Reality Check – What is CALM?

Serena: Welcome to the reality check psychosis is real. So is recovery podcast.

Ashley: I'm Dr. Ashley Weiss. I'm a child adolescent psychiatrist

Serena: and I'm Serena Chaudry. I'm a clinical social worker

Ashley: and we are the co founders of Epic NOLA, which is early psychosis intervention clinic in new Orleans and also the co founders of calm clear answers to Louisiana mental health.

Serena: On today's episode, we're going to tell you a little bit more about what Calm is and how it came about.

Ashley: Dr. Chaudry, tell me a little bit about your training and why you decided to work in this field. I mean, I know personally, but our listeners. Also deserved now.

Serena: So my background is in social work and public health, and I trained at the University of Michigan, where I went to study more macro level social work, really trying to better understand policies and systems and health [00:01:00] communities at large.

I was not interested at all in doing clinical social work. I, while I was getting my M. S. A., W. I thought it would be interesting to also pursue my master's in public health to gain a different lens to use in working with communities. So I loved my training. I did that work for several years in New York City, working with survivors of torture and war trauma.

And while I found that work super rewarding, it was hard. to work at the community level and see changes happening so slowly. And while I was doing that work, I was able to also observe the impact that trauma had on some of the individuals in these communities. And that sparked my interest in the clinical work that I never had any desire to pursue.

And that's really what pushed me into getting my LCSW. I worked in both the [00:02:00] community, in community mental health with a wide range of individuals and also in private practice, vacillating between the two in different cities, places and spaces until I met you. Now tell the listeners where you trained and how you came to be here.

Ashley: I'm from Alabama and coming to New Orleans for college was a, an exciting opportunity. Loved it here in the city. Decided to do my master's in public health, even though I know I wanted to be a physician, but I kind of wanted to explore what the bigger picture looked like before I went all in on medical school, because I knew once medical school started that I wouldn't be able to do anything else other than study medicine.

So I did my MPH and it was awesome because. You could kind of see the, the bigger picture and had a fantasy about being able to integrate direct care with a public health effort, um, but it wasn't sure how, how that was going to happen. But I [00:03:00] always was fascinated by schizophrenia really more because it was pretty amazing that people could have such extraordinary experiences and kind of thinking about what our brain was capable of experiencing.

That's beyond just the ordinary, and, uh, so psychiatry was always pretty high up there in my interest. And then, I was in medical school in Florida, and Katrina happened. And, for some reason, I decided I needed to come to New Orleans post Katrina to do residency training. Which was It's wild and truly like in the trenches, so to speak.

There weren't a lot of inpatient facilities, there really weren't a lot of functional facilities at all. So we were having to be creative and having to figure out, you know, unique treatment plans for individuals. Anyway, psychiatry residency, then child adolescent psychiatry fellowship here at Tulane. And have [00:04:00] stayed on as faculty and then I, you know, had a patient and fellowship that it was his first diagnosis of schizophrenia, his first episode of psychosis.

And I got to be his therapist. I got to be his doctor. I got to be the person to support his family. To explain to his friends what was going on, to help him come up with solutions for working and how to take breaks when he needed to, and all these things, and I realized that this was something different that I was doing to kind of help this person in this first phase of illness, and I stumbled upon the first episode, Psychosis Literature, and Met a mentor, Dr.

Shirhari, who's at Yale, shout out to Vinod, finished fellowship and stayed on faculty and thought, wow, it would be really cool to only do this work and to have a clinic that's specialized in these individuals and somehow managed to have coffee with you. And so here we are.

Serena: [00:05:00] Yeah, I know. It's pretty wild to think.

about the fact that you had this idea, and then this idea, you had things in motion to start the clinic, and then we had coffee, and you shared that idea with me, and We joined forces and here we are.

Ashley: Yeah. I remember feeling like I'm going to be really manipulative right in this moment because I'm going to try to get a community mental health agency to bring me on as a child psychiatrist and also quid pro quo allow me to have a couple of hours to recruit first episode psychosis.

Referrals, and they were like, yeah, cool. That's, that's great. The woman who was running the agency, you know, had a very vested interest in, in schizophrenia and recovery of individuals with schizophrenia because of her. You know, experiences with her family. [00:06:00] So I think it was just like a natural buy in, but they, I felt kind of awkward at first saying, I'll give you this if you do this.

And part of the ask was to have you come on for a few hours. So it was, um, I think it was how it was meant to happen. But. Going from an idea to few hours a week, um, where you and Michael and I got to hang out and talk about patients to now doing what we do is a massive leap. Huge.

Serena: And I think the reason it's worked and the reason it continues to work, I believe in part is that we continue to think big and we continue to ask for things and try things that maybe don't seem to work.

Seem typical in the mental health field and take risks. And I think the risks have paid off. We have this super vibrant clinic with an amazing team of dedicated [00:07:00] and passionate people, um, and at the core of it are patients who are, uh, I think inspire all of us each and every day.

Ashley: Yeah, so a little bit about our clinic and what is early psychosis intervention, I think that there's probably some room for explanation.

So we have a program, and it's really person focused and family focused, and I feel like that that was all. Those qualities were always just natural in the people that we, we work with now that they're very focused on the individuals and focused on families, which is great. But with that in mind, you know, we offer psychiatric services, which is usually medication management with some therapy.

And then people have an individual therapist that they can really work on, um, more supportive goals or [00:08:00] really like dig down and deep into psychological issues that might be going on, all in the setting of recovery from the psychosis experience. People also get to, um, come to groups. I get to interact with peer support specialists, their family gets support.

Now they get to have a wellness coach and work out, um, in our gym. And so they kind of have a, I like to think of it as a early psychosis recovery home, instead of a medical home. more specific, but kind of their home base for when this first starts happening. We're a little bit unique because we don't discharge people.

I mean, people can leave if they want to. We're not going to make anybody stay, but they can stay in treatment for as long as they're getting benefit. from care.

Serena: I do think it is like no other place I've worked. And I think the testament to that being a reality is the fact that we have patients who have been [00:09:00] with us for almost eight or eight plus years now.

And I think it's the Recovery home, so to speak for the patients and their families. And I think what's been really cool is to see also how we've been able to integrate families into different aspects of our care. If patients are wanting and willing to have them involved and thinking about our new family support group.

Um, we have a mom's group that we've had for many years now and we Been hosting fundraisers for the last couple of years in my mind is an awesome celebration of recovery from psychosis, and we've had family members, cousins, brothers, sisters, and patients sort of involved in those fundraising efforts, which has been really fun.

Ashley: Yeah. And now we have, uh, I guess in August it'll be our eight year anniversary. Nine, if we go back into the very, uh, [00:10:00] There's a clinical team for people that are in need of treatment. Um, but then we also have a psychosis early detection campaign, which is calm, clear answers to Louisiana mental health. And so.

One of the reasons that that's important is that a lot of the people that come to our clinic aren't, they haven't been in help seeking mode. Uh, they're usually young, healthy, late adolescence, young adults that have kind of maybe drifted away from primary care, drifted away from going to see the doctor because they're generally well, and then, you know, start having psychosis symptoms.

So, given that people with psychosis have so much stigma against them, it becomes very difficult to ask for help or to explain the unexplainable of what's going on in someone's mind. So we, um, have this, um, a psychosis awareness program so we can get out into the [00:11:00] community and try to encourage people to seek treatment early and also encourage like the community to support people seeking help early.

And I think that's one of the things that you and I like really bonded on was being able to have this love of taking care of individuals, but also this need to send this message.

Serena: Absolutely. It's been fun. Sending the message has been fun. It's a hard message to send, but I think we found really creative ways to do it.

And I think some of those ways have been inspired by our patients and definitely inspired by our collaborators in this. And we're lucky to work with a social marketing. Group and film production company to help us with our messaging and with spreading the word and helping to young people to be reflective.

So shout out to Red Rock Marketing and to Fireside Productions for their help that we're doing with Calm.

Ashley: So [00:12:00] Serena, what is your favorite part of like the treatment process? It could be like a person that comes to your mind or a part of the process. I'm going to name two.

Serena: I

Ashley: think one,

Serena: being able to work with people over time.

I found that to be so rewarding on a human level and clinically as well. I think it is rare in this day and age to be able to have a mental health provider that you work with over many years. And I think we've been fortunate enough to be able to work with patients. During their first episode of psychosis and throughout their recovery and to see how people recover and the meaning they make from their first episode of psychosis is super inspiring and, uh, Just getting to talk to those people on a regular basis as they grow up and move out into the world is one of my favorite aspects.

And the other, uh, favorite aspect of [00:13:00] treatment is the moms group. Um, I am very inspired by the moms I get to meet with every other week and it's really been a joy of my clinical work over the last many years. So same question back at you.

Ashley: I think that I really. Love getting to have the time to figure out, you know, a medication plan that really sits right and feels right with the individual.

And oftentimes when people first come, I'm usually backtracking and trying to kind of start over with, with meds that are simpler to manage, you know, figuring out convenience for the, the individual. helping them to like, learn about what they want out of the medication. And when they start feeling more like themselves, um, I can like hear it and I can [00:14:00] hear how they're then like reflecting on things they're talking about with their therapist and stuff.

And it's like this Parallel process of like seeing, you know, men, these medications take time. They take so much time, which is the most frustrating thing about being a psychiatrist is about their medications take a long time. It's so much different than like a 10 day course of antibiotics and your infections gone.

Like you have to wait months. And then like, usually around month four, this like thing happens where people start feeling more like themselves. And um, and then being able to kind of, you know, it's not all the medication, it's the medication combined with therapy, but seeing them like simultaneously truly like work together.

And I think that is the, that's the coolest part from a, from like a doctor standpoint, from a human standpoint, the coolest thing has been some of our patients having children [00:15:00] over the last couple of years, um, that has been really, um, Amazing. And, uh, actually family planning with, with people and talking about what the risk to their children may be for bipolar disorder, schizophrenia, and just having like realistic, nonjudgmental and honest conversations about what life might look like, what, what they're going to do for their child to like help support them and identify early warning signs, things like that.

Like that's been really rewarding. And also makes them feel old. But, um,

Serena: But a good old. I think the other piece like in this growth over the past many years has been right, the growth of our clinic um, the space, so to speak. We grew out of our original space. We're located in a stand alone clinic in Mid City in New Orleans.

I think it's cool that we have our own [00:16:00] place in space. space where people can come. It doesn't feel as medicalized. I think, as you said before, and um, we've acquired another suite in this same, uh, building at 4, 000 Bienville. And in that new space, we also have a gym. Which, as we talked about before, has been super awesome to see people, patients come in and they see their psychiatrist or they see their therapist and then they go see our wellness coach and they work out and they feel good about themselves and they get to work off some of this weight that Unfortunately is a side effect of many of these medications and we're growing outside of this space in mid city as well and are in the process of expanding throughout Louisiana, opening some spoke clinics out in south central Louisiana and in the Acadiana region, which I'm super psyched about.

Ashley: I feel like we plotted that on a plane ride many years

Serena: ago. We did and it's [00:17:00] becoming a reality, which is so cool. I think we like drew it out on a napkin or a scrap piece of paper

Ashley: or

Serena: something.

Ashley: I was going through some of my old stuff, trying to clean up, um, and found some of these like old notes for people, um, that know Serena and I, they won't be, would not be surprised that there are a bunch of scrappy planned out projects we'll bring to everybody's attention.

Some moment in time, I'm hoping that people outside of New Orleans and more rural areas, uh, will have easier access over time. That's going to be fun.

Serena: I think this podcast was one of those scrappy ideas that It's now becoming a reality, which, you know, I'm really excited about sharing our passion and our team and our patients with the world.

I think we have the best job and I think there's a lot of value in being able to share that with others. And with, at the [00:18:00] heart of all of that are, as I said previously, our patients and their success stories. And I think If other people who are experiencing symptoms of psychosis can sort of hear and see some of our patients or meet some of the, our team members or meet some of our mentors, they can maybe, hopefully feel more confident and more comfortable reaching out for help because at the end of the day, that's what we really want is to inspire.

By your reflection and help give people the courage to reach out to us or to someone in their area to get the help they need

Ashley: on that note of talking about really cool success stories and really amazing people that we get to interface with every day. I have to point out behind me. I'm glad that it gets to hang on my wall, but it's a reminder every day of the unique insights our young people have [00:19:00] and how helpful that they could be to other people who are maybe in the same situation but haven't yet asked for help.

I think that our decision to say psychosis and to talk about psychosis Explicitly with this word is, is important and has been very intentional to use this word in a way that is not troubling. It's just a, a word that describes certain constellation of experiences and it's often misused, but the only way that we can change misuse is to use them more accurately.

And our patients tend to want, they, they want us to use this word because this is the word that they see when they go on internet and stuff, and they want to understand it. They want to understand why it's called this. And so I really feel like that's been kind of, we had a lot of conversation about this in the beginning and a [00:20:00] psychosis, or do we say something else?

And the people that we were beginning to see were clearly saying psychosis. And it just felt really important to kind of make a stand about that. Kind of take it back, maybe. Sounds dramatic, but why is it a word that we're just going to continue to allow to be misused?

Serena: Yeah, I think there's been a really positive response from the community about this, too.

You know, we have people coming up to us and recognizing CALM and talking about how they feel it's been helpful for them to hear and see the messaging from it. So I think we've gotten good affirmation from the community about that. Well, I'm excited to continue this conversation and in our future episodes, bring on some of these patients, bring on some of the people that we've referenced in today's episode and to talk in more detail about psychosis and the symptoms and help people to better understand what might be happening [00:21:00] to a young person in their lives.

Ashley: I am too, and would love to like hear what people think, to see comments. I'd love to answer questions. Um, so please, please, please share this with someone that you might, where you think it might be useful. Ask us questions, send us comments. We are open to continuing the dialogue. Give us ideas for

Serena: guests to bring on, topics to talk about.

We're open until next time. Thanks for taking the time to get your reality check. And remember psychosis is real. So is recovery.

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