Psychiatric Services From Pages to Practice

Dr. Mette Ødegaard Nielsen (Unit for Complicated Schizophrenia, Glostrup, Denmark) joins Dr. Dixon and Dr. Berezin to discuss patient motivations and experiences of antipsychotic medication tapering at a clinic in Denmark.

Transcript

• 01:02 Nielsen interview
• 02:22 Tapering medication
• 04:09 Controversies around tapering
• 07:07 Debilitating effects of side effects
• 09:09 The tension between medication and side effects for the clinician
• 12:47 Top line findings
• 15:28 Psychotic symptom relapse
• 17:38 Differences by medication
• 19:43 Expectations from patients
• 21:47 Shared decision making
• 24:44 Mixed expectations and reality
• 27:20 Relapse
• 29:50 Close contact between patients and clinic staff

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Maggi A. Price, Ph.D., M.A. (School of Social Work, Boston College) joins Dr. Dixon and Dr. Berezin to discuss gender-affirming psychotherapy (GAP), a comprehensive, evidence-informed, and human-centered set of practices focusing on the treatment of transgender youth developed by Dr. Price and colleagues.

The training discussed in the podcast is available to the public at a reduced cost at https://www.affirmlab.org/gaptraining with the discount code "psychserv50."

Transcript

• 01:27 How did you end up on this project?
• 04:20 Gaps in care for transgender youths
• 05:47 Methods
• 08:47 Human-centered design
• 09:28 Stakeholders and focus groups
• 12:32 Domains
• 15:22 Key themes
• 18:17 Can you separate out gender identity from other goals of therapy?
• 20:38 Bringing in providers who are less supportive of potentially hostile
• 23:40 Providers who work in areas of transgender discrimination
• 26:03 First steps

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Dr. Sharon Hoover (University of Maryland School of Medicine, Baltimore) joins Dr. Dixon and Dr. Berezin to discuss the provision of mental health services in schools: why it matters, who it touches, how it's funded, and how it's doing.

• 01:15 Background
• 02:46 Provision of school mental health
• 09:56 How mental health services differ between ages and grades
• 11:08 COVID pandemic and youth mental health
• 15:29 Federal funding mechanisms
• 18:39 Using the funding while it's still available
• 22:10 Partnerships in school mental health
• 23:00 Medicaid
• 27:11 Medicaid billing and complications for school systems
• 28:47 Technical assistance for schools
• 30:07 Data systems
• 33:49 Temperature check

Transcript

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Simon Graham, M.B.Ch.B., M.R.C.Psych., and Kathy Curtis (Spring House Psychotherapy and Personality Disorder Service) join Dr. Dixon and Dr. Berezin to discuss the use of a local case management team and a combined day treatment and crisis service for patients with borderline personality disorder in Liverpool, United Kingdom.

Transcript

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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

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.

Listen to other podcasts produced by the American Psychiatric Association.

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