← Leading Organizations That Matter
Leading Organizations That Matter
42. An Interview with Dr. Andrew Gerber: Behavioral Health Care - The State of the State
00:45:15
Loading summary
Transcript28 lines
- [00:00]
Ray Spadoni
Foreign.
- [00:07]
Andrew Gerber
Welcome to Leading Organizations that Matter, a podcast about leadership, organizational culture, and how we find meaning and purpose in our work. I'm your host, Ray Spadoni, former healthcare CEO, current consultant, author, and speaker. Today's topic is an interview with Dr. Andrew Gerber, Behavioral Health Care the State of the State. I'm delighted today to speak to Dr. Andrew Gerber, the President and Medical Director of Silver Hill Hospital in New Canaan, Connecticut. Dr. Gerber is an accomplished and very highly regarded leader in the field of behavioral healthcare, leading a hospital that offers inpatient, residential, and outpatient levels of care, along with various programs around nursing research and education. He completed his medical education at Harvard Medical School and residency at New York Presbyterian Hospital, Weill Cornell Medical center and New York Presbyterian Hospital Child and Adolescent Psychiatry Residency Training Program of Columbia and Cornell Universities. He completed a postdoctoral research fellowship at the Department of Child and Adolescent Psychiatry at the Columbia University New York State Psychiatric Institute. He maintains academic affiliations with the Yale School of Medicine, Columbia University Medical center, and the University of Massachusetts. Let's jump right into it.
- [01:54]
Unknown
Dr. Gerber, welcome to the podcast and thank you so much for being here.
- [01:58]
Ray Spadoni
Thanks for having me here, Ray.
- [02:00]
Unknown
It's great. Thank you. Our topic today is a big one and one that we can surely address from the leadership point of view, which is what this podcast is about. But I think that'll be difficult without setting the stage first and discussing what is probably a much broader issue, which is a more of a societal, cultural, maybe sociological one, and that relates to the fact that we hear that there is a mental health crisis taking place in our society right now. And in fact, we probably hear that so much that we might even become numb to the fact. So I guess a two part question. The first is, is that true? And secondly, if so, how did we get here?
- [02:47]
Ray Spadoni
Well, I think it's a great place to start, Ray, and I really appreciate you using that as our jumping off point. I have mixed feelings when I hear people say there's a mental health crisis. On the one hand, I welcome the attention that people are increasingly giving to the fact that mental health is important and that there are things we can be doing as a society and as people to improve the mental health of ourselves and each other. So when I, when, when the crisis is used in the name of decreasing stigma and bringing attention to a crucial area, I'm very happy. Where I'm less happy about the use of the word crisis is when it sounds like it's brand new and that this therefore is something that we need to Find a recent or proximal cause, meaning it's all about COVID or it's all about social media. Again, not to suggest those aren't two important contributors to mental health difficulties, but the notion that this mental health crisis is somehow something brand new that just happened in the last few years to me is misleading. And the other reason that I'm, I get sometimes concerned is because we have a habit in our culture. And I don't want this to be one more example of it, to have a Crisis du jour, that is, it's the crisis for now in 2024 and in 2025 we'll have something different. In 2026, we'll have something different. And then mental health crisis will be passe. And I think that would be very counterproductive. So it's not quite a yes or no to whether we have a crisis. Do we have mental health problems? Absolutely. They are long standing and they will be with us forever. Are there things that have made them worse in recent years? Yes, and I think we need to do something about them. If you'll remind me, I think that was the first part. And remind me the second part of your question.
- [04:44]
Unknown
It's, you know, it's a, you know, recognizing that we do want to avoid crisis du jour, as you mentioned. But, you know, there's at least there's more in the media. I think there's a higher level of awareness. And so if things have become more acute, more intense in this regard, why.
- [05:03]
Ray Spadoni
Right, so. So, yes, and I agree with you that it is certainly more in the media. I think there's a combination of factors and sometimes in medicine we use this phrase acute on chronic, meaning you've got chronic difficulties that have probably been growing in the mental health arena for several decades. There's data that goes back at least into the 1950s about various changes within our society and particularly our culture around how we raise children and young people, that I think there is good data to support the idea that this has contributed to a steady rise in distress and stress on young people in particular. And then we see an acceleration of that in over the last, let's say 20 years that has had multiple factors, some of them society based and some of them more recent, such as, for example, the rise of the use of cell phones, which I think we all agree have had certain toxic impact and will continue to do so unless we work on it as well as Covid, which certainly for reasons that I think people have discussed a great deal, led to increased loneliness and isolation. But Given that those last two factors have been very well discussed, I do want to go back a little bit to what I see as a broader set of reasons that, that go back several decades and are particular to young people. I think the role of parenting and the way we treat young people in our society has changed over the course of these last 50 to 70 years. We are increasingly treating children a, as fragile and needing to be protected from all of the challenges of the world. And in the name of being good parents and caring parents and loving parents, we have inadvertently created, I think now, generations of young people who have had less experience with things like wide open time and the ability to then fill that time with their own activities as opposed to being scheduled. We have made it harder for them to find their way and take on challenges on their own in the name of protecting them. And so we have more and more late adolescents or young people in their early twenties who just don't have the skills really to go out and manage independently. And if you combine that with a wider sense among young people that it is harder to exceed what their parents accomplished and harder to get into college, harder to find well paying jobs, that the world itself is less hospitable to them, you see a direct, I believe, consequence in increasing rates of depression and anxiety and ultimately suicidality among young people. These then have lifelong consequences because one thing we do know is that upwards of 80% of lifelong mental health struggles begin in childhood and adolescence. So if we're, if we're disadvantaging kids right from the beginning and robbing them of some of these experiences, we're, we're setting them up unfortunately for increased mental health problems for their entire lives.
- [08:44]
Unknown
Fascinating and, and distressing. It's, you know, I'm of the generation of parents for which it is said we are helicopter parents. And I think that probably wasn't an expression in prior generations. I think we invented and perfected the concept. And if there's an upside emerging here, as I think the next generation of parents has a higher level of awareness of this and there may be a movement to kind of go back to more open time and other sorts of things that might help this, but for the time being we do have problems. I spent a lot of time as a consultant working with acute care hospitals and there's a phenomenon of overflowing emergency departments. Sadly, there are oftentimes young people who are borders, who are in effect living there, sometimes lying in beds in hallways and gurneys for days awaiting placement to services. And you know, that's far from ideal for those patients and their families. And it's a real challenge for the hospitals as well. You know, going back to is there a crisis? Is there not a crisis? You know, I just wonder if there's objective data that you've looked at that you've seen that is may lead someone to conclude that, yeah, this is a growing issue certainly when it comes to lack of placement, lack of services. And so now folks are sitting in emergency rooms waiting to receive care in a more appropriate setting. Any thoughts about that?
- [10:29]
Ray Spadoni
Absolutely. I think what you're pointing out very importantly is there are two sides to this crisis. One is what you might call the demand side, which we've been talking about already, which is the growing need and the growing levels of distress, particularly among young people, but of people of all ages, that has created more demand. And there is very a solid data to suggest that when you survey people of all ages and you ask them about their levels of distress and ultimately get to diagnoses and levels of psychopathology, that those have been rising steadily for years. But the other side which you're now bringing us to is the supply, meaning how are we doing in terms of provision of mental health services? One could argue that even if they had stayed the same over the years, that would be inadequate. But actually the provision of mental health services at the higher levels, meaning what I would consider to be moderate to severe illness, those services have decreased. So while we're having increasing demand, we have decreasing supply. And there are a number of factors that are causative of that. Let's go back again to the 1950s. In 1955, there were upwards of half a million psychiatric beds in the United States. And these were beds that were in all sorts of different institutions, but certainly including larger scale facilities which somewhat justifiably got the reputation for being often not great environments for the treatment of mental illness. And then you had a period of time starting in the 1960s, but really carrying all the way through the 1990s, where there was a drastic decrease in the number of psychiatric beds in this country to the point that now we have, at least at the state level, something like a tenth of the number of beds that we had in this country in the 1950s, closer to 50,000 than 500,000. And that was principally driven by decreased state spending on high acuity mental health. The wish, and really the, the, the, the, the PR for what was called deinstitutionalization was we have better treatment now. We don't need those beds because we have new Medications, and we have a move to community mental health and the community mental health Act. The 1960s was really a very exciting and optimistic time. However, there were two big problems to that. One is that the new treatments, the medication, and the outpatient services were not as effective as everybody hoped they would be. They were somewhat effective. We're glad to have those. But particularly in the case of more severe illness, meaning people with chronic, severe psychiatric illness, including psychotic disorders, including very severe depression or bipolar disorder, including very severe trauma disorders, all of those disorders were not fully treated by the newer medications and the community systems. And the second was that while money was withdrawn from these state facilities, an equal amount of money was not put in to the community mental health systems that were set up. The states generally got out of the business and expected the federal government to step in. The federal government did not fund the community mental health act at the levels that were originally projected. And then in some ways, the coup de grace to this whole problem was the rise of managed care. After the failure of the Clinton health plan in the early 90s, when we saw managed care really say, hey, we are going to stem these increasing healthcare costs in this country by building a system that really takes the control out of the hands of the providers, and for all sorts of very understandable reasons, says we're going to have to make these decisions at a higher level. The problem, though, with that, particularly when it comes to mental health, is that the stigma and the uncertainty around proper mental health treatment has meant that while there's been a lot of open discussion around how much we should be paying for cancer treatments and for orthopedic treatments and for cardiac difficulties, the transparency and the conversation around adequate treatment of mental health has been much more limited. And that has led to what I would call a crisis in parity, meaning that virtually all of the payers, government as well as private commercial payers, have obstacles in place for getting adequate reimbursement of mental health services that just do not exist in the same way for physical health. And. And so when we then ask the question, why are those young people lying in gurneys for days, if not weeks on end in emergency rooms because there are no psychiatric beds in this country, we have to ask, well, why are there not enough psychiatric beds? And to me, there's a very simple answer to that, that the reimbursement from the payers is inadequate. There is no health system in this country that is incentivized to open more beds, psychiatric beds, because they lose money. And like it or not, we live in A capitalist society where these hospital systems are businesses and if they lose money on every psychiatric bed, their job is to keep the number of those beds down to a minimum. And that's the crisis we have now.
- [16:38]
Unknown
I was working within the payer side, the managed care industry, back when the car vote happened and there was a split between payment for behavioral health services and all other medical benefits. And so some look back at that splitting, that bifurcation as the beginning of what you're describing. And I like that term, a crisis in parity. But I wonder if the splitting of that, because we're complicated IT machines and it's hard to split us into different components ourselves, everything's connected. But did that create more levers for payers to begin the process of what you're describing?
- [17:25]
Ray Spadoni
I think that's right. And you certainly have more expertise in that than I do. But that is my sense that that's where the problem really started to get worse. I don't think it's unfixable though. I mean, you know, obviously there is some temptation to say we have to change the entire system, but barring that, I do think that transparency goes a long way to fixing this. And one of the things that I've become very interested in in the last couple of years is how hard it is to, to get good data on what I think should be very transparent things. Meaning how much do various payers reimburse mental health expenses? How does that differ by different providers, by different region, by different payers? In a free market, we need to know the pricing data. We also need to know the cost data. How much does it cost an individual hospital to provide a given set of services? I'm not an economist, but my impression is that in any industry, if you obscured all of the price data and you obscured all the cost data, it would be very hard for the free market to function. Well, a famous economist I heard once said that the problem with our healthcare system is it's both the worst of the free market and it's the worst of the government controlled market. At the same time, if we were just one or the other, it would be better off. To us, it's a bad combination.
- [19:10]
Unknown
Right.
- [19:11]
Ray Spadoni
Wow.
- [19:13]
Unknown
Well, you know, I'm, I'm, I may circle back, you know, to the point particularly around transparency. And I think that's, that's where a lot of solutions begin. You know, it seems. But you know, we just, we talked a bit about the sort of the more acute and the severe side and the issue in emergency rooms. But I also Spent a lot of time working with primary care practices and you know, physicians in general, certainly primary care doctors, no question, but physicians in general are facing a lot of challenges today. There's a lot of burnout. There are, there's a growing and I think sort of alarming amount of concern that's been rising up around shortages in certain specialties. And certainly among primary care doctors, they're under a lot of strain. Some of that's payer caused and so forth. But I hear a lot about primary care practices. Physicians want to get their patients the services that they need and sometimes that kind of leans into some of the issues we're talking about, talking about and wanting to get placement, wanting to get services. And there's been a call for the primary care doctors to treat more of this themselves. And some physicians are more comfortable than that with others. I know that there are a lot of people wearing suits that are very much concerned about productivity and getting as many patients seen as possible and reducing waiting lists for primary care doctors. This isn't just an issue of emergency rooms and what happens, but this is affecting the rest of the system. Any, any, any thoughts about that part of it?
- [20:53]
Ray Spadoni
No, it's, it's an interesting question you're bringing up. And, and you know what, while I, I know I've been a little doom and gloom so far, I, I want to point out a couple things that I think are actually quite good and hopeful. I think the fact that we're talking more about what I would consider the milder side and again, not to, not to minimize, it's important anyway. But the milder side of psychiatric difficulties or mental health crises, which I would put under that, you know, that title of wellness or stress or burnout. Right. We do now speak more about that at the workplace, at primary care visits in our society and family. Anybody with young children or teenage children, as I have today, are familiar with driving the car and listening to the conversations in the back seats. My impression from that is that young people are far better at talking about that than they ever were part of. When I hear these conversations about the importance of wellness and burnout and getting that into the primary care visits, I'm glad. That to me is a positive step when the illness is mild. The good news is there are a lot of good and mostly low cost solutions. Primary care doctors prescribing relatively safe and efficacious medications like SSRIs, like Prozac. That's a good thing that that happens as often as it does recommending therapists in the community nowadays even recommending online tools. And while, you know, the traditional doctor response to hearing anything online is be careful, that's not safe, the truth is that for mild illness, these are effective, scalable, cost effective tools. So I'm not against any of that. I think where things start to get harder, though, is when the difficulty level becomes moderate to severe or the challenges. Because now those other tools aren't good enough. And I think sometimes in the public mind, they've all been conflated. And we think, oh, an online tool or an app or a low level therapist without a lot of training, maybe one or two years of training should be fine either to prevent or treat somebody with a moderate to severe psychiatric illness. But the fact is that's not what those tools were designed for. So you have to have a system that's set up to catch those difficulties when the needs aren't being met or when the needs grow. And that's where I think now primary care doctors say I have no one to refer to why. And I'll just use the example of a Boston or New York or a Connecticut or San Francisco or Chicago. Because a lot of the best trained therapists and psychiatrists no longer accept insurance. They now only take private pay. Why? Because the insurance reimbursement rates are low. So it's in their financial interest to do the care they want to give. And they also don't have the paperwork and the bureaucracy. So now there's too few people who take insurance. I'll just speak in the area that I live in, Fairfield county, which is a very mostly affluent area, you've got a lot of therapists and psychiatrists. Many, if not most of them don't accept insurance. And that's not right. That's not what our country and our system was built around. But it is, I believe, a product of the failure of adequate reimbursement rates for the treatment of moderate to severe illness.
- [24:43]
Unknown
I'll come back a little bit to what's happening in terms of the broader system. But as this is a podcast about leadership and you lead a significant inpatient behavioral health, inpatient and outpatient behavioral health facility, I wonder if you can talk to me about the business of behavioral health, the industry of behavioral health and its current state, chronic underpayment. Granted, you touched on that, but what's happening now? Key trends. Where do you see the future going for the broader industry and for institutions such as yours?
- [25:27]
Ray Spadoni
So it's a complicated picture, and I think it's every day brings news, and one can be Both optimistic and realistic. At the same time, I think, I think in general the large healthcare systems and the academic medical centers have reached what I think and hope is a nadir in terms of the amount of psychiatric or mental health services that they provide as a system. Meaning I think they've minimized it as much as they can because of the losses, the financial losses. And at worst, I don't think it will drop any further. I think it will stay where it is. There is a large public and private outcry about not enough services and that's all good. It keeps them from reducing further. I know you're a Boston guy and I vividly remember it doesn't feel that long ago to me. The Beth Israel Hospital announced it was closing its department of Psychiatry. And that seemed like the time when things could actually get worse. And I remember the outcry from the community and from the staff, including non psychiatrists, saying, you can't do that. And they reversed that decision. So I thought, good, it won't get worse. At least I do see a lot of private interests going into this question of affordable, scalable mental health care. You, I can't open my email or a website without seeing a new app or a new service that is being made available. In general, I see those as for mild or mild to moderate illness. So that's good. I think the question though is who's going to fill that space? Who's going to fill that need for the more severe treatments, that is the inpatient units, the residential programs, or what might sometimes are called intermediate levels of care, the higher acuity services, outpatient or residential, that are meeting the needs for folks for whom the classic outpatient treatment is not sufficient. I think there are two possibilities. One is that there will be private, nonprofit or for profit institutions. Our hospital is, is a non profit, but we're private and we have the ability to really hone in on that middle range, that intermediate level, those intermediate or high levels of acuity and use a combination of things like philanthropy and subsidize, subsidizing lower expense care with the fees from higher cost care. And there's a few hospitals like us in the country and I think there could be more that take that kind of cross subsidization model to building services. That's working and I think that's an improvement. We're growing as a hospital and certainly our peers, places like McLean up in Boston, Lindner out in Cincinnati, Menninger in Houston, Shepherd Pratt in Baltimore, are doing similar things to us in terms of really Focusing on mental health, staying independent. Ish. I know McLean's part of the larger harbor system, but still has some independence. The others are mostly independent systems and I think growing in a limited way. But the other thing that I am hopeful for is with increasing pressure on the government and employers for health care reimbursements that do follow parity. And just within the last month we had the Biden White House issuing a final rule about tighter controls around payment. And following the 2008 Parity Law, I think there is a decent chance that there will be increasing pressure, particularly on the commercial payers, but ultimately on government payers as well, to increase reimbursements for high acuity or intermediate acuity care. And that will then incentivize the larger systems to start building back some of their inpatient units, their residentials, their intensive outpatient. That's really what I hope to see over the coming years. But it's going to take organization, it's going to take advocacy at all levels of government. And I ultimately and believe that employers are going to have to pay, play an important role there. Because if the CEOs and CHROs of talking about leadership of large companies say part of the way I'm going to attract and retain workers is by getting them better mental health benefits, not just for them, by the way, but for their whole families. And that they value that not just from ethical grounds but, but from productivity grounds. Because employees who have good mental health care and who families have good mental health care and which of us doesn't have a family member who's got who's needed some more mental health care, it's everybody that the employers are then going to drive this and the insurance companies are really going to follow the employer's lead. That's my hope. And I guess the coming years we'll see if that happens.
- [30:48]
Unknown
You mentioned, Andrew, attracting workers more broadly and the availability of this as a benefit to help do so. But the most fundamental basic building block of the industry you're in has to do with making sure you have enough workers. And I have many clients that are struggling mightily in this way. And that includes therapists, whether psychiatrists, psychologists, social workers and so forth, just to meet the need. And that has been a pretty significant constraint. You know, you mentioned under reimbursement. So obviously there's an economic component to this. But how are things going for you in this regard? And what can we do as a culture to make sure we have enough folks to care for those who need this level of care?
- [31:37]
Ray Spadoni
No, I think I think if there, if there's one thing that I've spent the most time working on at my hospital over the last few, few years, really ever since COVID it's what you just asked about. It's how do we really create an environment for our workers where they want to come to work, where they feel fulfilled in their jobs and where they stay. Because being understaffed, having low morale or having lots of turnover are terrible for everybody. They're terrible for our business, they're terrible for our patients because our patients rely on stability and therapists who are engaged and doing well. And they're bad for our workers because they obviously would like to find a place to go to be well paid and fulfilled and stay. So it's amazing to me, but five years ago I didn't have a chro. The director of HR in my hospital reported up to somebody else at the time, the chief financial officer. And I would, I would never, couldn't even imagine that now, Now I have a, we call her chief people officer, but a chief human resources officer who reports directly to me as the CEO. I think that's crucial and I think most other, not just hospitals, but all businesses have moved in that direction. There isn't a meeting of our leadership team where we don't talk about some issue around morale and engagement among our staff. And obviously, as you mentioned, part of that is to do with compensation and fair either cost of living increases or merit based raises every year, which we have been doing over the last several years and has been an important piece looking at benefits packages because many of our employees tell us that that's a crucial reason why they either stay or don't stay at a job and then looking for growth within the organization. The days of people, you know, coming to work and saying, you know, that's I'm just staying in this job feel to me to be over. Our employees want to know what are, what am I learning, what new opportunities am I going to have, what trainings are going to be made available to me and what's, what's, what's the path within the organization. They expect their managers to be having those conversations with them in a regular fashion. And that's now what we expect our managers to do. Because part of their job to create that, that environment, that morale, that retention is to be thinking of a pathway for every one of their direct reports. And we've seen that as a culture shift over the last several years at our organization. We're hearing from our employees that that's being very Helpful. And you know, as often as possible, we try to retain people within the organization, but even if it means them getting a job elsewhere, what we've realized is that them feeling taken care of and being recognized is going to lead to greater morale from all our staff. And lo and behold, when our staff are happier, our patients do better. Because I think, as you already alluded to in the mental health field, more than any other field, the, you know, what is our, what is our tool? Our tool is the psyches of our workers, right? They are the ones who are caring for our patients. And if they're not, they don't feel cared for. If our workers don't feel cared for, our patients don't feel cared for. So, you know, I haven't solved, we haven't nobody solved this, but I can tell you that my colleagues in the field, we all talk about this every time we get together and, and it's the number one thing on our mind.
- [35:22]
Unknown
Can you speak to psychiatry and what may be happening in medical schools to attract young physicians, those in training, to want to pursue psychiatry?
- [35:38]
Ray Spadoni
The good news there is that the interest in psychiatry is at an all time high, meaning that medical students, who are often very idealistic, as I think we like them to be, find psychiatry not just fascinating from an intellectual perspective, because I would argue more so than any other field within health care, the rate of new discovery and the rate of learning about the brain and how it works is greater because there's so much still we don't know. It is by far the most complicated organ and organ system in the body. And not to say that there aren't new things to learn about every organ system, but it's still exploding in terms of what we've learned about how the brain functions. So that's very attractive to medical students. But I think they're also attracted to this notion of how much room there is to help people. I think many illnesses are seen these days as a little bit more cookie cutter, that they have these certain problems and you apply these certain solutions. Not so in psychiatry. There's so much of yourself you put into these treatments. So I, whenever I meet a new medical student who's interested in psychiatry or a new resident, I'm so impressed by how much they've done and how much they know. And I'm very hopeful for the future. I think the question they often ask is what kind of job can I have where I can continue to feel fulfilled and where we don't want them to end up? And we've heard about this in recent years is as some kind of a machine writing prescriptions every 15 minutes. That's not a good use of all that training. And frankly, it's not good care. The question then becomes, how do you make the use of psychiatrists cost efficient? If you have them doing psychotherapy that somebody with much less training and less expensive could do, it's probably not the best use of them from an efficiency perspective. So we have a phrase we use in the field a lot now called working to the top of your license. And it's meant as a positive, because what I think psychiatrists offer is a very extensive and broad training. So they can refer to or oversee or supervise therapists and pharmacologists and nurse practitioners and social workers and psychologists. They really can put this all together. Certainly at our hospital, most of our psychiatrists, we have 20 psychiatrists, full time psychiatrists on staff here are in a supervisory role, meaning they're leveraging a team, a wonderful multidisciplinary team. And of course, as we know today, that doesn't mean that they're telling people, they're barking orders and telling people what to do. In contrast, they're using their knowledge and leadership skill to bring the best out of everybody and to learn from all the other professionals on their teams and to mentor those individuals. That's the top of the license for me for psychiatry. And the great part is it's not only an efficient use of resources, it's highly fulfilling for psychiatrists. And I hear a lot of job satisfaction for my psychiatrists.
- [39:07]
Unknown
Well, that's great. That is a reason to be optimistic. If the interest in psychiatry has grown and if it's highly fulfilling and the nature of the job and what you're treating and as you said, how much of yourself you put into it, I would imagine is different than other fields that these folks could choose. And that's hopeful. Are there other systemic solutions that you'd like to see implemented more broadly within the behavioral health realm that would be beneficial?
- [39:45]
Ray Spadoni
Yeah, I mean, the other big one on my mind, and I think it's. It's such a delicate thing, is the appropriate use of technology. And, you know, I think psychiatry, probably more so than any other medical field, has had a kind of historic fear or reluctance to use technology. And I think that's. That's a bad idea to just avoid it because a, it's coming whether people like it or not. But b, and more optimistically, there are so many opportunities I see within the health, within psychiatry and within mental health to leverage technology in Positive ways, but it's got to be done in a sophisticated fashion. And if psychiatrists sit back and say, no technology for me or not my problem, you can be sure somebody else is going to come up with a solution that they won't like. What I say to my colleagues is, whether or not you like technology personally, you need to be thinking about this as part of the future. How can technology help you do your job better? And I think once you put it that way, everybody can come up with something. Whether it's to do with how we take notes, whether it's to do with how we assess our patients and track their progress over time, whether it's to do with our interventions having value in between sessions and not just when they're sitting in the office. These are all things that technology is far better than doing than us with our pen and paper. And so we have to be part of designing those. So just to give you an example, we have a partnership here at Silver Hill with this amazing startup called Tetricus, which started as an AI company, but from the very beginning, and really because of the vision of their founder, it saw itself as being a consultative and helpful to experienced professionals rather than replacing them. And it doesn't mean I can promise every mental health professional that their jobs won't change. No, their jobs will change. But good technology doesn't replace people. It makes them more efficient. And of course, they're going to have to get trained to use it in that way. So. So I'm very excited about this collaboration. We're starting to change the way we do treatment up here in New Canaan. We're in the process of designing a new outpatient program in New York City that's going to heavily leverage technology for communication and, and to make our treaters better at their jobs. And I think time will tell. There'll be some trial and error in there for sure. But I hope that this is another area that we see a lot of growth in the field.
- [42:37]
Unknown
Well, that's great. Technology and AI in particular, there's so much debate right now on, you know, the threat versus opportunity question. And, you know, some of that is perspective. And, you know, some, you know, see the world as the. As a glass that's half full, and they probably see the opportunity. Opportunity in it and vice versa. But it. It is a topic of so much discussion. I'm actually interviewing in a couple of weeks a. An AI expert who spends all of his time debating that very question and trying to help organizations think that through. It's certainly going to have a major impact on health care. Thank you Andrew. This has been a very, very interesting conversation and I predict that this will serve as a good primer for folks who are thinking about behavioral health, behavioral health industry, what's happening. And I truly appreciate your time and I definitely appreciate your very strong and very present leadership within the field. It makes a big difference. And so I appreciate you spending some time here. If folks want to learn a little bit more about you or your organization, some of the work you're doing and refer to how can people find you.
- [43:55]
Ray Spadoni
Best places is on our website, Silverhill Hospital, all1word.org and under under the staff page. I have a bio under there but you can learn about all of our services and all the ways that we're trying to be leaders in the field. And I just want to say Ray, how much I appreciate your work because I think bringing together the business side of healthcare with the vision for what is the best care, that's what's going to make things better for everybody. And that classic idea that somehow business and clinical is at odds is to me an outmoded way of viewing that we're all better working together. And it's been a pleasure working with you and getting to know you.
- [44:41]
Unknown
Great. Well, thank you so much and again, appreciate your time.
- [44:46]
Andrew Gerber
Thanks for listening. I hope you'll consider leaving a five star review on Apple Podcasts or your platform of choice that'll help others find us here. My mission is to help empower organizations that matter by supporting those who lead them. Feel free to learn more about me and my work at Red Sail Advisors.