{"version":"1.0.0","segments":[{"startTime":0.399,"endTime":5.28,"body":"my future not being canceled is in your"},{"startTime":2.32,"endTime":5.28,"body":"hands like a tiny baby"},{"startTime":6.24,"endTime":11.14,"body":"bird"},{"startTime":7.68,"endTime":11.14,"body":"[Music]"},{"startTime":13.0,"endTime":19.119,"body":"right welcome to pactic today is"},{"startTime":15.48,"endTime":22.0,"body":"Wednesday February 14th 2024 I'm your"},{"startTime":19.119,"endTime":23.48,"body":"host Dr Ryan oir I am a fourthe"},{"startTime":22.0,"endTime":26.32,"body":"Psychiatry resident in the national"},{"startTime":23.48,"endTime":29.119,"body":"capital region this is a podcast about"},{"startTime":26.32,"endTime":31.039,"body":"Psychiatry and Neuroscience I'm lucky"},{"startTime":29.119,"endTime":33.12,"body":"today to be a to bring you an interview"},{"startTime":31.039,"endTime":35.84,"body":"with one of my residency colleagues Dr"},{"startTime":33.12,"endTime":39.04,"body":"Zack Brooks who is passionate about"},{"startTime":35.84,"endTime":41.6,"body":"serious mental illness what is serious"},{"startTime":39.04,"endTime":43.079,"body":"mental illness you might ask well that's"},{"startTime":41.6,"endTime":45.32,"body":"one of the things we're going to discuss"},{"startTime":43.079,"endTime":49.0,"body":"and you may be surprised when Dr Brooks"},{"startTime":45.32,"endTime":51.76,"body":"explains how it was first formally"},{"startTime":49.0,"endTime":54.52,"body":"defined now I'm going to shamelessly ask"},{"startTime":51.76,"endTime":57.0,"body":"that if you do find this podcast helpful"},{"startTime":54.52,"endTime":59.64,"body":"or interesting or a good way to fill"},{"startTime":57.0,"endTime":62.0,"body":"your morning or afternoon commute could"},{"startTime":59.64,"endTime":64.72,"body":"you please rate it in whatever app"},{"startTime":62.0,"endTime":67.24,"body":"you're using that would help me out a"},{"startTime":64.72,"endTime":70.4,"body":"lot also you can send me feedback by"},{"startTime":67.24,"endTime":73.4,"body":"filling out a form atactic tocom or you"},{"startTime":70.4,"endTime":76.159,"body":"can comment on episodes on YouTube"},{"startTime":73.4,"endTime":79.64,"body":"search for this podcast by typing"},{"startTime":76.159,"endTime":84.56,"body":"atactic into the search bar without"},{"startTime":79.64,"endTime":84.56,"body":"further Ado I give you Dr"},{"startTime":84.92,"endTime":89.439,"body":"Brooks welcome to the podcast Zach why"},{"startTime":88.04,"endTime":92.2,"body":"don't you take a minute to introduce"},{"startTime":89.439,"endTime":93.84,"body":"yourself uh to the listeners like and"},{"startTime":92.2,"endTime":96.399,"body":"tell us a little bit about"},{"startTime":93.84,"endTime":98.24,"body":"yourself hey Ryan thanks for having me"},{"startTime":96.399,"endTime":100.119,"body":"um a little behind the scenes for"},{"startTime":98.24,"endTime":102.64,"body":"everybody Ryan and I are friends in real"},{"startTime":100.119,"endTime":104.52,"body":"life we're casually kind of chatting"},{"startTime":102.64,"endTime":106.52,"body":"about topics that we're both interested"},{"startTime":104.52,"endTime":107.759,"body":"in in Psychiatry and felt like you know"},{"startTime":106.52,"endTime":110.04,"body":"what we might as well record it because"},{"startTime":107.759,"endTime":112.56,"body":"Ryan has a podcast um but these are the"},{"startTime":110.04,"endTime":114.799,"body":"same kind of soapbox style conversations"},{"startTime":112.56,"endTime":116.799,"body":"we would have on or off the air in the"},{"startTime":114.799,"endTime":119.119,"body":"um parking garage every now and then"},{"startTime":116.799,"endTime":121.88,"body":"yeah that's true that's true I I have"},{"startTime":119.119,"endTime":124.6,"body":"kept Ryan from leaving to vent about"},{"startTime":121.88,"endTime":126.68,"body":"something oh my name is Zach I'm also"},{"startTime":124.6,"endTime":128.16,"body":"I'm in The Residency with Ryan similar"},{"startTime":126.68,"endTime":130.36,"body":"disclaimer you know this is all my own"},{"startTime":128.16,"endTime":132.16,"body":"opinion I'm actually another behind the"},{"startTime":130.36,"endTime":133.76,"body":"scenes I'm a big fan of the show it's"},{"startTime":132.16,"endTime":135.8,"body":"pretty cool to come on the show for"},{"startTime":133.76,"endTime":137.36,"body":"something that you are already a fan of"},{"startTime":135.8,"endTime":139.08,"body":"and uh I'm particularly interested in"},{"startTime":137.36,"endTime":140.76,"body":"serious mental illness that's something"},{"startTime":139.08,"endTime":142.44,"body":"that I've been passionate about for a"},{"startTime":140.76,"endTime":144.239,"body":"long time um there's serious mental"},{"startTime":142.44,"endTime":145.76,"body":"illness in my family that's part of what"},{"startTime":144.239,"endTime":148.48,"body":"got me interested in psychiatry in the"},{"startTime":145.76,"endTime":151.0,"body":"first place um some people in my family"},{"startTime":148.48,"endTime":153.879,"body":"got access to behavioral health services"},{"startTime":151.0,"endTime":155.4,"body":"and lived fairly functional lives a lot"},{"startTime":153.879,"endTime":158.16,"body":"of people did not have access to Bor"},{"startTime":155.4,"endTime":160.44,"body":"health services and have not been nearly"},{"startTime":158.16,"endTime":164.239,"body":"as functional in and out of psychiatric"},{"startTime":160.44,"endTime":166.92,"body":"hospitals State hospitals Etc jail um"},{"startTime":164.239,"endTime":169.76,"body":"prison Etc so I've seen directly"},{"startTime":166.92,"endTime":171.48,"body":"firsthand the effect that access to"},{"startTime":169.76,"endTime":173.8,"body":"Psychiatric Services particularly for"},{"startTime":171.48,"endTime":175.239,"body":"people with serious mental illness can"},{"startTime":173.8,"endTime":176.599,"body":"do and that's what made me interested in"},{"startTime":175.239,"endTime":178.4,"body":"Psychiatry it's what made me interested"},{"startTime":176.599,"endTime":180.0,"body":"in serious mental illness which I keep"},{"startTime":178.4,"endTime":181.64,"body":"using that term what we can talk more"},{"startTime":180.0,"endTime":185.28,"body":"about that later yeah I was gonna I was"},{"startTime":181.64,"endTime":187.12,"body":"gonna uh interrupt you for and say so um"},{"startTime":185.28,"endTime":188.959,"body":"casually if people say serious mental"},{"startTime":187.12,"endTime":192.319,"body":"illness I think people kind of get this"},{"startTime":188.959,"endTime":194.519,"body":"idea of okay that's that's a bad one"},{"startTime":192.319,"endTime":198.159,"body":"right that's something that like affects"},{"startTime":194.519,"endTime":201.799,"body":"people's lives uh a lot probably but I'm"},{"startTime":198.159,"endTime":203.2,"body":"sure there are other definitions and you"},{"startTime":201.799,"endTime":204.68,"body":"had mentioned getting services and"},{"startTime":203.2,"endTime":206.68,"body":"things like that so I think there are"},{"startTime":204.68,"endTime":208.72,"body":"specific definitions that are important"},{"startTime":206.68,"endTime":211.36,"body":"when you're talking about how people get"},{"startTime":208.72,"endTime":213.76,"body":"services or how get funded by the"},{"startTime":211.36,"endTime":215.12,"body":"government yeah and again I think for"},{"startTime":213.76,"endTime":216.64,"body":"behind the scenes for The Listener this"},{"startTime":215.12,"endTime":218.439,"body":"is what I mean that this would be a"},{"startTime":216.64,"endTime":220.439,"body":"conversation that we would have anytime"},{"startTime":218.439,"endTime":222.08,"body":"because it's just going already but yeah"},{"startTime":220.439,"endTime":224.879,"body":"so there's two terms that sometimes are"},{"startTime":222.08,"endTime":226.84,"body":"used interchangeably P SMI which is"},{"startTime":224.879,"endTime":229.2,"body":"persistent serious mental illness and"},{"startTime":226.84,"endTime":230.92,"body":"then serious mental illness and"},{"startTime":229.2,"endTime":233.72,"body":"sometimes those are used interchangeably"},{"startTime":230.92,"endTime":235.439,"body":"long story short we're talking about"},{"startTime":233.72,"endTime":236.76,"body":"mental health conditions that cause a"},{"startTime":235.439,"endTime":239.0,"body":"significant amount of functional"},{"startTime":236.76,"endTime":243.239,"body":"impairment in multiple avenues that"},{"startTime":239.0,"endTime":247.64,"body":"includes occupational social personal"},{"startTime":243.239,"endTime":249.159,"body":"relationships Etc so this term actually"},{"startTime":247.64,"endTime":251.4,"body":"like the concepts behind this have been"},{"startTime":249.159,"endTime":253.48,"body":"known for a long time right you know for"},{"startTime":251.4,"endTime":256.239,"body":"Millennia people have described in"},{"startTime":253.48,"endTime":257.919,"body":"various writings people who in old days"},{"startTime":256.239,"endTime":261.959,"body":"they used to say maybe like cultural"},{"startTime":257.919,"endTime":263.4,"body":"things such as had demons um or witches"},{"startTime":261.959,"endTime":266.52,"body":"and then later on you know people would"},{"startTime":263.4,"endTime":268.72,"body":"say that they were odd or you know"},{"startTime":266.52,"endTime":271.199,"body":"dementia precox even right like early on"},{"startTime":268.72,"endTime":273.36,"body":"set of dementia is what appeared like um"},{"startTime":271.199,"endTime":275.8,"body":"Catatonia has been noted for hundreds of"},{"startTime":273.36,"endTime":278.84,"body":"years and so but the term serious mental"},{"startTime":275.8,"endTime":280.52,"body":"illness actually came in 1992 that's the"},{"startTime":278.84,"endTime":283.16,"body":"first time it was like brought together"},{"startTime":280.52,"endTime":285.919,"body":"as a concept and like a lot of things it"},{"startTime":283.16,"endTime":288.68,"body":"was brought together because of funding"},{"startTime":285.919,"endTime":290.639,"body":"the alcohol drug abuse and mental health"},{"startTime":288.68,"endTime":293.84,"body":"administration reorganization Act of"},{"startTime":290.639,"endTime":296.039,"body":"1992 it's a big mouthful I'm a ctory"},{"startTime":293.84,"endTime":298.4,"body":"nerd so I think it's kind of a cool"},{"startTime":296.039,"endTime":300.199,"body":"aspect and Ted Kennedy was the person"},{"startTime":298.4,"endTime":303.08,"body":"who presented that and and was kind of"},{"startTime":300.199,"endTime":305.479,"body":"the main sponsor and it was almost 30"},{"startTime":303.08,"endTime":307.08,"body":"years it was 29 years after his brother"},{"startTime":305.479,"endTime":309.28,"body":"introduced the Community Mental Health"},{"startTime":307.08,"endTime":310.479,"body":"act which is was well intentioned but"},{"startTime":309.28,"endTime":311.759,"body":"kind of is how we ended up where we are"},{"startTime":310.479,"endTime":313.479,"body":"today when it comes to people with"},{"startTime":311.759,"endTime":316.6,"body":"serious mental illness explain what you"},{"startTime":313.479,"endTime":318.12,"body":"just meant by that yeah you know a"},{"startTime":316.6,"endTime":320.88,"body":"little another behind the scenes I would"},{"startTime":318.12,"endTime":323.28,"body":"say um Ryan has three podcasts from"},{"startTime":320.88,"endTime":325.28,"body":"December that are related to"},{"startTime":323.28,"endTime":328.6,"body":"schizophrenia um antis"},{"startTime":325.28,"endTime":330.199,"body":"psychotics anti Psychiatry Etc that are"},{"startTime":328.6,"endTime":332.479,"body":"related to anti psychotics and I think"},{"startTime":330.199,"endTime":334.8,"body":"that I see our discussions honestly as"},{"startTime":332.479,"endTime":336.0,"body":"like a continuation of your podcast"},{"startTime":334.8,"endTime":338.56,"body":"already so I would highly encourage you"},{"startTime":336.0,"endTime":339.68,"body":"to go listen to those um but you one of"},{"startTime":338.56,"endTime":342.72,"body":"the things you mentioned is like in the"},{"startTime":339.68,"endTime":344.24,"body":"early 1950s plor promazine or Thorazine"},{"startTime":342.72,"endTime":346.0,"body":"was first discovered right it was"},{"startTime":344.24,"endTime":347.88,"body":"discovered in France accidentally right"},{"startTime":346.0,"endTime":350.56,"body":"it was they were looking for things to"},{"startTime":347.88,"endTime":352.319,"body":"help with surgery anesthesia um and help"},{"startTime":350.56,"endTime":354.84,"body":"to sedate people and they're like well"},{"startTime":352.319,"endTime":357.08,"body":"they're not that sedated for surgery but"},{"startTime":354.84,"endTime":359.0,"body":"people who are Manish seem to be calmer"},{"startTime":357.08,"endTime":360.479,"body":"now it is a it's kind of sad that most"},{"startTime":359.0,"endTime":363.28,"body":"of the drugs we give at least the"},{"startTime":360.479,"endTime":366.84,"body":"classes were accidentally discovered"},{"startTime":363.28,"endTime":369.12,"body":"especially in Psychiatry exactly yeah go"},{"startTime":366.84,"endTime":370.039,"body":"ahead and when we say serious mental"},{"startTime":369.12,"endTime":371.479,"body":"illness I'm going to do a more of a"},{"startTime":370.039,"endTime":373.96,"body":"definition later but I I want you to"},{"startTime":371.479,"endTime":375.68,"body":"think about things that are so disabling"},{"startTime":373.96,"endTime":377.4,"body":"that you are likely not able to function"},{"startTime":375.68,"endTime":380.0,"body":"on your own without significant support"},{"startTime":377.4,"endTime":381.88,"body":"schizophrenia bipolar one disorder sto"},{"startTime":380.0,"endTime":383.08,"body":"affective disorder it's not quite that"},{"startTime":381.88,"endTime":384.599,"body":"narrow we'll talk a little bit more"},{"startTime":383.08,"endTime":386.28,"body":"about the actual definition but just"},{"startTime":384.599,"endTime":388.36,"body":"things that would cause such significant"},{"startTime":386.28,"endTime":390.12,"body":"functional impairment particularly pre1"},{"startTime":388.36,"endTime":391.52,"body":"1950s medic"},{"startTime":390.12,"endTime":393.16,"body":"that you were likely not able to live on"},{"startTime":391.52,"endTime":395.479,"body":"your own so for hundreds of years we"},{"startTime":393.16,"endTime":397.44,"body":"have people who when they became sick"},{"startTime":395.479,"endTime":398.84,"body":"quite sick mentally with mental illness"},{"startTime":397.44,"endTime":401.12,"body":"and suard we would become"},{"startTime":398.84,"endTime":403.039,"body":"institutionalized or hospitalized and"},{"startTime":401.12,"endTime":404.8,"body":"potentially for the rest of their life"},{"startTime":403.039,"endTime":406.759,"body":"and for a while that was very"},{"startTime":404.8,"endTime":409.68,"body":"prison-like right even until like the 17"},{"startTime":406.759,"endTime":411.96,"body":"1800s where people finally Unchained"},{"startTime":409.68,"endTime":414.0,"body":"from um the walls and things like that"},{"startTime":411.96,"endTime":416.12,"body":"and you know there's a lot of kind of"},{"startTime":414.0,"endTime":417.4,"body":"dark history of things that they tried"},{"startTime":416.12,"endTime":419.16,"body":"um you know we don't need to necessarily"},{"startTime":417.4,"endTime":420.879,"body":"get into that right now we can at some"},{"startTime":419.16,"endTime":423.16,"body":"point if you want but you know pouring"},{"startTime":420.879,"endTime":425.44,"body":"water on people in ice bats and Insulin"},{"startTime":423.16,"endTime":427.44,"body":"Comas and you know I mean pretty"},{"startTime":425.44,"endTime":429.319,"body":"inhumane things at times just because"},{"startTime":427.44,"endTime":431.0,"body":"they didn't know what to do um but"},{"startTime":429.319,"endTime":432.8,"body":"well-intentioned does not mean that you"},{"startTime":431.0,"endTime":435.68,"body":"was right"},{"startTime":432.8,"endTime":437.599,"body":"exactly so we get into like the 1950s"},{"startTime":435.68,"endTime":439.12,"body":"chlorpromazine thorine is developed and"},{"startTime":437.599,"endTime":441.039,"body":"in America at that time there's half a"},{"startTime":439.12,"endTime":442.199,"body":"million people are institutionalized and"},{"startTime":441.039,"endTime":443.919,"body":"the interesting part is that like there"},{"startTime":442.199,"endTime":447.0,"body":"would be people with Advanced"},{"startTime":443.919,"endTime":450.28,"body":"Alzheimer's Dementia in their 70s next"},{"startTime":447.0,"endTime":452.319,"body":"to a 22-year-old with bipolar one Mania"},{"startTime":450.28,"endTime":454.52,"body":"but we didn't have treatments for either"},{"startTime":452.319,"endTime":455.759,"body":"so we just would put anybody who the"},{"startTime":454.52,"endTime":458.479,"body":"families felt like they couldn't live at"},{"startTime":455.759,"endTime":459.8,"body":"home would just go there chlorpromazine"},{"startTime":458.479,"endTime":461.44,"body":"and antis psychotics starting to be"},{"startTime":459.8,"endTime":463.479,"body":"developed in the 50s change totally"},{"startTime":461.44,"endTime":465.639,"body":"changes the game right people in France"},{"startTime":463.479,"endTime":467.84,"body":"and in Europe to start with get"},{"startTime":465.639,"endTime":468.96,"body":"medication and they leave they go home"},{"startTime":467.84,"endTime":470.08,"body":"they haven't seen their family in a"},{"startTime":468.96,"endTime":472.319,"body":"decade and they come back and the"},{"startTime":470.08,"endTime":474.12,"body":"family's like oh my God you look a lot"},{"startTime":472.319,"endTime":476.4,"body":"similar to what you used to look like is"},{"startTime":474.12,"endTime":478.28,"body":"a revolution yeah yeah absolutely you"},{"startTime":476.4,"endTime":480.12,"body":"know it got to the point that after you"},{"startTime":478.28,"endTime":482.36,"body":"know over a decade since the medication"},{"startTime":480.12,"endTime":483.879,"body":"came out John Kennedy and and there's a"},{"startTime":482.36,"endTime":485.28,"body":"lot of books about the kennedies related"},{"startTime":483.879,"endTime":487.12,"body":"to mental health conditions in their"},{"startTime":485.28,"endTime":489.12,"body":"family um one of the ones that was that"},{"startTime":487.12,"endTime":490.72,"body":"their sister is kind of like was"},{"startTime":489.12,"endTime":492.96,"body":"hospitalized believe at St Elizabeth in"},{"startTime":490.72,"endTime":494.159,"body":"DC at one point and so um but there was"},{"startTime":492.96,"endTime":496.12,"body":"serious mental illness and she was"},{"startTime":494.159,"endTime":498.28,"body":"pretty disabled um due to her mental"},{"startTime":496.12,"endTime":499.599,"body":"health conditions and so there was in"},{"startTime":498.28,"endTime":501.24,"body":"their family they were quite passionate"},{"startTime":499.599,"endTime":504.08,"body":"about getting access to mental health"},{"startTime":501.24,"endTime":507.52,"body":"care and the Community Mental Health Act"},{"startTime":504.08,"endTime":509.759,"body":"was designed essentially to try to say"},{"startTime":507.52,"endTime":512.08,"body":"hey we now have medications"},{"startTime":509.759,"endTime":513.8,"body":"that can help a lot of these people no"},{"startTime":512.08,"endTime":515.12,"body":"longer need to be again it was literally"},{"startTime":513.8,"endTime":516.959,"body":"called institutionalized not even"},{"startTime":515.12,"endTime":518.68,"body":"hospitalized because you go there and"},{"startTime":516.959,"endTime":521.44,"body":"you're"},{"startTime":518.68,"endTime":523.12,"body":"there you to get treated they just stay"},{"startTime":521.44,"endTime":525.76,"body":"there so that you don't bother anyone"},{"startTime":523.12,"endTime":527.76,"body":"else correct yeah yeah you might just"},{"startTime":525.76,"endTime":529.08,"body":"roam the drowns you know or you know or"},{"startTime":527.76,"endTime":530.48,"body":"anything like like no one's necessarily"},{"startTime":529.08,"endTime":534.519,"body":"saying that you're like getting better"},{"startTime":530.48,"endTime":535.6,"body":"or even staying the same you're just not"},{"startTime":534.519,"endTime":537.519,"body":"you know your family couldn't take care"},{"startTime":535.6,"endTime":538.92,"body":"of you and now you're in removed from"},{"startTime":537.519,"endTime":541.12,"body":"them and the ones that cost more money"},{"startTime":538.92,"endTime":545.0,"body":"probably provided more comforts you know"},{"startTime":541.12,"endTime":546.839,"body":"and freedom for the uh I guess did they"},{"startTime":545.0,"endTime":549.2,"body":"call them patients or did they call"},{"startTime":546.839,"endTime":550.48,"body":"residents it depends on where they were"},{"startTime":549.2,"endTime":552.279,"body":"depending on the institution some of"},{"startTime":550.48,"endTime":553.279,"body":"them hardly even had Physicians right"},{"startTime":552.279,"endTime":554.959,"body":"some of them literally were"},{"startTime":553.279,"endTime":556.24,"body":"psychoanalysts or or if they were"},{"startTime":554.959,"endTime":558.519,"body":"Physicians they weren't practicing with"},{"startTime":556.24,"endTime":561.24,"body":"medications and so yeah I was listening"},{"startTime":558.519,"endTime":563.72,"body":"to a uh story of this journalist who got"},{"startTime":561.24,"endTime":566.079,"body":"herself committed in New York City to"},{"startTime":563.72,"endTime":568.64,"body":"one of their asylums for women and she"},{"startTime":566.079,"endTime":570.72,"body":"like she had a hard time getting out but"},{"startTime":568.64,"endTime":572.04,"body":"when she finally did she did it just to"},{"startTime":570.72,"endTime":574.48,"body":"get in there and see what it was like"},{"startTime":572.04,"endTime":578.079,"body":"and she wrote about it afterwards and it"},{"startTime":574.48,"endTime":580.76,"body":"was pretty awful yeah yeah these were"},{"startTime":578.079,"endTime":583.48,"body":"frequently not well taken care of"},{"startTime":580.76,"endTime":585.0,"body":"locations and also too you know now it's"},{"startTime":583.48,"endTime":587.6,"body":"very common place we think of least"},{"startTime":585.0,"endTime":589.2,"body":"restrictive environment but for a lot of"},{"startTime":587.6,"endTime":590.959,"body":"people that seemed like at the time that"},{"startTime":589.2,"endTime":592.68,"body":"was the least restrictive because there"},{"startTime":590.959,"endTime":595.24,"body":"were families were concerned hey if this"},{"startTime":592.68,"endTime":597.839,"body":"person is roaming around if grandpa or"},{"startTime":595.24,"endTime":600.16,"body":"Grandma's roaming around they may get"},{"startTime":597.839,"endTime":601.8,"body":"hit by a car or they may you know"},{"startTime":600.16,"endTime":603.279,"body":"trespass or you know and we don't know"},{"startTime":601.8,"endTime":605.12,"body":"what to do right and I think a lot of"},{"startTime":603.279,"endTime":607.04,"body":"times again well-intentioned families"},{"startTime":605.12,"endTime":609.0,"body":"just we don't know what to do and so"},{"startTime":607.04,"endTime":610.399,"body":"they would go there but least"},{"startTime":609.0,"endTime":612.44,"body":"restrictive environment now that there's"},{"startTime":610.399,"endTime":614.56,"body":"medications the idea is that maybe"},{"startTime":612.44,"endTime":616.0,"body":"people don't have to be"},{"startTime":614.56,"endTime":617.519,"body":"institutionalized for the rest of their"},{"startTime":616.0,"endTime":619.12,"body":"life which is well-intentioned that's"},{"startTime":617.519,"endTime":620.16,"body":"great if you can go home and live in"},{"startTime":619.12,"endTime":624.399,"body":"society"},{"startTime":620.16,"endTime":625.68,"body":"again the problem is that the idea"},{"startTime":624.399,"endTime":628.079,"body":"behind the Community Mental Health Act"},{"startTime":625.68,"endTime":630.12,"body":"of 1963 was to take the funding you know"},{"startTime":628.079,"endTime":631.8,"body":"500,000 people institutionalized"},{"startTime":630.12,"endTime":633.399,"body":"approximately obviously not all of them"},{"startTime":631.8,"endTime":635.44,"body":"are going to be removed but even if it"},{"startTime":633.399,"endTime":636.92,"body":"was 3 or 400,000 like that's a"},{"startTime":635.44,"endTime":638.88,"body":"significant amount shifting to"},{"startTime":636.92,"endTime":640.68,"body":"communities the idea being that that"},{"startTime":638.88,"endTime":642.16,"body":"funding would then go to Community"},{"startTime":640.68,"endTime":645.079,"body":"Mental Health Centers that was the"},{"startTime":642.16,"endTime":646.48,"body":"premise is that you know and in fact"},{"startTime":645.079,"endTime":649.32,"body":"you'd think it' be even cheaper because"},{"startTime":646.48,"endTime":652.399,"body":"you're keeping people full-time 24 hours"},{"startTime":649.32,"endTime":653.72,"body":"a day and so in an Ideal World now we"},{"startTime":652.399,"endTime":655.079,"body":"can move people to Community Mental"},{"startTime":653.72,"endTime":656.32,"body":"Health Centers we can maybe even see"},{"startTime":655.079,"endTime":657.6,"body":"more people and we can get them more"},{"startTime":656.32,"endTime":658.6,"body":"services and all these kind of aspects"},{"startTime":657.6,"endTime":661.36,"body":"but then they can go home and live with"},{"startTime":658.6,"endTime":662.639,"body":"their family and not have to be in a a"},{"startTime":661.36,"endTime":664.72,"body":"did for all intents and purposes an"},{"startTime":662.639,"endTime":666.639,"body":"institution depending on where you were"},{"startTime":664.72,"endTime":670.519,"body":"I don't think that"},{"startTime":666.639,"endTime":670.519,"body":"happened right"},{"startTime":670.6,"endTime":676.32,"body":"correct essentially what happens"},{"startTime":673.12,"endTime":679.839,"body":"frequently with well-intentioned cost"},{"startTime":676.32,"endTime":681.36,"body":"saving while also trying to improve care"},{"startTime":679.839,"endTime":684.36,"body":"it's very hard to do both at the same"},{"startTime":681.36,"endTime":686.0,"body":"time Congress you know not even being"},{"startTime":684.36,"endTime":688.12,"body":"partisan but just in general if you're"},{"startTime":686.0,"endTime":689.519,"body":"spending M millions or hundreds of"},{"startTime":688.12,"endTime":692.56,"body":"millions of federal"},{"startTime":689.519,"endTime":693.88,"body":"on Mental Health Services because you"},{"startTime":692.56,"endTime":695.92,"body":"have to because there's a certain amount"},{"startTime":693.88,"endTime":698.04,"body":"of people that are here full-time now"},{"startTime":695.92,"endTime":699.959,"body":"they go into the community well do we"},{"startTime":698.04,"endTime":701.16,"body":"need the same amount of money right the"},{"startTime":699.959,"endTime":702.6,"body":"premise was that the same amount of"},{"startTime":701.16,"endTime":704.24,"body":"money the same pot would just be"},{"startTime":702.6,"endTime":705.519,"body":"transferred into Community Mental Health"},{"startTime":704.24,"endTime":707.92,"body":"and that was going to provide so many"},{"startTime":705.519,"endTime":709.92,"body":"services but that pot gets cut and that"},{"startTime":707.92,"endTime":711.279,"body":"pot gets cut and that pot gets cut and"},{"startTime":709.92,"endTime":713.399,"body":"they say well we need the funding for"},{"startTime":711.279,"endTime":714.959,"body":"this and then they start closing so many"},{"startTime":713.399,"endTime":715.88,"body":"hospitals that even people who do"},{"startTime":714.959,"endTime":717.16,"body":"potentially still need to be"},{"startTime":715.88,"endTime":718.56,"body":"hospitalized there might not be a"},{"startTime":717.16,"endTime":720.56,"body":"hospital for hundreds of miles for them"},{"startTime":718.56,"endTime":723.48,"body":"anymore right and then the states have"},{"startTime":720.56,"endTime":725.519,"body":"to kind of take over each state and"},{"startTime":723.48,"endTime":727.36,"body":"Community has to just figure it out for"},{"startTime":725.519,"endTime":729.2,"body":"themselves and also too if you think"},{"startTime":727.36,"endTime":731.32,"body":"about politically what's going on in the"},{"startTime":729.2,"endTime":734.04,"body":"background around this time right so"},{"startTime":731.32,"endTime":736.12,"body":"that's early 60s as we progress through"},{"startTime":734.04,"endTime":737.6,"body":"the 60s people are being removed from"},{"startTime":736.12,"endTime":740.0,"body":"the institutions institutions are"},{"startTime":737.6,"endTime":741.68,"body":"shutting down well where is a lot of"},{"startTime":740.0,"endTime":744.48,"body":"funding and government attention going"},{"startTime":741.68,"endTime":745.92,"body":"towards the Vietnam War right you know"},{"startTime":744.48,"endTime":747.76,"body":"there's a lot of money that is going"},{"startTime":745.92,"endTime":749.44,"body":"elsewhere and they say we we have $300"},{"startTime":747.76,"endTime":751.44,"body":"million I'm not sure that number we have"},{"startTime":749.44,"endTime":752.6,"body":"$300 million here that's supposed to go"},{"startTime":751.44,"endTime":754.959,"body":"to Community Mental Health Services that"},{"startTime":752.6,"endTime":756.76,"body":"haven't even been developed yet no no no"},{"startTime":754.959,"endTime":757.88,"body":"no no let's let's you know let's fund"},{"startTime":756.76,"endTime":760.48,"body":"these things elsewhere we have other"},{"startTime":757.88,"endTime":761.92,"body":"things to fund and some did and actually"},{"startTime":760.48,"endTime":763.16,"body":"some of the ones that got good funding"},{"startTime":761.92,"endTime":765.12,"body":"actually did pretty well there's some in"},{"startTime":763.16,"endTime":766.399,"body":"Boston I mean again kennedies from"},{"startTime":765.12,"endTime":768.04,"body":"Massachusetts so it kind of makes sense"},{"startTime":766.399,"endTime":770.48,"body":"that they kind of prioritize their area"},{"startTime":768.04,"endTime":772.44,"body":"but several in Massachusetts and kind of"},{"startTime":770.48,"endTime":774.0,"body":"in the Northeast kind of became examples"},{"startTime":772.44,"endTime":776.32,"body":"of what was intended they would have"},{"startTime":774.0,"endTime":780.12,"body":"things like partial hospitalizations an"},{"startTime":776.32,"endTime":783.079,"body":"inpatient unit an intensive outpatient"},{"startTime":780.12,"endTime":784.279,"body":"residential uh Day program like and then"},{"startTime":783.079,"endTime":785.56,"body":"just a regular Mental Health Plan you"},{"startTime":784.279,"endTime":788.079,"body":"know the idea is that they have all"},{"startTime":785.56,"endTime":789.56,"body":"these different levels and hopefully"},{"startTime":788.079,"endTime":792.44,"body":"people can kind of slowly start to"},{"startTime":789.56,"endTime":793.92,"body":"transition down um and you know maybe"},{"startTime":792.44,"endTime":796.079,"body":"the day program would might be a"},{"startTime":793.92,"endTime":799.279,"body":"long-term thing but the cost of people"},{"startTime":796.079,"endTime":801.44,"body":"coming four hours a day versus the cost"},{"startTime":799.279,"endTime":805.399,"body":"of people being there 24 hours a day is"},{"startTime":801.44,"endTime":808.12,"body":"drastic yeah and I think um people being"},{"startTime":805.399,"endTime":809.44,"body":"basically imprisoned is different than"},{"startTime":808.12,"endTime":811.639,"body":"than getting to go home at the end of"},{"startTime":809.44,"endTime":814.48,"body":"the day there's a lot there's a lot of"},{"startTime":811.639,"endTime":818.639,"body":"more autonomy in the treatment as"},{"startTime":814.48,"endTime":822.6,"body":"well so well-intentioned did not go how"},{"startTime":818.639,"endTime":824.279,"body":"it was hoped and also too talking about"},{"startTime":822.6,"endTime":825.839,"body":"you you always have to think of you know"},{"startTime":824.279,"endTime":826.68,"body":"when I think of Psych history you always"},{"startTime":825.839,"endTime":828.48,"body":"have to think that what ST in the"},{"startTime":826.68,"endTime":830.72,"body":"background so in addition to Vietnam War"},{"startTime":828.48,"endTime":833.44,"body":"in late 60s obviously the person who"},{"startTime":830.72,"endTime":836.519,"body":"championed the bill JFK was no longer"},{"startTime":833.44,"endTime":839.24,"body":"the President right and so you know it"},{"startTime":836.519,"endTime":841.519,"body":"was his baby it was his bill he's no"},{"startTime":839.24,"endTime":842.88,"body":"longer around other things are going on"},{"startTime":841.519,"endTime":845.079,"body":"and so now all of a sudden it kind of"},{"startTime":842.88,"endTime":846.48,"body":"becomes on the back burner but the"},{"startTime":845.079,"endTime":850.199,"body":"problem is we've already shut down all"},{"startTime":846.48,"endTime":853.519,"body":"the institutions we did step one without"},{"startTime":850.199,"endTime":855.88,"body":"step two being done but now it's kind of"},{"startTime":853.519,"endTime":857.759,"body":"irrevocably done and one thing that I"},{"startTime":855.88,"endTime":858.88,"body":"think is super important and when we"},{"startTime":857.759,"endTime":860.04,"body":"think about serious mental illness is"},{"startTime":858.88,"endTime":861.8,"body":"that if you think about the number of"},{"startTime":860.04,"endTime":863.959,"body":"people experiencing homelessness in"},{"startTime":861.8,"endTime":865.44,"body":"America On Any Given night depends on"},{"startTime":863.959,"endTime":866.839,"body":"the article you read you know and the"},{"startTime":865.44,"endTime":868.759,"body":"study that you read it's it's all over"},{"startTime":866.839,"endTime":870.32,"body":"the place but it's somewhere between 400"},{"startTime":868.759,"endTime":872.68,"body":"th and a million depending on what you"},{"startTime":870.32,"endTime":874.079,"body":"read and I just find that the idea that"},{"startTime":872.68,"endTime":875.68,"body":"the number of people who were removed"},{"startTime":874.079,"endTime":877.68,"body":"from institutions and the number of"},{"startTime":875.68,"endTime":878.68,"body":"people that are experiencing"},{"startTime":877.68,"endTime":881.68,"body":"homelessness On Any Given night in"},{"startTime":878.68,"endTime":883.399,"body":"America is not dissimilar as somewhat"},{"startTime":881.68,"endTime":885.199,"body":"telling of what ultimately ended up"},{"startTime":883.399,"endTime":888.04,"body":"happening yeah and I think it's no it's"},{"startTime":885.199,"endTime":889.8,"body":"no um it's no secret that a lot of"},{"startTime":888.04,"endTime":892.279,"body":"people who are living with serious"},{"startTime":889.8,"endTime":895.519,"body":"mental illnesses don't have a place to"},{"startTime":892.279,"endTime":896.8,"body":"live or they prefer not to be stuck in a"},{"startTime":895.519,"endTime":899.279,"body":"place where there's people around trying"},{"startTime":896.8,"endTime":900.759,"body":"to control them so I I can divulge a"},{"startTime":899.279,"endTime":903.639,"body":"little bit of my past when I was a"},{"startTime":900.759,"endTime":907.04,"body":"younger guy like I went to New Mexico"},{"startTime":903.639,"endTime":909.68,"body":"and I lived um Outdoors you could call"},{"startTime":907.04,"endTime":911.399,"body":"it you call that homelessness right but"},{"startTime":909.68,"endTime":914.44,"body":"I was around a lot of the homeless"},{"startTime":911.399,"endTime":918.0,"body":"population that that were kind of out"},{"startTime":914.44,"endTime":919.56,"body":"there partly because they wanted to be"},{"startTime":918.0,"endTime":921.56,"body":"um but in some cases because they"},{"startTime":919.56,"endTime":924.04,"body":"couldn't hold down a job they couldn't"},{"startTime":921.56,"endTime":926.92,"body":"maintain a home uh and this and they"},{"startTime":924.04,"endTime":930.279,"body":"were just accepted among this community"},{"startTime":926.92,"endTime":931.6,"body":"of other like people who lived Outdoors"},{"startTime":930.279,"endTime":933.0,"body":"so there was there was there was a"},{"startTime":931.6,"endTime":934.68,"body":"difference between the people who were"},{"startTime":933.0,"endTime":937.079,"body":"there more by choice and the people who"},{"startTime":934.68,"endTime":939.16,"body":"were uh there because uh they didn't"},{"startTime":937.079,"endTime":942.24,"body":"really have anywhere else to be like I"},{"startTime":939.16,"endTime":944.88,"body":"got very comfortable talking to people"},{"startTime":942.24,"endTime":946.48,"body":"who I recognize now you probably had"},{"startTime":944.88,"endTime":948.639,"body":"very serious mental illnesses but at the"},{"startTime":946.48,"endTime":951.04,"body":"time I just thought that they were"},{"startTime":948.639,"endTime":954.0,"body":"strange like um because I didn't know"},{"startTime":951.04,"endTime":955.6,"body":"anything about uh Psychiatry or"},{"startTime":954.0,"endTime":957.959,"body":"psychology"},{"startTime":955.6,"endTime":960.24,"body":"really and you know that's still an"},{"startTime":957.959,"endTime":962.92,"body":"ongoing issue you know I'm not from New"},{"startTime":960.24,"endTime":965.68,"body":"York City but it was a big thing in 2023"},{"startTime":962.92,"endTime":968.36,"body":"that in New York city mayor Eric Adams"},{"startTime":965.68,"endTime":969.68,"body":"tried to in some regards remove people"},{"startTime":968.36,"endTime":971.36,"body":"experiencing homelessness essentially"},{"startTime":969.68,"endTime":972.8,"body":"saying like you know if you're sleeping"},{"startTime":971.36,"endTime":974.24,"body":"on park benches and things like that you"},{"startTime":972.8,"endTime":976.92,"body":"need to either go to the hospital or you"},{"startTime":974.24,"endTime":979.279,"body":"need to go to some kind of treatment or"},{"startTime":976.92,"endTime":982.88,"body":"residential which again is quite"},{"startTime":979.279,"endTime":985.68,"body":"presumptive in that one just because"},{"startTime":982.88,"endTime":988.279,"body":"someone does have serious mental illness"},{"startTime":985.68,"endTime":990.6,"body":"or isn't it's doesn't have a home or is"},{"startTime":988.279,"endTime":992.44,"body":"it ing homelessness doesn't necessarily"},{"startTime":990.6,"endTime":994.079,"body":"mean they need to be hospitalized right"},{"startTime":992.44,"endTime":997.199,"body":"and that's kind of the"},{"startTime":994.079,"endTime":1000.319,"body":"American aspect of autonomy versus we"},{"startTime":997.199,"endTime":1001.959,"body":"can fix you that is just try to force"},{"startTime":1000.319,"endTime":1003.88,"body":"them into a situation that you think"},{"startTime":1001.959,"endTime":1005.6,"body":"that they should want instead of"},{"startTime":1003.88,"endTime":1008.68,"body":"allowing them yeah like you said"},{"startTime":1005.6,"endTime":1011.24,"body":"autonomy uh and uh I don't wanna I don't"},{"startTime":1008.68,"endTime":1013.04,"body":"want to make anyone out there think that"},{"startTime":1011.24,"endTime":1014.56,"body":"I'm saying most people who are"},{"startTime":1013.04,"endTime":1016.04,"body":"experiencing homelessness choose it"},{"startTime":1014.56,"endTime":1017.56,"body":"that's not what I'm saying at all we"},{"startTime":1016.04,"endTime":1020.44,"body":"just assume things about them assume"},{"startTime":1017.56,"endTime":1022.8,"body":"what they want or need"},{"startTime":1020.44,"endTime":1024.52,"body":"you know we also too in America we have"},{"startTime":1022.8,"endTime":1026.679,"body":"certain aspects of our social safety net"},{"startTime":1024.52,"endTime":1028.679,"body":"compared to many other you know First"},{"startTime":1026.679,"endTime":1031.439,"body":"World countries that are quite limited"},{"startTime":1028.679,"endTime":1034.959,"body":"and so we tend to use the mental health"},{"startTime":1031.439,"endTime":1036.799,"body":"system um to provide many social safety"},{"startTime":1034.959,"endTime":1039.4,"body":"net services that in other countries"},{"startTime":1036.799,"endTime":1040.88,"body":"would be provided by a h a better Urban"},{"startTime":1039.4,"endTime":1044.039,"body":"Development Group or a better housing"},{"startTime":1040.88,"endTime":1047.64,"body":"group and so for instance it's you know"},{"startTime":1044.039,"endTime":1050.0,"body":"not uncommon in City hospitals and you"},{"startTime":1047.64,"endTime":1052.0,"body":"know uh Community Hospitals for people"},{"startTime":1050.0,"endTime":1054.72,"body":"who are experiencing homelessness to"},{"startTime":1052.0,"endTime":1056.24,"body":"come in and you know they may report"},{"startTime":1054.72,"endTime":1058.96,"body":"some suicidal ideation or homicidal"},{"startTime":1056.24,"endTime":1060.64,"body":"ideation and those and you know because"},{"startTime":1058.96,"endTime":1062.16,"body":"of that they need to be admitted or"},{"startTime":1060.64,"endTime":1064.44,"body":"their Merit admission and they're"},{"startTime":1062.16,"endTime":1066.679,"body":"voluntary um and that tends to spike"},{"startTime":1064.44,"endTime":1068.28,"body":"around really bad seasonal at times"},{"startTime":1066.679,"endTime":1071.72,"body":"right there's a huge ice freeze things"},{"startTime":1068.28,"endTime":1073.96,"body":"like that and you know people can get"},{"startTime":1071.72,"endTime":1076.08,"body":"I've heard Physicians say kind of like"},{"startTime":1073.96,"endTime":1077.0,"body":"oh they're here for this is an insulting"},{"startTime":1076.08,"endTime":1078.4,"body":"phrase but I'm I'm just kinding of"},{"startTime":1077.0,"endTime":1079.84,"body":"saying attitudes I've heard people say"},{"startTime":1078.4,"endTime":1082.88,"body":"oh they're just here for three Hots in a"},{"startTime":1079.84,"endTime":1084.48,"body":"cot right you know the idea that like oh"},{"startTime":1082.88,"endTime":1086.919,"body":"be you know there there's bad weather so"},{"startTime":1084.48,"endTime":1089.12,"body":"that's why they're coming in and that"},{"startTime":1086.919,"endTime":1091.28,"body":"may be true but we don't have a social"},{"startTime":1089.12,"endTime":1093.48,"body":"safety net system that provides other"},{"startTime":1091.28,"endTime":1096.48,"body":"Alternatives right if if you come to the"},{"startTime":1093.48,"endTime":1098.0,"body":"ER and you don't have something that"},{"startTime":1096.48,"endTime":1100.08,"body":"merits admission they're just going to"},{"startTime":1098.0,"endTime":1102.24,"body":"kick you back out we don't have you know"},{"startTime":1100.08,"endTime":1103.4,"body":"in other countries that that doesn't for"},{"startTime":1102.24,"endTime":1104.72,"body":"instance New Zealand they they don't"},{"startTime":1103.4,"endTime":1107.4,"body":"hospitalize people"},{"startTime":1104.72,"endTime":1109.52,"body":"for kind of passive SI unless they want"},{"startTime":1107.4,"endTime":1111.2,"body":"to kind of come in if you come in and"},{"startTime":1109.52,"endTime":1112.64,"body":"say hey I need housing they're just"},{"startTime":1111.2,"endTime":1114.799,"body":"going to help you find housing even if"},{"startTime":1112.64,"endTime":1117.12,"body":"it's temporary and so that's the other"},{"startTime":1114.799,"endTime":1120.12,"body":"aspect the mental health system is that"},{"startTime":1117.12,"endTime":1121.32,"body":"you know it kind of Fosters this overall"},{"startTime":1120.12,"endTime":1122.6,"body":"people get bitter especially in like the"},{"startTime":1121.32,"endTime":1123.559,"body":"emergency departments and stuff too"},{"startTime":1122.6,"endTime":1126.559,"body":"because they're like oh people are"},{"startTime":1123.559,"endTime":1128.72,"body":"misusing this but also what alternatives"},{"startTime":1126.559,"endTime":1130.88,"body":"are we providing people and so we kind"},{"startTime":1128.72,"endTime":1133.2,"body":"of end up using this as a huge safety"},{"startTime":1130.88,"endTime":1135.48,"body":"net and um that's the tough spot and it"},{"startTime":1133.2,"endTime":1137.12,"body":"gets very very complicated very fast"},{"startTime":1135.48,"endTime":1139.039,"body":"with the way that we provide social"},{"startTime":1137.12,"endTime":1141.48,"body":"social services here in the US and"},{"startTime":1139.039,"endTime":1144.28,"body":"different places because they often tie"},{"startTime":1141.48,"endTime":1146.72,"body":"those to being doing certain things like"},{"startTime":1144.28,"endTime":1148.32,"body":"oh if you do this you have to be in job"},{"startTime":1146.72,"endTime":1149.96,"body":"programs or you have to show that you"},{"startTime":1148.32,"endTime":1151.52,"body":"have uh filled out this many"},{"startTime":1149.96,"endTime":1153.2,"body":"applications and you have to have people"},{"startTime":1151.52,"endTime":1154.88,"body":"sign you we're going to kick you off"},{"startTime":1153.2,"endTime":1156.919,"body":"your your social because if you don't"},{"startTime":1154.88,"endTime":1158.6,"body":"have a job you know or if you're not"},{"startTime":1156.919,"endTime":1161.039,"body":"trying to get a job then you don't"},{"startTime":1158.6,"endTime":1163.84,"body":"deserve to be helped things like that"},{"startTime":1161.039,"endTime":1166.12,"body":"which just defao disqualify a lot of"},{"startTime":1163.84,"endTime":1168.0,"body":"people from help that probably you know"},{"startTime":1166.12,"endTime":1171.36,"body":"we we would spend a lot less money just"},{"startTime":1168.0,"endTime":1173.72,"body":"help in them than we spend now in the"},{"startTime":1171.36,"endTime":1175.96,"body":"system that we have um a lot of people"},{"startTime":1173.72,"endTime":1177.64,"body":"end up migrating I like to places like"},{"startTime":1175.96,"endTime":1180.679,"body":"California or Florida because of the"},{"startTime":1177.64,"endTime":1183.6,"body":"climates um I was just reading today I"},{"startTime":1180.679,"endTime":1187.76,"body":"guess the governor of Florida uh Ronda"},{"startTime":1183.6,"endTime":1189.72,"body":"santis is uh pushing to have it public"},{"startTime":1187.76,"endTime":1192.84,"body":"camping be banned across the State of"},{"startTime":1189.72,"endTime":1195.24,"body":"Florida as a way you know to get rid of"},{"startTime":1192.84,"endTime":1197.039,"body":"people or to be able to ship them off um"},{"startTime":1195.24,"endTime":1198.72,"body":"he likes to put people on buses and drop"},{"startTime":1197.039,"endTime":1202.4,"body":"them off in other states so so maybe"},{"startTime":1198.72,"endTime":1204.48,"body":"this is the way he can do that I don't"},{"startTime":1202.4,"endTime":1205.88,"body":"know and you know when we're talking"},{"startTime":1204.48,"endTime":1208.24,"body":"about people who are experiencing"},{"startTime":1205.88,"endTime":1210.799,"body":"homelessness and or who have serious"},{"startTime":1208.24,"endTime":1212.36,"body":"mental illness particularly if both if"},{"startTime":1210.799,"endTime":1214.44,"body":"you have serious mental illness or we're"},{"startTime":1212.36,"endTime":1216.2,"body":"saying things like schizophrenia bipolar"},{"startTime":1214.44,"endTime":1217.88,"body":"one sto of things that are so"},{"startTime":1216.2,"endTime":1221.72,"body":"functionally impairing that you are not"},{"startTime":1217.88,"endTime":1224.6,"body":"able to um you know maybe even complete"},{"startTime":1221.72,"endTime":1225.88,"body":"ADLs that at least not iadls um which is"},{"startTime":1224.6,"endTime":1227.36,"body":"activities of daily living or"},{"startTime":1225.88,"endTime":1229.559,"body":"independent activities of daily living"},{"startTime":1227.36,"endTime":1231.799,"body":"such as like doing your finances um"},{"startTime":1229.559,"endTime":1234.36,"body":"being able to grocery shop Etc pay your"},{"startTime":1231.799,"endTime":1236.159,"body":"bills if you have both of those for the"},{"startTime":1234.36,"endTime":1237.919,"body":"data shows that your lifespan is about"},{"startTime":1236.159,"endTime":1239.36,"body":"25 years less if you're experiencing"},{"startTime":1237.919,"endTime":1242.4,"body":"homelessness and have that as compared"},{"startTime":1239.36,"endTime":1243.919,"body":"to a peer who did not have homel did not"},{"startTime":1242.4,"endTime":1245.32,"body":"experience homelessness and did not have"},{"startTime":1243.919,"endTime":1247.919,"body":"serious mental illness some studies say"},{"startTime":1245.32,"endTime":1250.44,"body":"20 but 20 to 25 years if you have either"},{"startTime":1247.919,"endTime":1252.6,"body":"of those just one it's about 10 to 15"},{"startTime":1250.44,"endTime":1254.559,"body":"years off of your life Co has kind of"},{"startTime":1252.6,"endTime":1256.28,"body":"lowered the average age of America a"},{"startTime":1254.559,"endTime":1258.799,"body":"little bit but for the most part the"},{"startTime":1256.28,"endTime":1261.0,"body":"average male is upper 70s female around"},{"startTime":1258.799,"endTime":1262.039,"body":"80 but if you are somebody who"},{"startTime":1261.0,"endTime":1264.24,"body":"experiences homelessness for a"},{"startTime":1262.039,"endTime":1266.159,"body":"significant portion of your life take a"},{"startTime":1264.24,"endTime":1267.76,"body":"decade off if you're somebody who has a"},{"startTime":1266.159,"endTime":1269.2,"body":"serious mental illness and experience"},{"startTime":1267.76,"endTime":1270.279,"body":"homelessness take another decade off so"},{"startTime":1269.2,"endTime":1273.0,"body":"we're talking about you know a"},{"startTime":1270.279,"endTime":1276.0,"body":"significant amount of Life morbidity"},{"startTime":1273.0,"endTime":1277.96,"body":"mortality in addition to the fact of not"},{"startTime":1276.0,"endTime":1280.36,"body":"being limited functionality throughout"},{"startTime":1277.96,"endTime":1282.279,"body":"their life as well too so not only is"},{"startTime":1280.36,"endTime":1284.24,"body":"there money to potentially be saved if"},{"startTime":1282.279,"endTime":1286.559,"body":"we invested the social safety net"},{"startTime":1284.24,"endTime":1289.159,"body":"services but also like there are literal"},{"startTime":1286.559,"endTime":1290.679,"body":"lives to be saved"},{"startTime":1289.159,"endTime":1293.72,"body":"getting back to the History part so we"},{"startTime":1290.679,"endTime":1296.08,"body":"were in the the the 50s we got thorine"},{"startTime":1293.72,"endTime":1298.76,"body":"the 60s we we got we were we were"},{"startTime":1296.08,"endTime":1300.36,"body":"promised community health centers um and"},{"startTime":1298.76,"endTime":1302.679,"body":"those didn't really"},{"startTime":1300.36,"endTime":1306.6,"body":"materialize um then we're into the 70s"},{"startTime":1302.679,"endTime":1308.52,"body":"and 80s like what happened there yeah so"},{"startTime":1306.6,"endTime":1310.679,"body":"70s 80s um I think an important part"},{"startTime":1308.52,"endTime":1313.32,"body":"about the 80s is you know um like the"},{"startTime":1310.679,"endTime":1315.12,"body":"Omnibus act Cobra right we I think a lot"},{"startTime":1313.32,"endTime":1317.64,"body":"of the people heard Cobra for the first"},{"startTime":1315.12,"endTime":1318.64,"body":"time and um mtala right mtala some of"},{"startTime":1317.64,"endTime":1321.159,"body":"these terms"},{"startTime":1318.64,"endTime":1323.32,"body":"um during the Affordable Care Act but IM"},{"startTime":1321.159,"endTime":1325.08,"body":"tala um was actually from in the 80s"},{"startTime":1323.32,"endTime":1326.88,"body":"during the Raiden Administration bill"},{"startTime":1325.08,"endTime":1329.08,"body":"passed by Congress essentially saying"},{"startTime":1326.88,"endTime":1330.559,"body":"that like if you show up to the ER you"},{"startTime":1329.08,"endTime":1332.0,"body":"have to be able that they cannot deny"},{"startTime":1330.559,"endTime":1334.159,"body":"you Services if they're able to provide"},{"startTime":1332.0,"endTime":1335.799,"body":"them things like that so that's kind of"},{"startTime":1334.159,"endTime":1338.08,"body":"going on in the background Medicare"},{"startTime":1335.799,"endTime":1340.679,"body":"Medicaid right you know starts in the"},{"startTime":1338.08,"endTime":1342.159,"body":"50s and 60s and continues to pick up and"},{"startTime":1340.679,"endTime":1343.44,"body":"as more and more people go to that and"},{"startTime":1342.159,"endTime":1346.679,"body":"as people live longer we have more"},{"startTime":1343.44,"endTime":1348.4,"body":"people going to Medicare so the way"},{"startTime":1346.679,"endTime":1350.0,"body":"American Healthcare is even being"},{"startTime":1348.4,"endTime":1352.72,"body":"delivered is changing right more"},{"startTime":1350.0,"endTime":1354.039,"body":"Specialists less family docks right as"},{"startTime":1352.72,"endTime":1355.559,"body":"people kind of migrate more and more to"},{"startTime":1354.039,"endTime":1357.32,"body":"cities so so many things about the"},{"startTime":1355.559,"endTime":1358.96,"body":"healthcare system are changing health"},{"startTime":1357.32,"endTime":1360.679,"body":"insurance is becoming vastly more"},{"startTime":1358.96,"endTime":1363.6,"body":"expensive so all of this is kind of in"},{"startTime":1360.679,"endTime":1364.96,"body":"the background now we get to 1992 it's"},{"startTime":1363.6,"endTime":1366.559,"body":"been about 30 years since Community"},{"startTime":1364.96,"endTime":1369.4,"body":"Mental Health act for all intents and"},{"startTime":1366.559,"endTime":1371.039,"body":"purposes it was a failure right we shut"},{"startTime":1369.4,"endTime":1373.08,"body":"down institutions we did not provide the"},{"startTime":1371.039,"endTime":1376.36,"body":"Community Mental Health Services and I'm"},{"startTime":1373.08,"endTime":1378.6,"body":"not saying that that was JFK's fault but"},{"startTime":1376.36,"endTime":1381.48,"body":"it well sometimes he wasn't around"},{"startTime":1378.6,"endTime":1382.6,"body":"anymore exactly exactly yeah and so and"},{"startTime":1381.48,"endTime":1384.159,"body":"you know sometimes things just don't"},{"startTime":1382.6,"endTime":1385.44,"body":"work out and particularly as he was the"},{"startTime":1384.159,"endTime":1387.159,"body":"champion of it like it probably needed"},{"startTime":1385.44,"endTime":1390.159,"body":"him to kind of keep pushing through"},{"startTime":1387.159,"endTime":1391.72,"body":"right um but his brother actually um is"},{"startTime":1390.159,"endTime":1394.159,"body":"the person was one of the sponsors of"},{"startTime":1391.72,"endTime":1396.4,"body":"this bill and so it's kind of a big"},{"startTime":1394.159,"endTime":1397.44,"body":"mouthful um alcohol drug abuse and"},{"startTime":1396.4,"endTime":1400.12,"body":"mental health administration"},{"startTime":1397.44,"endTime":1402.52,"body":"reorganization Act of 1992 and there's"},{"startTime":1400.12,"endTime":1403.919,"body":"tons of stuff in there I um I'm doing a"},{"startTime":1402.52,"endTime":1405.96,"body":"presentation here in a few weeks about"},{"startTime":1403.919,"endTime":1407.32,"body":"serious mental illness in the military"},{"startTime":1405.96,"endTime":1409.44,"body":"um and so like read through kind of the"},{"startTime":1407.32,"endTime":1412.0,"body":"whole thing it's like you know way too"},{"startTime":1409.44,"endTime":1413.2,"body":"much very dense but it covers so many"},{"startTime":1412.0,"endTime":1415.919,"body":"things and and one of the things that it"},{"startTime":1413.2,"endTime":1417.039,"body":"talks about is essentially like state by"},{"startTime":1415.919,"endTime":1418.48,"body":"state right if you're in a state that"},{"startTime":1417.039,"endTime":1420.279,"body":"doesn't have a lot of money or a smaller"},{"startTime":1418.48,"endTime":1422.24,"body":"State you're like hey we only have a"},{"startTime":1420.279,"endTime":1424.08,"body":"certain amount of budget that we can use"},{"startTime":1422.24,"endTime":1425.64,"body":"to provide services for people who can't"},{"startTime":1424.08,"endTime":1426.6,"body":"necessarily pay for services themselves"},{"startTime":1425.64,"endTime":1429.32,"body":"we're talking about Mental Health"},{"startTime":1426.6,"endTime":1431.159,"body":"Services um the federal government says"},{"startTime":1429.32,"endTime":1432.559,"body":"you know what we shut down all these"},{"startTime":1431.159,"endTime":1434.279,"body":"institutions that we used to help pay"},{"startTime":1432.559,"endTime":1435.64,"body":"for maybe we can provide a little bit of"},{"startTime":1434.279,"endTime":1437.88,"body":"services you know to some of these"},{"startTime":1435.64,"endTime":1439.84,"body":"people as well too we'll provide blocked"},{"startTime":1437.88,"endTime":1441.0,"body":"grants we will give you a certain amount"},{"startTime":1439.84,"endTime":1442.919,"body":"based on the certain percent of"},{"startTime":1441.0,"endTime":1444.88,"body":"constituents in your state that have"},{"startTime":1442.919,"endTime":1446.6,"body":"serious mental illness to help kind of"},{"startTime":1444.88,"endTime":1448.44,"body":"subsidize their mental health for there"},{"startTime":1446.6,"endTime":1451.2,"body":"you have to Define serious mental"},{"startTime":1448.44,"endTime":1453.0,"body":"illness that's where it gets invented"},{"startTime":1451.2,"endTime":1456.32,"body":"was to get money from the federal"},{"startTime":1453.0,"endTime":1458.4,"body":"government okay exactly right yep and so"},{"startTime":1456.32,"endTime":1460.84,"body":"um essentially they're like we will give"},{"startTime":1458.4,"endTime":1463.0,"body":"you money based on a percent based on"},{"startTime":1460.84,"endTime":1464.24,"body":"serious mental illness well all 50"},{"startTime":1463.0,"endTime":1466.679,"body":"states we have to have some kind of"},{"startTime":1464.24,"endTime":1467.96,"body":"agreed upon definition so this bill kind"},{"startTime":1466.679,"endTime":1471.52,"body":"of you know kind of comes up with this"},{"startTime":1467.96,"endTime":1473.52,"body":"to um or around this time and it's it's"},{"startTime":1471.52,"endTime":1474.88,"body":"the layers and layers of it I'll I'll"},{"startTime":1473.52,"endTime":1476.84,"body":"give you what the starting definition"},{"startTime":1474.88,"endTime":1479.039,"body":"was this is what came out with in 1992"},{"startTime":1476.84,"endTime":1480.919,"body":"mental illnesses listed in the DSM at"},{"startTime":1479.039,"endTime":1483.0,"body":"this point we're in DSM 3 by the way"},{"startTime":1480.919,"endTime":1485.12,"body":"mental illnesses listed in the DSM that"},{"startTime":1483.0,"endTime":1487.32,"body":"resulted in functional impairment which"},{"startTime":1485.12,"endTime":1490.6,"body":"substantially interferes with or limits"},{"startTime":1487.32,"endTime":1493.0,"body":"one or more major activities so that's a"},{"startTime":1490.6,"endTime":1495.0,"body":"kind of broad generic thing but the the"},{"startTime":1493.0,"endTime":1497.2,"body":"funny part is is that we now also have"},{"startTime":1495.0,"endTime":1498.72,"body":"to Define functional impairment and we"},{"startTime":1497.2,"endTime":1501.24,"body":"also have to Define major life"},{"startTime":1498.72,"endTime":1503.159,"body":"activities so their definition then"},{"startTime":1501.24,"endTime":1505.32,"body":"required two further definitions"},{"startTime":1503.159,"endTime":1507.799,"body":"actually the American uh Americans with"},{"startTime":1505.32,"endTime":1508.84,"body":"Disabilities Act website Ada website"},{"startTime":1507.799,"endTime":1510.919,"body":"actually has some pretty good"},{"startTime":1508.84,"endTime":1513.76,"body":"information and it defines functional"},{"startTime":1510.919,"endTime":1514.88,"body":"impairment defines major life activities"},{"startTime":1513.76,"endTime":1517.159,"body":"we still kind of use some of those"},{"startTime":1514.88,"endTime":1518.44,"body":"definitions today I remember learning"},{"startTime":1517.159,"endTime":1521.12,"body":"about the Americans with Disabilities"},{"startTime":1518.44,"endTime":1522.88,"body":"Act when I was a kid because my dad had"},{"startTime":1521.12,"endTime":1525.08,"body":"had a traumatic brain injury and it was"},{"startTime":1522.88,"endTime":1526.679,"body":"pretty severe he he was in the hospital"},{"startTime":1525.08,"endTime":1528.6,"body":"for a very long time when he came out"},{"startTime":1526.679,"endTime":1530.0,"body":"you know he had all those"},{"startTime":1528.6,"endTime":1531.64,"body":"uh things that they talk about Phineas"},{"startTime":1530.0,"endTime":1535.0,"body":"Gage having like it changes in"},{"startTime":1531.64,"endTime":1536.919,"body":"personality and and um being very easily"},{"startTime":1535.0,"endTime":1538.84,"body":"anger just flying off the handle and"},{"startTime":1536.919,"endTime":1541.76,"body":"things like that he got involved in a"},{"startTime":1538.84,"endTime":1543.159,"body":"head injury support group um back then"},{"startTime":1541.76,"endTime":1545.279,"body":"because nobody really knew much about"},{"startTime":1543.159,"endTime":1546.24,"body":"head injuries the doctors knew nothing"},{"startTime":1545.279,"endTime":1547.84,"body":"they they would tell you nothing they"},{"startTime":1546.24,"endTime":1550.159,"body":"didn't know anything so you had to go to"},{"startTime":1547.84,"endTime":1552.24,"body":"the support groups to find out like what"},{"startTime":1550.159,"endTime":1554.88,"body":"happens to people who have traumatic"},{"startTime":1552.24,"endTime":1556.799,"body":"brain injuries and the the Americans"},{"startTime":1554.88,"endTime":1559.0,"body":"with Disabilities Act uh was one of the"},{"startTime":1556.799,"endTime":1560.919,"body":"things we learned about there because um"},{"startTime":1559.0,"endTime":1563.039,"body":"the guy who started the group his name"},{"startTime":1560.919,"endTime":1565.88,"body":"was Toby he was a police officer who had"},{"startTime":1563.039,"endTime":1568.88,"body":"been shot in the head and was uh uh"},{"startTime":1565.88,"endTime":1572.159,"body":"paralyzed on half of his body um plus"},{"startTime":1568.88,"endTime":1573.64,"body":"other things right but uh he had was"},{"startTime":1572.159,"endTime":1575.44,"body":"suing the city that we were in at the"},{"startTime":1573.64,"endTime":1576.679,"body":"time for violations of the Americans do"},{"startTime":1575.44,"endTime":1578.44,"body":"the Disabilities Act because they"},{"startTime":1576.679,"endTime":1580.52,"body":"weren't updating all their"},{"startTime":1578.44,"endTime":1582.039,"body":"infrastructure uh to be things like"},{"startTime":1580.52,"endTime":1583.799,"body":"wheelchair accessible and stuff like"},{"startTime":1582.039,"endTime":1586.88,"body":"that so he would he would just go around"},{"startTime":1583.799,"endTime":1588.64,"body":"town like like taking notes of where"},{"startTime":1586.88,"endTime":1590.88,"body":"there were no curb cuts and stuff he"},{"startTime":1588.64,"endTime":1592.84,"body":"built up this gigantic case against the"},{"startTime":1590.88,"endTime":1594.799,"body":"city first he just brought it to the"},{"startTime":1592.84,"endTime":1596.48,"body":"city and said you know please do"},{"startTime":1594.799,"endTime":1598.919,"body":"something about this but the city was"},{"startTime":1596.48,"endTime":1602.76,"body":"like this is too expensive man we we we"},{"startTime":1598.919,"endTime":1605.12,"body":"can't do that so he hired lawyers and it"},{"startTime":1602.76,"endTime":1608.72,"body":"they lost the city lost in court and had"},{"startTime":1605.12,"endTime":1610.76,"body":"to actually start uh doing the"},{"startTime":1608.72,"endTime":1612.799,"body":"work while while you were talking I"},{"startTime":1610.76,"endTime":1614.44,"body":"looked it up in 1990 so two years before"},{"startTime":1612.799,"endTime":1616.279,"body":"this bill came out is when the Americans"},{"startTime":1614.44,"endTime":1617.919,"body":"with Disabilities Act came out good know"},{"startTime":1616.279,"endTime":1619.24,"body":"and so I think a lot of those things"},{"startTime":1617.919,"endTime":1620.84,"body":"kind of tied into the other and honestly"},{"startTime":1619.24,"endTime":1622.08,"body":"this bill potentially might not have"},{"startTime":1620.84,"endTime":1623.399,"body":"existed without the Americans with"},{"startTime":1622.08,"endTime":1625.72,"body":"Disabilities Act Right we're drawing"},{"startTime":1623.399,"endTime":1628.679,"body":"further attention to people who need"},{"startTime":1625.72,"endTime":1630.6,"body":"more assistance and people who um you"},{"startTime":1628.679,"endTime":1631.799,"body":"know we as a society are deciding that"},{"startTime":1630.6,"endTime":1633.24,"body":"maybe the federal government should"},{"startTime":1631.799,"endTime":1635.039,"body":"potentially help subsidize some of this"},{"startTime":1633.24,"endTime":1637.039,"body":"funding because of the amount of care"},{"startTime":1635.039,"endTime":1638.96,"body":"that might be needed in this bill"},{"startTime":1637.039,"endTime":1641.159,"body":"actually among a number of other things"},{"startTime":1638.96,"endTime":1643.279,"body":"was you know the fact that they we need"},{"startTime":1641.159,"endTime":1644.64,"body":"to figure out what the definition of SMI"},{"startTime":1643.279,"endTime":1646.84,"body":"is well it's functional impairment in"},{"startTime":1644.64,"endTime":1648.559,"body":"major life activities well what does"},{"startTime":1646.84,"endTime":1650.159,"body":"that exactly mean"},{"startTime":1648.559,"endTime":1652.32,"body":"also kind of random but also in this"},{"startTime":1650.159,"endTime":1654.72,"body":"bill was the Sinar Amendment and that's"},{"startTime":1652.32,"endTime":1657.24,"body":"actually what upped the age of tobacco"},{"startTime":1654.72,"endTime":1659.919,"body":"sales to 18 at the time federally and"},{"startTime":1657.24,"endTime":1661.399,"body":"then 2019 it became 21 so but it's"},{"startTime":1659.919,"endTime":1663.279,"body":"actually interesting that I think it was"},{"startTime":1661.399,"endTime":1664.679,"body":"more state byst state potentially right"},{"startTime":1663.279,"endTime":1666.64,"body":"I think you know if you lived in a"},{"startTime":1664.679,"endTime":1668.399,"body":"tobacco State you know you're smoking at"},{"startTime":1666.64,"endTime":1670.559,"body":"a very young age my great grandpa"},{"startTime":1668.399,"endTime":1672.36,"body":"started smoking when he was seven right"},{"startTime":1670.559,"endTime":1674.799,"body":"and so um East"},{"startTime":1672.36,"endTime":1676.84,"body":"Tennessee I would go over to friend's"},{"startTime":1674.799,"endTime":1678.84,"body":"houses when I was in grade school and"},{"startTime":1676.84,"endTime":1681.36,"body":"they chewed to tobacco my friends you"},{"startTime":1678.84,"endTime":1683.64,"body":"know they'd play be playing video games"},{"startTime":1681.36,"endTime":1685.08,"body":"shoot spitting tobacco at a can and it"},{"startTime":1683.64,"endTime":1687.24,"body":"was disgusting because like the floor is"},{"startTime":1685.08,"endTime":1688.399,"body":"covered in tobacco spit but so that's"},{"startTime":1687.24,"endTime":1689.279,"body":"it's interesting just what all this bill"},{"startTime":1688.399,"endTime":1690.84,"body":"kind of covered right that's what"},{"startTime":1689.279,"endTime":1693.96,"body":"happens when you have you know 100 plus"},{"startTime":1690.84,"endTime":1695.84,"body":"page document um we're doing block"},{"startTime":1693.96,"endTime":1697.44,"body":"funding grants for constituents with"},{"startTime":1695.84,"endTime":1699.399,"body":"serious mental illness and we're upping"},{"startTime":1697.44,"endTime":1701.84,"body":"the age of tobacco also too kind of I"},{"startTime":1699.399,"endTime":1704.399,"body":"like the idea of this uh this act of"},{"startTime":1701.84,"endTime":1706.12,"body":"1992 was like the week after I was born"},{"startTime":1704.399,"endTime":1709.039,"body":"so I just I don't know it feels"},{"startTime":1706.12,"endTime":1711.279,"body":"serendipitous um on my interest in SMI"},{"startTime":1709.039,"endTime":1713.32,"body":"you're so"},{"startTime":1711.279,"endTime":1716.279,"body":"young so that was kind of the original"},{"startTime":1713.32,"endTime":1717.64,"body":"definition however the current like"},{"startTime":1716.279,"endTime":1720.76,"body":"National Institute of mental health"},{"startTime":1717.64,"endTime":1723.159,"body":"definition um is a mental Behavioral or"},{"startTime":1720.76,"endTime":1724.6,"body":"emotional disorder resulting in serious"},{"startTime":1723.159,"endTime":1726.519,"body":"functional impairment which"},{"startTime":1724.6,"endTime":1729.32,"body":"substantially interferes with or limits"},{"startTime":1726.519,"endTime":1731.159,"body":"one or more major life activities so"},{"startTime":1729.32,"endTime":1733.64,"body":"mental Behavioral or emotional disord"},{"startTime":1731.159,"endTime":1736.76,"body":"kind of how it classifies that okay and"},{"startTime":1733.64,"endTime":1738.159,"body":"CDC has just a slightly word differently"},{"startTime":1736.76,"endTime":1740.24,"body":"definition but it's Loosely about the"},{"startTime":1738.159,"endTime":1742.6,"body":"same and so depending on the study you"},{"startTime":1740.24,"endTime":1744.32,"body":"look at and the definition you're using"},{"startTime":1742.6,"endTime":1746.2,"body":"currently in the United States right now"},{"startTime":1744.32,"endTime":1748.799,"body":"the prevalence is between four to five"},{"startTime":1746.2,"endTime":1751.519,"body":"and a half percent of the whole"},{"startTime":1748.799,"endTime":1754.519,"body":"population of the population qualifies"},{"startTime":1751.519,"endTime":1756.96,"body":"as having a serious mental illness"},{"startTime":1754.519,"endTime":1760.799,"body":"correct looking at the the term like in"},{"startTime":1756.96,"endTime":1762.96,"body":"the UK they use severe mental illness as"},{"startTime":1760.799,"endTime":1765.76,"body":"SMI not serious mental illness so they"},{"startTime":1762.96,"endTime":1768.24,"body":"have a different kind of definition okay"},{"startTime":1765.76,"endTime":1770.84,"body":"and then we also like I said p SMI"},{"startTime":1768.24,"endTime":1773.279,"body":"persistent serious mental illness which"},{"startTime":1770.84,"endTime":1775.6,"body":"is considered similar"},{"startTime":1773.279,"endTime":1777.96,"body":"definition and but it has to have been"},{"startTime":1775.6,"endTime":1780.399,"body":"at least 24 months so that level of"},{"startTime":1777.96,"endTime":1782.48,"body":"functional impairment for at least 24"},{"startTime":1780.399,"endTime":1784.039,"body":"months with the idea that it likely will"},{"startTime":1782.48,"endTime":1785.24,"body":"be longer and persisting because you"},{"startTime":1784.039,"endTime":1788.159,"body":"mentioned earlier I think to a great"},{"startTime":1785.24,"endTime":1790.32,"body":"Point severe major depressive disorder"},{"startTime":1788.159,"endTime":1792.399,"body":"can be debilitating people can't get out"},{"startTime":1790.32,"endTime":1794.0,"body":"of bed but if they did ECT or they did"},{"startTime":1792.399,"endTime":1795.96,"body":"the treatment they need potentially"},{"startTime":1794.0,"endTime":1798.84,"body":"they're back you know at a certain point"},{"startTime":1795.96,"endTime":1802.36,"body":"functionally um versus people with"},{"startTime":1798.84,"endTime":1804.76,"body":"schizophrenia it is a lifelong condition"},{"startTime":1802.36,"endTime":1806.519,"body":"that not that depression isn't but"},{"startTime":1804.76,"endTime":1807.96,"body":"schizophrenia regardless of treatment"},{"startTime":1806.519,"endTime":1810.0,"body":"you're still going to have some slow"},{"startTime":1807.96,"endTime":1811.159,"body":"functional CAU up decline over time"},{"startTime":1810.0,"endTime":1812.36,"body":"versus if you get the appropriate"},{"startTime":1811.159,"endTime":1814.24,"body":"treatment for major depressive disorder"},{"startTime":1812.36,"endTime":1817.0,"body":"it's very possible that you could become"},{"startTime":1814.24,"endTime":1818.84,"body":"quite functional again and so and I I"},{"startTime":1817.0,"endTime":1821.44,"body":"think it's very important that none of"},{"startTime":1818.84,"endTime":1823.72,"body":"these definitions have ever used"},{"startTime":1821.44,"endTime":1825.799,"body":"specific DSM diagnosis right mental"},{"startTime":1823.72,"endTime":1828.88,"body":"illness is listed in the DSM yeah a"},{"startTime":1825.799,"endTime":1832.08,"body":"mental emotional or the point is is that"},{"startTime":1828.88,"endTime":1833.679,"body":"you don't want to either limit right"},{"startTime":1832.08,"endTime":1835.2,"body":"like you don't want to say that like oh"},{"startTime":1833.679,"endTime":1838.399,"body":"we didn't include that one so it can't"},{"startTime":1835.2,"endTime":1841.0,"body":"be that level of functional you know or"},{"startTime":1838.399,"endTime":1842.72,"body":"automatically say oh you have a bipolar"},{"startTime":1841.0,"endTime":1844.039,"body":"disorder you must have serious mental"},{"startTime":1842.72,"endTime":1845.0,"body":"illness now you won't be functional"},{"startTime":1844.039,"endTime":1847.44,"body":"right you know I think I think they're"},{"startTime":1845.0,"endTime":1850.399,"body":"trying to find that balance of you know"},{"startTime":1847.44,"endTime":1852.2,"body":"you're not defined by your diagnosis and"},{"startTime":1850.399,"endTime":1853.6,"body":"not all depressions are created equal"},{"startTime":1852.2,"endTime":1855.279,"body":"right you know so there's a lot of"},{"startTime":1853.6,"endTime":1858.559,"body":"aspects the point is more the"},{"startTime":1855.279,"endTime":1860.0,"body":"limitations which is all DSM right the"},{"startTime":1858.559,"endTime":1861.48,"body":"it's not a disorder if it doesn't cause"},{"startTime":1860.0,"endTime":1865.0,"body":"functional"},{"startTime":1861.48,"endTime":1868.0,"body":"impairment so in we got to the 1990s and"},{"startTime":1865.0,"endTime":1870.799,"body":"then new legislation defined serious"},{"startTime":1868.0,"endTime":1872.279,"body":"mental illness so that it could fund"},{"startTime":1870.799,"endTime":1877.08,"body":"start to fund things that should have"},{"startTime":1872.279,"endTime":1879.96,"body":"been maybe funded uh 30 years earlier"},{"startTime":1877.08,"endTime":1882.559,"body":"correct okay and but then what happened"},{"startTime":1879.96,"endTime":1885.6,"body":"how how well did that work because we"},{"startTime":1882.559,"endTime":1888.96,"body":"are now a couple decades past that I"},{"startTime":1885.6,"endTime":1891.12,"body":"think if you would pull a random citizen"},{"startTime":1888.96,"endTime":1893.72,"body":"how well do you think the United States"},{"startTime":1891.12,"endTime":1895.72,"body":"Mental Health social safety net is doing"},{"startTime":1893.72,"endTime":1898.24,"body":"I I don't think it would be a very"},{"startTime":1895.72,"endTime":1899.76,"body":"positive opinion I think some there's a"},{"startTime":1898.24,"endTime":1902.24,"body":"variety of reasons for that right we"},{"startTime":1899.76,"endTime":1904.919,"body":"talked about some of these already we're"},{"startTime":1902.24,"endTime":1906.96,"body":"expecting mental health to be a catchall"},{"startTime":1904.919,"endTime":1909.76,"body":"sometimes um when it doesn't need to be"},{"startTime":1906.96,"endTime":1912.2,"body":"or can't be I cannot prescribe any"},{"startTime":1909.76,"endTime":1914.12,"body":"medication that gives you a house I just"},{"startTime":1912.2,"endTime":1915.559,"body":"can't do it right I can't prescribe any"},{"startTime":1914.12,"endTime":1917.799,"body":"medication that will pay your"},{"startTime":1915.559,"endTime":1920.44,"body":"electricity bill there's just only so"},{"startTime":1917.799,"endTime":1922.0,"body":"much Psychiatry can do um and it needs"},{"startTime":1920.44,"endTime":1924.159,"body":"to be kind of more of a collaborative"},{"startTime":1922.0,"endTime":1926.72,"body":"system actually a little bit of a shout"},{"startTime":1924.159,"endTime":1930.76,"body":"out to um there are cities and there are"},{"startTime":1926.72,"endTime":1934.96,"body":"regions that have done good jobs using a"},{"startTime":1930.76,"endTime":1938.039,"body":"collection of federal state private"},{"startTime":1934.96,"endTime":1940.32,"body":"nonprofit Blends I think any state"},{"startTime":1938.039,"endTime":1942.12,"body":"that's feeling like they're going to get"},{"startTime":1940.32,"endTime":1944.159,"body":"a lot of their funding or most of their"},{"startTime":1942.12,"endTime":1945.6,"body":"funding for their Mental Health Services"},{"startTime":1944.159,"endTime":1947.639,"body":"from the federal government alone and"},{"startTime":1945.6,"endTime":1949.919,"body":"they're not willing to spend on it is"},{"startTime":1947.639,"endTime":1952.559,"body":"going to have problems well also I mean"},{"startTime":1949.919,"endTime":1954.2,"body":"that's just sort of to me the closer you"},{"startTime":1952.559,"endTime":1956.159,"body":"get to the community that you live in"},{"startTime":1954.2,"endTime":1958.2,"body":"the more appropriate you know the the"},{"startTime":1956.159,"endTime":1960.12,"body":"more actual knowledge the people are"},{"startTime":1958.2,"endTime":1962.72,"body":"going to have as to what works there"},{"startTime":1960.12,"endTime":1964.32,"body":"right and uh and so the people in those"},{"startTime":1962.72,"endTime":1966.519,"body":"communities need to be involved in"},{"startTime":1964.32,"endTime":1968.159,"body":"coming up with the solutions and doing"},{"startTime":1966.519,"endTime":1969.72,"body":"things that work there because and there"},{"startTime":1968.159,"endTime":1972.399,"body":"also will be able to be the people who"},{"startTime":1969.72,"endTime":1974.0,"body":"see well this strategy didn't work here"},{"startTime":1972.399,"endTime":1975.279,"body":"so they can rule things out and try"},{"startTime":1974.0,"endTime":1977.519,"body":"something different whereas if you're"},{"startTime":1975.279,"endTime":1980.559,"body":"just doing something that well they they"},{"startTime":1977.519,"endTime":1982.88,"body":"said at the N imh that this is the best"},{"startTime":1980.559,"endTime":1985.6,"body":"way to go maybe that doesn't fit your"},{"startTime":1982.88,"endTime":1989.919,"body":"community so well I will say a couple of"},{"startTime":1985.6,"endTime":1991.159,"body":"highlights that I think um both like an"},{"startTime":1989.919,"endTime":1992.44,"body":"example of a couple of things that"},{"startTime":1991.159,"endTime":1994.36,"body":"people have done well or regions have"},{"startTime":1992.44,"endTime":1996.32,"body":"done well and examples of further"},{"startTime":1994.36,"endTime":1998.279,"body":"legislation that has helped the"},{"startTime":1996.32,"endTime":2000.36,"body":"Affordable Care Act people have all"},{"startTime":1998.279,"endTime":2003.0,"body":"sorts of opinions because it became"},{"startTime":2000.36,"endTime":2005.399,"body":"political like many things in America as"},{"startTime":2003.0,"endTime":2008.48,"body":"far as mental health services go really"},{"startTime":2005.399,"endTime":2011.08,"body":"changed the game as far as making things"},{"startTime":2008.48,"endTime":2012.96,"body":"this is a incredible oversimplification"},{"startTime":2011.08,"endTime":2014.399,"body":"but as far as mental health services go"},{"startTime":2012.96,"endTime":2016.44,"body":"they were able to kind of Define the"},{"startTime":2014.399,"endTime":2018.519,"body":"idea that mental health conditions can"},{"startTime":2016.44,"endTime":2020.44,"body":"be just as debilitating and just as real"},{"startTime":2018.519,"endTime":2022.639,"body":"as physical health conditions which we"},{"startTime":2020.44,"endTime":2024.679,"body":"all knew but insurance companies were"},{"startTime":2022.639,"endTime":2026.84,"body":"not reimbursing that way the Affordable"},{"startTime":2024.679,"endTime":2029.919,"body":"Care Act said essentially if somebody"},{"startTime":2026.84,"endTime":2032.12,"body":"has a condition that merits DSM criteria"},{"startTime":2029.919,"endTime":2033.44,"body":"and is causing functional impairment"},{"startTime":2032.12,"endTime":2036.76,"body":"insurance companies you need to"},{"startTime":2033.44,"endTime":2039.72,"body":"reimburse as if that is any low back low"},{"startTime":2036.76,"endTime":2041.12,"body":"back pain or headaches or anything else"},{"startTime":2039.72,"endTime":2043.159,"body":"not that you're you're in to Bill at the"},{"startTime":2041.12,"endTime":2045.36,"body":"same level of you know a cardiologist or"},{"startTime":2043.159,"endTime":2047.639,"body":"anything like that but it totally change"},{"startTime":2045.36,"endTime":2050.44,"body":"the game because here's part of the"},{"startTime":2047.639,"endTime":2052.639,"body":"problem even with mental health subsid"},{"startTime":2050.44,"endTime":2054.399,"body":"if nobody takes Medicare or Medicaid"},{"startTime":2052.639,"endTime":2056.599,"body":"because the reimbursement rates are so"},{"startTime":2054.399,"endTime":2058.48,"body":"low then it doesn't really help right"},{"startTime":2056.599,"endTime":2060.159,"body":"and so and that's that can be a common"},{"startTime":2058.48,"endTime":2062.159,"body":"problem is that reimbursement rates for"},{"startTime":2060.159,"endTime":2063.72,"body":"insurance companies are so low that"},{"startTime":2062.159,"endTime":2065.919,"body":"people say I'm not going to take your"},{"startTime":2063.72,"endTime":2068.52,"body":"insurance even though you have insurance"},{"startTime":2065.919,"endTime":2070.359,"body":"that's a definitely a problem around the"},{"startTime":2068.52,"endTime":2072.28,"body":"area that we work in right now trying to"},{"startTime":2070.359,"endTime":2074.2,"body":"find psychiatrists that actually take"},{"startTime":2072.28,"endTime":2075.72,"body":"insurance at all in some cases and it's"},{"startTime":2074.2,"endTime":2077.48,"body":"not just psychiatrist now I've read a"},{"startTime":2075.72,"endTime":2078.839,"body":"lot of personal statements of people"},{"startTime":2077.48,"endTime":2080.919,"body":"writing on their own blogs doctors"},{"startTime":2078.839,"endTime":2083.639,"body":"saying I can't take Medicare or I can't"},{"startTime":2080.919,"endTime":2085.399,"body":"take Medicaid because I can't survive in"},{"startTime":2083.639,"endTime":2088.119,"body":"my business I don't know this is"},{"startTime":2085.399,"endTime":2090.48,"body":"people's anecdotal experiences so I"},{"startTime":2088.119,"endTime":2091.639,"body":"don't know how big the burden really is"},{"startTime":2090.48,"endTime":2094.399,"body":"along the lines when I was in medical"},{"startTime":2091.639,"endTime":2096.32,"body":"school um one of my rotations it was a"},{"startTime":2094.399,"endTime":2098.599,"body":"part Private Practice part Hospital"},{"startTime":2096.32,"endTime":2100.32,"body":"rotation and in their private practice"},{"startTime":2098.599,"endTime":2101.88,"body":"you know one of the Physicians was not a"},{"startTime":2100.32,"endTime":2103.72,"body":"psychiatrist by the way um different"},{"startTime":2101.88,"endTime":2105.0,"body":"specialty but um they were trying to"},{"startTime":2103.72,"endTime":2107.44,"body":"teach a little bit about the business"},{"startTime":2105.0,"endTime":2109.76,"body":"side of medicine and in their practice"},{"startTime":2107.44,"endTime":2112.44,"body":"they had a percentage of that we cannot"},{"startTime":2109.76,"endTime":2114.52,"body":"take more than x per of patients with"},{"startTime":2112.44,"endTime":2116.28,"body":"Medicare Medicaid because we are then"},{"startTime":2114.52,"endTime":2118.72,"body":"going you know lose essentially losing"},{"startTime":2116.28,"endTime":2120.44,"body":"money like we have to take a certain"},{"startTime":2118.72,"endTime":2121.56,"body":"percent because we you know and same"},{"startTime":2120.44,"endTime":2124.119,"body":"thing with hospitals right in order to"},{"startTime":2121.56,"endTime":2126.48,"body":"get federal funds you have to take"},{"startTime":2124.119,"endTime":2128.48,"body":"Medicare Medicaid but there's a certain"},{"startTime":2126.48,"endTime":2129.56,"body":"percent that kind of allows for things"},{"startTime":2128.48,"endTime":2131.119,"body":"to be reimbursed so obviously the"},{"startTime":2129.56,"endTime":2132.88,"body":"Affordable Care did not solve everything"},{"startTime":2131.119,"endTime":2135.68,"body":"and did not all of a sudden make a you"},{"startTime":2132.88,"endTime":2139.04,"body":"know a magic pill magic potion but it"},{"startTime":2135.68,"endTime":2141.16,"body":"did provide some incentive and for"},{"startTime":2139.04,"endTime":2143.599,"body":"people who have you know your average"},{"startTime":2141.16,"endTime":2145.76,"body":"health insurance you if you had Blue"},{"startTime":2143.599,"endTime":2147.119,"body":"Cross Blue Shield or Etna or Humana and"},{"startTime":2145.76,"endTime":2148.48,"body":"I don't endorse any of these I'm just"},{"startTime":2147.119,"endTime":2150.599,"body":"naming some big ones that i' you know"},{"startTime":2148.48,"endTime":2153.48,"body":"see commercials for if you have any of"},{"startTime":2150.599,"endTime":2155.16,"body":"those and a decent plan you would be"},{"startTime":2153.48,"endTime":2156.76,"body":"shocked if you were not able to find"},{"startTime":2155.16,"endTime":2158.24,"body":"some kind of Behavioral Health Services"},{"startTime":2156.76,"endTime":2159.96,"body":"maybe not a psychiatrist but a social"},{"startTime":2158.24,"endTime":2162.28,"body":"worker or a therapist or something at"},{"startTime":2159.96,"endTime":2164.04,"body":"this point right 15 years ago that was"},{"startTime":2162.28,"endTime":2166.48,"body":"not the case you would have to have the"},{"startTime":2164.04,"endTime":2167.92,"body":"top tier plan and even then you still"},{"startTime":2166.48,"endTime":2171.2,"body":"might not be able to so that definitely"},{"startTime":2167.92,"endTime":2174.2,"body":"is a big change wow yeah I was I was not"},{"startTime":2171.2,"endTime":2176.72,"body":"quite aware of that um so yeah it's"},{"startTime":2174.2,"endTime":2178.4,"body":"important I I I do see the change though"},{"startTime":2176.72,"endTime":2181.4,"body":"in just the insurance as a you know"},{"startTime":2178.4,"endTime":2183.319,"body":"basically like when I was younger I just"},{"startTime":2181.4,"endTime":2185.44,"body":"assumed because my family didn't have"},{"startTime":2183.319,"endTime":2187.44,"body":"much money and I and I didn't have a job"},{"startTime":2185.44,"endTime":2188.96,"body":"that made much that I just wasn't one of"},{"startTime":2187.44,"endTime":2190.76,"body":"those people who would wouldn't have"},{"startTime":2188.96,"endTime":2193.359,"body":"insurance I didn't even think about it I"},{"startTime":2190.76,"endTime":2197.2,"body":"wasn't like I deserve insurance or you"},{"startTime":2193.359,"endTime":2201.64,"body":"know I just re didn't go to the"},{"startTime":2197.2,"endTime":2203.839,"body":"doctor ever so um but people have a a"},{"startTime":2201.64,"endTime":2207.92,"body":"totally different expectation now now"},{"startTime":2203.839,"endTime":2209.72,"body":"they're they think of it more as a right"},{"startTime":2207.92,"endTime":2211.28,"body":"or at least as something like one of"},{"startTime":2209.72,"endTime":2213.0,"body":"those basic things you need to provide"},{"startTime":2211.28,"endTime":2215.359,"body":"for yourself and your"},{"startTime":2213.0,"endTime":2216.64,"body":"family and that actually ties into I was"},{"startTime":2215.359,"endTime":2218.56,"body":"talking about the significant decree"},{"startTime":2216.64,"endTime":2220.24,"body":"increas in life expectancy in people"},{"startTime":2218.56,"endTime":2223.56,"body":"that have been diagnosed with serious"},{"startTime":2220.24,"endTime":2225.64,"body":"mental illness it's very rarely the the"},{"startTime":2223.56,"endTime":2227.8,"body":"mental illness that kills them right"},{"startTime":2225.64,"endTime":2229.0,"body":"it's the other chronic health conditions"},{"startTime":2227.8,"endTime":2231.16,"body":"for which they're not receiving"},{"startTime":2229.0,"endTime":2232.4,"body":"treatment potentially because of their"},{"startTime":2231.16,"endTime":2233.96,"body":"serious mental illness right if they're"},{"startTime":2232.4,"endTime":2235.92,"body":"paranoid and they don't want to go to"},{"startTime":2233.96,"endTime":2237.319,"body":"the doctor because they're paranoid or"},{"startTime":2235.92,"endTime":2238.56,"body":"they're last time they went to the"},{"startTime":2237.319,"endTime":2241.079,"body":"doctor because their stomach hurt they"},{"startTime":2238.56,"endTime":2242.319,"body":"were involuntarily hospitalized because"},{"startTime":2241.079,"endTime":2244.76,"body":"people are like oh you're talking to"},{"startTime":2242.319,"endTime":2245.76,"body":"yourself well they're allowed to talk to"},{"startTime":2244.76,"endTime":2247.48,"body":"themselves they're not here for that"},{"startTime":2245.76,"endTime":2250.04,"body":"they're here because their stomach hurts"},{"startTime":2247.48,"endTime":2251.44,"body":"and so now they avoid care or you know"},{"startTime":2250.04,"endTime":2252.52,"body":"they have all sorts of feet injuries"},{"startTime":2251.44,"endTime":2254.68,"body":"particularly people experiencing"},{"startTime":2252.52,"endTime":2257.4,"body":"homelessness and things like that um and"},{"startTime":2254.68,"endTime":2259.319,"body":"so frequently you know we see the life"},{"startTime":2257.4,"endTime":2262.16,"body":"expectancy decrease and we think oh man"},{"startTime":2259.319,"endTime":2265.319,"body":"this must be just such a morbid and um"},{"startTime":2262.16,"endTime":2267.48,"body":"mortality inducing condition which it is"},{"startTime":2265.319,"endTime":2270.0,"body":"but it's not exclusively because of that"},{"startTime":2267.48,"endTime":2272.2,"body":"it's all the ramifications that go on by"},{"startTime":2270.0,"endTime":2274.839,"body":"mental illness being untreated leads to"},{"startTime":2272.2,"endTime":2276.56,"body":"these you know Downstream effects so we"},{"startTime":2274.839,"endTime":2278.8,"body":"got to the point where now we're finally"},{"startTime":2276.56,"endTime":2281.04,"body":"finally it seems like so finally we're"},{"startTime":2278.8,"endTime":2283.599,"body":"funding mental health in this country"},{"startTime":2281.04,"endTime":2286.56,"body":"like at least at a very basic level we"},{"startTime":2283.599,"endTime":2289.28,"body":"like decided that you need to do that so"},{"startTime":2286.56,"endTime":2291.4,"body":"we're doing that now sometimes like when"},{"startTime":2289.28,"endTime":2293.72,"body":"I refer patients out and they go to"},{"startTime":2291.4,"endTime":2295.64,"body":"certain places let's just call them"},{"startTime":2293.72,"endTime":2298.2,"body":"residential treatments and they come"},{"startTime":2295.64,"endTime":2301.119,"body":"back I kind of ask them what went on I I"},{"startTime":2298.2,"endTime":2303.76,"body":"review their records I see what happened"},{"startTime":2301.119,"endTime":2306.24,"body":"they like got started on five more meds"},{"startTime":2303.76,"endTime":2308.359,"body":"and like three diagnoses but nothing in"},{"startTime":2306.24,"endTime":2310.16,"body":"the records I got back lists a single"},{"startTime":2308.359,"endTime":2313.68,"body":"reason why they were given those"},{"startTime":2310.16,"endTime":2316.359,"body":"diagnoses to me it feels like these"},{"startTime":2313.68,"endTime":2318.839,"body":"places are are like okay we now that we"},{"startTime":2316.359,"endTime":2321.52,"body":"can charge insurance companies more"},{"startTime":2318.839,"endTime":2323.44,"body":"we're doing for-profit mental health"},{"startTime":2321.52,"endTime":2325.92,"body":"care where we just run people through a"},{"startTime":2323.44,"endTime":2328.359,"body":"grinder give them a diagnosis we can"},{"startTime":2325.92,"endTime":2329.8,"body":"bill for and a medication to match it so"},{"startTime":2328.359,"endTime":2332.44,"body":"that you know it looked like we're"},{"startTime":2329.8,"endTime":2334.839,"body":"treating people and then send them"},{"startTime":2332.44,"endTime":2338.92,"body":"out have you have you ever got the same"},{"startTime":2334.839,"endTime":2343.839,"body":"feeling before a absolutely it it's"},{"startTime":2338.92,"endTime":2345.599,"body":"unfortunate um but like a lot of so the"},{"startTime":2343.839,"endTime":2347.88,"body":"affordable CFT was very helpful in that"},{"startTime":2345.599,"endTime":2349.119,"body":"it said there's some aspect of parity"},{"startTime":2347.88,"endTime":2351.2,"body":"mental health and physical health"},{"startTime":2349.119,"endTime":2354.4,"body":"conditions both need to be reimbursed"},{"startTime":2351.2,"endTime":2356.4,"body":"with by insurance right however if you"},{"startTime":2354.4,"endTime":2358.8,"body":"are a primary care doc seing somebody"},{"startTime":2356.4,"endTime":2361.4,"body":"for bread and butter low back"},{"startTime":2358.8,"endTime":2364.04,"body":"pain that is not the same billing as a"},{"startTime":2361.4,"endTime":2366.599,"body":"cardiologist seeing somebody post stent"},{"startTime":2364.04,"endTime":2369.079,"body":"that has atrial fibrillation or you know"},{"startTime":2366.599,"endTime":2370.96,"body":"to blank some other condition right"},{"startTime":2369.079,"endTime":2372.72,"body":"that's a level one two or three billing"},{"startTime":2370.96,"endTime":2374.599,"body":"versus a level five billing and if"},{"startTime":2372.72,"endTime":2377.2,"body":"people who aren't familiar the basic"},{"startTime":2374.599,"endTime":2378.839,"body":"insurance has a one to five billon scale"},{"startTime":2377.2,"endTime":2380.92,"body":"which over the course of a day if you're"},{"startTime":2378.839,"endTime":2382.56,"body":"seeing 10 to 20 patients is"},{"startTime":2380.92,"endTime":2384.24,"body":"exponentially a lot of more different"},{"startTime":2382.56,"endTime":2386.319,"body":"amount of money generalized anxiety"},{"startTime":2384.24,"endTime":2388.359,"body":"disorder major depressive disorder"},{"startTime":2386.319,"endTime":2390.16,"body":"moderate the most common things that we"},{"startTime":2388.359,"endTime":2392.56,"body":"see you would have to do a lot of"},{"startTime":2390.16,"endTime":2394.68,"body":"documentation to be able to argue that"},{"startTime":2392.56,"endTime":2396.119,"body":"that's a level four or level five now"},{"startTime":2394.68,"endTime":2398.2,"body":"major depressive disorder severe with"},{"startTime":2396.119,"endTime":2400.0,"body":"Psy cotic features major depressive"},{"startTime":2398.2,"endTime":2401.2,"body":"disorder and with significant Catatonia"},{"startTime":2400.0,"endTime":2403.68,"body":"you know some significant amount of"},{"startTime":2401.2,"endTime":2405.319,"body":"functional impairment sure but the"},{"startTime":2403.68,"endTime":2407.0,"body":"billing aspect and again I'm not saying"},{"startTime":2405.319,"endTime":2409.359,"body":"that people are doing it just for money"},{"startTime":2407.0,"endTime":2410.48,"body":"and for profit definitely not in fact"},{"startTime":2409.359,"endTime":2412.4,"body":"like you mentioned especially in this"},{"startTime":2410.48,"endTime":2414.359,"body":"area the DC area a ton of psychiatrist"},{"startTime":2412.4,"endTime":2416.4,"body":"don't even take insurance so I think"},{"startTime":2414.359,"endTime":2419.04,"body":"people who take insurance like I'm glad"},{"startTime":2416.4,"endTime":2420.64,"body":"that they do but we've incentivized this"},{"startTime":2419.04,"endTime":2422.28,"body":"fee for service program and this is not"},{"startTime":2420.64,"endTime":2424.16,"body":"just in mental health this isn't broader"},{"startTime":2422.28,"endTime":2426.88,"body":"American Healthcare but we're seeing it"},{"startTime":2424.16,"endTime":2429.839,"body":"play out in mental health in order to"},{"startTime":2426.88,"endTime":2431.2,"body":"stay seemingly financially feasible a"},{"startTime":2429.839,"endTime":2433.52,"body":"lot of these programs feel like we need"},{"startTime":2431.2,"endTime":2436.52,"body":"to get level four level five billing for"},{"startTime":2433.52,"endTime":2438.72,"body":"everything so there is incentive to"},{"startTime":2436.52,"endTime":2440.119,"body":"diagnose people with bipolar 2 disorder"},{"startTime":2438.72,"endTime":2441.359,"body":"when it might be more of a borderline"},{"startTime":2440.119,"endTime":2443.599,"body":"personality"},{"startTime":2441.359,"endTime":2445.44,"body":"disorder we've seen it we've seen"},{"startTime":2443.599,"endTime":2448.92,"body":"somebody who we feel we knew for a very"},{"startTime":2445.44,"endTime":2450.68,"body":"long time that had X condition that as"},{"startTime":2448.92,"endTime":2452.359,"body":"far as billing goes doesn't hit that"},{"startTime":2450.68,"endTime":2453.44,"body":"they go somewhere else and they think oh"},{"startTime":2452.359,"endTime":2455.079,"body":"well and and here's the thing I'm not"},{"startTime":2453.44,"endTime":2456.119,"body":"saying that people are blatantly some"},{"startTime":2455.079,"endTime":2458.119,"body":"people probably are blatantly doing"},{"startTime":2456.119,"endTime":2460.319,"body":"things wrong for money probably true I I"},{"startTime":2458.119,"endTime":2463.319,"body":"can't speak to all psychiatrists I don't"},{"startTime":2460.319,"endTime":2464.76,"body":"think most are I think that's just it"},{"startTime":2463.319,"endTime":2466.68,"body":"might not even be them billers and"},{"startTime":2464.76,"endTime":2469.28,"body":"coders do the same thing for every"},{"startTime":2466.68,"endTime":2470.76,"body":"physicians in a hospital right emrs are"},{"startTime":2469.28,"endTime":2473.04,"body":"designed for coding they're not even"},{"startTime":2470.76,"endTime":2474.52,"body":"designed for providers it's designed to"},{"startTime":2473.04,"endTime":2476.24,"body":"make sure that they can get the maximum"},{"startTime":2474.52,"endTime":2477.599,"body":"amount of coding so they can get the"},{"startTime":2476.24,"endTime":2479.56,"body":"maximum amount of billing so they can"},{"startTime":2477.599,"endTime":2482.319,"body":"bring in the maximum amount of Revenue"},{"startTime":2479.56,"endTime":2484.88,"body":"it's very possible that you say rule out"},{"startTime":2482.319,"endTime":2486.839,"body":"bipolar 2 disorder and the coders say"},{"startTime":2484.88,"endTime":2488.24,"body":"bill for bipolar 2 disorder right and so"},{"startTime":2486.839,"endTime":2489.92,"body":"but in order to do that they then have"},{"startTime":2488.24,"endTime":2493.64,"body":"to slap the label of the diagnosis on it"},{"startTime":2489.92,"endTime":2496.839,"body":"right and so you know I I I don't want"},{"startTime":2493.64,"endTime":2499.319,"body":"to assume the worst of people but we"},{"startTime":2496.839,"endTime":2500.48,"body":"know for a fact that certain conditions"},{"startTime":2499.319,"endTime":2501.88,"body":"and certain levels of functional"},{"startTime":2500.48,"endTime":2504.8,"body":"impairment associated with said"},{"startTime":2501.88,"endTime":2507.48,"body":"conditions can make more money for"},{"startTime":2504.8,"endTime":2510.28,"body":"services so there is an incentive were"},{"startTime":2507.48,"endTime":2512.76,"body":"you to want to do so to add a few more"},{"startTime":2510.28,"endTime":2514.24,"body":"diagnoses on yeah I mean I think we"},{"startTime":2512.76,"endTime":2516.359,"body":"should all be talking about these sorts"},{"startTime":2514.24,"endTime":2518.839,"body":"of things and uh you know I think some"},{"startTime":2516.359,"endTime":2520.56,"body":"times we might not want to because there"},{"startTime":2518.839,"endTime":2521.64,"body":"there is a big anti- Psychiatry movement"},{"startTime":2520.56,"endTime":2523.839,"body":"out there and then there's a lot of"},{"startTime":2521.64,"endTime":2526.16,"body":"people that as a baseline I think"},{"startTime":2523.839,"endTime":2529.04,"body":"especially in the political climate now"},{"startTime":2526.16,"endTime":2531.52,"body":"have a kind of uh conspiratorial bent on"},{"startTime":2529.04,"endTime":2533.56,"body":"everything like if there is an incentive"},{"startTime":2531.52,"endTime":2535.72,"body":"that the government places then there"},{"startTime":2533.56,"endTime":2537.599,"body":"must be some giant conspiracy to do"},{"startTime":2535.72,"endTime":2539.52,"body":"something you know like and I don't want"},{"startTime":2537.599,"endTime":2541.2,"body":"to get the idea that we're we're we're"},{"startTime":2539.52,"endTime":2542.359,"body":"saying that and this isn't unique to"},{"startTime":2541.2,"endTime":2543.96,"body":"Psychiatry either I think that's the"},{"startTime":2542.359,"endTime":2546.24,"body":"important part to say like this is the"},{"startTime":2543.96,"endTime":2550.04,"body":"way American Healthcare System is set up"},{"startTime":2546.24,"endTime":2552.44,"body":"for example if you do a colonoscopy in"},{"startTime":2550.04,"endTime":2554.079,"body":"the hospital it's essentially no money"},{"startTime":2552.44,"endTime":2556.319,"body":"for the GI dock no money for the"},{"startTime":2554.079,"endTime":2558.92,"body":"hospital there is massive incentive to"},{"startTime":2556.319,"endTime":2560.839,"body":"do it in andout patient or like you know"},{"startTime":2558.92,"endTime":2563.079,"body":"urgent like urgent here kind of like"},{"startTime":2560.839,"endTime":2564.96,"body":"Same Day Surgery Center the way billing"},{"startTime":2563.079,"endTime":2566.839,"body":"works is essentially all of the stuff"},{"startTime":2564.96,"endTime":2568.52,"body":"that goes into a I saw this directly"},{"startTime":2566.839,"endTime":2569.96,"body":"that one GI doctor worked with said it"},{"startTime":2568.52,"endTime":2571.359,"body":"could be up to four times difference in"},{"startTime":2569.96,"endTime":2573.96,"body":"price like that's the amount that they"},{"startTime":2571.359,"endTime":2575.68,"body":"can do save money billing Etc there's"},{"startTime":2573.96,"endTime":2577.16,"body":"all sorts of incentive like if they can"},{"startTime":2575.68,"endTime":2579.28,"body":"help it they're like oh someone comes in"},{"startTime":2577.16,"endTime":2580.8,"body":"with a GI bleed on Saturday they're like"},{"startTime":2579.28,"endTime":2582.72,"body":"can they wait till Monday and come to my"},{"startTime":2580.8,"endTime":2584.64,"body":"office you know even though we might"},{"startTime":2582.72,"endTime":2587.0,"body":"think diagnostically they need to be as"},{"startTime":2584.64,"endTime":2589.04,"body":"soon as possible but there's Financial"},{"startTime":2587.0,"endTime":2590.4,"body":"incentive and things like that it's not"},{"startTime":2589.04,"endTime":2591.72,"body":"unique to Psychiatry I think that's the"},{"startTime":2590.4,"endTime":2592.88,"body":"important part is that like yeah there"},{"startTime":2591.72,"endTime":2594.88,"body":"is an anti Psychiatry movement"},{"startTime":2592.88,"endTime":2597.28,"body":"Psychiatry is more difficult in some"},{"startTime":2594.88,"endTime":2600.44,"body":"regards in that we don't have the as"},{"startTime":2597.28,"endTime":2602.88,"body":"much objective lab data as compared to"},{"startTime":2600.44,"endTime":2604.559,"body":"right it's really hard to bill for"},{"startTime":2602.88,"endTime":2606.8,"body":"rheumat arthritis if you don't have"},{"startTime":2604.559,"endTime":2608.079,"body":"demaras for rheumat arthritis you either"},{"startTime":2606.8,"endTime":2610.68,"body":"do or you"},{"startTime":2608.079,"endTime":2612.319,"body":"don't you know my hands are stiff and"},{"startTime":2610.68,"endTime":2615.72,"body":"then get a diagnosis of rent toid"},{"startTime":2612.319,"endTime":2617.44,"body":"arthritis exactly exactly but if you say"},{"startTime":2615.72,"endTime":2619.72,"body":"you know my mood is low and things have"},{"startTime":2617.44,"endTime":2621.079,"body":"been tough and sometimes I think about"},{"startTime":2619.72,"endTime":2623.079,"body":"not wanting to be here anymore and my"},{"startTime":2621.079,"endTime":2624.24,"body":"appetite's changed and you know I do"},{"startTime":2623.079,"endTime":2625.88,"body":"think about things I wish I would have"},{"startTime":2624.24,"endTime":2628.4,"body":"done differently and and you lay US list"},{"startTime":2625.88,"endTime":2630.4,"body":"all these things it could be an"},{"startTime":2628.4,"endTime":2633.079,"body":"adjustment disorder right like life's"},{"startTime":2630.4,"endTime":2636.44,"body":"been tough it could be depression too"},{"startTime":2633.079,"endTime":2638.599,"body":"right and the incentive financially is"},{"startTime":2636.44,"endTime":2641.52,"body":"to say well let's put the one that would"},{"startTime":2638.599,"endTime":2643.68,"body":"be more financially Fe you know feasible"},{"startTime":2641.52,"endTime":2646.8,"body":"again not unique to"},{"startTime":2643.68,"endTime":2650.079,"body":"Psychiatry I criticize uh the way we"},{"startTime":2646.8,"endTime":2652.559,"body":"diagnose things a lot in the podcast and"},{"startTime":2650.079,"endTime":2655.16,"body":"uh but I don't I know I'm a fan I"},{"startTime":2652.559,"endTime":2657.88,"body":"listen I don't do it with the with the"},{"startTime":2655.16,"endTime":2659.4,"body":"intention of like ah Psychiatry sucks"},{"startTime":2657.88,"endTime":2662.44,"body":"but try just trying to figure things out"},{"startTime":2659.4,"endTime":2664.559,"body":"better um to be a better diagnostician"},{"startTime":2662.44,"endTime":2666.28,"body":"myself could you talk a little bit more"},{"startTime":2664.559,"endTime":2669.079,"body":"about maybe the history of serious Al"},{"startTime":2666.28,"endTime":2671.2,"body":"illness or can is there do you have some"},{"startTime":2669.079,"endTime":2673.76,"body":"some kind of personal anecdotes of your"},{"startTime":2671.2,"endTime":2675.96,"body":"own that that you think are especially I"},{"startTime":2673.76,"endTime":2678.319,"body":"don't know either powerful or like"},{"startTime":2675.96,"endTime":2680.359,"body":"affected you or something I think also"},{"startTime":2678.319,"endTime":2682.04,"body":"too like the like longer aspect of like"},{"startTime":2680.359,"endTime":2683.4,"body":"history of M I think I actually have"},{"startTime":2682.04,"endTime":2685.0,"body":"like a presentation I've done on that at"},{"startTime":2683.4,"endTime":2687.0,"body":"some point which I can maybe find and"},{"startTime":2685.0,"endTime":2688.04,"body":"bring back for next time um for anybody"},{"startTime":2687.0,"endTime":2689.72,"body":"who's listening we're planning on this"},{"startTime":2688.04,"endTime":2691.28,"body":"being a a multi-part series as many"},{"startTime":2689.72,"endTime":2693.88,"body":"times as Ryan will have me I'll I'll be"},{"startTime":2691.28,"endTime":2695.2,"body":"on um well I'm starting to think that"},{"startTime":2693.88,"endTime":2697.72,"body":"it's going to be very frequent because"},{"startTime":2695.2,"endTime":2700.48,"body":"it's gonna be a lot less work for"},{"startTime":2697.72,"endTime":2702.96,"body":"me just talk and then edit than it is to"},{"startTime":2700.48,"endTime":2704.839,"body":"try to like do all this reading and like"},{"startTime":2702.96,"endTime":2707.44,"body":"write something out and try to organize"},{"startTime":2704.839,"endTime":2707.44,"body":"my thoughts"},{"startTime":2709.4,"endTime":2714.559,"body":"which I'll talk about this next time but"},{"startTime":2712.319,"endTime":2716.92,"body":"uh I'm going into I'm doing the public"},{"startTime":2714.559,"endTime":2718.119,"body":"service Psychiatry Fellowship um with"},{"startTime":2716.92,"endTime":2720.559,"body":"University of Pittsburgh which is"},{"startTime":2718.119,"endTime":2723.119,"body":"focused on Community Mental Health"},{"startTime":2720.559,"endTime":2725.24,"body":"serious mental illness and providing"},{"startTime":2723.119,"endTime":2727.319,"body":"care in like resource limited settings"},{"startTime":2725.24,"endTime":2729.72,"body":"how to maximize that sorry it took me so"},{"startTime":2727.319,"endTime":2731.4,"body":"long to on here I knew I knew once the"},{"startTime":2729.72,"endTime":2733.24,"body":"once Pandora's Box was open though that"},{"startTime":2731.4,"endTime":2736.559,"body":"it was just going to be you know you"},{"startTime":2733.24,"endTime":2738.359,"body":"know part part one of question mark well"},{"startTime":2736.559,"endTime":2740.64,"body":"Dr Brooks thank you for coming on the"},{"startTime":2738.359,"endTime":2744.319,"body":"show uh we will have you back for sure"},{"startTime":2740.64,"endTime":2745.599,"body":"if you'll have us Dr is a pleasure um"},{"startTime":2744.319,"endTime":2747.4,"body":"you know thank you again like I said I'm"},{"startTime":2745.599,"endTime":2749.28,"body":"I'm a fan of the show so if it's just me"},{"startTime":2747.4,"endTime":2750.28,"body":"listening that's fine I'm I'm happy to"},{"startTime":2749.28,"endTime":2753.369,"body":"I'm happy to do"},{"startTime":2750.28,"endTime":2753.369,"body":"[Music]"},{"startTime":2754.88,"endTime":2757.88,"body":"it"}]}