Latest / The Mental Health Evolution / Ep 55: Be the One Who Does It

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Ep 55: Be the One Who Does It · The Mental Health Evolution

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  (Transcribed by TurboScribe. Go Unlimited to remove this message.) This podcast is part of the Frederick Podcast Network.
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  Learn more at listenfrederick.com.
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  Welcome to Mental Health Evolution, a podcast about what's changing in mental health and
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  why it matters.
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  I'm your host, Rachel Harrison, inviting you into honest conversations with people from
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  all perspectives in the field, clinicians, tech founders, investors, insurance companies,
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  and all the folks in between.
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  Let's explore what's working, what's not, and what's next.
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  Welcome back, everyone, to the Mental Health Evolution podcast.
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  Today, we are going to do a solo episode.
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  And I'm excited to dig in and talk to you a little bit more about some of our conversations
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  with all the perspectives in the field, clinicians, tech founders, investors, insurance companies,
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  and all the folks in between.
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  So let's take a look at what is working, what is not, and what is next.
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  So I want to talk today about what's been on my mind lately, and I don't think I'm alone
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  in this, is how much has changed in a very short period of time.
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  Not just in mental health, but for small businesses generally.
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  The economy is shifting, AI is changing what's possible and what's expected, I'm hearing
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  podcasts about all kinds of wild things like how does this impact our workforce, we won't
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  have all these jobs, there's a lot of talk about how all this is impacting us and large
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  companies moving into spaces that used to belong to local independent operators.
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  And I think a lot of businesses in general are sort of figuring out the landscape while
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  we are trying to do the day-to-day tasks and figuring out how to stay relevant, how to make
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  decisions that make our organizations be able to stay afloat and to stay doing what
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  we're doing.
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  I'm seeing lots of different posts on Facebook of people that are saying things like, hey,
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  referrals aren't happening in the way that they used to, and I don't know what's happening
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  in my business, but things have gotten tougher.
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  I think there's just a lot of factors at play here, and mental health is no different.
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  So I think it can be tough.
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  I think this episode, I want to focus a little bit on what serves the needs of clients, patients
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  seeking mental health care best, like what is actually needed in this field?
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  Because after talking to everyone on all sides of this over the last year in this podcast,
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  I think everyone is trying to do something good.
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  Everyone is trying to make things better for clinicians, for clients, for accessibility,
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  and we are in a situation where a lot of new players are coming into the field, changing
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  the model, changing up what things look like, and that can be really overwhelming for people
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  that have been doing this for a while, specifically maybe group practice owners and solo clinicians
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  trying to figure out what is happening here, why are so many things changing, what is the
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  impact of tech companies that are coming into the field, what do these organizations look
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  like, what are they using to improve accessibility, how are clients getting care, are they going
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  directly to an insurance-owned clinic or are they going to somebody that's been operating
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  independently?
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  And I think there's just a lot of questions there, but I want to talk a little bit today
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  about what is happening for the people who are noticing the changes but not necessarily
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  coming in as the new people, the people who have been in this industry for a while and
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  maybe they are looking for how they still have a role, what their place is in the changes,
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  and I think there's a lot of things we can talk about today, and I'm kind of focusing
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  in a little bit on advocacy, and I just want to encourage organizations that might feel
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  smaller, they might feel like they don't have the marketing budget to compete with large
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  corporations, they don't have donations to political causes, but just focusing in on
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  what does the practice have that is local, especially the ones that are in-person, and
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  what are the differences, what is their role in this ecosystem of mental health in practice
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  and industry, even when things are changing dramatically, even when there's a lot of pressures,
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  there's a lot of different things going on. So, I want to kind of dive into a little bit
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  about that, starting with this first section, and I'm going to reference some of our previous
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  episodes and kind of where I'm gathering some of this data, and that gives you a place that
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  you can go back and listen in and dig in a little deeper if you're wanting to learn more
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  about that as well. But first, I want to talk about these forces at play, if you will. I keep
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  referencing these changes, but what is actually changing? And back in episode two, which was one
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  of our earliest episodes, we gathered a small group of local mental health leaders to talk
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  through what was changing in our industry. It was about a year ago, and we were looking at articles
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  about tech-driven platforms, about value-based care models that insurance companies were using
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  to evaluate and reimburse providers, about data privacy cases involving online mental health
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  companies, and even then, in those early conversations, the theme that kept coming up was
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  that the rules of the game are changing, and most clinicians don't know it yet, nor do clients. And
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  what has changed since then is the pace. Kathy Gilbert, who joined us in episode seven as a
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  with a deep background in insurance and provider network operations, put it really well. When I
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  asked her whether things were actually moving faster than usual, she said, and I'm going to
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  kind of paraphrase here, when she wrote her master's thesis on national health care in the 90s,
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  it took nearly 20 years for the ACA to get passed, and now policy changes that could affect millions
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  of people are moving in months' time. She says it doesn't feel settled, and she doesn't think that
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  it is settled, that the changes are continuing to roll out. We're definitely seeing that happening
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  with the big, beautiful bill that has proposed cuts to Medicaid, to the Affordable Care Act,
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  and to programs that fund mental health access for some of the most vulnerable populations.
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  SAMHSA, which is the Substance Abuse and Mental Health Services Administration,
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  has faced consolidation proposals. School mental health grants have been halted.
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  The 988 crisis line has seen reduced funding. And at the same time, on the provider side,
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  there's still a reimbursement gap that has not closed. Deborah Steinberg, who joined us in
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  episode nine, she's a senior health policy attorney at the Legal Action Center in Washington,
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  D.C., walked us through the Mental Health Parity and Addiction Equity Act and what it was supposed
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  to do. The law says that insurance companies cannot treat mental health differently than
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  physical health. And yet, the AMA's Mental Health Parity Index found that physicians providing
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  mental health care are reimbursed about 27 percent less than physicians providing physical
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  health care. And that's after a parity law has been on the books for years. So there are lots of
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  legal advocacy groups out there trying to look at this parity piece and apply it from the physical
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  health care reimbursement rates to mental health care reimbursement rates. When you hear parity
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  in general, that's what they're talking about. And the enforcement of parity? Well, the insurance
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  companies definitely found some loopholes. Federal agencies signaled they would not enforce some of
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  the rules designed to close those loopholes. It took Georgia's insurance commissioner on his own
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  to levy over 20 million in fines against the insurance companies for violating parity laws.
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  He said, and I want to read this quote directly,
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  three years later, our initial examinations show that insurers have turned a blind eye to the rules
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  and continue to deprive Georgians of the essential behavioral health resources they deserve. That's
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  just one commissioner in one state. That is not a system. This is an individual using his position
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  to fight for what the law already requires. And another force at play is absolutely AI.
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  We had Dr. Ajita Robinson on in episode four, and she gave us a great overview of where state
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  legislation is landing on AI in behavioral health. New York requiring chatbots to have protocols
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  around suicidality. Nevada outlining AI providing direct service care. Illinois prohibiting AI from
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  making therapeutic decisions. And we had Maryland State Delegate Lily Qi on episode 40, who talked
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  about the bill she worked on right here in Maryland, House Bill 883, which would have regulated AI
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  in behavioral health contexts. It didn't make it through the full session, but she was clear
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  in the absence of federal leadership, states have to be the backstop. And if no one is pushing states
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  to move, they won't. So that is the landscape, giving you some of the conversations that we've
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  had on this podcast. There's some tech disruption, corporate consolidation, insurance companies
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  operating in ways that kind of evade parity laws, federal funding erosion, AI moving faster
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  than regulation. And in the middle of that, clinicians who went to school to do therapy
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  don't always think about tracking all these changes. They don't always think about the laws.
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  They don't always think about advocacy. So in this next section today, I want to talk about this
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  advocacy response. And I think it's really challenging doing the day-to-day work of trying
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  to provide therapy to people that really need it, to provide medication management to people that need
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  it. It's really tough to make any space in that for watching the industry, watching what's happening.
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  That's actually a big reason why this podcast exists. I want to give people who are providing
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  care a way to understand what's happening in our industry without having to take all the time to
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  do it. We curate information for you. We provide articles. We give you conversations that are a
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  snapshot that hopefully help educate. And advocacy is the next step. It is the thing that we can do.
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  And there are a lot of people starting to band together and do these things because if the people
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  providing the care stay quiet, then no one is really there to fill that gap. What is needed,
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  what is happening, what works, what doesn't work. Clinicians have all kinds of expertise and
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  credibility that money alone can't produce. And I think for legislators and a lot of lawmakers in
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  different places, there is a lot of interest in actually understanding the day-to-day work. I
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  have found a lot of openness there. But I think it's hard for clinicians to find time and space to
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  do that. Care Cheevers, who joined us in episode 41 as the Vice President of Coverage Policy and
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  Inseparable, which is a national mental health advocacy organization, she shared some data that
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  I think captures this well. Their workforce report, which looked at all 50 states and D.C., found that
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  only four states met more than half of their population's demand for mental health services.
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  And nearly half of all states meet 25 percent or less. And that's one of the biggest reasons
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  that there are new companies, that there's new innovation, that there are people trying to create
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  access to care. And a reason as well that creates this access gap is that a lot of providers are not
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  able to take insurance. And that is because of low reimbursement rates. It's kind of a vicious
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  cycle here. But policies and advocacy can help change this. Cara also made the point that there
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  are three areas where state policy can make a real difference right now. Building a workforce
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  pipeline, supporting providers already in the field, and modernizing data and technology.
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  Each of those is a lever that advocates can pull, that legislators can pull, and that mental health
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  community shows up and asks for them. If the mental health community shows up and asks for
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  that. Sue Abderholden is a retired executive director of NAMI Minnesota, and she was on her
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  episode in episode 23 and said something that has stuck with me. When I asked her about the phrase
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  the mental health system is broken, something I've said myself, she actually pushed back on that.
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  She said the mental health system isn't broken. It's still being built. And she meant that as a
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  call to action. We have the opportunity to build something intentional, but it requires showing up.
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  It requires using our voices and not stepping back. In this last section of the solo podcast
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  today, I want to talk about what advocacy actually looks like. Specific things that are happening
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  and ways, even if you don't have a ton of time, that you might be able to dive in. I think there
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  are some different levels of advocacy. They're not mutually exclusive. You can operate in more than
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  one of these certainly at the same time. The first level is legislative advocacy, and this is what
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  most people think about. It's showing up to a committee hearing. It's writing your state
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  representative. It's participating in your professional association's lobbying efforts.
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  It feels more formal and sometimes a little intimidating, but it's more accessible than
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  most clinicians think. Delegate Lily Qi gave us a great window into this in episode 40,
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  and she talked about that House Bill 883 and how it came to her. Someone just brought the idea.
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  Someone said, this is a problem. This is what needs to happen. She was on the right committee.
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  The timing was right, and she moved on it. It didn't make it through the session, but the door
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  is not closed. State-level legislators are often more accessible than federal ones. They do respond
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  to constituent contact. They want to know what's happening in their districts, and as Delegate Chi
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  pointed out, the absence of federal action on things like AI regulation in different states
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  is where the work is actually happening. Deborah Steinberg, in episode 9, made a similar point
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  about parity enforcement, saying that the law exists. The problem is that enforcement is
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  inconsistent, and it decides on who is going to push that forward. Advocacy in this space could
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  look like supporting organizations that are doing parity monitoring, like the Kennedy Forum's Mental
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  Health Parity Index, or it could look like contacting your state insurance commissioner
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  directly when you see a violation. The Georgia example shows that when someone in power decides
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  to use that power, things happen. The second level is organizational advocacy, and this is working
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  through your professional organizations. The American Counseling Association, the American
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  Association for Marriage and Family Therapy, NASW, your state licensing board, advocacy arms,
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  these organizations already exist to represent the profession, and they are more effective when
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  they have member engagement. If you're paying dues and not engaging, then there's some supportive
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  advocacy, certainly, but it might not take much to be involved in what's actually happening.
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  Inseparable is another example, and they do research, track state-level policy, and translate
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  it into action steps for advocates and lawmakers. These organizations that need visibility and
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  support from the clinical community to do their work effectively. One of the things Kara said
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  that I found really valuable was that clinicians have firsthand stories that advocates and
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  policymakers don't have. When you can say, here's what my caseload looks like, here's what I'm
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  seeing, here's what I can't do because of reimbursement gaps, that testimony is powerful.
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  The third level is community-level advocacy, and this is where episode two, the Real Change Initiative,
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  was instructive, starting a small grassroots local group together and getting some awareness
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  in the community. That was called the Real Change Initiative. It wasn't a lobbying effort, it was a
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  local community-facing effort to raise awareness and keep building relationships. And the principle
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  underneath it, that clinicians organizing together around shared concerns, speaking publicly, educating
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  communities, is advocacy. It shifts the narrative, it builds the kind of public understanding that
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  eventually supports policy change. And Malcolm Fergal, who leads the Coalition for a Healthier
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  Frederick County, talked about this in episode 28. His work is specifically about systems-level
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  change, bringing together healthcare, nonprofits, government, and other sectors around equity and
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  access. He is not a clinician, but his coalition includes mental health providers, and the work he
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  does directly affects what happens to mental health care in our community. Connecting with
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  organizations like that, health coalitions, community foundations, civic organizations, is a form of
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  advocacy that doesn't require a trip to a local state government. The fourth level is your own
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  public voice, and this is the one that feels most personal and maybe the most available. It's what
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  you say publicly, on social media, in your community, in conversations with potential clients, and the way
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  that you talk about your work. The narrative around mental health care matters. When clinicians
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  are invisible, the public conversation about AI, about corporate consolidation, and about what
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  therapy actually is and why human being matters, that vacuum gets filled by someone else. To
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  reference Ajita Robinson again in episode 4, she made a strong case for clinicians being visible
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  advocates for their own field. She has a training program on AI for therapists, and she's vocal
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  about ethics in that space. And she is someone who is speaking up and shaping how other clinicians
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  think about these issues. And in the very last section today, I want to talk about what you can
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  do this week, because a lot of this is abstract. Some of you are hearing about legislative things,
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  even local things, and saying, I don't even know if I have space for that, and that's okay.
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  But here are a couple of action steps if you do have a little bit of time. Number one, find out
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  who your state representatives are and what committees they sit on. If they're health or
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  behavioral health committees, introduce yourself, send an email, go to a town hall. Most legislators
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  will meet with a constituent who makes the effort. You don't need to have a polished policy argument.
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  You just need to tell your story. Number two, look into Inseparable's workforce report for your state.
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  It scores all 50 states on how well they're meeting mental health workforce demand.
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  If your state is failing, and there's a good chance it is, that's a good conversation starter.
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  It's something that you can be talking to your community about, or to a legislator,
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  or a hospital system. Number three, if you're a member of a professional organization,
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  and you haven't engaged with their advocacy arm, maybe just look up what they're asking for.
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  Can you sign on to letters? Can you show up to virtual advocacy days?
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  They're doing the work, and member engagement makes it more credible.
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  Number four, talk about it. Talk publicly about why your work matters, about what practice means
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  to you, your group practice, your local practice means to you, and what gets lost when reimbursement
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  is so low that you can't afford to take insurance. Consumers are part of this equation. They vote,
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  they make choices, and they can also advocate, but they do need to understand the stakes first.
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  And number five, be the one who does it. The person who is going to fight for
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  independent mental health providers, for fair reimbursement, and for thoughtful AI regulation
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  in a system that's designed around what patients and clients need. It takes all of us.
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  So lastly, as we close out this episode, kind of summarizing some of the themes
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  specifically around advocacy and about what people are doing, who are the organizations
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  that have been around for a long time, the group practices, the solo practitioners,
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  looking around at all the changes and thinking what can be done. Advocacy is one way.
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  We are, as Sue Abderholden put it, still building this system. What role do we want
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  these practices to have? What role does a tech company have? What role does AI have?
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  These are all things that are still really in process. And it means that there's voice,
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  that there's room for development here. I started this podcast because I wanted to
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  raise the conversation about what's happening in our field. I will continue to do that. And
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  I've been grateful to have guests who are doing remarkable work, attorneys, delegates, advocacy
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  organizations, community coalitions. And the takeaway from all of those conversations is that
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  change is not happening. In spite of individual effort, it was happening because of it.
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  So being one person, one organization, or one conversation really does matter.
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  I hope this episode gives you something to think about and maybe something to do. As always,
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  everything we've referenced today will be in the show notes. And if this conversation
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  resonated with you, I'd love to hear from you. Thanks for being here. And we'll be back next
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  week with more on how the mental health industry landscape is changing. Bye for now.
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  Thanks for listening to the Mental Health Evolution podcast. Join the conversation,
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  find us on socials, send us your thoughts, and tell us what you're seeing in your corner of
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  the mental health world. Until next time, stay curious and keep evolving.