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MunicipalHi, I Am Dr. Jonathan Sherin, Director of LA County Mental Health, AMA!

May 1st 2017 by JonSherin • 7 Questions • 117 Points

UPDATE: Thank you for your great questions; feel free to keep in touch with me or LACDMH over social media and I look forward to answering more of your questions next time.

I am Jonathan Sherin, M.D., Ph.D., a father, surfer, wellbeing advocate, psychiatrist, neurobiologist and – as of this past November – the new Director of the Los Angeles County Department of Mental Health (LACDMH). I oversee the largest public mental health system in the United States with a budget approaching $2.5 billion. We serve over 250,000 residents annually in one of the most ethnically- and culturally-diverse counties in the nation.

Prior to joining LACDMH, I was the chief medical officer and executive VP of military communities for Volunteers of America, one of the largest national direct service non-profits. Over the years, I have served in various clinical, research, teaching and administrative leadership positions for the Department of Veteran Affairs. In my last such post, I directed mental health for the Miami VA Healthcare System.

As an expert on veteran issues, I have testified to Congress on a variety of trauma-, recovery- and reintegration-related challenges veterans face, including homelessness and suicide.

As a researcher, I have published a number of papers in the fields of neurobiology and psychiatry – including a “Science” article that described my work discovering a core sleep circuit in mammals (a.k.a. the sleep switch). I have also received the prestigious Kempf Award from the American Psychiatric Association for my conceptual model on the psychotic process.

Lastly, I am currently a volunteer clinical professor of psychiatry and behavioral sciences at both UCLA and the University of Miami.

For the next hour (1:30p to 2:30p Pacific Time), I welcome your questions about mental suffering, confronting stigma and changing our perceptions, language and attitudes to create a new culture that promotes mental health. A colleague is helping me with typing down responses, but the words are 100% mine.

Proof: https://twitter.com/directorLACDMH/status/858049469232939008

If anyone is interested, here is my Twitter, plus LACDMH’s website and social media pages:

http://www.twitter.com/directorLACDMH | http://dmh.lacounty.gov | http://www.facebook.com/lacdmh/ | http://www.instagram.com/lacdmh/

P.S. This week, LA County is co-hosting the inaugural global summit dedicated to changing the way we think, talk about and take action for mental health. To learn more about & participate in this 3-day series of events to kick off Mental Health Awareness Month, visit http://www.changedirection.org/global-summit/

Q:

Dr. Sherin,

  1. How can LA County better address substance use problems, especially among our homeless? I've had to acquiesce to vague primary diagnoses like "Mood NOS" even when I knew a patient's biggest immediate impediment was their massive meth or alcohol use. We had several ED high utilizers--people who smoked meth, become paranoid/agitated in the community, and routinely get brought into the hospital by the police. At times, when I tried to focus treatment on problematic substance use in the chart, I've been told by administrators that the substance use was "not a mental illness". 

  2. What is going to be done about emergency room overcrowding? On rare busy mornings, I've literally had to walk over patients sleeping on the ground. At some point, so many patients in a locked environment has to be a safety hazard. Also, are there any new approaches to managing people who come in expressing suicidality for secondary gain?

  3. Residency location plays a role in a physician's decision on where to practice. Is anything being done to make up for the lost Cedars Sinai and MLK training slots? 

  4. What are the major barriers to better integrating medical and mental health care? Especially with regards to the electronic medical record and colocating medical/mental healthcare? The level of coordination between LA County's medical and mental health services is a large contrast to my experiences at Kaiser and the VA. 

A:

There is debate about the differences between “pure” mental illness and “pure” substance addiction…in either case individuals are suffering tremendously and these two different diagnoses tend to co-occur in many cases. Through efforts to integrate care both within the department and between departments we aim to provide integrated services to individuals with integrated problems.


Q:

Agreed! Also these positions should be well paid don't you feel? $15 an hour to disclose your mental illness doesn't seem like a good deal does it?

A:

For starters, all peers engaging in the serious business of caring for others need to be properly trained and receive certification as indicated given their role. It is my hope to expand opportunities for peers to become a core discipline in the Department not only through existing funding as well as expanding our resource streams. In particular this Department is committed to pushing for new legislation that will provide reimbursement through peer services at the state level.


Q:

How -- specifically -- will you be working on addressing the tremendous amount of inequality in the MH service delivery system across LAC?

A:

We are currently in the midst of conducting GAP analyses across all 8 Service Areas in LA County. Although our initial focus aims to identify underserved cultural communities, we are also looking to determine other aspects of being underserved. For example: are we best allocating resources across age groups? For women? For veterans? For those suffering from psychological trauma? For homeless? For the justice-involved?

These are very complex questions to answer as they require not only determination of who is getting what where, but also depend upon whether our services are being offered in a welcoming fashion.


Q:

Dr. Sherin, what percentage % of people are on Skid Row in LA because people they know in their lives have no idea how to get them help and what percentage % of people on slid row want no mental help themselves and people in their lives gave up on them or are these homeless are ignoring their family and friends despite the attempt's by their loved ones?

A:

There is a significant number of people on Skid Row who are homeless and have serious mental illness and/or substance abuse issues. While a significant number of them are unwilling to accept help, surely there is a number of them who don’t know how to get help. It is our intention to engage both groups to get them the help they need.


Q:

Thanks for this AMA! I recently accepted my mental illness (bipolar 1) and I've realized how lucky I am to have insurance and the money to pay for my medicine.

My question is: how do you see the availability of treatment for mental health going forward in 10-20 years? I believe it's a massively under reported and under treated aspect of our society.

A:

Through access initiatives, chief among them dismantling of stigma, it is my hope that both reporting and treatment of mental illness will rise to levels that rival those for physical illness. That said, I believe that certain technologies will provide new opportunities and solutions. One advance thatr we are working on currently leverages “FitBit-like” monitoring of mental health and well-being in combination with anonymous, virtual treatment paradigms to allow anyone to get help assessing their emotional state and receiving care in real time.

Another approach that we are interested in exploring involves the use of neuromodulatory interventions such as transcranial magnetic stimulation to augment other therapies.


Q:

Dr. Sherin, Thank you for doing this AMA. As a starting MFT trainee, I am curious about how the field is changing for therapists. I understand that in vivo services are becoming more common. How have you seen the field change and what should we starting out in the field expect in the next few years working within the mental health field in Los Angeles?

A:

Over the last five years the Department has implemented a number of evidence based practices serving clients with symptoms of depression, trauma, substance use, and disruptive behaviors with demonstrated outcomes. We fully intend to increase the training of our staff and our partners to increase our capacity and provide more in vivo approaches to care.


Q:

Dr. Sherin, what are your hobbies outside of work besides surfing? Do you play and watch any sports? Do you have any pets?

A:

In addition to surfing, other sports that I enjoy include mountain biking (particularly downhill) as well as skiing. In fact, I used to ski race through college. Just recently I lost my incredible Bernese Mountain Dog named “Berner” after 14 years of exquisite companionship.