loader from loading.io

Ep 45: Stop Doing What Worked Ten Years Ago with Dr. Elizabeth Carr

The Mental Health Evolution

Release Date: 07/02/2026

Ep 55: Be the One Who Does It show art Ep 55: Be the One Who Does It

The Mental Health Evolution

This week Rachel steps away from the interview format to do something she has been wanting to do for a while — take stock of everything the podcast has surfaced over the last year and pull it into a single, honest conversation about what is actually happening in mental health right now, and what clinicians and practice owners can do about it. The landscape has shifted dramatically. Federal funding for mental health programs is being cut. SAMHSA has faced consolidation proposals. The 988 crisis line has seen reduced funding. School mental health grants have been halted. Insurance companies...

info_outline Ep 54: Building Collective Power with Nicole Sartini show art Ep 54: Building Collective Power with Nicole Sartini

The Mental Health Evolution

Rachel speaks with Nicole Sartini, a licensed clinician, group practice owner, and founder of Build Better Health — a nonprofit think tank that is building the kind of collective provider power that this field has been missing. Nicole came to advocacy the way most providers do: through her own practice. In 2024, after ten years of building Bridge Counseling and Wellness into a 60-provider group practice in Louisville, Kentucky, she watched insurance carve-outs and contract repairing cut her practice's income by 30 percent for the same number of sessions. She started organizing locally —...

info_outline Ep 52: Follow the Money, Follow the Power with Joanne Frederick show art Ep 52: Follow the Money, Follow the Power with Joanne Frederick

The Mental Health Evolution

Rachel speaks with Joanne Frederick, founder and CEO of Government Market Strategies, about something most clinicians never see but feel every single day — the procurement decisions, ownership structures, and administrative design choices that determine who gets credentialed, who gets paid, and who gets left out. Joanne has spent more than 30 years on the inside of the largest government healthcare programs in the country — Medicare, Medicaid, TRICARE, and Veterans Health — helping clients win contracts in excess of 25 billion dollars and watching the same patterns play out across every...

info_outline Ep 52: Pessimism Is Not a Strategy with Marcus Schmit show art Ep 52: Pessimism Is Not a Strategy with Marcus Schmit

The Mental Health Evolution

Rachel speaks with Marcus Schmit, Executive Director of NAMI Minnesota, about what is actually happening on the ground as federal Medicaid funding cuts ripple through the mental health system — and why, despite everything, pessimism is not a strategy. NAMI Minnesota has been a statewide leader in mental health advocacy, education, and peer support for decades. Marcus stepped into the Executive Director role as his state was navigating an extraordinary convergence of collective trauma — the pandemic, the murder of George Floyd, a school shooting, the assassination of a state legislator, and...

info_outline Ep 51: 10 Years of Trauma Specialists - a Live Episode show art Ep 51: 10 Years of Trauma Specialists - a Live Episode

The Mental Health Evolution

This week's episode is something a little different. Recorded live at the 10-year anniversary celebration of Trauma Specialists of Maryland, this episode turns the tables on Rachel — instead of hosting, she is interviewed by two of her longtime friends and supporters from the Frederick community, Tom Lynch and Karlys Kline.   Tom Lynch spent more than 45 years practicing law in Maryland, most recently with Miles and Stockbridge in Frederick, and has served as chair of the Community Foundation, Frederick Community College, and the Frederick Chamber of Commerce. By his own account, his...

info_outline Ep 50: When Child Care Can't Wait for Nine to Five with Sara Bradley show art Ep 50: When Child Care Can't Wait for Nine to Five with Sara Bradley

The Mental Health Evolution

Rachel speaks with Sara Bradley, Executive Director of York Day Early Learning in York, Pennsylvania, about a problem most people in the mental health field have never thought about — and that affects millions of the patients they see every day. The American child care system was built around a standard workday. For the nearly 20 percent of workers who work nonstandard hours — overnight shift workers, first responders, healthcare workers, contract workers, and others — that system simply does not work. York Day is one of the very few organizations in the country trying to change that....

info_outline Ep 49: What Happens When You Replace the Fax Machine with Shana Palmieri show art Ep 49: What Happens When You Replace the Fax Machine with Shana Palmieri

The Mental Health Evolution

Rachel speaks with Shana Palmieri, Chief Clinical Officer and co-founder of XFERALL (pronounced Transfer-all) , a real-time patient transfer and care coordination platform that is replacing one of the most broken processes in behavioral health — the psychiatric placement referral.   Shana spent years as the Director of Behavioral Health Services at George Washington University Hospital in Washington, D.C., where she watched something that would change the direction of her career. Patients in psychiatric crisis sitting in overwhelmed emergency departments for hours, sometimes days, while...

info_outline Ep 48: Everybody's Talking About Mental Health But Nobody's Funding It with Stephanie Slowly Little show art Ep 48: Everybody's Talking About Mental Health But Nobody's Funding It with Stephanie Slowly Little

The Mental Health Evolution

Rachel speaks with Stephanie Slowly Little, Executive Director of NAMI Maryland, about the state of mental health care access in Maryland, the funding landscape facing nonprofit behavioral health organizations, and what it actually takes to keep showing up for communities when every turn is making it harder.   NAMI Maryland represents over 60,000 advocates, people living with mental illness, and supporters across the state. Stephanie, a licensed clinical social worker and public health executive with more than 17 years of experience, stepped into the Executive Director role in October...

info_outline EP 47: What the Research Actually Shows About AI Therapy with Dr. Nick Jacobson show art EP 47: What the Research Actually Shows About AI Therapy with Dr. Nick Jacobson

The Mental Health Evolution

Rachel speaks with Dr. Nick Jacobson, associate professor of biomedical data science, psychiatry, and computer science at Dartmouth's Geisel School of Medicine and director of the AIM HIGH Laboratory, about the first clinical trial of a fully generative AI therapy chatbot — and what the results actually show. The access crisis in mental health care is the starting point for understanding why Dr. Jacobson's team built Therabot. In the most well-resourced mental health settings in the United States, there are approximately 35 providers per 100,000 people. In any given year, roughly one in...

info_outline Ep 46: The Crisis Text Line with Dr. Shairi Turner show art Ep 46: The Crisis Text Line with Dr. Shairi Turner

The Mental Health Evolution

Rachel speaks with Dr. Shairi Turner, Chief Health Officer at Crisis Text Line, a nonprofit that provides free, 24/7 text-based mental health support and crisis intervention through a community of trained volunteer counselors. In 2025, Crisis Text Line had more conversations than any year since its founding — over 1.5 million — and the data from those conversations tells a story that every clinician and practice owner needs to hear.   Dr. Turner walks Rachel through how Crisis Text Line actually works: what happens from the moment someone texts HOME to 741741, how volunteer counselors...

info_outline
 
More Episodes

Rachel speaks with Dr. Elizabeth Carr, a clinical psychologist and the founder and CEO of Kentlands Psychotherapy in Gaithersburg, Maryland. Elizabeth leads a team of 20 doctoral and master's-level clinicians and has spent over two decades building a community-focused, financially sustainable practice through some of the most disruptive periods in the history of mental health care. A former Navy psychologist and sought-after speaker on practice management, she recently published a piece on strategic positioning during industry upheaval that is the centerpiece of this conversation.

The mental health practice landscape is shifting in ways that are affecting practices at every size — but not all in the same direction. Elizabeth describes what she calls the barbell effect: solo practitioners, particularly those operating fully virtual, are being squeezed out by venture capital-backed platforms with enormous marketing budgets and SEO dominance, while large practices that over-expanded during the COVID telehealth boom are now sitting on overhead they cannot fill. Mid-sized, community-rooted practices that stayed nimble are finding themselves in a stronger position — but only if their leaders are paying attention to what's actually happening in the market and willing to respond. Elizabeth and Rachel dig into what that looks like in practice: how to read referral data, when to pivot your service offerings, what AI can and cannot replace in clinical work, and why hyperlocal, in-person, relationship-based care may be the most durable competitive advantage a practice owner has right now.

Resources Mentioned

Articles Referenced:

Connect with Dr. Elizabeth Carr:

Connect with The Mental Health Evolution: