New Treatment Options for Mental Health With Dr Mustafa Tai from PsychPlus

Mustafa: I think the fact was that even patients being discharged from the hospital we’re having to wait weeks and even months to see a psychiatrist, let alone the general person who was not an acute enough to be triage in that sense.

And this whole goal of the company that, that we have here is, to bridge that gap. We want to make sure that patients are are able to get the help that they need. Because not only does this kind of help the, obviously the patient stay away from having their life disrupted, having to go to the emergency room, incur those costs, but also having to stay in a hospital if it comes to it as we know the early, the earlier the intervention in, any field of medicine, it’s ends up with better outcomes.

Bruce: Welcome to the future of psychiatry podcast, where we explore novel technology and new innovations in mental health. I’m your host, Dr. Bassi, an addiction physician and biomedical engineer. Today, I’m with Dr. Mustafa Tai, who is the medical director of PsychPlus, and he graduated from medical school in Pakistan and pursued psychiatry in the United States.

Therefore, he has a bicultural upbringing in Pakistan and the U. S., and Dr. Tai completed his residency at Rosalind Franklin University in Chicago, where he was involved in the care of both military veterans and active duty Navy personnel and Navy recruits.

Dr. Tai then received training in child and adolescent psychiatry from Rutgers University in New Brunswick, New Jersey, he has held academic appointments as assistant professor at Tufts University School of Medicine and the Boston University School of Medicine. He is a current practicing psychiatrist and medical director with PsychPlus.

So the mission, it sounds of PsychPlus, is to get individuals more psychiatric help within a day or two, and that sounds really important. because what most people know or what most people think or expect from psychiatry is a few months. So it’s pretty novel and impressive

Mustafa: So I think the gap that we had been noticing was that there’s 2 subsets of populations that we’re talking about, right? There’s 1 subset of people that are just being discharged from, more acute inpatient setting and there’s one subset of people that are looking for general life maintenance.

And I think both of those individuals although one a little more acute than the other both of those individuals were having a lot of trouble, being able to get that help in a non acute setting. I think the fact was that even patients being discharged from the hospital we’re having to wait weeks and even months to see a psychiatrist, let alone the general person who was not an acute enough to be triage in that sense.

And this whole goal of the company that, that we have here is, to bridge that gap. We want to make sure that patients are are able to get the help that they need. Because not only does this kind of help the, obviously the patient stay away from having their life disrupted, having to go to the emergency room, incur those costs, but also having to stay in a hospital if it comes to it as we know the early, the earlier the intervention in, any field of medicine, it’s ends up with better outcomes.

So being able to keep the patient in the community and get the care that they need rather than clogging up emergency rooms and inpatient psychiatric units not letting it get to that point. I think that was the main aim with which we’re, still working towards and we’re hoping to keep ourselves geared towards that direction.

Bruce: Yeah, absolutely. Better outpatient management does lead to a reduction of costs overall. If you think about the healthcare economy as a whole ER visits are extremely more expensive as are inpatient hospitalizations. And how often is it that a patient will call their outpatient psychiatrist and they say they can’t get seen, therefore you need to go to the ER if it’s something urgent, and it maybe could have been avoided by an empathic conversation with an adjustment of the dosage of medication risk screening, maybe getting more social support in that moment. And so often I think people do take the the safer more impulsive route is just to say, go to the ER because that’s out of fear of saying the wrong thing or not being able to provide the most timely care to that patient right away.

I noticed PsychPlus is also dedicated and focused on the patients who are being discharged from the inpatient unit. And trying to get those individuals an appointment within a week and 75 percent of PsychPlus patients can get a follow up appointment within a week of discharge.

Mustafa: I think the numbers are actually a little better. If I’m not mistaken, we try to get patients follow up within 48 hours. I think a lot of those 75 percent are mainly because it’s patient preference to be able to have that amount of time at home and then follow up with a psychiatrist when they’ve had a couple of days to adjust back to their daily life.

We’ve had, cases where patients had to get scheduled earlier, where as we know, the inpatient psychiatric unit, unfortunately, when patients get discharged from there with the current situation with the decreasing number of stays that we’re getting from the decreasing number of days that we’re getting for stay from insurance companies, etcetera patients are rarely at 100%.

They’re usually about 85, 80% of the way there. The rest of the 20, 15 to 20 percent takes a little bit longer and the way current trends are going. Unfortunately, we have to look for discharge around that time. But the good thing is that we can get those patients scheduled and we can get them scheduled. Much sooner than most other practices, especially if they’re going out to if they’re being referred to a different practice, those patients that we discharged from the hospital we have priority slots built in where we can get those patients seen almost immediately and get that continuity of care that we need to get.

Bruce: What’s unique about PsychPlus? What’s the secret sauce? What are you doing differently that allows you to have these much reduced wait times compared to most other psychiatric practices?

Mustafa: I think the, unique part about PsychPlus is that we’ve kept ourself open to all possibilities. We’re not limiting ourselves. And, we’re utilizing as much as we can in terms of regulations. We’re utilizing virtual visits. We’re utilizing in person visits.

We all know that when COVID started, virtual visits became a big thing, but as time went on, Some patients realized that they weren’t able to get that human connection with the virtual visit. So we’ve had people in offices again where we’re making sure that a patient’s preference is respected.

We’re trying to make sure that we’re retaining staff with the staff that comes on, which unfortunately, post COVID or pre COVID, whichever way you look at it, the way medicine has been going, it’s been, staff retention is a big concern. It’s a big issue, almost globally having, practiced all the ways, from Chicago to New York, Boston, and now in Houston staff retention is across the board.

It’s a big issue and we’re highly focused on that. We’re trying to make sure that we’re. Providing the appropriate support that our staff needs to be able to take care of our patients. And ultimately, that’s who benefits at the end of the day. We’ve not just kept ourselves open to the possibility and retaining staff, but we’re trying to expand to grow so that when there comes a point, unfortunately, we come towards the point of getting overwhelmed where we’re, where that’s only a temporary state where we’re continually able to add on more providers, more MDs, more nurse practitioners, where we can continue to provide those services as our patient population expands.

As we speak right now, we have three clinics I believe two clinics in in the city of Houston that are about to come up, including the clinic, including my own clinic, which we’re currently working on and we have, I believe, four clinics in the state of Texas that are currently under construction, so to speak that are about to open up. We’re constantly growing. And at the end of the day, the reason for all of this to be able to provide those services and keep that mode of getting patients seen and providing them that continuity as much as possible.

Bruce: I’m glad you mentioned employee retention because I think that’s a really important factor that maybe patients don’t hear about as often, but happier, more satisfied employees definitely leads to better patient care and better outcomes. And also when it leads to improved continuity of care for that patient, because it’s not like a restaurant where another employee can just take over and pick up everything. It’s not like internal medicine. They develop a really strong relationship with that one person. If that person leaves, they have to restart all over again. And that could be pretty disruptive to that patient’s wellbeing. And what is your company doing that maybe other companies can learn from to reduce burnout and to improve staff retention.

Mustafa: Absolutely. And you’re asking a little bit of our secret sauce I can’t tell you the amount of patients I’ve seen. As a practitioner of inpatient psychiatry, I can’t tell you the amount of patients I’ve seen that had to get admitted because their specific provider was not available or had left the company had gone to a different place where their insurance wasn’t accepted or something along those lines and they just didn’t feel comfortable with the person that was reassigned and that’s one of the realities, unfortunately, and some patients are able to better adjust and some are not.

And I think we have very strict protocols when it comes to the numbers. We don’t absolutely want anyone to be overwhelmed. So there have been times where we do work with mid levels just like most other large practices.

But there are absolutely times when mid levels have patients that they’re not able to see and we have our MD step in and get down to the to the nitty and gritty work there where we want to make sure that Patients are getting adequate amounts of care and no one is getting overwhelmed with the just the sheer amount of work.

We also have people free floating in the system that are able to pick up that slack for for a patient that needs general medication management, for example we know that this patient is not very specifically looking for specific individuals, just needs some medication adjustment or a general checkup to be able to make sure that they can kind of continue to function in the community. We have people free floating in the system. Our system is centrally connected. So if, there’s one clinic that the patient is in that is not able to see that patient or, get that patient connected to their specific provider we can get them transferred to another clinic or even temporarily so that their continuity of care is maintained.

We’re not limited geographically. Although we’re there in brick and mortar for patients that want to be seen that way.

For right now we’re in Texas. But yes, we are expanding. And we’re all over Texas. We’re down from McAllen all the way to Dallas.

We’re hoping to expand out of Texas soon as well.

Bruce: We also have licenses in Texas too, and I love working with patients in Texas. It’s an extremely diverse state, is what I’ve noticed. Urban to rural to the extremes of both of those categories. What have you noticed about the challenges for Texans receiving mental health care in your state?

Mustafa: I think I would be in a better position to answer that question in a few months. I myself just moved to Texas a couple of months ago. Even though I grew up here, but never, practiced here professionally for my training. I had moved out of Texas. I’m learning the system as much as, anyone I’m, realizing, especially, coming from the Northeast, I was practicing in Massachusetts, and I’m not sure if you’re aware of MassHealth out there

Bruce: Yeah. I actually grew up in Connecticut, so I’m familiar with Massachusetts.

Mustafa: MassHealth is basically their universal state healthcare. And it was interesting most of the patients, almost 99 percent of the patients we got had some kind of coverage. Even people that were undocumented had some kind of coverage. So it was much easier to maintain that continuity of care here, over there.

In Texas, I’m learning that with the insurance payer mix it’s, a little more challenging but which is again why I love working in PsychPlus. We accept all insurances and we get patients seen, especially as long as the patient wants to be seen by us. make sure that they get the services that they need.

Bruce: I want to ask you, what do you believe that PsychPlus brings to the table to help get people the mental health care they need in a timely manner?

Mustafa: So I think that kind of touches back on what we were talking about previously. I think the fact that we are at this time for any growing practice as we’re young and, but we’re growing by leaps and bounds. I think for any growing practice cost becomes a big prohibitive factor.

Having the amount of staff because again if cost wasn’t a factor, every single patient would be able to get seen as, as soon as they wanted to, right? That’s the limiting factor.

Bruce: you can’t talk about this without talking about insurance and reimbursement and stuff.

Mustafa: so I think 1 of the big things that we are doing because we’re growing 1 of the discussions that we have around the company is that we don’t want to look at cost at this time because growth is more important right now. So our job right now is, and it’s, a passion project at the end of the day.

It was started out of this need to get psychiatric services out there. The discussion around the company has been, what, right now the psychiatric need is much greater than any kind of cost that we would incur. And yes, we are keeping our bottom line in mind.

We don’t want to fizzle out in a few years, obviously, but our aim right now is to, Provide the services and the financial benefit will follow. Our aim right now isn’t just the financial benefit. We’re playing the long game. We want to around. We don’t want to just add them and then not be get overwhelmed and not be able to provide those services. the patient satisfaction fall and be nowhere in a few years we all know countless practices that have gone that down that route.

We want to make sure that patients that are seen by us are satisfied with the care that they’re getting and are able to continue to trust us to be able to provide that care.

Bruce: And which insurance, Medicaid, Medicare, do you take and what was the rationale behind which ones you take?

Mustafa: Including Medicare and Medicaid. There is no insurance that we do not take. So that’s, one of the other driving factors, as we know, that payor mix can make things complicated.

It can again, adding on that staff to be able to make sure that we are staying in compliance with all the insurances that we are able to, bill for services appropriately. It adds on an extra cost extra staff to be able to manage those things. But again, like I said, we’re keeping the service aspect in mind more than the financial aspect.

That’s our target right now.

Bruce: Gotcha. There was recently a listening session that was held by the DEA over two days regarding the prescribing of controlled substances via telemedicine. And one thing that struck me was the incredible variability of people’s opinions, There were people from chronic pain physicians, there were substance use physicians, there was hospice physicians, there was ADHD psychiatrists, there was the whole gamut there, and they all had a little bit of a different perspective on what their patients need, and also, even within one discipline, people had very different opinions about whether or not an in person visit was needed for controlled substance.

For example, in the substance use population, there was an individual from rural Virginia who said that you need to see the patient in person. You’re going to miss signs that will change the decision making. And then there were other individuals that said it. If you’re forcing them to go in person, that is going to reduce the ability for you to see more patients and you’re overall at the, on a population level, you’re helping fewer people and some of those people are going to not have treatment and overdose.

And so that is harm. That’s also harm. That’s the same as missing something as in person. does PsychPlus stand on that? Were you able to attend the listening sessions?

Mustafa: Unfortunately, I was not able to attend the listening sessions. I think at that time I was still getting oriented to this new role. And my focus was a little elsewhere. But I think with regards to PsychPlus, I think first off, obviously, the most important thing we want to make sure that we’re, making sure that we’re following all regulations, we, again, just like you mentioned, within the same field, we have different clinicians , and different MDs and in our practice that have a different view on this and I think as a company, I think we’re more focused on whatever care we’re able to provide.

And I think at the end of the day, it’s about what helps our patients, right? That’s the end goal, whether the clinician has the justification of having patients come into the clinic or another clinician that wants the patients to be seen even remotely.

At the end of the day, we all know that we all want the best for our patients. And I think that’s where PsychPlus is right now. We want to make sure that we provide the best possible care. Without providing undue burden or again, unnecessary over medication.

So we’re waiting on how things play out. For now we’re following through with the regulations again like it would be very easy for me to say during COVID things became much easier in the prescriptive sense that, we were able to provide all sorts of care across the spectrum.

But there are downsides to this and we are at the same time, we’re as much as we know the upsides. We also have to be mindful of the downsides. So we’re in a more contemplative state ourselves. And we’re waiting to see where the ball lands.

Bruce: So what are some major challenges for you all as a company? Say we were a fly on the wall in one of your meetings. What would be discussed? What’s active that you’re working on?

Mustafa: I think like I mentioned, I think growth is 1 of our main kind of, discussions that are going on when we are able to do that. And the fact that it’s all of us are, none of us are in just management positions.

We are, all of us that are in management are also clinically active and, we, that’s why we’re not losing sight of what the clinical needs are and often we’ll see that, we’ll see that when when we’re, when one is just part of management then sometimes the clinical aspect is lost.

Decisions are made that are not kept in mind with, are not where clinicians best interests are not kept in mind. So I think very importantly, when we do come together as a team, we’re able to keep that in mind because all of the manage, all of the management is currently are currently practicing.

So we’re able to keep that clinical aspect in mind. We’re able to keep the patient’s needs in mind because we are directly seeing patients ourselves. But in terms of where the company is going, I think growth is one of the biggest things that we’re talking about. As I mentioned, we actively have four clinics that are about to open up each clinic with with multiple clinicians, with MDs, with nurse practitioners, with We’re out of state, I believe by the end of this year. We’re seeing patients ourselves, so we’re not losing sight of what the clinicians needs are or what the patients needs are. As we see most often happen when people go away from the clinical side and go into just management.

Sometimes decisions are made, having worked in different, practices and facilities and hospitals, I’ve seen where management will sometimes make decisions that, make sense to clinicians, will not seem to be optimal for patient care. And I think the good thing about this practice is that all of us, all of the management, we’re actively seeing patients, we’re connected to patients directly.

So we are able to keep what the patient’s needs are as well as what the clinician’s needs are in mind. And having kept all those things in mind, we’re able to focus on growth, on sustainable growth. And we’re able to move fast for that reason, because we know where the gaps are and what our are looking for.

Like I mentioned, we have four, four clinics in the state of Texas about to come up with staff, with MDs, with nurse practitioners, with PAs, with therapists. We have, we, by the end of the year, we’re planning to expand into about six states and hopefully in about another year to year and a half in another 21 States.

We’re expanding and we’re keeping our main goal what the patient’s needs are and to be able to get the patients connected as our primary motivation.

Bruce: what do you see of the role of technology in the practice, either through the EHR system, or the telehealth system in terms of its usability as a method of increasing overall access to care for individuals in Texas, who may have varying needs or resources available to them.

Mustafa: I think I’ll preface this by saying that anybody who’s practicing medicine nowadays, if they’re not keeping that technological aspect in mind, whether it be the challenges or it be the opportunities I think they’re doing their themselves and their patients a disservice at this point.

I think in this day and age Where we have what in the United States, I think 75 or 80 percent of people connected to the internet. Healthcare being a much lower number. We need to keep that in mind and modify our practices and preferences accordingly. Because at the end of the day, it’s about the patients, right? We’re all here because we want to make sure the patients are cared for.

So I think this technology, these tools to our clinical practice, they only benefit us. They, I think the fact that, I think as a practicing psychiatrist, what I can tell you is that there are many places that are still using more physical and paper charting and we see the challenges at those places not saying EHR doesn’t have its own challenges, but the generally the ease of accessibility, the ability to gain medical records to review past records for patients to get their own medical records for whatever their needs are.

For connectivity purposes. Again, there are times when patients don’t really need to see a doctor, but may have a query or a question. Somebody is about to run out of medications or someone is a more critical acute state. If we’re ignoring the technology and the resources that are available to us, I think we’re doing ourselves and our patients at this, the service by not being able to provide services that we can.

Bruce: And in wrapping up the conversation about technology and the use of technology in the telehealth and telepsychiatry space, what sorts of problems or challenges do you anticipate that lie ahead in promoting access to care for all patients across Texas and other states?

Mustafa: I think the biggest challenge that we have is just getting the word out there. And I think we’re actively working on ways to better be able to market ourselves. Like I mentioned, we’re one of the few, if not the only practice that’s able to get patients seen so quickly.

Especially patients that are not connected with us already, patients that are already connected with services, it’s much easier for them to continue to get care. But our aim is to basically capture the population that, that doesn’t know that they actually need care, that these services are even available.

As we all know, mental health stigmata still exists to this day. Patients don’t want to be seen. A lot of times, even if they want to be seen, they don’t want people to know about it. So asking around and getting information about psychiatric care is a taboo in itself. So what we want to do is make it accessible to the point that people don’t really have to ask around for something.

We want to make sure that they have that information available. So we’re working on active plans to kind of promote or make our services, or at least reaching out to us more readily available. Because, the more people we remove , from the patient in between us, the more, the easier the pathway it is for the patient to get from where they are to us, where they can get care, the more I think we’ll see an increase in the number of people, willing , to get services and once they get service, they’re willing to continue to get them going forward for to maintain themselves in the community.

I think that’s one of the biggest challenges that we have the general person may not want someone else to know what their private business is, what their mental health issues are, and, just knowing that the service is out there, but, and they can get connected to it, may remove some of the hurdles that, that they are seeing for themselves.

Bruce: Do you have any recommendations for anybody out there who is interested in moving the field forward in terms of technological innovations, other sorts of cultural innovations, knowledge based innovations, what sorts of ideas do you have for maybe a young person who has a lot of motivation and interest in this field?

Mustafa: We need people to be innovating constantly and it’s easy for as clinicians, as people that are. Just as treating patients as people that are actively seeing patients, we lose size, lose sight of the of the possibility of innovation and how to move beyond our current scope of practice into, better ways and more accurate, appropriate, and apt ways where we can provide care.

I think it’s very important and psychiatry, unfortunately, is one of the fields that. Hasn’t had a whole lot of innovation, our last class of antidepressants that we developed came out in 1987. That’s when Prozac came out. I think we haven’t had pretty much any innovation since then.

We’ve had, TMS has come out. Sure. but again, there’s no, there’s nothing that’s changed the field. The last time we had a field changing invention come out was back in the eighties. We haven’t had a whole lot of new data.

Bruce: Anything that really excites you in terms of novel treatments, options available for people who may be struggling out there?

Mustafa: I think in the last couple of years, there has been some movement as again, as mental healthcare has gained a little more kind of, momentum, we’ve seen FDA provide that approval for, I think emergency use approval for MDMA for PTSD, we’ve seen, FDA provide that, approval for psilocybin microdosing.

And we’re seeing innovation and that’s how we stimulate growth, right? We get people excited about these new novel things that were taboo and are now going, I don’t want to say mainstream, but at least getting into this fear or the sight of people that want to look into this stuff and want to see where this goes. I think as clinicians, we sometimes lose sight of it, but we need to have at the back of our minds that, things need to continue to move forward.

And unfortunately, in this field we’ve for lack of a better word, we’ve stagnated a little bit. I think as a field, as a whole, we’ve stagnated a little bit, the more kind of more excited people we get into this field, and I can’t tell you the amount of medical students have tried to convince to, to come into psychiatry every time I have somebody on my rotation And I think that’s the part, right?

We need to actively market our fields so that we get people who want to come in and innovate in this field. As important as clinicians are innovators are equally important because they’re the ones that move the field forward.

Bruce: Are there any technologies that you are looking to integrate with the company and the company’s practice in terms of data collection or delivery of treatments such as VR, patient monitoring, is there anything in that front that PsychPlus is interested in?

Mustafa: So absolutely we have our own electronic health record and we’ve integrated that with not just the electronic prescription, which is again, which is becoming pretty common, but also with our app, where patients, can get screened. We have, the ability to get patients diverted to specific clinicians, specific therapists, depending on what their specific needs are.

Like I said, it’s all about reducing the number of encounters that someone has to get to be able to get to a clinician, having to go through as we’ve, been through customer service for airlines or whatever you have it, right? The number of people you have to talk to get to finally get to the person who can eventually help you.

It’s just it’s frustrating. So we’re, what we’re trying to do is use technology. We have our app that we’re utilizing for this purpose. And we have a few more things in, in the pipeline where we’re trying to reduce the number of hurdles that a patient has to go through to be able to get access to direct care.

We want to get them diverted to the appropriate person. If a person is looking for specifically for trauma focused therapy, we don’t want to get them set up with someone who’s there for a little more psychodynamic or, something like that. So we want to make sure that, we’re getting the appropriate people connected to the appropriate clinicians.

We’re trying to utilize technology to, to be able to achieve that goal. So just to be able to promote access to care.

Bruce: Great. Dr. Tai it was a pleasure meeting you and talking to you about PsychPlus and getting a little bit of insight into the mindset in that company in regard to how to promote equitable care across all Texans in the future and other states as well to individuals who don’t otherwise have access to that care and how to retain staff, leading to better patient outcomes, what the challenges lie ahead, what your mission is and how to incorporate technology into the delivery of care in the healthcare system.

So I really appreciated you giving me that overview, especially how it relates to the future of psychiatry.

Mustafa: Yes, absolutely. It was a pleasure on my part.

Bruce: Thank you so much.

Mustafa: Thank you, Dr. Bassi

Bruce: I’d appreciate it if you please like and share the podcast with your colleagues. It would be especially helpful for us. And if you’d like, please leave us a rating on your favorite podcatcher. If you’re a clinician, I developed a course on how to start a private practice. And for patients, I’ve also developed a course on ACT and CBT based lessons for treating and helping anxiety. And you can find those all on our website as well. Thank you so much. And I’ll see you in the next episode.