Mental Healthcare & Counseling
May 5, 2020
Welcome to Recovery Radio by Landmark Recovery with your host, Zach Crouch. In this program we’ll discuss the root causes and treatments of alcohol and substance addiction, speak with experts in related fields, and help navigate the road to recovery.
Now, here’s the host of Recovery Radio, Zach Crouch.
This call is being recorded.
Zach: Hi. I’m Zach Crouch and you’re listening to Landmark Recovery Radio, your source for addiction and recovery news and knowledge. You can find us online wherever you get your podcasts and don’t forget to subscribe to get the most up-to-date information from leading experts.
We have guest Brian Valasek joining us on the show today. Brian has over 14 years of experience in the mental health field and he currently serves as the Director of Restoring Hope Counseling and Coaching in Cincinnati, Ohio.
Brian, I’ve known you for a quite a while now and it’s just a pleasure to have you on.
Brian: Zach, I appreciate you having me on. It means a lot.
Zach: Tell us and the audience, for that matter why did you pursue a career in counseling anyway?
Brian: That’s a great question right off the bat there.
Zach: I got to say. I came off as being like somewhat pejorative. That’s not meant to be that way. I think it’s a great career.
Brian: What on earth would possess you to do that? It’s the same in the fortunes. That’s what. It depends on how far back you want to go for me to answer that question. I think probably the best way to answer that is to go back about maybe 20 years or so. You thought I was going to say childhood, right?
Brian: About 20 years ago when I went to university at Miami University I think I was introduced to an abnormal psychology class. It was just, “Oh, this is it. This is what makes sense to me. This I can understand. Algebra, no. History, don’t care.” Psychology was one of the only things that made sense to me and it just felt right.
Zach: It makes perfect sense. Right, right.
Brian: Yes. It was. That fringe element — folks with antisocial personality disorder, schizophrenia, it was kind of fascinating that there are people out there that experience that and it intrigued me. I was immediately curious. That would be the first reason, the thing that sort of piqued my interest.
The reason it probably piqued my interest is we have to go a little deeper to answer that question, get a little personal here. God bless my mom and dad. I love them to death. I think that some of the things that we did, some of the ways that I interpreted, some of the things that happened or didn’t happen left me feeling like an outcast. We moved around at probably a few critical times in my life. At some point I felt like what’s the point of making friends when we’re just going to move again? It’s a lot of investment in time and things like that.
Zach: How old were you, Brian when those critical times you’re talking about were?
Brian: I think the first main move was when we were 12. We moved from Cincinnati to Louisiana and we stayed there for five years which I’m grateful for. My best friend on the planet actually lives in Louisiana. We still stay in touch. I’m very grateful for that, but that was kind of…and we moved back five years later to Cincinnati.
That kind of back and forth thing and the way I interpreted it and how I kind of was…I felt like I was on the fringe or the outside of any group. It’s kind of strange. I only realized this many years later. A lot of this was subconscious, but if I was friends with somebody and talking to him and then a third person comes up that either knows them a little bit or a lot I immediately felt like the third wheel. I feel like I kind of did a lot of it to myself, but again that’s how I…if you put those two pieces…sorry for the long answer.
Zach: No, no. It’s very relevant for sure.
Brian: Right. If you put those two things together it’s like why was I interested in the outcasts, the person that has been sort of looked over it’s because maybe I felt that way myself. My passion for this counseling thing comes from that place. At first, it was for people with schizophrenia and I got into the mental health field in case management and things like that. For the past decade, it is kind of that passion for the outcasts specifically transitioned into the person who is addictive.
Zach: Yes, yes. I appreciate that. What comes to mind is this idea of the outcast you mentioned, I was thinking about the story of the underdog, someone who’s just not getting any chance or at least perceives doesn’t have the chance and there’s no way this guy’s going to win. I think for me that encapsulates what addicts and people with substance use disorder really represent is that.
That’s a cool thing to watch. You get to see the underdogs, so to speak break through and make a lot of change and a lot of progress in a pretty sure amount of time when they get support.
Brian: Zach, recovery is the coolest thing. It’s the coolest thing out there. It’s the most remarkable thing. To me, it’s the most courageous and difficult journey a human can take is to go from being enslaved in addiction to thriving in sobriety.
Zach: Yes, yes. You mentioned something I think very interesting especially as it relates to mental illness. Abnormal psychology brought that. I was watching a, it was a Netflix series. It was on a former Patriots ball player, a guy named Aaron Hernandez.
This guy after he…he committed suicide in prison, but in any event there was a tremendous amount of substance use that he had incurred over the years from smoking tons and tons of pot but also there was a tremendous amount I think of biological damage due to the hits he had received from football. He was diagnosed I believe with probably narcissistic personality disorder and antisocial, maybe even some sociopathy.
After this guy passed away, they did an autopsy on his brain. There was a hole in this guy’s brain and literally you could have stuck your pinkie finger through just where the, I think the pleasure centers of the brain. I think it’s fascinating because we’re starting to understand the brain and especially how personality is working and how mental illness plays into it and also addiction.
I think that for the both of us because we’re pretty early on in our career still to be in a place where that piece is going to be starting slowly understood more is only going to inform our abilities to help people out in the future.
Brian: You and me, you know what we both know that we are all about empathy and we’re all about crushing stigma. I hope that neurobiology awareness come into the forefront actually provide some level of both empathy and stigma-crushing because it’s a real thing.
Brian: I think, Aaron Hernandez if that’s accurate I saw that. I didn’t remember exactly that part of it, but if his brain is not as able to obtain pleasure he’s going to go to greater and greater lengths to get it. That sounds like a recipe for addiction, right?
Zach: Absolutely. I had a guest on he was a University of Pennsylvania professor, pretty recently. We were talking about how the dopamine systems of the brain that people with substance use disorder have they often just need to have something a little extra simply just to feel normal. I think that that’s something that is becoming more understood now is that it’s not a moral thing anymore.
It really is a brain thing for people with substance use disorder. They just started to learn about the genetics predispose them to really seek those things out in a lot of ways — those things that get them to feel simply normal.
Zach: I’m curious to know. With your history, do you find yourself ever kind of relating to the experiences of people that you’re treating?
Brian: Yes, absolutely. I think a lot of people that get into especially mental health treatment whether it be counseling or social work, whatever role that is I think most of us have some experience either personally or within our families or both. Yes, I can definitely relate to people in terms of self-esteem concerns, social anxiety concerns and to some extent, addiction concerns or at least substance use concerns.
A lot of my empathy for what people are going through is this essentially knowing that I’m one, at least I was and maybe I still am one decision or one tragedy away from having a fork in the road presented to me to go left or right and left will probably include substances at that juncture so I would have to prepare myself for that.
Yes. I got into marijuana pretty heavily in college. I call it a hiatus, had to take a brief hiatus from school for a while. I ended up working in a shipping department for office products and things like that, which again I’m grateful for all of this including that. I was being interviewed by a practicum student at a local university and I was telling her I’m happy about that time.
Brian: All of these experiences in life give me empathy. They give me understanding and connection points.
Brian: Yes. That’s part of it. Yes, yes. I could go on. I could go on about that.
Zach: Yes. No, no, no, no. You’re good. I was thinking, too about tyour fork in the road idea. In your experience, drug experience but also knows the truth, have you found to be true that it’s typically stress is the thing that triggers you to maybe want to go a direction that you don’t necessarily or you know is not going to be good for you? Is it emotional stress or what is it?
Brian: For me personally?
Brian: For people?
Zach: I would say for you but also for the people that you’re treating.
Brian: It’s a whole host of things. I try to work with people not on triggers but core drivers because just what’s the fuel source for this. For me, my biggest kind of triggers are probably when I feel invalidated or made to feel less that or shame, embarrassment, things in that. Those are my biggest ones, not necessarily hungry, angry, lonely or tired necessarily. That’s mine.
Definitely stress is one of them that I just mentioned is another for a lot of people; just the circumstances and environmental, financial, occupational stressors. Think about before we jumped on this call, we were talking about the stressors of what’s going on right now and this is fuel to the fire for addiction — boredom, loneliness, isolation. Are you kidding me? It’s a perfect storm.
To me, I have a bunch of different definitions of addiction. My favorite one is an obsessive excuse me, a compulsive relationship with a substance or behavior. When humans don’t have access to relationships, they/we seek fake relationships. Chemicals, especially alcohol is so plentiful. It’s now being delivered to your door.
Zach: That’s right. That’s right. I’m curious to hear, too your take on some would even love Brené Brown who had done a lot of work in helping resilience against shame that topic that you just brought up for yourself. Do you think that she’s made a huge impact in helping people because I think shame is a huge driver in addiction? Do you think that she has made a tremendous impact for people who have addictions?
Brian: Do I think shame has a huge impact?
Zach: No, no. Do you think that Brené Brown has made an impact just in reducing the shame?
Brian: I hope so. I don’t know how she couldn’t. I’m a fan of hers. I think what she has to say is right on target. I think just yes, everything about that it’s sort of de-stigmatizing. We talk a lot about changing structures and systems and the stigma within the profession itself and so forth. You hear me talk a lot about that, but we only have a half-hour. I don’t know how many soapboxes I’m allowed to get on here.
Zach: Jump on one now. I’ll pull you back down if we need to. Yes, yes, for sure.
Brian: She’s fantastic. I follow her on LinkedIn and things like that and I like what she has to say, absolutely.
Zach: How do you think being able to empathize with people going through struggles with addiction, how has that affected your abilities as a clinically-trained person, counselor?
Brian: I like to think that it’s a…I’m in a really good spot to have probably a perfect balance of enough experience in drug land to understand what people are talking about and connect and empathize without necessarily having my own strict golden path to recovery. I’m not in recovery personally.
Brian: That’s because I believe I could be addicted. I believe that I was clearly abusing substances. It was more about the people I was around trying to fit in with them than it was anything else.
Zach: How do you address that question though, Brian? When someone’s in group or individual session with you and they’re there for alcohol and drug-related issues and they ask you that question are you a person in recovery because it’s an interesting kind of question that gets asked. How do you respond to that?
Brian: It is. It’s an important question for the clients to ask and it’s an important question for me to answer honestly. People want to know, this is across the board. They want to know that you care about them. They also want to know if you know what the heck they’re talking about.
I essentially tell people either I’d straight up answer that question or I tell them, “Yes, I understand you want to know if I know what you’re talking about. Just give me a chance. You’ll see. You’ll see.” If I do answer more directly, I will tell them that I’ve had problems and maybe some of the stuff that I already told you just now, yes.
Zach: Sure. To take a step further, if they ask the question as a follow-up to that and say, “If you said that you had problems before then why aren’t you sitting in my chair?”
Brian: Good one.
Zach: Yes. It’s a tricky balance. I answered it when I was a counselor. When I get asked that question, I would often just reflect it back and say to them, “How is my admission of being an addict or a person in recovery or not in recovery going to help you?” Typically, it would usually hit persons on delusion around their own use. That’s been my experience. That’s not necessarily true across the board.
Brian: Now I’m curious what you mean by it hits their delusion.
Zach: What I mean by that is when I would get asked that question, usually it was around the next question would be if I said yes I am in recovery it would be something to the effect of, “Did you shoot dope underneath a drawbridge in New York City? Were you homeless ever?” I’d be like, “No, I wasn’t actually.” They’d be, “You can’t help me out, man.” I’d be like, “Oh.”
Brian: I see, looking for any reason to say that you don’t know what you’re talking about. You can’t possibly understand me.
Zach: Let me keep the focus off me. Right.
Brian: Right, right. Again, that’s what we do as counselors. We have to earn people’s trust and credibility and integrity and rapport and humor and all these different things that we use to connect with people. We do everything we can and if there are barriers to that it goes two ways.
We have counselors who could be doing something substandard or off target, but oftentimes it’s just like, “I’m giving you everything that I got. You’re going to have to trust that I will roll up my sleeves and will get to the bottom of this and I’ll work with you for as long as it takes to help you. If that’s not good enough, you might be making excuses.”
Zach: Yes. Let me ask you something. I learned in my time as the grad student especially in my training that the relationship among a person in treatment or in counseling and a counselor is responsible for 60 to 70 percent of the actual change that can take place. If you don’t trust your counselor, if you don’t trust your treatment it’s just not going to work. Compare that with something like evidence-based practices.
Do you see there being more efficacy in evidence-based practice versus the actual maybe relationship that someone has with their patient even if they’re not using say, an evidence-based practice being more effective? Does that question make sense at all?
Brian: The question makes sense, but it’s a very tough question to answer. I think the most effective counselors or counseling relationship is one that has both. If you ask me, I have very simple theories about counseling, a very simple sort of approach to it. I’m not a technique-y kind of guy. I tell people that I’ve kind of moved beyond techniques. I think you need to start with a basic technique. I’ve been doing this for 15 years. I’ve moved a little bit beyond some techniques and I sort of got my own going.
Counseling is primarily about supporting and challenging. That rapport, trust, camaraderie, everything that you mentioned, having a safe place where people can get vulnerable with, the person can get vulnerable with you and there may be some self-disclosure is fundamental. You can’t challenge somebody to think differently, to do more, to rise up to the capacity that you see in them that they may not see in themselves unless you have rapport.
You can’t just have rapport; otherwise, you’ll talk in circles.
Zach: I think that’s probably more true I think with subset of patients like adolescents. Adolescents I think are some of the hardest patients to work with because a lot of them had been told what to do. They’ve been told what to do without having any relationship. Parents, they simply just expect their kids to do X, Y, and Z but there’s no relationship there.
When I was going through my training as a counselor, I was told rules without relationship equal rebellion. I think that is true even with adults especially with people with substance use disorder.
I’m curious to know from you. What are some of the things you recommend people look for when seeking out a counselor?
Brian: That’s probably the most important question you’re going to ask today for the audience to hear. I personally think the most important thing is to talk to them first. See if you can get a 15-minute consultation with that person and ask them a couple of questions. Ask them how they do counseling. Ask them what the process is. Ask them how they would handle certain situations. People don’t take advantage of that very often at all.
15 minutes, I don’t know. I think most people sort of have good instincts and they can tell if they’re going to connect with that person or not in a 15-minute phone call. If you’re not connecting on the phone call, don’t schedule an appointment.
Shop around. Psychology Today is a great resource, psychologytoday.com. It has almost exclusively private practitioners. I’m biased towards private practitioners because I am one and because I feel like we can give our clients a little more time and consideration and thoughtfulness even between sessions.
Yes, I would interview your prospective counselor and not feel bad about not selecting them and hurting their feelings. We’re here to help so make sure that we can help. Just like there are good plumbers and bad plumbers, there are people out here doing counseling that shouldn’t be. Yes, it’s beyond just “Do they take my insurance? Do I owe my clothes to them?” You want to make sure that you can have a connection to them. I don’t know how to answer that but I think that’s the most important thing.
Zach: Absolutely. I think you said it very well. Do you agree with the statement and this is pretty common I think among the therapy world that the best counselors are also in counseling?
Brian: I think so. For example, I’ve never been in counseling so it puts a lid on my potential growth as a counselor. It also puts a lid on my empathy. Absolutely, I agree that doing counseling can make you a better counselor. Understanding the other chair, as we say will help you be a better counselor no doubt.
Zach: Good stuff, man. I really appreciate the opportunity just to connect. Obviously it’s always good to talk to you, Brian. For people that are interested in your services, where would they need to go to learn a little bit more about what you guys are offering at Restoring Hope?
Brian: At Restoring Hope, there are a couple of good places to go to. Call me. Can I give my phone number out here?
Brian: My direct line is (513)345-0741. I’m always happy to talk to people about what we do.
Zach: Can you give that one more time, if you don’t mind?
Brian: Yes, of course. (513)345-0741.
Zach: They can also check online?
Brian: Online, www.restoringhopecc.com. We’re also on all of the socials I think — Facebook and Instagram and LinkedIn. Yes, that’s the best way to get more information. We have a whole intake department called the connections team which will be the best way to get in if you needed immediate information. I didn’t say this. We can get you is as soon as next day. We don’t have a waiting list and we have people with all sorts of specialties — trauma, addictions, anxiety, depression, couples, family, etc. We got you covered.
Zach: Very cool. Do you guys take insurance, Brian?
Brian: Yes, we do. I could rattle off the ones we take. We do take a couple: Medicaid MCO’s, Paramount, and we take a few private insurances namely: Anthem, Aetna, Humana.
Zach: Perfect. Listen. It’s been a pleasure, man. I really do appreciate you coming on the show today.
Brian: Absolutely, Zach. It’s always a pleasure talking with you. I can’t wait to see you again in person. We got a rematch to that table tennis tournament we had going.
Zach: That’s right. That’s right. Any podcast guest that do come on or come visit our facility in Landmark Recovery in Louisville, Kentucky, I’m currently 4-0 with any podcast guest or visitors at this point. If you ever do want to challenge yourselves to a good Ping-Pong match, I’m always game for that, just FYI.
Brian: The undefeated Zach Crouch.
Zach: There you go, man.
Listen. If you know someone struggling with an addiction and are searching for answers, visit us at landmarkrecovery.com to learn more about substance abuse programs that are both saving lives and empowering families.
Until next week, I’m Zach Crouch with Landmark Recovery Radio.
Zach: Hi. I’m Zach Crouch and you’re listening to Landmark Recovery Radio, your source for addiction and recovery news and knowledge. You can find us online wherever you get your podcasts and don’t forget to subscribe to get the most up-to-date information from leading experts.
We have guest psychiatrist Dr. Liat Jarkon joining us on the show today. Dr. Jarkon is the Director of the Center for Behavioral Health at New York Institute of Technology College of Osteopathic Medicine. She has more than 30 years of experience in child, adolescent, and adult psychiatry. She is an advocate for breaking the stigmas surrounding mental health and is currently advocating for health insurers to provide more adequate coverage for mental health treatment.
Dr. Jarkon, thank you so much for coming on the show with us today.
Dr. Jarkon: Thank you.
Zach: If you don’t mind, tell me a bit about yourself and what inspired you to get into psychiatry.
Dr. Jarkon: I’ve been in private practice for about 33 years. The last three I also joined the Academic Center. I had a position in faculty at NYC COM. I’ve always been interested in people.
Zach: Can you hear me okay?
Dr. Jarkon: Yes. Do we need to start over?
Zach: We could edit that out. Let me go ahead. I’ll go ahead and ask the question again and I’ll turn my phone on silent. I thought it was already on.
Dr. Jarkon: Okay.
Zach: I’ll go ahead and ask the question. You can go ahead and answer. Tell me a bit about yourself and what inspired you to get into psychiatry.
Dr. Jarkon: I’ve always been interested in people and the human body. I ended up in medical school because of that. One of the things I didn’t realize is that I’ve always been interested in human behavior as well — emotions and reactions. While I was a medical student, I was learning about all kinds of medical illnesses and specialties from surgery to gynecology and everything in between.
I had an experience in an emergency room setting once where a wife came in with her husband who was very, very ill. He had consequences of diabetes. I was looking at him and of course the main purpose was to make sure that he was out of harm’s way physically. At the same time while that was being done, I couldn’t help but realize what kind of stress he was under emotionally — his anxiety level, his wife’s anxiety level.
I started thinking about how this one episode in his life is affecting his family and his job and his children who were at home. It really led me to understand that this is really what I want to be doing. I want to go more into understanding reactions.
Dr. Jarkon: That’s how I ended up in psychiatry.
Zach: There are things that I kind of point to for people who get inspired to go into recovery. For some people it is, some people call it you feel the fire or you see the light. It sounds to me like this is a kind of profound example for you of what inspired you. Had you been thinking about this fire to even see in this particular wife and husband in your ER?
Dr. Jarkon: No. I’ve always been interested in psychiatry. My undergraduate, I studied psychology and biology. I honestly didn’t know psychiatry in medical school. It really was a combination of things. While I was interested in psychiatry when I was doing my residency, we had an opportunity to work with children and adolescents. When I did that I said, “That’s really what I want to do.”
I ended up taking a fellowship in Child Adolescent Psychiatry. I practice child, adolescent, and adult psychiatry. It’s always been a part of who I am in terms of trying to understand people’s behavior even as a kid, why some people act the way they do and some people lose control and some people are mean and some are not.
It really lent itself while I finished all my sub-specialties in medical school realizing that regardless of the person’s medical issue or crisis, whether it’s again, gynecolgical work, whether it’s surgical or whatever it is there’s always an underlying emotional component. If that’s not taken care of it’s going to affect the physical component as well and vice-versa.
Zach: For sure. Can you tell the audience a little bit, too…I’ve got a very dear friend and he’s an internal medicine doc and he’s board certified in addiction and that’s helped his career. It’s helped him become more informed. Can you tell the audience about fellowships within med school and why they’re so important you think?
Dr. Jarkon: There are many, many different types of fellowships. There are fellowships in psychiatry, in addiction which is a sub-specialty of psychiatry as well. The reason it’s important is because it helps you to then focus more specifically on these areas. I think whether you’re going into medicine and end up being a gastroenterologist, someone who specializes in stomach diseases, it’s important to do that fellowship so you can then take your broad knowledge and put it more specifically to the audience that you’re assessing.
Zach: Got it. Being that you’re in this field now at least working with child, adolescents, adults for more than 30 years, do you see still a lot of the stigma surrounding mental health? What does that stigma look like?
Dr. Jarkon: The short answer is yes. There’s still a lot of stigma. It is getting better. It presents in a myriad of ways. When I joined the faculty three years ago at the medical school, one of the questions they asked me is “What is your goal?” I said, “My goal is to provide these medical students with on-site mental health services, but I need to decrease the stigma in order to do that.” I’m not sure they understood really what that was. I’m not sure I understood how to go about it really.
What we ended up doing is last September we launched the Center for Behavioral Health and the purpose of it was particularly to reduce stigma, to reduce stigma talking more about mental health, creating awareness, inspiring hope, solutions, educating — all of that is important even on a national level in order to reduce stigma.
What it looks like on the smaller level is colleagues of mine being very supportive of having mental issues with students, but saying things like, “Don’t say that you’re a psychiatrist too often. It’s like a little intimidating.” I respond with, “I don’t know what else to call myself.”
Zach: Right, right, right, right.
Dr. Jarkon: I continued to use that phrase and they got comfortable with it. It just shows you that even educated people, my colleagues were…the stigma starts on top. It has to be addressed on top in order for it to trickle down. The students initially were very concerned about seeing me, concerns again related to stigma. Is it going to be private? Is it going to affect my employment in the future?
All sorts of things like that and eventually students now, I’m seeing about a 150 to 200 a month and some of them stalking me on campus saying, “You know, I think we need to adjust my medication.” I say, “You think maybe we should wait to get into my office so we can talk privately?” They’re, “Oh, my friends all know. Now it’s all out there.”
We really have changed the culture on a small level and I think that’s happening on a larger level. With celebrities coming out from royalty to rock stars, this is not anything new. It’s just been closeted. The stigma is necessary in order to make it an everyday conversation. To me, that’s the way of acting as a catalyst to get solutions more openly available.
Zach: It seems obvious but I’ll ask the question anyway. What is the benefit then of having less stigma around mental health, your own mental health? Every day you wake up and you’re fighting something maybe that you can’t put your finger on but you know it’s there because you feel it. How does that benefit just your average everyday Joe who’s maybe got a 9-to-5 job working somewhere in America right now?
Dr. Jarkon: I think whether it’s your everyday 9-to-5 Joe working somewhere in America or a professional or anything, mental health does not have any prejudice. It affects every single category of people, religion, ethnicitiu, any population. It’s there. It’s estimated that maybe 20 to 25 percent of the population at some point had mental health effects that prevent them from functioning.
The reason it’s important to get mental health coverage is because just in the United States alone, the suicide rate has skyrocketed. It was the second leading cause of death among Americans ten to 24 according to the CDC. 17 million Americans have at least one episode of depression. That’s a huge amount.
Any illness, mental illness can lead to any physical or mental illness can lead to harmful consequences. If left untreated, mental illness can actually potentiate physical conditions like heart disease, diabetes, and stroke. The national suicide rate has jumped from 33 percent since 1999 according to the CDC and just from drug overdose alone rose by ten percent. The bottom-line is that we need to get this under control so that we can help people get back to their night classes, whatever it is they do.
Zach: In your opinion, what currently in terms of our narrative as a country needs to change in order for people to recognize the importance of mental health?
Dr. Jarkon: As we mentioned earlier, I think we do see the stigma is number one. They see whether again it’s celebrities, its everyday people just like we talk about heart disease, just like we talk about diabetes. There’s actually no difference. It is a medical condition, whether it’s depression, anxiety, drug addiction, alcoholism, bipolar disorder, anything you want to mention.
Physical and mental illness are connected. You can’t have one without the other. You can’t be a healthy individual physical and emotionally not well in order to function and vice-versa. You can’t be emotionally okay and physically not okay because that’s going to affect your emotions as well.
Zach: Yes. What do you see right now in your sort of purview, what are companies doing now? What are companies doing to support good mental health practices right now? What are things in your perspective that they could be doing more?
Dr. Jarkon: I think the main issue is health insurance. That’s something that I’ve been very passionate about. There seems to be still a disparity between health insurance coverage for mental health and physical health. Bottom-line is that insurers make it hard for patients to find in-network mental health professional.
With a study done, a third of the respondents of this study, this is a National Mental Health study, a third said they couldn’t find a therapist in their insurance plans; meanwhile, only nine percent said that they couldn’t find an in-network primary care doctor.
The other issues to the disparity between insurance companies they typically pay mental health providers less than they pay other providers. Basically doctors are getting paid 24 percent higher, medical doctors than behavioral doctors or therapists. That’s a huge amount. Many insurers don’t have health insurance coverage at all.
In order to try to repair this, in 2008 there was a federal law passed, Parity Law required that insurers that do offer mental health coverage to their employees they have to offer comparable mental health and physical health benefits.
The thing is that and this was through most insurance, employers as well as the Affordable Care Act, but there is a way to the insurance companies to even though it’s a way to try to reduce the disparities there was a way for them to circumvent this. They had many categories that they could exclude so that they might think therapy is not considered medically necessary. This was very damaging.
Zach: Can you give an example of that?
Dr. Jarkon: Example of?
Zach: Where the insurance companies found it not medically necessary, can you give just a real-life example?
Dr. Jarkon: Sure. Somebody says, “I got depression. I need to see a therapist.” It’s not medically necessary. They might suggest a cheaper type of treatment. I can’t speak for all insurance companies, but there have been many, many people even in my private office who come in and say to me, “You know what? I can’t get this covered.” One of the things that really led to my…
Zach: Does that mean that they’re going to have to go to another therapist or does that mean just in general like wherever they go to get that particular issue addressed they’re going to be met with all kinds of resistance?
Dr. Jarkon: Unfortunately what’s happening because of this is that there are…we don’t have enough affordable mental health care services. Many mental health personnel like myself when I was in private practice, I couldn’t afford to take insurance for my patients. The way that they reimbursed would not allow me to keep my office open. What happens is either patients who really needed to see me couldn’t or those that needed to see me just bit the bullet and they ended up having a lot of prohibitive out-of-pocket cost which is terrible.
When I joined the academic setting, I’m on all kinds of panels and I see that they’re getting paid which makes me feel great but some of them are coming in even on insurance panel saying that they only recover like five sessions a year because they deemed, the insurance companies that it’s not necessary to have more where as a clinician it’s my prerogative to say, “No. Mr. Jones really needs to see me once a week or once a month.”
Zach: Whereas if you had a medical condition as an example with addiction at least with diabetes if you needed to go see some medical doctor for your diabetic treatments, they’re not going to limit you versus someone who has an addiction issue they might say, “You can go see your therapist to talk about these issues ten times a year. That’s all we’re going to pay.”
Dr. Jarkon: That’s correct. Wherever there’s addiction regardless of what the addiction is, whether it’s food addiction, whether it’s alcohol, whether it’s drugs, somewhere someone is self-medication in a way for depression and anxiety. That’s kind of a common line with addiction.
If you could take that patient and you could get them into therapy and try to understand how did it come about, was it a family situation dynamically, is it a genetic situation then that’s how you do it, but you can’t say I’m going to do that in five sessions. There’s no way to predict that.
Dr. Jarkon: That’s the frustration that many mental health care providers have is that they’re being limited in terms of how they can assess, not how they can assess but how can they go about their progress. If I think that Mr. Jones needs to see me once a month or twice a month for a year for me to start tackling his addiction whatever it may be and the insurance says you can only do it in three sessions, that’s really not clinically sound.
Zach: Are you finding, too in your experience with working with some of these insurance companies that they are like, “That’s it?” On the front end that’s what they’re saying like this is kind of “We’re going to give you five sessions,” and that’s it versus you get an update at the end of five sessions and if they’re making progress they might give you more or less. In other departments they might give you more or less.
Dr. Jarkon: My experience with insurance companies I could tell you is based on my last three years in the school because that’s the only time I actually paid insurance because the school’s enabled me to be able to do that. I can tell you that it varies.
There are some insurance companies that say ten a year, 12 sessions a year, whatever it is, period, end of discussion. Some of them may suggest that three or four sessions you need to call and write up mountains of paperwork to try to say, “Mr. Jones is doing better but he still needs more.” They may send you more paper and say to you, “What kind of more? Why do you say more?” Honestly, when you’re trying to run a practice and just help your patients…
Zach: You can’t just do that. Yes, yes.
Dr. Jarkon: It’s really counterproductive. How am I going to explain to someone who’s not a healthcare professional that I need X number of sessions when I myself am just going session by session to know how my patient is improving?
Zach: I was just going to say I could tell you firsthand. My wife is a therapist and she accepts insurance from one MCO, Medicaid MCO. She’s in private practice. She probably spends more time just verifying, getting in notes on time, making sure that the paperwork there’s no sort of…that’s it’s all kosher obviously, but my point is she spends an inordinate amount of time for one patient, it’s one patient that she’s seeing that has this particular policy.
I bet if you added up all the hours she spends on that one patient she probably could see three or four, just the amount of time that she spends on paperwork.
Dr. Jarkon: It’s really, really difficult. I think that in particular with patients, people who have mental health issues again whether it’s addiction or any other spectrum of mental health disorders there’s so much stress on them to begin with that the last thing they need is to start fighting with insurance companies.
As a psychiatrist with over 30 years’ experience, there’s so much more that I know I need to learn. I’m always running every day, but I think I’ve learned how to adequately diagnose someone and when an insurance company has somebody contact me and say, “Can you tell me why,” it’s very disheartening.
I’ll just give you one of the statistics because of your audience. There was a report, a Janus study recently that found that patients with drug use disorders paid $1,200 more than average for out-of-network care annually than patients with diabetes. These are the disparities that I’m talking about. Why should that be the case?
Clearly people with all kinds of medical problems have stress and anxiety with them, too, but why should that be the case particularly? It’s very prejudicial in my opinion. I think it’s absurd in the middle of a suicide epidemic not to pay for mental health counseling as well.
Zach: I saw that you had taken that into account. You’re talking at least with the start of suicide rate goes you mentioned the general population. I had a guest on who works intimately with the vets and soldiers, active duty soldiers. That population their suicide rate is just it’s unbelievable.
Dr. Jarkon: It’s all from the insurance perspective, trying to be cost effective when the reality is that for example, recent studies showed $3.7 trillion are being spent annually to treat chronic diseases. I think then if the insurance invested more in mental health care and expanding it rather than making it impossible it could actually slash spending on chronic diseases over time. More importantly, it could save people’s lives. This is not the time to be frugal in my opinion.
Zach: What are we missing? What are we missing at the federal level? What are we missing in the state level right now?
Dr. Jarkon: I’m sorry. I didn’t hear your question.
Zach: I’m sorry, Dr. Jarkon. What are we missing then as legislators, as advocates at a state level and also the federal level then?
Dr. Jarkon: I don’t know that we’re missing anything. I think everybody is very well aware now. Mental health challenges are huge. They’re affecting us on every level. Now with the pandemic going on, the number of patients calling me and calling every other mental health provider is astronomical. Patients with pre-existing mental health issues are getting more anxious and depressed and they’re feeling isolated and it’s just a passive event. Those who never had mental health issues that were significant are now experiencing them.
This is the time to understand that we’re not missing anything. It’s just a matter of prioritizing in my opinion — prioritizing the efforts of supporting mental health providers just like we’re supporting amazing medical health providers right now in this pandemic. The mental health providers are right up there. They may not be in the emergency room, but they’re hearing about this. Some of them are in the hospitals, too.
This is something that has to be equally prioritized as much as medical health. The two go hand in hand. To me, mental health treatment is not optional; it’s essential to our functioning.
Zach: Let me just ask this. Do you think as an industry in general, is the mental health industry certainly in the addiction space that we’ve done a poor job of tracking hard data? Because that is often I think what is looked at. In a lot of ways, there’s not been good tracking of outcomes. Do you think that’s contributed to this? Is that changing?
Dr. Jarkon: You know what? I don’t really have much information on that. I have an epidemiological background. I have a master’s in public health, too. I don’t know the tracking system. I know the CDC is very, very adept at keeping track of many, many things. When I was getting my master’s in public health, there were lots and lots of resources to keep this information up-to-date. As far as that, I really don’t have much to say about that.
I think more importantly, having the resources and having the ability to keep track of it let’s do something with the results. If you see that the trend is going up which clearly it is, I just gave you several statistics today about suicide rate and depression and so forth then we need to make it a priority.
In terms of giving money to support these paying providers more, getting more people to go into mental health, I can tell you that for the last couple of years the residents are having a very rough time in getting into psychiatric residencies. It’s becoming a very popular specialty for people because they realize the importance. It’s still pretty much in its infancy compared to other specialties. There are huge amounts of progress, but still we’re learning a lot about it.
Zach: Yes, I think we’re still learning a lot about how just the brain works even though we’ve been studying it for some time now — how stress, how trauma, how addiction affects it.
Back to this piece around stigma and how it surrounds mental health, what could a guy like me do or just anybody that’s on this audience to help just kind of block this the stigma that surrounds mental illness and mental health?
Dr. Jarkon: Sure. One thing I can tell you is that in a very short amount of time, relatively short amount of time in two, three years that I’ve been at the school there’s been a huge decrease in stigma and the efforts that we made primarily were education. Having events like September is Mental Health Awareness month, May is Suicide Awareness month, having events for the students and the faculty, having people come on campus and describe the severity of it and yet not focus on the negative but how do we make it better.
When you do that, things happen. We’re talking more about it. We are creating more awareness. We’re offering hope and solutions in terms of organizing groups. I think the most important thing to do to reduce stigma is having it be spoken about. You see the celebrities all of a sudden now coming out of the woodworks about depression, anxiety and the royal family, members are coming out. That helps people realize there is no boundary whether you’re a royal or whether you’re a person of common descent. It affects everyone.
I think that knowing that you’re not alone is the very first thing. Actually the very first thing before that is realizing you have a problem. Once you can identify that your behavior is not something that’s allowing you to function normally then you need to get some help. Once you get some help that’s the first step.
When you do get that help, one way to maintain that and reduce the stigma is to keep talking about it. Talk to your family. Talk to your friends. Don’t be afraid to share because people are going to judge you because if they do they need to be educated.
Zach: I was thinking, too as you’re talking about some of those points we live in America and part of American culture is what? It’s our work. It’s achieving the American dream. Often I think what it says there’s a lot of “I think I’ll work all this.” Stress in our culture that contributes to a lot of mental health issues.
Being that that’s one of the I think stronger narratives in our country where it’s kind of built in to our institutions, companies, etc., with mental health I think being a strong part of what we’re talking about today it kind of goes back to my question earlier that how do we penetrate that sort of narrative? There’s this idea of “If I work hard enough and long enough then I’ll be able to retire, etc.” As I said, at what cost? At what expense? How do you balance I guess is my question the expectations? Go ahead.
Dr. Jarkon: I think this is one question and I think it’s ironic that it took a pandemic that we’re suffering right now…
Zach: Right, right.
Dr. Jarkon: Mixed with the coronavirus and COVID-19 as the disease to understand that the simple things are the most important things — the ability to meet people, the ability to go to the beach, to go to a park, to enjoy your family. That’s one of the things as a psychiatrist and I’m hearing over the last few weeks of the pandemic is, “You know what? I realized that I work too hard or I stress too much.” Just look at your family is so important and going back to basic values.
When you talk about the American dream, I think it has to be kept in perspective. Everybody has different goals. Is the American dream to make a million dollars? Is it to stay healthy for a long time? What is the realistic and appropriate dream for you and your family? I understand that one person’s dream may not be the other person’s dream.
Zach: Right. That’s such a good point.
Dr. Jarkon: Think again. Getting to know yourself and now we all have a lot of time to stay home and get to reflect a lot about ourselves right now to understand the truly most important things. It sounds very archaic, but it’s to be healthy and to be able to go out and do what you want to do and to function and to just basic things like being able to walk across the street to a neighbor and hang out in the rock. Put things in perspective. That’s the most important thing I think.
Zach: I really, really do appreciate that. You’re absolutely a hundred percent. With me being at home now, obviously most of us are throughout the day and evenings, spending time and not really as rushed has been a huge plus.
Dr. Jarkon: I have a lot of folks telling me despite the pandemic they actually feel more relaxed because they don’t have to set the alarm at 6:00 in the morning. They don’t have to rush and go here, there, and everywhere. They actually can just stop and smell the roses, as the expression goes and really enjoy the fact. Maybe it’s going to help people reboot ironically. Maybe this will help people reboot.
They’re talking that the canals in Venice are now clear. You can see fish in them as opposed to they were dark. They’re talking about air pollution quality is getting better, so many things that maybe we really do need to kind of look into ourselves and really take stock in what makes you as an individual happy. When people are more stressed, that’s when you see mental illness go up. That’s when you see addiction rates go up. That’s when you see people feel more out of control and try to control themselves as quick fixes.
I think that it’s really an important lesson ironically that sometimes it’s the world stopping the way it is right now to say, “Wait a second. Let me rethink this.”
Zach: Absolutely. I’m curious to hear from you. What’s been a blessing for you during this time?
Dr. Jarkon: Personally what I feel most grateful for is and I’m not an IT-savvy person necessarily is the fact that we still can be connected with patients and be able to support them during this time. I’ve been doing tele-medicine now for the last three-and-a-half weeks. Patients are so grateful that they’re still able to get connected to their providers and to continue the support that they started and also just spending time with family and rebooting and taking stock, exactly what you were saying. Taking stock and what makes it the American dream for us.
Zach: Pretty good stuff.
Dr. Jarkon: Yes.
Zach: Dr. Jarkon, we’ve covered a lot today. I just want to say I so much appreciate you coming on as well. I just want to say thank you.
Dr. Jarkon: It was my pleasure. I hope that your audience appreciated and got some information. You’re doing a great job. I think it’s a great service for your audience.
Zach: Thank you.
If you know someone struggling with an addiction and are searching for answers, visit us at landmarkrecovery.com to learn more about substance abuse programs that are both saving lives and empowering families.
Until next week, I’m Zach Crouch with Landmark Recovery Radio.
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