hi everybody my name is pat want and welcome to the show the big name of the show is mental health matters and as we all know mental health matters without good mental h we're not we're not anything and so therefore we're fighting very hard to help these people get rid of state so that more research can be done and to give them good lives and in order to give them good lives when they are able to function well enough they need it you know they need housing they need they need a lot of things so if you have a child with a mental illness you will you know that so will my guest today is laurie abrams barry who is the c e o of the l community health center hi larry hi pat oh you are thank you for asking me to be here hey it's my pleasure will i don't learn all about land community health center i want to learn all about you and we want to learn about as a mental health center yes it's grown so we're a much different organization than we were back then yes but we've pretty much stayed true to our to our vision  which at that time was to think about health and the broadest way possible we started off as a mental health center mainly because we asked people in the community what their health needs were and overwhelmingly people told us that the most pressing health need in the community was for mental health services and so that's how we started just by asking and  so over time of course we added primary care services and a whole variety of other health services as people in the community told us they needed them one way or another we had it and there's one place in it where it says mental illness is physical illness and was my doom boiling point of twenty five of them across the state they cost me a thousand dollars apiece and i went and collected all this money been myself and then i had my designer design a good billboard that would save the whole thing mental illness is a physical illness if you need help call and there was a number for  it was a number of forward five mil l and i love that bill lloyd campaign but what i loved about it is that the idea that somehow mental health issues are handled separately from physical health everything below the neck they don't think about mental health they don't think about dental they don't think about i care so all of those things are things that we think about at the link community health cent that that you can't do you often can't do one thing without considering all the others and especially for such chronic conditions as diabetes where so you've been a lot of physical problems in the year that are being taken care of along with mental health so how we how we think of it you talked a little bit about stigma in the in your in in the beginning we think that many people are still uncomfortable sadly going through a door that says mental health that's a top but if you're going to see your primary care doctor and there happen to be mental health services right inside there with with the medical services that's much more comfortable for many people who are resistant for one reason or another  for to expand medical services at community health centers and they did that purposefully because they were expanding access to insurance that insurance isn't enough by itself it's necessary but insufficient you also have to be able to find people to take care of you so as we we were able to get funding to expand our building and when we had the opportunity to build space the way we wanted to build it we built it so that all of the primary care teams you know the physicians the pediatricians had mental health had offices in their area where mental health providers could practice with them they share office space so they talk to one another and you know if you go to most doctors and you have a need for mental health services  you at the lynch munity health center the physician will say just a moment i'm going to bring somebody in to introduce to you and he or she will bring in a mental health provider into the room introduce the patient to them and suggest that maybe they'd like to have a brief conversation and so when they actually want to come back for a lengthy or conversation they already know who they're going to see they know them and  more comfortable and that's true and you know that's like a whole new way of doing things it is and it's but it's you know it's interesting because i hear our physicians say they can't imagine doing medical care without behavioral health right there conditions and mental health conditions you certainly want there to be some coordination absolutely whole some of the some of the mental health medications are very strong and so if you mix them with  you know something for kidneys or something like that you have to know if they'll agree well in addition to that a lot of the mental health or the psychiatric medications  contribute to you know they contribute to overweight and they contribute to diabetic conditions and so there's a bit of it's not it's a bit of a challenge for the providers to think together about how to make sure that they're maximizing the benefit both from the mental health perspective and from the medical perspective it's not really great if we cure mental health symptoms you are that mental health and medical services are organized in the united states usually a lot of physician groups tonight and you think of the you know and i do know that for fact  we have also a mental health area that was more of a traditional mental health center as part of the health center and we've now added medical services there and so in addition we've started to train some of our patients to become mental health counselors and to serve as volunteers with some of the patients and to so it's kind of like you know i think it's like different jobs throughout the organization who may have a history of mental health issues that are you know have been treated and so forth so you don't go into their background and say ok you have a mental illness you cannot job and they will hire them and and just like people with a disability you know people employers hate to say this but they do get a tax rate up to hire a disabled person and that's not saying that they go after that but that's something that is an incentive for a lot of these major companies to hire them organization so tax incentive isn't right what drives us what drives us is that there are people who have talent and if they may have a history of mental health issues if they can do the job where interested and hire good people don't realize that there are some mentally ill people who are doctors lawyers i wouldn't say indian chiefs but  go on to whatever it is that they're able to do and it gives them a paycheck and they feel kind of grateful that they're contributing and you know the that's the good part about it is so long as they can contribute to society they feel good and and you're doing that you helping them do that so i i take it we're more our focus though is more on helping people for cover cover you know and to get to a place where they actually could be could be working and where health center after all so right so our job is to see if we can get people healthy right people and there's but it's a low income community and so it's hard for the private practices to to sort of make a go of  it and so you see in cities around the commonwealth that are low income communities that community health centers sort of fill the gap although and it's it's interesting because more and more health centers are starting to look at how do i integrate behavioral health into what we're doing you know we are stock in trade has always been asthma and diabetes and hypertension and immunizations for kids and that's what kind of community health centers have been all about for years and more and more my colleagues are recognizing that mental health and addictions are really part of what we're seeing whether we knowledge it or not a lot of it yeah even if we even if there are community health centers that don't say they're doing mental health or addictions they've got patients with those well those issues  right and i also saw that you treat a moat forty percent children yes yes that's a lot of kids so one of the things that we do that's also a little bit unique is that we provide a lot of service in the in public schools so in in three high school in the three high schools and two of the three middle schools we have comprehensive primary care and mental health right there a nurse practitioner who can and can diagnose and treat and also mental health providers who are working with a lot of the kids in many of the elementary schools we now have behavioral health providers not so much medical because most of what is needed is mental health care there are a lot of kids with and and unfortunately kids who are struggling because of parents problems with mental health addictions or abuse so so  a lot of the children that we're seeing are are in the schools and i think we're doing some pretty good preventive work i think that's wonderful thank you i really do i'm always wanted to get into the schools and talk to the kids the middle schools the high school not so sure about you know grades one through four but they need a little bit of background are opportunities to make sure that kids can function in school and you know if you think about when you're talking about jobs and and all of that if we see that there are children that are beginning to struggle and rather than see them fall behind in school it we can treat it's going on or are support them it makes a huge difference in terms of really if you think about the statistics that i've seen about the relationship between the number of years in school and family income it  correlates almost exactly so if if a child drops out of school their income is going to be much less than somebody who has high school or somebody who has a college and  success in school is really very correlated to overall health which is also correlated to go all right success in schools so how do you do you individual as each child is if someone that is able to see that this child is falling behind and then someone is there to help them to pick them up to support them because my child will in high school and there was no support absolutely none and the doctors said keep her in school because it was the end of the twelfth grade caper in school and you know to see what happened will things there have been great and there was no support at all so i see something very different really pretty spectacular so the teachers know that they have support and can if the child is seems to be having some difficulty in school usually they'll start with guidance but if it seems like there's something going on that's for a mental health issue they'll refer them to the therapist who is at the school that full time who is our staff right and who will do an evaluation and then work with the school around what's the right the right approach sometimes it's their p and then that becomes confidential and just like being referred to of mental health counselor  therapist as an adult it's the same thing that our staff will involve the parents if as appropriate children need their parents involved in mental health care sometimes it doesn't mental health it just made me that that school will be able to handle it and sometimes will advise if if if that seems appropriate but we're in thirteen schools now in libya which is pretty amazing if you think about it that is pretty she was very able to manipulate it's called borderline personality disorder and i remember one time the school called me and they teacher she was coughing up blood so therefore she was able to come home and therefore she never left she never went back to school so if that happened at one of the high school where we are at and what we have first of all there's a school nurse working side by side with our nurse practitioner and our mental health folks and the student would have been brought in on to see the school nurse who would have pulled over the nurse practitioner who would because she never went back to school because the nurse practitioners in our school based health centers are all really you know that we used to look at this and say the diagnoses you know there would be upper respiratory infections they would be reproductive health kinds of kinds of things there would be asthma and then there would be depression anxiety i mean you know all of the and she's doing fine now but those days were bad you know when you have a daughter who's very sick like my daughter with schizophrenia and then you have another one who feels she needs attention so she's doing other things that she shouldn't do and then you have a husband who also has borderline and the house was pretty dysfunctional let me tell you things straightened out  so borderline is a pretty bad disease and but you can outgrow it as i've heard and luckily my daughter did so as as far as what we were talking about in primary care there are many primary care physicians that haven't a clue as to mental illness and you know what do we do with this patient next week you have a piece of paper and send them out and  from down the street from all that community health center and they got they're very interested in you know manufacturers are pay attention to sort of how things work so we've had them come in and tell us you know how to how to fix the way we are we work you know to be more efficient and and more responsive in some ways to patients shouldn't have to wait as long as sometimes they do and that sort of thing sometimes they just can't help that you know well so well we can do better and so gene done some work with us they actually measured what happened when if we refer if we used what we call a warm handoff as a way of referring  medical patients for mental health services right there in the team they measured that that that the likelihood of them following through and we actually tracked this was significantly higher than something you wanted to say to people if you want to give them your email if you want to give me a blog if you want to give them anything so i think for us it's really important that people get their medical care and their mental health care together so i'm not promoting us has a place to get mental health care unless people in the audience also want to get their primary care at the health center because it's a coordinated it's a coordinated effort but i would say that where our whole work our idea is to try to get rid of the stigma of getting treated for mental health issues of one kind or another and so the one thing i would say to everyone is if you have people in your family that have mental health issues talk about it the way pat does because there are very few people that i know and my wife who do not have somebody in their family who is struggling and the more we talk about it the less stigma there will be and the more likelihood that people will get care that they need one for families have somebody and you know you need to talk about it and i thank you for talking about it and i wish every single health care center what was like you know honestly a great so thanks for being on my show i appreciate it i love you  again soon and we'll talk about mental illness thank you for listening