Intro (00:01):
Welcome to Health Law Talk, presented by Chehardy, Sherman Williams Health Law. Broken down through expert discussion, real client issues and real life experiences, breaking barriers to understanding complex healthcare issues is our job.

Conrad Meyer (00:22):
And good morning, or good afternoon, whenever you’re listening to this. This is another episode of Health Lot Talk here at Chehardy Sherman Williams. Conrad Meyer in the booth. Today. In the studio with Roy Bellina Chris Martin cadre of Healthcare Lawyers. And today we have a very special guest in the studio Dr. Erik Hanson. Erik, how are

Dr. Erik Hanson (00:41):
You? I’m doing good. Thanks for having

Conrad Meyer (00:43):
Me. Absolutely. Absolutely. So today we, we thought we do a little, something a little more casual because everything’s been very topic oriented with respect to previous episodes. So in this one, we’re gonna have a just have, like a sit, sit down, and a cup of coffee with Dr. Hanson and bring him into speed and help us learn more about mental health. Dr. Hanson, I understand you’re a PGY four going into psychiatry here in New Orleans, Is that correct? Correct. And for our listeners, tell us a little bit about yourself and, and, and where you’re from, how you got there. What is a PGY four? because I, I sure didn’t know years ago, so hopefully you can figure that out and we can see where we go from here.

Dr. Erik Hanson (01:24):
So, PGY four is a fourth year resident. it’s it’s a name for any specialty. specifically though I’m a psychiatry, PGY four different residencies have different lengths. for psychiatry, it’s four years than after the fourth year. You decide whether you want do a fellowship and anything more specific or just be a general adult psychiatrist. so I’m a fourth year psychiatry resident. I’m from New Orleans, from, from Kenner and Meta, actually. I live in Meta now. so yeah. Any other questions? yeah.

Rory Bellina (02:00):
What so what led you into psychiatry?

Dr. Erik Hanson (02:03):
So, you know it’s an interesting process. You’re, as a med student, you do rotations in all the different fields, and then you’re expected to sort of make a decision about what you want to do, and it can be overwhelming. I really enjoyed psychiatry rotation the most. I felt like I was really helping people. I thought it was fun, too. I thought it would never get old, which I think is, is it was important to me. you know, a lot of stuff that we do every day gets kind of monotonous and, and routine, and I always thought it was interesting and I really felt like I was, you know, helping, helping people.

Rory Bellina (02:37):
So you mentioned that, you mentioned that this rotation’s been four years, correct?

Dr. Erik Hanson (02:42):
What’s

Rory Bellina (02:43):
That? This rotation, you’re in your fourth year, correct? Correct. Yes. So, you know, on all of our previous episodes, the topic of Covid has come up and I figured, let’s just get it out in the front right now. so you started before Covid and you’re now continuing with your fourth year. So tell us what residency has been like, You know, when Covid kind of started as it was ramping up and, you know, now we’re on the, the lower end, luckily in New Orleans. But tell us a little bit about how everything’s been going since this pandemic.

Dr. Erik Hanson (03:10):
So, residency at baseline is, is tough. and, and Covid certainly didn’t help with that. you know, the, the Covid spikes in the hospital, that aside, cuz you know, that’s been, been talked about a nauseum, it’s been difficult to, to do the, the level of care that we were previously accustomed to. you know, visits, having to switch to, to telehealth, and then the complications with that. As far as accessibility a lot of patients in psychiatry are less fortunate may not have access to, to te telehealth technology and stuff like that. also, you know, the, the assessment of a patient and how they’re doing their status is, is harder over a, a video visit. so that’s been difficult. The other thing is you know, it’s, it’s a struggle, especially at the beginning to make sure that you get good training. Because with a lot of the services cut back, you know, you are a resident, you’re supposed to be learning, supposed to be training. And so having adequate patience to see while everything is kind of shut down made it a little difficult. But after a while, things kind of shook out and you know it all the, all the, all the kings got worked out.

Chris Martin (04:29):
So tell the folks for, who don’t maybe know what exactly what Telehealth is, can you kinda walk us through that a little bit?

Dr. Erik Hanson (04:36):
So there’s, there’s several different platforms that it’s used. it can be as simple as a phone call. it can be also video where you’re, you’re logging onto some platform, a patient at home or in some other location is logging on. And then you’re, you’re talking with them, seeing them virtually essentially over a video like you would Zoom or Skype or, or what have you.

Rory Bellina (05:01):
We’ve had a couple of guests come on already and we’ve had some other specialties talk to us about telehealth during Covid. And, you know for some of them, honestly, they were okay with it. They thought that it increased their patient access. They were able to do things more efficiently. They could it was just, it, it was okay. How is psychiatry maybe the same or maybe different? I mean, have you enjoyed the shift to telehealth? Do you feel that you’re treating your patients of the same quality? Or, or would you rather it be face to face like we are today?

Dr. Erik Hanson (05:31):
So, I agree. I, I actually do, like, I do like telehealth a lot. I think it does increase access to care overall. it’s, it’s easier for someone to maybe step out at work and log onto a visit for 30 minutes instead of having to take off the whole day to drive down to the city to go to an appointment. Also, you know, sometimes things can be handled quicker over telehealth, You know, it’s just easy to hop on. You know, the, the, the major consequences of it are just, it’s, it’s not the same type of assessment. You know, if someone’s telling you how they feel, part of it in, in evaluating them is, is listening to what they’re saying. But the other part is observing them and seeing what they’re doing, how they’re reacting, how they’re telling you. And, you know, with the, a video alone, even if everything works completely how it’s supposed to, it’s difficult. And that’s not even talking about the technological challenges with internet connection and calls dropping, you know, the, the, the, there’s, there’s there’s been so many times where I’m starting a visit and I end up just hanging up and, and calling ’em on the phone cuz there’s the video’s frozen. I can’t hear ’em. Stuff like that.

Conrad Meyer (06:36):
And, and I know, I mean, I’ve read this and I don’t know how accurate it’s, and I’m gonna say the percentage, and I’m probably gonna get it wrong, so you’re gonna have to correct me, but is it 80% or 90% of nonverbal? of nonverbal Is communication nonverbal cues is it a high number like that? I can’t remember. Your nonverbals tell a lot about you Sure. In terms of about how you’re feeling. Yeah. But I forgot the number, but it’s really high, you know, and I, and I guess following to your point, going on a telemedicine route, even though we’re increasing access, it’s hard. Is it, Let me ask you, is it hard for you to read a patient’s nonverbals to assist you in making an assessment about the patient? Have you found that to be a challenge or is it, is it the same as it seeing in a patient in a room or, you know, what, what can you say about non-verbal communication using telemedicine?

Dr. Erik Hanson (07:30):
It’s absolutely more difficult. I mean, so first of all, you’re looking at this tiny little portion of them, you know, their head, maybe part of their neck and shoulders you know, and so you’re missing a lot of times their hand, you know, if they’re anxious and fidgeting. Right. sometimes medicines that we have cause a lot of side effects of abnormal movements, something like that. And you really just miss those. You don’t even get to see them you know, unless you have them pull the camera back and then go walk around their living room or something like that. it can, it can be difficult.

Conrad Meyer (08:00):
Yeah. I’ve, I’ve figured that. I mean, so I mean, I was thinking about yes, telemedicine, we, we’ve heard on previous episodes how wonderful it is in, in terms of, you know, cutting the red tape, giving the access that instead of maybe seeing eight or 10 patients a day, for example some of our previous guests have said, Well, we could see 15 to 20 patients a day. So from that standpoint, it looks like it’s, it’s, it’s, it’s getter gaining access. what do you see telemedicine now, even though, let’s say post covid, cuz like Rory said, we’re coming on the down slope. Right? Thank, thank you. amen to that. But do you, you see telemedicine being integrated into your practice real time?

Dr. Erik Hanson (08:43):
Absolutely. Absolutely. I think it’s, I think it’s a very useful tool to use, especially if things are straightforward. you know, if if something’s more acute, if someone’s in a crisis, of course seeing them in person would be better. But if something’s more routine or it’s telehealth or nothing, then obviously we’re gonna choose a telehealth appointment.

Rory Bellina (09:02):
And that’s what I want to ask you about is, is, you know, do you feel like you need to almost do a pre-screening now to see, okay, you know, Chris wants to come in today, he answered his questioner this way, I really need to see him in person. Rory filled out a questionnaire, he answered his questions a little bit differently. He can do, he’ll do fine with a phone call or, or a FaceTime. Do you feel like that that’s something that you’re gonna have to work into your practice?

Dr. Erik Hanson (09:24):
somewhat. Most, most of the, the, the clinics I’m at the initial visit is in person. and so you do get to lay eyes on them and see them in the full form, if you will for the first time. And then after that, you know it, it, a lot of it is convenience. If, if they say, Look, you know, I can only come back, but it’s gotta be a telehealth visit, of course you’re gonna choose that over them saying, I can’t come back. That sort of thing. So yeah, it, it, it, the, the good thing about having them come in person for the first visit is you can sort of triage and assess

Rory Bellina (09:55):
That. So you mentioned the clinics that you’ve been in you know, just now, what, what, what do you, what have you been doing lately?

Dr. Erik Hanson (10:02):
so I work I work several, several different places. currently I’m working at a clinic uptown also working at a, a detox facility in the area. and I do some work for the, the coroner’s office.

Rory Bellina (10:16):
Okay. You mind going into some more details? I mean, I’ve got some questions about all of those really. Sure. If we could keep going. Sure. I know Cony does as well.

Conrad Meyer (10:23):
My, my COGS attorney. Shoot. You can see it. So, So let me ask you this in terms of and I’ll give you like, like, like Letterman a top five. If you had to pick the top five things the top five mental health issues that you see in patients now, not the mental health world as a business. Sure. But if you had to pick maybe our top three, let’s say top three, what would you say are the top three mental health issues you’re seeing in patients now, whether telemedicine or in person?

Dr. Erik Hanson (10:54):
So a lot of it’s gonna depend on the setting that you’re in, you know, the, the type of patients that you’re seeing. but I would say from, from the patients I’m seeing anxiety, depression, and, and substance use.

Conrad Meyer (11:04):
Well, that, that’s a, that’s a very large portion of the top three. Yeah. Did it also go into your work then on the detox facilities?

Dr. Erik Hanson (11:11):
Yeah. of course in the detox facility, it’s, it’s almost exclusively substance use or dual diagnosis, meaning it’s substance use and another psychiatric issue like depression, anxiety, bipolar, schizophrenia, something.

Conrad Meyer (11:24):
Are they, are they on a lock? Are you on a lockdown unit

Dr. Erik Hanson (11:27):
At all? My particular one, no, I got it. Okay. So it’s completely voluntary. They can come and go as they,

Conrad Meyer (11:31):
And we’ll get into that a little bit later. I know Rory and Chris and I were talking about lot, you know, CECs and PEs, but we’ll at that in a little bit

Rory Bellina (11:38):
Later, and I’ve kind of gained the reputation on this podcast of always asking the Covid question. So I’m gonna, I’ll, I’m gonna stick with it. you know, what’s been going on, like you mentioned with substance abuse and, and depression anxiety during, during covid, have you seen, what are the trends that you’ve seen on

Dr. Erik Hanson (11:53):
That? So it’s, it’s certainly worsening. It, it’s, it’s definitely not improving it. you know, at the beginning of Covid, everyone was stuck at home and there’s this increased level of stress. And I think that, you know, even though things have opened up more, the quarantine process is is is a lot lighter than it was before. You know, that stuff doesn’t heal itself overnight. And so I think people are, are still suffering more because of covid. For

Rory Bellina (12:20):
Sure. And do you think that is, you mentioned lockdown, I mean, what, what’s your opinion on how it’s affected people with mask mandates and with, you know, now we’re looking at vaccine mandates. Are you, are you seeing that present in your population?

Dr. Erik Hanson (12:33):
Certainly, yeah. you know, the, the anxiety around wearing a mask, it’s, it’s constricting. and then certainly with, with the vaccine mandate, it, it can be anxiety provoking for many people with, with for a variety of reasons. Even, you know, the, the uncertainty of the vaccine or being uncomfortable with the mandate, something like that it doesn’t come up as much you know, in, in the patients. I see. I don’t know if they just, those kind of self-select out. but it, it has come up from time to time.

Conrad Meyer (13:07):
Well, and let me ask you this question. and it is going, I guess going to the, some of the heart of the matter, maybe trending. So as we sit here, we’re almost two years now, Like now I’m asking a Covid question. Yep. So, so two years now since we sort of started this journey.

Rory Bellina (13:24):
Yeah. And I remember the end of 19 is when this That’s right. Was breaking really in China and then beginning of, Yeah, well

Conrad Meyer (13:31):
Close to go almost to two years. So my question is, is, is the, the trends that we’re just talking about, the, the, the anxiety, the depression from whatever the mass mandates, whatever, whatever mandate, well, whatever mandate flavor we have this week. What do you see it leveling off now? Or did you see a peak at some point? I mean, or do you, or is it just constant?

Dr. Erik Hanson (13:55):
I think it’s leveling off. I think it’s improving I think, and I think things are starting to lighten up, and so a lot of those stressors are, are being lifted. That’s good. Yeah. I, I think it’s, I think it’s leveling off.

Conrad Meyer (14:07):
That’s good. That’s good.

Chris Martin (14:09):
So there’s been a lot of, in the news about opioid deaths and especially I think we’ve hit record numbers mm-hmm. is that covid related, do you think? Or, or, or is there some other? Cause

Dr. Erik Hanson (14:29):
A big reason is, is fentanyl. so in the past you would, you know, use heroin and it would be heroin, more or less. now the, the spike of fentanyl in the area is, is really the problem in my opinion. you’re not doing heroin. You might be doing some heroin, but you’re doing a lot of fentanyl. and the problem is, is the, you know, maybe you used to know what a gram heroin was, what it looked like. Now it looks like a gram heroin, but it’s half fentanyl. And, and so that’s how people are overdosing.

Rory Bellina (15:01):
Mm. You know, Chris brought up a, a really timely topic, especially here. You mentioned you’re from Kenner mm-hmm. , or you grew up in Kenner, and then just this area that there’s been a lot of of settlement, and there’s kind of the, the three levels of the, the, the, the defendants in the opioid epidemic we’re talking about the, the drug manufacturers, then the distributors, and then the pharmacies that actually filled that actually filled them. And there’s been a lot of, you know, information going on as far as what’s happened with that. And one of the, one of the big defendants actually just recently settled. And, and we don’t need to get into those details, but I’d love to get your opinion on, you know, the way it’s been explained to us and and different liability theories is that, you know, the, the distributors or, or the companies that I’ll say, not distributors, the companies that made the drugs pushed them very hard for a certain population, and distributors wanted to send those to the pharmacies that were filling them or market them to physicians.

(15:58):
And then the pharmacies would get that information and see, you know, Dr. Chris is writing a ton of prescriptions for opioids. So they, the pharmacies sold that information back up top to the drug manufacturers who then use that information and just was kind of this endless cycle. So I’d love to kind of get, you know, your thoughts on, because it, we’re, we’re starting to see the, the big defendants, you know, we’re talking about the, the Cardinal Health, the, the Walgreens Johnson and Johnson, CVS Care Market. A lot of them are starting to get pulled into this as well as an intern or settlement. So I’d love to know, you know, what kinda what you, what, what’s your thought on the, on the, on the pandemic and, you know, where things went wrong, Just, just kind of a general opinion on it.

Dr. Erik Hanson (16:44):
I think, I think you you touched on one of the points and it’s sort of the aggressive marketing targeted marketing. I think that’s, that’s a lot to blame here. you know, it, when, when you’re marketing any drug, I, I from that perspective, I understand you’re gonna want to target the people who are gonna use the drug maybe and who’s gonna prescribe the drug. It only, you know, makes sense from a money standpoint. But the aggressive and, and frankly, sometimes dishonest marketing, I think is, is really the problem with all of this.

Rory Bellina (17:16):
And you see that after, you know, it was marketed that there’s been a lot of changes put in place. We have the Louisiana, it’s called the pmp, Prescription Monitoring Program. You know, doctors are required to check that at certain visits and everything. And I think that’s done, that’s done a lot of good will you know, do you see any issues with, with any of those programs? Or is there something that you’d love to see kind of created to, to kind of, you know, help out with this pandemic or this epidemic of opioids?

Dr. Erik Hanson (17:43):
So the PMP is a very valuable tool. I use it on, on most patients in general, but especially everyone that I’m prescribing a controlled substance for. you know, by nature it’s a controlled substance, so it should be controlled and, and safer. There should be more safeguards in place. And I think we weren’t babysitting some of that. And now we are you know, before you would just prescribe it like you would any other medicine. But now with the, with the prescription monitoring program, it’s, it’s really hard. Minus them using a fake ID or some, some other alias that’s not pulling that data. It’s really hard to, to, you know prescri over, have someone doctor shop Sure. If you will mm-hmm. , because it’ll, it’ll just show up readily available.

Rory Bellina (18:25):
So do you think we still need, I mean, I, I think there’s still a need for controlled substances, especially for people that have, that are having extensive surgeries or, you know, I’m obviously not a physician, so I’m sure they’re prescribed for many other things. But, you know, what do you see the future of, for these controlled substances, post opioid epidemic? I mean, do we need to rein them in more, or kind of, what’s your thoughts on that?

Dr. Erik Hanson (18:48):
So, a lot of times with, with the controlled substances or, or medicines in general, there’s, it’s a pendulum. You know, it was swinging from over-prescribed to now it’s sort of swinging the other way, you know, where people are very cautious. Sure. We may reach a point where, I think you alluded to this, where maybe, you know, you had surgery and you don’t get pain medicines, that sort of thing. I don’t think that’s gonna happen though, to that extent. you know, people need pain medicines. I dunno if you’ve ever had a surgery, but they hurt. And you need, you need pain medicines to recover. I think people are being more conscious of it, which I think is one of the big things, only giving you what you need. Not, you know, just refilling it a nauseum, that sort of thing.

Conrad Meyer (19:28):
So as I regain myself after coughing my lung on the floor for a little while I wanted to ask it. I, and, and I, and I’ve seen this happen. I mean, I’ve, I’ve watched it at the board level mm-hmm. do you think so we have a, I’ll look at as a pendulum in terms of opio controlled substances, for example mm-hmm. where before we were, we were talking, you know, as Rory was alluding to this cycle of promotion. and then of course what was put out about treating the fifth vital sign, which was pain mm-hmm. . Right. And then suddenly, you know, everything was okay. We, we, you kind of treat it, it’s a fifth vital sign. You have to treat pain and then now, Right. With PMP and this epidemic, Oh, no, no. So it has, this, has the pendulum swung the other way now to where we’re not, we don’t want to, we don’t want to write any kind of controlled substances for fear. I’m gonna be brought in front of the board or, you know, do, or do you think we’ve settled back into a, a happy medium where, Hey, we know we need to write this. We have patients like you alluded to, who have surgery, we have pain, we have to write this. Otherwise, it’s, it’s, what’s the point? where do you think we are on the spectrum? Are we still overcompensating where we’re not writing anything, or we’re back to a happy middle ground?

Dr. Erik Hanson (20:40):
that’s a good question and one I don’t have an answer for. my, my sort of point was, I, I fear that, that people may be be too restrictive in prescribing. they have their uses, controlled substances have their uses. Right. It’s very effective for pain. And if you’re postop from a surgery and you need pain medicine, you need pain medicine. and you could even make a case that not prescribing pain medicines, in that case, people will just seek it out on their own anyway. So, you know, undertreating their pain just for fear of prescribing pain medicines, may actually

Conrad Meyer (21:10):
Sends them out. Sends them out to the market. Right. I got it. Yeah. Makes a good point.

Chris Martin (21:13):
On this subject of, of medication, have you had much experience with medical marijuana and, and with That’s

Conrad Meyer (21:21):
A

Chris Martin (21:21):
Great question. down that road.

Dr. Erik Hanson (21:23):
So I have not you need a, a, a special licensing process, which I haven’t gone down for, for a variety of reasons. it’s essentially, it’s, it’s I hear it’s very easy though, that’s anecdotal mm-hmm. to, to get a, it’s essentially a permission slip too. It’s, it’s illegal to prescribe marijuana. So it’s a, it’s a, it’s a permission slip that recommends it. Mm-hmm. . but no, I haven’t gone down that

Chris Martin (21:49):
Route cuz the legislature opened it up for chronic pain, which is pretty, pretty broad category.

Rory Bellina (21:56):
Right. There was chronic pain and a catchall. I believe the last provision in the statute was anything in which your physician reasonably believed you would need it for. So I think it could, it could be prescribed for a lot.

Conrad Meyer (22:08):
You know what, why don’t they just kick the can and just legalize it? I just don’t get that. I mean, are we, That

Rory Bellina (22:13):
Could be another topic.

Conrad Meyer (22:14):
Why, why? I mean, let’s let, let’s, let’s, Why are we always the last place to do things that other states seem to already do and seem to have no problem,

Rory Bellina (22:23):
Dr. Hanson? We don’t need a specific number, obviously, but

Conrad Meyer (22:26):
I don’t wanna go there.

Rory Bellina (22:26):
I’d love, I’d love to know though, I mean, you do these intake forms. I mean, do you see a lot of your patients admitting that they’re taking it for recreational or for reasons? I mean, are you seeing it a lot in your, in your patient base?

Dr. Erik Hanson (22:39):
You’re talking about ones who are prescribed

Rory Bellina (22:41):
Or, or not prescribed recreational use? Just recreational, Yeah.

Dr. Erik Hanson (22:45):
Oh yeah. Recreational marijuana use it, it it, it’s shocking how, how many are actually using recreational marijuana compared to that. It, the fact that it’s

Rory Bellina (22:55):
Still illegal and, and the stigma is, Yeah. I mean, in my opinion, I think the stigma is, is pretty much gone with it. I mean, if people are disclosing it to their physician, I think that that goes to show that, that I think the stigma’s moved away where, you know, if they’re not afraid to tell you that they’re using it and you’re still gonna treat them, I think that Right. That just goes to show.

Conrad Meyer (23:12):
Yeah. I mean, I, look, I I, I’m playing the devil’s advocate here. You know, I, i, I just, why is it, why take these baby steps? You know, just, let’s just go ahead and say, you know what, Let’s do what other states have done. Let’s legalize it that way. We don’t have the issue. We can tax out of it, make some revenue.

Rory Bellina (23:31):
What’s, what’s your thoughts on that, Dr. Hanson?

Dr. Erik Hanson (23:33):
So, I, I take a, a sort of going back to what I was saying about opiates in the, in fentanyl you know, if, if marijuana is regulated, I think that’s ideal. I think what’s not ideal is if it’s illegal. And so you’re using some synthetic marijuana to dodge a drug test or something like that, and then you don’t know what it is. It’s

Conrad Meyer (23:54):
Laced with something laced

Dr. Erik Hanson (23:55):
With knows something and now you’re in a, a, a, a rabbit hole instead of just using marijuana. And so that’s, that’s, it’s almost from a, a risk reduction standpoint, I think if, if it prevents people from using synthetic marijuana, which has its own problems in itself. And then also, like you said, if it’s

Rory Bellina (24:11):
Laced, I think we had a, a, a local story where, you know, some, some teenagers passed away from that, from laced synthetic marijuana. Yeah. Yeah. So you mentioned coroner’s office. I’d love to hear more about that.

Dr. Erik Hanson (24:24):
So, in Louisiana there’s a civil commitment process for patients who need to be involuntarily hospitalized in a, a psychiatric facility. it’s, it’s standard across every parish. if, if the criteria essentially is, if you’re deemed to be a danger to yourself, a danger to others, or gravely disabled, which is defined as inability to take care of yourself, essentially food, water, shelter healthcare needs, stuff like that.

Conrad Meyer (24:54):
And so, can you tell, so I know that you’re talking about a p correct? Yeah. So, so tell the listeners and I, there’s different forms. The p c, there’s a cec. Can you describe the differences between the two and, and or, and what other methods that you can do at your disposal for the coroner’s office to help people?

Dr. Erik Hanson (25:13):
So at p it’s a physician emergency certificate. any physician can sign it. essentially it’s, it’s holds you for a maximum of 72 hours. At that point, the someone from the coroner’s office comes and evaluates you and, and they get to it can get either they can let you know, say that you’re not a danger to yourself, not a danger to others, not gravely disabled. And then you’re essentially free to go.

Rory Bellina (25:38):
And that would be you in this case, Correct. Going to visit these patients? Yes. And they’re at a hospital or a psych hospital mm-hmm. When you would go visit them

Dr. Erik Hanson (25:43):
Right. In the emergency room or in a hospital setting. Okay. Right. Okay. Or they can institute in, in a cec, which is coroner’s emergency certificate which then can essentially allows the hospital to keep them for up to 15 days.

Rory Bellina (26:00):
I see. What typically, what type of patients do you, do you go visit in these cases or the people that, you know, just have breakdowns? Or is it, you know, related to them with, with criminal acts? Or is it a little bit of a variety?

Dr. Erik Hanson (26:13):
it’s, it’s, so by, by definition it needs to be due to a psychiatric condition. So you can’t just be a danger to others cuz you’re, you know, want to kill your neighbor. If it’s not due to a psychiatric condition, then it doesn’t meet criteria. So essentially everyone has a psychiatric not only diagnosis, but diagnosis is causing one of those three criteria.

Rory Bellina (26:34):
Okay. I think you knew this was coming, but here’s my covid question again. Mm-hmm. , have you seen any, you know, I assume that you were, you were working on this, you know, prior to Covid, Covid mm-hmm. . How has covid affected what you’ve seen, who you’ve gone to visit, you know, increased, decrease, that kind of thing?

Conrad Meyer (26:51):
I mean, on the cec? On the PEs and CECs.

Dr. Erik Hanson (26:53):
Correct. So I actually, I started in early 2020. Okay. So right when Covid started. But I will say the, if you test positive, well, right now, everyone who goes into a hospital is getting covid tested. Okay. and if you’re positive for Covid, you can’t go to a psych unit. they’re just not equipped to do the precautions and the ppe, that sort of thing. They don’t have the staffing for that. So you’ll get admitted usually to a, to a, just a regular medical surgical hospital floor. And then essentially you’ll receive psychiatric care from there, which is is is not good. Mm-hmm. . Okay. a lot of times if you, for example, have someone who’s very delusioned schizophrenic, bipolar, something like that, and you have these delusions of about something that’s not true, a lot of times part of the treatment is both medication, but also a lot of insight, reality based reminding if you will. And so if you’re stuck in a room and no one can visit you cuz your room is covid lockdown that you can see, that’s, that’s difficult.

Conrad Meyer (28:04):
Interesting. And, and another thing I wanted to ask you, and this might pivot a little bit mm-hmm. from, cuz I know Rory loves Covid. Yeah. I, I, I, I always, and, and I guess this, this, this could segue into a much longer sh you know, different kind of show mm-hmm. , but social media and its effects on young. And have you seen anything with respect to the online bullying, the, you know, and I guess I, I, the reason I asked this, I recently heard about a situation like this with one of my friends and his children. And, and, and so I’m curious, in your practice, have you seen the social media effects on mental health with children? Is that prevalent still?

Dr. Erik Hanson (28:48):
Very common. Very common. Unfortunately, yes. you know, cases as, as, as benign if you will, which it isn’t benign, but from, from, you know, a severity standpoint, just simple bullying for example, that’s one thing. But the others are there’s their suicidal and they cut themselves because of something that happened on social media, for example. Whether it was something someone said, a picture that was shared. Right. Something like that. It’s very common. And it’s, it’s hard to, it’s hard to, to talk to these kids, you know? Cause we grew up in a, a different time where it wasn’t as important. So it’s hard for us to say, Oh, that’s, you know, it’s just Facebook, ignore that, that sort of thing. Cause to them it’s important, you know, this is what everyone’s doing. That’s, that’s, that’s the, the age they live in. Right. So it’s, it’s, it’s tough. It’s tough.

Rory Bellina (29:35):
So from that standpoint, those patients that you would see, I mean, is it something that obviously, you know, know, medication can assist, but is it more of lifestyle or patterns of, you know, them getting off of it or their parents making them get off of it or? Yeah, absolutely. Or, you know, what’s the course of action for that? Cause I mean, I have a lot of friends and I’ve got a nine year old who’s already asking about it and I really don’t wanna go down that rabbit hole with him yet. Right. But, you know, you know, what do you do for patients like

Conrad Meyer (30:01):
That? That’s a great question. I mean, I love, What would you tell parents? I mean, you know, parents with children, What would you recommend with social media and kill and

Dr. Erik Hanson (30:10):
Children? You know, that’s a difficult question cuz there’s, there’s no right answer. it’s, it’s so prevalent in their life. Everyone at school has one. And so then, you know, it’s almost a risk of do you just just ban it outright or do you allow them to have one and then teach ’em the healthy ways to

Rory Bellina (30:27):
Use it? Sure. Because if they don’t have one, then they’re gonna be, they’re gonna get the outsider Right. And not included on things. But then if they do have one, then it’s everything that we know that’s going on with them,

Dr. Erik Hanson (30:36):
Or they’ll get one and you don’t know about it. Right.

Conrad Meyer (30:38):
That’s what I was

Dr. Erik Hanson (30:39):
Then you can’t police them. You can’t, and police is the wrong word, but you can’t keep an eye on it. You can’t help them learn how to manage it safely. Cause that’s what the big thing is. They’re gonna have one eventually. Sure. Right. Whether you know about it or not. And so ideally you would be able to, to, to sort of help them navigate that in a, a safe way. And

Conrad Meyer (30:57):
I think, let me tell you, I think I, I, I, I know this is sort of pivoting off topic in this show mm-hmm. , but I, I think this would be a good thing to bring Erik back. Absolutely. And, and maybe even pair that with the anti-bullying statute. We can get some of the, you know, sort from the District attorney’s office talk about bullying and, and things like that to help parents understand what they can do. Sure. Because I think this is a lot bigger. It, it’s all I think it’s getting is growing. Absolutely. You know, I, I already thought it was bad, but I think it, it continues to, to, you know, parents just don’t

Rory Bellina (31:28):
Know. Yeah. And, and, and, and, and like you said, and we’re now going off into the social media, we could talk about this for while, I mean, I, I think, well,

Conrad Meyer (31:34):
This is what happens when we have coffee with Dr.

Rory Bellina (31:36):
Hanson. Yeah. You know, we’ve, we’ve seen the documentary, the Social Dilemma, and the, the two people from Google have

Conrad Meyer (31:42):
That not

Rory Bellina (31:43):
Scare. You have gone on to do numerous podcasts like this. And I mean, you know, what, what they’re showing is that, and they go into very much detail that I’m sure you would understand. I don’t, but, but the, the social media, the algorithms, they really wanna manipulate your brain to where you’re on that thing as long as possible and scrolling as much as possible. And I, I, I’m sure it’s been said before, but I’d love to get your opinion on just the social media in, in general. I mean, I think it’s a necessary evil per se. I think all of our kids are gonna have it. I mean, what, I don’t know if you have children or not yet, but, you know, kind of what, what’s your plan for that? Or what do you tell your patients?

Dr. Erik Hanson (32:23):
So, you know, a lot of times, and this is, this is sort of the answer for a lot of things in this realm is, is healthy use of it is gonna be important. And then also, you know, other kids are gonna post stuff. You know what’s gonna happen. Right. And, and teaching your kid how to not let, So we can’t control what other people post. you know, you can’t control someone else, but you can control how it affects you. That’s very true. And so learning how to manage that is, is the big thing. And, and I mean, that, that can go on from, from social media and then not social media topics learning, you know, not letting other people their actions affect you in a, in a, a wrong way. but yeah, it’s, it’s as far as what’s my plan for, for, for my kid, I have a one year old. I don’t know. You’ve got

Rory Bellina (33:12):
A little bit of time, you’ve got a little bit of time on

Dr. Erik Hanson (33:15):
It yet. Terrifying. Right. Don’t, it

Chris Martin (33:16):
Is terrifying. Don’t teach ’em to read.

Dr. Erik Hanson (33:18):
Right. No, that’ll

Chris Martin (33:20):
Solve it. So if I could redirect back to sort of mental health. So we started, if if you had all power and you could change two or three things, you know, unilaterally with, with the state of mental health, either in the community or the state, what would you, what would you do?

Dr. Erik Hanson (33:40):
So one of the big things is availability of psychiatrists in this area. And that really comes down to residency spots. it’s a, a federal law that that limits those. and so if we could expand that, we could train more psychiatrists and, and that wouldn’t be a problem. from there, the, the sort of what we’ve been talking about, the substance use, you know, if, if you’re trying to treat, for example, depression, anxiety, schizophrenia, and they’re using substances actively, I mean, you have no shot. You know, it’s, it’s, you’re, it’s an uphill battle and you know, you’re at a severe disadvantage. Mm-hmm.

Chris Martin (34:17):
,

Rory Bellina (34:18):
That’s really interesting. You know, one thing that, that I just wanted to get your opinion on before we wrap this episode up is if, you know, if we, if we have a friend or a listener or a colleague that we think is having kind of mental health issues or starting to see depression, anxiety, you know, whatever it may be, you know, is it best for them to start with reaching out to a psychiatrist like yourself or a social worker, psychologist? I mean, you know, what, what, what kind of do you recommend? Because I know that there’s dueling schools of thought. Some people think, you know, psychiatrists only write scripts, psychologists, they only talk social workers. They’re not, you know, as a level of you are. So I’d love to kind of get your, your guidance on, on those people that are listening or that might have a friend that they’re, they’re thinking about might need some help.

Dr. Erik Hanson (35:02):
So to take it to, to the extreme. So, so, and then I’ll kind of work backwards from there. You know, if, if you think someone is, is suicidal, for example, and may be a harm to themselves, we talked about the P and the cec. There isn’t an OPC in order of protective custody, which we didn’t talk about that you, you go to the coroner’s office and you say, Look, I’m witnessing my friend doing X, Y, z I think he’s a danger to himself, or he’s not taking care of himself. That sort of thing. And then it’s sort of a no questions asked, which has its benefits and it’s, it’s downsides, but someone, a police officer will go get them. So if, if someone is not wanting to get treatment, but you think they need to be admitted to a hospital you can file an OPC that doesn’t guarantee they’re gonna be admitted.

(35:49):
What it does it guarantee is they go to an emergency room at that point, someone from an emergency room, a physician there will evaluate them and determine whether they, they can go home and manage this on an outpatient basis, or whether this needs a p e, for example. so less severe than that if someone is, is sort of just depressed, anxious, that sort of thing. Having a, a hard time, actually, most of the psychiatric care is actually done by primary care doctors. you know, every, I don’t wanna say everyone, more people have a, a primary care doctor than they do a psychiatrist. So that’s, that’s where most, that’s sort of the front lines really because of that, you know, in the, in the issue with getting access to a mental health care, you know, going to your primary care doctor is a perfectly legitimate option. and, and the idea being is that they, if they feel comfortable managing it, then they can sort of get that ball rolling quicker than if they were waiting four months to get in with a psychiatrist. That sort of thing. Right. As far as the medication and therapy, you know, the data shows that both is better than one or the other. So, you know, if someone just wants therapy and not medication, that’s better than nothing. And vice versa with medication and not therapy, but truly therapy plus medication is, is is ideal.

Conrad Meyer (37:05):
That’s good. Well, well, I wanna thank Rory and Chris for the wonderful show today. But most importantly thank Dr. Erik Hanson for stopping by. I think that’s gonna wrap it up for us today. Again, coffee with Dr. Erik Hanson. pgy soon to be what psychiatrist out in the field.

Dr. Erik Hanson (37:22):
Yeah, we’ll go with that. We’ll

Conrad Meyer (37:23):
Go with that. That’s good. That’s good. Well, thank you very much for stopping by today. And look, everyone, we really appreciate you being part of the show. drop us a line, leave a comment if you want. send us an email if you want to hear a certain topic on it. But again, thank you very much for joining another episode of Health Law Talks. Have a great weekend and enjoy.

Intro (37:42):
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