The Dose - Reforming Mental Health Support for Students and Health Care Workers
Episode Date: October 11, 2024Evidence of a mental health crisis is everywhere — from the recent surgeon general advisory about social media’s effects on our youth to the pandemic’s documented impact on medical professionals.... To whom does a college student turn for help so far from home? And who cares for the mental health of those caring for us? Enter Dr. Jessi Gold, a psychiatrist and the University of Tennessee’s first chief wellness officer, who aims to change the way student mental health is addressed on campus. She favors an open, flexible approach to helping students find the kind of help that’s right for them. Off campus, Dr. Gold has been conducting research into the overlooked mental health needs of our medical professionals. On this episode of The Dose podcast, host Joel Bervell talks with Dr. Gold about the systemic changes needed to support mental wellness across our college campuses and the entire ecosystem of medical professionals.
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The Dose is a production of the Commonwealth Fund, a foundation dedicated to health care for everyone.
My guest on this episode of The Dose is Dr. Jesse Gold, a psychiatrist and author now serving as the first ever chief wellness officer at the University of Tennessee, a very diverse five campus system.
There, student mental health is her focus. Right now, nearly everywhere we look, we are bombarded with data that young
people are struggling with mental health. This is a fact of life before and since COVID, and yet
infrastructure and attitudes are still catching up. We'll talk about mental health on campus and
what it means for students to seek
and find the right kinds of help. The pandemic also sparked another project for my guest,
as she was surrounded by colleagues in the caring professions who she noticed were rarely
acknowledged or addressed as people and professionals with their own mental health
challenges. The result is her brand new book out this month, How Do You Feel? We'll
talk about the research and what it means for caregivers to preserve and support their own
mental health as we dedicate our professional lives to caring for others. Dr. Gold, thank you
so much for being here with me. Thanks for having me. So as I mentioned in the show open, you are
the inaugural chief wellness officer at the University of Tennessee campus. Let's level set. Why now?
And why is this important? I would love to tell you it was always important to everyone. It was
always important to me. But I think inherently, the pandemic really opened people's eyes to just
how bad our mental health was. I think it kind of widened the existing cracks, which we saw in the
system in all systems, honestly, where there were challenges, we saw more challenges. And I think on a college campus, putting me in charge of this system as a
person who will center wellness and can do that across the state and all five campuses, and they're
really diverse in different campuses, also suggests it's a systems problem, right? It's not just a
problem you can fix by getting more counselors, which I
think is what people would love to do. And I think that that is not the right answer all the time.
You know, when they created this, it wasn't out of crisis, it was out of concern. And I've been
able to go all across the state and get to see really, really different campuses, like one that's
really sports and fraternities and sororities, one that's a thousand students. Those are very, very different populations. And my job isn't to come tell them what to do. It's to kind
of add and find the ways that I can be helpful. Absolutely. You kind of sit at this interesting
perch of being able to give us a snapshot and insights more broadly on student mental health
today. As a student myself, it does feel like there's been more conversations about mental
health than there were when I was an undergraduate. But is that track with what you're seeing
actually on the ground and through your work? I think there's more conversations, but I don't
know if there's more help seeking. I know that sounds strange because it would make sense if
people talk about things more that then they would come get help because they identify it more.
But I kind of feel like talking
about it and having the words for it doesn't always translate into people going, oh, now I
should get help for it. And certainly not early. I think we still really define the need for help
around crises and around like my grades are bad. So you could say to a student, like, what else is
going on in your life? And they're like, I haven't left my room. I drink sometimes, I don't sleep. And then you're like, but my grades are good. So I'm great. And they have a bigger
vocabulary around mental health, but I don't think that they always know what it means. Like when I
had a conversation with a bunch of grad students recently, and the number one thing they said that
they needed on campus for them was awareness. And it's that they feel like they don't have it in
that they don't know where to go for help and they don't know how's that they feel like they don't have it in that they
don't know where to go for help, and they don't know how to access help, and they don't know when
to ask for help. They just know that mental health is more normalized. I think that's such a really
interesting point. It makes a lot of sense. And we'll get to social media in a second.
But curious, has there been an uptick in diagnoses on campus too? When you think about,
like you said, people seeking less mental health access and accommodations, maybe feeling like they know what it is, seeing it on
social media, has there been an actual uptick in diagnosis on campuses for students? Yeah, I mean,
I think it's been, it was a crisis before the pandemic. So I just want to say that this time
period is particularly stressful for people. It's a time of identity development and experimentation.
It's a time of just like neurobiology causing mental health conditions and that age group.
And so I think it's really important for people to know it's not like the pandemic magically made
them feel bad, but it did really change what college looked like for them. And it did really
change their social interactions and their isolation. And people talk a lot about troublemaking friends now. And I don't know that they would have felt like that before,
but maybe they did and we just didn't ask them. But what I see is still, we've definitely had
more crises. We definitely have more people asking for time off from school. I think depression,
anxiety, ADHD are still the most common diagnoses you see on a campus. But I think students use the word
trauma a lot more than they used to. And I think identify it and are aware of it. And that makes
it hard for therapists on campus that are really supposed to be short-term therapists to help
manage all of that. And so I think what they're seeing has become a little more challenging for
them just because sometimes, you know, sort of
the way the system is set up to take care of folks, it's really set up to deal with adjustment issues.
Like you're having a breakup, you don't like your class, you are struggling for an exam. It's not as
much set up to deal with like all these people coming in with psychiatric illnesses who need
medication and all these people who develop them and get crises. And so, you know,
not every campus can get a psychiatrist to work there, you know, and I think that that's a big
thing. And also, it also suggests that, like, we're better at managing mental health in younger
folks. So the people who are going to college might come in with a more complex history,
but if they're treated and they made it to college, maybe we just supported people who
would have never made it to college before because our meds are better and our treatment in younger folks is
better and the way that we're like finding it and assessing it is better. And so we're getting some
sicker folks coming in. But is that because we are better at dealing with them when they're younger?
Or is that because they're sicker because of the pandemic? I don't know that we could 100%
say the answer to that. Yeah. And I want to shift to social media for a moment, particularly platforms like
Instagram and TikTok, which we both use very frequently.
You more than me.
Not true. You're doing an incredible job. I love your content.
But as we both know, last year, the Surgeon General issued a new advisory about the effects
that social media has on youth mental health.
And I'm curious, given your role as a mental health advocate, how do you navigate those complexities?
And at times, the irony that's there with promoting mental health well-being in these digital spaces and balancing doing good and giving education with the harms of it.
Yeah, I'm really glad that you mentioned the balance because I think sometimes when this issue
is presented, it's like social media is so bad. Get off social media. Everyone should be off social
media. And I don't feel like that. I think it has some benefits. It definitely has benefits in what
we do in educating and misinformation. And we really would be harming our patients if we were
off of it entirely. That's what I think. And so for me, I've noticed there are times where it really
affects my mental health. The pandemic was a really big time for me. There was a bit of conversation
for a while where the healthcare workers would talk about their experience. And I somehow got
in my head that my job on X was to basically be like, I'm here. I validate you. Thanks for sharing.
And I felt somehow responsible for finding all of the people who were sharing and validating their experiences. And I would stay up super late thinking that my job
was to fix that for them because if they disclosed and no one said anything, they've never disclosed
before. This is new. We need to support them. And I really had to evaluate where that was coming
from and why. I think some of it was a need to be really helpful and try to be a beneficial
person on social for them. But also I needed to actually say, this is affecting sleep and that's
not good. This is making me mad and that's not good. This is becoming sort of a weird obsession
and that's not good. And I think it was serving some purpose for me that I didn't realize at the
time. And I needed to step back and say someone else
will handle it or mute is okay. I think it's a balance and it's about kind of understanding what
it's like for you and knowing that you're allowed to take breaks and you're allowed to not respond
right away and you don't owe anybody anything. Now that's really powerful and it's not easy to
do it all to step away, especially when you went into a career dedicated to try and help people,
right? But when helping may be hurting yourself, you can't do everything all at once,
no matter how much we want to. For many college students, especially in their first year, of
course, it's the first time that they're away from home, having to navigate self-care on every level.
I remember my own experience having to be in a new environment where you don't have your parents
that are taking care of you anymore. And data tells us that one in five Gen Zers are in therapy. 60% take some medication to help manage mental health.
College students right now are mostly Gen Zers. And you touched on this before, but are students
adept at navigating the on-campus mental health systems, finding the right help, and kind of bring
it back to social media as well. How are they using social media and how is that influencing how they come to you when they do seek help?
Oh, these are such good questions. Thank you for asking them.
You know, I think when you land on campus, you often can get lost in the system.
And that is because you don't realize how much your parents were doing for you.
So sometimes your parents pick up your refills.
Sometimes your parents make your appointments or whoever your guardian is.
And so a lot of people just in the transition will be like, I feel fine and have that sort
of adrenaline from the beginning and just think that they don't need meds anymore because
they feel fine.
And then a bit later, they have finals or midterms or whatever.
And all of a sudden, it's like, oh, no, I need an appointment now.
But that's a lot harder to get in, right?
And so I think that the transition period can be really hard because they don't realize
how much they actually needed it or they want to try without it.
And that can be a big challenge.
I think some schools have too many resources and some schools have too few.
And both are hard for people.
So if there's a lot, sometimes people don't even know where to start.
And they're like, do I go see a dean? Do I go see student success? Do I go to housing? Do I go to counseling?
Like, when do I use these things? And so I think that can be really confusing in places that have
tried to have a lot of resources for students. And then obviously not every campus is able to
do that either. And in more rural areas, there might be like one counselor and recruiting that counselor could be a lot of work to even have that person. And then if students don't like that
person, what are you supposed to do about that? Because you couldn't find one in the first place.
So that I see a lot. And then, you know, the social media question as a psychiatrist is kind
of interesting. I think in therapy, people have mentioned that people use words more like therapy speak,
like come in with a diagnosis already or use words like triggered or narcissist or trauma
because they saw it on TikTok or Instagram and they think they know what it means from
that.
And they use it a lot in like everyday conversation.
But just because they kind of have heard it doesn't mean they're using it right.
But also doesn't necessarily mean that they have a diagnosis, first of all. Sometimes they're labeling things that are just feelings
as a diagnosis. And then sometimes they come in with a laundry list of things that they saw on
TikTok, for example, that told them they had a diagnosis. And it's really because of the algorithm,
because the algorithm was like, ooh, you watched a video on ADHD, want another one, want another
one. And so they come in and they say, I have ADHD. And then you say, well, why? And they just
describe the videos and I'm not an invalidating person. And so I say, okay, tell me more. Like,
what about that resonated and all of that. And then I say something like, have you ever thought
that concentration could be something more than ADHD or different than ADHD. And they haven't because they saw 75
ADHD videos. And so sometimes they'll listen and they'll hear about how you can have poor
concentration because of sleep. You can have poor concentration because of anxiety. You can have
poor concentration because of depression. But sometimes they're like, you are invalidating
my experience. I think that that can be particularly challenging if the groups that are coming in
are groups that are traditionally underdiagnosed for things like that.
So if it's a female or a person of color, like the internet is saying, and they're not
wrong, that you've long been underdiagnosed.
And so you come in and you say, I've long been underdiagnosed.
I should be diagnosed.
And it can feel really bad to those people.
And I think for me, it has been hard to navigate like good patient doctor relationships in
those settings, as much as I am fully aware of what they see on social and probably more open
to those conversations than some of my older peers. I think that they still just don't want
to hear that. And that can be pretty hard for me because I'm not going to give a medication that
can worsen your anxiety if you have anxiety, Like, I'm just not going to do it.
And I get why you think I should, but I can't because it's not good practice.
I'm nodding my head so much right now because I find myself at this intersection sometimes of wanting to put information out there.
But then actually worrying that I may be contributing to people only getting one piece of it, right?
In medical school, we learn about the differential diagnosis, how there could be so many things going on. But when you can only talk about one of what the possible 20 could be,
but it can be difficult to have those conversations in a way that makes sure that the patient feels
heard, but at the same time is getting to the heart of their diagnosis. And I'm glad you mentioned
people of color and the kind of how that can be underdiagnosed as well for specific groups.
You oversee a really diverse collection of the five
campuses in Tennessee. Some of them are more urban, some are more rural. Is there enough
culturally competent or fluent care available? And also looking at kind of mediums that it's
delivered through, whether it's telehealth options or in-person options. Yeah, I mean,
there are a lot of telehealth companies that have tried to fill this gap and taken to really target college populations because licensing alone is really complicated.
If you see a college student because they might, you know, you have to be licensed in the state that they are in physically.
It doesn't matter if they saw you in Tennessee.
If like you're not licensed in California and they go home for the summer, you really aren't supposed to see them.
And so for college students, because there's a lot of transitions,
there's internships and jobs and school, and you're going all over the place. And that can make something like a telehealth company make sense because they have people who are licensed
a lot of places, or you could switch pretty easily in a place where you're trying to recruit to a
college campus where they're paid less than working in private practice, where it's a rural
setting and maybe you only want to live there because your family is close, right? It's a very
specific person that you're recruiting for that. And if you try to expand, first, your school
doesn't have the money, but you're also not competitively recruiting. And that makes it
really hard. I know a lot of therapists that work on college campuses and they do it because they
care about the students and the population.
Because if they took another job, if they did anything else, they'd make so much more money and have a better lifestyle.
You know, the telehealth companies really can bridge that gap and do try with access.
And just, you know, if you have one therapist on a campus, the chance that that therapist matches any identity you are looking for. You know, a lot of students really want people who look like them to take care of them,
particularly in mental health, because they don't want to educate around the issues. And so
there's access through those sites to have a bit more ability to match, even have people who can
speak different languages. And I think if college can't afford it and integrate it into their
system, it kind of balances it. But the need and the ability to actually solve the perfect matching is a huge problem kind of in mental health around the country, in all health care around the country.
I think that I feel comfortable treating people who don't look like me because there's like two to three percent black psychiatrists and I'm very used to that conversation.
But I often say, if you want me to help you find
someone who looks like you, I will do my best to help you. But I must also tell you that it's rare
and you might not be able to. And I think that that is a hard conversation because I get why
you might think, especially in mental health, that you're better off with somebody who has a
similar life experience. Absolutely. I think that's a perfect transition point to start talking about caregiver mental health.
So as I mentioned briefly earlier, as a psychiatrist, you experienced and you saw your colleagues
across the healthcare landscape pushing in historic ways to care for patients during
COVID.
Your book is a blend of memoir, reflections on your own experiences, but it's also more
than that because you conducted research and really dive into some questions that hadn't previously been well-illuminated.
So very basically, how are our carers doing?
I mean, very similarly to college students, honestly, not well.
We were another group that was struggling long before COVID, that COVID added these
additional stressors and made things worse.
Our burnout in healthcare was like 50% pre-COVID, right? And that's more than any other profession,
any age match peers. And then, you know, all of the challenges that came with COVID. I mean,
the uncertainty of it, the way medicine was like first appreciated, then not, the way that we kind
of like we're taking care of really sick patients
who are dying at rates we weren't expecting. Those are all new stressors added on top of the
clear problems in the system of medicine. And burnout is relevant to everyone because not just
is it related to depression? It is. Is it related to substance use? It is. But in patients,
it's related to like errors or people staying in the hospital longer or people not being as satisfied with care. And then on a bigger system
level, people leave. When you're burnt out, you leave. And we just talked about access. If you're
the one person who does this particular thing and you leave, people don't have access anymore. If
you're the one person that looks like the population and you leave, people don't have
access anymore. And that makes a huge difference in outcomes and care. Absolutely. And I'd like to also focus in
on nurses, pharmacists, that entire ecosystem of professional caregivers that surround and support
us and our patients. How are they kind of faring with everything as well?
Thank you for asking that. I think sometimes we get the microphone and don't pass it in these situations. And like I used to see people who were like cleaning the hospital or greeters in the hospital. We don't have any data on what their mental health is like or the people answering the phones. We don't have information about that. We have some on doctors. We have a little less on nurses. And then like it really starts to get pretty small when you get to pharmacy or dentistry. But what you see is like people who care for other people traditionally are not good at caring for themselves.
And as a result of, you know, culture and stigma and sort of belief that we're not supposed to get help and our jobs are not supposed to affect us.
A lot of us don't get help when we need it.
In nursing, a lot of it affects things like staffing ratios and doing
extra shifts to cover for people who couldn't stay. And you hear from nurses, like the shortage
really can impact their mental health because they're taking on more or there's travel nurses,
they have to train them. And so there's all these systems at play, but it makes it harder for the
people who are in it. Absolutely. In your clinical practice, you treat many healthcare professionals.
There are mental health strategies that are broadly useful, but what specifically is there for caregiving professionals? Yeah. So I wish we were treated like a separate population and we
had cultural competency for healthcare. We do for police and people who are EMTs and we don't for
us. And I think we do have a specific set of needs that are not covered.
And every time someone comes to me and they go, you're an expert in this, like who is an expert
in this? That's awesome. Like, I think it's really important that we realize that we have differences,
you know, because we don't want to be told to go to sleep when we can't. Like if our shift is like,
it's just impossible to do that. Or as a resident, like get more control over your schedule. Like, okay, like that's not a helpful thing to tell me, right?
And so inherently, I think things that work for us, like we're perfectionists, we're very
bad at self-compassion.
So when I say that, I mean, how nice are we to our brains?
And so sometimes, you know, if we make a mistake, we're much more likely than other professions
to say like, that's on me and I'm a horrible person, then I should learn from that.
You know, I think another thing that tends to work for health care workers is like not prescribing a coping skill, but letting them figure out what that looks like for them.
So I think traditionally things have been offered in hospitals and it has always kind of come off like silly to folks. Like they're like,
oh, good, a yoga class. Oh, good mindfulness. Like they're just not going to fix anything.
And they're just going to do this instead. And there's truth to that and how that feels for
folks. So I could tell you there's evidence that mindfulness works. But I could also tell you I
hate mindfulness. And I've tried it a bunch of times. And that doesn't make me somehow bad at
coping, which I've heard from patients. It just means that you could try something else and that's okay. And maybe like third, which is like maybe
surprising to some people because they haven't thought about it. We're really bad at like
identifying any sort of mental health word or feeling. Some of that comes from the fact that
all in training, they tell you not to pee, not to eat, all this stuff. And so you basically ignore all your physical sensations. And so why would like a feeling be allowed? You don't see
people talking about their feelings either. And so you push those down just like you do
all your physical sensations. And then when you say like, how are you? Like, I mean, they don't
have feelings. Like they can't name words. Like it's okay and fine, which aren't feelings or they feel numb a lot of times, but they don't realize it. And so like getting to the
ability to sort of identify how things affect you and that they can affect you and that those words
can be named can be a pretty simple thing, but can make a big difference.
And the title of your book is How Do You Feel? How did you land on that?
I mean, so psychiatrists maybe like traditionally do a lot of like, well,
how does that make you feel? But inherently for me, I felt like, you know, seeing healthcare
workers, we spend so much time asking that of other people, but we don't actually use the you
to mean ourselves. You know, it's a deeper thing than just saying, how are you? How do you feel
has like a bit of a deeper word than that.
But the you is to me, what's the most important there.
The you is what's the most important.
I love that.
And as we wrap this conversation, I'm curious, in researching your book, what was something
that shocked you, surprised you, or that you hope that people when they read it are
left with?
So something that surprised me is like how many
people told me codes are how they learned about emotions in medicine. So codes, if they're not
in healthcare listening, you know, doing CPR and somebody who may or may not survive across the
board, like if I was actually tallying them, I would say like 90% of people said they learned
emotions in codes because as a med student, you maybe see your first
one and nobody reacts. Nobody does anything. So if you react, you stand out. We don't want to stand
out at all. We already don't like standing out for the size or length of our white coat, right?
We're hoping that we don't stand out. And so we learn not to. And we learn that it's not acceptable
or you're not supposed to react to it.
And almost every single person I talked to had a conversation like that with me where they said
codes were the reason. And I hadn't really thought about that because it just didn't cross my mind
that that was such a pivotal thing for people to see. But of course, like seeing someone die,
especially would be impactful on people. But I think it's the death with no acknowledgement.
And so, you know, there's some places that do things like a pause, and they don't talk,
and they just give you like a moment. And I think that it can be a tiny but good intervention where
you're actually acknowledging that you're human in that setting, and that that might have affected
you. Obviously, talking about it is nice, too, but that doesn't always happen in our setting
or we don't always have time. What did you want to surface in the book when you heard so many
people mention that they first learned about emotions through codes? I mean, I think that we
don't talk enough about the culture of medicine. Like the same way when I said that we don't really
consider ourselves or we're not viewed as like a different population that needs cultural
competency. We don't like to admit that like when you are in medicine, you learn a lot of things that
you're learning from what's around you, not in a book. And part of that sort of, we call it
hidden curriculum, right, is emotions. Like we learn that good doctors are stoic, that if you
share your feelings or have feelings, you're making it about you. That if bad things happen, they are supposed to because that's life and you're a doctor
and people die.
And that's just like what you see and what you're told.
You're not going to have feelings until you have really bad, big, big, big, big feelings,
right?
And like those will be the ones that end up in my office.
I also think, you know, it teaches you a lot about how to interact with trainees.
Because like, to me, if that is where everybody's learning about emotions, we need to intervene there.
Like we aren't, we shouldn't just go to lunch.
We should have pauses or we should have conversations or we should at least say to the trainee,
is that the first time you've ever seen that?
Is that something you want to talk about?
And at least give them the space to do it.
I've heard plenty of people where the trainee still sort of like buttons up and gets angry
about being asked and feels like somehow they did something wrong.
And I totally get that.
But I think noticing those places where we learn these things and doing better is why
I ask those questions, because we can do better.
And a lot of that is culture change.
And that's on us.
Dr. Jesse Gold, thank you so much for asking the question. How do you feel,
not just to patients, but also to caregivers, because it's truly making a difference. And
thank you for being on the podcast and sharing your thoughts. I learned so much from you.
Thanks for having me.
This episode of The Dose was produced by Jodi Becker, Mickey Kapper, and Naomi Leibowitz.
Special thanks to Barry Scholl for editing,
Jen Wilson and Rose Wong for art and design,
and Paul Frame for web support.
Our theme music is Arizona Moon by Blue Dot Sessions.
If you want to check us out online, visit thedose.show.
There, you'll be able to learn more about today's episode
and explore other resources. That's it for The Dose. I'm Joel Brevelle, and thank you for listening.