Psychiatric Services From Pages to Practice

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 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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 Background02:46 Provision of school mental health09:56 How mental health services differ between ages and grades11:08 COVID pandemic and youth mental health15:29 Federal funding mechanisms18:39 Using the funding while it’s still available22:10 Partnerships in school mental health23:00 Medicaid27:11 Medicaid billing and complications for school systems28:47 Technical assistance for schools30:07 Data systems33:49 Temperature check 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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. 03:04 Homelessness in Los Angeles County, California09:04 The paper and services11:39 Lanterman-Petris-Short (LPS) conservatorship13:44 Outpatient conservatorship (OPC) pilot program15:54 Skepticism18:48 Beyond conservatorship: other aspects of the program22:34 Initial evaluation25:21 Quantitative measures28:33 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. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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. 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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. 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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 aFeeling 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 Oregon 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 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. 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] See the Psychiatric Services Editor's Choice collection, "Responding to the Opioid Crisis." 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

Lauren Southwick, M.P.H., and Sharath Guntuku, Ph.D., join Dr. Dixon and Dr. Berezin 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 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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. 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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. 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

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. 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. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org