In this third - and final - installment of our mental health series, Stan and Clarence chat with Dr. Mike Trangle about mental health policy implications.Join the conversation at healthchatterpodcast.comBrought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships. More about their work can be found at http://huemanpartnership.org/
Hello, everybody. Welcome to Health Chatter. Today's show is the third in our trifecta of shows on mental health, and we're going to be focusing on policy implications, which is an interesting twist when you think about it as it relates to a medical-oriented condition. So we'll have some interesting insights with our illustrious guest, Dr. Mike Trangle, and we'll get into that in a second.
Of course, I'd like to thank our great crew that's second to none. And I keep saying that, and I'll continue to say that because they really are. Maddie Levine-Wolf, Aaron Collins, Deandra Howard, Sheridan Nygaard do our background research for us, help us with recording from time to time. And Sheridan also does our marketing for Health Chatter. So thank you to all of you. Matthew Campbell,
Without his logistical production expertise, we would be lost. So thank you to him for getting our shows out in great fashion. And then also I wanna, especially thank and always thank Clarence, Clarence Jones. This has been a fun endeavor. We continue to enjoy it. We always say that when we stop having fun, the show will stop. But I don't think that's going to be a problem.
I really, really don't. So Clarence, thank you. And then finally, Human Partnership is our sponsor for these shows. They provide some really good insights for us. And our community, organization that's really involved with health issues, a great, great community partner. And I recommend that everybody check out their website at humanpartnership.com. With that, let's get the show going.
We have Dr. Mike Trango. And as I mentioned, this is our third show on mental health. We probably, and Mike can probably attest to this, we probably could do a bunch more And who knows, we might do that coming up. But we've talked about other aspects, the clinical aspects and the problematic aspects of mental health. And so today we're going to be talking about policy implications.
Dr. Trangle has an illustrious career in dealing with mental health. And he keeps a real positive attitude about it. And it's greatly appreciated. He's a distinguished lifetime fellow of the American Psychiatric Association, a media past president of the Minnesota Psychiatric Society.
He was on the National Quality Forum Standing Behavioral Health Measurement Committee, participates in a lot of policy-oriented issues around mental health, certainly in the state of Minnesota, and is noted nationally to provide some insight as well. So Mike, thanks again, really. Greatly appreciate you being with us today.
You know, when I was president of the Minnesota Psychiatric Society, it wasn't immediate. It was a few years ago now.
A few years. Okay. So it wasn't immediate past. It was in the past.
Yeah.
But nonetheless.
I'm over my PTSD from it.
Okay, okay, okay.
Great.
So thanks for being with us. So, all right, let's get this one going here. You know, this is kind of the angst that I have felt around health issues as it relates to policy. There are some health-related issues that get a lot of funding. They get a lot of research dollars. et cetera, et cetera.
And, you know, I certainly can relate to that, you know, when I was dealing with cardiovascular issues at the state health department. But there always seems to be an angst or a disconnect between truly what is needed in the mental health arena, and God knows we need help in this arena, and those particular policy needs. So Mike, to kind of get this going, do you sense that as well?
Do you see that it's a harder sell for mental health issues from a policy perspective than perhaps some of the other clinically oriented issues and diseases and manifestations that we all deal with?
I mean, I think that's an understatement. Understatement, okay. So not only do I agree with that, I think it really is understated. And I don't know how to say it exactly, but I don't want to be redundant from what I said on one of the earlier podcasts we did. But I mean, there are certain things, if all of a sudden you have a heart attack or something, it may scare you and make you anxious
Um, but it's not taboo to talk about it, you know? Yeah. And you can, and I think mental health stuff, not so much substance abuse disorder. I think that's just plain discrimination and you have to, uh, buck up and try harder. And it's a character flaw in, in, in the myth, not in reality, you know? Um, but for mental health issues, um,
it's just scary to people and they want to deny it or suppress it or not want to talk about it and they they don't even relatives you know historically even though it's better now want to avoid any shame or stigma associated with it and it's sort of like uh uh you know it was avoided more than anything you know let alone research you know um and it wasn't like it was uh um
the gun lobby you know the tobacco lobby saying you can't research we're going to put that into federal law because of politics and uh financial districts you know interests it was more sort of widespread than that so you know you've been in the field a long long time has it
Has it gotten better?
Yes, it has gotten better. We now have much stronger lobbying. And I think in some ways, the strongest lobbying for sure in Minnesota is NAMI, the National Alliance for Mental Illness, mainly composed of folks that are family members. And they've been empowered and have done a superb job of speaking up about those issues. I may have a little vested interest.
I've been on the board of NAMI for a while, but even before it, I was admiring them and stuff and speaking out. And the other kind of powerhouse nationally, a little less so in Minnesota, but up and coming, is nationally it's the Mental Health Association, which is composed in some sense with a higher proportion of people with lived experience, as well as others that are interested parties.
Here, the chapter in Minnesota is called Mental Health Minnesota. Renamed, but also sort of, they're finding that people listen to them and seek them out and are more interested like in Mental Health Minnesota in the old days doing surveys. What do you think?
There are ambassadors who can speak to the experience to both in different chapters throughout the state and let people know whether it's county employees or mental health providers. There are advisory groups that are getting more potency. And it's really important that that happens.
So, Clarence, before I pass the baton to you, it's like you're involved in the community a lot.
Mm-hmm.
And I can't help but think that you see some of these true mental health issues. So besides, you know, some of the thoughts that you have in general, you might want to add that into the equation here.
Yeah, you know, that's actually my question here is, how is mental health impact measured? Because I think that part of... What concerns me, I think you use the term, it's understated. I mean, you talk about funding and things like that. How do they measure that?
Because as a person, as a community member, I see a lot of issues that I'm not quite sure that we are really gathering what's really going on. So how is mental health issues impact measured?
So let me just dig into it here. So in 1996, more than a few years ago, in the federal level, there was a Mental Health Parity and Addiction Equity Act that was passed. It took Congress more than 10 years to actually come up with rules of how are they going to define it and how they were going to try and see if anything happened.
You know, and then they came up with rules that sat on a shelf and nobody noticed. Then in 2008, this is where Wellstone and Domenici came up and they passed the, what was it technically called? The MHPAEA, very, very sexy title, but Mental Health Parity and Addiction Enforcement Act, you know? And came up with stricter kinds of things to try and enforce it. And it also didn't get enforced.
Like a year and a half ago, two years ago, they did an audit, which was a joint audit, looking at health plans and seeing if they were actually complying with the treating mental health issues and substance use disorder issues equally, and found that no health plans did in the nation. This was a joint study done by Department of Labor, HHS, and what was the other department?
I don't know, it's in my notes here, but there were three, labor, health and human services, and commerce, that's the other one. And basically no health plans were doing it. It still wasn't being enforced. Minnesota came up with a law that got passed and also isn't being enforced much.
You know, Minnesota got a grant maybe three, four years ago, a one-time grant to hire somebody to try and look at enforcing parity. And the first thing they found out, this was through the Department of Commerce, was that nobody even knew that Commerce was involved. We all fought to complain or let them know if there were problems or issues.
And with this dedicated person, they started getting the word out there and they started getting some complaints and we're now seeing some, and then that grant went away. So the dedicated temporary kind of person to work on that went away.
And commerce tends to be a small department with a lot of, unlike other departments in the state of Minnesota with a lot of duties and not enough people to do it, to do the duties. And yeah,
One of the things that I and NAMI and Minnesota Psych Society lobbied for was, and it finally happened, was to come up with dedicated funding to have basically a two-person department called the Enforcement Department within Commerce, which hasn't started yet. It's supposed to start next January.
But if you notice, Minnesota had earlier this year did an enforcement action with a fine against health partners. And more recently, they did it against, who was it they did it against more recently?
Was it Alina?
Yes. No.
Okay.
No, it was a health plan. It was either Medica or Blue Cross Blue Shield. Yeah. But they didn't know their enforcement.
Yeah, yeah. So I want to do a follow-up question really quick, though. So what does this policy confusion have to do with the impact on health? I mean, you know.
Well, how do I want to say this? You guys have a core of researchers and you care about data. And you want to factually base whatever opinions you come up with. Correct? Correct.
Yes.
Yes. I think that hasn't been done in mental health much. It hasn't been measured much, which is what one of you were saying earlier, right?
So, you know, when you really think about this, it's like, you know, first of all, what comes to my mind, Mike, is how does Minnesota compare like with other states around the country? Are we even though you're describing here a not too good situation, are we still maybe a little better than what's going on in other states?
Or is everyone, you know, all the states kind of fumbling around trying to figure out what's the best way to get this thing going?
So there were measures that came out in 2023 from Mental Health America, which is the consumer-based association that I talked about. And if they look at adults, Minnesota is ranked, and this is in, they're trying to look at the prevalence of mental illness, which tend to be, as well as how high your access is to get care for people and whether they get better.
Okay, so they have a series of measures looking at prevalence and access. In that, I'm scrolling through here. In that one, Minnesota was ranked number one is the best, number 51 is the worst. Minnesota was number 36. And looking at the same thing for youth in Minnesota, Minnesota was 21.
in looking at just the prevalence of mental illness, which I think if you think about it, is how much is going on at this point in time. So you might have people that got depressed, but got treated and got better. And then it wouldn't be, our prevalence rate would be a little bit lower. And in that ranking, we are number 41, even worse.
Wow.
And access to care, which I think is hugely important. Right. And you look at how many adults could just, who had things but did not receive treatment, who report having an unmet need, who are uninsured and then have a harder time getting access, who are living with more than 14 plus days in a month and could not see a doctor because of costs.
Or, you know, basically, so it's people that really need help and aren't getting it. Minnesota is 14. So a little bit better than that in access.
All right. So who's, Clarence, I'll get to you in a sec. Who's kind of like the best in the country? Is there a particular state that's kind of? ranking up there, like, I don't know, Hawaii usually gets some good rankings, you know, on health-related issues, but is there one that sticks out that- Yeah, let me look it up here.
You know, perhaps could be a model to help, you know, other states get the ball rolling here a little bit? Clarence, and I'll let you chime in in the meantime here, too.
Yeah, I was, yeah, I think that, thank you for those rankings.
In the overall adult rankings, they vary from state to state. It's not like one is good in everything. Yeah, right. So the overall ranking, Wisconsin, Pennsylvania, Massachusetts, Delaware did okay.
Okay.
The worst ones were Kansas, Oregon, which is a little surprising, Arizona, Alabama. Yeah. Yeah.
And we're kind of middle of the road from what you're saying.
Go ahead, Clarence. No, I was very interested in terms of the ranking because mental health is one of those issues that we talk a lot about in the community. And the unfortunate thing is that it's that many people, when they talk about it, they're not sure what to do. or they talk about access and things like that.
And so this kind of conversation I think is very, very important for us to understand about health policies and how and why we should be involved in them. I mean, if we're in this kind of situation, we need to be more involved. And from a community perspective, we need to be more involved in it.
You know, can I just say one thing? You're right. We do need to be more involved. But when you compare that to the general medical rankings, which are a little more consistent. Right. You know, Minnesota does really pretty well. If you look at longevity, we're one of the top ones.
But but there are there are consistent states that basically have better access and better quality and better ways to get people in to help them get in Massachusetts. Minnesota, Wisconsin, some other New England states, Hawaii tends to do okay there. But in mental health, we're at best just average.
Yeah. You know, it's interesting because it's, you know, in many things, you know, Minnesota is... is pretty good health-wise, but this is a consistent thing. We have disparities. We have problems with access to care. And so I'm sure, correct me if I'm wrong, Mike, that that rings true in the mental health arena as well, access and disparities.
And I was going to say the same thing too, before you answer it, Mike. is that I think that you're right. While those rankings are high or those rankings are what they are, I think in communities, especially other communities, it's a lot worse. And that's why this conversation is so important because it is a consistent conversation that comes up, but it's like, how do we enter the conversation?
How do we answer the question? What can we do? And I believe that this kind of conversation helps us to to rethink or to, you know, hopefully to incite people to be more concerned about the public policies and to work towards getting better access for these services.
Yeah. You know, It's so multifactorial. But if you think about it, just in the U.S., compared to other countries, other countries may have national health services and everybody gets access to care, it gets paid for. The U.S.,
is all over the map and depending what's going on with state legislatures and politics and whether you don't wanna pay for stuff with taxes, you know, less people get covered by insurance, it's harder to get into MA, there's less money available for disability kind of wraparound services and stuff.
Um, so, you know, in Minnesota tends to, in terms of social support compared to the whole vast U S tends to be, tend to have a sort of a little better safety net for mental health, social services. Um, uh, but, uh, and a little, and more people here tend to get insured one way or the other Minnesota care covers the working or, you know, some of that kind of stuff, but what's available.
But but it's still we don't even think about it. It's like the air we breathe about how the population in the U.S. is stratified by wealth, by whether you're employed, whether you can qualify for M.A. or not, by whether your county is a richer county and chooses to sort of have more county based services for things. And it's not that way so much for medical things. Yeah.
It's worse, you know, and traditionally it's changed, but traditionally it's been, even if we might pay for medical stuff, we would pay less for mental health, Medicare, you know, the national thing was 80% paid for, for medical and 50%, you know, until about 15 years ago, you know? And yeah,
you know, chemical dependency services weren't paid for at all, you know, and how hard or easy you make it to get into those services. And the other thing you think about is, how do I want to say this? In mental health, the tradition has been If you have a problem, you have to prove it's a bad problem. You've had it for a while before you'd have access to services.
Not at all like, I had a heart attack and I need something. My leg, I need rehab services. Here you've got to prove that it's bad, it's serious. Much worse than for medical things. It's always been sort of unfair. And it's just...
And certainly, based on some of the information that our great staff have provided here, mental health issues more than likely will lead into other health-related issues. So it's like they go hand in hand here. And it's like, all right, what's going on? All right, so here's... Before I get out, you know, for the listening audience, I'll give some of these statistics that we're seeing lately.
I mean, and I'm sure this has even gotten worse during COVID, for instance. But all right, Mike, I really need an opinion from you. If you had a magical wand in your hand right now, where would you focus mental health, policy out of the gate. I mean, based on your professional experience, what would you really like to see really move? Call it a priority from your perspective.
You know, I think I agree with what Biden was saying. You know, he did a thing like a week ago or whenever it was. And he said, one of our priorities is to really enforce parity. And we're really mean at this time, even though it's the fifth time around and it's been meant, but not really enforced, not really followed up on really for at least 20 or 30 years. It's been lip service. Yeah.
And I don't know exactly, the Department of Labor is now soliciting feedback on how they wanna sort of really mean at this time and enforce parity. And one of the things that they're highlighting in what they're proposing at least, they're still getting feedback on it is, Every health plan has to have a statement of purpose on what they mean by parity.
They have to have clear definitions on what limitations are and why. And they have to have a written analysis comparing the limitations and measuring it. and measuring outcomes. Although in a funny way, outcomes are, you know, historically have been weird. You know, it's like, how many people have we covered on this or something? It's a raw number. It doesn't give you a percent of the population.
It doesn't compare you to medical. How many people get in? How long do you wait to get in for X, Y, or Z? You know? And if you don't measure it routinely, you don't know where you're at. And if you try to improve it, you won't even know what parts are improving and what parts aren't improving.
You know, so one of the things that we proposed, for example, here, we being sort of a consortium of mental health folks, is what we proposed and didn't make it through the legislature. The only thing that really made it through the legislature, not the only thing, there were a lot of things that made it through the Minnesota legislature. But one of the things we proposed that didn't was that
Everybody that's paying for mental health services and CD services should be measuring how long it takes to routinely get in, not in emergency cases or urgent cases, how long it takes to get in and whether you can get back in in a timely way. And it should be compared to the medical services.
So if I'm waiting to get in to see a psychiatrist, it shouldn't be any longer than it takes me to get in to see a primary care doc or an orthopod or a heart person. You know, dermatology is hard to get into these days. Right. Yeah.
Dermatology.
But we're worse than dermatology. At the same time, at the same time, we've been proposing that we sort of in a supervised safe way, expand the workforce so that we're including nurse practitioners. physicians assistants that have specialized training in, in psychiatric behavioral health issues, both mental health and substance abuse issues.
And that we measure that and compare them to nurse practitioners in medical surgical kinds of places. We're proposing your measure. If you break your leg, how long does it take in to get into a rehab or a transitional care unit? We should do the same thing that people are now sitting on inpatient psych units waiting to get out, but they're not safe to go home.
How long they're waiting to get into a foster home, how many they're waiting into a residential treatment center, those kinds of things and compare those. And I think doing that, that expecting the health plans to improve, we said by 25 percent each year until they're within 10 percent of what it takes to get into the medical surgical would really go a long way.
You know, so let me ask you, get in. You're not going to get help. You're not going to get better.
Exactly. So let me ask you, you know, your dear colleague, Nico Prank was, you know, the co-chair of the, of Healthy People 2030, the objectives for the nation. Okay. So I don't know if you're, you're familiar. I know I'm not off the top of my head, but you know, from the mental health standpoint I'm, I believe they at least touched on this idea of parity.
Okay, but even still, an objective for the nation by 2030, you know, my feeling is can we wait that long? And I really don't think we can. I think we've got to get our acts together and get moving.
Yeah, I mean, more and more people are dying for lack of getting in and getting what they need.
Exactly.
And like we talked about earlier, we're sort of in a period where the percentage of people with anxiety, worsening anxiety and depression is skyrocketing. Suicides are going up. We know that deaths of despair from sometimes intentional, sometimes accidental opiate overdoses are increasing majorly. I think the urgency is there. It really is a crisis.
I appreciate that. That's kind of my next question, which is, I don't have a magic wand, but I do want your opinion about this. What did COVID uncover about mental health conditions in this country?
Yeah. How do I want to say this? I mean, COVID... isolated people, remove them from their normal habits, less exercise, less going to work and getting whatever social supports you might from colleagues there, as well as more pressures. One of the things that showed, though, was that for mental health and for substance abuse disorders, video or just telephone, audio only, can be a lifeline.
You know, there was a surge in kind of telehealth, both audio only and televideo. And the surge has sort of gone down and it waxed and then it kind of waned, except for behavioral health, where it stayed right up there. I was the immediate, unlike for the psych society, the immediate past chair of the Governor's Mental Health Advisory Council. And we heard in spades there, it just...
how crucial it was, especially for people that had substance use disorders and their group stopped because of COVID, but being able to talk to somebody, whether it's televideo video or audio only was a lifeline for many of them. And it just kept them alive. They, they didn't relapse as much. They didn't overdose. Uh,
And it was the same thing for people that were rural or old people that aren't technologically sophisticated and couldn't get televideo stuff going or didn't have good internet. That really is hugely important. It doesn't replace, it's not an either or, but your internet is on the fritz. If you can talk to somebody on the telephone, it can, it could just be so helpful, you know?
Exactly.
When do you use it? But having it in your armamentarian is, and having it in your armamentarium in a way where it's not more costly. During the pandemic, televideo was paid for at the same rate as face-to-face. And when that emergency ends, some health plans are talking about paying less for it or not paying for audio only or paying less for that. I hope that doesn't happen.
There's been an emergency extension, but that question is going to get called and hopefully people can band together and say, don't shortchange people. It's necessary. Absolutely. Behavioral health problems.
And that was kind of like my follow-up question too, is that there has to have been some learning that will be applied to public policies around mental health? I mean, you just talked about the telehealth and the importance of that. And I don't understand if it was working, why would they take it away? Or why would they penalize people for utilizing something that we know worked?
I'm gonna answer this uncharacteristically, a little more diplomatically than I sometimes would. This is health chatter now. You can say what you need to say. I'll do both. I think there's a reason to sort of, I think there are always a few bad apples. And there are a very small number of people that try to do fraud and abuse.
And many of our payment systems, whether it's Medicare, whether it's Medicaid, whether it's private insurances, are always on the watch for that. And I think it's been overdone, over claimed, and there are all these rules and regulations to try and catch these things.
And I think they cause, I don't think you can ignore it, but I think it's made it much more difficult and scary for people to try and do it. And because of that, you're always have some tension to be about how do we avoid that? How do we enforce things? But at the same time, how do we make it easy enough for people that need it to get in?
And that caused too much rigmarole and this and that and steps and delays and weights and barriers. And I think we are far more people harmed by the barriers than we do by catching fraud with our existing systems. Yeah, no kidding. And I. and how do I want to say this? Nobody wants, you know, healthcare is getting more and more expensive for everybody. And how do you keep the costs down? You know?
And once again, I think we've done a much better job of keeping the, I think we've done a poor job of keeping the costs down, but even a better job of screening people out and limiting what they get.
yeah yeah in in the pursuit of trying to keep it affordable and not hitting sort of the the uh um classic things you don't think about that are really problematic you know like uh looking at costs you know and trying to figure out how do we keep how do we keep them down whether it's uh um
all the things with the, all the sort of like hoops we have to jump through, how many people have to, how much time, effort, energy goes into sort of doing that, the delays that go into that. It's a very costly part of our system. And I don't know.
You know, I'll be honest with you. This is kind of where, you know, it's very, very complicated. There's a gazillion variables, as you noted earlier, Mike. But Here's the bottom line, as far as I'm concerned, somebody presents themselves desperately needing help. Okay, if they're able to even get to that point, desperately needing help with some mental health disorder, it's like,
When they're in that state, I can only imagine that they don't care about all this other stuff, the research, and they don't care about the numbers. I need help now.
I need to see somebody good right away.
Exactly, exactly. And it's like, what the heck? Why is the system so unnecessarily burdensome and broken? to the point whereby that person cannot get help.
And it's more broken in behavioral health, I think, than anywhere else around.
I tend to agree. I mean, you know, some of the numbers here, this is insane. 2019, nearly a billion, this is worldwide now, nearly a billion people, including 14% of the world's adolescents were living with a mental disorder. This is insane. This is unconscionable, I believe.
People with severe mental health conditions die on average of 10 to 20 years earlier than the general population, mostly due to preventable things that can help them. I mean, it's just insane. In Minnesota, I think we might've mentioned this in one of our previous show, but it's worthwhile stating it again.
In 2023, 28.3% of adults in Minnesota reported, this is close to a quarter, one in four people reported symptoms of anxiety or a depressive disorder compared to 32% in the United States overall. All right, so we're maybe a little better, but not good by any stretch of the imagination. And I believe that we're going to see other major issues that affect our health overall, like another pandemic.
It's inevitable. We'll see that. And guess what? Mental health will be greatly affected if our history, based on this one and previous ones, bears us out. So it's like, I feel so almost helpless as a healthcare provider trying to provide some insight for people that really need some mental health expertise. And where do people begin to even start?
Yeah. Let me ask this question really quickly and we'll get back to your question, Stan. When I think about mental health, I think I have a very global perspective of what that looks like. Okay, I think I have this broader worldview is that, you know, it's somebody that truly acts out with behaviors that are noticeable.
But I want to ask the question about what are the other conditions that people don't identify as mental health issues that we should be making people aware of from a community perspective? Am I making sense?
Yeah. I mean, the ones that people notice, you know, are somebody that has a psychotic episode and acts strange and scary, talks to themselves. But in a lot of ways, if you're depressed, you know, most people, not, not, not everybody, but most people kind of shut down, you know, and, and they, they, they lose their, they lose their optimism. They lose their energy. Their sleep is affected.
They're, they get totally pessimistic. They, they may show up at work, but not think or do anything that speak up. They may just stay at home and they sort of fall into isolation and you may not know them because they're not, you're not seeing them anymore, you know? And, and, you know, um, how do I want to say this?
Uh, there's such an interrelation between people that I, I'm a, I'm a woman and I get depressed. You might be a little more like a woman that's really upset about something. You may be a little bit more likely to get depressed. If you're a guy, you might be drinking more or using drugs more. And it shows up that way, you know, it's cause and effect both ways, you know, but, uh, um, and, and, um,
You know, we don't really have a good way of measuring all the suicides. It's always undercounted. You know, some car accidents, some overdoses, you know, that kind of stuff. It's they're not really accidents always, you know. Yeah.
So how do we help people? How do we help people identify these issues? Because I think that, you know, for some some some behavior people just say, well, it's just normal. You know, I mean, you talk about drinking, you know, well, you know, everybody drinks, you know what I mean? So how do we, as a community member, I'm asking this question as a community member, okay?
I think people, how do I want to say this? People are reticent and avoid asking people because of the shame and stigma and just discomfort.
And, and if you have somebody you care about and you kind of know, I think it would be great if you sort of say, you know, I noticed you're not your normal self these days, you know, it's something going on or, you know, you're doing okay, you know, and, and just shut up and listen, see what they have to say, allow them to talk and, and, um, You don't have to cure them.
You don't have to this and that, but you don't. Most people welcome being asked and somebody reaching out in a sort of a supportive, neutral way. And then maybe you can problem. You don't have to cure. You know, you don't have to be an expert, but you can reach out, let them know they're not alone. You notice something could be an entree. Maybe you should get some help.
But if you don't reach out and just sort of try to begin a conversation, not in a blaming, shaming way, but in a supportive, I care about you way.
You know, I think that's the way to start. Yeah. As you were talking about that, I thought I think about how we greet each other. How are you doing?
Exactly. You know, you know, and actually ask them what they how are they doing?
Yeah.
Not like a nice weather.
Exactly. Exactly. Exactly.
You know, I got I got a great little sidebar story on that one about two, three months ago. One of our neighbors down the street, I saw her walking on the sidewalk and I knew that she had just gone through a medical issue. And so she was carefully walking down the sidewalk and I saw her and really encouraged her, really, really encouraged her. And
I know, I just know that it really felt good to her to know that somebody was willing to just stop and, you know, and give her a hug. Then this last weekend, we had a little alley party and there she was and she looked great. I mean, you know, from when I saw her just, you know, two months ago or whatever, and I told her,
I went out of my way to go up to her and say, you know, I see you looking much better and I'm hoping that that is the case. A simple little thing like that can really be helpful for people and their mental health. I would, I would assume, you know, just this more human interaction.
I think though, you know, uh, Dr. Trangle said this, is that I think that people are afraid of being intrusive, you know, getting into their, I always talk about there's a difference between business and business. You know, people don't want to get into your business, you know what I'm saying? And so they're very, very surfacy in terms of that.
And I think that what you're saying, using even finding the language to ask the question, is gonna be very, very important. And then to help people understand that, to go deeper with the, how are you doing? And then how are you really, really doing? That's what I wanted you to say. How are you really, really doing? It's something that we need to talk about.
And I know that this is back to our work about policies, implications and stuff like that. But I think the more that people are aware of what is really going on, the better off we can be as a nation. And I think that that's, and as a community.
You know, it's not even finding the words. There are studies that people have done saying that if you just look somebody in the eye, you know, and smile at them, it's a way of recognizing them, saying they exist, noticing you. And a smile means, you know, I mean, if you notice them and you like frown and make a fist, it's the opposite bad effect. But if you smile...
it's a warm, encouraging gesture that helps people feel a little better.
One thing I know for sure is I've been telling friends and colleagues and family that have something that comes up medically or mental health or what have you. And I offer this idea to them. I said, put me, Stan, on your speed dial. If you need help, I'm there for you. I'm really, and I mean that sincerely. And whether they do or they don't doesn't really matter.
Just the gesture means so much for a lot of people.
I want to tell this story. You told your story. I remember a news reporter, this had to be 20, 30 years ago, who decided he was going to be on the streets for a week. And he was on the street for a week as a homeless person. That's what he was going to do as a homeless person.
He said it only took him maybe a day and a half before he felt totally out of it because people wouldn't look him in the eye. They wouldn't say anything to him. And that made me cry. Because I think about the humanness of people, but it also maybe made a commitment to look people in the eye.
I mean, even the homeless people or people that I'm not necessarily appreciative of their behavior, I still will look them in the eye and say something to them because I think it's important to recognize, as Dr. Trangle, you said, the humanness of them, which is something I think that we forget because we all need to feel like we belong. That's my story.
And folks with some of the serious chronic mental illnesses like schizophrenia or something that are struggling with voices or homeless and they don't smell so good because they can't get an adequate place to sleep and shower and change clothes. One, it's way overstated, the potential for violence. And everybody is scared of that. But just because you're psychotic,
I mean, how do I want to say this? The odds of you being violent are like not much different, a smidgen higher than anyone else. And the odds of you being victimized by violence are much, much greater than everyone else.
you know, but, and just acting like they're real people and human and as deserving as you of respect and courtesy goes a long, long way, you know, and challenging some of those assumptions.
And I think many of us have been behavior modded a little bit to talk psychobabble, but you know, that if you do that once in a while, someone will ask you for money or change or something, and you want to avoid that. Can you don't, you know, And but people overreact to that, you know. Yeah.
And it's just so helpful to just smile, say hello or nod, you know, as well as sort of engage in a conversation, you know. Yeah. Yeah. Before we run out of time and I don't know exactly when that is, but I want to at least mention one thing that that I have strong feelings about, you know,
In the psychiatric world, there's been sort of one kind of thing that's really evidence-based as being more effective than other things and much more accessible. Given the shortage of psychiatrists and other mid-levels and even therapists and stuff, it's hard to get in. And one of the models is something called collaborative care management.
is where it's a model where it's based in the primary care clinic and the primary care doctor's office. And And it's something that is between 90 and 100 studies talking about how it's much more effective and cost effective and works faster than other studies.
And it expands the access by having a psychiatrist consult to the primary care doctor just one or a couple hours a week, depending on how large the panel is. And there is a care manager there. who is someone who has a role of educating patients in mental health issues, following up with them.
Like if that person gets diagnosed with depression, maybe they get referred to a therapist and told to start an antidepressant. He or she might call the patient after that and say, were you able to get an appointment with a therapist? Does it feel okay? Did you get in? Do you need any help troubleshooting?
Because if you're depressed, you don't have your normal perseverance and energy and initiative to follow up on things. Or it could be they call and they say, did you get your script? Did you take it? Any problems or side effects or there's something to troubleshoot here? You know, and that person educates, follows up.
The patient that comes in is on a registry and we track how they're whether they're getting better or not, whether we actually measure their anxiety level or the depression level, make sure it's getting better. If not, we troubleshoot and modify their treatment plan. There's someone who can pick up this person is complaining of insomnia.
So you can kind of the psychiatrist can give them advice about let's look at their sleep hygiene. Let's look at how they're doing any any caffeine or other things that might interfere with sleep. Either they're taking it, it keeps them awake or withdrawing from something that keeps them awake. You know, that kinds of stuff. And It's used in all the mental health illnesses.
The primary care doc does the prescriptions, but the psychiatrist runs the list and gives advice to the primary care doc and to this care manager. And it works really well.
So is that like a referral type of thing?
Well, if you go to, if you're in that primary care clinic, you'll, you'll see the care manager and they'll screen things and, and then they'll talk to the psychiatrist about it. And the psychiatrist might be giving advice on 80 to a hundred patients, you know, not, and they're there every week. One either, either physically or virtually and, and giving advice.
And it's something that was good enough that Medicare adopted it and pays for it. Most private health plans do, but not all. But in Minnesota, Minnesota MA doesn't pay for it, which is not a small percentage, if you think about it.
And if you're a primary care doc and you want to use this for everybody that's depressed, you want to have to pick and choose, depending on their insurance type, who you can give it to. Or else you give it and then you lose money. Then you say, I can't continue to do this. I'm going to stop doing this.
So there was a bill in the legislature this last session, which was introduced primarily to sort of mandate that Minnesota MA pay for it. It got transfigured in the legislative process and it mandated that all private plans pay for it. Medicare already pays for it, but it excluded Minnesota MA.
You can't make this up.
No, no. And it just needs to be available for everybody, and it needs to be, and it would be really nice if we follow up on it this year. And, you know, and Minnesota DHS, we presented it to them. They made some good, they thought it was a good idea, but they wanted to sort of look at it more, and the timing was short, and they took it out of the governor's budget.
But I hope they follow through, and if not, I hope the legislature makes it happen either way, or ideally both. Yeah. It becomes mandated. And I think DHS goes with it. And it's one of those things where it got caught up in this thing where the fiscal note, they couldn't figure it out and they didn't do it. And it really saves money. There's an ROI with it.
But on the other hand, how they fiscally account the ROI, Like a lot of things, if you treat mental illnesses or substance abuse, it decreases your medical costs down the line. But you still have to pay for it initially. And whether they're really going to cost account that, how they'll do the fiscal note, I don't know. I'm sure there'll be a battle over that.
But it's one of the things we should really all support in this next year's legislative session. And the Commonwealth has recommended that all states mandate that MA pay for it. Then it's like, I think a little over half the states have done it so far, but not Minnesota.
You know, there are particular models that have been proven pretty successful, like dentists, for instance, helping patients identify potential heart-related problems and getting those patients vaccinated.
to the point where they don't even treat them in the dental office, get them into their primary care doc, because for instance, their blood pressure is really high and off they go to get that taken care of before they get their teeth cleaned, for instance. So there are some interesting connections between healthcare providers that hopefully might have some implications even in here.
So Mike, I wanna try to, end this show on a positive note. Okay. So based on your, your career and, and what you're seeing, um, what do you think, what, what's really good? What do you see that's really positive right now?
I think the most positive thing is, um, Most people are starting to realize and understand, and at least partially, not completely, appreciate that mental health and substance use disorders are really important. Yes. They're worsening and they deserve attention, effort, and to get better.
Yeah.
Whether that will that focus will stay there or it'll kind of peter out. I don't know. There's less stigma talking about it. And I don't know. You're including it in your podcast. I don't know if it was five years ago, you know.
Five years ago, we weren't doing our podcast. Now's the opportunity. So, Mike, sincerely, many, many thanks for this trio of shows on mental health. I'm assuming that there will be more episodes.
questions and issues that that come up and hopefully we can reserve the right to give you a call and have you back on our show or for that matter even if there's something that you want to say through a through a podcast like this health chatter feel free to contact us it's it's been truly a uh a pleasure connecting with you over these three shows so thank you very very much
To our listening audience, we have great shows coming up, as you well can imagine. Check out our website at healthchatterpodcast.com. Typically, we get a show out about once a week or so. So keep health chatting always.
Hi, everyone. It's Matthew from Behind the Scenes. And I wanted to let everyone know that we have a new website up and running, HelpChatterPodcast.com. You can go on there. You can interact with us. You can communicate with us, send us a message. You can comment on each episode. You can rate us.
And it's just another way for everyone to communicate with Stan and Clarence and all of us at the Help Chatter team. So definitely check it out. Again, that's HelpChatterPodcast.com.