Psychiatric Services From Pages to Practice

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

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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

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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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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

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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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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

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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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Howard H. Goldman, M.D., PH.D. (PS emeritus Editor-in-Chief) and Alison Cuellar, Ph.D., (George Mason University, Fairfax, Virginia) joins current PS Editor-in-Chief Dr. Lisa Dixon to discuss the peer review process from the perspective of both reviewers and editors.

Transcript

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Nathaniel P. Morris, M.D., joins Dr. Dixon and Dr. Berezin to discuss an evidence-based approach to involuntary psychiatric hospitalization. Dr. Morris is an Assistant Professor of Psychiatry in the Department of Psychiatry and Behavioral Sciences at the University of California, San Francisco.

• How did you get interested in this topic? [00:51]
• What is involuntary psychiatric hospitalization? [02:28]
• How does it vary by state and nationally? [04:46]
• What don't we know about the evidence behind involuntary psychiatric hospitalization? [05:46]
• What are the challenges of investigating involuntary hospitalization? [07:32]
• What is meant by "involuntary" [09:49]
• Lack of evidence [11:55]
• How do you approach studying this subject? [14:12]
• Alternatives to involuntary hospitalization [17:33]
• Who gets hospitalized? [19:27]
• Open Forum [21:30]
• What does public tracking mean? [22:50]
• How can we manage this if we don't even know anything about the practice across this country? [23:58]

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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Shalini Lal, Ph.D., joins Dr. Dixon and Dr. Berezin to discuss the perspective of patients related to recovery, treatment, and relapse following first-episode psychosis. Dr. Lal is the Canada Research Chair in Innovation and Technology for Youth Mental Health Services and an associate professor at the School of Rehabilitation, University of Montreal, Montreal, Canada.

• How did you get interested in this topic? [01:26]
• What do we mean by the word "relapse"? [04:33]
• What's the perspective of an occupational therapist on first episode psychosis? [06:21]
• Questions for the focus groups [07:55]
• Moving beyond the relapse binary [09:10]
• Categorizing and summarizing [12:44]
• Four factors [14:20]
• The complications of technology [15:01]
• Positives and negatives [17:01]
• Social environment [19:20]
• Relationships with healthcare providers [21:43]
• How did participants understand the meaning of relapse [22:12]
• The value of qualitative research [25:35]
• What's next [28:52]

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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Dr. Bonnie Zima, M.D., M.P.H., joins Dr. Dixon and Dr. Berezin to discuss trends in child emergency department discharges, hospitalization, and mental health care utilization before and after statewide school closure orders due to the COVID-19 pandemic. Dr. Zima is a Professor-in-Residence in the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles.

• How did you get interested in this topic? [01:06]
• Study design [02:26]
• The team [03:25]
• The data set: Pediatric Health Information System (PHIS) [06:51]
• What's in the data? [08:06]
• Looking at data from 2019 and 2020 [09:27]
• Medical data as a baseline [10:10]
• Changes are relative [12:07]
• Stratification by psychiatric disorder [12:35]
• Untangling the effects of the pandemic [15:53]
• Examining the co-occurrence of medical and mental health disorders [17:13]
• What are the important take home lessons [19:12]
• IS there a correlation between the severity of the outbreak and service utilization? [22:36]
• What's next for this research? [23:23]
• Research and COVID [26:08]

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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Dr. George Pro, Ph.D., M.P.H., joins Dr. Dixon and Dr. Berezin to discuss the downward trend in the provision of mental health services in Spanish across the US, despite the rapidly increasing Hispanic population. Dr. Pro is an Assistant Professor in the College of Public Health at the University of Arkansas for Medical Sciences.

• How did you get involved in this research? [01:04]
• What are the demographic challenges and what do we know about services provision in this population? [02:20]
• The level of mental health care service utilization [04:45]
• Why focus on language access? [05:39]
• What did you find? [06:48]
• The National Mental Health Services Survey [08:25]
• National results [10:24]
• The importance of data visualization [12:39]
• Figures and how they convey information [17:02]
• Ohio and North Dakota: rate of change, not overall population [20:07]
• What are the limitations to this approach? [21:43]
• Communicating data to policy makers [23:26]
• What's next for your research? [24:45]

Figures from the article:

Figure 1

Figure 2

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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.

Listen to other podcasts produced by the American Psychiatric Association.

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