In the third episode of The Earth Disease, journalist Jared Downing discusses how social determinants of health programs intersect with climate and health policy.

Jared produced this series in 2021 as part of the Health Affairs Podcast Fellowship Program.

Guests in this episode include Aaron Bernstein from the Harvard T.H. Chan School of Public Health, Megan Sandel from Boston Medical Center, Adam Abdul Musawir from Good Food Markets, and Gary Cohen from Healthcare Without Harm.

Works Cited:

• Boston Neighborhoods Impacted By Urban Heat (The Scope Boston)
• A City Divided In Life And Death (The Margins)
• Health Spending In Most OECD Countries Rises, With the US Far Outstripping All Other (OECD Health Data)

Music produced by Seth Kennedy.

The health care industry is among the most carbon-intensive service sectors in the industrialized world. It is responsible for 4.4–4.6 percent of worldwide greenhouse gas emissions and similar fractions of toxic air pollutants, largely stemming from fossil fuel combustion.

In the second episode of The Earth Disease, journalist Jared Downing explores ways that the health care industry is working to curb its carbon footprint.

Jared produced this series in 2021 as part of the Health Affairs Podcast Fellowship Program.

Guests on this episode include Dr. Ashish Jha, Bob Biggio from Boston Medical Center, Jeff Thompson formerly from the Gundersen Health System.

At the time of this recording, Dr. Jha was the Dean of the Brown University School of Public Health. He is currently the White House COVID-19 Response Coordinator and Counselor to the President. The views represented in this podcast are his own.

Works Cited:

• National Health Care Spending In 2020: Growth Driven By Federal Spending In Response To The COVID-19 Pandemic (Health Affairs)
• Health Care Pollution and Public Health Damage In The United States: An Update (Health Affairs)
• Sources of Greenhouse Gas Emissions (Environmental Protection Agency)
• Budget of the United States Government

Music produced by Seth Kennedy.

Health Affairs Pathways explores the avenues and alleyways of the health care system through a variety of storytelling – from investigative journalism and health policy explainers to long-form interviews.

Unique series are created by fellows at the Health Affairs Podcast Fellowship Program, designed to support early to mid-stage professionals pursue an audio project, tell a unique health care story, and highlight voices that may not be heard otherwise.

Our third and final series for the 2021 cohort, The Earth Disease, is from Jared Downing, a journalist based in New York City. In this series, Jared Downing explores the intersection of climate change and health policy.

Jared produced this series in 2021 as part of the Health Affairs Podcast Fellowship Program.

Guests on this episode include Ashish Jha, Aaron Bernstein from the Harvard T.H. Chan School of Public Health, Mariel Fonteyn from Americares, and Ed Gerber from the Lestonnac Free Clinic.

At the time of this recording, Dr. Jha was the Dean of the Brown University School of Public Health. He is currently the White House COVID-19 Response Coordinator and Counselor to the President. The views represented in this podcast are his own.

Works Cited:

• Climate Change (World Health Organization)
• Spreading Like Wildfire: The Rising Threat of Extraordinary Landscape Fires (United Nations Environment Programme)
• It's Not Your Imagination. Allergy Season Gets Worse Each Year (Vox)
• Record-breaking Temperatures Have Been Reported In the Northeast, And Some Cities Could Feel As High as 110 Degrees Fahrenheit (Insider)
• Mental Health and Stress-Related Disorders (Centers for Disease Control and Prevention)
• Understanding Lyme and Other Tickborne Diseases (CDC)

Music produced by Seth Kennedy.

On the final episode of While We Wait, Avni Kulkarni and Sania Ali explore emergency psychiatric assessment, treatment & healing - or emPATH - units, and how they could re-imagine care emergency psychiatric treatment delivery.

The featured guest on this episode is Scott Zeller, formerly from the American Association for Emergency Psychiatry and currently the vice president of Acute Psychiatry at Vituity.

While We Wait was produced by Sania Ali and Avni Kulkarni for Health Affairs.

Theme music by Tommy Scanlon.

Related Links:

• Effects of a Dedicated Regional Psychiatric Emergency Service on Boarding of Psychiatric Patients in Area Emergency Departments (NCBI)
• emPATH Units as a Solution for ED Psychiatric Patient Boarding (Psychiatry Advisor)

If you or a loved one is thinking about suicide, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. You can also call 911.

DISCLAIMER: This episode contains information on excessive use of police force and the death of Elijah McClain.

The US mental health care system is facing an emergency. How do we respond?

In the penultimate episode of While We Wait, Sania Ali and Avni Kulkarni explore different models for crisis response and first responders, including law enforcement, EMTs, and social workers.

Guests on this episode include Thom Dunn from the University of Northern Colorado and Anthony Hall from the DC Department of Behavioral Health.

While We Wait was produced by Sania Ali and Avni Kulkarni for Health Affairs.

Theme music by Tommy Scanlon.

If you or a loved one is thinking about suicide, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. You can also call 911.

How do we translate policy solutions into practice? Avni Kulkarni and Sania Ali learn about the next generation of mental health policy: the certified behavioral health clinic (CCBHC).

CCBHCs are one-stop shops for integrated mental health care that are tailoring treatment to fit you rather than fitting yourself into treatment.

Sania and Avni speak with two CCBHC executives hailing from two very different parts of the country: New York City and Nowata, Oklahoma.

Guests on this episode include Yaberci Perez-Cubillan from Acacia Network and Josh Cantwell from Grand Lake Mental Health Center.

While We Wait was produced by Sania Ali and Avni Kulkarni for Health Affairs.

Theme music by Tommy Scanlon.

Related Links:

• The National Council for Mental Wellbeing's Certified Community Behavioral Health Clinic Success Center

If you or a loved one is thinking about suicide, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. You can also call 911.

Integrated care is eliminating the goose chase for mental health services. On today's episode of While We Wait, Sania Ali and Avni Kulkarni interview two members of the Behavioral Health Integration (BHI) Task Force about the current state of our mental health care system and policy solutions.

The interview points to a promising opportunity to coordinate mental health services with the foundation of health care services: primary care.

Guests on this episode include Kenna Chic and Marilyn Serafini from the Bipartisan Policy Center.

While We Wait was produced by Sania Ali and Avni Kulkarni for Health Affairs.

Theme music by Tommy Scanlon.

Related Links:

• Policies To Improve Implementation And Sustainability Of Behavioral Health Integration (Health Affairs Forefront)
• Tackling America's Mental Health and Addiction Crisis Through Primary Care Integration (Bipartisan Policy Center)
• Access To Mental Health Care And Incarceration (Mental Health America)

If you or a loved one is thinking about suicide, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. You can also call 911.

DISCLAIMER: This episode contains outdated and potentially offensive language to describe mental illness.

While We Wait co-hosts Avni Kulkarni and Sania Ali step outside the hospital and dive headfirst into the archives to learn about a seismic shift in mental health policy that’s left the health care system scrambling to fill the cracks for decades. They examine words like “parity,” “deinstitutionalization,” and “non-quantitative treatment limits.”

Listen as Sania and Avni go back in time to make sense of it all and trace the roots of the mental health boarding crisis.

The featured guest on this episode is Andrew Sperling, former director of legislative advocacy from the National Alliance of Mental Illness and current senior director of government affairs at Intra-Cellular Therapies.

While We Wait was produced by Sania Ali and Avni Kulkarni for Health Affairs.

Theme music by Tommy Scanlon.

Related Links:

• Mental Health Policy: A Complex History (Health Affairs)
• The Kennedy Forum
• 25th Rosalynn Carter Georgia Mental Health Forum (The Carter Center)

If you or a loved one is thinking about suicide, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. You can also call 911.

DISCLAIMER: This episode contains information about suicide. If you or a loved one is thinking about suicide, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. You can also call 911.

In today’s episode, Avni Kulkarni and Sania Ali head to the emergency department (ED) to learn how our nation’s safety net is struggling to keep up with the increasing demand for emergency psychiatric treatment. They learn about the boarding crisis through the lens of a clinician discussing how they decide which patients need inpatient admission and what tools they can use to treat mental health crises.

Guests on this episode include Shilpa Patel and Meghan Schott from Children's National Hospital.

While We Wait was produced by Sania Ali and Avni Kulkarni for Health Affairs.

Theme music by Tommy Scanlon.

Related Links:

• Emergency Department Length-Of-Stay For Psychiatric Visits Was Significantly Longer Than For Nonpsychiatric Visits, 2002-11 (Health Affairs)
• Psychiatric Boarding In US EDs: A Multifactorial Problem That Requires Multidisciplinary Solutions (Center for Health Care Quality) 
• Computerized Adaptive Screener May Help Identify Youth At Risk For Suicide (National Institutes of Health)
• IMPACT DC Asthma Clinic
• National Alliance on Mental Illness

Welcome to While We Wait, the second series from Health Affairs Pathways. In this series, Sania Ali and Avni Kulkarni explore the mental health boarding crisis.

To start, Avni and Sania introduce you to the story of Karin Broadhurst and her son who waited for 36 days in the hospital for psychiatric treatment in Boston.

Long delays in care are commonplace for mental health patients who arrive in the emergency department (ED). Rather than a safety net, the ED can be a place with no progression in treatment where patients wait for change. Why? Because a mental health emergency can be an emergency that the ED isn’t ready for.

The Mental Health Boarding Crisis refers to the long-standing, nationwide problem of holding patients for hours, days, or even weeks in emergency departments and other observational settings because there are no available inpatient psychiatric beds in the hospital.

Guests on this episode include Karin Broadhurst, Dr. Patricia Ibeziako from Boston Children's Hospital, and Massachusetts State Senator Cindy Friedman.

While We Wait was produced by Sania Ali and Avni Kulkarni for Health Affairs.

Theme music by Tommy Scanlon.

Related Links:

• 'This Is A Crisis': Mom Whose Son Has Boarded 33 Days For Psych Bed Calls For State Action (WBUR)
• A Plan To Reduce Emergency Room 'Boarding' Of Psychiatric Patients (Health Affairs)
• Mental Health-Related Emergency Department Visits Among Children Aged <18 Years During COVID-19 Pandemic - United States, January 1-October 17, 2020 (Centers For Disease Control and Prevention)
• Roadmap for Behavioral Health Reform (Commonwealth of Massachusetts)
• National Alliance on Mental Illness

If you or a loved one is thinking about suicide, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. You can also call 911.