1 00:00:09,240 --> 00:00:12,090 Announcer: Thanks for joining the Re-Think and Re-Tool podcast 2 00:00:12,090 --> 00:00:15,900 with Mehul Mankad, MD where we take a look at the people side 3 00:00:15,900 --> 00:00:19,050 of healthcare and new ideas about enhancing overall 4 00:00:19,050 --> 00:00:22,770 wellbeing. So welcome, the doctor is in the house. 5 00:00:25,690 --> 00:00:28,270 Mehul Mankad: Welcome to Re-Think and Re-Tool sponsored 6 00:00:28,270 --> 00:00:32,350 by Alliance Health. This is my home on cod psychiatrist and 7 00:00:32,350 --> 00:00:36,040 Chief Medical Officer for Alliance. You know, something 8 00:00:36,040 --> 00:00:40,750 we've all learned in the past few years is that the emergency 9 00:00:40,750 --> 00:00:45,670 room is not the only place or even the best place for people 10 00:00:45,670 --> 00:00:49,480 who are suffering from a mental health crisis to find support. 11 00:00:50,170 --> 00:00:54,460 When folks are not yet engaged in mental health care, or if 12 00:00:54,460 --> 00:00:57,430 they can't reach their mental health provider between visits, 13 00:00:57,880 --> 00:01:03,190 where can they turn? Today, I'm fortunate to get the opportunity 14 00:01:03,250 --> 00:01:07,120 to speak with Dr. Chuck Browning, Chief Medical Officer 15 00:01:07,150 --> 00:01:12,220 of RI International, from crisis phone calls to crisis 16 00:01:12,220 --> 00:01:20,440 facilities, nobody knows this stuff better than Dr. Chuck. Dr. 17 00:01:20,440 --> 00:01:27,730 Chuck Browning. Hey, good to see you. So, you know, I wish these 18 00:01:27,730 --> 00:01:31,090 were face to face because I feel like you know, now that people 19 00:01:31,090 --> 00:01:35,590 are out and about, it would be nice to record in person. But we 20 00:01:35,590 --> 00:01:40,000 will we will do the best we can virtually. But very much 21 00:01:40,000 --> 00:01:45,220 appreciate you joining us today. You know, I was thinking, as I 22 00:01:45,220 --> 00:01:49,390 was preparing for our time together, that I would share a 23 00:01:49,390 --> 00:01:53,890 little story with you. And then you tell me how things are 24 00:01:53,890 --> 00:01:59,830 different these days. So as my teenage daughter likes to say, I 25 00:01:59,830 --> 00:02:05,260 was trained in the last century. And so I did, I did a fair 26 00:02:05,260 --> 00:02:08,680 amount of my medical and psychiatric training in the 90s. 27 00:02:08,950 --> 00:02:14,470 And at that time, if somebody had a crisis, whether it was a 28 00:02:14,470 --> 00:02:18,280 behavioral health crisis or a physical one, there was 29 00:02:19,030 --> 00:02:21,700 essentially two things they could do. They could call their 30 00:02:21,700 --> 00:02:26,170 doctor's office if they had a doctor and try to get some help 31 00:02:26,170 --> 00:02:30,910 after hours. And if that didn't pan out, which it often didn't, 32 00:02:30,970 --> 00:02:37,690 their only option was to go to the emergency room. Now, my 33 00:02:37,690 --> 00:02:42,490 understanding is times have changed a lot. And so what would 34 00:02:42,490 --> 00:02:44,470 it be like for somebody these days? 35 00:02:46,590 --> 00:02:48,600 Chuck Browning: That's a great question. And I'm gonna give you 36 00:02:48,600 --> 00:02:51,510 a couple of different answers. One of them is that, 37 00:02:51,510 --> 00:02:55,620 unfortunately, across our country, and I do this a lot 38 00:02:55,620 --> 00:02:58,350 talking about crisis systems consulting with multiple 39 00:02:58,350 --> 00:03:03,570 different country of countries and states around our country in 40 00:03:03,570 --> 00:03:06,240 looking at crisis care. And unfortunately, right now, in so 41 00:03:06,240 --> 00:03:10,320 many parts of our country, that's still the go to option. 42 00:03:10,620 --> 00:03:15,870 It's to call 911 or go to the emergency room. Unfortunately, 43 00:03:15,870 --> 00:03:18,960 that is still the place that we're in. But the good news is 44 00:03:18,960 --> 00:03:25,200 there is a lot of development of a better system for emergency, 45 00:03:25,380 --> 00:03:30,780 psychiatric and substance use substance use, supports being 46 00:03:30,780 --> 00:03:34,320 developed and working really well and showing both good 47 00:03:34,320 --> 00:03:38,520 outcomes in a business case and a clinical case in different 48 00:03:38,520 --> 00:03:42,570 states. And there's more momentum hold than there's ever 49 00:03:42,570 --> 00:03:47,430 been before coming through the pandemic, and different 50 00:03:47,460 --> 00:03:50,310 movements related to social justice, justice, and the 51 00:03:50,310 --> 00:03:53,430 involvement of mental health and law enforcement in the community 52 00:03:53,730 --> 00:03:58,710 that has produced this momentous occasion that we've never had 53 00:03:58,710 --> 00:04:02,910 before to really push forward a change in our emergency medical 54 00:04:02,910 --> 00:04:06,660 system for behavioral health. And so that's really exciting. 55 00:04:07,440 --> 00:04:09,390 Mehul Mankad: So I'm yeah, I'm excited to hear about that as 56 00:04:09,390 --> 00:04:12,840 well. And I'd love for you to unpack some of that you shared a 57 00:04:12,840 --> 00:04:17,760 lot with us. And so you kind of described it as a system, rather 58 00:04:17,760 --> 00:04:21,270 than kind of a one stop shop being the er What do you mean by 59 00:04:21,270 --> 00:04:23,220 a system for crisis? 60 00:04:24,650 --> 00:04:27,080 Chuck Browning: Well, the best way for me to describe it and 61 00:04:27,080 --> 00:04:30,530 hopefully in the short term that makes sense for the listeners is 62 00:04:30,560 --> 00:04:33,710 to compare about the system that we have, if you had chest pain, 63 00:04:34,340 --> 00:04:40,220 you know, you can call 911 and if the 911 Caller see certain 64 00:04:40,220 --> 00:04:43,910 things that you can handle safely at your home, then then 65 00:04:43,910 --> 00:04:46,880 they'll help you do that. But if you need someone to come to you 66 00:04:46,880 --> 00:04:50,390 then they activate with GPS technology and things like that 67 00:04:50,420 --> 00:04:53,420 a paramedic or EMS to come to you. And then they have 68 00:04:53,420 --> 00:04:56,240 equipment infrastructure to assess you on site. And if 69 00:04:56,240 --> 00:04:59,600 you're stable based on like your EKG there and the parameters of 70 00:04:59,600 --> 00:05:01,640 what's going on. On, they may let you, you know, help you stay 71 00:05:01,640 --> 00:05:04,760 in the community and connect with follow up. But if you need 72 00:05:04,760 --> 00:05:07,580 more than you can go to the emergency department. And once 73 00:05:07,580 --> 00:05:10,760 you get to Emergency Department, there are standards of care 74 00:05:10,760 --> 00:05:13,880 based on, you know, years and years of studying how this is 75 00:05:13,880 --> 00:05:18,050 done across the country. And the beauty of this system is that it 76 00:05:18,050 --> 00:05:20,870 doesn't matter whether you're insured or not insured, what 77 00:05:20,870 --> 00:05:25,610 your race or age, or demographics are, that you're 78 00:05:25,610 --> 00:05:28,190 gonna get access to care, that's pretty standard across the whole 79 00:05:28,190 --> 00:05:31,820 country. And we don't have that for mental health and substance 80 00:05:31,820 --> 00:05:36,020 use. The other piece is that we those three pillars are there in 81 00:05:36,020 --> 00:05:38,210 our emergency medical system. But also if you have chest pain, 82 00:05:38,390 --> 00:05:42,080 if you go to the hospital, you don't just either go home, or go 83 00:05:42,080 --> 00:05:47,360 to the ICU and have a you know, full on cardiac operation. 84 00:05:47,540 --> 00:05:51,020 There's lots of layers of continuum in between that are 85 00:05:51,020 --> 00:05:53,810 offered to you based on what your needs are, you might have a 86 00:05:53,810 --> 00:05:57,110 step down unit, you might go to an outpatient rehab, there might 87 00:05:57,110 --> 00:06:00,290 be a more cardiac intensive care unit, you might do it and get to 88 00:06:00,290 --> 00:06:02,660 a stent if you need that level. So I mean, there's so many 89 00:06:02,660 --> 00:06:06,020 different pieces that are there. And they're all driven on data 90 00:06:06,020 --> 00:06:09,530 and studies, what works, what doesn't work. And it's kind of 91 00:06:09,530 --> 00:06:12,200 publicized, and people follow that. And so we're decades 92 00:06:12,200 --> 00:06:15,260 behind that in behavioral health in emergency response systems. 93 00:06:15,440 --> 00:06:19,550 But there are states where we're seeing that level of change 94 00:06:19,550 --> 00:06:23,750 occurring. And then nationally, there's really cool movement 95 00:06:23,750 --> 00:06:27,590 called 988, which is the installation of a number. That's 96 00:06:27,590 --> 00:06:30,980 the equivalent of 911, for emergency behavioral health 97 00:06:30,980 --> 00:06:34,550 calls, that's going to be implemented nationwide in July 98 00:06:34,550 --> 00:06:38,510 of 2022. And as that unfolds and moves forward, there's gonna be 99 00:06:38,510 --> 00:06:41,750 growing pains as there was when they activated 911. But it 100 00:06:41,750 --> 00:06:45,710 offers finally a really a real big opportunity to create a 101 00:06:45,710 --> 00:06:49,460 system where somebody can call and get specific supports for 102 00:06:49,460 --> 00:06:52,670 behavioral health crisis. And then if they need an another 103 00:06:52,670 --> 00:06:55,910 layer of care, having local support teams that can come out 104 00:06:55,940 --> 00:06:58,160 anywhere in the community and see people and hopefully 105 00:06:58,160 --> 00:07:01,700 destabilize, excuse me to not destabilize, de escalate, 106 00:07:01,880 --> 00:07:04,040 whatever they need to stabilize, and then be able to stay in the 107 00:07:04,040 --> 00:07:07,490 community. And then if they need help, then there are places that 108 00:07:07,490 --> 00:07:10,190 people can go to that are specifically designed to handle 109 00:07:10,190 --> 00:07:13,970 emergency medical care. And ri as the chief medical officer 110 00:07:13,970 --> 00:07:17,120 there, that's what we specialize in is that crisis receiving 111 00:07:17,120 --> 00:07:19,850 center in North Carolina, some people call it facility based 112 00:07:19,850 --> 00:07:20,630 crisis. 113 00:07:21,950 --> 00:07:26,180 Mehul Mankad: Wow. So that what you're describing to me is this 114 00:07:26,180 --> 00:07:31,460 brave new world that some parts of the US have already adopted. 115 00:07:31,880 --> 00:07:36,320 And then other parts of the US, I'm hoping are looking at where, 116 00:07:36,470 --> 00:07:40,760 right now, someone might call 911. And at some point, it'll be 117 00:07:40,790 --> 00:07:48,290 988. And then there will be kind of layers and nuance in terms of 118 00:07:48,320 --> 00:07:53,420 what is available and what the outcome will be. And not just 119 00:07:53,450 --> 00:07:59,120 this one dimensional model of law enforcement, sometimes 120 00:07:59,120 --> 00:08:03,260 picking people up, and then dropping them off in an 121 00:08:03,260 --> 00:08:07,580 emergency room. So you had mentioned mobile crisis, you'd 122 00:08:07,580 --> 00:08:12,800 mentioned facility based crisis. I've also heard of something 123 00:08:12,800 --> 00:08:16,940 called behavioral health, urgent care. Could you tell us a little 124 00:08:16,940 --> 00:08:19,490 bit about these, these kind of these different levels that 125 00:08:19,490 --> 00:08:20,780 you're talking about? You're? 126 00:08:20,000 --> 00:08:24,350 Chuck Browning: Sure. So the principal pillars, if you look 127 00:08:24,350 --> 00:08:29,060 at SAMHSA's, national toolkit for crisis care are that you do 128 00:08:29,060 --> 00:08:32,600 have the basics of the equality and parity to emergency medical 129 00:08:32,600 --> 00:08:36,320 services. So a crisis call on and that will be 988, that you 130 00:08:36,320 --> 00:08:39,290 would have mobile support teams, which is the equivalent of EMS 131 00:08:39,290 --> 00:08:42,620 and paramedics, and then crisis receiving centers, which are the 132 00:08:42,620 --> 00:08:45,860 equivalent to an ED, but specialized in those things. 133 00:08:46,220 --> 00:08:51,620 Then, having a certain level of essential crisis care principles 134 00:08:51,650 --> 00:08:55,430 that layer into that. So safer, Zero Suicide or Zero Suicide 135 00:08:55,640 --> 00:09:00,260 principles use heavy significant use of peer support, recovery 136 00:09:00,260 --> 00:09:02,810 oriented principles and trauma informed care principles that 137 00:09:02,810 --> 00:09:05,750 are built into that have in coordination with law 138 00:09:05,750 --> 00:09:09,410 enforcement and emergency medical services in all those 139 00:09:09,410 --> 00:09:13,580 three lanes, and then being able to maintain safety for the 140 00:09:13,580 --> 00:09:15,950 guests and the staff, because that's a big deal during crisis 141 00:09:15,950 --> 00:09:19,970 situations for some certain psychiatric and substance use 142 00:09:19,970 --> 00:09:22,880 situation situations that come up. However, when you look at 143 00:09:22,880 --> 00:09:25,730 the whole continuum model, just like in medical care, it's 144 00:09:25,730 --> 00:09:31,040 important to have other layers to see if you have those basic 145 00:09:31,040 --> 00:09:33,590 pillars. In an ideal system, you would continue to have 146 00:09:33,590 --> 00:09:36,860 otherwise. So behavior health, urgent care, would be like going 147 00:09:36,860 --> 00:09:39,470 to an urgent care for medical things instead of going to the 148 00:09:39,470 --> 00:09:42,740 emergency room. So if you're have you know, strep throat and 149 00:09:42,740 --> 00:09:44,660 you don't want emergency room and you don't have a primary 150 00:09:44,660 --> 00:09:47,690 care that can get you and you can go to a Minute Clinic, have 151 00:09:47,690 --> 00:09:50,120 that test done and find out yes or no and get a prescription for 152 00:09:50,120 --> 00:09:53,990 antibiotics. And that's been shown to kind of fit the model 153 00:09:53,990 --> 00:09:57,320 that many people like that to get served in that way. And so 154 00:09:57,440 --> 00:09:59,720 there are definitely situations where people have run out of 155 00:09:59,720 --> 00:10:03,110 their med occasions, but they're not having an intense crisis 156 00:10:03,110 --> 00:10:06,320 that they would need to be, you know, definitely in a 157 00:10:06,320 --> 00:10:09,830 hospitalized or things like that. And so there's lots of 158 00:10:09,830 --> 00:10:13,550 situations where having layers like that are great, having 159 00:10:13,550 --> 00:10:16,790 different ranges of care for different levels of substance 160 00:10:16,790 --> 00:10:21,080 use severity, intensive outpatient programs, MAT 161 00:10:21,200 --> 00:10:24,800 programs and things like that offer lots of routines and 162 00:10:24,800 --> 00:10:26,750 alternatives. And the other thing that often gets missed in 163 00:10:26,750 --> 00:10:30,920 crisis is how much social determinants play a part in 164 00:10:30,950 --> 00:10:35,780 people's presentation and needs. So housing issues, you know, 165 00:10:36,320 --> 00:10:39,770 food, being able to obtain access to medication, 166 00:10:39,770 --> 00:10:42,950 transportation, different things like that can have big impacts 167 00:10:42,980 --> 00:10:46,190 on folks that we see oftentimes come to our crisis centers over 168 00:10:46,190 --> 00:10:48,980 and over again. And it's not just about finding the right 169 00:10:48,980 --> 00:10:52,880 medication or having a follow up appointment. There's, there's 170 00:10:52,880 --> 00:10:55,130 things in their life that are basic needs that are driving a 171 00:10:55,130 --> 00:10:57,140 huge amount of stress or things that are going on. 172 00:10:58,220 --> 00:11:01,790 Mehul Mankad: Wow. So one of the things you'd mentioned that I 173 00:11:01,790 --> 00:11:06,950 don't automatically think about when I think about crisis, is an 174 00:11:06,980 --> 00:11:12,530 orientation towards long term recovery, and not just a crisis 175 00:11:12,620 --> 00:11:16,130 that's right in your face. And I'd love for us to come back 176 00:11:16,130 --> 00:11:19,010 after the break and hear some more thoughts about that, 177 00:11:19,010 --> 00:11:22,010 because that's really a different way of thinking about 178 00:11:22,010 --> 00:11:27,470 crisis than I think a lot of people do. So, I do want to warn 179 00:11:27,470 --> 00:11:30,110 people, though, when we do come back from the break, Dr. Chuck 180 00:11:30,110 --> 00:11:34,520 is going to share one of his guilty pleasures, we will, oh 181 00:11:34,520 --> 00:11:35,090 gosh. 182 00:11:37,700 --> 00:11:40,610 Unknown: At Alliance, we see health care differently than 183 00:11:40,610 --> 00:11:44,750 some. Every day we walk alongside the people we serve on 184 00:11:44,750 --> 00:11:48,890 their chosen path to recovery and self determination. We 185 00:11:48,890 --> 00:11:51,500 believe in health care that concentrates on the whole 186 00:11:51,500 --> 00:11:56,300 person, including support that promotes physical, social, 187 00:11:56,630 --> 00:12:00,950 emotional, and financial well being and housing security, 188 00:12:01,700 --> 00:12:05,570 helping people live healthier, more satisfying lives. That's 189 00:12:05,570 --> 00:12:06,500 the Alliance way. 190 00:12:15,440 --> 00:12:18,050 Mehul Mankad: All right. Dr. Chuck, you ready to tell us what 191 00:12:18,050 --> 00:12:22,370 is that thing that people don't know about you that they might 192 00:12:22,370 --> 00:12:23,060 be interested in? 193 00:12:25,850 --> 00:12:29,720 Chuck Browning: By the admitting this, I'm a very lack luster, 194 00:12:29,870 --> 00:12:33,800 lead singer of a garage band of folks that are much more 195 00:12:33,800 --> 00:12:37,520 talented than me. In the band in my neighborhood, we play up in 196 00:12:37,520 --> 00:12:40,850 the attic and call ourselves three floors up. And we do we do 197 00:12:40,850 --> 00:12:42,980 play gigs for people in our neighborhood are willing to put 198 00:12:42,980 --> 00:12:47,480 up with listening to us. Every once in a while, we've seen a 199 00:12:47,480 --> 00:12:51,440 variety of like 70s, 80s, 90s, sometimes a couple of current 200 00:12:51,440 --> 00:12:54,350 songs that even kids at our neighborhood that are of those 201 00:12:54,350 --> 00:12:57,320 families will come and participate. Sometimes it's fun, 202 00:12:57,320 --> 00:13:01,700 it gives us something to do some nights together to practice and 203 00:13:01,700 --> 00:13:04,610 keep together and a lot of camaraderie. And we try to 204 00:13:04,610 --> 00:13:06,260 engage other people in neighborhood to play like 205 00:13:06,410 --> 00:13:09,500 tambourine or we had a lady play a flute for one of the songs. It 206 00:13:09,500 --> 00:13:10,100 was great. 207 00:13:10,130 --> 00:13:12,380 Mehul Mankad: That's awesome. So three floors up to tell me 208 00:13:12,380 --> 00:13:14,600 something that's on your setlist for three floors up? 209 00:13:15,230 --> 00:13:18,140 Chuck Browning: Oh my goodness, some of it would definitely be 210 00:13:18,140 --> 00:13:21,140 what your daughter was accusing you of during your times in the 211 00:13:21,170 --> 00:13:25,430 90s. We we tend to do really well with certain all rock songs 212 00:13:25,430 --> 00:13:29,990 like in Red Hot Chili Peppers. Audio Slave, even some of those 213 00:13:29,990 --> 00:13:33,470 tight groups Foo Fighters that stuff. But we do a variety, a 214 00:13:33,470 --> 00:13:33,980 lot of different things. 215 00:13:34,830 --> 00:13:36,870 Mehul Mankad: That's awesome. That's awesome. I did not know 216 00:13:36,870 --> 00:13:40,500 that about you. And just you know, you've got to you got your 217 00:13:40,500 --> 00:13:47,520 own layers, like an onion never seen in public. And yeah, we may 218 00:13:47,520 --> 00:13:51,090 have to book Three Floors Up for like the Psychiatry Association 219 00:13:51,090 --> 00:14:02,100 meeting or something. No. Maybe not. So, so coming back to our 220 00:14:02,100 --> 00:14:07,020 topic, you were mentioning that one of the approaches that 221 00:14:07,020 --> 00:14:13,290 you're fond of, with working with individuals in crisis is a 222 00:14:13,290 --> 00:14:18,540 recovery orientation. I think I know what that means. But could 223 00:14:18,540 --> 00:14:22,710 you help unpack that and just kind of lay it all out there as 224 00:14:22,710 --> 00:14:26,430 to what a recovery orientation is? And how would that be 225 00:14:26,430 --> 00:14:28,920 relevant to crisis? Because I gotta tell you, when when I've 226 00:14:28,920 --> 00:14:32,520 taken care of people in crisis in like an emergency room 227 00:14:32,520 --> 00:14:36,690 setting. It's really just about what can we do for you in the 228 00:14:36,690 --> 00:14:40,350 next hour? Not anything beyond that? 229 00:14:42,360 --> 00:14:45,090 Chuck Browning: That's such a great question. Well, it's one 230 00:14:45,090 --> 00:14:48,720 of the reasons I love working at ri, which stands for, you know, 231 00:14:48,720 --> 00:14:52,410 the former name was recovery innovations. And it originally 232 00:14:52,410 --> 00:14:55,650 was started by a group of folks decades ago who were out in 233 00:14:55,650 --> 00:14:58,350 Arizona who were extremely interested in the involvement 234 00:14:58,350 --> 00:15:03,030 and use of peer support. In this crisis care continuum and 235 00:15:03,030 --> 00:15:06,450 spectrum. And so I have been so fortunate over the years of 236 00:15:06,450 --> 00:15:09,660 working with ara to really be able to have the experience of 237 00:15:09,660 --> 00:15:14,550 seeing the power of what these recovery oriented approaches 238 00:15:14,580 --> 00:15:19,800 bring to crisis care, as well as a person's longer term work as 239 00:15:19,800 --> 00:15:24,390 well. And we talk about what we call pure power practices, as 240 00:15:24,390 --> 00:15:28,140 part one of our keys that are on our way of what we do. And we 241 00:15:28,140 --> 00:15:31,110 label those in certain approaches. And they're very big 242 00:15:31,110 --> 00:15:33,570 parts of recovery oriented care. And by the way, when you look at 243 00:15:33,570 --> 00:15:36,690 SAMHSA's national toolkit for all layers of care, whether it's 244 00:15:36,690 --> 00:15:39,690 crisis call on or mobile support, or crisis receiving 245 00:15:39,690 --> 00:15:43,680 centers, it is a recovery oriented approach. And so our 246 00:15:43,680 --> 00:15:46,890 peer power practices include strengths based, which means 247 00:15:46,890 --> 00:15:49,380 focusing on what people's strengths are, instead of their 248 00:15:49,380 --> 00:15:52,620 weakness in their crisis. It involves looking at the whole 249 00:15:52,620 --> 00:15:56,040 person's health. So it's not just about their illness and 250 00:15:56,040 --> 00:15:58,950 their diagnosis, which is a psychiatrist, we get trained to 251 00:15:58,950 --> 00:16:02,760 do that all the time. It's also about looking at what is matters 252 00:16:02,760 --> 00:16:05,220 to them and their life, their meaning and their purpose, their 253 00:16:05,220 --> 00:16:08,190 family and connections and support systems and where they 254 00:16:08,190 --> 00:16:11,730 are. So it's really about not just focusing on this person has 255 00:16:11,730 --> 00:16:14,820 schizophrenia, this person who has depression, is looking at 256 00:16:14,850 --> 00:16:18,420 what is going on your life that brought you to this crisis, and 257 00:16:18,780 --> 00:16:22,620 what are the meaningful things in the big picture that you can 258 00:16:22,620 --> 00:16:25,890 control that we can help empower you and support you to work on 259 00:16:25,890 --> 00:16:30,930 that. And you just would be amazed at how often that is such 260 00:16:30,930 --> 00:16:33,120 a huge part in a crisis situation of helping someone 261 00:16:33,120 --> 00:16:37,920 improve quickly, and having more feelings of hope about their 262 00:16:37,920 --> 00:16:41,010 situation by being able to connect into these humanistic 263 00:16:41,130 --> 00:16:45,360 things. And I really believe and I'm participating with things 264 00:16:45,360 --> 00:16:49,980 that we're doing Ri and studying this is when you when people 265 00:16:49,980 --> 00:16:53,130 come into a crisis situation, and they feel cared for by the 266 00:16:53,130 --> 00:16:57,060 team, that that has an impact in your crisis improvement, that 267 00:16:57,060 --> 00:16:59,520 just this concept of feeling cared for has been studied in 268 00:16:59,520 --> 00:17:03,420 the hospital systems a lot as to what creates success. And that's 269 00:17:03,420 --> 00:17:07,500 usually the number one measurement that that guests or 270 00:17:07,500 --> 00:17:11,250 patients talk about is do I feel cared for. That's the number is 271 00:17:11,250 --> 00:17:13,440 not hospital food might be a complaint. But what really 272 00:17:13,440 --> 00:17:17,700 matters is do I feel cared for. And so that's such an important 273 00:17:17,700 --> 00:17:22,500 piece that we try to instill in all of our staff. But it's not 274 00:17:22,500 --> 00:17:24,900 easy to do, because there's so many different staff members, 275 00:17:24,990 --> 00:17:28,350 crisis work is really hard. You see people going through really 276 00:17:28,350 --> 00:17:31,380 tough times who might on their worst day be really irritable or 277 00:17:31,380 --> 00:17:35,310 angry about situations that can be violent, even. So it can be 278 00:17:35,310 --> 00:17:37,410 scary to work in that environment, if you're not 279 00:17:37,410 --> 00:17:39,990 feeling trained, and having the tools and the resources to do 280 00:17:39,990 --> 00:17:44,610 it. And so it takes a lot of work and infrastructure to have 281 00:17:44,610 --> 00:17:47,550 that kind of customer service angle where you can do that. 282 00:17:48,180 --> 00:17:51,510 Having peers as part of our treatment team is and giving 283 00:17:51,510 --> 00:17:56,850 them voice and value in the whole treatment team also makes 284 00:17:56,850 --> 00:17:59,550 a big impact. I think the whole and creating that recovery 285 00:17:59,580 --> 00:18:02,400 approach, because I can't tell you how many times I've had a 286 00:18:02,400 --> 00:18:05,400 peer support person work with someone who's I've walked in 287 00:18:05,400 --> 00:18:07,830 your shoes, I've been where you've been. And here's where I 288 00:18:07,830 --> 00:18:11,940 am now. And it just creates this lane of engagement, that makes 289 00:18:11,940 --> 00:18:14,730 it so much easier. And then for them to say, hey, you can trust 290 00:18:14,730 --> 00:18:17,250 talking to Dr. Chuck, he is gonna listen to you, He cares 291 00:18:17,250 --> 00:18:19,620 about you getting better and working on this thing. So tell 292 00:18:19,620 --> 00:18:21,930 him what you told me, you don't want to really feel about it. 293 00:18:21,930 --> 00:18:25,230 And it just opens up this lane of engagement, that oftentimes 294 00:18:25,230 --> 00:18:30,180 you don't get because of past contexts that people bring into 295 00:18:30,180 --> 00:18:32,490 their situation. And that's that trauma informed care piece, 296 00:18:32,490 --> 00:18:35,370 which is another one of our pure power practices is spin in time 297 00:18:35,400 --> 00:18:38,190 from a recovery perspective, trying to understand what people 298 00:18:38,190 --> 00:18:41,190 are going through. And instead of it, how it's impacting you, 299 00:18:41,190 --> 00:18:44,370 as a staff member working in crisis, thinking about what 300 00:18:44,370 --> 00:18:47,700 they're bringing to you and your situation, understanding that 301 00:18:47,700 --> 00:18:50,280 and having empathy so that then you have a better chance of 302 00:18:50,280 --> 00:18:53,160 engaging with them and help them partner with them in a 303 00:18:53,160 --> 00:18:56,010 collaborative way. And that's, that's our fourth pure power 304 00:18:56,010 --> 00:18:59,340 prices, collaboration. So when you partner with people, they 305 00:18:59,370 --> 00:19:02,970 take stake in what they're doing. And so many times in 306 00:19:02,970 --> 00:19:05,670 hospital settings, you're a piece of the puzzle of getting 307 00:19:05,670 --> 00:19:10,110 processed. And so we really talk about, we want to partner not 308 00:19:10,110 --> 00:19:13,920 process do with and not do too, and it's really easy in crisis 309 00:19:13,920 --> 00:19:17,520 to not do that. Because your time pressured, there's 310 00:19:17,700 --> 00:19:20,100 parameters of business rules and things like that. And they're 311 00:19:20,100 --> 00:19:23,250 all together in this ball of tension that you have to pull 312 00:19:23,250 --> 00:19:26,610 out. But when you take the time to do that, you usually end up 313 00:19:26,610 --> 00:19:29,520 getting much better outcomes and much better customer service 314 00:19:29,520 --> 00:19:30,330 experience. 315 00:19:31,200 --> 00:19:39,060 Mehul Mankad: The idea of using peers and including people with 316 00:19:39,060 --> 00:19:43,080 authentic lived experience has been around in mental health for 317 00:19:43,080 --> 00:19:48,090 a while. I just I'm so impressed that you're passionate about 318 00:19:48,210 --> 00:19:53,580 introducing it from the moment that people hit the door with a 319 00:19:53,580 --> 00:19:54,810 mental health crisis. 320 00:19:56,610 --> 00:19:59,520 Chuck Browning: It is we call it peer first peer last. You see 321 00:19:59,520 --> 00:20:02,550 one for First and last. So our peers are not prescribing 322 00:20:02,550 --> 00:20:07,290 medications. They're not making diagnoses. They're not doing 323 00:20:07,290 --> 00:20:10,890 certain licensed clinical roles. But they're, we're, they're 324 00:20:10,890 --> 00:20:15,150 indispensable in what they do for the milieu for our teams for 325 00:20:15,150 --> 00:20:18,150 helping the rest of our staff use peerpower practices as well 326 00:20:18,150 --> 00:20:22,110 not just the peers, it makes a big impact. So I think am I 327 00:20:22,530 --> 00:20:22,800 doing? 328 00:20:22,830 --> 00:20:25,650 Mehul Mankad: Yeah, yeah, I think I know the answer to this 329 00:20:25,650 --> 00:20:32,460 question, Dr. Chuck, but I'm gonna ask it. What gets you out 330 00:20:32,460 --> 00:20:36,330 of the bed in the morning? Why do you do what you do? Because 331 00:20:36,330 --> 00:20:38,970 you have options, you are a doctor, you can do all kinds of 332 00:20:38,970 --> 00:20:40,590 other stuff. Why do you do this? 333 00:20:40,000 --> 00:20:45,340 Chuck Browning: That's a great question. And thatcalls that 334 00:20:45,370 --> 00:20:48,970 calls for some self analysis. I did that during residency 335 00:20:48,970 --> 00:20:53,590 training, to my therapy, I gotta go go, deep. No, I mean, really 336 00:20:53,590 --> 00:20:57,670 just basic human things of having significance. So being 337 00:20:57,670 --> 00:21:00,850 able to be a part of a movement that potentially is changing the 338 00:21:00,850 --> 00:21:05,830 country's way of how we support a group that for so long, has 339 00:21:05,830 --> 00:21:09,430 been disenfranchised, marginalized, not treated 340 00:21:09,430 --> 00:21:13,210 equally, and having a lot of stigma. And especially when you 341 00:21:13,210 --> 00:21:16,750 look at minorities and minority populations, and how they get 342 00:21:16,750 --> 00:21:19,780 treated in crisis situations compared to the other 343 00:21:19,780 --> 00:21:24,610 demographics, it's an it's a chance to have a big impact on 344 00:21:24,610 --> 00:21:28,480 the way our system operates. And so that's one thing. The second 345 00:21:28,480 --> 00:21:31,900 thing is like I described as just when I started working over 346 00:21:31,900 --> 00:21:35,650 10 years ago, with Ri and being a part of what they do with this 347 00:21:35,650 --> 00:21:38,320 recovery oriented approach in this peer care and seeing how it 348 00:21:38,320 --> 00:21:42,640 works. And then Larry, on top of it, seeing that we had an option 349 00:21:42,640 --> 00:21:45,220 in North Carolina in the areas where we're operating for people 350 00:21:45,220 --> 00:21:48,370 not to be handcuffed to a gurney in an emergency room for five 351 00:21:48,370 --> 00:21:51,190 days waiting to go to an inpatient stay for seven days, 352 00:21:51,190 --> 00:21:54,940 that's three hours away, away from their family and support 353 00:21:55,120 --> 00:21:58,390 and those types of things and having people and friends call 354 00:21:58,390 --> 00:22:01,870 me and say I need some help with these suicidal thoughts. But I 355 00:22:01,870 --> 00:22:04,060 am not going to the emergency room, they will lock me up and 356 00:22:04,060 --> 00:22:06,640 I'm not going to happen. And being able to see people have a 357 00:22:06,640 --> 00:22:10,450 better experience that's meaningful. And so it's, it's 358 00:22:10,480 --> 00:22:13,960 really cool to be a part of it on a day by day level here in 359 00:22:13,960 --> 00:22:16,660 North Carolina, but also on a national and international. 360 00:22:16,930 --> 00:22:21,190 Mehul Mankad: level. Well, Dr. Chuck Browning, thank you for 361 00:22:21,190 --> 00:22:25,450 doing what you do and for being our guest. We appreciate it. 362 00:22:26,110 --> 00:22:28,030 Unknown: Mehul it so much fun. Thank you. 363 00:22:28,960 --> 00:22:31,783 Announcer: The Re-Think and Re-Tool, Healthcare in the New 364 00:22:31,843 --> 00:22:34,908 Era podcast is produced by Alliance Health, a North 365 00:22:34,968 --> 00:22:38,332 Carolina public managed care organization. This show was 366 00:22:38,392 --> 00:22:42,117 produced by Brandon Alexander our associate producer is Denise 367 00:22:42,178 --> 00:22:46,023 Dirks and executive producer is Doug fuller. View our show notes 368 00:22:46,083 --> 00:22:49,628 and hear other episodes at AllianceHealthPlan.org/ podcast. 369 00:22:49,688 --> 00:22:50,950 Thanks for tuning in.