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

On this episode, Ashley Weiss and Serena Chaudhry speak with clinical social worker, Dr Deidre Hayes, DSW, BCD, LCSW-BACS. Dr Hayes is the Director of Clinical in Community Focussed Curriculum and Training, and a Professor of Practice at Tulane University.

Dr. Hayes is currently co-leading the Empowering Change Task Force, addressing diversity, equity, and inclusion within schools and facilitating connections between medical schools and inter-professional educational programs.

Join us as we learn more about her incredible journey and the changes she has experienced in the diagnosis and treatment of severe mental illness over the years.

Subscribe for more episodes of Reality Check, where we uncover the truth behind mental health, one story at a time.

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

Podcast produced by Red Rock Branding – www.redrockbranding.com

Good afternoon. Welcome to Reality Check. It's Serena here today with Dr. Deidre Hayes. And I'm super excited for today's conversation with you because Deidre was my clinical supervisor when I was training to become a licensed clinical social worker. So we've known each other in many capacities for many years. And today we continue in conversation and in our work with helping young people who are managing chronic and severe mental illnesses. So welcome.

Thank you, Serena, and I'm so excited and so proud to be here with you today.

So I want to start by asking you to tell us a little bit about yourself, what you're doing now and your journey to doing the amazing work that you are doing now and have done over the past many decades.

Wonderful. So I am a clinical social worker. I have been in the field, as Serena said, for many, years. started, my first job was as an undergraduate at DePaul Hospital, and I actually worked on a psych unit. I was 19 years old and I worked on an adolescent psych unit, which is, I don't think they would allow that anymore.

This is one of many things that makes your journey special.

I was an adolescent on the adolescent unit, which is interesting. And so when I started out, I studied psychology. I wanted to be a psychologist. And when I got this job, because I knew somebody who knew somebody on the unit, and I saw the work that was done and the roles, the many roles that people played on these psych units, I understood then that I wanted to be a social worker. I didn't want to be a psychologist because the social worker did the family sessions.

They ran the groups. They had individual sessions with the kids. they conferred with the psychiatrist. They actually took a lead on the team. And I was like, my God, this is what I want to do. The psychologist at the time, and now psychologists have different roles, on the, on on that, on that unit, psychologists did only testing and they did these long reports, individual reports. And you know, they did all of the

the test and they interpreted the test and to me that just seems really boring. Yes.

You like to wear many hats.

I was like, I don't want to do that. So that's how I started. started, I have a psychology degree from Loyola University. Loyola was very close to DeBoe Hospital, so I could zoop from class to work the unit. It was all fun. And when I graduated, I applied for a job at Covenant House and I got the job. And once again, I was an adolescent on an adolescent unit because Covenant House was an agency that housed youth between the ages of 16 and 20.

And they only hired people 25 and older, except they hired me because they said, she's mature. I was like, sure I am. So I got to work at Covenant House at 22 years old when everybody was, some people at the time, Covenant House did not even ask for IDs. So some people were really older than me on the unit, which is funny. Right. And yeah, cause people, they did not ask for IDs. I mean, they wanted IDs and they helped you secure IDs, but if somebody,

needed housing or they needed shelter and they came without an ID, they accepted them and they took them at their word. So it was really a really special place to work. I learned a lot. There were many professionals there who worked to that, you know, Covenant House was their part-time job. Once again, social workers. And so that's what started me on my journey to know that I wanted a master's in social work. At Covenant House, of course, you know, there were many...

kids with many issues, kids who had trauma, kids who had mental health issues, kids who had made quote unquote life choices that parents didn't agree with, and their parents put them out of their homes, and some kids who had lost their parents to illness who had no place else to go. So it was a very special place to work. And it helped me, think what Covenant House taught me was to have unconditional love and unconditional positive regard for the people I serve.

So as a social worker, when I went into the field, because I had the Covenant House experience as a graduate with an undergraduate degree, I was able to take those lessons with me into my professional career as a social worker.

I love the story because I think, Ray, I think it's so important for us to all identify where our values, our core values in work come from. And the fact that you can still name them and identify where you were and what you were doing when they formulated is super, super cool. I'm going to pause you in your journey really quick because you were on an adolescent unit. I forgot this part of your story. Yeah. DePaul hospital. And I'm just curious.

Yes.

for curious to know what you saw at 19.

What I saw was really interesting. What I saw was that the majority of people, the majority of the kids who were in the hospital at the time, as I reflect back on that experience, many of them did not have chronic and persistent mental illness. Many of them were kids who were having problems at home or they had gotten in trouble in school. And instead of putting them in juvenile, they put them in the hospital. And so these were people who had very good insurance. DePaul was not a public hospital.

Interesting.

And many of them had, some of them had personality disorders, but many of them really just needed to have a time out. know, there were people with chronic and persistent mental illness there. And those individuals, just as I reflect with the profound issues, were fewer than those without profound issues. Now, when we looked at the unit that was the military unit, those individuals had more trauma.

and more experiences that brought them to the hospital that were more traumatic in nature. Right? So you had a unit that was dedicated just to military and military insurance. And then you had the adolescent unit and then you had the kiddo unit, right? There were people on our units that there were at least two kids who were adopted kids and the adoptive parents turned the back end and they actually stayed in the hospital for more than one kid was there nine years. So it was treated.

more like a group home than not.

Right, a holding center or a group home, right, as opposed to a treatment facility. That's fascinating.

a week, may that be long enough.

I think we're in this really tricky place with insurance coverage and hospital systems where we've gone to the other extreme and we're not keeping young people long enough. We're not giving them a fair chance at stabilization and launching from the hospital back into their lives. We're prematurely discharging them and expecting them to go back to being a young person in a really complicated and stressful environment.

And then if they don't educate the parents enough, you you have to educate parents about what this disease is and how to treat it and then how to support their young people through that disease. And I find that hospitals, at least in Louisiana now, they medicate in discharge. They stabilize in discharge. And when you ask a parent, like, did you have a family session or did you have a conversation? They will have a phone family session.

Sometimes it might be a virtual family session, but it's not a session that helps to stabilize the household or a session that will help to give the parent confidence in their knowledge of their child's issues.

Right, because you and I both know that having a phone conversation or speaking over Zoom is different than being in the room with someone and creating space for affect. it's a shortcoming of the system presently. Absolutely And it does a disservice to families and young people. Absolutely so back to your journey, but I think it's fun to take pauses to juxtapose what was then and what is now and where we're still falling short. So you go, you work at Covenant House, then you...

I go to Tulane University and I get my master's in social work. And then I went to work at a mental health, an outpatient mental health clinic. It was a state-run outpatient mental health clinic and it was located in between the Desire and Florida housing projects, which was considered one of the worst neighborhoods in the world. They actually did documentaries on it. It was considered a

We addressed it in a way, but we hadn't named it so much. even in terms of child sexual abuse, those things, you had like A Courage to Heal, which was my favorite book in the whole wide world. So you had workbooks and you had books, but it wasn't named so much. It wasn't like this thing that people acknowledged, right? And that clinicians even acknowledged and that psychiatrists acknowledged. It was not a part of the continuum.

Right. So if they didn't acknowledge it, what did they do?

Medicaid, Medicaid, Medicaid. So people got medicated for depression. People got medicated for anxiety. You know, they got labeled. Many, many people were considered bipolar disordered or they got depressive disorder syndromes. Many black people got schizophrenia that, and they were misdiagnosed to individuals who probably were close to the bipolar disorder or trauma disorder. And so what you saw was that, that

These clinics, tried to, I can say that my clinic was a safety place for people. And that's because we were in the middle of the neighborhood. And really because the neighborhood was so bad, I hate to say it, nobody else wanted to come to that clinic.

Your specialized center for residents.

Yes. Yes. And so they could come, they could come, they could say, I need to go to charity, which was our go-to hospital when people wanted to be admitted. And they got, I think they got a really good level of care based on what we knew then. Funny story, because I was new out of school and I always told my students, when you are a student, you sometimes know more than the people where you're going to work because you have, have learned the most.

recent evidence-based practices, right? You have the knowledge of the most recent research and interventions. And so I came there and I tried to do a group for women and women who had experienced trauma. was one of the best and worst experiences I ever had because I can also say that because I didn't know a lot, I made a couple of mistakes here and there, but it was really a good group. And when we started that group, there was another man.

housing.

about it.

who was a male and he started doing a group for depressed men, which, you know, back in the eighties and nineties, men would never acknowledge depression. Right, right. They would not acknowledge depression. They might acknowledge anger, but not depression. And so he did the group for depression, but we were both the newest people in that clinic. were the most newest graduates, you know? So we got to do our little stuff, which was fun, you know? Yeah.

Very.

Yeah, so I think progress is that we can acknowledge now, and we do acknowledge and diagnose trauma in the clinical setting and around the spectrum. And we can more clearly see and understand its role in the progression of mental illness.

Absolutely.

And I think that is a good thing because as we know in stressful environments and excuse me, in stressful households, trauma is a contributing factor to psychosis definitely and chronic and severe mental illness.

Hmm.

And when young people experienced psychosis along with trauma in the household, that makes it just so much more difficult for them to progress.

Yeah, absolutely. So progress on one part. We're naming something that has been there for a long time. Yes. All right. So if I remembering correctly, at some point in your journey, you worked on an act and fact team.

Yes. One of my favorite things to do. so act as assertive community treatment. In fact, as forensic assertive community treatment, it is an intervention that started out, I want to say in New York, but it could be California. I'm not sure which one, it was a, it was a big state and they actually understood that individuals with chronic and persistent mental illness need lifetime support.

So tell us a little bit about that.

They may not need intense support in a lifetime, but they need lifetime support. And so when the ACT and FACT teams were formed, they were formed for life. So once on an ACT team, always on an ACT team. You had a hundred members on your ACT team and you had 10 staff and each staff person represented different roles, including nurses, psychiatrists, social workers. You had a housing specialist. had some ACT teams even have nutritionists.

and trainers on them, the PAC teams they're called. Yeah, the PAC teams, they can be specialized, but they have different roles on these teams and the person is seen at least four times a week. And if they're having an episode, they're maybe seen seven times a week in an effort to prevent a hospital. Right. And so you get, you see these people, you create a treatment plan for them, you help them stabilize in housing, understanding that they can live alone.

station.

if you provide them with the support, right? And so the ACT team is a really great thing. I think once again, we come back to the pendulum swinging that now insurance companies are, once the person reaches stabilization, they're taking them off the ACT teams and giving them a lower level of care, which then sometimes in some cases causes the person to have another episode or have another issue.

destabilizes them.

Yes. So that's part of the problem. Once a person, first of all, if a person is chronic and persistent mental illness and they had not received treatment in a while, just building a trust takes so long. It takes a long time to build trust. When we first started, we could, we had 90 days to engage, which means we had 90 days to build a trust with that person. it's not, but now they have two weeks.

not a long period of time.

Yeah. And which is nearly impossible when you're trying to establish trust with someone who is paranoid and or right. Right. Anxious, socially anxious, right. That there are multiple barriers to doing that. And it's a really unrealistic, I think talking about the pendulum swinging and the people being kicked off, I'm going to say, act teams.

transfer to a lower level of care really undermines what you just said and what we at Epic believe to be true that if someone is diagnosed with a chronic and severe mental illness, is a diagnosis that is likely going to stay with them over the course of the lifetime and they need support over the course of the lifetime. We've made an active decision at our clinic not to.

discharge people unless they want to be discharged. It's not about just treating people for their first episode of psychosis. It's treating them after and beyond and throughout their lives. And so from a systems perspective, where and how can we make changes? What can we do to advocate for the changes that need to be made to support young people over the course of their lifetime?

Well, I think one thing is, is to start listening to clinicians because we are in a position as clinicians where we listen to insurance companies, right? And so the system is upside down basically. that's in medical care as well, right? If I am the doctor and I said, my patient needs this, then me who has a relationship with the patient should be the primary place person who makes the decision.

and not a person who's on a computer looking at algorithms. Right? So I think that's the first thing. The second thing is to have care that's more accessible. I think here in New Orleans specifically, you know, we don't have an adolescent hospital that is local and convenient to the clientele we serve. I think that's a huge thing. We used to have one, NOAA, it closed. And it wasn't the best hospital, but...

It was what we had and now we don't have anything.

Right, right. And sometimes something is better than nothing. Yeah.

And when you're talking about parents who don't have transportation, who can't get to their kids, kids who are being transported in a way to me that is not providing safety and sanctuary to these children, you're either providing medical transportation or an ambulance service to a hospital that's unfamiliar to a child in a place that is not their home where their parents cannot get to them. That's further traumatizing for a child.

Absolutely.

You know, so that, think that's all of those things need to be talked about and discussed and we need to really, really, really connect the dots. And it doesn't take a rocket silencers to do that.

It just takes someone who's willing to pay attention and call a spade a spade. And really, right. So any other part of your journey that you want to highlight that's brought you to the present moment?

Right.

Let's see. I also did a lot of substance abuse treatments. So I did substance abuse treatment. I worked with crack addicts back in the early nineties, I guess in the early nineties. one of the things I did at that particular agency was counsel children of substance abusers. So once again, even though the trauma wasn't named, the trauma was there and recognizing and acknowledge that intergenerational trauma.

And so it was like one of the first, guess, two-gen programs because it did house, it did allow women to have their kids on site with them. so we, we did a lot of connecting families back together in that program. And, and it was a really odd program. It was a religious program. And so it had its issues as well, but I can say that, you know, during that time, people did not acknowledge co-occurring disorders, believe it or not.

And so, I guess we're really tracking the progress we've made. Yes, I know. So at substance abuse centers, they did not allow people to take their psychotropic medications. Which is so interesting.

This is fun.

Yeah, right. When we know why a lot of people are using, right, to manage their...

There are and so we did a lot of work there and we did take co-occurring disorders and we did work with the clinics. There was a new one center for addictive disorders and there was the mental health clinics that was separate, but now they're under one umbrella, the behavioral health system in Louisiana, but then they were separate and they didn't talk to each other. And to further state OCDD, which, which service individuals with intellectual disabilities.

didn't talk to either one of them either. So none of them talk to each other. None of them acknowledge the fact that co-occurring disorders existed, which is really interesting based on what we know now. And so to know now that those systems are connected and there is at least some discussion between systems says a lot.

Yes, no it does. And I think that is another great milestone and marker of progress. I believe at least in the work we do, there is more to be done in getting systems to talk to each other. We talk often about the genetic risk for young people with a psychotic disorder. And if you have a first degree relative or if you have a family history of psychosis, you should know that at a very young age, pediatricians should know that they should be able to have that in the chart to then watch.

HUH?

for changes in behavior, perceptual differences, so that we can catch young people early when things are changing for them. And then try and prevent them from ever converting to psychosis and prevent them from going to the hospital and during a trauma and traveling down a path that they don't need to travel down. getting pediatrics to educate families at an early age about mental

wellness and mental illness.

Absolutely.

And then I think the other place in space where there's room for systems to connect our schools, right? We were just speaking with another guest on our podcast about the need for middle schools, high schools to really be educated about in our situation, psychotic disorders, and to know the vulnerability of the young mind and 16 to 25 year olds being very vulnerable to developing their first episode.

If you are a caregiver, a teacher, an educator, a pastor, working with young people, you have to have a bit of knowledge about this or know where to turn. So I appreciate and am excited about systems talking in the context of co-occurring disorders and still see that we have a ways to go.

Absolutely. Absolutely. And you know, one of the things that I was listening to a young woman on the last, I think the last podcast we did, one of the things that she said was, my mom educated me about my dad's illness. And so when I felt the symptoms, I knew what it was. And so, and that gave her power.

Yes.

Yeah. And so that to me just says everything. Yeah.

She is a powerful young woman and she has, from my perspective, managed herself well, put herself on a road of recovery, which is not smooth and linear, right? There are going to be bumps along the way, but she is an advocate. She's in tune with herself and her symptoms, and she's out in the world living a full life, which is what we want for all these young people.

Absolutely, and it's possible.

100%. Yes, and speaking of young people, so we're treating them, but also teaching them. And so I want to bring us up to the present moment before we close and ask you to talk a little bit about the teaching that you are doing now and have been doing for the past many years.

Many years at this point, huh? Yes. So I am at Tulane University. I'm a professor of practice at Tulane University. I'm also co-chair of the Empower and Change Task Force, which is a task force that works with community issues, clinical community issues. So we bring a lot of trainings to the school and to the students, as well as we look at curriculum and how curriculum, how our curriculum can be the most evidence-based, the most progressive curriculum as it relates to clinical community work.

So that's what I'm doing now. also provide supervision for individuals who work in the community, which I love because it keeps my foot in that door of knowing what's going on in different agencies and what the issues are for young people right now. And I think many of the young people who are working in the system and in agencies are having issues like with resources and some of their frustrations lie in the fact that their systems are disconnected.

Yeah, yeah.

But they're learning evidence-based models like Children's Bureau. They are really doing really great work in terms of how they treat children and how they approach the work that they do.

Yeah, we do have a lot of resources in our community that are doing great work. Children's Bureau is one of them. So I think that's important to acknowledge. And I love that you're in the classroom and doing supervision. was a beneficiary of your supervision and this, you know, benefiting from all the wisdom that you've gathered over the years. So I think it's great that you're still doing it and providing inspiration to new social workers. So I do want to end on that note. And I'm curious what

pearl of wisdom or advice you would give to someone contemplating or inspired by entering the profession of social work.

Well, I think this is a great time for creativity in this profession of social work. The work that you guys do at Epic NOLA, it was a gap in services that you identified and then you chose to put your resources in place to fill that gap and look at how much you've grown. Right. And that is such a great thing. And just like you identified that gap and you were able to put a program in place.

that is based on evidence, but that is based on what we know and the feedback of the people you serve, right? I think that makes all the difference in the world. So I think if the words of wisdom would be go in, don't get frustrated, see where you can create and add something to the body of work.

love it. Thank you so much. Thank you for taking us on the journey of your life and sharing it with others. All right.

Thank you, Serena.