Navigating Psychosis & Behavioral Health Systems: Against All Odds: Dr. Gary Tsai (ep. 52)

As a psychiatrist and system administrator who grew up with a mother with schizophrenia, Dr. Gary Tsai offers an insider’s perspective on the process of seeking care for serious mental illnesses, informed by both firsthand personal and expert professional experiences.

Dr. Tsai is also an award-winning documentary filmmaker and author, physician who is board certified in psychiatry and addiction medicine, and the director of the largest substance use system in the nation.

We’ll talk about his story, his documentary called Voices, and the tips in his his new book titled Against All Odds, including:

• How to approach impacted loved ones and resistance
• Understanding behavioral health systems, policies, programs, laws, practitioners, and payers
• Identifying a good clinician or care team
• Being an effective advocate
• … And much more.

Against All Odds offers tools and strategies to navigate the recovery journey and will reshape your understanding of serious mental illness and behavioral health systems!

LINKS:

http://voicesdocumentary.com/film/

www.AgainstAllOddsToday.com

Mindy and her book: https://mindygreiling.com/

Randye and her book: https://benbehindhisvoices.com/

Miriam and her book: https://www.miriam-feldman.com/

Hosts:

Who:

Randye Kaye - was a morning Radio Personality bringing humor to CT families when her own son was diagnosed with schizophrenia. Now she is still a Broadcaster, Actress, Voice Talent, Speaker, and Author (“Ben Behind his Voices”)

Miriam Feldman -  is an artist, writer, and the mother of an adult son with schizophrenia. Her book, "He Came in With It" chronicles her family's story and was released to rave reviews on July 21st, 2020.

Mindy Greiling - Mindy Greiling was a member of the Minnesota House of Representatives for twenty years. She helped found the nation's first state mental health caucus, which successfully lobbied for a significant increase in Minnesota's mental health funding Her acclaimed memoir is “Fix What You Can.” 

Transcript

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SPEAKER_01 0:01

Welcome to our podcast, Schizophrenia. Three moms in the trenches. From the place where schizophrenia and real life collide. East Coast, West Coast, Middle America. With Miriam Feldman, Mindy Gryling, and Randy Kay. Welcome to episode 52. We're going to get right down to it. Often we start our podcast with a little mom chat, but we just did an entire episode 51 about that. So unless uh Mindy or Mimi, you have anything vital to share since last week, I would like to get right to our guest. I am so excited to have Dr. Gary Sai on the show. Dr. Sai and I met 10 years ago, is it, Dr. Sai? I think at the American Psychiatric Association. Remember having quite a chat. And at the time, your documentary, the Voices documentary, was just about to come out, I think. And we'll talk about that in a second. Very, very powerful. But the first thing I want to talk about tonight is your work, which in 2022 has resulted in a book that I think all of our listeners will really, really want to read. Dr. Sai, you're an award-winning author, filmmaker, and physician. And as we'll hear in the second, the son of somebody with schizophrenia. You get really giving an insider's perspective. And let's start with the book. Now, the foreword and a review by Patrick Kennedy, former U.S. representative and founder of the Kennedy Forum. His opinion of your book, which by the way is called Against All Odds and Insider. Well, let me just pop this up. You can tell me the subtitle, An Insider's Roadmap to Serious Mental Illness and Behavioral Health Systems.

SPEAKER_00 1:56

Is that Yeah, the title is Against All Odds, a practical guide to successfully navigate psychosis and behavioral health systems.

SPEAKER_01 2:04

Okay, awesome. So I'm reading from the back cover, which is what I have in front of me right now. Um, Senator uh Representative Kennedy says through Dr. Sai's unique perspective as an expert and as someone who has walked this journey personally, Dr. Sai illustrates important considerations for all caregivers with grace and compassion, an invaluable tool for lay people and experienced clinicians alike. And the other thing that struck me first was your dedication. Do you mind if I read it out loud? To my mom for teaching me about unconditional love, my dad for showing me how to good be a good father, my brother for being there for me during our journey, an unimaginably supportive wife, and all those touched by psychosis and other serious behavioral health conditions. That's a that's so beautiful. And you are now talking to three of those people. We each have sons with schizophrenia. They are all thankfully still alive and in various chapters of their recovery process. We know we're very lucky about that. We are fierce moms and advocates and all authors of books telling our journey. And I know you've read mine. Mimi's is um he came in with it, and Mindy's is fix what you can through her story and her view as a state legislator. So welcome. So tell us, tell us about you, tell us about your story about your mom and what brought you to write this book.

SPEAKER_00 3:44

Yeah, so I mean, first off, I want to thank you for having me here. Uh, numerous people have come up to me about your podcast, and I I love uh the work that you do and I love the the stories that you tell through your perspectives. I think that's really important. Um you know, I um, as you mentioned, I'm physician board certified in addiction psych and uh addiction medicine and psychiatry. Um I did grow up with a mom with schizophrenia. Um we had a lot of challenges getting her care. My parents immigrated here from Taiwan um uh decades ago. Um and um, you know, she never had insight into her condition. And so treatment, um, as many of us know for individuals with psychosis and other serious mental uh illnesses can be extraordinarily challenging for individuals who don't have insight because it's it's hard to agree to treatment for a condition you don't believe you have, particularly if there's medications that you know may have undesirable side effects. And so um that really um frankly made me quite frustrated. Um and um while I was planning on going into medicine, I was really turned off by psychiatry as a whole because I felt like if psychiatry couldn't help my family, I felt like my family really needed help, um then what was the point? Um and that that perspective changed um when I went through my psychiatry rotation a third year of medical school. And I saw people get better. And I realized that our challenges weren't clinical challenges. It wasn't that there weren't good medications or good social workers. Uh, they were systems-level issues and policies that essentially blocked our family from uh the services that we needed. Um, and that really got me interested in uh systems level uh leadership and design. Um and so today I'm the director of substance use for Los Angeles County. Um uh and um, you know, work still do a lot of work related to uh serious mental illness, just because it's it's kind of where I came from. Um the reason why I wrote the book was because you know I lost my mom a couple years ago. Um uh to breast.

SPEAKER_01 5:57

Did she ever oh to breast? Did she ever uh get to a place of partial recovery or recovery with her schizophrenia?

SPEAKER_00 6:05

Yeah, you know, she actually went through uh insisted outpatient treatment program in another state. I'm based in California right now. Um, and um that worked in terms of her taking medications on a regular basis. Um, I wouldn't say that she ever regained full insight, um, but um That's dreamland.

SPEAKER_01 6:28

That's dreamland, I think. But anyway.

SPEAKER_00 6:31

You know, I think our our family was able to demonstrate that we were going to be there for her no matter what. Um, you know, because there were, you know, criminalization, other things happened where we were able to demonstrate that. And I think that process, which took multiple decades, um, I think earned a certain amount of trust where um, and also I think our condition kind of evolved as she got older, where you know, she would at least take her medications. She acknowledged it did help with sleep, and that was enough to just kind of you know have things be relatively stable, um, which you know, we were really blessed to be able to experience uh my mom uh in a in a non-psychotic state. Um and uh and when we lost her a couple of years ago, um similar, I think, probably to you, um, you know, I really felt like uh I had the perspective that I wanted to share, particularly in the hopes that it might help other families. Uh, and in this case, you know, my perspective is um certainly as a family member, um, but also as you know, a clinician, um, and also as a systems administrator. And that's really what the book focuses on, is kind of better understanding uh the behavioral health system as a whole, because I find that um one of the key barriers that many people and families experience is just trying to navigate the extraordinary complexity of behavioral health systems. And when you first start out, when your loved ones first begin exhibiting symptoms and you don't know what's going on, it's very difficult to learn all of that. I think I've come across many families who have learned that over the course of decades, um, which is fine, but the book aims to fast track that learning process so that people don't have to necessarily kind of make two mistakes in order to learn uh, you know, one or two points.

SPEAKER_02 8:26

I would like to um zero in on some of those system barriers that you're talking about. And by the way, I am really impressed. Randy read the testimonial on the back of your book from Patrick Kennedy, but the one from Dr. E. Fuller Torre is equally laudatory, and he's one of my heroes. Um, I've read two or three versions of surviving schizophrenia. And so to get such a rave review from him, I think will make a lot of people familiar with him, which is a lot of people dashed to read your book. I know I'm on that list. I haven't had a chance to read it yet. Um, and then Lisa Daly from the Treatment Advocacy Center, in addition to Randy knowing you, she highlighted your book and you as a guest for this program. And I know your book is on the summer reading list for the Treatment Advocacy Center. So that's um another feather in your cap. Uh, but the systems that, you know, I was interested to hear when you said it's not the professionals, it's not the medicine. I'm a some of us, uh Mimi and I are, and Randy too, are big uh fans of clozepine for the two of our three sons who are taking it. So we see meds as really important. But what are the barriers that could you give us two or three that really stick out in your mind that keep people from accessing the mental health system?

SPEAKER_00 9:57

Yeah, uh that's a great question. You know, I I think that um it's very reasonable and we should have mental health systems that um are primarily focused on voluntary care, just because um there are clearly a lot of people that need mental health services, and um, most of them would benefit from voluntary care. They don't need to be compelled into treatment. Um, however, um our systems are not uh, I would say adequately designed for the full spectrum of individuals with psychiatric conditions. And I'm particularly focused on individuals on the more serious end of the spectrum, which is about 5.6% or so of the um uh population.

SPEAKER_02 10:43

Um are we.

SPEAKER_00 10:46

Yeah. And then the and then there's particularly the portion, the 40 or 50 percent of that population that have uh the condition known as inosignosia, uh, where you know their uh there's damage to the area of their brain responsible for self-awareness and self-reflection. And so their ability to realize that they actually need help for a condition is damaged, right? And um, I think that that's an area of our system that we can and need to be doing better in. Because when you think about medical systems, when you think about conditions like dementia, um, when those situations happen where someone with diagnosed dementia is not making reasonable medical decisions, our medical systems do not allow them to continue making that decision. They they reason that they lack that decision-making capacity, and because of that, we are going to help make the best decision for you in this instance. And I think that um, you know, brain conditions are brain conditions, whether it's dementia or whether it's schizophrenia, and that there's an opportunity for us to better address that, to better meet the needs of individuals in that particular situation. And the reason why I'm being so nuanced is because this is a nuanced issue, and I think it's important. I think oftentimes people kind of um what when you take a black or white approach to this and and kind of apply these words to say, you know, uh that we need to be providing involuntary care to everyone, that is certainly not what I'm saying. Um, but I'm saying that uh just like with other conditions, um, there are more serious conditions that require tailored interventions. And I think that those tailored interventions apply to individuals in those circumstances on the more serious end of the spectrum who um lack decision-making capacity and significantly contribute to the high need populations or high utilizer populations that many systems try to problem solve around. Um, I think that that's one key barrier. Um, I also think that applying system design principles to how we construct our systems is really important. And what I mean by that is how can we um simplify the complexity of our behavioral health systems to the end user externally, even though we know when you look under the hood, there are multiple balls of yarn that we're trying to kind of piece together, right? The outside world doesn't need to know that uh because um just like Apple, right? Uh, who who designed, I mean, they're known for designing very usable functional products, right? Um, I would, I think there's opportunities for behavioral health systems to take some of those principles to make sure that our front door is as clean as possible, as simple as possible, uh, in the interest of helping people navigate that complexity. And that was really also rationale for the book in terms of trying to kind of untangle that ball of yarn that are behavioral health systems, um, in a way that's hopefully understandable, particularly for people who are just beginning this journey. Because I, you know, I was getting connected to a lot of families with loved ones, maybe first, you know, early onset psychosis, um, where I was kind of explaining the same thing multiple times, which was fine because I'm passionate about that work. But I thought that, you know, the book could perhaps help uh convey some of that.

SPEAKER_01 14:11

I I love that. And um Mimi has a question in a second, but along the lines of what you're saying, so it's like putting in what we wouldn't give for a nice user interface on the mental health system so that we can use it really well. I often say when I speak to, and I believe when we met at the APA, I was speaking to psychiatrists about the family role and and how we can help. And um I often suggest that I know when I gave birth to my children, there was a childbirth educator at the OBGYN. So the doctor didn't have to explain many things over and over again. They could send me to the educator. How lovely would it be? You know, and we're not going to fix the system in this podcast, but I know looking at your table of contents that you're talking about the system and teaching about the system and then getting to tips, which will be the last question we'll ask you about what caregivers can do. But how lovely would it be if there was a serious mental illness educator to help to help families through that? Mimi, what is your question?

SPEAKER_03 15:12

I have a question for you, Dr. Sai. Um, you mentioned this issue about people with dementia or or Alzheimer's, and it's something that I talk about a lot when I am giving talks about that differentiation, where somehow it's completely acceptable and understood that those people cannot make decisions for themselves, and the system has something built into it to help facilitate them getting the proper care. Do you think that the reason that doesn't exist with serious mental illness is a lack of an understanding of anosymagnosia? Because that's what I run into a lot is that the providers who should know this better than anybody kind of act like, well, you know, it's up to him, whatever he wants, and they don't quite seem to understand.

SPEAKER_00 16:04

Um, I would agree that there is um a general lack of understanding, and I think sometimes almost a philosophical disbelief of the existence of a nosy gnosia for psychiatric conditions. Um, I mean, it's well documented in neurology, um, which is the specialty that typically treats individuals with dementia. Um, but when it's been applied to psychiatry, I I have had instances where I actually psychiatrists have questioned um me when I've talked about a no signotia. So I do think there's an element of that. Um, I also think that with behavioral health conditions where the manifestation of the condition is in one's behaviors, right? Um, there's a natural judgment there because we all kind of understand the world by what we see, and oftentimes that's behaviors. And that there's a certain connotation there that this individual's choosing um these behaviors and making these decisions, and you know, perhaps we just need to let them make these decisions. And I think that something that um caregivers um understand in interacting with their loved ones with psychosis for many, many years and interacting with them in different ways is you really get to understand all of the little nooks and crannies and nuances of the condition. And you get a sense that it's not about I'm not explaining the reason why you need help clearly, right? This is about you fundamentally um do not uh believe that you have a condition that's very evident to everyone that's interacting with you. Um and um for me, and why I feel so passionate about this is it becomes an equity um and a rights issue for me, right? Where um, you know, if if we have systems that block these individuals from services, um, that's not fair for them, right? And and we can't say that we're thinking in their best interests if they lack that decision-making capacity. And again, most people with psychiatric conditions do have decision-making capacity, so they should be allowed to make the decisions, but there is a portion that do not.

SPEAKER_03 18:18

Well, and that's why I, among a lot of other people, have a strong feeling that there should be a delineation between serious mental illnesses and all the rest. And I think that there is a there is a push, and I support it to re-categorize them as neurological diseases. I mean, anybody who's dealt with somebody in severe psychosis and schizophrenia understands that this is not a behavioral issue, but it seems to be hard to get that through to providers.

SPEAKER_01 18:45

Right. And and um I think we're gonna table that for another episode at another time because that's a very, very deep issue, but a a very important point as well. I want to just read the chapter headings of what's in this book, and then I want to talk about your documentary. Mimi has just seen it, so I'm gonna let her take the take the ball on this. But just so if you're thinking of buying Dr. Sai's book, uh, chapter one is an introduction, you'll hear his story. Chapter two, it's what we've been waiting for. It's called a practical guide, right? So the basics. And it's like a couple of pages on each thing. What is schizophrenia, what's schizoaffective disorder, bipolar, what's anastignosia, some theories. And then you get to chapter three. And I love this title, Dr. Psy, how to approach a loved one with serious mental illness while taking care of yourself. And then chapter four has an overview of these systems and laws and insurance types that we're talking about. Chapter five is getting help and treatment options. That's I'm going to ask you to focus on in a couple of questions away, effective advocacy as a caregiver, and then planning ahead and your conclusion. So this is um, this is not an encyclopedic book. It's 125 pages, a practical guide, because relatives of people with serious mental illness often don't have time to read a 400-page book. So I appreciate that. Um, so we'll go back to your book and maybe grab some of the most important tips from you in a second. But I also told Mimi and Mindy about your wonderful documentary, which I watched 10 years ago, but Mimi just watched it. And so um, it's called Is it Voices Documentary? What's the website?

SPEAKER_00 20:25

It's just called Voices. Uh, the website is uh www voicesdocumentary.com.

SPEAKER_01 20:31

That's where I got it from. Okay. So, Mimi, what did you think of it?

SPEAKER_03 20:34

Well, I was very moved by it. And you know, I have to admit at this point a lot of times it's I can't even watch another documentary about mental illness. Um, it just gets to be too much. But um I was very moved by this. Um and I think the three different stories were so diametrically in other in other directions, each one, that it really encompassed a lot. Um, I'm wondering, because it was done around 10 years ago, back then there weren't as many documentaries as there are now, how the response was to that back then and how things may have changed between now and then. And I also would be curious to know how you chose those three particular subjects.

SPEAKER_00 21:20

Yeah, great questions. Um, you know, the the response back then, I would say, was overall uh positive. Um you know, I I think the you're right, there have been more kind of mental health documentaries since that time. Uh the goal with the documentary was uh really um founded on the idea that if decision makers, including lawmakers, and I know that we have one participating today, um uh uh could feel what families feel and understand that you know this is not one condition, right? Serious mental illness, schizophrenia, it's not one condition. Um it can manifest. And present a lot of different issues that need to be understood compassionately differently. And so that was really the reason why we had the three different members that we highlighted in the film. I have to also, though, say that part of that was luck, right? Because the work of identifying subjects for the film was largely interviewing people on the street, because originally it was focused on just homeless individuals. And I interviewed dozens, maybe hundreds of individuals. And, you know, you do learn that the percentage of people who are homeless on the street at the this was in San Francisco at the time, is actually quite a bit higher than who have uh mental illnesses than what the textbooks tell us, right? And I think one of the reasons why is because if you do a survey or if you have someone go out on the street and interview people, if and they don't have insight, you know, they're not going to acknowledge that they have a condition. Um and so you can imagine why the data might be different. Um, but I found it uh number one, I learned a lot in that process um in terms of people's stories and some of the issues and ways in which we could design our system better. I also learned that it was very difficult to find someone who was psychotic and also able to engage enough in the you know short clips that you oftentimes need for uh film, right? Um and so part of that kind of resulted in us broadening the focus and including other stories, which is how we um focused on the Vietnamese family whose uh mom immigrated to the US and experienced psychosis, and also the the family up near Fort Bragg uh in Montecito County where um Mendocino County, where um you know their son was in the was involved in an unfortunate incident um with untreated uh schizophrenia.

SPEAKER_02 24:03

Well, stories I can say as a as a former legislator are what move elected officials. You know, we get so many facts and figures and things to read. And just like uh Randy said, families in distress can't read 400 page books and and elected officials can't read 20-page memos. But if you hear a good story uh in a hearing, everything stops and the whole room starts to listen. So that you're just very uh brilliant to do that story. I would like to go back to your book if that's all right. And um we just had a mother who contacted us. We have a Randy has set up a chat where people can contact the podcast and then one or all three of us answered.

SPEAKER_01 24:46

And that's on our that's on our Facebook page. Just go on there and search for three mom schizophrenia, you'll find us. We've got about 1,200 people in the in the on that page without advertising it. So yeah, you can chat with us on there. Yeah, go ahead.

SPEAKER_02 24:59

And thanks to Brandy for doing all the technology for us for that as well. Umy and I. If I say young yeah, we would be hoped at that. But anyway, the last mom or one that recently contacted us, I see as one of the topics in your book, and that is resistance for um a loved one that's resistance. We have had Dr. Amador on here, so we've discussed the leap method, but I would be interested because she has a daughter who's living with her, is refusing everything, and is becoming obnoxious, and they can't the system can't find housing for her, so she doesn't want to put her daughter out. And so many families that you know are in that situation. So beyond the leap method, uh, what could you what do you have in your book, or what could you tell families like her and like all of us have been at various times of how to access the system when we have this person-centered care, and they say there's nothing we can do if your family member isn't voluntary. Meanwhile, we know something is going to happen, and for all of us it has when we don't get any help.

SPEAKER_00 26:06

Yeah, I mean, it's a really difficult situation. And I know that there are a lot of families in that situation. I first off, I would say um uh I know it's not easy, right? So there's no single uh way to address resistance effectively. Um, but for me, it's about identifying every little thing that can give you that can increase the likelihood that your words are making an impact, right? And so it's kind of like that rock climber where you don't need a giant ledge in order to put your fingers on. You just need a little bit uh in order to kind of get to the next little crack in the rock, right? And so um there are a lot of ways to get there, right? Um, some ways are to identify um what your loved one uh cares most about, right? Um and sometimes it's things there, it's activities that they're no longer engaging in. Um sometimes it's activities that have been impacted as a result of um what they're doing or what they're not doing. Um or or you know, maybe someone really enjoys their naps and sleep, right? And their sleep's being disrupted, right? Is there a way uh that we can find uh some help to improve your sleep? Um so finding something that people care about, um uh expressing concern, right? Um, a more long-term way uh that I've found is helpful is kind of um it sounds cliche, but you know, I would describe it as kind of the power of unconditional love, right? Um that's part of the reason why I kind of mentioned it in my in my book. Um, I do believe that um if, and I also think that this is why there's some data that in developing countries that are more kind of collectivistic in terms of how they approach um you know psychiatric conditions, why there are some good outcomes there, right? But the more that we can demonstrate, you know, um, even if you're not doing exactly what you know we would prefer you uh would you do, um, we will be there for you. Um if if you're picked up by the police, we will be there for you, right? If you end up in the hospital, we will be there to pick you up if you need something, you know. Um, and it's not about, I'm not saying that you shouldn't have any boundaries, right? Um, but it's about just being consistent in terms of that support. Um uh I think that that that can be a way to slowly kind of uh break down and uh break down resistance. Um there are also motivational interviewing principles that can be employed, I think, for anything, including if your kid's not doing their homework.

SPEAKER_01 28:41

Um so can you can you elaborate on those just um a little bit?

SPEAKER_00 28:45

Yeah. So there are certain um aspects of you know, uh rolling uh with resistance, for example, right? Not directly confronting, but kind of um trying to identify where the resistance is and then kind of uh leaning into it and rolling with it instead of direct confrontation. Um there's also kind of soliciting uh more information um from the individual so that you can again again kind of identify the little ledge that you can kind of make a little bit of progress in. Um uh and then also just really reflective listening, um, just to demonstrate that you know you are hearing what they're saying. Um because I think sometimes, um oftentimes when it's resistance, it's because people feel like they're not being heard, right? So you can at least demonstrate that you are hearing them and then kind of explain um why you you may think that there's also another path forward. Um so those are some strategies. I know that it's a little bit general.

SPEAKER_01 29:47

Um yeah, it's a it's a great place to begin. Um, you know, and and we've been, if if you're new to the podcast, you know, we three moms have been at it a while. Our our kids are in their 30s and 40s. And so uh we do hear a lot from people just at the crisis beginning of the journey. Oh my god, what is happening? Can I fix it? How can I fix it? So we get that we've been there. If you want to hear the beginnings of our stories, it's in all our books, and we talk about it on the podcast. Um but I love that you've written a practical guide and you've given some general things about approaching a loved one and uh how to deal with resistance. Can I take another topic with just and we maybe get one or two tips? And of course, we're going to hope people will then go to your book for more concrete things. But what about um identifying a good clinician or care team? I know you have information on that in your book. Would could you give a couple of tips about that?

SPEAKER_00 30:51

Yeah, um, I mean, I think that's a really important aspect of just making sure that you connect with a practitioner that meets, I would say, both uh the individual with the conditions needs, but also the the caregivers' needs. Um and so uh what I would say wow, we'd say that again.

SPEAKER_02 31:10

That's really that pre-time. Say that again.

SPEAKER_01 31:15

So someone that's gonna meet the caregivers' needs as well as okay, that's thank you.

SPEAKER_00 31:21

Milo, I mean that would be actually for for particularly complex psychiatric conditions. Um, the extent to which they're willing to engage and listen to caregivers, I think is really important. Now, you know, I'm biased too, because I'm a family member as well. But um the reason why I think it's important is because um caregivers are generally there um with the client much more than any practitioner ever will be. Um, and they generally know the the individual better than anyone. And so um when you have uh uh a practice where you rely on good information or make good informed clinical decisions, that's really important. And so I think you know, engaging a care uh a practitioner who um seems to be willing to actually spend time um engaging and getting information from caregivers, I think is important. Communication skills, um, you know, including kind of timeliness of communication back, uh, but also their ability to explain what's going on. I think that's um really important. I pay less attention to things like where people graduated from, um, kind of what degrees, how many degrees they have, you know, I because I've met a lot of people from um, you know, maybe not Ivy League schools who are really, really, really strong impressive clinicians. And I've also met kind of vice versa, right? Um, and it's not to say that if you graduate from an Ivy League school, then you can't be a good practitioner, but it's just that that's I don't for me, that's not a top criteria. Um, and then in terms of um kind of practice style and perspective, um, you know, I don't shy away from uh individuals who are earlier in their career, right? Um, and the reason why is because I think sometimes individuals early in their career, there are a couple benefits, right? Even though they have less experience, um, they're tend to be up to date in terms of the most modern thinking around prescribing. Um, and also they tend to be more open to kind of integrated care thinking, um, inclusive of including caregivers, but also inclusive of, you know, well, let's pay also pay attention to your physical health needs uh and and other needs, right? Um and I think that that's really important.

SPEAKER_01 33:37

So we have about five minutes left, and I want to make sure you have an opportunity to say anything we haven't asked you yet, but I have a question for you as a practicing psychiatrist. Do you personally ever find it frustrating that you uh can't spend as much time with your patients as you would like to? Because uh a lot of uh families we know are obviously very frustrated because there's a three-month waiting list to find a psychiatrist. And then when they do, they only they spend 10 minutes, you know. So your uh uh your list of ideal qualities is like uh, you know, my my dream psychiatrist. But um what's it like from your end when you meet, and I know you're running a substance abuse center and you're maybe a little more uh high up in the administrative, but in your experience, did you or have you ever gotten frustrated with the lack of uh support from the system for spending enough time with your patients?

SPEAKER_00 34:36

So um right now uh I do do more administrative work and so I don't see a whole lot of patients. But when I did see um clients, yeah, you know, there would be times where I wanted to spend more time with individuals. I would say oftentimes I would um, you know, because oftentimes for our meeting, for example, you would schedule 50 minutes so that you have 10 minutes for documentation, right? I'm I'm the type of practitioner. Well, if I need that 10 minutes, I'll meet with that person for the full 60 minutes and then I'll just stay late in order to do documentation, right? Now that can contribute to the burnout. So I'm not necessarily advocating for that. That's just kind of my approach and style. Um, and so to your question, I would say, yeah, I I do get uh I would get frustrated at times. And I think that there are different ways to address the need for uh a practitioner's own sense of satisfaction and fulfillment in their work. Some of it's what I described in terms of you know stretching things a little bit. Uh, some of it may also be doing things a bit outside of um just the direct clinical practice, right? Like writing a book or you know, working on other projects that contribute to this broader mission of why you wanted to do the work that you're doing to begin with, even though it may not be kind of the direct client interaction. Um, and then also just the fact that, you know, oftentimes care is about longitudinal relationships, about building relationships over time. And so it doesn't have to be that, you know, in one instance you need to cover everything in order to feel like you know you've done your best. There's an opportunity to meet with someone later, too, right? Um, but I can say, you know, the reason why I have so many white hairs, I have a lot of frustrations, even kind of outside of the not having enough time with clients, right, at a systems level. Um, you know, I think I tend to be a little bit impatient in a way where I hope that translates over to uh actual change in terms of what we need with the system.

SPEAKER_02 36:33

Related to that, and I love it that you're uh a son, a family member too. So you see it from both sides, but related to Randy's question about what about from your end? Um, you talk about being in your book about being an effective advocate. And we as mothers know that if we come on too strong, we're emotional, we're tiger moms, we're obnoxious, we're angry moms or something, uh, versus being an effective advocate. Where is the line, or how can you help us know where the line is?

SPEAKER_00 37:04

Yeah, you know, that's a really good point. And I've I oftentimes struggled with that as well when I was advocating for my mom. You know, one of the things that I uh highly suggest, um, and this may feel a bit like a school exercise, but I think it's important is documenting uh the clinical history of your uh loved one or of the individual who's impacted, um, almost akin to the way that a behavioral health practitioner would document. And I actually recommend a specific format in the book to follow. Um, and the reason why I think that's important is because it gives behavioral health practitioners who may be meeting your loved one for the first time a perspective that's very similar to what they would how they would approach a case. And there may be instances where they can easily take that information and translate it into their note, right? And then you've effectively incorporated your input into their clinical reasoning and decision making. And so I think that that's that's uh one kind of tip. The other thing I would just say, and I emphasize this as well, is um we we know as caregivers, uh, it's a marathon, right? And I know that every ED visit, every hospitalization feels like that's it. We gotta, you know, this is the time. But I think we also have to pace ourselves and realize that there's only so much that we can do. Um, we do need to collectively influence and change the system, um, and individuals can, but it also oftentimes takes time, right? And I think having that amount of kind of compassion for the caregiver, uh, ourselves oftentimes is really, really important because um I just know how much of a struggle it is for for many. And um, yeah, I think it's an important perspective.

SPEAKER_01 38:50

Thank you. Oh, I was I was muted because I was typing something to Mimi. Did you want did you want to ask the final question there?

SPEAKER_02 39:04

Or and you're muted too, Mimi.

SPEAKER_03 39:08

I'm so professional here. My question is, is there anything that you want to add in terms of like the the hot tip or the secret passwords that's gonna help us in how we deal with these things?

SPEAKER_00 39:25

I think we covered a lot of ground, a lot of the ground that I was wanting to cover in this uh uh interview. Um, you know, I do hope that the the book uh and perhaps voices, the documentary uh can be helpful for folks. I also know that there's a lot of people with their own um perspectives. Um uh you know, I think one thing that I've really appreciated is uh around advocacy, um, the advocacy community is that is the power of story, right? And um there are a lot of stories being told now. Um and I think uh continuing to think about how we how we can tell stories in a compelling way. Animation, for example, I I've I've and I found animation to be particularly compelling because it forces you to have kind of simple imagery that's easy to understand. Um, I think that that's important. So um no, you know, I really appreciate the forum uh and the opportunity to talk about against all odds, um uh to hopefully help families and individual individuals with serious mental illness navigate behavioral health systems. Um and I appreciate the conversation with you three moms. Um, thank you.

SPEAKER_01 40:31

You know, every everyone loves loves moms and um I I love the except our sons sometimes, but you know, we're doing all right. The book is Against All Odds, a practical guide to navigating psychosis and behavioral health systems, available on Amazon and also in bookstores, or you can find it, Dr. Gary Sai, it's spelled T-S-A-I, I'm sure you can find it on Amazon. And there's also a website, against allodstoday.com, and the website for your documentary is voicesdocumentary.com, and I believe they can watch the film on that website.

SPEAKER_00 41:07

You can stream it on Amazon.

SPEAKER_01 41:08

Um stream it on Amazon even better. So any uh any other uh contact information you would like our listeners to have, or will that pretty much you covered all the main uh websites.

SPEAKER_00 41:22

Thank you.

SPEAKER_01 41:23

Well, thank you so much, and thank you. You know, it just was such a delight to meet you a decade ago and a delight to see you again. Um, award-winning author, filmmaker, and physician, and very, very strong advocate. Dr. Ste, thank you so much for joining us today. Hey, thanks for joining us for this episode of Schizophrenia Three Moms in the Trenches. With Randy Kay, Mindy Gryling, and Miriam Feldman. To get in touch with us or to learn more about our books, please visit our websites at MiriamHyfenfeldman.com, mindygryling.com, or randyk.com