Latest / Becker's Healthcare Behavioral Health / Dr. Dan Schatz, Medical Director of Addiction Services at NYC Health + Hospitals

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Dr. Dan Schatz, Medical Director of Addiction Services at NYC Health + Hospitals · Becker's Healthcare Behavioral Health

• 0:00
  Welcome everyone to the Becker's Healthcare podcast series.
• 0:02
  I'm Mariah Muhammad, writer and moderator with Becker's
• 0:05
  Healthcare. And I'm thrilled to have with me
• 0:07
  today doctor Dan Schatz, medical director of addiction
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  services in the office of behavioral health at
• 0:12
  NYC Health and Hospitals.
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  Doctor, welcome to the podcast. We're very excited
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  to have you join us today. To get
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  us started, would you mind please introducing yourself
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  and telling us a bit about your background
• 0:22
  and organization?
• 0:23
  Sure. Thank you so much for having me
• 0:25
  today. I'm excited for the opportunity to talk
• 0:27
  to you about addiction in New York City
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  Health and Hospital.
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  I'm a primary care doctor, an internist, and
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  an addiction medicine doctor. As you stated, I'm
• 0:35
  the medical director for addiction services for, New
• 0:38
  York City Health and Hospital, which is the
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  largest public health care system in the in
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  the country.
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  And we provide approximately 60% of behavioral health
• 0:46
  services in New York City,
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  serving over 80,000 individuals across our 11 acute
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  care facilities.
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  In my particular role, I'm the clinical lead
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  for addiction services,
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  overseeing those 11 different sites, which include addiction
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  services in the outpatient setting, the emergency department,
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  inpatient,
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  community. And then, of course, addiction is not
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  just isolated to the specialist, but, we have
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  to help all services across the health care
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  system.
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  Wonderful. Thank you so much for giving us
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  that background. So jumping right into,
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  kind of mental health and addiction.
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  What are some signs that someone is struggling
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  with addiction?
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  And say if you do see these signs
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  in a loved one or yourself,
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  what should you do? Are there any next
• 1:30
  steps?
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  Yeah. This is a very typical question that
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  we hear all the time. And not to
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  get overly technical, but I actually really like
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  the diagnostic criteria that we use. It's, from
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  the DSM five criteria that these are kind
• 1:42
  of where we make the diagnosis
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  of mental health and substance use. But the
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  idea is that there's 11 different criteria.
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  And if you meet two or more, then
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  you have classified as having substance use disorder.
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  The more criteria you meet, the higher, your
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  severity is. And these criteria, without jumping into
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  the specifics, is really when you start seeing
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  that the substance use is starting to affect
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  you biologically.
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  So you're having you know, you're falling down,
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  you're tripping, you have
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  wounds or injuries,
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  maybe socially.
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  So you're giving up activities that you used
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  to do. You're not interacting with your friends
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  or family as much as you would like.
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  And quite honestly, the question in itself means
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  that there is a loved one who's concerned
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  about it, which is one of the criteria.
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  Has there been a loved one who has
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  expressed concern about your substance use? So you're
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  already meeting one criteria if you're already, concerned
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  about it. And then the third is psychologically,
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  is that if you're feeling, if you're seeing
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  a dependence
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  and needing,
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  additional
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  medication or additional,
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  substance to get the effect that you had
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  before, you have cravings,
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  and you're thinking about it. You're spending a
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  lot of your time
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  thinking about,
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  getting your substance or recovering from your substance.
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  So if you see your loved one giving
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  up and retreating kind of from their normal
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  activities,
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  this is where it should raise a flag.
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  And, of course, the diagnosis itself should be
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  done by a professional.
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  But, you as a loved one should express
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  that your your your kid you're concerned and
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  that you wanna help and that you love
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  them no matter what,
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  because this is always a a journey and
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  it's difficult and, that you know that there's
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  care,
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  that that's available, that's effective that I'm sure
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  we'll get to later in this conversation.
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  Yes. Absolutely. We'll definitely get there, and those
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  are amazing,
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  steps that you share.
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  I personally am in New York City. I
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  live in Brooklyn right now.
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  So this is for me and the audience.
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  But how do you access care and addiction
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  services in in NYC?
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  Yeah. Again, being from New York City Health
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  and Hospitals, I feel, so fortunate and proud
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  to be part of this large organization. So
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  we have 11
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  acute care hospitals, but we also have many,
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  federally qualified health centers, so more like community
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  health care. And we even have outreach into
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  the community.
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  So we are really committed to excellence in,
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  providing comprehensive personal care
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  wherever you interact with our system. So if
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  you interact with our system and you have
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  you're struggling with addiction, we are training everyone
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  to recognize,
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  to,
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  screen for, and to refer to the addiction
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  services at any of these facilities.
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  So at all 11 of our acute care
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  facilities, we absolutely have addiction services,
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  both in the outpatient and on the inpatient
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  side.
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  Behavioral health in general
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  that does have some knowledge and experience about
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  addiction has over 5,000 staff in the 11
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  hospitals and 30 community health care centers that
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  I referenced before. And this does include both
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  the emergency department, the inpatient,
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  and outpatient, and really excitingly into the community
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  too. We have programs that, don't just stop
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  at the four walls of our hospitals.
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  And so, you know, the the focus of
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  what we try to do both in behavioral
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  health and in health and hospitals and the
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  addiction field at large is to provide high
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  quality, low threshold care. So low threshold means
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  I don't care if you have if you're
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  using
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  benzos like Xanax
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  and also opioids like Betel. We're going to
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  treat whatever you're willing to treat right now.
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  We're going to help you as much as
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  we can.
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  If you come into the emergency department, we'll
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  get you care. If you just wanna cut
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  down, we'll help you,
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  get where you wanna go as comfortably and
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  safely as possible. We hope that by accepting
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  you,
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  and and saying our doors are always open
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  that,
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  you're ready that allows for change to occur.
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  In addiction, it's really an exciting time,
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  because there is so much, from opioid settlement
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  dollars,
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  to, increased focus from the, city and the
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  community on addiction services that there's a lot
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  of innovation that's happening. So we have these
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  consult teams. We have these fans that go
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  into the community and help patients right there.
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  Ultimately,
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  if you you or a loved one is
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  suffering from an addiction or even just concerned,
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  about increasing use, please come to one of
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  our our facilities.
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  Everyone in our facility should know how to
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  get you, the care right away and to
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  get you to, the addiction services for ongoing,
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  expertise.
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  Yes. Yes. Absolutely. Innovation in this space is
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  definitely
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  what we need. I hope to to see
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  it continue to expand in this way.
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  What are some of the most common challenges
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  on the journey to recovery
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  from substance use disorders? I I know there
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  are probably a a ton of, challenges.
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  There there are a lot of challenges. And
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  at the same time, it's also
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  I I realized the more and more I
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  treat addiction, it's actually simple also. It's what
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  we kind of all need. Right? We need
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  I I break it down into three things.
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  Right? You need health and security. So a
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  lot of our patients,
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  might be homeless,
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  might have other complex medical care or,
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  psychosocial issues, and, of course, those need to
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  be addressed. That's kind of a standard medical
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  care,
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  and the whole person care is You you
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  need a house. If you don't have a
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  house, it's really tough to deal with the
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  addiction.
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  Well, that's true for everybody, whether you have
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  an addiction or not. You need that safety
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  and security.
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  The second is you need connections.
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  You need a sense of belonging.
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  So a lot of our addiction services
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  focus on providing community. What can we learn
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  from each other?
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  And this goes all different directions from the
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  patients to our staff, from our staff to
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  the patients, and from the patients to each
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  other.
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  I'm really proud and excited
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  about,
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  one of our growing workforce
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  in health and hospitals and the addiction services
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  is the use of of peers.
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  So people who have lived experiences
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  who now are working in the system saying,
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  hey. I know what you've gone through. I've
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  been there. I understand this. And they get
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  to really align and,
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  provide allyship.
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  So a lot of our patients
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  actually start in one of our services,
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  realize that they really like helping others, and
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  supporting each other, go right to,
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  a a new training academy that we have
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  called peer academy
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  that trains many peers. And after they get
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  their their SERPA, which is their, official,
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  licensure,
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  then they come back and and now they're
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  part of the team in this from the
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  staff perspective. So in that sense, we really
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  create a community,
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  And this is important for, individuals you might
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  see,
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  out on the street or for, you know,
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  friends or family even. Addiction is a very
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  isolating,
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  activity.
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  They're often ostracized. They're or, you know, said
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  just why can't you just say stop or
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  no?
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  What we need to understand is that they
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  they still
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  crave connections to others.
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  I'm sure you and many of your listeners,
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  have heard about the loneliest epidemic.
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  It's it's acutely
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  prevalent in in these patients, and they seek
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  that community. So if you're a loved one,
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  even though I know it could be tough,
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  I will tell you that the patients hold
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  themselves out
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  as as saying, I don't wanna burn that
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  last bridge, but your love and your support
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  is really part of the treatment, and it's
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  absolutely needed. So that was the second thing.
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  So the first thing is,
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  medical and safety,
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  and the second one is community, and the
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  third one is a sense of purpose.
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  I have, treated hundreds and thousands of patients
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  myself, although, again, most of the time I'm
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  overseeing,
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  administratively,
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  and so many of my patients are just
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  looking for a purpose of something bigger and
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  and something bigger than themselves. This is, again,
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  this is true for us as well. And
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  it's really tough for the original question, although
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  I've gone far off topic here maybe,
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  is is that,
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  what is one of the challenges? And it's,
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  it's very hard for our patients who who
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  they they've lost hope. They don't,
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  know what that next step is. It's it
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  seems every step they take forward is two
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  steps back. And every time there's a setback,
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  that makes their body crave the substance even
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  more. And so really having that sense of
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  purpose,
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  whether that's in work that lots of our
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  patients get purpose from that, whether it's volunteering
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  or being part of your your church or
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  or or community in that sense. So, in
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  some ways, it's really complex, and it's harder
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  for our patients, but it's also no different
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  than what everyone else is experiencing.
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  Yeah. Yeah. Absolutely. Thank you so much for
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  sharing that. And
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  throughout all these answers, you've given,
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  some responses to the next question that I
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  was gonna ask you. But, overall, how is
• 10:36
  NYC Health and Hospitals helping New Yorkers overcome
• 10:39
  these challenges?
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  No. Addiction is highly stigmatized,
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  from top to bottom for many decades, and
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  I'm happy to have seen actually rapid change,
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  here in New York City Health and Hospitals,
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  but across the city, the state, and and
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  across the country.
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  There really is a a huge paradigm shift
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  that's happening.
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  So I'm so appreciative of the giant shoulders
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  that we stand upon at this state to
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  allow us to get here
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  and also recognize that there's a long way
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  to go.
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  So, we're committed to, a cultural and clinical
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  shift in our understanding and treatment of patients
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  with substance use disorder.
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  It was not uncommon,
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  back in the day that you'd,
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  we would take care of a patient and
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  say, oh, they're they're drug seeking.
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  But actually, they're not drug seeking. What they're
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  what they're looking for is relief. They're actually
• 11:30
  in physical and and medical
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  withdrawal.
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  Their body is is nauseated in pain,
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  not to mention,
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  the cravings for for the the substance as
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  well. So it shifts,
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  from from,
• 11:44
  head butting to, hey. This is a medical
• 11:46
  issue that we have tools for.
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  And that's really important,
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  and that that's a big shift. And one
• 11:52
  one of the ways we're doing that is
• 11:54
  for our first ever, system wide,
• 11:56
  addiction workforce training program.
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  And through this, we're, giving lots of videos
• 12:02
  and training to all of our staff throughout
• 12:04
  the system, in particular behavioral health staff. We're
• 12:06
  doing live actor simulation
• 12:09
  for all emergency department doctors that really do
• 12:11
  focus on this issue of of stigma,
• 12:14
  and and and treatment.
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  Another thing that I think is really important
• 12:18
  is, there's this belief that, you know, treatment
• 12:21
  might not work or, you know, they're just
• 12:23
  going to relapse anyways or they're going to
• 12:25
  cycle through our system. Well, I'm here to
• 12:26
  tell you that these medications for addiction, in
• 12:29
  particular for opioid use disorder, but also alcohol
• 12:31
  use disorder,
• 12:32
  are incredibly effective.
• 12:34
  They're life saving and they improve quality of
• 12:37
  life. They are more effective than almost any
• 12:39
  other intervention we do in the health care
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  system, and yet relapse is still common.
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  Just like relapse on,
• 12:48
  smoking cessation and asthma
• 12:50
  or exercise and diet with high blood pressure
• 12:53
  or diabetes.
• 12:54
  When someone relapses with diabetes and they they've
• 12:57
  had an improvement with their sugar numbers and
• 12:59
  then they relapse and start eating their cake
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  again, we don't yell at them and say
• 13:03
  that this is a moral failure. We just
• 13:04
  say, okay. What can we do? How do
• 13:06
  we get back on this? And how do
• 13:07
  we provide the treatment that you need? We
• 13:09
  need to do that for addiction also,
• 13:12
  that we need to focus that this is
• 13:13
  a journey,
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  that it is a chronic relapsing,
• 13:17
  disease,
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  and that we are supportive of that. And,
• 13:20
  and we have medical interventions
• 13:22
  as well as behavioral interventions that are incredibly
• 13:25
  successful
• 13:26
  and meaningful.
• 13:28
  As the largest,
• 13:30
  municipal health care system in the country and
• 13:32
  treating, you know, over sixty percent of behavioral
• 13:35
  health. In our system, we actually see over
• 13:38
  tens of thousands of patients every year in
• 13:40
  the medical EDs
• 13:41
  for addiction. So what we like to say
• 13:44
  is not every patient's gonna be ready for
• 13:46
  treatment right then, but we wanna take advantage
• 13:49
  of every single opportunity.
• 13:51
  So in the emergency department, we have a
• 13:53
  program called ED Leads, and we have peers
• 13:55
  and social workers who will come there and
• 13:57
  do what we call SBIRT, screening, brief intervention,
• 14:00
  and referral to treatment. They communicate and are
• 14:03
  well integrated into ED,
• 14:05
  teams and general ER teams, the physicians and
• 14:07
  the nurses. And so they're well aware of
• 14:09
  each other, and we take advantage of the
• 14:11
  moment and say, if you're not ready now,
• 14:13
  we'll get you next time. And we just,
• 14:15
  kind of persistently have hope,
• 14:18
  that the patients will engage at some point
• 14:20
  and, and if not, that they know that
• 14:22
  we're here and we're supportive of them.
• 14:25
  What patients need is to feel seen, have
• 14:28
  dignity.
• 14:29
  We wanna reduce their risk even if we
• 14:31
  can't remove all of their risk, and we
• 14:33
  wanna start lifesaving treatment. What we really wanna
• 14:37
  get across is that we wanna earn the
• 14:39
  patient's
• 14:40
  respect and time.
• 14:42
  It takes a lot of time to interact
• 14:43
  with the healthcare system, and so we wanna
• 14:45
  make it meaningful and impactful.
• 14:47
  So what are the concrete issues that they
• 14:49
  need? What can we help them with today?
• 14:51
  Not some five or ten year goal. What
• 14:53
  what do they need right now? Let's meet
• 14:55
  that. Let's show them that we're here to
• 14:57
  support them, and then we'll take we'll take
• 14:59
  the next step together.
• 15:01
  Perfect. Yeah. Addressing the stigma is definitely important
• 15:04
  and really helps people take the first step
• 15:06
  to getting help. Letting them know it letting
• 15:08
  them know it is okay
• 15:10
  is essential,
• 15:12
  especially for addiction.
• 15:14
  What are some of the best approaches on
• 15:16
  training a workforce to provide trauma informed,
• 15:20
  patient
• 15:21
  centered care
• 15:23
  for their patients with substance use disorders?
• 15:26
  Yeah. Great. There's a there's a lot in
• 15:28
  that question.
• 15:29
  A lot of our patients do experience trauma.
• 15:32
  It's very common that,
• 15:34
  a lot of these individuals with, you know,
• 15:35
  kind of more severe substance use disorder have
• 15:38
  experienced childhood trauma, which just kind of highlights
• 15:40
  that they you know, a lot of these
• 15:42
  patients didn't choose to be addicted to whatever
• 15:45
  substance they had. They had a lot of
• 15:47
  risk factors, and they had a lot of
• 15:49
  trauma, and they use substances to forget about
• 15:52
  it for a little bit. But, unfortunately, the
• 15:54
  more they use, the kind of the the
• 15:56
  cycle kind of continues,
• 15:58
  and creates more difficulties in their life, which
• 16:00
  makes them use more substances and then becomes
• 16:03
  the, biological
• 16:05
  dependence on the substance itself.
• 16:07
  So, I really love the question and appreciate,
• 16:09
  the time to take this. Again, being in
• 16:12
  behavioral health, we have, we have teams that
• 16:14
  work on,
• 16:15
  trauma and domestic violence,
• 16:18
  so we have a full range of support,
• 16:20
  but we also have that,
• 16:22
  system wide behavioral health training that we have,
• 16:26
  a series of videos that we're creating,
• 16:29
  and trainings that we explicitly
• 16:31
  talk about trauma.
• 16:33
  And, really, it goes,
• 16:34
  it gets to a lot of the stigma,
• 16:36
  you know, and it and it's from the
• 16:38
  front desk all the way back to the
• 16:40
  physicians. Right? If the front desk is says,
• 16:42
  why are you acting up so much? It
• 16:44
  might be just because the patient has to
• 16:47
  go talk to their parole officer. They have
• 16:49
  to go talk
• 16:50
  to their their housing person, and they have
• 16:52
  to take care of their kid. And the
• 16:53
  fact that they've been waiting in the waiting
• 16:55
  room for ten or fifteen minutes is a
• 16:57
  lot to take.
• 16:58
  And so making sure everyone's aware and making
• 17:01
  sure that they're not taking it personally,
• 17:03
  to be open and supportive,
• 17:05
  and how to talk to the patient in
• 17:07
  a respectful and dignified way is really critical.
• 17:09
  And that's what a lot of our, training
• 17:11
  is about.
• 17:13
  And and and this training is, again, not
• 17:15
  just going to the physicians or the social
• 17:18
  workers or the nurses. It's to,
• 17:20
  the front desk. Right? It's the entire team.
• 17:23
  And we what we need is there's been
• 17:26
  a a history
• 17:27
  of, stigma put upon these patients.
• 17:30
  So we need a lot of positive experiences
• 17:33
  to earn their trust and to earn their
• 17:35
  confidence in us that we're going to,
• 17:37
  provide, treatment. So upon, full implementation,
• 17:41
  we'll provide,
• 17:42
  training to over 3,000,
• 17:45
  health and hospital staff,
• 17:47
  to achieve the system wide culture change
• 17:49
  and facilitate additional,
• 17:51
  treatment and care.
• 17:53
  And and this includes,
• 17:55
  both asynchronous
• 17:56
  and synchronous training.
• 17:58
  So we have,
• 18:00
  a lot of videos that they can watch
• 18:01
  and training and material, but we also have
• 18:03
  a number of learning collaboratives,
• 18:06
  as well as in person,
• 18:08
  kind of live actor simulation. So, we have
• 18:11
  a pretty robust,
• 18:13
  plan
• 18:14
  to to address stigma. And I like to
• 18:16
  tell people that stigma is not just some
• 18:18
  soft issue. It's the matter it's a life
• 18:21
  or death issue. It means they either seek
• 18:23
  out care or they don't seek out care
• 18:25
  because they don't they're too scared to cross
• 18:27
  our our four walls or a hospital.
• 18:30
  And the last piece I'll say is that's
• 18:32
  what makes me really excited that we're even
• 18:33
  going into the community.
• 18:35
  Crossing,
• 18:37
  a door into a hospital is a threshold
• 18:39
  that some patients don't wanna take. And we
• 18:42
  wanna meet them where they are, so we
• 18:43
  will go into the community to meet them.
• 18:45
  We'll take care of them virtually if we
• 18:47
  need to, whatever we can do to support
• 18:49
  the patient,
• 18:50
  for what they're ready with.
• 18:52
  Absolutely. Thank you so much for those final
• 18:54
  thoughts. This has definitely been a very informative
• 18:56
  discussion. So, again, I wanna thank you so
• 18:58
  much for coming on Bedford Health Care, especially
• 19:00
  for the first time. I look forward to
• 19:02
  connecting with you again soon.
• 19:04
  Thank you so much for the opportunity, and
• 19:06
  I really appreciate your thoughtful,
• 19:08
  questions.
• 19:09
  Of course. Talk to you soon.