Psychiatric Services From Pages to Practice

Amandeep Jutla, M.D., joins Dr. Dixon and Dr. Berezin, with guest host Dr. Matt Hirschtritt, to discuss concerns surrounding the use of large language model chatbots and psychiatric risk.

• 01:08 Introduction
• 04:03 Language models in 2019
• 05:18 The appeal of chat-based AI for autistic adults
• 07:34 Do you use chat-based AI models personally?
• 09:44 Specific concerns of interacting with AI chat bots
• 11:07 The illusion of speaking with a person
• 13:34 Suggestions for clinicians and researchers
• 16:17 Questions a clinician should ask
• 18:29 Uses for AI models
• 20:11 Can chat bots get good at providing advice?
• 21:30 Regulations?
• 24:12 Motivational interviewing

Transcript

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Rachel Oblath, Ph.D., joins Dr. Dixon and Dr. Berezin, with guest host Dr. Matt Hirschtritt, to discuss repeated utilization of emergency psychiatric services among youths in both emergency department and alternative settings.

Transcript

• 01:10 Emergency psychiatric services utilization
• 03:57 Previous studies and unanswered questions
• 07:01 Emergency room and urgent care
• 08:39 BEST program
• 10:53 Findings and considerations
• 13:46 Results
• 15:56 Repeat utilization
• 19:03 Effectiveness of inpatient care
• 20:06 Non-ED settings
• 21:46 Implications
• 25:52 If you could change one thing …
• 27:56 Stones left unturned
• 29:12 Variables

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Katherine Koh, M.D., M.Sc., joins Dr. Dixon and Dr. Berezin, along with guest host Dr. Matt Hirschtritt, to discuss street psychiatry: what it is, its history, and what it means for the treatment of unhoused patients in often adverse settings.

Transcript

• 01:08 What is street psychiatry?
• 05:03 Path into street psychiatry
• 08:24 Purpose of the article
• 09:22 What makes street psychiatry unique
• 14:09 "A long walk"
• 15:45 When does a person become a patient?
• 18:36 Rewards and challenges
• 26:14 Recovery and relationships
• 30:37 A philosophy of working with highly complex cases
• 35:14 Uncertainty and instability

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Ruth S. Shim, M.D., M.P.H., and Alex Shevrin Venet, M.Ed., join Dr. Dixon and Dr. Berezin, along with guest host Dr. Matt Hirschtritt to discuss equity-centered trauma-informed education (ECTIE), a model that can be applied across the educational spectrum.

• 04:15 Expanding equity-centered trauma-informed education (ECTIE) beyond K–12
• 05:59 Five core components
• 10:25 Reception from teachers and school administrators to ECTIE
• 12:41 Unconditional positive regard
• 14:22 How did your collaboration begin?
• 17:29 Medical school and TIE
• 19:42 Bidirectional nature of ECTIE
• 22:00 "Asset-based lens instead of a lens of saviorism"
• 24:45 Take home points on ECTIE

Transcript

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Dr. Kathyrn Ridout (Kaiser Permanente Northern California) joins Dr. Dixon and Dr. Berezin to discuss implementing measurement-based care for solo and small-group practitioners.

Transcript

• 00:33 Ridout interview
• 00:57 Background
• 02:56 Measurement-based care
• 04:32 Large integrated systems versus small group and solo practitioners
• 06:25 Evidence for the utility of measurement-based care
• 07:37 Communication and engagement between clinicians and patients
• 10:22 Edge cases that don't quite fit
• 13:44 Beyond just the PHQ-9
• 15:00 Moving beyond the measurement of just symptoms
• 16:04 What should providers be looking for in measurements?
• 17:27 Computerized adaptive testing
• 19:08 Artificial intelligence
• 22:23 When the measurement doesn't match
• 26:31 "Base truth"

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Dr. Robert Drake (Columbia University, New York) joins Dr. Dixon and Dr. Berezin to discuss a personal reflection looking back at research conducted at Dartmouth in the 1990s looking at mental health, employment, individual placement, and support.

Transcript

• 00:49 Dartmouth in the 1990s
• 01:59 Failures and successes
• 04:01 "This was really the greatest serendipity of my life"
• 07:05 Employment versus day centers
• 09:11 A pivot point
• 11:07 Assertive Community Treatment (ACT)
• 12:53 Finding a job, and a path
• 16:03 Too sick to work?
• 18:47 Individual Placement and Support (IPS)
• 21:00 Wanting to share this experience
• 22:36 Replicating this program in other environments
• 24:43 The reflection
• 29:36 Building relationships
• 31:17 Building IPS
• 33:35 Advice for employers

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Dr. Benjamin Brody (Weill Cornell Medicine, New York) joins Dr. Dixon and Dr. Berezin to discuss how Joint Commission accreditation can be evolved to ensure that it is aligned with best incentives to for high-quality behavioral health care.

Transcript

• 00:52 Brody background
• 02:51 Inpatient work
• 03:42 The tension of inpatient psychiatric care
• 05:28 The Joint Commission
• 07:39 What the Joint Commission is doing well
• 09:04 Best practices
• 11:02 Who ordered what, when, and where
• 13:33 Including the patient as a stakeholder
• 20:23 Comprehensive treatment plans
• 22:25 What would you do if you were CEO?
• 24:34 Ensuring that the things the Joint Commission focuses on are the things that improve patients' lives.
• 25:14 A vision for quality improvement that engages stakeholders
• 30:12 Shared decision making

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Dr. Judith Cook (University of Illinois Chicago) joins Dr. Dixon and Dr. Berezin to discuss an intervention designed to help improve financial literacy and competency and reduce economic strain for people receiving services for psychiatric disorders.

Transcript

• 00:57 Psychiatric services research
• 02:05 Clinical work and Thresholds
• 03:46 Current role
• 04:23 Why does financial wellness matter for this population?
• 06:43 Psych rehab
• 08:05 Spending triggers
• 10:59 A psych rehab framework
• 12:53 Financial wellness
• 14:10 Beyond trans-diagnostic
• 16:24 The curriculum
• 20:10 Receiving a good financial education
• 21:32 Top line findings of the trial
• 25:07 The emotional context of financial wellness
• 25:55 Trained peer instructors
• 27:34 Policymaker takeaways
• 30:30 Financial literacy does not imply financial wellness
• 32:07 Small goals towards financial wellness

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Dr. Kevin Simon (Harvard Medical School and Boston Public Health Commission) joins Dr. Dixon and Dr. Berezin to discuss the processes behind and concerns surrounding involuntary psychiatric hospitalization.

Transcript

• 01:03 Career path
• 03:42 Boston Public Health Commission
• 09:28 Collaborators
• 13:09 Section 12
• 16:14 Transportation
• 17:17 Rates of involuntary transport
• 22:29 Requests that don't end in transport
• 23:42 Police involvement

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Eunice Wong, Ph.D., (RAND, Santa Monica, Calif.) joins Dr. Dixon and Dr. Berezin to discuss a review taking a look at the interactions of faith communities and the mental health sector in the provision of mental health care.

Transcript

• 00:56 How did you arrive at this field of study?
• 02:58 What is RAND and what do they do?
• 04:11 How are works for a think tank evaluated?
• 05:21 The interaction of faith communities and mental health service provision
• 07:38 Types of collaboration – PSFPTP Hankerson episode
• 09:57 Why look at the literature now?
• 11:12 What kinds of questions are you asking?
• 12:57 The complexity of different faiths, and different organizations
• 15:56 Topline findings
• 18:12 Does the research paradigm work in situations like this?
• 22:03 Discussing a patient and provider's religiosity
• 23:20 Assumptions and characterizations of faith-based organizations
• 24:55 Destigmatizing conversations about mental health and behavioral health in faith-based communities
• 27:39 The multilayered nature of faith-based community participation
• 28:53 Future research

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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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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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