Why Treating People Like People Makes Recovery Possible with Dr Ann Roselle and Leslie Carpenter

What if stability starts with a warm relationship, a full fridge, and a Medicaid card—then the meds can do their job? We sit down with clinician Dr. Ann Roselle, DNP, and advocate Leslie Carpenter to unpack how serious mental illness care goes right or goes wrong, and why the difference often isn’t a new pill but a better system.

We explore the real-world work of engagement when insight is limited: showing up without an agenda, finding common ground in music or pets, and using motivational interviewing and CBT to keep people coming back. Leslie breaks down what assisted outpatient treatment (AOT) actually does—no forced injections, no jail threats—and how it holds systems and teams accountable to stay involved. Together, we look at the “black robe effect,” why patients get quietly dropped without AOT, and how small fixes like transportation, food access, and scheduling make adherence possible.

Families are the missing link. We clarify HIPAA myths and share a practical playbook for bringing relatives into care without breaching privacy: gather collateral, offer general education, and plan periodic updates with consent. We also challenge the meds-versus-therapy false choice. Long-acting injectables can anchor stability, but therapy, skills training, and community resources turn stability into recovery. Payment models should require psychosocial care across settings so people don’t get “a bed and a pill” and little else.

We close with what training leaves out: the political and social determinants that decide who gets housing, benefits, and follow-through. You’ll hear concrete steps to advocate locally—town halls, targeted emails, sharing proven models—and simple clinic moves that change lives fast: enroll Medicaid, arrange warm handoffs, and measure success by responsible transitions, not speed. If you care about schizophrenia, bipolar disorder, AOT, family engagement, and real outcomes, this conversation gives you tools you can use today.

If this resonated, subscribe, share with a colleague, and leave a review with the one policy or practice change you’ll push for this month.

Let’s Connect

Dr Dan Wesemann

Email: daniel-wesemann@uiowa.edu

Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner

LinkedIn: www.linkedin.com/in/daniel-wesemann

 Dr Kate Melino

Email: Katerina.Melino@ucsf.edu

 Dr Sean Convoy

Email: sc585@duke.edu

 Dr Melissa Chapman

Email: mchapman@pdastats.com

Transcript

SPEAKER_04 0:02

Yeah. Just my take on things. My answer number two. Identifying challenge in your beliefs. Identifying challenge in your beliefs.

Meet The Guests And Mission

SPEAKER_00 0:28

Thank you for recording. Welcome back, everybody. Welcome to another episode of Peplause Ghost. So excited to be joined here by another couple of wonderful guests here. Really excited to get into their expertise and their content and working with those with serious mental illness and really being strong advocates for generally improving the overall system of care that we have in the United States for people with serious mental illness. And so really wonderful to introduce Leslie Carpenter and then Dr. Ann Rosell. And then as always joined with Dr. Melissa Chapman Hayes. So we're here again to kind of get into this a little bit. So why don't we just kind of get going right away? And uh would you mind maybe just uh take a few moments here to just kind of give us some background on what draws you to this population? I know Dr. Rosell, you're you're you know content expert here with serious mental illness, and and Leslie, you're you know a policy advocate and and really a strong advocate of assisted outpatient treatment. So would you mind kind of sharing a little bit just what brought you to this space and what sort of experiences you've had and what keeps you in this space, I guess.

SPEAKER_02 1:35

And do you want to go first?

Why They Chose Serious Mental Illness

SPEAKER_01 1:37

Sure. So what drew me to it initially was you know, seeing how psychiatric patients, when they're on the medical side of the hospital, aren't necessarily treated well and the fundamental misunderstandings of, say, a patient with schizophrenia who is really starting to break down while getting the medical care that they need because they're away from rituals, routines, things that were really necessary for their well-being or their medications being adjusted, you know, for valid reasons, but it causes a deterioration and then the lack of understanding. And so when I was pursuing my doctorate and doing rotations in community mental health, I really fell in love with it because that's where that's where these patients are, that's where they're served, and there's such a need, and it just it is just such a perfect fit.

SPEAKER_04 2:32

Thanks, Ann. That's great.

SPEAKER_02 2:36

So I have a family member who lives with a very severe schizoaffective disorder, and he's been sick for about 18 years. And so in navigating the very siloed broken system, we encountered many more barriers than help for our son. And gradually I began decided to leave my career as a physical therapist to spend the rest of my life working in various ways to improve the treatment of people with these severe mental illnesses. And from that space, I did work with my husband to improve Iowa's commitment law to allow for AOT because that was one of the treatment models along the continuum of care that would be really helpful for somebody like my son, who, like many people with severe mental illness, have no idea that they're sick because of anasycnosia. So that was one of the first actions that we did. And then it took me five years to get the first AOT program established here in Iowa. Since then, obviously, I've done a lot of other things, including going to work for the Treatment Advocacy Center. But that's really what spurred it on was recognizing how big of a barrier anasygnosia is for people to receive care in the community. That patient population is at high risk in the community because they repeatedly stop taking their medications and participating in treatment.

Building Trust Without Insight

SPEAKER_00 3:56

Yeah, well said, I think, you know, and then and I love the answers, they're very complimentary, right? I mean, so you try to get the treatment and then, like you mentioned, and then then they go into the treatment, and then they everything that's medical gets viewed through the psychiatric lens sometimes, and so they don't get the care that they need as well. So you mentioned uh anasagosia. I hope I that's always a mouthful, but it's you know, this idea that people with serious mental illness just have a real struggle with insight and just don't see the illness that they're experiencing, and it's very unique to those with serious mental illness. Looking at it from a framework, you know, here at Peplow's Ghost of maintaining that therapeutic connection, that you know, just how we connect with someone with that sort of illness, how how have you seen kind of people work through those kind of uh difficulties, especially in the beginning of getting to know them and getting them the care that they need?

SPEAKER_01 4:46

For me, it's the persistence. If I can just, you know, find just the smallest thread, whether it's a love of like fishing or skateboarding or something or a band that I can connect to the person with, then I can get them usually to come back and have more conversation with me. I might, I might not get them the first, you know, however many visits to acknowledge that they have an illness, but I've gotten them to engage in the system and learn, like, oh, going to see Anne isn't so bad. You know, she's gonna talk to me about things I like and she's gonna get to know me versus, you know, going showing up with an agenda of you're gonna show up, you're gonna commit to doing this, you're gonna commit to, you know, working with your therapist, you're gonna commit to taking XYZ medication, you know, just meeting them where they are and letting, you know, in a way, them kind of drive the boat for a while in terms of how a visit's gonna go. And I think that if I can just keep them coming back in the beginning, to me, that's a success.

SPEAKER_02 5:58

I would agree with that. And that's very foundational to what you see AOT clinicians and judges do. They basically participate in repeated motivational interviewing conversations, asking the person what they want, what's important to them, and then partnering with them around that, helping to provide these supports that they need to reach whatever goal it is. And it might be as simple as not ending up back in the hospital or not getting evicted from an apartment. And they repeatedly have conversations about hey, if you will continue to take the medications, we're gonna go ahead and continue to help give you the support to reach your goals. And you can reach these goals, right? You can go back to school, you can have a life. That message of hope, I think, is one of the key things for also bridging that relationship that's too often missing in my experience and what we hear from others in the area. So, you know, obviously CBT for psychosis, the CRT, all of those techniques for partnering are really helpful. But Anna's completely right in saying figuring out a way to have a conversation and engage in a two-way manner really helps. And staying with it.

SPEAKER_00 7:11

Yeah, I love that. And one thing before I turn over to Melissa, but I I I always like to say too, it's like becoming one of their people, you know, the people that they turn to in a time of need. You know, if they need hospitalization, maybe they can contact me and we can work on making that transition as seamless as possible. But just yeah, be one of their be one of their people. And I don't know. Yeah, that's great. So thank you.

SPEAKER_03 7:33

I think that flows in nicely to the next question, which is about assisted outpatient treatment or AOT. And I know you were mentioning, you know, CBD cognitive behavioral therapy. So sometimes AOT can be framed by critics as coercion, but then advocates see it as a black robe effect that provides a lifeline. You two have different experience, you know, Leslie and the legislative family sphere, and then Anne and the clinic. How can AOT and having an AOT mandate actually serve as a foundation for a stronger therapeutic alliance rather than a barrier to it? And maybe Leslie, you can go first and then Anne will flip it.

SPEAKER_02 8:15

Yeah. Yeah. I just want to address the coercion part first because that is a frequent criticism. And the thing that I want everybody to understand is that AOT does not ever hold somebody down and medicate a person against their will. That is just not part of the process whatsoever. There is no mechanism to do that. There is no threat of somebody going to jail for not taking their medications. The difference that it provides is that it ensures that the clinicians are going to stay engaged with the patient. And it does have that black robe effect on the patient or the person as well as the clinicians and the whole treatment system. Because what happens without an AOT order for somebody who doesn't know they're sick all too often, and this is not a criticism of any specific clinician out there, but the reality is for my son, he was fired by multiple providers. He was refused admission to a certain hospital because of how sick he was and the fact that he consistently stopped taking his medications. And that's the reality in the states where we don't have AOT yet and where we don't have it implemented yet. The providers, like an ACT team, might go out and knock on that door three times. And if the patient never wills is willing to engage in treatment, they just close the case. And that's unacceptable while we have people ending up homeless, untreated, and in jail. So my perception is that of course we all want voluntary care. We all know voluntary care is much more effective. But for the people, the very small subset of patients that we're talking about, the choice isn't between voluntary care and involuntary care. The choice is between involuntary care and no care at all.

SPEAKER_03 10:05

Thanks, Leslie. And do you want to provide a clinician perspective on that?

Practical Help Beats Barriers

SPEAKER_01 10:11

Sure. So I I you know live in one of the two states of the country that does not have AOT in any form really on the books as a law. My state is runs pretty anti-AOT and views it, takes that coercion viewpoint, like from a top-down approach at the state. And it's interesting to me just because my experience is I don't see it that way, you know, because one site that I've worked at, you know, we had the court support services division contract, and we got people who were like mandated to come to us. And it was really frustrating because, you know, no, we can't force them to take medication, but they did, you know, patients came consistently because they knew that was what was keeping them out of jail. And so if we're already kind of like in a backdoor way, like halfway there with select sites across my state, why not offer it to everyone who can benefit? And why do we have to wait for someone to be involved with the court system? Like, why can't we take a more preventative approach? You know, we're talking about a small percentage of people who are engaged in mental health services anyway, and then an even smaller percentage who would qualify for something like this. And you know, I really look to Leslie for guidance on this topic just because she has so much experience in it, and hopefully she's gonna help me get more in my state. Fingers crossed.

SPEAKER_00 11:50

The last two holdouts, right? Hopefully.

SPEAKER_01 12:07

You know, from that motivational interviewing approach that, you know, was mentioned, just over time, like why what's not working for you? Why do you feel like this isn't working for you? How would you like to see it change? You know, you can you can get people there.

SPEAKER_02 12:22

I would like to add to that, I completely agree. The feedback we get from patients is just amazing in terms of them saying, this is the first time anybody has repeatedly worked to help me get the care that I need. The first time anybody ever got me signed up for insurance, got me housing, got me food. You know, sometimes those barriers are as simple as one woman in our local pro program, they asked her why she had missed her appointment to go get her long acting injectable. And her answer was, Well, I've run out of food. Wow. What were the solutions? Get her signed up for food assistance, get her to the grocery store, reschedule that appointment for the afternoon and take her for lunch first. You know, get that next month of medication on board and solve that problem of her not having enough food in her house, right? Sometimes the simple solutions are there that it's just nobody's asking the person why they aren't coming back in to get those next medications.

Families, HIPAA, And The Missing Link

SPEAKER_00 13:25

Yeah, I mean, that speaks so much. I mean, and and and I'm sure we've kind of maybe heard of this or experienced this ourselves, but is you know, we get in situations working with serious mental people with serious mental illness, and and I always feel like I'm an I, you know, if I'm I'm just practicing myself, I feel like I'm on an island and it's and it's so scary. And it's because there's so many needs of these these people. So working within a team, working with people who are going to look at other things, because you know, maybe, yeah, where to get food resources within a community, maybe that's not my area of expertise, but if we can connect in with people that can do those kind of simple things, I I think that has a larger impact than any medication that I can prescribe for sure. So yeah, thank you. Kind of chip gears a little bit, you know, talk continue to talk about kind of relationship stuff. And you've written about this patient family nurse triad in the context of a serious mental illness, and that the family is a missing link. And, you know, and HIPAA sometimes really kind of, I think for practitioners, sometimes we feel like it hamstrings us, you know, it kind of keeps us from reaching out to family members. What practical stuff would you say, you know, from both your perspectives of, you know, understanding the limitations of HIPAA, but then also, you know, engaging family members so that we can get that triad going to without violating any of the privacy issues that they may have.

SPEAKER_01 14:43

It's to me, it's like so simple, but you know, it's it's really about you know sitting everyone down at the start and being like, this is where we are. You know, I understand you're concerned about your loved one and you want to know what's going on. But the truth of the matter is because I work with adults, as long as safety isn't an issue, their appointment is going to stay with me, which allows the patient to know that you know their privacy is gonna be respected. But that being said, I tell families all the time, if there's a concern, call me. I can listen, I can hear what you have to say, you can leave me a message, you know. I I routinely will get messages from you know various family members before a loved one's appointment, which is fine. It gives me so much information, you know, and I'll work out deals. Like I may not call you back every time, but every few months we'll sit down and we'll do an update together about you know what's what's happening. And that way everyone feels like they're being heard, their voices are acknowledged, that they're staying in the loop, and that the patients most importantly feel like their privacy is still respected.

SPEAKER_02 15:53

I love that approach, Anne. I wish more providers understood just everything that you just had to say there, because HIPAA doesn't actually limit the ability of a family to provide information to providers, and providers are not obligated to share what we provide to you as information to tell our loved ones. And we encourage you not to do that at times, because so many times that really damages our relationship and it further increases that gap where we're less able to help them. We all know that the evidence is there showing that when families are involved, outcomes are better. The other thing I always like to point to is that if I were bringing in a mom with Alzheimer's, providers would be considered negligent, medically negligent, if they didn't involve us in the care of our adult, you know, parent with Alzheimer's. And yet we don't have that same understanding for people with schizophrenia and bipolar disorders, right? And really, I can't point to a patient population who's more at risk for adverse outcomes if they're not getting good help and support from every aspect of their lives. And so we provide a lot of helpful guidance for families and providers on our again, treatment advocacy website that can be really, really helpful. So I want to say that I so appreciate what you just had to say.

SPEAKER_01 17:14

And if I can build on that, I think, you know, and I'm sure Melissa, Dan, you guys would agree with me that a really like sound, competent, savvy provider is who is gonna understand those differences and be invested in like walking that fine line and you know, doing that balancing act of you know, bringing everyone together in a manner that you know respects all parties involved. So that way we can get the best outcomes because, you know, as Leslie's pointed out, the evidence shows when families are involved, this population does better.

Therapy Versus Meds Is A False Choice

SPEAKER_02 17:51

Yeah. And the other one point I want to make is because you have so many providers listening, is there is never any reason that you can't be providing education generally. You can say, I can't share the details of your loved one, but here's what we really usually recommend for someone with schizophrenia or someone with bipolar disorder, and point them to other places where they can get information, whether it's a book or NAMI family to family. All too often I hear from providers, well, you know, your son is so lucky because he has such an involved family. So many people are abandoned. And what I will say is they're not abandoned by families. Families are not invited in, we don't get the education. And when you don't have the education and know what you're doing, you burn out, you burn out really quickly. And sometimes the illness itself makes the person leave us, sometimes to other parts of the country because of the nature of their paranoia and delusions. And so, if you're seeing a missing family, the first question I would be asking is how can I reach out and find them and bring them in?

SPEAKER_01 18:56

And also the education on the symptoms, the difference between positive and negative symptoms. Just because the positive symptoms of you know disorders like schizophrenia have gone away, it doesn't mean the disorder doesn't exist. Those negative symptoms persist and they're really profound and really difficult for people to understand that this is, you know, part of the disease, part of the process. And when you give that information and spend time and really educate people on that, it helps families come to the table, I think, even more because they're like, oh, okay, no, they're they're still sick. Like this is still part of the disease course.

SPEAKER_04 19:36

Correct.

SPEAKER_00 19:38

Love it. I mean, that's yeah, you guys are going. And I I just loved everything about that. I mean, I think the HIPAA, yeah, from a from a provider point of view, and in having conversation with colleagues, it's it's so much of it's viewed as so restrictive, but it's really not. I mean, that's that's a that's really kind of a naive understanding of HIPAA, and uh, and I think it does just does take a little bit more oomph, but I I I really love. The idea too of this you know changing the way you kind of view it as saying that you know that that they abandon their family. It's it's the illness that really struck that keeps them from connecting to their family, and their family usually in my experience for sure, too, is that they want to connect with, you know, even if they're in Minnesota and they're down in Arizona during the winter months, they still they they're they're desperate to know what's going on with them. And uh any connection, any communication would be so appreciative of them. So yeah. Melissa, you got the next?

SPEAKER_03 20:27

Yes. So the Pep Laws Ghost podcast, uh, you know, we often explore how psychotherapy is being squeezed out by medication management. But for patients with schizophrenia or bipolar disorder, stabilization is a prerequisite for talk therapy. So, how do you balance the need for more robust pharmacological intervention, like long-lasting injectables that you've mentioned, with slow relational work required for long-term recovery? And either one of you can jump in on this one.

Training Blind Spots And System Fixes

SPEAKER_01 21:00

This is a great question. And I'm not sure I still have a great answer for it, because yeah, it's it's a fine line, and definitely you know, like in a clinic like mine where we ask that people be involved in you know therapy to have access to the med management, it's a challenge. But I guess I'm blessed with like a team behind me that like sits down and like just does the work and gets to know people. And even if sometimes it just means like, you know, having a person in that seat for like, you know, five, 10 minutes just to have that check-in and that, you know, consistency and and and build that relationship, then that's what we do for a little bit. You know, on the other hand, I try to build on that in my appointments where it's never just about the medication. The medication, yeah, it's the bulk of what I do in my role, but we're not just gonna be like, are you taking it? How's the dose? How are you feeling? Any side effects? Great, here's your refill. See you next month. It's about like, okay, well, tell me what's happening in your life. How are things at home? Like, how's your dog? You know, like pulling out those things because often in that I can find the threads of what is needed for the long-term recovery. And then the therapist and I can collaborate and like each of us then build on the information that we both glean in our separate, you know, appointments. So it's just one brick at a time.

SPEAKER_03 22:39

Yeah, and that's fine line. Leslie, what do you got?

SPEAKER_02 22:44

I'd like to, yeah, I have some significant thoughts on this. So often for the people who are the most sick who are ending up in settings like residential care facilities, have homes, you know, along the continuum. It's really about that bed and the pill, and they're not getting the psychotherapy that is so essential and so helpful. And I'd also like to push back a little bit on this approach the person has to be fully stable before they can engage. I really would, because I can tell you that it is very possible for our son to be delusional, right? And able to have rational, reasonable conversations at the same time. And some of that information gets in. It may not get in as effectively when he's much more stabilized, but it needs to start happening then. And we need to start thinking about building the system that requires that the psychotherapy and those other types of behavioral supports are there in all of the settings, from outpatient to inpatient to residential care facilities or whatever they're called in the different states, and tie it to them being paid. If you're not providing this, we're not gonna pay you. You need to build this into what's happening at these locations. And the reason I feel that way is that if you don't give a financial incentive, it's not gonna happen. And if we came at this the other way, I think that would really be a way to approach it, as well as training up the direct care support professionals who are dealing with these people most of the day and most of the time, who simply don't have enough knowledge about what these illnesses even are, because they need to be supportive of what's happening between the psychiatry prescribers and the psychologist or other therapists who are helping the whole team. Everybody needs to get on the same page, and we need to build a model that requires that. I'm a dreamer.

SPEAKER_00 24:49

I love it. That's why I'm just dreaming. That's great. Yeah, I mean, don't stop. I mean, I think that's yeah. I I mean I think we're all here on that same dream, right? I mean, I I don't think any of us are are kind of in disagreement. I I just what keeps going through my mind is is we just need to treat them like human beings, right? I mean, like this is these are these are very basic foundational things. I and I love how you say, I mean, yeah, before you ask them how they're doing on their meds, you know, how's your dog doing? You know, how's how how's you know, how's your apartment? You know, ask them about the things that are really, you know, because yeah, they're here for the meds, but it that may not be the most important thing in their lives right now. It's it's more about they've got a sick kitty or or you know, they got a kind of not so nice uh landlord that's uh kind of harassing them and things like that.

SPEAKER_01 25:30

So exactly. Sometimes the medication aspect is really secondary in the entire visit.

Policy, Not Politics: How To Advocate

SPEAKER_00 25:36

Yeah. Yeah. And if you don't, and if you don't bring it up, you know, no one will. And so that relational side that, you know, I think is so so very you know, again, foundational and and and sometimes we forget. I remember I went to, and I was I'm always saying I'm I'm a self-proclaimed Stahl groupie. Uh Dr. Steven Stahl is a big psychopharmacologist in California. And and I like a lot of the work he does, but I remember him saying, you know, we don't need a new pill for people with schizophrenia. We've got a lot of them, and you know, maybe there's some new technology that comes out, but we need more resources, just like you were saying, Leslie. We need we need more funding. We need more people that go into the home, more, you know, and I think he would call it, you know, act programs where, you know, you kind of, again, similar type of model to AOT, but uh, but more of those wraparound services to really care for. You know, it's uh medications do a piece, but they don't they don't do everything here. So let me ask kind of maybe the last question here, talking about Leslie, you've advocated for kind of this both and model, meaning that we need, you know, we need more beds, and that's across the country, right? I mean, there's more beds that's needed for acute situations with people with serious mental illness and AOT, but we also need more peer support, more community services and things like that. So for clinicians and students listening, what is what's the one thing that's maybe a blind spot in the training? I know both of you do a lot of education, and uh, you know, you're you're traveling all around the country. Leslie's kind of doing doing your education, and you've spoken with our students at the University of Iowa. And I know Anne, you're you're teaching at uh Yale University. And so it's I think you know, education is a piece of it. So you know psychiatric training very intimately. Where would you say are the blind spots? Or where, again, let's dream a little bit more and say for psychiatric training. What's what would be the thing that you would wish was in those programs, every program that's you know going to treat and care for people with serious mental illness?

SPEAKER_01 27:24

I think for me, it's getting more of the political determinants of health and the social determinants of health ingrained into the curriculum just as much as the clinical diagnosis and reasoning, the pharmacology, the physiology, because it has such an impact on this particular population. It is about the beds, the availability, having the community services, you know, the difference that, you know, getting someone a lunch or, you know, extra cash or foods, you know, food stamp access that it really makes in these people's lives. So understanding how all of that plays a role in a person's well-being just as much as, you know, all the kind of meat and potatoes, if you will, of like why we traditionally went into this field to learn about and and the impact it has, you know. Healthcare is political, you know, and and we need to understand it intimately as providers to do the very best we can.

SPEAKER_02 28:31

Interesting answer, Anne. I had never thought of it as political. Love it. What I would add from the family member perspective is definitely more emphasis of educating uh people about the need to get integrated with the other things in the system in the community where they're working. Understand where the shelters are, understand where all your community providers are, understand the resources that are available for the person and their families in terms of making appropriate referrals for those additional things. It might be voc rehab, it might be supportive community living, right? It might be somebody needs to go and learn daily living skills again. Understand what the resources are in your community where you're practicing and build those relationships so that as you go along in your practice model, you know how to quickly communicate, collaborate, and cooperate with the other players in the system to have that wraparound support for somebody that you know is at high risk. I think building out that understanding would make a big difference in addition to the things that we've talked about, the HIPAA education, the importance of gathering collateral information from family members. Because so often we think of only practicing in my realm, right? I'm in a hospital, my goal is to discharge. Good God, really? It really should be. Let's have the goal be a responsible discharge plan to the right level of care with the warm handoff and getting the communication around that to help it be successful. So those are my initial answers. And of course, you know I have more to say on that, but I'll try to keep it short.

SPEAKER_00 30:09

No, no, don't do that. Yeah, no, go in.

Closing Reflections And Next Steps

SPEAKER_01 30:11

I also want to point out, Leslie, that our answers are actually incredibly synergistic because when you understand the socio-political determinants of health, you understand better what the resources are, what resources are still lacking, what are the roots as to what I can do as a provider to go and advocate and get those resources in play. How do I advocate to keep the dollars that support the resources, you know, flowing? So it's just they're hand in hand.

SPEAKER_02 30:40

Can I share one more example from our AOT program that I think help illustrates this point?

SPEAKER_00 30:45

You don't even need to ask, Leslie. Go ahead, please.

SPEAKER_02 30:48

Okay. So one of the stories is there was a gentleman who was really circling the drain. He had over 50 some admissions to either the ED, the crisis stabilization unit, or one of the inpatient psychiatric units here in town. He was referred for AOT, thank God. Do you know what the first thing he did they did, the AOT coordinator did to help this gentleman? She got him signed up for Medicaid. Seriously, why hadn't the hospital recognized he'd been going through the same door? The definition of insanity is doing the same thing over and over again and expecting a different result. I'm sorry, but well before 50-some admissions, he should have had somebody sign him up for insurance so that then he could get an IHH worker, so that then he could get housing, so that then he would have a stable situation in which to stay stable. It took immense work to get him readmitted for a length of time that was rational and to get him discharged to the right level of care so that he could eventually get into SUD treatment, which he desperately needed because he had a co-occurring disorder. It took immense work from that AOT coordinator to make all of that happen. And it shouldn't have. That should be routine. This is the stuff we need to fix. And if we start all doing that, we can save a lot more people.

SPEAKER_00 32:18

Wow, I don't want to piggyback on that. That's that's powerful. I mean, I and there's so many thoughts that go through my head. I mean, I think of that hospital and all the money it's lost. I mean, if you get them on Medicaid, then you can, I mean, that's just a self-serving kind of thing that you would want to do as well, let alone just, yeah, that's that's just a general humanistic right thing to do and keep that person from from caring. So yeah, I, you know, maybe kind of got a few minutes, you know, mention political side of things. I think one of the things that sometimes gets a little intimidating is people think of, you know, I can't have an impact on political type of things. And in my current role as the ISPM president, you know, we've got this series called um policy, not politics, which is kind of an ongoing educational thing where people can learn how to be more interactive in in their policies, you know, and things like that. And so because I agree with you, Ann 100% that there is so much political policy kind of driving force here that we and the in the work that we do. So you mind sharing kind of a little bit about what you've done and maybe kind of offer something of of what people can do to get involved if they're if they think, you know, oh yeah, that's a problem, but I just don't see how I can maybe help.

SPEAKER_01 33:22

Yeah, it's like again, to me, it's like a no-brainer. It's easy, but I love policy. I was one of those ones where I was like, yes, I have a policy class now. So but just going to like town halls with your local reps, it's a great way to just to start to make your face known, you know, have your voice out there, ask questions, you know, and then you can build contacts so that way, you know, for example, I was really irked one day about like insurance companies consistently saying, well, you need to you can only prescribe 90 days, but like that's not appropriate for some of our patients. You know, patients are coming off suicide attempts and you know, things that we're like, no, I don't want them to have 90 days worth of medication on hand. You know, so then because I went to the town halls and I knew who the players were, I could, you know, send emails to the right people and be like, uh, how can we talk about this? Like, this is an issue, like this shouldn't be demanded of us using our clinical judgment. You know, get get the right people thinking about those questions so that they can bring it to the next level. Or, you know, in our state with the AOT, just building those relationships and and you know, learning who the people are who are for it, the people who are who are against it, what reps are gonna be friendly, what reps are gonna be a little like reluctant. And then again, just being able to then go and just ask those questions over and over.

SPEAKER_02 34:53

I love that. And and I love your point that you can you don't have to have all the answers, but you can go and ask the questions. They say the best way to make a friend is to ask a favor, and I have found that to be true. If you were to ask them, what advice would you give for solving this problem? It it's a great way to bridge that relationship and start finding your way toward the solutions. And you may already know the solutions, but you can kind of guide them there and let them think they've thought of it, right? That technique works as well. And what I would say is not everybody has to go to work at the legislative level, right? You can simply start sharing information if you see a good article of a model that you think is a really great idea or a good thing that other people should learn about, share it on social media. It can be small in addition to doing some of the harder work of going and getting legislation enacted.

SPEAKER_00 35:46

Awesome. Well, this has been inspiring to me. I've got a little goosebumps. So thank you both for sharing your expertise, your experience. And yeah, if this is again, and I know that you know contact information will be available through the podcast as well. So feel free to reach out. I know Leslie and Ann love to make those connections. I I think that's the last thing that you know you said, Leslie. It's it's you know, it's not just relationships that we have with our patients with serious mental illness, it's the relationships we maintain with each other. And uh and that's always what I've loved about this podcast is is connecting with other people that are of like-mindedness, and and maybe we kind of see a future that's a little bit brighter and and keep dreaming, like I like you said too. So thank you so much. I appreciate everybody listening to this episode. Look forward to more episodes coming soon. And please reach out if you need anything. Like, subscribe, and and keep listening. So thanks so much. Take care.

SPEAKER_04 36:34

Too much stuff like this, too much deep, oh. They feel it before it's true. Work hard until those thoughts are finally leaving, so you can be you, huh? They feel it before it's true. Work hard until those thoughts are finally leaving, so you can be you, guide discovery. Identify and challenging your beliefs, all beliefs, framing your mind. Negative thoughts release, let it go. Cognitive distortions decrease until they taste. Yeah, guide discovery. Identify and challenging your beliefs of framing your mind. Negative thoughts release, let it go. Cognitive distortions decrease until they taste.