Welcome to the Reality Check podcast. Psychosis is Real, so is Recovery.

On this episode, co-founders Dr Ashley Weiss and Serena Chaudhry speak with (their boss!) Dr John Thompson, a professor at Tulane University School of Medicine. Join us as they explore the treatment, systems, and funding around psychosis treatment.

Dr Thompson is Chairman and Professor of the Department of Psychiatry and Behavioral Sciences at Tulane University School of Medicine in New Orleans. He is also its Director of Forensic Neuropsychiatry. In addition, he is the founding Director of the Tulane Fellowship in Forensic Psychiatry and is the Clinical Director of Feliciana Forensic Facility, a 700-bed forensic hospital in Jackson, Louisiana.

For more information about Clear Answers to Louisiana Mental Health (CALM) and their Early Intervention Psychosis Program (EPIC NOLA) visit the website: www.calmnola.org

Ashley: I'm dr. Ashley Weiss. I'm a child adolescent psychiatrist. And I'm Serena

Serena: Chaudhry. I'm a clinical social worker.

Ashley: We are the co founders of Epic NOLA, which is an early psychosis intervention clinic in New Orleans. And also the co founders of CALM, Clear Answers to Louisiana Mental Health.

Ashley: So welcome to this episode of Reality Check. I'm Ashley Wiese. Hi, and I'm Serena Chaudry. And today we have a very special guest, one of my personal mentors, but also our boss, Dr. John Thompson, who is the chairman of the Tulane Department of Psychiatry and Behavioral Sciences here in New Orleans. So thank you for being here.

Ashley: Yes. So one of the things that we wanted to talk about today is the gap in care. Serena and I working in early psychosis and you having such a big part in long term care of people with more chronic psychotic disorders. We'll get to the gap part, but I think at first just to hear about your journey of even becoming passionate about this area of medicine, this area of psychiatry.

Dr Thompson: Sure. I had no idea I was going to be a psychiatrist when it all first started. I was an x ray tech in the military and thought I was going to be a radiologist and then hung out with a radiologist for a little time and realized that I enjoyed talking with people more than taking pictures and trying to diagnose things by x ray.

Ashley: Being in the dark room.

Dr Thompson: And in my third year, I met my first manic patient in the throes of mania. And for those of you who don't know, sometimes patients when they're in the throes of mania, they get into what we call hypergraphia and they write and write. And he asked for a pencil and a piece of paper in his room that he was in.

Dr Thompson: And we came back the next morning and the entire wall was covered with hypergraphic writing, including the ceiling, which required him to stand the bed on its side and stand on the bed because it were. 10 foot ceilings. And the entire ceiling was covered in, in pencil writing of various delusions that he was having.

Dr Thompson: And that doesn't happen with every person, but it was, it was life changing for me because I said, this is really what I'm interested in. And then when I became interested in forensic psychiatry, it was also to treat patients at the state forensic hospital at University of Florida, where I was, I spent my.

Dr Thompson: Fourth year of, uh, training, taking care of about 45 or 50 guys in the forensic hospital where there are a lot of folks with severe mental illness and just really enjoyed that. So that's, that started it, and I've been engaged in taking care of those folks ever since.

Serena: Yeah. I'm curious, you've been doing this for a while, what keeps you going?

Dr Thompson: And placing them in various state hospital systems, primarily in Louisiana, but around the country to take care of the population because in the forensic system, you typically are taking care of folks that end up in an inpatient type facilities. But then we also transition them out in the communities, teaching doctors how to treat them both in the acute setting, the chronic settings, and then how do we transition folks safely out into the community where they can function in society.

Ashley: And so I'm just wondering how you personally manage that. Yeah,

Dr Thompson: it is. I think oftentimes we don't really think of schizophrenia or bipolar disorder as brain disorders, but they truly are. And so it was a lot of popular press about neurosurgery and operating on brain tumors and all the expense that goes in that and the work that goes in that And then you see these young people in their 20s and they have a diagnosis of schizophrenia and they start to lose their ability to love their parents the way they used to because they have affective dysregulation and they can't necessarily connect with them in the way that they used to.

Dr Thompson: They don't really understand what's happening to them. They don't understand why other people don't see what they're seeing in their delusions and sometimes in their hallucinations. And so They aren't on the same page oftentimes with their caregivers and their family members. They're trying to help them and they see those people as being foreign or alien or are not really wanting to help them.[00:07:00]

Dr Thompson: And so it's, I think it's really difficult when you see parents that have raised a child to teens and then 20s and then this disease starts grabbing hold of them and they feel they're losing their ability to reason with their kids. That's probably the hardest part.

Serena: What? So there's been a lot of progress in the last several of decades.

Serena: And I think the fact that Epic NOLA exists is an example of the progress that's been made in helping to treat young people when they're experiencing their first episode of psychosis. What do you think have been some of the bigger gains in the last couple of decades?

Dr Thompson: Yeah. The, obviously we're going from the, a lot of dirty medications to cleaner medications.

Dr Thompson: And it's something that I used to do back in the day instinctively is. That I see my patients more frequently, I talk to their family more frequently, I try and help them with social issues more frequently. Those kinds of things really back when I was practicing in many of the mental health centers it would be they go in, they get their prescription and you sign them up for six months to come back and do the same thing.

Dr Thompson: And there's really not a whole lot of contact with them. So you can imagine you're out in the real world and you have a mental disorder that Maybe increases your level of paranoia and you're trying to talk to somebody about it or and you can't really talk to anybody about it because every time you talk to somebody about it, they go, I don't know what you're I can't understand that.

Dr Thompson: And I don't think patients with chronic mental illness have really had that available to them. Even, even in private practice settings, oftentimes there are long gaps between their treatment and the family is stuck with negotiating what's going on with them. And so it's all in the lap of the family.

Dr Thompson: There's a lot of organizations that have been out there for a long time to help with those issues, but it's great to see the psychiatrist and the psychologist and the social workers stepping up to the plate and saying, I really need to spend more time with this patient. Rather than just looking for the magic pill that's going to fix whatever symptom they're having on that particular day.

Ashley: And like, that's what. We learn from like, we've learned about this degenerative. Potentially degenerative illness through watching people with really with a lack of care and the belief that you don't, you won't get anything from psychotherapy and the acceptance that these people are going to end up in the hospital.

Dr Thompson: Or even the idea that you would use a mindfulness therapy, teach somebody how to meditate, right? We would, when I first was training, the idea that you would teach somebody with schizophrenia, how to meditate, they would. Um, and I, I remember just figuring out on my own and when I would say, Hey, I was at the VA and I'd say, Hey, I need to see this guy like in two weeks and they'd like, two weeks.

Dr Thompson: So we got, we'll have to see more frequently. And that was unheard of. And I was just working that out on my own, it seemed to make sense to me. And so now we have good evidence and data that shows that you really have to be thinking of the whole person. And we have to be using strategies that include mindfulness, behaviors, yoga, things that help people to calm themselves and calm their mind.

Dr Thompson: How do you learn ways to calm that down without necessarily a pill is going to calm it down for a half hour, 45 minutes, but you're living with it every day. And how do you practice that? So you guys do a great job of teaching that skillset. to the patient population. And for the first break guys, I think it's, that's always the hardest, right?

Dr Thompson: They're most confused. They really don't understand what's going on. They're not really sure what is

Ashley: such a pivotal part of their life.

Dr Thompson: Yeah, sure. A big part.

Ashley: When you mentioned intuition, I love that because like your intuition is to be there more for the person, spend more time with them, develop a connection with them.

Ashley: His family didn't understand what was going on. And we're judging him in like a religious way. And

Dr Thompson: so

Ashley: I just was like, Oh, I got to talk to them and let them, I got to tell them what's really going on. And then like his job was like, gosh, if they would just give him like a 15 minute break, it would be so much better.

Ashley: And then he went out to see his friends and his friends. Yeah. You know, we're worried about him and I was like, shoot, I got to just give him some context to help them with their friend. And I was just like, what am I doing? I'm doing this like thing that totally makes sense. And then I got on a pub med and I was like early psychosis and then came upon this wealth of knowledge, but it is very intuitive.

Ashley: It's not rocket science.

Dr Thompson: Right.

Ashley: It's like really good care.

Dr Thompson: Don't do that. One of the things forensics teaches you is don't like once you got the patient, don't let go of them.

Ashley: Oh wow. Yeah. Because

Dr Thompson: if there's any kind of court order where you can help. The person by either bringing them before the court so the court can say, Hey, you need to follow this plan or whatever, or you can get them onto longterm injectable medications when it's appropriate.

Dr Thompson: This is horrible. And yet, because of the awkwardness of dealing with folks that have chronic mental illness that are don't necessarily want to engage in care at times allows a lot of. Sort of ignorance because it's difficult to deal with it. That's what we do it being a doctor's that it's not easy We just difficult right?

Dr Thompson: Yeah and being a care provider and mental health. You have to really Go in there and do it.

Serena: And you do it and you do it over the course of a lifetime. I think keeping people in care is recognition that there is a life to be lived and it's worthy of living. Right. People deserve to be supported along that path.

Dr Thompson: Because I, I always teach people that psychosis is like a dance, and it's from taking care of your patients. They may go, a guy may go, that Bible verse is popping into my head again, that always pops into my head when I first start getting into trouble, and then it allows you to. Do an intervention. But if you don't know your patient well enough, you may not know that's the first sign.

Dr Thompson: And sometimes that takes longer than they expect or they want.

Ashley: Yeah. Yeah, so. On the issue of systems and not everybody with severe mental illness is going to end up in the forensic system. Thank God. But a lot unfortunately do and trying to avoid that is. Avoid it from the beginning is so important because once it seems like gosh, once anybody has any kind of charge, even if it's just for trespassing, it's so hard to then move forward and get a deal with the lawyers and get it taken care of.

Ashley: And I guess just thinking that you work at that end of the spectrum, we work at this other end of the spectrum. And what would you say? What would your argument be to all of the stakeholders out there that hold the purse strings? So to speak. where there's funding lacking to actually give a what about giving these people a chance.

Dr Thompson: in the acute hospital. So it's not only the stakeholders, it's up and down the chain that folks are, it's a gigantic problem that it takes community leaders, it takes judges, it takes the leaders that have control of the purse strings, all of those, all of us have to come together to make a big difference.

Dr Thompson: But I think we need navigators with patients that have these difficulties so that they know what the resources are and they could plug people in the resources and plug people in the support to their family. The funding, even though we're seeing a lot of mental health is important since the pandemic, I think These folks have a different kind of mental health issue that's much more commute, much more severe and much more acute.

Dr Thompson: And so you have to really bomb it with resources to make a big difference, but in the long run, it makes society better. You know, schizophrenia and bipolar maybe represents 1 to 2 percent of the population when you add it up, the most severe ones like that we typically get to take care of. But the economic burden is gigantic when you think someone's life shortens.

Ashley: How is it not something that like people care about?

Ashley: I don't, it's mind boggling to me because like you mentioned, if any other, if it was a heart condition where you have a 20 year reduction in life expectancy, it would be this whole big thing. Like, how is it? Serena and I talk about this a lot, that the writing is on the wall in our society or societies across the communities around the world about what happens when you don't do anything.

Ashley: Like, why is it this, why is it so hard? It's mind boggling.

Dr Thompson: And so I, I think, and many of the original researchers were neurologists in the first place because they weren't really psychiatrists. We were alienists back in the day, which tells you a little bit, right? And so we're alienists and our patients are still alienated at some level, but it's. It, one of the things that, as a psychiatrist, one of the things you note when a patient has schizophrenia and has, is, is that there is an oddness or a disconnectedness with and how they relate to you.

Dr Thompson: And when they're different from you or odd from you in any multitude of different ways, from the color of their skin, all the way to what they may think politically, to their religious beliefs and everything. It makes it more difficult for us to have human interaction with them. And so I really think that part has always been difficult is that even though we know it's a brain issue, we know the parts of the brain that deteriorate and schizophrenia over time and a certain subset of that population.

Dr Thompson: And yet it still may be difficult for us to sit down with a person with it and relate to them and try and help them.

Ashley: It's yeah, I, I totally agree and at the same time though, I think about it's difficult to sit down and speak to people with Alzheimer's,

Dr Thompson: you know, and then,

Ashley: should cross. Should cross fields and cross

Serena: illnesses. So sad. And the spectrum of life from younger to older. And I think there are these moments of discomfort when people are having difficulty connecting with someone who is odd or behaving odd or oddly or differently. It really requires a level of self reflection for the individual.

Serena: What can listeners do? What can they do to help move us in the right direction?

Dr Thompson: They certainly there's There are tons of great foundations that are out there that really do spend a lot of time developing the kinds of things that you guys are developing as well. The National Alliance for the Mentally Ill, there's lots of foundations that I think that they can contribute to.

Dr Thompson: But I just think being open to, in general, just being open to How do I contribute? Whether I contribute by being a part of the solution and volunteering or just reading to understand mental illness more or understand psychosis more. It's easy to say I don't really want to deal with that because a subset of this population possibly could be violent or they're odd or it's going to make me feel uncomfortable.

Dr Thompson: And my dad, we have to really support him. to get him support. I have a, one sister goes one day, the other sister goes the other day. Luckily, they had seven of us. And, and I take them to lunch on Thursday when I can manage that. And then we have some help coming into the house to keep mom at home. But as she progresses, she could easily have very similar symptoms to patients with schizophrenia where she has hallucinations at night and gets scared.

Ashley: Yeah. And I think just the. It's ironic that it all comes back to like our own self reflection and how we're going to deal with other people. And, but yet we will sometimes judge the other on how they're presenting to us when our own perception is everything. And it's been, it's so cool that like in clinics sometimes and in groups, I'll hear people in group even saying that, or I'll hear my patients tell me about being in group.

Ashley: And they would be like, Oh, this person. They did this and I was like taken back and I thought it was odd and then they're like, but then I was thinking maybe I'm just misjudging this as I probably did something odd at one time too. Maybe I'll just go say hey to him. And I'm like, that's such a beautiful basic life skill, right?

Dr Thompson: Right. And my mom every once in a while, cause she's a, she's a very wise woman and she's 91.

Dr Thompson: So if you lived in 91, you can't be too dumb. And so we'll be sitting there thinking she's completely out of it. She's not really getting what's going on. And some. insightful statement just pops out. And so we started writing those down. And so, and I think you can do the same thing for your patients. I was always amazed by, I remember this one patient I had, he had, he wasn't quite schizophrenic, but he had such horrible OCD that it looked like schizophrenia at times when we were dealing with him.

Dr Thompson: And I'm like, if Mr. So and so can come up with that as a positive thought for the day, I sure can keep those positive thoughts with me. We always learned, I think, from our patients as well as taking, helping to take care of them.

Ashley: Yeah. Every day. Any last things you want to talk about, Serena?

Serena: No, I think it was a great conversation.

Dr Thompson: Super. Thanks for all the hard work you guys do.

Serena: Thanks for the hard work that you do too. Thank you for supporting us and doing it.

Dr Thompson: All good. And this is a cool podcast. Y'all have fun with it. I hope it grows.

Serena: Yeah, we'll see. Okay.

Dr Thompson: Hang in there.

Serena: Bye. Thanks. Bye. Until next time. Thanks for taking the time to get your reality check and remember psychosis is real so is recovery