Head Inside Mental Health
Todd Weatherly, Therapeutic Consultant and behavioral health expert hosts #Head-Inside Mental Health featuring conversations about mental health and substance use treatment with experts from across the country sharing their thoughts and insights on the world of behavioral health care.
Head Inside Mental Health
Building a Treatment Community for Lasting Change with Dr. Amanda Fialk
Change doesn’t fail because people are weak; it fails because we try to do it alone. We sat down with Dr. Amanda Falk, Partner and Chief Clinical Officer at The Dorm, to unpack how a true treatment community helps young adults move from symptom relief to purpose-driven lives. Amanda brings deep clinical expertise in DBT, CBT, EMDR, and family therapy, but her core message is simple: relationships make recovery sticky, and the milieu is the method.
We dig into the first month of care, when few new clients feel “ready.” Instead of waiting for motivation, the team builds it through orientation, peer mentorship, and small wins. The milieu becomes a laboratory where patterns surface and are reshaped, then tested in the world while support remains close.
We also confront systemic barriers—insurance that splits housing from care, compressed timelines that undermine outcomes—and talk about what real change requires: programs collecting and sharing data, aligning on standards, and pushing policy so payers fund what works.
If you care about young adult mental health, transitional treatment, and outcomes that last, this conversation offers a clear, practical path forward. Subscribe, share with a friend who needs it, and leave a review to help more listeners find these tools and stories.
Hello, folks. Thanks for joining us on Head Inside Mental Health, featuring conversations about mental health and substance use treatment with experts, advocates, and professionals from across the country sharing their thoughts and insights on the world behavioral health care. Broadcasting on WPVM 1037, the voice of Asheville, Independent, Commercial Free Radio. I'm Todd Weatherly, your host, therapeutic consultant, behavioral health expert. It is my privilege and pleasure to welcome Dr. Amanda Falk to the show today. Dr. Falk is partner and chief clinical officer at the Dorm, a young adult treatment community with locations in New York City and Washington, D.C. Amanda received her master's degree and doctoral degree in social work from the Verse Weiler School of Social Work, where her dissertation focused on the clinical implications of countertransference and the treatment of addiction. She completed psychoanalytic training at the Institute for Contemporary Psychotherapy in New York City. Prior to joining the dorm in 2011, Amanda was the program director for the New York Center for Living and Flatbush Addiction Treatment Center. Amanda has specialized training in DBT, CBT, addiction, and co-occurring disorders, eating disorders, family therapy, EMDR, and motivational interviewing. She is a member of the National Association of Social Workers and the New York Academy of Medicine and an adjunct professor at the Verse Weiler School of Social Work. Amanda believes that clients and their families need to be treated holistically and from a strength-based perspective. And she has seen firsthand the healing power of therapeutic alliance. On the fun side, Amanda is a competitive figure skater growing up and a U.S. figure skating association gold medalist. Wow, that's cool. Um, she loves sports, but she is a huge New York Ranger hockey fan and an avid Crossfitter. Amanda, welcome to the show.
SPEAKER_02:Thank you. Thanks for having me.
SPEAKER_03:Absolutely. I've known you guys for quite some time now. The dorm, what's the how long has the dorm been around?
SPEAKER_02:Oh, about 17 years.
SPEAKER_03:Yeah, yeah. You guys have got a got a good run going. And I've seen you speak at conferences before. I think we met, I don't know, probably six or seven years ago. Um, and I've had I've had a couple of clients there at the dorm getting your services uh there in DC. But um, you know, you guys are in the dorm in and of the name, of course, speaks to you know, young adults and young adults that are looking at their futures, probably college involved on some level, um, and getting those things. But the thing that I really like um about just kind of the way that you present the program, and I'm sure this speaks to your expertise and training, which is it is a treatment community, which is a different way than most places talk about their program. So tell me a little bit about why you refer to it as a treatment community specifically.
SPEAKER_02:Yeah, I when I talk about the dorm and I sort of describe the model of the dorm, a core pillar of the model is community. Um it is really hard to be a young adult. Like period, full stop right there.
SPEAKER_03:Um just right, yeah.
SPEAKER_02:Especially being a young adult. If you think about it, being a young adult today is is so different than it was 20 years ago, 15 years ago, 30 years ago. It's it's a complicated time in the developmental life cycle. You add having uh a mental illness or having uh an addiction issue or an eating disorder on top of that, and it makes it even more complicated and challenging. And what we ask when young adults come to treatment is is a lot. It's it's no small feat. I always I I love to think about um this concept of change, right? And we think about change is what is change? And when you when you actually think about what change entails, change in and of itself is hard. And even small little changes are hard. I remember being in my, it was definitely the first week of social work school, and one of our professors said to us at the beginning of class, who in this class wears a watch? And you know, about 70% of us raised our hands and she said, I want you to take off your watch from the wrist that it's on, and I want you to put it on the other hand. So we did. And the second that I did that, I felt uncomfortable. Like my watch does not belong on my right wrist, it belongs on my left hand.
SPEAKER_03:Why am I doing this?
SPEAKER_02:Why am I doing this? Let me take it off my right wrist and put it back on my left wrist where it belongs. This is a small ask in theory, right? Just changing the hand that your watch is on. And it is a change and it felt uncomfortable. Even this small thing felt uncomfortable. If you think about like our basic routines, like when you shower, with the way you brush your teeth, like we all sort of have our routines and the way that we do things. You change one little thing in that routine and it feels uncomfortable. We are asking young adults to make pretty substantial changes in the way that they are living their lives, right? And not only are we asking them to make these changes, we're asking them to sustain these changes. They can't just switch the watch to the other rich again, right? We want them to make changes that they are sustaining. And I truly believe that in order for change or in order for recovery to be sticky, there has to be like the a sense of community. There has to be like this strong social support behind it. Um because it is so hard and they can't feel like they are alone and the only ones in this process. Also, we have to make the process fun. Like there has to be joy and laughter and fun and humor in this experience of recovery, of treatment, of change in order for it to feel like manageable on a day-to-day basis. We're asking them to sit in group therapy, to do individual therapy, to participate in coaching, to participate in family work. This is really hard work. There has to be some like relief throughout the day, too, where they can sit around with a bunch of their peers, play some board games, listen to music, hang out, and and have fun. So the community really provides that extra scaffolding to help hold these young people up uh in this process of change, which you know can feel like a roller coaster at times.
SPEAKER_03:Yeah. And I, you know, I just um I got back from Chicago though, we were at a a conference and had the guys from Mininger and McLean and somebody from Rogers, and everybody were talking about psychodynamics. And um, one of the things that really kind of stuck out to me, um, as as technical as we can get about all that stuff, is that you know, when you work with community as a as a as a medium by which treatment and care and change and healing takes place, there's this co-regulation thing that happens. Like even if I'm the person who's having a bad day today, I've got three, five, ten other people that I'm connected to who are having better days than I'm having. And I it's it's and I borrow their ability to regulate and handle the day.
SPEAKER_00:Yes.
SPEAKER_03:Um, and and of course, you know, part of what you're talking about in your training is something you see, you see the power of therapeutic alliance. It's like gaining this even more than any more than any methodology is this therapeutic alliance. And so and some of that therapeutic alliance also lives in community. When a per when you get a when you get a young adult that's coming in for the first time and they've got all the stuff that comes up for a person, maybe they've come from treatment or whatever, and they've had a lot of kind of you know, big T therapy. Um, what does it look like? You know, what do you you as a person seeing this person emerging into your community? Like, what is the practice that you engage in, welcoming them in and getting them uh to interface in a way that that's gonna help this change occur? Like, what's that process look like?
SPEAKER_02:Yeah, and I think community comes into that process as well. Um, I think it's um it's very rare to see a 19, 20, 21, 22-year-old walk into a trip treatment facility and say that they're excited to start treatment, they're ready to do the work, they're glad to be here.
SPEAKER_03:You know, you don't I'm stoked about being in treatment today, right?
SPEAKER_02:I mean, every so often you see it, but more often than not, um, young people are entering treatment and they're saying, I don't want to be here. Um, my parents are making me be here, school's making me be here, um using a lot of other language to describe their feelings about stuffing colourful language that we don't allow on the radio.
SPEAKER_03:Right, exactly.
SPEAKER_02:About start for treatment. Um, and that's normal. And I think we have to really normalize that not only for in young people who are entering treatment, but also for their families. I think this idea that um, you know, somebody has to be motivated or want treatment or um be ready for treatment for treatment to work, like I don't necessarily think that that's the case, right? Like the symptoms of their illness are are making it so that they they can't feel that motivation, that readiness. And that's our job, right? When they enter treatment and they're not excited to be there and it's everybody else's fault but theirs, it's our job to really try to engage them in this process. And um, oftentimes that work, ironically, also gets done a lot by the community. I can say so many things to a young person who's about to start this process. And and my words likely mean very little on that first day. They don't know me, we don't have a relationship. I am some adult in their life or some other adult in their life trying to, you know, you're barely oriented in the first place, right? You know, exactly. However, you know, when we give them their peer mentor, their buddy who um sits down with them or they're part of the orientation group where they're meeting a bunch of their cohort and other peers in the community who have been here who say, Listen, we didn't want to be here either, like at all. And this was what our day one looked like, but we promise you like just hang in there, it gets better. Um, this place isn't so bad. Um, the treatment actually works, you're gonna feel better. Those words coming from their peers do mean something to them. And I think what's so powerful in a therapeutic milieu is to have people that are at different stages in the process because for the people who have been in the milieu longer, they are farther along in their recovery process, they've accomplished many of their treatment goals, they have an opportunity to do service, to be a mentor to somebody who's coming in, which is really great for them and their sense of self-esteem and efficacy and identity. It's something to be really proud of. And um, for the newer folks to have somebody that's farther along to serve as a role, to be that role model, to be that inspiration, to not just be some other adult that's saying something, but to be somebody who's walking the walk, who's in their shoes saying, listen, you got this, it's gonna be okay, um, is is really powerful um for them as as well. So I always say to families and and to young adults that really the first week or month of treatment is really about um engagement, orientation, engagement, assessment. Like the work will get done after that, but you have to like really spend the time and the diligence that's necessary around that engagement phase, which involves not just the treatment team, but the whole community wrapping arms around the new person that's walking in the door.
SPEAKER_03:Yeah, the kind of be here now moment is what you're trying to get get to. And it, you know, people are we all get weirded out and we don't know what's happening. And and if we get to a place and we feel disoriented, we don't know what's happening. Theoretically, we can comfort that by having some version of the future that we feel like is reliable. Like I can, it's not right now, but I can hope. And it's like you give them all these people who've already lived some version of the future, and it's like, yeah, it's gonna be okay, actually. Just hang tight and just be with us. Um, and I I think that that's the you know, that's the gateway, right? That um people have to walk through. And ultimately, it's not just the gateway, it's also the goal, like being comfortable in discomfort, yeah, being able to like connect and make connections so that you can move forward and everything else. What you know, and that the the question I have about that is you know, you've created a program that revolves around some of these principles and and bringing a person in, but the end goal, the outcome is to be them arriving in the world in some way that allows them to navigate those things on their own and do and replicate that in some new place if that's where they're going. What's the what's the picture that you try and paint for them as they start to kind of come into their own bodies and know what they're doing? What kind of picture are you helping them paint for the future that you think is viable? Like what is the program trying to do uh with regard to that?
SPEAKER_02:Yeah, I mean, at the end of the day, I think that if I could sum it up in one sentence or two sentences, that we want to help young people to establish lives for themselves outside of treatment that feel meaningful and purposeful and aligned with their authentic self, right? So what that looks like for one young person might be very different than what it looks like for another, you know, and um each individual is is unique. And for for some, it might be that it is going back to a college campus and being able to um to be on a college campus in a manner that's congruent with wellness, right? For others, it might be that college isn't their thing. That's not sort of aligned with what's meaningful, purposeful, and authentic for for them. It might be finding gainful employment, you know, but I I think that um and and the range of what you know vocational areas of interest are also varies. I think a lot of young people um, you know, they they graduate from high school and they feel a lot of pressure once they enter college to sort of know what to major in, know what they want to be when when they grow up or when they graduate.
SPEAKER_03:Grow it up now. Figure it out, right?
SPEAKER_02:Figure it all out. You should know what your career is going to be. And a lot of that is dictated by who their community was growing up, right? And in some communities, everybody goes off to either be like in banking or lawyers or doctors, in other communities, it might look different. Um, but they haven't even had a chance to step back and think about wait, what do I want? Like what actually feels good for for me, not for my parents, not for everybody that I went to high school with, but you know, for for me. And I think that that when we look at treatment as a whole, many clients are coming to us experiencing some some pretty acute symptoms of their mental health diagnoses. And step one is of course, we want to provide symptom relief, right? The symptoms are what are making them feel really bad. The symptoms are what are interfering with their ability to experience meaning and purpose in their lives. So first we want to address the symptoms and we want symptom relief. Once we have symptom relief, that's just part one. Part two is now what? Now what do we want to do with this life and with the skills that we built? Because now we can actually have a life. Um, and I think too often treatment stops right after step one and doesn't address step two, and and step two really needs to be addressed. So a lot of times what we'll see is um what's so great about having a a therapeutic milieu is it it's almost like this little laboratory, right? So all of the patterns that tend to happen, like socially, interpersonally, emotionally in in life outside of treatment, tend to manifest themselves within the milieu, which is good. We want that because that's when we get it. Totally. Um and that's where we can do the work. We can say, hey, wait, it's happening. Remember how you told us about how in all of your friendships this tends to happen? It looks like it's starting to happen here too.
SPEAKER_03:So what here you are again?
SPEAKER_02:Right. So, how do we do it different? What skills can we use? And if we can create these corrective emotional experiences within the therapeutic milieu, then we have the opportunity to say, okay, now let's start thinking about doing some stuff outside of treatment. Do you want to take a class? Do you want to get a part-time job? Do you want to volunteer? Do you want to do an internship? Let's do some of that stuff so that you can practice all of these skills that you're learning here in the outside world while you still have us like kind of running alongside you. Um, and that's I think where the magic happens because then they start experiencing success outside of treatment, um, which then enables us to over time say, You got this. You've been working, you've been taking classes, like you're you're doing it, and you're doing it in a way that feels, again, meaningful, purposeful, authentic, all of those things, skillful.
SPEAKER_03:Yeah. And you know, I think that it's the thing that parents run into a lot. You know, you you kids, and this doesn't happen for all kids. I I I've got one in each category. I got one kid that's off at college, one kid that's living at home while doing his first year in college. But they go even then, they go off, and everything that they're doing is somewhere else.
SPEAKER_02:Right.
SPEAKER_03:And you know, and as a parent, you you hope what you've done is is said enough to them and given them enough tools to and so that when they do run into something that they can't navigate, that they they trust you, they come to you, and you're like, well, look, you know, just apply these things and and and make sure this goes well. But for for kids that may not have that relationship, or they're struggling with mental illness, or they, you know, they don't know where to turn, they end up in this, they end this this kind of black hole. You know, like there's they don't feel connected, they don't know what to do, they don't know where to turn for solutions, they don't have anybody they're willing to reach out to, they feel ashamed. There's all those pieces. The this thing about treatment community you got going on, of course, is the is the immediate feedback piece. It's like, I see that this happened, or I see that this pattern is emerging, or that you're having these feelings. We notice this with you right now. And we we want to know if you notice and what you plan to do differently about it, so that you can create a mechanism for how that's gonna exist later on. And that's got incredible power. What what's a like what's your favorite? I know you've had every every program. I mean, everybody has various levels of challenge, but there's always the one who comes in that looks hopeless. Like they're just they've got no skills and they feel like they got no grounding, and then they pass through the program and they come out the other side with this kind of incredible. Like, what's your what's one of your favorite stories? Success stories.
SPEAKER_02:Oh, that's such a hard question.
SPEAKER_03:They're all great. I know they're all great, but you I you know, you can you end up having your favorites without over-identifying somebody, of course, you know.
SPEAKER_02:Yeah, I mean, there's a handful that stick out to me. Um I'm trying to pick between these two, but um, maybe I'll do both. Um do both. Um you know, in addition to the to the community aspect of of the model, um we also have really tried to sort of reconceptualize what what coaching can look like in um within a clinical program. Um so when clients come to us, they they get both a therapist and a coach. But I think what's unique is that both people are licensed clinicians. So I might be the the coach for one client, but be a therapist for a different client. So you you play like sort of all the roles. And the reason that we decided that all of our coaches had to be licensed clinicians is because we discovered very early on that the coaching really needs to be very clinically informed, because it's oftentimes during the coaching that some of your most sort of profound and impactful clinical opportunities present themselves. And maybe that's because um coaching during coaching, it defenses are just down a bit. You know, coaching typically happens outside of a therapeutic office, right? More like in the community. Like coaching can happen in Central Park on a basketball court. It can happen walking around, handing out resumes, it can happen. Um it's it's more community-based, right? Um so oftentimes movement oriented, right?
SPEAKER_03:You know.
SPEAKER_02:So I think that there's just more opportunities and coaches can get, you know, pretty creative. So we we had um one client, this is a while back, that that we worked with who, you know, came to us with some pretty profound, complex trauma. And um, you know, therapy was extraordinarily difficult for her. Um, to the point that, you know, it she wasn't really able to talk, to participate. She was very, very shut down in a therapy session or in any therapy session. The second that she walked into a therapy room, she would sit in groups and and definitely would be like engaged. You could tell that she was listening, but active participation was not sort of something that that she was able to do in the beginning stages. Um, so that's sort of where the coaching came in. She had um she had one activity, one hobby that she absolutely was a passion passionate about. She loved, loved, loved rock climbing. Um and, you know, that was something that she would actually talk about, right? Like there wasn't much that she would want to engage in conversation about. But if you asked questions about rock climbing, um, she would communicate, talk about it, seem animated about it. So um we we had the idea that for coaching, why not go to like a rock climbing gym? It's hard in New York City. We're not just like scaling mountains in Central Park, right?
SPEAKER_03:Um, but there's there's something you go outside the city, you can find some. Outside the city there is, yeah.
SPEAKER_02:Um, but there's great rock climbing gyms. Like there's a couple of really good ones, and she knew all of them. So we thought, let's let's like actually do some like coaching, let's take her there and do that. It's her happy place. Let's see like how she presents. Um, lo and behold, um, you know, when coaching would happen within that sort of environmental context, she started talking more and about non-rock climbing topics as well. And a relationship actually started to form in a way that probably would have taken, I don't even know, maybe a year if it was just like conventional therapy. Um, and then of course, as we know, once you have that relationship, then work can actually start to get done. And slowly but surely we were able to start doing some more of like the conventional trauma work. But I think that what people don't realize, and we do a lot of research too, and when we look at um trauma and um sort of the data that we collect around trauma, um you know actually doing like certain physical activity can can help with symptoms of trauma. And um when you see improvements due to like physical interventions to help with trauma, then that is positively correlated with interpersonal symptoms that are a result of trauma, like impulsivity that's a result of symptoms of trauma. So like they're all sort of correlated with one another when you look at the subscales of trauma. So doing that physical work is impactful. But um relationship was formed, trauma work started happening, that then enabled her to open up, especially in the groups that were run by the person who she had been doing the coaching with, which then allowed her to open up in other groups that some of her peers were in. And it just becomes a snowball effect. But it started with rock climbing.
unknown:Right.
SPEAKER_02:That's where it started. Um so, like you said, you know, there's we all go to school and it's very important to um learn DBT and to learn EMDR and to learn CPT and to learn all of these different types of interventions. But at the end of the day, without the relationship, none of the interventions are going to work anyway. So we have to get creative in terms of how we are doing the engagement, how we are doing the relationship building and think outside of the box. Um, so that was a big one. And then of course, you know, we have, as I'm sure many people can relate to that work in the field, the clients that um literally won't get out of the car. Like won't get out of the car.
SPEAKER_03:I'm not going anywhere.
SPEAKER_02:I'm not going, I'm not getting out of this car. And you're spending like six hours trying to get them out of the car. I'm not coming, I'm not gonna talk to anybody, I'm gonna not gonna make friends with anybody, I'm not gonna do treatment. This is, and then it's oh it's those ones that you know, months in, you're like, okay, it's really getting ready to like discharge. I'm not ready to discharge yet. Um, and and those ones always make me um smile as well.
SPEAKER_03:Well, you know, I I like this rock climbing. I'm an old rock climber from from long ago. Um, and you know, the thing I used to say about rock climbing is that it will, you know, it just won't, it doesn't lie to you. You know exactly where you stand, you know, which way's up and which ways down, and and and there's also the centering, like you you keep your body, you keep your body centered so you can make a move or you can go, you know, climb to a location that you picked out or what have you. And I I I've always talked about that from a you know experiential standpoint, like the therapeutic value of that metaphor is really it sounds like she kind of got it on her own, too. Like she was able to process things while she was in this kind of the happy place, you know. But she started applying the rules of what you know rock climbing is to her expression in therapeutic work. That's really cool, you know. Do you are you in? I mean, I know that there's experiential aspects to the program. Like, how do you that's one example? Like, how do you intentionally engage uh some of the experiential stuff into the program?
SPEAKER_02:Yeah, I mean, I think that's where we have to really understand that our clients are our best teachers. They they tell us what they need and from and it changes as cohorts change too, right? But um having movement um as part of, again, when we look at the model, if community is a a core pillar, if individual therapy, if coaching, if you know psychiatry, movement, right? And nutrition are also core pillars. Um, having a yoga instructor, having um a personal trainer, having somebody who does mixed martial arts and you know uh mindful walks. We have a cohort of clients who this past summer were really into pickleball and you know, going out, doing that, but integrating in um, you know, the experiential, the movement um is is key to to wellness.
SPEAKER_03:Um that bilateral hemispheric coordination thing, right? The brain having to get both sides of itself working and talking to one another really helps for the emotional regulation in the end, ultimately is what it boils down to.
SPEAKER_02:And again, it's like it's like you know, sometimes it was on those walks to or from pickleball where like like really important conversations, like groups, group therapy like happens during those time periods.
SPEAKER_03:Right. You can't recreate it in a in a you know in a room in the end. Like it's hard to recreate that kind of thing in a room. I you know, I um in working with folks that are going, I mean, I think that transitional programming, you know, we we look at treatment and the and the flow of treatment. Somebody has a crisis, maybe they end up in the hospital, and then they maybe they go to residential care, right? It's pretty intensive. I I refer to residential care uh as often as not as a pressure cooker, like it's really designed to get in there and do a lot of kind of core work and things like that. But and I'm not and each of these can be a very important step, but I the rubber meets the road in programs like the door.
SPEAKER_02:Yes.
SPEAKER_03:The rubber meets the road where a person actually starts to be in the world and engage with others who are also being in the world and find community and find connection and find it in a way that causes them to sustain it elsewhere, to sustain it in what is ultimately to become an independent life, right? Um in all of your training, and and you spent time in residential programming, what made you focus and become, you know, a founder and help start up a program that was aimed at this transitional component? What was the thing that it that brought you there?
SPEAKER_02:Yeah, I mean, there's a couple of different things. Um, you know, when you look at generally speaking, outcomes and outcome data for both mental health and substance use treatment, quite frankly, it's it's unacceptable, right?
SPEAKER_03:Like right, it's really yeah, you're right. It is.
SPEAKER_02:Can you imagine? Like, I I remember like one time um I was thinking about I I hate going to the dentist. Like, I'm really bad about the dentist. I'm not, it's not my thing. Um can you imagine if when I went to the dentist right before he started or she started a procedure? Um they said to me, there's like a 35% chance that this will work. But only like a 35% chance that this procedure will work.
SPEAKER_03:We're really kind of not sure, actually, but here we go, right?
SPEAKER_01:I would say you must be, I'm not gonna do this then. Why would I do this? Like you have to tell me that this is gonna work.
SPEAKER_02:It's it's it's and I don't think that the that we hold ourselves as a field, generally speaking, for a variety of reasons, which would be a whole different podcast. Um right. I I think you know we need to hold we need to try to to do better and and to be better. And too often in mental health treatment, you see this revolving door. So often we get clients at at the dorm that are coming to us and it's their second, their third leave from from school, and it's like, oh, like that can't feel good. That's not that must it's not good for this young person to have to experience failure over and over and over. It's not true.
SPEAKER_03:Well, and they start to think that that's what's true about the world. They're just a failure all the time. Like they start to identify with it, right? You know?
SPEAKER_02:Totally. So um, I think one of the reasons why we we see so much recidivism in mental health and substance use treatment is because there's not adequate sort of transitional programming and transitional care. A lot of times people are feeling, you know, they're they're having a crisis, as you said. They're having some very acute symptoms. They go into a hospital or a primary facility, and then in some cases, like five days later in a hospital, they're they're out. Or if it's primary, maybe they're in like a 30-day program and they leave and just sort of do like a conventional IOP. And that that that jump, it's just too big of a jump, right? Um, we want to get treatment right and we want to get it right the first time so that it doesn't have to happen again. And that's where transitional treatment that is phased, that is titrated over time, that that includes um a reintegration component while treatment is still happening, um, is really important. The other thing I think that is really important is that um there's there's a variety of options available out there for young people. For some young people, doing transitional treatment in um a more um, you know, rural setting in the mountains or in the woods is is what speaks to them. And and that's great if that's what speaks to you. For other young people, doing that is not congruent with who they are, and being able to do really comprehensive um clinically sophisticated transitional treatment in an urban environment where they could see themselves like living long term is also a huge area of need. And I think that they're somewhere along the line, some like myth got created that in order to get comprehensive, sophisticated, um, intensive treatment, you have to like be in the middle of nowhere. And I I don't think that's true for everyone.
SPEAKER_03:It's the fool on the hill myth, right?
SPEAKER_02:Right, right. And for some for some members of our community, quite frankly, it's not an option because it's not like safe for them to be in those spaces. So um, yeah.
SPEAKER_03:Well, I think the dorm, you know, the program that you're running there and programs that are that are like it. I in in my world, I know that there's there's a number of them to choose from, but when I say there's a number of them, I'm like, what? 10? 15, maybe, you know. As far as the rest of the treatment world is concerned, that's where the big gap in this care model is, right? Um, and uh, you know, insurance is partly to blame. Yes, because you know, they won't pay for housing, and as soon as you separate the clinical from the residents, then you're you gotta pay for housing, they'll pay for the other, right? And you know, I was talking to what Dr. Dr. Ellenhard, not not too la Grosse Ellenhord recently, and and coming out of a a the mental health model, he's like, you know, we were closer in the 70s to what this model should actually look like than we are today, because managed care came in in the 90s, right, and you know, gave us treatment periods and separated things and tried to do a kind of an economic management model, a medical model, and overlay it on behavioral health. And it's like, well, you can't treat mental illness the same way, right? You just you just can't. So the question I'll ask you that I ask almost every guest is what do you think is gonna make the turn? Like when as a community and as a society, here in the US or elsewhere, when do you think that we're gonna recognize the model doesn't quite work and that we need we got some gaps to fill, yeah, and we're gonna we're gonna move our outcomes are terrible. And what are we gonna do about that? What do you think is gonna make the turn?
SPEAKER_02:Yeah. I I actually think that there's a a a pretty good awareness within the mental health field that this is the case. I I think the question is how do we um advocate for more macro level change so that we as mental health providers can actually do the work that we know works um and do it for everybody so that everybody has access to this. And if if if I think about what will need to happen for that to happen, um, I think there's a couple of things. A, um every program should be doing research and collecting data, like data, data, data, data, right? Because there's no arguing with reliable um and valid data and and research. Second, I think that like-minded folks working in the mental health field and programs need to come together and share data. Um and metadata, right? Yeah, and really like work together, form um alliances with one another so that we can together as a a field and as leaders within the field really work to disrupt the status quo, to advocate, to um to and I'm talking like more like you know, policy change, right? Like go to the Capitol, do advocacy work. Um, because at the end of the day, really what's standing in the way of acting. To the right type of treatment and us being able to provide the right type of treatment, you you kind of named it, is insurance companies, right? Um and government can do things to mandate that their policies change so that mental health care, physical health care um is guided by sound principles of care and created by clinicians who do treatment. Right. And not grounded in, you know, profits that insurance companies make. So I I do think that um, you know, a lot of us go to go to school myself included. I I went to school to um to become a clinician, right? To do the the therapeutic work on more of a micro level. And as I've grown in my career, that that will always be my passion. I love doing that work. And in order to help more people, I think we all have to carve out time to do that macro level advocacy work as well.
SPEAKER_03:Well, making statements like that and putting it out on the air, I'm with you on that that tack that we we we gotta gather together to help make some change. And part of this podcast is designed to get educate people so that we can start doing those things. But um, Dr. Falk, thank you so much for being on the show today. Um, I'll come down there to DC and be with you when we go, you know, Marchdon Capital to say hey. Mental health, mental health is important. Um, but this has been Dr. Amanda Falk with the Dorn. Amanda, thank you so much for joining me today, head inside Mental Health with Todd Weatherly on WPBM 1037, the voice of Ashwell. We'll see you next time.
SPEAKER_02:Thank you.
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