Latest / Behavioral Health Brief / Ep. 8 | See The Person, Change The System

Transcript

Ep. 8 | See The Person, Change The System · Behavioral Health Brief

0:02
Speaker 1: Welcome to the behavioral health breed presented by TURNED Behavioral
0:07
Speaker 1: Health Services. Behavioral health is about people, people who deserve compassion, dignity,
0:14
Speaker 1: and the opportunity to heal.
0:17
Speaker 2: What if The difference between reaching recovery and reaching a
0:20
Speaker 2: breaking point is not simply willpower, but whether someone is
0:23
Speaker 2: seen soon enough and whether help is built to reach them.
0:27
Speaker 2: These seven conversations begin in very different places, a sister's struggle,
0:32
Speaker 2: a personal recovery journey, decades of military service, homelessness, clinical care,
0:38
Speaker 2: veteran support, and health policy. Together they tell one connected story.
0:43
Speaker 2: What we live through can become a responsibility to others.
0:46
Speaker 2: Being seen can create the trust required for change. But
0:50
Speaker 2: trust must be backed by organizations, communities, and systems that
0:54
Speaker 2: act before crisis. This is see the person, change the system.
0:59
Speaker 3: I would say, just ignoring what I had done and
1:03
Speaker 3: what it had meant to me and what it had
1:05
Speaker 3: done to me. And it was only after about a
1:10
Speaker 3: year's worth of work with a clinician and a couple
1:14
Speaker 3: of medications which are interesting. Neither one of them has
1:18
Speaker 3: a primary diagnosis of treating PTSD, but what they do
1:27
Speaker 3: overcomes the PTSD. I was within a matter of a
1:33
Speaker 3: month After starting the medication, the dreams went away, the
1:37
Speaker 3: nightmares went away. I thought more clearly about my life,
1:43
Speaker 3: and I was really privileged. So the challenge was acknowledging
1:49
Speaker 3: the fact that you are suffering that you know, Pretending
1:52
Speaker 3: that you're not leaves you thinking that everything's okay. And
1:58
Speaker 3: yet when you talk to these veterans who are talking
2:01
Speaker 3: about the complexity of transition, I would challenge that they're
2:06
Speaker 3: not admitting what they ran into during their time and service.
2:10
Speaker 1: Interesting. Interesting, And I think you've spent some time with Christina,
2:15
Speaker 1: our program manager. Did you share that experience with Christina
2:19
Speaker 1: because she experiences some of what you're talking about in
2:22
Speaker 1: the clients that she serves every day.
2:24
Speaker 3: I did. I talked to Christina a lot because for
2:28
Speaker 3: a lot of reasons, we have some ships in common.
2:31
Speaker 3: And what our discussion was is you have to admit it.
2:36
Speaker 3: If you are unwilling to acknowledge that you have a problem,
2:41
Speaker 3: then that problem is going to grate on you in
2:43
Speaker 3: a way that is hard to understand. And I was fortunate.
2:48
Speaker 3: I had gotten through my time in the Navy, okay,
2:52
Speaker 3: I'd gotten through my time at Lockeed okay. But when
2:56
Speaker 3: I stopped that real work, thet act of PTSD became
3:02
Speaker 3: more evident, But it was another seven or eight years
3:06
Speaker 3: before the VA gave me that PTSD diagnosis and convinced
3:12
Speaker 3: me to get treatment for it.
3:13
Speaker 1: Was that here in Sandia, and that was here in Sandia,
3:16
Speaker 1: well at the VA right up in La Jolla.
3:17
Speaker 3: Yeah. So I encourage veterans that I talked to, particularly
3:24
Speaker 3: those that are having problems, to acknowledge that they're having
3:28
Speaker 3: the problems, to talk to the VA about it, and
3:31
Speaker 3: to get themselves into some level of counseling.
3:36
Speaker 4: My journey began when I was young. I have two
3:39
Speaker 4: younger sisters, and one of my sisters has mental health
3:45
Speaker 4: and learning disabilities, and being the older sister, I was
3:50
Speaker 4: looked upon to help take care of my sisters and
3:55
Speaker 4: support them as both my parents worked. My parents did
4:01
Speaker 4: their best to take my sister to the doctor to
4:05
Speaker 4: find out what was going on. She was struggling in school,
4:08
Speaker 4: She wasn't making friends, and in fact, she was really
4:11
Speaker 4: harassed and bullied while at school, and she got misdiagnosed
4:18
Speaker 4: and bounced around different providers. And during her teenage years
4:25
Speaker 4: she became one of those kids where it was like
4:27
Speaker 4: she didn't want to go to another appointment. She just
4:29
Speaker 4: refused to engage in treatment and move forward. And my
4:34
Speaker 4: dad at the time really looked at me as an
4:37
Speaker 4: older sister, on what can I do. At this point,
4:41
Speaker 4: he was in law enforcement, He had several positions within
4:45
Speaker 4: the San Francisco Police Department and had really instilled in
4:49
Speaker 4: me an interest in working in public service. I became
4:55
Speaker 4: really interested in psychology based on the experience of what
5:00
Speaker 4: I saw going on with my sister and what was
5:02
Speaker 4: happening to her and the impact that it took by
5:05
Speaker 4: the time that she was a teenager. And so from
5:09
Speaker 4: then I decided to go off to college and major
5:13
Speaker 4: in psychology and social work. I went to the University
5:16
Speaker 4: of California at Berkeley, where I got my bachelor's degree,
5:19
Speaker 4: and then following that, I decided to go on for
5:22
Speaker 4: my doctorate. And I learned that at the University of
5:25
Speaker 4: South Carolina, well you went all the way across country,
5:28
Speaker 4: all the way across country. University of South Carolina had
5:32
Speaker 4: a dual focus doctorate on both clinical and community psychology,
5:38
Speaker 4: and that really aligned with my interest in psychology and
5:42
Speaker 4: social work because the community psychology piece was all about
5:46
Speaker 4: community mental health and working in the community and bringing
5:50
Speaker 4: services to clients and how to do work that was
5:54
Speaker 4: early intervention and prevention, which is really what my sister
5:58
Speaker 4: didn't wind up getting. Way of being bounced around between
6:02
Speaker 4: different providers and misdiagnosed, she really didn't get the early
6:05
Speaker 4: intervention that, in my opinion.
6:08
Speaker 1: She needed.
6:09
Speaker 4: So following University of South Carolina, decided it was time
6:13
Speaker 4: to come back home to California and landed at University
6:18
Speaker 4: of California, San Diego for my predoctoral internship and postdoctoral fellowship,
6:25
Speaker 4: And through the work there, I did a placement in
6:32
Speaker 4: the Department of Veterans Affairs at the VIA Medical Center
6:36
Speaker 4: and that began my work leading to my Residential Treatment
6:40
Speaker 4: director position working with Vietnam era veterans, and I really
6:45
Speaker 4: found myself gravitating towards working with those veterans because they
6:51
Speaker 4: had challenges with navigating the VIA system of care, and
6:55
Speaker 4: they also experienced stigma and discrimination coming back from Vietnam
7:03
Speaker 4: that impacted their willingness to even engage and looking at
7:07
Speaker 4: how to navigate the VA system for care, even going
7:11
Speaker 4: outside the VA system for care, and that really just
7:14
Speaker 4: resonated with me. With the experience from what my sister
7:17
Speaker 4: had gone through and continued to motivate me to work
7:22
Speaker 4: in community mental health and progress my career. And following
7:28
Speaker 4: my time at the VA, I had the opportunity to
7:32
Speaker 4: come to turn Behavior Health Services fifteen years ago. I
7:36
Speaker 4: started as a vice president and I've had a couple
7:39
Speaker 4: of different positions within the agency as you know about,
7:42
Speaker 4: and currently I have the honor of overseeing several divisions
7:47
Speaker 4: of our mental health and substance use treatment programs in
7:52
Speaker 4: San Diego as well as all the way back up
7:54
Speaker 4: to the San Francisco Bay Area where I'm originally from.
7:57
Speaker 5: And so for me, I started as as a client
8:03
Speaker 5: in drug court and my last arrest really was it
8:08
Speaker 5: was a huge change for me in my in my life.
8:11
Speaker 5: Like I mentioned, going from like death to life, and
8:15
Speaker 5: that's really what it was. It was it was a
8:17
Speaker 5: death to an entirely different way of life. And then
8:23
Speaker 5: drug court for me was was a was a lifeline.
8:28
Speaker 5: But it's a drug court is a very intense, intense
8:32
Speaker 5: outpatient program. It's a whole whole person treatment. So you
8:38
Speaker 5: have to complete you have to get a full time
8:42
Speaker 5: job within the first thirty days. Wow, you have to
8:46
Speaker 5: be employed, absolutely full time too.
8:48
Speaker 1: Full time.
8:49
Speaker 5: You have to have twelve step program. You have to
8:52
Speaker 5: complete those twelve steps. You have to have a sponsor
8:55
Speaker 5: within the first thirty days or sponsors to call in,
8:58
Speaker 5: you know, to your counselor and you know, report that
9:00
Speaker 5: you're doing your steps. You have to go to group
9:02
Speaker 5: every single day. It's like nine groups a week that
9:05
Speaker 5: you're attending. You know, Uh, it's a lot. It's a lot.
9:10
Speaker 5: You're going to court once a week and so so
9:13
Speaker 5: it's a lot. And what it is is is boundaries
9:17
Speaker 5: and structure and you know, things that it wasn't experiencing
9:21
Speaker 5: out you know, on the streets.
9:23
Speaker 1: You're currently working with someone who's close to graduating. What's
9:27
Speaker 1: it been like to walk alongside someone at their point
9:30
Speaker 1: in their journey.
9:31
Speaker 5: Yes, I think I'm I'm probably just just as excited,
9:33
Speaker 5: almost as as he is, you know, because I you know,
9:37
Speaker 5: I get butterflies in my stomach and it's just like
9:39
Speaker 5: a recharge to my own recovery. Every graduation. It's such
9:44
Speaker 5: a beautiful experience, you know. So I'm I'm really excited
9:48
Speaker 5: for him, you know, and just want to support him
9:51
Speaker 5: and everything that that he needs, you know, And at
9:54
Speaker 5: this at this point, he doesn't have very many needs
9:56
Speaker 5: because he's he's he's just met all you know, you know,
10:00
Speaker 5: requirements and everything of the program. So right now it's
10:04
Speaker 5: just kind of like, you know, just being being there
10:06
Speaker 5: for support.
10:08
Speaker 1: So he's kind of he's made it all the way
10:10
Speaker 1: through what you described earlier today AA and the steps
10:13
Speaker 1: and with his sponsor and has got a job and
10:16
Speaker 1: reconnecting into the community and he's ready to graduating the.
10:20
Speaker 5: Right and so he's just doing recovery services and just
10:24
Speaker 5: you know, meeting, meeting with me one on one and
10:27
Speaker 5: you know, just just gliding on through.
10:30
Speaker 1: I think that's going to be a really meaningful day.
10:33
Speaker 1: I want to be there when that graduation happens to
10:36
Speaker 1: see that, because that's full circle. Could you describe that
10:40
Speaker 1: full circle feeling? I swhere from the sheriff's car that
10:44
Speaker 1: you describe in the book in the back of the
10:46
Speaker 1: sheriff's car and everything that you've been through and then
10:50
Speaker 1: to that day to be on stage at his graduation
10:56
Speaker 1: and you're going to be highlighting him. That's going to
10:58
Speaker 1: be amazing.
10:59
Speaker 5: Yeah, thank you. It's gonna be incredible to go from
11:02
Speaker 5: being on this stage as as a client graduating to
11:06
Speaker 5: being on the stage as an alumni president speaking, and
11:09
Speaker 5: then to be able to be on the stage as
11:11
Speaker 5: accountslor for the program.
11:13
Speaker 2: Experience can create a reason to serve. Yet the veterans
11:17
Speaker 2: story exposes the next obstacle. People often remain silent when
11:20
Speaker 2: they expect to be judged, diminished, or defined by a condition.
11:25
Speaker 2: A service can exist and still feel unreachable. The next
11:28
Speaker 2: two voices show what begins to lower that barrier. Before
11:31
Speaker 2: treatment plans and program outcomes, there's a more basic intervention
11:35
Speaker 2: making someone feel human again.
11:37
Speaker 6: Though there is not a lot of services, ye that
11:40
Speaker 6: I know of, right, I don't know about services. I
11:44
Speaker 6: don't know anything about recovery or anything at this point,
11:48
Speaker 6: hadn't heard of it, didn't really know anything about addiction.
11:52
Speaker 6: Just happened to roll into it. One of my favorite
11:56
Speaker 6: stories to tell before I be left being home, as
12:00
Speaker 6: was standing on the corner of Georgia and Olympic and
12:03
Speaker 6: right now, that's about approximately where the Staples Center is, right, OK,
12:07
Speaker 6: so we're talking that area, and before that area, I
12:11
Speaker 6: actually was on Fifth and Crocker downtown LA, and I
12:14
Speaker 6: moved over to Georgia and the Olympic, which is in proximity,
12:20
Speaker 6: some miles away from each other, in the hopes that
12:23
Speaker 6: I wouldn't be in that Fifth and Crocker area because
12:26
Speaker 6: it was really really dangerous, a lot of death killings,
12:29
Speaker 6: people jumping out of buildings, everybody getting high. And the
12:33
Speaker 6: funny thing about that gym is that there's a police
12:36
Speaker 6: station right in the center of that, right on Sixth Street. Right,
12:40
Speaker 6: So I move over Georgia and Olympic and there is
12:46
Speaker 6: no services. So you're only talking about hotels, liquor stores,
12:51
Speaker 6: a business on one corner. So you got two hotels,
12:55
Speaker 6: one business on the other corner and a liquor store
12:59
Speaker 6: on the other one. So that's my proximity. Now I'm
13:02
Speaker 6: not leaving that area too much. I just stay in
13:05
Speaker 6: that area for years.
13:07
Speaker 1: When did you end up becoming incarcerated? Then, in this
13:10
Speaker 1: journey that you're sharing.
13:11
Speaker 6: So my last time I was incarcerated, which I told you,
13:14
Speaker 6: been a jail, a simple brand back then those days, right,
13:19
Speaker 6: I was standing on the corner. And this is I
13:23
Speaker 6: because I love I love police, right, And this is
13:27
Speaker 6: one of the reasons why, because they just hold I
13:30
Speaker 6: just have a dear place for them in my heart.
13:32
Speaker 6: I'm standing on the corner and there's a police officer
13:35
Speaker 6: by the name of Officer Williams. I've never got an
13:38
Speaker 6: opportunity to see him again. Probably wouldn't know him if
13:40
Speaker 6: I met him, but I know that he was approximately
13:43
Speaker 6: he was over six feet tall. And we're standing on
13:46
Speaker 6: the corner together. He has arrested me several times because
13:50
Speaker 6: that's his beat, right, And we're standing on the corner
13:53
Speaker 6: and I'm standing next to him and by this time,
13:56
Speaker 6: I am you would not recognize me. So the woman
14:00
Speaker 6: that says before you the day is nowhere near the
14:04
Speaker 6: woman that was standing there at that corner that day.
14:07
Speaker 6: Ten shades darker, because that's what cracked cocaine and alcohol
14:11
Speaker 6: did to my skin. Clothing very different, a T shirt,
14:17
Speaker 6: maybe a pair of shorts on and just standing there,
14:21
Speaker 6: maybe with some tennis shoes on. And he's talking to me, right,
14:24
Speaker 6: and he was a very nice man. He just would
14:27
Speaker 6: arrest me all the time, right, So not just me,
14:31
Speaker 6: but other people. And I forget what we were talking about.
14:36
Speaker 6: But for one moment, I forgot where I was and
14:41
Speaker 6: what that looked like for me was I forgot that
14:44
Speaker 6: I was homeless and that I was on Georgia and
14:46
Speaker 6: the Olympic because of whatever we were talking about took
14:50
Speaker 6: me out of that for a minute. He looked down
14:53
Speaker 6: at me, the tall man. I looked up at him,
14:56
Speaker 6: and he said, what are you doing here? And I
15:00
Speaker 6: just start crying because the truth of the matter is, Jim,
15:06
Speaker 6: that that I told him I don't know. And that
15:10
Speaker 6: was the first time that I give an honest answer.
15:13
Speaker 6: That is the first time in that whole time that
15:16
Speaker 6: I just told you about anybody talk to me as
15:21
Speaker 6: if I was a human being and looked at me
15:25
Speaker 6: as if I was more than a crackhead and a
15:29
Speaker 6: homeless person on the street. So even though I don't
15:33
Speaker 6: have a card and all of that stuff, homelessness is homelessness.
15:37
Speaker 6: And when you're homeless, people don't see you. I make
15:41
Speaker 6: it a point to see people today. People don't see you.
15:44
Speaker 6: They walk by you, they look at your clothing, they
15:47
Speaker 6: look at how you what you look like, and they
15:50
Speaker 6: sum you all up as nothing.
15:53
Speaker 7: Well that the more colorful of background, the more qualified
15:56
Speaker 7: their background.
15:56
Speaker 1: That's right, Yeah, that's it.
15:58
Speaker 7: It's it's uh, it's this. We we recognize that lived
16:03
Speaker 7: experience has tremendous.
16:04
Speaker 4: Value, you know, we.
16:08
Speaker 7: Love that we bring it into the fold. It's who
16:10
Speaker 7: we are, it's where we have a rich tapestry of
16:14
Speaker 7: second chances at our organization. Now, one of the things
16:17
Speaker 7: I want to point out is it doesn't replace education
16:21
Speaker 7: or training or professional experience, but it adds to the
16:26
Speaker 7: robustness of the services that we can provide. Where else
16:31
Speaker 7: can you sit in an interview and listen to a
16:35
Speaker 7: candidate list off that he was formerly incarcerated, homeless, substance abuse,
16:42
Speaker 7: mental illness. He has skill sets that are not so
16:45
Speaker 7: legal and they don't really apply to what he's interviewing for.
16:48
Speaker 7: The mainstream employer is going to run for the hills.
16:52
Speaker 7: But we get excited. Why we do because we know
16:56
Speaker 7: that when he sits in front of that client, that
16:58
Speaker 7: client is going to be able to see themselves. They're
17:01
Speaker 7: going to know that they are They're seen and accepted,
17:04
Speaker 7: and it's authentic and it's real, and that's what we want.
17:08
Speaker 7: We want that experience.
17:10
Speaker 2: Being seen can open the door, and compassion can help
17:12
Speaker 2: someone remain engaged. But a human connection cannot carry the
17:16
Speaker 2: burden alone. People still encounter waiting periods, disconnected agencies, eligibility
17:22
Speaker 2: rules and funding structures that delay assistance. The final theme
17:26
Speaker 2: moves from a community response that successfully bridges one of
17:29
Speaker 2: those gaps to the larger incentives, determining whether help arrives
17:33
Speaker 2: early or only after hardship becomes a.
17:36
Speaker 1: Crisis, and kind of back to some of the things
17:39
Speaker 1: happening key for our active military and veterans in San Diego,
17:44
Speaker 1: a question what are we getting right and where do
17:48
Speaker 1: we still need to be honest about improvements for veterans
17:51
Speaker 1: in our active military in San Diego.
17:54
Speaker 8: I mean, you throw a rock and there's a veteran
17:56
Speaker 8: organization willing to help people out. So I think from
18:00
Speaker 8: a carrying capacity and a desire to help veterans, we're
18:04
Speaker 8: doing that in spades. We're doing a great job there.
18:08
Speaker 8: I think where I think every community could do better
18:12
Speaker 8: in this area, or you know, the country could do
18:15
Speaker 8: better in this When folks transition out of the military,
18:20
Speaker 8: they haven't had opportunities to interview for a job every
18:23
Speaker 8: you know, as often as someone their same age and
18:27
Speaker 8: peer group, so they're often like lacking some of these skills.
18:31
Speaker 8: And I think employers and this is something that employers,
18:36
Speaker 8: if they just understood this, they might have a little
18:38
Speaker 8: more grace for someone coming straight out of the military
18:40
Speaker 8: looking to work for them. So if we could find
18:43
Speaker 8: a way to bridge that skill gap and then also
18:46
Speaker 8: encourage employers to maybe take a chance, I think we
18:49
Speaker 8: could really help improve the lives of our veterans.
18:53
Speaker 1: Great input, And how did community based organizations complement government efforts?
18:59
Speaker 1: And and what government can't do? If you could talk
19:02
Speaker 1: to that bean, you're working for the mayor's office and
19:05
Speaker 1: you're working with multiple organizations out there, you know what,
19:08
Speaker 1: what what can we do more that the government can't do?
19:13
Speaker 8: I mean just direct access to resources. Like I had
19:15
Speaker 8: a gentleman call me and he was in the process
19:18
Speaker 8: of getting a voucher for housing and it was like
19:22
Speaker 8: two weeks before he was able to move in. And
19:24
Speaker 8: during that time, he's living on the street with his dog,
19:27
Speaker 8: and there's not a lot of places that'll it'll take
19:29
Speaker 8: someone with a dog or a pet in general. And
19:32
Speaker 8: so he's like, I just need some food and some clothing.
19:35
Speaker 8: And I can't provide him with clothing. I don't have
19:38
Speaker 8: those resources personally. But I was able to call support
19:40
Speaker 8: the Enlisted Project and Tony Treverian and his team were like,
19:45
Speaker 8: what can we what does he need? Let me know,
19:47
Speaker 8: come by the warehouse, pick up whatever you think this
19:50
Speaker 8: gentleman needs. And I was able to deliver a box
19:53
Speaker 8: of goods. And this guy was, you know, overwhelmed with
19:57
Speaker 8: the generosity of the community, and that kept him afloat
20:02
Speaker 8: until he was able to get into housing. And I've
20:04
Speaker 8: checked in on him a couple of times, and he's
20:06
Speaker 8: got an apartment. He's happy, and he's stabilizing, and he's
20:10
Speaker 8: waiting for an opportunity to pay it forwards.
20:12
Speaker 1: I don't know about you, but I dread the day
20:15
Speaker 1: I got to pick up the phone and call the
20:16
Speaker 1: doctor because I know I'm not going to get to
20:18
Speaker 1: see him for three months, right, because they're too busy.
20:21
Speaker 9: And so let's take this kind of I think we
20:24
Speaker 9: all agree that, like, there is baseline severe frustration with
20:27
Speaker 9: the nature of healthcare generally in this country, right. And
20:30
Speaker 9: I think part of the reason that you know that
20:33
Speaker 9: this person, Luigi, I can't remember his last name, has
20:35
Speaker 9: become a bit of a folk hero is that people
20:39
Speaker 9: buy and large have experienced that frustration with healthcare. I
20:42
Speaker 9: have experienced it. I was a behavior health director in
20:45
Speaker 9: the County of San Diego at my son at the
20:47
Speaker 9: time was sixteen year old. He needs. Sixteen years old,
20:49
Speaker 9: he needed mental health care, and I couldn't get him
20:52
Speaker 9: access to healthcare through my employer driven health plan. It
20:56
Speaker 9: was just wild.
20:57
Speaker 1: We get calls like that all the time. People will
20:59
Speaker 1: reut when I'm out in public. Hay, my son was great,
21:03
Speaker 1: straight a's Baseball All Star and everything like that. Now
21:06
Speaker 1: he's kind of fallen off the track. Can't help, right,
21:09
Speaker 1: I can navigate him, but it takes so long to
21:11
Speaker 1: get into the system. Like you said, you sixteen year
21:14
Speaker 1: old son needed healthcare, you couldn't get him into the system.
21:17
Speaker 9: You were leading, You couldn't get it, and I was leading.
21:19
Speaker 9: I mean, and I've got other stories about like the
21:21
Speaker 9: you know, needs that my family has had while I
21:23
Speaker 9: was director in San Diego and couldn't get them help either.
21:26
Speaker 9: I mean, the system is built in such a way
21:29
Speaker 9: that it's extremely frustrating, and people become discouraged and then
21:33
Speaker 9: they cease seeking care when they need it, which is
21:36
Speaker 9: really probably. So that's baseline. Now, let's look at California
21:39
Speaker 9: and behavioral in specific. Right, I was just getting the
21:44
Speaker 9: triple aim idea right that, like, people will cost less
21:48
Speaker 9: if we protect them from costing a lot by protecting
21:52
Speaker 9: them from episodes of crisis. Right that relies on this
21:55
Speaker 9: idea of an incentive right, that insurance companies as the
22:00
Speaker 9: payers for all of health care that they face risk. Right,
22:05
Speaker 9: risk is woven into how it is that they function financially.
22:10
Speaker 9: They are paid for They are paid through what's called capitation.
22:14
Speaker 9: That means they're paid an amount of money per person
22:17
Speaker 9: who is enrolled in that health plan. They're paid that
22:20
Speaker 9: amount of money irrespective of how well that person is
22:24
Speaker 9: doing in terms of their health or their or their morbidity.
22:27
Speaker 9: So the healthier they are, the better off the insurance
22:30
Speaker 9: company does, right, because they're paid that amount per person
22:32
Speaker 9: either way. This is in the public insurance space. So
22:35
Speaker 9: they're highly incentivized to keep people well. That's the idea.
22:40
Speaker 9: If they're highly incentivized financially, you can, like, you don't
22:43
Speaker 9: need to talk about the ethical dimensions or you know,
22:46
Speaker 9: heaven forefend the moral dimensions of how it is that
22:49
Speaker 9: they might operate as you know, their businesses. The fact
22:52
Speaker 9: is that at a basic economic level, they're incentivized to
22:56
Speaker 9: help people stay well. That's the idea California has structured
23:00
Speaker 9: in the space of public insurance, medical primarily California has
23:04
Speaker 9: structured care so that managed care plans in fact are
23:10
Speaker 9: disincentivized from taking care of people when they are well.
23:15
Speaker 9: They are disincentivized from getting resources to people farther upstreams
23:20
Speaker 9: so that they don't go into episodes of crisis. And
23:24
Speaker 9: why is that. That's because managed care plans in the
23:29
Speaker 9: public insurance system in California are only responsible for the
23:33
Speaker 9: behavioral health care of people who are designated as needing
23:37
Speaker 9: mild or moderate intervention. When people are designated with a
23:42
Speaker 9: serious mental illness. On the mental health side, on substance
23:46
Speaker 9: use is different, weirdly, in California, anybody in substance use
23:50
Speaker 9: disorder is a spectrum disorder at this point. Anybody with
23:53
Speaker 9: a substance use disorder is the responsibility of the county.
23:56
Speaker 9: On the mental health side though, and often the cocurrents
23:59
Speaker 9: of something disorder and mental health of course, like have
24:02
Speaker 9: this kind of compounding impact right on the mental health side,
24:07
Speaker 9: if you are sort of deemed seriously mentally ill, if
24:12
Speaker 9: you go into an episode of crisis, in fact, you
24:16
Speaker 9: may be a member of a managed care plan, and
24:18
Speaker 9: you may have like you know, been tracked by that
24:22
Speaker 9: managed care plan and that managed care plan may have
24:26
Speaker 9: decided not to invest resources upstream to keep you well,
24:32
Speaker 9: and they should suffer that decision. Right, they should suffer
24:36
Speaker 9: that desert because they are incentivized generally to be paying
24:39
Speaker 9: to keep people. In California, that incentive doesn't exist because counties,
24:45
Speaker 9: county behavior health departments are deemed the crisis payers. So
24:51
Speaker 9: a person when a person who would otherwise be a
24:54
Speaker 9: risk for a managed care plan, when they start not
24:57
Speaker 9: doing well, they just get pitched over.
24:59
Speaker 3: To the CA.
25:01
Speaker 2: Across these seven conversations, the same pattern appears at three levels.
25:05
Speaker 2: At the personal level, experience can become purpose. At the
25:09
Speaker 2: relational level, dignity creates trust, and at the systemic level,
25:13
Speaker 2: coordination and incentives determine whether support is dependable or whether
25:18
Speaker 2: people are left to reach crisis alone. The call to
25:21
Speaker 2: action is not the same for everyone. As an individual,
25:24
Speaker 2: notice the person others pass by. As an organization, create
25:29
Speaker 2: a door that does not close without showing someone the
25:31
Speaker 2: next one, As a community invest earlier in mental health, housing, employment,
25:37
Speaker 2: recovery and navigation, and as a decision maker, ask what
25:41
Speaker 2: the system is rewarding. Compassion matters most when it becomes
25:45
Speaker 2: a practice. People can rely on see the person, build
25:49
Speaker 2: the path, change the system before the breaking point.
25:53
Speaker 1: This has been the behavior of health brief, where insight
25:56
Speaker 1: meets impact, boiled by