Sober Vibes Podcast
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Sober Vibes Podcast
Fixing a Broken Mental Health System w/ Alice Feller
Episode 194: Fixing a Broken Mental Health System w/ Alice Feller
In episode 194 of the Sober Vibes podcast, Courtney Andersen welcomes Alice Feller to the show. They chat about the broken mental health care system and Alice shares her knowledge of how the system is failing many in the United States.
Can we truly fix a broken mental health system?
Alice Feller is a clinical psychiatrist with a subspecialty in the treatment of substance use disorder. Many of her patients suffer from severe mental illness and often live on the streets or behind bars. She has worked in hospital emergency rooms, psychiatric wards, outpatient clinics, chemical dependency treatment programs and in private practice
In this episode, you will learn:
- Fixing a broken mental health system
- lack of hospital beds for inpatient care
- Addiction and Mental Health
- Treating Substance Use Disorders
New Sober Breakthrough Mini Coaching Session
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Hey, welcome to the Sober Vibes podcast. I am your host, courtney Anderson, and you are listening to episode we're getting on up there. We're so close to 200. If you are new here, welcome. And if you are a good person of the world who's been listening since day one, thank you. I appreciate it. I hope you enjoy this episode.
Speaker 2:We have a great guest today. Her name's Alice Feller and she is a clinical psychiatrist and she does specialize in the treatment of substance use disorder. This conversation's just a little bit kind of free flowing, I have to say, and she really specializes in a broken healthcare system and how that healthcare system, that broken system, has led to a lot of homelessness and people coming out of prison not having places to go. So it's a very interesting conversation. You know lack of hospital beds for people with mental illness issues and addiction, and Alice really sheds a light on it. She does have a new book that is out called American Madness Fighting to Help Patients in a Broken Mental Health System. You can find that I link it in the show notes and all of Alice's information. I will link it in the show notes below. Let me know what you thought of today's conversation.
Speaker 2:As always, I appreciate you listening. If you haven't yet, please rate, review and subscribe to the show. The reviews help and also that way you subscribing or following because I think on some of these platforms now it's following a show. That way, you always get updated when a new episode comes out, like last week I was sick so I didn't get to put that episode out until, I think, friday or Saturday and you can't always count on seeing everybody's posts on social media when there's a new episode that drops. All right, enjoy and keep on trucking out there. Hey Alice, welcome to the Sober Vibes podcast. I'm excited you're here today. Thank, you.
Speaker 2:So why don't you share with me kind of your backstory? How did you get in to?
Speaker 1:what made you want to go to the psychiatrist route when entering the medical field. So it's been very important. Mental illness has been very important in my family. I had a father who was definitely not altogether normal and it involved all of us. I mean, the whole family was kind of distorted because of that and it was interesting to me. You know, I liked the patients, I like doing that, I like listening, so it was just the more the most fun of anything in medicine, right?
Speaker 2:right. And then also to you being a child of somebody who had mental health issues. How did you work? And then, as a psychiatrist, how did you work through your issues? I'm sure that impacted you in some type of negative way, right? So how did you work through your issues? I'm sure that impacted you in some type of negative way, right? So how did you work through those issues yourself?
Speaker 1:Oh my, it's not like. You know, I did one thing and got through it. You know I mean partly. I was able to change my own life. I got married, had a family, had a career, and those things are probably more important than anything else.
Speaker 2:Yeah, so just as you evolved as an adult and whatnot, when you felt like you needed to get help with that, you sought out what you did. But yes, definitely I think there is a lot of true power in healing as well. I can only speak from it myself of when you do develop your own family unit and you kind of cut ties or break that generational trauma and do everything in your own power not to keep repeating the cycle. You know, for me that was giving up drinking, like, and that was what started. And then, of course, in my sobriety, in my recovery, I was like, oh, there's other issues I have to now work on right. So you really are into. What you specialize into is the treatment of substance abuse disorder too.
Speaker 1:That's definitely part of my specialty.
Speaker 2:Yes, Okay, so how do you see it? How do you treat people with substance use disorder?
Speaker 1:Well, I listen to them, try to make a connection, hear what it's like for them and kind of gently, gradually take a history because it's important. You know they may say I feel like I might be drinking too much, and then you find out that oh my goodness, there's all these other drugs too. So they all need to be addressed. And you know, depending on what they tell me like if they're interested in treatment, they've really reached that point, then that's an easy jump to. You know, we have this program or you might also want to do that, that kind of thing. If they're. You know, really, if they've been dragged there by someone else, then it's a different thing. You just want to make a connection.
Speaker 2:Yeah, so what have you found in your expertise of what you've seen through the years? Do you feel like people who come up with the decision of their own to stop using or drinking to end their addiction usually has more long-term success than somebody who was brought to you or there was an intervention done? How have you seen that play out? Because I think that would be very interesting to hear from you.
Speaker 1:Well, you know, there are a lot of people who sort of come to it one day or one week and decide to stop using their drug of choice, stop drinking, and very wholeheartedly get into a program and do all the steps and still roll back into it. So it's not always it seems promising and it's very sad when they do, and I know that people are always unhappy with themselves when they do that. That's not where they were trying to go. But if they're, as you say, brought in by someone else say the mother or the wife or the husband, somebody it's definitely a harder climb. It's quite a climb to see that this is your problem too and that you would be happier without it and that it's causing you all these different problems. That may not have been obvious. So sometimes people you know catch on to that and they, they do get better.
Speaker 2:I don't know if this is going against anything, but I'm just wondering because you've seen this so much when somebody comes to you, can you tell with the history of your knowledge and almost like spidey senses, if somebody is BSing you in sessions or like if they're BSing their family just to pacify their family, to be like, okay, I'll just say this and this and this just to get them off my back?
Speaker 1:Yeah, right, so well. I would never just see someone individually. That's not enough. They need to be in a group. A group is really the best possible treatment, because they get to know people and those people know them and will give them feedback and support, much more so than just one therapist. So do I recognize BS? Yeah, it feels different it feels very different.
Speaker 2:Right, you hear that Good people of the world I call my audience the good people of the world and all fun Therapists and doctors and all that and they can smell the BS a mile away, so don't even try it anymore. So you have written a book in the last couple months, and what's the name of your book?
Speaker 1:It's called American Madness, Fighting to Help Patients in a Broken System.
Speaker 2:Okay, so from your opinion, has the mental health system always?
Speaker 1:been broken. It hasn't always been as broken as it is now. So when I was first starting out, I was an intern resident in a community mental health program in San Diego and we had kind of the good things going. We had a small hospital. We could see people for as long as they needed to be in the hospital, you know a week or two weeks and sometimes more, but usually that would be it. And then we had a clinic that connected. We connect all the providers connected with each other and that's important All part of the county system.
Speaker 2:Yeah.
Speaker 1:And right now you know the way it is in California. Anyway, all the money, from about a third of the money, comes from this one pot, mhsa, which came into, doesn't matter. Anyway, the law about it is that it has to go through. Nonprofit means that all these different little agencies, kind of mom-and-pop shops, each one is doing something and they don't communicate with each other about what they're doing, they don't share information about patients and they are very much motivated to stay alive because they have to get funded every year.
Speaker 2:When did that? I mean, I live in Michigan, so I know that in this conversation, right like every state's going to be different, but when did you see the change? Because I feel like that happens up in Michigan too that providers stopped talking with one another, and I, for a couple reasons why I know this, but one is because I worked at a pain clinic and that was a little bit different, but there was some disconnect with the providers and then one of our doctors being like why is this doctor prescribing him or her this medication? Because the doctors I did work for were very thorough. So when did that disconnect happen? Stop, or when did that disconnect happen?
Speaker 1:Well, I think it's gradual, but it started, you know it really jumped with a couple of things. One of them is electronic medical records. We used to write our yeah, write our write actually on paper, our intake and our progress notes and our discharge summaries. Anyway, it was geared toward helping take care of the patient and other people would read them. You know, we'd read, I would read old hospital, get a chart that covers a bunch of different admissions, for instance, and you can see a lot, which is one way of communicating with people, with other providers.
Speaker 1:And then in San Mateo, when I was an intern, we all had each other's numbers, we could call each other. And then actually what happened for me was that I went into private practice after a few years because I saw that it was getting. I worked at Highland Hospital, which you wouldn't know, but it's the county hospital in Alameda County and it's just incredibly over. You know there weren't enough beds, so people would come in and then we'd find an excuse, you know, in a day or so, to to discharge them. We discharged people to the street. So that was, I mean, that started in 1965 with the IMD.
Speaker 2:Yeah, I remember. So I went into the pain clinic. I started working there in 2011. And that's when I had to start switching over. When I started there, they're like okay, you can start scanning in all of these medical records. So I think it was like probably 2008-ish, let's just say like the start of it, right. And then by a certain year, I think that everybody had it was mandatory, correct for every medical office whatnot hospitals that they all had to be electronic.
Speaker 1:Right.
Speaker 2:So that's very interesting of something that was supposed to be more right, like helpful, actually started a disconnect in doctors talking with one another for proper care for these patients.
Speaker 1:Right, yeah, very much so, especially because those EMR records, the electronic records, are, in my experience, used as billing documents and you spend the same amount of time every time you see the patient filling out a long computer form. Whether you're just seeing them, you know, for a follow-up, and basically you want to spend time with them and then, you know, gets some use out of the hour, we spend as much time documenting things on the computer as we do with the patient, which is terrible.
Speaker 2:Yeah, and not everybody has the patience to get on a laptop. Like honestly, it does take a long time. I watched it and the notes that you had in there, where it was just sometimes easier for people just to write it all out. So what else do you speak about in your book? How else is this system broken?
Speaker 1:Okay, Well, one of the big things is that we have very, very few beds for people who are in real crisis and need hospitalization. And that's because of the Congress passed a rule in 1965, when they created Medicaid that said you cannot use Medicaid dollars to pay for inpatient care for psychiatry or for substance addiction. So that really started a huge shutdown of all the psychiatric hospitals. So now the way it is now is that people are treated the way it is now is that people are treated. About 90% of our severely mentally ill people are living behind bars and they're treated sort of but not nearly like what they need, and the suicide rate is high and the neglect rate is really's obviously it's bad.
Speaker 1:So not being able to use medicaid or medical in california is just a huge. It's a disaster. The hospitals can't live without it, especially for people who are not functioning well, which is the people who need that kind of hospitalization. They don't have private insurance and the insurance companies have also discovered that they don't have to pay. No one will hold their feet to the fire and make them pay, because that would involve on our end, it would involve divulging patient information. You didn't cover Joe Blow's. You didn't respond to my claim for Joe Blow's care, or if it's on behalf of the individual patient they're being seen on their insurance or they're just sending claims to their own insurance company. The insurance will just stand it Right, Never respond.
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Speaker 2:So it's very sad, but it's just very interesting that something that goes back to the 60s, that you know, our government decided for us that they weren't going to use this to treat it, because it still goes back to how mental illness has been treated forever in this country, right, I mean these psychiatric wards up until, I'm probably sure, in the last 20, 30 years, even probably 20 years, with, you know, these hospitals where people were treated it was inhumane. And so then you have a government made a decision about mental health and addiction and then to addiction being more criminalized at the time, you know. And so there's really a lot of years, that so many, there's decades, since the late 60s, that there has to be something that's done. I used to go pick up my mom's medicine and she didn't have insurance and she paid out of her pocket. And every time at the pharmacy they're like does your mom have insurance? And I was like no, and they would always look at me and they're like this is a lot. I'm like I know, but I would just go there with cash to pick it up for her and again, this was a time I could do that right, like this was back in the nineties so, and it always just like the look on that pharmacist's face of that. They just felt so bad.
Speaker 2:But that was the case of somebody who did not have insurance and had to pay out of pocket for these medications. That helped. You know that when she is medicated she is amazing, you know, and so it is. People need their medication to feel their best and to function, and so that's all been and it's all been taken away through the years and to nowadays, with insurance of even what.
Speaker 2:I saw up until the point of me leaving the medical field because I used to do claims on people's medications on Oxycontin, vicodin, all of that. I used to do the claims for it and people would call me and yell at me. I'm like I am not the insurance company, I'm just trying to get you a prior authorization right. And at that time insurance kept. It's been getting more and more strict of what they cover. And there is now people are like why am I even paying for insurance? It doesn't pay for anything for me. Yeah, throughout, it's a very interesting topic, and I'm sure it's just. I'm sure some people listening are very upset with their insurance companies and how they were treated. You know, trying to figure out their own mental health and addiction. So let's talk, though, about the lack of the hospital beds. Okay, share with us what do you mean by like? Are we talking in an inpatient hospitalization?
Speaker 1:So, for instance, in our county hospital now we have a county hospital dedicated to mental illness and only one out of four people who like brought in by a cop on a 5150, only one out of four is actually admitted to that hospital because they're so short on beds. So that means that people will stay in the emergency room and maybe get a little bit of treatment or maybe not, but anyway they just get sent out. That's one thing. If we were allowed to bill Medi-Cal Medicaid, it would be so much easier. They could build more homes, build more beds, more facilities.
Speaker 1:It's also it's not just the money savers, it's also the people, I would say on the left, even though that's kind of a broad definition to catch, catch all. But I would say, you know, there's been this feeling over the years really last 50 years that people that there is none one thing, that there is no such thing as mental illness, it's just labeling, uh, labeling people who are a little different, but in locking them up, locking them up is worse than jail. People have seen, uh, when flew over the cuckoo's nest I'm not sure if you saw that, oh my god, yes, great movie.
Speaker 2:very sad, but movie Jack Nicholson was amazing.
Speaker 1:He was, yes, but that is so different from the reality of a psych hospital, you know, and he, Ken Kesey, wrote that book while he was doing his master's, I guess, in creative writing at Stanford and he got a job at the VA hospital, the Menlo Park VA hospital, which is a teaching hospital. It's a really good hospital. None of what he wrote would ever have happened in that hospital. But he also was in an acid, LSD. It was an experiment. So every week he'd sit in this little room off of the ward and he'd be tripping on acid, and so it's hard to imagine that he didn't use all of that to dream up a really, really scary scenario.
Speaker 1:And in the book he lays it out very clearly that this is not reality. This is through the telling of one guy who's clearly psychotic. But when they brought the movie out they didn't have anything like that and it was all reality, that it wasn't just that but that that was a good push. So there's still an awful lot of opposition to hospital care or psychiatric reasons. There's a lot of ignorance and a lot of kind of righteous indignation about it, which is very sad.
Speaker 1:So, what do you do? Well, we agitate. We do so many things to take. We do so many things. We try to take care of people who are living on the street because they didn't ever get the right care. That's hard because they disappear. You know, people on the street don't stay in one place and it's hard to go out and find them. We'll do that with the case managers who make a point of trying to go out and find them. In an ideal system, we would have beds enough for everyone who needed it and then step down beds for people who were stable but still needed some inpatient care, and then we'd have outpatient care and those would all be all be connected, right?
Speaker 2:so the lack of this broken mental health system has now then created two types of issues again going to then. Now you have a because, because people aren't getting the the accurate, the correct care. So now too you are. Then I don't want to say a boom of homelessness, but that's what has happened, yeah, and or incarceration, and then too, in the incarceration, it also too, probably creates a homelessness coming out for some, because again then, once they're out, I don't really know how that works, but when they're out, I'm going to assist, I'm going to assume that they don't get the accurate care that maybe that they were having in when they were in prison.
Speaker 1:Right, yeah, Well, I don't know how much care they do get in prison. It's not, it's not like a hospital at all. But yeah, people get discharged and without notice to their families, without any kind of preparation, just like okay, here's your stuff, Goodbye, You're out. And it's terrible. I mean people have been really institutionalized and suddenly they're out there trying to care for themselves, and often the best end. It's very hard to get a job once you've been convicted of a felony. I mean nobody wants. It's hard to get a job anyway.
Speaker 2:My sister. She's got a felony charge, so I just know the system from her and I'm not outing her on the show. We have a show within the show where she's on this podcast too and she shared that too and she actually wants to start doing more stuff to help women when they get out. But yeah, it's you know you can no longer vote. I mean, she can't even go to Canada.
Speaker 1:Yeah, it's crazy. And so many people are there by virtue of their mental illness. You know no treatment.
Speaker 2:I went to California a couple. This was a trip I went to a couple years ago and it was in Southern California, in Orange County, and I was and I get it because of the weather, I understand the weather aspect right, and I get it because of the weather, I understand the weather aspect right. I have never seen such extreme wealth met by extreme poverty and it was one of the saddest things I've seen in my life and also to made me feel a certain type of way in that state and it was very hard to just comprehend seeing both of those, if that makes sense. So, and I mean, you see it, you're up in San Francisco, so you, you see it in plus two with your profession, you, you see it all the time.
Speaker 2:So, you know, in Detroit, here, the Metro Detroit area, I you don't see, yes, in downtown, of course, but it's not like a California or even to Denver. Denver has a high population of homelessness, right? So what are your thoughts on that of you living in, you know, in a state where it's like extreme wealth and then homelessness, like that?
Speaker 1:Yeah, well, part of it is the lack of beds. I mean, I think other states are better than we are. I think that they did. You know they call it deinstitutionalization, shutting down the hospitals but I think we probably did it more absolutely than a lot of states.
Speaker 2:So, yeah, how for you, when you know seeing people on group or whatnot, is your take to treat the addiction first and then get into the mental health issues after they are treated for addiction? How does that go? Because I am a firm believer. You know people who have just what I've seen and experienced and of what I know it's yes, usually mental health issues get some, have someone arrive to the point then of addiction right, and then in the recovery process it's like you've got to take care of the addiction and not using that day and then, when you kind of level out more, then start treating the mental illness.
Speaker 1:Yeah, absolutely, I completely agree. Yeah, because you know the drug or the alcohol changes you and it may be covering up something. It may be that without that drug in your system all the time you're much better, and so it may be causing something. So you really need to know that, and the first step, as you say, is the addiction part.
Speaker 2:How long from your expertise would it take for somebody's and I know everybody's different, but just like around about like how long would it take, because I get questions asked all the time. It's like how long am I like in, you know the detox part and I explained about pause, right, but for you, so how long in your expertise would you say somebody could be in that part where their body has to level out and almost return to like ground zero, right, like baseline?
Speaker 1:Yeah, well, it depends a lot on which drug we're talking about and how far gone somebody is. You know people, if they go into DTs, you know when they stop they need some serious care right away. If it's less than that, it's also, you know, the inpatient treatment, like the 30-day inpatient treatment is really helpful, not just for detox but for just being in a safe place where they don't have to perform. They don't have to be anything that they're not. All they have to do is stay there and not use or not drink.
Speaker 1:I think that you learn how to be yourself again or how to be without the drug. You can stand to just do these things, the ordinary things that talk, you know, talk to other people, have a meal, watch TV, just these very undemanding things, and then, yeah, so that's. So part of that is withdrawal. For things like crack, cocaine, it takes at least two weeks just to be able to restore your normal brain chemistry, and all that time it's just a horrible withdrawal and people are rightly not rightly but it's very hard not to use, but you know it's very hard not to use. So, yeah, obviously they need a safe sheltering place where they can be and not have to cope and not have to be happy and not have to be cheerful and jolly or calm or anything.
Speaker 2:Yes, absolutely. I do want your opinion too, if you can touch upon this, because this is something I just told you. I have a two-and-a-half-year-old In my brain. Obviously all moms, their brain chemistry changes after having a child and then I ended up getting diagnosed with postpartum OCD. With postpartum OCD, and I'm wondering, because sometimes I wonder with women who have addiction, especially with alcohol, that after they have a child, that with that addiction and with going into the postpartum, if sometimes it's almost like their brains break, you know, and just because I know of some women who, after having a child, has really elevated their addiction to the next level when it comes with booze. And then I just wondered on the impact of, like a new mom brain and addiction, if you have anything to add on to that.
Speaker 1:Well, you know, if you're basically if you've been staying drug free while you're pregnant so as not to hurt the baby, and then you have the baby, you know it's quite likely that you will have postpartum depression and on top of that, now you can drink because you won't hurt the baby. I mean, obviously it's not a great idea, but I imagine that a lot of people sort of dive back into it.
Speaker 2:Okay, so you're saying I just want to make sure I heard that right. Let's say, you used up until the pregnancy, you stopped during the pregnancy and you have more of a greater chance than developing postpartum. I don't know, I don't know Just in the postpartum stage. That's what you're saying. Okay, yeah, right, right. Then just to go back to that and then that escalated, because it's a very again just going through that in the last couple of years. It's a very interesting time that nobody knows, until you become a mom, you know, you don't know all those things, and then you're in it and you're like nobody talks about this, until you bring it up to a girlfriend and they're like, yeah, yeah, this has happened, right, so, so, yeah. So any tips or any suggestions I should say for you know, anybody struggling out there with mental health issues and especially addiction issues.
Speaker 1:Well, find some good help.
Speaker 2:Yeah, yeah, a therapist for sure, and you know. And stop using your drug of choice today. Yes, of course, of course. So where do you, where can people get your book, which I will link everything below, but I'm assuming on amazon they can find your book yeah, they can find it on amazon and a bunch of other places.
Speaker 1:Okay, and then. And what's your website? It's alicefellermdcom. Okay, perfect.
Speaker 2:So well. Thank you so much for being here and I truly, truly, truly appreciate you taking your time to share with us this and again for the listeners out there, you can connect with Alice, and all of her links will be in the show notes below. Thank you so much for joining us today and we'll talk soon.
