Exploring Ryan Carruthers’ Philosophy: Mental Health for All

Intro  

Welcome to another edition of Inspired Stories where leaders share their experiences so we can learn from their successes how they’ve overcome adversity and explore current challenges they’re facing.

Welcome to another edition of the Inspired Stories podcast where leaders share their experiences so we can learn from their successes and be inspired by how they’ve overcome adversity. My name is Anthony Kodespode and today’s guest is Ryan Carruthers, Chief Clinical Officer of Centerpoint which offers over 40 programs including mental health, substance use treatment, primary care and housing. Ryan is a licensed mental health practitioner, licensed alcohol and drug counselor and certified peer support specialist in the state of Nebraska. He holds a PhD in counseling studies and is a member of the motivational interviewing network of trainers. He’s also worked as an adjunct professor and taught many other addiction counselors and mental health practitioners on topics of harm reduction, suicide prevention and alternatives to the 12-step programs. He started Omaha’s first smart recovery meeting and has created programs for educational courses, outpatient programming, adolescent family education courses and residential curriculum. At the end of the 2007-08 school year, Ryan was awarded Miller Public Schools Expanding Horizons Award for making a difference by enhancing students’ learning of curriculum through practical experience in the school environment.

Ryan has held various positions with Centerpoint and has been their Chief Clinical Officer for the last three and a half years. Now before we get into all that good stuff, today’s episode is brought to you by my company, Add Back Benefits Agency where we offer very specific and unique employee benefits that are both great for your team and fiscally optimized for your bottom line. One recent client was able to add over $900 per employee per year in extra cash flow by implementing one of our innovative programs. Results vary for each company and some organizations may not be eligible.

To find out if your company qualifies, contact us today at addbackbenefitsagency.com. Now back to our guest today, the Chief Clinical Officer of Centerpoint, Brian Carruthers. I appreciate you making the time to share your story today.

Yeah, thanks for having me on. So, Ryan, when was it that you first realized that you wanted to serve others through behavioral health assistance? Yeah, so I was a mathematics and German double major in college. This is a natural transition, right?

Yeah, absolutely. And I was about three and a half years into that when my life kind of took a turn. So in my intro, you said I’m a certified peer support specialist and that means that I myself have lived experience with addiction and mental health struggles. And so I found myself here in the state of Nebraska in a residential recovery program for a pretty severe addiction. And through that journey, I decided I wanted to continue my education, but I was going to switch over from German and mathematics into human services and into addiction counseling in particular. And so my own journey kind of inspired coming into the field of mental health. And that was a little over 21 years ago.

And so it hasn’t been a straight line ever since, but I saw what kind of my purpose was and have kind of pursued that all the way through now to being a PhD. Wow. So this is a powerful story.

I’d like to dig in here if you don’t mind a little bit. So you found yourself in an addiction recovery center. Did you admit yourself or family or friends kind of directing you, kind of pushing you to go there?

How did that kind of unfold? Yeah, it’s always kind of a combination of things when people make that decision. Kind of the crux of it was I knew that I could not continue. Along with the addiction stuff, I also had some pretty gnarly depression that I was struggling with.

And so the end of that part of my life, that part of my story, was on a bridge and I wanted to jump off. And so I actually reached out to my uncle who had had similar kind of struggles and had been through some treatment and said, hey, I need some help. And he got me help.

By the end of that day, I was in a rehab center and starting the long journey of recovery. Wow. That’s powerful. And maybe the most surprising part of that is that you were actually able to reach out for help. Folks find themselves in that kind of a position struggling with depression, struggling with addiction. What they need the most is help from somebody, from a trusted, you know, loved one. But that can be the hardest phone call. That can be the hardest conversation for that person to initiate.

Yeah. And I had really kind of said to myself, look, I’m going to make one phone call. And if he doesn’t answer, then, you know, it’s not meant to be.

And it just so happened that he answered the phone and was available to come get me and kind of dropped everything that he had going on and put his focus and attention on me and the rest, as they say, is history. How long were you in the treatment center? I was kind of a traditional short term residential program. So it was about 30 days.

Okay. And was it while you were in there that you had the idea of sort of changing your education and career trajectory or did that come later on? Yeah, I think the initial idea of it kind of came there. I really enjoyed helping the other people that were there just kind of in conversation, not really, you know, formal helping. But then one of my counselors that was there actually said to me, hey, have you ever thought about, you know, doing something like this? And that kind of formally put the idea in my head. And then when I came out and did some recovery housing for a while with some other people in early recovery, I decided, yeah, this is this is what I want to pursue. Okay. And so you went back to school, you started taking different courses and what did the path look like from there to center point?

Yeah. So I kind of took a, I guess, a non-traditional approach in mental health, excuse me, mental health and addiction. A lot of times people will come out of school and go work for an agency. And then after working for an agency for a number of years, they’ll go into private practice.

I took the opposite approach. I started off in private practice. I had a small private practice that actually grew into a couple of different locations and employed several other counselors and staff and did that for almost a decade until the business side of it was not my strength.

I really enjoyed meeting with people and developing programs and relationships with people in the community. And maybe not even the business side of it, but really the hiring side when I opened up a second location, I hired someone to run that location and it turned out to be a hard lesson for me. It ended up bankrupting the business and myself along with it. So in going through that, I then had to kind of go work for nonprofits all the while. So I started out after having gotten my associates degree because that’s kind of all you really need to practice drug and alcohol counseling.

Mental health practice requires a master’s degree. And so I was continuing my schooling while running the practice. And then when I closed that down, went and worked for a couple different nonprofits. But the thing about running your own businesses, you get to do what you want, how you want it, when you want. And then when you go work for a nonprofit agency providing mental health services, it’s not quite the same.

You don’t have the same level of freedom. And so I have a particular way I view addiction counseling that isn’t necessarily the norm. And it’s really the idea that abstinence from everything isn’t the only solution. That there’s a lot of people out there that want help, but maybe they want to stop using their drug of choice like methamphetamine or opiates. The opiates have been in the news a lot lately. And so we have people come in like, look, I need to get off of the heroin or the fentanyl. But don’t try to pressure me to stop smoking weed, for instance.

The kind of traditional mode of addiction recovery says, no, you got to stop everything. But then what that does is that closes doors to people. And people end up dying when they don’t get help.

And so the kind of addiction counseling and mental health practice, honestly, that I utilize is called harm reduction. Which just says we really meet people where they’re at. We help them with what they’re willing to get help on.

And then we leave the door open for them to get help for these other issues that they may not be ready to stop, like alcohol or marijuana. And when I was in private practice, I was able to do that kind of on my own. I was able to just practice the way I wanted. When I went out and started working for agencies, that wasn’t the case. And so what kind of makes CenterPoint such a great fit for me is that they’ve been practicing harm reduction for the last 50 plus years now. And really putting a focus on meeting people where they’re at. And one of the things we say all the time is that better is better. You don’t have to be perfect. You know, where a abstinence only program really pushes people towards 100% all the way.

And we want to be able to help people when they’re ready for 70% of what we have to offer. So that’s kind of what has made CenterPoint a great fit for me. In terms of how I got here, it was actually by happenstance. I had ended up as a director of a residential program here in Omaha, run by another nonprofit when they, because of budgetary issues and some socio-political realities of taking federal money, which is really what runs the mental health and addiction treatment industries in the United States, they decided to no longer operate the programs they were operating, which happened to be where I was working was the state’s largest residential mental health and substance use treatment facility. And so the state said, look, we need this program to keep going. And CenterPoint stepped up to the plate and said, we’re willing to keep running the program. Even though, you know, in the six months prior to CenterPoint taking over, the program had lost over a million dollars.

And so it was a financial mess. And CenterPoint stepped up to the plate and I was able to continue in my role as a director here. And then over the last seven and a half years have just kind of grown with the organization into the chief clinical officer role. So CenterPoint acquired the entity that you were working for before it was in financial straight straights, and they were able to come in, kind of patch it up, fix it up. You stayed on and sort of the same kind of leadership role that you have before. And your role is just continue to grow with CenterPoint.

Yeah, absolutely. And it’s just been a really good fit for me. And I think for the organization as well, I’ve been able to kind of bring my vision for how treatment is supposed to occur. And it’s almost like I have the freedom of private practice again, without having to, you know, be the one who runs payroll, you know, we have a team for that. So yeah, it’s you get to focus on your strengths and your love.

And you’ve got other people to support those other elements of the business. Yeah, I want to explore this idea of harm reduction a little bit more. This is a non traditional approach. And I guess when you first started talking, my mind said, wait a minute, that doesn’t seem like the right way to go. I mean, if they’re having trouble with substances, don’t you want them off everything?

Like, you know, if you tend to have addiction towards this thing, aren’t you, you know, probably going to have addiction tendencies towards other things. But then I heard what you said about meeting them where they are, right? Because if you, I think this is what I hear you saying, if you take such a hard line stance with folks, it’s all or nothing, you’re going to get some people who just say, well, then it’s all like, you know, I’m not coming in, I’m not doing this program, that’s not where I’m at right now. And like you said, people end up dying.

Because they go too far the other direction. What was it that sort of led you to this thought process of it doesn’t have to be abstinence? Yeah, that’s the that’s the key question, I guess. Myself, I kind of came to this harm reduction approach by listening to the people I was working with. Going back to my private practice, I kind of had that what you described to kind of, you know, traditional mentality of it’s all or nothing.

And, you know, this is how it is, you have to stop everything, or else you’re, you know, destined to, you know, die from this. And two things, one, I had gotten a really good training. A colleague of mine had said, hey, have you ever thought about this training in motivational interviewing?

That’s what it’s called. And basically, just is the approach that teaches you to not push people towards things, but rather to walk with them in the direction that they want to go and allows them free choice, right, without judgment. The idea is that, you know, there’s here in Nebraska, just a couple weeks ago, we we finally, I think we’re the 47th or eighth state or something to pass medicinal marijuana. But the truth is that whether it’s alcohol or marijuana, caffeine or tobacco, adults have choices to make. And we want to we want to respect those choices, regardless of whether they’re in line with what is ultimately the healthiest for them. And what we find is that when you don’t push people into something they’re not ready for, they tend to get around to making the right decision for themselves.

The decision that they’re comfortable with. And when someone says, this is something I want, not something that I need, or someone, you know, a court or a family member or something is saying that I have to do, you know, in my own journey, my family had done some, you know, if you’re familiar with the TV show intervention, they had done some of those kind of confrontational interventions with me, where they said, look, this is this is it, you’re going to do this, or else. And when presented it that way, I said, or else, you know, and just kind of went that went that path. But by listening to the people I was working with, they told me, they’re like, look, you know, I’m going to do what I’m going to do. So I can come in here and be honest with you about it. Right. Or I can come in here and tell you what you want to hear.

Right. The choice is up to you as the therapist. How do you want to approach me?

Right. Because if you approach me in this way, I’ll be honest with you. And I’ll tell you, yeah, you know, when I get off of probation, I’m going to go back to smoke and weed. And I’m like, okay.

Right. The other thing that we see, especially with younger folks, you know, if you think of a teenager coming into a treatment center for a drug problem, they’ll come in and be like, well, yeah, but we should be legal. And all their try all that is, I try to tell new counselors and therapists, all that is is a litmus test, right? They’re just testing you to see if they can trust you. Because if you say, no, yeah, it shouldn’t be in, you know, it’s still bad for you. And the drug is a drug is a drug, you know, just answer them with some kind of cliche. Then now they got what they want, they got an argument, right? And they know it’s me versus you rather than we’re on the same page. And so regardless of whether I believe marijuana should be legal, the harm reductionist in me says, when someone says something like that, well, we should be legal. I’m like, yeah, okay. And just agree with them, right? Regardless of what I actually believe, that’s, you know, as a helper, that’s not my role to impose my values on you. And so this is part of that motivational interview style that you’ve learned is, yeah, kind of how to gain trust with them and walk with them until they’re ready to take that step.

Yeah, I couldn’t describe it better myself. So you talked about the show intervention, do those interventions, do they ever work? Are they ever effective?

I mean, work, you know, effectiveness is hard to say in our field, right? What do you measure, right? Do you measure pure abstinence? Do you measure, I mean, the intervention itself, its only goal is to get the person into treatment, right? And so does it get them into treatment?

Sure. A lot of times it does. Then, you know, the question of whether or not the treatment is effective, that’s a totally different question, right? You know, on that, though, that question of is it effective, our work, you know, we do measure at center point, whether or not someone maintains abstinence, you know, during our programs, after the program, etc. But that’s not how we measure our own success. At center point, our mission is to help the people we serve get better sooner for longer.

But the question is, how do you measure whether or not someone got better? And we have an approach for that. We use a tool, it really looks at their ability to function in their daily lives, right? That’s why people actually come into treatment, is because their life is falling apart. Is it because of the drugs?

Sure. But some people are able to, just through a reduction in substance use, maintain a job, right? Who’s to say that’s not a success? In their eyes, that’s what they wanted.

They wanted to be able to maintain a job, or they wanted to be able to rebuild relationships, right? And they’re able to do that, maybe, while still smoking weed or drinking socially, or even some binge drinking, you know, on a limited basis. But then, you know, if I get into the heavy drug use, the illicit drug use, whatever, so then functioning kind of falls apart. And so our approach is to help people with their functioning. And one of the ways that we teach that is really focusing on their coping mechanisms. You know, the idea is that for a lot of people with addiction, you know, and this is true even with business people, that some of our worst problems are actually our solutions, right?

Someone who spends five hours a day doom-scrolling during the election, you know? That’s a solution for them, right? That’s how they’re managing their anxiety or depression in that moment. And so it’s when those things that we look to for relief, those start to impact our functioning, that’s when people start to look for help. Because what they’re doing to cope just isn’t quite working. Is harm reduction considered an alternative to a 12-step program? And are there other methods that aren’t 12-step?

Yes, yes, certainly. Yeah, so smart recovery is by far the largest non-12-step recovery program that’s available out there. Now, 12-step programs themselves aren’t really treatment. That’s a free mutual aid support group that’s available in the community. And so the approach we take to that is we educate people on what the 12-step programs are, what smart recovery is, what refuge recovery is, which is kind of a Buddhist approach to recovery. Moderation management is a more harm reduction approach that teaches people what alcohol moderation is and is appropriate for a lot of people that have had, you know, kind of more moderate alcohol problems. And so, yeah, our approach is just that you have to find your own path, right?

You have to find something that’s going to work for you and your family and your situation. And, you know, the evidence base is that the way we do it, that’s the way treatment is effective. Pushing people towards kind of one modality of recovery like the 12-step programs is just not very effective.

Yeah, you know, I’ll have to profess some ignorance here because I get a lot of what I know about recovery and addiction and 12-step programs from news and television programs. And they sort of present it as, you know, if you’re an alcoholic, like one tiny taste of alcohol, like sends you, you know, spiraling. But what I’m hearing you say, I think, Ryan, tell me if I’m wrong, is there’s sort of a spectrum, right? Like, yes, there are some people like, you know, a single taste is going to, you know, send them off on, you know, a bad bender. But, you know, there are people who, you know, alcohol, they’re, yeah, they consume too much of it, but they can find a more moderate way to consume that and still function in their lives. Is this correct?

Yeah, yeah. And I think the best evidence for that is that, you know, something like 30% of any college campus meets diagnostic criteria for a moderate to severe alcohol use disorder. And yet, those same folks, by the time they’re 25 or 30, most of them didn’t end up in rehab. Most of them did not, you know, kind of spiral.

They certainly had all the diagnostic features. But what happened is, they developed some other coping mechanisms, they changed their social surrounding. They, you know, kind of grew up, right? They matured, what we say, they matured out of the substance use issue. And maybe they have some lingering, you know, misuse kind of tendencies where they will binge drink and potentially cause some problems that way.

But certainly nothing like they were when they were, you know, 21 on a college campus. So we’ve been talking about Centerpoint and the services that you provide for folks dealing with substance issues. And obviously that is heavily intertwined with mental health issues as well.

Do you ever work with folks who are not dealing with an addiction problem, but do you have mental health issues? Yeah, absolutely. And the idea is we want to take a biological, psychological, and social approach to helping people, regardless of what brings them in. So this biopsychosocial model really says we need to address all of the issues that the individual has. And so like when you were talking about, you know, the services that we provide, we’ve actually taken it so far as to bring primary care in-house. And so that way we’re addressing those primary care needs, we’re addressing the mental health needs, we’re addressing the substance use needs. We have, you know, 200 plus units of supportive housing that we provide as well to the community. Because, you know, our CEO often says it’s like if you go into a car shop, excuse me, with four flat tires, and the place is like, look, all we do is, you know, at this shop, all we do is front right tires. That’s it. You know, those other three tires, you got to go down the road to get those fixed.

Well, that’s not going to work out very well, right? And so whether it’s mental health, substance use, you know, a combination of the two, which is typically the case, that where there’s one, there’s the other, especially for the people that do have the addiction issues, they almost always have some underlying mental health stuff. So about 70% of the people we see every year are kind of what we call co-occurring.

So they’ve got a little bit of everything going on. And that other 30% then those are folks that aren’t dealing with an addiction problem. Yeah, yeah, there’ll be folks that have mental health issues, that, you know, whether it be depression, anxiety, or one of the more severe and persistent mental health issues, you know, bipolar, schizophrenia. So let’s talk about mental health.

I feel like, you know, you kind of want to make this point about everybody has mental health. It’s just sort of a matter of where you are with it. Yeah, absolutely. The truth is in the kind of post-COVID era, we’ve kind of come out with this lesson that mental health is something we have to take care of. It’s not something you have or you don’t have. It’s something that is, as you said, with addiction, is on a spectrum, right? And any given day, depending on your stressors and what’s going on, you know, politically or what’s going on financially, you know, in your life, that your mental health is going to ebb and flow. And this idea that people with mental health issues are, you know, people in a hospital somewhere. It’s just not the case.

It’s all of us. One of the things that we saw starting a couple months after the initial lockdowns of COVID was huge spike in the diagnosis of anxiety disorders. What kind of what we found was that these people had anxiety issues already, but they never had anything that kind of spurred them to go get help with it. And whether it was the isolation or, you know, getting laid off, you know, even temporarily during early COVID, the way that the world changed made people a little bit more aware of mental health issues. One of the good things that has come out of that awareness is that we found more foundations, more folks being willing to give money to nonprofits like ours in order to address mental health. There’s been a lot of really good conversations over the last three, four, you know, five years, I guess now, surrounding mental health.

And some of that is directly attributable to COVID. Yeah. What have you found to be sort of some of the more effective methods to help people who are on that mental health spectrum kind of move from one end closer to the other?

Yeah. So I think we utilize several different kind of approaches. I want to start by talking about one of the most important ones, and it’s not something we do directly with people, but it’s more of a system thing. It’s an approach we adopted probably three, four years ago that had mental health systems and hospital systems, physical health systems as well, develop what’s called a zero suicide framework.

One of the things that research shows us around suicide is that many people who end up dying by suicide were in a behavioral health or a physical health setting within the 30 days prior to their death. And what a tragedy, right? What was it that was missed, right? What was not done? How was it that this person fell through the cracks and this didn’t get appropriately identified and treated when the person was seen by these health professionals? And so several years ago we implemented this wonderful framework called zero suicide. There’s a whole institute dedicated to making sure that health systems make sure that folks just don’t fall through the cracks. And so we developed what we call our life worth living pathway. And basically what it does, it just assures that that people that were asking the right questions, that were providing the right interventions, and that if someone is at risk for suicide, that we are making sure to go above and beyond with that person to make sure that worst case scenarios to person dies by suicide, we as professionals won’t have to ask ourselves, what else could we have done?

Because we’ll have done all of the things possible to intervene. Now that being said, the types of interventions that are really shown to be most effective, there’s kind of two schools. One is like said earlier, motivational interviewing. And the idea of treating people with dignity and respect regardless of whether they are experiencing the same reality that we are, regardless of whether they’ve committed crimes and have these backgrounds that would be judged by society.

When they’re coming in for help from a professional, they shouldn’t be judged in our environment. And so motivational interviewing is something that we train all of our staff in. And then the other one is cognitive behavioral therapy. And this is what just about every self-help program that’s every self-help book, they’re all based on cognitive behavioral therapy. And the idea is we’re trying to help people change the way they think and feel. And then behaviors kind of come along for the ride. Because if I am thinking in a rational way and I’m feeling emotions that are in line with my reality, then I’m probably going to be making decisions that are healthy decisions. One particular other approach that we do, and this one’s a little bit from mental health specific to addiction.

And again, kind of comes in on the more controversial side. It’s called contingency management. And a contingency, of course, is just if this, then that. Well, contingency management says, if people engage in these behaviors that we want to see from people, then we give them a reward, right? It’s kind of pure Pavlovian behaviorism, which just says that you reward people for what you want to see them do. And so contingency management says, hey, if you attend your groups that you’re supposed to go to that you signed up for, you pass a UA, that your analysis, right? Like you don’t have any drugs in your system. And you complete some homework assignments, then you’re gonna get a $15 Walmart gift card.

Not much, $15. I was gonna say, is that strong enough to keep somebody from using a substance of choice? It often is. Contingency management is the most highly rated research-based approach to addictions.

And so again, it’s controversial because you’re giving people money, right? But like in our, we have a residential short term that’s like up to 60 days. So someone might be there five, six weeks, something like that, but up to a couple of months. And during that program, they can earn four gift cards that they walk out of the program with, right? So that’s up to 60 bucks. And I tell people, okay, so it’s controversial that we pay them a dollar a day. I mean, in the big scheme of it, right? This really isn’t your money.

Feels like a pretty good investment. Yeah, absolutely, right? And they’re staying, because they have to stay, they have to do BT expectations of the program.

They have to pass UA’s. And it’s really not that big of a deal. But I’ll tell you for the people we tend to work with, 60 bucks is sometimes a really big deal. 52% of the people we served across the organization last year had an income of $1,000 or less for the year.

Yeah. So I mean, basically they have no income. And we serve a disproportionately low socio-economic group, even within the addiction recovery and mental health space. We kind of really specialize on people that are really struggling across all domains of their life and those kind of social determinants or social drivers of health, income, housing status, all that are pretty big struggles.

So 60 bucks in gift cards to Walmart can be a really big deal for a lot of the people we’re working. That actually kind of leads me to a question that I’m wondering, you know, when you’re talking about somebody who’s suicidal, if they were to be able to give words to why they felt that way, what do you think the biggest reasons would be? Is it I’m broke, I’m lonely, I don’t have a connection to anybody, I don’t have a place in this world. Like, and this is a gross generalization, everybody’s different, everybody’s going through their own thing, but I don’t know, are there sort of some pillars or some buckets that you see as commonalities here? Yeah, I think, you know, the commonality is that people see ending their own life as a solution. That they- To pain that they’re feeling. Yeah, yeah, to, you know, we call it psych ache, right?

Psychological pain that they’re experiencing. Sometimes when we’re talking about suicide, we use the analogy of Shakespeare’s Hamlet, to be or not to be. And a lot of people don’t maybe realize that when he’s going through that soliloquy and doing to be or not to be, you know, he literally starts listing off reasons to kill himself or not to kill himself. And that is what to be or not to be is, is should I kill myself or not? You know, Hamlet was suicidal.

And, you know, it’s a pretty common theme actually in a lot of Shakespeare’s work. But at the end of the day, what we find is that, I mean, basically there’s three buckets then of people that are experiencing suicidal struggles. There’s people that are, they are to be, they’re to, they are determined, they want to continue to live their life.

And it scares them tremendously that they’re thinking about suicide. And that’s the person in the to be bucket. Then there’s the Hamlet, the to be or not to be. And they’re really ambivalent about life. And they’re like, I could go either way, I don’t know how it’s gonna end. Maybe very depressed, but I want to be better.

I want to live. And this tends to be a little bit more of a longer term struggle when people are ambivalent like that. And then there’s the last bucket, which is people that are determined not to be. And those are the scariest, I guess. We’re there, the idea of dying by suicide really looks like the best way for them to deal with their problems.

But that group is the smallest of the three buckets. Most people that are experiencing suicidal ideation are really ambivalent and they are struggling and it is a back and forth. And then there’s people that are experiencing that and they’re really just wanting something, just wanting that help, just wanting that something that’s going to help them. And the good news about people, for anyone who’s out there who’s got family or they themselves are struggling with suicide, most suicidal crises end in people not dying.

And most people, the experience of suicidal crisis will never experience another suicidal crisis. Is that right? Yes. Once one attempt is sort of enough to… Well, and not necessarily even having made an attempt, but having struggled with the thoughts of it and sought help for it or just been at a point of real desperation. But yes, even after attempts, most people will make it through. And not have that be their fate. For those people listening today that maybe they’re struggling with something really big, they’re having these thoughts or they know somebody who’s in this predicament.

What do you recommend? Is there a toll-free number? Do they call 911?

Like what’s a good step to get yourself or someone else close to you help? Yeah. Yeah, I’m gonna give you a short answer and then a little bit longer answer. I mean, the short answer is we have a number in the United States and this came about after COVID and has been quickly implemented across the entire United States. It’s 988 and it’s meant to mimic the 911 system. And so you can dial it anywhere in the United States. You can also text 988 or go online and chat with 988. And so like here in Lincoln, Nebraska, our team is the 988 crisis response team. And so if the folks get a call in Lincoln, our crisis response team will go out to the site and kind of help the person in need. But going back to, I guess, the broader question, what can people do? And to emphasize my point that we all, no one’s immune to mental health issues.

About a year and a half ago, my teenage son was struggling with his mental health and made a near fatal suicide attempt. Even being in the field, knowing all the resources, knowing all the signs, no one’s immune to this. I responded as best I knew how, which I think is pretty well. And the reality is two months later, he had another near fatal suicide attempt.

And it’s been just about a year and a half since his second attempt and happy to say he is doing better. But the reality is that we all have to have mental health on our radar because it is our sons and daughters, our moms and dads, our brothers and sisters, friends, coworkers that are struggling every day with things that we don’t always know, right? It’s the, you don’t know what crossed someone else’s bearing and what they’re kind of carrying on the inside. And so, the thing that I think is really reassuring is, like I said, we’re having conversations now and making resources easier to get to. The fact that we have a nationwide 988 number that you can just dial and a trained crisis counselor will be there to talk to you, regardless of where you live in the country. That’s fantastic progress.

Wow. What did that look like for you as a family, coming out of that with your son? Because one of the questions that I had down to ask you, Ryan, was, okay, what are the signs to look for? You know better than anybody the signs to look for.

And this was still present. If I see somebody hobbling around on crutches, I can see they’ve got a problem with their leg. I’m gonna hold the door for them.

I’m gonna, hey, can I carry that for you? That kind of a thing. Right, with a mental health issue, it’s going on under the surface.

It doesn’t always have a physical manifestation. If you is one of the world’s most trained professionals in this area have struggles, like what is it the rest of us should look for? Yeah, I think the thing you wanna primarily look for is something being different. And I mean, there’s the kind of classic signs are social isolation.

That’s first and foremost. Most people that are struggling are going to have a period of social isolation in the lead up to their attempt. Most people also make suicidal communications prior to making an attempt. One of the things that is really important is if someone ever says something like that to you to respond with warmth, understanding, compassion and to make a commitment to help them find the resources that they’re in need of. Again, if I see that as a solution to my problems, then what I really need is other solutions. And so providing a message of hope and like said, a commitment to either help get them help or to stay with them until you can find someone who’s appropriate to help get them help is really what’s required in those moments.

Yeah. So we’ve talked a lot about different types of treatments, your thoughts, your approaches to treatment, but I’m kind of curious to take a step back and big picture, what is it, Ryan, that you do as the Chief Clinical Officer? Are you sort of directing and educating the other clinicians? Do you get any sort of one-on-one time or group time with folks there at the facility that need assistance? What does your role look like there?

Yeah, it’s a little bit of everything. It’s one of the things I love about my role. So the first part, if I’m meeting with people, kind of doing groups or individual kind of work as a therapist or a counselor, it’s typically because we’re short-staffed. Now, the reality of the workforce across the United States and is certainly been the case in Nebraska and certainly in behavioral health is that the workforce has been lacking.

There haven’t been enough people to do the jobs. And so it’s been a matter of, if you have clinical license, you’re going to be meeting with people. There was a period of 18 months, maybe even a couple of years, where about 20 hours a week, I was meeting with people. To where we were that short-staffed. Now, some of those staffing issues have led up and now it’s more of someone’s on vacation. I might do a little bit of work with someone or if there’s some turnover. But in general, my job would typically not include very much of that direct individual work with people in the programs. And so what I do is, yes, I do a lot of training.

Training of our staff. I also do grant writing, a decent amount of grant writing. The truth about behavioral health, non-profit work is that we have, I guess the term now is braided funding where we have to take a little bit from over here and a little bit from over here and kind of mix it all together and try to make sure there’s enough to pay the bills every month. And so yeah, so I’ll do some grant writing to make sure we get funding. And then things like policies and procedures to make sure that we’re doing things the way that they should be done. If there’s critical issues they’re going on inside the organization, then I’m going to kind of be digging into those and identifying, hey, what went wrong?

And how can we learn a lesson from this to make sure that these kinds of issues aren’t going on anymore? You know, I always like to ask a question in my interviews, Ryan, where I invite people to talk about a particular challenge personal or professional that they’ve overcome. I feel like we’ve already hit on quite a few for you, but if there was a different one you had in mind I didn’t want to skip over it. Sure.

Something we haven’t already covered. No, I think one of the things that stands out to me is that as I was closing down my private practice, I was also getting my PhD. And I tell this story to interns and new staff all the time, or sometimes even other executives when they’re discouraged or something maybe didn’t quite go right. I had a lot going on in my life, just closing down a practice, but also working on PhD.

And my family was growing. I was taking two research classes for my PhD. And long story short, I failed both classes. I have always kind of been an overachiever and an accomplisher, kind of what some people call a type A personality, right?

Like always moving and doing things and setting goals and trying to accomplish stuff and to fail a class, yell on two classes while getting my PhD. Yeah, I was pretty devastated by it. And I almost dropped out over it. And I took a leave with everything I had going on in my life. I took a leave from school.

And they had some kind of policy, you can only take leave for so long or whatever. And so they emailed me and they said, hey, we need to know in the next 48 hours if you’re gonna re-enroll, otherwise you’re dropped and you’re not gonna be able to get a PhD. And I was like, I’m not even gonna respond. I’m just not gonna continue. And then I had a moment, there was about three hours till the deadline that they had said for me. And I said, no, I’ve come this far. I’m gonna go back, I’m gonna finish. And I went back and re-enrolled in the classes and got A’s in both of those. I had like three more classes to go in the coming semester and was able to finish it out. But I tell that, like I said, especially to interns and newer staff if they’re struggling with something because it’s so easy to put in a lot of work and then you get your report card back and it’s got an F on it. And to just say, okay, I guess that’s not meant for me. And fail is temporary as long as I keep going. So I re-enrolled and saw it through. And so what do you think it was that three hours before the deadline that something arose inside of you?

I don’t know. It was really, I think that type A, that desire for perfectionism. I’ll tell you one conversation that I had when I was 16 years old, I was in Boy Scouts and I went on and got my Eagle Scout and my Scout leader just got me he comes back into my head all the time and he was getting his doctorate. And he told me when I was 16, he’s like, you’re gonna get a doctorate, right?

And I’m like, well, yeah, yeah, I’m gonna do that. And I was probably 22 or 23 and had sent him an email about my family. And he said, where you at on getting your doctorate? And I didn’t really have an answer at that point. And then he said, well, you told me you were gonna do it. So I’m expecting that you see it through.

And maybe it was that commitment I made to that man many, many years ago. It, I said I was gonna do it. And, you know, the thing I tell the interns though is that no one knows that story that I got F’s. Unless I tell it, right? Like, unless I tell that no one, you know, most jobs when you go apply, you know, in my realm, if you have a license, you’re qualified for the job, right? Where you got your degree, what your GPA was, you know, if you failed any classes along the way, those things, that, you know, that’s not story. Right, yeah, I mean, I write my own bio, right?

I write my own resume. I don’t have to throw that on there. But the failure just gives me character unless I let it define.

Oh, I like that a lot. And that’s exactly why I like to ask this question on the show because, right, people see you like PhD you overcome so much and, you know, getting to hear those, you know, in between stories along the way, like, man, I was getting close and I failed two classes. That could have been the point where you threw in the towel.

That’s the point where a lot of people throw in the towel. Oh, this is too hard. Clearly this just isn’t for me.

I need to find something else that’s easier. But there’s something to be said for resiliency, you know, to put it sort of into a cliche, if at first you don’t succeed, try, try again, right? Ryan, any mentors or books that have been particularly helpful for you in your trajectory? Yeah. I, well, first I’ve had, I’ve been blessed with probably four mentors throughout my adult life.

Then I’ve kind of leaned on it at various times. The one that stands out to me probably the most is a guy by the name of Larry Duncan. And he has been a coworker and a teacher of mine, literally when I was at school, he was a teacher. He was a supervisor of my internship. We’ve worked together. I’ve worked for him and he’s worked for me. Like we’ve had numerous different relationships over the years. But when my center is off and I need to check in with someone about something professionally, that’s the first name I think of. And I’ll always be grateful for the role he’s had in my life and in my career. In terms of books, I’m a book on tape guy.

I commute a lot between Omaha and Lincoln with our different locations. And the last several years, I’ve kind of hung my hat on Simon Sinek and his work and leaders eat last is one that I really love. It was funny, we were at a executive and leadership retreat for our organization and there’s probably 40 of us there, all the supervisors and everything.

And this is a couple of years ago when I was really into Leader Z last, his book. And we were at this retreat and we catered lunch. And no one else knew I was reading this, right? And so I’m just sitting back watching the lunch line. And without any prompting, like I was gonna wait to eat on purpose, cause I’m reading this book about leaders eat last.

And at the time we had five members of our executive team and they were five of the last six people to eat. And to me it was just kind of an allegory, right? It was just like personified right there in front of me. And I said, this is a team I really appreciate being a part of because very naturally they’re doing what leaders do, which is letting, letting other people go to the front to get the credit and make sure they get fed first and then we’ll kind of stay in the background and let folks take credit for the work that they’re actually doing. It’s almost like everybody was reading that book at the same time, but they weren’t.

They just, they had that sensibility about them, which is a big reason why you feel so at home there. Yeah. So I’ve got just one more question for you, Ryan, but before I had asked it, I wanna do two things. Everyone listening today, if you enjoyed today’s content, please hit the like, share or subscribe button on your favorite podcast app. Ryan, I also wanna let people know the best way to get in touch with you. What would that be? Yeah.

My email is probably the best way. It’s R-Currothers, C-A-R-R-U-T-H-E-R-S at center point. That has an E on the end. So C-E-N-T-E-R-P-O-I-N-T-E dot word. Great, and we’ll have that in the show notes for people. So last question for you, Ryan. I’m kinda curious, what do you see being, maybe the big changes coming to your industry in the next couple of years?

Yeah. The biggest thing on the, on the Ford, kind of on the, as we look forward in behavioral health, one that’s gonna be interesting to watch, I guess, which is the impact of AI in behavioral health. There’s already several applications that are being tested out there for the use of AI, but, and I think just in the world in general, we’re kinda looking to see how is this going to have an impact, but behavioral health is certainly an interesting one. And then, you know, the biggest, I guess, trend that I think we’re starting to see is a move towards what I described as the biopsychosocial model, which is, you know, the idea of if someone comes in to your organization for help, whether it be for substance use or mental health or physical health issues or whatever, that they be able to get kind of all of those from the same team.

Not necessarily the same person, but at least the same team. Shouldn’t have to fill out new paperwork every time I go, you know, looking for, you know, another service to try to get better. And so I think that between just that philosophical, that that’s probably the best way to provide care, and then the reality that nonprofits, especially in the area of physical health, and behavioral health are really struggling financially.

It’s just a reality right now that margins are non-existent for healthcare-based organizations. I think we’re gonna see a coming together and organizations that are ready to take on other organizations under their umbrella, and kind of emerging for the purposes of survival and really for efficiency. I think that that’s something that’s gonna happen that a lot of smaller kind of one-off programs that are struggling are probably going to likely be taken over by some larger nonprofit, you know, health systems, et cetera. Going back to the AI components. So the AI that’s being developed, are they sort of like chatbots so that, hey, I’m having an issue and, you know, rather than, you know, having to pay money to sit with a counselor or therapist, that I could use this chatbot, and that could give me some assistance?

Yeah, yeah, that’s one area that’s being developed. Another is AI that does documentation for the profession. So it will listen to a session and type up the note in the correct format, and then the clinician can kind of review it, make sure everything’s accurate, add anything, and approve it kind of saves, makes the work a little bit more efficient, allows me to spend more time providing the care, rather than documenting the care it provided. And then other areas that are in development and somewhat interesting is an AI that will listen to me provide some therapy, and then will give me feedback on how well I did, what did I miss, what other approaches could I have taken?

And so, you know, a lot of interesting areas for AI development there, and I think different companies and different schools on the academic side are kind of approaching all of those ways that AI might be able to help us, help people better. Love it, it’s gonna be fun to see how all that evolves. Ryan, I wanna be the first one to thank you for sharing both your time and your story with us today. I really appreciate it. Yeah, thank you very much. Folks, that’s a wrap on another episode of the Inspired Stories podcast. Thanks for learning with us today.