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Healthcare Upside/Down: You’re Gonna Need a Bigger Boat

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ECG’s radio show and podcast, Healthcare Upside Down, offers unfiltered perspectives on what’s working in US healthcare and what’s not. Hosted by ECG principal Dr. Nick van Terheyden, each episode features guest panelists who explore the upsides and downsides of healthcare in the US—and how to make the system work for everyone.

Before the advent of social media and the endless “entertainment” on television, we were all kept on the edge of our seats at the movies. Summer blockbusters gave us iconic scenes and catch phrases that became part of our collective vocabulary and shared experiences.

Our guests on episode 76 of Healthcare Upside Down are Dr. Thomas Sachs III, President of Bradley Hospital, and Ellen Hallsworth, Director of Bradley REACH.

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If you saw Steven Spielberg’s Jaws in the theatres back in 1975, you no doubt remember the suspense, the music, and that iconic line uttered by Chief Brody when he comes face to face with a gargantuan great white shark:

“You’re gonna need a bigger boat…”

It’s a line you’ll still hear now and again, particularly when proposing a solution to a monumental problem. Like, say, improving access to mental health treatment.

The most recent data on mental health incidence in the US tells a very depressing story (pun intended). A large, multiyear study led by researchers at Johns Hopkins Bloomberg School of Public Health based on data from 2016 to 2019 found that:

  • Overall, 21% of children in the US ages 3 to 17 have one or more of the common mental, emotional, and behavioral health conditions assessed.
  • The prevalence of mental health problems across US children ranges from about 15% to 60%—as high as 3 in 5 children in some areas.

Parents struggle mightily to access the right resources for their children only to discover that there’s no support available, or if there is, the wait will be weeks to months.

How do we create more resources and provide better access?

Joining me on episode 76 of Healthcare Upside Down are Henry Sachs III, MD, President of Bradley Hospital in Rhode Island, and Ellen Hallsworth, Director of Bradley REACH. They talk about how their pediatric psychiatric care program, delivered virtually, is helping solve the challenge of a lack of psychiatrists, psychologists, and other key clinical providers—and bringing relief to children and families. Below are a few excerpts.

Increasing access to behavioral health treatment.

Henry: “We had the unique opportunity to build a continuum of care that really didn’t exist in other places. But we were sort of limited—we’re in Rhode Island, and people had to travel to us. So we had the opportunity when the pandemic hit to look at what we could do virtually. And to our surprise, our partial [hospitalization] programs and our intensive outpatient programs, especially for adolescents, actually worked very well virtually. We had evidence that the outcomes were just as good. So this has been our opportunity to expand beyond the Rhode Island region and bring our services to [people who would have had to travel].”

Ellen: “We’re all about increasing access to quality care. There are very few psychiatrists, very few psychologists, and we are able to hire providers anywhere in the country for Bradley REACH. So we have psychologists in Texas, Baltimore, and Virginia, and psychiatrists in New York, Pittsburgh, and Arizona. I think that’s hugely exciting in [terms of] opening up access to care.”

Advantages of virtual care.

Ellen: “I know a lot of people have had negative experiences with virtual schooling, and it’s one of the barriers we face. But we hear over and over again, from families in the program, that they were surprised by how well teenagers were able to build really strong bonds with the care team and with each other virtually. And that’s a huge advantage. They said they felt comfortable sharing information virtually, and in some ways that’s less daunting, particularly for anxious teenagers, than in an in-person environment.”

Henry: “I see child behavioral health as an incredibly valuable resource and an incredibly scarce one. What this service does is take the pressure off emergency rooms and inpatient settings. It allows those who really need to be an inpatient to be there, tries to make emergency rooms more efficient, tries to avoid having kids come to the emergency room. We’re trying to get that level of care [to kids] where they live, where they are, as opposed to either getting no services or having to go to very intensive inpatient care.”

Recognizing the value.

Ellen: “I would like people to really understand the value of this level of care from a reimbursement point of view—keeping kids out of inpatient hospitalization and the ED—and from the family point of view—it’s better for kids and families if kids can stay home.”

Henry: “I think the continuing challenge is to [expose more people to this model]. People see the problems. They don’t necessarily see healthy solutions. I think there are opportunities to do that on several different levels. And I think it’s going to take a national effort to do that over time.”

On the podcast, Ellen and Dr. Sachs talk more about their treatment philosophy and how Bradley REACH is addressing physician burnout.

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Edited by: Matt Maslin