June 3, 2020: There’s a reason why we keep hearing so much about self-care – it can be a powerful buffer against the mental and physical health impacts of stress, which is in no short supply lately, especially during the coronavirus pandemic. In this episode of the COVID Series, we’re talking about the mental health of our staff with Joe Grasso, a clinical psychologist and the Director of Clinical Partnerships at Lyra Health. We discuss the increase in stress, fear, anxiety, and depression that Joe has witnessed and how dangerous that can be, as it is directly related to an increase in cases of self harm and thoughts of suicide. He offers some advice for individuals battling with additional stress during the pandemic, as well as some advice for employers who are concerned about the mental health of their workforce, particularly on observing the signs that may be indicators of emotional distress, and the ways in which managers can assist employees and point them in the direction of professional care. For more on protecting ours and our employee’s mental health during the pandemic, tune in today!
Key Points From This Episode:
COVID Series: Mental Health of Our Staff
Episode 260: Transcript - June 3, 2020
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[0:00:04.5] BR: Welcome to This Week in Health IT where we amplify great thinking to propel healthcare forward. My name is Bill Russell, healthcare CIO coach and creator of This Week in Health IT a set of podcasts, videos, and collaboration events dedicated to developing the next generation of health leaders.
Well, we have a special request here with the programming team at This Week in Health IT, would like to highlight solutions that deliver hard dollar savings to healthcare in under 12 months. This is in direct response to comments we’re hearing on the show as well as comments I’m hearing in my consulting practice. Before you drop me an email, I need solutions that have successful client stories. I receive about 10 emails a week from companies that want to highlight their product on the show and my first question is always, “Put me in touch with a reference client.” Amazingly, about 90% of those requests fall away which I find really interesting.
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This episode and every episode since we started the COVID-19 series have been sponsored by Sirius Healthcare.They reached out to me to see how we might partner during this time and that is how we’ve been able to support producing daily shows. Special thanks to Sirius for supporting the show’s efforts during the crisis.
Now, on to today’s show.
[0:01:35.5] BR: This morning we’re joined by Joe Grasso, the Director of Clinical Partnerships with Lyra Health. Good morning Joe, welcome to the show.
[0:01:42.0] JG: Hi, thanks for having me.
[0:01:43.6] BR: Well, I’m looking forward to this conversation, there’s an awful lot of discussion happening about employees, how they’re dealing with the pandemic and then going back to work at this point, and I appreciate you offering your expertise. I caught one of your webinars online which is how I really got informed about what Lyra Health does. But, for our audience, why don’t you share a little bit about what’s Lyra Health about and what do you guys do?
[0:02:11.0] JG: Sure. Lyra is a mental health benefits provider and we work with innovative, self-ensured employers to transform mental healthcare through technology, but also with the human touch. So, you know, we work – mainly are focused on making access to high quality, evidence-based care that has outcomes to demonstrate effectiveness for employers.
[0:02:36.0] BR: Fantastic. I’ll tell you what, here is what we’re going to try to do. I think we’ll start generically and we’ll talk about the strains that really, everyone’s sort of dealing with, and then I really want to focus in on what it’s going to take to bring people back to work. Let’s start with what kind of things are we seeing in the area of mental wellness right now? What are people struggling with?
[0:03:00.3] JG: Yeah, right now at Lyra, we are seeing a lot of increase in stress, fear, anxiety, and depression. In fact, we surveyed our provider network and what we found is that almost 60% of our practitioners reported that their client symptoms have been worsening over the course of their achievement. What we’re seeing is, not only is that negatively impacting their quality of life but it’s also specifically impacting their work productivity.
In fact, 80% of the providers that we surveyed had said that the largest toll that the pandemic was takin on their client’s mental health is specifically in the realm of work. I think what’s been most surprising and concerning to us at Lyra is that we’ve seen an increase in the number of clients who are reporting self-harm or suicide.
In fact, it’s been a 33% increase in individuals who have those indicators. We always want to be especially attuned to increase in severity to the point of someone considering something like self harm or suicide. I think it just goes to show the added stress is having wide ranging effects, from additional feelings of anxiety and worry, all the way up to people feeling this increased sense of hopelessness, helplessness, and desperation.
[0:04:33.3] BR: Are those some of the things we should be looking for, in terms of just recognizing the stress itself? Is it things like – I mean, depression is such a big term. I mean, I don’t even know if I can qualify myself when I’m depressed. What are some things that would tell me that I’m really struggling with the added stress of this pandemic?
[0:04:56.2] JG: Yeah, it’s a very good question and I think a lot of people right now are trying to differentiate, well what is everyday stress or feeling momentarily down and what is the kind of issue that should lead to me seeking help from mental health professional? I think the common thread across all conditions that benefit from something like therapy, for example, would be an impairment in ability to function.
If I’m feeling down, or I’m feeling periodically overwhelmed, or stressed out, but generally, I can get through the day. I can do the things that I need to do, at work, at home, in my relationships, then I’m probably functioning relatively well. Maybe I could benefit from some support through a self-care app or meeting even with a coach, a certified coach, which is something Lyra offers.
But if it’s reaching a point that the change in my mood or emotions or my behavior is really significant and severe, and I’m not able to carry out my day-to-day tasks, or I notice that gradually over time I’m dealing with this chronic issue that’s impairing my ability to function, then I want to make sure to reach out to mental health professional, because that’s starting to reach the level of significance that would suggest maybe I have a diagnosed condition that best benefits from something like therapy or medication management.
[0:06:26.1] BR: Yeah. I’ve interviewed a bunch of people, today is my day for sitting in the studio and conducting the interviews. I talked to a bunch of healthcare executives, they’re all sort of approaching this work from home and then coming back into the office thing just slightly differently. It’s interesting because we’re in uncharted territory, right? We’ve never pushed this many people home so quickly, and then potentially brought them back so quickly, where we’re creating this effect I think on people.
What advice do you have for healthcare executives and leaders who are concerned with the impact of COVID 19 and really, their workforce’s mental health, just in general? I mean, we’re creating a lot of – I mean, the pandemic creates some scenarios and then we could unwittingly create some scenarios that really adds to that stress.
[0:07:21.5] JG: Absolutely. I would first say, they’re right to be concerned. When we look at the research on life disrupting events, that might be analogous to what we’re experiencing right now. There’s no perfect comparison point, but you look at other life disrupting events and how people fair, it’s clear there’s a trajectory of mental health effects and the immediate response, we’re in the acute phase. We’re very much focused on how do we deal with meeting our immediate needs and our immediate adjustment and we’re kind of rallying in action-oriented mode.
What happens over time is that, as people start to recognize, we’re in a marathon, not a sprint. We’re not going to immediately return to pre-COVID normal for example, now that we’re out of the acute phase. Then you start to see another wave of mental health symptoms because people can start to despair a bit. Or like you were pointing out, as people return to work, that brings a whole new source of anxiety.
I’m worried about my potential exposure risk. Maybe I’m noticing that I have symptoms of panic or fear just by and be out and about in the world after a prolonged period at home. What I would encourage people leaders to think about and, you know, organizations that are trying to plan ahead for return to work, is to first make sure that we have the kind of culture that makes it acceptable and, even for most, reaching out for support. Having a psychologically safe workplace, which starts with people leaders modeling the kind of behaviors they want to see in their employees. To the extent that managers, supervisors, directors, all the way up to the top of the chain, can model openness around mental health, offer – even work-appropriate testimonials to how they’ve struggled, ways in which their emotions have been impacted.
Ways that they’re dealing with it, including consideration of mental health support, through a therapist, a prescriber, some form of professional support. That goes a long way towards normalizing mental health at work and getting permission from employees to consider it for themselves. Another thing I would want to make sure, people, especially in benefits leadership are thinking about, is a comprehensive review of what services are available to support their employees. Now is the time to be looking at what are our mental health solutions and how are they meeting this unique need?
That means, making sure that you have the kinds of solutions that are flexible in terms of modality. We want in-person availability for our future where that’s readily possible for everybody but, right now, we want video capability to want to make sure that people can get telehealth services for mental health needs. That we have coverage within our network of providers to ensure that we’re able to address not only the garden variety mental health issues like depression, anxiety, insomnia but also that there are specialists in the network to deal with issues like suicideality, substance use.
These are issues that a lot of providers don’t’ feel comfortable addressing so you can’t assume that just by nature of a large network, in terms of members, that you’re well equipped to meet employee needs. The last thing I would mention is just making sure that it’s easy to get access to care. We know from extensive research that one of the big barriers to people getting the help that they need during critical moments are these barriers that are caused by logistics involved with access to care.
Things like not being able to figure out who the right provider is for me. Not having a way to book appointments online, so that I’m playing phone tag with providers and ultimately find out they’re no longer in the network, for they’re no longer seeing clients, or they’re not the right fit for my needs. Creating or making sure that, in your review of your solutions, you’re checking off the features of your solutions that map on to the pain points that people are most likely to face when they’re trying to access care.
[0:11:50.5] BR: Yeah, I mean, that is so true. I mean, having family members in my immediate family that have struggled with depression and, you know, you have to take down the barriers. The stigma is the first thing you take away, you got to make modalities such that, you know, when they are somewhere – I’ve heard of story of somebody who is in a bathroom, you know, crying and they actually use their mobile app and they got a hold of the mental health professional and they had a conversation. You know, it doesn’t happen when you’re in the right place always.
Making those modalities easier, being aware of the stress that we’re causing, and all these things are good. In fact, one of the reasons I wanted to have you on was you guys did a webinar and you shared some tips for people. Getting down to the individual, maybe beyond the corporation itself, because we’re going to have a lot of listeners that are health IT professionals and they’re looking at this. You have some tips like follow CDC precautions, stick to the facts, take a media break, check your thinking, prioritize self-care
I wanted to go through those a little bit for people because I know I find myself doing normal tasks, going to the grocery store for the first time. I got my hair cut this week and there was – it was different, right? You are thinking about things that you normally weren’t thinking about. So let us walk through those a little bit, for those people who are maybe getting back into it and thinking about going back into the office.
Let us start with how does following CDC precautions really help somebody to address the anxiety associated with this?
[0:13:39.8] JG: Yeah, absolutely. I am glad that you bring that up because there are a lot of things that people can do on their own to manage their own everyday worries and stressors out. I have to say, I’m a little envious that you got your hair cut. In the Bay area that is not possible right now, but, you know, I think you are right. As people are going out and about into the world, they may want to expect that their anxiety level can increase.
And in this transition to return to work or even just returning to being in public spaces again, it's reasonable to expect that added stress will follow and there will be challenges. In anticipating that, it is important that people recognizes what causes stress. You know when I ask most people what do you consider the biggest sources of stress, they talk about the stressor. You know, it is a relationship, a work situation, finances, but the other parts of stress have to do with our thinking.
And those are the parts that we have control over. So my perception of a stressor, if I perceive a stressor as something that’s catastrophic and terrible, and I think about it in doom-and-gloom terms, well, my stress levels is going to rise. Versus if I think about that stressor in more balanced terms that yes, it is an inconvenience, it is a disappointment, or yes there is a risk like in your example, going out to the grocery store. There is an increased risk of exposure there versus me staying at home.
But keeping that in perspective, making sure I am not jumping to unhelpful conclusions like just because I go to the grocery store, there is increased risk, it doesn’t mean that it is necessarily likely that I can track COVID-19, that I become extremely ill, you know, that I end up in the hospital. It is amazing how the mind can jump to those conclusions, so we are trying to reign that in.
Then countering it with the third piece of how we perceive stress, which is our ability to hope. Reminding yourself that even if there is a stressor, and even if you perceive it to be a significant one, remind yourself of how you’re equipped to deal with it. Don’t undermine your ability to pull on some resources and strengths and get through it. So again, in the situation of going back to the grocery store, you know, yes it is true there is increased risk of exposure, but there is also things that you can do to mitigate that risk by following some of the CDC precautions.
Wearing a mask, using hand sanitizer in the store, keeping six feet of distance from anyone else in the store whenever possible, limiting the amount of time I spend on the store, so limit my amount of exposure. Then when I go home, I can disinfect you know all of my goods, wash my hands, and that reminds me that I do have some control in a situation that could feel like I am out of control and it is that lack of control that ultimately leads to the anxiety.
[0:16:39.9] BR: You know it is interesting, because I told somebody that I got my hair cut, and they’re like, “I can’t believe you are doing that.” And I said, “You know, it was a really different experience.” I mean, from you made your appointment online, they gave you a time, you didn’t wait inside the facility. You waited inside your car, then you got a text message that said, “Hey come on in.” So then you go in, you do have to wear a mask. There is hand sanitizer there.
They are actually cleaning the equipment just like you would in a hospital, for heaven’s sake! I think I was only in there for like – I don’t have a lot of hair – but I was only in there for like 15 minutes. In and out, with a mask on the whole time, the person doing the hair cut had a mask on him. So that is sort of a – it is interesting, because that is an example of society has really changed. We are really taking this seriously and things are going to be better, but it is different.
You know the first time you do it you’re like, “Wow, this is” – you know, “am I always going to wear a mask? Is this always going to be this way?” It was interesting. You talk a lot about the mind and our mind does start to like, I don’t know, it starts to spiral. It starts to say, “Oh man,” you just start to – I don’t know what happens, but it really is a battle to keep from escalating what is really out there, because in reality when we are looking at COVID, you know we are still only talking about –
You know even with transmission rates and that kind – I mean, we are talking about people are – the rate of death associated with this is still in the single digits and the low single digits associated with it. The number of asymptomatic cases is pretty high. But still, because we are inundating ourselves with this information all the time, we are reading about it. I am producing a podcast everyday about it, you might think it is bad and it is. I mean there is a lot of people impacted.
But at the end of the day, you know the percentage risk and those kinds of things, your mind can really escalate that pretty significantly.
[0:19:04.2] JG: Right, it is so easy to lose perspective and it is a perfect storm, right? Because as human beings, our minds are already wired towards a negative bias. You know our minds love to focus on the negative, filter out the positive, and then we have this inclination for worry. In the absence of concrete information about the future or what happens next, my mind is going to want to fill in the blanks and guess what? It likes to go in the blanks with worst case scenarios.
And then you add the media on top of this and, especially if you are getting media that’s a little sensationalized for example, then you add all of those factors up, and it is no wonder why we can easily spin into those worst case scenarios that evoke all of this fear and anxiety. The good news there is we can ultimately exert some control by checking our thinking. Kind of reigning it in, and making sure that we are not running away with inaccurate or unhelpful beliefs about the situation.
[0:20:08.3] BR: Let’s talk about managers, and I am probably this – yeah we are getting close to the end here but let us talk about managers. I think one of the mistakes we make as managers is we think everyone thinks like we do, and they have the same risk posture that we do, and they are handling this the same way we are. But the reality is, if you have a staff of 3, 6, 700 people they’re going to be on all points of the spectrum from I am not worried about this at all to really crippling fear of this.
So you know, in terms of managers, how do we take all of that gap into account and at what point are we saying to somebody, “Hey, I really recommend that you have some conversations with a professional about this.”
[0:20:55.7] JG: Yeah, great questions. Managers are really well positioned to notice these signs of distress and, hopefully with this information that we talked about today, recognizing that those signs are more likely. Especially around returning to work, I want managers to pay close attention to shifts in mood and behavior that seemed unusual or out of character for people and would suggest potential distress. Like, Someone crying at their desk that is obvious.
What ways where it might be less obvious, someone who is pulling back at work, withdrawn. Someone who is usually pretty engaged and participatory now isolating or no longer meeting their work performance metrics. So also recognizing that a shift in work performance can be a symptom of emotional distress, which is why it is so important that we not make assumptions about employee’s behavior. So if we see an employee who is struggling in their work performance, we are not assuming it’s because they willfully disregard their work, or they’re checked out or they don’t care.
It may be because of some emotional distress but the only way to know is by having a conversation with them. So I think the broad guidance here is to keep the bar low, because the ultimate intervention that I am suggesting here is a simple conversation, where you are checking in, you are saying, “Hey, I just want to check in on how you’re doing, because I have observed X, Y or Z,” and letting them share as much or as little as they want.
And if they do share that they’re facing some kind of emotional struggle, having some ready information about your company’s benefits and services that are available to point that employee in the right direction as support in the long term. That is the last piece I’ll highlight. Some managers can feel like, “Well I am not a counselor. I don’t want to be their therapist.” I wouldn’t encourage that but you can still follow up when you see a sign of concern.
Ask open ended questions about how someone is doing to get some additional context, but then make it your goal to point them towards the services that can support them. You don’t have to be the long term support, but you can direct them towards things that are ultimately really useful for improving quality of life.
[0:23:15.9] BR: Joe, thanks very much for taking the time. Is there somewhere where they can go to maybe get some more information? Both about the things we are talking about and also about Lyra Health?
[0:23:26.9] JG: Sure, yeah I think our website, lyrahealth.com, is a great resource. We have a blog that is regularly updated with expanded content on topics on these, and we also have webinars that we developed specifically around the response to the mental health effects in COVID-19 that are publicly available as well. So you can find more information about Lyra and some resources that are hopefully helpful.
[0:23:53.8] BR: Fantastic, thanks for that and thanks again for your time, I really appreciate it and you know, thanks for all the work that you guys are doing.
[0:24:03.3] JG: Thanks Bill. I appreciate you having me.
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