Psychiatric Services From Pages To Practice

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 pe

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 c

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 me

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   Subscribe to the podcast here. Check o

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 

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

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 comm

Milton L. Wainberg, M.D., joins Dr. Dixon and Dr. Berezin to discuss protocols for studies implementing comprehensive mental health services in low- and middle-income countries. Dr. Wainberg is a professor of clinical psychiatry at Columbia University and the New York State Psychiatric Institute and director of the Global Mental Health Implementation Science program at Columbia University. Development of the author's partnership with Psychiatric Services to publish protocols to address the gap between global mental health research and treatment [1:59] Applying lessons learned in low- and middle-income countries to the United States [11:17] Overriding themes of the published protocols [15:41] Key advantages, challenges, and design solutions of these programs [20:15] Overview of what related studies are doing at other sites [21:35] A call to be bold in engaging with complex problems in mental health care [28:11] List of published Global Mental Health Implementation Science Protocols: Adaptation and Implement

Leopoldo J. Cabassa, Ph.D., M.S.W., and Ana Stefancic, Ph.D., join Dr. Dixon to discuss the effectiveness of the Peer-led Group Lifestyle Balance intervention, a 12-month manualized healthy lifestyle intervention delivered by peer specialists, in a sample of persons with serious mental illness who were overweight or obese and living in supportive housing. Dr. Cabassa is an associate professor at the Brown School at Washington University in St. Louis. He also is director of the NIMH T-32 Training Program and co-director of the Center for Mental Health Services Research at the university. His work aims to improve care for underserved communities, with a focus on disparities among racial-ethnic minorities with serious mental illness. Dr. Stefancic is an associate research scientist in the Department of Psychiatry at Columbia University. Her research interests focus on evaluating housing and support services for individuals who have experienced homelessness, psychiatric disabilities, and other medical conditions.

Wanda G. Wright, D.D.S., M.S.D., joins Dr. Dixon and Dr. Berezin to explore barriers and facilitators in addressing the oral health needs of individuals with mental illness from the perspectives of patients, psychiatrists, and dentists. Dr. Wright is affiliated with the School of Dental Medicine at East Carolina University, where she is Assistant Dean for Diversity, Equity, and Inclusion; Assistant Professor; and Division Director of Dental Public Health. Introduction to the field of dental public health [1:39] Issues of diversity, equity, and inclusion in dentistry and dental health [2:50] How Dr. Wright became interested in this area, and the type of collaboration that is involved [4:44] Details of the research [6:40] Did any results from the research stand out to Dr. Wright? [10:26] Key findings of the research [11:58] Description of public sector funding for dental services [12:44] Examples of integrated dental and mental health clinics, training, and hospital care [14:57] Discussion of stigma [19:18] Ch

Michael F. Hogan, Ph.D., joins Dr. Dixon and Dr. Berezin to discuss the challenges and opportunities for nationwide reform in systems of care for individuals in psychiatric crisis in the United States. Dr. Hogan has served as commissioner of the New York State Office of Mental Health, director of the Ohio Department of Mental Health, and commissioner of the Connecticut Department of Mental Health and Addiction Services. He was chair of the President’s New Freedom Commission on Mental Health under President George W. Bush. He has been appointed to the board of The Joint Commission and as a member of the National Action Alliance for Suicide Prevention. How Dr. Hogan became interested in this area of research [2:10] How an ideal crisis system would operate, and what aspects of such a system are currently missing [7:10] How widespread is this model throughout the United States? [16:02] Other recommendations the article makes to improve crisis services [23:22] Efforts to improve the National Suicide Prevention Li

John Torous, M.D., M.B.I., joins Dr. Dixon and Dr. Berezin to discuss the expanded access to smartphone apps for mental health on college campuses as well as issues regarding the privacy, efficacy, and quality of mental health apps. Dr. Torous is the director of the digital psychiatry division at Beth Israel Deaconess Medical Center and an instructor in psychiatry at Harvard Medical School. How Dr. Torous became interested in this area of research [1:27] What does it mean to be a director of digital psychiatry? [2:27] Why colleges are a good place to study digital psychiatry [3:47] A sense of the landscape of digital mental health or digital psychiatry on college campuses [5:20] Pros and cons of digital mental health tools [7:25] Major findings of the study [12:39] Key conclusions of the study [16:42] Evidence base for mental health apps [18:34] Recommendations for college mental health organizations [20:35] Questions surrounding legal liability [22:57] Emerging issues in the field [25:08] Final thoughts fro

Ayana Jordan, M.D., Ph.D., joins Dr. Dixon and Dr. Berezin to discuss disparities in initiation of and engagement in mental health care among persons from racial-ethnic minority groups. This topic formed the basis of an Editor's Choice collection assembled by Dr. Jordan. Dr. Jordan is the associate program director of the adult psychiatry training program and an assistant professor of psychiatry at the Yale University School of Medicine. She also is a member of the Psychiatric Services Early-Career Psychiatrist Advisory Committee. Dr. Jordan's career interests [2:11] Development of the Editor's Choice collection on mental health disparities by race and ethnicity of adults [6:44] Dr. Jordan's perspectives in the area of mental health disparities [10:50] Dr. Dixon's statement on racism and creation of an advisory group to address racism as it relates to the journal [17:37] Dr. Jordan's plans to update the Editor's Choice collection [20:21] Dr. Berezin's take on the Editor's Choice collection [23:08] How health

Erik Messamore, M.D., Ph.D., joins Dr. Dixon and Dr. Berezin to discuss suggestions for informing the public more effectively about the potential benefits and risks of marijuana in state medical marijuana programs. Dr. Messamore is Associate Professor of Psychiatry at Northeast Ohio Medical University and Medical Director of the university's Best Practices in Schizophrenia Treatment Center. How Dr. Messamore became interested in medical marijuana policy [2:33] Points raised by patients regarding the benefits and risks of medical marijuana [5:57] A history of the legalization of medical marijuana in the United States [7:54] The difference between the authorization of marijuana for medical use relative to recreational use [10:24] Discrepancies between the approval processes of regular medicines and medical marijuana [12:32] The role of industry and lobbying [18:09] Recommendations for what state governments should be doing [19:22] Side effects of cannabis [20:43] Arguments for the continued loosening of cannab

Matthew Goldman, M.D., M.S., joins Dr. Dixon and Dr. Berezin to discuss the significant changes in mental health policy prompted by the COVID-19 crisis across five major areas: legislation, regulation, financing, accountability, and workforce development. Special considerations for mental health policy are discussed, including social determinants of health, innovative technologies, and research and evaluation. The article was authored by the members of the Psychiatric Services Policy Advisory Group, which aims to guide the journal on how to maximize its relevance and impact on mental health policy. Dr. Goldman's research interests, and how his responsibilities have changed during the COVID-19 pandemic [3:29] What is mental health policy, and how is policy evolving during the pandemic? [6:35] Differences between legislative and regulatory frameworks [9:13] Discussion of changes involving financing, accountability, and workforce development [14:14] Discussion of changes involving state licensing [17:41] Umbrel

Mark Munetz, M.D., and Elizabeth Ford, M.D., join Dr. Dixon and Dr. Berezin to discuss their work in the field of providing services to individuals who have criminal justice contact and serious mental illness. Articles discussed: Black Robe/White Coat: Mental Health Providers Must Reclaim the Role of Caring Clinician Clinical Outcomes of Specialized Treatment Units for Patients With Serious Mental Illness in the New York City Jail System How each author became interested in the field in general and the topic of their article [2:14] Take-home messages from Dr. Ford's work [9:07] Dr. Munetz's experience with mental health courts [9:38] Areas of overlap between the articles [12:41] How to approach these areas of research [18:29] How unusual are the examples featured in the articles? [21:28] With improved funding, would individuals be more empathic toward people involved with criminal justice? [24:39] How the personal reflections discussed in these articles may interact with the field generally [26:40] What adv

Delbert G. Robinson, M.D., joins Dr. Dixon and Dr. Berezin to discuss barriers to the use of long-acting injectable (LAI) antipsychotic medication. Dr. Robinson's path to this particular area of research [1:43] How have people traditionally viewed LAIs? [3:32] A different approach to LAIs [4:13] The trend to use qualitative methods to understand perspectives of different stakeholders [7:28] Scope of the study [8:13] What the barriers are to more uptake of the use of LAIs [14:18] Barriers stemming from the individual level (interactions between a clinician and a patient) and the systems level (clinics not having appropriate infrastructure) [19:48] What is the next step in this line of research? [22:20] 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. Browse other articles on our web site. Be sure to let your colleagues know about the podcast, a

Patricia E. Deegan, Ph.D., joins Dr. Dixon and Dr. Berezin to discuss the dynamic journey that is learning to use psychiatric medicine optimally to support recovery. It requires more than learning to take pills on schedule. As people recover, as they learn and grow, as they age, and as their concerns and interests evolve, the use of medication as a tool in recovery also evolves. What is Pat Deegan, Ph.D., & Associates? [1:15] Dr. Deegan's personal experience with mental illness [2:48] Recovery as a journey [5:06] Challenges people face when using medication [9:53] The clinician-patient relationship [14:04] Using analogy to understand the use of medication [17:25] Personal motivation for using medication [18:32] The context from which this Personal Accounts column emerged [22:44] Subscribe to the podcast here. Check out Editor's Choice, a new 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 o

Natalie Bonfine, Ph.D., joins Dr. Dixon and Dr. Berezin to discuss the reasons why people with serious mental illness are overrepresented in the criminal justice system. Dr. Bonfine also outlines ways to address the multiple factors that contribute to justice involvement for this population. Dr. Bonfine's professional background and research interests [2:05] Development of Dr. Bonfine's article [3:20] What is the criminalization hypothesis? [5:06] What is the criminogenic risk perspective? [10:13] How can the community mental health system address this issue? [12:48] Discussion of the sequential intercept model [17:50] What changes are necessary for the community mental health system to become “intercept 0” [20:41] A counterargument [26:50] Final thoughts [28:55] Check out Editor's Choice, a new 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 web site. Be sure to let your

Dr. Dixon and Dr. Berezin discuss substance use among LGBTQ young adults with probable substance use disorders and characteristics and job stressors associated with turnover and turnover intention among community mental health providers. Introduction to article on substance use among LGBTQ populations [1:00] Study design [2:12] Study results [6:32] Introduction to article on turnover at community mental health centers [15:16] Study design [16:06] Study results [18:16] Check out Editor's Choice, a new 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 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. Follow the journal on Twitter. E-mail us at psjournal@psych.org