We’ve all been through a lot in the past year. The global pandemic has been rough on everyone, and those living with schizophrenia have had some unique challenges. But necessity is the mother of invention, and all the chaos has led to some innovative solutions. Join us as Rachel and Gabe discuss some of the silver linings of COVID-19 and how we can all move forward in a mentally healthy way.

Craig Chepke, MD, FAPA

Craig Chepke, MD, FAPA, is a board certified psychiatrist in Huntersville, North Carolina with over 16 years of experience in the medical field. He works with adults and the aging population in all diagnostic categories, but has special interests in neuropsychiatric conditions, treatment-resistant/severe-persistent mental illness, and movement disorders.

His approach to treatment is personalized to each individual person, from the newest leading-edge medications to older underutilized treatments. He strongly emphasizes psychotherapeutic interventions and physical health and wellness through exercise, dietary modification, and supplementation. Chepke has also been named a Fellow of the American Psychiatric Association and is a board member of the CURESZ Foundation.

Rachel Star Withers

Rachel Star Withers creates videos documenting her schizophrenia, ways to manage and let others like her know they are not alone and can still live an amazing life. She has written Lil Broken Star: Understanding Schizophrenia for Kids and a tool for schizophrenics, To See in the Dark: Hallucination and Delusion Journal. Fun Fact: She has wrestled alligators.

To learn more about Rachel, please visit her website, RachelStarLive.com.

Gabe Howard

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author.

To learn more about Gabe, please visit his website, gabehoward.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Schizophrenia. Hosted by Rachel Star Withers, an advocate who lives openly with Schizophrenia. We’re talking to experts about all aspects of life with this condition. Welcome to the show!

Rachel Star Withers: Welcome to Inside Schizophrenia, a Healthline media podcast. I’m your host, Rachel Star Withers here with my wonderful co-host.

Gabe Howard: Gabe Howard, I love introducing myself, thank you for that opportunity,

Rachel Star Withers: I know, I know you like to say your name so.

Gabe Howard: It is, it’s one of the few names that I pronounce correctly 100% of the time.

Rachel Star Withers: So man, Gabe, this past year, we’ve all been in pandemic mode and of course, wherever you’re living at, that means different things.

Gabe Howard: Very true.

Rachel Star Withers: I live in the country, so I have not had the same struggles as a lot of people in very urban, dense areas.

Gabe Howard: It is very interesting to know people all over the country, for example, we have coworkers in New York City who have a completely different set of rules than I do in central Ohio versus you who have a completely different set of rules in a more rural area. And yet it’s the same pandemic for all of us and we’re all experiencing it very differently. Which begs the question, are we all going to experience the transition out of the pandemic differently?

Rachel Star Withers: And even earlier this year, Gabe, I got to come and visit you and I was shocked at the differences just that your area of Ohio had compared to where I live in South Carolina. So all across the country, all across the world, I think everybody is in a different place.

Gabe Howard: That’s very true, and it makes it very difficult if you’re somebody like you, Rachel, living with schizophrenia, you are trying to figure out the best way to move forward. You know, first you had to learn all different coping mechanisms, routines, etc., into the quarantine. And now you have to learn all new coping mechanisms out of the quarantine. Where do you find information for that? And of course, the answer is on the Inside Schizophrenia podcast.

Rachel Star Withers: Absolutely, people living with schizophrenia, we don’t have a quote unquote, normal life ever, and it’s just so many obstacles of just what it’s like to be us. And then you have the world around us, you know, was going crazy for this past year. So you have even more obstacles.

Gabe Howard: Rachel, the reason that we point all of this out is because this episode of Inside Schizophrenia is going to be slightly different from other episodes. There’s no data. We’re coming out of the pandemic right now. So it’s not like we can have a two year research study to know the best way for people living with serious and persistent mental illness to manage coming out of pandemics. Right? We do have a great guest coming up, Dr. Craig Chepke. He has excellent information about what we’ve learned and about what he recommends in his practice to his patients. But all of that said, there’s going to be a lot more. Rachel, what do you advise then we normally have on this show, but we wanted to cover it. We thought it was important to cover it because, frankly, everybody is going through this together, albeit different iterations. But this has really impacted everybody. And, of course, it’s going to impact people with schizophrenia differently than it’s going to impact the, quote, unquote, typical population.

Rachel Star Withers: And we’re not going to fully know the effects of the pandemic has had on everyone, but especially people with schizophrenia, until many, many years down the line, and we’re able to look back at the stuff. So if you’re out there and you’re just having a hard time and this past year’s been rough and you’re having a hard time transitioning out of this past year. Don’t worry, you are not alone. More than ever, I would say everybody is in the same boat with you. Even if they act like they’re not, they are. It has been shown that people with schizophrenia, we are at an increased risk to get COVID. So do keep that in mind, even if you’ve had vaccines and whatnot. Social distancing. We are at an increased risk of getting covid and we usually have worse outcomes, including mortality. So please, everyone out there, we’re still being safe. And do know that you still have like this is a threat. This is still a threat. Don’t just kind of be like party time.

Gabe Howard: Rachel, obviously, this has been a difficult time for everybody and we’re specifically talking about people who live with schizophrenia, have you noticed your symptoms increasing during the last 18 months?

Rachel Star Withers: When it comes to the psychotic symptoms, I’ve seen like a few being brought out and it’s something interesting when you’re looking at the whole pandemic that we’ve been going through, there’s been a lot of fear. If you turn on the news, there’s fear, whether it’s fear from the infection, fear from a vaccination, fear from just other people. You know, there’s a lot of misinformation and fear. And unfortunately, for a lot of us, that plays into our hallucinations. We’re already paranoid. And I do think that that has kind of been like eating at my brain a little bit the past year. It has made me overly paranoid and I have had to kind of watch that. Something that was interesting and like we said, we don’t really have any good studies. But there’s an evolving study that came out of China where they released some of their results. But of course, nothing is finished in any way. But they had found a 25% increase in the rate of schizophrenia diagnosis during this pandemic kind of area, which is a that’s a big, big jump. But what was interesting is that it was in the age range of age 39 to 50 where, as you know, most schizophrenia tends to come out around age like 19. So that is it like a latent age for you to be diagnosed with schizophrenia. And a lot of it had to do with psychotic symptoms coming forward. People who seemingly did not have paranoia and hallucinations or at least they were much more kept in check, pretty much out of control when the pandemic hit. And I can see so much of this, you know, the isolation, the depression, all of this. Yeah, big enough to push some people who probably had schizophrenia to begin with, but they were very like well managed. And all of their management just kind of was taken from them and pushed them into a fully psychotic episode. That’s scary to me. I feel that I’ve definitely, yeah, experienced that on a small level this past year.

Gabe Howard: Let’s go all the way back to the beginning of the pandemic. Now you are like me, Rachel. You set up your life to manage the symptoms of a severe and persistent mental illness. You had routines, coping skills. You had everything set up so that you had the best opportunity to manage your illness as possible. And then one day, everything changed because of the pandemic. You know, suddenly coping skills that used to be available were now, as I have fondly said, illegal. The world had changed, meaning you needed to change. And people living with schizophrenia, just like many other people, aren’t so quick on the uptake. It’s hard to change those routines. And I know that you felt some growing pains adjusting that routine, but of course, you did it and now you’ve got a brand new routine. Everything is going fantastic and now the world is changing again. What advice do you have for people that are now for the second time in an 18 month period, forced to reevaluate their routines and coping mechanisms to face the quote unquote, new reality of life after COVID?

Rachel Star Withers: I think people with schizophrenia, there’s multiple issues that are going to make these adjustments hard for us. I think the biggest one has been isolation. Because for so long, I have to fight against becoming isolating, isolating myself. So all of those routines, all that stuff I did was to keep me from isolating. And then we have this whole year where that’s like that’s the goal is isolation and distancing yourself. And I’ll be honest with you, I like a lot of it. I like not being, I don’t want to say forced, but I like not having to oh, I have to, like, come up with some excuse not to go hang out with people. Because usually I would in the past make myself go and do these things so that I didn’t isolate. Whereas this past year, you know, nothing has been going on. So I haven’t been invited out. I haven’t had to do work events. I haven’t had to do personal events. And that’s been great. It’s been a huge weight off my shoulders. In a bad way, though, because that’s not good for me to feed that isolation that I unfortunately crave, because once I start to isolate, I get weird very, very quickly and the rest of my symptoms flare up. When I talk about this, this isn’t just being an introvert. The isolation feels good at first. And then next thing you know, I’m a hermit, not showering, not eating, goblin person. I’m almost like a little scared that the world is opening up because I’m now I’m going to be thrown back in to having to do these things, which I know are very, very good for me and very important that I do. But now I have to.

Gabe Howard: It sounds like you’re saying that you’re out of practice. Is there any concern about getting back up to speed? You’re sort of describing the off season of sports, right? When the season ends, you’re in tiptop physical shape. You know exactly how to win the Super Bowl and then the off season hits. You know, there’s no games, etc. And now you’re in training camp. Is there a training camp for this?

Rachel Star Withers: I think everybody it’s going to be figuring that out for yourself, making your own little baby training camps, and that is exactly what I have been doing little by little, bit by bit, as the world has opened around me, kind of venturing out more. The other day, I went to eat just at a restaurant, just me. Nothing exciting there. But, you know, yeah, I had to interact with the waitress and all that, and it was little, but it was a lot more than I’ve done this past year because, you know, most restaurants were closed. That would be my training camp is these little little things like that that I’m doing. I went out shopping to Target and like, you know, the big stores. So I’ve been doing that a lot lately. I’ll go there for just one little thing because it gets me out having to be around people.

Gabe Howard: I think it’s great that we’re talking about social activities because I know how important that is, especially for you, Rachel, but now let’s talk about going back to work. Before the pandemic, you worked a part time job about 20 hours a week. And you once told me that the reason that you had that job wasn’t for the money, it was for the routine. It was for the project. It was for? What word did you use? It was for not the friendship.

Rachel Star Withers: The socialization.

Gabe Howard: Yeah, and I remember hearing that I thought, wow, I’ve I’ve never had a job for any other reason but the money and that was very interesting to me. But because of the pandemic, that business, it went under, it’s not even there anymore. It’s not even an option to go back. What are your plans to recapture that? Because that was a huge part of your recovery. That was a huge part of your coping skills and your routine. And it’s not like you can just step back into it.

Rachel Star Withers: No. And just to kind of help everyone understand, I taught modeling and acting classes to all ages. My youngest student was six. Oldest one I ever had was 92.

Gabe Howard: Wow.

Rachel Star Withers: So you’d be surprised the people who come in and they’re like, you know, my dream has always been to walk a runway and they’re in their 70s. You know, you’re like, cool, cool, cool. Seventy year old man didn’t see that coming from you. But hey, let’s do it. Let’s bust out those heels. So you would be, like, shocked the people. And that was part of the thing is I love that job because I got to meet all these different people. Gabe, have you ever seen me in high heels?

Gabe Howard: Only a couple of times, and it is incredible because they’re not just regular high heels,

Rachel Star Withers: No.

Gabe Howard: Rachel, they’re like, you’re taller than me when you wear them. And I’m six foot three for the audience perspective.

Rachel Star Withers: Yeah, I, modeling shoes, stilettos, I only wear four to six inch heels. Now, 99% of the time I’m in my converse but I got to almost be a character when I taught those classes. I got to be somebody else. I got to dress up. I had to do my hair and makeup for it. There were just so many little things that it was good for my schizophrenia. It kind of like broke up my day. It broke up me wanting to isolate off and not take care of myself because we had like a dress code. So I had to maintain a certain image for that job. And it no longer is there. The biggest thing is I miss like being able to talk to people. I kind of feel like those were my friends. We’re like work friends. And even though a lot of them were just like acquaintances, it was nice to be able to be connecting. I am stepping my little toes back into the water on Monday. I’m going to start a temporary job. My mom, when I told her about it she goes, Rachel, that sounds great. It is going to get you out of the house. So I guess everyone’s feeling that. But I’m going to be working for a movie and my go to part, as always, is a cop. So I’ll be playing a cop for this movie that’s shooting in the area. Nothing big, but it’s going to get me out of the house. And I was able to get some of my former acting students cast. So it’s going to, I think it’ll be good for me. I’m going to get to go see some of those old faces, you know, for about two weeks we’ll be together. It’s a very relaxed shoot. So for me, that’s my training camp. I think that’s going to be a really good two weeks to adjust me back into this world.

Gabe Howard: For those who don’t know, Rachel is a professional actress and stuntwoman, she has been in some Marvel movies. She’s really cool. You can find her on the Internet movie database under Rachel Star Withers. What advice do you have for people that don’t have that option? Should they just jump right back in and get a part time job? Should they volunteer first?

Rachel Star Withers: First thing, whenever we’re talking about jobs and stuff, obviously we all need money. I get that. But your schizophrenia needs to come first. Just because you’re offered an incredible job that works you 40 hours a week and it breaks you mentally and then sends you into psychotic episodes and now you’re in the hospital. What was the point of all that? So when I talk about jobs for me, I’m always focused, first off, on my schizophrenia. Is this job going to be good for it? And right now, this is my little training camp we’re going to try. I don’t think I can jump back in to my 20 hours a week at any place. I don’t feel mentally like I could. I will feel like more maybe hey, let’s start off five, 10 hours a week build from there. So if you’re out there, I can’t stress this enough, start small. Don’t do anything that is going to potentially send you to having a psychotic break that is going to, let’s say, backfire and push you back into isolation. Start small. You know, the money is important for everybody, but your mental health is more important. That’s always going to be my go to thing. If you’re like, hey, Rachel, I’m good. I can handle 40 plus hours a week. Awesome. Awesome. You know yourself. I know myself. I cannot. So, yeah, take that into account. It’s not just about the money.

Gabe Howard: Rachel, I couldn’t agree more, and one of the things that I’m thinking about is the advice that I give to people who are newly diagnosed or newly in recovery or newly going back to work, it’s move slow. We always compare ourselves to either where we were, where we thought we were or where other people are. Don’t do that. There’s absolutely zero point in that. It will only set you back. Take little baby steps, move forward, and eventually, before you know it, you’ll get there. I imagine Rachel and I don’t want to put words in your mouth that the routine that you had before the pandemic didn’t pop up in a couple of days. It’s something that you worked on for a very long time, cultivated. And then finally it was, quote unquote, perfect. And I know the pandemic wrecked it, but of course, you can’t expect to get it back in less time than it took to create it in the first place.

Rachel Star Withers: Correct, and even when I’m looking back, you know, throughout the years, every year, different things change about my schizophrenia. My work life has changed. Keep in mind that it’s not like you just were like put on pause for a year with this whole pandemic going on. Your schizophrenia, it’s still, you know, you and it evolve together. So you’re going to have to like pretty much say, OK, now we’re at the next phase. What works for me now? And in six months, that could be different. In another year from now, that could be totally different. So don’t like stress out feeling like you have to pick back up exactly where you left off.

Gabe Howard: There’s not a lot of research on how global pandemics impact living with mental illness. And I thought, well, why not? This isn’t the first pandemic. There was the flu pandemic of 1918. What research did they find on how the pandemic impacted the nation’s mental health? And by and large, the answer was they didn’t even look. It wasn’t on their radar. Now, this is very, very new. We’re still in the COVID pandemic, but there’s studies cropping up. People are looking into it. People are discussing mental health. That does show progress. I know that this is not the stigma episode, that was last month. But do you see it as progress that people are studying the impact of a global pandemic on our mental health?

Rachel Star Withers: I think it’s wonderful, I love that there’s multiple levels to it. Right away, people have been worried about how is this going to affect children? How is this affecting older people? How is this affecting, you know, just even just workers from working in person to now to just constant zoom. The fact that over the past hundred-ish years, mental health has become something that we realize, hey, this is a big deal. It’s not just the physical. I think this is a lot for us as a society in a good way. In some of our past episodes, you know, we’ve brought up that the treatment for schizophrenia over the past hundred years has been kind of rough. But it’s a good step in the right direction. Everybody is saying, hey, it’s not just about the physical health.

Gabe Howard: Rachel, you always get to interview the coolest guests, and this episode is no different. You interviewed Dr. Craig Chepke. Now I’m going to let you introduce him.

Rachel Star Withers: Excited to be speaking now with Dr. Craig Chepke, he is a board certified private practice psychiatrist and he is also an adjunct assistant professor of psychiatry at the University of North Carolina. So excited to be talking with you today. Tell us a little about yourself.

Craig Chepke, MD, FAPA: I’m excited to be here, too. Rachel, thanks for having me on your show. So I grew up in Charlotte, North Carolina, and have my practice here in Huntersville, just outside of Charlotte. And I see patients across the entire spectrum, everything from depression and anxiety to schizophrenia. Schizophrenia is one of my favorite populations of people to treat. I’m on the board of directors for an organization called the CURESZ Foundation. It’s a nonprofit dedicated to helping people living with schizophrenia and their loved ones. And so I’m really excited to be here and help to educate some people, hopefully.

Rachel Star Withers: Now, you during this pandemic have actually been involved in some quite innovative ways of changing treatment for people with severe mental disorders. Tell us about that.

Craig Chepke, MD, FAPA: So, as I mentioned, people with severe mental illness is one of my passions and one of the big tools that I think is really beneficial for many people with severe mental illness, SMI, are long acting injectable antipsychotics. That for the right person, they can dramatically reduce the risk of relapse, hospitalizations, increase functionality and with the pandemic, though, that’s one of the few things that psychiatrists do that have to be in person. I felt like LAI’s are life saving treatments and how could I continue to offer them in a safe way that was safe for the patients and for myself and the staff and everybody. So what I did was instituted a drive up service that I had the people drive up and roll down the window, roll up their sleeve, and I could go out and quickly give them the injection in their arm. We’d both wear masks and equipment like that and enable people to still continue getting the medication that was, as I said, for many people, life saving, but do it in a way that was much safer. And then for the actual appointment, then we could do that over a telemedicine connection and it would dramatically reduce the amount of contact time. And that’s been a huge hit. I’m kind of kicking myself for not thinking of it earlier because people love it so much. It’s so much more convenient, especially if they don’t have an appointment that day. They just needed their monthly injection or however often they happen to get theirs, then I’m planning definitely on continuing it even when all the restrictions are lifted.

Rachel Star Withers: Yeah, it’s an absolutely great idea when you think about it, I know for me personally, having the exact same issues with medications where you have to have the full appointment. I think I’m like, why haven’t more doctors been doing this? It almost seems common sense now that you bring it up. But something else is really neat that you’ve done is that you’ve actually opened up your offices to allow patients to use the Internet, to come into the lobby, even the parking lot, and use your Internet to access other doctors, other telehealth. And I know a lot of people might be thinking, well, you can go to McDonald’s or the library or wherever to use free Internet, but especially during the pandemic, a lot of that was closed down. So it’s really cool that you allowed people and encouraged people to come in and focus on the telehealth and other parts of pretty much their whole wellness, not just about mental health, but their whole body.

Craig Chepke, MD, FAPA: Yeah, so many people with severe mental illness have socio-economic disadvantages, that they may not have a high speed Internet connection, they may not have the type of hardware, computer, tablet, whatever, to be able to access the Internet because I might not be the only health care provider they see. They probably have a primary care provider or maybe potentially other specialists, and they might not be able to access a lot of that care. And we’ve got good Internet, we have a tablet or two around that we could let people borrow. And so now we have a guest network that we let people come and they want to sit in the parking lot and the Wi-Fi stretches out there. They can log in from there if they have a device, if they need to borrow one, they can borrow one of the tablets for half an hour, however long their appointment is with one of their other telemedicine providers and we want to make sure that we’re thinking about the entire patient. And people with severe mental illness are more likely to have things like high blood pressure, diabetes, cardiovascular disease. And that’s even before the medications that medications can often fuel to the fire and worsen some of those.

Craig Chepke, MD, FAPA: And I believe what’s the use of trying to save someone’s life psychiatrically if what I’m doing is going to cause them to maybe take 10, 15, 20 years off of their life without watching out for cardiovascular disease, which is the number one killer in America of all people. So I’ve really prioritized that the past few years and done everything I can. I also partner with a lab company. They send out things like a glucose meter, a blood pressure cuff, and a scale that once a month the patient takes the readings, texts it to the lab, and then it comes up on a dashboard for me on my medical records system. I can track how they’re going with those. And if people start gaining weight, their blood sugars start to go up, then we can intervene early and try and get those treated before they become major cardiovascular risk factors.

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Gabe Howard: And we’re back discussing transitioning out of the pandemic with schizophrenia.

Rachel Star Withers: As we’re looking forward, Dr. Chepke, the CDC has now said that vaccinated Americans don’t have to wear the mask as much and so many things are going to be opening up. What kind of changes do you see coming for health care, for people with schizophrenia and whatnot, like as we move into this post pandemic society?

Craig Chepke, MD, FAPA: Well, you know, I think it’s really tough because honestly, it’s really not postmortem. We’re still in the thick of it. We as a country have made a lot of progress, but there’s still a long way to go and we’re certainly not out of the woods. So definitely, I think, still continuing to be cautious. And the CDC announcement, one way I heard it put was that it was the right decision handled wrongly. And I think that’s probably pretty accurate. There was a lot of confusion and still continues to be. You know I’ve been vaccinated as a health care provider for a couple months now. But I still now and plan for the near future, if I’m out in public, I’m probably going to be wearing a mask. People can’t tell that I’m vaccinated.

Craig Chepke, MD, FAPA: And I’m also just setting an example that, hey, it’s OK to wear a mask. There’s nothing wrong with it. And continuing to kind of model the behavior because people who aren’t vaccinated should wear the masks. And I think it’s an individual’s comfort zone that people who are vaccinated but still might be worried that they might need to wear a mask, go ahead and do it. If you want to go ahead and not wear the mask, go ahead and don’t do it if you’re vaccinated. And I would put out there and urge the people that if you’ve not yet gotten vaccinated, please definitely do, especially people with schizophrenia. There’s very good evidence, unfortunately, that people with schizophrenia are more likely to have severe covid cases and to have mortality risk to die from covid that people without schizophrenia.

Rachel Star Withers: Now, with the pandemic, we saw so many very quick advances in telehealth, I think there were also so many, you know, even private practice, doctor’s offices that weren’t doing telehealth. And then overnight, it’s like we’re going to find a way because we have to. Do you think these advances are going to continue on now that things are starting to open in person?

Craig Chepke, MD, FAPA: Definitely, and let me say, I was one of those private practice practice docs that I was always very anti tella psychiatry or not love technology. I’ve got so many different phones and smart watches and everything. I love technology except that I always felt nothing will ever replace being in the same room as one of my patients. But overnight, on March 13th of twenty twenty, I became a psychiatrist overnight. Like you said, I had to. Necessity is the mother of invention. And having been thrown into it, I do see that there’s a lot of advantages. I still prefer seeing people in person, but there’s a lot of situations where it’s better. People who have difficulty who might live farther away that they don’t have. It’s hard for them to drive the distance because there’s not enough psychiatrists in the country to have one and be lucky enough to have one or multiple in everyone’s local town, someone who might have transportation difficulties, a variety of different things. The No-Show rate has gone down quite a bit because people don’t have to travel to get to the office. So I definitely plan on continuing with a hybrid approach and it’s probably going to be different for each person.

Craig Chepke, MD, FAPA: Some people I might see once or twice a year in person, then the rest of the time telehealth might be every other visit, telehealth in person, in person. It just is really going to depend on what that individual person needs, the amount of monitoring that they might need that would be better off in person. For instance, people on antipsychotics need monitoring for tardive dyskinesia and it can be done over telehealth to be certain, but it’s better to do it in person. So that’s one consideration. But yeah, I’ve definitely changed my tune that I’m willing to be flexible with it going forward. Kind of like with the drive up the drive is that it’s something that I, in hindsight, look back and think, why didn’t I integrate some of these techniques sooner? And, you know, there’s nothing like being thrown into a situation where you have to figure something out to really get outside of your comfort zone and figure out how can I improve things, how can I make this work instead of just complain about it?

Rachel Star Withers: Have you seen that dealing with people who have schizophrenia and their caretakers, their loved ones, have you noticed them preferring the telehealth?

Craig Chepke, MD, FAPA: One thing that has been a big positive for sure is that it’s been able to integrate families into treatment more I always have operated off of in most of my patients, a family type approach where I like to have a spouse, a sister, partner, mother, father, whoever come into the room. Unlike a lot of psychiatrists, I would say that it’s like going from seeing someone two dimensions to seeing someone three dimensions. When you have someone who is close to them, that can give kind of a different perspective. And but that’s been if someone didn’t have a person locally, that often didn’t happen. Sure. We always could have picked up the phone and conference calls went into session. But in reality, I found that that almost never happened. But now with telehealth, it’s much easier that people are always, oh, hey, my son has an appointment with you. He said it’s OK if I can come conference into this telemed session. Can you send me the link, or something like that. And it could be someone across the country, sister or brother or whatever, or it could be someone who is local, but they might not have had time to take off of work, to come in to the appointment or, you know, various reasons. So I had a lot more family and friends involvement in my patients with schizophrenia, especially over the past year with a Psych. And I think that’s been tremendous. And again, why don’t we ever just pick up the phone and do it and do something about that? Necessity is the mother of invention that it forces to shake things up. And I think that’s a great thing that we’re really moving forward.

Rachel Star Withers: It’s one of the things that I’ve seen that I hope so many doctors like you do embrace the hybrid model. I know from talking to the family and caretakers, a lot of times, you know, they have a lot going on, you know, and it’s hard to be able to, you know, take off work and stuff to go to someone’s doctor’s appointment, whereas it’s so much easier when you do have the telehealth. I don’t think it should be, you know, just telehealth. I do think yeah. Like you said, especially with monitoring tardive dyskinesia and different things that in person helps. But I do love the hybrid model that’s come from, you know, the pandemic. And I hope so many more doctors offices like you embrace it and pretty much see where it can go. Fortunately, us with schizophrenia, we sometimes don’t want to seek help. And it’s anything that, like, knocks those roadblocks, knocks those excuses out of the way of, well, I can’t make it. It’s like you also have a phone.

Craig Chepke, MD, FAPA: Exactly, that’s why I was thinking is that, yeah, OK, well, we we’re scheduled for in person and you can’t make it happen until meddling. We can still do it. You don’t have to. Don’t worry that your car got a flat tire. I’m still going to see one of the things that we haven’t talked about that I think is really cool about telemedicine is that when people are doing it from their home, it’s almost like doing a house call, like an old school doctor. So I’ve been able to see the environment the people are actually in, and that’s given me a window into their world in a way that I hadn’t before, something that I hadn’t really thought of that I was missing out on. Some psychiatrists are on our teams that do home visits, things like that, for years. But for me, it was a new experience. And I really like that, being able to see what’s going on in my patients’ life in their own environment. And that can give me a lot of insights that has really helped with building my alliance with patients and furthering their treatment.

Rachel Star Withers: That is such a good point, I hadn’t even considered that, but it is true, it’s not exactly like a home visit, but it is. It’s a mini home visit into that person’s world.

Craig Chepke, MD, FAPA: There and sometimes I’ve had people take me on a tour of the house and just if they’re doing the session on the phone, like, let me show you around and I can really see what’s going on in their life. And it’s up to them that they want to do that or or just have it in the one room or. But it’s just nice to have that option and it puts them more in the driver’s seat. I’ve actually had a fair number of people with schizophrenia and some people with social anxiety, things like that, who have really opened up more over telemedicine. Maybe it’s that they feel that in person that it’s just a little bit too overwhelming feeling under pressure to make that connection, but that separation of the telemedicine connection, that puts them more at ease. And they’ve actually opened up and talked more than they ever did in person. So that’s then, you know, another quote. And again, like I said, there’s all these unexpected advantages here and there that each one might be just a little bit of an improvement. But you add them all up and you start to get a pretty big return. Wow. There’s a lot of potential here that we’d been missing out on. So once again, the hybrid approach definitely, I think for pretty much all patients is going to be advantageous.

Rachel Star Withers: Now, a lot of people with the pandemic, we’ve seen a lot of big pushes for mental health during the past few months or this past year, but sometimes it seems like there’s more talk about mental health and less talk about mental illness.

Craig Chepke, MD, FAPA: Well, there’s always the problem of stigma, unfortunately, and stigma towards psychiatric illness has gotten better as years have gone by, but it’s still not good by any means. And I think mental health is just maybe kind of a way of rebranding it instead of seeing illness, that it’s something that you have to do to preserve your health. And that, to a degree, is true. But fundamentally, we’ve got to break down the fact that there should not be a stigma against people with severe brain illnesses like schizophrenia. I mean, no one looks at someone with Parkinson’s disease or Alzheimer’s disease and said, can’t they just get a job? Why don’t they just work harder? I wish they would just go away. The type of things that often, unfortunately, are thought of people with schizophrenia. But schizophrenia is a brain illness just like Parkinson’s and Alzheimer’s. So really, there should not be any stigma. We have to, as a society, fundamentally break that down. It’s OK. I have a brain disorder. It’s called schizophrenia. And there’s nothing to be ashamed of about that. And that’s where we really need to go as a society.

Rachel Star Withers: As we are transitioning and, well, it would be wonderful if all of our listeners could have you as a doctor who has had such an open mind to this telehealth and hybrid modeling, so many of our listeners do not have doctors who are as open to it at the moment. What advice do you have for listeners out there as they are in this transition mode?

Craig Chepke, MD, FAPA: Well, I think make sure that you’re continuing with care in some way. We need to make sure that everyone gets continuity of care. And if you don’t have a doctor who is is open to telehealth, the thing about telehealth is that you find anyone within state lines that as long as someone’s got a license to practice in your state, you no longer have to worry about finding someone who practices within half an hour of where you live. You can get someone completely across the state because with telehealth, it breaks down those barriers. Geographically, there is a lot of opportunity. You might just have to expand your radius, but telehealth takes away a lot of those barriers. Even with the hybrid model, again, the people were flexible. It could be that maybe it’s just once or twice a year that you have to make the journey to the office. So if it’s a couple of hours away, you don’t have to do that often because the rest of it is going to be telehealth. Don’t settle for something that is not meeting your needs in terms of your health care. If your current treatment plan with your current physician is not working out and you’ve discussed with them and you’ve tried to work it out with them to see if can they change? And the answer is no for one reason or another, don’t settle. Find something better because everybody deserves the best possible care and just keep pushing to have the best life that you can in people with schizophrenia can live normal, healthy, fulfilled lives. And they just need a health care provider who’s going to partner with them to help them achieve that.

Rachel Star Withers: Absolutely, I love the way you said that. Absolutely. And for me, it’s very hopeful when I’m able to talk to doctors who are excited about finding new ways to treat people, because unfortunately, I’ve myself gone to many doctors who are not that way. So it’s always exciting to hear someone who is excited about the possibilities with technology, the possibilities of just change.

Craig Chepke, MD, FAPA: Another kind of catch phrase that I’ve used a lot is that the most important thing that a physician can give to a patient is not a prescription. It’s hope. Having hope and positivity myself is something that hopefully can inspire my patients, that they can still keep hope and that they can keep fighting because fighting brain diseases like schizophrenia is like a war. So if I can inspire someone to keep hope and keep fighting, then that’s my job.

Rachel Star Withers: That’s great, that’s so much of what we need is hope, how can our listeners find out more about you and your practice?

Craig Chepke, MD, FAPA: Sure. So probably the easiest way would be to go to my practice’s website, which is www.ExcelPsychiatric.com, also probably if you Google me, I’ve written lots of articles for various websites and publications. As mentioned, the CURESZ Foundation, I’m on the board of directors for CURESZ.org. C U R E S Z dot org. Also, you can find out just a ton of great resources for people with schizophrenia, about LAI’s, tardive dyskinesia, the other antipsychotics and just educational resources. That will be a couple of good places to look for more information.

Rachel Star Withers: It was lovely speaking with you today. Thank you so much for everything you’re doing, working to help people with schizophrenia and for their loved ones and caretakers and everything. Thank you so much, Dr. Chepke.

Craig Chepke, MD, FAPA: My pleasure, Rachel. Thank you so much for having me on your show today.

Gabe Howard: The hybrid changes of medicine were something that I really focused on listening to that interview. Was that striking for you as well?

Rachel Star Withers: Absolutely. Pre pandemic, I really had never done telehealth and then pandemic hit, and the doctor I was actually going to, they shut down pretty early in. And so I spent the next few months on waiting lists getting shuffled around. And I’ve since then, I’ve got to actually have like multiple psychiatric telehealth visits. I even used an app for one of my general practitioners and it was like a texting app. It’s kind of weird. There’s all these like new things that they existed pre pandemic, but not many people were utilizing them. And the pandemic is like, oh, wow, suddenly everyone has to utilize them. And I hope that, like Dr. Chepke was talking, that this keeps evolving, that we really kind of have this really great hybrid care where, yes, I may be able to go to see my doctor in person, but I can also have all of these other little things connect me to them. Or maybe I only have to see them once every few months in person. But I’m able to do weekly check-ins. I’m able to do some sort of app situation where I’m able to do like, hi, how are my symptoms? And it gets sent to them. I don’t know. I just see there’s so much potential there.

Gabe Howard: When Dr. Chepke said that he did not like telehealth and that he did not want to do it, but of course the COVID pandemic forced him to. As a patient, I did not want to do telehealth either. I can go to the office. I want to go to the office. That’s how I received my care. I really felt like an old man sitting on a porch, like very curmudgeonly. And then, of course, as a patient, I had to because it was the only option. Listen, this is, I’m doing this for life. Like whenever I end up in a doctor’s office, I’m like, this could have been a Zoom call. I do think that there is a definite silver lining in that it pushed technology forward. And here is why I think it’s a silver lining. What a place of privilege I had when I said I could get in my car and drive to the hospital and meet my psychiatrist. Not everybody has that option. Not everybody has access to their own transportation. Not every area has good public transportation, especially rural areas, which, of course, you’re intimately familiar with, Rachel. You can’t just hop on the subway. It’s not an option. A barrier to care was being able to show up at the office. There’s also a shortage of psychiatrists. So this is moving the needle on this as we come out of the pandemic. Rachel, do you hope these things stick? Do you hope that telehealth and the use of technology in the treatment of schizophrenia is something that we continue doing?

Rachel Star Withers: I think it absolutely has to stick when it comes to treating schizophrenia, especially people who are newly diagnosed or not diagnosed yet. Family out there, caregiver kind of situations, I think that this is a whole nother avenue of being able to get that person help. So often people message me and be like, hey, I just, I can’t get them to go to the doctor. I can’t get them to do this. I can’t you know, I can’t get them to go to their follow-up appointment. Use this as a tool. Say, OK, we have a zoom call. That’s a lot easier. Like they don’t have to go anywhere. I’m not saying just surprise them and be like, guess who? And put the phone in front of their face. But this does make it easier. One thing that I love that Dr. Chepke brought up was that it’s easier to have the family involved because, yeah, I mean, beforehand, trying to get everybody off work to make it to an appointment versus if we’re already at the house being able to, hey, can you come sit in here or even be able to patch someone in. I love this. I think that support system wise, this is the next level of care.

Rachel Star Withers: You know, that’s one thing we’re always harping on, Gabe, is how important the support system is for schizophrenia and other serious mental illnesses. But this is like the easiest way to really involve your support system into your care, being able to pull them in and not even if you’re like, you know, I don’t feel comfortable with them, you know, knowing all that stuff from my doctor. Hey, even if it’s just like the first 15 minutes or the last 15 minutes. Say, hey, the doctor is going to talk to you about my medication changes or actually even introducing your doctor or counselor or whoever to those that you live with, even introducing them to your dog. I have a counselor that I see and she at one point was like, is that your dog in the background? And I was like, oh, yeah. She’s like, let me meet him. And it was cute. And it definitely put my guard down. I honestly, Gabe, I’m excited because I feel like this is the next stage of schizophrenia treatment. Is these hybrid models and being able to turn it into a community support group.

Gabe Howard: Another thing that Dr. Chepke mentioned that really raised my eyebrow was the drive up injectable where you don’t even get out of the car, he comes right out. It only takes a couple of minutes. It makes it a lot easier. There are many barriers to care that I don’t think that people think about. And time is one of them. A lot of people living with schizophrenia don’t have a lot of time. They’re managing a lot or they can’t get a ride. They don’t have time to wait in a waiting room because the person who brought them doesn’t have time to wait with them for an hour and on and on and on. When he was like, yeah, I just have like an open hour where you text me. I come out, boop, and you go. I was like that. And he said, he’s going to keep it up after the pandemic and he feels foolish for not having thought about that before. I thought, yeah, kind of cool. Rachel, from your perspective as somebody living with schizophrenia, how do you feel about this? You know, drive up, get your shot and go model.

Rachel Star Withers: I love it. So many people with schizophrenia, you know, we have anxiety also, we have issues. You might be having hallucinations that make sitting in a waiting room difficult. And I don’t know, I like this, especially if you can stay in the car. That’s one less obstacle you’re having to overcome to getting your treatment, which is that’s the whole point of everything, is to get treatment. So anything we can take out to make it easier for people to get treatment. I love it. And I’ll be honest, when it comes to injectables, that’s always been one of my biggest hang ups, is how hard it can be to get them. And I love that he came up with this, the system to make it easier.


Gabe Howard: It feels a little strange to say that the global pandemic has created opportunities, it has made life better for people living with serious and persistent mental illness and schizophrenia. But there have been these silver linings, and I think they are worth discussing, especially since we had to go through this hell for the last 18 months. I’d like to think that for the next several decades, the silver linings will stick around, the removing the barriers to the care, the embracing technology, the getting people access that they didn’t previously have.

Rachel Star Withers: I have hope that we will totally get that out of our suffering and to my listeners out there, my caretakers, my people with schizophrenia, be pushers of that hope. Bring it up to your own doctor. Let them know that, hey, this really helped me during the pandemic. Can you continue doing this? Hey, I really loved this change. Can we keep it up? Because you guys are the ones that’s what makes stuff change, OK, is when the patients and those with the patients are saying, hey, this is what really helps. And just like we heard with Dr. Chepke, he listened. Doctors, they do care about you. They want to make life easier on you. They want to help their patients, you know, so speak up and let them know, hey, genuinely, this right here, this change helped me or hey, I heard about this that one mental health facility was doing. How can I get that in my town? How can I get that started here? Is there anyone in my area who is doing such and such? The really great thing about the apps and stuff is that there are so many now that are available to sign up on where it doesn’t really matter where you’re located exactly. Now, I know this gets into the hedges of insurance, but that do allow you to have these different, like, counselor meetings and things. So speak up and like try and find these different ways. My schizophrenia is going to be different than yours. OK? We all have things going on in our lives and our symptoms are going to kind of change. So it’s up to you to really figure out what works for you and to adjust, because what works today might not work in a month from now.

Rachel Star Withers: It might not work in a year from now. It might not work as the pandemic’s lifting or the next big thing happens in our world. If you’re out there and you have schizophrenia, I want you to know, like you have been living this last year and you’ve been adjusting to these catastrophic events and you’re still here. You didn’t just survive schizophrenia, you survived the whole world falling apart. Like, that’s amazing. Like everyone survived the world falling apart. But you did it plus something else. So actually, like, hey, that’s pretty cool. If you’re a loved one out there, like, tell your person with schizophrenia, like, hey, you’re actually doing really good. You’re still here. You are like just taking life. And you’re just like dominating. And I know it might not feel that way. I know to me it does not feel that way. OK, I’m not like whoa! But when I look back that, hey, I have survived, I lost all of the major structures that I had put in place over the past twelve years for managing my schizophrenia. They all fell apart. They were taken from me. But we’re still going. And I built new structures and I’m building new ones now and I’m changing them. That’s what dealing with our schizophrenia is all about. So if you’re out there and you’re struggling, that’s OK, because it’s awesome that you’re still going. Like that’s the main point is that you’re still going and you’re still adjusting. Thank you so much for listening to this episode of Inside Schizophrenia. Please, like, share, subscribe, rate our podcast. And we will see you next time here on Inside Schizophrenia, a Healthline Media podcast.
Announcer: You’ve been listening to Inside Schizophrenia, a podcast from Psych Central and Healthline Media. Previous episodes can be found at PsychCentral.com/IS or on your favorite podcast player. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. Thank you and we’ll see you next time.