Asa part of our series about Mental Health Champions helping to promote mental wellness, I had the pleasure to interview Brent Turnipseed.
Brent Turnipseed is a board-certified psychiatrist, entrepreneur and mental health advocate. In 2016 he co-founded Roots Behavioral Health in Austin, TX with the goal of making mental health care more accessible and affordable. He is particularly interested in innovative approaches to mental health including psychedelic-assisted psychotherapy, mindfulness-based cognitive therapy and brain optimization.
Thank you so much for doing this with us! Before we dig in, our readers would like to get to know you a bit. Can you tell us a bit about how you grew up?
Thank you for inviting me to share a little bit about myself with you and your readers. I grew up in Austin, Texas, with my mom, dad, and younger brother. I spent much of my childhood reading, creating some sort of art, or playing outdoors and exploring nature. I grew up in the late 1970s and early 1980s, well before smartphones became part of our culture, and I’m very grateful for that. Not having that technology, without a doubt, led to a richer and more fulfilling childhood.
You are currently leading an initiative that is helping to promote mental wellness. Can you tell us a bit more specifically about what you are trying to address?
I’m a psychiatrist, and operate two outpatient behavioral health clinics with my wife, Andrea. I serve as our Medical Director; I teach and supervise our other providers, and I lead any research efforts at our clinics. As many readers probably know by now, the United States–and truly much of the world–is in a mental health crisis, notably depression and suicide epidemics. This crisis existed well before the covid-19 pandemic, though the pandemic exacerbated and also drew attention to the problem.
At our organization, Roots Behavioral Health, we have the audacious goal of elevating the standard of behavioral health care, which includes the field of psychiatry. We need to do a much better job preventing, treating, and eradicating mental illness. While we certainly prescribe medications during most of our patient visits, I’d like the public to understand that medications are tools for treating symptoms but they almost never lead to any sort of lasting cure, not the way an antibiotic might alleviate a case of bacterial pneumonia. For people to experience a cure in our field, we have to work extensively to identify contributing factors to poor brain health. And most importantly, we must work collaboratively with our patients to implement a healthier lifestyle to effect lasting change. There are no shortcuts to good health. It takes work but in many instances, it can be done over time. To take this approach, we use a comprehensive Brain Health Assessment to help patients achieve their health goals.
Can you tell us the backstory about what inspired you to originally feel passionate about this cause?
For far too long the field of psychiatry has treated mental illness as if the brain exists in a vacuum, as if the brain has no connection or relationship to other systems within the body. This, of course, is patently false. Many systems in the body–particularly the endocrine, immunological, and cardiovascular systems, play important roles in brain health. Thanks to pioneering research and work by many in medicine, we are now entering an era where we can connect the dots between a contributing factor and the damaging result in the body that may, for example, cause or sustain depression. When I started my career nearly 15 years ago, if I treated someone for depression, I’d prescribe an antidepressant, and I’d typically refer them to psychotherapy. And assuming this approach helped the person, hopefully about one year later we could try to stop the medication and see if their depression returned or not. In some cases it would not, but for a majority of people that was not true and they would have to remain chronically on a medication, or more than one medication as is often the case in psychiatry. I’d always been dissatisfied with the old model. I suspected there had to be a better way to help people, and that is what we’re hoping to do at Roots Behavioral Health.
Many of us have ideas, dreams, and passions, but never manifest them. They don’t get up and just do it. But you did. Was there an “Aha Moment” that made you decide that you were actually going to step up and do it? What was that final trigger?
I’ve always enjoyed trying to solve challenging problems. Depression is probably one of the biggest challenges in our field. It leads to profound disability in many cases, and sadly, can be fatal–in the sense that severe depression can lead to suicide. To make matters worse, it is quite challenging to effectively treat, and rarely do people experience any sort of cure.
In 2018, my wife and I attended a training for ketamine-assisted psychotherapy (KAP) in the Bay Area. At that time, ketamine was considered mostly fringe in our field, despite the fact that the National Institute of Mental Health conducted their own study which had shown incredible benefit in treatment-resistant depression. Published ketamine research was reporting response rates (how many people had significant improvement) of close to 60%, and that was in treatment-resistant depression. That group typically has response rates of less than half that amount. Because we became a provider of ketamine, I quickly appreciated that we were seeing many patients with chronic, debilitating depression, most of whom had never enjoyed significant relief from their condition. Ketamine did not work for all of them, and because they had come to us–in many cases they would say “as a last resort”, I felt an obligation to think of anything I could do, guided by safety and evidence, to treat their depression. As a result, our clinic became skilled at treating depression. I can thank ketamine for pushing me to think more deeply about how to treat, and ultimately resolve, depression in our patients.
Can you share the most interesting story that happened to you since you began leading your company or organization?
I mentioned how when we first implemented ketamine into our services that it was a fringe treatment. Very few psychiatrists would consider offering it in their clinics. For one, it’s usually administered intravenously and psychiatrists are not trained to give IV medications. It can also be given via intramuscular injection. Either way, psychiatrists are not accustomed to administering any sort of procedure, especially in an outpatient setting. So there we were, offering IV and IM ketamine, and when we told colleagues–other psychiatrists and psychotherapists–about ketamine they were aghast. They would look at us as if we lost our sense of judgment. People would ask me, aren’t you getting your patients high? And I’d answer, well I suppose so but the NIMH endorsed it and it’s shown to be safe and effective for severe depression. What I realized then was that we were radically challenging the status quo, and when you do that, it makes people uncomfortable. I quickly understood, thankfully, that this also can mean that you’re doing the right thing and that it’s trailblazing work. I began to see ourselves in that light and have owned it ever since. Colleagues who were critical of our ketamine work now refer their patients to us.
None of us can be successful without some help along the way. Did you have mentors or cheerleaders who helped you to succeed? Can you tell us a story about their influence?
I would never call her a cheerleader, but I must mention my wife, best friend, and business partner, Andrea Turnipseed. Andrea and I founded Roots Behavioral Health together at a time when we had a one year old daughter, and soon would be pregnant with our son. Andrea is our Executive Director, and our work styles, personality types, and actual roles complement each other perfectly. As any business owner knows well, starting and growing a new business is extremely challenging, and for us to have each other has been invaluable. I come up with many ideas that I believe are terrific, but Andrea is skilled at poking holes in concepts that aren’t fully fleshed out, or ones that are just plain bad! She also has been an invaluable emotional support during difficult times, and I hope that I’m as helpful to her as she’s been to me.
One example does come to mind. We used to only offer ketamine with psychotherapy, though this treatment was unaffordable for many patients. Insurance would not reimburse for the therapy component because it lasts two hours–they only pay for one hour. It didn’t sit well with me to know we were turning away patients suffering from severe depression, some of whom were suicidal, because of cost. I therefore advocated to our leadership that we should offer both ketamine with and without psychotherapy. It might sound simple but to change the ketamine paradigm presented many logistical challenges, and that is where Andrea came in to help make it work. She and our Director of Operations, Dave Wofford, are both excellent in helping make things happen at Roots. And now we are able to offer a ketamine treatment for just a $25 copay in many instances.
According to Mental Health America’s report, over 44 million Americans have a mental health condition. Yet there’s still a stigma about mental illness. Can you share a few reasons you think this is so?
Seeking mental health help means one has to be vulnerable and admit something is wrong. This is easier to do if we have an infection or a broken bone. It’s not as simple when we’re talking about depression, PTSD, or bipolar disorder. I think some people fear that if they face mental health challenges it means something is wrong with them as a person–no one would ever think this, again, about a broken bone. So the problem lies in this idea. We need to help people understand that mental illness is not unlike other health conditions. Yet when our brains are sick or compromised, we place all these judgments on ourselves. As clinicians, we need to help people understand that to have a mental illness is not a personal failure. It is a problem that can be addressed, improved, and ultimately resolved.
In your experience, what should a) individuals b) society, and c) the government do to better support people suffering from mental illness?
On the individual level, the best way a person can help support someone suffering from mental illness is to be available to listen and offer help when practical. Additionally, they can help normalize the experience by sharing their own experiences or that of any friends or family who have also had a mental illness. Nearly every person I meet has had a personal experience with a mental illness, or knows someone close to them with one. Mental illness is pervasive and crosses all racial, cultural, and socioeconomic strata.
I see society’s and the government’s role more closely aligned. Our society is currently at a low point in terms of how we live–our lifestyle–and its relationship with our mental health. We work too much, take too little personal time and vacation time. We have an extremely unhealthy relationship with technology; this begins with smartphones and our blindness to boundaries around its use. We also have become more overweight as a society in the past few decades, and this has a proven adverse effect on brain health. 70% of American adults now are categorized as overweight or obese. We need to understand how to eat healthier. We also have become sedentary (this is related to our overuse of technology), and about 70% of Americans do not meet the CDC exercise guidelines–which are not rigorous, by the way. It is not a coincidence that those two percentages are approximate to one another.
One function of government should be to protect its people. Protection begins with regulating technology companies, and our society needs to think hard about this and become engaged with elected officials. And we need to back away from polarization. We are all much more alike than different. The tribalism of Democrat versus Republican or liberal versus conservative is incredibly self defeating for everyone. If we can do that then we can get more out of our government. Our government could perhaps help in terms of education programs to get the word out about these lifestyle problems. And our federal government could stand to significantly improve Medicare reimbursement for mental health services. Private insurers follow suit typically in terms of rates. Of all medical specialties, psychiatry has one of the lowest rates of participation on insurance panels. This makes accessing mental health care challenging and makes it unaffordable for many people.
What are your 5 strategies you use to promote your own well-being and mental wellness? Can you please give a story or example for each?
The five strategies I’ll lay out are interconnected. They are lifestyle tenets we promote in our clinics. Strategy one begins with technology, primarily with so-called smartphones. They are ubiquitous and it is becoming clear that they make us very distracted, and disconnected from real people in real life. Many apps on the phones are problematic though in my view, social media apps are, with little exception, antithetical to well-being. Social media keeps people engaged in a false reality, and as a result, people tend to feel worse about themselves. This is especially true of children and adolescents, and this conclusion was made by Facebook’s own internal research. And their research was validated by a third party that came to the same conclusion. And what did Facebook–now strategically called Meta–do? They hid this information in the service of retaining users and advertising revenue. Essentially, money. Society has to be better than this. Unregulated technology poses one of the greatest threats to our humanity and our mental health. I realize many readers may not agree with my assessment. That’s fair, and there are exceptions to what I’m saying. However, I’m speaking in broad terms, relating to most cases. And I challenge anyone using a social media app to delete it for one month and ask yourself–honestly–at the end of that month how you feel. In most cases the answer will be “much better”. And they will realize they’re more focused, more productive, and more connected with real humans in real time. What I’m saying is especially true for someone dealing with depression or anxiety. So in terms of practical strategies, seriously take stock in screen time and smartphone use, and strongly consider reducing it. Additionally, consider turning off all push notifications. In most cases, they distract and keep us from living a life with greater depth and meaning.
The second strategy is to optimize sleep. Many of us do not get an adequate amount of sleep. And even if we do, the quality of sleep is often not good. Compromised sleep, long term, is consistently associated with a shorter life span, and increased rates of cancers, as well as increased rates of dementia. Why is that? Our body and especially our brain does most of its repair, cleaning, and maintenance during sleep. I won’t go into all the things one can do to improve sleep, though there are many excellent resources on this topic. Consider reading Why We Sleep by Matthew Walker, PhD.
Strategy three is optimizing diet. This cannot be understated. What we eat is perhaps the greatest determinant of our health, including brain health. As a nation, we’ve been confused about diets for decades. Fortunately, it’s becoming fairly clear what is best for most people in most instances. The Mediterranean diet has consistently shown to lead to the best cardiovascular and brain health outcomes. Not to mention that it should, over time, allow some people to lose excess weight. Also, a ketogenic diet might be a potent intervention for those really struggling to lose weight and it can have powerful healing effects on a brain that’s been stuck with chronic mental illness. There are plenty of books to learn about both diets.
The fourth strategy is about getting physically active. As I mentioned before, fewer than 30 percent of American adults get adequate exercise. I grew up in the 70s and 80s and recall during that time that there was a running craze, followed by Jane Fonda promoting Jazzercise. It used to be more exciting and inspiring to work out. At the very least, most people would benefit from walking. I think most New Yorkers walk about 5 miles per day. It is apparent from walking around Manhattan versus Austin who walks more. Exercise need not be that difficult, expensive, or challenging. People can start modestly, and increase in very small increments. Once it becomes a habit, most people can’t imagine not moving their body because it feels good, our brains work better, we sleep better, and learning is greatly enhanced.
The final strategy is to get in nature, as much as possible. We are animals, and evolved from a natural environment. We are not supposed to be isolated, inside a room, away from sunlight and fresh air, for very long. The longer we avoid nature, the worse we tend to feel. Our entire nervous system tends to feel calmer when we are among trees, birds, plants, etc. As one can imagine, it can be easy to combine this strategy with exercise.
To summarize, we need to be in nature, we need to move our bodies more, and we need to place firm boundaries around technology. Our sleep is best when we exercise, eat well, and avoid screens. They are all interconnected. In its essence, this is a foundational prescription I would recommend for anyone.
What are your favorite books, podcasts, or resources that inspire you to be a mental health champion?
Books that inspire me, and that I feel could be valuable to your readers, are: 1. Stolen Focus: Why You Can’t Pay Attention — and How to Think Deeply Again by Johann Hari. 2. Brain Energy by Chris Palmer, M.D. 3. The Daily Stoic by Ryan Holiday. 4. The Wind-Up Bird Chronicle by Haruki Murakami. I will add that reading fiction helps activate what are called mirror neurons and connects us more deeply with our humanity and that of others, something that can benefit us all.
I must give great credit to Andrew Huberman, PhD, and Tim Ferris. They both host excellent podcasts that have helped educate many people about how to live healthier and optimize brain health. I’m grateful to them as resources for our patients.
If you could tell other people one thing about why they should consider making a positive impact on our environment or society, like you, what would you tell them?
I would tell readers to consider Joseph Campbell’s statement about leading a life with bliss. He said ““Follow your bliss. If you do follow your bliss, you put yourself on a kind of track that has been there all the while waiting for you, and the life you ought to be living is the one you are living. When you can see that, you begin to meet people who are in the field of your bliss, and they open the doors to you. I say, follow your bliss and don’t be afraid, and doors will open where you didn’t know they were going to be. If you follow your bliss, doors will open for you that wouldn’t have opened for anyone else.”
This wisdom invites us to connect with ourselves deeply, connect with our feelings, drives, fears, aspirations, and by being attuned to them, we find fulfillment, not instant gratification. He also challenges us to aim high with goals and aspirations and be willing to put in the work–we derive great satisfaction from work. This is inherently part of human nature and you can see this in young children.
How can our readers follow you online?
Readers can visit our website www.rootsbehavioralhealth.com or follow us on Instagram @rootsbehavioralhealth for updates.
This was very meaningful, thank you so much. We wish you only continued success on your great work!