March 29, 2020: Dr. Dana Udall from Ginger joins us today for the next installment of our COVID-19 series. Ginger is a full-stack, behavioral health system, offering care and content of different types to their clients. The focus of our conversation today is how Ginger is doing this in the context of the current health crisis. One of the most important points that Dr. Udall makes during our conversation is to reframe this period as not only a health crisis, as is often stated, but also as a crisis of mental health. We touch on the article that Dr. Udall authored about eating disorders and our guest's thoughts on simple practices for healthcare professionals in this stressful situation. We discuss coping mechanisms, helpful strategies and why self-care and downtime are so important for everyone. Dr. Udall also stresses the utility of exercise, intentional thought and better communication. She believes that it is only together that we can make it through these challenges and the hurdles of isolation and loneliness need some effort in order to be avoided. We discuss creative ways to combat these issues and Dr. Udall shares some info on the great free service that Ginger is providing to healthcare professionals.
Key Points From This Episode:
Mental Wellness in a Time of Crisis with Dana Udall, Ph.D. with Ginger
Episode 212: Transcript - March 29, 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 with our continuing coronavirus series. We’ve moved from understanding the health IT problem, really to looking at a set of solutions. My name is Bill Russell, healthcare CIO coach and creator of This Week in Health IT, a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.
Before we get going, I want to give you three resources for those in health IT during this crisis, the first for CIOs, I’m currently helping my coaching clients, CIOs as a sounding board and advisor through this time. If you want to connect with me over the next two months to experience what coaching is like at no cost, shoot me a note at firstname.lastname@example.org. For anyone at health IT who find themselves in uncharted territory, which is just about everyone right now, and you want to start crowdsourcing solutions with a team of seasoned professionals and other health systems. we’ve setup two ways that you can do that.
The first we now have a Slack channel that is supported by our sponsors. VMware, Galen Healthcare, Sirius Healthcare, StarBridge Advisors and Pro Talent Advisors. The Slack channel allows you to get your questions answered, you can post questions around telehealth, scaling BDI, EHR performance, leadership, what are you doing with your teams. We’re seeing a lot of health systems just sharing their best practices, we saw a really cool – actually, a couple of cool solutions that I think are interesting.
That you know, we are literally watching an episode of MacGyver here that these IT organizations are putting together some really cool solutions. If you want access to these things, send a note at email@example.com and we’ll get you set up. There’s already 15 health systems represented and that’s growing by the day. We like to have every health system represented and sharing your best practices with each other.
Our sponsors are also supporting an email channel some of you, Slack might not be your cup of tea. You could just send an email to firstname.lastname@example.org. If you have a question, we will route that to someone who can help get an answer. I really want to thank our sponsors for stepping up to provide these services to our listeners.
I also want to thank last thank here before we get to our guest, I really want to thank our sponsors for these shows, Sirius Healthcare has stepped up to sponsor all these episodes over the last couple of weeks which is great because our production cost has gone up , we’re doing a show every day and they have graciously stepped in and I appreciate them doing that and also their commitment to the industry and providing this information out there.
Okay, to our guest today. Dr. Dana Udall is the chief clinical officer for Ginger, an online mental health system coaching therapy in content type company.
[0:02:41.4] BR: Good morning Dana, welcome to the show.
[0:02:44.0] DU: Good morning, thanks for having me.
[0:02:46.9] BR: I really – I have a bunch of really practical things that we’re going to talk about what manager should do with their staff and how they should be thinking about it, we’re going to talk about families and things people are doing at home and those kind of things. But before we get into that, give us the couple of second overview on Ginger, you guys are a really interesting company.
[0:03:06.3] DU: Yeah, we have been around for almost a decade at this point and we are a full stack, behavioral health system, we offer various levels of care, coaching therapy and psychiatry as well as content, all within an integrated network. This means that we can really tailor care, people have access to coaching 24/7 and then we can bring in therapists and psychiatrists as needed. We’re able to serve the great majority of most populations and work with many, many employers from around the globe at this point.
[0:03:35.8] BR: Yeah, I appreciate you coming on the show. I mean, you are one of the people that has been hurt by my learning curve of coming up to speed as a podcast host, I actually did an interview with you at one of the conferences and that the audio is so bad I couldn’t air it. I felt so bad and that’s only happened to me twice, so I’m getting better at it and I apologize for that.
The other thing I wanted to call out, you wrote an article recently and I thought it was fantastic, When Hiding is No Longer an Option — Recovering from an Eating Disorder. My Journey To Control Less, Trust More and Embrace Vulnerability. I thought it was a fantastic article, I highly recommend it to people who haven’t been out there and I’m not sure what site it’s on but if you just search for that title and your name, it will come up. How did you come – how did that article come about?
[0:04:27.2] DU: Well, it’s obviously a story that is many years in the making and my own experience with an eating disorder was gosh, 25 years ago or something, maybe 30 years ago. Long time ago, but I think part of what I was really hoping to do is to destigmatize mental health and to really talk about kind of coming out of the shadows and saying you know, I have had this issue, many people l have had similar circumstances and we can go on to live really full and productive lives.
As well as highlighting the importance of mental health for my own journey. I have received many years of great therapy and really come a long way as a result. That was really the intention and I think that as C suite executives, other leaders, can really talk about their own experiences and come forward. I think it can change the tenor in the country in terms of people feeling like it’s okay, I can ask for help and we’re all human.
[0:05:17.2] BR: You know what’s interesting? I think I did the interview with you at the health conference and that’s when Bernard Tyson had gotten up on the stage and said, you know, we have a problem in healthcare and said, we’ve separated the head from the rest of the body and he talked about mental health and just following that, he’s no longer with us, just following that talk but that will be part of his legacy is his removing the stigma and talking about this to that audience, I believe.
All right, let’s get to — you know, these are interesting times, these are extraordinary times for many and a lot of health workers are working 12 hour shifts and even more. What are some things that we should be considering from a mental wellness standpoint for those people who are putting in so many hours on the front line?
[0:06:04.8] DU: Yeah, this is something we’ve given a lot of thought to over the past two weeks and we are really hearing that these workers are extremely stressed and obviously, healthcare workers are dealing with their own fears of contagion, right? Having to be out there supporting folks in hospital settings, very often.
Also helping people who potentially have COVID-19 on a regular basis. They’re both potentially exposed to it, having to be in this very intense work setting and then going home and having to probably deal with their own anxieties, whether that’s about financial status, their own health, their family’s health.
There is an intensity and I think for these workers, it’s very hard to get time off or down time. One of the ways that we are really trying to address this is through a new offering that all frontline healthcare workers are now able to get Ginger coaching free through their employers, this is really important to us, we really want to support those who are supporting others, it’s something that is really top of mind and we’re working hard to really get this community of folks connected.
The other thing I just want to say is that I think this is where on demand behavioral health becomes really important. You’re working a 12 hour shift, I mean, the idea of taking time out and going to meet with a therapist, something like that just isn’t reasonable or practical. I think what is much more feasible is going in your break or at lunch, we hear this all the time, right?
Somebody’s chatting in with their coach and saying, "I’m so stressed, I just had this terrible interaction with a patient or I feel like I don’t have any support right now and then within a matter of minutes, they can be taught coping skills, reminded of the resources they have, so that they can go back on to the floor, work with patients again and be much more resilient.
[0:07:45.1] BR: I mean, that’s a phenomenal service and the thing I liked about that’s really to your solution that Ginger had is you did have a – or you do have an online solution that people can really sign up very rapidly. I mean, within 60 seconds, you’re actually talking with somebody, and then you have multiple tiers, all the way up to psychiatry, that can be sort of referred through the tool.
Which is amazing, what are some of the coping mechanisms that people, granted, this is This Week in Health IT. We’re probably not talking to a lot of people that are front in line clinicians, we’re probably talking to a lot of people who are working long hours, they even might be in their homes working long hours, their door is shut, their family’s on the other side. But they have to be working because they just have so much to do. What are some coping skills for those people?
[0:08:40.2] DU: Yeah, absolutely. You know, we are able to look at data across wide spectrum of population so we can understand how individuals are doing and then across our system. We’re hearing things like, "I’m so isolated, I’m so lonely, I’m anxious. I’m really worried about my financial prospects. It’s hard to work with the kids right outside."
So we hear these things from our members all of the time and some of the things that we’re talking with people about are things like breathing techniques. Learning how to use mindful meditation. We’ve actually started doing this at the Ginger staff. We offer three, drop in meditation groups for our staff over the course of a week because that’s a really important skill, it’s very effective, it’s very quick so you can do it within a matter of minutes and regulate your nervous system so you can be more effective.
We’re also talking to people about how they can increase their social support, how they can reach out to others through technologies like Zoom or Hangouts and have conversations, have happy hours. Increasing that connection, and then there’s other things like getting exercise in your home, what does that look like, you know, are there yoga classes you can do? Are there at home workouts that you can do because we know there’s a lot of evidence that exercise can really decrease levels of anxiety and help people feel better.
I think having access to that kind of on demand coaching really access to social supports, managing the anxiety, these are some of the main ways that we’re really talking to people about.
[0:10:04.2] BR: Are there bad thought processes that are sort of – that you can identify like somebody is going to try to be the hero here, they’re going to try to work 80 hours and they’re going to forsake all the other things that are going — I mean are there those kind of things that you just look at and go, “Okay that is a bad framework. You are operating from a bad framework, you are going to get yourself in trouble."
[0:10:28.5] DU: Yes and I think what has happened, what we have seen is that people very early on I think there was a lot of like, “Okay, I can do this.” And what is happening now is we don’t know how long this is going to last and people need to be able to make work sustainable. So that means trying to not be the hero and saying instead, “How can I be most resilient?” And for most people that means building in breaks, really emphasizing self-care.
So it is not a luxury but getting that physical exercise, talking with the coach, doing meditation is key to being sustainable overt ime. The other thing in terms of thinking areas that we see a lot is catastrophizing and I think what is really confusing about this situation is it can feel really catastrophic and it may have catastrophic effects for our economy and for some people’s health but if we get into the thinking of like, “Oh my gosh, what if? What if? What if?”
And then we are a year down the road, we are not able to make good decisions in the moment. So that is a cognitive error and our coaches do a lot of work in helping people reframe it so they can think, "What do I need to do in this moment to be successful? So that I am actually capable of long term planning that’s effective." Rather than getting into fast of worry where our brains really are not very functional.
[0:11:37.2] BR: So as a manager one of the challenges I would think is you don’t have much time. So you are doing a lot of blanket managing at this point but one of the things I’ve noticed with my children is that each one of them is so distinct in how they are dealing with this. You know my youngest is in college, and she was living with us and she has one frame of mind. My oldest lives with five girls, five women in another state and she has a different frame of mind.
And my son is in a completely different frame of mind and in a different part of the country and I find that when I talk to them I have to use different language, different things to do just sort of calm them a little bit and to help them to think through these things. How do managers sort of – I guess the first thing is recognizing that your staff is probably all over the board. But the second thing is how do they communicate in such a way that doesn’t accentuate the crisis as much as bring forth calm that we can make good decisions out of that?
[0:12:47.0] DU: I think that is the sweet spot, exactly what you said is that managers need to be able to manage their own anxiety so that they can communicate in a way that is effective, be heard, be supportive but they also — I think it is okay for managers to be vulnerable right now. I think one of the things that really is helpful for all of us is to say, "We don’t have to be perfect." So the manager doesn’t have to come in and say, “I have this all figured out and this is what we are going to do.”
I think it is helpful for managers to be transparent and say, you know this is a really stressful time as well as to normalize for people. So there is no one way to respond to this correctly. So managers can say to some folks, “Gosh, it sounds like this is really intense for you. Let’s talk about getting you some support. What do you need right now? Here are the benefits that are available to you.”
And to somebody else, they might not take that same tact. They might be a little bit more kind of, “Hey, I am glad to hear that things are going pretty well.” So I do think tailoring the message and for the manager to get their own support, so they are really well resourced and could be in the position to advise people that is super important right now.
[0:13:47.5] BR: We are going to end on an up note. I am going to ask you for some creative things that you have seen the people are doing either videos or whatever because there is a lot of creative things that people are doing out there. But one of the things I wanted to touch on before we get there is this is probably the worst situation for mental health I could think of. We just send a bunch of people home, we have sent them home without jobs, without security, without paychecks.
And then we told them, you have to stay — in some cases, you have to isolate and stay in place and stay at home. You know what – how are we protecting that group of people? How are we supporting and helping that group of people? Because a lot of them have lost their benefits and those kind of things. So they probably feel isolated and alone.
[0:14:35.3] DU: Definitely and we are seeing this in our data. So we are able to track sort of mentions of COVID. We saw a dramatic spike in February when the first case was identified in the US. We are seeing our members talk about things like isolation, loneliness, panic. So this is definitely reflected in what we’re seeing and it is really a mental health crisis. I think we are used to thinking of this as a health crisis or the financial implications, but this really is a great test of our mental health system and our capacities as individuals.
So I think for individuals to find ways to connect remotely and as you said there are a lot of creative ways of doing that. I’ve heard people watching TV shows together, having happy hours remotely. We have done remote playdates at Ginger. So everybody is together, we just have all the kids, we are doing story hour. So I think that there are creative ways to do this. You know I am very aware that there are people that are isolated and don’t have very many options.
Or they are in a community where they are not able to walk outside and engage with neighbors. I think that the one upside is that because stigma has decreased with mental health, we are talking about this in a much different way than we would have five or 10 years ago. I don’t think at that point people would be saying, “Yes, this is impacting mental health to the extent that it is.” So we are aware of it, we are mobilizing lots of resources and we’re also trying to work with employers. So that they are ready and they can really meet the needs of folks so that you know, have to try to minimize those effects whenever possible.
[0:16:06.3] BR: Yeah, for our family we did a family reunion. We had a Zoom family reunion and everybody was on and the first part was fun trying to get the grandparents on Zoom and them teaching them that the camera actually is pointing at their forehead. Anyway, everybody enjoyed it. Everybody had a good time and that was it. That was pretty good.
My daughter who is now home from college and doing college remotely had a once a week, they get together and they watch movies together. And literally they are all watching the same movie and I am not sure how they’re doing this. I am not sure what the tech is but it is synced. They are all watching the same movie and the video camera is on them to see their expressions and those kinds of things and they are talking through the movie and having a good time that way. You know it is interesting, all of these things that we probably would have told our kids to stop doing two months ago, are great right now.
[0:17:05.8] DU: Right and I think that is important. A lot of time parents will say, “Well, how do I structure today and what do I do?” Those are important questions and I think what’s also important is the mindset, so that we are being flexible. We are creating structure and we are knowing that these are really uncertain times. So what I always talk to people about is really leaning into their values. This is a time where if you want to be resilient, you can really practice that.
And you can show your kids what that looks like. So it might be that you lose your cool at some point and then you say, “You know mom needs to get sit by herself r read a book or take a walk right now." And then you are able to come back and say, “I apologize. You know I lost my cool. I am really trying to be resilient. This is stressful for all of us and this is what I am going to do to take care of myself."
Those lessons, I think we are being forced to really confront our own demons and how we parent. And how we live in close proximity, this is an opportunity that many of us would not have had to kind of be that intentional and get as much practice. So whether we like it or not there really are opportunities for people to be trying to live more congruently with their values and really practice a lot of the things that we think about that maybe aren’t forced to do so regularly.
[0:18:13.6] BR: So Dana, I will give you the last words. So actually what I would like for you to do is you are saying health systems, people in the frontline for now, their organization can sign up for Ginger and make that available to their staff, how can they do that?
[0:18:27.0] DU: Yep that’s right. So we have information on our webpage, ginger.io with all of that information on how those health systems can get in touch with us, what that process is like. We are also offering our in app content to the public at this point. So we are in the process of rolling this out right now, members on our system can get access to things like breathing exercises, meditation practices, activity cards and ways to gain skills.
We are making those available to the public on our webpage as well. So those are some of the ways that we are really trying to meet this need, trying to scale care and help those who otherwise may not have access, really take advantage of our services.
[0:19:05.0] BR: That is fantastic. Thanks for doing that and Dana, thanks for taking the time to come on the show, I really appreciate it.
[0:19:09.9] DU: Absolutely, thanks so much for your time as well.
[END OF INTERVIEW]
[0:19:12.7] BR: Well that is all for this week. Special thanks to our sponsors, VMware, StarBridge Advisors, Galen Healthcare, Health Lyrics and Pro Talent Advisors for choosing to invest in developing the next generation of health leaders. The show is a production of This Week in Health IT.
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