Transcription:
The Growing Importance of Behavioral Health in the COVID and Post-COVID Landscape

Intro: The following SHSMD podcast is a production of DoctorPodcasting.com.

Bill Klaproth (Host): On this edition of the SHSMD podcast, we're going to talk about the growing importance of behavioral health in the COVID and post COVID landscape. Our healthcare workers are taking it on the chin. It has been rough. We're talking depression, substance abuse, domestic violence, anxiety. All of this has been exacerbated by COVID. So, what do we do now? And what does it look like in the future?

Well, we're going to find out what Dr. Harsh Trivedi, who has penned an article for future scan 2022 to 2027, to be released later this year. This is a timely and important topic to talk about. And I'm so excited to talk with Dr. Trivedi. So, let's not delay any longer, shall we? Let's get to that, right now.

This is the SHSMD podcast, Rapid Insights for healthcare strategy professionals in planning, business development, marketing, communications, and public relations. I'm your host Bill Klaproth. And in this episode, we talk with Dr. Harsh Trivedi. He is a subject matter expert and author of an article in Future Scan 2022 to 2027 to be released at the end of this year. If you don't know what Future Scan is, Future Scan is a series of publications for healthcare leaders that the American Hospital Association's Society for Healthcare Strategy and Market Development, as we lovingly know, as SHSMD, in collaboration with the American College of Healthcare Executives has published annually. You can learn more at shsmd.org/futurescan. And we're going to talk with Dr. Trivedi about the growing importance of behavioral health in the COVID and post COVID landscape. Dr. Trivedi, welcome to the SHSMD podcast.

And as you know, we start every episode of the SHSMD podcast with Rapid Insights. One quick tip someone can use to make their marketing communications better today. Dr Trivedi, once again, welcome. And give us your Rapid Insight.

Harsh K. Trivedi, MD, MBA (Guest): Bill, thank you so much for having me. My Rapid Insight for behavioral health is that we're at a point right now where every family and every community is impacted by behavioral health. Get to know what your community needs and direct your marketing towards solutions that will impact your community.

Host: Get to know what your community needs. That is so important and then direct those resources to address those issues. Well, Dr. Trivedi, thank you for that. And this is really going to be good. We can't wait to read what you wrote in the upcoming Future Scan, 2022 to 2027. The Growing Importance of Behavioral Health In the COVID and Post COVID Landscape. So, let's start with this, Dr. Trivedi. This is a big subject. Why is behavioral health in the COVID and post COVID landscape so important?

Dr. Trivedi: I think the importance really comes from the fact that as we have all dealt with the pandemic, there really isn't any single person or family or community that hasn't been impacted by COVID, or the behavioral health consequences. And so, even before COVID, we weren't doing great when it came to suicide rates, they were already at their highest in 30 years.

Post COVID, we're seeing opioid overdose rate the highest since that epidemic began in the early nineties. And we're seeing that everyone's impacted by financial stress as well as stress of losing people in their lives or having medical consequences of COVID. And so, whether you're a part of healthcare, whether you're in the general community, regardless of what you do, the behavioral health impact is going to be huge. And it's important because we know of the substantial relationship between overall health and behavioral health.

Host: This has really exacerbated behavioral health issues that were already there. Right? It's just really made them more intense and more worse. Is that good way to put it?

Dr. Trivedi: It definitely has an and we're also seeing people who honestly never had behavioral health issues before, all of a sudden finding it difficult to deal with things and then others who had actually gotten treatment, were doing well, get tripped up after like 15, 20 years of sobriety and all of a sudden, things just got to be too much. The isolation was too much and just dealing with everything that came with it, just got to be too much.

Host: So, I just want to kind of set the table here. When we talk about behavioral health issues then, are we mainly talking about things that we know of, like depression, substance abuse, domestic violence? What else should we know about when it comes to behavioral health?

Dr. Trivedi: Yeah, I think the important thing to keep in mind is behavioral health isn't a vanilla diagnosis in the sense that it makes up a number of different conditions. And what we're going to see is when we talk about chronic health conditions and people think about diabetes, high blood pressure, things of that sort; when we talk about behavioral health, it's those things that happen most commonly, that we're going to see more of in terms of people. So, we're going to see, the most prevalent thing is actually anxiety. We're going to see depression. We're going to see substance use, and then we're going to see mood disorders, thought disorders, PTSD. It's that whole variety of things. And it's really going to be based on the general rates that happen in society and all the time, except we're going to see more people relatively in terms of volume of patients coming out with these concerns. The general proportion will be pretty similar.

Host: I think, and this is my own opinion, we were starting to be more open to people discussing mental health issues. And then most recently with some of our sports stars at the time of this recording, the summer Olympics are on, and everyone's talking about Simone Biles and mental health. And that has become a topic, certainly that a lot of people are talking about. And it really is, I think opening up a lot of people's minds, if you will, to the struggles of mental health and how it's okay to talk about it. Probably many years ago, you would never mention it. But now I think it's okay to talk about mental health as part of your overall health and not just your physical health, but your mental health too. Do you think we're finally starting as a society to understand mental health is quite frankly, just as important as physical health?

Dr. Trivedi: I think we're definitely getting there. You know the thing that I would say, and I think the phrase is actually is great as really it's okay to not be okay. And whether it's the Simone Biles. Whether it's Michael Phelps, whether it's a number of athletes that have come out across sports; what they're showing is even the people that we perceive to be most athletically competent people that are competing globally for different things, they too are impacted by things like depression and stress. And I think the nice part of what I will say is generally within the workforce, the younger generations, generation Z, not only are they comfortable talking about it and admitting what's going on, they actually come to the workplace really expecting that their employer is going to help take care of their mental health needs. And I think that's definitely changed the conversation.

And also I think created space where it's okay to say that without having impact on whether you have a job or what does that mean? I will say, every family is impacted in some way by a mental health issue or condition. Simply it's just that because of the stigma, people haven't talked about it I really do hope we are at a new chapter where it's okay to talk about it. And more importantly, we help people that are talking about their difficulties in the same way that we would help someone who comes out with a cancer diagnosis or is dealing with any other health issue.

Host: Right. It's okay to not be okay, that is a great way to say it. And when it comes to our healthcare workers who have been on and still are on the front lines of COVID, do you think they'll be getting the behavioral health care they need?

Dr. Trivedi: Yeah. I think what differentiates our experience with COVID is when you're in healthcare, you know, you're going to be doing life and death work. What made this different is usually when you come to the workplace, the life and death that you're dealing with is someone else's. This is, I'll say first time, in terms of a large population of healthcare workers going into work, and you're worried about your own safety, whether it was access to PPE or how exactly does COVID get transmitted. The fact that you saw your colleagues contract COVID, die of COVID. And that was just part of the regular, everyday activity of going to work. That was a different kind of vulnerability that, that honestly, most of us in healthcare aren't used to.

And what that's led to is I will say a lot more anxiety, stress, trauma. And the interesting thing about the body is, you know, we have our fight or flight response. We get through these things and we've battled for the last 15 months. And it's finally that moment where you think you have a moment to breathe, maybe COVID is taking a pause. And although things seem to get better, that's when it all hits you. And so oddly enough, we're seeing a lot more of that. And I will say at the time of this taping, we are seeing the increase in the Delta variant. And I can tell you, there's kind of this gut check that's happening across health care right now because people are basically saying, they're dreading having to go through another wave of COVID. And I think these are all things that will have lasting behavioral health impacts. And honestly the best way to prevent it is that we have to support our folks right now in the moment, and do everything that we can first of all, to prevent issues, but more importantly for those and we know it's going to happen that have things like PTSD come up, we have to provide them the right care and the right support, so they can keep on working.

Host: That really puts it in perspective. When you talk about nurses going to work, of course, they chose this profession. They know that they would be in situations where they would see other people in life or death situations, but not themselves. But now it is for themselves. I'm worried about my own health when I go to work and I'm seeing my coworkers contract COVID and die, I'm scared for my own health. And what that means for my own family. So yeah. You talk about stress producing. And how anxiety could play into that. Oh my goodness. And then the second wave you take a deep breath you yeah, ah, man, okay, we made it. And then all of a sudden, kabam, here we are again. Oh my gosh. I can't imagine what our healthcare workers are going through and knowing that they are going through that Dr. Trivedi, then, how do we help these people? What does the C-suite need to understand about behavioral health in the COVID and post COVID landscape and what should they do? How should they equip leaders to identify behavioral health needs in their staff before they become so critical?

Dr. Trivedi: The biggest thing I would say is, you know, we, in terms of healthcare C-suites, we've done a great job of thinking about, and we have a good global supply chain for PPE. Do we have enough ventilators? We put in a lot of work on those plans. We haven't done the same level of homework as it comes to are we taking care of burnout within our staff. Are we doing the right things to afford access to the right behavioral health services? And I think now more than ever, that importance of mental health in the workplace really comes to the fore. We're seeing already people are choosing to retire early or even leave the field because they don't want to go back and do one more shift, which is a cope shift. Right? And so I think organizations need to be intentional about how they plan for supporting their employees and I will tell you that EAP model of old, simply doesn't do it. Talking, calling up a random person, doesn't help enough. There has to be something above and beyond that. And because of the stigma, we also need to make it so that it's okay to bring up these things and to talk about these things. As well as similar to Simone Biles, there are days where someone's going to say, you know what, I know that I'm on that shift, I'm just mentally not in a state where I could possibly go in.

And we need to be able to respect that. And cover for each other and make those things happen. And I think the more rigidity that we have, the less we're able to flex to meet the needs of our employees or support them in the right way, it will impact our ability to keep operations going. And the last part of what I would say is just as behavioral health, when we talk about employees, different people need different interventions, to either feel comfortable or feel better. And so in terms of, when we're thinking about the solutions, a one size fits all solution, isn't going to work for every person.

And that's where we have to get nuanced into how can each person get the right help that they need? And it has to go beyond what we've done traditionally. And one of the biggest things we lack is access. When that person needs help, can they get help today? And most health systems still struggle with that.

Host: So, that makes a lot of sense. Everybody is different. So, we need to meet the individual needs of our healthcare workers. How do we do that? How do we meet the individual needs of our healthcare workers? How do we put a plan like that in place?

Dr. Trivedi: You know one of the biggest things that I would say is, first we have to create the time and the space for healthcare workers to be able to do kind of that self-check, that barometer within themselves that says, how are you doing? And so whether it is simple evidence-based scales, which help people kind of figure out how stressed are you? How depressed are you? How are you feeling?

It's a little bit of screening. And then as people screen, there are things that I will say of the healthcare worker is savvy in the sense that, you can provide education, information, you provide time, you may be able to help a lot of people deal with what's going on around them. The next step of that is there are going to be people who will require some type of a clinical intervention.

And I will say, simply being able to get together as groups of healthcare professionals, and I, I've seen this happen across multiple states now. Where it'll be a group of nurses that get together and talk about how difficult things are or what they're doing to cope. That group experience can be incredible for them. For some folks it's going to be more than that support group, which can be either individual therapy or medications for some, but I think, it will be one of these things where, whether it's a app as a solution or talking to a therapist as a solution, or doing something truly on one's own, or just getting better information about how to turn your mind off when you're not at work or how destress, or I think all of those things are important. And I will say beyond the clinical frame part of what made COVID particularly difficult is reconnecting with family, with support. The things that you looked forward to in life and how do you help incorporate those things back in so that there is a balance between work life and home life. And there is things that you look forward to beyond your next shift at work. And I think all of those things come together where it's family, it's faith, it's everything in terms of community. And how do we keep those things going even if there's another wave of COVID that happens in our community?

Host: That's a good question. How do we keep those types of things going through this current new surge. And if there is another one in the future. Let me ask you this, Dr. Trivedi, there are some in our society that are questioning. We were just talking about Simone Biles saying, oh, she's a baby. When I'm sick, I go to work. She just needs to tough it out. Forget about this mental health stuff. When I have a problem, I just keep going. What about people that say that, yeah, this whole mental health thing is overblown. You just got to pull yourself up by the bootstraps and just keep working through it. What about people that say those types of things when it comes to mental health?

Dr. Trivedi: I think it's the combination of things. First thing I would say is, as we progressed through time, we learn more. So, we used to think the boxer that keeps on getting hit in the head, but keeps on going back into the ring, was stronger, braver, smarter. And then we came to find out that, that boxer developed concussions that led to all kinds of other problems, right? And so there is a price that you pay when you keep on going. And I think the second part of this is sheer, just understanding what's going on. I think we have a lot of euphemisms. Or, you know, just dumb comments that we make about, well, you know, just pull yourself up by the bootstraps or and I think the difficulty here is, depression is just as real as a concussion, is just as real as cancer. And it takes a toll on a person. And whether that toll is thoughts of suicide or not wanting to continue in your life. One of the interesting things is, across the world, depression and anxiety are the leading cause of people being unable to work. And the global impact is about a trillion dollars a year, in terms of even people that show up to work, if you're not mentally there, it's called presenteeism and I guess the comment I would make about whether it's Simone Biles or any other athlete; there's a point to which your body can physically and mentally take the toll and the stress of being in that role. And there's a certain point at which going any further, may cause irreparable damage or very much may cause damage that's going to take years to undo. And honestly, for each individual, they need to make that decision of whether it's worth taking on that hit and I would say give Simone Biles a ton of credit for realizing, maybe it's not really worth it. And I think that we should respect that in as much as we may respect the football player, that's gotten a concussion that says, you know what, I'd rather retire a few years early and have my cognitive abilities left for me to be able to live the rest of my life.

Host: Absolutely. And as far as Simone Biles goes, for the naysayers who are putting her down and calling her weak and a baby and are criticizing her for not just pushing through it; guess what. You're not twisting 14 feet up in the air doing somersaults. And if you land wrong, you could break your neck. So, let's remember that, before we start criticizing her for having some kind of a mental condition where she can't perform right now. So, let's not knock her for that. This is a gold medalist. She should be earning our praise right now, not our criticism. Well, this has really been fantastic. Thank you so much. And we look forward to the article in Future Scan. Once again, thank you so much for your time. We appreciate it.

Dr. Trivedi: I think this has been a great conversation. I think the upcoming Future Scan article has so much more information that is practically helpful. I will say, it's just been such a pleasure speaking with you. And this has probably been one of the more fun podcasts I've done. Thank you so much for putting this together.

Host: Dr. Trivedi. Well, thank you so much for that. It's really an important topic and I'm thrilled that we're talking about it and I can't wait to see what you write in Future Scan 2022 to 2027. It's going to be released at the end of this year, the Growing Importance of Behavioral Health in the COVID and Post COVID Landscape. Dr. Trivedi, thank you again. We appreciate it.

Dr. Trivedi: Thank you so much and have a great day.

Host: That's Dr. Harsh Trivedi. And you can learn more about the upcoming Future Scan at shsmd.org/futurescan. And if you found this podcast helpful and of course, how could you not please share it on all of your social channels. And please hit the subscribe or follow button to get every episode. This has been a production of Dr. Podcasting. I'm Bill Klaproth. See ya.