The Evolution of Mental Health Care: 200 years at Hartford HealthCare's Institute of Living: Episode 3

In recognition of the 200th anniversary of Hartford HealthCare’s Institute of Living (IOL) this year, Hartford HealthCare has partnered with the Connecticut Historical Society to present Common Struggle, Individual Experience: An Exhibition About Mental Health. 
 
 This special podcast series will take us through the history of mental health treatment in Connecticut, and behind the scenes of the IOL, the first psychiatric hospital in the history of Connecticut and the third in the nation.

The journey of mental health care through the 19th and 20th century is a fascinating one. The IOL played a significant role in fundamentally changing approaches to mental health – blazing a trail of moral, ethical treatment for others to follow.

In episode three, Hartford HealthCare’s Steve Coates talks to Dr. Javeed Sukhera, chair of psychiatry at the Institute of Living and chief of the department of psychiatry at Harford Hospital.

They discuss the current state and rising need of quality mental health access in the U.S., how the IOL has historically pivoted to meet the needs of any given era, and they also look at a future filled with new possibilities in the field of mental health treatment. 

Check the links in this episode’s notes to listen to episodes one and two which feature the Connecticut Historical Society’s exhibit and a fascinating conversation with Dr. Hank Schwartz. 

Be sure to follow Hartford HealthCare on your favorite podcast platform where more episodes focusing on the IOL’s history, present and future will publish throughout the year. Just search “Hartford HealthCare” on your favorite podcast platform.

The Evolution of Mental Health Care: 200 years at Hartford HealthCare's Institute of Living:
 
Episode One: featuring the Connecticut Historical Society

Episode Two: featuring Dr. Hank Schwartz

Learn more about Hartford HealthCare's Institute of Living

Learn more about Common Struggle, Individual Experience: An Exhibition About Mental Health Presented by Hartford HealthCare Institute of Living

Transcript

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SPEAKER_02 0:06

For us to be able to meet this new level of demand post-pandemic, plus the existing demand that was also gradually increasing pre-pandemic, we have to acknowledge that normal wasn't working.

SPEAKER_00 0:23

In recognition of the 200th anniversary of Hartford Healthcare's Institute of Living this year, Hartford Healthcare has partnered with the Connecticut Historical Society to present Common Struggle of Individual Experience. An exhibition about mental health. This special healthcare series will take us through the history of mental health treatment in Connecticut and behind the scenes of the Iowa, the first psychiatric hospital in the history of Connecticut. The journey of mental health care through the 19th and 20th century is a fascinating one. The Iowa played a significant role in fundamentally changing approaches to mental health. Chief of Psychiatry at the Institute of Living, the Chief of the Department of Psychiatry at Hartford Hospital, they discuss the current state and rising need of quality mental health access in the U.S., how the IOL has historically pivoted to meet the needs of any given era, and they also look at a future filled with new possibilities in the field of behavioral health. Here's Steve Camut.

SPEAKER_01 1:39

In the first podcast of the series about the IOL's 200th anniversary, we talked to Dr. Hank Schwartz about the history of the IOL and the history of behavioral health in context with this 200th anniversary. It was surprising to me and maybe to others that mental illness was recognized 200 years ago as an illness and was treated as such, although we hear about the draconian treatments. As we look ahead to say the hundred or two hundred years from now, how will people look at behavioral health and how we're handling it as a society? And really, what's the IOL's place in the future?

SPEAKER_02 2:15

So I think part of why the IOL is so special is because there is that history, that tradition, that connection with a mission that really centers around moral treatment, humane and dignified treatment that centers those we serve. And it's a mission that's connected to the people who work here, the physical space that we inhabit. But part of what's exciting about the future is just like we've done in the past, we are uniquely positioned to be a leader in reimagining and somewhat dismantling and rebuilding the way we view existing mental health services. Now, there's a lot of problems with the way we do inpatient care, for example. And you only need to ask a patient how that experience can be. Despite our best efforts, and of course we save lives and we help people. Overall, inpatient care throughout the country has changed into something that could be at times perceived as dehumanizing or at times perceived as coercive, where people who are admitted to inpatient psychiatry don't always feel like they have an ability to be human or to the connect to the things that make them human. So because we had that tradition, I believe under the leadership of HHC and today's day and age, we can be leaders in reconnecting ourselves with a more humane and dignified version of treatment and change the way we do inpatient care so that we focus on healing and so that we focus on bringing us back to that basic humanity and dignity that we were founded on.

SPEAKER_01 4:07

So, say looking ahead, 20 years, can you see us making improvements in treatment in behavioral health? Will there be leaps and bounds in terms of the difference people will see?

SPEAKER_02 4:19

So it totally depends on the day you catch me. Um some days I would say, yes, we will. We'll do it in six months and not six years. In some days, it's harder, and I'm more pessimistic. And I say that honestly because change is messy, and I think any of us that work in leadership roles appreciate that it's a beautiful mess, but it's a mess nonetheless. I believe in my heart of hearts that we will make change by leaps and bounds because we have to, because the cost of not doing it is too great. And I also believe that we can and will do it by co-designing that future with patients and families that we serve. Because by working together, we can actually get back to the heart of what we're supposed to be doing.

SPEAKER_01 5:18

When you talk about working together, is that more about families getting involved in this personalized care? What exactly does that mean?

SPEAKER_02 5:27

When I say co-design, what I mean is creating processes, not where we have a table and we invite patients and families set to our table, but where we engage proactively and meaningfully with patients, with communities, and seek their input on what care should look like and bring our input to the table and actually work together in partnership, not in tokenistic or superficial ways. Co-design isn't unfamiliar. Um, there's many places that have done this uh in different contexts. When I was earlier in my career, we had an initiative where we co-designed a program for young adults based on what they said, not what we needed. And so it it's this different kind of partnership that seeks to share decision making and power, essentially.

SPEAKER_01 6:23

With the pandemic and so much focus on depression, suicide, mental illness related to the pandemic, this seems like a pivotal moment for behavioral health to make some strides in in how treatment is identified or how behavioral health issues are identified and treatment is delivered.

SPEAKER_02 6:45

So at this moment, we are at a unique moment. And a moment like this hasn't happened for I'd say two generations. Yes, it can be an experienced in a challenging way, because of course, any chronic, unpredictable stress has mental health consequences, and it has had mental health consequences, which has led to more people seeking help and reaching out, which I think reminds us how important it is that when someone builds the courage to ask for help, that there's someone there when they need that. Now, for us to be able to meet this new level of demand post-pandemic, plus the existing demand that was also gradually increasing pre-pandemic, we have to acknowledge that normal wasn't working. So it's not about going back or thinking about things the way they were. I think we have to realize that we can either let this moment own us, or we can own this moment. We can open up the conversation about the shared vulnerability so many people experience, those who struggle and those who typically don't. And in that conversation, we can make a case for something better, a different way of approaching how we serve people who are struggling, a different way of delivering care that reaches out beyond the walls of the IOL, that embraces technology, that fosters early intervention so people don't have to be in their worst possible state to access help. And that fosters connections with communities, with primary care, um, with pediatrics, with schools, because it really is about reminding people who are struggling that they already have what they need. All we can do is create space for them to heal. And that space is here at the IWOL, and it will always be here. But we need to share and spread what we've got at 200 Retreat Avenue across the state of Connecticut.

SPEAKER_01 8:57

As we talk about strides made in behavioral health treatment and identification for illness, I think the elephant in the room for some might be, and not just at Hartford Healthcare, but across behavioral health care across the country, is access. How can people get in to see clinicians? And is there a solution? Will we see improvement there?

SPEAKER_02 9:18

So it's a loaded word. And I say frequently that the term access means different things to different people. For me, in my role as the leader of the IOL, uh, it is about when someone builds that courage to ask for help. Is there someone available to answer that call? Because that moment matters. And I think that there are honest challenges with supply and demand, there are challenges with the workforce, there's challenges with resourcing. But every red line that we thought we had was crossed in the past two years. And so again, we have to get outside of our heads and think about different ways to organize care delivery, different ways of thinking about step care so that people again get care earlier before the crisis happens. Different ways of making sure that some of the more complex patients and families who are struggling have uh more resources and supports and teams to support them. Mental health care is not one size fits all, and we can't make mental health care better by just looking at one part of it because then it's going to have unintended consequences on other parts of it. So I think to go back to your question, we need to make sure that access means something positive to people who need help. And if we want to get there, we need the support of our community, uh, and we need the support of our state and our country and people who haven't suffered to help us design different ways of making sure we provide access that uh don't assume that we're gonna have uh double or triple the number of mental health workers in the next few years. Because I don't think that's happening. But what we can start to think about is how do we look at our teams? How do we leverage people who are recovery support specialists who live with so much experience and skill?

SPEAKER_01 11:23

Uh, how do we change the way we do things? What about the field of psychiatry as a profession? Are people going into it? Will the need match the number of people that are choosing it as a profession in the future?

SPEAKER_02 11:39

So actually, people are going into psychiatry. There's increasing numbers, encouraging numbers of medical students interested in careers in psychiatry and even child psychiatry, which is my subspecialty. I think that there are a lot of people interested in psychiatry and other mental health professions. But the workforce needs pre-pandemic were so stark that we can't expect things to dramatically change in the short term. We can work to cultivate more interest, we can advocate for uh training and postgraduate training programs, which we are and doing, and we have some amazing programs at the IOL. But I do think that psychiatry also has to hold up the mirror to ourselves and ask how our profession uh has a history, as was shared in previous podcasts. But we have to acknowledge, we have to name some of the harms that have come from psychiatry and that some have experienced from psychiatry, even though we may not feel like we were part of it. Because for psychiatry to embrace the future, we also have to embrace different ways of approaching mental health and mental illness. We have to resist the over-pathologization, if that's the word, and over-medicalization of mental health, uh, because what we are hearing from patients is that that does not serve them well. And that the traditions of psychiatry, one of the gifts I say of being a psychiatrist is I get to hold a lot of knowledge and theory. Get to hold the psychological, the social, the developmental, and the biomedical. And so in my work with patients, I bring all of that to the table in terms of what I can offer and share. But our profession at times has shifted in many focused ways to exclusively biomedical thinking. And it's time, I would say, for us to open things up.

SPEAKER_01 13:43

Expand on that a little. As people go into medical school, if you had to talk to somebody who may be thinking of another path in medicine, what makes psychiatry special to you?

SPEAKER_02 13:54

I love my job. I truly do. I go home from most days and feel honored to be able to share space with young people who inspire me every day. Uh, I work with with children and youth and young adults, and I love my job because they challenge me to bring my most authentic self into our interactions. And when my kids were younger, you know, they'd say, What do you do? And I would explain it, but I would say, my job is actually to cultivate hope. And what greater job could there be than to help someone see in themselves that amazing strength and power that they had all along, to be able to give the gift of validation, to see someone else truly and help them transform from something they're struggling with into something that they uh survive and transcend. So I love being a psychiatrist. I can't say enough good things about it. And I hope that anybody, uh, whether they're in medical school and considering psychology, psychiatry or other professions like psychology, social work, uh, I think that it's it's all about leaning in to our humanity as health workers and embracing the gift of being able to help and support people through their struggles.

SPEAKER_01 15:16

Really can't talk about the IOL without talking about research and technology, as the IOL has been really a leader in that over these past 200 years. What do you see in the future for the IOL in those regards?

SPEAKER_02 15:29

So I am so excited about the future of research and innovation and knowledge mobilization at the IOL. The IOL is a unique place. I think people um don't always appreciate that it is not always typical for um a facility that isn't part of a university to have such a strong world-class leading-edge uh research footprint. And we do through our Olin Center, through our anxiety disorder center, through our clinical trials unit. So for our future, we honor the amazing things we're doing in the present. But we look forward to embracing the fact that by being this amazing space, we can be an incubator for ideas. We can be a generative place where we embrace innovation. Um, so research on things like psychedelics is definitely on the horizon for us to expand and consider, uh, continuing our tradition of amazing transformative neuropsychiatry research. And we're also leaning in to the topic of racial trauma, understanding it, how it works, and how to heal from it is another big area of growth for us. The most important thing that makes me excited is that we want to be a place where we do community-engaged research. Not research that gets published in some journal, that sits on a shelf or on a paywall behind a website for years, but research that is designed and driven by community, research that translates into impact and innovation that helps us move forward because truthfully, we don't have the greatest track record of transformative research discoveries and mental health. But we have all the conditions at the IOL to be a place for those kinds of ideas.

SPEAKER_01 17:21

Someone is sitting here 50, 100 years from now talking about the history of the IOL from this point. What do they say?

SPEAKER_02 17:29

Wow, that's a tough question. That's a tough question. So it's tricky too, because it feels like I don't know what's going to happen in the next five days, right? So 50 years from now, I mean, my my aspiration, my dream, I'll be long gone, probably from this world. And I would want people to say two things about DIY. First is it's a place where the people who work there feel seen, heard, valued, and are able to come into their work being the most authentic version of themselves and bring their fullness and their identity into their work and their humanity. And I also would dream that the Iowa would be a place that continues to be known worldwide, but known and associated with the place that centers the dignity and humanity of patients, a place that other jurisdictions and centers can say, look, look at what they're doing and how they've changed the way we do our core business of treatment in a manner that brings it back to the basics of connecting people with their own strength and their own power.

SPEAKER_01 18:45

Dr. Sukara, thanks so much, and congratulations on this milestone for you and for all of our colleagues at the IOL. My pleasure. Thank you.

SPEAKER_00 18:53

Thank you. Steve Coates and Dr. Sukara. Check the links in this episode notes to listen to episodes one and two, which feature the Connecticut Historical Society's exhibit and a fascinating conversation with Dr. Hank Schwartz. Be sure to follow Hartford Healthcare on your favorite podcast platform, where more episodes focusing on the IOML's history, present, and future will publish throughout the year. Just search Hartford Healthcare on your favorite podcast platform. For Hartford Healthcare, I'm Enron DePierre. Thanks for listening.