- [Narrator] This is a production of WEDU PBS, Tampa, St. Petersburg, Sarasota.

- We have a trillion dollar a year problem.

The thing is, it's all in our minds.

What I'm talking about his mental health.

The National Alliance on Mental Illness estimates depression and anxiety disorders cost the global economy one trillion dollars each year in lost productivity.

That doesn't take into account other brain disorders like bipolar, schizophrenia or substance abuse.

Coping with the stress of COVID-19 has only made things worse.

You're about to meet a leading Tampa Bay healthcare professional who's breaking new ground to meet this growing challenge.

- [Narrator] Suncoast Business Forum brought to you by, the financial services firm of Raymond James, offering personalized wealth management advice and banking and capital markets expertise, all with a commitment to putting client's financial wellbeing first.

More information is available at raymondjames.com.

(upbeat music) - Mental illness is a lot more common than we think.

One in five US adults experienced mental illness before the pandemic hit, and one year into the pandemic, that number had doubled to 40%, including depression, anxiety, and substance abuse.

That doesn't include the family members, coworkers and employers who are directly affected.

How well are healthcare providers meeting this challenge?

BayCare Health Systems is the largest healthcare provider in Tampa Bay.

BayCare's Behavioral Health Vice President Gail Ryder is developing new strategies to meet that challenge.

Gail, welcome to the Suncoast Business Forum.

- Jeff, thank you for inviting me.

This is a lovely opportunity.

- Now, behavioral health and mental health symptoms have really grown a lot in 2020 due to the pandemic.

Some people are referring to it as an epidemic within a pandemic.

What has been your experience and what are the research numbers telling us?

- Well, here's what we know and here's what we have observed.

At the beginning of the pandemic, what we knew as providers was that the change, there was a major change in the environment which was gonna cause fear, which was gonna lead to anxiety.

So we knew that was gonna happen, but we didn't know what we were gonna see.

And I think in the beginning, what we did see, I'm gonna tell you what we actually saw was increased use of alcohol and drug clearly from the very beginning.

So that really started manifesting itself.

So, that was a really big challenge.

Then all of a sudden we saw people who never had touched mental illness before we're showing up saying they needed help, something was wrong.

The people who were mildly ill became moderately ill, the people who are moderately ill became severely ill.

So we've seen an increase of the elderly needing help.

The isolation, the change in their environment, how they go about their daily business.

All of these changes have really rocked people's worlds.

So that population has really taken a really big hit.

And then the other population that has really taken a big hit with this pandemic is the kids, the kids.

The kids are feeling isolated also.

They don't have access to their peers, their world has changed, the things that they rely on are gone.

So those populations have really surfaced.

- The prevalence of mental illness is a lot more common than we think.

The National Institute of Mental Health estimates that one in five adults experience mental illness and one in 20 experience serious mental illness.

How do you see the healthcare system addressing this?

Is it being addressed adequately in your opinion?

- Behavioral health is just coming out of the dark.

People are talking about it more.

Thank goodness for our young generation.

They're allowing people to feel more open and go for for services.

So the healthcare providers have recognized that and are really pulling those young people in to help beat the stigma back.

So people ask me about stigma all the time and I just can't, you know It's so hard to talk about stigma.

I think stigma is gonna go away with the older generation is what I think.

So, I think we're coming out of the dark.

- What would you say are the economic consequences of mental illness?

- Well, there's many, I mean There is the economic consequences of lost work days are the big one, you know And even if you're at work and you're really thinking about your child who you think is taking drugs or your mother who you think is not surviving at home, you're not present to the task.

So it's called presenteeism.

I think that for sure.

It's causing the work environment to think a little bit more carefully about what services that their employees really need.

The normal and customary health benefits now EAPs are being brought to the fore and EAPs are growing.

- Employee assistance programs are becoming more prevalent.

And what sits within the employee assistance programs is growing.

Financial aid help, lawyers are being brought to the table in a divorce to help them mediate divorce.

So a lots of things are being brought to the employer environment to help their teams survive these changes.

- When it comes to mental health, what does the research tell us?

Is it genetic or is it lifestyle or is it environmental or some combination?

- So what we know now.

Here's what we know today.

We think about it in three buckets.

We know that there is a DNA connection to some of the disorders we see.

Most prevalent is depression and schizophrenia.

Then there's what we call the brain circuitry group where you get ADHD and where you get Alzheimer's.

And then there's the environmental factors, the environment, your stressors that bring on anxiety and substance use disorders.

So those three buckets.

Now, while we have buckets, our patients don't live in one bucket which makes it more complex.

They live in many of the buckets.

So that's why treatment is so complicated also.

- How have healthcare providers and insurance companies address mental health issues?

And is it changing?

- I think what's happening between the providers and the insurers is integration at all levels.

Meaning, back in the day, the insurance companies used to have the behavioral health carve-out companies.

Over the past, I would say 10 years, they're moving that behavioral health into the medical parts.

So we've get the integration of medicine and psychiatry together.

That's great movement.

It would be nice if it was a little faster, but that's movement.

The providers are also doing a lot of psychiatric or mental health and medicine connections in the community.

I think the message is, it's about one body, it's about, how do you not take care of the mind the same way you take care of the body?

So I think that integration is what's on the minds of the providers and the insurers.

- Now you are Vice President of Behavioral Health at BayCare Health Systems, and it's the largest provider in the area.

15 hospitals, 30,000 employees, a budget of more than $4 billion.

What is BayCare's approach to mental health and mental illness.

- Wow, that's a great question and it's a big, awesome story.

BayCare has always thought that there is no health without mental health.

That's been a motto they've always had.

One of the reasons I came to Florida is that BayCare was a very unusual, and it wasn't baker at the time actually, it was a system of a federation of hospitals but they had managed to bring together public and private psychiatry.

Rare, very rare.

But there was the opportunity.

So, with that as the backdrop BayCare has been asking for the 10 years I've been there, "What's going on in the community and what more can we do?"

So that is where BayCare is.

I guess the the tagline is, "There isn't any good health outcomes without mental health."

- Let's talk about your formative years.

Let's talk about your family where you grew up.

- Well, I was born in East Meadow, Long Island and I am the eldest of five children, and I am the daughter of two first-generation Italian people.

And so I grew up in a very loving, intact, boisterous, exciting, happy family.

And my dad was the consummate teacher.

He was a really a remarkable man.

And he would tell us during vacation times, tell me where you wanna go and research it and tell me how we get there and how much it's gonna cost.

So me, I was like, "Oh, I wanna go to California, I wanna go to Chicago."

My brothers, "Let's go camping, let's go here."

So he never really could afford to take seven of us to the exotic places that I wanted to go.

So he said, "You're going to college, here's your chance."

So he said, "Don't go further than Colorado 'cause it'll be a lot of money getting you back and forth home, and if you do go to school, it's gotta be a Jesuit college."

That was the way it went.

So I went to Creighton University in Omaha, Nebraska and the Midwest was remarkable.

What a wonderful place?

It was a different lifestyle out there.

And so I did my graduate and undergraduate there and I wound up my degree is in special education.

So I wound up as principal of a school in a psych hospital.

And I went from MS (indistinct) and I loved it.

Emotional disturbance was my specialty.

The journey is a really interesting one.

When I was in Nebraska and I was in the psych hospital in the school, I received a phone call at the nurses station and there was a mother in Iowa and she was crying and asking me if I thought, when she found visine in the pocket of her adolescent child if he was taking drugs.

Well, what was happening then was the federal government had called in all the family farm loans.

So all the farms in Nebraska and Iowa were experiencing adolescent suicides and drug abuse.

So, it was a crisis.

I said, "Well, let's go to the..." We went to every grange hall in Nebraska and Iowa and we did talks on adolescent suicide and addiction.

What a remarkable experience that was?

So after that, they made me the program director because I was developing programs.

So, that was wonderful.

Then my brother died.

So, I would have stayed and lived in the Midwest the rest of my life for sure.

But my brother who died of cancer and I knew I had to get back east.

So I took a job as the principal of a school in Massachusetts for adolescent boys.

And these boys were adopted children of wealthy families and I was at that school for several years which was really remarkable.

But I missed the clinical environment, so I then wound up taking a job at a psych hospital again and then wound up at the Institute of Living in Hartford, Connecticut where I was program director and I developed with my colleagues a not-for-profit managed care company for mental health.

The Institute of Living is a very longstanding, reputable psychiatric institution that was a member of the Ivy League of psychiatric hospitals.

There were 13 hospitals at the turn of the century that took on the new treatment mortality at the time which was moral treatment.

It was the time when they were coming out of the asylums and there needed to be treatment.

You couldn't leave the mentally ill in asylums.

So there were a group of hospitals that went to York, England, and they studied under a doctor named Dr.Tuke.

And Dr.Tuke believed in the moral treatment.

And moral treatment at the time, now this is 1900s.

So moral treatment meant that you would take the mentally ill, have them work on farms, be out in the fresh air and find purpose in their lives.

And that was the treatment between 1900 and probably 1930.

And they all came back and built psychiatric hospitals.

They bought land, and actually they bought farms because the patients would work on the farms.

So that was the treatment of the time.

And then the 13 hospitals and the institute was one of them.

After the moral treatment came the medicines.

So that was the introduction of the first psychotropic meds in the 30s, and then psychiatric treatment went on from there.

- After the Institute of living, you moved to New York City and worked with some of the top medical schools and some of the top physicians in the country.

- Tell us about that.

- Yeah, when I joined New York Presbyterian, it was the year that the two hospitals merged.

That was the Columbia Presbyterian Hospital and the Cornell Medical Center, they merged.

What didn't merge were the two medical schools.

So, Columbia and Cornell.

In the beginning of the merger they thought they would but they didn't.

When the hospital came together, they hired a psychiatrist to be their president.

His name is Dr. Herb Pardes.

And he did a couple of things that would pull together the system rather quickly.

He decided to bring together what was known at the time as service lines and in key areas.

One was psychiatry, neurology, oncology, women's, children's, we had medicine, but there were three things that a service line was supposed to do.

One, create a strategic plan, where are you going and how are we gonna get there?

The second thing was program development, and the third thing was quality.

Quality had to be a part of your journey.

So, I was asked at the time to lead the psychiatric service line.

And the psychiatric service line was the two chairman of the departments of psychiatry at the time and myself were to do this work.

So, that was the journey that we took for the 15 years I was there.

And I would say halfway through the 15 years, I was asked to take on the neurology and neurosurgery because the vision that Herb had was the brain Institute, a brain center and start working with the researchers and the clinicians across those services.

And that was very exciting.

- So after 15 years at New York Presbyterian, working with some of the top physicians in the country, you came to the Tampa Bay area, you came to BayCare.

What attracted you to BayCare?

- I think they were two things.

They were three things, there were three things.

I think the time in my life my daughter had just graduated college.

So, and my husband like what are we?

Empty-nesters, what are we gonna do?

And my family was here, my mom and my sister, and we were up in New York without any close family.

So it was the time in our lives.

It was my family and then the third thing was, how progressive BayCare was with mental health.

And when I say it was rare, it's still rare.

It's growing, but I'm talking about the things that we get to do in Tampa Bay because the belief is that there is a public private partnership that needs to happen to make sure the outcomes for the patients are optimum.

And those three things brought me to Tampa.

So I've been here for 10 years.

- Several years ago BayCare undertook a study to evaluate the needs, the mental health, behavioral health needs of the greater Tampa Bay area, West Central Florida.

What did that survey tell you?

- Well, there were three.

Let's talk about three surveys, three things.

Early on, BayCare had their community health needs assessment.

And that was a deep dive into the community, to hear the community voice.

What's not happening?

What's going on?

Which led them to the community health needs assessment.

And what kept on popping up constantly is that mental health and substance use was a need, a need, a need.

So, that was well-known.

We wrote plans around how we were gonna help the community.

The second thing that happened was... And our board plays a really strong role in asking the right questions.

We need to do more mental health, what do we need to do?

So we gathered a group together internally and we started asking the question about, how big is this problem?

And you spoke about how big this problem is.

It's a problem for our community, it's a problem for everybody who lives and works in Tampa Bay.

So, the decision was to bring together some of the leaders in our four counties to have the conversation.

How big is the problem?

Do we think we have the problem licked?

And if not, what's missing?

And that group turned up three major things that they wanted to work on.

We did a gap analysis, what's missing.

And the three things that this particular group thought was missing was navigation systems.

Where do people start when they even begin to think that there's a problem?

Urgent care, why do we have urgent care for medical issues but not for behavioral health issues?

And the third that they really wanted to take on was stigma?

So, the result of that meeting which was over at least four months, two major meetings with community leaders.

We're talking businesses, schools, the mental health community, the political community, the Sheriff's office, all the stakeholders, was to support the notion of a new not-for-profit.

The name of which is the Tampa Bay Thrives.

And that was launched in the community and supported by the community.

And they are working on their first project now which is navigation.

So that's bringing awareness, bringing public private together in a more intense way in Tampa Bay.

And we know the unmet need, I think on the acute side and we're busy adding more acute beds to our compliment here at BayCare specifically around mental illness and medical issues together which only a medical center can do.

So we need to come on strong with that.

But secondly, what they found was that in the Tampa Bay community, we are about 200 providers short of meeting the need.

So we are adding 65 providers in five counties over the next three years.

And we're focusing on our kids, adults and substance use disorders.

And that's just this year.

So those are the three studies that we had done leading us to new ideas and new programs which is very exciting.

- All too often, people with serious psychiatric problems end up being confronted or confronting law enforcement or end up in the criminal justice system.

How common is this?

And is there an alternative?

- So what's been emerging over the past couple of years is a direct conversation between law enforcement and mental health.

And it starts actually law enforcement started it to give them kudos.

We know we're seeing this out there but we're not mental health professionals.

We shouldn't be doing this.

We're saying, "Yeah, you're right, but how do we do this?"

Out of fear for what it's like being with them.

So over the years, there have been many programs in Tampa Bay that have started up.

We have one in Pasco County for many years with the Sheriff's department where we developed a program where we ride along, we go along with our sheriff.

And through that conversation, we're learning their world, they're learning our world.

So the cross-pollination of conversation and the cross-pollination of, what verbiage do we all use?

So we're getting together.

That is really kicking up in all the communities.

Pinellas has it, Winter Haven has starting it.

I just finished working with Tampa police and all the providers, they're starting it.

The sheriff in Hillsborough has got a mental health unit.

So, these conversations are evolving in the right way.

- I don't know about you, but I've noticed a lot more advertisements on television commercials, announcements specifically about mental illness, about therapies, about drugs that you might take for even things like schizophrenia or bipolar.

Have you noticed the same thing and what are your thoughts about this?

- I'm thrilled, I have to say it honestly.

I saw the commercial for a new schizophrenia drug and it was talking about a family, somebody in the family living well with schizophrenia and having the family embrace it and understanding that there's gonna be these ebbs and flows but there's some medicines that help them live well in the community.

That does more to let people know and to see it.

And then you saw the one about the depression and the bipolar, the same thing.

How she resolves it and has a healthy... People can live really, really well with mental illness.

And that's what those are showing.

And we've long been waiting to see that.

And that I think is terrific.

And we're gonna need to see more of it 'cause people can live well with mental illness and be very productive.

- Now, the COVID-19 pandemic obviously effective all of our lives.

In your opinion, is there a need for a post COVID treatment program?

- I've been doing a lot of thinking about that and I think absolutely.

And I think we're just beginning to see the tip of that iceberg.

People are complaining about sleep disorders, some cognitive issues, and obviously psychiatric issues.

So hopefully maybe by the end of the year, a post COVID clinic might be in our feature.

Bringing together those specialties to help people with post COVID experiences.

And the one thing about the pandemic though that's...

There's a lot of nasty things we can say about this pandemic, but there have been some bright spots.

I have to be careful with that but clearly people are more willing to talk about their anxiety in relation to it.

So there's more talking, the more we talk, the more others talk about getting help and it's okay to get help and reach out is gonna really bring us out of that fog.

So, I think when people can connect their anxiety to what they've experienced with the pandemic, they know what's causing it and they're willing to say, "Okay, I can get past this."

What we don't know is what is it gonna look like coming out?

'Cause we're talking about it now.

Our people are gonna adjust to the old way and then the next question is, "But we keep on hearing it's not gonna be like the old way way."

And people are anxious to find out, what is it gonna look like?

So I think this fear and anxiety for change it was gonna be with us for a long time.

- What mental health initiatives do you and BayCare see on the horizon.

- I think we see a lot of integration, I think we see more working with our medical colleagues, more collaboratively.

We have been working in our primary care programs for nine years now.

That integration of mental health and medicine is where this is all going.

And I think we're gonna see more of that as time goes on.

And I think that's the power of a health system embracing mental health is, how do we bring all that together?

So I think that's on our horizon.

I think it's bringing medical to our mental health clinics.

So how do we have everybody embrace, this is just a part of how we're doing your assessment, how you're thinking and your mental wellness is as important as everything else.

So, I think that's where BayCare is going.

- Well, Gail, I'd like to thank you so much for being our guest today.

- Well, it's been a pleasure and I am so glad you asked me because we've just participated in trying to lift it out of the fog, right?

- Absolutely.

- Thank you.

- Thank you.

If you'd like to see this program or any of the CEO profiles in our Suncoast Business Forum archive again, you can find them on the web that wedu.org/sbf.

Thanks for joining us.

The Suncoast Business Forum.

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