Special Guest Interview: Dr. Steve Khachi of Mind Study Center
Today, we’re excited to share a captivating interview from a recent episode of the Sit and Stay podcast featuring Dr. Steve Khachi, a pioneer in psychiatry and the founder of the Mind Study Center.
In our discussion, Dr. Khachi delves into the urgent need for better access to mental health services, the challenges of training the next generation of mental health professionals, and the innovative approaches transforming psychiatric care.
Dive into this enlightening conversation as he unravels the complexities of advancing mental health care in today's world.
Parker Anderson: Welcome back to the Sit and Stay Podcast presented by RipsyTech. You're joined by your usual hosts, Parker Anderson, and Tom Tarshis. Hey, Tom.
Thomas Tarshis: Hey Parker, good to see you, sir.
Parker Anderson: Good to see you too. Today is a very special episode of the podcast. We are honored to welcome Dr. Steve Khachi, a Stanford-trained physician and founder of the Mind Study Center in Pasadena, California.
Dr. Khachi specializes in psychiatry for all ages with expertise in psychopharmacology and psychotherapy. He holds a BS from UC Santa Barbara—my alma mater, go Gauchos!—and an MD from the University of Wisconsin. He completed his Psychiatry residency at UC San Diego and a fellowship at Stanford where he served as Chief Fellow. He currently is on the voluntary faculty at USC's Department of Psychiatry and Behavioral Sciences.
His extensive background spans diverse clinical settings, and his dedication to integrated, evidence-based care has made him a leader in the field. His list of accomplishments is so impressive, I couldn't fit all of them into this introduction! Welcome to the podcast Dr. Khachi!
Steve Khachi: Thank you so much, Parker, for that kind introduction. I feel truly honored to be here today. This is a fantastic platform. I feel fortunate to be here.
Parker Anderson: We are very happy to have you. So for today's podcast episode, we wanted to talk a little bit about you and your background, so let's dive right in: Why did you decide to become a mental health clinician?
Steve Khachi: Oh, this is a complex question (laughs). I have to answer it in a few minutes, so I'll do my best. I studied biochemistry and molecular biology when I was in Santa Barbara. I loved chemistry, and when I took a biochemistry class, I was so excited to see the direct application of chemistry in the human body. The more I got into biochemistry, the more I was fascinated about these molecular interactions that make up complex species—humans and all animals. With that, I decided to pursue medical school and study medicine and how I could utilize my passion for bio chemistry and physiology in impacting people's lives.
Interestingly, I did have to take a psychology class as a general education requirement, and I was immediately fascinated by this other organ in the body—the human brain—and its impact on behavior, mood, thoughts, mental health... I was just so excited learning about the complexity and mysteries of the brain. With that background, I started medical school, and right away, I knew that I loved neuroscience. I love to learn and understand this, again, sophisticated organ and all its neuronal networks and such.
And actually, after my second year of medical school, I decided to pause and went on to do two years of research. I went to UC San Francisco for a year of research, and afterwards, I actually got a very nice fellowship. It was called the Howard Hughes Medical Institute Fellowship, which funded my research to go to the NIH National Institute of Health, and it was really interesting.
They brought 50 medical students to live in a house inside the NIH, and we lived there and did science for a whole entire year. I look back, and it felt like a science boot camp. We were very fortunate. We would have guest speakers every week in a very intimate setting with dinner with Nobel Laureates and Nobel Prize winners in different fields coming and giving us talks.
I was really interested by the work that Eric Kandel had done also. He was a psychiatrist who actually won a Nobel Prize in delineating the biological mechanisms of memory, which was another phenomenon of the human brain. That was very interesting.
With that mindset, I came to medical school. I thought I wanted to pursue neurosurgery. I think I loved the human brain so much. I thought, “I gotta’ touch it. I’ve got to get in there!” But soon after a bit of rotation, I realized that neurosurgery was still not answering the questions I had. How does the human brain work? What are the impacts of mood, thoughts, feelings that come as a result of the function of this organ?
Then right after my Psychiatry rotation, I thought, “Wow, this is the field.” This is the field that brings all of my passion and integrates it all together in one specialty. Neuroscience, biochemistry, the desire to help people improve their quality of life, and reducing stigma surrounding mental health conditions that I believe happens as a result of difficulties within the brain. And with that, I started my career.
Tom Tarshis: That's amazing Steve, and actually, I've known Steve for some time. I don't think I've ever fully heard some of that origin story, so I was thrilled hearing that. It was great to get that extra context.
Steve Khachi: Yeah, it's been a really interesting journey, and I always say that I am fortunate to be in this field that's always changing and always advancing for the better.
Parker Anderson: I saw that you're certified for ‘adult psychiatry’ and ‘child and adolescent’ psychiatry. What led you to child and adolescent psychiatry specifically?
Steve Khachi: Great question. When I was doing my general psychiatry, or focusing on adult mental health, I started seeing a pattern where I felt that I could have been more effective if I was there earlier in these adults’ development, and soon, I learned that if I could change or have an impact early in childhood just by a bed, I'm able to change the trajectory of many growing adults years after. And child and adolescent psychiatry just felt like the right fit. I feel that it just really completed my focus and passion for psychiatry as a whole.
Sometimes I say that I feel I'm more equipped as an adult psychiatrist when I'm treating adults because I have a child and adolescent psychiatry background, and it just brings it all together. Now, I am not limited to one age group, and I can see the lifespan. And that's how it started, and I’m so happy to be part of the small child and adolescent psychiatry team. There's not many of us out there and I'm hoping that there will be more and more physicians and psychiatrists getting into this field.
Tom Tarshis: Yeah, we all hear prevention is the best medicine, and I think that was the reason you gave for doing child psychiatry–well, mine was mainly to play video games with my patients (laughs), but the reality is that it becomes very clear when you’re seeing some adults that if someone had just been there when this person was 12 or 13-years old… It makes our jobs easier actually to change the trajectory, and it can be a much more hopeful experience I think.
Steve Khachi: And as you said Tom, even with the smallest change of one degree, we can see how much impact it has down the line. And the other thing is if I can be slightly effective at reducing stigma at such an early age that as adults, people would feel comfortable going and seeing a mental health clinician without all the stigma that we hear.
Parker Anderson: So as I mentioned, you founded the Mind Study Center in Pasadena, California. Tell us a little bit about that. How long have you been in operation? And what was the process like getting started?
Steve Khachi: Yes, yes, well that's a complex question too (laughs), but let's get in there.
Parker Anderson: Only the hard questions! (laughs)
Steve Khachi: Yes, again from my background, as you heard, I was absolutely pursuing a very academically oriented sort of career path, but the longer I practiced, especially during my fellowship, the more I realized I love clinical practice. I love what I can do with each patient, and with that mindset, I came here to Los Angeles. I started a solo practice for two years, but it felt like I was missing the big picture–how I can be effective for my patients as a whole and having a more holistic approach.
That's what I had really enjoyed at Stanford–having other mental health clinicians come together in a very collaborative way delivering care, and all of us being involved in different parts of one's mental health care. So psychologists, neuropsychologists, therapists, family therapists... And especially when we’re treating children, we're not treating them isolated in a vacuum. We're really treating them in a very systemic way within the system and that involves school, parents, family therapy, parental counseling… We sometimes need extensive neuropsychological or psychodiagnostic assessments. All of that together really helps us be more effective as opposed to being alone.
And in the private [practice] world, I felt that's really not happening. We try to maybe reach out to a clinician, and sometimes it happens, sometimes it's hard. With that mindset after two years of solo practice, I founded Mind Study Center with that exact mission where we can bring all these experts from different areas in one convenient location to deliver care.
Here, we truly have an open-door policy. I actually pass by, and I see one of our psychologists is chatting with our family therapist about a mutual patient. Yesterday, we had our clinical meeting, and we sat at a table–I might be the psychiatrist, Dr. Meraki did the neuropsychological assessment, Abigail is [the patient’s] psychotherapist, and another therapist is doing family therapy. So now we're all coming together, talking about the same family, same patient. We're all up to speed. And that really has changed how I practice and how others practice, and that's all what really attracts people.
I feel we are much more effective this way, and the other thing is now I'm able to integrate all aspects of what I've been really enjoying about psychiatry, whether it’s reducing stigma, mental health education, public awareness of what we can do to increase access to mental health care, and then also focusing on prevention. This is something that is not easy to do in every setting, and in this setting, we've been able to do it.
Parker Anderson: That is amazing. To continue on with that passion and enthusiasm, let’s talk about what’s going on in the mental health field right now that you’re excited about.
Steve Khachi: Oh, where do I start? There are so many. Of course, there are things that we are becoming more and more aware of, whether it’s increasing access to mental health, reducing stigma, and focusing on prevention, as Tom shared. The best care is actually not to get to a point of a disorder or an illness. We've been successful in doing that with cardiovascular diseases, such as by reducing smoking and drinking, and [prevention has] made a huge impact with colorectal cancer prevention. So, prevention is key, and we need more of that in mental health. It might sometimes seem vague, but we have enough tools and information to utilize it, and of course, continuing with research and innovation, which has been ongoing.
I'm really excited about the technological advancements coming to our field. For the longest time, we might have been very limited to medications only, or psychotherapy only, but we are actually expanding and using other innovations such as TMS, transcranial magnetic stimulation. I really see that as a medical breakthrough. We're able to localize areas of the brain responsible for mood regulations, such as the dorsolateral prefrontal cortex of the brain. We can very nicely localize that area and use a non-invasive procedure—less invasive than medications—utilizing only magnetic fields to stimulate those exact neurons or nerve cells in the brain and be effective for treating depression and other conditions.
We know a lot of times [that for] our medications in clinical trials, if the first antidepressant is 50% or more successful, that's great news. By the time you go to the second antidepressant, because the first one was not effective, it drops all the way down to 20% or lower. Then TMS comes in for treatment-resistant depression, meaning they did not respond to one or two medications. It’s showing us efficacy anywhere from 65% to 90%. This is really exciting, and I'm really excited that as of March 22, 2024, one of the TMS devices was FDA approved for ages 15 and up. It's already coming to adolescents, and I see this as a more effective way of treating treatment-resistant depression.
We started TMS here, and it's been really successful. Our patients have been benefiting from it significantly, and what I'm proud to say, consistent with our model here at Mind Study Center, is [we have] direct physician involvement. There is always a physician here. There's always interaction. It's not just, “Go sit on that machine and somebody else is going to do it.” We are hands-on, and that was a reason that I wanted to make sure we bring this technology here.
We started doing virtual reality (VR)-assisted psychotherapy now for a lot of conditions that require exposure therapy, such as phobias, anxiety, PTSD, OCD. We're able to simulate environments and situations that mimic the triggers and actually treat a lot of these conditions with VR. So this is another exciting thing that I see more and more of.
The other things that of course we are hearing and are excited about are AI and machine learning. I don't think we are there yet, but are we going to get to a place where we can utilize these tools for diagnosing mental health conditions more consistently, or predicting treatment outcomes, or personalizing care? This is another really exciting area along with genetic testing, where we can personalize treatment plans based on genetic information and help determine what medications can be useful. This is the area called pharmacogenetics. We are not there yet with pharmacogenetics; some commercial companies may advertise that we can use this genetic testing and tell you exactly what medications to use, but I have to have long conversations with my patients explaining that these are just genetic profiles of our liver enzymes. They are not yet as informative as we would like them to be.
Lastly, wearable technology is very exciting. I'm not sure where we are, but can we get to a place where we can have devices that monitor physiological indicators of stress and mood, providing real-time data to help clinicians and patients be more effective in our treatments? There's a lot going on. These are just a few things off the top of my head.
Tom Tarshis: Yeah, I think the nice thing about your research background and academic pedigree is you can be critically aware of the research and what does work for the patients, and like you mentioned, there are plenty of companies that you can go plunk down thousands of dollars for pharmacogenetic site testing, and they’ll claim it could be very helpful or miraculous information, and maybe one day. But as you mentioned, we’re not there yet, and there are lots and lots of very exciting new things, but only some of them have the evidence to really back up their use right now. And it’s great for the patients at Mind Study Center that your background and training keep it so that your patients are only getting proper treatment.
Steve Khachi: You know, it’s our motto. I feel like it’s written all over Mind Study Center. We practice evidence-based medicine. We are excited for these technologies, but we're not there. Unfortunately, some companies may take an exciting idea, run with it, and commercialize it, but that doesn't mean [the research is] there yet. So, when we talk about wearable technologies or genetic testing? Yes, we do want to use these one day. Imaging studies? We want to be able to one day get a nice fMRI to predict conditions and outcomes, but we are not yet there. Those who unfortunately claim at this time and age that they can do that—the research is not showing that. We don't have the scientific evidence that we are yet there, but one day we will.
I always need to remind patients that we shouldn't follow what sounds innovative if it’s not yet evidence-based. I am excited for it too, but I do not want people to get into treatments that have not yet been shown to be evidence-based when we actually do have evidence-based treatments for the same exact conditions. So, it's really important to build that trusting relationship with your psychiatrist, psychologist, therapist, where you can be sure you are getting evidence-based recommendations.
Parker Anderson: So let’s flip things around a little bit. We just talked about things you're excited about. Is there anything about the current state of the mental health field that you would change?
Steve Khachi: Oh, yes, a lot. Where do I start? (laughs)
Of course, the main one that's on our mind every day is access to mental health, increasing access to mental health services. And people have different ideas, and they’re all valid. I think addressing the shortage of mental health professionals is one thing. We need more training programs, more incentives for our young medical doctors to actually choose psychiatry over other fields. I sympathize; it's not easy to become a psychiatrist, much less a child and adolescent psychiatrist. They could pursue becoming an orthopedic surgeon or a plastic surgeon instead. For psychiatry, it's four years of general psychiatry plus two years of child and adolescent training—that’s six years post medical school. It’s long and difficult, but we need more programs, and we need to incentivize more medical doctors to enter this field.
The other thing I feel is important is advocating for better insurance coverage for mental health services. Make care more affordable and accessible. Of course, this is a big topic–politics, policies. There is a lot to say, but if mental health conditions were reimbursed [properly], and clinicians were able to actually treat and see more patients because [taking insurance] is feasible, then that would bring more accessibility. Part of the challenge is that many clinicians and psychiatrists are not on insurance panels because it's difficult to run their practices when reimbursements are not comparable to those in other medical fields, whereas mental health is so important—one out of five children, 20% of children, will experience a mental health condition that absolutely deserves mental health care.
So, you can imagine, but there’s no access. So those are definitely areas that I feel are very important and topics that come to mind. We also need to focus on emphasizing preventive measures, which is not happening as much, and supporting specific populations; that’s another area. Providing targeted support for groups with unique mental health needs, such as veterans, LGBTQ+ individuals, and those with chronic illnesses. We need more specializations in these areas.
And of course, there's research and innovation—not just in creating another similar antidepressant or antipsychotic, but in more innovative measures. And hopefully for biomedical and pharmaceutical companies to be incentivized to actually expand their research.
Tom Tarshis: Yeah, we've talked a lot on the podcast about how the majority of mental health clinicians don't take insurance, and a big piece of that is that the reimbursement amounts are not up to other fields, and then the other caveat there is even if you manage to get a reasonable reimbursement amount, submitting your claims to insurances and dealing with the headaches of getting those payments in, that’s something that RipsyTech’s trying to streamline, and we’re making some progress, but when over half of providers in a given field are not using insurance, specially for mental health, that affects all of us.
Steve Khachi: Absolutely, it reduces access for all.
Parker Anderson: Steve, is there anything else about the mental health field that you’d like to shed some light on?
Steve Khachi: I think each one of these points I shared with you I can go on and on talking about. Definitely in a nutshell, these are areas of focus, and I think we are making some progress but progress has been slow, and I’m hoping we can get to a place not only where we have better access to care but also really treating many psychiatric conditions and improving quality of life for children, for adolescents, for adults, and families.
Tom Tarshis: I think there’s not too many physicians like Dr. Khachi who have the… I don’t know if it’s entrepreneurial spirit or drive or frustration with the current system to just actually say, “Hey, I’m gonna build this multidisciplinary center that's working hard to do the right things and [provide] evidence-based treatments,” and I wonder Steve when you reflect on when you started and where you are now… I just envision Mind Study Center getting bigger and bigger and expanding throughout. What was it that was driving you to take this path? Because it's more than just the clinical care and some teamwork. There's something else.
Steve Khachi: Well, Dr. Tarshis, you’ve definitely been an inspiration, and throughout my training and the work together, I found all of this admirable, what you have done with [your] clinics, and as I started my own practice initially, [I was driven by] frustration with the system. I felt that I had this excellent training where I could be very impactful in my patients' lives, but many times my hands were tied. And there was so much bureaucracy and hoops and challenges that I had to go through in order to deliver the right care that everyone deserves, and that was very challenging and still is challenging.
And the other part was that I felt I wasn’t as effective when I practiced alone, and this is a very complex field that requires different experts to come in and work with different angles of mental health. And that was definitely another part that really inspired me. How can I bring a very good group of professionals who do different things in one place, so we can start diagnostically on the right path? Because that sheds light on what we're going to do [when we come] up with a treatment plan and providing that treatment plan that we think is the right path.
So all of that led to founding Mind Study Center. Where still, there are those challenges. We still have to deal with insurance and pre-authorizations, but we've been trying to reduce as many obstacles as we can to narrow down and really focus on good patient care. And the people who come and work here and want to be part of the Mind Study Center family, they come for that reason. They bring their expertise, but then they are really focused clinically on what they can do for their clients and patients without all of those obstacles, which I deal with in the background.
Tom Tarshis: Awesome. So just trying to do the right thing and enough leadership skill and quality, and it’s been great to see where you’re at and where you’re going. So, congratulations and strong work on behalf of [all] patients and society.
Steve Khachi: Thank you, thank you.
Parker Anderson: So keeping the focus on Mind Study Center, I understand that you do organize events from time to time. Do you want to talk about some successful events you’ve had in the past and let us know about any that you have coming up?
Steve Khachi: Sure, yes. Again, part of our mission is reducing stigma, getting information out there and letting others know what we do and [how] this is different. I usually tell parents that navigating the maze of getting mental health care is really complex. I am in this field, and sometimes I feel confused and overwhelmed by where to go. But imagine someone who’s not in this field, and their child is struggling with attentional difficulties, behavioral problems, depression, anxiety. Where do you start? Who do you go see? What do you do? So, that's definitely one of the challenges that I'm sure many would share, and for part of that, our mission is public awareness and education.
We've been consistently going to all these surrounding schools in our communities and giving talks to parents. So there's a lot of parents’ education nights that we organize, and we go there and talk about different conditions or getting mental health care. So that's been a really successful series of events that we've been doing, and usually we go as a team. We go with a neuropsychologist, a child psychiatrist, a therapist, so that way we can really bring our model and show exactly how we do it. So, it's not just one person doing it all.
The other thing is in the community, we recently moved to a new location and had our open house a few weeks ago, which was great to bring all the colleagues in the area and psychologists, psychiatrists, therapists, educational therapists, schools. And [they] all come and see what we do and how we do things and also learn about [each other]. We are very interested in finding like-minded people, so we can actually have ongoing collaboration. So that's been really nice to have these open houses, and we plan to do more, maybe not open houses, but having more workshops, educational lectures, and so forth.
We usually show up and go to different organizational shows and conferences. Dr. Tarshis and I are usually at AACAP (American Academy of Child and Adolescent Psychiatry). [Mind Study Center] has a booth there, and just has a presence to say, “This is how we are doing things. This is our model.” And we’re, of course, interacting with other child and adolescent psychiatrists, and hoping to do more of that.
The other thing is I'm involved with various lectures whether it's at USC to other colleagues, or I just had one for the Los Angeles Psychological Association, sharing thoughts, ideas, and different approaches. So a bunch of events are always happening and others in the clinic are attending, and I think it’s an ongoing collaboration within our community.
Parker Anderson: Steve, it’s been amazing learning more about Mind Study Center and yourself. Mind Study Center sounds like such an amazing place to both work and receive treatment from. So, I think the hot question on everybody’s mind is: Are you hiring right now?
Steve Khachi: The answer is always (laughs). We'd love to have like-minded people join the Mind Study Center family–those who have the same mission, passion, and desire to focus on good patient care without the bureaucracy. We are usually interviewing and meeting with people, and I always say that we want people to be here who feel this is the right fit for them. There might be a lot of excellent clinicians where this might not be the right place for them, but the right fit is really the key. We are fortunate that we have gathered such a group of professionals.
Parker Anderson: Amazing. Before we wrap things up, is there anything that the two of you would like to say?
Tom Tarshis: Steve, we usually share a [Mental Health Business Moment of the Week], and I wonder if there’s anything fresh within the last couple of weeks that was a frustrating piece of running your practice or anything from being a business owner as well as being the researcher. Any little nitpicky frustration that showed up in the past couple of weeks on the top of your head?
Steve Khachi: I think what used to be frustration is becoming the usual obstacles as you get used to them (laughs). But, it’s always about how we can maneuver around obstacles to get the right care for our patients. I have patients who are suffering from treatment-resistant depression, and they've been on ten different medications, ongoing psychotherapy. TMS is the right treatment for them, but TMS can be expensive. We need insurance companies to step up to get the right care for our patients, so they don't get hospitalized or have their quality of life remain poor as a result of this medical condition. It's frustrating when insurance companies might reject one, or we know what the treatment is, but we don’t have an easier way to deliver it.
Tom Tarshis: Yeah, agreed, and [the Mental Health Business Moment of the Week] usually revolves around something with insurance companies.
Steve Khachi: Yeah, so pre-authorization of medications. You know this is the right medication, and an insurance company says, “No, this is a brand medication, and we don't want to pay for it.” And now many patients might not be able to afford such expensive medications even though it's the right one.
Parker Anderson: Well, this has been an amazing conversation. Steve, we really appreciate you offering your time for us today, and it’s been a wonderful episode. We hope to see you soon. Hopefully, at this year’s AACAP in a few months.
Steve Khachi: Thank you so much for having me. When you shared the podcast with me, I was really excited and I listened to a few and I thought, “Wow, this is an incredible platform,” and a place where everyone can come, whether psychiatrists, psychologists, even patients to hear both of you. And Dr. Tarshis, your years of experience in the field, all the challenges, and having a place for everyone to talk about these very important topics, thank you for doing this and thank you for having me.
Tom Tarshis: Thanks so much for being our first guest ever for our podcast. And any mental health professionals who are in the LA area or Pasadena and are thinking about doing their own thing or looking for a great place to work, give Dr. Khachi a buzz just to see the office he set up, how it’s arranged, and its philosophy. Dr. Khachi is a great mentor as well, so I’m sure he’d be happy for anyone to stop by and say hi. But thank you so much Steve, we really appreciate it.
Steve Khachi: Thank you so much.
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Stay tuned for more insight and stories in next week’s blog post!
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