1 00:00:00,120 --> 00:00:02,720 Speaker 1: What if everything you thought you knew about autism and 2 00:00:02,759 --> 00:00:07,200 Speaker 1: mental health wasn't the full story. Today's conversation might change 3 00:00:07,240 --> 00:00:09,360 Speaker 1: the way you see it. This is why not me 4 00:00:09,720 --> 00:00:14,720 Speaker 1: embracing autism and mental health worldwide, real conversations about autism, 5 00:00:14,840 --> 00:00:17,800 Speaker 1: mental health and the stories that shape our lives. I'm 6 00:00:17,840 --> 00:00:21,480 Speaker 1: Tony Mantor. This is where understanding begins. If this kind 7 00:00:21,520 --> 00:00:24,680 Speaker 1: of conversation matters to you, follow the show so you 8 00:00:24,760 --> 00:00:27,720 Speaker 1: don't miss what comes next. Joining us today are two 9 00:00:27,800 --> 00:00:31,080 Speaker 1: people who share the same mission on mental health, finding 10 00:00:31,120 --> 00:00:34,720 Speaker 1: better ways to help people who are struggling. Doctor Alan Meyer, 11 00:00:34,840 --> 00:00:38,040 Speaker 1: a physician based in San Diego who works closely with 12 00:00:38,120 --> 00:00:43,120 Speaker 1: individuals facing complex medical and mental health challenges. Also joining 13 00:00:43,240 --> 00:00:46,920 Speaker 1: us is Anne Marie Counsel, a retired senior Deputy City 14 00:00:46,960 --> 00:00:49,919 Speaker 1: Attorney for the City of San Diego and now a 15 00:00:49,960 --> 00:00:55,000 Speaker 1: founding partner and mental health policy advisor with Quarter Turn Strategies. 16 00:00:55,080 --> 00:00:56,680 Speaker 1: Thanks for joining us today. 17 00:00:56,560 --> 00:00:57,400 Speaker 2: Thanks for inviting me. 18 00:00:57,440 --> 00:00:59,760 Speaker 1: Anne Marie will be joining us shortly, so let's start 19 00:00:59,800 --> 00:01:02,680 Speaker 1: it up with this. When you're looking at behavioral health, 20 00:01:02,920 --> 00:01:07,360 Speaker 1: you have the clinical perspective and the policy perspective. Where 21 00:01:07,400 --> 00:01:09,319 Speaker 1: do you see the biggest gaps in the way the 22 00:01:09,360 --> 00:01:10,720 Speaker 1: community addresses it. 23 00:01:11,040 --> 00:01:14,560 Speaker 2: That's a good question. I see both, but I see 24 00:01:14,560 --> 00:01:19,440 Speaker 2: the policy impacting the clinical We've seen that in California 25 00:01:19,800 --> 00:01:22,920 Speaker 2: with our laws related to substance use disorder treatment and 26 00:01:23,080 --> 00:01:27,160 Speaker 2: people getting excluded because of with all their presentation chalked 27 00:01:27,240 --> 00:01:30,920 Speaker 2: up to substance use disorder. Or we have laws that 28 00:01:31,280 --> 00:01:36,120 Speaker 2: have said that dementia and cognitive disorders, neurodevelopmental disorders are 29 00:01:36,440 --> 00:01:40,840 Speaker 2: mental disorders. So then you get clinical decisions that point 30 00:01:40,880 --> 00:01:44,199 Speaker 2: to gaps or exclusions in the law as the reason 31 00:01:44,520 --> 00:01:48,600 Speaker 2: why this person can't come to a recommended destination like 32 00:01:48,600 --> 00:01:50,120 Speaker 2: an inpatient psychiatric unit. 33 00:01:50,320 --> 00:01:52,920 Speaker 1: Many people hear your name connected to this field, but 34 00:01:53,040 --> 00:01:55,880 Speaker 1: may not fully understand the work behind it. Can you 35 00:01:56,160 --> 00:01:57,800 Speaker 1: walk us through what you actually do? 36 00:01:58,000 --> 00:01:58,240 Speaker 3: Yeah. 37 00:01:58,240 --> 00:02:01,600 Speaker 2: So, I'm a psychiatrist that University of California, San Diego. 38 00:02:01,880 --> 00:02:06,280 Speaker 2: I finished residency in twenty eighteen, and since i finished residency, 39 00:02:06,360 --> 00:02:09,200 Speaker 2: I've worked at in patient psychiatric units. I've worked on 40 00:02:09,480 --> 00:02:13,320 Speaker 2: medical surgical floors, particularly for people who are admitted for 41 00:02:13,400 --> 00:02:16,600 Speaker 2: medical hospitalizations because they don't and they don't fit into 42 00:02:16,639 --> 00:02:20,000 Speaker 2: the psychiatric behavioral health world. Currently, I work with the 43 00:02:20,000 --> 00:02:23,080 Speaker 2: City of San Diego with their Fire Rescue Department, UH 44 00:02:23,320 --> 00:02:25,640 Speaker 2: the behavioral health officer for the city, and I work 45 00:02:25,720 --> 00:02:28,960 Speaker 2: with people who frequently utilized nine one one and sometimes 46 00:02:29,040 --> 00:02:31,160 Speaker 2: up to one hundred and two hundred times in a year, 47 00:02:31,480 --> 00:02:35,120 Speaker 2: and a lot of those folks have a combination of 48 00:02:35,360 --> 00:02:40,440 Speaker 2: substance use disorders, mental health, cognitive disorders, musical issues, and 49 00:02:40,520 --> 00:02:43,560 Speaker 2: because of their complexity, they fit in nowhere. So people 50 00:02:43,560 --> 00:02:46,520 Speaker 2: who cycle through the emergency departments and through the jails, 51 00:02:46,680 --> 00:02:49,000 Speaker 2: those are that's the population who I work with. 52 00:02:49,600 --> 00:02:52,680 Speaker 1: I'm really glad you brought up the part about the city. 53 00:02:53,040 --> 00:02:56,360 Speaker 1: Since you work closely with local government and have seen 54 00:02:56,400 --> 00:03:00,000 Speaker 1: things firsthand at the street level, what have you learned 55 00:03:00,040 --> 00:03:03,200 Speaker 1: learned about the role a city can play with mental 56 00:03:03,200 --> 00:03:07,880 Speaker 1: health services, especially on the things that people might not realize. 57 00:03:08,040 --> 00:03:11,480 Speaker 2: Yeah, so, I think in each state is probably different 58 00:03:11,480 --> 00:03:15,000 Speaker 2: on how they break down the responsibility for mental health. 59 00:03:15,040 --> 00:03:17,680 Speaker 2: And I think in cities often cities get the blame 60 00:03:17,919 --> 00:03:22,160 Speaker 2: for mental health crises. And in California, it's the counties 61 00:03:22,200 --> 00:03:25,600 Speaker 2: that get the money from the state for behavioral health 62 00:03:25,639 --> 00:03:30,400 Speaker 2: infrastructure and planning, and it's the counties that are authorized 63 00:03:30,440 --> 00:03:35,120 Speaker 2: by statute to carry the responsibility of public conservator, public guardian, 64 00:03:35,240 --> 00:03:38,240 Speaker 2: and so cities can help in terms of zoning laws, 65 00:03:38,440 --> 00:03:42,040 Speaker 2: cities can help in terms of housing, and that In California, 66 00:03:42,080 --> 00:03:46,680 Speaker 2: behavioral health is almost one percent managed by counties the 67 00:03:46,720 --> 00:03:50,720 Speaker 2: city county. Like in California, there's some counties like San Francisco, 68 00:03:50,880 --> 00:03:53,440 Speaker 2: where the city and county are together, but in the 69 00:03:53,480 --> 00:03:57,440 Speaker 2: majority of counties, cities and counties have separate governmental entities. 70 00:03:57,840 --> 00:04:00,800 Speaker 1: When you were doing this work on the ground, did 71 00:04:00,840 --> 00:04:04,440 Speaker 1: you ever feel a disconnect between what you were seeing 72 00:04:04,520 --> 00:04:08,240 Speaker 1: firsthand and what some of the people in city or 73 00:04:08,360 --> 00:04:13,800 Speaker 1: county offices might have misunderstood because they were sitting behind 74 00:04:13,840 --> 00:04:14,400 Speaker 1: that desk. 75 00:04:14,760 --> 00:04:16,640 Speaker 2: Yeah. I think there needs to be a lot more 76 00:04:16,680 --> 00:04:20,120 Speaker 2: recognition as to the I think the needs of cities, 77 00:04:20,120 --> 00:04:24,200 Speaker 2: and I think police departments and fire rescue departments understand 78 00:04:24,279 --> 00:04:27,000 Speaker 2: the gaps in the mental health system intimately because they're 79 00:04:27,040 --> 00:04:30,280 Speaker 2: experiencing it every day. I think when you're removed from that, 80 00:04:30,480 --> 00:04:33,479 Speaker 2: when your job is in contracting or your job is 81 00:04:33,520 --> 00:04:37,200 Speaker 2: in quality assurance, equality improvement, you don't necessarily see the 82 00:04:37,240 --> 00:04:39,320 Speaker 2: needs of people on the front line, and so the 83 00:04:39,360 --> 00:04:42,720 Speaker 2: systems that are built, especially in the public behavioral health setting, 84 00:04:42,839 --> 00:04:47,040 Speaker 2: don't address the needs of the most severely vulnerable people 85 00:04:47,160 --> 00:04:50,200 Speaker 2: in our community, and I think that's been a chronic frustration, 86 00:04:50,320 --> 00:04:53,880 Speaker 2: I think an age old frustration in California when. 87 00:04:53,720 --> 00:04:57,880 Speaker 1: You work with city, county, or state government. There are 88 00:04:58,000 --> 00:05:02,120 Speaker 1: policies that always sound great when they're on paper, but 89 00:05:02,200 --> 00:05:05,680 Speaker 1: when they're put into practice on the street, the reality 90 00:05:05,920 --> 00:05:09,240 Speaker 1: it can be very different. Have you seen examples where 91 00:05:09,279 --> 00:05:13,080 Speaker 1: that gap between policy and reality became very clear? 92 00:05:13,560 --> 00:05:16,240 Speaker 2: Yeah? I think in addition to that, you get policies 93 00:05:16,320 --> 00:05:19,680 Speaker 2: or you get laws that are passed then are described 94 00:05:19,800 --> 00:05:22,520 Speaker 2: and are different than what's described. So I think some 95 00:05:22,600 --> 00:05:25,400 Speaker 2: of the marketing doesn't always match up with what the 96 00:05:25,480 --> 00:05:29,039 Speaker 2: law actually says. Yeah, And so a case in point 97 00:05:29,040 --> 00:05:32,120 Speaker 2: would be the Care Act in California, where the Care 98 00:05:32,160 --> 00:05:36,200 Speaker 2: Act was a dean does like a court mandated treatment, 99 00:05:36,320 --> 00:05:40,080 Speaker 2: but it doesn't actually mandate treatment. It's court supervised, but 100 00:05:40,160 --> 00:05:42,599 Speaker 2: it's not court mandated. And so I think some of 101 00:05:42,600 --> 00:05:45,160 Speaker 2: the initial marketing in the Care Act led the public 102 00:05:45,200 --> 00:05:47,080 Speaker 2: to have a different opinion of what the law was 103 00:05:47,160 --> 00:05:50,480 Speaker 2: than what the law actually read as. And so you 104 00:05:50,600 --> 00:05:55,000 Speaker 2: get that too with implementation how counties would decide to 105 00:05:55,040 --> 00:05:57,680 Speaker 2: implement the law, Like, for instance, in the Care Act, 106 00:05:57,680 --> 00:06:01,520 Speaker 2: there's provisions for a court ordered mental health evaluation if 107 00:06:01,560 --> 00:06:04,560 Speaker 2: the person's safety is at risk. We did a Public 108 00:06:04,600 --> 00:06:08,000 Speaker 2: Record Act request on all fifty eight counties and no 109 00:06:08,200 --> 00:06:11,800 Speaker 2: county had processes that were in effect that created or 110 00:06:11,839 --> 00:06:14,800 Speaker 2: allowed for this court ordered mental health evaluation to happen. 111 00:06:14,960 --> 00:06:17,400 Speaker 2: And so you have laws that are passed that reference 112 00:06:17,560 --> 00:06:20,920 Speaker 2: these court ordered mental health evaluations, and no county has 113 00:06:20,960 --> 00:06:24,960 Speaker 2: operationalized it, even though it's been in existence since the sixties. 114 00:06:25,160 --> 00:06:28,000 Speaker 1: Yeah, I'm really glad you brought that up. Many states 115 00:06:28,480 --> 00:06:32,200 Speaker 1: approach this very differently. Some call it AOT and others 116 00:06:32,240 --> 00:06:35,840 Speaker 1: have different acronyms for it. In some states, if a 117 00:06:35,880 --> 00:06:39,440 Speaker 1: person is not considered a threat to themselves or others, 118 00:06:39,880 --> 00:06:43,799 Speaker 1: the system can't really step in even though that person 119 00:06:44,040 --> 00:06:49,480 Speaker 1: clearly needs help. How does California address that particular challenge? 120 00:06:49,800 --> 00:06:54,839 Speaker 2: So California's Assisted out Patient Treatment Plan is optional for counties, 121 00:06:55,000 --> 00:06:57,640 Speaker 2: and only twenty eight of the fifty eight counties have 122 00:06:57,720 --> 00:07:01,680 Speaker 2: implemented assisted out patient treatment or law law, and access 123 00:07:01,800 --> 00:07:05,400 Speaker 2: to this program is limited because while the Care Act, 124 00:07:05,440 --> 00:07:08,479 Speaker 2: you have a bunch of different petitioner entities that can 125 00:07:08,560 --> 00:07:11,320 Speaker 2: go directly to the court and say this individual is 126 00:07:11,320 --> 00:07:14,200 Speaker 2: someone who needs help. Only the county Behavior Health Program 127 00:07:14,240 --> 00:07:18,239 Speaker 2: director can make an application for assisted out patient treatment, 128 00:07:18,320 --> 00:07:20,600 Speaker 2: and so access is really limited on top of the 129 00:07:20,600 --> 00:07:24,600 Speaker 2: fact that it's optional and not implemented in more than 130 00:07:24,640 --> 00:07:26,440 Speaker 2: half of California counties. 131 00:07:26,560 --> 00:07:29,160 Speaker 1: So how do we move this from being available in 132 00:07:29,200 --> 00:07:33,080 Speaker 1: only half the counties to something that's available statewide so 133 00:07:33,160 --> 00:07:36,240 Speaker 1: everyone who needs help can actually get it right? 134 00:07:36,920 --> 00:07:39,040 Speaker 2: And so I think that's the hope with the Care 135 00:07:39,080 --> 00:07:43,520 Speaker 2: Act is it's in many ways take two on assisted 136 00:07:43,520 --> 00:07:47,000 Speaker 2: out patient treatment, and it comes with more funding for 137 00:07:47,400 --> 00:07:50,920 Speaker 2: counties to bill the state directly for outreach because one 138 00:07:50,960 --> 00:07:54,040 Speaker 2: of the issues is it costs more and it's more 139 00:07:54,080 --> 00:07:57,560 Speaker 2: time consuming for people for counties to care for folks 140 00:07:57,600 --> 00:08:00,600 Speaker 2: who are more difficult to engage, and so the Care 141 00:08:00,640 --> 00:08:05,320 Speaker 2: Act provides incentives for counties to engage the people who 142 00:08:05,560 --> 00:08:08,200 Speaker 2: need help the most. And so I think care Act 143 00:08:08,360 --> 00:08:12,760 Speaker 2: is an effort to realize that initial vision of Laura's Law. 144 00:08:13,480 --> 00:08:17,240 Speaker 1: So what do you see as the biggest challenge in 145 00:08:17,240 --> 00:08:21,480 Speaker 1: integrating mental health care with the rest of the healthcare system, 146 00:08:21,800 --> 00:08:25,160 Speaker 1: So this way, hopefully it can be treated more effectively. 147 00:08:26,080 --> 00:08:31,000 Speaker 2: Yeah, I think the I mean that's a multi layered question. 148 00:08:31,080 --> 00:08:34,120 Speaker 2: So federally. I think there's problems with how mental health 149 00:08:34,120 --> 00:08:37,280 Speaker 2: has been structured because of the sins of the past. 150 00:08:37,559 --> 00:08:41,040 Speaker 2: You know, we have institutionalization that happened in the sixties, 151 00:08:41,640 --> 00:08:43,920 Speaker 2: earlier than the sixties, and then in the sixties there 152 00:08:43,960 --> 00:08:47,440 Speaker 2: was an effort to deinstitutionalize, and with that there was 153 00:08:47,679 --> 00:08:51,440 Speaker 2: a federal disincentive to pay for mental health treatment in 154 00:08:51,800 --> 00:08:56,400 Speaker 2: standalone in patient psychiatric facilities. So there's a ban on 155 00:08:56,920 --> 00:09:00,120 Speaker 2: Medicaid reimbursement for beds that are more than were in 156 00:09:00,200 --> 00:09:03,480 Speaker 2: sixteen beds, and so you don't have the federal support. 157 00:09:03,520 --> 00:09:06,240 Speaker 2: And so, you know, mental health has looked at differently 158 00:09:06,360 --> 00:09:09,440 Speaker 2: than physical health, and so you've got that layered on 159 00:09:09,520 --> 00:09:13,640 Speaker 2: top of state issues where the preference is on community 160 00:09:13,679 --> 00:09:17,280 Speaker 2: based outpatient treatment, which it should be, and there's individuals 161 00:09:17,520 --> 00:09:20,200 Speaker 2: that are too severe for that level of care, and 162 00:09:20,240 --> 00:09:23,600 Speaker 2: so you get a small population of people who fall 163 00:09:23,640 --> 00:09:27,679 Speaker 2: outside the cracks of a public behavioral health system, and 164 00:09:28,160 --> 00:09:30,520 Speaker 2: it's really what to do with that group and how 165 00:09:30,559 --> 00:09:32,320 Speaker 2: do you pay for it and how do you build it. 166 00:09:32,360 --> 00:09:34,920 Speaker 2: So in California they had Proposition one, like a six 167 00:09:34,960 --> 00:09:40,840 Speaker 2: point four billion dollar bond for outpatient and inpatient facility development, 168 00:09:41,000 --> 00:09:43,920 Speaker 2: and the hope is that we can boost up an 169 00:09:43,960 --> 00:09:48,199 Speaker 2: area of care that's been severely underinvested in for decades. 170 00:09:49,120 --> 00:09:55,000 Speaker 1: Something that has always amazed me. We often separate mental 171 00:09:55,040 --> 00:09:59,720 Speaker 1: health from physical health, but the reality is they're deeply connected. 172 00:10:00,080 --> 00:10:03,680 Speaker 1: If your mental health isn't right, your physical health often 173 00:10:03,800 --> 00:10:08,480 Speaker 1: suffers as well because one affects the other. Right, too 174 00:10:08,520 --> 00:10:12,240 Speaker 1: often we measure health by physical signs, heart rate, blood pressure, 175 00:10:12,320 --> 00:10:16,319 Speaker 1: lab results that doesn't always reflect what's happening in someone's mind. 176 00:10:16,679 --> 00:10:19,800 Speaker 1: How do we help people understand that mental and physical 177 00:10:19,840 --> 00:10:21,880 Speaker 1: health are inseparable right? 178 00:10:22,040 --> 00:10:24,080 Speaker 2: And I think that gets to a very important point, 179 00:10:24,200 --> 00:10:26,760 Speaker 2: an issue that I see in the hospital system all 180 00:10:26,800 --> 00:10:29,040 Speaker 2: the time. Just because a person can walk doesn't mean 181 00:10:29,120 --> 00:10:31,400 Speaker 2: they can care for themselves, and so what does it 182 00:10:31,480 --> 00:10:34,000 Speaker 2: mean to care for yourself? And I think there's a 183 00:10:34,160 --> 00:10:39,480 Speaker 2: huge area that occupational therapy can play in healthcare settings 184 00:10:39,520 --> 00:10:42,440 Speaker 2: where we're looking at not just physical health, but someone's 185 00:10:42,559 --> 00:10:45,280 Speaker 2: ability to function. And we're looking at more than just 186 00:10:45,360 --> 00:10:47,680 Speaker 2: walking and whether or not they can use the bathroom 187 00:10:47,679 --> 00:10:50,320 Speaker 2: on their own, but whether they can take their own medications. 188 00:10:50,520 --> 00:10:54,480 Speaker 2: That's an area where we call it instrumental activities of 189 00:10:54,559 --> 00:10:58,400 Speaker 2: daily living, where you're looking at someone's independence with medications, 190 00:10:58,480 --> 00:11:02,000 Speaker 2: you're looking at someone's ability to grocery shop, to clean 191 00:11:02,000 --> 00:11:04,000 Speaker 2: their house, to take care of you know, what does 192 00:11:04,000 --> 00:11:06,400 Speaker 2: it really mean to be independent? And we don't do 193 00:11:06,480 --> 00:11:09,640 Speaker 2: that hardly at all. And I think if we took 194 00:11:09,679 --> 00:11:12,080 Speaker 2: more time to look at whether we're setting a person 195 00:11:12,160 --> 00:11:14,600 Speaker 2: up to succeed or not. By looking at assessing these 196 00:11:14,640 --> 00:11:18,000 Speaker 2: instrumental activities of daily living, I think we'd have less 197 00:11:18,120 --> 00:11:20,640 Speaker 2: people who return to the hospital. But you're right, we 198 00:11:20,679 --> 00:11:23,120 Speaker 2: have to We not only have to integrate the person's 199 00:11:23,120 --> 00:11:25,400 Speaker 2: physical health with their mental health, but we need a 200 00:11:25,400 --> 00:11:27,400 Speaker 2: holistic understanding of who they are. 201 00:11:27,679 --> 00:11:30,520 Speaker 1: We spend a lot of time talking about treatment, but 202 00:11:30,640 --> 00:11:34,640 Speaker 1: prevention is just as important. How can our healthcare system 203 00:11:35,120 --> 00:11:40,640 Speaker 1: start focusing more on identifying mental health challenges earlier and 204 00:11:40,679 --> 00:11:45,080 Speaker 1: supporting people for things reach a crisis stage? Right? 205 00:11:45,720 --> 00:11:49,840 Speaker 2: And I think getting more at root causes where instead 206 00:11:49,880 --> 00:11:53,240 Speaker 2: of looking first for what medication can I prescribe? What 207 00:11:53,360 --> 00:11:55,640 Speaker 2: assessment do I need to do to find out more 208 00:11:55,679 --> 00:11:58,760 Speaker 2: about the person? Because if I'm prescribing a medication, I'm 209 00:11:58,920 --> 00:12:01,480 Speaker 2: presuming that they can take it and that they'll take 210 00:12:01,520 --> 00:12:04,520 Speaker 2: it reliably. But if they don't have the cognitive functioning 211 00:12:04,679 --> 00:12:07,400 Speaker 2: to do that, I'm just adding one more minute. I'm 212 00:12:07,400 --> 00:12:10,560 Speaker 2: doing what's easiest, and I'm contributing to a mess, you know, 213 00:12:10,640 --> 00:12:13,720 Speaker 2: to disorganization, which can have consequences. 214 00:12:14,000 --> 00:12:17,400 Speaker 1: I've spoken with people on the autism spectrum and others 215 00:12:17,520 --> 00:12:21,120 Speaker 1: living with conditions like schizophrenia, and one thing I keep 216 00:12:21,160 --> 00:12:23,960 Speaker 1: hearing is that it can take ten years or more 217 00:12:24,320 --> 00:12:29,439 Speaker 1: to finally get the right support, treatment or medication. That's 218 00:12:29,480 --> 00:12:34,080 Speaker 1: a huge portion out of someone's life. That's a long 219 00:12:34,280 --> 00:12:38,000 Speaker 1: time to struggle through all the things that they go through. 220 00:12:38,520 --> 00:12:42,800 Speaker 1: Some go through homelessness, some go through drug addiction, some 221 00:12:42,920 --> 00:12:46,640 Speaker 1: go through every imaginable thing that we could think of. 222 00:12:47,480 --> 00:12:50,800 Speaker 1: So how do we get out of that ten year 223 00:12:51,040 --> 00:12:56,040 Speaker 1: journey so people aren't losing so many years just trying 224 00:12:56,360 --> 00:12:59,720 Speaker 1: to get the help that they desperately need in order 225 00:12:59,760 --> 00:13:01,040 Speaker 1: to of their life right. 226 00:13:01,760 --> 00:13:04,760 Speaker 2: I think we need to look beyond some of the 227 00:13:04,880 --> 00:13:08,240 Speaker 2: like superficial reasons. I see a lot of times people 228 00:13:08,360 --> 00:13:11,400 Speaker 2: leave the hospital setting and people say, well, people have 229 00:13:11,440 --> 00:13:13,480 Speaker 2: the right to make bad decisions and it doesn't go 230 00:13:13,559 --> 00:13:16,360 Speaker 2: deeper than that, or people get labeled as malingerers and 231 00:13:16,400 --> 00:13:19,440 Speaker 2: someone who's trying to manipulate the system but you have 232 00:13:19,480 --> 00:13:22,440 Speaker 2: to look deeper and say, well, why might the person 233 00:13:22,480 --> 00:13:25,240 Speaker 2: be making that decision, what's it due to? I think 234 00:13:25,240 --> 00:13:29,040 Speaker 2: the curiosity can help reduce that ten year gap because 235 00:13:29,040 --> 00:13:32,280 Speaker 2: there is a significant period before someone's diagnosed with dementia. 236 00:13:32,320 --> 00:13:35,959 Speaker 2: For instance, we have delays related to getting people involved 237 00:13:36,000 --> 00:13:38,920 Speaker 2: in the regional center. You talk about autism and if 238 00:13:38,960 --> 00:13:41,600 Speaker 2: they fell through the cracks before, you know, before they 239 00:13:41,600 --> 00:13:44,720 Speaker 2: were eighteen, and then finally get someone who who cares 240 00:13:44,760 --> 00:13:46,960 Speaker 2: and tries to get them involved in the system, but 241 00:13:47,000 --> 00:13:49,920 Speaker 2: they don't have paperwork before they were eighteen tried convincing 242 00:13:49,920 --> 00:13:52,600 Speaker 2: the regional center to get them an assessment, especially if 243 00:13:52,600 --> 00:13:56,280 Speaker 2: the person needs the help but doesn't understand that, you know, 244 00:13:56,400 --> 00:13:58,680 Speaker 2: understand the need for it, and doesn't agree to it. 245 00:13:58,840 --> 00:14:01,679 Speaker 2: I think it's really challenging, and I think some of 246 00:14:01,720 --> 00:14:04,760 Speaker 2: the system barriers and rules that are in place can 247 00:14:04,800 --> 00:14:05,559 Speaker 2: be an impediment. 248 00:14:06,080 --> 00:14:10,680 Speaker 1: Technology is evolving at an incredible pace. Do you think 249 00:14:10,760 --> 00:14:14,720 Speaker 1: these new tools, whether it's AI, better data, or new 250 00:14:14,800 --> 00:14:18,600 Speaker 1: medical research, could help shorten the long journey many people 251 00:14:18,679 --> 00:14:22,640 Speaker 1: face before the right diagnosis and treatment. Do you see 252 00:14:22,640 --> 00:14:25,960 Speaker 1: it becoming easier to help the people so they can 253 00:14:26,000 --> 00:14:28,120 Speaker 1: get back to living a better life. 254 00:14:28,320 --> 00:14:31,240 Speaker 2: Yeah, I think technology can be a very important tool 255 00:14:31,480 --> 00:14:36,280 Speaker 2: for access. I think the access points have been really constrained. 256 00:14:36,480 --> 00:14:40,000 Speaker 2: And the more that we can bring evaluation, bring assessment 257 00:14:40,120 --> 00:14:42,760 Speaker 2: to people who need it rather than requiring them to 258 00:14:42,760 --> 00:14:45,200 Speaker 2: come to a clinic or requiring them to come to 259 00:14:45,240 --> 00:14:48,280 Speaker 2: a building. The more that we can bring trained professionals 260 00:14:48,360 --> 00:14:50,840 Speaker 2: to where that person is at, I think, the quicker 261 00:14:50,840 --> 00:14:52,760 Speaker 2: we can get at treatment evaluation. 262 00:14:53,040 --> 00:14:56,440 Speaker 1: We often talk about government and healthcare systems. What role 263 00:14:56,520 --> 00:15:01,320 Speaker 1: does community organizations in grassroots efforts in helping people find 264 00:15:01,400 --> 00:15:02,360 Speaker 1: mental health support. 265 00:15:02,680 --> 00:15:06,160 Speaker 2: I think they're the ones who try to help the most. 266 00:15:06,640 --> 00:15:09,800 Speaker 2: I think traditional healthcare settings have a tendency to be 267 00:15:09,840 --> 00:15:13,680 Speaker 2: fairly monolithic. The more that we can partner with agencies, 268 00:15:13,800 --> 00:15:19,280 Speaker 2: with housing agencies, with shelters, with day programs, and embed telemedicine, 269 00:15:19,320 --> 00:15:22,760 Speaker 2: telepsychiatry and break down some of the barriers that separate 270 00:15:22,960 --> 00:15:26,400 Speaker 2: healthcare settings from housing settings, for instance, the. 271 00:15:26,360 --> 00:15:30,520 Speaker 1: Better perfect timing. Anne Marie has just joined us. Welcome 272 00:15:30,520 --> 00:15:32,880 Speaker 1: to the show. Thanks for joining us today. 273 00:15:33,240 --> 00:15:35,400 Speaker 3: Thanks for inviting me. I love this topic. I think 274 00:15:35,400 --> 00:15:36,280 Speaker 3: we can make a difference. 275 00:15:36,400 --> 00:15:39,080 Speaker 1: Anne Marie, Yes, we are trying to make a difference. 276 00:15:39,400 --> 00:15:42,400 Speaker 1: Before you joined us. We were discussing the growing concerns 277 00:15:42,400 --> 00:15:46,840 Speaker 1: of healthcare with so many professionals feeling overstressed and stretched thin, 278 00:15:47,520 --> 00:15:51,480 Speaker 1: with so many doctors, nurses, and providers feeling overstressed and 279 00:15:51,560 --> 00:15:55,280 Speaker 1: emotionally exhausted. Do you believe healthcare burnout has reached a 280 00:15:55,440 --> 00:15:57,479 Speaker 1: level of systemic crisis? 281 00:15:58,040 --> 00:16:03,480 Speaker 3: Absolutely? Our first response are medical professionals. You know, we're 282 00:16:03,520 --> 00:16:06,120 Speaker 3: talking about the people who aren't getting care, but how 283 00:16:06,120 --> 00:16:08,720 Speaker 3: many times is the caregiver the one who actually gets 284 00:16:09,840 --> 00:16:12,880 Speaker 3: something horrible happening because they're not taking care of themselves? 285 00:16:13,160 --> 00:16:16,760 Speaker 3: The compassion fatigue? You know, how long can first responders 286 00:16:16,800 --> 00:16:19,920 Speaker 3: respond to the same person over and over again and 287 00:16:19,960 --> 00:16:20,920 Speaker 3: then they pass away? 288 00:16:21,640 --> 00:16:22,520 Speaker 4: And it's heartbreaking. 289 00:16:22,560 --> 00:16:24,360 Speaker 3: A lot of the first responders I know that did that, 290 00:16:24,400 --> 00:16:26,760 Speaker 3: They do go to the funerals to show that this 291 00:16:27,000 --> 00:16:29,400 Speaker 3: was a person that they cared about and tried to help. 292 00:16:30,000 --> 00:16:33,320 Speaker 1: I'd like to build on doctor Meyer's thoughts. I'd love 293 00:16:33,360 --> 00:16:36,720 Speaker 1: to hear your thoughts on how you think this approach 294 00:16:36,720 --> 00:16:40,080 Speaker 1: should be sure. One topic I'd like to address is 295 00:16:40,120 --> 00:16:43,240 Speaker 1: the way we're thinking about crisis response and mental health 296 00:16:43,280 --> 00:16:47,400 Speaker 1: care based on what you have seen, what models or 297 00:16:47,440 --> 00:16:50,720 Speaker 1: approaches appear to be most effective in helping people during 298 00:16:50,720 --> 00:16:51,960 Speaker 1: these critical moments. 299 00:16:52,120 --> 00:16:54,800 Speaker 3: Are we talking in whether or not it's a peace 300 00:16:54,840 --> 00:16:59,360 Speaker 3: officer who's responding, or someone who's trained in psychological. 301 00:16:58,680 --> 00:17:01,640 Speaker 1: Treatment, anyone in the field that is properly trained. 302 00:17:01,880 --> 00:17:05,719 Speaker 3: Okay, I think that there are wonderful psychologists and there 303 00:17:05,760 --> 00:17:09,119 Speaker 3: are less wonderful psychologists, and there are wonderful peace officers, 304 00:17:09,240 --> 00:17:11,920 Speaker 3: and there are less trained peace officers. So I think 305 00:17:11,960 --> 00:17:14,760 Speaker 3: it's also about the person and not just the job 306 00:17:14,800 --> 00:17:17,679 Speaker 3: they're doing. Obviously, we want to move away from peace 307 00:17:17,680 --> 00:17:22,359 Speaker 3: officers being the primary fifty one fifty enforcer. However, I 308 00:17:22,440 --> 00:17:24,359 Speaker 3: want to make sure that people understand the role that 309 00:17:24,440 --> 00:17:29,920 Speaker 3: peace officers play. Because a psychologist who's meeting someone who's unstable, schizophrenic, 310 00:17:30,000 --> 00:17:31,440 Speaker 3: potentially prone to violence. 311 00:17:31,480 --> 00:17:33,320 Speaker 4: All of them are not prone to violence, but some 312 00:17:33,400 --> 00:17:34,000 Speaker 4: of them might be. 313 00:17:34,200 --> 00:17:36,280 Speaker 3: We want to make sure that everyone's protected, and so 314 00:17:36,640 --> 00:17:40,320 Speaker 3: by training our peace officers specialty units that can go 315 00:17:40,520 --> 00:17:44,240 Speaker 3: with trained psychologists and clinicians to meet them, that's going 316 00:17:44,320 --> 00:17:45,959 Speaker 3: to be our sefest bet and if we do it 317 00:17:46,080 --> 00:17:50,120 Speaker 3: proactively rather than reactionary, we're going to have a lot 318 00:17:50,119 --> 00:17:50,880 Speaker 3: better results. 319 00:17:51,359 --> 00:17:54,480 Speaker 1: Before we move forward, let's take a moment for our listeners, 320 00:17:54,680 --> 00:17:57,520 Speaker 1: Could you share a little about your background on your 321 00:17:57,680 --> 00:17:59,639 Speaker 1: role and the work you're involved in. 322 00:18:00,040 --> 00:18:00,520 Speaker 4: Oh? Sure. 323 00:18:01,040 --> 00:18:03,880 Speaker 3: So I started working with Aaron about four or five 324 00:18:04,000 --> 00:18:06,280 Speaker 3: years ago at the City of San Diego, where I 325 00:18:06,400 --> 00:18:08,280 Speaker 3: was a senior deputy city attorney. 326 00:18:08,520 --> 00:18:11,200 Speaker 4: I was a prosecutor for almost twenty years. 327 00:18:11,400 --> 00:18:14,960 Speaker 3: Then I worked on gun violence response or restraining orders, 328 00:18:15,119 --> 00:18:18,080 Speaker 3: especially for people who had mental illness issues and shouldn't 329 00:18:18,119 --> 00:18:20,600 Speaker 3: have a fire or within And then finally I got 330 00:18:20,640 --> 00:18:25,960 Speaker 3: moved to representing first responders who needed help navigating the 331 00:18:26,000 --> 00:18:28,159 Speaker 3: mental health system, and so in that way I was 332 00:18:28,160 --> 00:18:31,440 Speaker 3: able to help them through probate system, through the LPs, 333 00:18:31,480 --> 00:18:35,800 Speaker 3: secured conservatorship system, and other different avenues of care. Unfortunately, 334 00:18:35,880 --> 00:18:39,920 Speaker 3: you know, programs change, resources change, and so my role 335 00:18:40,119 --> 00:18:42,400 Speaker 3: was cut and so I was moved to a different department, 336 00:18:42,400 --> 00:18:44,600 Speaker 3: and so I decided to keep my work with mental 337 00:18:44,600 --> 00:18:47,399 Speaker 3: health going. I retired and now I serve as a 338 00:18:47,600 --> 00:18:52,200 Speaker 3: mental health policy advisor for municipalities, legislators. 339 00:18:51,600 --> 00:18:52,160 Speaker 4: Or lawyers. 340 00:18:52,200 --> 00:18:54,960 Speaker 3: But doctor Meyer still collaborates with me, thank goodness, because 341 00:18:54,960 --> 00:18:56,480 Speaker 3: we've been a team for a long time, know and 342 00:18:56,520 --> 00:18:58,960 Speaker 3: I think we compliment each other. So I'm pleased to 343 00:18:59,000 --> 00:19:00,520 Speaker 3: get to still write and work work with him. 344 00:19:00,720 --> 00:19:04,120 Speaker 1: Since you approached this from the legal side, what changes 345 00:19:04,160 --> 00:19:06,560 Speaker 1: do you believe need to happen. How do we help 346 00:19:06,600 --> 00:19:09,920 Speaker 1: policy makers and leaders at the state and local level 347 00:19:09,960 --> 00:19:15,080 Speaker 1: better understand that collaboration is essential not only for those 348 00:19:15,160 --> 00:19:18,960 Speaker 1: with serious mental illness that need the help right now, 349 00:19:19,560 --> 00:19:23,800 Speaker 1: they need to understand that by everyone working together, it 350 00:19:23,880 --> 00:19:28,560 Speaker 1: can help prevent these challenges from becoming even larger in 351 00:19:28,600 --> 00:19:29,120 Speaker 1: the future. 352 00:19:29,680 --> 00:19:31,160 Speaker 4: Well, I think it's already a huge issue. 353 00:19:31,160 --> 00:19:33,359 Speaker 3: But I like what you're saying, and I think programs 354 00:19:33,400 --> 00:19:36,679 Speaker 3: like yours are so critical. I think that grassroots effort 355 00:19:36,760 --> 00:19:39,080 Speaker 3: to start from the bottom up to say hey, we 356 00:19:39,200 --> 00:19:41,119 Speaker 3: don't like the way it is. When it comes to 357 00:19:41,119 --> 00:19:43,040 Speaker 3: what I think is going to get people's attention. I 358 00:19:43,080 --> 00:19:46,320 Speaker 3: think we really really have to force ourselves to look 359 00:19:46,400 --> 00:19:49,080 Speaker 3: at the number of people who are incarcerated who have 360 00:19:49,200 --> 00:19:51,600 Speaker 3: severe mental illness, and that if we could have gotten 361 00:19:51,600 --> 00:19:54,320 Speaker 3: them in voluntary care. And I am saying that in 362 00:19:54,640 --> 00:19:58,400 Speaker 3: voluntary care to care for their unstable schizophrenia or other 363 00:19:58,600 --> 00:20:01,199 Speaker 3: mental health disorder head of time, maybe they wouldn't have 364 00:20:01,320 --> 00:20:04,320 Speaker 3: committed that felony, or they wouldn't have been the victim 365 00:20:04,440 --> 00:20:06,720 Speaker 3: of that crime. And so I think we think of 366 00:20:07,480 --> 00:20:10,320 Speaker 3: vulnerable people. They might be the victim, they might be 367 00:20:10,359 --> 00:20:12,320 Speaker 3: the perpetrator, but all of it is because of a 368 00:20:12,320 --> 00:20:15,160 Speaker 3: failed system. And so if people can focus, we could 369 00:20:15,320 --> 00:20:18,679 Speaker 3: take some money, save money on the law enforcement end, 370 00:20:18,720 --> 00:20:21,080 Speaker 3: and reinvest it and I think would be better all around. 371 00:20:21,119 --> 00:20:23,040 Speaker 4: So hopefully we can get their attention in that way. 372 00:20:23,720 --> 00:20:26,720 Speaker 1: I'm glad you brought that up. I asked doctor Meyer 373 00:20:26,760 --> 00:20:30,240 Speaker 1: earlier about assisted outpatient treatment laws and how they vary 374 00:20:30,280 --> 00:20:35,880 Speaker 1: across states. We see some states implementing AOT, some doing 375 00:20:36,000 --> 00:20:40,520 Speaker 1: very little, and others struggling and having difficulty on how 376 00:20:40,560 --> 00:20:44,760 Speaker 1: to apply it effectively. How do we help legislators understand 377 00:20:44,840 --> 00:20:48,879 Speaker 1: that early intervention is critical, that waiting until someone is 378 00:20:48,920 --> 00:20:53,080 Speaker 1: a danger to themselves or others may miss the opportunity 379 00:20:53,320 --> 00:20:57,159 Speaker 1: to help them before a crisis escalates. How do we 380 00:20:57,200 --> 00:21:01,000 Speaker 1: get them to understand that this is not only helping 381 00:21:01,280 --> 00:21:04,479 Speaker 1: the person that needs the help now, but is also 382 00:21:04,680 --> 00:21:09,040 Speaker 1: helping prevent this situation to become a community crisis. 383 00:21:09,320 --> 00:21:11,560 Speaker 3: Well, I think that that's a great point to bring 384 00:21:11,640 --> 00:21:14,280 Speaker 3: up because a lot of people talk about AOT versus 385 00:21:14,320 --> 00:21:17,000 Speaker 3: care court right, because in California we have both, and 386 00:21:17,040 --> 00:21:19,720 Speaker 3: the problem with both AOT and Care Court is that 387 00:21:19,800 --> 00:21:24,359 Speaker 3: they have very very narrow criteria for who is eligible, 388 00:21:24,480 --> 00:21:27,199 Speaker 3: and so sometimes you have someone that has layer needs 389 00:21:27,280 --> 00:21:29,960 Speaker 3: but they're not eligible for either because of that narrow 390 00:21:30,000 --> 00:21:31,680 Speaker 3: criteria or if they get in. 391 00:21:31,880 --> 00:21:34,200 Speaker 4: These are both voluntary programs, So. 392 00:21:34,160 --> 00:21:36,360 Speaker 3: Don't make any mistake about it just because it says 393 00:21:36,400 --> 00:21:39,359 Speaker 3: assisted outpatient treatment with the Court, it is voluntary and 394 00:21:39,400 --> 00:21:42,320 Speaker 3: you cannot force someone to get medication through that. The 395 00:21:42,359 --> 00:21:45,520 Speaker 3: only way in California to force medication is under the 396 00:21:45,600 --> 00:21:50,040 Speaker 3: Lanternman Petris Short Act in the Welfare Institution's Code, which 397 00:21:50,200 --> 00:21:53,880 Speaker 3: is a different section for force medication and force treatment. 398 00:21:54,359 --> 00:21:55,280 Speaker 4: So I think when it. 399 00:21:55,240 --> 00:21:59,920 Speaker 3: Comes to AOT, honestly that should be the model voluntary care. 400 00:22:00,200 --> 00:22:02,800 Speaker 3: That's what we want, but we also have to have 401 00:22:02,840 --> 00:22:05,119 Speaker 3: compassion for those who are going to wind up in 402 00:22:05,200 --> 00:22:07,480 Speaker 3: jail or dead if we don't get them help. 403 00:22:07,680 --> 00:22:10,400 Speaker 1: That's a huge statement. I have to say. This has 404 00:22:10,440 --> 00:22:13,800 Speaker 1: been a really great session. Thank you so much for 405 00:22:13,880 --> 00:22:16,960 Speaker 1: being here today, and thank you for agreeing to keep 406 00:22:16,960 --> 00:22:20,520 Speaker 1: the conversation going. For those of you listening today, we 407 00:22:20,560 --> 00:22:24,600 Speaker 1: are actually recording more. Part two is coming next week. 408 00:22:24,720 --> 00:22:28,639 Speaker 1: There are many interesting subjects that we will be talking about. 409 00:22:28,960 --> 00:22:31,679 Speaker 1: So thank you for joining us. A sincere thank you 410 00:22:31,720 --> 00:22:34,919 Speaker 1: to our guests for sharing their journey. If today's conversation 411 00:22:35,080 --> 00:22:37,760 Speaker 1: helped you see the world a little differently, then we're 412 00:22:37,760 --> 00:22:41,280 Speaker 1: doing exactly what we hope to do. Until next time, 413 00:22:41,640 --> 00:22:47,040 Speaker 1: keep believing, keep learning, and most importantly, keep asking yourself, 414 00:22:47,800 --> 00:22:48,439 Speaker 1: why not me?