Psychiatric Services From Pages to Practice: Recent Episodes
Psychiatric Services
Editor Lisa Dixon, M.D., M.P.H., and Podcast Editor and Co-Host Josh Berezin, M.D., M.S., discuss key aspects of research recently published by Psychiatric Services (https://ps.psychiatryonline.org/), a journal of the American Psychiatric Association. Tune in to Psychiatric Services From Pages to Practice to learn about the latest mental health services research and why it is relevant. Topics include community-based treatment programs, collaborative care, evidence-based treatment and service delivery, criminal and social justice, policy analysis, and more.
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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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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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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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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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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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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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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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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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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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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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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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
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.
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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
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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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E-mail us at psjournal@psych.org
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]
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.
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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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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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Lauren Southwick, M.P.H., and Sharath Guntuku, Ph.D., join Dr. Dixon and Dr. Berzin 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
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 website.
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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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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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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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]
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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.
https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202100614
- 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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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.
https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202100257
- 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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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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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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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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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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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)
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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]
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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 Implementation of the Multiple-Family Group Intervention in Ghana
- The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity-Building Scale-Up Trial: Study Design and Protocol
- Technology-Assisted Teachers’ Training to Promote Socioemotional Well-Being of Children in Public Schools in Rural Pakistan
- Youth Functioning and Organizational Success for West African Regional Development (Youth FORWARD): Study Protocol
- Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence-Based Practices (PRIDE) in Mozambique
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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.
- How the authors became interested in this field [2:08]
- Summary of study findings [6:20]
- Details of the supportive housing sites [10:05]
- Description of the peer-led program intervention [14:04]
- Work of the peer specialists within the program [16:35]
- Discussion of usual care [19:16]
- Details of the main outcomes [21:27]
- Differences between peer-led and usual care [22:31]
- Discussion of fidelity [27:02]
- Discussion of patient-level randomization [28:22]
- Remembering peer specialist Kelli Adams [33:41]
- One key takeaway from the work [36:44]
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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]
- Challenges around referring patients for dental care and around access [21:10]
- The one policy Dr. Wright would change, and what mental health providers should know about oral health in general [23:19]
- The next phase of this research [26:12]
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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 Lifeline [29:12]
- How has nonsuicidal crisis been incorporated into the new three-digit (988) hotline? [32:11]
- Examples of larger structural changes in crises services [36:30]
- How issues of race and social injustice tie in to this conversation [38:56]
- Dr. Hogan’s thoughts on what the future holds [44:38]
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This article is part of the Think Bigger, Do Good series commissioned by the Thomas Scattergood Behavioral Health Foundation, Peg’s Foundation, the Patrick P. Lee Foundation, and the Peter & Elizabeth Tower Foundation. The full series can be viewed at www.ThinkBiggerDoGood.org.
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 from Dr. Torous [27:05]
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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 care systems can engage with policy, historical, and structural issues involving racism [24:37]
- Interventions required to address racism in health care and in scientific research [28:33]
- How funding priorities in scientific research affect racism [36:16]
- Final thoughts on the subject [38:38]
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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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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 cannabis policies [24:40]
- Response to cannabis advocates [27:28]
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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 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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E-mail us at psjournal@psych.org
This article is part of the Think Bigger, Do Good series commissioned by the Thomas Scattergood Behavioral Health Foundation, Peg's Foundation, the Patrick P. Lee Foundation, and the Peter & Elizabeth Tower Foundation. The full series can be viewed at www.ThinkBiggerDoGood.org.
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]
- Umbrella issues that affect policy [19:57]
Dr. Goldman is a Public Psychiatry Fellow at the University of California, San Francisco, and is a clinical instructor in the Department of Psychiatry at UCSF.
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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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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 advice do the authors have for younger professionals? [30:42]
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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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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]
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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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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]
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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.
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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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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.
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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.
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Nev Jones, Ph.D., and Christina Mangurian, M.D., M.A.S., join Dr. Dixon and Dr. Berezin to discuss the significant ethical, political, and procedural challenges that affect recruitment and retention of the peer specialist workforce.
- Introduction to the topic [1:05]
- Outline of the case study described in the column [6:20]
- Challenges involved in hiring peer staff [11:28]
- Tips for helping clients [14:42]
- Challenges dealing with microaggressions [17:54]
- What progress has been made? [23:19]
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.
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Dr. Dixon and Dr. Berezin discuss an innovative model to integrate medication-assisted treatment (MAT) in rural primary care settings for patients with opioid use disorders, and how mental health professionals can prepare and respond to the mental health consequences of increasingly dangerous storms.
- The barriers and facilitators that affect engagement with Project ECHO (Extension for Community Healthcare Outcomes) to implement MAT in primary care settings [0:58]
- How mental health professionals can help individuals affected by hurricanes [12:24]
We encourage listeners to donate to any trusted charity serving communities affected by Hurricane Dorian.
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.
Other articles may be viewed at our web site.
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Jonathan Purtle, Dr.P.H., M.Sc., joins Dr. Dixon and Dr. Berezin to discuss state legislators’ opinions about adverse childhood experiences as risk factors for adult behavioral health conditions, as well as how opinions vary between legislators with different characteristics.
- Dr. Purtle’s research interests [1:35]
- What are adverse childhood experiences (ACEs)? [3:50]
- How do the opinions of state legislators align with the body of evidence on ACEs? [6:57]
- Description of study methods [8:18]
- Characteristics of the surveyed legislators [13:00]
- Major findings of the study [14:54]
- What’s next in this line of research [25:36]
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.
Other articles may be viewed at our web site.
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Dr. Dixon and Dr. Berezin discuss psychiatric hospitalization of youths with autism spectrum disorder and whether increasing spending on home and community-based care lowers that risk [1:13], reducing hospitalization through court-ordered assisted outpatient treatment with or without assertive community treatment [11:20], and use of behavioral economics to enhance medication adherence [20:47].
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.
Other articles may be viewed at our web site.
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Dr. Dixon and Dr. Berezin discuss an innovative program to engage patients with early psychosis [1:12], two essays on the legalization of marijuana [11:25], and the aftermath of celebrity suicide [22:30].
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.
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Dr. Dixon and Dr. Berezin discuss a new model of inpatient care in England [1:23] and improving clinician practices when sharing notes with patients [14:42].
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.
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Paul S. Appelbaum, M.D., joins Dr. Dixon and Dr. Berezin to discuss what degree of responsibility universities have to prevent student suicide or violence on campus.
This question was the focus of two recent state supreme court decisions, in Massachusetts and in California. Looking to legal rules that define when duties exist to protect third parties, both courts held that the unique aspects of the campus setting create a responsibility for universities to take reasonable steps to protect students from themselves and each other. Widening the scope of institutional liability in this way could encourage schools to overreact to students with mental health problems, making them less likely to come forward for treatment.
Dr. Appelbaum is the Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law in the Department of Psychiatry at Columbia University, New York City, and is editor of the Law & Psychiatry column in Psychiatric Services.
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.
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Dr. Dixon and Dr. Berezin discuss the use of text messaging to detect postpartum depression (01:16), the use of telemedicine to improve medication adherence (11:45), and ethical considerations regarding Internet searches for patient information (19:56).
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.
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Dr. Dixon and Dr. Berezin discuss benzodiazepine use and misuse among adults in the United States, child protective service disparities and serious mental illnesses, and mental health self-directed care financing.
Dr. Dixon and Dr. Berezin discuss malingering in the psychiatric emergency department, the Netflix series 13 Reasons Why, and whether responses to item 9 of the Patient Health Questionnaire (PHQ-9) predicts suicidal behavior among outpatients with diagnoses of psychotic disorders.
Dr. Dixon and Dr. Berezin discuss the effects of transformational leadership on mental health practitioners’ attitudes toward feedback, provider attitudes and experience with measurement-based mental health care, and China’s reward policy for family care of persons with serious mental illness.
Molly T. Finnerty, M.D., joins Dr. Dixon and Dr. Berezin to discuss the use of a Web-based shared decision-making application for ongoing outpatient mental health treatment engagement and antipsychotic medication adherence.
Dr. Dixon and Dr. Berezin discuss racial and ethnic differences in treatment outcomes among participants in a randomized controlled trial of an intervention for first-episode psychosis; psychosis literacy among Latinos with first-episode psychosis and their caregivers; and recovery colleges, which involve supporting people living with mental health problems through adult education.
Dr. Dixon and Dr. Berezin discuss a collaborative practice model with pediatrics; continuity of information sharing between mental health care and primary care providers; and impacts on service utilization and expenditures of a whole health model at a community mental health center.
Ruth S. Shim, M.D., M.P.H., joins Dr. Dixon and Dr. Berezin to discuss how addressing the social determinants of mental health may help influence public policy and change social norms in an effort to eliminate inequities in care and improve outcomes.
Dror Ben-Zeev, Ph.D., joins Dr. Dixon and Dr. Berezin to discuss a mobile health intervention for people with serious mental illness.
Dr. Dixon and Dr. Berezin discuss housing and employment outcomes for mental health self-direction participants; results of OnTrackNY, a coordinated specialty care program for early psychosis; and a first-person account on the disabling effects of mental illness on education.
Dr. Dixon and Dr. Berezin discuss In SHAPE, a lifestyle intervention for individuals with serious mental illness; outcomes of a peer mentor intervention for persons with recurrent psychiatric hospitalizations; and the inaugural Viewpoint column in Psychiatric Services. Viewpoint is a new feature that touches on controversial and important current topics. Our first Viewpoint discusses work requirements in Medicaid.
Articles may be viewed online at ps.psychiatryonline.org.
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Lloyd Sederer, M.D., Chief Medical Officer of the New York State Office of Mental Health and adjunct professor at the Columbia University Mailman School of Public Health, joins host Josh Berezin, M.D., M.S., to discuss psychiatric workforce issues, a depression-prevention program in high schools, and how implicit bias affects mental health care services. Articles may be viewed online at ps.psychiatryonline.org.
Dr. Dixon and Dr. Berezin discuss recipients of electroconvulsive therapy, or ECT; peer-led self-management of general medical conditions for patients with serious mental illnesses; and racial, ethnic, and gender disparities in health care access and use among U.S. adults with serious psychological distress. Articles may be viewed online at ps.psychiatryonline.org.
Dr. Dixon and Dr. Berezin discuss discharge practices in individual placement and support programs, a quality improvement approach to improving use of constant observation in a general hospital, and three nontraditional approaches to improving psychiatric care. Articles may be viewed online at ps.psychiatryonline.org.
Dr. Dixon and Dr. Berezin discuss person-oriented recovery of individuals with serious mental illnesses, the management of common medical conditions by office-based psychiatrists, and behavioral health care coverage under the Affordable Care Act. Articles may be viewed online at ps.psychiatryonline.org.
Dr. Dixon and Dr. Berezin examine the links between mental illness and child abuse, explore the effects of a police-based crisis intervention program, and look at whether financial incentives promote smoking cessation in a Medicaid population. Articles may be viewed online at ps.psychiatryonline.org.
We are conducting a listener survey. Please go to ps.psychiatryonline.org/podcast and select the link to the survey. It won’t take more than a few minutes to complete, and your feedback will remain anonymous. We appreciate your responses. Thank you.
Dr. Dixon and Dr. Berezin discuss what policy makers can do regarding fentanyl and the evolving opioid epidemic, explore communication strategies to counter stigma and improve mental illness and substance use disorder policy, and document how the concept of multimorbidity is making its way into clinical practice. Articles may be viewed online at ps.psychiatryonline.org.
We are conducting a listener survey. Please go to ps.psychiatryonline.org/podcast and select the link to the survey. It won’t take more than a few minutes to complete, and your feedback will remain anonymous. We appreciate your responses. Thank you.
Dr. Dixon and Dr. Berezin discuss mental health programs offered in religious congregations, explore the association between direct-to-consumer advertising and medication adherence, and review strategies to prevent suicide in hospital emergency departments. Articles may be viewed online at ps.psychiatryonline.org.
Dr. Dixon and Dr. Berezin discuss the controversial practice of outpatient commitment (community treatment orders or assisted outpatient treatment) and its effect on mortality, the use of the ECHO model (Extension for Community Healthcare Outcomes) in providing case-based training for health care providers via videoconferencing with a team of specialists, and whether mental health courts affect rates of recidivism. Articles may be viewed online at ps.psychiatryonline.org.
Editor Lisa B. Dixon, M.D., M.P.H., and co-host Josh Berezin, M.D., M.S., discuss the dollars and cents behind a collaborative care intervention for perinatal depression, how individuals experience involuntary admissions to psychiatric hospitals, and how the use of psychotherapy relates to polypharmacy. Articles may be viewed online at ps.psychiatryonline.org.
In this inaugural episode of Psychiatric Services From Pages to Practice, Psychiatric Services Editor Lisa B. Dixon, M.D., M.P.H., and Podcast Editor and Co-Host Josh Berezin, M.D., M.S., discuss researchers’ inside look into medication management visits, discuss outcomes for forensic assertive community treatment (ACT) teams, and explore the issue of patients’ autonomy with first-episode psychosis treatment. Articles may be viewed online at ps.psychiatryonline.org.