Chronic, Not Crisis: Rethinking Behavioral Health Systems with Luke Bergmann

Chronic, Not Crisis: Rethinking Behavioral Health Systems with Luke Bergmann

What if the fix for America's mental health crisis isn't more funding or more infrastructure, but common sense? Dr. Luke Bergmann has spent 15+ years leading behavioral health systems in New York and California — most recently as San Diego County's Director of Behavioral Health, now a Principal at Health Management Associates. In this conversation, he pulls back the curtain on why our system so often fails the people who need it most: institutions incentivized to keep beds full instead of keeping people well, a billing policy that split his own stepfather's care in two, and a federal policy landscape he calls "whiplashy." This hits close to home for Bergmann. He shares the story of his stepfather, whose final year was shaped by a system that couldn't treat him as a whole person, and how that experience now drives his work bringing county behavioral health and community clinics to the same table. Whether you work in healthcare, advocate for mental health reform, or are simply trying to understand a system that touches almost every family, this conversation offers a clear-eyed, hopeful case for change. 🔔 Subscribe for more conversations at the intersection of mental health and policy. 🔗 Watch more interviews in the series: [tntopenmind.org] Interview recorded on Jan 16, 2026 00:00 – Introduction 00:45 – Why Dr. Bergmann dedicated his career to behavioral health 02:59 – Staying hopeful amid policy "whiplash" ($2B in grants cut, then restored) 04:38 – A personal story of common sense abandoned 09:04 – The billing policy that split his stepfather's care in two 11:38 – Current work: bridging county behavioral health & community clinics 14:00 – Fixing the community clinic problem that took his stepdad 16:09 – HR1 and the threat to Medicaid enrollment 18:11 – Twin crises: community clinics and county behavioral health 21:31 – Fixing the same-day billing policy — low-hanging fruit 22:03 – Why county behavioral health is often the most resistant to change 24:12 – What behavioral health can learn from primary care 25:43 – Why behavioral health is "obsessed" with the word crisis 28:04 – Renaming crisis as chronic illness — and the pushback he got 29:56 – Inpatient psych beds: the "motel chain" business model 32:08 – Training primary care doctors in psychiatry: a real-world example from NYC 34:18 – De-stigmatizing care by integrating it into primary care 34:53 – Final thoughts: common sense, hope, and getting in touch Tags: behavioral health, mental health, mental health policy, mental health advocacy, healthcare reform, integrated care, psychiatry, mental illness, substance use disorder, addiction recovery, community health, primary care, Medicaid, healthcare policy, mental health crisis, health equity, public health, healthcare leadership, San Diego County, Health Management Associates, HR1, FQHC, crisis care, chronic illness, mental health awareness Subscribe to TNT Open Mind Insights - Mental Health Interview Series [https://mysoundwise.com/soundcasts/1777417681925s] on Soundwise [https://mysoundwise.com/soundcasts/1777417681925s]

The Pediatrician Who Became a Child Psychiatrist with Dr. Bruce Leewiwatanakul

Most parents, and plenty of providers, assume mental health "treatment" means medication. A triple-boarded child psychiatrist explains what it actually looks like for kids. Dr. Bruce Leewiwatanakul is a pediatrician and child psychiatrist. He now runs integrated and collaborative care, the model built to reach kids with mild-to-moderate mental health needs before those needs turn into a crisis. In this conversation with Dr. Sarah Arshad, Dr. Leewiwatanakul breaks down how collaborative care actually works in a pediatric setting, why so much of effective treatment has nothing to do with a prescription, and what early screening is already getting right. He's candid about where the model strains under a teen's schedule and a parent's, what it would take to expand past anxiety and depression into behavior management, and the investment kids' mental health still isn't getting. In this episode: In this episode: Why a pediatrics background changes how you diagnose and treat in psychiatry What the Post-Pediatric Portal Program is, and why most people have never heard of it How collaborative care manages a whole population of kids proactively Why "treatment" usually starts with sleep, screens, and behavioral activation, not medication What's working: earlier screening and catching kids before things get worse Where the model breaks down for teens, and what real investment would unlock His plea to stakeholders, families, and government on kids' mental health Interview recorded on: Jan 16, 2026 Learn more about TNT Open Mind Insights: www.tntopenmind.org If you're a pediatrician, primary care provider, NP, PA, fellow, or anyone building behavioral health into a pediatric practice, this conversation is for you. 0:00 Introduction — meet Dr. Bruce Leewiwatanakul 0:47 Why medicine, and a mother's advice to do something worthwhile 1:43 The detour into teaching near UCLA 2:29 What drew him to kids and family systems 5:59 Finding psychiatry by listening to kids at midnight 7:10 The gap pediatrics alone couldn't fill 8:12 What the Post-Pediatric Portal Program is 9:47 Pediatrician or child psychiatrist? Holding both 10:26 How a pediatrics brain changes his psychiatry 12:40 Prevention and anticipatory guidance in mental health 13:01 Why he joined the TNT Child & Adolescent Psychiatry Fellowship 14:36 Collaborative care and integrated care, explained 16:30 What's working: screening and catching kids early 17:40 What "treatment" actually means 19:15 Why therapy for kids looks nothing like the movies 22:54 The magic-wand question: investing in collaborative care 25:07 A plea to stakeholders, families, and government 26:30 What keeps him doing the work child psychiatry, pediatric mental health, collaborative care, integrated care, behavioral health, child and adolescent psychiatry, primary care psychiatry, post pediatric portal program, Bruce Leewiwatanakul, OHSU, Doernbecher Childrens Hospital, behavioral health care manager, anticipatory guidance, early intervention, youth mental health, behavioral activation, TNT Open Mind Insights, pediatrician to psychiatrist, kids mental health Subscribe to TNT Open Mind Insights - Mental Health Interview Series [https://mysoundwise.com/soundcasts/1777417681925s] on Soundwise [https://mysoundwise.com/soundcasts/1777417681925s]

Perinatal Recovery & Shame-Free Care With Amber Williams

What does it look like when a patient becomes the CEO? Amber Williams walked into Janus of Santa Cruz suffering with substance use disorder as a teen mom with a newborn son and no insurance coverage left. Twenty years later, she runs it — and this September, Janus opens its first major infrastructure project: a 25-bed perinatal facility built so mothers in recovery won't have to be separated from their babies. In this conversation, Amber talks with Autumn Payne about what it takes to put clients at the center of every decision — from building environments that raise expectations, to asking providers to check their biases before they walk into a patient room. She also gets personal about the moment her own bias crept into her clinical work, and what she did about it. If you work in healthcare, treat patients with substance use disorder, or care about what recovery looks like for families — this conversation is for you. In this episode: Why environment is a clinical tool, not an amenity The three barriers keeping providers from treating substance use disorder What happens when you recognize your own bias before it reaches a patient Why perinatal-specific facilities are so rare — and what's at stake without them The aging population being left behind on medsurg floors Where a bottomless well of hope comes from Chapters 0:00 Introduction 1:20 How Amber first came to Janus as a patient 4:00 The decision that changed everything 5:30 Putting clients at the center of every decision 7:00 Why environment is a clinical tool 9:00 The new 25-bed perinatal facility 11:30 Why perinatal facilities are so rare 13:45 Three barriers providers face with SUD patients 18:00 Checking your own bias — a personal story 21:30 What to do when you can't check it at the door 23:00 Self-care for clinicians in high-intensity settings 25:00 Warm handoffs in a 15-minute appointment 28:00 Resources: 988 and the ED Bridge program 29:30 The California SUD landscape 33:00 The aging population left behind on med surg floors 36:00 Where Amber finds hope Interview Recorded On: March 20. 2026 TNT Open Mind Insights is a video series linking personal stories to solutions in mental healthcare. Sponsored by UC Irvine's Train New Trainers Primary Care Psychiatry Fellowship and produced by Ethical Narrative Storytelling Agency. 🔗 Hear more insights: [tntopenmind.org] Connect with Amber: https://www.linkedin.com/in/amber-williams-laadc-98779b111/ Connect with Janus of Santa Cruz: https://janussc.org #SubstanceUseDisorder #AddictionRecovery #PeriNatalCare #BehavioralHealth #MentalHealth #HealthcareProviders #TNTOpenMindInsights #HealthcarePolicy #StigmaFreeRecovery Tags: substance use disorder, addiction recovery, perinatal care, behavioral health, mental health, healthcare providers, stigma, recovery, Janus Santa Cruz, TNT Open Mind Insights, healthcare policy, maternal health, addiction medicine, California healthcare, substance abuse treatment, harm reduction Subscribe to TNT Open Mind Insights - Mental Health Interview Series [https://mysoundwise.com/soundcasts/1777417681925s] on Soundwise [https://mysoundwise.com/soundcasts/1777417681925s]

When Diabetes Meets Depression - Lessons from the Bronx with Dr. Alyson Myers

What happens when you treat diabetes without addressing depression? Or prescribe insulin to a patient with no refrigerator? Dr. Alyson Myers has spent her career answering questions like these — and her answers challenge how most clinicians were trained to think. Triple board-certified in internal medicine, psychiatry, and endocrinology, Dr. Myers practices in the Bronx, where the gap between clinical guidelines and patients' lived reality is impossible to ignore. In this conversation, she breaks down the bidirectional relationship between metabolic and mental health, reframes what "non-compliant" actually means, and shares how a five-year chart review revealing a 44% amputation rate led her to co-found a multidisciplinary limb preservation clinic. This is whole-patient care in practice — not as a concept, but as a necessity. In this episode: Why treating diabetes without addressing mental health guarantees worse outcomes for both The real meaning of "non-compliant" in underserved communities How inaction violates the oath to do no harm A data-driven response to a 44% amputation rate in the Bronx The cost of diabetic foot ulcers to patients, families, and the healthcare system What telehealth rollbacks mean for urban populations How Dr. Myers protects her own mental health while carrying the weight of this work ⏱ Chapters 0:00 Introduction 1:01 Why diabetes became personal — and professional 3:20 Listening as a clinical tool 4:27 The whole-patient model: why silos fail 5:38 Food insecurity and glycemic control 6:49 No refrigerator? Getting creative with insulin storage 8:02 Reframing "do no harm" — inaction is harm too 8:47 Diabetes and depression: the bidirectional relationship 12:39 Med-psych training and what most physicians are missing 14:02 Women's health, menopause, and the data gaps 15:05 Social drivers of health and what "non-compliant" really means 17:48 Telehealth rollbacks and the CMS policy gap 18:28 Health equity, DEIB, and the Albert Einstein legacy 20:55 A 44% amputation rate and the clinic built to change it 23:50 The true cost of diabetic foot ulcers 26:06 Physician wellness: how Dr. Myers stays grounded 28:36 Reasons for hope 32:26 Connect with Dr. Myers 🔗 Hear more insightful interviews :🌐 tntopenmind.org 📸 Follow Dr. Myers on Instagram: @dr.savalimb Tags: diabetes and mental health, health equity, behavioral health, integrated care, diabetic foot ulcer, limb preservation, Bronx healthcare, health disparities, endocrinology, diabetes depression, social determinants of health, whole patient care, telehealth policy, physician wellness, TNT Open Mind Insights, healthcare leadership, diabetes care, underserved communities, non-compliant patients, biopsychosocial model Subscribe to TNT Open Mind Insights - Mental Health Interview Series [https://mysoundwise.com/soundcasts/1777417681925s] on Soundwise [https://mysoundwise.com/soundcasts/1777417681925s]

Bilingual Providers: Building Trust With Kids with Marcos Cota

What happens when a provider speaks your language? Bilingual pediatric physician assistant Marcos Cota knows firsthand. Growing up in a Spanish-speaking household in Truckee, California, he watched families struggle to be heard in a system that wasn't built for them. Now practicing at Community Health Alliance in Reno, Nevada, Marcos is doing something about it. In this conversation, Marcos shares what it really takes to build trust with Latino families, why kids should never have to translate for their own healthcare, and the very real gaps in pediatric mental health access that are leaving families with nowhere to turn. As a TNT Fellow training in Child and Adolescent Psychiatry at UC Irvine, he's expanding what's possible for the communities he serves. If you work in healthcare, advocate for mental health access, or care about equitable care for kids — this conversation is for you. Chapters: 00:00 — Introduction: Meet Marcos Cota, PA-C 01:26 — From Family Medicine to Pediatrics 02:20 — Why Language Barriers Fall on Kids 03:43 — Culture, Trust, and Better Patient Outcomes 06:01 — The Limits of Interpreters 07:20 — Marcos's Personal Connection to the Work 09:08 — Community Health Alliance: Filling the Gaps 10:38 — Barriers Facing Underserved Families 12:51 — Why Marcos Joined the TNT PC-CAP Fellowship 14:41 — Seeing the Whole Patient: A Pattern of Purpose 17:07 — Pilates, Wellness, and the Mind-Body Connection 20:55 — The Real Barriers to Wellness Recommendations 22:19 — Magic Wand: What Pediatric Care in Reno Really Needs 24:20 — What Gives Marcos Hope 25:25 — How to Connect with Community Health Alliance Interview Recorded On: Jan 17, 2026 🔔 Subscribe for more conversations on mental health, equity, and the people closing the gaps in care. 🔗 Watch more interviews in the series: www.tntopenmind.org bilingual healthcare, pediatric mental health, language access, mental health equity, bilingual providers, Latino health, child adolescent psychiatry, pediatric care, community health, TNT fellowship, health equity, Spanish speaking provider, underserved communities, mental health advocacy, cultural competency, physician assistant, bilingual PA, kids mental health, healthcare access, Community Health Alliance, Reno Nevada healthcare, pediatric psychiatry, language barriers healthcare, Latino families, behavioral health Subscribe to TNT Open Mind Insights - Mental Health Interview Series [https://mysoundwise.com/soundcasts/1777417681925s] on Soundwise [https://mysoundwise.com/soundcasts/1777417681925s]