Accelerating Change in Mental Health with Malekeh Amini, Founder & CEO at Trayt.Health and Roshni Koli, Chief Medical Officer Meadows Mental Health Policy Institute

[00:00:00] Hey everybody, Saul Marquez with the Health Matters podcast. I want to welcome you back

[00:00:13] to another episode here in health Las Vegas 2023. I have the privilege of hosting two

[00:00:19] extraordinary guests in healthcare. First, I want to introduce you to Malek Eamini. She

[00:00:24] is the founder and CEO of Trait Health. We also have Dr. Roshni Kohli. She's the medical

[00:00:31] director at Meadows Mental Health Policy Institute. I want to welcome both of you to the podcast.

[00:00:36] Thanks for being with us.

[00:00:37] Thank you for having us.

[00:00:38] Thank you.

[00:00:39] It's a pleasure. And Malek, it's good to see you again. We did one of these a few

[00:00:43] months ago and folks if you haven't had a chance to listen to his interview, I will

[00:00:47] post it in the show notes. But let's get started. And for those that haven't had

[00:00:52] the privilege of meeting either of you, what is it that inspires your work in healthcare?

[00:00:57] What inspires me in healthcare and in doing what I'm doing right now is my own personal

[00:01:02] journey as a parent navigating the very complicated behavioral health system, trying to get the

[00:01:08] right care for my own son and really identifying that many times even I can't get the

[00:01:13] answer and I considered myself someone who had access and was more privileged in that

[00:01:18] space. But even I had to rely on ER many times to get the right treatment or access to the

[00:01:23] right care. And when I think about this at a societal level and individuals who live

[00:01:28] in mental health deserts and have no access at all to care, it just is the part that

[00:01:33] inspires me to do what I do today.

[00:01:36] Thank you for sharing that.

[00:01:37] My journey into medicine, I think first started with just a desire to be able to help

[00:01:41] people. And I've always been drawn to children and I love the innocence of children

[00:01:46] and the way that they can teach us so many things. We think we know more as we grow

[00:01:50] older, but I find so many times both as a mother and as a physician, I learn from kids

[00:01:55] and adolescents all the time.

[00:01:56] My journey into medicine and healthcare, I really started as a child and adolescent

[00:02:01] psychiatrist and women's mental health psychiatrist at a women and children's

[00:02:05] hospital. I had a very nonlinear journey into being a healthcare leader.

[00:02:09] Opportunities presented and I showed up and learned a lot.

[00:02:13] I gradually moved into the policy realm over this last year because I really found

[00:02:18] that if we want to make an impact in mental health, we need to think about those

[00:02:23] policy levers that really are able to provide equitable care to all.

[00:02:27] And why my vision is really that any child, any adult, any mother that

[00:02:33] walks into a hospital, that their physical and mental health are seen as

[00:02:37] one in the scene. For far too long, we've looked at this fragmented

[00:02:41] type of care and this fragmented model and it's time to reimagine the health

[00:02:45] system and really think about mental health as essential.

[00:02:47] Love that. Thank you so much. Yeah, and I think it's really important.

[00:02:51] We can learn a lot from kids. And as a dad, I definitely understand

[00:02:55] the importance of having a seamless experience for my son and everybody

[00:02:59] listening too. You guys all understand that.

[00:03:02] You guys have a session later today and that will focus on the

[00:03:06] foundational role of social determinants of health and the role

[00:03:09] that they play in mental health, especially for children and adolescents.

[00:03:12] What do you think social determinants of health contribute to the

[00:03:16] conversation or context of mental health care?

[00:03:18] No, I think social determinants is really understanding the entire

[00:03:22] environment, the entire picture that an individual experiences.

[00:03:26] It's recognizing that not everyone has equitable access to opportunity

[00:03:31] and to health care. And so it's really allowing us to look at

[00:03:35] what are the essential aspects or the non-medical drivers of health

[00:03:40] that can help us to influence better quality and better outcomes of health care.

[00:03:45] Thank you for that. Yeah, no, I mean, that the environment matters.

[00:03:48] Yeah, just to build on this is exactly where the traits vision is as well.

[00:03:53] But I think it's well documented that social determinants

[00:03:57] of health have a huge impact on the health outcomes for all.

[00:04:02] And there are many social programs today that are trying to address food

[00:04:05] insecurity, transportation, housing, unemployment, and all of those

[00:04:10] are really important factors to create depression, anxiety in any family, honestly.

[00:04:15] But what is and those programs have been to some degree effective.

[00:04:18] But as Dr. Roshe calling just mentioned, one of the important factors

[00:04:22] is really to be able to break down social determinants

[00:04:26] to a much more granular level that really highlights an individual

[00:04:30] patient's environment in a way that provides information for clinical care for them.

[00:04:35] Are they still dealing with some untreated childhood trauma?

[00:04:39] Are they having support and a healthy family environment?

[00:04:43] Those are some of the types of things that we don't really consider

[00:04:46] to be social determinants of health, but are really key pieces of information

[00:04:50] that impact someone's behavioral health symptoms and even their response

[00:04:54] to treatments and how their outcomes improve.

[00:04:56] Really being able to break that down into the levels that are necessary

[00:05:01] to define the exact environment that Dr.

[00:05:03] Cole was just mentioning, I think are key and that's going to be part of the topic

[00:05:07] for us this afternoon as well.

[00:05:09] It'll be an exciting conversation.

[00:05:11] And by the way, for those that are listening to this podcast,

[00:05:14] that conversation happened already at the event, but you'll be able

[00:05:17] to check it out virtually and we'll make sure to provide a link in the show

[00:05:21] notes below. Where do you see data increasingly play a role

[00:05:25] in the delivery of mental health care?

[00:05:28] Data and generally data analytics have been transforming industries for years

[00:05:33] and we see that everywhere around us in our everyday lives and don't even think about it.

[00:05:38] In healthcare, we've lacked a bit in really looking at that data

[00:05:42] and analytics as a real tool for clinical care.

[00:05:45] And I think that one of the things that's important in mental health is not

[00:05:49] just data by itself doesn't mean anything, but really collecting

[00:05:52] the right data and all of the information that you need,

[00:05:56] structure and get in the right way and then having the analytics

[00:05:59] that could really synthesize that information and create

[00:06:04] actionable insights for anyone who's making a decision is really key.

[00:06:09] And in mental health, it's no different.

[00:06:10] In fact, it's much more instrumental to moving mental health

[00:06:14] and transforming mental health.

[00:06:15] This is not going to be one of those areas where incremental change

[00:06:19] is going to really redefine this industry.

[00:06:22] It's going to be transforming the entire way we deliver care.

[00:06:26] And so collecting a lot more data, we tend to isolate the brain

[00:06:30] and really collect data on brain symptoms in a very specific way.

[00:06:34] And even today, those are collected on paper most of the time,

[00:06:37] but to really collect only brain data as if it's an independent organ in the body.

[00:06:42] But it's not.

[00:06:43] So one of the things, for example, that we are doing is collecting

[00:06:46] over 750 factors on each individual patient of physical symptoms

[00:06:52] or other medications, brain symptoms, environmental factors,

[00:06:56] social determinants, childhood trauma, resiliency, baselines, family history.

[00:07:01] A lot of information needs to be collected

[00:07:04] in order to really create that comprehensive picture of a single patient.

[00:07:09] And then it needs to come from multiple sources

[00:07:12] if we really want to have all that information.

[00:07:14] We have patient-facing applications, family-facing applications,

[00:07:18] secure entry points into our platform by any observer.

[00:07:22] For child and adolescent, we have school counselors

[00:07:25] that are able to put in content.

[00:07:26] We have primary care physicians that are actually providing information.

[00:07:30] And an individual clinician's brain is just not able,

[00:07:33] like any other industry,

[00:07:35] not able to really look at all of this data,

[00:07:37] synthesize them, analyze them in a single clinical visit

[00:07:41] and create actionable insights from that.

[00:07:43] So building that layer of artificial intelligence,

[00:07:47] use of technology, analytics is really going to be also key

[00:07:51] in making sense of that data.

[00:07:53] So I think we need to think about this as a kind of we're building it

[00:07:57] from the ground up and really creating a brand new model

[00:08:01] to deliver clinical care is how data is going to transform mental health.

[00:08:05] It sounds like there's a lot of data that can be gathered.

[00:08:08] It's a community-based approach.

[00:08:10] The different entry points from teachers to counselors, health systems.

[00:08:14] So maybe did you want to comment on that data question?

[00:08:17] But from a clinical perspective, when we think about best practice,

[00:08:21] it's measurement informed care,

[00:08:23] meaning that we're getting data points with a validated assessment tool

[00:08:27] to track something like depression or anxiety.

[00:08:30] We don't want to rely solely on the clinical interview.

[00:08:34] We want to have some objective data points

[00:08:36] in which we can see whether the treatment that we're providing is affected.

[00:08:40] And like Malika was mentioning, we want to understand

[00:08:43] not just how the depression and how the anxiety is doing,

[00:08:46] but we want to be able to gather data from all of these key informants.

[00:08:50] So when we see a child in a clinical setting,

[00:08:53] we also have to think about how are they doing at school?

[00:08:55] What is their school functioning like?

[00:08:57] What does their teacher think of how they're doing?

[00:08:59] Do they have friends? What does that look like?

[00:09:02] We want to be able to coordinate with their primary care physician

[00:09:04] because that individual is really the quarterback of the team.

[00:09:08] They are the individual that's oftentimes known a child from the birth

[00:09:12] and has a good relationship with the family.

[00:09:14] So we want mental health care not to be isolated,

[00:09:18] but to be coordinated in the entire way and the vision in which we see care.

[00:09:22] And so this measurement informed care is really important

[00:09:25] because a validated assessment tool in and of itself

[00:09:28] is just some information that a patient or a parent may fill out.

[00:09:32] What we really need to do is be able to leverage data,

[00:09:35] to leverage AI to help provide the information that a physician needs

[00:09:40] to be able to enhance their medical decision making.

[00:09:43] It doesn't take away from the medical decision making.

[00:09:46] You still really need that individual,

[00:09:48] that clinician to be able to provide their clinical expertise.

[00:09:51] But data can be an incredible, helpful factor

[00:09:54] in helping to synthesize that information

[00:09:57] so we can really do the best work we can when we're with the patient and family.

[00:10:01] That's fantastic.

[00:10:02] And did you want to comment on that too, Malakair?

[00:10:04] It was just in agreement with Dr. Kohli, you know what?

[00:10:07] Any technology, any AI platform,

[00:10:10] I think there is a huge misconception when we talk about artificial intelligence

[00:10:14] thinking that it's going to transform by itself.

[00:10:17] It is only a tool to enable clinicians to make the right decision.

[00:10:21] This isn't in any industry.

[00:10:23] I don't believe any industry is going to actually have just AI run it.

[00:10:27] There will always need to be expertise to make those decisions.

[00:10:31] But it's just providing the kind of tools they need to make a more informed decision

[00:10:35] and to have all that synthesized data.

[00:10:37] That's great. Thank you guys for sharing that.

[00:10:38] Certainly promising to have data as part of the care experience

[00:10:43] and also the provider experience, right?

[00:10:45] Giving them what they need at their fingertips to deliver the best care

[00:10:48] that they can to these kids.

[00:10:50] What advice are you sharing with leaders right now in approaching mental health care?

[00:10:56] I think one is that recognizing that equitable access to care does not exist right now.

[00:11:02] We have to recognize that there's been marginalized communities for decades,

[00:11:06] for hundreds of years and recognize the aspect of structural racism

[00:11:10] within our community that for a long time has meant that not every individual

[00:11:15] has the same access to care and that every individual has equity within that.

[00:11:20] So when we really look right now, when we're thinking about AI,

[00:11:23] when we're thinking about innovative data tools,

[00:11:26] I think we want to be really thoughtful that we're really doing it with a goal

[00:11:30] of creating equitable access for all.

[00:11:32] And then the second thing is that recognizing that data helps us to

[00:11:35] understand an individual's environment, helps us to understand what type of

[00:11:39] trauma or grief they may have experienced or what may be going on in their life

[00:11:43] that's contributing to their behavior and to their symptoms.

[00:11:46] So really recognizing that mental health or mental health symptoms are

[00:11:51] really just a symptom we need to get to the root cause of what is contributing

[00:11:54] to it, to be able to really make a difference.

[00:11:57] And then the final thing that I would say is that make sure that as we're

[00:12:00] looking at all of these data platforms and these tools,

[00:12:03] that we're doing it in coordination with clinicians.

[00:12:06] And so that part is key, that when we're making all of these different

[00:12:11] changes and we're trying to leverage better health care and better quality

[00:12:14] outcomes, we need to do that in partnership with health systems with

[00:12:17] clinicians so that we're really taking the best of both worlds,

[00:12:20] the data platforms and the clinical focus and that together in that

[00:12:24] partnership, we can really achieve that goal of providing excellent care for all.

[00:12:29] Thank you, Dr. Lovki.

[00:12:30] Yeah. And it's rowing in unison, right?

[00:12:33] Everybody's on the same page rowing in unison.

[00:12:35] So to just build on what Dr.

[00:12:37] Coley said, I think there needs to be an awareness and I think it's

[00:12:41] begun for leaders to actually recognize that there are gaps in care,

[00:12:47] that there are real disparities and access to behavioral health care,

[00:12:50] especially my advice to leaders today, which are going to be really the

[00:12:55] leadership in federal funding agencies and statewide funding agencies in

[00:13:00] places where decision making can be done at a scalable level is to

[00:13:05] really think about how program successes are across the country.

[00:13:10] There are some real case studies done that are improving patient health

[00:13:14] outcomes that are providing more equitable access to care.

[00:13:17] We're looking at a number of them in the state of Texas right now and that

[00:13:21] they have really proven to be successful programs and the foundation for why

[00:13:27] they are successful is the fact that there is a truly coordinated effort

[00:13:31] to deliver standardized products, to deliver standardized programs in a way

[00:13:37] that are not measuring success by just how many people are using it,

[00:13:42] but measuring success through measurement based care, looking at patient

[00:13:46] health outcomes, looking at what demographics of patients are really

[00:13:50] receiving the care and would they have had access outside of these programs?

[00:13:54] There are so many case studies across the country that are proving to be

[00:13:59] more successful. Public funding is taxpayer funding.

[00:14:02] There is no reason why we should think about them as any different than

[00:14:07] private funding is.

[00:14:08] There needs to be a way of measuring success by how they're returning that

[00:14:12] investment. Are they if you're improving patient health outcomes,

[00:14:16] if you are creating more equitable access to care, reducing potentially

[00:14:20] ER visits by people who otherwise won't have no access to other types

[00:14:24] of care is going to reduce the cost of care.

[00:14:27] At the end of the day, my suggestions to policymakers and to leaders

[00:14:31] is to really look at how we coordinated and worked together

[00:14:35] towards a common goal when we were trying to contain a pandemic and how

[00:14:40] we were able to accelerate the development of vaccines in a way that

[00:14:44] genuinely did contain it in a much shorter period of time.

[00:14:48] Had we not done that level of partnership, private public

[00:14:51] partnerships to get something like that done?

[00:14:53] Mental health is probably the number one public health problem in

[00:14:57] the country today and maybe globally.

[00:14:59] And I think we need to have the same coordinated efforts, looking at

[00:15:03] what is successful, looking at how these partnerships can deliver

[00:15:07] patient health outcomes, can deliver a lower cost of care, can deliver

[00:15:10] access for all and roll them out similarly, consistently across the

[00:15:15] country and really contain this at a federal level rather than at federal

[00:15:20] at very local levels.

[00:15:21] There are no local variations in this.

[00:15:23] There are no state variations in this.

[00:15:25] It's just a matter of really looking at how things have been successful.

[00:15:29] Where have we seen patients get better, patients have access

[00:15:32] and use that as a benchmark to roll out consistent programs?

[00:15:36] Yeah, the need for standardization, consistency, integrated care.

[00:15:40] These are the themes that are rising to the top in our discussion.

[00:15:44] And look, you guys are doing incredible work to make this a reality.

[00:15:47] And so I want to thank both of you for the work that you've done

[00:15:50] and you continue to do what call the action would you leave our listeners with today?

[00:15:55] I find myself reflecting on the fact that mental illness is a pediatric illness, right?

[00:16:00] Half of all mental illness presents before the age of 14, 75% before the age of 24.

[00:16:06] And yet it takes eight to 10 years on average for an individual to receive treatment.

[00:16:12] We have an incredible delay and gap in care.

[00:16:16] If we were able to reduce that and really look at ways in looking at early

[00:16:20] intervention, early diagnosis, prevention and early access to treatment,

[00:16:25] we have the opportunity to completely change the trajectory of a child's life

[00:16:30] and to change what our community looks like.

[00:16:32] So I think the call to action here is from a policy standpoint,

[00:16:37] are we looking at policies that really look at equity with mental health

[00:16:41] and physical health, one in the same, recognizing the importance of investing

[00:16:46] in mental health, recognizing that means that we're investing in our future.

[00:16:49] And do we are we really creating programs that are enhancing those healthcare

[00:16:55] systems that exist?

[00:16:56] Are we supporting our primary care physicians?

[00:16:58] Are we supporting our educators?

[00:17:00] Are we supporting our health systems?

[00:17:02] Do we make sure, do we ensure that those individuals have a voice for how

[00:17:06] we make policy recommendations that ultimately affect all of us?

[00:17:10] Thank you for that.

[00:17:11] Yeah, absolutely.

[00:17:12] Just you said it so well at the policy level.

[00:17:15] And I do agree.

[00:17:16] I think that it takes way too long from the day a symptom appears until

[00:17:22] we move to a diagnosis, move to treatment.

[00:17:25] And we tend to wait because we are a system that's driven by diagnosis,

[00:17:29] diagnostic codes, everything is based on a single diagnosis.

[00:17:33] But the policy discussion has already been made.

[00:17:36] I think Dr.

[00:17:36] Coley explained that really well.

[00:17:38] I would even go back to primary care physicians and empower them

[00:17:42] and also talk to families like myself, like other ones, the others

[00:17:45] that are either limited by cultural limitations and stigma around

[00:17:50] mental health or not really recognizing that symptoms of mental

[00:17:54] health are still mental health issues.

[00:17:56] And to really speak up, to seek help, talk to your primary care

[00:17:59] physician, talk to your school counselor at the very early stages

[00:18:04] because they are capable and they have the resources and they have

[00:18:08] the opportunities to really seek the type of consultations

[00:18:11] that are out there today and funded and be able to receive

[00:18:14] the types of support they need to treat you where you are.

[00:18:18] It is it's most important really to for in terms of improving

[00:18:23] patient health outcomes, most important is to provide the right

[00:18:26] care at the right time for the patients where they are.

[00:18:29] Otherwise you'll be waiting in a 2000 patient waitlist to get

[00:18:33] into a single psychiatry clinic when it's too late.

[00:18:36] So really being able to treat the symptom level at the earliest

[00:18:40] phase with the people that are accessible to you is really key.

[00:18:43] Thank you, Malika.

[00:18:44] Thank you, Dr.

[00:18:45] Coley. Look folks, health matters.

[00:18:48] That's the name of this podcast.

[00:18:49] But health matters in the behavioral and mental sense.

[00:18:53] It's the same.

[00:18:54] And so I want to thank both of you for being with us today,

[00:18:56] sharing your message.

[00:18:58] Folks in the show notes will provide ways to get in touch

[00:19:01] with Malika and Dr.

[00:19:02] Coley learn more about what trait health is up to as well as

[00:19:06] the health systems that they work with.

[00:19:08] Thank you both for your time today.

[00:19:09] Thank you for having us.