Psychiatric Services From Pages to Practice

Courtney von Hippel, Ph.D., joins Dr. Dixon and Dr. Berezin to discuss burnout and negative job attitudes, and how lived experience might help provide a buffer in mental health workers. Dr. von Hippel is an Associate Professor of Health and Behavioural Sciences at the University of Queensland in Brisbane, Australia.

• How did you get involved in this research? [01:16]
• A profession with a huge amount of burnout [03:20]
• What does burnout lead to? [05:45]
• Private versus public practice [08:07]
• How does a provider's lived experience change their experience with the job? [11:03]
• Who did you look at and what did you ask? [14:57]
• What did you find? [19:17]
• Was there anything about your findings that was surprising to you? [20:52]
• Lived experience versus self-disclosure [22:22]
• Do different kinds of lived experience translate? [24:03]
• Next steps for research [25:54]

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Mark Savill, Ph.D., joins Dr. Dixon and Dr. Berezin to discuss using online psychosis screening data to see what can be learned about the population taking the assessment, what can be done to close the gap between screening and treatment, and to reduce the duration of untreated psychosis. Dr. Savill is a professor in the Department of Psychiatry and Behavioral Sciences at University of California, Davis.

• What's your background? [01:17]
• Prodromal Questionnaire Brief (PQ-B) [03:03]
• Duration of Untreated Psychosis (DUP) [03:40]
• What does the beginning of treatment mean? [05:22]
• How can the internet help to decrease the time from symptoms to treatment? [07:20]
• What are people looking for and what are they finding? [10:05]
• Mental Health America screening [11:00]
• Where does the PQ-B fit?
• What did you investigate? [14:33]
• Getting people into treatment – from A to B, or from A to L? [18:53]
• What did you learn? [19:50]
• The numbers [25:02]
• Further research [23:24]

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Daniel M. Blonigen, Ph.D. joins Dr. Dixon and Dr. Berezin to discuss implementing moral reconation therapy (MRT) in a noncorrectional setting among justice-involved veterans receiving residential mental health treatment in the U.S. Veterans Health Administration with an aim towards reducing criminal recidivism. Dr. Blonigen is an Associate Director at the Center for Innovation to Implementation, VA Palo Alto Health Care System, in Palo Alto, California.

• Blonigen interview [00:55]
• Veterans Justice programs [02:29]
• Moral reconation therapy (MRT) [03:18]
• Treatments for criminal recidivism? [04:24]
• A group based, cognitive behavioral intervention [05:13]
• The structure of MRT [06:22]
• How does MRT avoid implying there's one right way to live? [10:10]
• MRT in a residential mental health setting [12:58]
• A hybrid trial design [15:47]
• Bringing together research and implementation [18:38]
• What did the participants think of MRT? [19:09]
• Listening to people who didn't engage [20:34]
• Barriers to MRT implementation [23:23]
• Does MRT overlap with other treatments in residential settings? [25:30]
• What's the next step? [27:16]

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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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Margaret E. Balfour, M.D., Ph.D., and Jason Winsky, B.A., join Dr. Dixon and Dr. Berezin to discuss their special article published in Psychiatric Services, "Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies," looking at collaborations between police and clinicians in the treatment of mental health and behavioral health emergencies. Dr. Balfour is Chief of Quality & Clinical Innovation at Connections Health Solutions in Tucson, Arizona, and Sgt. Winsky is a police officer and supervisor of the Mental Health Investigative Support Team with the Tucson Police Department.

• Balfour and Winsky interview [00:32]
• How did you get started in this work? [01:22]
• Police department mental health team [02:44]
• Crisis Response Center [03:04]
• Why Arizona? [03:58]
• Arnold vs Sarn [04:54]
• Twenty-three hour observation model [05:35]
• Funding [06:20]
• How the crisis system works in Tucson [07:44]
• Easy access for law enforcement [10:11]
• Crisis management from the law enforcement perspective [10:39]
• Police training in dealing with mental health crisis [12:41]
• Who the police bring to the crisis center [14:59]
• Challenges in providing mental health services for intoxicated and violent patients [16:21]
• Keeping patients out of the justice system when possible [17:31]
• "No Wrong Door" policy [18:47]
• How this works in practice: the lady with the car [21:05]
• Creating the opportunity for creative solutions to removing barriers to mental health care [23:56]
• "There can't be a rule for everything in crisis" [24:44]
• Social justice framing of the paper [26:49]
• The Technical Assistance Coalition working papers series [29:24]
• What would you add to enhance the program? Housing, housing, housing [30:07]
• Collaboration between siloed systems [32:01]
• Working with stakeholders [32:59]
• The impact of mental health crisis on people of color [34:41]
• Other places doing great work [37:13]

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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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Cameron Schilling, M.P.H, joins Dr. Dixon and Dr. Berezin to discuss the effects of high deductible health insurance plans on enrollees with mental health conditions and substance use disorder. Mr. Schilling is a programmer and data analyst from the Center for Mental Health and Addiction Policy at the Johns Hopkins School of Public Health, and an author of an article in the journal.

• Health insurance and how it works
• What is a "high deductible" health insurance plan?
• Premiums, health care utilization, and planning ahead
• Employment and insurance
• Deductibles, premiums, and health savings accounts
• Co-occurring disorders and high deductible insurance
• Healthcare utilization and high deductibles: increase and decrease
• How do people navigate this?
• The literature: high deductible insurance and bipolar disorder
• Little change when accessing care, but decrease in likelihood of seeking treatment
• Prioritization and tradeoffs
• Do people with a mental health diagnosis and those co-occurring substance use disorders access care differently under high deductible plans?
• Choice of health care plans provided by employers
• Let's talk methods
• Impact of high deductible plans on healthcare utilization

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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.

Browse other articles on our website.

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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Dr. Debra A. Pinals, M.D., joins Dr. Dixon and Dr. Berezin to discuss two forthcoming articles from Psychiatric Services looking at persons with intellectual and developmental disabilities in mental health systems. The first paper addresses clinical considerations, and the second looks at policy and systems considerations.

Dr. Pinals is a Clinical Professor of Psychiatry and the Director of the Program in Psychiatry, Law, and Ethics at the University of Michigan Medical School in Ann Arbor, Michigan.

Topics discussed in this episode:

• Mental health systems and law enforcement
• Medicaid-funded and state-funded systems
• Defining the patient population
• "Beyond Beds" and the psychiatric continuum of care
• Seeing the population beyond just crisis
• Dealing with aggressive behavior and overmedicating the population
• Restricting individual autonomy as a last resort
• Applied Behavioral Analysis
• Overlooked stressors and potential drivers of crisis
• Role of evidence-based practices in this population
• Distinguishing between mental illness and intellectual disabilities, and how they interact
• Encouraging communication across systems
• Expansion of crisis services
• Rehabilitation services versus habilitation services
• Where does neurology fit in?
• What system does care take place in?
• How do we improve things from here?

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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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Deborah K. Padgett, Ph.D., M.P.H., and Daniel Herman, M.S.W., Ph.D., join Dr. Dixon and Dr. Berezin to discuss a potentially effective and affordable approach to ending homelessness for many Americans by extending the authorization that U.S. health authorities gave to shelter providers to move residents into hotels.

Dr. Padgett is a Professor at New York University's Silver School of Social Work. Dr. Herman is a Professor at Hunter College's Silberman School of Social Work and Director of the Center for the Advancement of Critical Time Intervention.

Topics discussed in this episode:

• Career trajectories: planned and unplanned transitions
• Homelessness issue pre-pandemic: 40 years in 4 minutes
• Structural racism as a contributor
• SMI: a subset of homelessness issue
• COVID contagion leading to general agreement on the need to "de-densify" shelters
• Permanent hotel housing: measurable outcome improvements and qualitative game changer
• Discussion of Critical Time Intervention

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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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Sidney H. Hankerson, M.D., M.B.A., joins Dr. Dixon and Dr. Berezin to discuss efforts to train African American clergy interested in interpersonal counseling in managing major depression among community members, as they are positioned to curb the cultural mistrust and depression stigma that impedes the use of traditional psychiatric services among African Americans.

Dr. Hankerson is Assistant Professor of Clinical Psychiatry at Columbia University, College of Physicians and Surgeons, and the New York State Psychiatric Institute.

• Journey to this area of research
• Grady Hospital patients requesting pastor involvement
• Importance of NAMI-sponsored suicide prevention program at a large church in Queens
• Summary of current paper
• Description of and relationship with church involved in the study
• Talking with pastors and community members about the intervention
• Distrust of institutions
• Depression stigma
• Future work involving community health workers
• How to get involved
• Personal connection with mental health

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Benjamin G. Druss, M.D., M.P.H., joins Dr. Dixon and Dr. Berezin to discuss two articles:

1) A qualitative study of barriers and facilitators to transitions from the emergency department to outpatient mental health care

2) Supporting the mental health workforce during and after COVID-19.

Dr. Druss is a psychiatrist and a professor in the Department of Health Policy and Management at the School of Public Health at Emory University.

• How research interests and career path have provided expertise on these two seemingly very disparate articles (1:36)
• Background on interests in emergency department transitions (3:01)
• Methodology of ED transition study (4:23)
• Questions asked of subjects (7:52)
• Client, provider, and system perspectives (8:50)
• Social determinants of treatment seeking and post-discharge care (12:09)
• Surprising findings (14:38)
• How ED visits are often a confluence of factors that are outside of the control of patients (16:35)
• Structural factors compounding transition difficulties (18:38)
• How technical assistance supports the adoption and sustainment of evidence-based practices (23:00)
• Factors affecting successful implementation of evidence-based interventions (26:44)
• COVID disruption (29:00)
• COVID's long-term effects on mental health service delivery (33:00)
• Panoramic view of COVID's effects on the field from adjudicating papers (34:51)

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

Browse other articles on our web site.

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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Marie Brown, Ph.D., and Nev Jones, Ph.D., join Dr. Dixon and Dr. Berezin to discuss steps to build a pipeline of researchers with significant psychiatric disabilities and intersecting lived experiences and to increase service user participation in the U.S. mental health care system.

Dr. Brown is a licensed clinical psychologist, postdoctoral fellow at Columbia University Irving Medical Center, and a cofounder of Hearing Voices Network NYC. Dr. Jones is an assistant professor in the Department of Psychiatry at the University of South Florida.

• How the authors began their collaboration [1:35]
• Genesis of the collaboration on the two Open Forum pieces in Psychiatric Services [2:38]
• Background of advocacy to have people with lived experience in mental health research positions [5:00]
• A paradigm of what meaningful participation would look like [7:59]
• Should the same standards of participation and inclusion apply to other research areas? [11:47]
• Is research disconnected from practice? [16:01]
• Steps the research community and academia can take to address these issues [22:11]
• Self-disclosure of psychiatric disability/lived experience [27:30]
• Deepening engagement of service user participation within the mental health system [31:50]
• The "radical roots" of the concept of peer support [34:33]
• What relational psychotherapy has to do with deepening engagement and service user participation [39:18]
• How Dr. Brown's experience with the Hearing Voices movement has informed her work [46:31]
• Activities designed to deepen engagement and help build a diverse lived experience pipeline [48:19]

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

Browse other articles on our web site.

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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E-mail us at [email protected]