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MONICA BERNER: I'm Dr. Berner. As a family physician, I've cared for patients for over a decade. Currently, I also serve as chief clinical officer. In this podcast series, we take on key health care challenges facing workforces today and discuss what we can do together to address them for employers like you and your employees.
The field of behavioral health is more talked about today than ever before. According to one recent poll, 74% of full-time employees in the US say it's appropriate to discuss mental health concerns at work. For a topic that has continued to be stigmatized and lack the understanding and support it really needs, that's a positive sign.
But too many people still struggle to find the support they need. In fact, it's estimated that as many as 50% to 70% of those living with a mental health condition don't receive treatment. The numbers of those struggling with behavioral health across conditions are still enormous. And for employers, the economic and human cost of behavioral health continues to be a top priority.
Today's guest is Dr. Arzubi, co-founder and CEO of Frontier Psychiatry. His accomplishments are wide-ranging, including starting the first psychiatry residency in the state of Montana, launching a Project ECHO program to support behavioral health care in remote locations, and starting a virtual-only mental health care organization, Frontier Psychiatry. I'm honored to have an opportunity to talk with him about what we can do to change the current state of mental health in our country. Dr. Arzubi, please introduce yourself. And since we're opening with signs of progress, tell me something you see, in terms of behavioral health access, that gives you hope.
ERIC ARZUBI: So first of all, Thanks for having me, Dr. Berner. It's nice to see you again. And again, I think it's important to call out that a few of the things that we were able to accomplish in Montana happened in part thanks to support from Blue Cross Blue Shield of Montana, and so thanks to you and your leadership for that. So
In terms of improving outcomes for behavioral health, and I would say also for people struggling with substance use disorders, because I like to think of those two things as really together because those things often co-occur. I think we need to think about those two at once. What's making me optimistic-- again, because we're looking at the headlines, it can be difficult to stay optimistic because we keep hearing about growing suicide rates, the mental health crisis that's affecting youth, the surgeon general calling that out.
There are several trends that are converging right now that I think make me more hopeful about what we can do over the next 5, 10, 20 years. So first of all, the stigma that you describe definitely exists. But I'm seeing-- the fact that we're having a podcast, an interview like this-- people are more willing to talk about it. So I think the fact that we're more willing to talk about it and call it out, I think that's important and an important trend.
Number two, telehealth-- and unfortunately we had COVID, and it took COVID for this to happen. But telehealth is more widely adopted now by providers as well as patients. And so now that's become a more widely used tool that I think we still have a long way to go before we fully take advantage of that as a tool. Number three, artificial intelligence is making our jobs as providers, as doctors, often easier, making us more efficient. Not that we're using AI to treat patients, but some of the workflows are being made more efficient, and we're able to do things more quickly and save us more time and reduce the chance of burnout.
And then finally, value-based care is starting to enter into, really, more circles in health care. And so if we're able to actually get more for the dollars that we spend in health care and do that in behavioral health, I think that keeps me optimistic as well. So a little bit of a long answer, but four important trends that at least keep me optimistic that we can do better.
MONICA BERNER: No, those are all really great things. And I agree with you 100%. It's multifactorial, the positive direction that we're moving. So one thing I want to talk about, and you touched on it a little bit in your comments and I know is a passion of yours, is the need to scale mental and behavioral health care. There's a drastic shortage of practitioners, as you know. That's one of the reasons that you started the psychiatry residency. But there are other opportunities to better connect care, and there are different ways to share knowledge. And there may be more compelling things happening right now than people realize. Can you talk a little bit about some of this?
ERIC ARZUBI: Yeah, absolutely. So I think too often-- what's great is there are a lot of great and effective interventions when it comes to mental health care as well as addiction treatment. But to your point, they're not being scaled. They're not being scaled, really, much of anywhere, especially rural communities. Because a lot of medical schools and psychiatric residency programs happen and actually are hosted in urban areas. And in rural Montana, for example, New Mexico, Texas, some of the states that I know you guys operate in, scaling those interventions out to more remote communities is more and more difficult.
ERIC ARZUBI: So I don't think we're ever going to be able to train our way out of this shortage. So we're never going to train enough psychiatrists. I know we're using more and more nurse practitioners and physician assistants, which is great. But again, I don't know that we'll ever train enough. So I think what we need to do is really look at the tools that are available to us and use those in an effective way. Also, I think in training programs, like psychiatry residencies and training programs for nurse practitioners, really teaching future professionals, future mental health professionals how to think big picture instead of just always focusing patient by patient, which is important, but how do we think bigger picture and think as a system how we can make a contribution that maybe we're not thinking about right now?
And then one other thing I'd add is actually in Chicago, there's a wonderful lab at Northwestern called the Lab for Scalable Mental Health. And the lead researcher there, Dr. Jessica Schleider, is actually doing a study on-- and actually had been studying single-session interventions for, gosh, I think at least five years, if not 10 years. And so there are a lot of really interesting things happening that, again, continue to give me hope that we'll be able to scale interventions more broadly.
MONICA BERNER: So as you know, Dr. Arzubi, and as I've mentioned, I'm a family physician, so the things that you're saying really speak to my heart because so much of what you do is connected to family and the social dynamics of behavioral health and so much of what family physicians do. But in the work that I do with Blue Cross and Blue Shield, I also think even larger, 360 degrees. And I think about the role employers play in people's health.
So as someone who understands very well the family ecosystem, the work ecosystem, the community ecosystem, and how it impacts behavioral health, can you think about how that translates into something that a workplace ecosystem might support? And talk a little bit about where you see potential parallel dynamics at play. How can workplaces impact employee behavioral health?
ERIC ARZUBI: I think we've all been in jobs or worked for employers that have either lifted us and made the workday easier, and others that maybe haven't done so, where you don't feel validated or supported at the workplace. So again, it varies workplace by workplace. That's to say that every single workplace has a culture. They have a culture, and that culture may be really supportive, inspiring. It validates your contribution and supports your needs inside the workplace and outside. We often talk about work-life balance.
So I think the kind of culture that every organization has is critical-- is critical because it will have an impact on employees' mental health. And again, even if somebody decides not to focus on culture, there's going to be a culture anyway, whether you like it or not. So you might as well be deliberate and try to create one that is positive, validating and supportive.
And so yes, I think it's great. I think it's important to pick great health plans that have a lot of resources when it comes to somebody who all of a sudden is struggling with a behavioral health problem or a substance use disorder. But I think it's a partnership with the people who also run the organization. And I think it's incumbent upon them to make sure that they're creating workplace culture that's supportive, it's non-stigmatizing, and validates people's concerns about what's happening at work and at home.
So again, after all, we spend-- I guess commonly you say it's at least 2,000 hours a year at a workplace. That's going to have an impact, right? So the culture and the ecosystem that you find in the workplace will have an impact on how you feel at the end of the day and how you feel at the end of the year.
MONICA BERNER: We've talked about a lot in our short time together. But I think, in my mind, the real message is that there is progress, and we should be optimistic about the future. We should be encouraging the continuing dialogue around behavioral health conditions. And we should also recognize that while there is a need to expand access to behavioral health specialists, whether it's through training more providers, physicians, and others, whether it's through supporting people in remote areas, or providing access through virtual care, the truth is that it takes all of us as not just clinicians, but family members, employers, and coworkers to address the issue and to support one another in behavioral health conditions.
So knowing that, and knowing that we have employers that are hopefully listening to this podcast, for those employers listening in, I hope they'll talk about these sorts of things. And could you leave us with the top three things that they could start to work on to help improve behavioral health access for their employees?
ERIC ARZUBI: Sure. So I think in any situation where you're trying to move something forward-- and in this case, we're talking about improving outcomes for the employees of an organization and improving their outcomes in terms of mental health and substance use disorders-- I think it's important to have an internal champion. Because what happens too often in organizations is that no one person is really accountable or in charge of it. So in the end, there's either finger-pointing when things don't work, or nothing gets done because nobody's really leading it.
So one of the things I would recommend is that there be at least an identified champion who continues to make it OK to talk about this issue and is really in charge of harnessing resources to really improve the well-being of the employees. And I think that means thinking about two things at the same time. One is what's HR doing and what's leadership doing to promote a culture that's healthy, supportive, validating, and inspiring. And then on the other side is also making sure that there's a health plan in place that makes it easy to access the professionals you need at the right time. But again, I think having someone in leadership who's really accountable for that, I think, is absolutely critical.
Then number two is certainly making sure that that person has the resources available in order to actually make that difference and thinking about this problem and this challenge holistically.
And then number three, I think it's important to collect data and continue to monitor data. Because I think it's pretty clear that not only in the larger economy, but also company by company, employees who struggle with depression or anxiety-- And I hate to say this, but we're thinking about it as-- if you're a business owner, and you have a number of employees who are struggling with depression or anxiety, first of all, that's not great because people are suffering, so we don't like that.
But then secondly, it affects how the company operates. So you have more absenteeism, more presenteeism. And that impacts the bottom line. And so really there are lots of reasons why addressing this issue is critical and important. Again, most importantly, it's great for the culture. And just as human to human, it improves outcomes, and we all want that.
And then secondly, if you want to make the business case for it to-- I don't know-- investors or the CFO, it actually has a return on investment. So those are the three things I'd be thinking about. And making sure you're able to speak the language of finance, but also be able to speak the language of-- as a human who cares that people do better.
MONICA BERNER: Thank you, Dr. Arzubi. That is incredibly sage advice, not only as a clinician but as a caring individual that I know you to be.
ERIC ARZUBI: Well, thank you. I appreciate it. And again, I think podcasts like this are critical to, again, giving more voice to this issue, reducing stigma, and making it safer to discuss. So really trying to move the needle on this. I appreciate your leadership and what your organization is doing.
MONICA BERNER: We employers are trying to support their people through all of these complex challenges. It's a lot, especially with how difficult it can be to access care. We've made great strides in behavioral health, but that doesn't mean we're done. Embedded, adaptive support makes it easier to do more for employees wherever they stand today.
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