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Reimagining Behavioral Health in Post-Acute Care Through Telepsychiatry · Becker's Healthcare Behavioral Health

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  Hi, everyone. This is Brian Zimmerman with Becker's
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  Healthcare. Thank you so much for tuning into
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  the Becker's Healthcare podcast.
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  Today, we're going to talk about reimagining behavioral
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  health in post acute care. Joining me for
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  this discussion is doctor Glenn Redmond.
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  Doctor Redmond, thank you so much for being
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  here. So you you are, the medical director
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  of telepsychiatry with Lumina Care.
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  Can you share just a bit more about
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  yourself, your professional background,
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  the work you've done in health care, just
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  so listeners can really appreciate where you're coming
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  from?
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  Yeah. Definitely. So I am a board certified
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  psychiatrist. I practice
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  mostly in Minnesota and then across the country
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  in in digital telepsychiatry
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  space.
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  And I have done a lot of different
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  roles in the field of mental health from
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  serving as a chair of a department
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  in in a rural hospital to serving as
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  faculty at the University of Minnesota
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  to working in interventional psychiatry, which is a
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  really neat, newer area of psychiatry where we're
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  trying to bend the needle on treating depression.
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  And I have a wonderful family in Minnesota.
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  I enjoy the weather even though it's really
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  cold in the winter.
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  I'd love to do some winter sports. So
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  just excited to be here and and continue
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  this conversation.
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  Yeah. That
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  great to hear your background and everything you've
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  done and and the perspective you bring in
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  it. As a fellow Midwesterner,
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  let's all try to stay warm as we
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  move through the conversation today.
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  Wait. Wait. Wait. Wait. It can't be brutal.
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  Yes.
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  We talk a lot about we're hearing a
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  lot about sort of the the phrases behavioral
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  health integration,
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  sort of really bringing behavioral health into to
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  broader health care, making that work, making that
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  all sort of align with different health care
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  services.
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  Can you talk a bit about how telepsychiatry
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  fits into sort of post acute care today
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  in terms of behavioral health integration? What role
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  does telepsychiatry
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  play here?
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  Yeah. Absolutely. I I I think you hit
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  on a good point there.
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  In that for a long time, there has
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  been silos with mental health. It's it's only
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  more recently, I'd I'd say, especially in the
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  last, ten to twenty years that there's been
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  a renewed focus on mental health and incorporating
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  into all areas of medicine.
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  And there's a history. There's a a long
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  reason why that's happened. And so
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  we're in a wonderful spot with telepsychiatry
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  to
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  reach people that we could not reach before.
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  And I think more than ever, we're recognizing
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  that
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  behavioral health is a part of general health.
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  You know, we separate it
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  just historically for a lot of different reasons
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  and to conceptualize these things. But brain health,
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  mental health, it's all part of general well-being.
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  So what happens in the body affects the
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  mind and vice versa.
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  And so with behavioral integration,
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  it's trying to recognize
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  that we need to
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  infuse more behavioral health into post acute settings
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  and partner with primary care providers to expand
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  the access
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  and to incorporate in other mental health professionals
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  within that setting to try and make sure
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  that we're fully treating and multiplying the effect
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  that mental health providers have.
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  It's it's a reality these days that we
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  we're not gonna be able to produce enough
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  psychiatrists
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  at any time soon to keep up with
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  demand and even with advanced practice providers, that
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  fill some of the gap. But there's such
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  such demand these days. We have to multiply
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  the workforce we have.
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  And in a way, that's where trying to
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  use behavioral integration with with going ahead and
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  incorporating a primary care provider with mental health
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  services to expand that. And I would say,
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  especially in the post acute setting,
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  it's it's really important because
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  in those settings, people are at higher risk
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  for rehospitalization.
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  They're at higher risk for coming into through
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  the emergency department, which in a lot of
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  places in America right now are crowded and
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  have a lot of mental health emergencies.
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  And it's not uncommon for people to spend
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  days
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  within, within an emergency department, which is a
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  chaotic environment before they get placed in
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  a hospital setting. And so that's one of
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  the things we we try and do at
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  Lumina Care is we're trying to keep people
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  in their long term care settings. We're trying
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  to,
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  or if, you know, they transition out, we're
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  trying to make sure that they have the
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  care needs that they have so that they
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  can stay home, they can get the care
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  or they stay at the long term care
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  facility, get the care that they need, and
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  prevent
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  rehospitalization,
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  prevent worsening of disease state, treat things as
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  acutely as we can
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  to get on top of those
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  before they get worse. Yeah. It's about keeping
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  keeping patients in the right care settings, correct,
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  for for them, for for the system. And
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  to to your point, I think there's broad
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  knowledge, broad agreement in the industry about just
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  how important mental health is, behavioral health is.
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  It's all health. It's all sort of a
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  part of it. But the system we have
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  isn't sort of set up in a way
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  that kind of acknowledges that, which creates unique
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  challenges in different care settings. Can you unpack
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  just a little bit further for the audience
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  when it comes to skilled nursing, long term
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  care facilities?
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  What are the unique clinical operational challenges there
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  when it comes to behavioral health? How do
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  these challenges sort of affect residents, staff, care
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  teams on the ground?
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  Can can you can you unpack that, share
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  some details with our listeners?
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  Yeah. Absolutely. Thank you for asking that, Brian.
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  I would say, you know, right right now
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  across the nation,
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  long term care facilities,
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  nursing homes, assisted living facilities,
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  it it's a
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  challenging environment to be. And there's a lot
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  of demand, and there's a lot of care
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  needs with oftentimes
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  challenges with staffing,
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  challenges
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  with balancing
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  care needs, budgets,
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  providing
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  excellent quality care. It's, you know, it's in
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  a lot of ways, these are some of
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  our most vulnerable populations in the country.
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  And we have an aging population. It's no
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  surprise. The the baby boomers are getting older.
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  It's our our largest population group. So there's
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  gonna be more and more people in long
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  term care settings, the rate of Alzheimer's disease.
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  The population number with that is growing. And
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  so
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  it's in in a way, the demand sometimes
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  for it outstrips what what facilities are able
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  to handle. And there's also a huge cost
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  issue with it too that sometimes makes it
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  challenging and what states are able to support.
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  And
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  and, and and what people are able to
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  pay for it. So it's a reality that
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  some of these facilities are really expensive, and
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  and how do we provide the care? So
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  I would say, some of some of the
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  biggest things that we're seeing in terms just
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  specifically
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  about behavioral health, I'd say the number one
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  thing is access. Like I said before, there's
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  a big shortage. You know?
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  There's only about 2,000 psychiatrists that come out
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  of training
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  each year, and, you know, a good 60%
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  of the workforce is at retirement age. And
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  so that gives you a little sense. Now,
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  like I said, with advanced practice providers, there's
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  a lot there's a lot more, and there's
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  there's growing numbers, so that helps out. But
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  if you're in a remote setting you know,
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  I I live in Minnesota. So let's say
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  you are in Southern Minnesota. Let's say if
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  you're in a place
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  like Virginia, Minnesota, you have limited access. You're
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  far away from larger health systems.
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  It can make it really challenging. And so
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  telepsychiatry
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  allows people to come into this space they
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  that they wouldn't routinely,
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  and I think that can be a a
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  a real strength. So getting people access. You
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  know, thank goodness we have these technologies and
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  abilities these days that we didn't prior.
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  So the number one thing, like I said,
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  is just access, having enough providers, getting people
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  in there. That's something Lumina Care we're trying
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  to do. We're trying to reach people in
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  hard to reach places.
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  And and what I what I commonly see,
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  why I think that's so important is I
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  I've seen
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  countless times in my work in hospitals where
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  people end up
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  getting worse and worse without the care they
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  need. And then by the time we get
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  to the hospital,
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  if they didn't have behavioral health care outside
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  the hospital. Let's say they're in a long
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  term care settings. The primary care team's doing
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  the best they can. You know, the the
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  average primary care provider, let's say a family
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  doctor coming out of residency only gets about
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  two to four weeks of training in mental
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  health in terms of dedicated rotation time. It
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  can be even less for other specialists like
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  internal medicine. And so primary care providers are
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  asked more and more to do more and
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  more mental health. And in a way, they
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  don't have
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  they have to learn so much. Like, how
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  how can we expect them to to do
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  such a level of that? And so
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  oftentimes, primary care providers in these facilities are
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  trying to do the best they can, but
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  these are sometimes very complex mental health concerns.
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  And so
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  I've routinely I've seen people where, you know,
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  they come to the hospital and they're so
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  sick that it then takes me two, sometimes
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  three months to get them better with different
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  things we have to do and sometimes interventional
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  treatments.
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  And what could be nice is if you
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  have access then to to psychiatry
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  expert level services,
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  you can treat it ahead of the time,
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  and you can hopefully prevent it from getting
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  worse.
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  And so,
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  that's that's a really important thing. And then
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  I think just, you know, along those lines
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  of access is just training staff, and that's
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  something we try and do at Lumina Care
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  really especially is is work with the facility
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  at our staff work with the staff at
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  facilities to train them about behavioral interventions,
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  when to to get us involved. There's a
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  lot of things you can do that aren't
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  medication
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  related to to help behavioral health challenges in
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  facilities.
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  And so education
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  and then just support people need. And and,
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  you know, one of the hard things with
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  with the last, you know,
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  roughly four or five years with the pandemic
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  is just access to to staff to care
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  for residents and facilities, and that's a big
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  thing. And I know a lot of people
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  are trying to work on that. And so
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  while there's unique challenges, I think we're in
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  a good spot. And and one of the
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  neat things about
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  mental health these days is we're trying to
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  push into how do we prevent things. It's
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  it's often the health care system we have
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  right now is we react when things are
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  bad.
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  You got a disease. It's at a point.
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  Okay. We can treat it. Mental health, especially,
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  we don't tend to treat until people are
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  really sick and they're demonstrating depression or psychosis
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  or agitation and dementia.
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  So there there's a movement within the field
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  to try and recognize, treat people earlier, use,
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  you know, technologies to help us recognize things
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  earlier,
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  and get people in to be seen sooner
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  so that we can treat conditions before they
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  get worse. And the evidence shows the faster
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  you're able to treat something,
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  the better off the outcomes tend to be,
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  which, you know, is is an exciting thing
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  there. So I I think there's definitely hope
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  in the situation for care as as, things
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  expand.
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  Yeah. I was struck by your comments there.
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  And early early on, you said, you know,
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  thank goodness we have this technology. And I
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  was thinking to myself, when you're talking, I
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  was like, if we didn't,
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  it could be a very a big crisis
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  on on our hands because, as you mentioned,
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  there's just not enough psychiatrists to go around.
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  The demand is is going up and up
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  and up in in long term care facilities,
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  but it's also going up elsewhere,
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  especially as the the
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  the knowledge about how important this is to
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  be proactive. That means you've got to give
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  people access to these types of services where
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  they didn't have them previously.
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  So how do you think, I guess, beyond
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  post acute settings too, where do you see
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  telepsychiatry
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  really having a
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  a great impact, especially particularly, I think, too,
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  in in underserved areas, rural metro communities,
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  communities that traditionally haven't had access to great
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  psychiatry? It seems like you know, I I
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  don't wanna go off too much of a
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  tangent here, but it seems like more of
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  the access to psychiatry has has been, you
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  know, among the worried well is the the
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  phrase I've heard before. But this seems like
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  a having a potential to finally get more
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  access to care to those those communities that
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  that really have some acute challenges that need
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  help. So curious to hear how you're thinking
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  about
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  how what differences technology can make for for
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  broader communities and and the industry as a
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  whole.
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  Yeah. Definitely. No. That's that's a wonderful question,
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  Brian. I appreciate you asking that. Yeah. I
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  I think I think we're sort of at
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  an inflection point where we're starting to
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  be able to reach people a lot better
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  with technology services, tele telepsychiatry
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  services, and even I'll mention app based services.
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  And, there there's, you know, been exciting research
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  out of different institutions
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  like University of California,
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  San Francisco,
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  using technologies
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  to try I'd mentioned trying to figure out
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  when people are going through a mental health
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  crisis before it displays in larger form. And
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  so, you know, some of the interesting stuff
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  is using app based technologies to to go
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  ahead and look at
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  how you're interacting with apps, and you might
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  be able to spot depression
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  earlier by seeing, hey. You're not engaging
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  with your calendar as much. You're using it
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  slower. Maybe your typing speed slower. And so
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  I I think in the future, we'll have
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  more ability to sort of use the technology,
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  especially with the with more artificial intelligence coming
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  about, recognizing things a little bit sooner to
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  get that. And and so those would be
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  things that are easily more accessible. One of
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  the challenges even to admit for people in
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  rural settings is even lack of access for
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  Internet.
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  You can't really do telepsychiatry
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  services unless you have good Internet access. And
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  so, you know, how do we sometimes bridge
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  that gap? And, you know, we we often,
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  with Lumina Care, try and solve that at
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  facilities we're at if if they have challenges
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  with their Internet connections. And, you know, we'll
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  we'll go ahead and provide, we'll provide routers
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  and try and make that accessible. And there
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  needs to be more of that, trying to
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  reach people in their homes. Fortunately, cell phones
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  often do provide enough,
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  ability to do that. And so I I
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  think what you'll see in the future is,
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  you know, a combination
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  of app based mental health care,
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  potentially helping your clinician decide what to do.
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  The second thing is technologies to help reach
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  people in in places that might not have
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  had Internet access.
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  And then and even using,
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  you know, artificial intelligence
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  with combination
• 14:11
  with a health care provider
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  to help sometimes guide treatment. So you might
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  talk to an AI, therapist
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  provider in a way, and then you're gonna
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  couple that with the actual provider themselves engaging.
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  And so it's all about duplicity of care.
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  How can we multiply these things? And and
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  and I think that that'll help out. And
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  then even just,
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  you know, in rural settings, I I think
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  as someone that's practiced a lot of my
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  career in rural settings, it's having having providers
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  know the community. And so
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  how do we how do we get providers
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  to to feel like they're on a foot
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  with things? And, you know, using the example
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  of of Lumina Care, which I work with,
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  what we do you know, we we couple
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  telepsychiatry
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  with actual in person. We have facilitators that
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  go in with the iPad that allows us
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  to communicate. So you do have a personal
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  touch on top of,
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  remote care, and it allows the providers sort
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  of have the hands and feet to do
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  sometimes what they need to do to help,
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  care for the patient the most. I think
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  there'll be more technologies,
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  more ability. There's gonna be more providers coming
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  out with advanced practice providers that, you know,
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  helping helping these communities.
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  And I I think I think it'll help
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  out. And then and then in a way,
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  I I gotta say, you know, in mental
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  health, we
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  we're we're starting to shift into newer treatments.
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  We're getting away from what we call, like,
• 15:32
  me too drugs. It's just the same drug.
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  You know, for example,
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  an antipsychotic
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  like Zyprexa is a common antipsychotic used. And
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  over the history of pharmacology,
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  you know, we ended up just tweaking the
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  structure a little bit and made a new
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  drug, and then you made a new drug.
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  And it's all, like, the same basic drug,
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  but you just tweak a couple chemical structures.
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  But we're having some more novel things, and
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  then and I'm hopeful for that. I'm hopeful
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  for even I I think one of the
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  key features is maybe epigenetics
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  in in the sense of what you're exposed
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  to sometimes changes your genes and how can
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  we sometimes modify those genes to change maybe
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  the expression of disease state through different technologies.
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  So I I think we're at one of
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  the brightest points for mental health care in,
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  I would argue, the history of the world.
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  Even the last hundred years has been astounding,
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  the amount of things that come out.
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  And so I think we're in a great
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  point with that. And and it's also, I
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  think, the culture at large, like, how do
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  we
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  how do we shift in a mindset of
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  caring for our most vulnerable
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  and helping people out in great need and
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  and trying to use all the services we
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  have available to meet those care demands in
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  innovative ways. And and so I'm I'm hopeful
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  for the future. I think tele psychiatry is
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  here to say it's not gonna go anywhere.
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  I think it'll just advance with its abilities
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  to provide
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  exceptional care. And and as a reminder to
• 16:52
  your audience too right now, the study showed
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  that telepsychiatry
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  services are equally effective as in person services.
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  So that's often something that patients will ask
• 17:01
  me and, hey. Why why can't I see
• 17:04
  you in person?
• 17:05
  Doesn't this work better? And, you know, I
• 17:07
  I remind people, you know, hey. It's it's,
• 17:09
  it's equally effective these days, and the studies
• 17:12
  support that.
• 17:14
  And and so it's, I and I think,
• 17:17
  so I think it's overall, if I were
• 17:18
  to summarize, I think I think there's exciting
• 17:20
  stuff going on for the future.
• 17:22
  Yeah.
• 17:23
  Touched on a a lot there in terms
• 17:25
  of what's going to evolve, and it's gonna
• 17:27
  be interesting to see how how the industry
• 17:29
  how it all comes into harmony. You know?
• 17:31
  The the Yeah. The the new technologies, the
• 17:34
  new therapies, the new treatments,
• 17:36
  telepsychiatry
• 17:37
  also still the, as you mentioned a couple
• 17:39
  of times, getting to know the community, like,
• 17:41
  making it personal, making it human. You got
• 17:43
  AI with education. Like, there's so much happening.
• 17:46
  It's gonna be fascinating to to see how
• 17:48
  it all lines up and all comes together.
• 17:51
  We've covered a good bit of ground today,
• 17:52
  doctor Redmond. Is there anything
• 17:55
  that you'd like to share that maybe we
• 17:56
  haven't touched on with our audience? Maybe it's
• 17:58
  something you wanna reemphasize, leave it to you.
• 18:00
  Just final question, what do you wanna leave
• 18:02
  folks with?
• 18:03
  Yeah. Yeah. Definitely. No. I I think, I
• 18:05
  think it's maybe a message. It's it's a
• 18:07
  message of hope and a and a message
• 18:09
  of
• 18:10
  a lot of the things available
• 18:13
  that people have right now to access in
• 18:15
  mental health care. I think it's it's primarily
• 18:18
  just getting people to the table. And a
• 18:20
  lot of my work that I do as
• 18:21
  a clinician is is not only thinking about
• 18:24
  medical treatment, but it's the entire
• 18:27
  environment people are in and different things they
• 18:30
  do. And, you know, the the evidence is
• 18:32
  so clear about certain things like exercise, nutrition,
• 18:35
  relationships,
• 18:37
  spirituality,
• 18:38
  all these different facets of life. And so
• 18:41
  a lot of what I do as a
• 18:42
  clinician is just think about those those different
• 18:44
  things and how to incorporate in, not only
• 18:47
  to, you know, my you know, when I'm
• 18:49
  thinking about if I have to give someone
• 18:51
  a medication or or a therapy I'm doing.
• 18:53
  And so I I think it's a maybe
• 18:55
  a reminder while I'm oh, I'm emphasizing the
• 18:58
  advanced technologies I think we'll have in the
• 19:00
  future that'll help out.
• 19:02
  Good old fashioned community,
• 19:04
  good old fashioned,
• 19:05
  you know, safe place to live,
• 19:07
  you know, a supportive job, even just a
• 19:09
  community that cares for you, I think is
• 19:12
  is a lot of the recipe for mental
• 19:14
  health success for people. And then and I
• 19:16
  and I think it's a really a time
• 19:19
  for us to all support each other in
• 19:21
  in the midst sometimes of challenging times and
• 19:24
  especially in the avenue of mental health care
• 19:26
  and in long term care settings. And I
• 19:29
  I think about how can we how can
• 19:30
  we,
• 19:31
  you know, treat people like we would wanna
• 19:34
  treat our own grandparents
• 19:35
  or, like, our own family members. That's that's
• 19:38
  often, the paradigm I use. And I think
• 19:40
  it's an important thing in health care.
• 19:43
  And the last thing is, I would say,
• 19:44
  for people in in the realm of health
• 19:45
  care too, I think, you know, just starting
• 19:48
  on my experiences with great leaders, I I
• 19:50
  reflect back on, hey. How can we make
• 19:52
  the health care system
• 19:54
  a little bit better each day? That's all
• 19:56
  you gotta do. One thing to make it
• 19:58
  better. What can we do? How can we
• 20:00
  make it a little safer? How can we
• 20:01
  make it a little bit more
• 20:03
  effective? Where can we sacrifice what we need
• 20:05
  to sacrifice?
• 20:06
  And I, I I think it takes all
• 20:09
  of us in that process to advance things.
• 20:11
  So
• 20:12
  together, I think we're strong.
• 20:15
  A wonderful place to leave you, doctor Redmond.
• 20:17
  Appreciate you you wrapping things up on a
• 20:19
  on a note of optimism
• 20:20
  and hope there. Appreciate you coming on the
• 20:22
  podcast. Thanks so much, Brian. Appreciate the time,
• 20:25
  and happy to connect today, and thank you
• 20:27
  for this, ability to speak today and and
• 20:29
  to your audience.
• 20:30
  Absolutely. One more thank you to doctor Redmond.
• 20:33
  We also wanna thank our podcast sponsor, LuminaCare.
• 20:36
  You could tune to more podcasts from Becker's
• 20:38
  Healthcare by visiting our podcast page at beckershospitalreview.com.