Mental Health During the COVID-19 Pandemic Podcast Transcript

Transcript

As the pandemic continues Allina Health admin believes we need to find ways to safely coexist with COVID. I’m Tom Lindquist, and today I’m talking with Cara McNulty and Mary Beth Lardizabal. First, let me let you introduce yourselves. Cara, if you can go first?

Thank you, Tom. I’m Cara McNulty and I’m the President of Aetna Health Mental Wellbeing. And in the role, I am responsible for the clinical outcomes for behavioral and mental health. As well as our employee assistance program that serves in totality, between the two pieces of work, serves about 25 million members every year.

Thank you, Cara. Mary Beth?

Yeah, hi everybody. I’m Dr. Mary Beth Lardizabal. I am the Vice President for the Clinical Service Line Mental Health and Addiction, for Allina Health. So, I oversee all mental health along with my great team of leaders for the whole system. From inpatient to outpatient clinics, the whole continuum of care.

Thank you both. This is an incredibly important topic. A lot of news and activities has been directed on how to prevent this but we’re not spending enough time, in my opinion, on the impact to behavioral health. So, we’re seeing spiking stress and anxiety in a lot of people. So, Cara, can you talk to us a little bit about some of the causes for this and some thoughts around those?

Sure. So, if we think about what has happened over the last months I mean, we know that anxiety, stress, depression, is continuing to be on the rise. But what we’ve seen in this unprecedented time and uncertain time is, that this transition home, the change in our work-life balance, the insecurity of jobs whether it is will I keep my job or will I be furloughed, has caused a dramatic increase in stress and anxiety. When we look at our overall Aetna book of business, we’re seeing an increase in above 55% in just reported stress and anxiety. When we look at what people are reaching out for services regarding, it might not present itself as I’m stressed, or I have anxiety. It might start as I’m worried about a financial issue and I need some help or counseling. And then, as we’re unwrapping that we see you know, there is, people aren’t sleeping, there’s added stress, there’s depression taking place.

So, we see it coming from all angles. The other thing that we see is, people are focusing on their basic needs before they’re getting care. And so, when you think about the transition that has happened as we’ve all moved home, and working at home, or our kids are at home, etcetera; people first focused on their basic needs. And so, we saw a big spike in people reaching out because they needed help with daycare, and how do I do online school? And then, it turned to more finances, how do I pay my rent? And then, food insecurity. And now, we’re at a point where people are going through this pandemic long enough that they’re seeking support. They’re saying, I think I need help. I am at a point that this is more than just lack of sleep or stress. So, we’re seeing this grow, we’re seeing this increase, and we’re seeing it across the continuum of populations from young adults and adolescents through to seniors.

Mary Beth, what about from your perspective?

Cara’s right on the money. I think you know, the interesting thing as we look at the evolution of the pandemic is, really to me, I see it as like an acute stress response. So, you had that first month of lockdown and as Cara talked about, we really focused on our basic needs, our animal body, are we going to have enough to eat? The fear. You know, when you think about an acute stress response the first thing you have is fight, flight, or freeze. And everybody was kind of fighting for resources. I’m going to run to the store and guess what, someone’s getting toilet paper? I’m going to get some too, they must know something I don’t. So, the level of panic was like I have to take care of things. I don't know if I'll get to the store again. So, there’s that fear, and managing, and worrying you know, walking outside. What does that – I mean, we didn’t even know the characteristic of the virus that was attacking us. And it was like an enemy. It was like a war that was invisible. That type of response is totally normal in that situation. This is not a normal situation.

But then, as we got our needs met and we’re able to settle, able to calm realizing okay, we have some things we can do to prevent the virus. And that’s one thing I think is really important for people when they have this sense of anxiety, what can you control? And as the pandemic continued, we knew that washing your hands was effective. That wearing a mask does help. So, we were able to kind of step back a little bit, our anxiety came down, and then we started thinking about other things. And then, we started noticing other things. Okay, I have enough toilet paper, I have enough food, but I haven’t got to see my grandmother who is in the nursing home. My kids have been in lockdown with me in my house for weeks, and weeks, and weeks. So, how do we manage that?

That’s a great segue. So, your question, how do we manage that; I think about it through the lens of what the health plan can do. But then, also, through CVS Health and Aetna. So, Mary Beth, what resources currently at Allina Health to help with mental wellbeing?

Well, the great thing about Allina health, I really do believe this, is that we’ve always put an emphasis on mental health care. That is one thing Dr. Wheeler from the CEO on down said that mental health is so important, and it affects everyone. So, we have a full continuum of service in it. And we have really increased our services to be more emergent access to care. We have emergency appointments, we have hotlines. One thing that we’re particularly concerned about is making sure that all our healthcare workers have access. Because they’re going to be the ones, I think, greatly impacted over time with this continued care, and the demand on our hospitals, and our mental health workers. So, we have a peer to peer support group and a referral to appropriate mental health services. We have services for all our employees. We have resources on our AKN, lots of different ways in terms of how do you learn coping skills, how do you talk to your kids about the Coronavirus? We have two websites, and I’m a child psychiatrist by training so this is really important to me, how do you talk to your kids about the virus? How do you talk to them about the fact that they can’t go to prom or they can’t go to graduation?

I mean, these are the things that we started realizing. I think in the acute phase we thought oh, you know, we’ll do this for a month and then we’ll be fine, and then we can go back to normal. And then, we realized no, this is going to be an ongoing pandemic until maybe we get a vaccine, maybe we get our numbers down. So, we’re just trying to make sure that we increase our access to mental health to everyone.  

Kara, what about the resources that CVS Health has available?

Dr. Lardizabal just absolutely nailed it looking at addressing across that continuum; we are taking that same approach and making sure that we’re meeting people across their needs and in their time of need. So, for our own employees, we are focused really intently on burnout, resiliency, mindfulness, and making sure they’re getting their access to care. Because we know as providers it’s easy to put off our own care. For the public that we serve, very similar as well looking at how do we ensure people have the appropriate resources. So, we have a microsite available at AetnaHealth.com that is full of information. But not just broad information, it’s really curated information that’s helping people through that process of fear and fight and flight. And looking at okay, how do we support, as Mary Beth said, adolescents, young adults, essential workers, healthcare workers, and think elderly. So, really curated materials. We also, across the country, since the beginning of the pandemic, liberalized what we call our resources for living line, which is an expanded EAP offering for anyone in the United States. And what that does is offers confidential free care that helps someone navigate not only their mental health needs but also their social determinants. 

So, maybe you’re trying to find that toilet paper, or needing access to a food shelf, or worried about paying your rent; this online telephonic resource that we provide offers that support and help. And that line is getting utilized every day. We’ve served thousands of customers and people who aren’t our customers as well. The other thing we’re doing is, a lot of webinars, on-site debriefing for employers. So, some of our large employer populations were doing debriefing and counseling sessions for their essential workers, as they continue to go into work and serve the needs of many of us and millions of Americans. And then, we’re also doing things, because we believe that healthcare providers are so essential to getting us through and beyond this pandemic, we are doing specific partnerships with organizations like Give an Hour. Give an Hour is a non-profit organization that offers free counseling services for any healthcare provider. And we’re doing this service because what we know is our healthcare providers often don’t seek service, or don’t want to go through their own insurance because they're worried about stigma.

So, we have a lot of efforts going, we are casting the net wide. And just like Mary Beth talked about you know, one of the things I would say that CVS Health, Aetna, and Allina have in common and just coordinate is, Dr. Wheeler’s total understanding that we have to look at people within the community holistically and addressing them in that social determinants, as well as mental health aspect. So, lots of good work, lots of good partnership.

I couldn’t agree more. Mary Beth, as we think about this, help us understand what some of the behavioral health warning signs are that we should be aware of.

Sure. You know, I think it’s different for everyone, but I really think, what I look for when I’m with my patients or with my employees is, I worry – and actually, it’s very similar to burnout. So, when you think about acute stress, you have this fight or flight, you do something. But then, the situation doesn’t change, the stress continues. And at some point, you kind of hit a wall, you become emotionally exhausted, you start to withdraw, you start to disconnect. You might notice that their behavior changes. Or, I start asking about sleeping. Because people are waking up, they're worried in the middle of the night about COVID, they’re worried about their finances, and they just are fatigued. They might start to have kind of a pessimistic or hopeless attitude, right? They’re kind of giving up, they don’t know what to do next. So, I always – and I ask obviously about mood. But sometimes it doesn’t look like sadness. This is important, that a lot of people think that even depression is just sadness. Well, it’s actually quite often irritability. So, when you see people really start to be irritable or have what you know, what we might call a short fuse, then I know their stress level is getting unbearable. So, then, I would try to start to intervene.

So, are they doing their regular activities? You know, they’re not enjoying things the way they used to. They used to always go out for a walk and now they don’t. They can't get out of bed in the morning. They’re not getting to work. With kids, they’re stopping connecting with their friends on video games. So, all these things that change from their normal activity.

That’s a great insight. So, the last question for both of you, Cara I'll start with you, and it’s open-ended. And the question is, what is your best advice for coexisting with COVID-19?

You know, I think it’s easy to say we need to remain hopeful, but we have to do that in action. And so, one of the things that we do a lot of focusing on with our own employees and with our provides is not only to talk about hope and resiliency but to show signs. And to show positive things that are happening within the healthcare system, withing communities, within – those small wins. Because otherwise what we can hear as humans is this isn’t getting better, we aren’t making progress, when is there going to be a vaccination? So, we focus on hopefulness and building resiliency. The other thing that we continue to do is to talk about what is there to look forward to and what are we striving towards? And although COVID has really changed and caused a lot of negative things to happen, and grief, and loss; we’re looking at what are the positives that are coming out of this? We see that mental health wellbeing is being talked about more than it probably ever has. You can’t open a newspaper, look at an article, have a conversation without it coming up. So, we’re using that as a hopeful action that will continue that momentum. 

We also are highlighting the fact that people are receiving care in ways they never have. And can we take this time to look at how we transform care in a way that reduces the barriers and access? So, we’re focusing on the positive, we’re focusing on helping people look forward to what’s coming, and really trying to damp down that this is going to stay like this forever. Because what we know in life is it’s impermanent and this too will change. 

Great. Mary Beth?

You know, to me, and Cara said some of this, but it’s really important to take a step back and accept things as they are because this is not going away. I think initially people really had a wish that it would be over and now, we’re realizing it’s not. And that’s what causes some discouragement and hopelessness like Cara was saying. But the reality is, is that you have weathered bigger storms. I mean, we have done things, we can move forward. I think accepting things as they are and then making some decisions about your life. What do you want to do? How can your life have meaning and purpose when our schedules have been turned upside down, our kids aren’t going to school? So, I think it’s time for a bit of reflection and to get in touch with how we feel about it. I think what we don’t want to do is we don’t want to act like it’s no big deal and we want to kind of minimize what’s happening. This is a huge change. This is something that none of us, almost none of us have ever experience this. So, it’s okay not to be okay. And guess what? Everyone else is having the same experience.

So, connecting with other people to talk about the experience; what is it like for you? How can – and we’re so more similar than we are different in this. Connecting socially, which is one of the things that I think is so interesting about this, one thing that we’ve learned from this pandemic is maybe we were too busy. Maybe when we slow down we actually have a quality of life that’s different, that we enjoy. And we didn’t even realize what we were missing. And some of these very small things, having a little bit of time with your kids instead of rushing out the door is a great gift to have. So, taking the time to notice these small things and to just – you have now the ability to create a new self, a new schedule, a new way of being. And I think that is an opportunity – and maybe we’ll talk a little bit more about how healthcare has changed because of this pandemic because there is great opportunity with the way virtual care has developed. But I think there’s also great opportunity for how we structure our lives and what we see as important. And we know now that maybe I’d like to spend more time with my family, I’d like to spend more time outside. And these are all really things that we’re going to take with us past this pandemic, I think.

Those are great responses from both of you, thank you. And I love that it’s okay to not be okay. So, that’s the end of the questions. I just want to thank you both for your thoughtful responses and insightful answers to those questions. So, thank you very much.

Great, thank you.

Thank you.