just don't takethat view of somebody being
(20:13):
defective.
I more take the view thatthey're struggling and they need
healing, whatever the primaryconditions really are.
Well, and I think that you'restruggling and they need healing
, whatever the primaryconditions really are.
Speaker 1 (20:21):
Well, and I think that you're saying something
that's really key here andyou're naming something else
that is you haven't overtly said, but it's why the work that
you're doing, I believe, isinnovative and effective and
something that a lot of theworld misses out on trying to
bridge.
How do we bridge this piece?
But first of all, treating themlike human being yeah um, and a
(20:42):
whole person.
Right, you know they're not anumber, they're not a script.
They're, yeah, this person.
We need to look at the wholescenario.
But the other piece is thislong like where are they going
to be a year from now?
We're two years from now.
I've got to think about theirlife in a long-term scenario and
I think that that's the trapthat the hospitalists say, for
(21:03):
example, can fall into.
It's like I don't know wherethis person's going.
Now I'm going to script them asbest I can to manage symptoms
and hope that that works out,but the truth is is they're
going out into an environmentthat's not very supportive.
They fall over.
You've been involved with PACteams.
You know assertive communitytreatment.
You've seen where it lands onthe ground, where it falls over,
(21:29):
where people run into theirstumbling box and end up
repeating the cycles andeverything else.
Some of your programming isalso it's got.
You know PHP and IOP aspects ofit and you've done a lot of
outpatient care when you know,know for you, where does the
rubber meet the road out there?
Well, that's after treatment.
You know what I mean.
Speaker 2 (21:42):
Yeah, that's residential I mean, I really
believe that the model that wegenerally have in our culture is
flawed, and you're you'realluding to that, yeah, you
think flawed and and so, sadlyand tragically, people who go
into a higher level of care andthen struggle, they lose hope,
they internalize shame, theyhear that they're treatment
(22:05):
refractory or treatmentresistant and what I say is like
, are they treatment refractoryor did they just not get good
treatment?
That's the question that wehave to pose here, I think,
because whether it's like theydidn't get good psychiatric
management, which you alluded to, they really have bipolar
disorder.
Nobody treated that.
They really have trauma.
They never had EMDR, theyreally have depression.
(22:27):
They've only been on 20milligrams of Prozac for three
years or something like that.
Speaker 1 (22:31):
They went to the hospital, they put them on the
velvet hammer and sent them outthe door.
Speaker 2 (22:35):
Yeah, so what happens ?
The model is you mentioned thiswith the hospital, so it's this
model that, because we're cheapand we're a society that wants
to get everything done fast, soit's like, oh my God, the
person's symptomatic Put them ina 24-hour care, put them in a
hospital, glue them up to wherethey just okay, they're not
about to die tomorrow, right,okay, they're not going to die
(22:57):
tomorrow.
Boom, there you go.
Speaker 1 (22:59):
Better job die tomorrow, right Okay.
Speaker 2 (23:00):
They're not going to die tomorrow.
Boom, there you go.
And even if you think aboutthis, is this is mind boggling
when you really think about thetraditional model, residential
care being 24 hour care, phpbeing six hours.
So that model of residential toPHP is completely insane.
Speaker 1 (23:18):
It's upside down.
Speaker 2 (23:19):
It's insane.
And so our model allows or asmooth transition from that
24-hour care, which right now wedo it under the model of PHP,
with supported housing.
We will have actual residentialcare as well, because we've
just recognized the need forthat.
But the 24, 24 hour care, wecan gradually taper down that
(23:42):
clinical programming from 12hours to eight hours, et cetera.
So we take a really seriouslook at patients before they go
from 24 hour care to having theeight hours or six hours of PHP,
because that is when they arefirst.
Now they're out in the world ontheir own.
So we, one of our little rulesof thumb is that they don't move
(24:04):
down to the lower level of careuntil they've demonstrate an
ability to like, manage thatfreedom.
It's just like if your kid islearning to drive, you're not,
you're, I'm in Miami, we're justgoing down the street on on,
you know, 57th Avenue orsomething I'm not going to be
like.
Okay, we drove in the parkinglot here, go, drive up I-95.
Speaker 1 (24:23):
Well, Gen Xers, that's the way we did it.
We decided that that was not agood way.
Speaker 2 (24:28):
Yeah, it's like, no, that's not going to work.
So I think that this wholemodel is just flawed and this
tapering down of care that'sreally attuned to where the
person's at, and it's like, oh,they struggled a little bit, we
moved them down to PHP eight andnow in that little window of
time they, you know, drank orsomething like that, and then
when you have the relationship,they can talk about the behavior
(24:51):
too.
Right.
Speaker 1 (24:52):
They come to you about it, yeah.
Speaker 2 (24:53):
They can tell you, tell you more about it.
So I think that is really nice.
And then also we keep thatstable housing and the stable
treatment team all through allthose levels of care.
So as they're moving around,that team is with them.
They're not switching, They'vegot the same team.
They still have a stable placeto live all the way down to IOP.
But you mentioned PACT.
That's where this focus onacute care and then just turn
(25:17):
your back on the patient in asense at the IOP level is so
wrong.
It's so flawed, because peoplehave to get integrated into the
community.
They have to have that lifeworth living.
I mean, loneliness is a bigissue for folks like the surgeon
general named loneliness, a bigproblem in our society.
(25:38):
It is Loneliness and havingmeaning, having a routine.
We all need it.
Look what happened to us whenwe lost our routine during COVID
the depression ratesskyrocketed.
I mean, for me, even workingremotely, a lot of times
sometimes I'm like I need to goin and be with my team in person
.
Speaker 1 (25:59):
Well, we run into this with our clients all the
time as well, and it's and toreally say positive things about
the kind of the model you'rereferring to, especially the
treatment model that youdesigned down.
There is hey, I want to comeout of this emergency level,
this kind of 24 hour supervisionlevel of care, and just go into
outpatient without anysupported housing, without any
(26:21):
other components that are goinginto my, the support that I need
it's like.
So let me get this straightYou're going to come right out
of this 24 hour environment.
You're going to go spend Idon't know six hours, six hours
a day, five days a week, doingsome intensive clinical work,
and then you're going to go hometo be alone at night.
Speaker 2 (26:39):
It's insane, todd, are you?
Speaker 1 (26:40):
kidding me.
Speaker 2 (26:41):
Isn't it insane that we actually expect people to
heal and do well in that modeland a lot of them don't even get
that PHP.
They might just go straight tooutpatient or to IOP and it's
like how can you expect somebody?
And look, our patients are verycomplex and by the time
somebody makes the decision togo into 24-hour care, you know
(27:02):
them because you're taking them.
You know you're figuring outwhat to do.
Their lives are really in astate of major disarray.
So they're coming to us withreally serious things happening
for them and those things arenot solved in 30 days in a
24-hour care setting.
Speaker 1 (27:23):
Your PHP.
I mean, I think that to call ita PHP is almost a disservice,
because they're in a supportedhousing, they've got coaches
with them all the time.
They're in a highly structuredenvironment.
There's never really eyes offof them, so they're really in
what most would refer to as aresidential treatment
environment, even though there'ssome really eyes off of them.
So they're really in a whatmost would refer to as a
residential treatmentenvironment, even though there's
some space that exists betweenwhere they live and where they
(27:45):
get treatment.
Speaker 2 (27:46):
You know it's we were referring to, you know commonly
the Florida model, right, andit's like well, we want to get
the licensure and bill, but yeah, I mean back in the day when,
when I first started at likeSanta Barbara this year is, we
didn't need 24 hour nursing tobe residential.
That just kind of came into thefield that residential needed
24 hour nursing and honestly,that was an insurance company
(28:09):
ploy to try to get rid ofresidential programs, put them
out of business, because mostpeople with eating disorders
some need 24 hour care, but mostpeople at the residential don't
need 24 hour nursing.
They need 24 hour monitoringand they may need nursing
throughout the week.
But it was really not somethingthat it it really wasn't
something that actually madeclinical sense.
(28:29):
So you know, they needed the 24hour monitoring more than
anything and that's what.
And then we that's what's soimportant to block the behaviors
and give them the support, andthen the tapering down and the
building the connections in thecommunity that uses.
That's where that PACT modelcomes to play.
Speaker 1 (28:47):
So I got a question that I ask a lot of the folks
that come on the show that aredoing innovative work in the
private sector, have worked inthe public sector, and the
question I have is what's thedivide?
You know where?
Where do we bridge this gap?
Speaker 2 (29:05):
What do you think where?
Speaker 1 (29:07):
where do you think?
How?
How do we?
Is there a chance at it?
Where do we start?
Like what's your answer?
Speaker 2 (29:12):
to that.
I am so glad you asked this.
Okay, here I go.
Okay, so this is this issomething that bothers me so
much, like, first of all, thefirst thing we're talking about
here is the separation betweenacute care and then dumping
people, dropping people off.
Of course patients want toleave and they want to be in the
lowest level of care.
(29:33):
That's normal.
But so that's the first problemwe have.
And then the second problem isthis use of this model of pact
and sort of community treatmentthat kind of follows the acute
treatment, and the way we do itis really not widely done.
It's done.
Pact is done in two groups pactmodel it's done in some places
(29:55):
with really wealthy folks whocan pay cash for these kinds of
services, right, we have some ofthose programs.
Right and great, those peopleget great care.
And you also see that it's donein some public mental health
programs, because some of theseprograms realize, oh, this
(30:16):
actually saves us money, whichit does.
I started a PAC program.
Speaker 1 (30:18):
Little blips of good stuff in the country right I
started a PAC program in Nevadaand we brought people out of the
hospital.
Speaker 2 (30:25):
We reduced recidivism .
It does actually save money todo PAC programs.
Is my cat distracting you?
Speaker 1 (30:32):
Oh no, not at all.
Speaker 2 (30:33):
Okay.
So, by the way, that's mymeaning.
I'm a foster mommy for cats,I'm a cat lady and I'm a big
believer in just say yes when itcomes to fostering, if you want
meaning in your life.
So, anyway, that's my plug formy one of the ways.
Speaker 1 (30:51):
I do, there you go.
Speaker 2 (30:52):
Okay.
Speaker 1 (30:52):
You're carrying across the board, you know.
Speaker 2 (30:54):
Across the board.
Yeah, my, yeah, okay.
So as long as it's notdistracting, todd, I'll just not
make my cat get down.
But so the one thing we talkedabout is this bifurcation where
you've got the private high cashplaces doing PAC and then
you've got some hospital systemspublic, like Medicaid, medicare
(31:17):
population doing PAC becausethey realize, oh, this actually
saves money, people aren't goingin and out of the hospital and
that's for the people that don'tknow.
Pac stands for AssertiveCommunity Treatment or Program
for Assertive CommunityTreatment, and it's sort of this
hospital without walls conceptthat was really derived from
taking all the staff that was ina hospital and planting them in
the community and doing a lotof work in the community and
(31:39):
doing a lot of work in thecommunity.
It started in like, I think, theseventies in a public system in
Wisconsin, if I'm not mistaken.
But so it's this public.
Certain public systems havepacked and then the high count.
So what I want to do, what myhope and goal and vision, is to
(31:59):
bring this model that blendsthat acute phase that we're able
to do with that integrated youknow the principles of PACT so
that people are getting intotheir life in a meaningful way,
and we've got that blendedtogether and deliver that into
the commercial space so that Ican work with programs.
(32:19):
You know that, you know wherethe mom or the dad is the
teacher, or the mom or the dadis the janitor, whatever and
they have health insurance withX payer or Y payer, so that this
cause, this model, is reallypeople with mental illness and
eating disorders.
They're owed a better model ofcare and it shouldn't just be if
(32:42):
you have the cash to go pay fora packed program, or it
shouldn't just be okay.
The person is so debilitatednow that they have no functional
life and they're just onMedicaid and Medicare and
they've ended up in the publicsector and they really haven't
been able to heal because theyhaven't ever got the care that
they want.
(33:02):
Because every one of us, wedeserve a chance.
People deserve a chance to getto that essence, to get to that
place where they can manifestwhat they're meant to be.
And the integration of the pactwith acute care is really my
passion and my hope is that Ican convince the payers and the
(33:23):
commercial insurance industrythat this is so beneficial that
it reduces the trauma on thepatient, on the family, reduces
recidivism, it makes people havebetter outcomes and it
ultimately Cost less money itdoes cost less money.
It does cost less money.
You know what, even if it costsmore, it should still be okay,
(33:45):
but it does actually cost lessbecause, I mean, acute
hospitalization is a crazyamount of money.
Don't forget, when you're doingthis assertive community
treatment, you're making surethey're going to their doctor
appointment and getting theirpreventive screenings done, and
so you're doing you're not justmaking sure the mental health is
taken care of, you're makingsure they're getting their pap
(34:05):
smear, they're getting theircolonoscopy and mammogram and
all that preventive stuff, andyou're saving money along those
lines of going to the dentist.
You know things like that.
Speaker 1 (34:15):
I mean it's a very similar analogy.
It's a very similar analogy.
I was recently in Connecticut.
Dr Rocky Murata was on the showrecently, dr Andrew Gerber, ceo
of Silver Hill Hospital.
They were doing a presentation.
It was a conference Virgil gotto present at it and everything
else, but one of the things thatwe ended up talking about
(34:36):
because they did a panel at theend was this subject and I said,
look, insurance companies aregoing to save a lot more money
If they just go ahead and payfor what we call well, you and I
would call actual care.
Speaker 2 (34:50):
Yeah.
Speaker 1 (34:51):
Long enough at all the levels and allow a person to
progress and everything elselike pay for it.
Speaker 2 (34:56):
Yeah.
Speaker 1 (34:56):
And you're going to get better outcomes out of the
people.
Dr Gerber said look, insurancecompanies are never going to do
that.
You're going to force them intoit because the average payer,
the average subscriber, rather,only stays with their company
for two years.
Yeah, I said well, yeah, but ifthey all did it, then they
would all say, yeah, they wouldall benefit.
(35:18):
It was universal yeah what isthe argument?
What's the argument that youwould make to an insurance
company with all that kind of?
Speaker 2 (35:26):
I mean that does that whole piece of what that person
said about the.
The lifetime like the.
The risk to the payer is likeoh, I've got this patient, I got
the subscriber for two years,so why should I pay for this
longer length of stay?
Right, I would say a couple ofthings.
One is, even if you pay for alonger length of stay, if these
(35:50):
patients are getting out, youknow three, you know two, three
weeks into higher level or aweek in the hospital, whatever,
they still cost the house, thesystem a lot more money Cause of
also the medical visits theyend up in the emergency room and
they end up having thesepatients end up having recurrent
hospitalizations a lot of thetime.
Speaker 1 (36:10):
The revolving door.
Speaker 2 (36:11):
Yeah.
And then I think the otherpiece of it that gets really
missed is the impact on thefamily and the people.
You know it's like your kid hasa major mental illness.
Like you're not going to be atwork.
You know you're not, you'regoing to be calling in sick,
you're going to get sick.
You're going to have not,you're going to be calling in
sick, you're going to get sick.
You're going to have more.
You're going to be lessproductive, you're going to be
(36:33):
less happy, you're going to have.
Your concentration is going tobe impaired.
So I think if payers thoughtabout the whole system too, that
would really help.
Another, another barrier to thismodel is and it's beginning to
change with some payers but whenthe behavioral health and the
medical are split off, so that'sa big problem.
So the behavioral health sideis like, well, if it's saving
(36:56):
money on the medical side, Idon't get the credit for that.
It's just my P&L is behavioral,and then there's over there is
the medical.
So the psychiatric care savedmoney on the medical side, but
the behavioral side didn't getany credit for that because it's
a separate organizationliterally, which is completely
ridiculous.
So I think moving in thedirection of these models going
(37:22):
to be more integrated is really,really important and you do see
that more and more and it isabsolutely silly that they
aren't more integrated, but it'sreally just the way the models
were derived.
Speaker 1 (37:34):
Well, it's almost like you know.
This just occurred to me.
I don't know why, but there'sthis dyad going on where
healthcare issickness-incentivized.
You know, the longer a personstays in care, the longer a
doctor gets paid to monitor, thelonger drugs get used for that.
You know, longer a person staysin care, the longer a doctor
gets paid to monitor, longerdrugs get used for that.
You know lifetime drug,lifetime prescriptions for.
(37:55):
You know, managing a medicalcondition say it's diabetes it's
like, well, you're going to beon this medication for the rest
of your life.
So you have this healthcaresystem that's that's aimed at
sickness.
You know, either it's sicknessin seven lives or it's just we
don't do anything until sicknessoccurs and then there's a
problem and it's emergency carekind of stuff.
Speaker 2 (38:13):
That's not the big issue, right there, right.
Speaker 1 (38:15):
Then you've got the other side.
You've got insurance companiesthat are paying for health care
and they're denials oriented.
You know what I mean.
Yeah, they're trying every waythey can not to pay for this
person's long-term care or bigmedical need or expensive
psychiatric need in thisparticular case.
If we could split this scriptand just say let's incentivize
(38:39):
health care, let's incentivizewellness, right, aren't in the
hole on paying for long-termconditions for which there's not
a lot of really good outcomes,versus going ahead and paying
for care people need, includingpreventative care, and getting
far better outcomes.
(38:59):
It's almost like the Monsters,the Monsters Inc thing Laughter
is 10 times more powerful thanscream.
Speaker 2 (39:14):
Health is 10 times more powerful than scream.
Health is 10 times lessexpensive than sickness.
Yeah, absolutely.
I think we all have a tendencyto sort of underreact, I think,
to our own health, healthcareneeds, right.
But then it's like break ourleg, like we're going to go to
the emergency room but we mightnot have thought about what you
know, stretching or exercise orwhatever that might've made us
(39:35):
had better balance or whateveryou know we're.
I remember you're making meremember that book, seven habits
of highly effective people, andhe had like yeah, and I don't
know if you remember the gridwhere it was like things that
are unimportant that requireurgent attention versus things
that are important that don'trequire urgent attention.
(39:56):
Like the things that areimportant that don't require
urgent attention, those justlike they're important but
they're not urgent and so theyjust get like falling off the
way to the background.
Speaker 1 (40:06):
What?
Speaker 2 (40:07):
was the background.
So you're, you're managingthings that are urgent and
important, like the broken leg,and you're also managing these
that are urgent and unimportant,like checking your phone and
all of this instead of takingcare of yourself.
So where our, our prioritiesget really you know where we put
our time and how we, you knowhow we use our time is, like,
really important.
And so with the, I think in theinsurance space, it just
(40:31):
naturally sort of happens oflike, okay, we just got to
handle the acute stuff, but theother stuff I do think that you
know, when I talk to some of theinsurance companies, another
thing that has happened is thatthere's a little bit of like, I
think, cynicism sometimes aroundmental health care, because
there's such a huge variabilityof the quality of that care.
(40:54):
And so I've talked to some ofthe payers who they don't want
to pay for care that they don'tfeel is going to be effective.
Or they see the fact that, yeah, when you just go to
residential and then you go outand then you go back, it costs
them a lot of money to pay forresidential care.
That doesn't really workbecause the model again is
flawed, because it's lack offollow through on the other side
(41:16):
, or the or the other thing thathappens is, you know, and I and
I hate to say this, but I thinkto the lay person if they have
a loved one with a mental healthproblem or a needy disorder,
they're not necessarilydiscerning between different
residential care.
They're just like my kid wentto residential care, my kid went
to PHP.
They don't understand.
(41:37):
There's a whole bunch ofdifferent kinds of programs,
different quality, differentskill of the teams, like
different philosophies.
So the insurance payer, likethe family, maybe just be like
residential care and like itdoesn't work.
Speaker 1 (41:52):
Yeah, it just goes in and out because I've been to
three places and it didn't workright, yeah, and so the
insurance companies also getcynical too um and they they
need a therapeutic consultantthey do if they, if they decide
that they, when they sign on andbringing you with me, we, we're
going together.
Why don't?
Speaker 2 (42:09):
I bring you to my next meeting with my next major.
I'm going to bring you Todd.
I'll be like you know what.
I want Todd to join my meetingto talk with you a little bit
about it.
Speaker 1 (42:18):
I'm just a guy, you know.
Speaker 2 (42:20):
You're just a guy that knows what's happening out
there, right?
Speaker 1 (42:24):
Well, you know, honestly, I don't think it's
that hard to look at and seewhat the problem is and what the
solution is.
I don't think this is rocketscience.
Speaker 2 (42:35):
Honestly I've said this so many times Like what
we're doing is not rocketscience.
Like sometimes people are like,oh my gosh, your program is so
innovative.
Speaker 1 (42:45):
I'm like this is literally common sense.
Well, I think that not todiminish what I think is a truly
accomplished clinician andsomebody who knows how to
provide real care to people,that's a skill and an art and
let's not diminish that.
But if we take the 10,000 footview, we look at what the
system's supposed to look like.
I agree it's not really allthat complicated.
(43:08):
The trick is time We've got togive people enough time to heal
and the right modality thatmatches their condition.
You know those are yourprinciples.
If we can start sticking tothose, we're going to get
somewhere, I promise you.
You know what I mean.
Speaker 2 (43:24):
I couldn't agree.
And then the other third thingthat you said the time, the
modalities, right, and I'mconfident you're going to agree
with me is like the quality ofthe human being that are there
with the person, those peoplealso understanding the
modalities care system, if youwill get a lot of a beating
(43:47):
because there has been a lot ofturmoil and turnover in the
space and much of that is tiedinto low reimbursement because
that's right.
Quality.
Speaker 1 (44:01):
There you go.
Speaker 2 (44:02):
Quality of those, and I'm not saying that somebody
with less experience is lessquality, because you can have a
brand new person, be a freaking,a plus clinician.
Speaker 1 (44:11):
But you need their investment.
Speaker 2 (44:13):
Yeah, but it's like people aren't going to keep.
I mean, look, working in theseprograms a higher level of care.
It's like you know the machine.
You know it's just firing,firing, firing, firing at all
times.
So this is the kind of workthat takes stamina and passion
and conviction and all that.
You know if people aren'tgetting reimbursed or excuse me
(44:33):
paid for their services and youknow getting raises.
Speaker 1 (44:37):
They're getting niggled and dimed.
Speaker 2 (44:39):
Yeah, and it's very difficult and I've found that to
be true myself.
One of my struggles is just,hey, the cost of doing this has
gone up and up and up and acrossall domains and it's very hard
to tell very hardworkingclinicians like I don't have
enough money to give you a raiseright now, and we run into that
a lot.
And that's very connected withnow we're talking about again
(45:02):
the insurance industry, where,if you really think about it,
we're paying all this money toinsurance companies and how much
of the money that we're payingand their budget is actually
going to administrativefunctions and paying for these
systems of denying or notdenying care.
(45:23):
It's not actually going toactual care.
Speaker 1 (45:27):
Putting bonuses in executive pockets?
Speaker 2 (45:29):
Yeah, it's not actually for the therapist
that's doing the therapy, and sothat's a little bit of a
predicament or a pickle, but Ifind personally that's something
I'm going through right now isjust having so many deserving
staff that I want to give moremoney to to keep them and to
incentivize them because theydeserve it, but finding it
(45:51):
difficult to do that based onyou know what our reimbursement
rates really are.
Speaker 1 (45:57):
I don't think.
I don't think you're alone.
I don't think you're alone.
Speaker 2 (46:01):
Yeah.
Speaker 1 (46:02):
Wendy, it has been.
I've had such a good time justtalking with you.
It's been really great.
Thanks for being on the showwith me.
This has been Head InsideMental Health broadcasting on
WPVM 1037, the voice ofAsheville Dr Wendy Oliver-Pine
on the show.
Wendy, thank you so much forbeing with us today and I will
look forward to seeing you whenI get down to Florida here in a
(46:22):
few months.
Speaker 2 (46:23):
I am so happy about that, todd, thank you very, very
much for.
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