Stan and Clarence chat with Dr. Mike Trangle about Mental Health, introducing a 3 part series.Dr. Trangle serves as HealthPartners Senior Medical Director for Behavioral Health and President of the Minnesota Psychiatric Society. In addition, Dr. Trangle serves as Clinical Assistant Professor of Psychiatry at the University of Minnesota Medical School Department of Psychiatry.Listen along as Stan, Clarence, and Dr. Trangle chat about the growing mental health crisis.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 episode is on mental health. This is one of three shows that we have with our great guests. I'll introduce them in a minute. Today's show is where we stand on the issue of mental health. And boy, oh boy, there are a lot of variables related to mental health for sure. So what we want to do
is first of all, thank all the people that are involved with Health Chatter, Manny Levine-Wolf, Aaron Collins, Deandra Howard, Sheridan Nygaard, do all our great background research for us and give Clarence and I some good talking points to discuss with our guests. And if we do it by ourselves, even they give us some good talking points as well. Then in addition,
We have Matthew Campbell, who's our production manager, who's second to none. He does all the logistics behind the shows, keeps everything going technically. Then we have Human Partnership, which is our community sponsor. That is a great, great organization. I recommend our listening audience. Check them out. You can go to our website.
healthchatterpodcast.com, and also link to their website and see all the great things they do in the community to address health issues, frankly, for all of us. And then, of course, there's Clarence Jones, my great colleague and partner in crime as it relates to health chatter. We've been chatting a lot about a variety of different health issues. This is, I think, our 55th show, Mike.
So it's been going for a while. It's a great, great podcast, and it's great having Clarence as a colleague. So today we're going to be looking at the state of the art in mental health, and I've got a great guest for us today, Mike Trangle, Dr. Mike Trangle. He and I go back a long, long way. We were in high school together. We were on a tennis team together.
And our professional lives kind of went in different directions. But we always knew kind of where each other was in the environment here. We could always connect.
Isn't there a song like that, You Are Always On My Mind? You Are Always On My Mind, exactly.
And anyway, Mike has got a great illustrious background in the area of mental health. And he really is a gem for those of us in the state of Minnesota that can rely on his expertise and his insights. He's been involved in a variety of different mental health oriented issues, including eating disorders, chemical dependency, crisis stabilization for adolescents.
Most recently, he was at Health Partners, heading up their psychiatric initiatives there. And most recently, he's a distinguished lifetime fellow of the American Psychiatric Association, immediate past president of the Minnesota Psychiatric Society.
He's on the National Quality Forum Standing Behavioral Health Measurement Committee and participate in our governor in the state of Minnesota, his advisory council on mental health. and also a task force on competency restoration. So he's got it. He's got it in his head on where we stand with mental health.
And we'll also be having Mike on in a couple of other shows down the pike on looking at mental health as it relates to particular population groups and age groups, and then also a following show on policy implications, what we can do from a policy perspective in order to change these things. So, Mike, thank you. Thank you. Thank you for being with us today. It's a pleasure.
It's great seeing you as well. So let me kick this off. I'm going to ask this, maybe it seems like a simple question, but it probably has a longer answer. What, Mike, what have you seen? I mean, you've been in this arena for a long time now. So what have you really seen in the area of mental health over the years?
I mean, there's got to be some torches that we all should be carrying, things that have changed, things that have gotten better, things that have gotten worse. What's your perspective on it?
My perspective is a little bit twofold or color. Yeah. When anyone starts their chronic career, and I started as a clinician, through psychiatric residency, seeing patients, both adolescents and adults, and doing a combination of inpatient and outpatient work, and then adding substance use disorder work.
And early on in anybody's career, you want to sort of master your trade, you know, perspective and competencies. So as I went along my career, I sort of knew more and got better, get experience, you know, so you're loving by knowing more patients and your own life experiences. At the same time, it's been very apparent to me that early in my career, you know, Nobody talked about mental health.
You know, if you think about it, somebody got sick, got hospitalized. You know, they never got cards. A lot of people visiting letters. You know, I don't know if they got cakes or dinners left over. You know, one of the spouses was in the hospital and stuff. It just wasn't done. It was like it was like a dirty word almost. Yeah. So much shame. and avoidance about it.
And I would say over the decades, I think both families first, and then patients to a lesser extent started realizing there's stigma involved here, and it's totally unwarranted. People don't choose to have mental illnesses. People really don't choose to have substance abuse disorders, but they still have to deal with the fallout coming from that.
And as that has gotten more acceptance by the advocacy groups that it's OK, and maybe we need to fight for our slice of the pie, things have changed. It still has a long, long way to go if you look at the statistics. But I think in some sense, the core, one of the core issues is this is not my fault. I shouldn't need to be ashamed or hide, you know, that kind of stuff.
Yeah. That's a huge change. Yeah. You know, it's really interesting because, you know, in my notes that I got from our crew, The first word that I put on my list of questions besides this one was stigma. And there was a stigma. There still is. There still is that stigma. It's like if people are labeled with a mental health disease, it's kind of like not good.
It's just like people have this attitude about it. And it's unfortunate.
I'm sorry, Matthew. You raised your hand and I didn't even look up.
That's okay. Hey, I do appreciate this conversation. As you were talking, I had to go back to my childhood when I thought about this term. We didn't talk about mental health. We talked about being crazy. And everything went underneath that particular title. And so as you were saying, if you were crazy, people just left you alone.
But there's so many different things that impact our mental health that we could never even thought about, so many different types of conditions. And so could you talk about some of the conditions that are involved with mental health issues so that people can get a better understanding of these are some of the things that do affect your mental health?
Well, think about the pejorative terms that got used when we were growing up. Someone was a retard. Yeah. Mental retardation is one of the things we deal with, whether it's because someone has a uh, Down's syndrome, you know, or other kinds of things, someone's psycho, you know, which usually means psychotic disorder, you know, or crazy or you're yellow. I mean, that could be your coward.
It could be an anxiety disorder, you know, but the way it's, especially amongst teenagers who are sort of like rudels in teaching each other and stuff, um, And if you think about it, something that used to be considered a mental illness decades ago was being gay, let alone getting into all the trans, lesbian, binary kinds of things.
But that was also sort of, if you want to insult a teenage boy, you would call him gay or something, you know, because there was so much shame associated with it. That, as more evidence came out probably 20 years ago or so, it got removed from being a disorder, a mental health disorder, you know. But initially it was plugged into that category without good evidence.
And it's kind of interesting that there seems to be a renaissance of hate and prejudice against trans people these days, right now, that's sweeping the country. And not just in the US, other countries too. But it's kind of interesting how politics certainly doesn't follow evidence.
And how and why somebody brainstorms, let's pick on these people so we can divert attention from something else now, or at least get more support now. That's a mystery. I'm not a politician, but it's still a mystery to me. And I don't understand that.
Let me ask you something, Mike. You know, all the years, and you've been involved in it for a long time. Talk to me a little bit about communication around mental health. How is it that we've, you know, certainly we have venues today for communication that lend itself to quick information. Okay, maybe not always accurate information. But tell me how communication vehicles has either helped
the mental health issue or has been detrimental to it?
Well, just take the internet. Yeah. And not getting into fringe segments of it. Yeah. There's abundant data that for a minority of teenagers,
people that are going through the developmental stage where they're trying to figure out who they are, separating, individuating from their parents, and who am I, what's my identity, when I'm not just reacting to my parents, either modeling from them or trying to separate and fight with them to become my own person. But during that turmoil, the minority of them can find
fellow people struggling with whatever they're feeling, whatever they're struggling with, and get some support. So in a modest, small way, it's kind of useful in that way. In a bigger impact, and for many more people, the perfectionism and the unreal expectations and the trolling and a vehicle to sort of get out your hatreds and your own feeling bad and taking it out on other people.
You know, it's diminished self-esteem, whether it's self-image, whether it's just self-esteem, whether it's whether you can be okay with yourself and happy and reasonably content with life, or you feel like you're a failure. Yeah. So like many things, I think it's had a mixed reaction.
And depending on which subgroup you fit in and how you use it and how much of it you use, it could be a little bit of an aid or it could be a big bummer.
yeah so let me let me ask this question because i you know it's it you know and and and i come from a community perspective so you know i get all these i get all these comments people will say about different different kind of topics but what percentage of our population really is affected by mental health issues you know i mean percentage of which populations you say Yeah, just in general.
I just want to do just something in general. And the reason why I ask that question is that a lot of times people come up with all kinds of data. They say half of us have mental health issues. And we know that that's not true. But I know that there's some specific population, some specific information that we need to know to help to address some of the myths about this particular issue.
So you can just, wherever you want to go. I'm okay with that. Wherever you want to go, because we're going to touch somebody someplace.
Okay. If you look at the Mental Health Association of Minnesota, 2019-2020 survey showed that 20.78% of adults were experiencing mental illness. Okay. If you look at... There's a... How do I want to say this?
Right now, the percentage of people that talk about symptoms, and it's a little bit lower, enough cluster of symptoms to give you a diagnosis has been increasing pretty rapidly, especially anxiety and depression, and more so in adolescence than adults. And if you're talking about a certain point in time, let me see. I have it right here. Give me a second. Okay.
I mean, this is a very, very interesting topic. And I think, like I said, it touches on so many parts about populations and communities. There's just so many misconceptions, thoughts, and
So like in Minnesota, 28.3% of adults in Minnesota have depression and anxiety lately. Okay.
Is that considered chronic? Or is it more acute?
Symptoms of. It's more acute. More acute. Or it could be a worsening of a chronic one if they're lumped together.
Yeah.
All right.
I would say the theme that I've seen when I looked at sort of the literature for this is Minnesota is not looking good and the U.S. is looking a little worse. Not a lot worse, just a little worse. So there's like 32.3% of adults have depression or anxiety right now compared to 28.3% in Minnesota. And that sort of ratio is pretty consistent for most everything.
So we see, let's talk a little bit about acute and chronic. So, like, for instance, people who, let's just say, who have had a heart attack, okay, or heart failure, all of a sudden, they can easily go into a depressive state, or they can have anxiety about that.
Or some lucky balls.
Right. So it's like, all right, as a clinician – Would you label that more, shall we say, acute as opposed to chronic? In other words, a mental illness that people just have for a long, long period of time as opposed to it, the mental health issue being associated with another issue such as heart disease?
You know, we should probably make a distinction between something happens and you have a reaction to it. Okay, yeah. You know, which in a technical sense is called an adjustment reaction or adjustment disorder. Okay. It's unlimited and it doesn't last for more than three months kind of thing, you know?
Yeah, yeah.
And... So if you think about it, you know, you've got chest pain, the ambulance takes you to the ER, you know, and they say, well, you're having a heart attack. You know, you've got a few waves and ST elevation in your EKG. Right, yeah. Maybe I'm talking Dr. Babel there, but you've got symptoms of it and you have proponents and stuff.
And then they want you to sign and say, well, we're going to do a – radiological study. And if we find something, we want to sort of do a stent. We want you to give us permission to do both in one fell swoop. Yeah.
Yeah.
Yeah. Okay. So, you know, and then you go there and they find, oh, you got a blockage in your main artery that they call the widowmaker.
Yeah. Yeah.
Right. You know, the LAD. And, um, You know, anybody's going to be panicky at that. You know, you'd have to be like artificial intelligence to not react to that.
Right, exactly.
So it would be weird if you weren't. having a really scared, terrified reaction to that.
And your blood pressure doesn't go up. Yeah, right.
Well, you know, it depends how much of a blockage you have.
Yeah, right.
Exactly. So anyway, he goes through the surgery and you don't die. Then you find out I have no damage or I have a medium amount of damage and my ejection fraction is not as potent. My heart isn't pumping out the blood as strongly as before, you know. Yeah. You don't know if you have permanent damage or temporary damage or how much.
You know, so you're going to continue to be pretty darn worried about that, you know, and you go to cardiac rehab and eventually it kind of wears off and you go on with your life, you know, and most people won't stay in that acute reaction for that long unless they somehow get depressed, you know, because you can also have a depression and whenever you're depressed.
uh everything's not as good you know you're more pessimistic it's not going to work out well you don't have your energy you don't have your concentration you don't have your normal sort of sense of optimism you don't initiate things you know and a subset of depression can be an agitated depression with a lot of things yeah not everybody gets that but so um it can be blurred by other things happening but if it's just a pure adjustment reaction
uh uh that's not really depression gotcha okay and and and in those kinds of situations for listening audience um Do psychiatrists, for instance, work with like internists or cardiologists in this particular instance in order to coordinate care? Or is it really more situational like you're talking? It's a quick adjustment and then thank you very much.
Whereas you, in your practice, you were seeing perhaps more serious ongoing chronic cases. Or is it both?
Yes, it's both. How do I want to say this? I think theoretically what you're talking about is a psychiatrist and or therapist coordinating and talking all the time with the internist and staying in touch. Right. Wonderful goal. I don't know that it necessarily happens that way most of the time.
Gotcha.
People are busy. They have their practices. You know, you might send a copy of your evaluation. If something comes up and you're really worried, you might give a call. But it's the exception, not the norm.
Gotcha, gotcha. You know, it's interesting though, in your statistics you talked about, and I'm hoping I'm saying this correctly, about a third of the people in the country, you know, you're talking about the difference between Minnesota and the country, about a third of us have some kind of mental health issues. What's the mental health care like, the access? in this country?
I mean, if we have so many people with this issue, I mean, we're talking about it quite a bit, but what's your thoughts about the mental health care access in this country?
So if you look at it nationally, 54.7% 54.7% of adults with mental illnesses do not receive treatment. Wow. Okay. And it's, how do I want to put this? It's not good anywhere. The state that has the best access, according to this MHA study, is Montana, which is not what I would have expected. Neither did I. And they don't have that many people. Well,
And that means four in 10 adults with mental illnesses do not receive treatment. So only 60% of people get in. Wow. And that's the best state. Right, right. You know, if you look at the average, 28.2% of all adults with mental illness reported that they were not able to receive treatment they needed. 42% of that group said they couldn't do it because they couldn't afford it.
Other people find out that there just is a shortage, whether it's therapists, whether it's psychiatrists, they're busy. The workforce is shrinking as the baby boomers retire and they're not being replenished because the schools to train them and put them out I don't want to say this.
To me, this relates, if you want to talk about the root cause of a fair amount of this, I think if you think about the stigma and how that has impacted things, until just about 10, 20 years ago, if you had Medicare and had a medical problem, Medicare pays 80% of your doctor costs. If you had a mental health problem, they would pay 50%.
You know, mental health and being a psychiatrist or being somewhere, anywhere in the mental health diaspora has never been, how do I want to say this? You have Dr. Welby's growing up. Yeah. And Casey. Yeah. Traumatic. They're great friends, great love lives, and they make a lot of money. Not Dr. Welby, but the other ones. But you had very few shows kind of lionizing psychiatrists.
And it wasn't prestigious. It didn't pay that well, and less people went into it, which means you have workforce issues in terms of access. And if you don't pay well, you also have less people going into it, not just prestige, but money-wise, they're combined. And it's always been that way. It might be changing lately because there's such a shortage, they have to pay more.
And health plans, well, even Medicare, I mean, have been able to get away with it. I mean, there was a parody law that got passed a long time ago, but it's just beginning to be enforced a little bit now. Did that answer your question? I think I started to ramble a little.
No, you know what? I want to say this real quick. Dr. Michael, I want to appreciate you because you always say, how do I say this? And that's what this health chatter is about, is to say it. Because because because the thing that's most important for us really is to be able to have an authentic, open, honest conversation. And you are the expert, you know, and I guess so many questions that I have.
And I just want you to just, you know, be safe. But say it. Just tell us what the real deal is, because that's what we want to do on this particular program. So I appreciate you.
Let me broaden this a little bit. I know mental health matters or chatter or whatever it is. What is it called again?
Health chatter.
Health chatter. It's not just mental. OK, that's good. Because it's worse for substance abuse. And I want to ask the conversation. OK. For most people that have substance abuse disorder in the U.S., 93.5% did not receive any form of treatment.
That's sad.
That's very impressive. Only 6.5% got in for treatment.
That's insane. Unbelievable.
Yeah. You know, it's interesting enough, but right now we're, you know, with Human, we're doing some things around substance abuse education training. We just trained like 30 young people to go into the community to talk about this issue. And what you're saying is that 93% of them, of people that they may be talking to won't even have access?
93 and a half percent.
Wow. Wow, that's good to know, but it's also sad to know. Exactly. Especially with the issues that we're having that are being compounded by the stressors, the fake news, and relationship, all those kinds of things. It's something that we really, as a community, have to think about and talk about.
So I'm going to put this in perspective a little bit. When I was an undergrad at the University of Minnesota, I had a position at Fairview Hospital on the West Bank of the river as a psychiatric technician for adolescents. And many, many of those kids that were admitted to the hospital back then were, quote, behavior problems. That's what they were diagnosed as. behavior problems.
And although we did see, you know, medically oriented, you know, problems as well, paranoia, psychosis, you name it. But has the language of mental health changed?
You know, how do I want to say this exactly? Yes and no. Okay. I mean, behavior problems or EBD, emotionally, behaviorally disturbed, are more school education labels. And they're not clinical psychiatric diagnosis. Interesting.
And yet they were hospitalized.
Yeah, yeah. So when you say behavior problems or EBD, I don't know what it means. It means with a given patient and I've worked in hospitals for a long time, it's kind of meaningless, you know? It's like, what, what are the cluster of symptoms? What's the actual diagnosis, you know? And, um, generally, uh,
uh these days psychiatric units are such a shortage of beds the people that get into psychiatric units are people that really are sort of like um if they wouldn't be there they wouldn't be safe yeah yeah yeah they're there for safety's sake not to control behavior per se yeah yeah yeah which of course which of course we we um causes its own reverberations down the pike
If you're not going to treat them there, where do you treat them?
problems is not necessarily ideal but if you don't have other places or ways to intensively engage not just the patient but the family you know to get them better they don't get better they just get kicked like a can getting kicked down the road you know they go to juvenile detention and they have something ordered but it doesn't really happen very reliably whether it's in-home other stuff and things just get worse if you have a system that's not been adequately funded
with adequate uh numbers of clinicians and resources things don't get better yeah so let me talk about also um over the years you know in your practice have you seen a a major change in medication for instance you know medications tend to incrementally improve um and um and help
they tend to not be the panacea that people tend to think or that tends to be sort of highlighted in dramatic movies and TV shows. Yeah, yeah, yeah, yeah. And even if they do work, they oftentimes have some side effects
that uh mean and if you're talking about for people with schizophrenia or psychosis it's more than a little you know they have significant side effects that cause people to say it may not be worth it you know yeah um
But it's like you almost always need to do working with the individual and the family and their psychology and the kind of lives they live and what kind of support systems they have, how they think of themselves, what can they do differently, whether it's cognitive behavioral therapy, other kinds of things. You want to sort of do a balanced approach that's not one simplistic answer.
All right. So for our listening audience, this gives us frankly just a tip of the iceberg of addressing mental health. Hopefully in our next two shows with Dr. Trangle, we'll be able to look at, we'll get a little bit more into the nitty gritty I know, for instance, that Mike is very involved with policy changes, and hopefully we'll be able to share that with all of you so that you're aware.
You're simply aware of what's out there. Hopefully our goal for Clarence and I and Health Chatter is to really, really break through even more the stigma that's attached to mental health. Because yes, I would say it's maybe gotten better, but it could be a lot better than when we're at for sure. So any other closing thoughts for this segment, Mike?
Well, you know, part of what I thought you were going to ask more about, I got a million statistics, but it's the same as what I've already said. So I don't think to go over adolescents versus adults. Yeah, we'll get into that for sure. But if you think about access, I don't think it's a simple thing. And it's like, You know, you got the stigma, you got the expense involved.
Some of the data that I have here shows that if you have private insurance, the co-pays are about twice as much for mental health, even now. And the deductibles compared to medical things. So that hasn't stopped. It's. workforce issues, it's balance of life issues, you know, and you got to know you have a problem, you know, and it's not a lot of people don't know what they have.
It's not like I got chest pain. I mean, if somebody has a panic attack, they're probably going to end up in the ER, but otherwise it's something's wrong, but it's not what you don't know what it is necessarily. You got to figure out, I have a problem. And a lot of times, you know, people sort of just say, what's the matter with me? You know, I'm just not thinking clearly.
I got to like get through this. I got to, I'm not, what am I, too wimpy or something? And you don't know that you need help. And then you got to feel like it's okay if I need help. And then you actually have to get in.
and find out whether you can you know get in and and since there's a shortage it's not easy to get in you got to jump through a number of hoops you got waiting lists yeah the uh if you look at the health plan networks they oftentimes have phantom people in them you know uh people that aren't taking anymore and that kind of stuff um So it's just not easy, you know.
And there are a lot of barriers to surmount to think about, know what you want to do, and then actually get in. I'm on the board of Minnesota Konami, and they do an annual survey. We do an annual survey. And what they found, it's not really statistically, it's not like publishable.
in terms of the rigor you know um but what they found is uh people had a great difficulty accessing all different kinds of services whether it's inpatient beds whether it's residential treatment whether it's just psychiatry especially child psychiatry or therapy and they found out especially for psychiatry that a lot of people just give up and stop trying
they can't get in they call so and so so many people they're not taking they're not even on the list anymore blah blah blah they don't take insurance you know right but it's not easy and a significant percentage of people just stop and they give up and they just never get in so mike let me ask you we did we did a show um
a couple months ago on the issue of trust. So let's just say, for instance, you know, you have a patient. It seems to me when you're dealing with mental health issues, probably many health issues, but certainly with mental health issues, there's got to be a real trust factor between the patient and the provider. Talk to me about that a little bit.
Yeah, you have to, if I have a patient coming to see a new person, you know, if I'm Um, let me, let me back up a second.
Say I have a mental health issue and depending what it is, you know, if you look at the two most common things, anxiety disorders and depression, you know, I'm really pretty fearful and nervous and scared about, I'm going to see someone, I don't know what the heck this person is going to do for. And, um, I don't trust it necessarily. I'm kind of vigilant and, uh, um,
finding someone who is a good match that could kind of get me and that I can learn to trust is huge, you know, or if I'm depressed, the issue is I'm not myself. I have no energy. I have no initiative, you know, um, I was sort of one of the leaders of a diamond study that happened in Minnesota.
Yeah, yeah, I remember that.
And as Juergen Unitzer would say, who was the guy that sort of like with Wayne Caton developed sort of a collaborative care model, which is by far the most evidence-based thing to treat depression and other diseases turning out. He would sort of say, one of my first patients said, when I'm really depressed, I can't even get out of bed anymore. I get dressed. I don't shower.
I don't do my daily hygiene. I just don't have the energy. I don't have the initiative. I don't care. I know it's not going to help. Nothing's going to get better. What's the use? And for me to get up and call a doc and say I'm not doing well is way more than I can handle. And so you're taking people that are at their worst and they're not functioning well.
And you're asking them to sort of like fight the system, which is stacked against you to get in. And it's too much.
You have to fight the system at the same time when you're dealing with your medical issue. It's just like, whoa, it's overwhelming.
You know, and it's funny because ideally the system, if you talk to people that say it needs to be designed so there's no long door and that people will get you in. and get you in a timely way. But each agency has their own way to protect themselves. And there are sociologists that have done studies looking at therapy
patients and it's like uh in the old days this might have been the 60s or 70s they would say that the kind of patients that therapists like to see are young verbal uh attractive and i don't know what the obvious i don't remember what the uh intelligent and i don't know what the s was but yeah uh it's not your disheveled schizophrenic who's homeless and wants to do something about it you know um and those people somehow don't seem to make it in
One, they're not as competent and two, David Mechanic did some of the studies looking at how institutional barriers sort of creep up to make it a little nicer workplace for some people.
You alluded to some of the variables that link today that are causing people to become more and more depressed or more and more anxious. You know, being, you know, gay or lesbian or bisexual, that certainly has its implications. Or we have societal issues like that we all faced one way or the other. COVID, okay, which was you know, over the edge for a lot of people.
And everybody got way isolated.
Very isolated. And you can imagine if you have a mental health issue on top of that, oh my God. Right.
You know, um, Uh, I've been a leadership vice chair and chair of the governor's mental health advisory council for a while. And we heard from a lot of people during COVID, especially people with substance abuse, um, they couldn't go to groups.
You know, they couldn't stay so clean and then say when they started using again, you know, and, um, um, what turned out to be a huge lifeline for them was just a telephone, you know? Uh, yeah. And there was a huge fight going on in those days about what people are going to pay or not pay for audio only, you know, but you got a lot of people in rural areas, a lot of people in
in the inner rings where they don't have, you know, it's not just a rural, but it's also if you don't have money or a good network in the city, there are a lot of people that didn't have good internet access, couldn't do the video or it was in and out. And they found that just calling and talking to your CD counselor or your shrink on the phone was the lifeline.
And they said, that's what kept them alive. Wow. And we argue vociferously that, one, it got added to the pandemic exemptions. And then just recently, they extended the study. Instead of just saying we should pay for audio only for CD and mental health, they just extended the study for a year or two. It's not going to come up again in a year.
And it's those kinds of things that are life and death for people that I think legislators and sometimes health plan people don't get. you know, right.
And, and we'll address that in, you know, in, in one of our shows that we have the policy stuff for sure, because I can, I can only just begin to imagine the, the implications that, um, policy has for, for treatment. And, um, Or intervention. And you talk about calling somebody on the phone or even a Zoom type thing.
I can't imagine that that perhaps is the same thing as like a in-person therapy session, okay? Where if you need to, you can hug a person or what have you. The personal interaction is compromised, but it's better than nothing. For sure.
People talk about it like it's either all one or all the other. If you're deaf, then you're trying to maximize, optimize how it goes. You do it in person. Sometimes you do the televideo. But if it's not available that day because the internet connection keeps going out, at times you use audio. At times you do face-to-face. At times you do Zoom.
It doesn't have to be talked about like it's this or that. It's both and. Correct.
Right, right, right. They can complement one another for sure. So final thoughts for kind of this state of the art, kind of the gestalt of it all here before we go into our next show with you on looking at different population groups, Mike.
I am fairly optimistic. I do think things are getting better, and I think there's sort of a glacially slow but sort of steady kind of progress towards more and more people realizing it's not your fault if you have a mental illness or substance abuse. You are just as deserving as anyone else to be treated fairly and equally.
And little by little, I think everyone's starting to get that and more resources are being put into it. And I would say 20 years from now, it'll be a lot better, even if it doesn't happen instantly.
Yeah, yeah. You know, I could argue the same thing, you know, in the cardiovascular arena. You know, it's just like, yes, things have gotten better, but we're still, it's still like, you know, the number one cause of death in this country. So what's going on? You know, where are we going here? So, you know, things do get better.
You don't have access. You don't have the same access problems. Correct.
Absolutely.
And that's because you got money put into it. It's a procedure based thing and it pays well.
Absolutely. Absolutely. You nailed it on that one. So, all right. So for our listening audience. This is the first of a trifecta of shows on mental health. And I greatly appreciate your insights, Mike, on all of this. And if need be, we'll do more, you know, as things progress. Our next show, interestingly enough, is on pediatric emergency room concerns.
And a very, very dear colleague of mine and neighbor turns out that many mental health patients are showing up in the ER where they aren't treated for ER oriented things, but they need to stay there because they have nowhere else to go. So, I mean, talk about a mental health issue. Oh my goodness. All right. So all these things kind of meld together. So stay tuned for that for our next show.
So for our listening audience, Thank you for coming to this particular show, listening in. Again, it's the first of three. And keep health chatting away.
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, healthchatterpodcast.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 Health Chatter team. So definitely check it out. Again, that's healthchatterpodcast.com.