Falling Through the Cracks with Dr. Carol Olson, MD

A person gets stabilized in the hospital. They're discharged. They leave the residential program almost immediately, stop their medication, and end up back in an emergency room or a jail cell. Dr. Carol Olson calls it "chasing your tail," and it's the pattern most families living with serious mental illness know by heart. In part two of this conversation, Dr. Olson explains the federal rule behind it: a 1960s Medicaid provision called the IMD exclusion that still shapes how long anyone can stay in a psychiatric hospital. She walks through why the average stay is seven days when treatment often needs a month, why Arizona authorized a level of care that has never opened, and why mental illness is the only condition with a limit like this. Then the conversation turns to what high-potency cannabis is doing, what she's seeing with ketamine and telemedicine prescribing, and how to report a prescriber who isn't paying attention. The last third is the practical half, and it's the reason to stay to the end. Schizophrenia as a lifelong condition and what that actually means for medication. Clozapine, an option most families have never heard of. Long-acting injectables. How to say yes to someone living at home with conditions rather than making it all or nothing. Supported living. Payees, guardianship, and mental health power of attorney. Deborah brings years of navigating this as a mother. Dr. Olson brings a physician's view from inside the system. Next time: the policy fights happening right now: the federal push to de-prescribe, the executive order on psychedelics, and a Supreme Court decision called Olmstead that quietly shapes where people with serious mental illness are allowed to live. Go to P82HOMES.ORG for resources. Go to deborahgeesling.substack.com to learn more on local and national policy. 0:00 Introduction 1:23 Psychosis in depression and bipolar disorder 4:19 How long you actually get in a hospital 6:39 The IMD exclusion — the rule behind everything 8:08 The cycle: stabilize, discharge, relapse, repeat 10:04 The law Arizona passed that never opened 11:23 Why mental illness is treated differently 13:55 Cannabis and psychosis 16:05 Ketamine, psychedelics, and telemedicine 20:43 How to report a prescriber 21:28 Who's most at risk 22:28 Schizophrenia is lifelong — what that means for medication 23:38 Clozapine: the option most families haven't heard of 24:26 "This is as good as it's going to get" — and why it wasn't 26:07 You can say yes, with conditions 28:06 Supported living, and mom guilt 28:46 Money, guardianship, and power of attorney 31:17 Closing thoughts