Andrew Martin: Well, I’m sitting here with Dr. Moe
Gelbart from Gelbart and Associates and also from
Thelma McMillen Center. Dr. Gelbart is the founder of
Gelbart and Associates in 1976. He’s a psychologist
and he also is a founder and executive director of the
Thelma MacMillan Center for outpatient chemical
dependency at Torrance Memorial Medical Center. It
is an outstanding outpatient program, but we’ll learn
more about that as we go along. So thank you very
much, Dr. Gelbart for taking time to speak to us. Tell
us a little about you and the programs that you’re
Dr. Gelbart: Sure.
Andrew Martin: So, the place to start, I suppose, is at
the beginning. Maybe you can tell us a little bit about
your background and what led you down this path.
Dr. Gelbart: Well, long story short, because much more
went into it, but I was a teacher from 1969 to 1974 in
Brooklyn, New York and I was fortunate to be assigned
to a program that had the most emotionally disturbed
kids in school. In fact, in high school, they wouldn’t let
those kids move around. In other words, they didn’t
trust them to be with the general population. Nowadays,
there’s a lot better programs designed for special-
ed kids like this, but this is back in 1969. Anyway,
long story, so I was chosen to be one of the two teachers
that stayed in a room with them all day. But we did
have a lot of outside help which came from psychologists
and social workers. So I became interested in
the field, went to the school, got a Master’s at the City
College of New York, decided I wanted to go further,
left teaching, and came out to USC in 1974 and got
my PhD in 1978. So that’s the short story as to how I
initially got started with Psychology.
Andrew Martin: Right. I know that you have a very
diverse background as you have moved from the East
Coast to the West and you’ve had involvement in many
different aspects of mental health.
Dr. Gelbart: Correct.
Andrew Martin: And now behavioral health as well.
When you moved from New York out to the West
Coast, what brought you out here?
Dr. Gelbart: Okay. Part, strictly to go to school. I was
admitted to the program at USC and came out. And
those of you who are from New York, especially in the
seventies, certainly know why I never went back: just
take a look at the beaches in California. My friend
today, from The Hampton’s in New York, sent me a
picture of his backyard yesterday, filled with snow. I
sent him a picture of my backyard, or me sitting in my
lounge chair out in the backyard. So, that’s why I never
Andrew Martin: And you shortly opened up Gelbart
Dr. Gelbart: Correct.
Andrew Martin: But you also have had some experience
at the Sheriff’s Department. Can you talk a little
bit about that?
Dr. Gelbart: When I came back to California, I already
had my master’s and then I immediately got my MFT.
So since 1976, I’ve had my MFT and, had been working
at that, while I was going to school getting my
doctorate. At the end 77 or 78, I got a position as a
psychologist with the Sheriff’s Department in Los Angeles.
It was probably my internship, as well. I mean,
the hours counted towards my internship, and it was a
great job. It was working with the police officers and
their families. And then I became somewhat expert in,
or at least experienced in, the hostage negotiations.
And that was at a time when there were an awful lot
of airplane hijackings, and came not-to-far after the
Olympics in, if my memory serves me right, Munich.
The Olympics where there was a big hostage crisis.
Anyway, I helped develop the first hostage negotiation
team. And as part of my dissertation I really did the
first research in hostage negotiations. My research, my
dissertation, was on psychological factors related to
successes as a hostage negotiator.
Andrew Martin: Interesting. Now I know that you
have some specialties that you work with, particularly
with Gelbart & Associates, including pain management,
and sports psychology are some things that you
have a great interest in.
Dr. Gelbart: Correct
Andrew Martin: But where did that interest come
Dr. Gelbart: I’ve always been interested in athletics,
so anything to do with performance enhancement of
some sort, I’ve been involved with; really, since I started
studying in the early 70s. Again, either ahead of my
time or not good enough or whatever one wants to
call it, I actually went through my original dissertation
in sport psychology. And I was in some form of sports
psychology and, and I was even in touch with at the
time with 2 most well-known sports psychologists in
the country, there were very few, Typco and Olgerbee
at San Jose University. And again, long story short, my
department at USC said no, that’s not really an appropriate
and proper thing for studying academically, and
so they wouldn’t let me do a dissertation in that. And,
and I really regret that. In fact I regret today particularly
as today is the day after the Super Bowl. And a good
friend of mine, in fact somebody who I wanted to be
my intern many, many years ago, Mike Gervais, has become,
through those two psychologists, a very famous
sports psychologist and was the psychologist for the
Seattle Seahawks who just won the Super Bowl.
Andrew Martin: Interesting.
Dr. Gelbart: It was a large part in their actual success. I
Andrew Martin: I’m sure. Very interesting.
Dr. Gelbart: So that was that. And pain management,
you know, like many things in life, for me at least, it’s,
you know, just make sure the doors are not bolted
and locked when the opportunity knocks. So they can
open quickly. And I had no interest in, or knowledge
of anything to do with pain management at the time
but a great job opportunity came along and you know,
I quickly became knowledgeable and, over the years,
relatively the expert. Started 2 programs, an inpatient
program at Bay Harbor Hospital, and then an outpatient
program at Torrance Memorial Hospital. Again,
both in the late 70s.
Andrew Martin: Now was that your entrance, or entry
so to speak, to the Torrance Memorial Hospital program?
Dr. Gelbart: Yes, it was, actually. That was way back as I
said, back in, believe me, 1979 or so, or maybe 1980 by
the time we opened a pain management clinic here.
Andrew Martin: How did that lead into the chemical
dependency program at Torrance Memorial?
Dr. Gelbart: well, eventually Torrance Memorial opened
up an inpatient psychiatric unit, probably in the mid
80s or so, and they asked me to be the head of psychology
for the department. So as an inpatient unit,
I did all the psych testing and anything to do with
psychological care of the patients even though there
were other people running groups and so on. And
at the time, managed care was starting to be more
and more of a factor, and in order to be a full service
hospital, they asked me to develop a chemical dependency
program. By then I had already developed my
own expertise within managed care corporations as
someone who worked closely with them developing
managed care provider panels, so I had that knowledge
and experience. So, I did some research in terms
of who we wanted to partner with and wound up with
three other people who had been working for Vista
Recovery Centers at the time and started to develop
our outpatient program back then.
Andrew Martin: And that outpatient program is what
eventually launched the Thelma McMillan Center?
Dr. Gelbart: No, It transformed into the Thelma McMillan
Center. For 10 years it was at Torrance Memorial
Hospital, opened in 92 I believe, January of 92. And
for those that are familiar, you know chemical dependency
in an acute care hospital (A) is not common,
number one, and (B) is not, was not a very high priority
for the hospital. And so, it was evidenced as that it was
not a high priority, but we had a very small physical
space available to us and not a lot of support. I mean,
not anything negative, but it was not a big part of the
hospital. And so for ten years, it was a very small staff,
maybe 5 people to 6 people. We began to build up a
very good reputation but it always primarily serviced
the psych unit, psychiatry unit, and then the psych
unit closed. So we could maintain, continue to go on,
with the chemical dependency program.
Andrew Martin: I see. I know you have a lot of experience
with managed health care. You’re on a bunch of
Dr. Gelbart: Yes.
Andrew Martin: One of the things that’s on everybody’s
mind, nowadays, is what’s going to be happening
with managed health care along with the Affordable
Dr. Gelbart: When you find out, please let me know.
I say that, tongue and cheek. You know, we just had
a speaker who was Michael Walsh, the head of the
National Association of Treatment Providers in the East
Coast, and who lobbies for substance abuse and mental
health coverage, you know, through the Affordable
Care Act. And we asked them specifically to come and
speak to us about the effect of the Affordable Care Act
on mental health and substance abuse treatment. We
had a full packed house of 300 people and although
it was nice and informative, it could’ve been summed
up in one sentence. He didn’t really know where the
future was going. Now, there’s probably a lot more.
There is parity which means there have been laws
passed where mental health and substance abuse are
to be treated by the insurance companies as on par
with medical problems. But insurance companies are
ever increasingly finding a way to try to get around the
rules so that they can save money. And you know, Michael
Walsh’s other main point really was (A) he really
didn’t know what the effect of things would be, and
(B) get out there, hit the streets, join committees, be
political and fight for our rights as mental health and
substance abuse treatment providers.
Andrew Martin: Terrific. Fight for our rights as providers.
Is that getting involved with your local council
members, your local senators, assemblymen?
Dr. Gelbart: According to him, yes. Anything and
everything, small and large. Because again, the bills,
apparently, are passed but the loopholes are also available
for insurance companies to get around that. And
again, they obviously, like they will at all times, especially
in managed care, look to save their money.
Andrew Martin: Certainly. Okay well, that’s, that’s
good information to have. Let’s get back to Torrance
Memorial Hospital. I know that you have a unique
relationship with Torrance Memorial Medical Center.
And it’s an interesting agency in and of itself. So can
you talk a little bit about their background and how
you work with them?
Dr. Gelbart: Sure, maybe its best to fast forward the
second half of the question you asked about the
outpatient program, which was started, as I said, in
1992 when we had this small program. But then, in
11 years ago now, which would make it 2002 I believe;
Carl McMillan, a local businessman here in the South
Bay, a very wealthy local businessman, donated approximately
$6 million to Torrance Memorial Hospital
earmarked for the substance abuse program. And, to
increase it’s visibility and it’s functioning and so on,
including starting an adolescent program in addition
to our adult program. That was the largest donation
the hospital has ever received: since then we received
2 more, a little larger. But, at that time it was very,
very large. It may have been the largest that we could
locate in, really - that any one person donated to a
particular chemical dependency program anywhere in
the United States. So, as I mentioned earlier, this program
was not necessarily the biggest priority, became
a program of importance within the hospital. And we
began to receive a great deal more support and visibility
and so on. But having said that, the hospital has
always been great, and I’m not just saying that. I’ve
been doing this long enough that I am being as honest
with you as I can. The hospital is a unique hospital.
It stands alone. What I mean by that is that it’s not
part of a large corporation. Little Company of Mary
for example is part of Provident Medical. I mean the
UCLA groups and Tenant, and Catholic Hospital West,
and all these different large organizations which make
decisions again based on bottom line. Torrance Memorial
is an independent standalone hospital strives
to continue to do so even in the face of very, very
difficult times in this day and age to do that, medically.
And their mission is really to provide the best care and
to be a community resource. So that’s always been
our mandate. Our mandate is, has been do the best
we can. If the community needs the program, we will
support it. And then, we were required to provide an
awful lot of community service at no charge. And by
the way, it fits in perfectly with Karl McMillen and his
mandate and his position and his vision of the future
because his is about giving away and helping. So the
two go hand-in-hand perfectly, and as I tell people
many times in 22 years of running this program, I’ve
never once had pressure, to say the census is too low.
Now we have a good census. But, there’s never been
any kind of pressure, what we call, heads-on-beds
mentality. Like rope, rope ‘em in, get ‘em in, get people
into your program. And in fact we are capable,
as a result, to do initial assessments of people and
provide them with the best recommendations which
very often are not our program. So, that actually feels
good. When I go to conferences, I love being at the
conferences because we are, well first off we serve
only a very specific group of people. People who live
in the South Bay ranging from you know, a little North
to the airport, down, east to the Harbor Freeway in
South Bay Long Beach. Now we get people occasionally
from outside those areas, but that’s our prime
geographical location. And if you don’t live there, then
you’re probably not going to come talk to the Thelma
McMillen Center. If you do live in that area and you
really do need help with substance abuse than you
really should come to the Thelma McMillen Center
because it’s the best place to be for getting that kind
of help. It’s great when we go to a great conference
like The Evolution of Addiction Treatment and, and you
know, there’s booths with residential inpatient, everybody
is sort of, for lack of a better term, looking for the
same patient, the patient has a choice decision. They
go to place “A” in Washington or place “B” in Florida or
place “C” in Palm Springs or “D” in Minnesota and so on
and so on. Anyplace place, you know, “F” through “Z”
in Malibu. But we don’t have that, so we’re not really
in competition with anybody. That feels really good.
So the hospital’s been incredibly supportive of not just
our program, but of ensuring and helping us make
sure we do the right thing for the community.
Andrew Martin: Right. The programs that are offered
at Thelma McMillan Center, maybe we can talk a little
bit about the various programs? As an example, the
reputation of the adolescent program is stellar. But
also there’s adult programs and so maybe we can talk
a little about that.
Dr. Gelbart: Okay. We have basically two treatment
programs. We have an adult program and a teen program.
They’re both IOP, which is Intensive Outpatient
Programs. Our adult program, which has been around
over 20 years, in duration is a nine month program. It
is three phases. After the initial assessment we decide
if this is the best place for the person to be. The
person goes through an intensive phase, which is five
times a week for six weeks. And again, 30 visits of
intensive, which includes some barometers and some,
some yard markers that they have to pass, like doing
the first step and going to so many meetings, and having
so many days of sobriety and so on. They then go
to a transitional phase which is a three times a week,
six week program. And then they go 6 months of aftercare
which is 1 day per week. The program consists
of individual therapy, group therapy, education, group
lectures, as well as lectures with families. We have a
gym that people can do working out in. And we’re
going to be adding some newer modalities that have
proven themselves to be evidence based, and effective
within a scope of treatment. So we already started
some of the mindfulness groups. We’ll be working a
little bit more closely with trauma based programs and
groups. We’re looking into medication assisted treatment.
You know, we have a medical director, Dr. Robert
Swift, and you know, again many of the insurance
companies demand that you at least evaluate somebody
for Campral, and Naltrexone, and Vivitrol, and we
do an awful lot of work with Suboxon presently with
our opiate dependent people. But that’s the guts of
our adult program. When somebody is appropriate,
we think outpatient is the preferred form of treatment.
A lot of people used to think, and still do in certain
areas, that if you really want real treatment, you got to
go away for 30 days, or whatever, or longer - and that’s
better than outpatient. And actually, if it’s appropriate,
what I mean by appropriate is if a person can stay
sober, has a support system, has ability to structure
their time, and basically can stay sober for 24 hours,
then sometimes the outpatient is actually preferred.
The person gets to stay in and get help in the community
they live in. They get involved with 12-step
programs in the community they live in. Your families
have much more involvement because they’re right
there. They continue to stay at work. They continue to
stay with their family. So there’s a lot of advantages to
being an outpatient program. In fact, one of our areas
of treatment, that we do an awful lot, is with inpatient
programs. Some of the best in the country, like the
Betty Ford Center. Because when somebody goes
away to treatment for 30 days or 60 days or 90 days,
or whatever length of time, guess what? They have to
come home. When they come home, for some it’s like
“boom”. New ballgame. And the programs attempt to
transition them, they still, or very often, they’ll come to
our program, because it’s so cost effective. And they’ll
go through our outpatient program as a nine month
way to transition into the community.
Andrew Martin: When we can add that length of time
into the treatment regimen. I mean those success
statistics are staggering.
Dr. Gelbart: Absolutely. In fact when we work with
Betty Ford Center or Michael’s or Promises or a number
of inpatients; we tell them, look, when you utilize us
in that way your program becomes better. So you’re
going to the Betty Ford Center for ninety days and
then you come to Thelma McMillen for 9 months. The
people got sober at the Betty Ford Center but they’re
going to be much more likely to stay sober than had
they not. Our results in our adult program, by the way,
over the years, we started to keep a lot of outcome
data. And we have better outcome data of, at least
what we’re keeping, than the general average within
the industry. So we probably have about oh maybe
65% or 70% of people who start our program finish
the intensive phase. And then, from that, once they
finish the intensive phase, probably about 30% to 35%
dropout rate. We’re trying to study, right now, why
that is. Who’s dropping out and what’s happening
so that we can make some decisions about shoring
up the program. So for example we’re getting a lot
more young people, 20 to 25, and I have a feeling that
they’re higher dropout rates, so we need to maybe
put a track in for young people because they have a
different set of problems. But anyway, our results are
Andrew Martin: You mentioned a family component. I
am such a big believer in family and you must include
the family system in the treatment program otherwise
the odds of long term success for the individual are
greatly reduced. Can you talk about what the family
component looks like?
Dr. Gelbart: Well, the family basically has, I mean in
terms of of the logistics of it, they have a family group,
group therapy where the family gets together and a
multi-group therapy where the family and the patients
get together. And then they also have family sessions,
you know, individual family sessions just for their
family and themselves. So that’s the, basis, you know,
primary sources of help.
Andrew Martin: That’s pretty comprehensive.
Dr. Gelbart: And we have Al-Anon, of course. You
know, we’re, we’re a 12 step-based program, so the patients
are, I wouldn’t say required, I mean, they’re certainly
encouraged. I mean, if somebody doesn’t want
to go to 12 step, we have a long discussion with them
around what that’s about, and what Alternatives they
can find. But the families are certainly encouraged to
go to Al-Anon. In fact, we have Al-Anon, several Al-
Anon meetings right here on campus.
Andrew Martin: Fantastic. Well, how about the teen
program? What does that look like?
Dr. Gelbart: Very similar. By the way, one last thing on
the adult, we have a morning program and an afternoon
program. So depending a person’s work scheduling,
it’s really hard to switch between them, but
people pick either from the morning or the evening.
And, and occasionally we let them switch. Because we
get people who are on alternating schedules, like they
work grave yard one month and then next something
else. And we have flight attendants or policeman and
so their schedules shift and so they can mix and match
sometimes. We have a relatively flexible schedule
in that way, as long as a person’s doing well. Once
they’re not doing well, we crank up the structure and
they have to go as scheduled. But anyways we have
a morning and afternoon program. The adolescent
program is only afternoon and that’s when treatment
starts, right after the school bell. It is similar except
it’s a little longer, it’s a year-long program but it is an
interesting thing. Let me explain because we had to
go through some adjustments and changes. I’ll tell
you one. First question, Andrew. What percent of kids
do you think that have been referred to our program
really want to come and want to be there?
Andrew Martin: Can you go with a negative percentage?
Dr. Gelbart: I think maybe in all the years, maybe, we
might have had one, but I don’t think so. They’re all
brought in kicking and screaming and scratching and
you know, resenting and resisting and so on. Somebody’s
forced them to come in. Interestingly enough,
very quickly they recognize they want some help, a
good chunk of them, because they know that their
lives are out of control. But the reason I say that is
when we started the program, it was a year-long. Tell a
kid, look, there’s a year-long program, they don’t even
want to come in for one day. It’s kind of like saying,
you know, in AA, it’s you get sober one day at a time. If
you have to tell somebody, look, let’s do this one year
at a time, you’d lose a lot of people in sobriety. So,
when we used to tell children that it’s your problem,
they resisted even further, and so we changed it. And
so what it basically is, there is an intensive phase as I
said, with the adults. The intensive phase is longer. It’s
ten weeks four times a week; and then they go into a
transitional phase, which is three times a week for the
next six weeks, which comes to 6 months total, at that
point they complete the program. But they’re offered,
if they want to graduate, and graduate means to come
for another 6 months once a week. So some do. Some
pick the company, they like it at that point, but if they
want to leave it at six months they have completed the
program. They are offered the ability to come as long
as they want. So they can keep coming back up until
the age of 18. So some come even longer than one
year but the Components of the program are similar
and individual, and group, and lecture. And, you
know, similar as the adult. The big difference is, the
family becomes even more important, especially in an
outpatient. You know, parents would like it to be like,
“here, here’s my son. He has a drug problem. I’ll pick
him up in six months and he’ll be cured.” So, they don’t
want that involvement. But they pretty quickly find
out that this is a three-legged stool. Us, the parents,
and the child, and if one of those legs of the stool is
missing, the stool wobbles and doesn’t work. So we
have to have very significant family involvement. And
sometimes that causes a problem. Sometimes parents
can’t do it, or won’t do it, I feel for them. Sometimes
they have three kids and they have stuff to do, this one
to soccer practice, and that one, and Johnny’s causing
all the problems anyway, and why do I have to now
send more time with him and his problems. So that’s
the kind of resistance we have to work through.
Andrew Martin: Yeah, I can understand that. So the
treatment outcomes you were mentioning earlier are
excellent for the program.
Dr. Gelbart: Yes.
Andrew Martin: Why?
Dr. Gelbart: That’s a good question, but I think I know
the answer. I think it’s our staff, quite honestly I think
it is. Anytime I have any kind of discussion about our
program, whether it’s been like we’re having here, or in
an interview, or wherever it is, it always comes down to
the staff. Because, you know, basically, as nice as our
building is, and it’s a beautiful building, and it’s nice to
have our facilities, and our gyms, and our libraries, and
all those things that, thanks to Carl McMillen we have.
You know, you close the door of the room, you put
eight or ten or 12 people in it, and then basically you
have somebody who’s working with them and teaching.
The quality of that person’s ability and work is
really what it comes down to, and we have incredible
counselors. And I know anyone in any program would
say that. But you know ours is evidenced by probably
300 plus years of sobriety amongst them. They have
their own programs, personal programs of recovery.
They certainly understand this. They have probably
have two hundred cumulative years of experience in
our program. We have people who have been here
twenty years, so they stay, it’s very rare that somebody
actually leaves. That’s the part that amazes me, they
come to work for 20 years because they want to give.
It’s part of their, their own program. It’s part of giving
back. And it’s great to work here for the hospital and
in this environment. As an example, in 22 years, we’ve
never laid anybody off because of census. You know,
many programs get slow, staff goes down. Things
get busy, they put more staff on. One of our biggest
benefits is you come to work here we take care of you
because you take care of us. So, anyway, long winded
again. Staff is, is one of the reasons why. The other is,
we have support. You know, we have support from
the hospital, we have support from Carl McMillen,
not just his financial support, which we do have, but
you know, Carl McMillen is an incredible business
person and his wealth is built on excellence. And, you
know, excellence, to him, was excellence in the, in the
plumbing industry. He calls it legendary service for
Todd Pipe and Supply. That’s their tagline, their motto.
And that’s all he demands from here. He only wants
to know, how you become the best of the best. That’s
all he’s interested in, because that’s all he knows. So,
again, he doesn’t run the program. But, you know, we
have a moral kind of answering to him to do. So we
carry that torch seriously.
Andrew Martin: Indeed. That treatment philosophy,
extends out in the reputation of the program. I can tell
you that from the outside.
Dr. Gelbart: Well, thank you.
Andrew Martin: So you have nearly 40 years of experience.
Dr. Gelbart: Almost, 38 years at this point, almost. Just
to be exact.
Andrew Martin: Who’s counting?
Dr. Gelbart: Well, I started when I was seven.
Andrew Martin: That’s a tremendous amount of exposure,
and knowledge, and experience to figure out the
kinds of people that can best deliver services to those
patients who are out there.
Dr. Gelbart: That’s a good point that I don’t realize and
you’re absolutely right.
Andrew Martin: And I think that also extends into your
agency, Gelbart and Associates.
Dr. Gelbart: Correct.
Andrew Martin: And we haven’t talked about that too
much. So let’s talk about Gelbart and Associates.
Dr. Gelbart: Well, Gelbart and Associates is a multi-disciplinary
behavioral health group. Which is basically a
private practice with 25 providers, right now, in three
offices. We have five psychiatrists at present, psychologists,
and MFTs and LCSWs make up the remainder.
Again, I’ve been doing this since 1976 with a group
practice. When I started I was by myself so it took a
little while but then I realized I had more work than I
could handle and rather than refer it out I hired somebody
on as an assistant, and when that got more work,
a second. And before I knew it, we have 25 people
at present. And there, again, I probably pick people
who work well with me and within the systems that
I work in. It’s not necessarily for everybody, but it
works well. So, some people have been here 30 years.
They’re licensed and they’re independent so they
could go work on their own if they wanted to. But I
always believe, at least in private practice, on the other
as well, it’s a little different, but I’m always involved in
win-win. In other words if you come to work here, it’s
win-win. I don’t want to convince you to work here.
And I hope you don’t convince me I should take you
because it’s not accurate. Because, ultimately, that’s
going to turn into a problem. So, I think that’s part of
why people stay. You know, the question, what do we
do? Like I said, we have people who specialize in little
children. We have people who specialize with children
and adolescents. We have people who specialize with
geriatrics. We have an awful lot of people with a great
amount of substance abuse and related family kinds of
knowledge and understanding. And, of course, everybody
treats depression and anxiety and marital issues.
Our business is probably about 90% insurance based.
So we are on all the managed care plans. We’re easily
the largest group here in the South Bay, as well as very
prominent in the insurance panels within the South
Andrew Martin: Right. You must have seen some
really significant changes over the years. Particularly
in how managed health care funds treatment. And
I’m, I’m just curious. What do you think the most significant
change has been? With regard to delivering
services to the individuals that need those services.
Dr. Gelbart: A good question. I think that the biggest
change in the years that I’ve worked has been in managed
mental health care. In other words, when I first
started mental health was insurance covered. Federal
insurance coverage grew, grew a little more, but there
was no management of the care. So you had people
who could be in therapy for 20 years and nobody was
ever monitoring what was going on. So there’s good
and bad to managing the care. I’ve always thought of
it as being good for us. So it’s a tradeoff. We wind up
kind of making a contract with an insurance company
that says, look you said we’ll be on your plan, you send
us more of your patients, as a result. We will, accept
2 things. We’ll accept some oversight from you. But
we’ll make sure we’re therefore providing the care
in a certain way which basically means it has to be
medically necessary and we are doing the appropriate
proper treatment and making the right progress. The
downside is the rates go down. Or they certainly went
down then and really one of the biggest downsides
in the managed care mental health field is that the
rates have hardly ever changed. And so some of them
are the still the same as they were 20 years ago. My
rent is not the same, I can tell you. My bills are not the
same. But some of the managed care provider’s rates
that they pay are still what they were 20 years ago. On
one hand, I say it’s unfair, on the other hand, they’re
working in another world. So if they want to go to a
company like Northrop Grumman, and they want to
get that business from Northrop Grumman and cover
their people under the mental health, they’re going to
have to provide a certain level of contractual services
saving them money.
Andrew Martin: Yes.
Dr. Gelbart: Otherwise they’ll go to somebody else to
save it. And so it’s a system. Cost of care, cost of medical
care, has kind of spiraled out of control for many,
many reasons. And you know, managed care is just
probably the biggest thing in mental health that has
tried to come to contain the cost, and that’s really nice
at present. But I do know a little bit about the Affordable
Care Act, and some of the things that have spun
off in accountable care organizations, is that there is
an awful lot more attention to quality of care going
forward, rather than just cost saving. And that was not
the case early on in, I mean, it was ugly quite honestly.
It was ugly when managed care started. Some
companies would give you two or three visits and you
had to beg for two or three more visits. You spent
your time on the phone. And, and that stuff doesn’t
happen anymore. On the clinical end, I mean there’s
new medicines and there are some newer treatments,
and there is really a better understanding of much of
substance abuse and mental health particularly from a
brain and biological point of view. So, you know, that’s
been helpful too.
Andrew Martin: The brain science advancements have
certainly helped us understand chemical dependency
in a great way.
Dr. Gelbart: Absolutely.
Andrew Martin: These advancements that we’ve experienced,
particularly with the treatment of addiction,
you have also witnessed firsthand. In your opinion,
what do you think the 1 or 2 greatest advancements
have been for us in the effective treatment of this
Dr. Gelbart: First thing that comes to mind is, is more
and more scientific evidence to validate the notion
that it really is a disease. Which takes a lot of the stigma
away, takes a lot of the negative of view of people
trying to get help. Which is not so important in terms
of how somebody from the outside views it, but if
you-yourself have the problem and you feel it’s not a
disease, that’s the difference between saying, hey I’ve
got an illness versus, hey I’m this, bad, evil person who
can’t control myself. You may not seek help, on one,
versus the other. So, I think it’s very much validated,
to many, many people, the notion that this is really an
illness. And what makes an illness, is it’s got an etiology,
it’s got biological markers. It’s got a course of how
it develops and it’s got a course of treatment. Which,
if you follow the treatment, you wind up with, not
necessarily a cure, but a resolution and a remission of
sorts. A secondary value to that is to the lawmakers,
that’s why we have parity. Because the lawmakers can
be convinced that this is an illness just like diabetes.
You wouldn’t withhold from a diabetic, diabetes treatment,
or heart treatment from somebody who’s got an
illness: but in the old days it would be like why would
I want to spend my money on some guy who’s just
drinking? That’s his problem. Let him stop drinking.
So, what I’ve seen is a beautiful thing is the integration
like, you know, Dr. Allen Berger talks about, integration
of 12 step and psychotherapy and so on. But the integration
of 12 step and how it fits so beautifully with
being able to fit with newer developments and findings.
It doesn’t take away. For many years we’ve had
AA. Now what we have are things which take AA, take
that ball, and run even further with it. So that really is,
to me, one of the really beautiful things about it. It’s
not finding out we’ve been going down the wrong
path. We’ve been going down the right path, now we
know why. And we have more to do to go down that
Andrew Martin: Yes. A lot of complimentary approaches,
is what I would call that.
Dr. Gelbart: Exactly.
Andrew Martin: Well, what do you think the future
Dr. Gelbart: More and more complex kind of treatments.
Meaning, more evidence based treatments
and modalities that actually work and help in conjunction
with what we have; complementary, as you say.
Probably, quite honestly, although some people will
shake thinking about it, more biological treatments,
more medications that will work better at providing
relief, or relief from cravings or, you know. I think what
we’ll find is that the biological treatments will work in
conjunction with rehab treatments. And you know,
they are doing fine with Suboxone as an example
which is sort of miraculous in some ways even though
it causes its own problems. But in and of itself, it
turns in to its own problem, so it’s really ethically only
utilized if one is, incorporating a treatment program
alongside it. So, I think the future is going to be an
awful lot of advancements in the science and the medication
of addiction. I think that probably there will
also be some more affordable ways to treat people.
You know, some people want to drive a Rolls Royce
and some people want to get around in a Ford Fusion,
or something. We’re always going to have that. And
we have that in the treatment world, and that doesn’t,
I guess, make one worse or better than the other. It
just means it’s different. I think we’ll have more options.
I think the Ford Fusion is going to be working a
lot better than they are now. But, but they’ll always be
options for Rolls Royce’s too If one wants them.
Andrew Martin: Sure. Well, Dr. Gelbart thank you so
much for making the time to speak with us today. I
really appreciate it, and I wish you all the success in the
Dr. Gelbart: Same to you and thank you for having me.