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 Dr Vinod Srihari.

Yale Professor, Dr Srihari is the Director of the Connecticut-based Step Learning Collaborative, including Mindmap. In this episode find out what sparked the inception of CALM and Dr Srihari's impact. We also explore the stigmas around psychosis and the importance of exploring alternative ways of reaching people through innovative and experimental marketing strategies.

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

You can connect with Dr Srihari via the website www.mindmapct.org

Ashley: adolescent psychiatrist. And I'm Serena Chaudhry, I'm a clinical social worker. And we are the co founders of Epic NOLA, which is the Early Psychosis Intervention Clinic in New Orleans, and also the co founders of CALM, Clear Answers to Louisiana Mental Health.

Vinod: Good. Thank you.

Vinod: That's very kind and not true. I wasn't the first to just start it single handedly, but, but I appreciate the sentiment.

Serena: Yes, we hold you in very high esteem.

Ashley: In fact. I tell the story to all of my medical students who ask me how to find a mentor. And I was like, Oh, you just cold call them. You just search what you want.

Ashley: In fact, you could find a really good article online and just. Start email stalking the author and eventually they will write you back and have a call with you. And they're like, no, I'm not doing that. And I'm like, really? That's what you do. And that was on. What was the old software? I think it was Skype.

Vinod: I think we had a Skype call. It was a

Vinod (2): Yeah,

Ashley: so that's my advice and I appreciate you answering the Skype call.

Vinod: Well, not many people start with a phone call and then build an entire clinic and proceed from there.

Vinod: So it's, it's been really a pleasure to watch and be privileged to be involved in the story at Epic NOLA. So kudos to both of you and your team.

Ashley: Well, thank you. And we thank you in our mind every day. So I want to hear what. In your mind was, because I can't remember, it's been like 12 years, your impetus for building Step.

Vinod: And there was an expectation as a junior faculty person that you were going to develop an area of work of scholarship of your own. And other than knowing that I wanted to work with people with schizophrenia, I didn't really have it. A clear idea of what that would be, and it turned out that Scott Woods, who had been running a clinical high risk program for many years, had previously tried to start a first episode program for those individuals who had converted or, you know, transitioned to psychosis and was very interested in trying again.

Vinod: But I think Scott's nudge was very useful because it, it forced us to think about what we actually wanted to do and write it down. And once we, we had to write it down, it almost made it more real before it even was the case. So it got things moving faster than I think I would ordinarily have done it.

Vinod: So since then, I've sort of feel like I've been solving. different problems, but it's, it feels like it came from a kind of mix of luck and being in one place and arriving in a clinic with not a clear plan. So for people who are wondering how to get from A to B, I think my, my approach was. Moving from one point to another that made sense in the moment, rather than having a grand plan and then, you know, seeking it out and

Ashley: see Serena, we learned that from you and we learned that it was okay to have multiple iterations based on experience.

Ashley: Absolutely. Uh,

Vinod: Going to be mad if you have a group of people who already want to solve the problem to begin with, and it's and they're unlikely to be stopped just with a lack of funding. So, in retrospect, I think that was the key driver is that there were a bunch of us who just wanted to do something about the problem, and I think I just got picked to be the person who would.

Vinod: And I think that has remained part of our DNA and step. And it only began because we needed to get grant funds because we couldn't find other ways to fund the clinic. But since then it's become part of what we do, because we find that it's a way to sort of demonstrate to ourselves that we're having an impact, but also to.

Vinod: Demonstrate to others that we're, we care about whether or not we're having an impact in a very concrete way.

Serena: And you give yourself space to address the gaps and to improve the quality.

Vinod (2): Yeah, exactly.

Serena: So I'm curious. So in this journey that you weren't necessarily set on leading, but have become the leader in, at what point did you consider and then connect with RedRock to create MindMap?

Vinod: And there were 2 problems with this 1, it was just taking too long to assemble these groups and we didn't have the time to do this in a 5 year grant. But second, we were getting people in these groups who did not represent the target group we were trying to reach because by definition, for a variety of reasons, they had already declared themselves to be informed about or affected by psychosis.

Vinod: And we were designing a campaign to reach people who had not been identified as having psychosis. And I, I got the sense, the strong sense that what they were telling us to do was not actually going to be the best way to reach young people with these illnesses. So, for example, advising us to not use words like schizophrenia or psychosis.

Vinod: And I ran into Glenn at a meeting with a clinic in one of our target towns. And I heard that he had been running a campaign for them around, I think, reducing problematic drinking. And I struck up a conversation and I discovered that he was really easy to talk to and I got the sense he'd be easy to work with.

Vinod: And then I started sort of seriously reading up on marketing and social marketing to try to think about a way to justify how I was going to describe how we were going to do this to my academic peers. Because I didn't know anything about marketing and it felt to me somewhat illegitimate to be selling our services as if it was a product.

Vinod: Try this message. If it didn't work, try another message. And it also was free of kind of ideology, I would say, about how people change their behavior. So I think there's a certain educational ideology that might come from educational psychology. Or even clinical psychology where the, the idea is you educate someone that they have an illness, you let them know about the value of treatment.

Vinod: And then they get motivated to call the number and come for care.

Ashley: It's just that easy as if,

Vinod: But there are many of these models, you know, trans theoretical models where you are different stages. And on the other extreme is the law, which is, I don't care what, you know, I think if you don't change, you're going to go to jail and that's another way to, but marketing, I feel like sits in the middle.

Vinod: Where it's a strategy to persuade people to do something without forcing them, but also without requiring that they be enlightened in order to purchase the product that this seemed to me to fit very well with young people who don't want to come for care. They don't like what you're selling, so you need to sell them a bit on it.

Vinod: So I gradually became more comfortable with the idea and then I started working with Glenn's team and the social marketing approach provided a kind of theoretical background to enable me to then more comfortably embrace. The various ways in which a marketing firm like Red Rock can deploy different ways of messaging and so on.

Vinod: So I had to go through a bit of a journey in my head, but I think the actual practicalities of working, it was a lot of fun. It was very creative work. Many different ideas could be discussed and tried. There was a refreshing lack of shame for failing because we produced lots of. In messages that didn't go anywhere, that didn't land, that's the nature of communications at a mass level where you don't meet your audience.

Vinod: You just are messaging out into a mass market and you have to try many different things and hope that some of them stick for some people enough that. You see a reduction in delay. Long answer to a good question, but sorry for going on.

Vinod: It was a learning experience. And I, I don't, I think there are obviously other ways to do campaigns to reduce delay. And in fact, if you look at the literature, as I know you have, there is a preference for a theoretically based approach that. Is tied to a certain model of behavior change in which one does one thing measures whether it changes that thing, whether it's attitudes or knowledge and then hopes that it measures and changes behavior.

Vinod: And so it's a different And that's another reason why it was easy for me to sort of feel confident abandoning all these more respectable theories of change that as clinicians, we all feel like it's hard to give that up because what are you doing? Then you feel like you're doing random things. But in fact, if you look at the success that the advertising industry has had and getting people into.

Vinod: certain kinds of clothes or certain kinds of glasses who all believe they chose it when in fact they're all wearing similar things at a similar time. So it couldn't have been such an individual choice, right? So this would be doing that kind of thing, but in a service, in service, hopefully of not a commercial goal, but a, but a public health one.

Vinod: And so what we're left with then is a very pluralistic sort of flexible approach to messaging across multiple channels. But then what we have to do then though is be very careful about measuring impact because. If you can't measure a lot of theoretically driven intermediate outcomes, you at least need to show that you changed the outcome you care about most.

Vinod: But because we were able to reduce DUP and do it in a way that made it very hard to argue that it was a chance reduction, you know, we had a control site, we tracked other events, you know, it was very hard to say this just happened randomly. I think we've established that something about our campaign was involved in reducing it.

Vinod: And now what in our campaign is a different question that actually I don't have an answer for, but I also think. It's not a question worth answering, so, so we're proceeding with the kind of the kitchen sink social, you know, multi modal approach to continuing to reduce delay. And constantly measuring it over time to make sure we're going in the right direction.

Ashley: I have to go like figure out to make it. easier or try to, it's just so difficult. The, that first moment and unfortunately that first moment is a really long time in most people's life thinking about DUP, but I will say selfishly that the idea, but being financially responsible, the idea of working with a group that already Same language as what we were trying to do felt really comfortable and that I wasn't having to sell [00:19:00] anybody on this idea that this was really important, you know, wasn't having to go out and pitch something to marketing company.

Ashley: myself. And so it felt really good just to be automatically like have that shared language and not language literally, but some shared knowledge or experience with talking about something that people often get really uncomfortable talking about.

Vinod: Yeah, yeah, exactly. I think, yeah, we were lucky to find Red Rock.

Vinod: They're clearly Public health mission oriented, and I will say it was a very useful exercise for us in the clinic to have to really explain to them why we wanted to say what we wanted to say. And sometimes to be told if you say it that way, you're going to alienate or scare people. So can you come up with a different way of saying it?

Vinod: These are illnesses that incite fear and even prejudice. So we're working to educate people who are very different from the people we work with and spend our time with every day. And I think Red Rock was very good at constantly reminding us. That if we really wanted to reach people who are not us, we needed to speak in a way that resonated with young people who had no context of clinical care and maybe didn't have much knowledge or had knowledge that was wrong and so on.

Vinod: They can't offload it to someone else.

Ashley: Mm

Vinod (2): hmm.

Ashley: Yeah, the being with them in the moment and doing like the collective brainstorming has been the best part. About, about the whole experience. Yeah,

Serena: it's really feels liberating to step outside of our day to day lives, our clinic lives into this other world of marketing and to share our experiences with their ideas to come up with.

Serena: I'm going to go back to language, to a language or an approach that resonates more with the masses. I think marketing is a connector.

Vinod: We have a long history in the United States and not just in this country. You could argue that in some ways it's a responsibility of clinical services that believe they have something of value to offer in terms of Improving outcomes to take some ownership of how to actually market this and in the best sense of the word to explain to people in language, they would understand why their services should be sought because to presume that people would already know this, especially given what they've already heard in the media and still see in movies.

Vinod: And also to understand that sometimes they may know the wrong things about what they do. They may fantasize that what psychiatrists and psychologists and social workers do is lock people up, strap them down, shock them without their consent. You know, all these fantasies that people still have about mental health care in the U.

Vinod: S.

Ashley: Yeah, that's super true. What kind of switching gears away from the darker side, what has been like your favorite campaign that you guys have done or like your favorite messaging that landed or, or even it didn't land, but you just really loved it?

Vinod: Oh, it's a good question. I think you get different answers from different members of my team.

Vinod: And and what happened was nothing like that. It was a very educated group of people sending me text messages, sort of reading my responses. back, asking for clarifications. It, it felt like I was in it and I wasn't seeing anyone. I wasn't hearing anyone. It was all by text and I found it to be an incredibly, a remoralizing experience, shall we say, because, because I think there are communities in Reddit that have been formed and are quite supportive and well informed.

Vinod: In terms of others, I would have to say maybe the, the ads we put on the skins of buses that went around the towns was probably the community favorite. And I was surprised at the degree to which people We're happy to have words like psychosis pasted on big billboards and in some ways it felt validating to us because the feedback we had gotten on from focus groups was a lot of concern about the use of words like schizophrenia and psychosis.

Vinod: But when we actually put these words out to clarify and to essentially take back control of these words and

Vinod (2): and

Vinod: defang them, basically, as words of abuse, right, that this is what it is and the feedback we got from mostly from my clinician peers. was very positive. They were like, it was so great. I was drinking at a fountain.

Ashley: Yeah, those are those have been some really great moments, especially on the interstate coming around the Superdome at nighttime where it was just like psychosis is real.

Ashley: So is recovering is like Beautiful picture and friends like text me on their way home, you know, that they just saw it.

Serena: I remember early on one of our first bus ads, we were at the NAMI walk and you and Michael and I saw the bus going by and we're riding after it. So excited to see it. The bus going down magazine street.

Vinod: Yeah. I mean, you, you might be able to tell this better than anyone about. These words and their meaning may have changed in the community or just making those words more acceptable in public spaces. I would like to think that people who have these diagnoses feel safer because they're represented in these public ways.

Vinod: Right? I don't, I don't know, to the degree to which that's true, but. I do think sometimes being afraid of these words is part of the problem, not the solution. And so I.

Ashley: Yeah, I 100 percent agree. Probably talked with you at length about this in the past, but we kind of, in the clinic, like we made that, you know, decision to, to speak those words and to, I think the only, the way that they've developed such a stigma is because of what other people have attached to the word.

Ashley: I remember being on it when I was an intern, and I remember working on an inpatient unit and being just completely. Shocked that the 18 year old that we had with their first psychosis that was a college student that we didn't have like a big family meeting that we didn't have a, a, a really big discussion about this experience for this person, what this might mean, where do we go from here, how to like, you know, support the family that doesn't know that's confused [00:29:00] and it was like, you know, an altered mental status, And I'm like, we can't even say it.

Ashley: Like if we can't say it, like what do we expect for other people to do? And so then they're revolving door happens

Vinod (2): because

Ashley: no one said like no one, you know, and not to say, you know, we, I'm sure that we both have a lot of people coming into the clinic that don't have schizophrenia. They don't have bipolar, they might have something, you know, something else is going on, but they even in the moment appreciate saying, you know, I have psychosis, I'm staying away from LSD forever.

Ashley: Thank you very much. I realize that this happened. And it's not going to happen again, like if it's, you know, substance induced or whatever. But

Vinod: yeah, no, it's, it's great to talk with, with you. And I think as clinicians, we, we may want to keep, it's not an easy issue. And what I mean is this concern about language.

Vinod: So they think it means that it conveys a lack of hope. And so sometimes delay sort of having a clear sense of communicating clear sense the family about what's required because they don't want to use the word and, and I, I understand what that's like. And I appreciate it because I have seen family members who heard that term or said that, well, it isn't that, is it?

Vinod: Other than and to marginalize them and I can appreciate that if they're saying it, it can happen. It has happened. So I'm not in our work in our clinic and working with colleagues that I do found that when we actually have worked with individuals with schizophrenia spectrum disorders, our family members who are struggling with what to do about a child who's, you know, at risk of going to jail unnecessarily because they're scaring the neighbors.

Vinod: That we are ever worrying about what words we use because the problems are not about language in that sense, right? So there's almost no words you could use to make it better or worse. So I, I, I'm, I'm, I struggled sometimes because I don't want to sound. insensitive to the real harm that badly used words can have and do have in our communities.

Vinod: That's not the problem we're trying to solve in the end. But I'm happy to be disagreed with and I say this, you know, in as many for as I can to, to leave open the space of people to say, well, that may be your experience in the position you're sitting in, but, but this is not what we want. I have not in clinical care, frankly, ever encountered a problem like with language, for example.

Ashley: But it's not to assume that no one else in the room has their own lived experience, lived experience of having. Like losing someone to psychosis and, you know, was in my family and a lot of how I engage with my patients is, you know, because of like, I can easily, easily kind of be in that moment and, you know, and empathize.

Ashley: So you can, like, be aware of your, of your role and maybe your privilege in the role, but also, like, in the moment of also taking ownership of, like, what you believe in. And I see, you know, kids and young adults and, like, they don't, they don't want anything sugarcoated or, like, they want to be straight up.

Serena: Yeah. I think there's a lot of appreciation for being direct and being clear. I

Vinod: It may not always be psychosis. It may not always be a mental illness, but There's a sense in which this is also an illness like other illnesses. And so while it is distinct, it helps to not make it so unique that it doesn't benefit from the experiences of people who have all kinds of chronic illnesses of which we should fully expect that everyone is part of that world, right?

Vinod: Right. We, we all want. All of our humanity to be part of this, of the mix of services we provide.

Ashley: So kind of thinking ahead, there's so many questions I want to ask you. Do you have like any additional mission with MindMap? I mean, you guys are in your next iteration.

Serena: Do

Ashley: you have any personal goals with

Serena: 2. 0?

Serena: 2. 0.

Vinod: So well, other than the fact that 2. 0 is targeting 169 towns, whereas 1. 0 was targeting 10. So this is a big effort to scale, which we're very much in the early stages of. I think the, where it's going to is vision of a statewide learning health system where I think the best example I can point to.

Vinod: That there's a complete integration of missions between the best clinical care and research. And these are not We're trying alien to each other. They're not in conflict, although they are different buckets of activities, right? That are often led by different kinds of people. So the goal is to build that statewide where currently we're focused on just really improving access through mind map.

Ashley: Yes, that sounds like a similar mission.

Vinod: Indeed. Yeah. So am I allowed to ask you guys a question?

Ashley: Yeah,

Serena: go for it.

Vinod: What's, what's next for Epic NOLA? Where do you see yourself in the next couple of years?

Serena: Everywhere. Across, across Louisiana

Ashley: and in California. I mean I think it's just amazing that it was so fun to be at IEBA with you and with the Norway group and to have like similar passionate about this, which just tells me that it's possible, right?

Ashley: And be, you know, assisted one way or the other. And I think getting into some of the areas in the state that have different struggles and trying to understand. How to communicate with them, which might be different than New Orleans is a big goal. And then even beyond, I mean, we've been pretty shocked by like the social media relationships of people that aren't even from here that can really increase your reach so that you're simultaneously intentionally trying to reach your, your, maybe your referral.

Vinod (2): Yeah.

Ashley: But also just, you know, reaching people in general.

Vinod (2): Yeah.

Serena: And

Ashley: we want to go places. And go on tour providing AP care and education and so in two years, Serena and I, and maybe it's hopefully our team will get as excited about driving across the country in said van as we are, but we will have driven across

Serena: the country at least once, if not twice,

Ashley: doing calm pop up events.

Ashley: Yeah. Maybe we'll come out to New Haven. We'll just go around. That would be great.

Vinod: That's a really neat idea. We, you know, would you consider using it in, around Louisiana to do what the Norwegians did? You know, these early detection teams they sent out to rural areas. Yep.

Ashley: I'm even trying to figure out how I can have clinic.

Serena: the potential here is so great. And I think, you know, I don't remember if I've talked to you about, we've done a couple of comp pop ups in California that have been super well received.

Serena: And I was, fearful, nervous that people were going to ask why this Louisiana campaign was in San Diego. But the reality is that the message is the message and psychosis, psychosis, whether it's in Louisiana or in California, and being able to talk to people about it creates spaces for people to ask questions and to educate that is real and necessary everywhere.

Vinod: That's really great. I love it. You come in California. Yeah.

Ashley: So hopefully we'll.

Ashley: See you again in Berlin, but I think it's really amazing what you've done and

Vinod: right back at you that we both

Ashley: love that. We did a kind of do it

Serena: together now.

Vinod: Yeah,

Serena: it's fun to be in conversation with like minded people and inspired

Vinod: who you planning to have on next. Do you have a list of guests that you have in mind?

Ashley: Whoever that you think would be most valuable to come on, we would love to, if we're not most valuable, but available and

Serena: willing to, yeah, we're really wanting to write, expand the conversation and draw different people in. So we're looking locally and beyond, so we're open to ideas to you and to all the listeners.

Ashley: Gosh, I give like the same answer all the time. I feel like, I don't know, like I want I really everybody from their own vantage point. And I mean, I say that honestly, because I'm not a marketer and I, I feel like every person and sounds so melodramatic, but like every person has their role or their responsibility over there, a part in this society and this reality that we've created where A lot of the people that we are involved with and care for, like, would have never had a chance like 30 years ago, 20 years ago, you know, like it's, uh, and that's, it's just true, you know, and so everybody kind of has a role to play, I think, with like youth and young adults.

Vinod (2): Yeah.

Ashley: Like getting your stuff printed, getting it prepared, like going to markets, doing these things. And, you know, we had three people come and not a lot of business, so to speak, but they were, first of all, the artists that were there, one of them was like, I'm just glad Jacob was very apologetic. Like, I'm sorry you didn't make a bunch of money.

Ashley: Like, I mean, it just, you know, these connections happen that might seem small, but I think,

Vinod (2): yeah, Yeah. Sure.

Serena: For every person who feels more comfortable talking about it, I think that's progress.

Vinod (2): Yeah.

Serena: And for every decision that's made, whether it's someone with lived experience or someone who's been a caregiver, that's,

Vinod: that's progress.

Ashley: I know we're just being real here, but this is happening in my head and then I, I am continually impressed at that to the node and I, I kind of like, I hope after my life and when I'm, so I know it's not gonna probably not gonna happen in my lifetime, but definitely. The next 50 years, we'll be doing a better job as a whole.

Vinod: Right, I think when it comes to the brain, I think many people feel like they should know more, even though they haven't studied the brain and. For those who do study the brain, I think there's a sea of ignorance about what is going on in this complicated organ, right? But there's something about losing control of one's mind that feels mm-hmm

Vinod: Without knowing a lot about how they arise and how they work and we're quite successful at them. So in that respect, it's not that different. We're actually have treatments that are quite effective. They're not perfect. They don't cure. But that's true of blood pressure, diabetes, cholesterol. But I think what makes it gives it a particular spin is that it's an illness that affects a person's sense of themselves.

Vinod: I think there you want much more than just an account of it. how the kidney works. It feels much more personal. I think we are very far from providing something like that. So I acknowledge that even though we feel like we know a lot and can do a lot, it feels like very little to someone who's facing a child who's just completely changed as a person.

Ashley: and that's a very well said, I could

Vinod: keep talking about this forever.

Vinod: So I do want to let you talk to me or, but, but it's great. You're doing this. And I think podcasts are really can be a very. Useful way to information out that's very different from reading and watching, right? It's more intimate, so hopefully you'll keep doing this and you'll let us know how to do it better.

Ashley: Oh, yeah, hopefully, yeah, I will be next to the first mind map. Of course, indeed,

Vinod: if we figure out what, how we're going to do this. You're pioneers, you know, and I think Nola, you know, we're still trying to figure it out. Yeah, we

Ashley: basically, we were basically in like marketing jail for a little bit because they were like, you are not doing what you said that you are going to do with the podcast.

Ashley: You need frequency, you need consistency. Serena and my collective

Vinod (2): to

Serena: this, uh, new phase.

Ashley: This is a, I know, we're on a behavior plan. Yeah. Serious. This is, we are. And so, we, we earned our reward, we earned our stickers today.

Vinod: Well, I'm glad to have played a small role and I, I, I, I hope this takes off and keep going. Yeah.

Serena: Thank you. Thank you. It was great seeing you. All right. Yeah. Great seeing you. We'll see you soon. Okay. Good night.

Vinod: Bye bye. Bye

Serena: bye. Until next time, thanks for taking the time to get your reality check. And remember, psychosis is real.

Serena: So is recovery.

Ashley: If you have enjoyed this episode or found it useful, please subscribe wherever you get your podcasts from and check out the website calmnola. org.