The Battle Within: Dr. Marisha Chilcott on Mental Health in First Responders and Innovative Treatments

Jerry Dean Lund: 0:15

Welcome to today's episode of Enduring the Badge Podcast. I'm host Jerry Dean Lund and if you haven't already done so, please take out your phone and hit that subscribe button. I don't want you to miss an upcoming episode. And hey, while your phone's out, please give us a rating and review. On whichever platform you listen to this podcast on, such as iTunes, apple Podcasts and Spotify. It helps this podcast grow and the reason why, when this gets positive ratings and reviews, those platforms like Apple Podcasts and Spotify show this to other people that never listened to this podcast before, and that allows our podcast to grow and make a more of an impact on other people's lives. So if you would do that, I would appreciate that from the bottom of my heart. My very special guest today is Dr Chilcott. How are you doing, doctor?

Dr. Chilcott: 0:55

Hello, nice to see you, Jerry.

Jerry Dean Lund: 0:57

Nice to see you too. It's taken a little bit of a minute with our schedules to get connected, but I'm glad we did and I'm glad we're going to talk about some different things. Maybe then that we haven't dived down too far on the podcast and it's going to kind of dive down into your specialties of working with first responders and doing some different types of treatments as well. But, dr Chilcott, introduce the audience to yourself.

Dr. Chilcott: 1:22

So I'm Marisha Chilcott. I'm actually trained as a family physician, but I got really interested in mental health because I first of all, actually, I read Michael Pollan's book how to Change your Mind and got excited about the concept of the use of psychedelic psychotherapy as a mode or mechanism to really significantly improve mental health and wellness for people in general. But backing up a little bit, even though my board certification is in family medicine, I worked as an ER physician for a county hospital in Northern California, Contra Costa Regional Medical Center for seven years. During that time I got introduced to urban search and rescue through a buddy of mine who was really involved in Task Force Four out of Oakland Fire. And when, sadly, my friend Mark Stinson Dr Mark Stinson, who was really involved in urban search and rescue around the world died unexpectedly, I got a call from the chief Chief Hoffman out of Oakland said hey, we need a doc on the team. Mark had talked about you, Would you please consider joining Task Force Four. And although Mark's shoes were way too big for me to fill, I was pleased to be able to serve and I was on the team for 10 years. So I spent a lot of time with firefighters doing drills being deployed, kind of just doing the whole situation, and then kind of honestly related I met my partner and so I am partnered with a firefighter who gets to share with me lots of the experiences not everything, but I have a sense of the spouse's perspective of what it's like to be with a firefighter, and that's a whole other set of circumstances. But independent of that, I just really wanted to address mental health in this country because it, I feel like, is at the root of so much of what we struggle with, and if there is mental healthfulness, then there's less violence, then there are better, stronger families, there are improved employment, employer situations and there's less homelessness and other crime with mental health. So that's my motivation and I started Be the Change in Mental Health as a 501c3 non-profit because it's my feeling that this is a modality that needs to be brought to people in general and not just be a privilege of folks with a lot of money.

Jerry Dean Lund: 4:10

Yeah, yeah, excuse me. I mean you're very culturally competent. I mean being on the task force and having a partner with you, know, and being in the ER like it's. You're very well versed, I'm sure, in the firefighter world and can see how mental health plays a big role in in our society, right, especially being in the ER as well. And I agree with you. I think it is the root of a lot of things that are going on in society. It's just the mental health. I don't know if we call it a crisis anymore or what we call it.

Dr. Chilcott: 4:48

You know, the use of the word crisis and and and other things are kind of the the terms that get people excited and make for headlines. It's an issue and it's something that's worthy of addressing, and one of the things that we need to do is is destigmatize it. So you know, just kind of focusing on the firefighter world, suck it up, buttercup is not a way to manage the stress of any kind of job, whether you're someone behind a desk or someone who's jumping out of bed and jumping into a rig and going code three to anything. So that attitude that we should stuff our feelings and not address when things are hard, is something that has to change in order for us all to be more well. And I like to use the words wellness and health, because it shifts away from a stigmatized sense of sickness and disability. And the reality is we all get stronger when we have the opportunity to recover from stress. That's what the gym does, right? Yes, stress your muscles. You've got little micro tears and then, with recovery, you allow those muscles to regrow and then they're stronger. And the same thing happens with mental challenges that if we actually use the stresses to create circumstances that we get better at managing, then we get better at managing them. You just think you think about, like when you first learn to drive a manual shift, like there's so much to think about, you can barely do it. But you get better at it. The first time you go to a code and you're, you know, brand new paramedic and you're trying to think what's the order, what's the thing like, what do I need? And then, after you run your 75th code, you're like, yeah, here we go, slap the stickers on your pulse, ox, somebody place an IV, get the tube ready. Like like all of that becomes rote because it's no longer stressful. So that's resilience and the opportunity to create growth out of stressful circumstances. And if we treat the most horrific of our stressful circumstances as opportunities to learn and grow, then we will do better at the next time. And we don't have to have that be something that echoes in our minds and paralyzes us when we're triggered by a similar situation happening again. So that's that's my goal is to help people do that, and I have this modality called ketamine assisted psychotherapy, which is incredibly effective at helping people do exactly that.

Jerry Dean Lund: 7:37

Yeah, let's. I want to go back just a little bit about you know, like talking about feelings and stuff like that or stuffing things down. I think a lot of that and the you know, the suck it up buttercup type, where that comes from. Do you think maybe it's just from people not knowing how to deal with their emotions, so they just stuff them down, like people really never were given opportunities or taught, you know, on how to deal with their emotions. So the thing is to just stuff them down, right, to not even show any emotions because it's like, say, it's weakness. So do you think maybe some of that's just like emotional intelligence that's just not there for being taught?

Dr. Chilcott: 8:13

Sure, I mean. So it's our culture, it's not just the culture of firefighters, it's the American culture, you know, it's the, the rugged independence, it's the belief that the ability to just soldier on and I mean, look, it's in our language soldier on and just do it alone and take care of yourself and don't necessarily pause, because if you pause you might not be able to react. And it's actually like, fundamentally, it's a fantastic defense mechanism that stops serving us at a point right. And so we were taught by our parents, who were taught by their parents, in order for people to survive really, really difficult situations. And at some point, you know, we were taught by our parents, who were taught by our parents. Those techniques are just not as useful, and it's not that they were never useful and it's not that they aren't useful in the moment you don't have. There are certainly a lot of circumstances where you cannot pause to allow your emotion to process, because you got to deal with a situation at hand, and what we are proposing in this new way of thinking is that after we've gotten that situation it's gotten through it, then it's a time to go back and let the feelings flow and process through them and get through. And that's that it is emotional intelligence and it's a new way of thinking, feeling and being in the world that turns out to be a lot more productive and, long-term, a lot more effective. But there's a difference between long-term and short-term, right. So short-term, we got to just deal. Long-term we have to, like, breathe again, get strong. It's that whole recovery thing. Right, you got to recover to get strong. If you just work, work, work, work, work, work, your muscles would all break down, you get injured, doesn't work out, and that's what we see in the fire service, right, we work, work, work, work. And then that emotional toll gets to be too much and then that's how we end up with a really significant percentage of folks feeling like they can't finish out their careers. It's a horrible thing to be in the last three years and thinking I just have to hang on, I just got to get to 55 or I just got to get to 50. And you know, you're thinking there are other humans you can think of right now who are in that space, who aren't going to quite make it to retirement. And then the most horrible thing is, if you're just hanging on like that, you get to retirement, you go and you dive a heart attack. What's the point of that?

Jerry Dean Lund: 10:52

Yeah, yeah, this job is really like these careers are really marathons and you got to like treat them as such, like there's no sprint to the end, unfortunately. So how does the ketamine therapy, or modality, how does that work?

Dr. Chilcott: 11:09

So let me just back up first, because I'm sure that there are listeners out there who've got ketamine on the rig and who say like, oh, I know what ketamine is about. You know we push it when we need to send a patient into a K-hole, get them out of the car, do we got to do? And too bad, so sad that they look like a crazy person as they start to emerge. So ketamine is a dissociative anesthetic and its effects in terms of anesthesia are pretty well understood to separate the body from the awareness, so it's called the psycholytic lytic, meaning to cut the psyche away from the body, and that's why you can manipulate someone's body and they don't feel the pain or don't experience the discomfort when they're in that anesthetized state. And, as we are well aware because of our paramedic experiences, it also doesn't drop blood pressure and doesn't depress respiratory drive. So it's a really, really great medication to use in the acute situation and does not increase the risk of shock or cause problems with it, as do our benzos and our opiates, right. So that's why we use it in the field and that's what makes it a super, super safe medicine to use in another circumstance. What has been observed through years of using this medication as an anesthetic is that there's a lot of folks who, after they've come out of receiving ketamine for anesthesia, say, wow, yeah, it feels great to have my shoulder back in place and I feel a little lighter. The depression seems to be about. I didn't even know I was depressed or I didn't even know I was that anxious, but I just feel a bit better. So that's a chemotherapeutic effect of ketamine itself. We know that ketamine is an NMDA receptor agonist and for a while it was believed that that was the antidepressant effect. However, we actually can compare it to another NMDA agonist called NAMMDA, which is an Alzheimer medication that has absolutely zero antidepressant effect, and so that has led us to understand that actually that's not how it works as an antidepressant. It turns out that it does cause some increased expression of brain-derived neurotropic factor, bdnf, which in turn increases the dendritic expression. So the growth of little dendrites at the ends of neurons, which then results in new neuropathways. New neuropathways means increased plasticity, which means a capacity to have a new way of thinking. That doesn't totally explain why the day after you feel a bit better, but it does explain why, when used with therapy, people can think differently and have different perspectives than they did before. So ketamine-assisted psychotherapy has a real emphasis on psychotherapy because if you just use ketamine as an antidepressant, that antidepressant halo fades relatively quickly. Max effect is about two weeks. So it's really great for feeling better in a short term and so therefore really great to help someone get out of acute suicidality. But it's absolutely imperative that immediately following the use of medication, someone then has some assistance with therapeutic guidance, if you will, to say okay, now how are we going to choose a different path? Coming back to how this helps with managing trauma is that after a traumatic event we can have a lot of just reactive processes and thought patterns. What ketamine-assisted psychotherapy can do is help us shift our reactive thoughts to a different thought. You don't have to actually go back and remember the trauma. You don't have to go through a process like EMDR where you relive trauma and try to move it from left side. I'm not diminishing it in any way. Emdr, I'm a big fan of EMDR. I've benefited from myself and the usefulness of that is to reorganize how our memories are stored, and I just want to distinguish that that's not how ketamine seems to work. As far as we know, ketamine is more like. This is my favorite analogy and I've said it lots of times. It's like a blizzard in your brain, blizzard brain, lots of snow. You come out of it and there's beautiful, clean snow all across the landscape. And then, as a therapeutic endeavor, one decides what are the new tracks I'm going to lay down in this new snow, what's the path I'm going to carve? Then, through therapy, and if you've ever broken trail in deep snow, you got to go back and forth and back and forth over this new track in order to actually lay down a new trail. This analogy continues to work because if you don't do that, as the snow melts, the old tracks are still under there, the old garbage is still under there, and if you haven't dug a new trail, you're going to slide back into that old track. That, in a nutshell, is how it works. It's a fantastic modality. Have you ever had?

Jerry Dean Lund: 16:46

an opportunity. Tell me about that a little bit. I have. It was a really interesting experience. I didn't know what to expect. To be honest, it was really a good and relaxing experience for me. I guess I don't know a psychedelic experience in my brain like the way things flowed. Things had texture, sound, had color. The whole experience inside there didn't bother me at all. I felt very comfortable for about 99 percent of the time. Every once in a while I'd have this thought of am I still in control? I totally left my body and I'm gone. But it was really good and it did give me that fresh perspective of things, just things like I came outside, things seemed to be brighter and just awakening my mind a little bit and body Disassociated but then reconnected it back in a better way. That's the best way I can explain it. But here's the part that I struggled with was the actual going through the ketamine treatments and then getting therapy that coordinated with. That is really difficult here, just because everybody's so backlogged. Right, yeah, you can get into ketamine clinics, but getting into therapy after that or try to time those together is almost impossible.

Dr. Chilcott: 18:19

Right, that's the struggle, because there are lots of ketamine clinics across the country. Now, to be super transparent, I availed myself of the services of one this very weekend, but I have it coordinated so that later today I'll get to talk to my therapist in order to have that consolidation then At our office, we are not a ketamine clinic, we're a therapy clinic that has ketamine. All of our services are actually coupled and you can't do one without the other. You could do some therapy, but really we focus on you. If you do any ketamine assisted anything, it's the therapy that really counts. Now, for anybody who's listening to this, that's further away and knows that there's a ketamine clinic around the corner, the tricky thing is to establish a relationship with a therapist first, have that coordinated in terms of your schedule and then work the ketamine into just before those appointments, because it's the therapy that really matters For us. It's all mixed together as an absolute. One of the things that's exciting is that, because individual treatment with ketamine and therapy can be pretty expensive, we're working on how to reduce those costs and how to get them covered by either workman's comp or insurance or some other mechanism. We're piloting programs with first responders, with individual departments as well as I don't know what you call it cohorts of multiple departments. By discipline we're doing firefighters or EMS or law enforcement as separate cohorts and using group therapy as a way to reduce the cost so that each individual pays less and then they actually get more out of it too. It sounds crazy to have a quote psychedelic experience in a group setting. That can be intense, but more importantly, it's the download and integration afterwards with a group of other people who have not necessarily the identical experience, but at least enough of a similar frame of reference that the overall awareness is I'm not alone. I'm not the only guy, I'm not the only gal, I'm not the only firefighter, engineer or captain who struggle with this circumstance. This circumstance doesn't necessarily mean the terrible call. This circumstance means the trouble I have when I go home and my wife is pissed off because I got mandated. It's not my fault, I got mandated and haven't been home for five days and miss the kids birthday party and she had to drive the carpool for three extra whatever all of those things. But that's what people struggle with too. It doesn't mean you have a bad marriage. It doesn't mean that your wife or girlfriend or boyfriend whoever doesn't understand you except that they don't and you're not alone in that lack of understanding. Maybe the person next to you has a way that they've talked to their spouse that helps them get through it and help their spouse understand, and you can have that too. Or maybe there's just a relief like it's not just me. I'm not the bad guy, I'm not the terrible wife, I'm just someone who has a really hard job, and my hard job is different than other people's hard jobs and I have a different kind of set of things that I have to deal with. But this person next to me, they get me too.

Jerry Dean Lund: 22:06

Yeah, I like that. So what does that look like? Because the setting I feel like for first responders it's got to be a little bit different, maybe in some ways because they got to lower their guard and especially in a group setting. Can you paint the picture of maybe what that looks like a little bit?

Dr. Chilcott: 22:26

Sure. So the first thing that it starts with is actually a little bit of a group meeting to get to know one another first, so that there can be a bit of okay, I'm safe. And one of the things that's really critical is setting the boundaries of confidentiality and that everyone is going to come to the table and play with a whole heart and an open heart and to set the stage right from the get-go that vulnerability is not a weakness but a strength, and that we are each who are participating, responsible for protecting each other, just like we protect each other every day on the job. And you don't have to like each other to protect each other and you don't have to like each other to respect each other. But it's about respect and the inherent kindness and pride in that that sort of brings a group together, that we're going to be a team here. Whatever it takes, we're going to be a team and it's us against all of the rest of the environment and everything else in this group setting. So first, it's really important that our therapists have cultural competence and the capacity to bring that together. So that's what it looks like. First is setting that before anybody gets any medication. Then you come back and have a bit of preparation to talk about what it may or may feel like and what to expect. And then you lie down on a comfy mat and we encourage people to bring their favorite pillow or their would be your soft blanket or whatever else that they want to hold on to. And in the group medication setting, everybody's got eye shades on, and then there's music playing in the room that everybody is hearing at the same time. We are actually experimenting also using headsets where everyone's listening to the same music but also a little bit isolated from each other's noise making. To be honest, we're still playing with that because everybody's used to writing in the rig with the headsets, where you can hear each other but you can't hear the outside, you can't hear the siren as much, and so we're working with that as well as another modality. But just in general, everybody's got headsets, eye shades on, music in their ears, and then you get medication all within about a minute and a half, so everybody's kind of at the same level. At the same time, medication is administered per kilograms, so it's weight based, and therefore everybody has a relatively similar level of medication. That said, different sensitivities dictate that some people get more or less. And then it's a. It's a bit of a ride. The very first time this is administered. It's a little lighter, so that people can kind of just get a feel of what this is going to be like. We don't expect that everyone's had a ketamine experience in the past or any kind of drug experience, and so it's important to feel like, okay, this is a safe circumstance, because it can be pretty disorienting. And then after 30 to 40 minutes people sort of come to come out of it and we talk a little bit we kind of call that landing just about how you feel and so forth. And then people take the rest of the day off, don't drive home. Someone's got to pick them up, take them home. And then the next day there's a group integration setting and integration is about this therapy and it's a bit of talking about not what the trip was, not what any trauma was in the past. But in our preparation we talked about what do you want to get out of this? What's your intention? So if your intention is to just not yell at your kids so much, or your intention is to be able to wake up without anxiety, or your intention is to just be a better human being, whatever your thing is. Then we revisit and say, okay, you said your intention was this. Is that still your intention? Are you wanting it closer to it? And maybe where do you want to go instead? Because we assume you start at point A, you set an intention which is going to be point B, you take the medicine, you're now at point C, you're not at A, you're not at B. Now you're at C and you may not want to go to B anymore. Now you have a new point D that you're trying to get to and you can see the path to it and you can actually start cutting that trail. Yeah, so that's what the sessions look like, and then it's rinse and repeat and you do it again in one to two weeks, depending on what the schedule allows. So, as you can imagine, when we're working with multiple departments with different shifts, sometimes it takes us a little bit to keep a cohort together. We try to do things where it's like one a week, but depending on fire season, depending on other things, sometimes that can be challenging.

Jerry Dean Lund: 27:34

Yeah, I would imagine that could be challenging with everybody's schedule and trying to keep everybody together, and I think you would form that really good bond in those groups. Like you're saying that, I thought you put that very well, like how right to protect each other you don't have to like each other. So I think that's what was put very well. I mean, especially in a group setting like that, you can just be there for each other, you don't have to like each other, you don't have to go out with each other after, like you know, it's just be there for them, be a good, human right, just be a good, which could be really hard for some these days. But I, you know, I like when I went in, I did have an intention and my intention was different every time too In a group setting. I haven't done in a group setting yet, I've been thinking about it, but I could see how, like noise canceling headphones in a group setting would be really, really good because it kind of keeps in your own space. But it is a really I thought it was very relaxed feeling for me. I think when maybe people have I've seen have a problem with ketamine is when their intentions aren't like their intentions to fight the way they feel, not just embrace the way they feel, right, have you seen that?

Dr. Chilcott: 28:52

Yeah, and so and that's part of the preparation that the therapist goes through with the group is the idea that you're just going to let go and let it ride. If you fight the medicine, you can. You can stay out of it, you can use your mental strength to avoid slipping into the place. And then, if the medication is so strong that you're going to slip into it anyway, it can be really scary because you're losing control, and so that need for control needs to be acknowledged and then eased off, and that's a hard thing. So part of our job as the clinic is to provide a safe enough container that someone feels okay letting that go, and it's not always easy. It's definitely not always easy for the human that's letting control. It's not always easy for those of us that are managing the situation. Full disclosure I typically give people a little pro-panel law, so are you familiar with that? It's a beta blocker that just blocks the sympathetic response, so that even if you're feeling like I don't want to, you don't get the necessarily like the clenchy fist, sweaty palm, heart-racy feeling of anxiety associated with the sympathetic response. So that can help too.

Jerry Dean Lund: 30:18

Yeah, yeah, I think I got that with mine too. I was just so relaxed and just like I just embraced it right and with my intention. Just let it work, because I get where first responders we don't want to let control of things. But that's what I'm here for. I'm not here to fight it. I'm here to like, get results and better my life right, which, like you say it, betters everybody else's lives around you. When you can be the best person you can be, what are some of the other things that are you working in other groups of? Are you just all in first responders or are you working with other groups?

Dr. Chilcott: 30:59

So we do a lot of individual work first of all, but then the other groups that we're focused on are veterans of foreign wars, so and there's a bit of overlap amongst vets and first responders that work is also focused on acute suicidality. So more than 6,000 veterans committed suicide last year alone. That's 16 a day, and we are right now proposing to the veterans' administration as well as to Kaiser Permanente to do pilot programs to provide intensive outpatient relief for suicidality. So in that situation that's individual work, but it's multiple ketamine administrations in a week with intensive therapy to just get someone out of the darkest part of their cave and show them that there's a light at the tunnel it's not a cave and help them get through it to get out of the place where you believe that every day looks like today and today looks terrible, so that hopelessness.

Jerry Dean Lund: 32:06

Yeah, yeah.

Dr. Chilcott: 32:08

Yeah, and then the other group that we're working with really actively are women victims of sexual violence. So there's an extraordinary number of women who have been raped lack of a better term and the majority of those who have had those experiences had their first type of unwanted sexual experience before the age of 17. And those scars and injuries follow women, follow people, their whole lives unless there is very active healing to address it, and this modality also really helps deal with those things. But I also wanna dispel the myth that you have to be sick or that you have to be unwell to take advantage of something like this. My favorite tagline is you don't have to be sick to wanna be more well. Like you don't have to be a total fat swab, didn't want to be healthy and fit. Right, you can be healthy and fit and think. But I wanna better my PR on my next race, or I wanna just feel even better the next time I go start a new sport and I wanna have strength in my shoulders and my knees and my back and not be afraid to try out kite surfing or try out some other crazy sport, because I have just baseline comfort in my body. So like that, if we have baseline comfort in our mental health and wellness, then we can be more and do more and participate and start things like a podcast after a career like who's thought right Like? there's. That takes courage, and to be able to do something scary requires some sort of confidence in oneself. Because courage is beyond, is not not being scared. It's being scared and thinking I can do this, I can try and I can stretch and I can make it happen. And when we are less mentally well, it's hard to find that, so it's forgetting better. So we can do better.

Jerry Dean Lund: 34:17

Yeah, no, I like that. I like that. I mean, I hadn't really ever thought about that before. Like yeah, I mean you could use these ketamine treatments right, maybe preventively, like without being yeah, absolutely Preventively and also just as maintenance.

Dr. Chilcott: 34:34

It's, like, you know, one of the things I'm just gonna back up just a little bit at first responders. Think of things as being, you know, we have to fix the trauma, as if we're not gonna be traumatized again, like you don't get to get well and then stay well unless you continue doing the kinds of things that keep you well. Just like you can't train for one event and, you know, totally kill the marathon and think, oh great, I don't have to run in again, I'm just gonna maintain this fitness. You gotta keep running, you gotta keep working out, you gotta keep doing it. And mental wellness is the same thing, because as soon as you get better from the whole series of crap that you dealt with, you're gonna go out and take a call and do it again. You're gonna find something else and it's gonna surprise you because it's gonna be from some other angle. But as we get better and better, it's also we get better at seeing those things and dodging them and flexing and healing again. And then things like ketamine assisted therapy can be just kind of a little bit of coaching, a little bit of improvement. It's like you know, you've really got a great golf swing, but taking that one lesson a year where someone looks at your golf swing that you can't see and says you know, just shift your hips this way. And oh my God, who knew? Yeah, yeah, yeah.

Jerry Dean Lund: 35:55

And that's really a great way to. That's a great analogy, you know to put it, for the ketamine. You know why is the insurance so hesitant to like get involved in I mean?

Ad: 36:09

this is probably.

Jerry Dean Lund: 36:10

I mean well, I mean the spark.

Dr. Chilcott: 36:13

It could be a whole another insurance companies have as their mission to make money. So until they are persuaded and they will be that it is less expensive to pay upfront and to pay ongoing for this apparently expensive modality, it's far less expensive to do that than to pay for disability or heart attacks and back injuries and weird abdominal pain that we don't know where it comes from, which are all somatic manifestations of stress and anxiety and other problems. You know that until they understand that these things are related and doing this well from the get go, which is helping us stay well from the get go, prevents their costs later, they're not going to be persuaded. Until that's the case and one of the problems is this is a soapbox, you don't you?

Jerry Dean Lund: 37:06

may not know, I know.

Dr. Chilcott: 37:11

I'll wind up quickly Is that in our, in our health care system. We don't have a health care system, we have a sick system. We don't take care of people until you're sick and you know, there's a tiny, tiny bit of like a nod to wellness or a nod to trying to get you to not smoke cigarettes and maybe reduce your cholesterol a little bit. But we didn't start paying for that until it was really clearly demonstrated that it prevented heart attacks, and heart attacks are expensive. Hip fractures are expensive, but it's, it's it. But the problem is that the insurance company that pays for the prevention is not the same insurance company that pays for the long term cost. Most of the long term costs happen after the age of 65, when Medicare picks up the bill. So if I'm Blue Cross, blue Shield CEO, I've got almost no incentive to take care of you when you're 45, because the problems that you have in your 45 are not going to be really my cost ever. So too bad, so sad, sorry. So that's why insurance? companies don't want to pay for it. But now, just like workman's comp finally figured out that helping people recover from injury made for less cost long term you know, from physical, from, from back injuries, joint injuries and so forth they are going to and we're pushing this envelope hard figure out that helping with mental health is going to help reduce their costs in the long term. And so, rather than going after the general insurance companies in the case for first responders, we are working actively to lobby with workman's comp agencies to help us get that paid for.

Jerry Dean Lund: 38:52

So yeah, that's sad that there's. I mean, I kind of figured that was the answer, but I mean it's like it's sad that they can't see that paying some money in the beginning, you know, is this and helping people. It's just so much better like cost management and just I Think once again, always think like a ripple effect, like what's the ripple effect of, like, you know, paying for someone's Ketamine treatments in the beginning of their career and then maybe like, right, it's a maintenance through their career and type stuff like that I have a happy, healthy person in their career field or whatever through their life. Right, right, you're gonna stay healthier. Right, if you're happy, you're healthier, so you're showing up to work right and healthy and right, helping the people that you go on call this is like this whole thing, but it's just like, ah, you know, a few bucks to help him, like I'll save some money.

Dr. Chilcott: 39:45

But but actually mean. So that's why, like thinking about it, where should the insanity plays? It should be in place at the administration level of a department, because you're gonna have less sick calls, which means you're gonna have to pay for less overtime, which means you're gonna have less disability time. You know, like like all of those things have tremendous long-term value. Quantifying it is Not yet part of something that I can actually speak to. I can. I can tell you that, qualitatively, my hunch is my belief is that it's gonna be far less expensive to take care of people early, but it takes a little while to collect all that data and to persuade the Folks at the top that this is how they should be actually allocating these sources.

Jerry Dean Lund: 40:30

Yeah, yeah, definitely. Before I let you go, I have another question first, like the ketamine treatments and and the cost, and like the department and working with them, is this something that you just do in in California or is this are you working other places to help other, like departments and things like that?

Dr. Chilcott: 40:52

So right now. So I'm in Santa Rosa, california, and I am I, not I, my team be the change of mental health as a as a clinic is partnered up with first responders resiliency Inc. Which is also located in Sonoma County, but has relationships with multiple agencies across the country, and so, although we are currently just in Sonoma County, we are Looking forward to opportunities where we'll get to serve a much broader audience, and, although we are just one organization doing this, there are others and we are not trying to monopolize. We want to spread this word and we want to help other people in other places Do this as well, and so, if there are any folks listening who are interested in getting this, where you may be located, we are happy to help and talk to other clinics to help them To deliver services like this, because our mission is to help people get better, not to be the biggest clinic in the country. If that's not our job. Our job is to help people get better, and if that's spreading the word and sharing our Lessons learned, then that's a perfect way to do it too.

Jerry Dean Lund: 42:12

Yeah, I think that's a good, a good approach, right? That's Serving the people and I believe in like karma, right? You know, putting the good out there, it'll come back to you. Sorry, I thought of one last question. Do you think Maybe some of the reason why people don't do ketamine or choose it not to do it is like maybe they'll think they'll get addicted to it or that they'll be some kind of like fear of that?

Dr. Chilcott: 42:36

There's a huge fear of that, and that's where I'm really careful to say that it can't be just ketamine. So one of the challenges is, if you come to associate the good feeling with the medication, then you can come to the belief that you only feel better with the medication and Tolerance develops, and so then you need more and more, and then that can lead to addiction. So we're really careful to Be clear that it's it's. The medication is just a Tool that helps the therapy. The medication is not the answer. It's that most of us take a long time to get benefit from therapy, and I'm sure that there are listeners out there who've been, like I've done therapy. I've been for 20 years, blah, blah, blah, and I can't actually get anywhere with it. Or, worse, I have therapists that don't really understand me, and I spend $180 an hour explaining to them what the tones are, and, just to you know, there's a lot of frustration with that, yeah. So the point, though, is that it helps us each as individuals, no matter what our Background is, get more out of therapy more quickly, so that we don't have to spend our lives in therapy. Yeah and if you start using ketamine on a routine basis, like accessing it over the internet and Doing a little here and doing a little there, it is a drug of abuse and you have to be careful about that. So, like many things, a tool used the wrong way becomes a problem.

Jerry Dean Lund: 44:13

So Very true, I thought it was. I was mine Just boggled by when I saw this on the internet that they were sending ketamine doses to people's houses, and then I don't know how the whole process worked. But that and putting them through some kind of therapy, no it's like I can tell you I tried.

Dr. Chilcott: 44:35

I went online. I had like a Maybe three-minute conversation with some dude and I didn't know what steady was in who said he was an NP. He said, okay, cool, here we go. And then Three days later I got a FedEx pack on my door I didn't have to sign for it for 800 milligrams of ketamine. So this is not a public service announcement, this is a warning. So it is not the same and it was really dangerous and I look forward to honestly, I look forward to the DOJ Shutting this situation down, because I think it's really, really dangerous, and there's been articles in the New York Times and others talking to people about how they got addicted and it's a problem. And the problem with an addiction to ketamine is someone may have to take your bladder out. No joke. The long-term side effects of overuse of ketamine is chronic, horrible cystitis, the treatment for which is removal of your bladder and wearing a bag for the rest of your life. It is not cool, so don't do that.

Jerry Dean Lund: 45:37

That's a good good to tell people that after we like Explain that this is not. This is not good. This is not good therapy, right? This is not. This is basically just Taking a drug, right.

Dr. Chilcott: 45:49

You're not. Drugs are not therapy. Yeah therapy is we're getting your mind right and working through stuff and feeling good about your own ability to manage things, because you do have your brain and your mind want to be well and want to serve you, and when you have access to that, it is it's a wonderful thing to be a healthy individual.

Jerry Dean Lund: 46:14

Yeah, definitely, definitely, dr Chokot. Where can people follow you and like learn more about what you're doing in the clinic?

Dr. Chilcott: 46:22

and sure, so we're kind of old-fashioned. We have a website, so our offices or our clinic's name is be the change in mental health, and we abbreviate abbreviate that to BTC mental health org. We also have social outlets on Instagram and LinkedIn and Facebook, so that's BTC mental health, is our handle for all three of those and that's kind of that's where we are right now to. You know, we're relatively new. We've been around just since the beginning of 2022 and so we're getting the word out and getting more information. First responder resiliency Inc has information and links to us as well, so that's FRRI org and and and I really appreciate you and the opportunity to speak so that this may get a little bit more information out there.

Jerry Dean Lund: 47:25

Yeah, no, I think it's. I think it was great. I think it was like really gave people a good idea about ketamine and the understanding on how to use it and how not to use it and what it's used for, and it's a tool like it's. Once again, it's a tool that can be used to better our health. So why not try these different tools? Right? It may not be the fix all for for everybody, right?

Dr. Chilcott: 47:52

Yeah, it's not a fix all, but it's a really fantastic tool.

Jerry Dean Lund: 47:57

Yeah, great. Well, thank you so much for being on today and please reach out to Dr Chilcott and on our social media links and then you can. It's first responders Inc. Right first.

Dr. Chilcott: 48:11

First responder resiliency Inc.

Jerry Dean Lund: 48:16

Okay, and also follow them as well to there. Thank you so much for being on today.

Dr. Chilcott: 48:22

Thank you so much, jerry. Have a good day.

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