Healing A Broken Mental Health System: Peter Loeb Of Lionrock On 5 Things That Can Be Done To Fix Our Broken Mental Health System
An Interview With Stephanie Greer
Reducing stigma by taking care of people who need it: the federal government unwittingly contributes to the stigma surrounding mental health and substance use disorders.
The current state of the mental health system is a conversation that echoes in the halls of policy-making, the corners of social advocacy, and within the private struggles of individuals and families. As we continue to witness an unprecedented need for robust mental health support, the shortcomings of the existing system become more glaring. It is within this backdrop that we seek the insight of those who are at the forefront of behavioral health. In this interview series, we are talking to behavioral health leaders, policymakers, mental health practitioners, advocates, and reformers to share their perspectives on healing our broken mental health system. As a part of this interview series, we had the pleasure of interviewing Peter Loeb.
Peter Loeb is the CEO and a co-founder of Lionrock Health, the pioneer of telehealth substance use disorder treatment. In his four-decade career, he has worked to drive value in the financial services, entertainment, renewable energy, and healthcare fields. Married for 40 years, he holds a BA from Brown University and an MBA from Harvard University.
Thank you so much for joining us in this interview series. Before we start, our readers would love to “get to know you” a bit better. Can you tell us a bit about your background and your childhood backstory?
I grew up in NYC in a loving family and had the benefit of a great education. I’m grateful for the opportunities I’ve had. I’ve been married for 40 years and have three grown daughters and three grandchildren. I’ve applied my energies in diverse fields. I’ve worked in the financial markets and played in a rock and roll band. I lived and worked in Milan, Italy for several years in the 1980s. I moved to California and worked for SEGA and Electronic Arts in the 1990s. I co-founded Lionrock, the pioneer of substance use disorder telehealth care, after the death of my sister from SUD-related causes in 2010. My LinkedIn is here (https://www.linkedin.com/in/peterloeb/) if you want to see more about my professional history.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My best advice comes in two pieces: “never give up”, and “always have a Plan B and a Plan C”. “Never give up” doesn’t mean just banging your head against the wall, it means staying focused on the goal and adapting to the conditions you encounter as events unfold. Plan A very often fails. Plan B isn’t an assured winner either. Plan C may not be the preferred course of action, but if it gets you to the goal, you win. Make sure to define your goal big enough to encompass all of your plans of attack. It’s easy to become discouraged when your Plan A fails, let alone your Plan B. Accept that you will encounter real obstacles, generate multiple paths to victory, and you’ll be ready for whatever comes your way.
Let’s now shift to the main part of our discussion. It is often said that “the mental health system in America is broken”. What does that statement mean to you? From your perspective what is “broken” today?
The mental health system in America is broken in the same ways all of health care is broken in the U.S., though the mental health system takes the problem a step further by adding the complexities of deeply-held stigma to the mix. Though the “death panels” — about which opponents of the Affordable Care Act warned us — didn’t materialize, healthcare is nonetheless rationed now, in the form of reimbursement practices by the payors. I am a capitalist, don’t get me wrong, but let’s be honest: if the payor’s stock price is the primary driver of policy, then patient care cannot be.
Because mental health in general, and substance use disorder in particular, still carry enormous social stigma, their treatment is an easy place for the payors to look for savings. It’s no secret that existing mental health parity laws go largely ignored and unenforced, and that’s just the start. Because we are a national telehealth company at Lionrock, there is another layer of complexity associated with state-level regulators, and even the federal government plays a role in its inadvertent perpetuation of stigma. It all adds up to the market dynamics we see, which tend to hamper the provision of good mental health care. I’ll go into more detail in my top 5 list.
What about any bright spots? Do you think there are any elements that we get right in today’s world that we wouldn’t want to reverse unintentionally?
When we started Lionrock, the word “telehealth” was not in use, and substance use disorders were simply called “addiction”. Pretty much everyone told us that our live video methodology wouldn’t work. We discovered that the Joint Commision, the famously tough healthcare quality assurance agency, was on our side. They have accredited us since 2012, and their vote of confidence has helped us a lot. Along the way, we discovered that plenty of people who wouldn’t get treatment in brick-and-mortar settings would be willing to seek help online. We discovered that there were real advantages to getting help online and that we could manage the aspects of in-person care we could not provide online. For better or worse, the COVID pandemic catapulted telehealth to the mainstream, and our practice tripled in size “overnight”.
In recent months, we have 1,000 people in treatment at the IOP level of care on any given day, and we employ nearly 200 people. We are spread across America — we’ve been remote workers since 2010 when we started — and have been using Zoom since 2014. If we allow any of the dominant powers — payors, regulators, etc. — to move backward on the acceptance of telehealth for mental health, it will be a big loss for patients who need and want the modality.
Another bright spot is the coming of Psychedelic Assisted Psychotherapy. At Lionrock, we are responsibly pushing forward a telehealth version of this modality that prioritizes safety and whole-person outcomes, and we are seeing great promise. On the business side, we see many of the same challenges we faced bringing telehealth SUD care to market and we’re bringing our experience to bear in working with the psychedelics, which for the moment are limited for us to Ketamine-Assisted Psychotherapy. Despite the counter-culture overtones that surround psychedelics, we should not be shortsighted about their tremendous potential value to society when applied with prudence.
In your opinion, what are the 5 most impactful things that could help heal the broken mental health system? These could be on any level including training, workforce, policy, culture, equity etc.
1 . Greater awareness of what mental health problems are, particularly SUD, would reduce stigma. Stigma around mental illness and SUDs drives two impediments to get help.
First, the general public, many employee benefits managers, and even some healthcare professionals, do not know that most people struggling with an SUD are self-medicating a mental health disorder. 70% of SUD patients have a diagnosable mental health disorder, and sub-clinical issues drive many more SUD cases. Because alcohol and other readily-abused substances are typically associated with pleasure, those people who are not aware of the self-medication dynamic believe that people struggling with SUD are hedonists who lack the discipline to live a “normal” life. People who share this viewpoint are much less inclined to offer coverage of SUD treatment to their employees or treat people struggling with SUD with the normal respect they would offer someone with a physical disability of the same acuity.
Second, people struggling with SUD know that they are disrespected and feel the same disrespect for themselves because they can’t control their SUD. This gives rise to shame that tends to decrease the willingness to seek help for an SUD.
2 . Reducing stigma by taking care of people who need it: the federal government unwittingly contributes to the stigma surrounding mental health and substance use disorders.
In 1965, the federal government passed a law governing Medicaid that contains the Institution for Mental Diseases (IMD) exclusion. IMD prohibits Medicaid reimbursement of residential mental health treatment in a facility with more than 16 beds. At the time, the goal was to treat more mental health patients at an outpatient level of care using new anti-psychotic medications and thus avoid the expense of government-supported, long-term mental health care. It didn’t work. Among many negative dynamics that the IMD engendered is a reinforcement of the stigma associated with SUD.
In many cities across the U.S., we see a growing population living on the streets without shelter. Many struggle with mental health problems, and many self-medicate with substances. These people need mental health treatment. This affects stigma because people struggling with earlier-stage SUD typically can hide their struggle to some degree. Their colleagues at work, their neighbors, and even their friends and loved ones often do not see the problem because their perception of SUD is based on people living on the street. This dynamic holds back an understanding of SUD and a willingness to make treatment broadly available.
3 . True acceptance by employers and payors that mental health/SUD care is worth the investment.
Major studies show that recovery treatment works. If people struggling with SUD get treatment at earlier stages (lower acuity), the benefits to employers are significant, particularly if reducing turnover is a goal.
Moreover, SUD is co-morbid with many chronic illnesses. In 2018, The Department of Health and Human Services published a study that concluded that “Findings reveal a striking pattern of multicomorbidity of SUD and chronic diseases and its positive association with hospitalization. Behavioral healthcare integration should consider efforts to assess and treat comorbid SUD and chronic diseases, especially among adults with multiple chronic conditions.” (Drug Alcohol Depend. 2018 November 01; 192: 316–323. doi:10.1016/j.drugalcdep.2018.08.013.)
Often, employers and health plans favor the medical model when treating SUD, in which drugs are prescribed to avoid overdose, but the psycho-social work that focuses on root cause analysis and treatment is limited. Patients achieve maintenance, but not remission.
4 . Reimbursement rates and practices that reflect the economic realities of providers.
It’s a truism in healthcare, and it is particularly so in behavioral health generally. The qualifications and compliance processes required for reimbursement of clinical professional care are strict, which in turn requires the expenditure of significant overhead and compensation expenses. Even at levels of care proven to be effective and efficient, the levels of reimbursement by payors are too low to adequately fund these expenses. Is this because of the stigma around SUD? I think so.
5 . True reciprocity of state licensure for clinical behavioral health professionals — realizing the promise of telehealth requires it
De facto license reciprocity for behavioral health clinical professionals was a reality during the pandemic, and no lives were lost as a result. This streamlining significantly reduced operational expenses experienced by national telehealth providers like Lionrock. In the aftermath, states have clawed back that authority, and the opposite is true. For medical doctors, The Interstate Medical Licensure Compact streamlines the process of multiple-state licensure in 39 states and territories. Behavioral health has nothing like this, and the diverse state licensure requirements and application processes create an unnecessary burden for telehealth behavioral health companies.
Are there any books, podcasts, or other resources that have helped you understand or manage your condition better?
The Courage to Change: A Recovery Podcast is a resource I recommend to help anyone better understand substance use disorder. Host and co-founder of Lionrock, Ashley Loeb Blassingame, is 17 years sober herself and a certified addiction and intervention counselor (CADC II, CRPS, and CAI). The podcast shares stories about people who have overcome great adversity and trauma, showing listeners that you can change if you want to change and that there is recovery, whether for substance abuse or other mental illness.
How can our readers further follow your work online?
https://www.linkedin.com/in/peterloeb/
Thank you for your time and thoughtful answers. I know many people will gain so much from hearing this.
About The Interviewer: Stephanie Greer, PhD is the Co-founder and CEO of Akin Mental Health — a company dedicated to guiding families on their journey supporting a loved one with mental health challenges like bipolar disorder, schizophrenia and severe depression. Stephanie is passionate about this topic from her own personal experience growing up with a mother who struggled with bipolar 1 disorder and found a path forward to overcome the obstacles and live well. Stephanie’s professional experience includes a doctorate in neuroscience as well as design research roles at Hopelab and Apple. Stephanie brings this personal passion together with her world-class science and technology background to support families across the US in their personal journeys supporting loved ones with mental illness. To learn more about Akin Mental Health and join our community, visit us at akinmh.com.
