Support for Arkansas Week provided by the Arkansas Democrat Gazette, The Arkansas Times and KUARFM 89.

Hello again, everyone.

Thanks very much for joining us.

A new state law opens the door to a new approach for delivering urgently needed psychiatric care and other mental health services in Arkansas, and that includes counseling for substance abuse.

Clinicians predict it could produce dramatic results with much less red tape and at far less expense.

That's in the moment.

First, a crisis averted, A debt ceiling lifted, financial markets reassured.

For the moment, all four Arkansas congressmen voted for the package approved a couple of nights ago.

Our two senators were divided.

So some thoughts on that showdown and a couple of other issues now from some familiar faces.

Bill Vickery on the right, Michael Cook from the left.

If you don't know him, you'll figure it out pretty quickly.

Chances always.

Thanks for coming aboard.

Well, what do we make?

All four of our House delegates, all four Republicans, went with the leadership.

The the Freedom Caucus itself was was splintered.

What do we make of all this on my House side?

Let's start there one.

If I can't, I'll just look.

I think it is a little bit of and I don't want to be too optimistic here, but I think it's a little bit of a wedge for things going forward in that you did have a significant bipartisan engagement here from both sides.

You had to some degree, you had some theater from the extremes again I think in both parties.

On the outskirts.

But that core, that big middle I think we have, this could be the beginning of what can really be a government that coalesces together around issues now you know, gun to our head on this one.

I mean you had to do it.

I mean there's just no way the catastrophe that would be associated with it doesn't just affect Wall Street bankers.

It it works its way down all the way to folks.

In nursing homes here in Arkansas.

So, so it had to be done.

But you know it's a reason for optimism.

I think you're thinking maybe a move to the center.

It is interesting to watch Keen Jeffries and Kevin McCarthy work together.

They they never dialed the rhetoric up against one another and these things tend to lend themselves to a lot of heavy duty rhetoric and it was it's possible.

It's possible that we could see some real cooperation Now he's really qualifying it well.

I agree, and I don't agree with what Bill had to say first.

I do agree.

I was happy as everybody.

That both Joe Biden and Kevin McCarthy got together, went into rooms together and cut a deal that not everybody's happy with either either side.

That's that's the art of a deal where not everybody's 100% happy, but you got the job done.

So it's a benefit to both Biden and Kevin McCarthy, who I have to give him some credit here, but I don't agree that this is a new way of doing things in DC.

I'm not that optimistic here.

Everybody had to come together because they knew if we didn't the economy would take trillions of dollars will be lost in value like Bill was saying on down to the little guy at the lowest level.

So they had to on this one issue come together.

But I still think we're we're still.

Tribalism.

The partisanship will continue soon after this deal is is signed by President Biden.

Well, as we noted up top, there was division and our two Senate senators, Mr. Bozeman went with the majority and the leadership.

Mr. McConnell and Senator Cotton went the other way.

Bill, what do we make?

Well, I think, look, I think some of that's insider stuff in Washington.

To some degree I think you had cotton in a group of people trying to to make a point in in with McConnell that the the Senate stuff is a lot more of this sort of true insider baseball.

It's a different it's a completely different animal over on the Senate side then on the House side.

I I think if if it had been, if there had been genuine peril to the deal, I think you would have seen a different outcome.

But I I think they had.

They knew they had it and they they yeah, exactly.

Yeah.

No, I was going to say the fact that because it passed overwhelmingly, Tom Cotton was able to do a stray vote because he knew it wouldn't.

Nobody got mad at him because it was going to pass.

So he gets to go on TV and a rail against it and get some publicity.

And at the end today, like Bill said, it's inside baseball.

That doesn't really affect anything.

Well, are you 2 guys in agreement then on this bipartisan solution here that Mr. Cotton is in fact burnishing his bona fee days in some way?

You know, he's been, he's always trying to do that.

That's not a that's not a weird thing or unique thing.

He's always trying to get himself on.

Fox News and get them to get more national exposure.

Well, that's awfully cynical.

But well, I will say this, we do have on the Republican side, we do have an embarrassment of riches in terms of people who hail from the natural state here, who who have some degree of a of a national profile, some bigger than others, others developing others.

I I mean, I think it's no, I mean look, it's not a mistake that you see a lot of folks moving to the fore.

As we get to a presidential year and and we're not that far away, it's it's shocking that we stay here, you know, early June and we're talking about the 24 election cycle.

But yeah, that's the truth.

Well, it's not really shocking.

Is it true the White House is, is is saying it was some justification.

Here is another quote, another bipartisan victory for Mr. Biden.

He was.

He's doing what he was elected to do what the country expected of it.

When That's exactly right.

Yeah.

I think Biden has done a fantastic job.

He's gotten things done.

He got the this done.

He's gotten some other great legislation, such as the transportation infrastructure.

He's been able to because he's worked.

He's been there for so long.

That's the benefit of his experience of being able to.

Get the job done.

He's not worried about cut a deal.

He's not worrying about crowing on you know like when this debt ceiling came out he was real come about it.

He was not trying to you know go to the tops of the buildings and scream I did the best deal ever.

Just get the job done.

That's what people elect him to do And he's showing time and time again that he gets the job done.

That's built any way your thoughts on that and be any impact at all on on next year this debt now we we I promise you.

There are a There's a cadre of people in Washington and throughout many states in this country that are begging for the Democratic Party to nominate Joe Biden once again.

I'm not sure the guy can stay awake all the way through November of next year.

I, I, and I I still contend that he won't necessarily make it to the starting gate and that you'll see some sort of maneuver, A pivot.

Because you got to remember, this is a guy that never really won a primary and became the Democratic nominee.

Because COVID came in, they shut down.

Once Obama anointed him, they cleared the field.

And so, you know, he's at his age.

And listen, I don't take any comfort in saying this, but, you know, there's some serious physical health issues and mental issues that are there.

I think all those are exploited in a real campaign, and he's going to have to run.

And yet I can't stop him.

And he just got this great deal cut.

I mean, it's funny how Republicans on the one hand said, oh, he can barely craft two sentences together, but but yet he's able to do all these things and get the job done.

And if you believe he had any notion, it's funny how you have to do one or the other.

He's doing, you know, he's calling out members of Congress that have been dead for a year in his speech.

He's done a fantastic job in this, this latest bipartisan deal, another example of bipartisanship.

That he's been able to get done is you know it's it'll be a tough race because don't forget you have Trump in the wings there.

That's the that's the absolute worst person that the Republicans are going to nominate and it looks like the heap will probably be the nominee for Republicans come 2024 Little Rock if we can go a couple of things here the governor now in her 5th, 6th month and office has is sending.

The guard to the border with an open slap against.

Yeah, president.

Yeah, this, I mean, Sarah Sanders.

It's all about raising our national profile.

The most dangerous place to be in Arkansas is between Sarah Sanders and a Fox News TV camera, because she will run you over to get in front of Fox News.

Sending 80 troops to the border is not going to make a difference but it gets her on Fox News News Mac ONN all about raising our national profile because she's trying to either get the VP slot for 2024 or get on the short list.

So we're her whole administration for a year for a while now has been stunts trying to get more publicity.

Another latest example of her trying to raise her profile.

So so let's be clear if this were a tornado or a hurricane and we sent troops down to.

To assist in that it it would be hailed, it would be the right thing to do.

We would talk about how that we all share the burden here in the United States.

There is a real human crisis that has occurred for now almost two decades at the southern border.

It's very clear there's also a definite policy crisis is that is occurring relative to to immigration.

And let's be very blunt here, Mexico is a narco state, there's no doubt about that.

They are run by a series of drug trafficking families.

They don't stop these people at the southern border because guess what they are, they are dollar signs to these drug traffickers because they move them across the border the same way they do their product and they make money off of them.

And the the human toll that it that occurs at the southern border, primarily in Texas and to a degree in New Mexico is a real tragedy.

You have a federal administration that has paid no attention to this because it doesn't help them with their base.

It's not an impact in the Upper West Side of Manhattan or Brentwood or the Gold Coast in Chicago.

This is a major, big time issue.

I do applaud her for engaging in the issue.

This is a national issue.

I like when governor packs are, when the Governor Abbott or Governor DeSantis send some of these folks to other places and we're all Americans, we should share in this.

We should share in this burden in terms of dealing with this.

So it's a major, major issue and it's something, look, it's something she did the right thing and and I think showing some leadership to a degree not what's not what's coming out of Washington is this policy or politics is politics.

It's all about theater.

I mean, yes there's a big promises at the border, but 80 troops over thousands of of of the border between the US and Mexico, it's not going to make a difference.

It's about getting more publicity getting herself on Fox News.

It's not it's that's what it's all about.

Should be there should be 10.

1000 United States Marines on the border at a minimum, right now to deal with the crisis that stops it.

Got to end it there because we're out of time.

Gents, as always, thanks for being here.

And you'll be back soon, Definitely.

And so will we.

Just a moment.

In recent months, one after another surveys studies that_a pressing need for expanding mental health services, including treatment for substance abuse or addiction, and beyond that, a need to make those clinical services more easily accessible.

A new state law embraces what is called collaborative care management.

It's intended to deliver psychiatric or counseling treatment faster, more efficiently and at less cost by integrating or incorporating those services at the primary care level.

And it mandates reimbursement for those services by private carriers.

Now with more on that program joining US cosponsor of the law, primary sponsor Senator Kim Hammer of Benton.

Doctor Patty Gibson, president of the Arkansas Psychiatric Society and Doctor Tisha, Dean of EU AM.

S Department of Psychiatry and director of its Behavioral Health Integration Program.

We thank all of you, Senator, let me begin with you.

What was the impetus for the bill?

What moved this onto the calendar?

I think the recognition that in society today that we have an increasing number of individuals that would benefit from.

Additional or at least identified need of mental health services.

And one of the things that we realized from this with the help of these ladies, these doctors here is that if we can catch somebody at a primary care level that we would actually see savings to the cost.

But greater than that, we'd have an improved quality of life for individuals by having something like this bill that would allow.

For primary care physicians to be recognized or to recognize the need for mental health services, they're going to be compensated to those senators.

So where they explain where the savings are coming from, why is this going to cost less?

Because from experience and from other studies have been done by other programs in other states.

We recognize that if we can have somebody identified earlier that has a need for mental health services and we can get that initiated sooner than later than what we would see is a reduction in maybe the increase of medical medicines.

Or in worst case scenario inpatient psychiatric facilities that cost an astronomical amount of of money.

But it's hard to put a cost on quality of life also.

And if we have people that are mentally in in in good treatment, then other parts of your life such as physical, spiritual, other areas of your life are also improved and that contributes to the overall savings doctor.

There would seem to be a practical advantage in in.

Capturing, if you will, or diagnosing these ills at the primary care level, I'd say at the general practitioner's office.

I'm assuming that's a big part of the motivation here.

Yes, for sure.

Strategy of it, yeah.

And we know I'm the rural Arkansasan.

I grew up in rural northeast Arkansas and.

I know a lot of times things get caught and we see things at a primary care level and then people are able to get support there in a place where they feel comfortable, in a place where they don't feel stigmatized.

And it also builds on that existing relationship that people have with their primary care providers.

Are we equipped in terms of psychologists, psychiatrists, the clinical community that would deal with this?

Are we ready to handle this case loan well, one of the beautiful problem to have, yes, we always we're always have a job.

One of the beautiful things about collaborative care management is that it really stretches our resources.

It puts the psychiatrist or the the psychiatric provider at a consultant level.

So the primary care provider still manages and is in control of the patients.

Care, but they get access to an additional team member.

So that means that person, the psychiatrist is able to manage a much larger patient load and able to help the the primary care physician to manage them.

So we take the resources that we have and we make them, we make them more efficient, right.

So this is kind of a referral situation or one model of it anyway would amount to a referral situation from the primary care or an expanded.

What it really does is it brings a a mental health team into the primary care setting.

So it's team based care and it's whole person care.

So instead of having you go to the one office to get your physical health taken care of and then having to go to a separate business building separate office with separate insurance to get your mental health care, it brings the team into primary care.

So actually the primary care doctor and this could be a family doc, pediatrician, OBGYN.

They actually would have a care manager who's either in their office or available virtually fairly immediately.

Within the next 24 to 48 hours, the care manager could talk to the patient, get an assessment, and then that care manager meets with the psychiatrist as a consultant and then the the psychiatrist gives feedback to the primary care doctor.

So it brings the team so that the patients get all their care and primary care and.

Although the primary care doctor continues to prescribe the meds under the guidance of the psychiatrist and then the care manager continues to follow up.

So patients may continue follow up as needed weekly, monthly over several months until they are better.

The the, the Senator mentioned this that there is as as did your colleague is it growing are we is this a result of COVID but the the demand for psychological?

Psychological or psychiatric services seems to be exponentially larger than it was only five years ago.

Are you?

Well, the interesting thing is yes.

If you look at the statistics, they're all higher in terms of suicides, more depression, anxiety, more overdoses.

But a lot of what the pandemic is done is just reveal how bad the system, how bad the care in the system, and how much.

Need there was already because gaps.

So there's been so much.

There's been a high level of mental health need even before the pandemic and but there's never been enough mental health provider, psychiatrist, psychologist, therapist and even back five years ago if a family doc referred a patient to primary to the psychiatrist, 6 out of 10 did not go so the family doc was left taking care of.

Of them and actually six of them never never got any treatment.

So the family docs treating them on their own what's been what's been the block there.

The stigma that was mentioned earlier or the availability of care or the stigma and the lack of.

I think I read recently there's only 500 psychiatrists in the state of Arkansas and maybe a total of 5000 mental health providers right now like if Senator Hammer.

Came to me and said, hey, as a friend, I'm a senator, you're a psychiatrist.

Can you get me an appointment?

It would still take me probably two to four weeks to get him an appointment and he's going to have good insurance and but there's just not enough providers out there.

And then if you start looking at the whole rural state and people that don't have the insurance that's needed.

So we'll never be able to see enough but what this does is bring the mental health team, psychiatrist, care manager, therapy into with the primary care Doctor Who can provide whole care to the patient.

This is going to be there's there's an expense attached to this senator, there is.

But the one thing we found that was interesting was that all the private carriers, there was no resistance on the part of the private carriers because some of them.

We're already covering these services because Blue Cross has embraced this, has it not And it's one of the larger carriers in state, yes, because they recognize in fact we used one of their cost studies in order to justify why we wanted to do this because they realized from their own studies internally and externally that it actually creates savings to the system.

So you got improving the quality of life you've got.

You've got professionals in the medical field, psychology field all working together and everyone is being reimbursed appropriately or you know to a benefit.

So it's not a, what would I say, it's not a reason not to see somebody.

And so one of the things we realized from the studies was that it actually created savings and we hope eventually that Medicaid will realize that it's also a cost savings and that.

As time passes on and they realize that that we would be able to get get individuals covered through the Medicaid program also.

In fact you had hoped to include Medicaid in this new statute.

We did, right, We did.

But you're having conversations with those conversations continue with the Medicaid conversations are continuing and and we recognize that in you know in the time that we live that.

We, we want to be careful with the budget, but also we realize that if the private carriers have caught on that it is a savings and they are implementing it, then why would we not also include that in our Medicaid Services so that we can see the same results in the Medicaid population.

Let me go to Doctor Dean again to follow up on what your colleague and I were discussing earlier and that's the demand for services, the level of.

Of disorders or complaints that you were saying.

Are you saying this is a practitioner, you and your colleagues, whether it's anxiety, suicidal tendencies?

Yes.

And you know, I think again, like Dr. Gibson alluded to, I mean the the studies do show that there's higher numbers than there were.

So I don't think that we can say there's not more.

But I also think that we are recognizing it more and they were talking about it more.

One of the great things about collaborative care that I think helps some of this.

Need and kind of demand for services is that there's a knowledge transfer.

So I as a psychologist and working side by side with physicians and residents.

At UAMS, we do training in this model with our residents.

And so they get the knowledge that I have.

I teach them about mental health and I teach them how to manage things and the psychiatrist teaches them too and so.

There's actually less need for specialty mental health for people who have higher acuity.

That's great and there's always going to be those.

But we can manage a lot of patients in primary care for fully equipped and that will decrease some of that demand on our more specialty services.

Is this, I'm sorry, is this a mission that the practitioners, the primary, the Obgyn's, the GP's, is this a mission that they what's been the feedback from them so far but.

They'll say is they see so many patients a day that have mental health issues, either recognize that they walk in and say I need help with depression or the doctor recognizes that actually the blood pressure's high, the diabetes is out of control, the sleep is bad, and actually it's related to an anxiety and depression.

And so they struggle trying to take care of these patients because they don't have the full knowledge time.

And experience.

And so that's the advantage of bringing alongside specialists to work with them.

Yeah, I think, I mean getting to the knowledge transfer they learn and we can treat people within primary care and we're also able to help teach people and do preventative care.

And so we're talking about catching people earlier we can help educate people about.

Things to look for, stressors, learn how to manage stress so that they don't get to a place where they are needing to go to the emergency room.

And so that again, is where the cost savings goes in because people are using less services.

All right, Senator, we've got the last few seconds left if you want them.

Always glad to take the last few seconds.

Thank you.

You would close for your bill, if you would.

I would close for my bill, yes.

And I and I want to express my appreciation to the two doctors here and everybody that came together to make this possible.

I think as time goes on, now that we have this in place, that we will see the realized savings from the decreased visits to the ER, the inpatient treatment centers and just really a removal of the stigma.

That will create people to feel free to seek out help from their primary care physician, who for the most part is who people are seeing at the front end.

So why would we not include them in the circle in order to give people what they need help with there?

Senator, doctors, thank you both, all of you, very much for coming in.

Come back soon and we'll be back.

We conclude the broadcast on a somber note, the passing of a friend and colleague, a man who enlivened and enriched each of the many editions of this broadcast on which he appeared over the many years.

He wore many hats.

Hoyt, Purvis, and these were but a few journalist, Assistant to Senators Jay William Fulbright of Arkansas, Robert Byrd of West Virginia, World Traveler, more than 100 countries.

Sports fan who believed baseball was a gift from the gods, an educator and an administrator at first at the University of Texas and then for 34 years at the University of Arkansas, White was an author and constant scholar, a presidential appointee, a mentor to countless students and an inspiration to all who knew him.

He was Mary's husband.

The father of Pamela and Camille and the grandfather of their children.

And he was a friend.

See you next week.

Support for Arkansas Week provided by the Arkansas Democrat Gazette, The Arkansas Times.

And KUARFM 89.