March 4, 2026 Forum

Jeremy

I think that brings up a point. From a population basis, what you would want to develop is an interprofessional team that engages with each other so that the appropriate care can happen at the point of life of the person, where the community health worker might get extra training in cognitive behavioral therapy. So, they might recognize and initiate appropriate treatment plans if it’s not going well. They would then engage with a therapist. The therapist might, in turn, say, “I’ve never seen this person. You can’t tell me about them. I want to see them myself.” This is what any reasonable therapist would say: “I’m not going to give you advice over this phone about somebody I’ve never met. Your patient needs to make an appointment with me.” The physician responds, “But, you’re booked out six months, and the patient don’t have any money. The therapist responds, “Well, sorry. Thanks for calling”.

And that would be the same with a physician, so that what ends up happening is the experts are so isolated in these very expensive palaces, so to speak. I say that somewhat jokingly because, of course, primary care and behavioral health are struggling. But compared to what’s going on out in the community, I think we would have the same culture shock our therapist had coming into primary care. It would be like sticking us out there in some hotel or some apartment complex and told, could you figure out who needs antidepressants? “You know, Jeremy, you’ve got a weekend. Why don’t you go to each place and figure out what help they need?” I would be overwhelmed immediately with the needs that were unmet. Oh, my God, their blood pressure’s off the charts. And so, how we engage at a population level has to be rethought, I think.

And the integration of behavioral health into primary care is a part of that package of trying to make primary care more useful to more people, as opposed to what Bill Gillanders is saying. We’re kind of going backwards, being less useful and narrowing ourselves. There are plenty of family doctors who won’t see kids, won’t see anybody over the age of 65, won’t see anybody who’s pregnant, won’t see, . . . They declare, “I don’t take care of people with behavioral health needs. I don’t take care of people who have substance use disorders.” There’s encouragement almost to be like that right now.

Bill B

The matter of cost and access is certainly challenging. Let me offer a solution from the behavioral health perspective. The solution centers on the role that can be played by groups. A patient might not be able to afford individual services in their healthcare system. They can’t pay for one-on-one behavioral health services, but why not groups? For instance, one of the books I wrote years ago that actually sold quite well concerned the recovery from strokes. My coauthor of the book was someone who mostly did work with stroke survivors in group settings. She used the group to address all of the behavioral issues associated with recovery from strokes. Her work was very powerful. And what was interesting is that she ended up having two kinds of stroke groups. She found she needed to get the survivors in one group and then there were the people helping them. She convened a separate group for these helpers to talk about how you provide the support? And what do you do when you get really tired of always working with your spouse or parent? The role of the group often can be very powerful in this way: sharing ideas and comfort. And I think it’s often cost-effective and it’s definitely not AI.