Serious Mental Illness and Homelessness, An Interview with Senator Henry Stern and Dr. Curley Bonds

An interview with California State Senator Henry Stern and Dr. Curley Bonds, Chief Medical Officer for Los Angeles County Department of Mental Health about legislation and programmatic changes needed to better serve highly vulnerable individuals. Curt and Katie talk with both Senator Stern and Dr. Bonds about the limitations of Laura’s Law and the Lanterman-Petris-Short Act as well as the hope for stronger, more collaborative mental health initiatives for individuals grappling with serious mental illness and homelessness. We talk about the practical funding and workforce concerns as well as how to fix them while also supporting mental health professionals.

It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.

Transcript

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Interview with Senator Henry Stern (D-Los Angeles) and Dr. Curley Bonds, CMO for LA County Department of Mental Health

Senator Henry Stern is a sixth-generation Californian and native of the greater Los Angeles area who has represented the nearly one million residents of the 27th Senate District since first being elected to serve the 27th Senate District in November 2016.

Stern has chaired the Senate Natural Resources & Water Committee since 2018, where he has worked tirelessly to bolster the state’s wildfire preparedness, push to have the state address the climate change emergency, improve our democracy and fight to help some of California’s most vulnerable members.  He was also recently appointed as Chair of the Joint Legislative Committee on Emergency Management. In addition, Stern sits on the Senate’s Budget, Environmental Quality, Judiciary, and Energy, Utilities & Communications committees, as well as the Budget Subcommittee on Resources, Environmental Protection & Energy.

A former educator and environmental attorney, Stern received his undergraduate degree from Harvard University and earned his law degree at UC Berkeley. Born in 1982, Stern lives in Los Angeles County with his wife, Alexandra Stern, whom he married in 2019.

 

Curley L. Bonds, M.D., oversees all clinical practices for the Los Angeles Country Department of Mental Health (LACDMH) as well as the full range of programs that function to engage and stabilize clients by bringing them into the Department’s community-based system of care.

Dr. Bonds is a psychiatrist with extensive experience in a variety of clinical, academic and research settings. Most recently, he was the Chair of Psychiatry and Behavioral Medicine at Charles R. Drew University School of Medicine in Los Angeles and the Medical Director for Didi Hirsch Mental Health Services. His areas of expertise include healthcare disparities, cross cultural psychiatry, psychosomatic medicine, and collaborative healthcare.

Dr. Bonds has won numerous teaching and advocacy awards including Chief Resident of the Year in 1996 and The Exemplary Psychiatrist Award from the National Alliance on Mental Illness in 2009. He is active with several professional organizations including the American Association of Community Psychiatrists, the Association of LGBTQ Psychiatrists, the Black Psychiatrists of America and the American Psychiatric Association. Dr. Bonds is a Distinguished Fellow of the American Psychiatric Association and a Fellow of the Academy of Consultation-Liaison Psychiatry. He is a past president of the Southern California Psychiatric Society and the recipient of their 2018 Distinguished Service Award.

He completed his B.A. in sociology at Emory University and earned his M.D. from Indiana University School of Medicine.

In this episode we talk about serious mental illness and homelessness:

• Continuing our special series on Fixing Mental Healthcare in America
• What the ideal mental health care can look like for individuals with serious mental illness, substance abuse treatment, and navigating homelessness
• The siloed nature of services at present
• The importance of consistent engagement and familiarity
• Recovery-oriented and person-centered care
• The importance of self-directed care
• Wraparound services
• The importance of engaging people with lived experience
• Culturally responsive services
• The current laws protect autonomy without the means to support people without capacity
• The bureaucracy that is keeping people from getting the services they need

“We’re trying to now reset when we look at what a Laura’s Law or an LPS law reform would be, not just to look at the definition, say of grave disability, but to put a model together that’s going to sort of articulate a much broader framework that starts from this place of relentless engagement, that starts from this place of integrated services, and that starts from a rights based approach, as opposed to a sort of regulatory or sort of government dictated approach. — Senator Henry Stern

• Changes to Laura’s Law and LPS Act that are needed to better serve individuals with grave disability or require conservatorship
• Engagement, rights, and how to better serve individuals
• Assisted Outpatient Treatment – how it can be best utilized and most effective
• The ability to shift things through budget and regulatory changes
• The understanding that current caseloads that are too high and the need to add resources
• Alternatives to long term conservatorship
• The willingness to invest in services and solutions
• Balancing the tension between self-advocacy/self-determination versus providing care
• Mental Health Advanced Directives as a tool to help with making these decisions
• Who can and should be at the table in making these decisions
• The desire to invest in people to provide services
• Whether to invest and how to assess efficacy
• The problem of the fragmented systems and communication about mental health advanced directives
• The importance of education for people needing and providing care on the options
• Looking at the benefits and “selling” the positive elements of assisted treatment
• Letting clinicians do clinical work – why that’s important and ideas of how to make it work

“We have to let clinicians do what clinicians do best — take care of people.” — Dr. Curley Bonds, CMO for Los Angeles County Department of Mental Health

• Tracking outcomes effectively while diminishing bureaucracy
• Looking at the most effective goals and outcomes for clients
• Looking at unfunded mandates and how to support therapists and clients to get services without so much paper pushing and complicated outcomes
• Having service providers at the table to create the programs effectively
• Results-driven metrics and payment (the pros and cons)
• Addressing policy and stigma
• Looking at the problems with the current process for services and conservatorship
• Ideas for redirecting funding and working in collaboration with law enforcement
• How to take part in these efforts and weigh in on legislation, especially early in the process
• Our reflections on the interviews and the next steps

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

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Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Los Angeles Times Op-Ed: Our mental health laws are failing

Laura’s Law

LPS: Lanterman-Petris-Short Law

Dr. Partovi in Skid Row

California Tax Law H – Homeless Initiative

MHSA: Mental Health Services Act

Office of Senator Henry Stern (D-Los Angeles): State Capitol, Room 5080, Sacramento, CA 95814, (916) 527-4947

RAND Report: How to Transform the US Mental Health System

Relevant Episodes of MTSG Podcast:

Fixing Mental Healthcare in America

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW

Music by Crystal Grooms Mangano https://groomsymusic.com

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).

… 0:00
(Opening Advertisement)

Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 0:15
Welcome back modern therapists, this is the Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is our second episode in our special series of Fixing Mental Healthcare in America. And just for us to be able to bring wonderful content to you, we’re not going to be able to do this series one week right after the other, so you’ll get some of our regular episodes mixed in throughout. But this is our second episode, following up on our interview with our wonderful friends over at the RAND Corporation. If you haven’t listened to that first episode yet, go ahead and go back and listen to that one and come back to this one. But in this episode, we are talking with California State Senator Henry Stern, as well as LA County Department of Mental Health Chief Medical Officer, Dr. Curley Bonds, talking about the ways that California’s laws are shifting, and ways that they’re kind of holding us back, and being able to treat people with severe mental illness, especially as it relates to the ongoing homeless crisis that is happening here.

Katie Vernoy 1:21
This conversation will be primarily around California initiatives and things that are happening or have happened in California. But I do think it’s a good model for other programs in in your state where you are. And so I think it’s an important lesson, because California can be the jumping off point and the testing ground for best practices. There’s a lot of stuff that we bring up, that’s very California specific, we’ll put links to all of it in the show notes, but we wanted to give you a couple of things right up front so that you can at least take it in without having to stop and head over to the show notes over at MTSG podcast to try to understand what we’re talking about.

Curt Widhalm 1:59
Trying to keep this as brief as possible here. A couple of things that are mentioned are things like Laura’s Law and Assisted Outpatient Therapy and the Lanterman-Petris-Short Law. All of these are California laws that have been replicated in some other locations as well that define what a grave disability is as far as needing to be able to intervene with people with severe mental illness who may not have the capacity to understand their own ability to either enter into treatment or recognize their need to enter into treatment. Laura’s Law specifically is the result of a woman named Laura Wilcox who was killed by an untreated person with severe mental illness. That law was signed into California in 2009.

Katie Vernoy 2:45
And I think the important thing to take away is that there’s also some different taxes that got put into place that have funded several different programs. One of them is MHSA or Mental Health Services Act, and that was implemented in 2004. And that was a tax on over one million dollars personal income and that expanded intensive services. The final program that was discussed was also a pilot program, that Department of Mental Health is looking to start which is the home or homeless outreach mobile engagement team. And that also is kind of aligned with this. How do we help folks that are grappling with severe mental illness and it has mechanisms for treatment as well as conservatorship.

Curt Widhalm 3:26
As Katie said, we will include that stuff in our show notes over at mtsgpodcast.com. Here’s the episode: We are joined today by Senator Henry Stern representing California’s 27th Senate district and also my senator, and very glad to have him representing me and all of the people of the San Fernando Valley and extended areas around that. And part of where we come into this is following up on an articles that Senator Stern wrote with Dr. Jonathan Sherin from the Los Angeles County Department of Mental Health that appeared in the Los Angeles Times in December of 2020. Addressing mental health issues, and especially some of the limitations of California’s laws around being able to work with clients, and especially from the mental health side of things, requires a whole lot of changes to California’s laws. And California has traditionally been very forward thinking when it comes to a lot of mental health laws. But as this article in the LA Times points out, sometimes this can be limiting to being able to deliver a lot of the mental health treatments that people like Katie and myself and all of our listeners here are supposed to be doing in our jobs. So thank you very much for joining us, spending some time with us to be able to talk about how can we actually implement some of these changes into the world to better be able to deliver mental health services, especially as it comes to our homeless population.

Senator Henry Stern 5:02
Well, thanks for having me, Curt and Katie, I sincerely appreciate it, you know, and just tell you, you know, I come at this not as a clinical expert. And you know, I’m an attorney by trade. So I do have that sort of sensibility, I suppose. But I also come to this as just a lay person living in LA. And, you know, going through this over the last few years and watching homelessness change.

Curt Widhalm 5:29
So, we weren’t able to do a joint interview with Senator Henry Stern and Dr. Curley Bonds. So we’re gonna bounce back and forth a little bit here between them. This is Dr. Curley Bonds.

Dr. Curley Bonds 5:38
I’m Dr. Curley Bonds, and I’m the Chief Medical Officer for the Los Angeles County Department of Mental Health. So, I am responsible for overseeing all of the clinical operations in our department. We happen to be the largest public mental health system in the country. We have about 6000 employees. And I primarily oversee directly the psychiatrists, which they’re about a little over 230. And I’m also responsible for policy parameters, sort of the clinical guidelines, how the work gets done, sort of the on the boots on the ground person to make sure that everything that we’re supposed to be doing according to our responsibility as the county’s mental health plan actually happens.

Katie Vernoy 6:19
The first question I have is, in an ideal world, what would mental health care look like? We’ve got a lot of different people within the homeless population. And in looking at your article, it was very clear that there’s different ways that people are, are ending up homeless without mental health care. And I’ll let you go into more of the details of that. But I think for me, Where are we aiming for in an ideal world?

Senator Henry Stern 6:43
We’re aiming for, I think, a future where mental health care isn’t some separate service from a broader suite of services, that, at present is essentially a bureaucratic labyrinth, for somebody with zero means and no trust left in the system whatsoever. And people aren’t navigating our system. And so, you know, the future to me is a place where substance abuse treatment, funding, and services aren’t separated in some silo over with our public health departments. And then field psychiatry, and medication, and behavioral treatment, aren’t siloed in Department of Mental Health, and then housing dollars and services aren’t then stuck over in Housing Community Development. And so you have one person, a real person that you’re actually trying to engage, and not just engage once and say, Why don’t you want this? Why don’t you want this service? But to be able to relentlessly engage, to be there every day, to have familiar faces coming back time and time again, and breaking down barriers where maybe it starts with talk to Dr. Partovi in, you know, on skid row, it starts off in with treating a boil or providing food or sort of those initial trust building touches, and then can accelerate all the way into housing placement, into treatment beds, into new medication adherence, into a whole new plan and a very intensive kind of care. Right now it’s wooden, it’s bureaucratic and no wonder a lot of people on the street, don’t trust us. Because you don’t know if the same person is going to show up the next day. And you’ve never heard of this person before. So is that really a great housing opportunity? Or am I getting pushed into something I shouldn’t be a part of? It’s to try to sort of humanize and unify our interface with the most vulnerable people among us. And, you know, that’s going to take consistency and integration in a multi layer government process that heretofore has not been particularly tuned to the service to the customers we’re we’re serving.

Dr. Curley Bonds 9:13
Well, the ideal looks like a system that’s recovery oriented, and person centered. And it really respects the values of human dignity and respects the need of people to make their own outcomes and to participate in their care. So it’s really important that people have options and that we offer services in the least restrictive environment. That we give them what they need, not what we think they need. So wraparound services that include everything from visits with therapists, assistants from peers, people with lived experience should be a part of the equation, making sure that the professionals who work with them respect their unique cultures, who they are as people, and that they can speak the right language and provide services that are really just comprehensive and least intrusive as possible.

Curt Widhalm 10:05
What is keeping us from being able to do that? How are our laws and our systems preventing us from reaching that kind of idealized care that’s leading to the mental health crisis that many people are facing now?

Dr. Curley Bonds 10:18
Well, I started out by saying, as a psychiatrist, I’m very focused on what we can do. So I’d like to say that in some ways, the laws do help. They definitely protect an individual’s autonomy. But I would think where we fall short is when someone doesn’t really have capacity to know that they need help. Our laws are really all about self determination. But when you have a person who has an acute psychotic episode, or say a mania, someone who really doesn’t have the wherewithal to make well informed decisions, then the laws are kind of a fail proof system, for those individuals will really depend on them to kind of know they need help and to seek it when they need it. When it gets into involuntary treatment, there is just a complex morass of legalities, different things that people need to meet, criteria in terms of how many times you’re hospitalized, how many times you’ve been arrested, before we can really move forward with involuntary treatment. Our systems really sympathetic, but I would say that it leaves those folks who are what we refer to as gravely disabled, to kind of fend for themselves. And they’re often not the ones who are coming out for treatment on their own. They’re languishing in our streets, people experiencing homelessness, who just get kind of overlooked by society.

Curt Widhalm 11:32
A couple of the things that in the LA Times article that Senator and Dr. Sherin had talked about were a couple of the laws that specifically need to be changed: Laura’s Law and the Lanterman-Petris Act that would allow for some of this better care. What kind of changes are we looking for, to those two specific areas of law that would help to put some of this stuff into motion?

Senator Henry Stern 11:58
The past conversation about reforms to the LPS Act, as well as Laura’s Law have really centered around question of whether you define a grave disability as merely a physical condition, a physical health question, someone who physically cannot take care of themselves, or may be a risk to themselves or others. But it is not brought in some of these other factors around mental health, that we think in many ways, do reduce people’s capacity to be able to engage in care. The origins of the LPS Act deals with conservatorships not just for folks living on the streets, but this is also what’s used in trust and probate, right, for people who are experiencing dementia or Alzheimer’s or issues where they no longer have capacity, sort of built around that loved one who no longer can sort of make some of those legal decisions for themselves. Because a conservatorship where you’re actually no longer in full control and full capacity over your major legal decisions, but you, you end up submitting that to your guardian, or to your conservator, with the county or a designee. It is a very aggressive and very comprehensive kind of status. And it’s not one that necessarily you want to go to first. That’s the most extreme case. And I think we’re trying to now reset when we look at what a Laura’s Law or an LPS law reform would be, not just to look at the definition, say of grave disability. But to put a model together, that’s going to sort of articulate a much broader framework that starts from this place of relentless engagement, that starts from this place of integrated services, and that starts from a rights based approach, as opposed to a sort of regulatory or sort of government dictated approach. What Dr. Sherin and I have been thinking about, since we wrote that article and sort of working on is, can we start to articulate a different kind of right, not just the civil liberty to do whatever you want, but the right to live safely? And if we can start to reframe this issue, not so much as who’s going to be conserved and who won’t be conserved, and what do we need to do to the law to make more people eligible for conservatorship? I think if we stay in that frame, we’re not going to make progress. I think if we redefine it as a rights based issue, as a matter of both budget and policy, and as a way to sort of combine whatever those legal reforms that are needed, say in our assisted outpatient treatment laws or in our conservatorship laws, along with adequate resources, and a system that’s going to work. We’re gonna be able to punch through this impasse we faced over the years because up until this point, disability rights groups, civil rights groups, a very validly even the behavioral health experts in our county officials saying, we’re gonna go tell us to do a bunch more work essentially, right? You’re gonna say there’s all these gravely disabled people, and we want to bring them in our caseload is already50 to one. So what is it that you actually want us to be doing here? You will audit us to criticize us. And then, like, we have no ability, even if we wanted to bring more people in to even care for the people we’ve got already. When you have social workers with 50 cases on their desk, there’s no way folks in that kind of condition can get dealt with. And so that’s the big reset we’re looking for. There’s specifics within assisted outpatient treatment and LPS reform that we can, I’d love to get into. I mean, we can talk a little bit about say, not just the 5150 process, but the 5250 process, right? And what longer term temporary holds look like, as opposed to the long term conservatorship, it’s a multi year process. Is there a intensive, near term engagement that we can reach where we get people back to adherence on their medication? I mean, I think of the poor family down in Orange County with the gentleman who was killed by two cops after a jaywalking incident gone wrong, and he was having a total mental health crisis. And a year prior had been like coaching his kids soccer team, but from non adherence to his meds, and a breakdown, and a few more things, suddenly finds himself into a confrontation, that’s life ending. We may not have had to say, conserved that individual and say, put him in a county locked bed for two years. It may have just been a matter of approaching him with the right field psychiatrist, or the right kind of care out in the streets, trying to bring him back both with his family, but also just getting adherence back on medication, and then making some decisions. I’m very interested in not just the sort of the big ticket item of how can we expand the use of conservatorships and amend grave disability? Or how can we compel more assisted outpatient treatment? But really the services and the resources that we want to wrap around that, so that we don’t have to do it. Or that we can get actually caseload? I mean, what I’m interested in, what does it look like when you actually have a one to one caseload? What does it look like when you actually have folks like you, right therapists or behavioral health experts out in the field, actually able to manage their clients relationship, just like you would a normal patient, just like you would somebody else, right, and not process them through. Might be expensive, right? We’re talking about it might cost us $100,000 A person, for instance, to get them both, you know, $25,000 for housing subsidy $25,000 for not just a subsidy for that housing, but the ongoing costs of maintaining it, $25,000 for the services provided and another $25,000 say for the people, the actual budget, not just the medical treatment, but the budget itself. So say it’s $100,000 a person, you know what, why not go look at the 1000 most vulnerable people in Los Angeles and say, Let’s be that intensive. Like if we actually invested that much upfront, and that that kind of integrated solution, could we maybe have a very different conversation with people experiencing homelessness who are also going through a mental health crisis than we are right now. Which is, you run into a confrontation with the police, or you end up in a locked bed or forced hospitalization, or you’re just left to die. None of those work.

… 18:33
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Katie Vernoy 18:34
For me, when I’m listening to you, I hear balancing the tension between self advocacy and self determination on one hand, and this idea around getting care to people who need it most. And oftentimes, that is something where we get into whether it’s social inequity or inappropriate levels of care, and you’re already talking about this, but I just wanted to kind of go specifically to this tension, because I think there are always there always going to be people who then define what is the point at which someone is able to be conserved or at what point can they be compelled to treatment. And, and in reading the article, there was talks about Advanced Directives. And there was also talks about having all different folks at the table and and making sure that every stakeholder including people who are in recovery, that kind of stuff. So I just want to talk a little bit more about that because I know for our audience, I think our audience holds that tension a lot around where is self determination, self advocacy, and the ability for someone to get the care they need and to be able to determine that and to not have racism, you know, inequities, those kinds of things, get into those decisions, but also recognizing that we have people on the street, who potentially with intensive engagement could have a much higher quality of life and and truly do better in the world. So how are you looking at balancing that tension? Because I think it is such a hard line to walk. And it’s so hard because at some point someone has to make a decision. And that’s going to be impacted by that person’s perspective, their their history, that kind of stuff. So what are your thoughts on that?

Dr. Curley Bonds 20:17
Well, when you say pre directive, I think what comes to mind, for me, is an Advanced Directive. And I guess a little bit of history, this started out in medicine, back in the 80s, and 90s, when people were known to have life threatening conditions, they were able to say, what do I want to have done in the event that my life is threatened? For example, if my heart stops do I want CPR and chest compressions? If I can’t breathe on my own do I want to be put on a breathing machine? So, they’re able to determine ahead of time before they get into a crisis, or even when you’re admitted to the hospital, sign this form, tell us what you want done, what you don’t want done. And if you’re not able to tell us who do you want to assign that responsibility or authority be it a loved one, a spouse or a family member. And those advanced directives are now sort of codified part of the medical record. It’s a federal law that I think when you go into the hospital, you’re supposed to fill out one of these and then the staff are obligated to abide by it. With psychiatric crises they’re not always life threatening, but let’s just say that someone comes in, and perhaps they’re so impaired by their symptoms of psychosis, maybe they’re hallucinating, or they’re paranoid, they can’t trust anyone, they can’t make good decisions. If you have a pre directive or an advanced directive in place, they’ve thought about this ahead of time, who do I trust? Who do I want to be able to make decisions about how I want you to help me? Do you want to, if you want to give me medications, which ones work best for me? If I absolutely don’t want medication, what are the alternatives that I’d like you to try? And when done correctly, they’re very collaborative. And I would say, they result in less course of care. People who have the capacity to dictate or designate who I want to make decisions on my behalf, what I want done for me, how I want it done, and where I want it done, can avoid things like having to send out the police, putting people in handcuffs and then taking them off, involuntarily to a to a place where they’re frightened and afraid, without being able to say this is what works best for me.

Senator Henry Stern 22:23
Yeah, I mean, it’s an inherently human enterprise. And it is ultimately going to be judgment call. I think I’m really interested in using clinical expertise to drive that decision making. I think that’s what starts to neutralize a lot of that tension is when you have people who’s taken their Hippocratic oath, and who is their whole job is care. And they have that really acute focus on the individual, that they can then have a whole suite of tools in their toolbox to use. If we in government say are just trying to automatically slice up the population of people experiencing homelessness into categories and sort of pigeonhole them and just make bureaucratic wooden decisions from up in Sacramento or even behind some desk at county that doesn’t rebuild trust. The empowerment of our field, psychiatrists, or behavioral health therapists, the people out there who know how to make those judgment calls, and recognize that it’s a spectrum. And it’s not just a binary set of decisions, that’s going to, I really think, cut through a lot of this tension. You guys, you just don’t have time when you’re working with this population. It’s the same as being, you know, calling a public defender, right? Anytime you’re dealing people who don’t have means public defenders have 50 or 60 clients, too. It’s like, can you really go into court and advocate for your client well, when you just have like, 15 minutes to work on it? It’s the same thing if you have 60 conservatees or, or even in your community, say you’ve got a regional field operation, you’re field psychiatrists trying to look after one person for all of Skid Row. That’s what we got right now out there. Right. I mean, it’s like, hey, good luck, Dr. Sherin, like, I want an army of behavioral health therapists and social workers and field psychiatrists, where we, and it takes money. And it takes money investing in people. And it’s not just taking money investing it in the capital side of it. Because that’s been the tendency is yes, housing first, right. But step zero is, you know, if you’re not adhering to your medication, or you’re not, you know, you don’t actually have a relationship with your, your doctor at all, it’s a little bit arbitrary, to just pluck a person out of the ether and throw them into housing. That’s not a formula for success. So I really think empowering you know, our experts in the medical community. You guys are the best at making these tough ethical judgment calls. Right? That’s where that’s what you go to school for. That’s what you train for. That’s what you build up over time. So I don’t know I know that doesn’t maybe answer specifically, you know how it’s going to work. But I think that model, we have been under resourcing that part of the services for so long. No wonder no one trusts anybody.

Curt Widhalm 25:13
This money piece is, it’s a hard sell, especially when the costs that you’re talking about are not going to be able to be statically looked at as far as this is just money out the door. But when we look at dynamic scoring of legislation, where this is going to save money in emergency rooms, this is going to save money in the correction system. Part of this is looking at, you know, in order to pay mental health people to go and have those clinicians be on a caseload of one to one, one to four, whatever makes sense, is being able to provide the supports and structure for those people to be in those positions. And mental health being one of the underpaid places of this, this is kind of a two part question here is How do you sell dynamic bills like this when it comes to scoring to your colleagues in the legislature? And how do we make sure that our mental health clinicians are being paid at a place in what is a long, slow process where there’s very little positive day to day work that respects their workload enough that keeps them in those positions to see this fully successfully through?

Senator Henry Stern 26:31
Yeah, and it’s long money, too. It’s not short money. It’s not just boom, grant metrics, what’s it look like in a year, give it back? I think the political cycle doesn’t always align with the treatment cycle. You see, sometimes that political urgency that we need a win, I’m under too much pressure, I’ve got to show results. You know, what’s the press release we as legislators need to expand our political horizon, and bring our community along with us. And I, you know, I will say, I think for all of the frustrated neighbors, and homeowners and people who were out there, feeling uncomfortable, you know, crossing the freeway underpass, or, you know, walking to the coffee shop or walking their kids to school or, and that that animosity and the tension that’s that’s ratcheting up around LA, before they were attacking this governor for the pandemic, that it was really homelessness, driving it. Those sensitivities, they’re not ill founded. I can’t say that legislators need to ignore their people more, because they should be impatient. But I think people are willing to invest. I think you’ve seen voters time and time again say actually were willing to put big money up. H and H HH in LA, for instance, like those aren’t, those aren’t small amounts of money. And even MHSA it’s original, you know, the proposition that now Mayor Steinberg helped push through years back. There’s the public has a political will. The current thesis, I think for for trying to build a consensus around folks like me, in my line of work, who like a short term victory, is there’s an allure to accountability. And there’s an allure for innovation right now. Where we say, it’s not just a matter of like, how can you show the math in a one year timeframe for something that actually the math lines up in a five year timeframe? But how can we just show that we’re fixing the problems that at least are in our purview? You know, the fact that the Department of Public Health controls all the substance use abuse funding, and that’s where on substance use treatment money goes. And it’s a totally separate silo for MHSA is really inefficient, and doesn’t make a lot of sense. So the pitch I’m trying to come up with is, why don’t we just give it a shot. We don’t have to spend endless money here, we don’t have to commit ourselves to an entirely new model. But at least let’s try some pilots and see if they work. And see if spending big upfront and investing in people and that service side, not just the bed and the infrastructure. If that starts to pay dividends and give us give us the time we need, but like, why can’t we take a chunk right now, pull it across a few silos, lump sum of those boxes. And the public I think will be up for it. If they say, Oh, you guys are actually trying to do something creative here. And now I see there’s somebody on my street corner with that yellow polo shirt or the purple, pick your polo shirt color, right? They start to see if they start to see you. And not by the way, it doesn’t have to be that they call 911. But when they call 211. And somebody actually picks up like, block by block, we’re going to start to win people back. And then the political patience is going to increase and then the willingness to do the long term funding is going to go. So I’m really eager to start and Dr. Sherin’s home pilot to me is really exciting and very small scale right now. But that is somewhere I think we’re saying, can we actually put some real firepower in into a program like that. And, again, 500, the most vulnerable or 1000 of the most vulnerable and just be upfront with people say it’s, it’s 75,000 people, and this isn’t the entire population, and we’re not over promising. But here’s what we are going to try to do. And just be really honest with folks and not, you know, we get in trouble when we, we pretend like we’re gonna solve it all. I don’t think we solve all this overnight. I really don’t

Katie Vernoy 30:40
10 or 15 years ago, there were advanced directives like this, that some of the Wellness Centers were were training on and those kinds of things. And it seemes like such a great idea. It seems like it’s not necessarily taken off. Do you have any sense of whether or not something, I mean, it was pages of things with who’s going to be with me for different reasons. I mean, it was basically an advanced almost treatment plan, depending on status, it was really, really great. Do you have any sense of, if that’s something that would hold up if people are actually using those things, because it seems like a really wonderful tool and I, I learned it like 10 or 15 years ago with LA County Department of Mental Health.

Dr. Curley Bonds 31:21
It is a wonderful tool. And I’m glad that you were aware of it back then. Unfortunately, I don’t think that every corner of the mental health professional world knows about these. For one, there’s the problem of our system is very fragmented. If you’re say in the Kaiser system, where you’re in the private share insurance system, or if in the public system, then those are all three different systems. If you’re in managed care, you might have that filed in your chart at your managed care provider. If you’re enrolled in the Department of Mental Health, you might have been at one hospital that you’ve been admitted to but the outpatient clinic where you get your treatment may not know about this. So one problem is collaboration and coordination of information across these different barriers, these different silos of care. Another is making sure that consumers or clients who are coming in for services are aware that these exist. There is a law in California, the health care decisions law that provides a template, but it’s really focused more on medical issues about some of the things I mentioned earlier about CPR, chest compressions, those sorts of things. And you have to kind of write in and anticipate that I might have a mental health crisis. And for those who’ve been in the mental health system before, they might have the wherewithal to do that. But the majority of folks walking around, they’re not anticipating that they’re going to be in the hospital because of an attempt to hurt themselves, or they’re going to, you know, lose their ability to think clearly and not be paranoid. So, people just don’t often think about it practically.

Katie Vernoy 32:49
Well, I think there’s also the element of there are folks who don’t get to a place where they really can do that type of planning, whether it’s kind of ongoing delusions, or paranoia. And so there seems like even with these pre directives, or advanced directives, there’s still a population of folks who can have a vague idea of how they might care for themselves, be able to elucidate that and then still end up, you know, really gravely disabled but not qualifying as gravely disabled. And so it becomes something where it just it feels like there’s a lot of folks that are just stuck, whether, even if these pre directives come into regular usage, there’s folks, I think that wouldn’t use them because of their paranoia or who would not use them because they didn’t think to. And so how do we reach more of these folks who are really needing treatment, or needing some sort of support?

Dr. Curley Bonds 33:45
Well, I think there are two components to that. And I would agree with everything that you just said. One is educating the people who are receiving care that this is an option. And I think it’s also educating the people who are providing that care, the psychiatrists, the therapists, the nurses to say, when someone isn’t in a crisis, this is a conversation that we need to have. I would say one of the other barriers is making sure that family members and others know about this so that when the person is in a crisis, they know to say, hey, I have this piece of paper, or I have this form, and I know where it’s located, and I can provide it to the paramedics or the hospital staff so that when a crisis comes, that it will be actually utilized. I worry that these types of things are sort of like a power for, I guess, a healthcare attorney, power of attorney that people need to know that it exists. It’s like a medical will, so to speak, but it requires two signatures or notarisation. So, someone else has to know about it because I think too often those folks who don’t have them, they’re not engaged in care in the first place. And for people who are engaged in care, often the focus is on solving the immediate crisis, putting out the fires. But what we need to do is talk to them about when things are pretty calm and good, let’s talk about what works for you, what heals you so that we can make sure we put those things in place when you get to the point of crisis.

Curt Widhalm 35:02
One of the things that Senator Stern has a couple of bills out this year on is about assisted outpatient treatment, and some of the ways of making that more successful. From your perspective in the boots on the ground side, what does successful assisted outpatient treatment look like?

Dr. Curley Bonds 35:21
Here in California, we have Laura’s Law that passed back in 2002. It wasn’t until about 2014 or 15, that we actually got it up and running. So it’s a relatively new concept of assisted outpatient treatment, which is court ordered or mandated. Unfortunately, it’s again, one of those systems where people have to fail first, before they get enrolled. About half of the people who are approached with this, which is to say, hey, we’re going to ensure that you get the services that you need, they have to agree to it. And if they don’t, then you go through the legal process. At that point, it sometimes puts up this adversarial relationship with the care providers. It’s a problem from the beginning, if someone doesn’t agree to it. So you really have to sell people on what those services are, what the benefits are. And a colleague of mine at UCLA, Joel Braslow has done a lot of research in this area nationwide. And he’s talked about how the things that people really want, again, if we can emphasize those things; like you’ll have access to therapy, you’ll have access to medication should you desire it, we’ll help with transportation, we’ll help you with employment, we’ll help you with organizing your life better, being able to stay out of the hospital, to stay out of jail. I think if we can emphasize those aspects of assisted treatment, as opposed to the course of mandated parts, there is, I would say a small percentage of folks who respond to what’s called the black robe effect. You know, the idea that someone has said in a courtroom that you have to do this, they’ll actually do it. But I think the treatments themselves are only effective, and people only stick around for them if it’s something that they’d benefit from, something that they want. Because a lot of the people who don’t succeed in outpatient assisted outpatient are the ones who are lost to follow up, they just disappear from whatever program that they’re enrolled in.

Katie Vernoy 37:07
Oftentimes for those that level of services or resources, so there’s childcare and transportation or financial support for families that need rent, or those types of things, just kind of keeping folks moving forward, out of jail, out of the systems, those kinds of things. There’s a lot of bureaucracy that can get in the way of that, or there’s just a lot of service providers who are doing who are pushing a lot of paper. And so do you have a sense of how these types of intensive services with lots of resources could be implemented and still be something where clinicians can focus on their clinical work, and the bureaucracy is diminished. I know this is all very, very pie in the sky. But like that there’s, is there a way for us to do high quality work, and let clinicians be clinicians, because there’s so much else that ends up like a lot of unfunded mandates that end up in some of these policies that providers have to navigate around to try to have enough money to pay for providers to do the services?

Dr. Curley Bonds 38:12
Well, there’s a lot packed into that question. But I don’t want to walk out of this interview and lose my job. But we have to let clinicians do what clinicians to best: take care of people. And I think this is something that our director, Dr. Sherin says a lot, “They need to take care of the people, not the charts.” And by that what we mean is that, you know, I think sometimes we take well intentioned, motivated, ambitious, energetic, young people, we put them into the system. And we say, you know, we need you to stay here until eight or nine o’clock tonight to finish documenting what you did during the day, as opposed to spending your time doing those things. So we have enormous requirements. And I get it, you know, we have to be responsible as a system to the government, that we’re spending taxpayers money in an intentional and meaningful way, that we’re not just off providing meaningless treatments. And we also need to track outcomes. But I think there are only so many times and so many ways that you can measure someone’s progress, as opposed to just sort of sitting back and saying, Let’s spend a moment just talking about what’s going on with you, what you need. I think we need to make it so that the documentation requirements are less onerous. And I also feel like if we could come up with a system, and this is something that we’re attempting to do, that focuses on what happens at the end, not happens during the middle of treatment. But where do people go? Do they get back to their lives? Do they get back into school? Do they get back into meaningful relationships? Let those be the measures as opposed to how many minutes of psychotherapy or crisis management or medication support did you provide? Because when we do stuff like that, it causes people to put up like, it shouldn’t be like taking your car to the mechanic and they give you an itemized inventory of everything that that happened. It should be Hey car went smoothly, passes the smog check. You can go X number mph and that’s what the goal is and I think we should look at people not the way that we look at say things because we’re really looking at outcomes at the end of the game.

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Katie Vernoy 40:03
I’ve worked in some of the Department of Mental Health contracted agencies in the past and on some of these programs I worked in the Cal Works program, worked with a lot of homeless and different populations of adults. And I think there’s, there seems to be less of a political will to throw money at adults. I also worked with children. And it seems like there’s there’s a little bit more MHSA seems more aligned on the on the kids side than the adult side. So. So I think that there’s there might be some pushback. So I’m just going to leave that there. But the thing that I kept seeing, especially in the adults programs is this need to have these metrics and outcome measures. And I think that those are very credible, like we need to do that. But oftentimes, the onus is on the service providers to spend countless hours doing reports. And that is not service, that’s not client care, clearly. And so to me, I am so appreciative of hearing around this, let’s let’s invest in people, let’s invest in services. But is there a mechanism to try to make sure that these service providers are also at the table in designing these programs, because oftentimes, there ends up with a lot of unfunded mandates, which is, we need this form in triplicate, obviously, with digital, we’re not doing triplicate, but like, it’s, it’s kind of that we need this report at this time. We need this to be filled out at this time. You know, there’s these five things that you have to do when you first meet a client. And not only is that kind of onerous on the service provider, but it can also be a friction or a barrier to treatment for the folks that we’re trying to serve. So do you have a sense of how that’s being addressed? Because I think for me, I get very excited about this idea. I’ve worked in wraparound programs, I’ve worked with folks that were in, you know, in South Los Angeles on the streets, you know, like I, I’m excited. But I also recognize that there is a potential for a lot of unfunded mandates which make programs not only not immediately effective, but also not sustainable.

Senator Henry Stern 42:06
Yes, and I think we’ve seen it happen. I mean, we’ve seen, you know, we have this MHSA accountability committee, and there’s, you know, we saw an audit come out from the state that we had worked on, and, and even with that, you know, State Auditor’s report that we asked for on our LPS and conservatorship programs, its plans, audits, metrics, reports, all that without money is just an exercise in circular bureaucracy. And it’s a very dangerous thing. To whom much is given, much as expected, but to whom nothing is given. I don’t, the expectations can’t really be there. So I think if we, I’m interested in the experiment around a… you know, this kind of local pilot, not just being one of a different kind of service, but also maybe a different kind of interface between state and local. And if we let service providers try to design this with us from the ground up, we’re gonna get a lot better outcome. Like, when we’re when we’re working on policy this year, I mean, our our intent is to design a big table and let folks who are actually on the ground, who actually have to do the paperwork, and push it up, say, what’s working and what’s not. And don’t let turf and territory and actually politicians do have some value, right? Because I don’t have any, any sort of built in allegiance to whatever protocol I’m in charge of enforcing. right. I’m trying to sort of look overall at outcomes, and maybe bust through a bit of the turf battles or the sort of the headaches and just, you know, I think you’ve got to do without making the process totally opaque. And you can’t say we’re undercutting accountability, but it’s like, what does accountability really mean? You know, what is it that we’re actually looking for, and not have 15 sets of metrics, but actually, like, simplify this, and really be clear about the outcomes and let the clients and the service provider serving those clients say what those are. I want the client, not just not just even on the service providers, I want the people who are actually receiving these services to help us define what that is. And folks who have say, come out of, you know, their issue or back adhearing to their medication or in a, you know, in transitionary housing now or have gone through it. Those who’ve actually navigated this, they’ve got it. That’s what we meant. I think Dr. Sherin, I what we’re talking about this new kind of stakeholder process, too.

Katie Vernoy 44:35
My I’m hearing kind of results driven funding. And so what would be the mechanism and maybe I’m in the weeds, but what would be the mechanism for for clients that are truly struggling, who are not as responsive to treatment, who are needing more services, and so it’s longer and more intense to get to that outcome. How do we make sure that providers are not saying well, okay, I’m going to only take on the easy clients because I can get them to an outcome. And that’ll only take me an hour a week. Whereas if I take on the clients who really need the services, that’s 10 hours a week, and I get paid the same, so I’m taking the easy clients.

Dr. Curley Bonds 45:17
That is a great question. I think there are a couple of options. And I’ll speak from my experience as a clinician. When you have wraparound services like full service partnership, or FSP, where you’re allowed to focus on the services that you need to provide, and you have a limited number of people that are responsible for providing those services to, let’s just say that in order to qualify for that enhanced level of service, you need to have a person who starts out with different checkmarks against them. I mean, I don’t like the word. But cherry picking is something that providers will do if they are told that this is what the end report card is, they’re going to pick the students who are going to succeed. So this is giving providers more resources to treat those people that are harder to engage. I say that they’re the folks who have tri-morbid conditions, often there’s medical problems, there is substance use disorders, and mental health problems. And sometimes they have involvement with the criminal justice system, because those are the folks that providers tend to shy away from. But let’s just say that, hey, if you take on a population of folks, and look at it from a population management perspective, that have all these other assorted problems, we’re going to give you a little bit of a pass, we’re also going to give you more resources, we’re going to allow your staff to help fewer clients assigned to them, so that they can do more. And then let’s just say that we’ll have to adjust those outcome measures because we’re not expecting all these people, you know, they’re not going to head off to get four year degrees. But let’s just say that we do things like keeping them out of jail, keeping them out of hospital, keeping them in community, which is really the essence of what we’re trying to do.

Curt Widhalm 46:51
What do we need to change policy wise and practice wise, in order to make this stuff happen?

Dr. Curley Bonds 46:58
Well, certainly legislation does help. But I think we need to think about what our community values. I think we need to get people to understand that mental health problems are just like physical health problems. I would say that in terms of one of the big things that our department is focused on, especially our director, is when does involuntary treatment become an option? And not waiting for the person to get to the place where they’re in such crisis that their life is in danger, but let’s just say that they’ve had a pattern evidenced by clinical interactions, and had admissions to hospital and just failure to thrive, so to speak, that we can do some interventions a little earlier before it gets to the point where we really can’t help them. I’ll take medical issues as an example. And this is something that we’ve tried to change the legislation, but it’s really within the law now, if someone’s at risk of death, it’s kind of very concretely interpreted as the person is suicidal, or they want to die by suicide, they’re had of weapon, where they’re going to jump. But really, they’re more subtle versions of killing oneself slowly through not taking care of diabetes or an infection. I think those people, we need to have laws that allow us to reach them a little sooner, so that we don’t have to be so concrete. And also to know that our legal process is really cumbersome. And we need to make it so that it’s easier, and that I don’t want to take away people’s liberties. But right now, if someone does need, say a conservatorship, the court process is very extensive, very lengthy, it can take months just to get a hearing, where you’re in front of the judge. And then if that person’s requests a jury trial, then it takes even longer. And the reimbursement for a lot of these things just isn’t there. So I would say that as important is putting in place policies that address the needs of people is putting in resources because you know, nobody wants an unfunded mandate. But often, we’re kind of told to do things like assisted outpatient treatment or full service partnership, but then we don’t get the dollars to support that. We’re hopeful that as we start looking at alternatives to having say, law enforcement involved, that some of the dollars that were previously diverted to building incarceration settings and paying for law enforcement, we think some of that money should come to mental health and we at times will need to partner with them. But there shouldn’t be a failed first approach where you need to be arrested or hospitalized before you get these enhanced services.

Curt Widhalm 49:29
For our listeners who are feeling a call to action out of this kind of stuff, right now, what without like everybody just calling and emailing you with suggestions that…

Senator Henry Stern 49:42
I don’t mind that.

Curt Widhalm 49:45
What do you encourage for our listeners who want to be part of this advocacy process early on and being able to help get this lifted to actually see this kind of stuff through?

Senator Henry Stern 49:56
You know, interfacing with now such as my office, but I think the other leaders in the Capitol on this and doing it, you know, everyone’s busy, but we’re going to try to create space for this conversation. And, you know, we’ve got a bill we’re introducing that is going to touch on this idea of defining relentless engagement. And sort of scoping out what we actually meant in that op ed, we wrote. There gonna be a few other bills moving. I’m working on one with Senator Eggman, actually two with Senator Eggman, around AOT reform and around medical condition and sort of changing out the 50 to 50 hearing processes work, to a number of other bills. But I would just say, using the channel you’ve got with a very open Senate office here and joining some of our future roundtables and actually weighing in and taking the time to tell us your, your on the ground experience. And like, what does that paperwork headache look look like that Katie’s talking about there. Like, we need that testimony and that data early. So, I hate to answer your question the way you said you wanted to avoid, which is just calling my office. But I think I think, you know, I do think it’s going we want you to weigh in on our legislation. And we’re going to need to be to kind of reach out beyond the Capitol bubble to do that. And so, I would say, reconvening in those sort of more informal settings where it’s not as postured as a committee hearing, but a place that we can actually do work will be big. And so it’ll be both. I think the budget process will be very active this year. And so if, if people are interested in a broader pilot, like I’m talking about, engaging their assembly members or their senators in wherever they live, especially if you’re in the Southland, here, we’re trying to rally the entire sort of LA County delegation, just as tip of the spear. But I think it’s true everywhere. Curt, you’ve been brave and you know, entrepreneurial over the years to reach out and have these meetings with us, right? I mean, you’ve sort of done that legwork. And I don’t know what your experience has been. But like, hopefully, it’s been good, where like, you feel like, okay, the phones picked up and like, I talked to their staff, or I talked to the Senator and doing that, that kind of engagement and bringing your expertise to bear with your member and saying, please go work with Senator Stern. And this big group on our mental health reform, you’d be doing us such a huge favor, because I need motivated legislators to put their sweat and time into this with me.

Curt Widhalm 50:16
All of my advocacy efforts, I’m always surprised at how human our representatives are, when we do actually contact them. It’s easy to get upset with people on social media and kind of de you know, dehumanize all of people in you know, 140 characters or less. But every time that I have reached out and worked, especially very proactively early in the process, it has always been a very warm welcome.

Senator Henry Stern 53:07
We can help you and your listeners get their their their sea legs here, too. We don’t want this to be an intimidating process. And sometimes it feels like, Oh, I’m calling my senator, like, are they really going to talk to me or not. But we are public servants at the end of the day. And I think this issue we’re so desperate for, like, real information that I think you’re going to find an open door. And if you don’t on, if you don’t find an open door in your particular district, do your member is like, not that into it, come over to us, we’ll help you out. And then we’ll send you back to them. And we need their vote.

Katie Vernoy 53:43
You’ll arm them with some information.

Senator Henry Stern 53:45
That’s it. That’s it.

Katie Vernoy 53:47
Join the mental health army.

Senator Henry Stern 53:49
That’s it. That’s what it’s gonna take. And people who have a lot of other important stuff to be doing to take their time to do advocacy. That’s the X Factor. And it’s so hard to ask you to do that. Because you have like trying to get through pandemic, you’re trying to do your job, trying to like live your life. It’s like, oh, and by the way, you have to be on a zoom call with the state senator or the state assembly member. It may seem like superfluous, but I’ll tell you, it can move mountains if you do it the right way.

Katie Vernoy 54:22
What was your favorite part about these interviews? For me, I loved the fact that we were calling both a person high up in Department of Mental Health and a state senator out on unfunded mandates and taking care of clinicians. And got their answers on the record.

Curt Widhalm 54:40
And I’m glad that they responded to us well, that I think that they both recognize it as a problem. And this is something where they were at least extremely polite. But I think that both of them have these kind kinds of considerations in mind, especially with the kinds of programs that they’re talking about where it takes long term commitment and retention of employees to be able to build the trust in these kinds of communities. And if we are going to keep people in these positions, they need to be compensated as some as a as a job, as a career that is there to actually work on this problem. And I know that anybody in any of those positions, who’s going to get their feet held to the fire there, that I’m impressed with the responses that they gave, and that gives me the courage and the hope that we can continue to advocate for. If we’re actually going to fix this, we need to take care of the clinicians as well.

Katie Vernoy 55:45
And I think there was hope I saw as well around being at the table. After our conversation with Senator Stern, he invited us to have more conversations. And with with Dr. Bonds, we were also seemingly welcomed into ongoing conversation., I just feel like these conversations are both important for our audience. But I think it’s also important to recognize that speaking out and showing up, can impact the conversations that are happening, as well as potentially shift how policies are implemented or even programs built.

Curt Widhalm 56:27
Actually, we’re gonna return to our regular programming for a little bit. But as we continue with this series, part of the extension of this is looking at how these very same clients that we’re talking about on this policy end of thing, end up interacting with some other systems. And so the continued focus within this special series here on fixing mental health care in America, we’re going to be talking with people who work with severe mental illness in jails, in hospital emergency rooms, and continuing to explore how all of these things are interrelated, especially when it comes to Senator Stern’s comments around all of the different departments that we ended up having mental health treatments be subservient, or second thoughts, too. And so to really be able to create a streamlined mental health system, we have to look at all of the places where mental health is being provided.

Katie Vernoy 57:23
And we know and we’ve already started reaching out to some of you, but we know that you’re on the frontlines. And so we’re hoping, dear modern therapists, that if you’re resonating with this, if you have something to add to this conversation, this is an ongoing process, this series that we’re putting together, and we still have time for more interviews and more interchanges around fixing the mental health system in United States. And so please, please, please reach out to us, you can certainly send us an email over at podcast at therapy reimagined.com. And you can certainly join our Facebook group, the Modern Therapists Group and join the conversations there. But we’d love to hear your perspectives on this as well, because this is not just the two of us, you know, blazing this trail, but actually getting real stories from real modern therapists.

Curt Widhalm 58:13
You can find all of our show notes at mtsgpodcast.com. And until next time, I’m Curt Widhalm, with Katie Vernoy. And a very special thank you to Senator Henry Stern and Dr. Curley Bonds.

… 58:21
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Curt Widhalm 58:23
I think we’re good.

Katie Vernoy 58:26
Yay.

Announcer 58:27
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