Dismantling the Status Quo: The People's Solidarity Fund with Nicole Sartini, LPCC, IMHP

*The audio in this episode is not my favorite. Thanks for your understanding!*

In this episode, host Sivie Suckerman welcomes her first-ever return guest, Nicole Sartini. Nicole is a licensed professional clinical counselor, integrated mental health professional, and a fierce advocate for social justice and health insurance reform based in Louisville, Kentucky. Following up on their previous conversation from August, Nicole shares vital updates on her macro-level advocacy work within the Mental Health Insurance Reform Taskforce, to challenge corporate greed and the monopolization of the behavioral health profession. Sivie and Nicole dive deep into the newly formed 501(c)(3) nonprofit, Build Better Health, and explore a groundbreaking, cooperative alternative to traditional health insurance known as the People Solidarity Fund.

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Nicole Sartini is a licensed counselor, mental health leader, systems reform advocate, and social impact entrepreneur working to transform how healthcare is structured, funded, and delivered in the United States.

She is the Founder and Executive Director of Build Better Health, a nonprofit advancing equitable, transparent, and sustainable healthcare systems, and leads the Mental Health Insurance Reform Task Force, a national, multi-discipline coalition of provider advocates spanning more than 40 states. Through this work, she focuses on enforcing parity laws, challenging harmful insurance practices, and advancing structural reform that protects both clinicians and the communities they serve.

Nicole is also the Founder of the People’s Solidarity Fund, a cooperative healthcare model being developed as an ethical, community-centered alternative to traditional insurance, designed to bring care, funding, and decision-making back into right relationship.

With over two decades in the mental health field, including building a large integrative group practice called Bridge Counseling and Wellness based in Louisville, KY, Nicole has transitioned from clinical care to focusing her work on advocacy, coalition building, and system design.

Her work is rooted in the belief that healthcare can be mutually respectful, collectively minded, and heart-led in a way that puts people over profit and truly serves the whole.
 
Links:

MHIRTF is currently conducting a national provider survey to better understand how insurance practices impact clinicians and the communities they serve. This data supports ongoing advocacy efforts and helps inform more just and equitable policy solutions.

Take the survey: https://forms.gle/bRNdaLhfk9mYZTok6

Clinicians who are interested in learning more or participating in this work are invited to complete the Get Involved form and attend our monthly national meeting. Meetings are held via Zoom on the second Wednesday of each month at 11:00 AM ET and include updates, shared learning across states, and opportunities for deeper engagement.

Get involved: https://bintake-formbh.zapier.app/get-involved

Register for meetings: https://us06web.zoom.us/meeting/register/9a3WuXZmRjyxPXNlHRU0-A

Build Better Health website: www.buildbetterhealth.org

Bridge Counseling and Wellness website: www.bridgemndbody.com

Mental Health Insurance Reform Task Force on Facebook: https://www.facebook.com/MentalHealthInsuranceReformTaskForce

This episode was produced and edited by Sivie Suckerman, MA, LMHC, ACS

Transcript

SPEAKER_00 0:00

Hey everybody, my name is Civy Suckerman, and this is Therapists Unchained, a podcast hoping to empower, educate, and inspire mental health clinicians across the country facing the unique systems that we're facing in this really ever-evolving mental health landscape. And I'm very excited to have a return guest. You're my first returned guest, Nicole. I know I want to introduce or reintroduce everybody to Nicole Sartini, who is a licensed professional clinical counselor and is an integrated mental health professional. Did I get that right this time? That's right. Oh, because I messed it up last time. And Nicole is coming to us out of Louisville, Kentucky. She's got over two decades of experience in mental health. She's an advocate for social justice and health insurance reform. She's a speaker and facilitator on authentic empowerment and heart-led leadership. She's just an incredible. If you didn't listen to our first episode, which was, let me see, I have it open so that I could remember when it was released. It was back in um August 15th, is when that episode came out, where Nicole and I were talking about, she's got a bunch of projects going on, folks. So back then we were talking about mental health insurance reform task force, which I want us to continue talking a little bit about today and any updates and stuff that Nicole's doing on that. But also another project that Nicole's been working on that is close to my heart, which is something called the People's Fund, um, which is about kind of getting, well, you can talk about more about what that's about. But anything else you'd like to add to your intro, Nicole? Did I miss anything about what you're doing?

SPEAKER_02 1:41

Well, I I really actually have learned that part of growing is sometimes subtracting things. It's not always just adding. And I have been refining in that way, and I've I've actually not doing the the authentic empowerment stuff and all that anymore because my heart is 110% in this macro work right now. I am pretty obsessed. Uh, it's like I can't stop myself from wanting to learn everything I can about how we can help move our profession forward in terms of both challenging corporate greed. When we know that a 1% of, you know, 1% of the population owns 95% of the world's wealth, financial wealth. Um, and that that that is infiltrating into the behavioral health profession, the mental health profession, in the sense that uh certain organizations are consolidating, as you very well know and talk a lot about on this show, um consolidating our field and into ways that kind of squeeze independent providers out and small practices out. And I just want to learn as much as I can about that and to do my small part in advocating for for change. And as we were doing that, Savit, like you pointed out, uh naturally we started to look at how other systems were affected also, and healthcare as a you know, as a full, as a full industry, um, how insurance companies are uh influencing that in ways that don't serve, which is where, I know we'll get later into talking about People Solidarity Fund, but where that idea came from, which is is a an initiative that supports more than just behavioral health, it's it's for all of healthcare. Um but yes.

SPEAKER_00 3:28

Well, and when you're talking about consolidation, um, and just so folks know, Nicole and I were chatting before this that people sometimes ask me to have interview questions, which I never have. If you've listened to the podcast, it's probably not a huge surprise. That I kind of wing it with everybody. But when you were just talking about that, um, I don't know if you saw on PBS recently, and I'm gonna see if I can find the clip and maybe put it on the therapist unchained website. But when you're talking about the consolidation of power, so to speak, especially within insurance companies, there was a wonderful interview with Mark Cuban. Did you see that interview on PBS? Yes. He did such a great job, and I think I posted it on the Therapists Unchained Facebook group as well, the clip that I found, because he did such a great job of talking about vertical integration and the centralization of power and control, and how when you you were talking, you mentioned something about like um independent practices, whether it's an independent physician, an independent mental health clinician. They don't want us to succeed. And it he didn't talk specifically about mental health, but when he was talking about in the clip I saw, he was talking about that um the the sort of independent physician specifically is kind of going extinct at this point, and it's by design that insurance companies target us more for clawbacks, they pay us less. And I think this transition or transfers to what we're seeing happen in mental health as well, and why they're trying so desperately to scoop us up all into these venture-backed platforms, because we all know that they're colluding with insurance companies to price fix, to create this monopoly of care. So that at some point, and I don't think people realize this, the more we all start huddling into these therapist farms, I have deep concerns about insurance companies. I mean, Mark Cuban was talking about creating some law that forces insurance companies to divest from anything that's not specifically providing insurance, which I think is a great idea, because they're trying to buy, they're trying to own everything. And the work that you're doing with the insurance task force, you know, I'm curious about how that is kind of fitting into the work that you're doing as far as divesting from like insurance companies should just be providing insurance and not be like CVS owns Aetna. Like that's problematic to me.

SPEAKER_02 6:00

Right. Yeah, no, it's definitely problematic. And there are there's a huge list, and I don't have my notes in front of me, but there is a huge list of of companies, um, both insurance companies and like you you call them tech tech back uh companies that that are doing this. But like um I loved that interview, and um I I felt really proud because um right now we're doing this like virtual tour across the US with the task force since we've been on last. It started kind of as a Kentucky thing, um, and it has organically, and I guess with some effort, grown into having uh membership from 40 different states. So right now what we're doing is our yeah, we have it we have active members from 40 states. Yes. That's the space that's on like thank thank you, thank you. I know uh I got the chill. Thank you. It it's it's super cool. Um, and and in the process, we're figuring out like what do people know, what don't they know? And sometimes it's really surprising what people know and don't know as far as how they can advocate for the field. And um, I hadn't uh one of the things he talked about in the interview was a little thing like um it's called medical loss ratio. And insurance companies are supposed to spend, according to the Affordable Care Act, uh, part of the Affordable Care Act in 2010 said that insurance companies are supposed to spend 80 to 85 percent of their profits, um, not their profits of their revenue on patient care, on client care improvement. And if they don't meet that mark, they're actually supposed to uh reimbursement. Give the money back.

SPEAKER_01 7:30

Yeah, give the money back.

SPEAKER_02 7:32

And and not many of us have ever heard of things like that happening, right? So that doesn't seem to be happening. Well, where is the money going? How is this then being approved? Because it doesn't seem like, you know, if you if you dig into it, you can see how that these numbers are being manipulated. It's very much because of that vertical consolidation that we were talking about. Um, they are paying their own subsidiaries to do things like run the network or do AI bots or um the prior off process or whatever. They're they're actually counting that as care, but the money is staying within the same profit loop, which is of course very problematic. To me, this whole thing, it's like we're talking about it as it applies to our field, but it's to me, it's like the philosophy of the entire world. Like we can't like this is a circle, not a hierarchy. I use that a lot, and when we're talking about our work at the mental health insurance reform task force, because I truly believe that everybody has like a set of skills that they're good at that can come together and make the web of our profession a lot stronger, and no one person is gonna be able to do the the work that needs to be done to help. But that's that seems like the same kind of idea. Like, like if if we're a world like that breaks down, and and I think that the opportunity that's available to us when systems are so corroded and so completely out of um out of the ethics that most of us in our profession especially uh share, right? Is that um you know that's where creation can come in. That's where new solutions can really um really come in. So yes, we are still doing the, you know, our our task force, we're really proud of the work we're doing. We're we're glad that we're able to go and do a virtual tour right now. We this week I was in uh virtually with state leads, by the way, it's not just me. There's a state lead in each of the states, and um we we're we're doing like a primary free educational like hour, like a lunch and learn hour, and we're given the basic information what people need to know to be able to effectively advocate and to work on reforming the systems that already exist. But we have that like we have these subcommittees, and we we have like a legal team and we uh or legal subcommittee, which is like legislation and litigation, and then we have an education committee, which is working on making materials for legislators, for other therapists, for um community members to understand what's going on. But then we have the innovation team, and that's where we started thinking about other ways that we can think outside the box that actually exists. This is the birthplace for creation. When things have kind of fallen this far, I mean, those of us who are paying attention are realizing that we were at a threshold in our profession. Either we're gonna be able to make it through and keep our autonomy or we're not. Like one of those things is gonna happen that we don't actually know yet, right? Um, so the other part that we wanted to do was to have other solutions. So we ended up, even though the task force started in um August of 2024, um we more recently, just this past year, um, formed an overarching umbrella called Build Better Health. And it's a 501c3 nonprofit, and we're having multiple initiatives under it. And this came from the innovation. So it started at the task force and then it ended up becoming oh, let's make something bigger and have solution-oriented plans in place.

SPEAKER_00 11:02

Task force is under the bigger, or I'm sorry, I didn't forgot what it was called. Bigger better health.

SPEAKER_02 11:07

Right now, Build Better Health. Build Better Health is the overarching nonprofit. And then we have the task force, which is of course our flagship initial, like, you know, our initial initiative. And then that's where People Solidarity Fund came on as its own arm of things because it it was like one of the solutions that um came out of like, you know, brainstorming, how can we move forward? Well, can we create a model where insurance is eliminated altogether and we're able to figure out how to how to do things without them? So that that was um that's kind of the thing, but but in that innovation committee, that's not the only thing that we're thinking of. You know that we're not because of the antitrust laws able to um technically unionize or whatever it is, right? But we found some ways that we can still potentially work together. One of those is through um certified integrated networks. So if we were to able or to organize nationally under a certified integrated network, that would um can you this is wait, can you just what does that mean?

SPEAKER_00 12:10

What is a certified integrated network?

SPEAKER_02 12:11

I'm gonna do terrible at explaining what it is, but there's a woman, Daphne, um from Ohio. Uh okay, so uh in our team, we have a uh Ohio is is fairly close to us, and um the members from Ohio have been active from the beginning, and they are taking the lead on this particular project. Um, and it is uh a certified integrated network is a provider agreement, like an independent provider agreement that shares like a central hub of um of certain amount of resources. And um with that legal, like, and I I'm afraid I'm gonna say it wrong because I'm not the expert on this particular part, but like uh under the legal framework that that allows us, we could actually um have permission to discuss rates. Um there are some other issues and challenges that come with organizing in that way. Uh one of those is that um we're moving toward value-based care as a profession, it seems like. So um there's certain like laws and ways we could come to agreements and to think it's kind of tricky. We also um they apparently it's easier if we have um a shared like EMR system that everybody uses, which would be a tough ask. Um apparently someone on our team is working on maybe a plug-in that could be that could be added to people's EMR system. So it's very much still in discovery. But what we're saying, the main point is that it can't just be, we know how laws work. Laws were the first parity law was in 1996 federally, right? And then like then it had then there was there were new laws in 2003, 2000, uh, well, 2010 was Affordable Care Act, but then um 2013 another parody law, 2000, you know, 21, then 22. Like all these were new laws, and they're just tweaking, tweaking, tweaking, and they don't there's not being followed necessarily.

SPEAKER_00 14:08

Is that what you said? Yeah, they're not being enforced. Um and when you were talking about that sort of shared EMR, I had this kind of light bulb moment of is that part of the way that like headway is getting away with it? Like, can we learn from what these big platforms are doing where I feel like they're skirting around a lot of this shit? Is there a way we can learn and beat them at their own game?

SPEAKER_02 14:33

You are hitting the nail on the head. Like, like a few that this is this is the way that we're thinking. Like, right now, yes, continue doing the work of legislation because sometimes it doesn't. You saw what Illinois just did with 1085, Hospital 1085, they raised the debt floor or the reimbursement floor for clinicians to 141% of the Medicare rate. That is huge. In 2027, anybody who's under a state um uh insurance, commercial insurance plan, it doesn't affect ERISA, unfortunately, of course, but the but the state plans, which is still over 40% of their plans, millions of people in Illinois are are gonna have easier access. I know that's how legislators have to hear it, access and stuff, and that's also important. Um, but the the bigger thing um for this conversation, which is for clinicians, is that um clinicians are gonna be getting paid an average about 30 to 40 percent more. So it can be effective. And it's not that there's nothing, let's hope that's enforced, like you said. Let's hope that's enforced. Um, we have been tracking where things have been enforced. We have an ongoing um document that kind of tracks that. Um, and I believe it's Massachusetts, had like Massachusetts and California both had like millions of dollars that they actually did when they enforced parity law, we're able to put back into the state. So I think that could be good when we're doing like our you know, tools for how do we effectively advocate the legislative level. There are tools that exist. It's just such a slow process and it doesn't always matter because sometimes they're not enforced, and especially on the federal level, and I think I mentioned it probably the last time because this is one of my the stats that just blow my mind is that in 2022 the Department of Labor um they audited 156 plans and none of them were found compliant with the law, but there were no consequences. So, what I'm saying is we can't just count on that. Um, there have to be innovative solutions, we have to continue pregnant creative. And you said beating them at their own game, that's one of the because see you'd still be using entrants in that in that framework, right? But then there's also a whole nother framework where we're just eliminating them altogether. So, like, how can like like just kind of doing whatever we can from multiple directions to see what we can really end up running with, what ends up being the most effective, and maybe it's a combination.

SPEAKER_00 16:54

Yeah. And I do want to talk about that People's Solidarity Fund. But I also, because you said something, and I've been doing some more research into this. You talked about antitrust, and that's always like we come up against this wall. And if folks don't know what antitrust is, it's what when people are like, how come we can't collectively bargain? Well, that's why we can't collectively bargain. They look at it as price fixing in the industry, even though I feel like they get to price fix on their side, but that's a whole nother issue that I don't understand how that all works. But I did a little research, and I'm not sure if you are familiar with a Texas law that got passed in 1999, and it's called the Physician Collective Negotiation Act. Um, the law allows independent, this is for physicians in Texas, and it got me thinking this law allows independent physicians to negotiate collectively with health insurers under certain conditions. It says normally that would violate the Sherman Antitrust Act because independent businesses agreeing on prices is classic price fixing. However, what Texas did was they structured the process so that the state actively supervises the negotiation, which triggers the state action. It's called an immunity doctrine. So let me see if I can find um, so the independent doctors can create a group to negotiate with a specific insurer, but they must apply for approval first. Then the state evaluates how many physicians are involved, their market share, whether the negotiation could harm competition. And the the state can reject it if they want, but they authorize like a messenger or a representative who communicates with the insurers on behalf of the group. This, when I found out at first, I'd never heard of this. And there's more to it. I'm not gonna read all of it, but it got me thinking that I mean, we're such a the United States is so unique because we're a country, but then we also, there's so much at the state level. And I sometimes get thrown off where it's like, where do we focus our attention? When I hear stuff like this, I think, okay, should we be focusing more on each state level to come up with these systems? And what should the states be working on versus at on a national level, what can we work on? Because we're such a unique country in that, where so much is at the state level, where they have oversight. But then we're also there's these federal mandates or that, well, I don't even know if they're mandates, federal rules that either um, well, either they're non-existent as far as like actually helping us or they're not enforced. I'm curious, number one, if you've ever heard of that thing that they did in Texas, and where you think something like that could possibly fit in to what you're trying to do as far as uh, because you said you have a bunch of state leaders that you're working with. Rachel, have you ever heard of that?

SPEAKER_02 19:47

No, I haven't heard of that. And now that I think about it, I'm I'm trying to recall if we have anybody from Texas on the team. But uh, if we don't, I'm gonna be needing to recruit some because that's really good information that we could learn from. Um that's a very creative approach to addressing the issue. In Kentucky, we're a very red state.

SPEAKER_00 20:07

And um But you have a Dem governor, you've got a blue governor.

SPEAKER_02 20:11

That's he's lovely, but yeah, like when when it when we go and and where things are being voted on, it's you know, so like You both love Mitch McConnell. Um yes, yes. And so like it's just been um just to get to the point where like a state like Illinois was able to get um, you know, that's been really hard, but to think like Texas getting to the point where they can like that's actually like that's where people can get it, because sometimes people are getting discouraged, like well, we'll never be able to do that. And I know because we tried to introduce a bill in our Kentucky legislator um with um Representative Wilner, but it was like, this is they're not going for it at all, like because it was not raising the reimbursement, and that's why we always talk so much about um client access, because it's oh, like it there has to be a certain language that can reach the population that you're doing. And it's not that again, like we really do care about client access to affordable care, that's actually true. But also clinicians are losing independence and they're not able to do their best work and that affects everything. So, but yeah, but but okay, so back to back sam task, Nicole. Okay. Um like uh no, but to answer the question, what you were saying about should we do national or state level. Um I've been saying to people that like this, what we're what happens in the state level does influence the national, the whole national landscape. Um so when when when there is a win, I was able to take that, I can take that, or you can take that to in your state and say, like this happened in Illinois. This obviously can be done. It is possible, and that that could influence state by state and therefore have a national influence that way. Um, I also think that this whole situation where consolidation of care is happening is a little bit it's newer to our field. So I think a lot of people lean on former legislation, they lean on what's been done. Done already. And in some ways, we're really having to think creatively. Now, there are um, you know, I was in DC back in October and I took in our federal priorities, and um uh I was at that point the thing that seemed the most relevant was the patients over profit act, um, which was specifically um saying some of what you're saying here. I don't even honestly, I don't exactly know where that is right now, but I know it hasn't been passed. Uh so like there's there's stuff that's kind of there's just with the federal state of things right now being in such disarray on so many areas and so many levels, it's been, I think, a little bit harder to make changes on a federal thing. So maybe it is, and with the federal law, uh federal, with the final rule being paused in 2025. I remember we were doing a round table um locally in Kentucky that like literally that day, and I had to change the slides and be like, well, the final rule is paused, so they're not gonna enforce it more. But those other laws still exist. Like that's what we have to remember as clinicians when we're advocating is like those laws before the final rule is paused, that was just supposed to strengthen and enforce and enforce the parity laws that were already there. It it didn't, it wasn't like a new, brand new law. It was just hard, it was just more enforcement. And I guess you probably know that that was blocked by um by insurance lobbyists, essentially, suing to to prevent that from happening, to prevent a law that's actually meant to serve the greater good um from happening.

SPEAKER_00 23:36

It's just it grosses me out. But I what I love is that I feel like I'm hearing more and more, and from both sides of the aisle, of a pushback on insurance companies monopolizing and the vertical integration of, I think it was, I don't remember the Republican legislator that I was like, damn, all right, I'm excited to see that. I wish I could remember who he was. But then I think AOC did this wonderful um, she had this like uh little board that and the image that she had around it. I think she was it, she was talking to the head of CVS or whoever they sent from CVS and looking at how CVS owns CVS, obviously. They own the pharmacy, they own Aetna, and then now they have these um facilities, these I can't remember the name of the brand that they use for their, it's like a Kinwell type thing, or there's other ones in different states where that they own, they own the doctors now too. And then I look at, like I've already said, I look at Headway has relationships now with Cigna and some of the other insurers. And then I go, you know, I see these Headway ads pop up, and this woman on her keyboard, and she's saying, with Headway, I get higher reimbursement rates than I could get on my own. And I'm going, ding, ding, ding, ding, ding, ding, ding. Hmm, how is that possible? How are they able to do that? And who are they colluding with? And that's not gonna continue. Like, here's where I see this going. I see CVS or United Optimum, whoever, starting to invest in Headway if they haven't already. And they may already be doing it. Headway, Rullo, Grow, Alma. So then it becomes that they are gonna be part owners or shareholders in these platforms. And guess what? When they pay us, they pay themselves. And those rates are gonna go down because they wanna stuff their pockets with it. They don't want to pay it out to us. So that's why I think like the work you're doing, when you talk about being creative, and like me saying we need to somehow beat them at their own game, I think that we're at this tipping point of if we don't, and I'm glad to hear legislators talking about it, like I said, it's starting to become more a part of what I'm hearing in in the legislature, which is necessary. And my hope is that um if we can, like what Mark Cuban said, that insurance companies should only be able to provide insurance. I just look at like what effect that could potentially have on the entire system and how many more openings there would be for us to advocate for ourselves and to take our power back. Sorry, I kind of want a little soapbox there. I'm not sure where I was like, what the whole, there's no question in that, but I just see how all the systems, like right now, the insurance companies have so much fucking power and control, and nobody is reining them in at all. So when I see stuff like the law in Texas, which again, I was surprised too that Texas did that. No offense to Texas, but that would not offend the state. That would have not offended the state that I would have thought would have had a law like that. How do we build upon this? And where does your People Solidarity Fund vision? Because we're talking about creative answers. And I look at People Solidarity Fund as a creative answer. So I'm curious because we haven't really talked about that aspect. Because the first time I had you on, we talked a little. If you want to know more in depth about the mental health insurance reform task force, look at the August 15th interview. Nicole and I do a deep dive into her work with that. I'm really curious how this People Solidarities Fund grew out of that and how it, because it feels like a creative solution to a systemic problem. So help us understand like what how did how did it get birthed, this idea, and what is the vision for People's Solidarity Fund?

SPEAKER_02 27:22

Okay. Um yay. Well, first of all, um uh you you started that that uh that part of of the conversation here with talking about AOC. And I just want to say, oh my goodness, is she not the most amazing? Oh my gosh. I'm just like, uh, she she is just just her history and how she's the the the story of the Phoenix rising up and then how uh she's able to advocate for so many people. It's it's amazing.

SPEAKER_00 27:50

Um just to be to be fair, my own rep Pramila Jayapal's pretty awesome too. I've seen her really. I went to one of her town halls and I was talking about vertical integration, and she totally gets it. She got it. She totally gets it. So we need these uh legislators to get it. And I think some of them on both sides of the aisle are starting to get it.

SPEAKER_02 28:14

And I and I want to say that because I I, you know, little little statements that we say in just little small chunks without context, um, you know, could be taken out of context. So I just want to say I definitely think there's purpose and point to it. And I'm really, really grateful for that that opportunity in the way that we were able to do some work, but it's just not the only piece. And I also want to say that I really actually do want people to be able to have affordable care. I think everybody should be able to access mental health care. So when I'm saying that, like it's like when we go in to talk about this stuff with our legislators, they they they they don't want us to say anything about a reimbursement, even though all of the surveys that we've done say that that's the top reason people leave the field. And it is technically an NQTL, a non-quantitative treatment limitation, it which is how, and I'm gonna get to People's Solidarity Fund, I promise. I know that's how these all this stuff is being measured, how parity is being measured in the first place, reimbursements on there. That's what the survey said most important. But when we go in to talk, they oftentimes, at least in in some of our states, um, they don't want to hear anything about reimbursement. So that's why I was saying it that way.

SPEAKER_00 29:18

But anyway, and but I think you're right. And um on the last episode, um, I'm gonna be going a larger time between episodes because I just I'm a busy person and I haven't had a chance to interview more folks lately. I have a list coming. But the last episode that was released, I interviewed Shannon Thompson, who is the executive director of the Washington Mental Health Counselors Association, which is the state chapter for our Omka, it's our state omka chapter. And she was talking about this around what you're talking about with this is work, this I put it in quotes, this workforce shortage, which I it doesn't exist. There's not a workforce shortage. And she's been reframing it locally with the Washington legislature as no, this is this is a pay equity issue. We don't have a workforce shortage, we have a pay equity issue. This is a this is an issue that is not just because if we have, I think the it's like 56% of people who graduate don't continue to get their license, or it might be the 56% do. Anyway, it's about half. About half the people that get their masters in a mental health field don't pursue licensure. And I see it, and it's like, well, what do you want? And when when you're talking about access, what about if you're a healthcare provider and you can't afford access? Like to me, that it's part of the issue. Like, if we're not being paid enough to survive, then we can't get health care either.

SPEAKER_02 30:46

Yeah, I mean, to me, it's a matter of mutual respect. Like, I always try to think of it things in terms of mutual respect. How can I both honor myself and other people? How can the greater good be served? I think the greater good is served when we think of it, when we do our best to remove like the eyes out of the situation the best we can, and then also recognize it's just facts that if people are trying to do a profession where they're trying to help people and be available before, which is which in our profession is 84% women. Um, like if if if we're trying to do that um and then don't have the basic support, yeah, like I I I did listen to part of that episode and I heard how I think y'all were saying it like, yeah, there's like a 50 per uh we're at about 50 percent um of what most people at our at our education level would earn, and we're doing work that is very um it has an immeasurable um cost also because being present and engaged for that long, there's a that takes a special kind of energy.

SPEAKER_00 31:47

And there's a pressure to perform because it I have to stack clients in order to survive. And then when do I breathe? When do I take a vacation? And you know, I was not to get too off track, but um both so one of my supervisors who's getting his PhD ended up going back into private practice at my group practice because it was just too much for him, and I totally get it, and I hope he's doing well. Hi, Cody, if you're listening. But we were talking about him and then um another clinical supervisor who's now my associate clinical director at my group practice, how all three of us now at this point have had spine problems and back surgery, and how a number of us at the practice have autoimmune conditions. And I go, I'm thinking, what are we doing to our bodies? Like, is anyone looked at like the health of mental health providers and what we're carrying in our bodies from doing this work and not being able to afford to take time off because we're struggling financially, people not being able to afford to access healthcare because we're struggling financially, and what the long-term impacts of that are on sustainability of this field. Anyway, it made me think about that too, because we started looking and we have associates, and we're the the sort of the veteran clinicians are talking about all of our health problems. And I'm going, oh God, I've never really thought about this before. But like, what are we doing to ourselves in this?

SPEAKER_02 33:14

This would actually be really interesting stats too, Columbia. I think it would be really interesting. Yeah, that would be extremely interesting. Um, well, I know that you want to make sure that we get to People's Solidarity Fund. So um, and so I'll I'll go ahead and like move that direction. Um well, um, after a lot of frustration with seeing, you know, this slow process, I I I am a high-energy woman, okay?

SPEAKER_00 33:39

I know you are. I know you are. I know you are.

SPEAKER_02 33:43

But but I'm working on like um riding those waves, and and I actually have come to a more of a place of peace with that. Less attachment to um the outcome, even though I hope that the outcome works as I want, but but but just trying to show up in a way that feels authentic and aligned um and using the unique set of skills that I personally have, because that's the only thing I can take responsibility for really in this situation. And um, when when I was thinking of it in terms of that way, I was like, you know, like, wouldn't it be nice if we could find a way, like look at first I was like, well, we could be an insurance company, and and like you were saying, like like do we could just do it better, we could do it transparent, and and like these insurance companies make, you know, uh like the elephant that what they make, uh 23 or 25 million dollars a year or whatever, like where they could be using the um the wage gap standard, and um all these things could be in place. And and at first I thought, okay, well, we could either be an interesting company or should we start just pushing for universal care, which I I am a fan of universal care, but when I was looking into it, I started thinking, all right, who's gonna like Medicaid MCOs are for-profit companies, they're for-profit companies, and that has a financial incentive to denying care, right? Like, so there's there's a financial incentive, and we we see problems with that. If we were to go universal health care, which I still do wish that there was a way for, and I still support the concept. Um, if but if we are able to do that, my concern is that those public systems would continue to be ran by these um these huge insurance giants. Um, and uh that's already how like the one like Medicaid in general is ran now by for-profit companies, um the same ones that are like Fortune 500 companies. And if um we were to go Medicare uh or if we were to go Medicare for all or whatever, like yes, there's part of Medicare that's run by the government, but a big chunk of it's the Medicare Advantage, and that is also ran by for-profit companies. So like they're managing and deciding and benefiting from denying care.

SPEAKER_00 35:46

I think all insurance companies should be nonprofits. I mean, but then they'd find a way to get around that shit too.

SPEAKER_02 35:51

But yes, well, and that's that's the history, by the way. It was um World War II. Um, like before that, most insurance companies, most most uh well there wasn't really insurance companies. It was um collective care, it was like it was nonprofit, the things that did exist, mutual aid type stuff. And um, when uh people, when companies weren't able to offer raises to their employees anymore, um, they the employers wanted to add some sort of other benefit, and that's where these insurance kind of agreements came, and then it got tied to employment. And um, when that happened, it slowly but surely, I think the mission drifted. So with People Solidarity Fund, one core part of what we're doing is we are deep in, we're studying mission drift. How does an organization start out with a certain intention and a certain goal and then drift from it? Because we've seen that happen a lot of places, probably even, yeah, like places that started out with really great intention. So we we don't think that that we would be immune to that necessarily because if that's the way the human psyche apparently works, let's study and figure out how does that happen, why does that happen, and and what do we do to prevent it? Well, a couple of things that we saw was um transparency is super key. Transparency is missing in a lot, like like transparency is missing, right? And so um one of the pieces and one of the key factors of our version of um this healthcare cooperative is um complete utter transparency. Transparency on what is the people who will who will eventually, no one has a paid salary now, but if and when that happens, um that would be completely transparent and be based on a wage gap standard, which means the highest paid employee doesn't make more than five to eight times uh the lowest paid member of the company. And so things like that can make a big difference in just setting a different tone for other companies that exist and saying, like this actually can be done. You can run an organization and run it in an ethical way. And here, let us show you exactly how we're doing it. Here's where every dollar is going. So there's not going to be any question of that 80 to 85 percent or whatever it is. But what we found out is that you pretty much have to be super, super, super, super wealthy, uh, or a big, you know, one of those big companies that you know, the I can't remember what they're even called, Civy, but the venture-backed platforms. Yes, you have to basically be that you know. You have to have investors, and there's so many. So what we're trying to do is not be tagged as an insurance company. Um, and so that's actually a big thing. And one of the things that we have to do is um we're we're doing like a more of a direct um direct primary care situation for our main doctors. We have some doctors that are working with us and stuff who already um know a lot and do a lot of direct primary care. And um, so we'll have arrangements like with them directly, but but as far as the the member experience, the goal is that it's based on this is another thing that makes this different. Um, it's based on your income. Your percentage that you put in is based on your income. It's not a fixed amount. So when we go get in, you know, usually when we get insurance, at least from an employer, you just have this is the amount for the plan, so on. This would be um two to six percent of your income goes into this pool. Um, and 90% of I'm sorry, um, 80% of it is your own money in an HSA account. So you put your own money in an HSA account that you can use for your own expenses. 10% goes into a shared discretionary fund. We have to call it a discretionary fund because to not be an insurance company, we can't um promise that we can cover expenses that go outside of what people can pay. We can't promise that. Um, but we can do our best to cover what we can, and we're gonna have a provider council and a member council or a council that's made up a governing council that's made up of half providers, half um members representing a wide range that will be that will change every two years so that we can make sure that um those decisions are being made based on everybody's best interests of what's being covered and what's not. Um, and then the other 10% would be for admin administrative stuff. Um, and we want to keep it under 10%. Most places spend a lot more than that, but that's because they're given these huge salaries that we don't we don't want. It's gross to us. Um that makes sense. Like um, and so um people can use that, but we're also have partnerships with um with other organizations um like medical debt abolition places. Um there's just a lot of other mutual aid type places that we can help if we can't provide the funding for any expenses that go over what's in that system, um, in that HSA account, or in our case, we call it a solidarity health account. But it technically is an HSA account, and that's important because we needed it to be a tax break for people still. Um even if you have insurance before this model exists, um, you should be aware that you're gonna get a bigger tax break if you do use an HSA thing. I didn't know that. I've always used a traditional PPO. Um, doing this research, um I was like, oh, okay, the the way that the whole thing works, like you it's actually more of a financial benefit to do it for um um through an HSA. So that's why that's a big part of it. It's not just primary care, of course. We've got um we're gonna have different tiers uh that people can choose to participate in. And one of those tiers, of course, includes mental health, um, but it's also gonna include things like um, you know, massage, chiropractic care, holistic ways of caring for ourselves. Um, and like that's an option people can add on. And and I can't go into all the details because we don't even have them all hammered out exactly perfectly about the amount each thing's gonna be or exactly what's gonna be included, but we do have representation from a wide range of um different disciplines contributing their thoughts and helping us figure out how we can actually build this.

SPEAKER_00 42:04

It it it like I'm trying to think of like a a way to describe it the way my brain is kind of understanding what you're saying. So it feels like it's in it's part self-funded plan, right? If we look at like self-funded plans, so it's part that, but it's also oh, I just had a thought and it it farted right out of my head. Um, there's like a self-funded plan aspect of it, but you're also how are you planning to manage like, and maybe you just don't have the answer, and that's fine, but like the administration, so it's oh, I know what I was gonna say. It's like a self-funded plan, but you're not outsourcing administration to one of these insurance companies, right? Like if I think about plans that fall under Arissa that are self-funded employer plans, the employer kind of has their own rules about like how they want it to work, but then they outsource it to Cygna or Aetna or Blue Cross Blue Shield or whoever else to oversee and be the administrator of it. And it sounds like you're doing something similar, but keeping it all in-house and not giving power to these outside insurance companies and figuring out a way to do that all internally. Is that, am I thinking about it in the right way?

SPEAKER_02 43:17

Yes. Um, yes, no uh we're we're we don't want to have a third-party administrator. We feel like that because because none of them are willing to be uh operate according to the ethics that we feel are important to bring the world forward in our in healthcare to create more mutually respectful systems. Um we haven't seen that yet. However, uh right now, gosh, there really are. We're we're we have like um in this group, we have like a a lot, we have an actuary um who I who uh they work for an insurance company now um and they have permission. They they I I I was worried about them participating with us and wondering how their work would take that. And I had so much respect for the Person when they said, Oh, I addressed it directly. And they asked them, you know, how do you feel about me doing this? Is this something that I'm allowed to do? And they said, uh, yeah. So um they have certain rules where if the insurance company's name gets brought up, they have to like back up or whatever. But like they are able to use their their skills, which are huge, because I don't know how to look at data that way and compare what would work. No clue. And that's what they have. And so, like, but we also have um, I can't remember what the original question was now. Whoops, sorry.

SPEAKER_00 44:33

But uh, but well, it's sort of like the the vision of it of it feels like a self-funded plan. I'm just wondering, making sure that I'm understanding it correctly. It feels like it has all the benefits of a self-funded plan that people kind of buy into without the without the outsourcing of the administration. And I'm curious how so it sounds like you're really doing a lot. I mean, there's so many details, and you're really like having an actuary is incredible. Um, but I guess maybe I didn't ask a question, but now I'm wondering like, how do you fit in the administrative burden? And maybe there's less of an administrative burden in the in the model that you're using because you're not an insurance company who and you get to do it your own way. So you decide what that administrative burden is. But I'm also assuming there still is a very large administrative burden of like claims, because I know, like when I talked with Shannon Thompson, we talked about a lot of people like, why can't our professional associations, why can't we get an association health plan through them? Why, and the big issue was the administrative burden. Like it's a lot to oversee and build out to do that. And I'm wondering how you're circling that square within this People's Solidarity Fund because you're kind of creating your own rules. Like that, like if it's an association health plan, you're still buying into this marketplace health insurance where there's these systems already built where you have to do X, Y, and Z, but you're kind of going, all right, we're not doing that. So how are you approaching creating your own model? And have you looked at like what the administrative burden would be of that?

SPEAKER_02 46:06

Well, there's a lot of answer unanswered questions still. I mean, we we've technically had like we had an interest meeting, but then we've only had uh, and we have like a base camp where we're keeping like all of our working documents and all that stuff. So we we do work on it, but as far as meeting as a full group, um you know, we've only done that three, four times, right? So like we're having conversations in between. So we're we're still in the early stages of this. So there's a lot of things that we don't know the answer to. But one really exciting part is that um we're actually just building a pilot right now for Louisville, Kentucky. Um, and while we're building the pilot for Louisville, we're creating a model that can be replicated. So instead of it being one big entity where power is centralized, we're we're creating a model that can be replicated, because that's also something we saw when it comes to mission drift, is that power does have to be kind of decentralized. So we're trying to learn how do we apply that very like well. And we're sort of doing the same concept with the task force. Um, like when we get a state lead, because because I do I do lead the meetings and stuff, and I think it's just kind of like the thing that I enjoy and I'm kind of like, you know, I I can pump people up or whatever, and that's good, right? But then, like when it comes to like there's no way that one person can so like you, so the state lead takes over, like we provide them with all these resources, and then they take over and they have their own pod now of their own advocacy that they're doing, and they just stay connected to the central hub. The similar thing would be for People Solidarity Fund. We want to create a model that it would need to be applied according to the needs and the and the wants of the councils within those specific cities, right?

SPEAKER_00 47:43

So and the laws within those states around because there are state-specific healthcare rules too.

SPEAKER_02 47:50

And so we have a couple partners actually building alongside us right now. Um uh our our most active member is um from Maine, and they're building a healthcare cooperative too. And so, like, we're it's it's like People Solidarity Fund is the global version, and theirs is called, I can't remember, and I feel bad about it, but uh uh but Alex is is uh is head of that and he's um yeah, he's building alongside us and and and we're using resources and information and sharing it and building a common hub so that that can be used for other people to repeat the process, because why just do it and then not track all of it down in a manual so other people can have access and then have that available? Um now, in order for people to like there, they're there I we don't know how it's all gonna go yet, but that's part of how we're doing it. Um and also I think that like you said, if people are using HSA cards and direct paying for most of their services, um that's gonna be that's gonna be a lot easier. Um you know, in that regard too, because there's not gonna have to be that administrative chasing of insurance claims and such. I don't think that we're gonna be able to what we're learning is that it might be possible that we have to partner with some sort of um catastrophic plan. Um it it it seems as though right now we're not finding the way through not having any involvement from an insurance company whatsoever at all if we're operating ethically, um, but we're still trying to figure out if there's a way around that. Um, because if you just have a we could just have a solidarity fund, but that wouldn't allow people to have the tax break. So we're trying to look at it honestly. We don't just want the thing to be like, oh, we made something that works, like it, if it doesn't serve the greater good, we don't want it, right? Like if it doesn't serve uh, we don't you you don't there's you're not gonna get a there's no purpose to it. This is generally how do we really serve and help solve the problem? What's a solution here?

SPEAKER_00 49:51

And if it was easy, somebody would have already done it. So it's gonna be complicated, and there is a lot of things to be thinking about. So just thinking, oh, we'll just pool all our money and everything will be fine is not because then you also have to look at the healthcare costs and you know, like pharmacy benefit managers and the costs of medications and the costs of like if somebody has cancer, that can be millions of dollars for that one person, right? And so we've made a system that's so complicated and you're trying to tear it open, but you're also still in it at the same time. And like, how do you how do you build something new within a system that is so complicated right now?

SPEAKER_02 50:36

It's so complicated. But this is something like let me give you an example of something I've learned along this process um about how actually it might be more doable than we think. Now, I will say there was a big group of people who did try to do it a long time ago, and we're trying to study what went well and what didn't, what worked, but it didn't work for them. Okay. So, like it's possible this, but but we don't want to stay in the system and we're gonna keep trying regardless. Um, and um in this, and we're gonna try to see study those things and see what we can learn from them. We've even been in contact with them, and like we're hoping that we can get past what those hurdles are, but this is something that I learned. You would think that like get doing something like getting a mammogram, right? Like, you would think that I I always thought like you have to have insurance for that, it's gonna be so expensive otherwise, or whatever, right? It's like literally to pay out of pocket for a mammogram is like 60 bucks.

SPEAKER_00 51:31

What?

SPEAKER_02 51:32

Yeah. So if we're using an HSA account and get rid of it, like we don't even, it's 60 bucks. So it's just 60 bucks for HSA. Yeah. So like we've been taught to believe that we're dependent on something that we might not actually be dependent on. Like in some cases that is true, like like they pay charge $500 for a screw on the neck, but but like it and people have not had insurance and had to pay certain amounts. So like we're trying to figure out, we're making a list of like where the costs are actually affordable and where they're not. Um, and also studying why is that. So we're kind of digging into it and like seeing do we need to do legal things from there too? Like branch off and do legal things from there and say this isn't right, why would this screw be 500? But then I can get a mammogram. I don't know, it's just it's just weird, right?

SPEAKER_00 52:21

Like it is, and it makes me wonder too when you think about these big hospital systems where they have entire departments fighting with insurance company. Like if an organization like you walked in and said, Hey, if you partner with us, we you'll need very little administration to oversee our patients. It won't really cost you, like, because I think about how much of our health insurance costs come down to over like oversight and administration, and like those people on the phone calling insurance, trying to get pre-authorizations and like those people are salaried employees. There are whole departments with managers overseeing that at hospitals. And if if we walked in and said, what would it cost you to see our patients where you know that you don't have to spend any money on that part of it? Right? Like that could be a huge cost savings that goes down to the consumer.

SPEAKER_02 53:19

Yes. And that that is that is the approach that we have been taking. And um, you know, it's still tricky because obviously I entered this thinking about behavioral health professionals in the beginning, and um, and it's just broadened. And so, like, uh I I we still don't a hundred percent know how is this gonna directly like well there but what we're trying to do is think of things in terms of what what else is really valuable. Like um one of our members, um he always talks about, oh, he's member of the Prout Alliance, which is a national alliance. Um, oh my gosh, I can't remember what it stands for again, but it's like um all about economic democracy. And he talks about um leisure capital. Like, like the like like so that's what you're saying right there. That's leisure capital, like to not have to do that. There's some you get to relax more, right? And that has value. Um, we also um with the task force, we're we're working on having an attorney who is um, you know, available. We're doing, we're gonna do a little bit of a membership tier eventually. And with that, we've got an attorney who will be like able to help support the clinicians. And we're we don't know all the details yet, but we're hoping for like an hour of advocacy available to you and access to the attorney or something. We don't know how it's all gonna go. But regardless, that could be a perk. So having support for where things don't go well from the organization, even if like the financial parts are still like not that different than what people are getting from other places. Um, is there another form of capital that we can offer because we organize from a more ethical and transparent way? And we're able to build partnerships that somehow benefit, you know, like so. That's this kind of thing, like one of our members is is building EMR system, and um they have a whole different way of approaching it that's really helpful. So maybe like I don't exactly know. Like that's the that's the part that we're still figuring out, and we've got a lot of um all we know is that we want it to be an improvement, we want it to be an we want, we want it to be an improvement for um just for like the way the business in in in healthcare is just done in the country, like we want to show a model of how it can be done better, essentially, in a way that's more respectful to everybody involved, including clinicians.

SPEAKER_00 55:47

Yeah, and it's a form of collective action. And whereas we may not be able to collectively bargain in a way, if if clinicians across discipline align with your mission, it's a way to collectively bargain if you're like, hey, we're all gonna drop out of your system or the their their system and build our own system. I mean, this is like I know it's kind of a big lofty, it's that B hag, the big hairy, audacious goal, but yeah, um, it's a way to kind of put the middle finger up and say, you're telling us we have no power, we're gonna just take it. We're gonna take our power instead of waiting for you to acknowledge. Yes.

SPEAKER_02 56:27

Yeah, we have we have a different form of power. We have the people. Like when we really look at that equation of that one one percent or whatever it is, like the power really stands with the people. So if we find ways, it and it is hard because it's a learning process to learn how to work with so many people, right? Like that's it's a learning process for all of us, but let's take it, let's do it, let's take the curriculum, you know, and like and let let's learn together and grow together and and figure it out. And with People Solidarity Fund, it could end up being that it's like, you know, as members that we get the greatest benefit. Because if we're saving ourselves, you know, hundreds of dollars on our insurance payments, that's gonna be a positive thing.

SPEAKER_00 57:10

Um, you know, and I just applaud you for, I feel like my experience of you, Nicole, since I've known you, is that you stick your neck into the most overwhelming complicated systems and have this creative drive and energy to try to rip them apart and say, you know, there's like, I mean, I'm sure there's some fear there, but your approach feels like instead of being afraid of the systems, let's let's go full bore into them and break them apart and really look at them. And I think for a lot of people, that feels so overwhelming. Like I don't even know where to start. And I'm hearing that from you too. Like, we're not exactly sure, but going into it anyway and doing it anyway, and bringing people together other anyway, and saying, I'm not gonna let this fear get in the way of like something needs to fucking change. And yes, it's overwhelming. And yes, like I don't understand half of it because that's by design. They create such complexities that it's like your head spins, but you're like, I'm gonna do it anyway, because something needs to be done. And you're getting traction, and people are drawn to the work that you're doing. And I just really want to like acknowledge that because not a lot of people have the tenacity to jump straight into the fire of some of the most complicated, messed up systems in this country and say, all right, let's try to let's try to figure out a different way to do this. That overwhelms most people. And I'm not saying that you're not overwhelmed by it because I'm sure you are, but you're doing it anyway. And I applaud you for that.

SPEAKER_02 58:43

Well, thank you. I really appreciate it. And I'll tell you something I was saying yesterday to one of the team members. Um, it's interesting how my brain is shifted. Um, and I think it's like really positive because I feel myself growing just as an individual. Like um, you know, I was raised in like a traumatic environment, and in the initial part, the way that I I was became in what you quote, overachiever, whatever it is, it came from my trauma, you know. Like I wanted to have a sense of control over my environment, and I wanted to like, you know, and so but but that's matured in me over the years, and I I've really enjoyed feeling that experience of of growth, and and I really appreciate that you know, you acknowledging the desire there. It and now it's become more of like, well, I've got a lot of practice at this, I feel like this is something I can do, but like my brain has started to almost like um I see it as like squishing down and becoming wider. And there's certain places I'm not, I don't feel like I can go in as deep as I used to because there's the management organization piece of like the 40 state thing. It's um it's like it's a whole different thing. So it's really taught me um a lot about releasing and allowing like other people to really truly like it. Like to the that that we really got the thing I preach, I also am need to learn, like we all do. Like that there really there are people who are able to delve in even deeper and bring that back up. And like, you know, if I can just be you know part of helping organize this and count on people to show up to dive in and bring in the parts that they can understand and they know. Um, we have seen that. And I I really do want to give a shout out to our team because it's been uh an incredible and humbling honor to see, like, and and I say it all the time, like I am definitely not the smartest person in that room. Um, um, and it's such an honor to like get to to be part of it. And um and I and I appreciate you acknowledge that and and definitely want to say that uh this is definitely a we thing, not a me thing. And um, and you know, even the work you all are doing is is part of that, right? So like it's and you're doing here at Therapist Unchained, it's like this is this is you know, uh it's an honor to see so many people who care.

SPEAKER_00 1:00:54

Yeah, and being able to figure out like what is the little part I can do, you know, because it's like what you're saying, like you can't control, you have to delegate, you have to open it up because you can't oversee the whole thing. And that's not a power kind of system that you want to be in anyway, because that stifles growth and creativity, being able to hand stuff off and say, all right, I can create this sort of infrastructure with help. And then at the end of the day, though, I'm reliant on everybody kind of showing up because I can't do all of that, and nor should I. Like every state's gonna be different, they're gonna have different needs, but can I create a space where everybody can come together? I mean, I that's what I hear you doing. And that's, I think, I mean, I've had to learn that as a group practice owner. Like, where can I start to relinquish some control over things and like say, fly, Bertie, fly? Like, I trust you, go do that thing. You have a vision, go do that thing, or therapist unchained. Like, there's only so much I can do trying to figure out where my role is, and it's in I like to talk to people. So I'm like, all right, let me just be a let me be a megaphone. Because and you know, I'm sitting on the board of M HP EA. We're still trying to figure out all of the stuff we're doing over there, but like I know I can't do all of it. And I'm so excited then when I see like what you're doing, and like, oh, cool, she's on that part. That's super rad. Or someone else I know who's trying to um that I was connected with, who's trying to get funding together to create um a stronger SEO presence for clinicians because we're being pushed out um algorithmically by Headway, Rula, Grow. Like we can't even get our names up at the top. And now there's, I saw someone woman post I'm trying to connect with her to get her on the podcast, who's like, how can we come together and pool our resources to get on top of fucking Headway being at the if you look for a like therapist in this state, Headway or whatever is the first thing to pop up. And that's problematic. It used to be psychology today listings and independent providers, you could find us, and now you can't. So I'm like, that's super rad. I'm not gonna do that, but I can have you on the show. That can be my where I create that space for that, and that's kind of what I hear you say too. Like, I can't do all of this, but I can create a space for everybody to come together to show us what everybody can do. And I'm just the one saying, Hey, let's all come together to do this, but I don't have the expertise to do all of it.

SPEAKER_02 1:03:14

And I think it's part of how we evolve as helpers too. Like this feeling of like um it can come from something that we've done like it like in the past because of anxiety, right? Like to now being something that we're doing because we want to, because it feels good, because we've we're good at it, because we like to. Like, like that's a whole different thing. It's a whole different way of viewing um service, which is important for us as mental health professionals and as women who've been conditioned by a patriarchal society. Um like that that are, you know, like it's it's cool. And I I really respect and appreciate the uh your the work you're doing, and I'm so grateful and honored to be able to have been a guest twice now. Thank you. Thank you. Very good.

SPEAKER_00 1:04:01

I admire your work so much, and I always have your invitations in my calendar, and someday I'll show up to one of those meetings. They are there, are they are in my Google calendar because I am on the list and I see it on Wednesdays when the Wednesdays that you have your mental health insurance reform task force meetings, and I'm like, there will be a day when I will be able to meet. Yes, I'll be so happy when you come and we'll give you yeah, but I just I keep it on my calendar because it reminds me this work is happening. Oh, even if I can't participate in it, when I see it pop up, I think once a month or whatever, I'm like, okay, that's happening right now. That keeps me going, just knowing that y'all are meeting and doing your thing. So I just I think you're such a powerhouse. I said this last time you were on the show. And I'm thrilled that you're my first guest to be on twice. I think that's cool. And it just shows like I mean, I'm I also like follow you on social media and see you dancing in your house with your kids and like all of that. And I love the joy and playfulness you bring to like your life and this work, and that you find times to dance, and that you you are focused on joy amongst all of these really difficult systems that you're trying to break open and redesign. And so I think you're a very unique energy and person. And I'm so happy that I have an opportunity to highlight the work that you're doing. And I will definitely have any information, like when I I'll reach out to you about what you want in the show notes, any of the organizations that you mentioned that people can connect with, please like give me those links. Um, and uh oh, I'm getting an error right now that I hope does not have a problem with the podcast recording, which says that there's a problem saving local backup of audio. So let's hope that not.

SPEAKER_02 1:05:52

Fingers crossed, fingers crossed.

SPEAKER_00 1:05:53

Oh my god, that's never happened before. Um, but uh I'm just it's Great to be in community with you, Nicole. And um, if this podcast reaches people that maybe your stuff wouldn't have reached and they get involved, then I feel like I've done my job.

SPEAKER_02 1:06:15

Thank you so much. It really means the world. And I and uh I I I I I do actually see that I don't think there's like a line happening when I talk, so it might be on my end. But um I see a line happening. Oh, you see a line? Okay, good. Um, okay, okay, okay. Well then I guess we'll just um go ahead and say um thank you so so much, Civy. Really, truly um it's such an honor to be in a world with um other people who care so much and who want to use their skills like this. And I'm just honored and grateful. And um I appreciate also the opportunity to be seen like that. Thank you. And for the work to be lifted, most importantly, because um, because yeah, we want we're serious about wanting to make a a real change, a real impact. So thank you.

SPEAKER_00 1:06:58

Thank you so much. And I'm sure I'll probably have you on again. Depends on how many episodes this podcast I end up doing in the long run. I don't know. It feels like I'm just gonna do it forever until things change. But for more information about Nicole Sartini and all the amazing work she's doing, all that information will be in the show notes. Thank you for being here. Thanks to my listeners for listening. We've had record-breaking months as far as listenership. So please continue to share this podcast. As I say in almost every episode, I have no marketing budget. I'm a one-woman operation uh from my dining room table here in Seattle, Washington. So the more that you can spread the word, the more that we can come together in community to fight back against these systems. So thank you to my listeners. Thank you, Nicole. Again, my name is Civy Suckerman, and this is Therapist Unchained.