The situation is all-too-familiar for those who struggle with depression and anxiety: after realizing you need help, you wait months to see a mental health care provider who may refer you to yet another doctor, therapist, or psychiatrist. These providers often don’t communicate, leaving you with fractured, insufficient care.
Dr. Jeremy Kendrick, MD, is a triple board certified pediatrician, child/adolescent and adult psychiatrist at the University Neuropsychiatric Institute (UNI) at the University of Utah, the leading mental health provider in the western U.S. His specialties include psychiatry and behavioral health, and Dr. Kendrick is a key player in the collaboration between UNI, Lives Unencumbered, and strategy firm Cicero Group to fix systemic problems and create a new, holistic treatment model.
Lives Unencumbered sat down with Dr. Kendrick to discuss current issues in the mental health care system and how we can change them.
This interview has been edited for length and clarity.
Lives Unencumbered: What are some of the inefficiencies and gaps you see in the current system for treating depression and anxiety?
Dr. Jeremy Kendrick: You come into medicine wanting to help people, and then when you get into practice, you start seeing a lot of barriers that relate to systems of care.
It's not just as easy as hanging your shingle on the door and healing the world; it's helping people figure out, first of all, that they need help. Education is a huge thing. The stigma around mental illness is still a major problem. It's getting a lot better, but we are still at a point where a lot of people don’t really understand the true nature of mental illness.
Once people realize they need help, it’s very, very hard to find where to get help, a support group to help them understand why they need the help, and the resources where they can turn to get the help. We do not have enough providers out there to serve the need, so you are looking at waiting for months to even to see a provider to open the door into some answers.
Once that door is open, you had your 45 minutes with a psychiatrist, and you walk out the door. It’s a daunting task to wrap all of the resources together that an individual needs to approach that point of mental wellness.
LU: What challenges have you faced in the mental health care system as a provider?
JK: I think a burden a provider experiences has a lot to do with the way providers spend their time. The classic model of sitting down face-to-face with a patient has a value, but you are limited by time. Having more innovative approaches to how we interface with patients helps more patients get access to finite resources.
Another major burden has to do with the stigma surrounding mental health. Patients enter into this very vulnerable position when they come in to see a mental health provider, and they are oftentimes very guarded with what they are willing to share. I think the lack of wraparound support and education is an another area that can be a stumbling block getting a person access to the care that they need.
LU: What kind of impact do you think is possible by creating a more responsive, attentive treatment process to address some of these challenges?
JK: Much of mental health delivery as it exists right now is somewhat in silos. You go to see your psychiatrist to talk about medication prescriptions. Psychiatrists may not provide therapy, so you are referred to another therapist, and your therapist and psychiatrist may not talk to each other. You may have some underlying concerns that are affecting your mental health, so you find yet another provider.
I think the promise behind these changes is having a model where you have all these facets of care delivered in a collaborative way so communication is happening seamlessly, and patients don't feel like they are living from encounter to encounter, but they are being taken care of by a team that has that holistic approach. Mental wellness is above and beyond a given medication or a given therapeutic approach or the right lab value from your medical doctor. Bringing all that together into one place is the promise that any mental health provider would welcome in with open arms. It’s really exciting stuff!
The concept of a medical home has existed for a very long time. I think there is an unanswered promise of creating a similar type of home for mental health and wellness that includes all of those aspects of your medical care — your psychiatric medication management, your therapeutic management, and other holistic aspects.
We have so much data and literature out there that show mental wellness is more than just a medication or a therapy, but unfortunately, patients are met with a system that is fractured into those silos. An approach that would bring all those pieces together and make communication happen across providers and specialties is something we have seen evidence for in other specialties of medicine. As of yet, I don't think we have had the opportunity to achieve that in mental health, and the promise is pretty amazing.
Read More: Learn about the new treatment process
being created by UNI, Lives Unencumbered and Cicero.
LU: Can you expand on patients living “from encounter to encounter?” How does that affect the care they receive?
JK: When a patient is suffering, their point of entry may be with a psychiatrist, it may be with their primary care provider, but it is a given event in time where they talk about how they are feeling and a recommendation can be made. That provider makes a recommendation within their specialty, so for a primary care doctor or psychiatrist, they may recommend a medicine.
They may then recognize that the patient may benefit from other types of things like therapy, but they may not provide that themselves, so they set up an appointment or referral. The patient has already waited four months to see the psychiatrist, and now they will wait another two months to see a therapist.
The thing that lacks is the glue in between those pieces that holds the whole picture together. The bridge that connects all of that together is just not available right now.
LU: What benefits do you see in collaborating with Lives Unencumbered to bring about the necessary changes to the mental health system?
JK: One of the promises we see is a group of individuals who advocate for a population of patients who don't have a lot of advocates. These patients’ providers care about them, but they are so busy seeing those patients for these appointments that it's hard for them to have the time to enact some of the changes that an organization like Lives Unencumbered is interested in making.
Those changes would build collaboration across specialties to build up advocacy for patients, like support groups and other things that we know as providers are essential for mental health, but we don’t necessarily have the capacity or time to get into.
Support the collaboration between UNI, Lives Unencumbered and Cicero group
to create a new path to treat depression and anxiety.