MGMA Podcasts

Well, hi, everyone. I'm Daniel Williams, senior editor at MGMA and host of the MGMA Podcast Network. Today, we welcome doctor Thomas Young. He's chief medical officer at Pro Am Behavioral Health. He's here today to talk about the missing link between mental and physical health care.

So let's go right to doctor Young. Thank you so much for joining the podcast today.

Pleasure to be here. I'm looking forward to the conversation.

Yeah. Now as mentioned, you are the chief medical officer at Pro Am Behavioral Health. You were telling me offline you founded the organization in 2016. Tell tell us a little bit more about Pro Am Health. What do you guys do?

And, talk about that evolution because I know mental health is top of mind to so many people right now. So many people are struggling, and we're gonna talk about that today to help provide some solutions and a pathway to better mental health.

Oh, absolutely. Be happy to. My background is primary care. I I started in primary care when I went to my residency in 1973, and I've been doing primary care ever since. I taught, family medicine, at a couple of locations over the years.

And and all the way through it and all my experiences, I oversaw Medicare for Qualys, for Washington, Idaho, and Alaska for several years. I was a medical director for the Idaho Medicaid program. And I think most in that program, particularly, I began to see the role that primary care was playing, in mental health. Because the way, the way mental health had been designed in this country, in the seventies, as many people know who would come from that era, we used to house a lot of people in, mental health institutions. In the seventies, we we turned the other way and went to community based mental health with which put the burden on burden on primary care.

And so as primary care sort of had all the burden, mental health, trying to do all the other things that that we did every day, in our practices, it became just really difficult, if not impossible. So as I evolved my vision of that, I saw that we needed to do some things, and sort of some things happened in my own family that focused, our family and myself on the importance of mental health. So that began my journey, in the nineties to to look for solutions, particularly focused on primary care. And so that was the evolution. ProM was the biggest step along the way.

Started in 2016. Had a lot of work in research, so I began to understand mental health from the research side and sort of taking research and putting it in the hands of usable hands of primary care providers. Okay? Research is sometimes difficult to transition. So one of our goals was early on was how do we transition all the stuff we know in research or specialists are using into the hands of us guys and gals out in the field,

if you will. Yeah. That is that's great news. I was just I got a notification on my phone earlier or actually yesterday that, National Mental Health Awareness Day is tomorrow, and that's just one more way that we are, bringing mental health out into the open and then the work that you're doing, your team is doing, and others out there to help provide solutions is just wonderful. So thank you for this work you're doing.

Wonderful. Yeah. Go right ahead. Yeah. What were you gonna say?

Well, I was gonna say, you you you you keyed on one word there in in your comment, which is on my phone.

Mhmm. Mhmm.

So one of the things, and I think we'll probably get to it, is the role, of technology to solve some of the issues that we have in primary care. Primary care providers, which includes pediatricians, internists, nurse practitioners, all the people at the primary care level, make about eighty five percent of the diagnoses of mental health in this country. They write eighty percent of the prescriptions for mental health drugs in this country. And, unfortunately, the tools that we've provided, don't allow them to get highly accurate diagnoses. So you couple that information, you say, well, then there's a problem that we can solve.

And then the the remaining problem that I hear from my doctor friends all the time is, okay. I find all these people. What do I do with them? Mhmm. We're we're so short of mental health professionals in this world, both at the treatment side and the diagnostic side, that there really is no place to send them.

And so accessibility and availability become issues, and therein lies where I think some of the technology solutions that we're going to see moving forward that can assist primary care providers, and not sort of jump the queue, but I think the real reality for primary care is that for primary care, mental health needs to be a collaboration.

Mhmm.

We have to see mental health collaborations in primary care. There's too much too much for us to do at the primary care level.

Right. We're

the we're the bull work for too much.

What does that collaboration look like then? What does a more positive or a better outcome collaboration look like for those primary care practices?

Well, I think for there's there's two ways to go at it for primary care practices, I think. One is there's a new model for therapy that can be integrated into primary care practices. That new model for therapy, I I consult with a clinic here locally that's that's building this model, And I see it building from other places. I think some of it came out. I worked at the University of Washington many years ago.

But what it is is you have a therapist in the office who is doing brief encounter therapy and is available to the physician, to to see patients while the while they're there in the office. What this usually what this model looks like is a social a licensed clinical social worker or LCPC, whatever the the designation in that state is, to to be available to see somebody initially for a short visit to get them introduced into the care model, bring them in, and then reschedule them for appropriate times. And most of the time, what goes on here in these practices is the ability for that person to be available to the doctor during the time the doctor is seeing patients. If he or she notices that there's a mental health issue, they can immediately bring somebody in, introduce them, and extend the care process. So that that's one way.

The other way is to use technology, to begin to to close that integration gap and to use that technology to be able to connect that primary care digitally, to advanced therapy, for example, a psychiatric consultation. So the ability for a primary care doc to obtain a psychiatric consultation and then get that information back and execute on that treatment plan and provide continued documentation, value based outcome measures, in other words, being able to track and follow, is the patient getting better? And so on a team or collaborative model or integrated model, I can I can involve a psychiatrist? I can involve a therapist, but I can use technology to wrap that up for me and make it efficient. Because, really, for the primary care provider, efficiency is key.

I've got a ton of patients to see, whether it's pediatrics, whether it's adults, or whether it's elderly. I got a lot of people to see. And I gotta be able to sort of master the ship, pilot the plane, and make sure that other things are getting done. And so I think technology begins to come into play here.

Mhmm. You mentioned so you told me offline you're in Idaho, and you're working with a practice there to get this integrated. So I I don't wanna read into that. Give me an idea. Give our listeners an idea.

Is this early stages of adoption of having this model you're talking about, or is this widespread yet? Where where are we along that sort of timeline?

That's that's a that's a great, great question. I'm actually giving a talk later here at a big session in Idaho on what's called hyper change. And so change is coming. Mhmm. We're seeing more and more of these kinds of practices, working with a a member of your organization, at a big development over in East Idaho with multiple clinics and a behavioral health group and a psychiatrist to build this collaborative model digitally, working with a consulting group, small consulting group that does rural work.

So we're seeing it coming. University of Washington, really developed this. Salt Lake City, Intermountain Healthcare has this model. So it it's evolving, and I think faster and faster and faster, as we see things moving. So the answer to your question is if it's early, second thing, but it's efficient, and it's relatively easy with the right technology for any practice to put in place.

The beauty of why it may work is that there's now a code for it. Mhmm. So one of the things that that we all know in primary care is it it's hard to do things that you don't get paid to do. Yeah. So NASS has just recently, actually, within the past, I think, sixty days, put out a new code called behavioral health integration.

So I think we'll see that change evolve faster and faster and faster because I I I can make it part of my practice. I can afford to make it part of my practice.

That is wonderful information, and this really gets to the heart of it. There's a need. There's a need for this code. There's a need for this integration. You and I were sharing some emails offline.

You've been looking at a certain study that came out. I think probably most of our listeners have have seen this study or other studies about what many have called it America's Mental Health Crisis, there is a need. And in this study, it cites, that more than fifty million people are experiencing at least one mental health illness. So let's go to that study first. What what is the study?

Just give us some basic, data, you know, some of the main data points that emerged from that study.

Okay. The study the study that we're talking about is, I'm gonna pull it up actually so that I can, represent it correctly. Okay. The state of mental health in America Twenty Twenty Three. And and in it here here's some of the the key takeaways.

Twenty one percent of adults are experiencing at least one mental health is issue. That's roughly fifty million people. Fifty five percent of adults with a mental illness will not have any treatment at all. Five point four percent of adults experience severe mental illness. That's schizophrenia, other psychotic disorders.

Twelve million people reported serious thoughts of suicide. We've seen suicide drive enormously increased numbers in this country, particularly predominant in several states. We've seen, for example, numbers of people increasing in opioid use disorder and multiple deaths in opioid use. So from this study, we can attest to the fact that that's going on. The other part of this and other and also highlighted in this study is the fact that children and adolescents have an enormous increase over the past four years.

Obviously, we can point to the pandemic, and we can say, this is the reason, but it's only part of the reason. K? We were seeing increased elevation in children's mental health issues pre pandemic. The pandemic simply accelerated that. So in this study, it highlights the the fact.

And the other other sort of interesting figure is over 50 of the people, up to seventy percent of the people that come into a physician's office are driven by behavioral health disorder. K? You can look at other statistics. And and going back even to the time when I was teaching and when I was a resident, I can remember my my head of my residency, my one of my professors looking at me saying, never forget ever. Fifty percent of the people that come in to see you aren't really physically ill.

And so that that becomes unchanged, if not worsened, since I started fifty years ago.

Mhmm. Yeah. Let let me just go back. You had the study open in front of you. Who conducted the study?

Let's get a better idea of who that is and if people have access to that, if they wanted to read more into the study as well.

Mental Health America

Okay.

Created the survey 2020 state of mental health in America survey by the Mental Health America group. And that study is available online. It was conducted by the NASH according to separate this is a set there's another survey that's attached to that that they used as data from the National Center for Health Statistics, that said, for example, forty percent of Americans reported symptoms of anxiety in 2020 when the study was done compared to just eleven percent in 2019. So in one year, you saw an increase of almost double in anxiety symptomatology. People have struggled during the pandemic, particularly.

Untreated substance use disorders have accelerated dramatically. So this is in this is in this study, from the Mental Health Association of America. Mhmm.

Does the study or in your own research, does it point to why we're seeing this extreme I I wanna call it an uptick, but it's a surge and epidemic of mental health illnesses. What is happening? Why are we having record levels of mental health, issues right now?

Well, I think I think that we can we can talk from this study and multiple other studies and what we see in in the data and what we see in our own work. The reality is, for children and adolescents, there's some different causation. For the adult population, what we're seeing is a gradual rise secondary to what what commonly happens, for example, in, in work related areas, in, financial areas. As you begin to stress families and family units, you see higher and higher rates of adult mental health disorders. In children, part of part of it, and I think we have to be honest with ourselves, is the social media issues.

All the studies point to that. McMurtry, the the surgeon general, has pointed that out directly, in some of the statistics from the National Institutes of Mental Health demonstrating the fact that, the issue with children related to social media, related to news. And if you if you go back and you look at things like, people's general sense of of security, general sense of, social isolation, we are seeing more and more social isolation, more and more splintering of connections, more and more ability for people to take sides, if you will, to be really split. If you and and you you can't go away from the fact that that in this country, we are seeing greater and greater sort of isolation to our own space. So all of that contributes, to the increasing problem of mental health.

The inability to get service increases, so exponentially, people get worse Mhmm. And more and more people come in. And, I I as I tell my patients, particularly when I see adolescents, because I I predominantly have been doing behavioral health for the past twenty years, children are the explorers into the wonderful world of psychotherapy for their families.

Mhmm.

So a dysfunctional, isolated, mental health, impaired family is going to have more problems in their children. So suddenly, one person with depression becomes two people with depression, becomes four people with depression, becomes an entire family with depressive symptomatology. And then you you couple that with what's going on in our society, particularly, you know, with the shootings and all the other things that make the news, the mental health status of Americans is poor

Mhmm.

Across the border. We've hopefully reduced the stigma of reporting it. Yeah. But still a problem for employers, but I think we're seeing people reach out more. We are seeing more people reach out for therapy.

That's a good thing. We've Right. Seen that almost double, in the past six years, the number of people asking for help. But you couple that with a really burdened primary care system, more people asking for help, fewer resource resources. We need solutions, and so I think those solutions become, technological as well as societal.

Right. And you did jump into the next part. I know this has been pretty heavy stuff that we're talking about, but it's heavy stuff that we're talking about, and it needs to be addressed. And so as you mentioned, there is a bright spot here where, Americans are increasingly seeking help. Talk about that.

What are some of the factors that are allowing people to feel comfortable? Comfortable may not be the right word, but they're open to seeking help, whereas in the past, they might have kept that private where then it can turn into a an episode. So talk about that where people are seeking help and what, the avenues are for them to do so.

Well, I think there's two there's two things, Daniel. I think number one, employers are more and more focused on employee mental health. They're looking forward in solutions in their companies. They're looking to be able to provide it. EAPs have never been a very effective way, but they're working to improve them.

So I think you're seeing it from the workplace side being a bit more acceptable. And then I think, honestly, with the advent of increased children and adolescents, I think suddenly adult parents and adult people in their lives are waking up to the fact that, oh my goodness. I need to get help for my adolescent, or I need to get help for my child, but maybe I need some help too. So I think that this sort of increase in visibility in children and adolescents and the okayness of making it visible, okay, in that age group. And it's it's like I've always said, you know, children are the explorers into the world of psychotherapy.

And I think because children have it's been more acceptable to discuss and look at, parents parents and adults have had to say, well, okay. I need to look at it.

Mhmm.

And and I need to to potentially get some help. And we're seeing a rise, for example, in the number of people, going in for treatment for addiction, alcohol and substances. Well, alcohol and substance people, the old question we used to ask was, why are you an addict? The new question that we're asking is, what are you trying to treat? And by changing that paradigm of discussion, now we're saying, well, there's there's underlying behavioral health disorder here.

Mhmm. Okay. So more and more people are seeking help for those disorders, and more and more people are being diagnosed with with what we call comorbid, behavioral health disorders, psychiatric disorder. So we're it's more and more acceptable. And the other reason, we're seeing a flood of these people, both adolescents and adults, into emergency rooms.

And so communities are having to pay attention because these people are flooding their ERs with suicidal ideation. Communities are now paying it. I have spoken more at community based programs over the past year on suicide than in any other single year I've been doing this in the past twenty. Mhmm. Because we were concerned.

Yeah. I have come across several articles and research studies lately about, the problems with isolation and loneliness. Yeah. Have you come across that in your research and tell us about that. How can we, alleviate that to some degree or provide people with a channel to not feel so isolated, to not feel so lonely?

That's a great that's a great, great point. Great observation. I treat, kiddos at at a college, nearby. And one of the things I've learned in the years doing that is the single most common thing that will drive, adolescent college student to the brink of suicide is loneliness

Mhmm.

To the point that I I've developed a little scale based upon our research that I can I can have our staff send out and find out people's level of loneliness, and I can send it out technologically on this wonderful device we call a smartphone? And I can get that feedback very quickly. So you're absolutely right. Loneliness is number one. United Kingdom recently put a secretary of loneliness Wow.

Into the into the government

Okay.

To begin to develop that. And so that that becomes really, really a a keen indicator of what's going on. So if people begin to get isolated, for example, I'll just use a personal exam my my daughter is a therapist. Okay. And she's, you know, she's in that age where and we live in the same town, and we share an office.

And I never talk to her on the phone. It's always by text.

Okay.

Okay? And and I I rarely get a phone call from my college students when they're in distress. I always get a text.

Sure.

Well, if you think about that, devices can make things better or they can make things more isolated. And I think to some extent, devices do ice isolate people. They can certainly be a solution, however, because they can also connect people. But you have to have the right reason for that device to be connecting you. So one of the solutions for that is some of the newer technologies, using what's called rules based AI can create, moments.

When somebody's really feeling lonely, I can use my device, and I can actually video chat with somebody, k, which is which is really a fairly human connectivity and what we've researched around video chat, for example. Now you get Zoom dysmorphia a bit, over time, but the reality is we can do things technologically to improve connectedness. And so the app you know, the absolute opposite of, loneliness is connectedness. So can using technology can be a solution. Offices, doctors can employ apps with their patients that allow that connectedness.

Right now, we use it just to sort of get data, back and forth. But can we do some things? Again, some of these more forward thinking practices, have what what are called, you know, ten minute chats. And this this in involvement of a of a process model inside a primary care office for behavioral health integration can employ the ten minute chat model. Okay?

Yeah. And I I have found this in my own practice extremely valuable if I, you know, I I follow-up my college kids a couple years later down the road, say, what was the one thing we did for you at the college that made it easier for you? And she's you know, a lot of them will say the ten minute

chat Okay.

That they could get with a therapist or a nurse or me on a regular basis just to check-in. So there are a lot of technology things, and that, I think, will help this loneliness issue, which is a huge issue around the world, not just here.

Yeah. I have I have a final question for you then. So as you know, many of our listeners, most of our listeners, are work at a at a medical practice in one, capacity or another, but they are often the decision makers in those practices. They have a leadership role. So what can practices do then from a preventative screening standpoint?

You know, on that front line at those primary care practices, what can they be doing to move this forward to get those people help?

Well, I I think you have to you have to have sort of a shift a shift in thought process. You have to say, I need to treat mental health just like I treat physical health. And physical health, I screen for diseases. We have the annual wellness visit, classic model, in medic Medicare. We all do wellness visits.

We all do blood pressure checks. We all do, you know, checks for other disorders, cervical screening, cancer screening, you know, breast cancer screening, screening for mental health. So screening starts there. Secondarily, get the right diagnosis very early. You don't necessarily have to treat it.

If you're in primary care like I've been, I didn't treat everything that came in the door, but my job was to find it and get it to the right place. Well, you need to find it, you need extra tools. You need different tools than than you have for physical health. And so screening leads you to improved diagnosis. And then I think the next most important piece, in in sort of what can we do to make it better is we can follow our patients along.

Much like if you have somebody with hypertension, you have them come back and check their blood pressure every six every three months. Or you ask them to take their blood pressure and charge. Same thing with mental health. If I'm gonna treat you, let's make sure you're getting better. And then I think the hope for the future, if you get into that screening, testing for or diagnostic interviews and then tracking and following, the hope for the future is that with improved diagnostic abilities and improved treatment abilities, we'll all be getting better outcomes because there's no question the change coming in mental health that will make it on the same footing with physical health.

Because right now, the only way to make a diagnosis in mental health is subjective. Let me talk to you. Let me ask you some question. The day is coming when we will objectively be able to say, here is a study, here is a test, here is something I can point my finger at and say, you have depression. Now I can change the paradigm.

Instead of saying, oh, I'll relieve your symptoms, I can cure you. So we that's where we are in physical health. I can cure you. We're talking about curing cancer. We're talking about curing heart disease.

We don't talk about curing flesh. But that's because we don't have the diagnostic aid, but that's coming. Yeah. So that's coming. The treatments are coming.

The whole model of how we treat mental health will change. It basically hasn't changed since the beginning. Mhmm. But it is changing. We are seeing new stuff.

And for that reason, I think getting in the habit of screening people like you do for physical disease, getting the right diagnosis like you do for physical disease, deciding on the treatment, whether you do it or whether you refer it or whether it becomes part of your behavioral health integration process in a clinic, and then following to see what the outcome is. That's that's where that's where the quote money is, I think, in this.

Well and as you said, there's a code for it now as well. Yeah. Right. That is

The codes for these screening, there are codes for the diagnostic interview process and for primary care, the ability to get a psychiatric diagnosis with the right tools in your practice to be able to refer them is the right thing to do.

Alright. Well, doctor Young, thank you so much for joining us and sharing these thoughts with us today.

I appreciate it, Daniel. And, anytime we could be of assistance, feel free to give me a call. Happy to talk with anybody.

Will do. So thanks again to doctor Thomas Young. Again, he is chief medical officer at ProM Health. I'm gonna provide direct links to the studies, and that code, that doctor Young was talking about. Thanks again for listening to the MGMA Podcast Network.

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