Episode Transcript
[00:00:02] Speaker A: Welcome to PG Pulse Press, Ganey's podcast on all things healthcare, tech and human experience. In this podcast, we'll be joined by some of the best and brightest minds in the industry to discuss challenges, share insights, and innovate the future of healthcare. Thanks for tuning in. We hope you enjoy the conversation.
[00:00:21] Speaker B: Joining me today is Carolyn Fenkel, someone I met earlier this year at our annual pediatric summit, where she gave a talk that I found really exciting. Carolyn is the chief clinical officer and co founder of Charlie Health, a virtual intensive mental health care provider for teens, young adults and families after career leading intensive inpatient and outpatient mental health treatment programs. She co founded Charlie Health in her adulthood with Carter Barnhart. Carolyn, thanks so much for being here today. Before we talk about your organization, let's talk about the big picture. Let's talk about mental health and get specific with what you're doing to help. In a little bit, you're so much more the expert than me on the big picture as well as what Charlie does. Can you give us your take on why youth mental health has become nothing less than a crisis?
[00:01:16] Speaker C: Yeah, absolutely.
I think that so much of the crisis is related to accessibility.
When it comes to mental health in the United States, we see a significant and severe resource shortage. 80% of people in the US live in an area without any access to appropriate mental health care providers, let alone high quality mental health providers. More than 150 million people live in federally designated mental health professional shortage areas. And that's a huge issue that we continue to see, which is that there's not enough therapists or psychiatrists that are ready to meet the demand of what we're continuing to see in the United States around increasing mental health issues. Nearly half of Americans have had to or know someone who has had to drive more than an hour round trip to seek treatment, some type of mental health treatment. And I think that we continue to just see this increased demand for these mental health services across it, and it's really kind of exacerbated that mental health shortage. So, if you will, it's sort of like a spiral, you know, it's like the excess, you know, you have a mental health issue, then you can't get accessible or high quality treatment, and then your mental health issue gets worse. Right? It's sort of like an infection. Like if you can't kind of start to treat that wound, it could get worse and worse and worse, which is what continues to create the mental health crisis. So to just think that it starts with inaccessibility and then the more inaccessible that it is the higher rate of mental health issues that become more and more severe.
So that's really sort of what we continue to look at over and over again, is just how it is that we can increase accessibility for high quality treatment.
[00:03:06] Speaker B: Well, when you look at sort of the secular trends going on, I'm sure you paid attention. When the surgeon general who trained with me at the Brigham long ago, Vivek Murthy, was told that social media and social isolation and loneliness, are these, in your mind, huge trends that are drivers, and do you think there's anything that we can do about them?
[00:03:32] Speaker C: Yeah.
So I sit on a nonprofit called be a part of the conversation, and what they bring is conversations to communities around substance use issues. And I worked in substance use for a very long time, and I treated adolescents who have substance use issues. And I saw a drastic change in about 2013, 2014, when suddenly when teens would come into me, they would stop talking about the kegger party that they went to over the weekend, they would stop talking to me about using drugs or alcohol. They would stop talking to me about having sex. And suddenly I started talking to them about isolation and how they just can't get out of bed. And so what I did was I created this talk for be a part of the conversation, which was fully focused on drugs and alcohol. And I called it isolation, the new drug of choice. And it really was the new drug and is the drug of choice for teenagers at this point in time, which is that your phone is going to be so much more interesting, more interactive, give you that dopamine, that positive impact and those positive feelings, then showing up to a party and feeling awkward and feeling weird and feeling vulnerable, and you're going to find yourself wanting to lay in bed and be on your phone. And it turns out that that actually has really increased and expedited this youth mental health crisis.
And it's more complicated to treat than substance use, quite frankly. You know, it's. How are you supposed to. The phone, it's two sides of the same token, which is it creates isolation and makes them feel more potentially excluded, seeing their friends at parties and things like that. And then, on the other hand, it makes them feel really connected to their friends. So it's really complicated to balance these two things back and forth with one another of take away the phone, which could be the drug. Now they feel even more disconnected. Now they're even more isolated.
So I think a lot of providers have been battling against this idea of, what do you do in these types of situations?
[00:05:45] Speaker B: Yeah, it really is incredible that the rise in mental health issues coinciding with the rise of social media, the rise of smartphones. But those aren't going away anytime soon. So I guess the pivot I'd like to make now is to think about can technology actually the solution as opposed to just the driver of the problems? It may not be the total solution, but part of the solution. So let's talk about the role of teletherapy and what Charlie does.
Like, tell us about it. How does it work, and how can it be helpful? And then what's your model for bringing something that might be helpful to people who need it?
[00:06:32] Speaker C: Yeah, absolutely. I think what I find the most exciting about our treatment approach at Charlie Health is our ability to cultivate connections among peers in this virtual setting. So you're right. You're kind of leaning into it and you're sort of embracing it, but you're doing it in a way that makes them feel healthy and makes them feel positive. One of the things that I know I listened to a while ago called rabbit hole. It was a really good podcast about how searching just one thing can lead you down a big rabbit hole. And so, you know, somebody searched something like healthy food, and that led you down to an eating disorder like thinspiration and this idea of, like, you know, trying to lose weight and, you know, so I just keep on thinking, like, at Charlie Health, we don't have those algorithms that might bring you there. We instead, are cultivating these really healthy, positive relationships.
You know, I think that in today's world, you know, so many people, like we said, are struggling with this isolation and loneliness. And, you know, it's especially true for these young people that are feeling like their bodies are changing, their minds are changing. Usually, they're having some family conflicts, since they're a little bit more rebellious than before. But what's the fundamental part of Charlie Health and the client experience is our group therapy, where our clients are paired with peers who are similar to their age, similar demographic. They have shared lived experiences who benefit from the same treatment approach. So we will offer a group for LGBTQIA individuals who are self harming and need dialectical behavioral therapy. And so being able to really, really curate that group, and that really goes back to our primary mission of Charlie. And looking at this idea of when you end up in a brick and mortar intensive outpatient treatment program, you could be placed with a person that's ten years older than you, a person that's struggling with something very different than you, and that's going to lead to increased isolation, which is the exact opposite, right? It's not what we want. And so, you know, at Charlie Health we've been able to, with our size and with our reach and with our span, really put into operations a group matching protocol and mapping to be able to get individuals that can hear the words, me too, I've been there. I know what that's like. And decrease that isolation. So unlike any of these place based treatments where limitations such as availability, geography come into play, the virtual environment offers this unparalleled opportunity for curation and customization based on the client's needs instead of just who happens to show up to the clinic that day.
[00:09:20] Speaker B: Yeah. When I first heard you talk, I mean, I came away struck by three things, you know, one was the idea that you could get people into groups that were there, people like them, because of your national scale, you don't just have to be like whoever happens to be there. So you don't have an eleven year old, you know, young girl who might have been cutting herself next to a 17 year old young person who was having gender identity issues, that you could actually have groups where people had something to say to each other that was like, you know, the scale enabled things that could not have been possible otherwise. The second was the timeliness. I'll come back to my third in a little bit. But the timeliness, how does the timeliness work for you? Work for you guys?
[00:10:09] Speaker C: Yeah. So this is something that's really near and dear to my co founder, Carter Barnhart, who's our CEO, our heart. And that's because we both worked at a similar company that did residential treatment as well as partial hospitalization and intensive outpatient mental health treatment. And unfortunately, we were frequently, the company that we worked at was frequently on a waitlist. And so Carter and I, being on the front lines, would be the ones who would be answering the phone calls of a mom saying, I've been sitting at the emergency room. I've been here for the last 12 hours. We have not yet seen a psychiatrist. We have not yet seen a social worker. I caught my kid cutting themselves 12 hours ago. I didn't know where to go. And we would say, thank you so much for calling us. First, what's your insurance?
Which is just so sad. And then second, I'm really sorry, but we have a two month wait list and we won't be able to get your daughter in with us to get the treatment that she so desperately needs today for another two months. And, you know, it's just so wild. To start to think about putting this into perspective with physical health care. I mean, that's something that we would never, ever put up with in physical health care. Right? Somebody calls and says, my dad just fell.
Can you be here? And them to say, you know, 911, we'll be there in two months. Like, it's just not something that would happen. But unfortunately, we live in a world that has created systemic issues that have, unfortunately, you know, looked at mental health as very different than physical health and looked at it as if it's not something that's needed immediately.
So when Carter and I came up with the vision around Charlie Health, we were incredibly dedicated to overstaffing our resources, overstaffing therapists, overstaffing everything above whatever we think that the demand is going to be, whatever our growth strategy team says that it's going to be, in order to make sure that there's never a time that we have a waitlist and we've stuck to that commitment.
Typically, when an individual calls in, they'll be in with a licensed therapist within 24 hours, and they'll be in a group therapy session within the 48 hours. And we have stuck to the idea that we are never, ever going to be on a waitlist. And if that means that we have a bunch of staff sitting around doing nothing, we're okay with that, because it's just so crucial.
[00:12:45] Speaker B: Well, that is amazing. And to me, it actually is.
An illustration of the principle that goes well beyond mental health, is we should be really trying to understand what people really need and confront it and then meet those needs. Well, let me bring up the third thing, which I came away fascinated from your talk about, which is I came away thinking, like, is telehealth actually better in this area than in person? I've always assumed that telehealth was a reasonable second choice at best. But I came away thinking, hey, maybe it's actually better. Better for the patient, better for the clinician.
You talked about, like, if someone's sitting at home on their couch petting their cat, might that be better than sitting on a hard chair next to someone who they've never met before?
And your take on, is it actually a better model?
[00:13:51] Speaker C: Yeah. So my experience around this, I think, is really unique.
I got a call from Justin, our third co founder, who talked about his friend who died and how important he thinks that it is to have these curated groups and talk to me about telehealth in 2018. And I was like, that's a really cute idea. Unfortunately, it's never going to work. And he was like, why? And I was like, because telehealth is stupid. And he was like, why? And I was like, because I did my dissertation on the use of technology in a therapeutic setting. And I sat with 40 social workers who all told me how much that they hate telehealth. You're not going to get any providers that are going to want to provide telehealth. Being in person is so crucial. You have to see their body language. You have to look in their eyes. You need to be breathing the same air. Like, stop it. This is not a thing that will be good. And basically, Covid hit. And I was running five different intensive outpatients and partial hospitalization programs across the country that were all brick and mortar, and I had to transition them. I'll never forget the date. It was Tuesday, March 23. And on March 24, we were now going to be virtual with five different sites, each with 50 patients.
And I remember crying myself to sleep that Tuesday night, thinking, tomorrow is the day that I'm going to have to lay off all my staff. These are people who I consider to be my family. These are people who I've recruited, who I've begged to join, who I've mean so much to me. And there's no way that we're going to open up a zoom, and teenagers are going to get onto the zoom for 5 hours. There's just no way. And when we opened it up, we had 100% participation. We had better outcomes, which is wild to think that you could have better outcomes virtually. And I think there's a lot of reasons for that, one of which is exactly what you just said, which is, if I feel safe, I am more likely to share things. That's just a reality.
When I was running this brick and mortar, I used to go in all the time and see this patient. We'll call her Anna. And she used to sit on the couch in the uncomfortable room with the fluorescent lighting. And she used to just not talk at all. I mean, we could not get her, you know, her hood would be up. We could not get her to talk at all about anything. So I get onto the zoom, you know, two days after we started this whole thing, and I'm seeing her in groups, and there she is, camera on, looking straight at the camera, starts talking about some childhood trauma. I'm like, Anna, what's going on? And she's like, what do you mean? And I'm like, you had your hood up. You wouldn't speak when we were in person. And she's like, well, you know, I have my cat, and I get to be laying in my bed and, like, it's a little bit darker. And I don't know. I just want to talk more with everybody. And I remember just being like, holy cow. This truly could be better than brick and mortar. And then the second thing that happened was, we know that parent participation in treatment is the single largest indicator for positive outcomes. So the more that parents are involved in their teenager or young adult's treatment, the more likely that their kid is to get better.
And we also know that in order to get a parent to come into a brick and mortar, especially a parent who has multiple jobs, a parent who might not have transportation, a parent who might have multiple children, it is very challenging to get them in, to come in, and. And oftentimes, I would sit with a patient in the morning, and they would say, last night, I cut myself. And I would be like, okay, I need to call mom. But I want to bring mom in in person to talk to her about it. We got to figure out how we're going to get rid of the razors. We got to figure out. And I would start working through this and call mom, and she'd be like, I can't leave work early. I've already left work early four times. I have to.
What would happen during COVID was I would have an individual say to me, look, I caught myself last night. And I would say, cool. Is mom around by any chance? And they're like, yeah, she's in the next room because she's working from home, too, during COVID So I'd be like, cool. Will you just, like, text her, see when she's free, if she could pop in? Mom walks into the room. Mom just walking into the room. That's it. Just her presence changes your outcomes tenfold. It just does, which is so wild to think about, just her showing up, modeling what it's like to show up to treatment for your kid.
And so then I would sit with her and be like, hey, mom, listen, you know, Anna told me that she cut herself. The razors are behind you. She gave me permission to talk to you about it. She wants to stop. And suddenly I'm now in a wraparound program. Right? Like, wraparound is where they show up to your house, you know, and where they actually do some really incredible family systems work.
And I think that between those two things, those two magical parts of just feeling like you're in a safe environment, you know, being able to have more parent participation can actually lead to better outcomes than brick and mortar. That is a reality. And I'll say one more thing, which is that the LGBTQIA community has done incredibly well, virtually. Why? Because when you walk around, you don't have your pronouns. Right. Sitting right here, right now, everybody on their zoom screen has what name that they want to be called by, and they have their pronouns, and they don't have to worry about their body. They're just. They have their face, their. Their neck up, and usually they'll put on makeup, or they'll do whatever they want to do to make themselves feel good. But oftentimes, when they're walking around in a body that doesn't feel right for them in person, they're going to experience more feelings of shame, had their barriers and their guards up, and they're not going to necessarily want to share. And so what we found is our LGBTQIA population just thrives in a virtual setting.
[00:19:30] Speaker B: You should write an article called exploiting teletherapies, unfair advantages.
You know them better than anyone else. All right, so let's talk about the outcomes. How is Charlie doing? What are the. What do we know about the outcomes?
[00:19:46] Speaker C: Yeah. So, we have written nine peer reviewed articles. One of them just came out today. So check it out on frontiers about our neurodivergent population and how well that they do at Charlie Health, especially getting that affirmed care.
So we have seen remarkable benefits of Charlie Health. And one of the things Justin, who's our third co founder, is a data guy and really, really into creating infrastructure that we can be always collecting. And I'm a social worker, right? So, like, for me, it's like, okay, we're just going to help a bunch of kids. But he was like, as soon as we started, he was so deep in creating data infrastructure that will help us to measure our patients. And now we have so much data from even four years ago until now, that we have just an incredible, very clear knowledge graph that shows us what's going on with our patients. When I say these things out loud, I love being able to say them, because I know how real that they are. And I also know, working at other behavioral health companies who sort of just do surveys and kind of come up with some numbers, I feel really lucky with what we've created in terms of just being able to measure how they're doing.
We see an 89% decrease in self harm behaviors. We have. 95% have reported alleviations and anxiety symptoms, 92% have witnessed enhancements in managing their depression symptoms, and 79% have experienced a reduction in suicidal ideation. And I think for me, when I read these numbers, they don't really.
They mean something to me, obviously, but for me, the stories are really what's so important. So I have up a couple alumni quotes that said, for a long time, I've struggled with self harm issues, suicidal thoughts. Charlie Health taught me how to resist my urges to self harm. I am forever grateful for this program. It's changed me in so many different ways.
I am forever grateful for everything that I learned, and I am incredibly happy and grateful for the individuals that I met in group who are just like me. You know, so just hearing these types of outcomes that we've seen and knowing that we've been around now for almost, almost four years, and sort of seeing we've treated now over 30,000 clients. If you had told me four years ago that we would have treated 30,000 clients, I would have been, you know, just. I would have fallen out of my chair. And so I think that, like, a lot of what we see with those improvements is, you know, a testament to how much that there's such a need out there, especially with that number. And then how neat it is to think that the bigger that we get, the more curated that our groups get. And so I think oftentimes people think about behavioral health companies that move too quickly and grow too quickly and then quality decreases. But for us, the more that we grow, the higher that our quality gets because our groups become more and more curated.
[00:22:48] Speaker B: My colleague at press, Gandhi, Amy Compton Phillips, she always says, no data without stories. No stories without data. And you've clearly got plenty of both. Well, let's wrap up by talking about your hopes for the long term. And when I say long term, I mean 1020 years. And, you know, where are you hoping that we're going to be, you know, as a country in youth mental health care and that kind of timeframe and, you know, and Charlie's role in it, you know, we're. We want to do more than crisis management. You know, we want healthier young people. So, you know, we won't be holding you to this, but we're curious to know, what are you hoping for?
[00:23:37] Speaker C: Yeah, so one of the things that I'm working on that won't necessarily be in the next ten years, but instead will be in the next year or two is how to utilize machine learning to continue to make our outcomes better and then being able to change the treatment for the next individual that comes in that looks and sounds like that patient. And so I think for us, that's something that we have been so deep into. We have an innovation, research, development and innovation lab that I've been working really closely with that has just been really eye opening on how it is that you can collect hundreds of thousands of data points, see trends that can then help to change the treatment. I think that it's something that a lot of people aren't doing, seeing that real, true feedback loop in behavioral health and in mental health. And it's something that I'm just continually amazed by the ways in which we're going to be able to tweak our treatment model to serve every single patient and not have that cookie cutter approach.
As far as, you know, ten years. I mean, it's hard to imagine. But for me, as a social worker, as somebody who's so dedicated to access, I want to be able to have a world where you call a line. And regardless of what, how old you are, regardless of what you're struggling with, regardless of what your insurance is, you will be in to see a mental health professional immediately.
And I think that they're trying to do that with 988, which is staffed with volunteers who oftentimes don't have the resources that they need. But to think about this idea that every single citizen deserves mental health care, immediate and high quality, that's my only hope.
[00:25:39] Speaker B: Well, I think that your work has made me feel more optimistic about mental health, but about care redesign in general, because I think that the principles that I see you bring to life are matching patients to the resources that will meet their needs better, meeting those needs more quickly, and then doing it in a way that is not only sustainable, but superior in ways that the traditional model couldn't match. And so I think that we've got big problems, big challenges, and we need all the creativity we can come up with to meet those needs. But I think that the work you're doing suggests, hey, we can do this. Well, look, it was very nice to meet you at our pediatric summit. I really enjoyed it as I communicate that day and as you can tell now. And I'm looking forward to watching what you do in the years ahead. And I know I'm going to learn not only about mental health, but for other areas in healthcare as well. So thank you very much for sharing your experiences with us today.
[00:26:52] Speaker C: Thank you so much for having me on. It was awesome and so great to spend time with you, and I just love everything that Prescott is doing. So thank you.
[00:27:00] Speaker A: That's a wrap. Thank you for joining us today, and special thanks to our guests for sharing their time and insights stay tuned for our next episode, which will be released soon. In the meantime, visit our website where you'll find more information on the human experience and a lot more.
