Healing A Broken Mental Health System: Jim Szyperski Of Acuity Behavioral Health On 5 Things That Can Be Done To Fix Our Broken Mental Health System

Thank you so much for joining us in this interview series. Before we start, our readers would love to “get to know you” a bit better. Can you tell us a bit about your background and your childhood backstory?

Igrew up in Greensboro, NC with great parents and my four siblings. Being the 4th of 5 children meant my childhood was what I would best describe as periodically off the radar in a busy household. My father was a WWII Navy veteran in the Pacific and post-navy, an early entrant into the McDonald’s business in the late 1950’s. My amazing Mom somehow managed through the five-child chaos to keep us engaged, and mostly on track and on time.

Dad graduated from college when he was 20 and was a stickler for a good education for his children. Not pleased with the school options in Greensboro after my older siblings went through, he sent me and subsequently my younger brother to boarding school in Virginia in the 9th grade. While a big change initially, I loved the school, Woodberry Forest, and the experience. To this day, I believe it was perhaps the single best thing they could ever have provided me. I am so thankful for all that they did for me, and us.

I attended the University of NC, to which I had grown up as a rabid basketball fan of, and moved to Atlanta in the late 1970’s after graduating from UNC. After a one-year stint as a banking trainee, I moved into technology in its very early days and have remained there since. There, I met my better half for the past 41 years and we raised our three children.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

This is tough as I keep a log of quotes that I find and review from time to time. Two stick out to me more than most. One is a quote I found on social media a couple of years back on courage, and what that really is for all of us that struggle with our own demons from time to time:

“Courage doesn’t always roar. Sometimes courage is the quiet voice at the end of the day saying, ‘I will try again tomorrow.’” — Mary Anne Radmacher

The second has been inspirational to me since I first came across it 30 years ago, perhaps because it resonates with the restlessness that often drives people to start something new. It is from Anthony Machado, a Spanish poet:

“Traveler, your footprints are the path and nothing more; Traveler, there is no path, The path is made by walking. By walking, the path is made.”

Let’s now shift to the main part of our discussion. It is often said that “the mental health system in America is broken”. What does that statement mean to you? From your perspective what is “broken” today?

In my opinion, mental healthcare is the largest healthcare crisis of our time, and from a clinical operations standpoint the most broken. Broken, in my definition, is a reflection of the state of mental healthcare in our country which I would briefly summarize as:

Oversubscribed: Increasing numbers of psychiatric patients presenting, and with more acute symptoms than ever is driving up the level of care they require and their length of stay.

Understaffed: An acute and rising shortage of nurses in general, and more specifically psychiatric nurses who provide the abundance of care in psychiatric facilities, is placing increasing strain on the mental health system.

Underfunded: Inpatient psychiatry services are reimbursed on a per-diem basis. In many cases, the reimbursement grossly fails to cover the cost of service provided. It is not surprising therefore that behavioral healthcare is generally the largest financial drain on a hospital.

An absence of standards and models that dominate the rest of healthcare: Psychiatry remains subjective, qualitative, and lacks standardized measurements that other areas of healthcare have relied on for years. Assessment and care varies widely from site to site, largely because system measurement methodologies that are effective in more predictable areas of healthcare like cardiology, oncology, etc. fail in behavioral healthcare’s more volatile environment. The result is they are quickly abandoned and operations planning resorts to nurse conversations at shift change, or homegrown spreadsheets or systems developed to accommodate the need. Out of necessity, nurse managers and administrators have had to “roll their own” to make the best of their situations. On an industry level this creates high variability, increases costs, and impairs discussions with payors for higher reimbursement for critical care services.

What about any bright spots? Do you think there are any elements that we get right in today’s world that we wouldn’t want to reverse unintentionally?

Far and away the biggest bright spot I see in behavioral healthcare is the incredible people who work in the clinical operations of inpatient units. There is a very special place in heaven for the nurses and staff treating these patients. Based upon the level of care and empathy of nurse managers and nursing staff in these units that we have met and worked with, the human touch is definitely something we do right and do not want to take away in any way, shape, or form. We need to augment their ability to do more of this.

1. Quantitative standards so data can consistently be collected, analyzed, and made actionable.
2. Thoughtful “ground up” development and implementation of technology with input and collaboration with nurses and staff to ensure effectiveness.
3. Responsible use of AI in clinical operations, and for clinical decision support only, period.
4. Higher reimbursement for critical care services and parity with the rest of healthcare. IMO, this means adhering first to steps 1, 2, and 3.
5. There will never be enough nurses or clinical staff to meet the rising numbers of patients suffering from mental illness in my lifetime. We need to do a much better job supporting the clinical teams we have, so providing technology that preserves their most important asset, TIME, is critical. And, in my opinion, that needs to be done following step 2 to be successful.

If all of the items on your list were magically implemented tomorrow what change might we see in the world? What are the signs (big and small) that would show us that the system is being healed?

I think we would see better patient care and safety, better staff care and safety, lower rates of burnout and attrition, higher reimbursements, etc. Stigmatization aside, it would bring behavioral healthcare more to parity with the rest of healthcare. The signs big and small that this is working, would show up in the data collected, whether that be higher patient scores for the facility, higher retention of staff, lower rates of burnout, reductions in operating costs by reducing variation, and more revenue for this sector.

What is a project you or others are working on today that gives you hope? How can our readers learn more about this work?

Working directly with our health system owners and partners, we have developed an AI agent, NORA, our Nurse Operations Research Assistant. NORA is an NLP interface for nurse managers and staff that quickly provides them (in their words) data and intelligence that they have never had access to or seen before to help them make more informed clinical decisions. By simply asking a question, NORA can gather and generate comprehensive summaries of patient data for nurse and clinician review. We believe NORA will change the landscape of clinical behavioral healthcare operations. To learn more about NORA and our BHOI (Behavioral Health Operations Intelligence) platform, you can visit us at www.acuitybh.com or contact us directly at info@acuitybh.com.

How do you see technology shaping the future of mental health care and its accessibility?

Technology, and particularly deep analytics and generative AI, are foundational to the future for behavioral healthcare. They aren’t optional as the system is failing (badly) and the problems are growing worse, not better. Yes, it has to thoughtfully and collaboratively designed and implemented, but like it or not, advanced AI will essentially be table stakes for all healthcare facilities serving behavioral healthcare needs for all the right reasons and addressing the 5 A’s that Penchansky and Thomas’s model articulated long ago: Affordability, Availability, Accessibility, Accommodation, and Acceptability.

In your view, how do social factors like poverty, education, and culture affect mental health care and its effectiveness?

The statistics in mental healthcare speak directly to this. People of all ages who are in poverty or have less formal education, or are minorities, almost universally suffer more severely from mental illness in all shapes and forms. In many cases, that is due to their ability to access or afford care for their mental health or the mental health of their family. Particularly populations that are rural may have to drive hours for treatment as there may not be a trained psychiatrist, adult or pediatric, in their county. There is a divide and it has to be addressed or we are simply reinforcing a failing status quo.

In light of the growing mental health crisis among young people, what innovative approaches or interventions have proven most successful for children and adolescents?

This is a question best answered by a pediatric psychiatrist or trained clinician. The statistics, particularly among adolescents, are horrific. To the question, and not being a psychiatrist, therapist, etc., my personal belief is screening every child, age 6 & up, every year, with a comprehensive screening assessment that can screen for multiple disorders (i.e. 10+) and might proactively catch our children suffering from mental illness before the 10+ years that currently exist between when a disorder first manifests and when it is actually treated.

And from what I have read, peer-to-peer interactions have been helpful, and there are a number of organizations that focus on creating communities, both online and in-person, to help address child and adolescent mental health. Like most healthcare issues, mental healthcare has deepening shades of gray on a spectrum. It is important to understand them at each stage of the spectrum, and that begins, IMO, with screening and accurate diagnoses.

We are very blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might just see this if we tag them. :-)

Frankly, I would start at the top of each one of these areas, from the President to heads of HHS and CMS on a Federal level, Governors and HHS leaders on a State level, to the leaders of each of the categories/industries you mention above. I believe that mental healthcare is the single most important healthcare issue of this entire generation, and we have a failing grade. I remember a study published last year or maybe 2023, that included a good sample size (6,000+ if I remember correctly) stated that in the 30 days leading up to the study, 1 in 4 adolescent males and 1 in 3 adolescent females had seriously considered suicide. I think if those numbers were applied to cardiology, oncology, or any other medical specialty, then we would be out in the streets protesting, but since it is mental health, we seem to walk right past it…that is unacceptable.

I suspect that everyone who may read this has a direct family member, or close friend, that is dealing with mental illness. The national numbers I have seen published state that anywhere from 1 in 5 to 1 in 2 have, or will suffer from, mental illness in their lifetime. As a nation, in fact globally, we have to rethink how we care and treat mental illness, and how we can better support the completely overrun heroes — and I mean that word, that are trying to help us all. I am more than delighted to take a “Baskin Robbins ticket” and stand in line to talk to each one of them.

How can our readers further follow your work online?

For those who are interested, connect with me here on LinkedIn, visit our website, and/or reach out directly to me via email at: jim@acuitybh.com.

Thank you for your time and thoughtful answers. I know many people will gain so much from hearing this.

Thanks to you for giving us this forum to express our thoughts.