Podcast: Taking Care of Yourself and Others

Episode Transcript

Jenn: Welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

Hi folks. Thank you so much for joining us today for “Taking Care of Yourself & Others.” I would like to introduce myself. I’m Jenn Kearney, and I’m a digital communications manager for McLean Hospital.

And before I actually jump right into the conversation I wanted to extend a huge and major thank you to the Mass General Hospital Institute of Health Professions, their mental health club as well as Dr. Marni Chanoff for being interested in hosting this session.

And we are recording this and hosting this in May, which is Mental Health Awareness Month. And it’s been a really great month so far of folks asking one another how are you taking care of your mental health? How are you doing?

And a lot of times it’s been not only how are you doing but like, how are you checking in on other people? Are you checking in on your friends and family? And do you find yourself advocating for mental health a little bit more often than normal?

So this chat today is going to be for all types of folks whether you are a student, a teacher, a patient, a current and future healthcare professional, all of you we’re going to talk about how to address mental health both in your day-to-day lives, as well as if you are a healthcare provider in your patients’ day-to-day lives.

And we’re going to talk all about how to take care of ourselves, our loved ones and if you are a healthcare professional or studying to be one, our future patients. So if you are unfamiliar with Dr. Chanoff, Marni Chanoff MD is the founder of the Integrative Wellness Group at McLean OnTrack.

And she’s an integrative psychiatrist who combines Western psychiatry practices, Eastern approaches to medicine, as well as nutritional psychiatry, culinary and lifestyle medicines, which Marni, I feel like just speaks to me on a whole new level.

So I wanted to start first of all, by saying just thank you so much for joining. And I’m super excited to have somebody who is just so reputable and knowledgeable as you to talk about this with us. Why is it so important to recognize mental health as being a huge contributing factor to our health overall?

Marni: Well, we are recognizing more and more that there is this real direct interaction between the brain and the body all the time. In fact, we’re actually one organism and the mind body connection has a lot of research that supports the fact that what is happening in the mind absolutely affects the physical body and vice versa.

And so it’s really important that we, as we are working with either the body or the mind in my field, that we are taking into account that the person is a whole person, and that there are the multiple pathways that connect the mind and body. So you really can’t separate them.

Jenn: So if we are someone who is teaching future health care professionals, what advice would you have about providing like an air quote soft entry to mental health in our curriculum?

And how can we start teaching the basics of mental health that would be both applicable to students taking our courses as well as the patients they’ll be taking care of in the future?

Marni: Well, I think starting with the fact that, depression and anxiety are so common and actually becoming more common and have become more common over the last year and several months during this pandemic. And so if you’re not aware of just those two mental health issues then you’re missing a large portion of the patients that you will be serving.

And I think, if you’re in the healthcare profession and you’re working say in primary care or physical therapy or occupational therapy, one’s mental health will have direct and indirect influence over how well they are able to take care of themselves, how much energy they have to really attend to their whole body health.

And it’s really important that people in the front lines, whether it’s physical therapy, occupational therapy, nurses, primary care doctors, understand that most people don’t go straight to a psychiatrist or a therapist that they actually, they are first sort of noticed as someone who needs help in the community and in other health professions.

And so if we can all work together to increase awareness and increase simple screening tools and questions, then first-line responders, the people who are on the front lines can actually screen and identify people much earlier than if we wait until symptoms get so severe that they present to the mental health professionals.

Jenn: So if someone’s in a field of work or preparing to enter a field of work that focuses really heavily on physical health, I would say a good example would be like occupational therapy or physical therapy. Why should we consider mental health as being a large component of that patient’s care plan?

Marni: For so many reasons, there is a bi-directional relationship between mental health and one’s ability to participate and really benefit from these other forms of medicine in the physical realm.

So for instance, if someone is depressed, number one, are they going to even make a physical therapy or occupational therapy appointment?

Number two, are they going to show up, number three, when they come are they really going to have the interest, the motivation, the energy to really sort of take in what’s happening in the room and really internalize the recommendations and remember those physical therapy or occupational exercises and then go home and do them.

I mean, I just finished a course of physical therapy and it’s a lot of work. And I remember leaving many of those appointments being like, wait, what did she tell me to do? And I’m actually feeling pretty good and I’m high-functioning person.

And so if someone is depressed, the likelihood that they’re going to be able to really utilize these essential forms of medicine really decrease.

And then the other thing is that the symptoms that often bring people into occupational therapy or physical therapy having to do with the body say pain, those symptoms can actually be more severe in someone who is depressed or anxious because their pain tolerance might be lower, their coping strategies, their ability to kind of rationalize what’s happening and kind of keep moving forward.

All of those things can go down and vice versa. If someone is in pain or are uncomfortable or they’ve lost some degree of functioning, that’s going to make them depressed and it’s going to make them anxious because they’re not sure what’s going to happen. They’re not sure if they’re going to be able to continue living their normal and best lives.

Jenn: So what advice would you have for folks who are starting to do either they’re fresh into the field of PT or OT or they’re just looking to brush up on patient skills. How can they start incorporating mental health into that field where folks are predominantly focused on the physiology aspect of it?

Marni: Well, I think it starts in the education, And having that exposure. So I think that we have a duty to really educate our students in all of our health professions.

What are some of the more common symptoms of depression and anxiety and then do, sort of practicums to help people get comfortable asking those questions? What are some of the simple screening tools that one can use?

And then how do you identify people who are really hurting and who are really at risk? And how do you ask, how do you train people and how do you become comfortable in your own early professional life to ask those hard questions, particularly about suicidal thinking and assess kind of that thing.

But even backing up way before then just becoming familiar with the signs and symptoms of depression and practicing asking them. So you become more comfortable and you don’t, you don’t look at it as kind of taboo or you don’t get wrapped up in the, I don’t want to insult that person.

I don’t want, there’s so much stigma around mental health. I don’t want to make that person uncomfortable by asking them, do you think you might be depressed? Are you feeling okay? You want to just look at it as yet another thing that we are all comfortable with that we all talk about, that we all experience and sort of approach it from that direction.

Jenn: So you teed me up beautifully to ask how would you respond or do you have advice in terms of responding to colleagues and healthcare who are speaking to or about a patient in a stigmatizing way regarding their mental health?

Marni: Oh, I would just tell them that, it really does such a disservice to make people feel bad about feeling bad.

And we have to really be sensitive to how it feels to be on the other side because shaming someone who might be depressed or making people feel ashamed that they just haven’t been able to do that exercise that you suggested last week can be really, really hurtful.

And really damaging and can make people very suspicious of ever seeking care again. I’ve heard so many stories of people leaving doctor’s offices or having interactions with nurses and it’s just awful.

So just being really, really sensitive, but not afraid. And that is the balance. I think that we all need to kind of practice and get comfortable with.

Jenn: So we have a variety of folks tuning in today about whether they’re doing clinical rotations, they’re learning about rotations or they’ve been practitioners for over 25 years but I’m sure they can all agree that there are always going to be folks that approach mental health with reluctance, disinterest, stigma, you name it.

They’re not going to want to talk about it and they’re not going to want to hear about it. Do you have advice for how we can talk to people who might be less inclined to want to even address mental health? Cause it is part of their, it’s something that they do need to consider even if they’re not interested in considering it.

Marni: So just so I understand. So you’re asking about the provider or the patient?

Jenn: The patient.

Marni: How to engage the patient and get them interested in even having the conversation. Well, I think that probably the best approach is number one for you, like sort of a broken record at this point already, we’re only like what 15 minutes in, but for you to get comfortable with the material.

And the more comfortable and at ease you are and more natural you are when you’re sort of asking or bringing up this topic the more comfortable you’re going to make that person feel.

And the more you can kind of normalize it as like we’re all human beings and we all go through tough times and sometimes life gets really, really hard and can really make us feel bad and can make us feel down and can make us feel hopeless.

If you can just sort of normalize it that we’re all in this together. And I understand what you’re going through because I can relate to it.

In some degree, you don’t have to disclose anything about your own experience or your mother’s experience or your brother’s experience but that you realize that we’re all connected to people who have mental health issues, if not ourselves.

And so to just really normalize that like, oh yeah we all, occasionally get headaches. We all occasionally feel down, let’s talk about it. And I think that approach can be really helpful.

Jenn: So for folks who are starting out on their journeys of trying to better understand mental health as well as mental health conditions, any materials or resources that you would suggest for them it could be anything that is geared toward folks in healthcare or the general public but anything that you love that comes to mind.

Marni: Well, I, there’s lots of really great things out there particularly on the kind of the mind body connection. Now that might be of interest to the group today. I welcome anyone to go to my website.

I’ve created a resource hub, marnichanoff.com, with a lot of links to resources and blogs and information about mind, body, health. On there, there’s connections to SAMHSA, to NAMI, to McLean that has a lot of information for everybody to be able to kind of access and utilize.

I think that there are if you know, Google, if you Google anything like I was trying to prepare for this a little bit and I just Googled physical therapy and depression, I found a really interesting study on screening that you can do and the efficacy.

So it’s everywhere. So if you’re interested and you’re curious ask Google some questions or find your own resources that really speak to you depending on your own area of expertise.

Jenn: I would be remiss to not ask this question having it be Mental Health Awareness Month, how can we introduce mental health conversations to people that we care about? Like family and friends.

Marni: I think it’s the same way. I think it’s just about taking a stance of I care about you, I’m interested in your experience.

I’m taking an approach of real curiosity rather than, sometimes I’ve worked with family members who just know their family member is suffering and they know it’s depression and they just want them to go get help and the person isn’t ready or they don’t want to talk about it.

So I always tell people just it takes time and the more neutral and curious you are the more you can ask open-ended questions. The more you can show someone that you were there with them rather than that they are the identified person with this problem that you want to fix.

The more you’re going to keep the conversation open and there’s going to be more of an open dialogue and an even playing field between the two of you. And I think the conversations will go much better.

Jenn: So we’ve got a heap of students joining us today and I would have loved this advice in the way back machine when I was a student myself. How can students reflect on their own mental health if they might be feeling burdened by responsibilities that they have both in and out of the classroom?

Marni: Well, I think being a student is an, especially a student studying healthcare of any kind it’s really intense and it’s really demanding.

And to recognize kind of how much you’re doing and how much you’re asking of yourself to stretch and to grow and to take in information both cognitively there’s so much information to take in.

And emotionally, that moving into the healthcare provider role takes a lot of growth. And a lot of stretching of our professionalism and sort of being able to ask the hard questions being able to absorb the pain and suffering of many of the people we work with and to recognize how hard we are working when we’re doing that.

And sometimes it shows up in symptoms that are identifiable and sometimes the symptoms or the result of all of that hard work can show up in more subtle ways.

So to really sort of be aware of what you’re feeling in terms of your energy and your cognition when you just reach that point where I just can’t take in any more information when it shows up in your body.

I mean, we’re all sitting in front of these cameras all day or even sitting in a normal classroom all day, that can really be hard on the body.

And so to really recognize that the mind, the body, the heart, the soul, it’s all being stretched and working really hard to move into that role and to just to recognize and honor all of the hard work and that you have to take really good care of yourself to be resilient and to sustain that level of hard work for a long period of time.

Jenn: So can you talk a little bit about burnout and what that might look like? Especially if folks are just starting to be in their own clinical practices and I guess a follow-up question would be that you did address resilience. Where is that tipping point between being strong and resilient and being like totally zapped?

Marni: Well, you can be strong and resilient and be totally zapped.

Jenn: Trick question. Thanks for your time, everybody.

Marni: Right, right, I mean, there are--

Jenn: Absolutely.

Marni: We’ve all got good days, we’ve got bad days, we’ve got good hours, we’ve got bad hours. And I think just to recognize that the strongest and most resilient people get zapped And it takes strength and resilience to recognize when you’re zapped.

And it takes strength and resilience to recognize when you need to take a step back and recharge and to give yourself permission to take a step and recharge that takes strength and resilience.

Jenn: So what can folks do, especially if they are students who are feeling burned out and overwhelmed, how can they address that with either people who are overseeing their rotations or like thesis advisors, bosses, any recommendations for how to address that with someone who they might consider a superior?

Marni: That can be really hard. You feel like you’re the only one sometimes. Everyone else seems to have it together. This person is so successful or has achieved so much. How could they possibly understand that I’m having a hard time?

So there’s a lot of projection that you’re the only one kind of in this position. I think it’s really important just to recognize that compassion fatigue, regular fatigue, burnout, really is just part of the process of becoming a healthcare professional and staying in the field over time.

And that it isn’t a reflection on who you are or how hard you work or how much you care. It is part of, I think it’s just part of the equation. And so if you can talk about it before it really gets in the way of you being able to do the work you need and really kind of give yourself permission to say I’m starting to struggle.

I’m just not able to absorb any more information and I have this exam coming up and I can use some support. What do you suggest? To reach out for support there was, when I was in my psychiatry residency at MGH actually MGH and McLean, one of the things they told us from the very beginning was to never worry alone.

Never worry alone. And I still use that and tell that to as many people as I can, because it’s okay to worry and it’s okay to be tired and it’s okay to be burned out. But when you feel like you have to bear that alone then it becomes a really big problem.

Jenn: I think that’s really lovely advice. I’ve never heard that before, but I also, I know I’m going to be using that in the future. Do you have any additional advice about how to prevent your own burnout?

A lot of folks have said they’re in healthcare because they want to care for others but they’re worried that they’re not doing enough caring for themselves in the process.

Marni: So if you’re worried you’re not caring for yourself enough, you probably aren’t. And there might be so many reasons for that. Some of them may be in your control and some of them may not be in your control.

So focus on the areas in which you have control. And become really careful and cautious and intentional about how you spend your time when you are not doing the things you need to do as a student or as a healthcare professional.

How do you spend your downtime? Can you prioritize your sleep? Can you prioritize your diet? Can you prioritize exercise? Can you prioritize learning how to breathe well? And make that your business to as much as you can. Prioritize those in your off time.

And then what happens I find is the more you do that the more kind of second nature it becomes and the easier it becomes to integrate that into your work day or into your school day because it just becomes more natural.

You become more aware of like, oh my God! I’ve only had coffee all day today. And I remember those days as a student. Oh, I had one sip of water today. I think not. Have I moved from this library seat in the last eight hours? Actually, probably not.

I mean, I was there. I remember it like it was yesterday. It’s intense. And so the more you can just make it part of your second nature, all of the basics. The basics of self-care, they’re basic but they’re brilliant, they work. And to really just prioritize and give yourself permission to do it is really the best way to go.

Jenn: So out of curiosity, what would be one strategy that you use to take care of yourself when you’re feeling burned out?

Marni: I have learned that for me and I tell this to so many people that for me sleep is the very best medicine of all. So I have become very focused on my sleep. And there’s so many things we’ve learned about sleep hygiene over the last decade that simple sleep routine techniques can be as effective as taking sleep medicine.

And so I really start there and if I can sleep then I can generally function pretty well and feel pretty good. When I’m not sleeping and I go through periods of time that I’m not sleeping well, it’s much harder for me to feel good and really help the patients and all the people that I serve.

Jenn: So if we are taking care of our own burnout we’re addressing it with our peers maybe even talking to our superiors about it. How do we talk to caregivers about it?

So how do we teach the caregivers that we’re working with like family members of clients or parents of patients? How can we give them advice to keep them from getting burned out?

Marni: It’s the same, same. The same advice. This, oftentimes if you’re a caregiver for someone who has a chronic illness, you’re in that role for the long haul and you have to be very aware of your signs of fatigue and exhaustion.

Cause those usually come before burnout, fatigue and then turns into exhaustion and then can turn into that kind of panic, anger, reactivity state, which can lead to burnout. So who can you ask for help? Who can you pull in? Who can support you? How can you be direct in asking for what you need?

People think that they can just handle everything sometimes and they feel bad about asking people for support. And they feel like, it means like maybe they can’t do all the things that they feel like they ought to be able to do. But it’s really hard to do that over a long period of time, which is what caregivers of people with chronic illness have to endure.

So pull in supports, what are your resources? What community resources can you utilize? Which friends and families can you have come in and give you even just a short break? Can you outsource anything? Can you share the load? Can you share the burden? Can you bring someone in while you’re caretaking to just attend to you?

Sometimes caregivers feel like they’re not supposed to have needs because the person they’re caring for comes first and it’s the oxygen mask. Like you have to put yours on first. You have to put your mask on first in order to be able to be effective.

This is about effectiveness. This is about not just being kind of strong, resilient, but it’s about how effective and productive can you be. So it’s really in the best interest of the person you’re caring for, for you to take care of yourself, a hundred percent.

Jenn: You’re going to love this next question. Someone asked, how do you incorporate Eastern medicine Ayurveda, et cetera, into your psychiatry practice?

Marni: Well, it’s an art and a science that I’m learning and trying to kind of integrate every day. A lot of people who come to me are interested in the integration.

So there’s more and more of an interest in bringing it in but it can be a little challenging to convince people that they should be interested in Eastern medicine when they’re a Westerner and occasionally vice versa.

Like sometimes people come in and they’re like, I don’t do psychiatry. I don’t do mental health. I don’t take medicine. I don’t believe in medicine. Well, let’s start with what you believe in. And so that’s what I do. I start with who the person is in front of me.

And I think as healthcare providers if you can do this and no matter what field you’re in if you’re going to be successful. Who is this human being? Who is this individual in front of me?

And what’s important to them and what are their values and how ready are they or how ready is this person to actually change and how interested and open-minded are they to kind of be open to new strategies? And if the answer to all of those is, yes, they’re ready and they’re interested in they’re open-minded, the sky’s the limit.

Ayurveda is a traditional Indian medicine that’s over 5,000 years old. It’s in my opinion, that’s something. Some people might not think that, they might need to wait until it becomes evidence-based in this Western country in our way of assessing science. And I respect that.

It’s very interesting that actually that Ayurveda that I bring into my work is evidence-based, at this point. It may not be evidence-based in terms of like being called Ayurveda, but like the sleep hygiene and the diet and exercise, this is all Ayurveda.

It might come in a different form but Ayurveda’s been practicing this kind of holistic medicine for thousands of years and now our science is validating it, we know that, you know, in the seventies, Herbert Benson coined the term the relaxation response.

And so now it’s something that has become totally incorporated into modern medicine. And what is it? It’s basically that if you practice meditation and you slow down your breath, that you can impact your nervous system you can impact your parasympathetic nervous system to calm and soothe yourself. Powerful, powerful medicine, it’s Ayurveda.

Jenn: Yes absolutely out of curiosity is that the same Benson behind the Benson Institute at MGH?

Marni: Yes.

Jenn: Very nice. And I can confirm that meditation and deep breathing exercises work wonderfully. I have been working on my own sleep hygiene basically the entire pandemic, and now I sleep like a baby. Thanks to all of that.

Marni: Wow that’s great.

Jenn: All it takes is 10 minutes of meditating a night and I’m usually out before the 10 minutes is up. So just a little change every day, but out of curiosity, because I know you do nutritional psychiatry what exactly is the role of nutrition and mental health is that ultimately we can feel better if we’re eating better. Like what’s the connection between the two.

Marni: That’s ultimately what it is and using kind of common sense in terms of what is healthy and what is not healthy. That sounds very easy and it’s not because there are huge influencers all around us all day all the time that tell us that we should be eating foods that are not healthy and that won’t make us feel good.

So those are the processed foods. Those are the foods high in sugar high in trans fat, high in salt. We know that people who consume highly processed, high fat, high sugar diets don’t feel good.

And we now have science and evidence based medicine that tells us that when people change their diet and move more towards whole foods and more of a kind of a Mediterranean style of eating that their depressive and anxiety symptoms can improve.

So what are those? That’s a plant forward diet. It doesn’t have to be a vegetarian diet plant forward lots of plants, lots of vegetables, lots of fruits, healthy fats, low sugar, low processed foods, lots of fish.

One of my colleagues actually came up to, he and his colleague came up with what’s called the antidepressant food score. And you can find that on my website too. It’s great. It’s this list of foods that have nutrients that are known to be helpful for brain health and the foods that are highest in these nutrients are up on that list. And oysters, super high in brain health, nutrients and vitamins look at that.

Jenn: As if I needed more reasons to get oysters.

Marni: Right go have your oysters, enjoy them. And you can find lots of vegetables up there. And so if you recognize that these foods actually have the vitamins and the nutrients that the brain needs.

And then the other really big thing is, a lot of the medicines we use in mental health increase the availability of serotonin which is a neurotransmitter that makes us feel good and makes us feel satiated makes us feel happy improves our mood, guess where most of the serotonin in our body is produced. Guess where it’s produced. You might know.

Jenn: I know, but you can tell everybody.

Marni: You tell everyone.

Jenn: Isn’t it from the stomach?

Marni: It’s in the gut, it’s in the gut. So we produce all of that like 90% of the serotonin in the gut. And so if you think about that, and if you think about actually caring for the gut and giving the gut what the gut really needs to really thrive you could potentially boost your serotonin levels which is a lot better than having to take a pill.

This, the science is early. And I think many of us are convinced that this is the way to go, and it might be the future. Hopefully it will be the future of mental health. And all health, whole health, but it’s not something that’s totally embraced by everyone, unfortunately.

And I don’t know about the students today but when I was in medical school we barely got any information on nutrition barely any information on nutrition.

So if you think even about the physical body and the rehab and the recovery that’s happening in the muscle building, you think about what is required to give the body those nutrients that it needs to really make the most of the therapy.

And how do you start implementing that into your physical therapy while the person is doing their exercises? Can you bring up a conversation about what they’re eating or how they’re sleeping. These things are we don’t have to be overly complicated.

Jenn: How would you suggest working toward having folks whether it’s patients or other healthcare professionals understand that occupational therapists truly do work in mental health?

Marni: How would I can convince an occupational therapist that they’re working in mental health?

Jenn: How would you suggest occupational therapists like teaching others to better understand that they are working in mental health and not just doing like bodily therapy?

Marni: Like to convince their colleagues or someone I see. Well, I think if you believe that what you’re doing is about mental health and you really see the connections and you have real examples of how you have seen mental health affect occupational health or vice versa.

Those examples are very powerful. There might be nonbelievers out there, but if you can give them one or two kind of examples of when you were absolutely convinced that this connection is real. I think that speaks volumes.

People like to hear stories, people like to hear first direct experiences. Those are very convincing. And so create your own catalog of case studies and protecting confidentiality share some of your experiences with others and convince them just like you’ve been convinced.

Jenn: I could not agree more with that as somebody who studied communication theory in graduate school, one of the most powerful communication theories that you can use in getting people to better engage in health behaviors or believe in the efficacy of health behaviors is narrative theory.

So talking to others with a real testimony that you can either identify yourself in the story or you identify somebody that you know, that would seem familiar like the same person in that story can have a really magnifying effect. So narrative theory is one of the best ways to go about that. I’m sorry I couldn’t. I just could not, I could not chime in.

Marni: That’s great, I’m learning too. That’s awesome.

Jenn: So I’m curious how we can work on reducing stigma in student populations about mental health specifically around seeking help for it, because it can be really hard for anybody to admit that they aren’t feeling okay or not feeling like themselves, but in student populations it seems like that’s even harder.

Marni: Well it’s a cultural shift that we need we need a real cultural shift. And I think that there this pandemic has really unveiled the mental health epidemic that we’ve known about in this country.

And the media is starting to get interested or became interested. Couldn’t hide from it anymore. Mental health is now something I see covered in the media, much more. You as a communications person might be really aware of this.

Jenn: Very much so yes.

Marni: And people are starting to feel more comfortable coming out and sharing their stories. These are influencers, these are celebrities. These are, I was just last I just started Oprah Winfrey and Prince Harry’s documentary.

So powerful to hear Prince Harry talk about his own experience and to see Oprah right there with him. And it’s just, this is how we’re going to shift our culture but it doesn’t have to it can happen within our own communities. The more we can talk about this, and again just normalize it as part of the human experience the less it will be stigmatized.

So it doesn’t mean it’s going to be easy. It doesn’t mean that it’s going to be easy to ask for help. It’s always hard to ask for help, but if you can find one person that you can confide in and give a call or reach out to and say I’m having a hard time can we talk? If you have a partner or if you have someone with you who supports you it can be much easier to reach out cause you don’t feel like you have to do it alone.

Jenn: Do you have any advice for how to find somebody that can help us with our mental health? Like what is a good starting point for that?

Marni: Well it’s a complicated question, because I would say just find a mental health person and talk to them, but it doesn’t really work like that.

So if you’re a student, can you really take advantage of any counseling service that there might be available if you’re already working, can you reach out to human resources maybe, and see if there’s anything there for you to learn about or to get support in.

But I think starting within the community is really important. So who are your contacts? Is there a teacher? Is there a professor? Is there a mentor? Is there an advisor?

That, as an adult if you’re not feeling like you are fully ready and able to kind of utilize resources is there someone else that you can talk with? Can you call your primary care doctor? The primary care, it’s challenging because they’re so busy but can you start there? Can you book an appointment?

Even a tele-health appointment and say, this is what I’m experiencing. If you’re looking for a therapist if you just know that that’s what you need. Psychology Today is a great resource. You can put in your zip code.

You can see there’s so many providers on there with different specialties. If you’re ready to reach out for therapy. And I those are sort of the big ones.

And then of course, family and friends and just to like start the search together I often will get calls from family members of people who are struggling rather than from the person themselves often. So it’s an effective way to reach out. Sometimes you’re not up for it yourself.

Jenn: So are you familiar with any options that might exist for a young adult, like a student that would want to receive mental health services but might not necessarily be able to afford them?

Marni: It’s a tough question. I think, well, oftentimes you have to start with finding providers who you know are on your insurance panel. Hopefully there’s some sort of insurance and primary care can be a good place to start with that.

There are organizations around that are, they have sliding scale fees that might make it more affordable. Training institutions will often slide their fees for students. There are some healthcare professionals who professionals out there who are able to slide their fees specifically for students.

So you really have to, you have to look around but finding that, finding either providers that take insurance or who have sliding scales can be a really good place to start.

Jenn: Another resource. If you are a student is going to your colleges health services department. I’m not, obviously every school is different. When I was in undergraduate, our health services offered 10 free therapy sessions to each student.

And then if you wanted to continue on after that usually the therapists that you were paired with were, they would give you either a reference out to somebody who was on your insurance or if you were on student insurance, they would give you a list of folks who are available on that insurance or would provide you with those resources if you were just unsure of if you wanted to continue.

So like health services and student life or residential life might also be a really good place to start too. I am curious, actually, a lot of folks have asked about mental health care and accessibility and this comes off of costs, not covered by insurance.

They’re curious about how it impacts clinical roles. When folks in clinical roles are referring out to mental health providers do you have any insight into this?

Marni: So is the question, how do you know who you can refer to or how do you know how to make a referral?

Jenn: It’s more about how accessibility for mental health is how clinical roles can be impacted if somebody might not actually have that accessibility.

Marni: How well someone is able to do their job if they don’t, if they can’t access mental health care themselves. Is that what you mean? Well, I think it’s a real question. And I don’t think that there’s any real answers or real easy answers.

I think it goes into that category of self-care and addressing your needs. It’s a real conflict and a real problem. If someone is unable to do their job because of a mental health issue that they can’t access treatment for.

So if you can’t access mental health treatment directly for whatever reason, I think starting with, again starting with primary care is important. And then opening that conversation up to human resources to your counseling center, to your whoever your direct supervisors are to say, I’m struggling. This is what I’m worried about, maybe they have ideas on how to access support for you.

Jenn: If a student is on a clinical rotation do you have any advice for responding to supervisors that are referring to patients as being air quote difficult?

Marni: That’s a tough one to be a student and to try to correct your supervisor. That’s very tricky. I think you can find a balance. I mean, you might want to just correct your supervisor and that may be who you are and you might just feel comfortable doing that. And if that’s what you choose to do then I would do it very respectfully

I would do it from a very calm place and a caring place, to try to avoid that conflict or that escalation. So I think if you do want to really sort of make that correction then I would just make sure it’s a good time and place for it.

Sometimes it’s not about the content in the conversation. It’s about timing and it’s about wording, so you don’t necessarily have to do it in the heat of a moment if you’re feeling it, maybe wait, I always say wait 24 hours before responding or sending an email that when you’re mad so that you can collect yourself and you can articulate what you’re thinking and feeling when you’re calm, composed and able to really do it in a professional way.

If you’re not comfortable correcting or confronting and that’s just not who you are that would probably be more like me. I would find a way to tell your supervisor that you see it differently. And it doesn’t mean that they’re wrong even if you think they’re wrong.

And it doesn’t mean you’re right, but I would you can say something like, hey actually I have a different perspective may I share it if that’s how you feel? So being professional, but also making room for the difference of opinion.

And the difference in perspective, I think is really probably the... probably the way you’re going to be most effective in getting that person’s attention and not creating a divide, but creating a dialogue. And that’s really what we all need to be doing is creating a dialogue. And that’s probably the in my opinion probably the best way to do it.

Jenn: Have you found in your years of practicing mental health have you found there to be any disparities that you find striking and has the pandemic changed any of those disparities in mental health care?

Marni: The pandemic has revealed the disparities in mental health care more than ever and it’s not just in mental health care, in healthcare. So there are disparities. Absolutely and I think that again, sort of highlighting them through this pandemic and bringing attention to these disparities over this last year I think hopefully over time will lead to change.

There’s so many variables involved into what creates these disparities and it’s going to take time to address them all. But we, again, just bringing them into awareness bringing attention to these disparities and having a conversation as to the nuances in them I think is there’s been a lot of movement. And so I’m hopeful.

Jenn: Do you think that what, so, one of the things that has emerged as a benefit of the pandemic would be like connected health, so virtual visits with a lot of providers, that’s helped with a lot of folks in not having gaps in their care plans. Do you think that digital health care, so like me and you chatting, but I’m giving you a copay would help with offsetting some of these disparities?

Marni: I think so. I think, I think telemedicine, I hope is here to stay. I can’t tell you how many people say that they prefer Zoom now over coming and seeing me in my office, it’s much more convenient.

It’s much more accessible for so many people. But the thing for us to keep in mind is that the people who are in underserved communities, so the communities where there are the most disparities those are often the people who have the least access to virtual health.

They don’t have the computer, they don’t have the phone they don’t have the right Wi-Fi. They don’t have the right internet connectivity. And so we have to if we’re moving in this direction, which I think we will we have to make sure that it is accessible.

Jenn: So as somebody who has blended both Western practices and Eastern practices into psychiatric care how can folks be more mindful when they feel like their heads are on a swivel? So between school, rotations, studying, socializing, sleeping eight hours, cooking for yourself, sitting in traffic, it can seem like 24 hours in a day isn’t enough, so any tips?

Marni: Slow down, slow down. And I think it is very important to go through a process of figuring out what are your highest priority items and what can you let go of? Because there’s only 24 hours in a day that’s not going to change, so what’s most important to you and what can you let go of?

And this is the practice. It’s acknowledging how you feel. It’s acknowledging what’s going on for you and your mind and body. It’s being honest with yourself. It’s reflecting on what, how you got to where you are. It is imagining where you want to go from here.

And it’s about figuring out how to get there by with your highest priority items and letting go of the things that are not serving you, are depleting you, whether it’s social obligations, whether it’s signed up to too many extracurriculars because you want to do everything all the time.

Sometimes you have to let go and realize it’s just too much for me if I can move through the day at a slower pace than probably most that’s a way I can really sort of, serve people in the way I want to and take care of my family and take care of myself.

I really have learned that I just need to slow down. And if that means I can’t do it all, then I can’t do it all. And I’ve learned that the hard way after many, many years of practice.

Jenn: I also, I can also attest to this in that I learned the hard way that timelines and deadlines are not always one in the same thing. And sometimes timelines can be stretched out accordingly if it means that you’re not stretching yourself too thin in the process.

Marni: I love that. I love your sayings. You have such great sayings. You really it’s really great. I like that. I’m going to use that one too.

Jenn: I’m glad we could just feed off of each other for the last hour.

Marni: That’s great. And actually that reminds me that what I find to be really helpful is to take a calendar and to look at your week at a glance and to plug things in, including sleep put it on the calendar with a reminder if you need to 15 minutes before, cooking, cooking is, it doesn’t even matter what you’re cooking.

If you can start cooking for yourself and freezing half of it and eating leftovers, you’re going to be healthier because you’re avoiding all of that process processed fast foods, restaurant food which is delicious but not supposed to be consumed every meal or most meals. And so plugging it in your calendar, different colors.

If that works for you, if it’s on the calendar you’re going to at least be reminded. If it’s not on the calendar you’re going to forget about it because it’s not the thing that is going to be most pressing or causing you the most sort of anxiety that needs to get done.

Jenn: And sometimes realizing that things that fill up one just because you think you’re only filling up one cup you can actually be filling up multiple ones. So like food prepping with friends could be both socializing and cooking and preparing yourself to be a little less stressed during the week.

Marni: That’s a great right, great technique. And walking with friends and listening to your audio book while you’re taking a, like these are the things if you don’t have time to read and walk do them together.

But I think that the thing is, really being very intentional about the choices you make and ask yourself those hard questions. Why am I doing this? Am I doing this cause I want to be doing this? Or am I doing this cause I think I’m supposed to be doing this?

And start to have that dialogue with yourself on an everyday, all day basis. I’m going for that third bag of chips. Do I really want those chips or am I just feeling anxious? And is there something else I can be doing to soothe myself? Those kinds of that ongoing dialogue will be so helpful over the long run.

Jenn: And I know that we are bumping up against the hour so I want to be respectful of your time but any last pieces of advice for folks that are tuning in that want to be more intentional about making mental health maintenance into a daily habit.

Marni: It’s essential and if you’re not a believer yet I think over time, you will be, unfortunately. And I think talking with people, talking with people who are 10, 20 years ahead of you, and asking them how they’ve taken, like you’re asking me how do I take care of my mental health?

What’s most important to me? Asking those questions so that you become a believer with other people’s firsthand experience and wisdom I think is a great way to start.

Jenn: And I think that’s a great way to end the session. So Dr. Chanoff thank you so much for taking the time to speak with me and everyone in attendance today a huge thanks again, to the Mass General Hospital Institute for Health Professions for bringing this event into our forefront.

We could not have done this without you literally and metaphorically. And I would be remiss if not to shamelessly plug McLean Hospital’s College Mental Health Program, where if kids are having a hard time finding resources the College Mental Health Program is actually a really great starting point too.

But again, Marni thank you so much for joining and thanks to you for tuning in. This concludes the session but until next time, be nice to one another but most importantly, please be nice to yourself. Thank you so much. Take care.

Thanks for tuning in to Mindful Things! Please subscribe to us and rate us on iTunes, Spotify, or wherever you listen to podcasts.

Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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