Psychotherapist Rodney Long, LISW, is back with Nick Angelis, CRNA, to discuss mental health tech start ups like BetterHelp, Mindbloom, and FieldTrip. Is it safe to take controlled substances like stimulants and psychedelics after a 10 minute online approval process? Is low-tech and personalized, or hi-tech and automated care the best way forward in 2023? Transcript below.
hello and welcome to the Ascend Health show I’m Nick Angeles I’m your host I’m a nurse anesthetist and I’m one of the owners of Ascend Health Center and I’m here again with Rodney Long licensed independent social worker how are you doing good good getting ready for the holidays yeah you know for two or three shows I’ve been plugging about this award we won for the best instructional runner-up but it’s it’s getting a bit much it’s run its course yes there might be two Awards actually oh it looks like it yeah the other one must be yours the avocado toast episode that’s right so I I wanted to call this is self-paced silly or what’s wrong with better help it’s basically that they’re right now there’s a lot of great companies making these fairly inexpensive uh therapy or medication or these online portal but they’re also not that great for you so I just want to talk to Ronnie about it and by the end we’ll probably have an opinion about it that you should listen to you have an opinion about it but we should talk about it and see maybe I’m missing something I mean I’m I’m very vulnerable like I’ll probably listen to your opinion and change my opinion maybe you should maybe you shouldn’t you’re a therapist like you’ve got these skills actually it is my personality yeah my brother and I used to argue about where to go to eat oh yeah and we’d convince each other and continue arguing this is the opposite just like to go at it yeah no one’s ever accused me of not being open-minded there you go there you go so so though so I’ll start with uh I guess my pet peeve because let’s be honest these uh the ascent Health show is just whatever soapbox sure yeah every day so my problem is uh with ketamine so obviously at Ascent Health Center uh news flash for those of you who this is your first episode we offer ketamine infusions sprovado which is s ketamine or half Academy molecule Jansen makes it into a nasal spray and we also have transcranial magnetic stimulation so these are all Cutting Edge mental health treatments that very few other places have because it’s a lot of Education a lot of expense and we also effort to people with other psychiatrists and therapists because you know why take on patients medications and do all these treatments when we can make it more available so the problem is that now there’s a I don’t want to say cheaper versions of it because they’re actually a little bit expensive but there’s ways that you can do a lot of these therapies online but can we be in controlled substance it’s a little bit like the Facebook Adderall if you’re aware of the photo yeah I think they clamp down on it I’m not getting as many ads I think I don’t yeah otherwise it’ll probably be a poor idea to even imagine but essentially you uh talk to a doctor through a Facebook ad and 10 minutes later like oh here’s my prescription of a stimulant now I’ll get A’s instead of B’s in 20 years from now I won’t understand why everything’s black and white and why I can’t find any joy in life once my dopamine receptors have burned out sorry it’s not a little bit too uh no
no I think it was no I think you’re spot on yeah yeah I think you’re spot on that’s but so the the issue is that uh a lot of these are meant to be very useful convenient ways to partake in healthcare and one of my main points is that you may want to ignore everything that we’re saying today and try it out because I could be wrong and maybe they’ll have like some sort of Deal or discount and you’re like nope this is working for me yeah no I I think that part of that was like for a lot of them especially on the mental health side you know you being on the the prescribing side I guess on the mental health side there I think a lot of it was about access you know especially during covid you know you saw an increase in these things which I think is really cool but I think I don’t know that access was really as much of an issue as people might have thought it was before um so and but what I think happens is a lot of these companies they get a lot of money behind them and so they get a lot of advertising and I think the service uh or the quality of the Care suffers a bit at the expense of growth and at the expense of kind of being on The Cutting Edge where somebody like I said is is really you know has that you here you know local kind of face to it and into who I know is doing the research and the work um where I think a lot of these newer companies kind of were all you know a lot of them are about growth and and so I think the the quality suffers on the back end that’s fair like we just had a team day at Ascend where uh for the whole day we didn’t have any patients in the office and my poor employees had listened to me all day we cut off early yeah but uh but I took this like Vision that it had in 2020 and edited it and I was like I had some really stupid ideas in 2020. like it was just like we’re going to be the premier provider in Northeast Ohio and Ohio and expand and I was like uh that’s terrible why don’t we just stay in like Fairlawn Copley Wadsworth since we’re on WCTV like we don’t need patients who I still have a few patients who drive for you know six or seven hours this evening but for the majority like you just need something accessible yeah yeah because if you’re an hour away from me and you’ve got an issue well gotta for especially for me as a nurse anesthetist like you’re gonna have to drive an hour for me to do anything for you
yeah so I think that’s a lot of it like almost a breakdown of community and community supports is why these things are thriving yeah yeah I think sometimes people want to try new things too you know I think especially on like in the mental health space I yeah I often hear people say things like you know I tried this or that medication didn’t work for me or this and and I’m like number one you probably played your own doctor like so often that happens I hear I hear that number two you probably gave it a week you know and then said it didn’t work so you know to have the opportunity to connect with a place that you can be in front of and really talk with I think is important so the more people we have doing that great I just want to make sure that we’re we’re doing it well you know so really I guess my complaint is more of an overarching complaint of society that uh Airbnb wouldn’t be in business if we still had friends that we could just spend the night at their house and go visit them that’s true Uber wouldn’t be in business if I just had a friend good enough to take me to the airport one night yeah so so maybe it’s just the way Society is kind of fragmenting into not having those connections okay yeah so that that makes sense yeah I think we’ve we’ve suffered and in a lot of ways in that and I think covid did a number on a lot of us you know one of my big gripes is I don’t think many people or maybe they can but I think more people would be happy if they worked less most people are satisfied at 40 50 hours a week and I think that people really need a lot more time to themselves because I think you can’t really spend a lot of time with your friends if you get home at six and are in bed by nine you know yeah did you talk to my wife before this episode I did not is this an intervention
it’s been a great show sounds
I I just think it’s tough man peop people like you know there’s there’s something like 168 hours in a week you know you spend 40 or 50 of that at work and on top of your travel time for that and getting ready and you know unwinding and then putting the kids to bed you might get an hour to yourself in the evening you know so I think it’s sometimes it’s hard for people to want to call a friend when they get an hour to them you know two hours and well you know that might be one of the reasons that my 2020 Vision was so dumb because you know you you’d start we’d started talking back then and that was when I was working 100 hours a week trying to get this business off the ground so of course the few minutes I had to like type out this like here’s how we’re going to be great I had stupid ideas
you know I commend you though I don’t know how I really recommend people who are able to kind of want to do these big things and then they do them you know that takes work it takes commitment you know and and I think that the process that happens when we’re trying to reach those big things you know there’s a guy he’s one of these big sales Guru guys his name is Grant Cardone you know he says 10x your vision you know so if you want to make a million dollars this year you know plan for shoot for 10 you know because you know if you shoot for a million you’re gonna make 7.50 you know right if you shoot for 10 you know you might you’re gonna you’re gonna be able to surpass whatever you think you can do so I always come in when guys can do that and some people are just wired that way you know well I mean that’s probably how these businesses like you said started where they have these great ideas of Nationwide networks but I mean I think what you’re also saying is um okay so you accomplished something you worked really hard for a while well you need to take that break you need to kind of pause and again something I’m struggling with now that okay you know I no longer amusing my personal savings for payroll sure but at the same time I don’t need to keep the same frenetic Pace especially in mental health because the nice thing about what we do is that uh people often criticize those of mental health issues but based on the most genius Minds because they have to struggle with their brains all day long so if they come into an office and they know everyone’s stressed and overworked and miserable like they’ll know oh yeah you can’t hide yourself though yeah I mean it’s it’s okay for me because I don’t I’m a pretty transparent person anyways I was never one of those nurses who could just smile and pretend to like somebody but and as a therapist if it’s the same thing like they will know oh yeah people can people sense what’s going on you know that’s kind of the emotional intelligence part about being able to pick up on when people are are upset or frantic or you know but but it is about slowing down too you know I think that’s why I hate social media you know I think they’ve sold the idea that people can be on all the time you know grind and hustle and you should you know you wanted to build your business you should you have to but I think at the same time like to me it’s a zero-sum game you know every hour I spend at work is an hour I don’t get with my son you know and so prioritizing that for a short time can be okay you know hey I got to spend the next five years kind of building this I think is important because that lays the groundwork for what I want to do but it’s okay that that changes too you know I thought I wanted to have 10 locations but maybe I’m okay with one you know yeah that’s okay yeah one of my breath my now they’re really funny yeah
one of my best friends uh Dr Milton dragadakis I just like seeing his last name the pediatric dentist and that was the challenge that he had like I can expand my business and have 10 of these yeah or this is a very crucial time for my kids and uh and it was nice that he didn’t just say oh I gotta do what I need to do for my kids he made into like a Pros cons sure type of thing like he treated it as an important decision yeah and uh spoiler he just still has the one location but it is important to like actually know what you’re giving up and is it worth it and what will I do once I achieve it yeah I think that’s part of it I mean these online therapies these you know kind of those kind of things they’ve I what they do is they allow people to to not fully engage you know with the process and and that’s all I tell people a lot of times is whatever decision you make just make it intentionally don’t just fall into life don’t just fall into the decision that you make so I have friends that work a ton and make a ton of money um but they might miss some baseball games you know I’m never going to miss a baseball game that’s just me I’m going to make less money but I’m not missing a baseball game and uh and so that that’s a decision that I feel like everybody has to make intentionally and so I think these online therapies and they give you again that illusion of kind of being able to say well hey I can work you know 50 100 hours and still kind of get my therapy at 10 o’clock at night when I chat with somebody online but we’re not really doing therapy then you have some support then and that’s great but I mean that’s what we need to maybe get through to that point where you can slow down a little bit that was a good segue back to our topic because I was also planning one as we’re talking about the other thing that you said about the authenticity of actually working with a provider that you know so I think that’s my problem with it that I feel that it’s almost like a tokenized system as you would almost like a Airbnb or Uber or something where it’s like all right here’s some of my money you know make me feel better and it’s not that give and take and sometimes awkward interaction with a real provider yeah yeah no you’re absolutely right I mean when I I’ve I’ve went on those sites to see what what kind of was what a lot of it comes down to a check boxes and an algorithm which isn’t how therapy happens that’s not how prescribing happens you know and so when somebody can hop on and they say well I need a a black therapist who’s lgbtq friendly and you know checks these other boxes um there’s no opportunity there to connect if I have a client email me I say call me right you know and we need to talk about what’s going on and so um people need that and and really we cannot commoditize Commodities uh therapy yeah and I mean and that’s why this is such a fun topic too because as a black male therapist you’re such a hot commodity and I’m just vaguely ethnic so yeah
ambiguous in a way right yeah yeah no that yeah there’s a there’s not a lot of of minority therapists out there if very few minorities and very and even fewer male minorities out there yeah but but that is exactly what you’re saying that a lot of times like this is exactly what I need not deliver it to me and it’s that cookie cutter approach that kind of fails us um and a lot of those uh type of therapies it is where the therapist is always on demand and when I started the clinic that was my idea like if you have a problem with pain or mental health you can come to the clinic and I’ll be there and I’ll fix you I was like oh this is a terrible idea yeah yeah because one of my teaching Reliance like from a business standpoint someone might argue sure that it would work but obviously it’s unethical if yeah you’re just teaching people that like you are their Savior and nothing else can happen without you that’s exactly it when I started I was like I’m for the people man so I want to be available and but the the problem is you know at that point I was prioritizing them more than everything became a crisis this you know yeah and um and I also wasn’t teaching them Independence you know so I gave that up and I think yeah from a business standpoint you know I one time had an idea for a business called Night Owl therapy where I was going to be a third shift therapist you know to people who needed third shift there right you know and the point is I want to help people you know we want to be available no it makes sense because like you can tell them like listen I know you’re about to spend 100 on Amazon
sorry and I’ll be 50 bucks that’s right and you won’t have this awkward explanation to yourself like what a third melon please you don’t even like grapefruit yeah that’s right man so yeah so I think it’s just just about that yeah yeah that makes a lot of sense because um back to my original point about the the ketamine or same with stimulants or no one I don’t think anyone has done like a benzodiazepine mailed order but it’s on its way if there’s any legality yes obviously um this and I should say this happened with opioids too that’s another reason I’m so against a lot of these um you know McKesson which is this is Community TV so we can talk smack about that okay okay now and this is all like this was a I think a 20 billion dollar lawsuit I don’t remember how many billions but McKesson was allowing pharmacies in West Virginia to fill massive amounts of opioid prescriptions like thousands of cars which would Verge on these cars and we get all the old boys they want and it was legal until obviously there are a lot of Overdose deaths and litigation and now mckesson’s really hard to work with um so this has happened before where we’ve made it really really easy to get things that should only be done with a face-to-face conversation um like one of our other guests you know Mark Garretson a nurse practitioner he won’t see patients unless it’s face to face for the first time yeah because like unless I get that connection like you’re not getting anything um and a lot of times like these are nuanced products like in the case of ketamine like in our Clinic we decide no you’re doing it in here in the clinic where we can watch you we’re not sending you home with anything and there are still good Arguments for these Services because obviously it’s a competitor so you’d expect me to be like oh this is terrible you need to see me only I can save you um and there’s there’s definitely uh places for it but it shouldn’t be your go-to or your first option when you’re still trying to see if a line of therapy or a line of medications is what you should be going for yeah I think that’s part of the problem is that we just want so much convenience you know in everything we do and you know with therapy I just had to tell a couple they were really really on the brink of divorce and they wanted to be virtual you know and I said I won’t see you guys virtual because uh if you’re on the brink you need to be in here I need to be able to see your body language I need to be able to see the way you connect with each other how you know your your non-verbals that kind of stuff um and I think the same is can be said for prescribing you know this shouldn’t be about convenience you know and I think that’s what we’ve made it about better help talk space you know kind of all these companies um McKesson you know it’s about convenience and and what’s easy and and I don’t think change happens that way right right because it was kind of convenient to slide into the issues that you had so unfortunately it’s going to be inconvenient and now’s a lesson for me too because of the way some of therapies have a descend work so quickly for patients yeah um you know I’d send them home like you know I ever have to come back you’re fixed great and now I mean that’s like no the the patients who do the best are the ones that uh will see them like once a month once every two months like the sweet spot where it’s not this uh yeah I really had to see his face again but at the same time it’s not complete like you got this oh yeah no that’s in for me that’s best practice in therapy too you know we if we if I start seeing you out a week and you progress every week and you progress really well we move to two weeks and monthly and and I might see you for six months you know once a month just to make sure you’re still doing well and I think that model of just having that support there when they might not have it with medication or therapy really makes sense and and again we’re not saying that it’s a terrible idea to ever use better help or mind Bloomer any of these services but you really should get a discount or a coupon to start yeah and uh we don’t think that they’re long lasting like maybe it can get you through something but you shouldn’t base what you need on and I’m not even saying that the clinicians aren’t caring now uh professionally speaking they probably aren’t the best because you’re working for like a one of those type of organizations but I mean it’s a little arrogant to say no I would agree with you though I mean what what I think happened with a lot of these were so many of these are venture are backed firms that are the the priority is profit you know and I we’re all a business at the end of the day I need to make money you need to make money but not at the expense of our our clients or our reputation exactly yeah and so I think that’s what happens where you found clients or therapists or prescribers who were able to really say like hey all I got to do is hop online and and I can you know see 15 20 people you know kind of whatever it is for your ass business in a day and make all the money I need to make then great and and I think we’re seeing that now that when the decision is made people can be greedy and and convenience doesn’t lend itself to long-term change right absolutely no that makes a lot of sense and part of that because so I said they might not be high quality but I’m not high quality in that I could never really do a self-pay practice like the ketamine uh infusions are self-pay but a complete self-pay I don’t have the mindset for it because I unfortunately I’m not like here’s your orange juice type of person I’m like look let’s find a discount and get you better cheap and you can get out of here like I don’t have the right personality in a little bit so that can be part of it too is that um and this is a podcast on the uh growing yourself to Wellness podcast I was on it yesterday you should really check it out it’s really fun yeah but we talked about self-pay versus insurance and that was one of the themes that came out that a lot of times uh self-pay actually saves money because it’s not the incredible amount of bureaucracy and cost associated with like wait what’s your insurance why aren’t they paying this who can we call so they’ll pay it yeah um but even that doesn’t always work well because of the same issues where you know sometimes not the right personality or the right fit yeah and it’s a quality of care versus customer service issue as well yeah I used to think that self-pay was that self-play therapists were better I like I used to think that I used to think well they must be so good that they could charge more money you know and really there’s kind of I I don’t believe that anymore what the truth is is that some people just decide to take insurance other people don’t I mean you make more money as self-pay um and and I think it’s probably true that there are good there it should they’re a good therapists on both sides what seems to be true for self-pay is that when you specialize in something people will pay whatever for it you know I you’ll spend a thousand bucks on your iPhone because you believe it’s worth it right now you’ll pay 150 bucks for a session if I could if I tell you I could repair your marriage you’ll pay whatever I whatever I ask you to pay for as you should because if you’re like thirty dollars I don’t know Rodney and that’s exactly it you know so often sometimes the insurance kind of um you know I worked for a good time with business owners I worked with men you know my pitch was my pitch then was I worked with men who learned money doesn’t buy good mental health that was my picture and uh but you’d see these guys who had the money to spend on this and uh and they would want to and they would almost look like they needed to be self-pay you know kind of thing and so um ultimately I think you get good care with both but I think the point is kind of what are you looking for in it because I do believe you know when you spend money out of your pocket it makes you have skin in the game right you know um you’re not going to miss appointments as frequently you’re not gonna you’re not but I think a lot of that comes down to the therapist too you know I always make sure that I tell my clients when we first start like don’t bail on me before this gets good you know what I mean like that that first 90 days I need you in here weekly so we can make sure we get the ball rolling you know yeah because you’re right you can find great clinicians in places where like wait what really that’s that’s where you go it’s like yeah I found someone that I like I’m doing well and it’s the opposite too where sometimes you can go to some sort of Posh like beechwood’s known for their self-pay mental health oh yeah and it’s the same thing I have usually the problem is though when parents really want the best for their kids that’s when it gets complicated I feel yeah yeah I I actually tell almost all the parents I work with now if you’re not willing to put in just as much work as you’re asking me to put in with your child don’t come because nine times out of ten you have a lot of work to do too that’s why we’re here and so they might pay 150 or 175 to see their kid but I quit seeing kids when I said I still see some now you know but but I I would say like hey you know the parent just wants to that Mom and Beechwood you know who just wants to drop 150 to say like hey my kid needs to talk to somebody and it’s like well this is a lot more work than just him coming in here once a week and we’re not just complaining about Beachwood like Pepper Pike we’re looking at you too that’s right Hudson that’s right you’re on our list but even even for my clinic you know we we’re in the Fairlawn Copley bath area and it was supposed to be when we first started again not taking my personality into account unfortunately um it was supposed to be like this you know mostly self-pay the ketamine infusions but then over time I was like well who really needs the care and ironically uh the people who are in most desperate need of care are those that fit between like Medicaid and Medicare and like insurance that does anything for you so that’s actually the Gap in this country is we have terrible High deductible insurance and that’s when you have to really make important questions about how like okay what can I give up is this actually serving me is it not um and and that’s again where some of these therapy places can kind of put a Band-Aid on it if it’s online but you really have to ask yourself like am I getting better like you know and part of it’s just finding a clinician he’ll be honest with you yeah I think that’s it sometimes you got to be willing to say this is out of my wheelhouse or out of my depth or you know that kind of self-paid versus Insurance seems to be strictly a business decision at this point in time you know what I mean like but in terms I have clients that have insurance that might as well be self-pay you know and uh and it cost them the same you know because they’re High deductible plan basically the whole year and so I think when we’re checking in with clients I check in with all my clients and I say hey yeah I work for you at the end of the day we want to make sure you’re getting better and so I’m checking in to say are we on track are you are you where you you want to be with this um because at the end of the day you might come in because you have a tough relationship with your mom let’s say and uh you might have to have some tough conversations and if you don’t want to then might be time to end therapy you know and if you’re willing to then let’s talk about that yeah so you’re saying like sometimes we can focus too much on the economic part of it like I’ve got a coupon wrong I’ve got a coupon to see you nothing at all wrong with me but use this coupon darn it yeah I tell people don’t don’t let money get in the be the reason you do or don’t do therapy you know uh especially from like the the discount portion I see these ads for better help all the time it’s like one month free or something like that you know and it’s like that really is to me is an ethical problem because if if you don’t have the money or the insurance to do therapy going to better help for a month is is might help I’m not going to say that it won’t but yeah but it’s certainly not going to solve your problems and I would hate to start something with somebody and get in the middle of something like trauma right and then we’re a month in and you got to stop coming because we didn’t explore that so the financial aspect of it no that makes sense because we are saying both and it is a bit of a Nuance approach we’re saying like it’s okay to kind of experiment and see what you need and get a clue for it but you also have to be aware of what it entails because that’s something with Psychiatry of course I’ve said it many times that that’s the challenge of Psychiatry is that how can I kind of dip my tone in the water without being on Zoloft for 30 years you know and these are honest questions that you should expect honest answers too yeah no I I think we owe it to ourselves to find what works you know I my my counselor the guy I see my psychologist is uh he’s 83 years old you know this 80 year old white dude he was he was a psychologist before he even had to have a PhD so he’s been he’s but he’s great you know he’s great but I went through probably three or four people before I found him you know saying here’s who I click with here’s what I need you know and once you find them that’s what you’re saying that like you just gotta stay with them that’s all there is to it so if you need if you are watching this and think you might need some help uh Ascend healthcenter.com is where we’re at it’s in Health Center and then if they want to reach you what’s the easiest way uh rodneylongjunior.com and you can always find him on psychology today ask around everybody knows around you know at least they should thanks I appreciate it right or we could have some sort of like almost like a bad thing you know since we’ve already talked about avocados and melon squeezers just flash a flashlight in there yeah just prepare your produce Ronnie will be on his way yeah thanks for joining us today for the show thanks [Music] [Applause] [Music]