We need a mental health infrastructure bill [PODCAST]

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“As we slowly emerge from the physical withdrawal required during the pandemic, the emotional toll of this past year will become increasingly apparent. Complicated problems demand organized, financially-supported solutions. We need a mental health infrastructure bill now, and we need to start rebuilding.”

Jennifer Reid is a psychiatrist and can be reached at her self-titled site, Jennifer Reid, M.D.

She shares her story and discusses her KevinMD article, “We need a mental health infrastructure bill.”

 

This episode is sponsored by the Stanford Physician Leadership Certificate Program.

For the aspiring physician leader, leadership skills are one of the most important and influential traits that will elevate your overall success. 
 
Leadership impacts nearly every aspect of your career in a complex and diverse health care system. Including how you effectively communicate and influence those around you, how you respond to conflict and make important key decisions, how you develop your team, and even how you navigate social dynamics in your workplace. 
 
Stanford Medicine recognizes the need to foster physician leaders in health care. That is why they developed the physician leadership certificate program. This 6-month cohort-based program includes live virtual sessions, self-paced learning modules, professional coaching, a capstone project, and much more: Providing C-suite education for the non-C-suite physician leader.
 
They encourage all early career and aspiring physician leaders to apply. To find out more about the program or apply, visit physicianleadership.stanford.edu.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show we have Jennifer Reid. She is a psychiatrist, and her KevinMD article, which we’ll talk about today, is titled “We need a mental health infrastructure bill.” Jennifer, welcome to the show.

Jennifer Reid: Thank you so much for having me, Kevin. It’s a pleasure to be here.

Kevin Pho: We’ll get to the article in a little bit. First off, briefly share your story and journey to where you are today.

Jennifer Reid: Sure. I grew up in rural North Dakota, in a really small town there, and my father was a physician and my maternal grandfather was a physician, so really, it’s in the blood. Over the years I always wanted to do medicine, and I started in internal medicine but then realized that psychiatry, and the patient’s narrative, their story, was more intriguing to me. So I switched over. Now I’m affiliated with the University of Pennsylvania. I worked there for a number of years, and now I’m in private practice, but I’m also trying to do some of my own podcasting and writing and some of those things these days.

Kevin Pho: So tell us about some of the typical cases that you see in private practice psychiatry. What’s a typical day like for you?

Jennifer Reid: With the transition with COVID, I’m primarily based in my home office, which is what you see here. I have an office in Philadelphia, but primarily I’m home. I see a lot of working professionals, actually. I see a lot of physicians, attorneys, and people who are out trying to contribute to the world and are struggling with things like anxiety and insomnia. Those are primarily the two areas that I work on.

I also treat people with something called interpersonal therapy, so those who are having a lot of relationship conflict or have gone through a huge transition or grief and loss, and I do some writing about that as well. So those are my primary focus areas, and like I said, I see a lot of people who are out there working and just trying to overcome some of those challenges.

Kevin Pho: There is a pretty big shortage when it comes to behavioral health specialists. We have a lot of health professionals in training listening to this podcast. What are some of the rewards, and what are some of the reasons that they should go into behavioral health?

Jennifer Reid: I love that question. Yes, absolutely, we need more people to enter into it, and I think it is an increasingly popular and more competitive specialty to choose. I do think that the work-life balance is more readily obtainable. My sister’s a surgeon, as is my husband, and I see how many hours they need to put in, and they certainly can’t work from home in their sweatpants on some days. So I think there is a nice work-life balance.

But as far as the interest in the area, there’s the growing field of neuroscience, and some of the epigenetics involved in the intergenerational transmission of trauma and some of the challenges we face there. Certainly our treatments are improving, but I just think it’s such a fascinating and growing area. Neuroscience is certainly very high on the list of areas where we’re doing some of the most interesting research.

I really love the way that I can see and help people over time, and really not only help an illness but help their entire being. You really see them, especially coming out of depression or severe anxiety, coming to life again in a way that I just didn’t see in any other specialty. Obviously I’m partial to mine, but I do think it’s one of the most exciting specialties that people can work in. You really can help, and you can do a variety of things. Look, I get to see patients, write, do a podcast, contribute to different things, and do a lot of teaching. It’s a nice way to have variety as well.

Kevin Pho: All right, so let’s jump right into your KevinMD article. This was published last year. It’s titled “We need a mental health infrastructure bill.” Now, for those of you who get a chance to read your article, just walk my audience through it. Share the story of why you decided to write it.

Jennifer Reid: I think it was really from thinking, certainly during the pandemic, as you were hearing in the general media about the shortage of providers and increasing rates of anxiety and depression and insomnia among all ages, particularly our youth, but all ages. It just got me thinking about how we reach a broader set of individuals with evidence-based, high-quality information about behavioral health, because I think there’s also this growing movement for wellness in general that isn’t necessarily based on evidence-based treatments.

So I was thinking, how do we find different ways to reach more individuals with some of these treatments? Because I see how beneficial they can be. I see how even a conversation with someone who comes in to see me with panic disorder, just explaining what’s happening physiologically, makes a huge difference for them, and they may have been coping with this for years and years.

So the idea was, how do we spread this information? What are the challenges that we’re facing as these numbers continue to diverge, the number of providers versus the need? And also, what are the different ways we can increase the number of providers, and why is that so important? Not only is it inherently important for mental health treatment and for people to be mentally well, but also even just economically and financially, right? You think about depression, you think about the lost days of work and some of the disability associated with that, you think about our overall GDP. If many of our citizens are struggling with mental health issues that are under-treated or untreated, that can cause a massive challenge economically as well.

So I was just thinking about the different structural pieces in place that limit the number of providers and that make it difficult to reach them, certainly in certain areas like rural North Dakota, where I grew up, but also just thinking about how this can affect things more broadly, so we can get buy-in from leadership that, look, we need to make some changes here.

Kevin Pho: So let’s go into more detail in terms of the limitations that you mentioned. You said that there are a lot of limitations on the number of behavioral health specialists out there. Talk more about that.

Jennifer Reid: I think within psychiatry we are dependent on the training programs and the openings for resident positions, and it is costly. Each program is trying to weigh the cost of adding its own resident slots if it needs to, but really we’re trying to get federal support for these increasing numbers of residents who are coming in.

I think another challenge, though, is just generational. Many of the psychiatrists who are out there practicing are in their 50s, 60s, and 70s, so what’s looming is a mass retirement of a number of different providers there. And, as you asked me to speak to at the very beginning, how do we encourage our young providers, or those in training, to go into psychiatry?

I think another challenge is that there is the law for mental health parity and insurance coverage, but honestly, the reimbursement rates at this point make it very difficult to sustain practices without really scrunching a lot of patients into a short period of time and potentially lowering the quality of care. So I think that’s another area. If someone’s coming in and they want to go into psychiatry, and they want to have their own practice, and they have a huge number of loans coming out of medical school and undergraduate, for example, it’s very hard to choose that and thrive and be able to pay those things off if you’re accepting insurance. That really decreases the access for so many patients who understandably need to use their insurance coverage for mental health treatment. So these are some little pockets of things that can be really big problems that I’m seeing over the next number of years.

The last one I would just touch on is burnout, physician burnout. One of my colleagues, Richard Summers, published a paper that really looked at who was struggling most with burnout among psychiatrists within our specific field, and it seemed like those who were younger and in training, women, and minority trainees are having more difficulty with burnout. That’s also worrisome, because we really want to try to increase both gender and other diversity within our trainees and future providers.

Kevin Pho: One of the things that you mentioned earlier was evidence-based psychiatric therapy. Are you seeing behavioral health treatments that aren’t evidence-based? How big of an issue is this?

Jennifer Reid: I think that there’s just a lot of misinformation out there, in that people who may not have a background or training in some of the specific diagnostic criteria or treatments that really have been studied are out there describing things like supplements. Certainly nutritional psychiatry is its own growing field, but to say, in isolation, that you can just eat these certain foods or really optimize your microbiome and then you don’t need to be on medication, I think some of that misinformation is worrisome.

And I think that there are things that are portrayed in the media, like a big paper recently saying that the neurotransmitter theory around depression was a little bit debunked, that it’s not a decrease or an abnormality in the amount of neurotransmitters like serotonin you have. But that was oversimplifying the diagnosis, or ideas of the etiology of depression, in the first place. So I don’t want that to make people out there who don’t really know how to interpret it think, “Oh, I should just stop my medication. They don’t really help anyway.”

So I think that’s where I’m struggling a bit, with some of the different pressures that are out there for patients who are trying to navigate a complicated system, and their family members, for that matter. They don’t necessarily know, “How do I parse out some of this disinformation I’m hearing?” And maybe they don’t have access to a trained mental health provider who can help them debunk some of these myths around their symptoms.

Kevin Pho: Now, if you were the architect of a mental health infrastructure bill, what would be the specific components that you would definitely want included?

Jennifer Reid: Great question. I think one thing we really need to try to optimize is having realistic reimbursement rates for care, so that we can really increase the number of providers who can truly sustain a practice that’s insurance-based. Because, of course, patients want to use their insurance to cover their mental health treatment, and so a lot of them are really boxed out.

How do we increase the number of providers? I think we do need to increase residency slots. I think that there is certainly an increase in nurse practitioners and physician assistants and others who are stepping in to help in this way. I think perhaps a little bit more structure could be in place for psychiatrists to really work at the top of their license and maybe even oversee some of these other providers, like they very much do in some of the other specialties.

How do we find a way that a psychiatrist could maybe consult across different areas? So there’s the idea of building psychiatrists embedded in other health practices into the structure, and this is increasingly happening in different academic centers around the country. I was embedded in the family medicine department at Penn for a number of years and was able to help them with their different medication choices, so they didn’t have to refer out to mental health as quickly, or maybe they were able to manage the meds themselves with increased confidence, because I was saying, “Yes, you can start lithium. Let me just help you get started. Here are some of the tricks and challenges that we can try to address.” So I think some of those areas are certainly where I see that.

And with social media, boy, that’s a much bigger issue, right? How do we protect our kids? I know there was a bill being worked through on getting our kids safe from a social media perspective, and some of the different limitations we could place in those areas. That’s a much broader topic, but I do think that we’re going to need to address some of the information that they are receiving, and some of it’s pretty scary, on social media and other online avenues.

Kevin Pho: We’re talking to Jennifer Reid. She is a psychiatrist, and her KevinMD article is titled “We need a mental health infrastructure bill.” Jennifer, as a primary care physician, and sometimes, like you said, we just don’t have access to behavioral health specialists in a lot of areas of the country, what are some specific things that I can do as a primary care physician to improve my behavioral health treatments? What are some high-yield things that primary care physicians can do?

Jennifer Reid: There are a couple of things that I really focus on that I certainly could recommend, and that would be really targeting anxiety and targeting sleep. Start with sleep. First of all, primary care providers, like I said, my father and grandfather were both primary care, and I so admire how quickly you can go through all these different body systems in your 20-minute visit, or whatever it may be. So I recognize there’s not that much time, for example, if someone comes in with a sleep complaint, to really go through a full sleep assessment. I may have the luxury of that time in my longer assessments.

But I think it’s about recognizing some of the pros and cons of medication for sleep, and knowing that ideally they’d be used right away and for a short period of time, but having some other recommendations and other avenues, looking into the idea of CBT for insomnia. I honestly think every primary care provider should do just a training course in that, maybe a day or two. It doesn’t take long. There are some great providers that I work with at Penn who do this teaching. And I think it’s just having some of those basic tenets: “Here are some simple things that I want you to try to do to help with your sleep.”

Because we know that sleep deprivation, and even insomnia, increase rates of other mental health issues, increase relapse rates of mental health issues, and can also increase rates of many other general health issues, so metabolic issues that people have. They can lower your immune system. It can increase inflammation if you’re not getting adequate sleep. So that’s one area that I think could be really high-yield: What are some basic tips that you can give patients that reverse what so many of them do when they start having trouble sleeping, like staying in bed a lot longer, or doing multiple different things in bed, or some of the things that people inherently try to do to sleep better, like using alcohol, which is self-defeating for sleep? So I think that could be really important.

And also, just the basic physiology of panic disorder, being able to explain to a patient what’s happening in your body: that this is absolutely normal, it’s just triggered at the wrong time, and it doesn’t mean that there’s anything going wrong. People come and say, “I must be going crazy. I’m having these panic attacks.” And look, we just have a really sensitive signal. How do we explain what that is, and how do we find ways to start re-exposing yourself to things you were maybe previously avoiding? Because avoidance is going to lead to more anxiety.

So those are two key things, and some of the things that I try to talk about on my podcast, or interview people about on my podcast, to see if I can get that information out there. And podcasts are free, right? This is a great modality to spread it, even around the world. So I think that can be really helpful too, to listen to some of those different podcasts that are out there.

Kevin Pho: So you’ve made a transition as a physician into the social media and podcasting world to really elevate your platform and elevate your voice, so you can share your message outside of the exam room. Give me an example of how that moved the needle to spread your message.

Jennifer Reid: Certainly. I think it’s the podcast, having thousands of listeners who are listening to different interviews with people who maybe are working in academia. I had a lovely interview with a woman at Columbia who does cannabis research, and she just talked about what truly is known about cannabis, what sort of studies have actually been done, and how much of what we’re being told in the different dispensaries or different medical marijuana clinics is truly what has been studied in a scientifically rigorous way. So in that way, it’s just getting that information out there.

But it was a conversation. I’m not a very formal person, so it was just a casual chat, and I think that kind of way of absorbing information is good for me. And I think many people appreciate that, people who would never pull out her journal article and go through and read it or understand the statistics. So in that way, I think it’s me with the podcast, talking about insomnia, doing one specifically about anxiety, sharing the things I share with patients every single day, as a way to try to reach more people that I simply can’t see one-on-one in my office.

And then I also think it’s the writing. There’s another article I’d submitted to your site, which I think is terrific, by the way, for elevating physicians’ voices. It’s so helpful and so nice, and I love to read it myself. It was about physician mental health, and writing about that helps me to process some of my feelings about it and understand them. I can also send it to individuals who are having some similar challenges and say, “Let’s see if this resonates with you,” or, “Let’s see if you have any comments on this.” So it just broadens the access. And I think the availability, and also the egalitarian aspect of podcasting and writing, where people can access this information for free, feels really good too, because then I think maybe I’m being a bit of a part of that solution to a provider shortage.

Kevin Pho: My final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Jennifer Reid: One thing I always say is that your mind should be on your side, and I think that’s what I run into with a lot of people struggling with anxiety, with insomnia, and with self-confidence issues, certainly people in health care, physicians who are really feeling such a sense of responsibility even for things that are broadly beyond their control. When you’re starting to battle with your own mind, that can really make it difficult for you to be out front doing your best work.

So I think about these different ways of helping, sharing tips on anxiety and tips on sleep, as making a healthier population that’s going out and solving some of these huge problems that I can’t solve myself, but that I worry about, or that I worry about for my kids or the next generations. So I think trying to get your own mind on your side can be such a powerful change, whether it’s coaching, whether it’s therapy, whatever it may be. I really encourage people to check it out.

Kevin Pho: Jennifer, thank you so much for sharing your time and insight. Thanks again for being on the show.

Jennifer Reid: My pleasure. Thanks for having me.

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