Latest / The Mental Health Evolution / Ep 23: Building a Mental Health System That Works with Sue Abderholden

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Ep 23: Building a Mental Health System That Works with Sue Abderholden · The Mental Health Evolution

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(Transcribed by TurboScribe. Go Unlimited to remove this message.) This podcast is part of the Frederick Podcast Network.
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Learn more at ListenFrederick.com.
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Welcome to Mental Health Evolution, a podcast about what's changing in mental
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health and why it matters.
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I'm your host, Rachel Harrison, inviting you into honest conversations with
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people from all perspectives in the field, clinicians, tech founders,
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investors, insurance companies, and all the folks in between.
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Let's explore what's working, what's not, and what's next.
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Welcome, welcome back, everyone, to the Mental Health Evolution podcast, where
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we are talking about how the landscape of mental health is quickly
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evolving in our industry.
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Today we are joined by Sue Abderholden, the retired executive director of
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NAMI, which stands for the National Alliance on Mental Illness in Minnesota.
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Sue spent more than two decades leading NAMI Minnesota and working at
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the intersection of mental health advocacy, policy, and systems design.
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Over the course of her career, she witnessed enormous changes in how
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mental health is understood, funded, and delivered from a time when systems
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were far more fragmented and underdeveloped to where we are today.
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We became interested in inviting Sue on the podcast after reading an
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article she recently wrote for the Minnesota Reformer, where she laid out
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a set of extremely informed and specific recommendations for continuing to
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build a stronger, more functional mental health care system in the United
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States.
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And the tone of the piece was really helpful in terms of
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looking at the mental health system as what is still being built
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rather than broken.
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So we're going to dig into that and highlight some of those
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things as we talk to Sue.
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But a couple of articles that we want to highlight first.
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First is the article by our guest, which is called, Here's How
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to Move Forward on a Stronger Functioning Mental Health Care System on
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the Minnesota Reformer.
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And we're going to dig into Sue's six points, maybe not getting
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to all of them in this podcast, but we're going to cover
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what we can.
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And then a few supporting articles that we have.
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The first is called The Landscape of School-Based Mental Health Services.
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And this KFF article examines how school-based and school-linked mental
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health programs reduce barriers to care.
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They highlight gaps in follow-up and explain why early identification and
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treatment are critical, highlighting one of Sue's main points.
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Another article that highlights another point that Sue is going to talk
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to us about is Trends in State Strategies to Improve the Behavioral
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Health Workforce.
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And this analysis reviews how states are addressing workforce shortages through
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loan forgiveness, supervision supports, and diversity-focused initiatives while
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expanding roles for peers and family peer specialists.
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So this article is helpful to kind of get a good look
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at that workforce and kind of where we are currently with that.
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The next article I want to highlight is called Mental Health Parity
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and Medicaid Implementation for State Agencies.
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And Milliman explores how Medicaid payment rates and parity enforcement affects
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access to care, sustainability of providers, and the ability to expand
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services.
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Again, kind of highlighting parity is one of Sue's points.
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And then lastly, I want to highlight an article called National Guidelines
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for a Behavioral Health Coordinated Crisis System.
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And this is SAMHSA's 2025 guideline of how to lay out mobile
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crisis teams, 988 call centers, emergency departments, and community services,
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and how potentially those systems can work together, which was another good
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point from Sue's article.
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So hopefully that gives you kind of a basis for where we're
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about to talk today.
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All of those articles and links can be found in the show
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notes if you're like, ooh, what was that?
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And I want to dive in a little bit deeper.
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We have got that for you.
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So turning to our guest now, welcome, Sue.
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Thank you so much for being here and for joining us today.
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Thanks for inviting me, Rachel.
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Of course.
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Let's dig into your article.
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To start with, you said something in that article that really stood
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out to me.
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You said specifically that the mental health system isn't broken.
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It's still being built.
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I would love to dig into that a little bit more.
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I know that personally, I have said those words about it being
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broken.
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And I know many people that have, and sometimes access to care
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is difficult or challenging in different settings.
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And that sometimes leads to that statement.
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But I'd love to hear more about what you've seen and what
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you mean by that statement.
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You know, about a decade ago, because I used to call it
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broken all the time too, I was really kind of thinking about
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it.
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And I thought, well, what did we have that broke?
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And we have the state institutions, right?
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That is not a system.
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And you know, and let's be honest, in a lot of the
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institutions, they closed because of the poor care that was being provided.
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They closed because President Kennedy thought people belonged in their home
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communities, you know, with, you know, the correct supports and helping
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families and all of that.
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And so when I thought about it, I thought, well, that wasn't
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a system.
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So we don't have a system to break.
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And what we've been trying to do is, you know, develop, you
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know, frankly, a, you know, robust, coordinated system, we have found out
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what works and doesn't work.
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And you know, we're not there yet.
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And so and I also think in working with families, it also,
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I think it's more hopeful to say that we're building something than
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we're fixing something.
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Yeah.
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So if I can rewind a little bit, how did you get
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involved with mental health and with NAMI in particular?
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Well, I've worked on, you know, disability issues my whole life.
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So I was at AHRQ in Minnesota for a decade.
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I actually ran constituent, co-ran constituent services for Senator Wellstone,
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worked at one of the parent training and information centers on special
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education, and then came to NAMI a little over 24 years ago.
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I have family members, but also during grad school, I worked at
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what was then a community facility of about 140 some beds for
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people who had a serious mental illness.
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And it was still better than the institutions at the time.
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But I did that.
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And I had also worked in a group home for children with
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multiple disabilities.
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And at the time, the only alternative was the state institutions for
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those children.
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And I actually saw how hard it was for families not to
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be able to care for their children at home.
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Also, for over a decade, I did respite care for children with
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disabilities and mental illnesses, their families.
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And so I've kind of, you know, had my finger in it,
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if you will.
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And then I also have family members.
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So I've kind of seen it on both the macro and the
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micro level.
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Yeah.
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Yeah, that's a great perspective.
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So when you think back to what the mental health system looked
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like when you started this work 24 years ago, what are some
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of the most meaningful changes that you have seen?
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So probably the biggest one was there had been a huge task
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force called the Mental Health Action Group, and they developed a list
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of model and called it the model benefit set.
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And we said, these are the things that Medicaid for sure should
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pay for and that health plans in the future should pay for.
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And up until that time, it was really based on grants or
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what money the counties were willing to put in.
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So if you needed an assertive community treatment team and there were
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no more spots open, that was it.
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If you needed in-home supports and the county ran out of
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money, you didn't get it.
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And so all of those things were moved to Medicaid, a whole
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range of services.
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And, you know, there was some people who said, well, you're medicalizing
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mental health.
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And I'm like, well, we're assuring payment for treatment that people need
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and for community supports that people need.
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And so I think that was actually one of the biggest changes
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that has been made over the years.
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I think the other thing that I've seen is some really important
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programs developed.
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I would say when we think about children, making sure that we
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were the first state in the country to make sure that teachers
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had continuing education on the early warning signs of mental illness in
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children, you know, with half of all mental illnesses emerging by the
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age of 14.
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I'm like, we've got to focus on kids if we want to
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really look at even secondary prevention, right, preventing these illnesses
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from becoming disabling.
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I think that is really tertiary prevention.
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I think that's really important.
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So making sure that teachers understood what they were seeing were actually
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symptoms and not behaviors and then creating our schooling to mental health
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program, which I like more than schools actually delivering the services
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themselves.
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What we heard from families is they really wanted a firewall between
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the education records and the mental health records.
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And so the grant money actually went to community mental health providers
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who then co-located in the school so they could see the
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child in their own milieu.
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They could work with the teachers and things like that, but they
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could also bill both Medicaid and private insurance.
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And then the grant money was used for children who were uninsured
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or underinsured.
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So maybe the families had a large deductible and also to pay
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for things that you can't pay for under insurance.
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And it is extremely popular program in Minnesota.
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It grows nearly every year.
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It's in about 65 percent of actual school buildings and over 80
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percent of school districts.
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And again, I think the difference from a school providing it is
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having, again, that firewall.
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But also when school is out, those providers are still there.
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The child changes schools, the providers are still there.
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And so that I think that continuity of care is important.
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And also it is not tied to special education.
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And so that is another important factor, because a lot of kids
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with a mental illness are not in special education.
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They might need a 504 plan, but they're not necessarily in special
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ed.
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So I think, you know, those on the kids side, those were
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two important things.
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I think another thing was really looking at the first episode of
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psychosis programs.
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So we didn't just rely on the federal block grant, you know,
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10 percent of the federal mental health block grant going to that,
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but also put a lot of state money in.
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I would say not enough.
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And we aren't there yet, and especially with Minnesota legalizing cannabis.
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But again, it is such an effective program in preventing, you know,
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what is a very serious mental illness from becoming disabling.
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And the young people that I've met who have been through the
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program, I mean, it's just amazing in terms of their recovery and
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their re-involvement with their community.
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So I think those were some really important things.
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You know, there was, of course, work on workforce so that we
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had enough people to do the work that needed to be done.
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You know, housing, employment, all of those things.
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And of course, criminal justice things, too.
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And I think an important thing in criminal justice is that every
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person coming into a jail gets screened for mental health so that
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they know up front whether someone is struggling or not.
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Yeah, those are pretty significant things.
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So I want to dive into this early intervention piece.
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That's one of the I think that's your first bullet point as
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far as what we need to continue to build.
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And I love this idea that if we are catching anything early,
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it's going to be that much better in terms of effectiveness of
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treatment.
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We're not letting symptoms get out of control.
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We're not having all of the additional things that fall apart in
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somebody's lives when symptoms get out of control.
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I love this idea of looking at you and also this idea
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about maybe even having a yearly type of screening, like a physical,
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like a mental health assessment for young people.
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So in an ideal world, what would you envision that this would
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look like?
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What we've seen some, you know, clinics do is they routinely do
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the PHQ-9, the depression screening for any time, any time any
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adult goes into the clinic.
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And I think that's great.
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But young people don't often go to clinics.
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And so I think we have to find other ways to do
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that.
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They're generally healthy.
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And so I think there's a couple of things.
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I think some of the online screenings are helpful for teens and
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young adults.
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We've seen colleges certainly push for having mental health services on campus,
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for raising awareness.
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And I would say that young people today, you know, under 40,
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really are much more aware about mental health than before.
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I think making sure that youth, as they go through, you know,
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they're doing a physical exam for sports or just the well-child
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visits that, you know, pediatricians and others are really checking in on
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those kinds of issues.
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And we've seen some of that happen.
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What doesn't happen is when someone screens positive.
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And that's where I think some of the disconnect is, like, are
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they getting referred to a mental health professional?
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Do they know how, frankly, to navigate their health care system to
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find out who is even in network?
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Do they know what to expect?
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How long do they have to wait?
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And we have seen some primary care clinics actually have a mental
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health professional on site so that it makes it very easy to
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kind of make that first assessment.
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But that's where I see us kind of falling down.
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People, again, I think most people have said, yeah, in the last
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couple of years, when I've gone to the doctor, they've asked me
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those questions about, have you been feeling sad and things like that?
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But what happens when you say you are?
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And that, I think, is a huge problem.
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The other thing, and, you know, some schools were kind of doing
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it and then that kind of fell off because some parents didn't
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want that to be done.
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And that became kind of a mess.
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But I do think that kids generally have to go see a
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pediatrician more frequently than, say, a young adult.
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And so that is another, I think, opportunity to really check in
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on how that child is doing.
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Yeah.
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Yeah.
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Yeah.
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And it sounds like maybe even some education to help folks understand
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the purpose behind it.
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Yes.
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And it doesn't necessarily mean someone's going to be given a pill.
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Right.
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You know, as we all know, just having a pill does not,
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you know, necessarily alleviate symptoms.
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There's also some other work that has to go on, whether it's
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therapy, nutrition, I mean, you know, all those kinds of things.
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So people shouldn't be afraid, oh, they're just going to give me
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pills.
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They should really think more deeply, frankly, about that.
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Yeah.
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Yeah, I definitely agree.
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So let's transition to another point that you made, which is workforce
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development.
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And you've kind of even talked about this in where you've talked
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about some of the areas that we've already grown.
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But the importance of building a robust and diverse mental health workforce,
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where are you seeing the biggest gaps right now?
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And what kind of investments do you think would make the biggest
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difference?
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So we generally have a white workforce.
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And of course, our country is not made up of just white
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people.
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And I think it is important that we create a diverse workforce
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and diversity on all sorts of things.
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You know, I think you can talk to a lot of women
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and they want their OBGYN to be a woman, right, because they're
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going to feel more comfortable.
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And so I think the same is true if you're African-American,
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if you're Somali, if you're Hmong, you might want to see someone
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who understands your culture, who understands racism, you know, to explain it
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to them.
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And I think that's really important.
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Some of the things that we need to do, frankly, to make
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that happen is we know loan forgiveness programs are extremely effective and
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that helps, especially if you're not coming into and going into graduate
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school with much money.
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We also know that a lot of mental health professionals, particularly social
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workers, right, have to pay for their supervision.
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So on top of your student loans, now you have to pay
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for the supervision that's required in order to become licensed.
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And so we had a small program that actually paid for the
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supervision, including in culturally specific clinics to make it easier,
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frankly, for people to be able to do their internships there.
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The other thing we know is that the tests are not necessarily
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culturally appropriate.
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And so we've seen the social work board, actually, you know, on
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the national level testing board say, yeah, we looked at who doesn't
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pass and it's people of color and men.
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So the test is really kind of normed to white women.
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And so they said the test doesn't necessarily tell us whether that
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is going to be a good social worker or not.
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So I think finding some alternative pathways is also important.
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The other thing that we did, which I thought was frankly kind
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of novel, is we did, I would call it a non-scientific
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survey.
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We found our health department found that we literally had thousands of
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people who graduated and didn't go on and become licensed.
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So we sent out a survey, again, non-scientific, but people responded.
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And what we heard is that people said, well, especially people from
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communities of color, they said, I can't find a supervisor from my
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race or culture.
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And then I'm having a difficult time getting through that supervision period.
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So what we did is actually paid BIPOC mental health professionals to
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become supervisors and just paid for them to do that.
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And it multiplied.
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I mean, we had over 200 people just in the first year
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actually go through that program.
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And so I think there are ways that are not necessarily, you
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know, complicated and not necessarily require a whole lot of money to
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create a more culturally diverse workforce.
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The last thing I would say is we've got to start paying
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people.
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You know, we know that a clinical social worker, I mean, in
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terms of those, you know, the graduate school, the hours of supervision
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makes less than a dental assistant.
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Now I want my teeth cleaned well, and there's, you know, I
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don't want to put down that profession at all, but the social
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workers, right, they're required to have a lot more education and training
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and they should be paid for that.
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Yeah, I think the question is, and then this leads into your
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next point, though, is where does that funding and parity come from?
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Right.
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That's the challenge I know firsthand as an organization is that when
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I am limited in what I receive for a session, I can
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only pay people so much.
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Right.
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I joke all the time that I would love and it's a
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joke, but not really.
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I would, I think $200 an hour would be a fair wage
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for anyone doing intensive mental health treatment with clients.
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Right.
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That that would be a fair wage, but that's not anywhere near
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the realistic place that is even doable with insurance and certainly Medicaid
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and things like that.
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So I'm curious what some of your ideas are in regard to
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that.
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I love how you said that insurance or Medicaid should reimburse the
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true cost of mental health care.
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Yeah, that I think is the challenge everybody can see in the
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system as it exists right now.
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You know, I think there's a couple of things.
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One is, let's be somewhat honest, you know, a lot of mental
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health professionals are women.
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And when it's a women dominated profession, you generally get paid less.
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And so, you know, let's just put that out there.
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And I think also with the mental health system, because so much
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of it is reimbursed under Medicaid rather than private insurance, that, you
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know, you're already getting much lower rates because of that.
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And, you know, in some health care programs, right, you can balance
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things out from something that isn't paid very much, but you're getting
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a lot of private insurance and so that you can balance it
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out.
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We can't do that in mental health because so many people have
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to rely on Medicaid and especially young adults who have, you know,
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emerging serious mental illnesses.
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They have to depend on Medicaid.
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And so I think, you know, one, obviously pushing for higher rates
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under Medicaid is important, but I also think pushing the what I
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call kind of the third pillar of mental health parity, the non
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-quantitative treatment limits, you know, in there is if you can't get
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enough people in your network, then you need to pay them more.
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And we know even psychiatrists often get paid a lot less than
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other types of physicians.
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And a lot of them are only taking private insurance now or
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I'm sorry, a lot of them are only taking cash only practices.
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And so really, we should be, frankly, pushing back on those health
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plans saying, no, you have to raise the rates because you don't
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have enough people in network to meet the need.
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And that is the one part of parity that frankly does not
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get enforced and is much harder to enforce because it's not as
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clear, you know, saying that you can't have arbitrary treatment limits, you
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can't have different out-of-pocket costs.
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Those are pretty easy to measure.
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These non-quantitative treatment limits are much harder.
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And that actually comes in.
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I would just add the non-quantitative treatment limits also comes in
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when we talk about paying for first episode of psychosis programs.
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How do health plans pay for new cancer treatments?
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What's their decision making process?
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And here we have a program that clearly is effective, not just
20:53
in this country, but around the world.
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Right.
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We know it's effective.
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Then why isn't private insurance paying for it?
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What is their process for adding new treatments?
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And frankly, they just don't add new treatments for mental health.
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They just don't.
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We had a situation in Minnesota where we finally developed psychiatric
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residential treatment facilities, which, of course, for kids are the only
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program that doesn't have to worry about the IMD or the Institute
21:19
for Mental Disease Exclusion.
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So they can be more than 16 beds and still get Medicaid.
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So we added them to our system in Minnesota.
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And the private health plans refuse to pay, even though under state
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law they're required to pay for hospitalization and residential treatment.
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They said, this isn't any of those.
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And we're like, well, it's one of the two.
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And we had to actually pass a law to require them to
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cover it, which is absurd.
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Oh, yeah.
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Yeah.
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And that that kind of leads into the last topic I wanted
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to jump in with you, which was about the crisis, mental health
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crisis.
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And you talked about how people can end up in jails or
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emergency rooms and looking at what brought them there.
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But even more specifically, how to build a unified mental health crisis
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system.
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So I would love to hear some of your ideas on that.
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You know, often I get, you know, sheriffs and others, you know,
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saying, why are all these people with mental illness in the jails?
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And I just say, well, who brought them there?
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You know, did police actually have to bring them to the jail?
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And I think that's a huge thing when we think about crisis
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services.
22:24
You know, I mean, the feds say you've got to have someone,
22:26
you know, someone to contact, someone to respond and a place to
22:29
bring people.
22:29
Great.
22:30
But I think we've made it complicated.
22:32
And in Minnesota, we've made it even more complicated.
22:35
So, you know, certainly 9-8-8 is wonderful.
22:38
And we have to keep getting the word out about 9-8
22:40
-8 and how effective it can be.
22:42
But second of all, we have a law in Minnesota that says
22:45
if you call 9-1-1 and you need a crisis team,
22:47
you're supposed to get referred to them.
22:49
It's called Travis's Law.
22:50
It was a young man who was killed by police in a
22:53
mental health crisis.
22:53
So you're automatically supposed to happen.
22:55
But what we've seen is despite the fact that we have had
22:58
a statewide mobile mental health crisis system for almost 20 years, maybe
23:04
even a little bit more than 20 years, covering every single area
23:08
of Minnesota, what we've seen is police departments deciding that they want
23:13
to do their own.
23:14
So instead of collaborating with that county crisis team, they want to
23:17
create their own team.
23:18
And we actually have state standards for our crisis teams.
23:21
So now I think we've made it like, so who goes out?
23:25
What is their role versus the county team?
23:28
And so I think we're making it really confusing for people.
23:31
And we have to remember, if you're an employee of a police
23:35
department, you don't have to follow HIPAA, but our mobile crisis teams
23:39
do.
23:40
And so, you know, again, that adds a whole lot of things.
23:43
But what what really bugged me, I'm going to be honest, you
23:46
know, I take well, when I worked for NAMI, I took a
23:48
lot of calls from families because I was usually there on the
23:50
weekend and late.
23:51
And so the calls came into my office and I took them.
23:54
And, you know, they're sitting there saying, I can see my loved
23:57
one decompensating.
23:58
I can see the symptoms coming back.
24:00
I don't know if they stopped taking their meds or the meds
24:03
not working or there was some kind of trigger.
24:05
I don't know.
24:06
But when I call the county and I ask for help, they
24:08
say if they're not willing to go to treatment voluntarily, you have
24:12
to wait until they're a danger to themselves or others.
24:15
And we just wouldn't do that for any other health care condition.
24:19
And so the idea I came up with is called voluntary engagement.
24:23
It's in our commitment law.
24:24
And we finally got money two years ago and the pilot started
24:28
in September.
24:29
And the idea behind it is if you see someone struggling, why
24:33
can't you send someone out then?
24:35
Why can't you send out a peer specialist to talk to that
24:38
person, to engage that person into treatment voluntarily?
24:41
Because we all know getting someone to treatment voluntarily usually is better
24:45
than having them committed.
24:47
And I understand sometimes you have to have people committed.
24:50
I'm not against the commitment laws.
24:51
But what I am against is waiting until someone hits a full
24:54
blown crisis where you need to call the crisis team or you
24:57
need to call the police and where they or they need to
24:59
be brought to the ER.
25:00
Why aren't we going upstream?
25:02
And so these pilots are supposed to track data to see if
25:06
we can prevent a full blown crisis from appearing.
25:09
And we did it in a very holistic way.
25:11
So not only do they go out and talk to the person,
25:14
but do they have health insurance?
25:15
Do they have a prescriber?
25:16
Do they have housing?
25:17
Right.
25:18
What's going on in their life?
25:19
They can go to the families and talk about suicide prevention, means
25:22
restriction, help them understand how to talk to someone who's hearing voices.
25:26
So we tried to kind of create kind of a holistic way,
25:29
not just a police officer going out and driving someone somewhere.
25:33
And so I think that's important.
25:34
The other thing that we've seen in Minnesota because of George Floyd's
25:37
murder is that the legislature changed the use of force laws, deadly
25:43
use of force laws.
25:44
So once that changed, when police come out to actually transport someone
25:48
to an emergent to a hospital, if that's what they need, what
25:51
happens is that if the person is not willing to get into
25:54
the car voluntarily, they won't transport them.
25:57
And I keep saying there's something between killing someone and getting them
26:00
into the car voluntarily.
26:02
I think there's something in between there.
26:04
And so the other thing that we tried to do is for
26:07
quite a few years as part of our Medicaid system under non
26:10
-emergency medical transportation, we created another type of vehicle called
26:15
protected transport so that you could actually transport someone in crisis and
26:19
dignity.
26:19
So it's an unmarked car.
26:21
Basically, it can be driven by someone who's taken mental health first
26:24
aid, so understands de-escalation.
26:26
And if the crisis team says, yes, they're safe to be transported
26:29
that way, they can be transported that way, not in handcuffs, not
26:32
on a stretcher.
26:33
Unfortunately, we only have about three vehicles in the state of Minnesota.
26:36
But we did last session allow our crisis teams to use their
26:41
grant money to buy a vehicle so that they can actually be
26:43
transporting people and not relying on police.
26:46
The last thing I'll say in terms of where to go, which
26:49
I think is always what people struggle with, we have not built
26:53
central receiving centers or those 23-hour centers in Minnesota.
26:58
Part of the reasoning behind that and for those states that have
27:01
done that, I understand.
27:03
Do you think it's great?
27:04
That's great.
27:04
But here, what we said is when someone is in crisis, health
27:09
care, mental health care, whatever it is, right, we just go to
27:12
the emergency room.
27:13
We go there.
27:14
We don't know usually about some of their place that only takes
27:17
people with mental illnesses.
27:18
And if you're building it so that only police can take them
27:21
there, then we've created a weird disincentive as well.
27:24
We want to avoid, frankly, contact with police whenever we can.
27:27
And so we've pushed and said for psychiatric emergency rooms within the
27:31
emergency department so that they aren't, you know, in a room that's
27:35
loud and, you know, all of that kind of stuff.
27:37
But they can be at a quieter part that's actually staffed with
27:41
mental health practitioners and professionals.
27:43
And then attached to that would be crisis homes.
27:46
So we have a lot of crisis beds in our residential facilities.
27:50
Our residential facilities are generally 16 beds so that they can get
27:53
Medicaid.
27:54
We have about 60 of them across the state of Minnesota.
27:56
So they're small.
27:57
And in rural Minnesota, they're often even smaller than 16 beds because
28:01
they can't fill 16 beds in, you know, northwestern Minnesota.
28:04
And so those crisis beds are helpful because these places look like
28:08
homes.
28:09
They don't look like a hospital or anything like that.
28:12
And so people can go there and, you know, frankly, sleep, recharge
28:16
their batteries, kind of address what's going on and, you know, be
28:20
well enough to leave within a few days.
28:22
And I think that's important, too.
28:24
Not everyone needs long term hospitalization, long term residential treatment.
28:29
For a lot of people, they just need that kind of break.
28:31
But it's actually staffed by mental health professionals and peers and
28:36
practitioners to really help that person through, you know, get through their
28:40
crisis.
28:40
Yeah, yeah.
28:42
That's a lot to take in.
28:44
But yeah, you know, you've done a lot of that's a lot
28:47
of great information to kind of synthesize about ideas of where to
28:52
go.
28:53
And I do think as our industry is changing a lot right
28:57
now, there is an opportunity to think about what else is needed.
29:01
How do we creatively address some of these issues that we're seeing?
29:05
And so I love how clearly your perspective kind of puts everything
29:09
together.
29:09
I want to just ask you one last question.
29:12
And if listeners could take one message away from this conversation, whether
29:17
it be someone seeking care or a provider or an organization, what
29:23
would you hope to have people take away from this?
29:26
That you can create change.
29:28
I think too often people are like, well, there's nothing I can
29:31
do.
29:32
And I teach a class for social workers on health and mental
29:35
health policy at the University of Minnesota.
29:37
And what I want them to take away from that is when
29:40
they're providing treatment or supporting someone, when they're hearing from a
29:44
family member who said, this doesn't exist, what can I do?
29:47
Not to just say, I don't know, but to say, let's look
29:50
at changing that.
29:52
Let's look into it.
29:53
Is it a simple law that can change?
29:55
Is it somebody who's just not doing their job?
29:57
Is it a misinterpretation?
29:58
But too often.