Mental Health "Help" Care in the Age of Covid

Coronavirus has disrupted mental health services in countries from all over the globe. Fear, isolation, loss of income and life have triggered mental health conditions and exacerbated existing ones in workers and families across the country. Janis DiMonaco, Ph.D., the founder of HMC HealthWorks, and Dr. Stephanie Straeter, the clinical director of Behavioral Health and Wellness at HMC HealthWorks, join Traci to talk about the mental stresses labor faces during a global pandemic and the need for mental healthcare, behavioral coaching, and patient advocacy.

Some highlights from Mental Health “Help” Care in the Age of Covid include:

02:03 – Marrying Our Passion with What We Do
05:49 – The HMC HealthWorks Approach to Healthcare
08:21 – Mental Stresses Labor Faces during a Global Pandemic
14:38 – That Personal Touch and Teletherapy
18:57 – Coaching: Not Everyone Needs Therapy
24:39 – How Do We Find These Resources?

Visit the HMC HealthWorks website:  https://www.hmchealthworks.com

Transcript

Narrator  0:02  

This is The World of Multiemployer Benefit Funds Podcast with Traci Dority-Shanklin. If you're interested in labor and union benefit funds, well, you've landed in the right place. We are a go-to source for all things union benefit fund-related, and we are going to bring you interviews with key decision-makers and fund professionals that guide these plans. They'll share their insights, experience, unique perspectives, all of the latest developments, and tips to unlock the mysteries of multiemployer benefit funds. Time is short, so let's get started.

Traci Shanklin  0:37  

Today, I am thrilled to bring together two distinguished guests Dr. Janice DiMonaco and Dr. Stephanie Straeter. I asked Jan and Stephanie to come on the podcast because of their extensive backgrounds in mental health. Dr. Janice DiMonaco is the founder and former president and CEO of HMC HealthWorks. She also currently acts as a strategic advisor to IBH and HMC HealthWorks and as a care clinic plus managing partner. Dr. DiMonaco has worked in healthcare for over 40 years and helped develop, implement and integrate the HMC HealthWorks programs into public sector, Taft-Hartley, and employer self-insured plans. 

Traci Shanklin  1:22  

Dr. Stephanie Straeter holds a Ph.D. in clinical psychology from Aliante International University and joined HMC HealthWorks in 2008. At HMC, Dr. Straeter helped create and develop the HMC wellness and behavioral health advocacy program, and trains nurse health advocates and wellness coaches to promote behavioral change. Dr. Straeter also maintains her own private practice. 

Traci Shanklin  1:51  

Thank you both for joining me today. I'd like to start by asking each of you about your backgrounds and how you got involved with multiemployer plans. Dr. Jan, why don't we start with you?

Janis DiMonaco, Ph.D.  2:03  

Sure. Thank you, Traci. I started to work with the multiemployer plans. In about 1978, I had a clinical practice in Springfield, Mass, and started to provide employee mental health programs to corporations. And my dad was a union official, and liked the whole idea, and thought it would be really great to offer those same kinds of services to unions. So, from there, I started to work with the multiemployer or Taft-Hartley plans in Springfield, Mass, around developing programs for them for substance abuse, mental health and wellness. And then from there, the company just grew to become a national company. And at one point, we were the largest provider of mental health and substance abuse programs, and wellness programs in the Taft-Hartley niche in public sector. So really, for all those years, we've specialized in joint labor-management plans, multiemployer, public sector, and Taft-Hartley funds, bringing mental health and substance abuse solutions for their plan participants.

Traci Shanklin  3:28  

That's great. So, Dr. Straeter, can you give us your background and how you found yourself working in this space with HMC HealthWorks?

Stephanie Straeter, Ph.D.  3:38  

In 2007, I was the clinical director for a residential eating disorder program. And I realized that really wasn't the best use of my skills and that program creation was where - I really where I excelled. And I wanted to continue to have an opportunity to create programs that would benefit many. And my father, the president of UFCW Southern California, he suggested that I get together with Dr. Jan, because she had done this so well, and to see if there was any opportunity with her company to be able to continue to do what I loved. And so, she said, "Yep, that's great, but you'll need to move to Florida." But, she said if you move out here you can help create our national wellness program with another nurse, and wellness was already a passion of mine because it was my lifestyle. So, that's where it all started with me getting involved with HMC HealthWorks in 2009.

Traci Shanklin  4:43  

It's so nice when we can marry what our passion is with what we do. 

Janis DiMonaco, Ph.D.  4:48  

You know, when you're raised in a union family, we really do understand the different perspectives of the union members versus non-union employers. When I started my business, I was strictly dealing with insurance companies and other non-union companies. So, the challenge for me was trying to figure out, you know, how to customize programs that I've been doing in the, you know, employers space and learn how to provide those kinds of programs in a joint labor-management environment. And it's so great because once you feel comfortable in it, you really don't want to work in any other environment. And I've known Dr. Stephanie's dad for many, many, many years. And it was a privilege and an honor to have her move here and, and help me build out other health and care management programs for the Taft-Hartley funds besides mental health.

Traci Shanklin  5:49  

So, you've kind of touched on obviously mental health as a big component of what HMC HealthWorks does, but can you just give me a little bit about what HMC HealthWorks approach to healthcare is?

Janis DiMonaco, Ph.D.  6:05  

HMC evolved from being primarily a mental health and substance abuse and wellness company into providing chronic disease management. When I was in clinical practice, we had so many patients who came to my office that didn't just present with a mental health or substance abuse issue. Often, they have other underlying health problems. And so, as time went on, I began to see that the union members or participants could really benefit from some personal touch and outreach, and personal touch for their medical conditions. And then, of course, we know that medical conditions are aggravated that much more or are exacerbated by underlying medical - mental health conditions like depression and substance abuse. So, it's kind of looking at it and saying it's a whole person. And it's not just their emotional well-being, they also have often medical and physical complications that either were caused by, you know, stress that was never really managed, or the condition is exacerbated by their mental health conditions. 

Janis DiMonaco, Ph.D.  7:32  

So, I think it was about 2004, we launched our fully integrated medical and behavioral health, population health management company. So, we have many Taft-Hartley funds that, uh, retain us for managing your chronic conditions as well as their mental health. We integrate with the carriers for their chronic disease management and their case management. We look at is not a one-size-fits-all. Because of the breadth of the programs we have, we do know how to customize. And we do know how to integrate with other providers that a trust fund may have that's already providing services that we also have. So, we might be just filling a gap of that continuum of care that someone needs to be - have their whole health manage.

Traci Shanklin  8:21  

As we all know, with everyone's experience firsthand with coronavirus, and all the impacts it's had in our society, the stress level of living through this pandemic has been enormous. So, you both are working in - in an industry where you're integrating, as you said, the mental health aspect of health care and providing services to meet that need. So, I'm just wondering how HMC HealthWorks assist in supporting people who - well, I mean, frankly, have been on the front line. We know about nurses and healthcare workers, but the teachers and the grocery store workers and so how are you addressing that and supporting that need?

Janis DiMonaco, Ph.D.  9:07  

Most of our Taft-Hartley funds were primarily in the retail food industry, or drivers, and transportation, and whatnot. So, we were watching the crisis and the stress levels, obviously increase and all of the unknowns. So, what we decided to do with our chronic care management program is to offer at no additional cost to our Taft-Hartley funds that members could call in or, you know, their dependents, could call in and talk to one of our behavioral health specialists or nurses about any problems that they were having. And then we would provide some navigation and education around things that they might be able to do to help better manage the crisis. We're open from 8 in the morning to 11 o'clock at night; we're 24/7; we have clinicians on call. So, I thought that that was really a great service. We already have behavioral health advocacy included with our chronic disease management, but we wanted to extend out more than behavioral health management. We wanted to offer education, coaching, crisis intervention, and things of that nature, and then help people navigate their benefit if they needed more help. 

Janis DiMonaco, Ph.D.  10:35  

The other is when people are faced with these kinds of crises, you know, the pandemic, the last thing they worry about is their health. And so, we are dealing with so many people that had conditions that would exacerbate Covid like obesity and hypertension. You know that's the high prevalence and the groups that we deal with. So, they also were, you know, really ticking time bombs in terms of getting Covid and having their conditions worse because of the comorbidities. 

Stephanie Straeter, Ph.D.  11:13  

So, last week, I took a call from the 64-year-old grocery worker, African American, and he was confused, disoriented. I had reached him on his fifth week of calling out from work. So, he had shared that he got Covid, Christmas Eve. And ever since then, he hadn't been thinking clearly. He felt like he was - there was a cloud and his mind blocking his thought processes and his ability to work well. So, he had started calling out. He used his vacation pay; he used to sick pay. And he shared that he had had a history of depression in the past. And due to the stigma had never gotten help with it before. And he had shared that in the past, he had thought about taking pills and ending it. Currently, he wasn't having suicidal ideation. But he said he didn't recognize himself. 

Stephanie Straeter, Ph.D.  12:13  

His priority - he's a divorced man - his priority is his grown children and grandkids. And he was sharing to me that, you know, when they come over, I'm just waiting, counting the minutes on the clock until they leave. He was isolating. He was withdrawn. His co-workers were calling him to see, you know, "What's up, when are you coming back to work?" And he wasn't taking any of their calls. He said that he felt too embarrassed to open up to his manager. And he had thought that he had called to get a therapy appointment. But he said no one had called him back. And actually, who he had called, was his medical provider. So, I asked him if he felt like that this time, getting the therapist would be enough to keep him safe, or did he feel like he needed more support at this time. And he said he just didn't recognize himself. And because of the past, you know, again, he wasn't having suicidal ideation in the moment, but he didn't know what the next moment was going to bring for him. 

Stephanie Straeter, Ph.D.  13:18  

So, he and I called his behavioral health company, and we - we got him to where he needed to be to the team that makes it the decision as to the level of care that somebody would need. And I let him know that I would be following up with him in the next few days and emailed him information on how to care for himself at this time. And that's what we do with the behavioral health advocacy as well. We stay engaged as a point person until that person has a working relationship with their therapist or psychiatrist.

Traci Shanklin  13:30  

That story was amazing. And I think that there's nobody who could hear that and not see that it's such, uh, an essential part of what is being provided, in particularly to participants that are lucky enough to have a health and wellness type benefit. So, how can we ensure that people know it's there for them? And I mean, your - that story is all I kept thinking is what if he hadn't found you in that moment? So, what is HMC doing that might be different, I mean, have you changed the way you're conducting business? Or have you always done it the same way? And how do you get that message out so that patients can find you?

Janis DiMonaco, Ph.D.  14:38  

We have a wall communication in program promotion strategy that we deploy for every client of HMC's, so it's a lot of mailings. It's phone outreach. It's welcome letters. It's all personal, but we're not into robocalls. We're really into personally outreaching, and also people can call in. 

Traci Shanklin  15:05  

What have you seen in terms of a shift in maybe this stigma that's attached to mental illness? I mean, you mentioned the gentleman, and his, you know, embarrassment that he had battled depression in the past, or that he was not feeling quite like he had all of his mental faculties post-Covid. So, how are you guys addressing that? Are you seeing that stigma is dissipating? 

Janis DiMonaco, Ph.D.  15:32  

The stigma has been definitely reduced, not eliminated, but reduced. And I think there's one benefit of Covid is all of the discussions that you hear in the media around the mental health crisis. And so, to that extent, if I could say one good thing has come out of Covid, is the recognition that having mental health issues is not new. What's new is to destigmatize it, and say it's okay, and help? 

Traci Shanklin  16:06  

How are the participants adjusting to the virtual counseling services?

Janis DiMonaco, Ph.D.  16:12  

A big obstacle for a lot of them is, you know, who's gonna watch the children, taking time away from work, the costs associated with transportation, parking, finding the place, and a lot of these people, some of them are working two jobs. They've got all these balls in the air. So, I think that, at first some of them questioned it, but once they see the ease of it, and - and how much less it cost them, they're on board for it.

Janis DiMonaco, Ph.D.  16:41  

I've always been a big proponent of teletherapy. But imagine, you know, if you had to see a family therapist, or for yourself personally, that you had to get in your car and drive and find the time to, you know, make an appointment. As Stephanie said, they don't have to worry about childcare, transportation, hours are more flexible. So, I think the whole promotion of virtual teletherapy has been great for access to mental healthcare.

Traci Shanklin  17:16  

We know that unemployment is at an all-time high. However, 17% of those unemployed are not even looking for work. Many strategists have suggested that that's due to working parents - predominantly women who have decided to stay home with their children until schools can reopen with a consistent schedule, and safely so that parents can feel confident sending their children back. As we look ahead, what are some of the things we can do to mitigate the impact the pandemic has had on children's mental health as well as parental stresses?

Stephanie Straeter, Ph.D.  17:52  

The need for services is going to extend for quite a bit of time because history has shown us that the psychological impact of dis - disasters usually outlast the physical impact. And because there was an economic crisis accompanying the pandemic, there might be a heightened risk for suicide and mortality due to deaths of despair. And in fact, you know, May 2020 analysis projects that based on the economic downturn and social isolation that additional deaths due to suicide and alcohol or drug misuse may occur up through 2029. So, with that being said, I think that we need to encourage schools, employers, churches, retirement communities, to name a few, to highlight the importance and promote the adoption of adult self-care, and positive parenting skills, you know, and that we really need to shine a spotlight on coaching. 

Stephanie Straeter, Ph.D.  18:57  

So, not everybody needs therapy. So, well-being stress resilience coaching is a combination of education and behavior change promotion, that can support people of all ages. And it's short-term and preventative. It could be provided in groups, you know, via zoom, you know, telehealth platforms. And it focuses on building individual's strengths to address you know, the challenges that they're encountering today. So, I would say, with people today are struggling with a loss of interest or pleasure in doing things, or they're bothered by feeling down depressed or hopeless, they definitely need to make an appointment with a therapist. And then for the rest of us, you know, if we're struggling with sleeping, eating, we find we're drinking a little bit more. We're shopping a little bit more. We're calling out sick a little bit more. We're losing our temper. We're losing our patience. We need to look into see if we can get involved in a stress coaching program. 

Stephanie Straeter, Ph.D.  20:02  

And that is going to help your children immensely because your children are sponges to your emotional - the way that you're handling your emotions. So, by the parents taking care of themselves and getting them their selves to a place where they're managing their stress, their mental illness, it's going to help to stabilize their children. And then you'll be able to continue to support them with putting that structure that we know that they benefit so much from in place, you know, continuing to uphold that, and speaking to them about what's happening in a way that you know that they can understand it.

Janis DiMonaco, Ph.D.  20:42  

One of the reasons that HMC merged with Integrated Behavioral Health is Integrated Behavioral Health had decided to really specialize in online self-help tools. And that you could do with or without coaching. I really embraced those. We're a very high touch company. But I think the younger participants, younger union members really embrace technology. And there are so many self-help apps out there that are really good. But, I felt that if they're a trust fund that is our client, we want to bring those digital solutions integrated with what we already provide. So, we have a lot of online digital solutions, where people can really learn how to better manage their stress their depression, learn more about it, but that also the option to click and get a behavioral health coach. Because if we can provide these kinds of programs earlier in someone's "going to be emotional well-being" journey, you're going to really go a long way towards avoiding a catastrophic incident.

Traci Shanklin  21:56  

What do you think that we should be looking for in our healthcare system or our benefits programs as we move past this coronavirus crisis, hopefully, in the near term, but certainly over the next five years. Stephanie, you certainly mentioned and bring up some startling statistics about the long-lasting impact of the mental component, post a crisis like this, or a pandemic of any sort. So, I'm interested to hear what you guys think we should be looking for? 

Janis DiMonaco, Ph.D.  22:27  

In terms of our vision, we really look at the future as not only expanding, you know, to have more teletherapy. But the reality is you can only have teletherapy when clinicians are licensed. And so, when you look at a shortage in terms of the demand, because the demand is so much greater now, I mean, I can remember years ago, when I was in private practice, you know, there are more therapists than there were people accessing care. It's not that way anymore. There's more people trying to access therapy than there are therapists. So, I think there's a recognition in the healthcare industry of the value of coaching. And coaching is not therapy. So, if you can engage with people who need, you know, emotional well-being support and education before again, it's serious. I think you can bridge that gap with behavioral health coaches. 

Janis DiMonaco, Ph.D.  23:31  

You know, HMC feels very strongly that coaching is - is a profession. And so, all of our coaches have gone through and became certified with well coaches certification program. Many of those coaches, that we have, have gone on to sit for their board. And this national board is also lobbying to have coaching covered as a reimbursable expense. But I think the day is going to come when that will happen. And it'll be a great way to bridge this gap. Just as primary care doctors were shortage and then you had nurse practitioners. And now you have nurse practitioners doing a lot of the same roles and they fill a huge gap. I think you're gonna see behavioral health coaches emerge as a covered benefit. I know we're recommending it going forward. I think that the demand is so huge for someone to talk to, I think the behavioral health coaching will be definitely something in the future.

Traci Shanklin  24:39  

For the union member listening to this podcast, how would a union member find this type of resource?

Janis DiMonaco, Ph.D.  24:46  

If they're covered by our programs, they just simply need to access, you know, their benefit that we provide it to the trust funds. If they're not covered, they will probably need to reach out to their carrier and see if there are any resources for them. Some carriers are starting to look at behavioral health digital solutions. It hasn't really emerged, you know, to the extent that, you know, it should. There's also many online programs that people can self-pay, and they're not expensive. So, for now, if they don't have the benefit, and they don't have access to an HMC type program, because we're certainly not the only provider out there, they could also go online and Google self-help programs for mental health, depression, or there's just so many now that are springing up all over, and some better than others.

Traci Shanklin  25:53  

My closing thought is tell me what you enjoy most about this line of work.

Janis DiMonaco, Ph.D.  25:59  

It's gratifying to be able to talk to the nurses and our behavioral healthcare managers and our wellness coaches, and, which I frequently do, and say, "You know, tell me what we're doing. Tell me who we've helped." Also, we can see it in the data that is so rewarding for me. And I've - I've just so enjoyed being a mental health advocate, going back to 1976, when there was such a huge stigma, and being out there lobbying for mental health benefits. I mean, it wasn't always a parity where you had to provide mental health and substance abuse benefits. And it was not unusual to begin to talk to a Taft-Hartley fund or public sector group and find out, they had no benefits, or they had limited benefits and not sufficient benefits. So, that's been very rewarding for me to be able to be advocate, promoting, it's okay to have help, and to seek care for mental health and substance abuse.

Traci Shanklin  27:04  

Amazing what you've done with HMC. And like you said, just really being an advocate for reducing the stigma and allowing people to know that it is, it's human. It's human to have moments in your life where you're struggling, and sometimes that it can be debilitating for longer-term - periods of time. And it's nice to know that there's advocates like you out there. So, Stephanie, I'm going to ask you the same question. Can you tell me what you enjoy most about this line of work?

Stephanie Straeter, Ph.D.  27:39  

I would say, it's being able to help walk beside people on really bringing about the changes that they want in their life. So, many of the people that come to us in the wellness program, they have tried quitting smoking; they tried losing weight; they've tried making these changes on their own, and quite frankly, to save face, they finally just give up. You know, they don't want to tell their whole family again that I'm quitting smoking for the 100th time, or I'm going to try to lose weight. So, they decide it's not important to them. So, it's really rewarding to be able to support them in reaching their goals, showing them a new way to do it because that's a big part of the program is - is showing them how to approach behavior change in a way that grows their confidence in their ability to do it and to go on to continue to make other changes in their life. 

Stephanie Straeter, Ph.D.  28:35  

It's so rewarding for me to be there for these people. It's just such an eye-opener to see, you know, we've come such a long way as Jan has said. There's so much further to go as far as being able to help people in their time of need. And what we already know is that these times they're not thinking as clearly they're not as organized. So, being able to help them get the services that they need, and to find the provider that will help them learn how to better manage their condition is what makes me tick. I love the work that I'm doing. 

Traci Shanklin  29:09  

I'm a mom, and I am a mom of a child that has suffered some pretty severe anxiety. And I know that I have learned so much in the last, you know, eight years, um, not quite eight years but about mental health and how to navigate through it. And it's no easy task to get the help you need to get, you know, the person seen as a complete - get all of like everything to be seen together. Everything's taken in isolation. Oh, she has a stomach problem. So, then it's this problem. Oh, she's depressed. So, she has this problem. Oh, she's acting out behaviorally. Well, she's this, and I kept thinking in my experience is getting it to be aggregated into one place would have been so much less stress on me. But, we also would have gone down so fewer paths and would have found the right path sooner. And so, I am a massive believer in what you guys are doing. And I applaud you. And I think during this time of Covid, it has become, I think, like you said, while if there is a silver lining, it's this, it's that it has become a conversation that we can have like today, and that the conversation like you had with that gentleman that he was - felt free enough to say to you, "I'm just not thinking right." And I think it's such an amazing thing. So, I really applaud you and thank you for your work. 

Traci Shanklin  30:47  

If you'd like to check out HMC HealthWorks or anything else you've heard on the podcast today, please visit our website at www.multiemployerfunds.com. That's www.multiemployerfunds.com. If you have enjoyed the podcast, please subscribe to us. We are now on Spotify and Google Podcasts in addition to Apple Podcasts, but you can also find us and subscribe to us on many of your favorite podcast platforms. Thanks again for joining the conversation where listeners connect with leading experts throughout the financial and investment world. Be part of the change. 

Traci Shanklin  31:32  

And that's it for this week's episode of The World of Multiemployer Benefit Funds Podcast. We love to hear from you. And if you have any comments, questions, or suggestions, head over to www.multiemployerfunds.com and let us know. Thank you for joining us, and we look forward to next time.

Transcribed by https://otter.ai