Access and Awareness for Mental Health Support Services

00:00:00:16 - 00:00:35:06
Tom Haederle
It's been about 17 months since the official end of the Covid 19 pandemic, but its effect on caregivers - stress, burnout, anxiety - remains. In Chicago, Northwestern Medicine has created a continuum of innovative mental health support programs that not only encourage its staff to seek out needed help, but also make a point of addressing the stigma that still holds too many caregivers back from taking care of themselves.

00:00:35:08 - 00:01:12:12
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle, with AHA communications. Creating mental health support resources is one thing. Getting people to take advantage of them can be an uphill climb. In today's podcast hosted by Rebecca Chickey, senior director of Behavioral Health Services with the AHA, and Emma Jellen, a former associate director with the American Psychiatric Association Foundation, we hear from Northwestern's chief wellness officer about how his organization raised awareness of access to its mental and behavioral health support services, and what other health systems can learn from Northwestern's example.

00:01:12:15 - 00:01:14:14
Tom Haederle
And now to Rebecca.

00:01:14:16 - 00:01:27:07
Rebecca Chickey
Thank you Tom. Indeed, it's a great honor to be here with Emma Jellen from the American Psychiatric Association Foundation and Dr. Gaurava Agarwal from Northwestern Medicine. Emma, I think you have the first question.

00:01:27:14 - 00:01:49:05
Emma Jellen
Yeah. Thanks so much, Rebecca, and thank you so much for having me here today. Dr. Agarwal, I wonder if you could just, talk a little bit about why and how Northwestern Medicine decided to build such a multifaceted offering of well-being programs and policies that really promote access to mental health care for your health care workforce.

00:01:49:07 - 00:02:08:29
Gaurava Agarwal, M.D.
I'd love to, Emma. Thank you, and thank you, Rebecca, for having me as well. You know, I think for those who don't know, I'm a psychiatrist, and I serve as our chief wellness executive in Northwestern Medicine. And as I took on these wellness roles, I initially sort of ran from focusing on the mental health aspects

00:02:09:01 - 00:02:31:29
Gaurava Agarwal, M.D.
related to wellness, to be honest with you. I really wanted people to understand that we were here to address some of the systemic issues that impact our well-being. And this was before the pandemic. And then as we sort of went through the pandemic, it was pretty clear that, A, some of the systemic issues, were going to have to be put on the backburner a little bit.

00:02:31:29 - 00:02:57:12
Gaurava Agarwal, M.D.
There was too much change going on. To be able to truly do other system redesign in the midst of a pandemic. And B, it was clear that we were seeing all the data that showed the mental health impacts of the pandemic on our health care workforce. And, we have tried to organize our wellbeing program to make sure that folks have resources at the sort of prevention level, you know, hopefully before they have issues.

00:02:57:14 - 00:03:29:00
Gaurava Agarwal, M.D.
But we realized we had to bulk up our resources available to individuals experiencing distress, due to the pandemic, things like burnout, trauma, etc.. And then we also needed to enhance our resources for folks whose distress had actually progressed on to actual mental health conditions such as depression, anxiety, post-traumatic stress disorder, etc.. That was really the genesis of, hey, how do we take a comprehensive look at making sure that the that our workforce has resources available to everyone of those levels?

00:03:29:03 - 00:03:51:02
Rebecca Chickey
I think the last time you and I met and talked, you had six or seven programs that were part of this multifaceted approach. Could you take a few minutes and maybe share with the listeners descriptions of one or two or three of the programs to give them a sense of the diversity and the different types of audiences that you're trying to meet their needs.

00:03:51:04 - 00:04:10:04
Gaurava Agarwal, M.D.
Sure. Happy to do so. And the reason we did that is what we have found is it's hard, even when we do things, it's hard for our workforce to tell us, oh, you guys did that? I didn't know about that. And for us, that is disappointing, of course because if we build them but they don't know about it, no one's going to be utilizing them.

00:04:10:04 - 00:04:32:05
Gaurava Agarwal, M.D.
And so we have tried to figure out what will increase the likelihood of our workforce knowing about things, so that they can use them. And, and for us, one of those things that helps us hopefully have greater penetration of awareness is having campaigns. Right? If we do one thing sometimes that can get lost in the shuffle.

00:04:32:05 - 00:04:55:19
Gaurava Agarwal, M.D.
And to your point, Rebecca, that one thing may be more applicable to one job family or another. When we do campaigns, we're able to have broader communications because maybe not everything will hit you, but at least some things will. And something will resonate or something will say, hey, this is something that I need. And so we said, if we're going to do this, let's, let's try to do a couple of these things at the same time

00:04:55:19 - 00:05:22:12
Gaurava Agarwal, M.D.
so we could truly launch a campaign and raise awareness about how the organization takes mental health seriously, and we support you seriously. So for us, again, using that rubric of wanting to bolster resources in the distress zone, we initially spent, time creating a peer support program. And that peer support program was initially for attending physicians.

00:05:22:15 - 00:05:48:22
Gaurava Agarwal, M.D.
And over time, that peer support program has increased to be available to our APPs, our nurses, our pharmacists and our residents and trainees. And so, as we saw the benefit of peer support and how it can help in someone's really acute time of need, we realized this is a great program for lots of different folks who may experience adverse events or medical errors or near misses at the bedside.

00:05:48:25 - 00:06:13:00
Gaurava Agarwal, M.D.
In addition, we expanded what peer support can support around. And so historically, these things are around those issues of adverse events or medical errors. But we wanted what we were seeing, particularly during the pandemic and frankly, unfortunately this continued, was incivility at the bedside. And so we created a trauma informed peer support program that supported around discrimination and bias at the bedside by patients and visitors.

00:06:13:05 - 00:06:43:28
Gaurava Agarwal, M.D.
And that was a big escalation. And that's, a program we call P2P Safer. You know, it's to provide a safer program, a safer environment for our health care workforce. In that same distress bucket w2e also launched coaching, particularly coaching around burnout, imposter phenomenon, etc., for our trainees, residents and fellows. And that program for us really provided many of the skills that I wish I had had as a resident and fellow.

00:06:43:29 - 00:07:04:11
Gaurava Agarwal, M.D.
You know, the medicine in some ways was the easy part. It's how do you continue to develop your professional identity, how do you balance your work and life in a different way? So that coaching program was something that we're really, really proud of. At the tertiary level, that final level where distress has progressed to disease, we took a nudge from other groups and said, hey, you know what?

00:07:04:11 - 00:07:36:12
Gaurava Agarwal, M.D.
EAP is not enough and you need to look at your EAPs. And so we did. And what we said is, hey, what do we know about how many sessions it takes to improve anxiety and depression. And so we increased, we picked a new EAP and we increased the number of visits our entire workforce would have by 33%, for any incident that they would have, which, to me and my specialty aligned better with how long it generally takes to feel better from mild to moderate depression.

00:07:36:14 - 00:08:01:29
Gaurava Agarwal, M.D.
We looked at the diversity of the therapists that were available to our workforce. Obviously when there is race concordance or ethnic concordance that can be a big increase in the desire for people to utilize the services that they feel understood or they feel like their therapist gives them. And we felt like, our prior vendor, we didn't feel like we had the diversity to offer our diverse workforce.

00:08:02:02 - 00:08:03:22
Gaurava Agarwal, M.D.
And so we enhanced that.

00:08:03:25 - 00:08:30:08
Rebecca Chickey
That's exceptional. I was just going to say, you truly offered the listeners what the definition is of multifaceted. Not only do you describe three different programs and approaches, but then within each program, customizing it to better meet the needs of the type of workforce and, and the diversity of our current workforce. So thank you. Emma, I think you have another question for him now.

00:08:30:10 - 00:09:00:19
Emma Jellen
Yeah. I mean, I was just going to say, wow. Like I've heard you talk about all the work you've done and the policies and systems changes you've made, to really create this culture of well-being and this campaign at Northwestern. But every time I hear it, I remain impressed. And I have to assume that perhaps a listener who has clicked on this podcast has a vested interest or is about to embark or has already embarked on this journey

00:09:00:21 - 00:09:23:19
Emma Jellen
as well. And perhaps after you listing all of the programs there, they might see this as a little bit daunting. But we know that you're not the first institution to do something like this, but we really hope you're not the last, right? So I wonder if you can share a little bit about the journey, where you started.

00:09:23:21 - 00:09:35:24
Emma Jellen
And, you know, maybe put people's minds at ease about the process or at least let them know what they're in for, just so we see more uptick and more implementation and adaptation of things that exist.

00:09:35:26 - 00:10:01:06
Gaurava Agarwal, M.D.
Yeah, I think that's a really good point. And I want to be clear. All these things sound like, you know, you had a master plan when you started, but, you know, we were just putting one foot in front of the other. And the peer support program started off as a single program in a single department. We have a Scholars of Wellness program, and one of our scholars, created a peer support program in the Ob-Gyn department of one of our hospitals.

00:10:01:07 - 00:10:21:12
Gaurava Agarwal, M.D.
That's where this started. And as we learned about the value that peer support can provide and how one would stand up a program in that one department, that one department turned into a hospital. And then as we figured out how you spread to a hospital, that one hospital turned into 11. And that was all for docs and then all the docs,

00:10:21:12 - 00:10:41:17
Gaurava Agarwal, M.D.
we understood what to do for the APPs. The APPs turned into the nurses, the nurses turned into the pharmacist, and the pharmacist turned into the trainees. And so I don't believe in sort of trying to do it all at once, because generally when I've tried to do that, I do nothing. And so I just we just try to continue to, to grow and provide as many resources we can.

00:10:41:20 - 00:11:10:09
Gaurava Agarwal, M.D.
One program that I didn't mention, earlier, that was a big part of this. And if you have to start somewhere, you know, we all have to sort of show utilization, an impact. And the truth is, we can build all this stuff, but people may not utilize it because they don't feel safe to utilize it because, historically, there has been A) stigma, and B) real repercussions for seeking out mental health care, for health care workers that are worried about licensure issues.

00:11:10:09 - 00:11:34:20
Gaurava Agarwal, M.D.
And so, we used the Dr. Lorna Breen Foundation audit toolkit to help change the language on our credentialing forms to make sure that there would be no stigma for seeking out mental health care. And that was in conjunction with the state of Illinois. Also changing, their verbiage on their licensure, because obviously you sort of have to do both.

00:11:34:20 - 00:11:54:03
Gaurava Agarwal, M.D.
Otherwise it's still important to do it locally. But when you have it both, that's when the research shows that our health care workers are more likely to utilize these sorts of resources. We made those changes incredibly easy in some ways. I don't like to say any change is easy, but it was easy in the sense that we had the playbook on how to do it.

00:11:54:06 - 00:12:19:08
Gaurava Agarwal, M.D.
And then we communicated it to folks to say, hey, we're, we're doing things and we're serious about this. And, I think that builds trust, so that the, the other stuff also can be heard in the vein of, hey, you know what? Now I can use that stuff. And so that's where I would say you should always start just because it'll be difficult to sustain other things if people don't feel like they can use the resources that you provide them.

00:12:19:08 - 00:12:47:22
Emma Jellen
So I've had the privilege and pleasure of working with you for about, I don't know, two and a half, almost three years now, longer than that with the center. But, two and a half, almost three years now on, the APA Foundation Center for Workplace Mental Health Frontline Connect initiative. And you know we recently released our toolkit Improving Mental Health Care for Clinicians: Leading Interventions for your Workforce, which you can find at Frontlineconnect.org.

00:12:47:24 - 00:13:24:10
Emma Jellen
But I wonder if you can share and speak to those folks who are like you, who are a leader at a hospital health system or a health care institution who are, you know, a chief wellness officer who are largely responsible for the mental health and well-being of their workforce. I wonder if you could speak to them and talk a little bit about what the toolkit we created together is, and how they can find value in it as they again embark or continue or, you know, this journey to really just increase access to mental health care for those who need it.

00:13:24:12 - 00:13:48:09
Gaurava Agarwal, M.D.
Absolutely. And, you know, it's been my pleasure to work on Frontline Connect. And what I would say is for me in the role I sit, we spent quite a bit of time, I would say over a decade, sort of saying what needs to happen, and why does it need to happen? Action needs to be taking around wellness and mental health for our workforce.

00:13:48:11 - 00:14:06:21
Gaurava Agarwal, M.D.
What I was looking for, and what sort of drew me to the project was how and what. I'm a coach. And so how and what are the questions I care about. What are people actually able to do in the real world? What are they already doing that they've stood up that's making a difference?

00:14:06:23 - 00:14:28:15
Gaurava Agarwal, M.D.
And that's what we try to do with this virtual video toolkit - I just didn't have time to read 300 pages, I just got to be honest with you. I wanted 15 minutes for someone to give me the seed of an idea of a program that they're using, because I can't - none of us, I think, can adopt a program just out of the box.

00:14:28:22 - 00:14:48:16
Gaurava Agarwal, M.D.
We all have our own cultures. We all have our own resources. We all have our own leadership. And so I don't need you to tell me every single detail because it's not going to matter to me. It won't work that way for me. I just need some of the basic ideas of what are sort of these programs that could address "X" problem?

00:14:48:18 - 00:15:18:07
Gaurava Agarwal, M.D.
And once I hear that, I can then take it through my lens and say, for us, we do have this need or actually, you know, we're doing okay on that thing, but if we have that need, how can I take the broad strokes of this program and apply it to my needs here at Northwestern? As you know, we identified the sort of exemplars across the country of people doing programs or having resources that were broadly available that we wanted people to know about, that we wanted to raise awareness about that.

00:15:18:07 - 00:15:39:14
Gaurava Agarwal, M.D.
We get a chance to help our colleagues show up about their programs. And they were really gracious in sharing their programs, how they launched it, some of the key learnings from their launches. And as we continue to record more and more of these video case studies, I found that, hey, you know what? Like, why can't we do four or five of these?

00:15:39:17 - 00:15:56:24
Gaurava Agarwal, M.D.
We're pretty close and we know something about a little bit about a lot of these. And so can we take that next step. And you've heard me talk about the influence of positive peer pressures. I can get competitive. And if I'm like, hey, this other health care system is doing this, why not us?

00:15:56:27 - 00:16:09:00
Gaurava Agarwal, M.D.
That fuels me. And, I believe that if, frankly, I use positive pressure on myself without knowing it. And in a nutshell, to do some of these social programs all at once in the campaign that I mentioned.

00:16:09:02 - 00:16:32:04
Rebecca Chickey
I so agree with you. I love the toolkit. I was honored to be present with the official launching of the toolkit and the fact that you can have digestible, inspirational knowledge transferred to you in a 5 to 10 minute video if they're even that long in some cases. It's just wonderful. And it is the environment that we live in now.

00:16:32:06 - 00:16:58:23
Rebecca Chickey
We are all fast paced and so bite sized learning is wonderful. Now the reason we're doing this podcast: bite sized learning. So as we bring the podcast to a close, this is always a challenging question so get ready. This is your Jeopardy question. If you had to pick, what are the three things that you want the listeners to really lock in on that you've said today, that you've shared today, you know, is it the toolkit that is a phenomenal resource to inspire?

00:16:58:25 - 00:17:06:24
Rebecca Chickey
Is it if you just start at one small unit, at one hospital, you can grow from there.

00:17:06:27 - 00:17:27:22
Gaurava Agarwal, M.D.
I think for me, the first one is sometimes what I hear is people say, I think we're doing alright on mental health. Okay, that's too broad to me. What do you mean by that? Which level of prevention are we talking about? Are we talking about prevention at that primary level? Are we talking about you have good amount of resources at that distress level?

00:17:27:25 - 00:17:52:21
Gaurava Agarwal, M.D.
Have you really checked to see if your folks in your workforce have good access to mental health care for mental health conditions? And how do you know? And so, really assessing current state and the spectrum of needs as it relates to wellness and mental health conditions, I think is important. Because what I think you might find is you are probably doing great in one of those buckets, maybe two of those buckets.

00:17:52:21 - 00:18:11:10
Gaurava Agarwal, M.D.
But I don't know that many people that are doing great in every single bucket and even us, there's still gaps for us. And so you have to know where you're at and where you really are sparse in your resources, because to me that's where you have, you know, the opportunity for the greatest impact. So that would be number one.

00:18:11:12 - 00:18:35:27
Gaurava Agarwal, M.D.
Number two, I'm biased, but I do hope the people look at Frontline Connect. There's a lot of people's good work there. And I believe in acceleration. And, I don't really believe that my brain needs to be that smart. I should be learning from the best of other people. And I think it'll accelerate your journey about the options out there and the places where you may be able to make a difference.

00:18:35:27 - 00:18:52:27
Gaurava Agarwal, M.D.
Even if after you do step one, you say, oh, I think I'm doing okay. Then if you see some of these and issues like, oh, you know what, I actually don't have any of those thing that may actually remind you to take a look at, you know, at the same you don't know what you don't know, you don't know what's out there.

00:18:52:29 - 00:19:12:19
Gaurava Agarwal, M.D.
And so it'll be hard to judge what are some of the gaps with that without looking at some of these best practices? Number three, I would say this is the time. What I failed to mention earlier is we had looked at changing our credentialing language five years ago, and I couldn't get it done. I couldn't figure out how to do it.

00:19:12:19 - 00:19:38:24
Gaurava Agarwal, M.D.
I couldn't really figure out who the players were. I don't know if it was top of mind for people. This is a different time. And so for those of you that have maybe tried some of this stuff in the past and it's been shot down or there's been blocks or barriers, timing is everything in change management. And so this is the time to take a look because what the disaster psychiatrist and psychologist will tell you is that it's not during the pandemic, it's not during a disaster that this stuff matters.

00:19:38:26 - 00:20:20:27
Gaurava Agarwal, M.D.
It's the aftermath where especially the folks that actually experienced and responded to disasters - in this case the pandemic - actually feel it. And long after society has moved on, the folks that actually responded, whether it's military or in our case the health care workforce, that's when these symptoms emerge. And so recovery is needed and potentially treatment is needed now. And so making sure that, you know, we don't get sort of seduced or trapped in this idea of, oh, the pandemic's long over, this is what we know about pandemic recovery or disaster recovery, I should say, is this is the time where those symptoms need to be, we need to be able to

00:20:20:27 - 00:20:25:19
Gaurava Agarwal, M.D.
look out for them and, aggressively provide the resources to treat them because they are treatable.

00:20:25:22 - 00:20:47:19
Rebecca Chickey
The time is now. If there is a sliver of a silver lining of the pandemic, I think it is that it really has opened people's eyes. It's reduced some of the stigma. And it's also focused on the true need for these services across the board, but particularly for our health care workforce who are on the front lines every single day.

00:20:47:21 - 00:21:08:14
Rebecca Chickey
So Dr. Gaurav Agarwal and Emma Jellen, thank you so much for being here today. And then for additional resources from the AHA, go to AHA.org/behavioral health. Thank you for your time and expertise and for the great work that you do each and every day. Gratitude.

00:21:08:16 - 00:21:16:26
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.