Latest / Becker's Healthcare Behavioral Health / Rylee Wilson speaks with Dr. James O’Dea and Dr. J. Craig Allen of Hartford HealthCare

Transcript

Rylee Wilson speaks with Dr. James O’Dea and Dr. J. Craig Allen of Hartford HealthCare · Becker's Healthcare Behavioral Health

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This is Riley Wilson with the Becker's Healthcare
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podcast. I'm thrilled to be joined today by
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two special guests, doctor James O'Day and doctor
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j Craig Allen. Doctor O'Day is senior vice
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president of behavioral health network at Hartford HealthCare,
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and doctor Allen is vice president of addiction
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services at Hartford HealthCare, the medical director at
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Rushford Center. Thank you both so much for
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being here today. Before we jump into our
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conversation, I'd like to ask you to introduce
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yourselves and tell us a little bit more
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about your background.
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Doctor O'Day, can I ask you to start?
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Sure.
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I'm happy to be here, Riley. Thank you
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for this opportunity.
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Yeah. Sure. I'm a, I'm a psychologist
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by training,
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and I've also got a business degree. I've
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been working in Hartford HealthCare for over thirty
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five years at this point. So I practice
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clinically for a very long period of time,
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then moved into various administrative roles. And now
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I'm just so proud to lead this amazing
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team of some 3,000
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people who work in behavioral health as part
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of this terrific organization,
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Hartford HealthCare, and really pleased to have the
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opportunity
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to talk about these topics today.
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Wonderful. Thank you so much for joining us.
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And, doctor Allen, can we ask you to
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introduce yourself?
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Yes.
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Thank you for having us on, Riley.
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I'm a child and adolescent psychiatrist
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and an addiction medicine doctor,
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and I'm the medical director here at Rushford,
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which treats behavioral
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health issues,
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all psychiatric disorders and
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substance use disorders.
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I see patients, but I also oversee our
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providers,
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in, this service. And as vice president of
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addiction services,
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I oversee our approach to identifying,
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engaging,
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and treating people with substance use disorders across
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the system.
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Great. Well, thank you both again for joining
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us, and I'm really excited to hear both
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of your perspectives on behavioral health and addiction
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medicine.
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I'd like to ask each of you what
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your top priority is when it comes to
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behavioral health at Hartford HealthCare this year. Doctor
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O'Day, can I come back to you to
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start?
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Sure.
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You know, Riley, I think it all starts
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with access.
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Right? We have to make sure that we're
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making care affordable care
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accessible
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to more and more patients.
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Historically, it's been a little bit hard for
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people to reach out. There's issues regarding discrimination
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and stigma.
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And one of the things that we know
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is that access to behavioral health care works
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so that when people are involved in treatment,
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they get better.
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And, you know, the the thing that troubles
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me the most actually is people wait too
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long to reach out to get care and
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treatment. So probably the biggest priority is to
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make sure that we're making care affordable,
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accessible,
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providing really, really high quality care to people,
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that is accessible to people from all backgrounds
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and all over the state of Connecticut.
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So I think it begins with access.
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Once we get people in the door, people
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get better.
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Doctor Allen, can you show your perspective on
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your top priorities in addiction medicine?
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Yeah. I I think that I would jump
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in
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on part of what doctor O'Day said
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along the lines of engagement.
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My
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biggest concern really is
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keeping people in treatment once they've accessed that
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treatment. And we know particularly
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with substance use disorders, but to some degree
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for all psychiatric disorders,
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the longer someone stays
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engaged
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in some type of treatment,
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as long as they keep coming back, then
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we have the opportunity
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to work with them using some of the
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strategies we'll talk about a little bit later
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today to help them
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get better. So, you know, the I like
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to say, something that,
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one of my predecessors
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has always had always said, Sam Silverman, and
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he would ask the medical students and the
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residents, what's the most important part about that
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first interaction,
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that first appointment?
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And he'd answer, but getting someone to come
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back for a second appointment. So all the
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strategies we can use
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to motivate people and engage people
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and activate people,
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towards,
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staying in treatment,
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is is what I worry about and,
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the strategies that that we try to incorporate
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and,
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develop here at Harvard HealthCare and in the
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behavioral health network.
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Great. Thank you both so much. I wanna
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talk about, value based care as well. Doctor
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O'Dare, I'd like to hear from you what
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you see as the biggest opportunities when it
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comes to value based care and behavioral health.
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Well, this is one of my favorite topics
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to talk about, Riley.
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I think we are on the threshold
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of what can be some of the most
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compelling times in behavioral health care in psychiatry
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and in the treatment of substance use disorders.
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And the reason I say that is it's
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long been understood
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that the twenty ish percent of the people
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that consume
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seventy percent or seventy five percent of the
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health care dollar, you know, these are folks
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that have chronic conditions.
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And sometimes those chronic conditions, when they also
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have conditions like depression,
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anxiety disorder, substance use conditions,
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it it it it really impacts on somebody's
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ability to manage their COPD,
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their congestive heart failure,
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their diabetes.
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So we've long understood the literature has always
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been really clear. You spend a dollar for
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behavioral health care,
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you save $6
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downstream.
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So I think we're on the threshold right
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now as we move into value based care
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as opposed to a fee for service kind
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of world
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that what's really gonna happen is where behavioral
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health has been seen
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for virtually my whole career as an expense.
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The reality is spending money on behavioral health
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care is an investment
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because it saves people from
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readmissions for their heart failure, for their diabetes.
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It saves them from
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being noncompliant with their medication,
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which then results in a foot ulcer and
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an amputation,
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and then they trip, and they have to
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have an orthopedic surgery, and then they have
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to go to a skilled nursing facility.
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These are the things that happen when you're
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not treating
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very treatable psychiatric conditions like depression,
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like anxiety,
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and including substance use disorders.
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So I feel so excited about this because
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for now, at this point in my career,
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I see partnerships
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growing between health systems like ours and insurance
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companies where we can engage in projects together
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where people will say, these are not expenses
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to the health care system.
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These are investments
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that save a lot of money downstream.
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I'm as excited about where we are in
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psychiatry as I've ever been in my long
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career.
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Great. Well, that's fascinating to hear about all
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the opportunities and the optimism there.
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I wanna shift gears and hear from you,
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doctor Allen, about the new treatments and technologies
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that you're watching, when it comes to addiction
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medicine.
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Well, I you know, I wanna start by
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saying
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the approach to treating people with
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addiction, with substance use disorders,
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It's it needs to be the same as
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chronic disease management for things like cons
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chronic obstructive pulmonary disorder, diabetes, hypertension.
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And, you know, meeting people
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where they're at working,
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on helping them to work on their issues,
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sometimes
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one step forward,
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two steps back, three steps forward. It's it's
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really important in any type of disease,
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but particularly
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for substance use disorders. So we look at,
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harm reduction strategies,
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developing safety plans,
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and,
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helping people to what what are the phrases
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people have used before? Like, things like naloxone,
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which is the opioid overdose reversal medication, getting
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that in people's hands.
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And, one of my, providers once said, you
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know, you you can't get someone to the
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end. You can't get someone to recovery, to
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the final goal if if they die in
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the meantime. So every step forward
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is is really important. And, you know, starting
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off looking at the new technologies,
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the new approaches,
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I I wanna hearken back to
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solid,
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evidence based proven
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approaches
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which need to be utilized fully, and that's
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medications for opioid use disorder, like buprenorphine,
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methadone,
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naltrexone,
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and,
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medications for alcohol use disorder. These are FDA
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approved medications which are
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still in this day and age under prescribed.
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And then when they are prescribed,
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they're often
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not taken for very long. So for instance,
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people that are on
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medication for opioid use disorder,
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within six months
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or seven months,
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almost half of them have stopped taking the
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medication.
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So strategies like long acting
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injectables
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can be really helpful in getting people to
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stay on medications that have been proven to
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be effective,
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engaging families and loved ones,
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using contingency
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management
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to help people to continue to stay on
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medications while they get other supports that they
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need through psychosocial and therapy
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is super important. But in terms of new
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approaches,
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new medications,
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you know, the the rage these days are
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these,
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glucagon like peptide one agonists, the GLP ones,
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the things, that are used to decrease people's,
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glucose levels to treat to treat diabetes.
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But,
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probably in in the the lay press,
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to treat obesity,
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and, people who are who are overweight,
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those medications
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have been shown
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to affect many different parts of of the
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body.
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But a part of the brain
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that is the same part of the brain
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that's affected for people who have substance use
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disorders, And there's been some strong signaling with
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studies that have come out recently
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showing that these same medications might be helpful
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for alcohol use disorder,
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nicotine use disorder, you know, tobacco use disorder,
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and and other substance use disorders. So that's
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really exciting, but we we have to get
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the data before we start prescribing those first
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line for substance use disorders.
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Other approaches include things like brain stimulation, transcranial
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magnetic stimulation,
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and, we're involved in some studies looking at
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opioid use disorder
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and how this
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noninvasive
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brain stimulation
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can have a positive impact
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on people who
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have,
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opioid use disorder and other types of substance
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use disorders.
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I'm keeping an eye out, for other brain
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stimulation like deep brain stimulation,
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looking to see where the data's gonna go
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with psychedelics.
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Things like psilocybin,
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have been used,
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back in the seventies. In 5060, '70 studies
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were done showing,
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some efficacy for alcohol use disorder. And now
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recently, these studies have been done again
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and,
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very, very promising results.
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Beyond that, there's,
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there are medications like immunizing
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people against the molecules
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that are involved with some substances,
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And then,
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IT, so app based programs
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have shown
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to be a new way to engage people
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in cognitive behavioral therapy,
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either to support
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medication management,
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or or in lieu of medication management. So
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it's a it's a as doctor O'Day said,
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this is a very exciting time, a very
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exciting time for psychiatry, and also a very
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exciting time for people with psychiatric illness that,
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manifests as addictions.
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Great. Well, I wanna end our conversation, you
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know, where we began, which was talking about
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access. And so I'd like to hear from
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each of you, you know, what you see
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as the biggest challenges when it comes to
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behavioral health access, and what are the bold
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solutions you think will help solve these?
12:32
Doctor Allen, can I come back to you
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to start?
12:34
Sure. You know, with substance use disorders in
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particular,
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access,
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can barriers to access can come in many
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different forms. There's,
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there's the discrimination and the stigma of even
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going out to
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to ask for help that gets in the
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way. And then there's those those same things
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that
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impact,
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providers
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who may not be all that familiar with
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people with substance use disorders.
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And, so people who have substance use disorders
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who do reach out can sometimes
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not be met with open open arms.
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Society in general
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is,
13:16
is is coming along in terms of their
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acceptance and understanding,
13:21
of substance use disorders. But all of those
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things can get in the way of access.
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And for substance use disorders,
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when you're ready for treatment, being able to
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get that treatment
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now
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is incredibly important because things can change. And
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those parts of the brain,
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you know, the the reward pathways of the
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brain
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create cravings
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and urges that,
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can drive you
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back to using again if you're not able
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to access treatment
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when,
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you're you're ready for it. So,
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very
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exciting,
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future,
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and,
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the easier you can make it for someone
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to get into quicker the into treatment, the
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quicker someone can get into treatment and the
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better you can engage them once they're in
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treatment,
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and the the longer they will stay and
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the better outcomes that you'll see.
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And doctor O'Day, you have the final word
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here. What bold solutions do we need to
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improve behavioral health access?
14:23
Well, first off, I really appreciate doctor Allen's
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comments on this. I think that for me,
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it be it it's about workforce.
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What the things that we need to do
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to make sure that we're bringing exciting people
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into the field of psychiatry and substance use
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treatment,
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social workers, psychologists,
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psychiatrists, nursing professionals,
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it's about workforce.
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And and I think, you know, the one
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of the things some of the things that
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we're especially proud of at Hartford HealthCare is
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the building of our relationships
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with various colleges and universities.
14:57
The kind of partnerships that we have with
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some of the colleges and universities
15:02
here in Connecticut are creating a pipeline
15:04
where we're engaging with high school students and
15:07
educating them about health care. We're engaging with
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college students, especially those that focus in behavioral
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health and providing internship and practicum opportunities.
15:18
You know, we're so excited about being a
15:19
really large training organization. And when people receive
15:23
their training with us, they get attached to
15:24
their supervisor.
15:26
They like the work that they're doing. They're
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excited to get their first job in health
15:31
care,
15:32
in a place that they've trained. So to
15:34
me, you know, a barrier to access is
15:36
not having the right staff. So the work
15:38
that we're doing to ensure that we've got
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a qualified workforce
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that's excited about the work that we do,
15:44
it really is around the partnership with our
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collegiate partners, and that's really showing great dividends
15:49
right now.
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Great. Well, thank you so much, doctor O'Day
15:53
and doctor Allen, for joining us today and
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sharing your insights. We hope to have you
15:56
both back soon and catch up on all
15:58
of your top priorities and these exciting new
16:00
technologies you're watching.
16:03
Thank you for the opportunity.
16:04
Thank you, Rodney.