The Symptom Media Podcast - Bonus Episode - Caring for the Caregivers

In this special bonus episode of The Symptom Media Podcast: Bridging the Divide in Mental Health, host Dr. Lindi van Niekerk, MD, PhD, is joined by J. Corey Feist, JD, MBA, Co-Founder and CEO of the Dr. Lorna Breen Heroes’ Foundation, for a powerful conversation on healthcare worker well-being, grief, and systems change.

Drawing from both personal loss and decades of leadership experience, Corey reflects on the death of his sister-in-law, Dr. Lorna Breen, and the cultural, educational, and structural barriers that prevent healthcare professionals from seeking mental health support. Together, Lindi and Corey explore how stigma, fear of professional repercussions, and unsustainable working conditions contribute to burnout, moral injury, and suicide risk among clinicians.

This episode moves beyond individual resilience to examine the responsibility of institutions, policymakers, leaders, and the public in creating safer, more humane healthcare environments. From federal policy reform and peer support to leadership training and cultural change, the conversation offers both urgency and hope—inviting listeners to consider how each of us can become an agent of change in the systems we inhabit.

This podcast is brought to you by Symptom Media - Mental Health Education & Training

For more information about the resources shared in this episode you can visit:
Dr. Lorna Breen Heroes’ Foundation https://drlornabreen.org

To learn more about Symptom Media and its mental health resource library visit: https://symptommedia.com/

Sign up for a free trial today!  Listeners, get a special 20% discount on a Symptom Media subscription. Use code: 20discount

Transcript

0:11

And welcome back to the Symptom Media Podcast, Bridging the Divide in Mental Health. I'm your host, Dr. Lindy Fannikank, and I'm grateful you've joined us for this special bonus episode to close out our first season. Our mission with this podcast has been simple but vital, to bridge the divide between the clinical and the experiential. By fostering dialogue between research, practice, and lived experience, we hope to have cultivated empathy and meaningful change in how we approach the challenges of our work and our lives. To listen to other episodes in this series and to learn more about Symptomedia's mental health resources, please visit Symptomedia.com. As we reach the end of our first season, I had the unexpected opportunity to have a conversation with another remarkable pioneer and advocate of mental health and wellbeing. Across the season we've explored moral injury, burnout, suicide prevention and the human cost of caring. Today's conversation brings those threads together with our guest in this bonus episode. Corey Feist is the co-founder and CEO of the Dr. Lorne Breen Heroes Foundation. Corey is a healthcare executive, national advocate, and one of the leading voices shaping the conversation around clinician mental health in the United States and beyond. In this conversation, Corey shares his experience of losing his sister-in-law Lorne to suicide. He reflects on how he and his family are journeying through grief. He advocates for a culture shift in healthcare and more than anything, he inspires us all to become agents of change. Thank you for joining for this episode and for staying with us through this first season. Thank you so much for joining today. We thought we were at the end of this first season and then we had this amazing opportunity to have this discussion with you and so we felt it deserves a bonus episode. Well, thanks for having me today and I'd love being your bonus episode. So Corey, I'd love to start. I mean, you're a lawyer by training and these days you are the CEO of the Lorne and Breen Foundation. Can you maybe take us back to the crossroads that really led you to where you are today? You know, if I take you back to about 2016, 2017, I was in a leadership position at the University of Virginia Physicians Group, which is the organization that employs all of the physicians and other advanced practice professionals at the University of Virginia Health System in Charlottesville, Virginia. And by that point, I had heard a steady drumbeat of concerns from our clinicians about what was getting between them. and their patients, just an incredible amount of bureaucracy and other challenges that was getting between them. And so we spent a tremendous amount of time before 2020, really focusing on getting at the root cause of their challenges operationally, then took the role as the chief executive officer of the organization. And shortly thereafter, we had this thing called the pandemic and the intersection between where we are today and Where I was headed, I thought on my career was the death of my sister-in-law, Dr. Lorna Breen, an emergency medicine physician leader at Columbia University and New York Presbyterian Hospital in Manhattan, who took her life at the beginning of the pandemic, citing real concerns around her singular need for mental health treatment during the pandemic and what that would do to her professional career. And the publicity that followed her death, notably the publicity that no one in our family wanted, but was kind of thrust upon us, opened up a spigot. And that spigot wasn't a millimeter wide, was miles wide of feedback from healthcare workers, their families, their friends, sharing deep concerns. And these were not pandemic specific concerns, these were pre-pandemic concerns around their lack of ability to do anything about their own mental health without fearing professional repercussions. or just the work hours or the violence and threats against them and just the landscape that has now become the day-to-day experience of our busy clinicians in the United States and beyond. So that was the intersection and really the catalyst for the creation of the Dr. Lorna Breen-Heroes Foundation in the early summer of 2020, which was the feedback to Lorna's passing and just, we couldn't ignore the volume of that feedback. And so we decided that once we were already in the arena, if you will, we were going to stay and try to make an enduring positive impact on the lives of those who spend their time taking care of all of us. I think your experience is really unique because it was part of your career leading you to this hearing some of the complaints of health workers. And then you've also had this very deeply personal experience. And I can understand that the combination of those two is a very clear red flag. or light saying this is maybe the path to go down. I wanted to ask you a bit more about your experience with losing Lorna to suicide and some, I'm sure it must have raised quite a lot of questions and emotions for you and your family. We've had a previous episode in this season where two of our guests, Amanda and Danielle, really unpacked just their journey and the length and the complexity of it when they lost their brothers to suicide. What was that journey like for you and your family? Well, we are about to be at six years and we're still on it. So the journey continues. I, my wife, her was a Lorna's little sister and really the closest, they were the closest connected in the family. And what Jennifer would say is this is not something you get over. This is something that you learned to live with. And For us as a family, Lorna was not a long lost aunt from far, far away, but rather deeply connected with our family and our children. So if we start with the atom bomb that was her initial passing, and then all of this publicity that we did not want, I mean, news crews on our front lawn and people wanted us to speak publicly about something that we were initially very shamed about. I mean, as the, I think the very first... other than just the shock of what's going on and not understanding the confusion, you just have this overwhelming shame because there's so much stigma around it. Well, once the news was out, if you will, that shame part was ripped right off. And in fact, was in fact, one of the blessings of the early publicity that we didn't ask for was we couldn't hide it. And in fact, I've actually often reflected if we were still hiding that secret, what that would... have done to us and not being able to speak about it. But so there was this initial catastrophe and the shock and the trauma that we experienced. And for many, many years, because of the decision that we made to create the foundation, I was forced to speak about this issue very publicly every day. And that was incredibly challenging and frankly, probably not the healthiest thing. the only reason that I did it was because of the feedback that I was getting from those who were hearing her story and it was resonating with them. And so we felt like it was worth the sacrifice of that moment and that period of time to give people the sense that they could do and need to do something different to learn from her, what happened to her and to not replicate it. One of the things that we've learned in the industry of suicidology and the study of suicidology is one of the best ways to prevent suicide is through what they call postvention. And so, you know, I basically have spent the last six years almost now in a big postvention exercise, which is how do we get at the root cause of these issues and how do we prevent them from going forward? you emotionally, was awful. It continues to be very challenging for the entire family and very real. I'm very real. so the journey is not over. The journey is continuing. And we'll just continue to try to put one foot in front of the other. And it doesn't hurt that we continue to make a positive impact and hear about that positive impact from millions and millions of people through our work at the Dr. Lorne Brin Heroes Foundation. So that's maybe a little bit of a bright spot in an otherwise very dark place. I can only imagine how hard it must be to deal with your own grief and to have cameras right up in your face and while going through that. But like you said, I think the work that you all are doing and the fact that you've casting light on this story and sharing Lorna's story has really given others a lot of um courage to come forward. And one of those physicians as well who we've had the opportunity to speak to and who was a guest on our podcast is Dr. Christine Mutier, who's the head of the American Suicide Foundation. And even she shared her own journey as a physician struggling with eating disorders, depression, that also got her very close to the verge of suicide. So maybe let's listen to what she shared on the episode that we did with her and then we can reflect on that. For me, it really spiraled into a full-blown eating disorder. I probably developed all sorts of maladaptive coping with it, know, stuffing the feeling of anxiety and just going towards actions such as you know, over-exercising and disordered eating cycles, that, you know, once you start going down that path, it took hold. So it was sort of like a force of its own that those behaviors became almost addictive and reinforced. And I then felt trapped over the course of about two to three years. And in the first couple of years, I was in medical school. My mode of coping with the academic fears and stress, was to essentially never stop studying. um It would have been unbelievable to me at the time that a few years later would become a dean and would be teaching medical students about the importance of sleep and exercise and caring for your own mental health and physical health and spiritual health and social health, all of that. But at the time, I didn't know any better and I really didn't even... have a language for what I was experiencing and I minimized and remained in much in denial, even though it was really becoming an experience of again, feeling like I couldn't control those symptoms anymore or the behaviors. And it was actually some peers in my med school class as I was losing weight and probably exhibiting some warning signs of anxious or depressed or not my healthy, normal self kind of behavior, they approached me and really asked me if they could help me find treatment. So that was the first foray into getting a little bit of therapy. But it wasn't until I got married after boards, after the end of second year, and I deferred the first clerkship and started as a third year medical student on the wards in a full blown um state of the eating disorder still just daily, uh multiple times a day. mean, really in the grips of it and still kind of in denial about what it was. Although I knew, I had kind of almost accepted, I had read about it, of course, as a good medical student does, um and had sort of come to this belief that I would live with this condition lifelong. and I would just have to self-modulate it. It was a very kind of fantasy version because what ended up happening is at the start of my third year of medical school, I really couldn't even function under the, you know, it's a big transition, obviously, starting on the wards and the way the curriculum was at the time. So I went to my dean for student affairs and I didn't have a good language for what I was experiencing. In a way, understandably, you know, she heard me saying things like, I don't fit in here. I don't, you know, I don't feel I'm able to continue. Well, what would you rather be doing? All I could come up with was the one moment of peace I had had, which was swimming. And so I probably said that. And she just said, but you've gone to all this work to come to medical school. You know, so was sort of this non sequitur, not really feeling heard or understood, but she may have been. More attuned than I realized because she would not let me drop out. I really was asking to disenroll and she said why don't you take some time off? And so I engaged in therapy and treatment for the first time, know sort of for real and it was life-changing. uh I believed that I did not have value unless I was achieving and performing and pleasing everyone around and some of these very early childhood internalized beliefs and messages were very strong inside me. And again, until I went to therapy, I was utterly unaware of that. For many health workers, just like what Christine said, the mental health challenges really sneak up on them quite early in their journey. And I remember even in my medical school class, the... The surprise more that medical students around me and my colleagues experienced when you did start struggling with depression and when the pressure around you just became overwhelming. It's something that's not acceptable. That's you've told from the beginning, you are there to serve others. You are some of the top people in the country intellectually. And so of course you must be able to handle the pressure of all this. And so I wonder if for you as well, Corey, was Lorna's death? that it's come by a surprise. And what do you think, reflecting both on Lorna's experience as well as Christine's, what could have helped preventatively catch this earlier, get people the support that they need? First of all, thank you for playing that clip for Christine. I've known her now for almost six years and I did not know that part of her story. So it's interesting to learn more about people's origin story of why they are doing what they're doing. And I'm so glad that she is where she is now. I would kind of put this in a couple different buckets. And one you just alluded to, which is a cultural component of healthcare. What does it mean culturally to get help? What does it mean culturally to ask for help, to be willing to receive help? What does that say about yourself as someone who can or cannot take it? You know, when I look back to my sister-in-law's story and the parallels, you know, even what you were just saying, her first day back to work was April 1st, 2020, and she had been very sick with COVID. and had been isolating and lost a ton of weight and still during her waking hours was trying to do two things. One was manage two very busy emergency rooms remotely. And then two, was getting her MBA at Cornell and trying to maintain the schoolwork that she had been plunged into. And by the way, she was really, really sick. And so on April 1st, she comes back in this incredibly debilitated condition to see an amount of death and dying and helplessness that she she had never experienced even as a very seasoned physician in New York City and When she called Jennifer to say hey, I I've never seen anything like this. She used the word Armageddon This is Armageddon Jennifer immediately said you need to go home and Lorna said that is the ultimate sign of weakness I cannot ask for help. I must stay and do this work and so then she put herself in a condition and you know kind of similar to Christine's situation where she just pushed through, where you think that you can kind of hold your breath just for one more minute. Well, Lorna tried to hold her breath and that was, she was scheduled for 10, 12 hour shifts in a row and she was working 15 hour shifts. So already depleted, pushing and telling yourself you cannot take a break. So you have this cultural component here within healthcare. First of all, you're attracting high achievers. These are people who are not used to failing, let alone getting like a B, right? Like, you know, these are, these are super overachievers who are really taught and in a very individual way that the harder you work, the more success that you will achieve. And when you need help, if you look to your toolkit that has gotten you to the place that you have achieved, asking for help from somebody else is not naturally in your own personal toolkit, right? It wasn't in Christine's. It certainly was not in Lorna's. And in fact, asking for help is the ultimate sign of weakness. So. There's a cultural challenge there. Another challenge is an educational challenge. And I've pointed this out a number of times now. It is incredibly predictable. Now Christine's example is not the perfect one, but Lorna's was that in the life of a busy clinician, even starting as a student, you are going to see traumatizing events, events that as a lawyer, I never saw as a business person I never saw, but it's a hundred percent predictable that in your career, you're going to see them and you're probably going to see them in education. And yet, in our education of healthcare workers in the United States, there is little to no even acknowledgement about what to do when you see your first death, when you see somebody almost commit a medical error, or there is a medical error, or there's violence, or threats, or verbal abuse, or all of the things that we don't get on our nine-to-five job in the United States when you're sitting behind a screen in your home office, if you will. Very traumatic thing. So curricularly, we have an opportunity to really train our healthcare workers how to handle this in a healthy way. And in so doing, we have an opportunity to educate them about what the rules are about doing something for yourself, formally in mental health or through something slightly less formal, which would be peer support. But just understand what the resources are and what the ramifications, if any, there are for doing so. Because as you know in Lorna's story, She was convinced she was going to lose her medical license in New York state, as well as her hospital credentials at New York Presbyterian for getting mental health treatment. She'd only ever worked there and she was convinced of it and she was a hundred percent wrong. But there was no knowledge that we could point to and there was no knowledge that she had other than probably what I would call water cooler talk and lore that was that, that she was, she was anything other than a hundred percent accurate with her, with her thoughts. So. I think you have a cultural component here. You have an educational component, not just about what to do in your time of need, how to handle these things in an appropriate way, but also what are the rules. And then, you know, that also drives to the structure and the structure of our systems in the healthcare delivery do not afford people breaks. Pilots have rules about the number of hours that they can fly. There is nothing similar like that in healthcare. Yes, during residency in the United States, physicians are capped at only being able to work 80 hours. If you knew as a patient that your physician and your clinical team had been awake for 36 hours before they performed an operation on you, would you let them? I mean, if my pilot had been up for 36 hours, I would not want her or him to land my plane, but yet we are willing to take this risk with our bodies in a different way. And so I think that the structures in healthcare, which is what we spend a tremendous amount of time at the Lorne Breen Foundation doing is how do we make sure that we are creating a safe environment to practice because it's clearly not a safe environment to practice. It's not safe for the patients and it is not safe for those who are providing clinical care. So those are kind of some initial thoughts that I would share with you. And each one of those has an opportunity for improvement and each one of those could have benefited Christine, ultimately did benefit Christine. It certainly could have benefited Lorna and the really thousands of people we've talked to since Lorna's passing have had a similar experience. And thank you for reflecting, I think on this experience. I oh I've trained in South Africa now almost 22 years ago and yeah, it was so similar. And I think that the big part of our training when I went to ask our Dean at the time when I was 21, seeing so many colleagues developing depression, we had a colleague committing suicide and We were told that the whole part of our training was to blunt us because the more they can blunt us in the first few years, em of course we can cope with things a lot better, but then the goal was to resensitize us after complete and utter blunting. And I think some of the damage that that kind of mindset does when it comes to training physicians and that remains throughout our training. There's this unspoken part of medicine which is just, this is what we do. You don't question it, you just are told this is how you do it and this is what you cope with. And so learning those boundaries of what, like you mentioned, a person in a different job would have had is very, very hard. I'm still learning. What's the normal limits of a working day and when do you say no? And that that could even be okay to do that. May I interject for just a moment on that? Because I think about another analogy in an environment that is similarly stressful and that environment is the armed services. I spoke with a gentleman who was a Navy SEAL who's created a really amazing company called Arena Labs. And this individual has shared with me his experience in training as a Navy SEAL and contrasted it to the experience of being a busy clinician. And I think it's worth understanding Navy SEALs in the United States are trained to do highly complex tasks under increasing amounts of pressure and stress. Sound like taking care of patients to me and yet. In their training, they are taught to learn how to, in a healthy way, recognize when their heart rate is elevated, recognize when they are sleep deprived, and then figure out how to mitigate against that. Contrast that to what you just described, which is what I would refer to as kind of an ostrich approach, which is we're gonna put our head in the sand and we're gonna kind of keep going on and then. Ultimately, you'll just figure it out. Why not in an educational environment give you the tools to recognize, okay, you are sleep deprived. You have not slept in 24 hours. What does that feel like? What are you unable to do? This is the equivalent to driving intoxicated. We now have tons of data on this. You we talk about not being able to get behind a uh wheel of a car when you've been awake for many hours, yet we're putting people in the operating room in patients' bodies. We are letting people change IVs and do all sorts of procedures on our patients with sleep deprivation as just one example. We know that their cognitive load can only take so much to do that very complicated task. So we do our best to make that environment is free from additional, this is the technical term, things and stuff as what that astronaut needs to do to repair a satellite. Why are we burdening our health workers with tons of cognitive overload and sleep deprivation and violence and threats and all of these things and then saying to them, now go do your best. And if you can't, you can't ask for help because that's a sign of weakness and it shows us that you can't take it. I challenge that hypothesis as one that is A, healthy for anybody in any way to learn or teach them. Now, that's easy for me to say. just went to law school and business school. I did not and will never be able to do what you all do as busy clinicians. Yet I do have to sit here from the side and ask the question, is there a better way and challenge the fundamental premise that there isn't? I so appreciate that you made that analogy with military training. always said medical school felt like the same as being in a military training camp. And I think there's slowly becoming a recognition of that. But still the big irony is that even if we have clinicians who can prescribe medicine, fill in charts, procedures, we're planting people's humanity. And so much about healthcare is not just executing functions, it's being able to care about another human being as well. And that's often the first thing that goes when you're exhausted and overworked, that you lose that caring aspect. I'd love to use this as the segue for us to listen to Andrea McKay. Andrea was one of those very special nurses. She's practicing in Scotland. She actually came into nursing a little bit later. So I think she, similar to you, she brought fresh eyes to the profession, which is so needed. If you've done something else and then you're into the healthcare world, you're more able to say, hey, exactly, why does this need to be that way? And so Andrea found herself on the wards during the height of the COVID-19 pandemic. And so I'd love, yeah, let's listen to her and then maybe we can reflect a little bit more on what we've discussed. And that was really terrifying because we knew it was coming and we knew it was going to be bad, but we couldn't really foresee exactly what it was going to look like for us. I remember describing it to somebody at the time as standing on a beach watching a tsunami coming and not being allowed to leave the beach. The hospital that I worked in at the time were quite proactive and they fitted out a brand new ITU unit in that time. didn't, I think they turned it around in about eight weeks. It was extraordinary. So the cases grew and grew and then finally they came to us. And I was at the time working on a surgical ward, which was elective surgery. All elective surgery was canceled. So we initially kind of didn't have anything to do. we were very much ring-fenced to try and keep our theatres clean so that we could still conduct some kind of operations if necessary and so forth. So the first feelings were of guilt that we weren't doing anything because I had colleagues who were working on COVID wards and other hospitals. But then I remember in the months leading up to the pandemic, my ward manager had... got a matron's post. So she had left not knowing what was coming. She had taken another post and so there was myself and two other junior sisters were left to run the ward. One of my colleagues stepped up temporarily into the sister's post to manage. And I remember that the day the bed manager phoned us to say that was it, we breached because our clean ward had the final side room in the hospital. So we had to take a COVID patient. And there was this sort of tangible fear because at this point we really didn't know what we were dealing with. Everything was very still, very new. So myself and my colleague went into the office with a list of our nursing staff and had to just go individually through the list. And so we were making decisions about who to send in to nurse this COVID patient, not really knowing how they were going to be affected. And that sort of weight of responsibility was... quite heavy. And then my colleague declared that she was pregnant, very early stages of her pregnancy. She was then off shielding. So it was myself and another junior sister running the ward. And we would go to meetings and we would get the latest advice from Public Health England. And almost within hours of coming out of the meetings, the information was redundant. because some new information had come to light. So we were in this constant state of flux of not knowing what we were doing. And there were issues with PPE, masks and so forth. And it was very slow to get everybody fit tested for those because we were essentially a clean surgical ward with limited COVID patients. So that was difficult. And then eventually I moved during the pandemic to ITU and that was obviously a completely different scenario. It was just as the second wave was coming and that was very difficult from a sort of moral injury point of view, which I didn't understand what that was at the time, but looking after patients and not allowing family and any of their relatives to come in. We had patients that were dying and we weren't allowing anyone to come in. We used to have patients make recordings that we would take into our sedated ITU patients and play them. And I remember many, many shifts of doing night shifts, listening to these recordings of somebody's child, grandchild, talking to them, knowing they probably would never see them again. It was absolutely heartbreaking. It felt wrong not to allow people in to see them. That was a really difficult thing. And small things. There was, teenage daughter recently played me a song by Taylor Swift called Epiphany. I don't know if you know it, but there's a line and it talks about the military and about nursing and... there's a line in it about touching through plastic because we were covered in plastic. We had aprons and we had our gloves on. as a nurse, obviously for doctors as well, but I think probably more so for nurses, we spend a lot of time holding people's hands and that sort of therapeutic touch. And to have it through a gloved hand felt awful. This was possibly the last handhold somebody might have. So all of that felt very, I'd use the word uncomfortable, but it was obviously much worse than that. And I'd come home and be exhausted from trying to give as much as I could and knowing it probably wasn't enough because they deserved more. so yeah, was dark times and yeah, it's all being evoked again now, as I said, cause it's the anniversary. And Andrea speaks about COVID and I think as you mentioned with Lorne has experienced during COVID too, COVID just lifted the lid. on what was likely beneath the surface for so long. It added that extra pressure that just made the pot boil over in so many ways and really exposed, I think, some of the mental health issues and the cultural challenges like you've mentioned already that is in healthcare that needs to change. I'd love to ask you if you could tell us a little bit more about some of the work that you have been doing at the Lorne O'Briain Heroes Foundation to both support health workers and bring about some of these shifts in the culture that is so needed. Absolutely. And thanks again for sharing that. uh certainly took me back to that time during the COVID-19 pandemic. Our foundation has really been focused in three main areas. The first is to advocate for policies at the federal and state level that are designed to support the mental health and wellbeing of our health workforce. The second is to accelerate solutions at an operational level, at a leadership level. at a cultural level to get underneath the curtain or behind the curtain, if you will, and really get at the root cause of many of the challenges. This isn't because our workforce is anything other than the most resilient people on the planet. It's not an individual failing that they're burning out. It's a systemic one. And then the third area that we're really focusing on is breaking down the silos that exist between different aspects of our healthcare delivery system, advancing collaboration across the healthcare industry so that we can wrap our arms collectively around the health workers and say, we hear you, we see you, and we are working together on a new day. Not just something for nurses or just something for pharmacists or just something for doctors. And then within that, just something for the certain specialties. No, we are going to work together. And so I'll focus on each one very briefly, but from an advocacy perspective, we were The beneficiaries of a phone call early on in the shortly after my sister-in-law died from from our United States Senator, his name is Tim Kaine, and he read about Lorna's story and saw parallels with the military and his son's lived experience in the armed services in the United States military and asked me a simple question. He said, how can I help? I serve on a committee that oversees parts of health care and I see huge parallels between what my son is experiencing in the military. I'd like to see what we can do with our work to help our healers. And so he and his team worked with a group of professional associations from across healthcare and developed the outline of what came to be the first ever federal law in the United States that created programs to support the mental health and well-being of health workers called the Dr. Lorne-Breen Healthcare Provider Protection Act. As we speak today, it is being extended for five years, a vote. by Congress just happened today. And the president will be signing that imminently to expand those programs for another five years. They were initially set for three years. So it's been amazing to watch the programs and the Lorne-Brienne Act in a nutshell created grants for healthcare organizations to help support their own. And it did that for a period of three years. And in addition to that, it created leadership training materials that were shared out by... the occupational safety arm of the Centers for Disease Control called NIOSH, understanding that healthcare leaders don't always have a playbook for this because healthcare is so designed with the patient in mind. This helps healthcare leaders understand. That's called the Impact Well-Being Guide. From a policy perspective, that's been a huge win for us. We've also made great advances at the state level to remove mental health barriers that um are real penalties for health workers where they're being asked at a licensing level and at a hospital credentialing level, if they've ever gone to mental health treatment, if they've ever sought therapy, if they've ever been diagnosed with a mental health condition, including substance use. And we're getting all these questions removed. In fact, we're about to make a big announcement and continue to update these maps that we have on our website at drlorenebrin.org in a national challenge that we're running, which we call the Champions Challenge for Licensing and Credentialing, because it's completely inappropriate for our health workers to be asked questions about their prior mental health treatment and diagnosis. It reinforces stigma. and it prevents them from getting their needed care. So advocating for policies has been a really big success for our foundation as has been accelerating our solutions. And we accelerate our solutions through a program that we would call a National Technical Assistance Program to actually implement the Impact Wellbeing Guide, which was created by NIOSH at the federal level, because the guide was the material, but there wasn't anybody to then follow behind and say, okay, hospitals, let's organize around it and let's implement. And so that's what we've done in large geographic cohorts of hospital systems. We call that program Caring for Caregivers. We've run that program now in Virginia, North Carolina, New Jersey, Wisconsin, and it's expanding. And what we're seeing is that healthcare leaders are using that time to really focus on what they, to first learn what they can do, because many of them, again, don't know what they can do in their sphere of influence and control to make the day-to-day experience of our health workers better. and then practice in a learning collaborative in a very focused way. And we're seeing decreases in the amount of time people are spending outside of work in administrative burden and reducing alerts for our nurses and many other very practical things get between our clinicians and health workers through that caring for caregivers program. And then the way that we have really wrapped our arms around the healthcare workforce to advance collaboration is through a coalition that we created. in the spring of 2021 called All in Wellbeing First for Healthcare. This is a national coalition with now has over 37 member associations. These are very large professional associations ranging from the American Hospital Association, the American Nurses Association to the American Medical Association and, and, and, and, and, and that will not go through all 37 members, but the membership is growing and, they're sharing across them, across the aisle, if you will, or across the silo. What is working for their subset of the workforce and they're exchanging ideas and accelerating practices. And they're also serving as advisors. So as an example, when the Centers for Disease Control and their arm, NIOSH, needed to develop this impact well-being guide that I just referenced, well, that group said, hold on, we are the experts in this work. Let us take a look at it and help you figure it out. And so they're really spending a lot of time together. Every two weeks we've been together since 2021. and it's growing. another, and the final way that we've done this is we have a growing group of volunteers who we call ambassadors. Over the last, over the last almost six years now, we've had thousands of people reach out to us and say, how can we be involved in this at a grassroots level? How can we help? How can I change my local environment? And so the Dr. Lorne O'Brien-Heroes Foundation ambassador program has well over 400 individuals, whether these are survive, family members who've survived the loss of someone to suicide. or these are spouses of health workers or the health workers themselves of all domains who want to try to make a change in their local environment. And so we've really spent a lot of time helping them figure out what to do in their local landscape. And again, all of this with the understanding that there's a long road ahead, but we've got great wind in our sails. If we keep focusing on the health workforce, then they get to do what they train for. I mean, it's kind of that simple, but we have so much risk if we don't act and don't continue to act that there won't be anybody to take care of any of us as we age and need health workers. And by the way, health workers deserve it anyway, because they're human after all. I mean, that's wonderful, because I was going to ask you about the need for cross-disciplinary approaches. And I feel like you've just outlined such a wonderful array of them. Through your work, you've been able to cross the bridges from policy down to the public. working with healthcare workers and across so many different disciplines. So you've really been building the bridges between the silos. So maybe before we just move on, do you see that there's opportunity for any further bridges to be built? Are there any areas that we need to still bring into this discussion? Some of our guests on the previous episodes really alluded to the need possibly for the arts. How do we bring the arts and healthcare in as a healing modality? But if you have any other suggestions on on ways some further bridges are needed to be built. So I think the arts are a great idea. I really focus heavily on the operations and the systems that got us in this predicament. Particularly in the United States, so much of that is pointed back to the administrative burden and bureaucracy that's created that gets between health workers and their patients. And so we need to make sure that we're doing is we are always including health care leaders, particularly frontline health care leaders who may have just... received what they would call in the military a battlefield promotion. They've not been trained in leadership. They were strong clinically and now they're in charge. And we expect that they all of a sudden know everything about leading teams, know everything about the operations, know everything about what they can do in their sphere of influence and control to make it better. Can't assume that. So our frontline leaders can, we need to continue to focus on not just our C-suite leaders, even beyond the C-suite. really engaging with boards of directors, you for nonprofit organizations, which most hospital systems in the United States are, the boards of directors are really still in their infancy and their nascent years, if you will, about their knowledge about this subject. They see lagging indicators like turnover, but there's not necessarily a connection explicitly made for them as to what the workplace environment is doing. So I think they play a very important role and they really need to be focused on. I'm kind of going bottom up and top down. So our boards of directors, as well as our frontline leaders, policymakers continue to need to be educated about what they can do and not just at a federal level in the United States, but also at a state level. There's a lot of healthcare policy that happens in a state level and they need to understand what they can do to make how those decisions impact the workforce. We can't just keep asking the workforce to do more. Oh, it's just three more clicks in the electronic medical record to fill out this form. They're already doing 300 more clicks than they need to be doing. So let's not add to them. So I would say those policymakers, those board members, those frontline leaders, and then importantly, the patients. And I want to pause there for just a minute, because when we think about the amount of violence and threats that are occurring in our workforce right now, I want to point to a television program that's on HBO Max right now called The Pit. It is a very realistic. depiction of what's going on in emergency rooms and they have some really graphic and accurate depictions of what's happening to overcrowded waiting rooms where patients are becoming indignant to a nurse being knocked out by a patient who was mad that it was taking so long to get into the emergency room and be treated. I think we need to do a major public awareness campaign in the United States to recognize it's not okay to physically or verbally assault or threaten a health worker. Why would you go to work every day if you knew there was a really good chance that you were going to be knocked unconscious or demeaned and belittled by the person that you are actually trying to help? It's unconscionable and it's a group of people that I think, and that's where the arts I think plays a really important role because shows like The Pit are showing what it really is. It's not making it look real sexy. And maybe just maybe as we go through educating through the arts, it will increase people's sensitivity and awareness that they need to ask our health workers how they're doing on a given shift when they go into an exam room and the health worker asks them the same question. I mean, you mentioned the pit and I was watching, This is Going to Hurt, which was a show about the the British healthcare system and the NHS and I think very similar. You watch those experiences and I just remember all my experiences and it's not easy watching. And that's a really good way of informing people about some of the realities that is happening and changing some of the perspectives around that. But I also really wanted to emphasize what you said, which is it's not necessarily the healthcare workers that needs to do one more thing. There's a role for everyone to play in this. There's a role for different people to become agents of change if we really do want to shift the system. And so I want to just come back to your story because I still feel this is why we wanted to have this conversation with you. You are such a wonderful example of somebody who's been in a different field, but who decided that I'm the one that's going to do something about this. And so what was that moment? You spoke right in the beginning of some of those crossroads, but what was that personal moment for you where you realized you need to be the one to take up the lead? and the charge in this and what gave you that courage to take that step? Interestingly, it was an emergency medicine physician who did it. You know, I would say in your question, you're making an assumption that I still feel like I'm qualified to do this, my friend, and that I should be doing this. There wasn't really one aha moment. was the tsunami though, of feedback that we received and the volume was so high. And we had been, we had this literally microphone and camera in our face. And I just thought people need to know, the general public needs to know, healthcare leaders need to know, policymakers need to know that our workforce needs help. And you know, I know many, many, you know, know hundreds, not thousands of physicians and they're busy taking care of patients. And the culture in healthcare is also not one where, you know, it's always the most well received when you raise your hand and you say, hey, this environment could use some fixin. So sometimes it takes somebody from the outside to shine that light back inside and provide a different path forward, or at least suggest another path forward, right? But it was that tsunami of feedback that we received. It initially was so overwhelming that uh we were almost paralyzed with it. But then the fact that it, frankly, It continued for three years. Every day I would open my email and open my phone to find messages from people that I didn't know the day before. I still get those messages, by the way. It's just not every single day. It's now like a couple of times a week, but it was those messages that were saying, you know, thank you for sharing her story. I did something different. I changed my life. And I point to the emergency medicine physician only because it was that summer of 2020 and we had received all this feedback and I'm going, well, wait a minute, I'm a planner. If you're going to create a new business, even if it's a nonprofit organization, especially if it's a nonprofit organization, you need a business plan, you need to understand, you have to have it all figured out before you start." And she said, just start, you'll figure it out. And I just frankly had to take a leap of faith. And I would say to you that one of the things in this entire experience for us as a family and for me personally, that I had to initially just accept was help, help from others and assume good intent that people are actually trying to help for the right reasons. You know, as a lawyer, you're trained to be a skeptic. That is what you are trained to do. When you go to business school, you learn how to be very skeptical about a whole different set of things. But we are not always just like, Hey, great. I'm going to ask for it and be receiving. But because of where we were probably emotionally and, just in that place, I had to accept on face value that when I received that outreach from people who were saying, I want to help you, that I wouldn't try to negotiate that away if you will, or or figure out a different way to do it on my own, I would just say, you know what, thank you. Let me know how I can help. Let's move forward. And I would say that in that way, this whole exercise for me and for us as a family and for many ways for our foundation has been a real testament to how people help each other and how humans look out for each other. I mean, we have had so much positive feedback and attention and all these things. Because we lost a family member and people have people lose family members all the time. Family members and friends die all the time. What was it different about this moment? I think it was the timing of it, the publicity about what it doesn't even matter. But people took care of us as a family. And you know, you were asking me about that kind of grief journey, that suicide journey. And they took care of us and they continue to take care of us. And by taking care of us, we are now turning that same energy and positive thought into taking care of others. through the Dr. Lorne Ruin Heroes Foundation and will continue to do this work. So it's a giving and receiving kind of loop, feedback loop here, but it's been incredible. So I wouldn't say there was exactly one moment, the moments continue, but I'll just end by saying one thing, which is, I was a couple years in and I was looking at myself going, what are you doing? Why are we doing this? And does this matter? You've told this story a thousand times now. You're standing up in front of thousands and thousands of people on a uh monthly basis, you know, getting emotional, telling this very personal story. What kind of a difference is this making and is this something that you should be continuing? And I remember opening my LinkedIn, getting a message through LinkedIn, and it was from a gentleman who had been at one of my talks. And he said, unbeknownst to either of us at the time of your talk, your talk saved my life. You provided me with the number 988. which is the National Mental Health Number. And you call that phone number and ask for help. And he said, I was having, I was gonna take my life. And I was ready and my significant other had left the house and I was prepared to do it and I remembered your talk. And I called the number and I'm here today because of it. And so it's moments like that that keep us going. And it was in that moment, it hit me right between the eyes. And so it's not just one moment. I wish I could point to one nice, crisp moment. As you can see, it's a whole lot of moments. And they continue. Also, I commend you for just the passion you bring to this and your willingness, like you said, the willingness that you've had to start this and to link arms with another and to just keep inspiring so many other people. That's often all it takes. We don't need to have any more qualifications, I think, than that willingness to do something about it. As we close, I want to ask you whether you have any guidance. So we have listeners, people who are there in healthcare. who are in different positions and how do could we guide, inspire people with some final words for how they could become agents of change in their settings? What are the few things they could do that can back them the voices of change in their own workplaces? Well, I think, thank you for that question because I think that there's so much to do that it can also be paralyzing and overwhelming. Our chief medical officer, Dr. Stephanie Simmons often often says, when you tell people to fix the system, they It's like asking them to boil an ocean and they don't know where to start. So one of the ways that we have tried to channel all of that is to, you know, for people to volunteer and become an ambassador with the Dr. Lorne Brin Heroes Foundation, because we're trying to help channel that work. And if you don't want to become an ambassador, no problem. I'm not out here asking for it, but it's, it is absolutely something that we've been able to try to get people focused because I think the focus is really important. I would start by looking also at our, at our champions challenge for licensing and credentialing. And even if you're not in the United States and you want to look at your use it as a guide for your own internal policies and practices, how are you speaking about mental health in your organization? How are you documenting in the electronic medical record when you see a patient with a mental health condition? How are you writing about it? How are you speaking about it? How, what are the policies and practices in your organization about getting mental health treatment and do people know about it? Or is there still a stigma? So that to me, that's a very focused way that we can get started on this. let's start by putting the oxygen mask first on the workforce. And one of the best ways we can do that is making sure they have access to mental health treatment when they need it. The next thing I would say is looking at learning about peer support programs. I think these peer support programs are the number one thing that we continue to hear from health workers that they want. They want to talk to somebody who's lived with the, know, walked the day in their shoes, if you will. And so learning about peer support programs and that this is more on the individual resilience side. But then, then I would, then I would go to, okay. let's figure out how we can in my environment, my local environment, understand what's really going on beyond asking about whether the workforce is engaged or not, whether workforce is turning over, what are the actual problems? And there's tons and tons of survey instruments and things like that out there that allow people to really diagnose the condition. And I think that is the critical component is you need to understand how to diagnose what the problem is because What's different in your unit, what may be true in your unit may be different in another unit. And so understanding what that local problem is and then developing a team around it, an interprofessional team around it and just start fixing it. And I would end by saying in all of this work, it's critically important to let the workforce know what you're doing. They're so depleted at this moment. They're so lost for hope that knowing that They're being seen and heard and valued and that their feedback about what operationally needs to change is being worked on is critically important for them not to lose hope and for organizational initiatives to really get at long-term change, not just putting a bandaid on this problem. Get involved in policy too and just reach out to us at the Dr. Lorne O'Brien Heroes Foundation. We'll direct you. Those are great practical suggestions. And I always feel the system doesn't change. Like we are the system. it's each of us contributing in whatever way we can. And I think you gave some wonderful recommendations and suggestions for how people can do that. Corey, thank you so much. I really appreciate the time for having this conversation and good luck with everything else that you are doing. And thank you for this work you're doing as well. Thank you so much for creating space on your podcast for this special episode. Let me know at drlonerbrean.org if there's anything that we can do to support you all. Thank you for taking the time to join us for this discussion. To learn more about our guests and to access the resources mentioned, please visit the Symptom Media podcast page at symptommedia.com. We look forward to having you with us again for our next important conversation.