“The Bipartisan Issue of Our Generation”

Roshni Koli, the Meadows Institute’s chief medical officer, receives a prestigious appointment in the fight against suicide. 

Dr. Roshni Koli, chief medical officer of the Meadows Mental Health Policy Institute

The Meadows Mental Health Policy Institute is focused on preventing suicide, a leading cause of death for people ages 10-64.

The Meadows Institute’s chief medical officer, Dr. Roshni Koli, has been an outspoken champion for integrated behavioral health care as a means of preventing suicide, and last June she published a joint op-ed in STAT News with the American Foundation for Suicide Prevention’s chief medical officer, Dr. Christine Yu Moutier, urging physicians, hospitals, and health systems to embrace this solution.

In recognition of her leadership, the National Action Alliance for Suicide Prevention, a public-private partnership, recently announced that it had appointed Koli to the organization’s executive committee.

As a member of the executive committee, Koli helps provide strategic direction to advance the national level work of the Action Alliance, including implementation of its National Strategy for Suicide Prevention.

To discuss her work to prevent suicide, Koli answered questions about her role and the opportunity to save lives.

Congratulations on your new role with the National Action Alliance for Suicide Prevention. How did that appointment come about?

It’s an honor to be appointed to the executive committee of the Action Alliance, which has been a leader in suicide prevention by bringing together leaders from the public and private sector with a shared vision and approach for identifying opportunities to strengthen the national response to suicide. I have had an opportunity to work with them twice before, including helping to facilitate a payer summit that brought together clinicians and administrative leaders from health plans to share what they are doing in the field of suicide prevention and to identify innovative and collaborative opportunities to reduce the rates of suicide.

Listening to these diverse perspectives convinced me that if we want to change the way we treat mental illness and have a transformative impact on reducing suicide rates, we need every member of the community – hospitals, local mental health clinics, schools, teachers – to come together and play their specific roles.

As a board-certified adult and child and adolescent psychiatrist, have you been focused on suicide prevention throughout your career?

The most significant and dire complication of mental illness is suicide. For any psychiatrist, it’s the core of what we do in clinical practice. When I stepped into my role as chief medical officer at the Meadows Institute, maintaining my clinical practice was very important to me.  It’s been so helpful for understanding the on-the-ground challenges that exist for identifying mental health concerns and delivering mental health care, and it allows me to speak in a way that makes sense to people and that they can relate to when doing technical assistance or talking to policymakers on Capitol Hill.

Do those messages resonate with lawmakers?

There has been a recognition that mental health is a bipartisan issue. I would go even further to say that mental illness is the bipartisan issue of our generation. At the Meadows Institute, we will continue to be out front with this idea, to plant that seed, because the work’s not done.

One of the Meadows Institute’s chief priorities is the advancement of behavioral health integration, specifically the Collaborative Care Model (CoCM). How can the screening, assessment and measurement functions that are essential to this model be brought to bear on the prevention of suicide?

Behavioral health integration and specifically CoCM empower primary care providers to care for individuals with mild to moderate mental illness. PCPs are facing unprecedented numbers of patients coming into their offices with mental health concerns, and a high number of PCPs feel overwhelmed and unequipped to meet the challenge of caring for patients with mental health concerns.

What CoCM does is surround the PCP with a team to help them to identity, detect and provide early intention and access to treatment for individuals with mild to moderate mental illness. Behavioral health integration and especially CoCM allows us the answer the “after identification, then what?” question in a way that is fiscally sustainable. Several studies show how it can reduce suicide and help with prevention, including a new one in the Journal of Affective Disorders that shows that CoCM significantly reduced suicidal behavior when compared to treatment as usual.

Do you feel the Meadows Institute is well-positioned to advance these solutions?

I don’t know of any other organization like the Meadows Institute that is able to take the lessons learned from the programmatic work and translate them into policy solutions. And this is the time that we must do this. Like the mental/physical health divide issue, we also fundamentally have a problem with policy and programs being looked at differently.

According to the CDC, over 49,000 people died by suicide in 2022, a record high. Why is suicide so prevalent? And why is the problem getting worse, despite all the attention mental health has received since the start of the pandemic?

Our mental health care delivery system was never designed to care for individuals holistically. Physical health and mental health for far too long have been seen as separate concerns. An example of this divide is that our electronic health records often lack interoperability, so the primary care provider can’t see what the psychiatrist has written or which mediations they have prescribed.

Because we saw unprecedented numbers of individuals struggling with depression and anxiety during the pandemic, I think that has somewhat reduced the stigma of mental illness. People are somewhat more willing to say, “I am struggling and need help.” That is a wonderful thing. Yet, even for individuals who have identified themselves as having mental health needs, there are not sufficient resources for every individual who has a concern to get high quality, evidence-based effective treatment.

What role do people with lived experience play?

A vital role! We get our best information about what it feels like for individuals to live with mental illness from people with lived experience. Incorporating the experiences of individuals who have experienced and received treatment for mental illnesses helps to design systems that are sustainable and really work to reduce stigma and meet patients where they are. We can provide the best evidence-based treatment, but if it doesn’t allow for patients to feel cared for, patients won’t be engaged in care and ultimately, treatment won’t work.

What would you say to someone with lived experience who wants to get involved? What concrete steps can they take right now?

I want individuals with lived experience to know that they are not alone and that their voice is valuable. Their stories are powerful. Sharing those stories is key to creating better policies, and those of us working at the policy level need to hear those stories. Another way to take action is by participating in research studies. We need to have more participatory research that contributes to research design – the how and why of what we are studying.

What about those who do not – or cannot – self-identity as needing help?

For far too long, we have not adequately identified individuals at risk of mental illness or presenting with early symptoms of mental illness. We are starting to move toward that. The US Preventive Services Task Force is now saying we need to screen every individual for depression and anxiety. We need to screen every individual for suicide, rather than being scared of asking the question. When we identify a mental health concern, we must be committed to being with patients and families to connect them with the care that they need.

What about you personally, as our CMO?

One of the aspects that is key to this role of chief medical officer is being in a place of confident humility – to bridge confidence in clinical experience, but also to recognize there’s so much I don’t know and no one individual can ever or should ever do it all. The most transformative impact comes from when we work together.

This interview was conducted by the Meadows Institute’s Geoffrey Melada.