Healing A Broken Mental Health System: Joe Perekupka Of Freespira On 5 Things That Can Be Done To Fix Our Broken Mental Health System
An Interview With Stephanie Greer
Early intervention vs Standard of Care: While the standard of care is always a preferred method of treatment, we need to replace the firm stance we have in place for standard of care with getting the patient into any treatment earlier in the diagnosis is better than no treatment.
The current state of the mental health system is a conversation that echoes in the halls of policy-making, the corners of social advocacy, and within the private struggles of individuals and families. As we continue to witness an unprecedented need for robust mental health support, the shortcomings of the existing system become more glaring. It is within this backdrop that we seek the insight of those who are at the forefront of behavioral health. In this interview series, we are talking to behavioral health leaders, policymakers, mental health practitioners, advocates, and reformers to share their perspectives on healing our broken mental health system. As a part of this interview series, we had the pleasure of interviewing Joe Perekupka.
Joe Perekupka is the CEO of Freespira, the maker of the first FDA-cleared digital therapeutic treatment for panic attacks, panic disorder and post-traumatic stress disorder (PTSD). Prior to Freespira, Perekupka was Senior Vice President, North America for Brainsway, a global leader in advanced noninvasive neurostimulation for mental health disorders, and served as Chief Commercial Officer at Eversana, a pioneer in next generation commercial services for the global life sciences industry.
Thank you so much for joining us in this interview series. Before we start, our readers would love to “get to know you” a bit better. Can you tell us a bit about your background and your childhood backstory?
I come from fairly humble beginnings. I grew up in the Philadelphia area with a strong blue collar background. Not having a lot of money meant my parents couldn’t afford to buy me things that most kids wanted and college was going to be a stretch, so at 7 years old, I got my first job as a paperboy. Waking up at 5 am to deliver newspapers before school instilled in me a strong work ethic, accountability, and effective time management. This early routine emphasized the value of every minute, as any delay in delivering newspapers meant being late for school. Education was a priority for me and I focused all my energy into my studies to ensure I would get into college. These early experiences also taught me the value of money and I was forced to learn how to manage money effectively. That skill set carried me through life and I found when I took over my first start-up, those skills, which I learned early on, kicked in like muscle memory.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“Keep your eyes open, mouth shut, and work hard.” This valuable advice from my uncle, shared when I was young, taught me hard work overcomes almost anything. At the age of 14, I secured my first real job as a bagger in a grocery store. However, I had to lie about my age since the legal employment age was 16. I was working for about 9 months when they discovered I was not 16 and they were discussing what to do with me. The manager said he couldn’t fire me because I was his hardest working and most reliable bagger. That was a defining moment for me because it reinforced that hard work really does pay off. I went on to become one of the youngest cashiers in that grocery store chain and secured the position of the youngest Nighttime Supervisor in the company’s history. At 16, they literally gave me the keys to the store and I was responsible for managing the store on weekend nights and closing the store. That role taught me valuable lessons: 1) How to work with people of various experience levels and backgrounds, 2) How to handle going from peer to supervisor with co-workers, and 3) understanding what is important and prioritizing tasks accordingly for you and the team.
Let’s now shift to the main part of our discussion. It is often said that “the mental health system in America is broken”. What does that statement mean to you? From your perspective what is “broken” today?
I have what might be considered a controversial view of this because to imply something is broken means that at some point it was functioning properly. I think the mental health system in America has never achieved functional parity with our chronic and general condition counterparts. We must acknowledge that there are vast differences with the mental health treatment paradigm including system-based barriers as well as individual barriers, such as stigma and cultural acceptance.
I feel mental health is severely lacking across all major metrics in comparison in the US health system. The first issue is that we have not fully recognized the direct tie to physical or general health and the incredible impact it has on total health for most individuals. The second challenge centers on the limited acceptance of modern treatment options, such as DTx products. and this is driven primarily by a lack of reimbursement which influences clinician endorsement. Third, there is an alarming disparity in inequitable mental health care, as 50% of individuals in the US reside in areas facing a shortage of mental health providers. Lastly, the incredible burden of proof placed on newer treatments as compared to the standard of care creates huge obstacles to getting patient care. The focus on standard of care vs. proactive and early intervention creates a huge barrier that stops many people from seeking care.
What about any bright spots? Do you think there are any elements that we get right in today’s world that we wouldn’t want to reverse unintentionally?
The bright spot in healthcare is at-home or digital therapeutics. We now are seeing greater use of virtual health care in mental health. We must embrace and encourage people to consider this as a viable treatment option and extend it to include additional at-home treatment options, such as Freespira. The integration of at-home devices/treatments will reduce the burden on the healthcare system and provide a better patient experience.
In your opinion, what are the 5 most impactful things that could help heal the broken mental health system? These could be on any level including training, workforce, policy, culture, equity etc.
- Multi-pronged approach: We need to understand that mental health requires a different treatment approach and we need to consider implementing a dual treatment program for patients earlier on in the treatment paradigm.
- Equitable Healthcare: Mental health experiences the greatest inequity of care in the country.
- Training: Train the residents on all mental health FDA-approved treatment options so they understand what is available and how to use them appropriately.
- Early intervention vs Standard of Care: While the standard of care is always a preferred method of treatment, we need to replace the firm stance we have in place for standard of care with getting the patient into any treatment earlier in the diagnosis is better than no treatment.
- Reimbursement for novel treatments: Reward commercial and Managed Medicaid payors for early adoption of digital therapeutics that can treat patients for mental health disorders.
If all of the items on your list were magically implemented tomorrow what change might we see in the world? What are the signs (big and small) that would show us that the system is being healed?
The most significant change we would witness in the world is a shift towards viewing mental health with the same importance as traditional general health conditions. Such a shift would result in a more widespread acceptance of openly discussing mental health challenges within the general population, empowering individuals to confidently seek treatment when necessary.
The biggest sign of the system healing starts with accurate and early diagnosis of mental health issues. If we are not identifying and accurately diagnosing individuals with a mental health condition then we can’t treat them properly. Secondly, we need to see more proactive intervention for patients suffering from mental health disorders. Lastly, we need to shift the mentality away from the standard of care as the primary way forward. We must find the best way to get the patient to engage in any treatment earlier in their diagnosis. This includes removing barriers to accessing care by offering at home/digital therapeutic treatments that remove the need to go to a clinic everyday and deliver virtual care options to their home.
What is a project you or others are working on today that gives you hope? How can our readers learn more about this work?
The most encouraging movement I am watching is creating PTSD benefit parity for first responders as compared with veterans. In most states, PTSD was not recognized as a job-related illness. Therefore, they were not provided the same level of benefits, including workers compensation, if they were diagnosed or suffering through PTSD symptoms. Washington State Governor, Jay Inslee was one of the first governors to enact a law that provided workers compensation benefits for first responders in May 2018. He went on to expand the bill in 2023 to include registered nurses as well. I applaud Governor Inslee for taking a bold step forward and recognizing the huge gap in care for our first responders.
How do you see technology shaping the future of mental health care and its accessibility?
This is a relevant and widely debated topic in healthcare today. Specific to mental health, there are multiple answers, such as machine learning, nanotechnology, and AI. However, I consider digital therapeutics to be the most transformative development in healthcare. DTx products are revolutionary in that they bring all three stakeholders together: payers, providers, and patients. More importantly, they provide a very clear pathway for improving the care patients receive regardless of ethnicity, gender, geography, or socioeconomic status. While there is a place for these other products in healthcare, they can’t achieve what digital therapeutics can. The convergence of technology with medicine brings the opportunity to diagnose and treat patients with a validated solution at home. We are shifting the norms surrounding the traditional treatment paradigm and successfully changing the way patients access healthcare. I believe this transformation will prove to be the most significant evolution in healthcare in our lifetimes.
In your view, how do social factors like poverty, education, and culture affect mental health care and its effectiveness?
Social factors are incredible deterrents to gaining access to mental health care. The largest issues facing individuals with mental health are stigma cultural issues and affordability. Stigma and cultural issues create individual barriers that stop patients from even seeking help with their mental health issues. However, the affordability factor is a global issue that impacts most patients. Mental health patients have to use out-of-network services at a rate of six times the general medical peer population. This significantly increases the out of pocket expense to the patient and creates an obstacle for them in getting care.
In light of the growing mental health crisis among young people, what innovative approaches or interventions have proven most successful for children and adolescents?
Before delving into the question, it’s crucial to spotlight a significant and expanding trend in the adolescent community where by both parents and patients are expressing concern with the effect the medications will have on their children. As a primary approach to treating their children, they are actively exploring non-medication treatments. This is where digital therapeutics companies can play a huge role for this population. The ability to have an FDA-validated treatment delivered to your home where you can fit the treatment into your schedule creates a much greater adherence rate and will lead to better outcomes.
We are very blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might just see this if we tag them. 🙂
I would love the opportunity to meet with Chiquita Brooks-LaSure the Administrator for the Centers for Medicare and Medicaid Services (CMS). In this role she will oversee programs including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act (ACA) health insurance marketplaces. I would like to meet with her because she is an impressive individual who understands the challenges confronting the most underserved populations in this country. She sits in the chair that can literally change the course for the many millions of patients who can’t gain access to equitable care in the U.S.
How can our readers further follow your work online?
The best way to keep up with what we’re doing would be to visit us at freespira.com. You can also follow us on LinkedIn and X (formerly Twitter), where we share the latest updates of our company’s journey.
Thank you for your time and thoughtful answers. I know many people will gain so much from hearing this.
About The Interviewer: Stephanie Greer, PhD is the Co-founder and CEO of Akin Mental Health — a company dedicated to guiding families on their journey supporting a loved one with mental health challenges like bipolar disorder, schizophrenia and severe depression. Stephanie is passionate about this topic from her own personal experience growing up with a mother who struggled with bipolar 1 disorder and found a path forward to overcome the obstacles and live well. Stephanie’s professional experience includes a doctorate in neuroscience as well as design research roles at Hopelab and Apple. Stephanie brings this personal passion together with her world-class science and technology background to support families across the US in their personal journeys supporting loved ones with mental illness. To learn more about Akin Mental Health and join our community, visit us at akinmh.com.
Healing A Broken Mental Health System: Joe Perekupka Of Freespira On 5 Things That Can Be Done To… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.