Latest / Becker's Healthcare Behavioral Health / Menopause & Mental Health: What Healthcare Leaders Need to Understand About Why the Two Can’t Be Treated in Silos

Transcript

Menopause & Mental Health: What Healthcare Leaders Need to Understand About Why the Two Can’t Be Treated in Silos · Becker's Healthcare Behavioral Health

• 0:00
  Hi, everyone. This is Lucas Voss with Becker's
• 0:02
  Healthcare. Thanks so much for tuning in to
• 0:04
  the Becker's Healthcare podcast series. It's great to
• 0:07
  have you.
• 0:08
  Today, we're exploring one of the most underrecognized
• 0:11
  intersections in women's health, menopause,
• 0:13
  and mental health, and what health care leaders
• 0:16
  need to understand about why the two
• 0:19
  can't be treated
• 0:20
  in silos
• 0:22
  anymore. And my guest, I'm so excited to
• 0:24
  have her on, is doctor Gavares Georgia Gavares,
• 0:27
  cofounder and chief medical officer of TalkCietry.
• 0:30
  Georgia recently joined us at the Backroads Behavioral
• 0:32
  Health Summit as a featured speaker on redefining
• 0:35
  menopause care, and we're certainly continuing that conversation
• 0:38
  here today. Doctor Guevara, so excited to have
• 0:40
  you. Thanks for being here. Thank you, Lucas.
• 0:42
  It's a pleasure with Beyond.
• 0:44
  I wanna level set our conversation a little
• 0:46
  bit and establish sort of where we're at
• 0:49
  right now. When you look at how health
• 0:51
  systems currently approach
• 0:55
  menopausal
• 0:56
  care, what's the most
• 0:58
  consequential gap you're seeing,
• 1:01
  and why does that matter so much in
• 1:03
  2026?
• 1:05
  Well, I think that I I think it's
• 1:07
  a, you know, a story we've been told
• 1:09
  we've been telling for a long time, and
• 1:10
  that's about how
• 1:12
  medical care is siloed from psychiatric care. So
• 1:15
  when we look at menopause care, you know,
• 1:17
  the fact that we're recognizing it more,
• 1:20
  Gen x, is aging into it. So, you
• 1:22
  know, a a large number of people, are
• 1:24
  aging into it. And
• 1:26
  but it's still not integrated as well as
• 1:28
  it should be with mental health care. I
• 1:31
  think it's it's
• 1:33
  it's something that we've seen for women's care
• 1:35
  for a long, long time, but just in
• 1:37
  general medical care, there has been these silos.
• 1:39
  So I think that while it's great that
• 1:41
  more and more people are focusing on,
• 1:44
  the care of women in this part of
• 1:47
  their lives, I think it's also
• 1:49
  not completely integrated into mental health treatment and
• 1:52
  mental health support for those women,
• 1:55
  as much as, hopefully, it one day will
• 1:57
  be.
• 1:58
  And we've touched on the intersection of this,
• 2:00
  and I just wanted to, bring up a
• 2:01
  couple of numbers from a research perspective because
• 2:04
  they they are very striking, very interesting.
• 2:06
  Research shows that perimenopausal women face roughly a
• 2:09
  forty percent higher risk of depression
• 2:12
  compared to premenopausal
• 2:13
  women, which is a striking number.
• 2:16
  What should that signal to health system leaders
• 2:19
  about, again, that clinical risk? And, again, what's
• 2:22
  at stake if we continue to silo and
• 2:25
  we continue to overlook some of these numbers?
• 2:28
  Yes. I think that, you know, when we
• 2:29
  look at mental health care and we look
• 2:31
  at that intersection with other medical issues or
• 2:34
  just in general physical health care, we do
• 2:37
  see that untreated mental health needs
• 2:40
  contribute to worse outcomes on the medical side.
• 2:42
  So when we see, such a large number
• 2:44
  of patients of women at a higher risk
• 2:47
  for depression, and we know depression is related
• 2:49
  to negative outcomes if it's not treated, then
• 2:51
  we're looking at a very, very large number
• 2:53
  of women who are
• 2:54
  risking worse outcomes on the medical side. So
• 2:57
  I think that we need to look at
• 2:59
  this as, you know, I've said this before.
• 3:01
  Many people have said it that mental health
• 3:02
  care is just health care, and we have
• 3:04
  to look at how,
• 3:06
  to integrate that into medical care. Because if
• 3:08
  we don't, then then we're just looking at
• 3:09
  worse and worse outcomes, on the medical
• 3:12
  side. Do you feel like that's happening right
• 3:15
  now, that shift is happening, or are we
• 3:17
  still a ways off from saying it's just
• 3:20
  health care?
• 3:21
  Yeah. It's definitely happening. I there's no question.
• 3:23
  I think that, you know, for better or
• 3:24
  worse, when the pandemic started six years ago,
• 3:26
  right, almost to the day, people really started
• 3:29
  to focus more on their mental health needs.
• 3:30
  You know, it was almost like we removed
• 3:32
  so many other things from their lives. They
• 3:33
  couldn't ignore it any longer. And I think
• 3:35
  for the past five or six years, we've
• 3:37
  really started to look more and more at
• 3:39
  mental health care. There's also a generational shift.
• 3:41
  I think more and more younger people are
• 3:43
  looking at these things earlier in their lives
• 3:46
  and valuing
• 3:47
  good mental health care as just part of
• 3:49
  good holistic care. So I think that, it's
• 3:51
  definitely changing,
• 3:53
  but, you know, it's like turning an ocean
• 3:54
  liner. There it it's it can be slow.
• 3:57
  So
• 3:58
  it's on a positive track for sure, but,
• 4:00
  you know, of course, there's more work to
• 4:01
  be done. No question about that.
• 4:03
  Yeah.
• 4:04
  I wanna talk about something that's that's quite
• 4:06
  unfortunate,
• 4:07
  and very unfortunate.
• 4:09
  A lot of women in this transition
• 4:11
  often
• 4:12
  have
• 4:14
  their symptoms
• 4:15
  dismissed, right, or misattributed,
• 4:18
  mood changes, anxiety, cognitive shifts, etcetera, whatever it
• 4:21
  may be.
• 4:22
  From
• 4:23
  your perspective,
• 4:25
  what are some of those failure points and
• 4:27
  how clinicians are currently trained
• 4:30
  in in in working this, and
• 4:32
  how care is coordinated across specialties when you're
• 4:35
  looking at this.
• 4:37
  Yeah. So unless you're actually training specifically in
• 4:40
  women's health, there's very generic information that a
• 4:42
  doctor gets in their training about women.
• 4:45
  And I think, you know, it's interesting that
• 4:47
  women, you know, get sick, and they have
• 4:50
  heart attacks, and they get cancer. So you're
• 4:53
  treating women regardless of your specialty. You're treating
• 4:55
  women, and you're treating when you're treating women
• 4:58
  in any specialty for any reason, these are
• 5:00
  things that are important to keep in mind
• 5:02
  as possibly a contributing factor. The risk is
• 5:04
  also I mean, not just that these things
• 5:06
  are dismissed and restricted, but I think the
• 5:08
  other on the other side of that is
• 5:10
  then
• 5:11
  over attributing something
• 5:13
  to it being just a part of their
• 5:15
  stage of life, you know, and relating things
• 5:17
  to fertility only, which is what this is.
• 5:19
  Right? Menopause is is part of a woman's
• 5:21
  fertility lifespan. And then ignoring that there may
• 5:24
  be other things going on. There was a
• 5:25
  very interesting, essay in the Wall Street Journal
• 5:27
  not that long ago about a woman who
• 5:30
  had a particular medical problem that kept getting
• 5:33
  attributed to perimenopause when in in reality, it
• 5:35
  was actually I believe it was,
• 5:37
  I believe it was a cancer. So I
• 5:39
  think that, you know, there is this risk
• 5:41
  of overcorrecting, you know, and we just have
• 5:43
  to remember that women are human beings. There
• 5:45
  are lots of parts to them, both physically,
• 5:48
  emotionally, and mentally.
• 5:49
  The other point is, you know, perimenopausal
• 5:51
  women right now are in that sandwich generation.
• 5:54
  Right? They're that generation of women that are
• 5:55
  taking care of both kids and parents. They
• 5:58
  have stress. They have a lot of stress
• 6:00
  in their lives. There's financial stress. There's emotional
• 6:02
  stress. There's lots of stuff going on in
• 6:03
  their lives. Can you imagine going to your
• 6:05
  wife and if she's in a, you know,
• 6:08
  having a a an episode of anxiety and
• 6:10
  saying it's because you're menopausal?
• 6:12
  Yes.
• 6:13
  Okay. You're gonna get clogged. Right? Yes. Yes.
• 6:17
  No jury would convict her. I think it's
• 6:18
  a matter of, like, really taking a step
• 6:20
  back and looking this just as part of
• 6:22
  a of a whole
• 6:23
  human and saying what else is going on.
• 6:26
  It's but also remembering that this is very
• 6:28
  much something that could be going on. So
• 6:30
  adding it to the list of things, but
• 6:32
  not then just saying it is because of
• 6:33
  this. And I made this point, I think,
• 6:35
  when I was on the panel, but I
• 6:36
  think that if we're just over attributing things
• 6:39
  to women and their, and their fertility, I
• 6:41
  think that we risk going back in time
• 6:43
  to a point where we literally came up
• 6:45
  with the word hysterical
• 6:47
  to talk about women who are acting irrationally,
• 6:49
  right, and attributing it just to
• 6:52
  to that. And I think that that is
• 6:55
  not where this should be going. We should
• 6:57
  be looking at this and acknowledging how important
• 6:59
  it is and also saying that this is
• 7:01
  one important aspect of a larger picture for
• 7:03
  women.
• 7:04
  And, again,
• 7:05
  hopefully, unfortunately, we're now at a point where
• 7:08
  that's starting to change and
• 7:10
  especially health systems, health care is understanding this
• 7:13
  now. You you've made it a point to,
• 7:15
  specifically at TalkCietry,
• 7:17
  to build your model around this sort of
• 7:19
  accessible
• 7:20
  in network psychiatry at at scale, which we
• 7:23
  essentially described.
• 7:25
  How does that model then change the equation
• 7:28
  around some of what we've talked about for
• 7:30
  women who are trying to navigate mental health
• 7:32
  support during perimenopause?
• 7:35
  So when we started TalkIatry,
• 7:37
  we started this because we wanted to give
• 7:39
  people access to high quality health care, and
• 7:41
  that was with psychiatrists
• 7:44
  who are specifically trained, right, in in their
• 7:46
  field. So,
• 7:48
  what we wanted to do is make sure
• 7:49
  that if a woman needed to see somebody
• 7:51
  to address their mental health needs, they were
• 7:52
  seeing a physician who was able then to
• 7:54
  look at them holistically
• 7:55
  and not just specifically for just what they
• 7:57
  were coming to see us for, but also
• 7:59
  take into account their entire medical
• 8:02
  status. So, we have providers who are specifically
• 8:05
  trained in treating
• 8:06
  women at various stage of their lives, including
• 8:08
  during pregnancy, in the postpartum period, in the
• 8:10
  period, in the perimenopausal period, in the menopausal
• 8:12
  period, and beyond. So we really wanted to
• 8:15
  give access to people, not just to any
• 8:17
  provider. Right? I mean, access is one thing,
• 8:19
  but you also wanna say, well, to whom
• 8:20
  and for what are you giving access? And
• 8:22
  that's where we really wanted to focus, that
• 8:24
  high quality provider where if you're going to
• 8:26
  see them, then you know that they're gonna
• 8:28
  be looking at you as, like I said,
• 8:30
  a whole person who could really, determine how
• 8:33
  much of this is something that they can
• 8:35
  handle, meaning the psychiatrist, or how to work
• 8:38
  with other providers in other aspects of their
• 8:40
  medical care.
• 8:41
  The elimination of silos that we've touched on
• 8:44
  and and Exactly. More integration across the board,
• 8:46
  which is so crucial for health care in
• 8:48
  2026 and certainly beyond.
• 8:51
  It was in
• 8:52
  even before it should have been here in
• 8:54
  the nineteenth century, but with this Correct. Correct.
• 8:56
  Yes. Better late than never. If you're thinking
• 8:59
  about some of the conversations that you've had,
• 9:01
  last week, but certainly also
• 9:03
  conversations that will probably come up for you
• 9:05
  here for the rest of the year,
• 9:07
  what's the one mindset shift or or structural
• 9:10
  change that you want leaders to understand that
• 9:12
  will move the needle on this issue
• 9:15
  further?
• 9:16
  I think when we're talking to systems, I
• 9:18
  know we're talking about on the provider level,
• 9:20
  but just, like, in general, larger systems, it's,
• 9:22
  you know, it's yes. We wanna provide good
• 9:24
  quality health care to to women, to everyone,
• 9:26
  certainly.
• 9:27
  But I think that what is very important,
• 9:29
  it's something that I talked about a little
• 9:31
  a few minutes ago, is that
• 9:33
  incorporating mental health care and making it part
• 9:36
  of general care is going to then translate
• 9:39
  into better outcomes on the medical side. It's
• 9:41
  gonna translate. And when we did this research
• 9:43
  ourselves, we looked at our our patients, and
• 9:46
  we see that they're less likely to go
• 9:47
  to the emergency room. They're less likely to
• 9:49
  be admitted to a hospital, not for psychiatric
• 9:51
  reasons, for psychiatric reasons, certainly, but in general,
• 9:54
  for all medical reasons. So all cause health
• 9:56
  care costs go down when you address mental
• 9:59
  health care. So I think that for systems,
• 10:01
  that's something that is very tangible. It's dollars
• 10:03
  and cents that actually is a reflection of
• 10:06
  better outcomes on the medical side.
• 10:09
  Consider the trickle down effect,
• 10:11
  which is so, so crucial. Yeah. Doctor Guevara,
• 10:14
  it's so fantastic to have you on. Thanks
• 10:15
  so much for taking some time. Anything else
• 10:17
  that you wanna add that we haven't touched
• 10:19
  on that that might be important for the
• 10:21
  conversation?
• 10:22
  I just really wanna stress that, you know,
• 10:24
  when we look at this topic, we have
• 10:26
  to remember that it is just one party
• 10:28
  of women, and I think it's just like
• 10:30
  anything else. We have to just consider it
• 10:33
  and add it to the list of things
• 10:34
  that contribute to someone's overall biopsychosocial,
• 10:37
  status. So I'm glad people are thinking about
• 10:40
  it more. I'm I'm thrilled about it, and
• 10:42
  I and I'm hoping that, it continues to
• 10:44
  grow. Doctor Greer, it's great to have you.
• 10:46
  Thanks so much for being here. Thank you,
• 10:48
  Lucas. It's my pleasure.
• 10:50
  We also want to thank our podcast sponsor,
• 10:51
  Talk Hietry. You can tune in to more
• 10:53
  podcasts from Becker's Healthcare by visiting our podcast
• 10:55
  page at beckershospitalreview.com.