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CEO Roundtable: Mental Health

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Springfield Business Journal Editor Eric Olson sits down with Debora Biggs, CEO of NAMI Southwest Missouri Inc.; C.J. Davis, CEO of Burrell Behavioral Health; Clay Goddard, director of the Springfield-Greene County Health Department; and Brooks Miller, CEO of Jordan Valley Community Health Center, to discuss how mental health challenges affect businesses and the community.

Pulse check
Eric Olson
: What’s the first word that comes to mind when considering the state of mental health?
Clay Goddard: Stigma. People are, in general, very uncomfortable talking about issues that revolve around behavioral health and substance abuse. 
Debora Biggs: Frustrating. Working for a nonprofit, a peer support agency, we’re working with the individuals on a one-on-one basis who are trying to access that system, and even for us helping them, it is so frustrating to just find the help. Then when we do, it’s long waits for individuals.
C.J. Davis: I’m going to pivot and say encouraged. One of the things that I often say when I talk about mental health issues, and it does go back to stigma, is that we have more people accessing mental health services than ever before. So, yes, a stigma does exist, but you’ll see anywhere between 20 to 30 percent more folks walking through the doors of mental health centers than ever before. Even though it is a daunting and frustrating thing, I’m encouraged by the fact that more people are talking about it than ever before. Has SBJ ever had a segment like this on mental health?
Olson: No.
Davis: I’m extremely encouraged by where we are as an organization, as a community.

Olson: Why are the rates up – why are more services being administered to meet mental health needs?
Davis: We have become way better at understanding what depression is and what depression isn’t. It’s not necessarily increasing, but more people are talking about it. Suicide, on the other hand, we have seen a mild uptick.
Goddard: Certainly there does seem to be more awareness, and in a connected world, there seems to be even more anxiety than maybe there once was. For people who are seeking outpatient mental health services, the top two issues are depression and anxiety. I don’t know if it’s that connectivity, but I think that plays a role.
Davis: Depression, anxiety and substances are the three leading causes of referrals in the community mental health world.
Biggs: Those are our most sought-after support groups.
Olson: The connectivity, to clarify, that you are referring to, is it a social media aspect?
Goddard: I suspect that plays a role.
Biggs: Our concern, too, about the social media, is that it’s also leading to higher isolationism, which leads to a lot of different things.

Changing tides
Brooks Miller
: You talk about the stigma, and I’m not certain it’s still the same. I believe that (post-traumatic stress disorder), for instance, is much more accepted than if you talk about addiction or if you talk about depression. Right now, we’ve become somewhat understanding of the fact that there are a lot of people who have engaged in trauma in their life, whether military, crimes or whatever. And now we have sympathy for PTSD, where we probably didn’t have it after the Vietnam War. That resonates with the shift that’s taking place toward greater acceptance.
Goddard: We’ve got to get beyond this thought that the brain is not an organ of the human body. If we see someone who is having a cardiac event, we step in and we try to help. If we see someone in crisis, we’re more apt to try to keep them at arms length. What you do at Jordan Valley, with integrating behavioral health with primary care, is the right approach.
Miller: There is a still a stigma about people who come in for no reason at all and continue to be depressed and withdrawn. That makes it a big challenge in the diagnosis and treatment … because if it’s directly related to a trauma or a traumatic event, you probably have a better idea of medication or counseling.
Davis: Trauma is something that happened to you, and we can sympathize with that. Whereas, still in our world today, if you or I are depressed, somebody says think your way out of it or suck it up.
Biggs: Go exercise.
Davis: But if you’ve been traumatized, that’s another thing. You’ve been a victim. Sometimes, people don’t realize we’re a victim of mental health, as well.

Getting help
Olson
: Everyone has a bad day. For me personally, I’ve never struggled with depression. Until this past year, I never would have said I’ve felt depressed. But maybe two or three times this past year, I have. At what point should you turn to somebody and say, “I think I might need some help”?
Davis: The moment in time that you wonder if you should access care is the moment in time that you should access care. Because here is what we know: Fifty percent of adults who need service don’t seek it. Fifty percent of people who have a suicide attempt do not have a diagnosable mental health condition. If you, for example, were limping for two weeks, you’d probably go to a doctor to find out what’s going on. But we still get into a situation where we experience some mental health difference in ourselves, and we still don’t access care in the way that we should.
Goddard: There’s people who know you well, and they probably noticed that something was off. We tend to be, as a society, reluctant to talk to people about those sorts of issues. A couple of years ago, I was lucky and got selected for a cohort of public health officials that got to go through a mental health first aid course. I was really skeptical going in, and it really changed my perception on how you should work with your family, with people you work with, when you notice something is off. I believe in that approach so much that we’ve had every one of our Health Department staff members go through that training.
Olson: Is this something offered locally?
Goddard: It is. It’s offered through Community Partnership of the Ozarks, and they have periodic training.

Problem solving
Olson
: How do we fix this? What are the challenges you are up against?
Miller: It’s workforce in my opinion. We have been fortunate that we’ve received a lot of resources that have come out at the federal and state sides. There’s an ongoing battle. I think, for staff, and it’s just a real challenge when there is so much need.
Biggs: It’s workforce, but it’s also facilities – having enough beds and places that people can go when they need longer-term care. There’s not enough of that right now.
Davis: We steal each other’s staff. We have 267 open positions right now, and we can’t hire fast enough. I think it is workforce, but I also think we need to eliminate some of the barriers that get in the way of accessing mental health services. Missouri just passed a law that will allow places like Burrell to provide telehealth services in their homes on their iPad. We go where people need us, not where we hope that they will go.
Olson: Is telemedicine already happening as a means to treat mental health patients?
Davis: Yes, we have telehealth providers. We have an app out there called myStrength, where anybody can get online, monitor their mood and get education regarding their diagnostic condition. This isn’t new to Burrell; this is in health care all over the place. You have to find ways to be on the mind of the prospective patient at all times, not just when they walk through the doors for care.
Miller: The challenge with behavioral health is not like you come into the dentist’s office and get a tooth pulled. You bring a child in and counsel with them for 50 minutes and return them to a home that’s filled with adversity. You negate almost the whole 50 minutes. That’s when you go to treat the whole family. It’s a different methodology.
Davis: That’s why I think it takes a village. It needs a partnership between every set of eyes that are on that kid.

Employers’ role
Olson
: You’re casting a very wide net of care. How can companies step forward and be a help in this situation?
Goddard: We’re sitting on near-record unemployment rates. If you look at employers, they are struggling to fill their shifts, especially if they are doing a pre-employment drug screen. I’ve also heard anecdotally of businesses here in town that will do a random drug screen on one of their shifts, and 20 percent of the shift workers will fail. We’re going to have to find solutions where we just aren’t saying, “You failed, bye-bye.”
Biggs: There are some simple things that employers can do. First of all, they just become educated about it and understanding what some of their employees are going through. There’s one example [of an employer] that came to us and said, “We need to have a better understanding of what mental health is and what mental illness is.” They called last week: “We’ve got an employee here who handed us a suicide note. What are the steps we need to take?” They are working with them and helping them be successful.
Davis: As a treatment provider, but also as an employer who employs 1,500 people across 17 counties, first of all, I need to know the impact that mental illness has on my workforce. How does that impact absenteeism? Productivity? Turnover? The second is to break the silence. To make sure, as an organization, you really create an accepting atmosphere of mental health issues, whether that’s starting an (employee assistance program), whether it’s spending a lot of time regarding the culture or whether that’s creating things such as a mental health day.
Miller: Where do you think we lose more productivity? The person with the swollen ankle that sits out for two days or a week or somebody who is deeply depressed?
Davis: If we recognize it, then we say we’re going to discipline you. If there’s a job you have to do and you can’t do it, you’re out. That’s the difference between some employers. How is it that they embrace this issue and convey the message to employees that we are deeply committed to you as not just an employee but as a human that’s valued in our workforce? That takes a pretty significant shift.
Olson: How many employers locally are embracing that?
Biggs: There are two that we work with specifically on that.
Davis: I would say it’s pretty small. The resources are there; the problem is people don’t know where to start.

New norm
Miller
: Is there a cure for behavioral health and mental illness? I think there’s different levels. Slight-to-moderate depression people can (utilize) self-help ideas.
Biggs: There are ways to manage it.
Miller: Some of the more difficult, any kind of mild bipolar or anything like that, is going to be maybe a lifetime issue.
Davis: We have peer support specialists, somebody that is really valuable as an employee. We have about 20-25 of these people who are in recovery – think about addictions – who have had a major mental health issue and received treatment and are now working. These folks are great workers. That’s just like saying to yourself, because you are depressed can you be a parent? I know great parents who are depressed.
Miller: The reality is, once again, our health plan doesn’t promote behavioral health or mental wellness nearly as much as it does for physical health. We, as employers, have not recognized the value or brought it to the level of concern.
Goddard: If it was diabetes or (chronic obstructive pulmonary disease), we would cover that without question.
Davis: Even places like Burrell, when I first got there, and I’ve been there a year, we had no EAP for behavioral health. And we’re a treatment provider.
Olson: What are the cures? What are the treatments?
Goddard: I want to get to these families where these adverse childhood experiences are happening and, to the best that we can, mitigate. That’s challenging. That is where your money is best spent rather than dealing with these issues after they have manifested.
Davis: The definition of recovery is important. Are you taking about an absence of symptoms? It clearly depends on the diagnostic condition. Most treatment involves some combination of medication and talk therapy. What we do know is that people can live extremely productive lives with mental health issues. Mental health is not a cancer diagnosis.
Biggs: Recovery is different for everybody, too. You’re talking about peer support, talk therapy, medication and we have a lot of people who find recovery through doing art, poetry, music, mindfulness, meditation – and it’s kind of whatever works.

Funding shortage
Olson
: Is there enough money to address these issues?
Goddard: No, next question. There is never going to be enough money. You have to work as a community to own this issue as a community and identify where your biggest opportunities to impact these situations are and then work collectively.
Miller: We live in a very reactionary society. It’s only when it becomes a crisis do we say, OK, it’s the time. What’s going to be the crisis in 10 years? Let’s prepare for it. All cures are local.
Davis: We just don’t put money into the wellness prevention side of mental health. Name the last time you took your kid for a psychiatric well check. We just don’t invest in that, unfortunately.
Olson: The last thought is from Brooks’ mouth. You asked, “What will be the crisis in 10 years?” Can you attempt to answer that?
Davis: We will talk about the geriatric population and how we have a lack of psychiatric and behavioral health services for them.
Miller: I agree.
Goddard: Aging and chronic disease are the two things we have our eyes on. We eat too much. We drink too much. We take drugs too much. As a result, we’re seeing lifespans shorten. That’s a big concern for us in public health.

Excerpts by Features Editor Christine Temple, ctemple@sbj.net.

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