Sep 29, 2023
Mental health remains a significant area of concern in healthcare, especially after the pandemic. Universal screening tools, such as suicide risk assessment, have become a vital resource. One of the best ways to normalize mental health screening is by integrating it into your clinical electronic health record (EHR) workflow. However, with the influx in risk assessments, is your staff confident and prepared to handle the needs that arise? And does your organization have the infrastructure required to support those needs?
While telehealth has alleviated part of the burden for providers, it has also exposed many ways technology can create barriers to care, especially for communities who are already at a disproportionate risk for suicide and addiction. So, how can we better coordinate care across the illness-wellness continuum? Join Danny Gladden and Dr. Sarah Matt as they discuss the progress and opportunities to support mental health and improve suicide prevention.
Guests:
Danny Gladden, director of behavioral health and social care, Oracle Health
Dr. Sarah Matt, vice president of product strategy, Oracle Health
Hear them talk about:
Learn more about Oracle Inpatient and Outpatient Behavioral Health solutions
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Episode Transcript:
00;00;00;00 - 00;00;30;09
Danny Gladden:
You're listening to Perspectives on Health and Tech, a podcast by Oracle, where we have conversations on creating a connected healthcare world where everyone thrives. Hi there. I'm Danny Gladden, clinical social worker, director of behavioral health and social care here for Oracle. Dr. Matt, so glad you are here.
Dr. Sarah Matt:
Thank you, Danny. I'm so excited. You know, when it comes to suicide prevention, I think there's so many problems that we could talk about, but I think there's also solutions and things we can do next.
00;00;30;16 - 00;01;06;28
Danny:
So I'm excited that we're talking about this topic today. Yeah. And, you know, I think we've made some great progress. And I say we as the collective, we myself, I'm a clinical social worker that practices in mental health services. I've actually ran one of the National Suicide prevention lifelines, but suicide prevention takes all of us. And so, you know, I'm actually just curious, you know, you're a physician—think about your preparation into sort of medical school and residency.
00;01;06;28 - 00;01;26;15
And you know what does what did your preparation look like as a physician assessing for and treating suicide risk?
Sarah:
So I went to med school a long time ago, I will say, But when it comes to training, it was very traditional. So four years of med school. And then I did my residency in general surgery and my fellowship in Burns.
00;01;26;17 - 00;01;56;05
So I'd say that when you think about structured learning for mental illness, it was pretty scared. Most of it was around inpatient mental health services. So that's the rotations that we did in medical school. Now there was the small bits and pieces you may have gotten on your primary care rotation, but it really wasn't a focus. Now today are unclear how the clinical rotations are going and how the medical schools have changed their training.
00;01;56;12 - 00;02;19;17
But I would say that for the generations of doctors that are in my age category, it definitely wasn't something that was highly stressed.
Danny:
Yeah, you know, in the last couple of years, I get invited from time to time to come in and speak to first or second year medical students, particularly on the subject of suicide assessment, suicide prevention, collaborative safety planning.
00;02;19;17 - 00;02;58;19
And I, I think that structurally we've come a long way in normalizing the assessment of suicide risk. We have built it into much of our clinical workflows. The Joint Commission has guidance on how on how we assess for suicide risk. But I think even maybe where there is some competence that's been gained, there's still a gap in competence, particularly because of our own fears around, oh, if I ask someone about their suicide risk, what will I do with the information they provide me?
00;02;58;19 - 00;03;28;02
And particularly I think about our community access hospitals it at 2 a.m. who are sort of dealing with folks with limited resources, limited specialty consultations and whatnot. And so we celebrate universal screening tools such as the Columbia Suicide severity rating scale or many other really great evidence based, validated tools. But I know that we have a long, a long way to go.
00;03;28;02 - 00;03;54;21
And so as we think about September Suicide Prevention Awareness Month, we think about the physicians and the nurses and those and quality and compliance who are working to manage risk within a within a hospital health system. What are you seeing best practices from a technology perspective in how folks are leveraging technology to assess for and prevent suicide?
00;03;54;24 - 00;04;18;18
Sarah:
So it's hard to say best practices because I think we can still do a lot better. A lot of times everyone at the administrative level of a hospital system recognizes the importance from a regulatory perspective, from a compliance perspective for universal screening for suicide. And a lot of times this kind of shows up as an extra forum for the nursing staff on intake and things like that.
00;04;18;20 - 00;04;37;14
I think some of the things that are missing are the why and the importance. And so in a system where nurses, doctors and all the rest of the staff are highly strained, sometimes it's difficult to do another form. The other thing I had mentioned is that a lot of times this burden is put again on medical assistance and nurses.
00;04;37;21 - 00;05;02;21
The providers rarely do these screens themselves, and I think that oftentimes they might not know exactly what the screening is or how useful it can be. So for their patients, where they may have a potential and or a diagnosis to have some sort of depression, anxiety, etc., there's things that they can use. There's tools that are available and they may not have all of those at their disposal.
00;05;02;23 - 00;05;57;11
Danny:
Yeah, again, back to the community access hospital or the Alaska village that's using a health aide, for example. I think about that 2:00 in the morning assessment that the sort of mandatory requirement in policy to assess for suicide risk and the patient sort of reporting some level of suicidal thoughts and the provider, the nurse, the health aide in Nome, Alaska, wanting desiring to do what's best to keep the patient safe, but also have limited resources to be able to, you know, get that get that individual true specialty care.
00;05;57;13 - 00;06;47;01
And so, you know, celebrate universal screening. But also worry about actual the what happens on the other side of a positive screening. Is it possible that we are unintentionally over hospitalizing folks with the best of intentions or over incarcerating folks with the best of intentions to keep to keep patients safe and to keep the community safe because of lack of available responsiveness from trained mental health professionals who can a dig deeper into assess, assessing and understanding is there a true lethality risk or is this someone who has what we might call morbid ideation?
00;06;47;01 - 00;07;18;00
You know, if I didn't wake up tomorrow, that would be okay. But no, I'm not actually going to hurt myself. And then also the ability to build collaborative safety plans. Right. We don't get to draw blood or run an X-ray to know someone's risk, right? We get to ask a bunch of really intrusive questions and then the intervention is not is not often, particularly for suicide risk, medication in real time or a cast or another medical device.
00;07;18;02 - 00;07;47;26
It is a really intense creation of a collaborative safety plan that's a usable tool for the for the patient to leave the hospital to help them recognize their own triggers and to help them utilize their own resources, their own social network, for example, to mitigate that risk. And so I celebrate universal screening and I worry about the infrastructure that's behind it.
00;07;47;26 - 00;08;21;23
And let's just say, Dr. Matt, the you know, someone does have a risk of suicide or other psychiatric disorders that need to be treated. We have an infrastructure that doesn't have enough available beds and that folks often get housed in emergency departments, get housed in municipal jail cells. At times they get housed in med surge out of a desire to keep them safe.
00;08;21;23 - 00;08;42;24
Sarah:
I'm curious what thoughts you have kind of on the current state of mental health delivery. So I think that, you know, as we go past universal screening, we've just screened all these people, just like you mentioned. Now, what is the problem? And I think you're right. In a lot of environments, everything from primary care to pre-hospital to inpatient.
00;08;42;26 - 00;09;06;07
The next step is the hard part is the hard part for the patient who may need extensive therapeutics as well as medication. But from a provider perspective, what do you do next? If you are in a small rural hospital, you may not have access to a psychiatrist in the middle of the night. It might be that that personally comes every couple of days.
00;09;06;07 - 00;09;24;12
It might be that you do a televisit in the morning. What do you do for that patient in the meantime? And you may not have a lot of options. So I think you're stuck in a lot of ways. If you're in a primary care environment and you have a patient that has immediate needs, what are you going to do?
00;09;24;12 - 00;09;49;27
How do you help them? You have to send them to the hospital because there's nothing else you can do. It's outside of your scope. And then if you're on the streets, you know, from a pre-hospital perspective, having been an EMT in the past and still as a firefighter now in a volunteer situation, when people are on the streets having a crisis, it can be really hard for civilians to say this person is dangerous or this person is having a mental health crisis.
00;09;49;29 - 00;10;14;16
And I think that what we found is there's just not the resources to come and assist those folks. We have firefighters, EMTs and police officers. That's basically we have on the streets. We don't have an army of social workers like yourself, Danny, that I can deploy to help people who really need it. Now, I know there are some cities and some municipality that are doing more in that area, but we could do a ton more.
00;10;14;16 - 00;10;49;28
It's really hard, though. So what I'd say is I think that universal screening or again, providers, nurses all doing the best they can, they're seen issues, but they don't have a lot of options for the next step. And I think that's problematic.
Danny:
Yeah, for sure. You know, in many cities across the country, law enforcement, paramedics and EMTs, firefighters are are getting some really great training crisis intervention, training to help be able to sort of manage a mental health crisis and in real time.
00;10;50;00 - 00;11;17;12
But the scale of all of us need some variation of mental health first aid, which is available for free in most communities to be able to, you know, for getting CPR training and first aid training. Mental health first aid training is also an essential part of being able to being able to work with folks in real time and in our communities.
00;11;17;15 - 00;11;46;28
You mentioned telehealth visits, and I was, you know, drawing on my extensive experience in Alaska. And you know, we have sort of a paradigm shift through COVID by which much of behavioral health services that occurred within the four walls of a clinic or a hospital have now transitioned to the home. And that's so exciting. It was it was it was a big shift.
00;11;47;00 - 00;12;19;24
But I also think about folks living with severe mental illness, often who share other social vulnerabilities, such as such as housing insecurity, such as technology insecurity. And I'm wondering if you can talk a little bit about tech equity and sort of the division between the advancements in technology and the delivery of care and those who are also left behind?
00;12;19;26 - 00;12;43;28
Sarah:
Absolutely. So I think it's interesting, Alaska is a really good example of where telehealth has been immense in the ability to reach patients. But I think we take for granted that you can have, I'd say, health care deserts in a big city, health care deserts in the middle of the country, health care deserts, not just in a third world country per se, but right here in places that we go every day.
00;12;44;01 - 00;13;12;11
And a lot of that has to do with socioeconomic issues. But what does that mean from an access perspective? Do our patients have Internet? Do our patients have cell phones? Do they have smartphones? Do they have enough data on their data plan to utilize that smartphone for a television as an example? So when it comes to mental health, there's a whole slew of new commercial offerings for tele psychiatry where they even will prescribe medication.
00;13;12;11 - 00;13;33;28
And that's a really interesting option, especially when we think about the stigma around mental health services. And so getting more people to be served is wonderful, but it may be disproportionately serving certain populations. The populations that their only Internet is at the library are not going to be able to have a televisit in the middle of a public place.
00;13;34;01 - 00;13;58;24
Those folks that have a data plan that maybe isn't so large, are they really going to use our data plan to have a televisit? Hey, that's a tough one. And the other piece is really around different kinds of people. It's even harder for children and teens to get the services that they need because pediatric psychiatrists are far and few between at baseline.
00;13;58;27 - 00;14;28;07
And again, a lot of people, especially minors, but in teenagers need help. They need lots of different things, but they're not on their own insurance. They don't have the ability to do a lot of things someone who's not a minor can actually do. So I think it makes it even more difficult.
Danny:
Yeah, And I'm thinking on the other side of technology, I don't I don't know if you know this data point, but in the United States, only about 30% of behavioral health providers are using some sort of a digital record.
00;14;28;07 - 00;15;16;26
And so not only are we sort of pre info sharing and pre and are off, we there's really no consistent way in which mental health data is collected and shared. And so it means each time someone is having a mental health crisis or needs to present for a new mental health provider, they have to start from scratch and retell their entire story, answering intrusive questions from a provider who is a stranger to them. And I'm super excited about, you know, from a policy perspective, I think I think there's some there's some great work happening in the United States to sort of encourage and push providers towards a digital record.
00;15;16;26 - 00;15;54;00
And I'm sitting in London right now where the NHS has a mandated that mental health providers move that are part of the mental health trust move to use have a digital record. And I think the more we can sort of use what are now traditional technology tools in the delivery of mental health service says the better we'll be able to paint a true picture of a whole person as far as care is delivered and folk can be shared.
00;15;54;03 - 00;16;32;00
One treatment plan that covers hypertension and diabetes and depression and anxiety. And so I certainly am excited about the direction we're going. I'm wondering, as you know, we probably have a couple of minutes left here. If you see anything on the horizon that that's exciting from you or from you from a technology perspective.
Sarah:
So I think now, especially in a post-COVID world, consumers are demanding more and ultimately it means there's more solutions for folks to obtain mental health services, whether psychiatrist, counselors, you name it, in the palm of their hand.
00;16;32;03 - 00;16;56;16
Now, again, we mentioned there might be some equity issues there for sure, but at the same time, there's so many folks who may have access to a cell phone as an example that could really use that assistance. So I think that the advent of a more consumer focused, patient centered experience is helping there. And with these new digital consumer grade solutions, it means we're digitizing behavioral health, even if it's from the intake part.
00;16;56;16 - 00;17;28;07
For a patient that's half the battle. As a primary care provider now in chronic care management, it's really hard for me to have a new patient come in who might be an immigrant who does not have documentation, to have someone who lost their insurance. All these different problems at the charity clinic where I work to help them in their journey, because if I had documentation of what their issues had been and how they'd been treating the past, my scope of practice includes depression, so I could definitely help them with some therapy and some medications.
00;17;28;10 - 00;17;54;01
But my solo practice doesn't include things like bipolar as an example, so how can I get them to the right people? But if it's not documented, that's really difficult for primary care doctors in particular.
Danny:
Yeah, such a great point. No doubt we are moving into what I would call the techno, you know, the technology age for mental health and social care service delivery.
00;17;54;01 - 00;18;27;18
And that's, you know, from a from a consumer perspective and the quality of applications that are making their way into the market. But it's also from available free available community resources. And I think maybe we can just close with this for our US listeners, there's available 24/7, the National Suicide Lifeline in the last 12 months. It's gone from a gone from a 1-800 to a three-digit number that that all you have to do is remember that number is 988.
00;18;27;20 - 00;18;55;14
It's available for you in your community today. It's available 24/7/365. It's available for you to be anonymous if you so choose. It's also available for you if there's someone that you care about and you're trying to figure out how best to help this person out; the folks who answered the 988 number are happy to sort of talk through with you how best to help someone that you care about get connected to resources.
00;18;55;16 - 00;19;18;05
Unknown
When you dial 988, our veterans have a have a special have a special option to talk to someone who is understanding and committed to veterans-specific topics. And there's also Spanish speaking. There's also a Spanish-speaking prompt or a prompt for our LGBTQ+ listeners. And that's just in the United States. I know we have listeners from all over the world.
00;19;18;07 - 00;20;05;27
Most countries have some sort of a national Suicide Lifeline phone number. So September Suicide Prevention Month couldn't be more lucky to spend some time with you. Dr. Matt, thank you so much for sharing your expertise and experience with our listeners.
Sarah:
Absolutely. Thanks so much for having me.
Outro:
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