Lisa Ventriss Interview of Rob Simpson, President and CEO, Brattleboro Retreat
Earlier this winter I spent several hours with Rob Simpson on an extensive tour of the Brattleboro Retreat. It was a fascinating insight into a complex world of frail populations, dedicated professionals, and strong regulation. My sincere thanks go to Rob and his colleague, Konstantin von Krusenstiern, Senior Director of Development, for their generous time that day. What follows is an abbreviated transcription of Rob’s interview for the Roundtable.
Lisa Ventriss (LV): You have been here for six years and have seen quite a lot of activity in the mental health arena during that time; this year being no exception. With much hard work, you and your team are making some important progress at the Retreat. So as leader of a high-visibility institution, where do you find your motivation as CEO? What is it that has helped you to hang on to the vision through the turbulent times?
Rob Simpson (RS): That’s a really good question. I think it’s four things for me. One is that I’m an Irish Catholic kid of a third generation immigrant family who grew up in a small rural community where everybody took care of each other, except perhaps for those people who had mental illness and then people didn’t know what to do with them. Like every family in America, I certainly had some folks in my family who were challenged. But, in particular, I had an aunt who did have major depression and was, also, the most special person in my family.
She was my piano teacher. At age five, she gave me my grand piano and then became my teacher. So, after school, Allie would trundle up and four days a week I’d have lessons with her. I remember when I was seven I scratched the piano and I said to my mother, “I’ve got to call Allie and tell her before she comes up, so she knows.” When she arrived, Allie looked at it and she said to me, “Robbie, if you look under that black paint, there is a beautiful mahogany piano. Let’s take the rest of that black off.” So we did, with my mother, and I still have that piano. Just this year I’ve decided to do a complete renovation of that piano. It’s a Kranich and Bach. They call them “chronic and cranky” because they’re hard to keep tuned, and it kind of reminds me of my aunt a little bit, you know. So it is a very special symbolic thing for me, that piano, and it has all to do about my motivation about this being clinician and the Retreat CEO. In many, many ways, my aunt, music and emotions about my past come together to underscore the fact that people can be very ill and can function and recover when they have a mental illness. She was a one-room school teacher and a phenomenal human being. So, I think that is part of my motivation. I always want to make it better for people who have a mental illness because they are just ordinary people, they’re just your family members. That’s how I feel about it. So, I know that’s part of what motivates me.
The second motivation is in knowing that I am a very lucky human being to have the opportunity to grow up in this country. My parents were wonderfully supportive, and they gave me terrific opportunities. I went to Choate, Amherst, Harvard, Simmons and the University of Utah graduating with two master’s degrees and a doctorate, but I never felt like I was a rich kid. I wasn’t. I was a middle class American who had opportunity. And so, I always remember that, a middle class American with opportunity; don’t ever take it for granted. And so part of what motivates me when I work in jobs is that I look around at the staff and say, “What else do you want to do? Where else are you headed? How can I help you make a difference?” I always want to make sure that I’m growing the staff, giving them similar opportunities to expand their skills and horizons that I had. So, I am a little indefatigable about that.
The third piece is that part of my self-identity is as an athlete. When you grow up as an athlete, you get several benefits. One is you get incredible camaraderie around you; the team is everything. You may be the fastest half back or you may be the toughest middle linebacker, but that really doesn’t matter. It’s not about you, it’s about the team getting the ball over the goal line. The lessons I learned from athletics have also never left me…work hard, never give up, play for the team and let yourself be coached if you want to be a winner. I also learned that interpersonal connections developed within a team must be nurtured and that they continue to make you a better person and leader all throughout life. Networking is a key ingredient to a leader’s success, a lesson reinforced by my father, coaches and the best bosses.
And fourth, you have to tell stories, because it is the stories that connect all of us. It’s not that as an organization we grew and we added 27 beds or 80 beds or whatever. That’s not it. It’s that the people who come here have the courage that we must support– that’s what connects provider and patient. That that story happens and is allowed to unfold. As a leader you have to work at expression and communication. Whether it is a letter to the staff about the meaning of a special holiday, or a letter to an employee about the loss of a family member, how a leader expresses themselves can mean the difference between establishing trust within the organization and the community or not. And you have to continually work on it. So that’s another thing a leader has to be. You have to learn to be a great story teller about the connections that connect the organization to its community.
LV: So let me ask you: We’re in the throes of healthcare reform, and we don’t yet know what everything is going to look like. My question is, when you look at all the discussions that are going on, what are the important bits of information that you are trying to get policy makers to understand about this segment of healthcare that you live in?
RS: Well, I think the most important thing is that behavioral health diseases – mental illness and addiction – are definitely part of the landscape, and even though they may be just, say, 6% of an insurer’s budget for direct treatment, the reality is that mental illness and addiction influence all the other diseases that a provider is treating. So where healthcare reform is going feeds right into the role of behavioral health, because everybody’s got a brain, and the brain is the most complex organ in the body. If it is not working correctly it creates significant problems for the functioning of the rest of the body.
Look at the role of behavioral health, for example, in cardiac disease. The reality is that 40% to 60% of people who are stented have the high probability of a subsequent depressive episode. So if you’re building an algorithm to reduce costs in a system, you’re going to evaluate up front before anyone is stented, who is likely to have a depressive response; let’s get psychiatry in there early and evaluate and make sure when that episode happens, we’re treating that person with a cardiac disease effectively. Now, why are we doing that? Because we want to relieve suffering, but the reality is that those people, who are stented and become depressed, they are likely to be back in the hospital in a short period of time – not for mental illness admission but for a further cardiac event. So, if you want to reduce hospitalizations, you’re going to focus on the mind – body connection to care for that individual.
There is a similar trajectory often with diabetes. Many individuals with diabetes are in conflict about having their disease and don’t want to take their medications or don’t want to take their insulin shot. So behavioral health clinicians have a lot to do with helping people adjust to having an illness. We come to the table as the compliance clinicians who help people adjust to the complex interplay of emotions and illness. Resolving addictive and mental disorders in the general medical setting will not only drive down the demand for medical care but also promotes a more efficient use of medical resources by both patients and family members.
The other element affecting health care delivery today is the opiate addiction epidemic that’s in this state. The transition from seeing addiction as part of a war on drugs to a war on the individuals suffering from the disease of addiction has gained significant traction in the public over the last 6 months. Today, public officials, led by Governor Shumlin, are moving toward treating addiction as a public health crisis, requiring treatment rather than incarceration.It has been a slow but gathering public attitude change as people have seen their child, uncle, brother, cousin develop a drug problem that in this country has led to the death of over 38,000 per year from overdoses. The “war on drugs” has failed with the more punitive aggressive ‘you use, you lose’ approach, as deterrence, has been largely ineffective.The shift that’s really taken place has been philosophical and strategic. People have accepted the fact that addiction is a disease that affects the brain and, therefore, it must be treated.
As a result we are seeing the return of drug courts. They’re bringing them back because locking up individuals with the disease of addiction is ineffective. The other part is that we are seeing young people becoming addicted to opiates who are using at earlier and earlier stages of their lives. We talk about the brain and what these chemicals do to our brains. There is a lot of evidence that in a significant number of chronic opiate users there is an underlying trauma history in the person. So let’s treat the trauma, because if you don’t treat the trauma, the drug abuse is never going to go away. So, I think the pendulum starts to shift when we think about how population health management approaches where we look at the public health implications of not treating addictive disease early and in more humane ways leads to larger societal problems including the misuse of public funds and under treatment of affected individuals.
LV: So you’ve talked about the fact that Brattleboro draws its patients from 27 states; pretty incredible for this asset and its’ unique niches of service delivery to uniformed service providers, emergent adults, teens, GLBT, and young children. If, in your wildest dreams, you could envision where Brattleboro Retreat was going to be in 20 years, what would it look like? Knowing what you know about how healthcare is unfolding; monetary and social pressures around all of these sub-specialty areas; hospitals undergoing dramatic changes, etc… Where do you see the Retreat?
RS: That’s a really good question, and I’m not sure my crystal ball is good enough…We don’t know what’s going to happen with the whole role of psychopharmacology and the development of additional technologies to treat illness. Will mental illness be cured in the next twenty years or will the symptoms be made more manageable by the virtues of technology we create? Possibly, which means you won’t necessarily need all the resources of the high-end inpatient hospital care. But that’s not necessarily going to solve the problem of people who suffer from other issues that influence their mental stability, like early trauma, etc. There’s still going to be a need for levels of community based service. But ideally, psychiatry will be more and more integrated into medicine. When we think of community care, psychiatry ought to be sitting right next to the primary care doctor and working together with addiction providers in the same suites. So that people go and they don’t feel stigmatized. Right now, if you go to the mental health clinic or the mental health center, there is a certain amount of stigma unfortunately assigned to that. But if you go to your doctor’s office and you’re just being treated as a human being for whatever bothers you like any other patient there for an illness…it’s different. The literature on best practice psychiatric and addictions treatment suggests that resolving these disorders in the general medical setting will drive down the demand for general medical health care, promote more efficient use of care by both patients and their families, and preserve scarce resources that can be deployed more wisely elsewhere.
So I see the Retreat playing more of a role in community-based services, not just providing the tertiary high-end care. IF we play a role in the new drug courts, mental health providers sitting right outside the judge’s office and in the court -we’re right here, side by side working in the best interest of the individual and the community. We can provide an instant opinion and work together with the judge in evaluating the right use of resources and focusing on the treatment needs of the individual. That would be wonderful underscoring that the stigma of addiction as just a behavioral disorder and not a medical disease will start to die away.
I think we can also play a role in the organizational development and leadership functions of organizations because we’re the “people” people. We understand more about all the dynamics of how people work on teams, and we can rule out the resistances that people have toward making a team successful. We can help with those “sticky” interfaces of human beings in the work setting. I could see us creating a consultation service where we provide more support in how to help organizations to run more efficiently with the people that are working there. At the Retreat we work with a leadership development company, Linkage, where we provide leadership assessment and training for our nursing, physician, social work and administrative leaders. The best leaders are not born, they are made through coaching, education, training and mentoring. This training has fostered increased focus and overall accountability and job satisfaction.
LV: So what do you do when you’re not charting the future of mental health? How do you unwind?
RS: I’m a gym rat; I go to the gym 3-4 times per week. I’m a skier in the winter and a kayaker in the summer. My wife, Ariane, and I travel a lot as well, as you know. And also recently I became a grandfather, and I’m very involved in my children’s lives. I try to live a very active life. Life is to be lived at its fullest.
LV: Well this is great, Rob. Thank you so much and I really appreciate it.
RS: Delighted to do it. Thank you for the opportunity Lisa.
Recent articles describing some of what Dr. Simpson spoke about:
Recent Commentary by Dr. Simpson: http://vtdigger.org/2014/03/16/robert-simpson-importance-context/