Elizabeth Bromley, M.D., Ph.D. (University of California, Los Angeles) joins Dr. Dixon and Dr. Berezin to discuss the use of outpatient conservatorship in the effort to address mental health disability among unsheltered homeless persons in Los Angeles County, California.

• 00:00    Introduction
• 03:04     Homelessness in Los Angeles County, California
• 09:04     The paper and services
• 11:39     Lanterman-Petris-Short (LPS) conservatorship
• 13:44     Outpatient conservatorship (OPC) pilot program
• 15:54     Skepticism
• 18:48     Beyond conservatorship: other aspects of the program
• 22:34     Initial evaluation
• 25:21     Quantitative measures
• 28:33     Coordination

Transcript

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Gregory E. Simon, M.D., M.P.H. (Kaiser Permanente Washington Health Research Institute, Seattle) join Dr. Dixon and Dr. Berezin to discuss the use of machine learning models to analyze electronic health records to predict antidepressant treatment response.

00:00     Introduction 02:31    Focus on practical research 04:55    Population studied 05:57    Predicting outcomes 07:20    Using diagnostic codes, not personalized notes 08:04    What three data items might be more helpful? 08:49    What key indicators are we missing in clinical care? 11:35    A billing tool, not a clinical tool 12:57    Is suicide a predictable event based on electronic health record data? 14:48    “Machine learning and artificial intelligence”  16:15    Methods 18:59     Can we do a better job clarifying what we mean by depression? 22:32    How can we use a predictive model in clinical practice? 28:20    Predictive models, probability, the weather, and communicating 

Transcript

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Misty C. Richards, M.D., M.S. (University of California, Los Angeles), and Nicole Kozloff, M.D. (University of Toronto), join Dr. Dixon and Dr. Berezin to discuss the need to remodel our systems and provision of mental health services for children and adolescents.

• 00:00     Introduction
• 01:18     Impetus
• 05:45     What constitutes a mental health crisis?
• 11:14     “Remodeling”
• 16:21     Differences by location
• 18:28     Remodeling primary care
• 21:25     Virtual care
• 27:19     New service models
• 32:19     Are we moving in the right direction?

Transcript

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Andrew D. Carlo, M.D., M.P.H. (Northwestern University Feinberg School of Medicine, Chicago) joins Dr. Dixon and Dr. Berezin to discuss the insurance acceptance rates of psychiatric practitioners compared with other medical disciplines.

• 00:00     Introduction
• 01:04     Background and Motivation
• 02:46     Data Set and Methodology
• 05:12     Restricted Data Set and Privacy Concerns
• 06:08     Research Questions and Goals
• 10:04     Findings: Insurance Acceptance Rates
• 11:29     Factors Influencing Insurance Acceptance
• 14:23     Magnitude of the Gap in Insurance Acceptance
• 15:44     Factors Affecting Insurance Acceptance for Psychiatrists
• 18:08     Challenges in Enforcing Mental Health Parity
• 19:27     Market Power of Psychiatrists
• 22:48     Impact on Other Mental Health Professionals
• 24:16     Importance and Implications
• 25:11     Potential Solutions and Policy Changes
• 29:31     Conclusion

Transcript

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Eliza Hallett, M.S., (Oregon Health & Science University, Portland, Oregon) joins Dr. Dixon and Dr. Berezin to discuss the challenges faced by staff and behavioral health service providers, including low wages, traumatic work environments, low wages, and physical and administrative infrastructure.

• Workforce crisis in behavioral health care [01:33]
• How representative of the country is Oregon? [03:45]
• Who were you talking to? [05:32]
• A figure on radio [06:30]
• Generating a theoretical framework from the responses [08:01]
• Qualitative methods [09:30]
• The five factors [10:33]
• Wages [14:05]
• Infrastructure [14:40]
• Are these issues unique to behavioral health services? [19:11]
• Legislative changes in Oregon [21:25]
• Feeling supported matters [23:39]
• Did the pandemic exacerbate the problem? [27:04]
• Take home [29:08]

Access the complete Behavioral Health Workforce Report to the Oregon Health Authority and State Legislature here.

Transcript

Figure 1.  Factors influencing turnover and attrition in the public behavioral health system workforce in Oregona

a Interviewees identified factors across three levels—system, organizational, and individual—that contribute to the direct drivers of workforce turnover and attrition.

https://ps.psychiatryonline.org/pb-assets/podcasts/transcripts/PS/PS_Chung_August_2023_transcript.pdf

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Henry Chung, M.D., (Albert Einstein College of Medicine, Bronx, New York City) joins Dr. Dixon and Dr. Berezin to discuss the differences between the collaborative care model and the colocation model, and the impact on Medicaid costs and utilization, for the treatment of patients with depression.

• Chung interview [00:58]
• A bridge between clinical and research work [02:32]
• The colocation model and the collaborative care model [03:44]
• What populations are you working with? [07:21]
• Differences in service utilization and cost [10:25]
• Methodology [10:47]
• Concentration on depression instead of other psychiatric disorders [13:59]
• Findings [15:11]
• Choosing between models [20:21]
• Impact of COVID [24:06]
• Final thoughts [28:21]

Transcript

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Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections.

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Joseph Parks, M.D., joins Dr. Dixon and Dr. Berezin to discuss guidelines for clinicians on how to deal with the increased prevalence of drugs adulterated with fentanyl and similar potent fentanyl analogs.

MDI publications can be found here.

• Parks interview [00:53]
• The National Council for Mental Wellbeing [01:21]
• Guidelines [03:50]
• Contemplation [05:02]
• A back-to-basics approach [07:13]
• Fentanyl test strips and harm reduction [08:37]
• Spillover [10:06]
• Issues with fentanyl [12:05]
• Incremental behavioral changes [13:44]
• Things people should know about fentanyl [16:29]
• Training for professionals [18:03]
• How things are moving [19:55]

See the Psychiatric Services Editor's Choice collection, "Responding to the Opioid Crisis."

Transcript

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Eric P. Slade, Ph.D., joins Dr. Dixon and Dr. Berezin to discuss the complex and often confusing world of dual eligibility for Medicare and Medicaid coverage when it comes to mental health services, in particular Dual Eligible Special Needs Plans (D-SNPs), a type of Medicare Advantage plan designed around those eligible for both programs.

• Slade interview [00:59]
• Medicare and Medicaid [02:24]
• Eligibility for each, and both [06:36]
• Dual eligibility [08:09]
• Who pays for care? [09:51]
• Managed care [11:13]
• Trade offs between traditional insurance and HMO plans [15:47]
• Medicare Advantage [18:17]
• Dual Eligible Special Needs Plans (D-SNPs) [19:06]
• D-SNPs from the perspective of consumers [21:34]
• Provider networks [24:50]
• Findings [27:07]
• Why do D-SNPs not have larger psychiatrist networks than traditional Medicare? [30:02]
• Mental health care and insurance coverage [33:47]
• What should policymakers take from this? [36:37]
• What should clinicians take from this? [39:56]

Transcript

Subscribe to the podcast here.

Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections.

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Lauren Southwick, M.P.H., and Sharath Guntuku, Ph.D., join Dr. Dixon and Dr. Berezin to discuss whether using a digital dashboard maintained by patients to track social media and other digital data usage had an impact on mental health therapy outcomes.

•    Southwick and Guntuku interview [01:37] •    What led you to this study design? [03:06] •    What did you think this would look like in a therapy setting? [08:00] •    Amount of data patients contributed varied widely [09:39] •    The dashboard [10:12] •    What were the effects of sharing digital data with therapists? [12:31] •    The Hawthorne effect [15:25] •    What’s next for your research? [18:23] •    Recruitment [20:46] •    COVID and people’s interactions with digital media and mental health [23:29] •    ChatGPT [26:50]

Transcript

Subscribe to the podcast here.

Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections.

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Breanna C. Keepers, M.D., M.B.A., and Ish P. Bhalla, M.D., M.S., join Dr. Dixon and Dr. Berezin to discuss the results of a survey of mental healthcare providers and their usage of measurement-based care.  Dr. Keepers is in the Department of Psychiatry at New York-Presbyterian Hospital, and Dr. Bhalla is Medical Director of Behavioral Health Value Transformation at Blue Cross-Blue Shield of North Carolina.

•    Keepers and Bhalla interview [00:50] •    Incentivizing provider behavior changes [03:01] •    Measurement instruments [05:30] •    Measurement-based care from the care recipient’s perspective [06:27] •    Study design [09:16] •    Clinical utility and measurement-based care [11:31] •    Are we using the right measure? [14:45] •    Heterogeneity in provider perceptions of measurement-based care [16:08] •    Training providers [17:25] •    Providing care is hard [19:36] •    What’s next for your research? [22:10]

Transcript

Subscribe to the podcast here.

Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections.

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Navdep Kaur, M.P.H., joins Dr. Dixon and Dr. Berezin to discuss persistent racial and ethnic disparities in mental health treatment access and outcomes prior to and following the passage of the 2010 Affordable Care Act.  Ms. Kaur is a predoctoral fellow at the Columbia University Mailman School of Public Health in New York.

• Kaur interview [01:01]
• Connecting your work with your passion [03:09]
• Affordable Care Act and mental health [05:39]
• What did you look at to study this? [09:11]
• What are we talking about when we talk about distress? [10:06]
• How do you define treatment usage? [11:30]
• What are your hypotheses for why your findings on mental health treatment usage look the way they do? [13:11]
• Disaggregating data for disparate groups [14:40]
• Has the amount of treatment change overall differed between subgroups and the whole population? [17:42]
• How do you categorize the various levels of stigma and attitudes towards treatment? [19:16]
• Sources of market failure – lack of providers, insurance, access [21:21]
• What would a data set that could answer your questions look like? [22:22]
• What are you working on next? [24:34]
• Has your passion survived contact with sample sizes, measures, and the nitty gritty of data sets? [25:20]

Transcript

Subscribe to the podcast here.

Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections.

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Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it.

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