Healing A Broken Mental Health System: Tyler Harrell of American Addiction Centers On 5 Things That Can Be Done To Fix Our Broken Mental Health System

An Interview With Stephanie Greer

More training for first responders and the front-line people who deal with mental health and SUD crises every day. We’ve come a long way, but there’s much more to be done.

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 Tyler Harrell.

Tyler Harrell is VP of Operations with American Addiction Centers. With more than 15 years of experience healthcare management and administration, Tyler is also a certified licensed professional counselor supervisor and licensed chemical dependency counselor. He’s passionate about leveraging a holistic approach to treatment that addresses the body and mind through cognitive behavioral therapy, motivational interviewing and 12-step programming.

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 wish I could say I had some deep, meaningful backstory or inspiration for how I got to where I am today, but the truth is, I’ve just always had a passion for working with people who were underserved, misunderstood or lived with stigma. Substance use disorder (SUD) is vastly different than any other disease: you don’t blame people for having cancer or diabetes, but those with SUD are often blamed for their disease. I’ve worked my whole career to change that perspective, first as a clinical psychologist and chemical dependency therapist, and now as an administrator.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

One that’s especially meaningful is Shakespeare’s “To thine own self be true.” This quote is a big part of the Alcoholics’ Anonymous program because it represents the need to be honest and sincere with yourself and your loved ones, to accept your disease and then take charge of it to restore your life and navigate recovery. It represents being mindful of what you do and living authentically and being accountable to your actions. It’s also a reminder that help exists regardless of your status — you just have to reach out and find it.

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?

A big issue is access. People can’t get the help they need for multiple reasons: so many can’t afford it, don’t have transportation or their living situation isn’t conducive to getting help — perhaps they’re homeless or live with others who have mental illness. Physical health also plays a role: how you eat, getting exercise, other medical conditions all contribute to a person’s ability to get help. If you can’t afford nutritious food or are so depressed there’s zero chance you’ll get exercise, that makes it hard to take advantage of help, even if it’s available. There’s also a lack of local availability in a lot of areas and not nearly enough providers to meet demand.

Too often, it’s about the cost. Treatment is reserved for those with insurance, and most everyone else doesn’t get any treatment until they’ve reached worst case scenario — they’ve attempted suicide or had a psychotic episode that got law enforcement involved. They go from emergency to emergency, with no real preventative or disease management intervention.

The prevalence of mass shootings, violence, and homelessness…it’s hard to think those aren’t affected by the lack of mental health and substance use treatment. It’s not the entire problem, but I think most would agree it plays a big part.

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?

One of the brightest spots is that our frontline first responders are getting much better at managing mental health situations. Police training in verbal de-escalation and dealing with a crisis has improved. They’re also thinking first about getting an individual help, rather than locking them up. Unfortunately, our criminal justice system has become the biggest provider of mental health services. Most counselors these days are finding jobs in that system and dealing with the lion’s share of patients that have nowhere else to go. But if they had been treated earlier, the crime that got them there may not have even happened in the first place.

I also think the decriminalization of drugs has helped to some degree, with a focus on treatment first. That doesn’t mean everyone should get a free pass to use whatever they want, wherever they want. But having more emphasis on treatment, rather than incarceration, is important, especially for low-level offenders. Oftentimes, they go to jail and end up coming out in worse shape and greater risk to themselves and society.

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. More training for first responders and the front-line people who deal with mental health and SUD crises every day. We’ve come a long way, but there’s much more to be done.
2. Improving access to treatment through better insurance coverage, including Medicare/Medicaid and state-provided coverage. And, along with that, allowing providers to capitalize on this coverage. The current reimbursement situation is cumbersome and very often limited in both how much insurers will pay providers for services and the duration of treatment they cover. That offers little incentivize for providers to accept insurance (versus only offer private pay) because it’s not financially viable, and most have significant student loan debt. It also hinders treatment outcomes when patients are limited to X number of sessions by insurers.
3. Address the veteran population. There are so many veterans struggling with PTSD, addiction and other mental health issues and they need our help. The Veterans Administration is working hard to improve — namely by partnering with private-practice providers — and we need more of that. This group is so needy of these services and so deserving.
4. Accessibility of low-cost insurance. The nature of their disease means that most people with severe mental health issues or substance use disorders don’t have jobs or much money, so they can’t get employer-sponsored healthcare and can’t afford to buy it on their own. We need to find ways to broaden access to insurance for underserved populations. I’m not necessarily saying nationalized healthcare is the answer, because that can have its own drawbacks, but we somehow need to get more people better access to affordable care to treat the underlying mental health issues before they become severe or develop into addiction.
5. Attract more counselors to the profession. Therapists go to school for six years to become a licensed mental health counselor and have some of the highest debt of all undergraduate degree majors. Yet insurance reimbursement makes it harder than ever to earn a good living in the current economy while repaying that student debt. That’s why many are turning to private pay practices, which only exacerbates the shortage and issues accessing care. We need to provide more incentives — like student loan forgiveness for these disciplines — to attract people to this field.

If all of the items on your list were magically implemented tomorrow, what change might we see in the world? What are the signs (big and small) that would show us that the system is being healed?

I think we could see crime decrease significantly. Robbery, theft, violence…a lot of that is related to mental health issues and crimes committed to fuel addiction. If we could address the underlying issues, that should drop substantially.

Also, the homeless population would shrink. Many individuals experiencing homelessness are suffering from mental health or substance use issues, and it’s hard to imagine they would continue to choose homelessness in a community where there’s adequate resources to treat those underlying conditions.

Overall, I think we’d also see fewer incidents of bad things reported on the news, and that’s good for everyone’s mental health.

What is a project you or others are working on today that gives you hope? How can our readers learn more about this work?

We are heavily focused on broadening our outpatient care. We know that there are a lot of people commonly known as functioning addicts — people with substance use disorder but who still carry on with their everyday life. They have jobs, take their kids to school, etc. just like those without SUD. They only seek treatment when things get really bad — they get a DUI, lose a job or their spouse leaves them.

We want to do more to reach those people before it gets that bad. We’re adding to our Intensive Outpatient Program (IOP) to offer sessions in the evenings and seven days a week, so those individuals in need can get help when it works for them without having to disrupt their entire life with a 30- or 60-day inpatient stay. We hope by making this more accessible, we’ll see people get earlier intervention instead of waiting for things to get really bad. And, I hope that it will help to reduce the stigma around getting treatment. Perhaps if people start to talk about going to treatment or “rehab” more openly, it will become more widely accepted.

How do you see technology shaping the future of mental health care and its accessibility?

The explosion in telehealth we saw during and in the wake of COVID was phenomenal, not only filling the void during lockdowns but even afterward, giving more people access to care from anywhere. But a lot of the pre-COVID restrictions have returned and cut off that access.

I think we need to keep that option open. Of course, insurance barriers still exist, as do issues for some around access to the internet or a phone — many people struggling with homelessness or SUD don’t have a phone plan or laptop for Zoom sessions — but remote care is definitely a step in the right direction. The broad availability of on-demand therapy with mobile phone apps is also extremely beneficial.

One of the things we’re doing to leverage technology is to offer our Connections alumni app to patients. Through this app, patients who have left our in-patient care can contact their peers in recovery, their sponsors or mentors and even reach out directly to our staff for help. We send check-in messages to them, and it provides a channel to get them quickly back into treatment if there’s any indication they might be at risk for a relapse. This support and accountability are helping them to maintain sobriety over the long-term as part of a healthy lifestyle.

In your view, how do social factors like poverty, education, and culture affect mental health care and its effectiveness?

It’s extremely complicated. Different ethnicities and cultures all have different proclivities toward seeking help. In some cultures, the stigma is pervasive — admitting you need help or reaching out is very much a sign of weakness and a source of shame.

At our centers, we see all cultures and all socio-economic backgrounds. It’s extremely important that we communicate that mental health and substance use disorder know no boundaries — every race, religion, income level and culture are equally at risk and affected. But treatment is effective across all walks of life — if you overcome that first hurdle and seek it out.

In light of the growing mental health crisis among young people, what innovative approaches or interventions have proven most successful for children and adolescents?

The most important thing is early intervention and prevention, especially in schools. We must teach kids at a very young age not only that it’s OK to come forward and ask for help, but also teach them resiliency and coping mechanisms so they can learn to navigate the world with confidence and fortitude. This way we can hopefully prevent mental health issues from taking over and becoming a defining factor in their lives.

We are very blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might just see this if we tag them.

My first choice would be the policymakers in our state and federal government who have control over Medicare/Medicaid and state/federal insurance programs — the ones who are the gatekeepers of those funds that can help people get the help they need. Maybe it’s our congresspeople or the president, but whomever has the ability to open up that funding stream and make sure the money is getting to the people who need it most.

How can our readers further follow your work online?

I’m personally on LinkedIn at https://www.linkedin.com/in/tyler-harrell/

However, American Addiction Centers provides an incredible wealth of resources around the trends, treatment and reporting from the field of mental health and substance use. You can find those here.

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.