Psychiatric Services From Pages To Practice

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 Subscribe to the podcast 

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 Subscribe to the podcast here. Check out Ed

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 resear

Dr. George Pro, Ph.D., M.P.H., joins Dr. Dixon and Dr. Berezin to discuss the downward trend in the provision of mental health services in Spanish across the US, despite the rapidly increasing Hispanic population.  Dr. Pro is an Assistant Professor in the College of Public Health at the University of Arkansas for Medical Sciences. How did you get involved in this research? [01:04] What are the demographic challenges and what do we know about services provision in this population? [02:20] The level of mental health care service utilization [04:45] Why focus on language access? [05:39] What did you find? [06:48] The National Mental Health Services Survey [08:25] National results [10:24] The importance of data visualization [12:39] Figures and how they convey information [17:02] Ohio and North Dakota: rate of change, not overall population [20:07] What are the limitations to this approach? [21:43] Communicating data to policy makers [23:26] What’s next for your research? [24:45] Figures from the article:  Fig

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] 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

Mark Savill, Ph.D., joins Dr. Dixon and Dr. Berezin to discuss using online psychosis screening data to see what can be learned about the population taking the assessment, what can be done to close the gap between screening and treatment, and to reduce the duration of untreated psychosis.  Dr. Savill is a professor in the Department of Psychiatry and Behavioral Sciences at University of California, Davis. What’s your background? [01:17] Prodromal Questionnaire Brief (PQ-B) [03:03] Duration of Untreated Psychosis (DUP) [03:40] What does the beginning of treatment mean? [05:22] How can the internet help to decrease the time from symptoms to treatment? [07:20] What are people looking for and what are they finding? [10:05] Mental Health America screening [11:00] Where does the PQ-B fit? What did you investigate? [14:33] Getting people into treatment – from A to B, or from A to L? [18:53] What did you learn? [19:50] The numbers [25:02] Further research [23:24] Subscribe to the podcast here. Check out Editor's Ch

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]

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