Changing the Conversation Around Mental Health and Wellness at Work [Podcast]

This transcript was edited for clarity.

Dr. Betsy Shapiro: Welcome to the American Dental Associations practice podcast, Beyond the Mouth where we won't discuss clinical dentistry, but everything else is fair game. I'm Dr. Betsy Shapiro, a director with the practice Institute of the ADA. In this episode, we're talking about keeping you and your staff mentally healthy during COVID-19 and any other time. Joining me is Alexa James, the chief executive officer at NAMI Chicago. NAMI Chicago is an affiliate of the National Alliance of Mental Illness. Its mission is to improve the quality of life for those who are affected by mental health conditions. Ms. James earned a bachelor's degree in psychology and a master's degree in social work from Loyola University, as well as a second master's degree in child development from the Erikson Institute. Hello, Alexa, and welcome to our show.

Alexa James: Hi Betsy. Thank you for having me.

Dr. Betsy Shapiro: We're delighted to have you. This is a very stressful time and we are so fortunate to be able to spend a little time and chat with you about it. To start, can you tell us a little bit about NAMI Chicago?

Alexa James: NAMI Chicago is an advocacy organization. We do not really provide direct service, so we're not doing therapy or psychiatry, et cetera. What our hope is, is to connect people to care and with the least amount of trauma. The mental health system is super complicated. It's so complicated in fact that you really need a broker agency to help you navigate the system, which is a problem. So a lot of our work is to advocate for a more equitable system that has more access, less expense, but also to make sure that people feel safe and comfortable seeking services. There is so much stigma surrounding mental health still. I do think that COVID-19 has actually really changed that conversation, which is a little bit of a silver lining of all of this. And we do so by connecting people through our helpline, support groups, the tremendous amount of training and education and really corporate wellness right now is at the core of our work.

Dr. Betsy Shapiro: Let's start out this conversation for dentists on a big topic. What is the baseline for most people? In other words, what does it mean to be well? 

Alexa James: I love that question. And it's interesting. It's being asked more. It never used to be asked. And I think that is because we all understand that mental health is a component to us daily, that it's no longer this like, Oh, some people are impacted like come on. Our brain is connected to our body, but our relationships are connected. So it's interesting that you asked about foundation because foundations of your mental health will change throughout your life and change depending on what your environment and experience looks like. But generally mental health or wellness looks like having functioning relationships where there's reciprocity. Now listen, some people really want to be alone and that's how they energize and that's fine. I have a lot of friends who are like, I don't like to be around people. So actually the beginning of COVID, some people were like, this is for me. And that makes sense. Not everybody's an extrovert.

But as humans, we do crave connection and we do heal in connection. It doesn't have to be 50 people at your birthday party, it can be one really important person, so that there's some level of connection there. So having a functioning relationship or relationships, really being able to manage trauma and stress in a way that doesn't interfere in your relationships, in your work, in your purpose, having a sense of purpose, something that we should spend some time talking about because it's been really missed during COVID this luxury of being creative and innovative and collaborative, and also having the ability to adapt to change. Change is very difficult and very triggering for most of us. Change isn't fun. But what is required of all of these behaviors is the idea that our foundation is strong enough, that our connections are strong enough and healthy enough, that we are working on healing and protective factors like exercise and eating well and reading and being stimulated, that all of those things are available for us to pull from when we need that additional support.

The challenge of course is when we don't have those protective factors, what we call those coping resources available to us, and then change is thrown at us and adversity and trauma is thrown at us, the relationship change, that's when we see people really start hurting and often suffering by themselves and not even knowing that's what's going on. That's, what's fascinating too, is the lack of mental health literacy, which I think is required to be really in touch with your wellness. So that was a long answer and I apologize, Betsy. The truth is there's really no standard operational definition of wellness because it is so based on how we feel and how we interact in community.

Dr. Betsy Shapiro: It makes perfect sense that it's a long answer. We are not one person across the board ever. And so I would suspect we're all responding a little bit differently to what is our level set. Not to joke about COVID or the pandemic, but I would tell you that my introvert self has been in training my entire life for a stay-at-home order.

Alexa James: Yeah.

Dr. Betsy Shapiro: I found it much less frustrating than many people I know. So I appreciate that it's different for everyone.

Alexa James: And you know what else is interesting is that folks who have managed high levels of depression and anxiety and worked really hard on it and understood their triggers and understood what they needed from their coping resources, are teaching us a lot. People who have not experienced that. People who are experiencing that for the first time are teaching us a lot about how do you cope in an uncertain environment where there's very little for us to control. And that's been super interesting. So there's folks who have fared differently because of their past lived experience.

Dr. Betsy Shapiro: Can we unpack that just a little bit. When your purpose has been shaken by something like COVID or any other experience and when your environment has drastically changed, how do you cope? What are those things that you're learning from people who have been through this and learned to cope?

Alexa James: Well, I think it's super important to acknowledge what hurts. Our body gives us data that we be often respond to with an intervention from an expert. We don't do that with our mental health. We don't use the way we feel as data. So the first thing is to identify, I am feeling grief. I am feeling loss and it is out of my control. What do I need to do to process how that feels so that I don't feel stuck in that emotional stress state. And actually a lot of what we use are our foundational tools to get us out of that. So purpose is making sure that your values and what you're doing match, and that you have an opportunity to be creative.

I started coloring. I'm an adult with a three and a six year old. It's really lovely. I am not a good artist. I do not care. I'm not going to be putting my pictures on the refrigerator with a magnet, but it's finding that outlet that really honestly serves the purpose of removing you from the rumination of what's making you feel out of control. That's what we need to stop and the definition of trauma and being traumatized is powerless. So it's identifying the grief and the pain, identifying what you're powerless over and frankly, putting yourself in positions that are a bit uncomfortable, because that is how growth happens in this new arena. Does that mean, well, I'm not typically a runner, but the gyms are closed, maybe I'm going to run, jog with a mask on around my neighborhood.

Creating new competencies is critically important. So identifying and then finding that safe person in your life. COVID has taught us and taught a lot of people that have called us how interesting it is to be forced to spend time with people who are not validating and who don't make us feel good. Our call volume has increased dramatically because people say, "It's just nice to talk to a clinician once a day and feel validated." So figuring out what conversations make you feel good and which conversations make you feel worse and trying to avoid those. I would say those are the first two steps.

Dr. Betsy Shapiro: You talked about acknowledging and saying, "This is what I'm feeling. I've got this grief, I've got this pain. I feel this sadness." Are there warning signs we should be looking out for either within ourselves or within our staff or members of our household?

Alexa James: Absolutely. What's interesting about the workplace, particularly with essential workers that are physically together is that you can notice behavior change and you can decide what to do with it. It doesn't have to be diagnostic. If somebody that you work with is more quiet than usual you can say, "How are you sleeping? Are you sleeping okay?" And maybe they say, "Gosh. No. I'm having wild dreams," which is actually happening a lot with COVID or, "I'm not sleeping," or, "My kiddo was up all night," or whatever. And then the next day you get to lean in again and say, "Did you sleep better last night?" So you start to find a connection. So things to look out for are behavior change, things to look out for too are agitation, maybe like sloppy work or details missed. When we are in a space of anxiety, which means that we're worrying all the time and we're hypervigilant and maybe we're even having physical symptoms. We want to see how people physically look, do they look more tired? Do they look less put together? Where they typically wearing makeup and mascara and lipstick, and now they come in with nothing?

Some other warning signs would be real morale issues, like folks who are feeling really hateful about their work, cynical about the bureaucracy or the leadership within work. That typically to me is a sign of burnout and also lack of insight, which is really a bummer because when we get burnt out, we get this compassion fatigue. When we get tired that this new environment that we have to work in, we often lose insight that what we're feeling is actually powerlessness. It really has nothing to do with the institution. So those are also some signs to look for.

And there's certainly remedies and things that can support folks, but physical signs, agitation, withdrawal, significant change in behavior, work product changes pretty dramatically. Or you may see your employee or your colleague throw themselves into work, which also happens a lot because some people freeze and some people just distract, distract, distract by working, and then also have the risk becoming burnt out from a different way.

Dr. Betsy Shapiro: It's very interesting as you go through that list and I'm sure this is happening for many of our listeners. I'm picturing different people in my life. And there were particular responses. And I was thinking, Oh yeah, that's a flag or that happened, now it seems to be getting better, but I should be aware of that. Dentists in general, we run a small shop for many of us and we're trying to do three things. We are providing essential healthcare to our patients, the brushing and the flossing and the physical health of their oral cavity. We need to be a leader to our dental team. And we also need to keep ourselves well in order to do those first two things. We can't do those if, if we're not healthy ourselves. How does a dentist include supporting the mental health of their team as part of their leadership model when they are struggling themselves?

Alexa James: I know this is so hard. It's just a hard time. I don't mean it's hard to do because we are going to give you those tools and you're going to feel good about them and we're going to support you as well as leaders. But I remember one of my chief integration officer said to me, like our second week of stay at home, he said, "We're all peers now." This isn't like, I'm good. I'm a clinician, I have two degrees, I'll take care of you. We're all like what is happening and then layer and layer on everything else and the complications of life. And there's no more separation between work and home now. We're all working too much because we can in this space so it's really tough for leaders.

The first thing I'll say is create equity in your big shop or small shop. And what I mean by that is safety of your patients has changed significantly and the protocol and all of these things you are doing to maintain safety of your patient population so that they feel good getting their healthcare needs met. Are you doing that for your employees? Are you creating a community that feels that safe for them and ask them what they need? I noticed that as a leader of this organization, we are housing people. We spent like $85,000 putting people up in hotels when stay at home started because our shelter system in Chicago was so fragmented. And I thought to myself, we are really going above and beyond for community because that's our mission. But I'm looking around at my team and they're tired and they don't want to go to the grocery store and they lost their gym membership. And I thought, if I'm going to do this for community, I'm going to do this for my staff too.

And we completely reframed the way we think of wellness. As a leader, we don't have the luxury of not being well during this time, we just don't. We are resourced people of privilege, having jobs and being employed during this time. And we can be sad and vulnerable, but we have to first figure out who we lean on so we can maintain and continue to encourage. It is okay to say to yourself, I am really low today. Today's a tough day. I realize I'm in month nine. My three-year-old can't go to school because there's a COVID scare. I didn't get my workout in. I can't feel right, whatever it is. I feel low today. I'm going to ask you to step up a little bit more. Thank you. Lean on your community and tell them how feel in and start to normalize that conversation in your community.

But just like we say, when you're getting on an airplane, put your mask on first, before you help others. We as helpers think that we are in control and nothing will bother us. And so it's super important to say, I am not of service to anyone, particularly as a business owner, as lead doctor, as leadership, if I am that while myself. And it doesn't mean you have to be perfect and it doesn't mean you can't ask for help. The first thing that I did is set up free therapy for everybody on my team. Some people used zero sessions, some people used 25, so we just paid for it. We found a clinician who was willing to do that. We set up breaks in a much more substantial way for people so they could really decompress. There is just constant stress all the time. And I'm sure many of you and your employees are afraid of getting sick too. So there's that going on all the time, again, this powerlessness.

How do you create wellness? I think you have to do it in buckets. You have to be well, you have to make sure that there's policies in place that support your employees, including safety, but also health insurance. Is your health insurance adequate to provide adequate mental health services, particularly teletherapy? And there also has to be engagement, which the associations are just so great around mental health awareness to increase mental health literacy. And the best thing I think you can do as a leader besides being well yourself is when you're onboarding or when you're having staff meetings, or one-to-one saying, "When you feel stressed or out of control, what do you need?" Some of them may say, "I need a really healthy lunch. I need to be able to take a walk during the day. I need to work more," whatever it is so that you can monitor and identify when they're feeling that way and then offer them a resource. They will work harder for you if you create that space for them I'm sure of it.

Dr. Betsy Shapiro: Thank you so much. That was incredibly powerful. Just the concept of we are all peers in this, there isn't a particular leader in this instance because we are all in the same boat, little variations of the same boat. In dentistry, many of us hold a morning huddle to go over the schedule for the day. It's a very short five minute meeting. We touch base. Here's where we have a space for an emergency. What are we concerned about? Anything like that, but it can also be a time for team building. Can you give us some specific ideas and tangible ways that dentists can incorporate team building into their staff meetings and focusing on mental health and wellness for our staff.

Alexa James: For sure. You can do a check in and check out every time you do a huddle. Name how you feel emotionally and physically. And we just had a meeting and our chief wellness officer went around the Zoom and said, "What are you doing to make it through today?" And I thought that was really a good question because part of wellness is insight, right? And so when you are allowed to take a moment and think about it, that in of itself is self-regulating. That is self-compassion right there. Oh my God. I'm thinking about myself for 30 seconds. When does that happen? Especially as a leader of a medical group, and it also tells your leadership or your colleagues, or it gives them an opportunity to be accountable to you.

You can do check-in when you're doing your huddle, you can say, who's your accountability partner today to do this one thing, to eat that healthy lunch to meal prep, and you check in with each other. We just start this culture of coaching and support around specifically mental wellness. And that topic will become normalized I think pretty quickly, particularly in this culture where people really are hungry to express how they feel.

Dr. Betsy Shapiro: Following up on that. What do you feel about if you're doing that in your morning huddle and someone says, and I would be the person saying this some days, "I got a great pan of brownies and I'm just eating them and powering through." And that's not a particularly healthy habit to deal with my stress, but that's my answer. Is that a time to try to intervene on that level?

Alexa James: No. You say, "Eat those brownies," and put no shame around it.

Dr. Betsy Shapiro: Okay!

Alexa James: Yeah. You're welcome. Now, all of you good folks listening are like 'cavities!' but I think that that's honest. So this is a such a good point Betsy, there is a difference between healing behaviors. I think of healing and behaviors as things that move you through the emotion so that you're stronger on the other side. And then there's coping. And frankly coping is to manage a feeling that feels uncomfortable when you just don't have the space for it. I'll go home after my kids go to bed and all the glass of wine and watch a silly show because I just needed to like numb a little bit. And that is fine to do once in a while. And we should not have shame around it. This is too much right now. Have any of you woken up and think what else is going to happen in this country? So give yourself some grace to eat those brownies or to make yourself like a cheesy something or to binge-watch. Give yourself some grace because you are surviving in a world and you're building resilience.

Dr. Betsy Shapiro: Thank you a million times over.

Alexa James: You're welcome.

Dr. Betsy Shapiro: My own part and everybody else who just heard you say that sometimes it's okay.

Alexa James: Sometimes it's okay.

Dr. Betsy Shapiro: Just grant yourself that permission and be as good to yourself as you would be to anybody else, you who said that?

Alexa James: Exactly.

Dr. Betsy Shapiro: One thing I do want to touch on. I admit that I looked at the NAMI website more than once as we were going through this. And I noticed that you did seem to have some team building resources. Are those available to anyone?

Alexa James: Anyone.

Dr. Betsy Shapiro: Okay. Is it a guide for someone to use for instance, in a dental office setting? Can they pick pieces of it that would be useful?

Alexa James: Absolutely. Yeah, we developed a toolkit around how to create wellness in the workforce. Now we think sequence is important. So don't implement a new policy without first doing the mental health training, but it's all in there. One of the things that is good about this remote work environment is we are far more accessible to places now outside of Chicago, to provide that consulting support around how you implement this stuff. The great news is none of this is rocket science, but you need leadership buy-in. You need to really believe that mental health impacts your employees, impacts your return on investment, impacts you, impacts your patients. And then what are some low hanging fruit ways in which to start to acculturate that idea. And many of you are probably already doing this and you're probably already doing it without even knowing it. When you give flexibility, when you give grace, when you listen with intention, that's what it is.

And now it's just building upon that and making sure that policies and programs are in place. It's even little things, Betsy, like changing six days, your PTO to well days. Frankly, I don't care how people take their sick days. If they're taking it because they're depressed and they can't get out of bed, if they're taking it because they need to celebrate something to be joyful, it's none of my business. This is your PTO, and this is your wellness and it should be comprehensive. And you can find that resource at namichicago.org, and also know that there's other resources on the website.

I'm sure many of you have kiddos. We have really interactive resource around how do you talk to your kids about their mental health? How do you listen actively instead of just the car ride, which I know is always the best time to talk to my kids because I'm not intensely looking at their eyes. But there's a lot of really helpful information. How to love somebody who's struggling. And also you can always call us at 833-NAM-ICHI. We are open seven days a week. We are free. We are available to help you find resources, but also coach you through conversation.

Dr. Betsy Shapiro: Before we let you go, is there anything else you'd like to add for our listeners?

Alexa James: I think that we are really worried as a community about what's going to happen, how our kids' mental health is going to be impacted by this, how our mental health is going to be impacted, all of the fears, our business longevity, all of this. And I think that there's obviously reason to be worried, but what I also don't think is being talked enough about is the fact that stress is okay. Stress really builds your ability to be resilient and resiliency is what we need and what we need to model to our employees, to our colleagues, to our family, that we can get through this if we are honest and accountable, if we lean on community. So what I would say is think of creative ways to maintain connection to community because that's really where we're going to start to feel better. And I know that it's difficult in this remote environment or in this disconnected environment where we're not hugging and spending time together in the same way, but that is important. And when that starts to slip, then I get worried.

But I think that we can model real strength here while still grieving. A lot of pretty terrible things that have happened. So you're not alone in feeling overwhelmed. You're not alone in feeling anxious and you're not alone if you feel low and hopeless, we got to find that hope for you though. And that's hopefully what NAMI Chicago can do to support all of you.

Dr. Betsy Shapiro: Thank you again for joining today, Alexa, and we truly appreciate you being with us.

Alexa James: Thank you, Betsy.