Latest / The Inspired Stories Podcast / Exploring Ryan Carruthers' Philosophy: Mental Health for All | Healthcare Series

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Exploring Ryan Carruthers' Philosophy: Mental Health for All | Healthcare Series · The Inspired Stories Podcast

0:04
Welcome to another edition of Inspired Stories, where leaders
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share their experiences so we can learn from their successes,
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how they've overcome adversity, and explore current challenges
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they're facing. Welcome to another edition of
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the Inspired Stories podcast, where leaders share their
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experiences so we can learn from their successes and be inspired
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by how they've overcome adversity.
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My name is Anthony Kotaspodi, and today's guest is Ryan
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Carruthers, Chief Clinical Officer of Center Point, which
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offers over 40 programs including mental health,
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substance use treatment, primary care, and housing.
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Ryan is a licensed mental health practitioner, licensed alcohol
0:43
and drug counselor, and certified peer support
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specialist in the state of Nebraska.
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He holds a PhD in Counseling Studies and is a member of the
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Motivational Interviewing Network of Trainers.
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He's also worked as an adjunct professor and taught many other
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addiction counselors and mental health practitioners on topics
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of harm reduction, suicide prevention, and alternatives to
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the 12 step programs. He started Omaha's first SMART
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Recovery Meeting and has created programs for educational
1:11
courses, outpatient programming, adolescent family education
1:16
courses and residential curriculum.
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At the end of the 2007 eight school year, Ryan was awarded
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Millard Public Schools Expanding Horizons Award for making a
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difference by enhancing students learning of curriculum through
1:29
practical experience in the school environment.
1:31
Ryan has held various positions with Center Point and has been
1:34
their Chief Clinical Officer for the last 3 1/2 years.
1:38
Now before we get into all that good stuff, today's episode is
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2:09
Now back to our guest today, the Chief Clinical Officer of Center
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Point, Brian Carruthers. I appreciate you making the time
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to Share your story today. Yeah, thanks for having me on.
2:20
So, Ryan, when was it that you first realized that you wanted
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to serve others through behavioral health assistance?
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Yeah, so I was a mathematics and German double major in college.
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This is a natural transmission trans.
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Position right. And I was about three, 3 1/2
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years into that when my life kind of took a turn.
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So in my intro, you said I'm a certified peer support
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specialist and, and, and that means that I myself have lived
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experience with addiction and mental health struggles.
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And so I found myself here in the state of Nebraska in a
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residential recovery program for a pretty severe addiction.
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And through that journey, I decided I wanted to continue my
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education, but I was going to switch over from German and
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mathematics into Human Services and into addiction counseling in
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particular. And so my own journey kind of
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inspired coming into the field of mental health.
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And you know, that was a little over 21 years ago.
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And so, you know, it hasn't been a straight line ever since, but
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I saw what kind of my my purpose was and, and have kind of
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pursued that all the way through now to being a PhD.
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Wow. So this is a powerful story.
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I'd like to dig in here if you don't mind a little bit.
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So you found yourself in an addiction recovery center.
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Did you admit yourself or family or friends kind of directing
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you, kind of pushing you to go there?
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How did that kind of unfold? Yeah, it's always kind of a
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combination of things when when people make that decision, kind
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of the, the crux of it was I knew that I could not continue.
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Along with the addiction stuff, I also had some pretty gnarly
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depression that I was struggling with.
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And so, you know, the, the end of my, that part of my life that
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that part of my story was on a bridge and I wanted to jump off.
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And so I actually reached out to my uncle who had had similar
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kind of struggles and had been through some treatment and said,
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hey, I need some help. And he got me help.
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By the end of that day, I was in a rehab center and starting the
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long journey of recovery. Wow, that's powerful.
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And maybe the most surprising part of that is that you were
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actually able to reach out for help.
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Folks find themselves in that kind of a position, struggling
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with depression, struggling with addiction.
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What they need the most is help from somebody, from a trusted,
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you know, loved one. But that can be the hardest
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phone call, that's can be the hardest conversation for that
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person to initiate. Yeah, and, and I had really kind
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of said to myself, look, I'm going to make one phone call and
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if he doesn't answer then you know, it's not meant to be.
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It just so happened that that he answered the phone and was
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available to come get me and, and kind of dropped everything
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that he had going on and and put his focus and attention on me
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and the rest, as they say, is is history.
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How long were you in the treatment center?
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I was a kind of a traditional short term residential program,
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so it was about 30 days. OK.
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And was it while you were in there that you had the idea of
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sort of changing your education and career trajectory or did
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that come later on? Yeah.
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I, I, I think the initial idea of it kind of came there.
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I I really enjoyed helping the other people that were there
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just kind of in conversation, not really, you know, formal
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helping. But then one of my counselors
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that was there actually said to me, hey, have you ever thought
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about, you know, doing something like this?
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And that kind of formally put the idea in my head.
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And then when I came out and did some recovery housing for a
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while with some other people in early recovery, decided, yeah,
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this is this is what I want to pursue.
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OK. And so you went back to school,
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you started taking different courses, and what did the path
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look like from there to center? Point yeah, so I kind of took AI
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guess a non traditional approach in in mental health, excuse me,
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mental health and addiction. A lot of times people will come
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out of school and go work for an agency and then after working
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for an agency for a number of years, they'll go into private
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practice. I took the opposite approach.
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I started off in private practice.
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I had a, a small private practice that actually grew into
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a couple of different locations and employed several other
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counselors and staff and did that for almost a decade until,
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you know, the, the business side of it was not my strength.
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I really enjoyed meeting with people and developing programs
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and relationships with people in the community and maybe not even
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the business side of it, but really the the hiring side.
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When I opened up a second location, I hired someone to run
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that location and it turned out to be a hard lesson for me.
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It ended up bankrupting the business and myself along with
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it. So in going through that, I
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then, you know, had to kind of go work for non profits all the
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all the while. So I started out after having
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gotten my associate's degree 'cause that's kind of all, all
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you really need to practice drug and alcohol counseling, Mental
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health practice requires a master's degree.
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And so I was continuing my schooling while running the
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practice. And then when I closed that
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down, went and, and worked for a couple different nonprofits.
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But the thing about running your own business is you get to do
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what you want, how you want it, when you want.
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And then when you go work for a nonprofit agency providing
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mental health services, it's, it's not quite the same.
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You don't have the same level of freedom.
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And so I have a particular way I, I view addiction counseling
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that isn't necessarily the norm. And it, and it's really the idea
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that abstinence from everything isn't the only solution, that
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there's a lot of people out there that want help, but maybe
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they want to stop using their drug of choice like
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methamphetamine or opiates. You know, the opiates have been
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in the news a lot lately. And, and, and so we have people
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come in like, look, I need to get off of the, the heroin or
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the fentanyl and, and, but don't, you know, don't try to
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pressure me to stop smoking weed, for instance, the kind of
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traditional mode of addiction recovery says, no, you got to
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stop everything. But then what that does is that
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closes doors to people and people end up dying, you know,
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when they, when they don't get help.
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And so the, the kind of addiction counseling and, and
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mental health practice, honestly, that, that I utilize
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is called harm reduction, which just says, we really meet people
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where they're at. We help them with what they're
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willing to get help on. And then we leave the door open
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for them to get help for these other issues that they may not
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be ready to stop, like alcohol or, or marijuana.
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And when I was in private practice, I was able to do that
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kind of on my own, right? I was able to just practice the
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way I wanted. When I went out and started
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working for agencies, that wasn't the case.
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And, and So what, what kind of make center point such a great
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fit for me is that they've been practicing harm reduction for
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the last 50 plus years now and, and really putting a focus on
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meeting people where they're at. And, and one of the, the things
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we say all the time is that better is better.
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You know, you don't have to be perfect.
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You know, we're a abstinence only program really pushes
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people towards 100% all the way and we want to be able to help
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people when they're ready for 70% of what we have to offer.
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So that's that's kind of what has made Center Point a great
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fit for me in terms of how I got here.
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It was actually by happenstance, I had ended up at a residential
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as a director of a residential program here in Omaha run by
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another nonprofit. When they, because of budgetary
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issues and some socio political realities of taking federal
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money, which is really what runs the mental health and, and
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addiction treatment industries in the United States, they
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decided to no longer operate the programs they were operating,
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which happened to be where I was working, was the state's largest
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residential mental health and substance use treatment
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facility. And so the state said, look, we
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need this program to keep going. And Centre Point stepped up to
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the plate and said we're willing to keep running the program even
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though, you know, in the, in the six months prior to Centre Point
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taking over, the, the program had lost over $1,000,000.
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And so it was a financial mess. And Centre Point stepped up to
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the plate and I was able to continue in my role as a
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director here. And then over the last 7 1/2
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years have just kind of grown with the organization into the
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Chief clinical officer role. So Centre Point acquired the
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entity that you were working for before it was in financial
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straight dire straits and they were able to come in, kind of
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patch it up, fix it up. You stayed on and sort of the
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same kind of leadership role that you had before and your
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role has just continued to grow with Center Point.
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Yeah, absolutely. And and it, it's just been a
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really good fit for me and I think for the organization as
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well. I've been able to kind of bring
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my vision for how treatment is supposed to occur.
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And it's almost like I have the freedom of private practice
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again without having to, you know, be the one who runs
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payroll. You know, we have a team for
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that. So yeah.
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It's you get to focus on your strengths and your love and
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you've got other people to support those other elements of
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the business. I want to explore this idea of
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harm reduction a little bit more.
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This is a, a non traditional approach.
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And I guess when you first started talking, my mind said,
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wait a minute, that doesn't seem like the right way to go.
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I mean, if they're having trouble with substances, don't
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you want them off everything? Like, you know, if, if you, you
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know, tend to have addiction towards this thing, aren't you,
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you know, probably going to have addiction tendencies towards
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other things. But then I heard what you said
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about meeting them where they are, right?
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Because if you, I think this is what I hear you saying, if you
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take such a hard line stance with folks, it's, it's all or
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nothing. You're going to get some people
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who just say, well, then it's all like, I, you know, I'm not
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coming in, I'm not doing this program.
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That's not where I'm at right now.
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And like you said, people end up dying because they they go too
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far the other direction. What was it that sort of led you
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to this thought process of it doesn't have to be abstinence.
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Yeah, that's the, that's the key question.
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I guess myself, I kind of came to this harm reduction approach
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by listening to the people I was working with going back to my
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private practice. I, I kind of had that what you
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described, the kind of, you know, traditional mentality of
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it's all or nothing. And, and, you know, this is how
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it is. You have to stop everything or
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else you're, you know, destined to, you know, die from this.
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And two things. One, I'd gotten a really good
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training. A colleague of mine had said,
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hey, have you ever thought about this training in motivational
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interview is what it's called and basically just is the
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approach that teaches you to not push people towards things, but
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rather to walk with them in the direction that they want to go
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and allows them free choice, right, without judgment.
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The idea is that, you know, there's here in Nebraska just a
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couple weeks ago, we, we finally, I think we're the 47th
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or 8th state or something to pass medicinal marijuana.
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But the, the, the truth is that whether it's alcohol or, or
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marijuana, caffeine or tobacco, adults have choices to make.
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And we want to, we want to respect those choices,
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regardless of whether they're in line with what is ultimately the
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healthiest for them. And, and what we find is that
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when you don't push people into something they're not ready for,
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they tend to get around to making the right decision for
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themselves, the decision that they're comfortable with.
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And when someone says this is something I want, it's not
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something that I need or someone, you know, a court or a
18:50
family member or something is saying that I have to do, you
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know, in my own journey, my, my family had done some, you know,
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if you're familiar with the TV show Intervention, they had done
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some of those kind of confrontational interventions
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with me where they said, look, this is this is it, you're going
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to do this or else. And when presented it that way,
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I said or else, you know, and, and just kind of went that went
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that path. But by listening to the people I
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was working with, they told me they're like, look, you know,
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I'm going to do what I'm going to do.
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So I can come in here and be honest with you about it, right?
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Or I can come in here and tell you what you want to hear,
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right? The choice is up to you as the
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as the therapist. How do you want to approach me?
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Right? Because if you approach me in in
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this way, I'll be honest with you and I'll tell you, yeah, you
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know, when I get off of probation, I'm going to go back
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to smoking weed. And I'm like, OK.
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Right. The other thing that we see,
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especially with younger folks, you know, if you think of a
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teenager coming into a treatment Center for a drug problem,
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they'll come in and be like, well, yeah, but we should be
20:18
legal. And all they're trying all that
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is try to tell new counselors and therapists all that is, is a
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litmus test, right? They're just testing you to see
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if they can trust you. Because if you say no, yeah, it
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shouldn't be in, you know, it's still bad for you.
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And a drug is a drug is a drug. You know, just answer them with
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some kind of cliche. Then now they got what they
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want. They got an argument from me,
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right? And they know it's me versus you
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rather than we're on the same page.
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And so regardless of whether I believe marijuana should be
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legal, the harm reductionist in me says when someone says
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something like that, well, we should be legal, I'm like, yeah,
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OK, and just agree with them, right?
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Regardless of what I actually believe, that's, you know, as a
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helper, that's not my role to impose my values on.
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You and so this is part of that motivational interview style
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that you've learned is yeah, kind of how to gain trust with
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them and and walk with them until they're ready to take that
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that step. Yeah, I couldn't describe it
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better myself. So you, you talked about the
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show intervention, do do those interventions, do they ever
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work, are they ever effective? I mean work.
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You know effectiveness is hard to say in our field, right?
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What do you measure, right? Do you measure pure abstinence?
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Do you measure, I mean the intervention itself, it's only
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goal is to get the person into treatment, right?
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And so does it get them into treatment?
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Sure. A lot of times it does.
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Then then you know, the question of whether or not the treatment
22:13
is effective, that's a, that's a totally different question,
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right? You know, on that though, that
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question of is it effective our our work, you know, we, we do
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measure at center point whether or not someone maintains
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abstinence, you know, during our programs, after the program,
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etcetera. But that's not how we measure
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our own success at center point. Our mission is to help the
22:40
people we serve get better sooner for longer.
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But the question is how do you measure whether or not someone
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got better? And we we have an approach for
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that. We use a tool really looks at
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their ability to function in their daily lives, right.
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That's that's why people actually come into treatment is
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because their life is falling apart.
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Is it because of the drugs? Sure.
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But some people are able to just for a reduction in substance
23:17
use, maintain a job, right? Who's to say that's not a
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success in their eyes? That's what they wanted.
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They wanted to be able to maintain their job or they
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wanted to be able to rebuild relationships, right?
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And they're able to do that maybe while still smoking weed
23:34
or, or drinking socially or even some binge drinking, you know,
23:40
on on a limited basis. But then, you know, if I get
23:45
into the, the heavy drug use, the illicit drug use, whatever,
23:50
so then then functioning kind of falls apart.
23:56
And so our approach is to help people with their functioning.
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And, and one of the ways that we teach that is really focusing on
24:05
their coping mechanisms. You know, the idea is that for a
24:10
lot of people with addiction, you know, and, and, and this is
24:15
true even, even, you know, with business people, the, some of
24:20
our, our worst problems are actually our solutions, right?
24:26
Someone who spends 5 hours a day doom scrolling during the
24:32
election, you know, that's a solution for them, right?
24:36
That's how they're managing their anxiety or depression in,
24:40
in that moment. And so it's when those things
24:45
that we look to for relief, those start to impact our
24:49
functioning, that's when people start to look for help because
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what they're doing to to cope just isn't quite working.
25:00
Is harm reduction considered an alternative to a 12 step
25:04
program? And if so, are there other
25:08
methods that aren't 12 step? Yes, Yeah, certainly.
25:14
Yeah. So SMART Recovery is by far the
25:18
largest non 12 step recovery program that's available out
25:25
there now. Now 12 step programs themselves
25:28
aren't really treatment. That's a that's a free mutual
25:34
aid support group that's available in the community.
25:38
And so the approach we take to that is we we educate people on
25:44
what the 12 step programs are, what SMART Recovery is, what
25:49
refuge recovery is, which is kind of a Buddhist approach to
25:53
recovery. Moderation management is a more
25:59
harm reduction approach that teaches people what alcohol
26:03
moderation is and is appropriate for a lot of people that have
26:08
had, you know, kind of more moderate alcohol problems.
26:14
And so, yeah, our approach is just that you have to find your
26:19
own path, right? You have to find something
26:22
that's going to work for you and your family and your situation.
26:27
And and you know, the evidence base is that the way we do it,
26:34
that's the way treatment is effective.
26:38
Pushing people towards kind of one modality of recovery like
26:43
the 12 step programs is just not very effective.
26:50
Yeah, You know, I'll have to profess some ignorance here
26:52
because I get a lot of what I know about recovery and
26:56
addiction and 12 step programs from news and television
27:00
programs. And they sort of present it as,
27:04
you know, if you're an alcoholic, like one tiny taste
27:06
of alcohol, like sends you, you know, spiraling.
27:10
But what I'm hearing you say, I think Ryant tell me if I'm
27:13
wrong. Is there sort of a spectrum?
27:16
Right. Like, yes, there are some people
27:17
like a, you know, a single taste is going to, you know, send them
27:20
off on, you know, a bad Bender. But you know, they're they're
27:25
people who, you know, alcohol. They're yeah, they consume too
27:28
much of it, but they can find a more moderate way to consume
27:33
that and still function in their lives.
27:35
Is this, is this correct? Yeah.
27:38
Yeah. And I think the best evidence
27:40
for that is that, you know, something like 30% of any
27:46
college campus meets diagnostic criteria for a moderate to
27:51
severe alcohol use disorder. And yet those same folks, by the
27:57
time they're 25 or 30, most of them didn't end up in rehab.
28:02
Most of them did not, you know, kind of spiral.
28:09
They, they certainly had all the diagnostic features.
28:13
But what happened is they developed some other coping
28:16
mechanisms. They changed their social
28:18
surrounding. They, you know, kind of grew up,
28:22
right. They matured what we say.
28:24
They matured out of the, the substance use issue.
28:29
And maybe they have some lingering, you know, misuse kind
28:34
of tendencies where where they will binge drink and potentially
28:37
cause some problems that way, but certainly nothing like they
28:41
were when they were, you know, 21 on a college campus.
28:47
So we've been talking about Center Point and the services
28:50
that you provide for folks dealing with substance issues,
28:54
and obviously that is heavily intertwined with mental health
28:59
issues as well. Do you ever work with folks who
29:03
are not dealing with an addiction problem but do have
29:06
mental health issues? Yeah, absolutely.
29:11
And, and the, the idea is we want to take a biological,
29:16
psychological and social approach to helping people,
29:21
regardless of what brings them in.
29:23
So this bio psychosocial model really says we need to address
29:28
all of the issues that the individual has.
29:30
And so like when you were talking about, you know, the
29:36
services that we provide, we, we, we've actually taken it so
29:39
far is to bring primary care in house.
29:43
And so that way we're addressing those primary care needs, we're
29:48
addressing the mental health needs, we're addressing the
29:50
substance use needs. We have, you know, 200 plus
29:55
units of supportive housing that we provide as well to the
30:00
community. Because you know, our, our CEO
30:06
often says it's like if you go into a car shop, excuse me, with
30:12
four flat tires and, and the places like, look, all we do is,
30:18
you know, at this shop, all we do is front right tires.
30:22
That's, that's it. You know, those, those other 3
30:26
tires, you got to go down the road to get those fixed.
30:28
Well, that's not going to work out very well, right?
30:31
And so whether it's mental health, substance use, you know,
30:35
a combination of the of the two, which is typically the case that
30:41
where there's one, there's the other.
30:44
Especially for the people that do have the addiction issues,
30:47
they almost always have some underlying mental health stuff.
30:53
So about 70% of the people we see every year are, are kind of
30:58
what we call Co occurring. So they've got a little bit of
31:03
everything going on and. That other 30% then those are
31:07
folks that aren't dealing with an addiction problem.
31:10
Yeah. Yeah, they're there'll be folks
31:13
that have mental health issues that, you know, whether it be
31:17
depression, anxiety, or one of the more severe and persistent
31:23
mental health issues, you know, bipolar, schizophrenia.
31:27
So let's talk. About mental health, I feel
31:30
like, you know, you kind of want to make this point about
31:35
everybody has mental health, It's just sort of a matter of
31:38
where you are with it. Yeah, absolutely.
31:43
The the truth is in the, in the kind of post COVID era, we, we,
31:50
we've kind of come out with this lesson that mental health is
31:54
something we have to take care of.
31:57
It's not something you have or you don't have.
31:59
It's, it's something that is as you said with addiction is on a
32:03
spectrum, right. And any given day, depending on
32:07
your stressors and, and what's going on, you know, politically
32:12
or, or what's going on financially, you know, in your
32:15
life that your mental health is going to ebb and flow.
32:19
And, and this idea that people with mental health issues are,
32:26
you know, people in a hospital somewhere, it's just not the
32:29
case. It's, it's all of us.
32:32
One of the things that we saw starting a couple months after
32:36
the the initial lockdowns of COVID was huge, a huge spike in
32:43
the diagnosis of anxiety disorders.
32:47
The what and kind of what we found was that these people had
32:53
anxiety issues already, but they never had anything that kind of
32:59
spurred them to go get help with it.
33:03
And whether it was the isolation or, you know, getting laid off,
33:08
you know, even temporarily during early COVID, the, the way
33:15
that the world changed made people a little bit more aware
33:20
of mental health issues. One of the, one of the good
33:23
things that has come out of that awareness is that we found more
33:33
foundations, more folks being willing to give money to
33:39
nonprofits like ours in order to address mental health.
33:44
There's been a lot of really good conversations over the last
33:49
3-4, you know, five years, I guess now surrounding mental
33:56
health and, and some of that is directly attributable to COVID.
34:04
Yeah. What have you found to be sort
34:09
of some of the more effective methods to help people who are
34:14
on that mental health spectrum kind of move from one end closer
34:17
to the other? Yeah.
34:20
So I think we we utilize several different kind of approaches.
34:27
I want to start by talking about one of the most important ones.
34:30
And it's not something we do directly with people, but it's
34:34
more of a system thing. It's an approach we adopted
34:39
probably 3-4 years ago that had mental health systems and, and
34:44
hospital systems, physical health systems as well, develop
34:49
what's called a zero suicide framework.
34:54
One of the things that research shows us around suicide is that
34:59
many people who end up dying by suicide were in a behavioral
35:06
health or a physical health setting within the 30 days prior
35:13
to their death. And what a tragedy, right?
35:18
What, what was it that was missed, right?
35:20
What was not done? How was it that this person fell
35:24
through the cracks and this didn't get appropriately
35:28
identified and treated when the person was seen by these health
35:34
professionals? And so several years ago we
35:38
implemented this wonderful framework called 0 suicide.
35:43
There's a whole institute dedicated to making sure that
35:47
health systems make sure that folks just don't fall through
35:52
the cracks. And, and so we developed what,
35:56
what we call our life worth living pathway.
36:00
And basically what it does, it just assures that people that
36:06
we're asking the right questions, that we're providing
36:08
the right interventions. And that if someone is at risk
36:12
for suicide, that we are making sure to go above and beyond with
36:19
that person to make sure that worst case scenario, if the
36:23
person dies by suicide, we as professionals won't have to ask
36:28
ourselves what else could we have done because we'll have
36:31
done all of the things possible to to intervene.
36:38
Now, that being said, that the types of interventions that are
36:42
really shown to be most effective, there's kind of two
36:46
schools. 1 is, like I said earlier, motivational
36:49
interviewing and the idea of treating people with dignity and
36:57
respect regardless of whether they are experiencing the same
37:03
reality that we are, regardless of whether they've committed
37:11
crimes and have these, you know, backgrounds that would be, you
37:18
know, judged by society when they're coming in for help from
37:22
a professional, they shouldn't be judged in our environment.
37:26
And so motivational interviewing is something that we train all
37:29
of our staff in. And then the other one is
37:32
cognitive behavioral therapy. And this is what just about
37:36
every self help program that's, you know, every self help book,
37:40
they're all based on cognitive behavioral therapy.
37:43
And the idea is we're trying to help people change the way they
37:46
think and feel. And then behaviors kind of come
37:50
along for the ride. Because if I, if I am thinking
37:54
in a rational way and I'm feeling, you know, emotions that
37:59
are in line with my reality, then I'm probably going to be
38:04
making decisions that are healthy decisions.
38:08
One particular other approach that we do, and this one's a
38:15
little bit from mental health specific to addiction and again
38:18
kind of comes in on the more controversial side.
38:21
It's called contingency management.
38:24
And a contingency of course is just if this then that.
38:29
Well, contingency management says if people engage in these
38:35
behaviours that we want to see from people, then we give them a
38:40
reward, right? It's kind of pure Pavlovian
38:44
behaviorism, which just says that, you know, you reward
38:47
people for what you want to see them do.
38:51
And so contingency management says, hey, if you attend your
38:54
groups that you're supposed to go to, that you signed up for,
38:58
you pass the UA, that your analysis, right?
39:02
Like you don't have any drugs in your system and you complete
39:07
some homework assignments, then you know you're going to get a
39:10
$15 Walmart gift card, right? Not much $15 is that?
39:19
Strong enough to keep somebody from using a substance of
39:22
choice. It often is.
39:26
Contingency management is the most highly rated research based
39:33
approach to addictions. And so again, it's controversial
39:39
because you're giving people money, right?
39:43
But like in our, we have a residential short term that's
39:47
like up to 60 days. So anyone, someone might be
39:51
there 5-6 weeks, something like that.
39:53
But up to a couple months. And during that program, they
39:57
can earn 4 gift cards that they walk out of the, the program,
40:02
right? So that's up to 60 bucks.
40:05
And I tell people, OK, so it's controversial that we pay them.
40:09
A dollar a day, I mean in in the big scheme of it, right, This
40:15
really isn't feels like. A pretty good investment.
40:17
Yeah, absolutely right. And and they're staying because
40:21
they have to stay. They have to do meet the
40:23
expectations of the program. They, you know, they have to
40:27
pass you ways and you know, it's really not that big of a deal.
40:35
But I'll tell you for the, the people we tend to work with, 60
40:39
bucks is sometimes a really big deal. 52% of the, the people we
40:45
as we served across the organization last year had an
40:51
income of $1000 or less for the year, right?
40:57
So I mean, basically they have no income.
41:01
And you know, we, we, we serve a disproportionately low
41:08
socioeconomic group even within the addiction recovery and
41:13
mental health space. We kind of really specialize on
41:16
people that are, are really struggling, you know, across all
41:24
domains of their life and those kind of social determinants or
41:28
social drivers of health, income, housing status, all that
41:34
are, are pretty big struggles. So 60 bucks in in gift cards to
41:39
Walmart can be a really big deal for a lot of the people.
41:43
We we're we're working. With that actually kind of leads
41:46
me to a question that I'm wondering, you know, when you're
41:50
talking about somebody who's suicidal, if they were to be
41:54
able to give words to why they felt that way, what do you think
42:01
the biggest reasons would be? Is it I'm broke, I'm lonely.
42:06
I, I, I don't have a connection to anybody.
42:10
I, I don't have a place in this world.
42:12
Like, and this is a gross generalization.
42:14
Everybody's different. Everybody's going through their
42:16
own thing, but I don't know, are there sort of some pillars or
42:19
some, some buckets that, that you see?
42:22
It's commonalities here. Yeah, I think, you know the the
42:28
commonality is the people see ending their own life as a
42:38
solution that they. To the pain that they're
42:41
feeling. Yeah, yeah, To, you know, we
42:45
call it psych ache, right, Psychological pain that they're
42:50
experiencing. Sometimes when we, when we talk
42:55
about suicide, we, we use the analogy of Shakespeare's Hamlet
43:03
to be or not to be. And a lot of people don't maybe
43:09
realize that when, when he's going through that soliloquy
43:13
and, and doing to be or not to be, you know, he, he literally
43:18
starts listing off reasons to kill himself or not to kill
43:23
himself. And that is what to be or not to
43:25
be is is should I kill myself or not?
43:30
You know, Hamlet was, was suicide, suicidal.
43:34
And you know, it's pretty common theme actually in a lot of
43:39
Shakespeare's work. But at the end of the day, what
43:44
we find is that there, I mean, basically there's three buckets
43:48
then of people that are experiencing suicidal struggles.
43:52
There's people that are they are to be, they're to they are
43:56
determined. They want to continue to live
43:59
their life and it scares them tremendously that they're
44:04
thinking about suicide. And that's the the person in the
44:07
to be bucket. Then there's the the, the
44:11
Hamlets, the to be or not to be and they're really ambivalent
44:16
about life and and they're like, I could go either way.
44:21
I don't know how it's going to end.
44:24
I'm, you know, maybe very depressed, but I want to be
44:30
better. I want to live.
44:35
And this tends to be a little bit more of a longer term
44:38
struggle when people are ambivalent like that.
44:41
And then there's the the last bucket, which is people that are
44:46
determined not to be. And those are the, the, the
44:56
scariest, I guess we're, we're there, you know, the, the idea
45:01
of dying by suicide really looks like the best way for them to
45:11
deal with their problems. And but that group is the
45:16
smallest of the three buckets. Most people that are that are
45:21
experiencing suicidal ideation are really ambivalent and they
45:26
are struggling. And it is a back and forth.
45:29
And then there's people that are experiencing that and they're
45:32
really just wanting something, just wanting that help, just
45:38
wanting that something that's going to help them.
45:44
And the good news about people you know for anyone who's out
45:48
there who's got family or or they themselves or struggling
45:52
with with suicide. Most suicidal crises and in
45:58
people not dying and most people they experience a suicidal
46:03
crisis will never experience another suicidal crisis is.
46:07
That right? Yes, once.
46:10
And so. One attempt is sort of enough
46:12
to. Well, and not not necessarily
46:15
even having made an attempt, but but having, you know, struggled
46:19
with the the thoughts of it and, you know, sought help for it or
46:27
just been at a a point of real desperation.
46:31
But yes, even after attempts most people will make it through
46:39
and not have that be their fate. For those people listening today
46:46
that maybe they're struggling with something really big,
46:49
they're having these thoughts or they know somebody who's in this
46:55
predicament, what what do you recommend?
47:00
Is there a toll free number? Do they call 911?
47:03
Like what? What's a good step to get
47:05
yourself or someone else close to you, Hel?
47:08
Yeah. I'm going to give you a short
47:10
answer and then a little bit longer answer.
47:13
I mean, the short answer is we have a number in the United
47:17
States and this came about after COVID and has been quickly
47:24
implemented across the entire United States.
47:27
It's 988 and it's meant to mimic the 911 system.
47:33
And so you can dial it anywhere in the United States.
47:36
You can, you can also text 988 or go online and chat with 988.
47:45
And so like here in Lincoln, NE, our team is the 988 crisis
47:52
response team. And so if the folks get a call
47:57
in Lincoln, our crisis response team will go out to the, to the
48:02
site and, and kind of help the person in, in, in need.
48:09
But you know, going back to, I guess the, the broader question,
48:14
what, what can people do? And to emphasize my point that
48:19
we all, you know, no one's immune to mental health issues.
48:28
About a year and a half ago, my teenage son was struggling with
48:36
his mental health and made a near fatal suicide attempt.
48:47
Even being in the field, knowing all the resources, knowing all
48:52
the signs, no one's immune to this.
49:00
I responded as best I knew how, which you know, I think is
49:06
pretty well. And you know, the reality is 2
49:10
months later he had another near fatal suicide attempt.
49:17
And you know, it's been just about a year and a half since
49:23
his second attempt and, and happy to say he is doing better.
49:31
And, but the reality is that we all have to have mental health
49:38
on our radar because it is our sons and daughters, our moms and
49:44
dads, our brothers and sisters, friends, Co workers that are
49:49
struggling everyday with with things that we, we don't always
49:54
know, right? It's, it's the, you don't know
49:58
what cross someone else is bearing and what they're kind of
50:02
carrying on the inside. And so, you know, the thing that
50:07
I think is really reassuring is like I said, we, we're having
50:12
conversations now and, and making resources easier to get
50:17
to the fact that we have an, A nationwide 988 number that you
50:21
can just dial and, and a trained crisis counselor will be there
50:29
to talk to you regardless of where you live in the country.
50:35
That's that's fantastic progress.
50:39
Wow, What did that look like for you as a family, you know,
50:47
coming out of that with your son?
50:51
Because one of the questions that I had down to ask you,
50:54
Ryan, was OK, what, what are the signs to look for?
50:57
You know better than anybody the signs to look for and you know,
51:01
this, this was still, you know, this was still present.
51:04
You know, if I see somebody hobbling around on crutches, I
51:09
can see they've got a problem with their leg.
51:11
I'm going to, you know, hold the door for them.
51:13
You know, I'm going to, hey, can I carry that for you?
51:15
That kind of a thing, right, With a mental health issue.
51:18
It's going on under the surface. It it, you know, doesn't always
51:22
have a a physical manifestation. If you know if you is one of the
51:29
world's you know most trained professionals in this area have
51:33
struggles like what? What is it the rest of us should
51:35
look for? Yeah, I think the thing you want
51:40
to primarily look for is something being different,
51:46
right? And I mean there's the the kind
51:49
of classic signs are social isolation, right?
51:53
That's first and foremost, most people that are struggling or
51:59
going to have a period of social isolation in the, you know, lead
52:07
up to their attempt. Most people also make suicidal
52:15
communications prior to making an attempt.
52:22
One of the one of the things that is really important is if
52:29
someone ever says something like that to you, to respond with
52:36
warmth, understanding, compassion, and to make a
52:43
commitment to help them find the resources that they're in need
52:50
of. Again, if I see that as a, you
52:57
know, solution to my problems, then what I really need is other
53:04
solutions. And so providing a message of
53:09
help and like I said, a a commitment to either help get
53:16
them help or to stay with them until you can find someone who's
53:20
appropriate to help get them help is really what's required
53:26
in, in, in those moments. Yeah.
53:32
So we've talked a lot about different types of treatments,
53:35
your thoughts, your approaches to treatment.
53:38
But I'm kind of curious to take a step back and big picture,
53:42
what is it Ryan, that you do as the Chief Clinical Officer?
53:46
Are you sort of directing and educating the other clinicians?
53:50
Do you get any sort of one-on-one time or you know
53:54
group time with you know folks there at the facility that need
53:57
assistance? What?
53:58
What does your role look like there?
54:01
Yeah, it's a little bit of everything.
54:04
It's one of the things I, I, I love about my role.
54:08
I, so the first part, if I'm, if I'm meeting with people kind of,
54:16
you know, doing groups or or individual kind of work as a
54:21
therapist or counselor, it, it's typically because we're short
54:26
staffed. Now the reality of the workforce
54:32
across the United States and is certainly been the case in
54:38
Nebraska and certainly in behavioral health is that the
54:42
workforce has been lacking. There haven't been enough people
54:46
to do the jobs. And so, you know, it's been a a
54:52
matter of if you have clinical license, you're going to be
54:56
meeting with people. There was a period of 18 months,
55:03
maybe even in a couple years where about 20 hours a week I
55:08
was meeting with people to where we were that short staffed.
55:14
Now some of those staffing issues have let up and, and now
55:18
it's more if someone's on vacation, I might do a little
55:22
bit of work with someone or if there's some turnover.
55:28
But, but in general, my job would typically not include very
55:32
much of that direct individual work with, with people in the
55:38
programs. And So what I do is yes, I do a
55:44
lot of training, training of our of our staff.
55:48
I also do grant writing, a decent amount of grant writing.
55:55
The, the truth about behavioral health nonprofit work is that we
56:02
have, you know, I guess the term now is braided funding where we
56:07
have to take a little bit from over here and a little bit from
56:09
over here and, and kind of mix it all together and try to make
56:12
sure there's enough to, to pay the bills every month.
56:17
And so, yeah, so I'll do some grant writing to make sure we we
56:23
get funding and then, you know, things like policies and
56:29
procedures to make sure that we're, you know, doing things
56:34
the way that they should be doing done.
56:39
You know, if if there's critical issues they're going on inside
56:45
the organization, then I'm going to kind of be digging into those
56:50
and identifying, hey, what went wrong and how can we learn a
56:54
lesson from this to make sure that these kinds of issues
56:58
aren't going on anymore. You know, I always like to ask a
57:04
question in my interviews, Ryan, where I invite people to talk
57:07
about a particular challenge, personal or professional, that
57:10
they've overcome. I feel like we've already hit on
57:13
quite a few for you, but if there was a different 1 you had
57:17
in mind, I didn't want to skip over it.
57:20
Sure. Something we haven't already.
57:21
Covered No, I think one of the things that stands out to me as
57:29
I was closing down my my private practice, I was also getting my
57:35
PhD and I tell this story to interns and new staff all the
57:43
time or, you know, sometimes even other executives when
57:48
they're discouraged or something.
57:49
Maybe didn't quite go right that I just I, I had a lot going on
57:56
in my life, you know, closing down to practice, but also
57:59
working on PhD and, you know, my family was growing and, you
58:06
know, I was taking 2 research classes for my PhD and, you
58:13
know, Long story short, I failed both classes.
58:18
You know, I have always kind of been a overachiever and an
58:25
accomplisher, you know, kind of, you know, what some people call
58:28
type a personality, right? Like always moving and doing
58:31
things and setting goals and trying to accomplish stuff and
58:37
to fail a class. Yeah, long two classes while
58:41
getting my PhD. Yeah, I was pretty devastated by
58:45
it and I almost dropped out over it.
58:54
And I took a leave with everything I had going on in my
58:57
life. I took a leave from school and
59:00
they had some kind of policy. You can only take leave for so
59:03
long or whatever. And so they emailed me and they
59:07
said, hey, you know, we need to know in the next 48 hours if
59:10
you're going to re enroll. Otherwise, you know, you're,
59:12
you're dropped and you know, you're not going to be able to
59:16
get a PhD. And I was like, I'm just, I'm
59:21
not even going to respond. I'm just not going to continue.
59:25
And then I had a moment. There was about 3 hours till the
59:31
deadline that they had set for me.
59:34
And I said, no, I've come this far.
59:39
I'm going to go back and I'm going to finish.
59:42
And I went back and re enrolled in the classes and got A's in
59:49
both of those. I had like three more classes to
59:52
go, you know, in the coming semester and was able to finish
59:57
it out. But I, I, I tell that like I
1:00:01
said, especially to interns and, and newer staff, if they're
1:00:06
struggling with something because it's, you know, it's so
1:00:10
easy to put in a lot of work. And then you get a, you get your
1:00:14
report card back and it's got an F on it, right.
1:00:17
And to just say, OK, I guess that's not meant for me.
1:00:21
And you know, fail is temporary as long as I keep going.
1:00:26
So I I I re enrolled and saw it through and.
1:00:31
So what do you think it was that three hours before the deadline
1:00:35
that something arose inside of you?
1:00:39
I don't know. It was, it was really, I think
1:00:42
that that type A, that desire for perfectionism.
1:00:48
I'll tell you one conversation that I had when I was 16 years
1:00:54
old, I was in Boy Scouts and, and I went on and got my Eagle
1:01:00
Scout and, and my scout leader just he's, he's comes back into
1:01:09
my head all the time. And, and he was getting his
1:01:12
doctorate and he told me when I was 16, he's like, you're going
1:01:16
to get a doctorate, right? And I'm like, well, yeah, yeah,
1:01:21
I'm going to do that. And I was probably 22 or 23 and
1:01:28
had sent him an e-mail about my family and and he said, where
1:01:32
you at on getting your doctorate?
1:01:35
And I didn't really have an answer at that point.
1:01:38
And and then he said, well, you told me you were going to do it.
1:01:43
So I'm expecting that you, you know, see it through.
1:01:48
And, you know, maybe it was that commitment I made to that man
1:01:54
many, many years ago. It I said I was going to do it.
1:01:58
And you know, you know, the thing I tell the interns though,
1:02:04
is that no one, no one knows that story that I got FS unless
1:02:11
I tell it, right? Like unless I tell that no one,
1:02:15
you know, most jobs when you go apply, you know, in in my realm,
1:02:22
if you have a license, you're qualified for the job, right?
1:02:26
Where you got your degree, what your GPA was, you know, if you
1:02:31
failed any classes along the way, those things that, you
1:02:37
know, they don't show up anywhere, right?
1:02:40
Yeah. I mean, I write my own bio,
1:02:43
right? I write my own resume.
1:02:44
I don't have to throw that on there that the failure just
1:02:49
gives me character unless I let it define.
1:02:54
Oh, I like that a lot. And that's exactly why I like to
1:02:56
ask this question on the show because right, people see you
1:03:00
like PhD, you've overcome so much.
1:03:02
And, you know, getting to hear those, you know, in between
1:03:06
stories along the way, like, man, I was, I was getting caught
1:03:09
and I failed two classes. That could have been the point
1:03:12
where you threw in the towel. That's the point where a lot of
1:03:15
people throw in the towel. Oh, this is too hard.
1:03:17
Clearly this just isn't for me. I need to find something else
1:03:20
that's easier. But there's there's something to
1:03:24
be said for resiliency, you know, to put it sort of into a
1:03:27
cliche at first. You don't succeed.
1:03:29
Try, try again, right. Ryan, any mentors or books that
1:03:36
have been particularly helpful for you in your trajectory?
1:03:41
Yeah, I, well, first I've had, I've been blessed with probably
1:03:49
4 mentors throughout my adult life.
1:03:53
They have, they have kind of leaned on it at various times.
1:03:56
The one that stands out to me probably the most is a guy by
1:04:02
the name of Larry Duncan. And, and he has been a Co worker
1:04:10
and a teacher of mine. Literally when I was at school,
1:04:14
he was a teacher, he was a supervisor of my internship.
1:04:19
We've worked together, I've worked for him and he's worked
1:04:23
for me. Like we've had numerous
1:04:26
different relationships over the years.
1:04:29
But when my center is off and I need to check in with someone
1:04:35
about something professionally, that's the first name I think
1:04:40
of. And, and I'll always be grateful
1:04:44
for the role he's had in my life and and in my career.
1:04:51
In terms of books, I'm a book on tape guy.
1:04:55
I, I commute a lot between Omaha and Lincoln with our different
1:04:59
locations. And the last several years I've
1:05:05
kind of hung my hat on Simon Sinek and, and his work and
1:05:12
leaders eat Last is one that that I really love.
1:05:19
It was funny. We were at a executive and
1:05:24
leadership retreat for our organization and there's
1:05:27
probably 40 of us there, you know, all the supervisors and
1:05:31
everything. And this is a couple years ago
1:05:35
when I was really into Leader Z last his, his book.
1:05:43
And we were at this retreat and they, we catered lunch it and no
1:05:52
one else knew I was reading this, right.
1:05:54
And so I'm just sitting back watching the lunch line and
1:05:59
without any prompting like I was, I was gonna wait to eat on
1:06:04
purpose 'cause I'm reading this book about leaders eat last.
1:06:07
And, and the, at the time, we had five members of our
1:06:14
executive team and they were five of the last six people to
1:06:20
eat. And to me, it was just kind of
1:06:23
an allegory, right? It was just like personified
1:06:27
right there in front of me. And I said this is a team I
1:06:29
really appreciate being a part of because very naturally
1:06:35
they're doing what leaders do, which is letting, you know,
1:06:40
letting other people go to the front to get the credit and make
1:06:44
sure they get fed 1st. And and then we'll kind of stay
1:06:49
in the background and, you know, let folks take credit for the
1:06:56
work that they're actually doing.
1:06:58
It's almost like everybody was reading that book at the same
1:07:01
time, but they weren't. They just, they had that
1:07:04
sensibility about them, which is a big reason why you feel so at
1:07:08
home there. Yeah.
1:07:10
So I've got just one more question for you, Ryan, But
1:07:12
before I'd ask it, I want to do 2 things.
1:07:15
Everyone listening today, if you enjoyed today's content, please
1:07:18
hit the like, share or subscribe button on your favorite podcast
1:07:21
app. Ryan, I also want to let people
1:07:23
know the best way to get in touch with you.
1:07:25
What would that be? Yeah, my e-mail is probably the
1:07:31
best way. It's R Carruthers, Carruthers at
1:07:37
Centrepoint that has an E on the end.
1:07:40
So CENTERPOINT e.org. Great.
1:07:46
And we'll have that in the show notes for people.
1:07:49
So last question for you, Ryan, I'm kind of curious, what do you
1:07:53
see being maybe the big changes coming to your industry in the
1:07:57
next couple of years? Yeah.
1:08:02
The, the biggest thing on the, on the, for kind of on the, as
1:08:07
we look forward in behavioral health, one that's going to be
1:08:12
interesting to watch, I guess, which is the impact of AI in
1:08:16
behavioral health. There's already several
1:08:21
applications, they're being tested out there for the use of
1:08:25
AI. But, and I think just in the
1:08:28
world in general, we're kind of looking to see how is this going
1:08:32
to have an impact. But behavioral health is
1:08:34
certainly an interesting one. And then, you know, the, the
1:08:40
biggest, I guess trend that I think we're starting to see is a
1:08:45
move towards what I described as the biopsychosocial model, which
1:08:50
is, you know, the idea of if someone comes in to your
1:08:53
organization for help, whether it be for substance use or
1:08:59
mental health or physical health issues or whatever, if they'd be
1:09:02
able to get kind of all of those from the same team, Not
1:09:06
necessarily the same person, but at least the same team shouldn't
1:09:10
have to fill out new paperwork every time I go, you know,
1:09:13
looking for, you know, another service to try to get better.
1:09:20
And so I think that between just that philosophical that that's
1:09:25
probably the best way to provide care and then the reality that
1:09:31
nonprofits, especially in the area of physical health and
1:09:36
behavioral health are really struggling financially.
1:09:41
It's just a reality right now that margins are non existent
1:09:46
for healthcare base organizations.
1:09:52
I think we're going to see a coming together and
1:09:56
organizations that are ready to take on other organizations
1:10:01
under their umbrella and kind of emerging for the purposes of
1:10:07
survival and really for efficiency.
1:10:11
I think that that's something that's going to happen that a
1:10:14
lot of smaller kind of one off programs that are struggling or
1:10:19
are probably going to likely be taken over by some larger
1:10:25
nonprofit, you know, health systems etcetera.
1:10:30
Going back to the AI components, so the AI that's being developed
1:10:34
or they sort of like chat bots so that, hey, I'm having an
1:10:37
issue and you know, rather than, you know, having to pay money to
1:10:41
sit with a, a counselor or a therapist, I, I could use this
1:10:44
chat bot and that could give me some assistance.
1:10:47
Yeah, yeah. That's that's one area that's
1:10:51
being developed. Another is AI that does
1:10:56
documentation for the profession, so it will listen to
1:11:02
a session and type up the note in the correct format and then
1:11:07
the clinician can kind of review it, make sure everything's
1:11:10
accurate, add anything and, and, and approve.
1:11:13
It kind of saves makes the work a little bit more efficient,
1:11:18
allows me to spend more time providing the care rather than
1:11:22
documenting the care I provided. And then other areas that are in
1:11:28
development and, and somewhat interesting is an AI that will
1:11:32
listen to me, provide some therapy, and then will give me
1:11:36
feedback on how well I did, what did I miss?
1:11:40
What other approaches could I have taken?
1:11:45
And so, you know, a lot of interesting areas for AI
1:11:48
development there. And I think different companies
1:11:51
are are and, and different schools on the academic side are
1:11:56
kind of approaching all of those ways that AAI might be able to
1:12:01
help us help people better. Love it.
1:12:05
It's going to be fun to see how all that evolves.
1:12:08
Ryan, I want to be the first one to thank you for sharing both
1:12:10
your time and your story with us today.
1:12:12
I really appreciate it. Yeah.
1:12:14
Thank you very much. Folks, that's a wrap on another
1:12:17
episode of the Inspired Stories podcast.
1:12:20
Thanks for learning with us today.