Friends,

The day after we recorded this interview, I picked up the May 2nd 2023 issue of JAMA and discovered that one of the leading research studies was about the rising trend in mental health-related ED visits among youth. https://jamanetwork.com/journals/jama/article-abstract/2804326

The stats were shocking and of serious concern. Between 2011 and 2020, the percentage of pediatric ED visits attributed to mental health issues had risen from 7.7% to 13.1% – and the annual absolute numbers had risen from 4.8M to 7.5M – an average annual increase of 8%!  Even more startling was the 5-fold increase in suicide-related pediatric ED visits, which had leapt from 0.9% to 4.2% of all pediatric ED visits. Think about it. One out of every 25 pediatric ED visits are due to suicidality, and one out of every 7 pediatric ED visits are related to mental health! 

The study authors stated that “these findings underscore an urgent need to improve crisis and emergency mental health service capacity for young people…”   This study was timely – but more to the point, this episode of Creating a New Healthcare’ was timely – in that we’re going to discover and hear about a company that has created an evidence-based, highly effective and accessible solution to the “urgent need” and “crisis” of acute mental health issues amongst youth in the U.S.  

Our guest today is Carter Barnhart. Carter is the co-founder and CEO of Charlie Health, the largest virtual provider of high acuity mental health treatment for youth in crisis. You’ll hear much more about Carter’s background and the reason she founded Charlie Health during the interview. Prior to Charlie Health, Carter was in the C-suite at Newport Academy, a teen residential treatment program.

In this interview, we’ll hear about:

Some important points to note about Charlie Health:

First – When Carter and others refer to IOP as “Intensive” Outpatient Programming, they mean it. The Charlie Health treatment experience is customized to the needs of the individual client, and it’s comprehensive. Charlie Health’s virtual IOP includes 9-11 hours of evidence-based care weekly, via support group sessions, individual therapy, and family therapy. In addition, they have 24/7 emergency crisis care available to their clients and families. 

Second – Carter and her colleagues have been incredibly diligent in implementing measurement-based care practices and outcomes transparency – both of which the behavioral health industry has been slow to adopt. They frequently partner with academic medical centers to study and publish peer-reviewed articles that demonstrate the efficacy of their program and track patient outcomes. What we know is that we now have an evidence-based program that is highly effective.

Third – Not only is the program effective, but it’s accessible in an unprecedented way to youth across the country, due to its being a virtual-first program rather than a place-based IOP. As Carter states during the interview, over 95% of the people in this country do not have access to mental health treatment. Charlie Health has solved that problem of accessibility for those struggling most acutely – not discounting the fact that internet connectivity is still a problem for many Americans.

Fourth – One of the profound advantages – and secret sauces – is that the virtual access enables Charlie Health to match the client with a therapist and a group of peers that are more like them – which Carter shares is a well known and critical success factor for sustaining engagement and achieving positive outcomes. Place-based brick and mortar programs have a far more limited selection of therapists and clients to match from. 

FIfth – Another profound advantage of Charlie Health is that they partner with hospitals and emergency departments. This sort of integrated care is absolutely critical if we are going to solve the mental health crisis. Patients do have the ability and opportunity to access Charlie Health directly if they are experiencing a mental health crisis, but they can also be transitioned to Charlie Health in a timely way from an ED or from an inpatient hospital-based unit.  

Finally – Charlie Health is a multi-faceted organization. In addition to its robust multi-modal IOP, they have a significant research arm, and they offer a “Charlie University” – on-going CEU training to their own therapists as well as for therapists outside of Charlie Health. One final significant activity is that they are constantly advocating for payment codes for IOP – what Carter refers to as an “uphill battle”, but one they seem to be winning as they are now live in 23 states!

The problem of acute mental health crises amongst youth in our country is alarming, and continuing to worsen. As I said multiple times during the interview, it’s nothing less than heartbreaking. The problem is compounded by the lack of access to care, and even more than that, by the lack of access to care that actually works and helps these young people. Charlie Health has taken a proven highly effective treatment approach – Intensive Outpatient Programming (IOP) – and made it much more accessible, more customized, and I would suggest, more effective. The work Carter and her colleagues are doing to obtain payment codes for IOP is also life saving. 

I’m overwhelmed by the magnitude of this heart-breaking problem, but even more overwhelmed by the empathy and effectiveness of the solution that Charlie Health has developed at scale. We need Charlie Health, and other virtually-enabled programs like it, deployed at many more hospital systems and ED’s across the country – as soon as possible.

Zeev Neuwirth, MD