"Being OK with Not Being OK": Destigmatizing Mental Health for Health Care Workers

Summary

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Podcast Summary: “Being OK with Not Being OK”: Destigmatizing Mental Health for Health Care Workers

Advancing Health — American Hospital Association
Date: September 17, 2025

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Episode Overview

This episode focuses on destigmatizing mental health for healthcare workers, highlighting the urgent need to normalize seeking support and the organizational and systemic changes required to improve access to mental health care in healthcare settings. Host Rebecca Chicky is joined by Corey Feist (CEO & co-founder, Dr. Lorna Breen Heroes Foundation) and Tiffany Little, RN (Director of Cultural Integration, Centra Health), to discuss collaborative initiatives that break down barriers to mental health care, share successful frameworks, and emphasize creating a culture where being “not okay” is accepted and supported.

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Key Discussion Points & Insights

1. The Dr. Lorna Breen Foundation: Mission and Origins

• Founded in 2020 after Dr. Lorna Breen, a respected emergency physician, died by suicide during the height of the COVID-19 pandemic.
• Mission: Support the well-being and job satisfaction of all health workers in the U.S., and foster a culture where seeking mental health care is seen as a sign of strength.
• Quote (Corey Feist, 01:20):
  “Our mission is to support the well-being and job satisfaction of all health workers in the United States. We envision a world where seeking mental health care is viewed as a sign of strength for our healthcare workers.”

2. The ‘All In: Caring for Caregivers’ Coalition

• Collaboration between the Dr. Lorna Breen Foundation, AHA, and other partners to tackle mental health stigma and access.
• Three Phases:
  1. Remove mental health access barriers
  2. Educate healthcare leaders on system- and individual-level well-being
  3. Facilitate a year-long learning collaborative among multidisciplinary hospital teams.
• Transparent Approach: Sharing best practices and progress to reassure the workforce that real change is occurring.
• Quote (Corey Feist, 02:35):
  "One of our primary goals at the Lorna Breen foundation was to bring together health care organizations in an interdisciplinary way to wrap our arms around the mental health and well being of our workforce."

3. Barriers to Mental Health Access in Healthcare

• Persistent professional and personal barriers: particularly invasive licensing and credentialing questions about mental health history.

• Fear of losing credentials deters clinicians from seeking help—a key contributor to suicide and poor well-being.

• Impact: 1.5 million health workers now benefit from more appropriate credentialing processes, thanks to advocacy and technical support from the foundation.

• Quote (Corey Feist, 04:27):
  "I was completely unaware of the stigma as well as the professional barriers and really potentially penalties that healthcare professionals in the United States have... These mostly appear in the form of overly invasive and really inappropriate questions."

• Quote (Corey Feist, 06:03):
  "The first [driver of suicide among health workers]... is this concern around the loss of license and credentials associated with the stigma for mental health care."

4. Driving Regional, Systemic Change: The Caring for State Caregivers Initiatives

• “Caring for Virginia's Caregivers” and similar efforts in other states take healthcare organizations through practical steps:
  • Addressing mental health access barriers
  • Educating multidisciplinary teams
  • Implementing operational initiatives to reduce burnout
• Federal Support:
  • The Dr. Lorna Breen Healthcare Provider Protection Act led to guides and learning collaboratives under CDC leadership.
• Quote (Corey Feist, 07:17):
  "Caring for Virginia's caregivers... are all efforts for us to take organizations through the phases of work from the Impact Wellbeing Guide... and become educated about the solutions and then finally culminate in a learning collaborative focused on an operational initiative that drives burnout."

5. The Centra Health Experience: From Stigma to Support

• Motivation: Recognized that well-being isn’t a “nicety” but an organizational necessity, especially after seeing the pandemic’s toll.

• Challenges Faced by Providers: High rates of depression, suicidal ideation, and substance use among healthcare workers—rarely matched by adequate organizational support.

• Implementation: Sought tools and frameworks (like those from the Lorna Breen Foundation) to change the culture and provide real resources and safe channels for support.

• Quote (Tiffany Little, 09:22):
  "We really need to find avenues that we could help support our healthcare team members, not only address their own well being so that they can carry that forward, but also not place calluses where we should have compassion because we were facing a compassion crisis."

• Leadership Buy-In: Crucial support from the C-suite, with concrete efforts to improve nurse well-being leading to better retention, engagement, and patient experience.

• Quote (Tiffany Little, 11:53):
  "Our CNIO... led this effort to make sure that our nurses were healthy and well. Because... we are hemorrhaging new nurses at a rate of 1 in 3 in their first year leaving the profession altogether. So what can we do to support that work of us being healthy and well and really figure out what those drivers are?"

6. Organizational Impact and ROI

• Tangible Outcomes:
  • Improved staff retention and engagement
  • Better patient experience and quality scores
  • More clinicians choosing to stay in environments where they feel supported
  • Direct financial savings by reducing turnover
• Workplace Civility: Not only a well-being issue but an economic one—workplace incivility costs the U.S. $2 billion/day (SHRM, cited by Tiffany Little, 13:40).
• Quote (Tiffany Little, 13:40):
  "It's a necessity, it's not a nicety... If you aren't healthy and, well, you aren't engaging in all those things that we need to engage in because we are stronger together if we're working towards things like recreating healthcare and making it accessible to everyone."

7. Destigmatizing Not Being Okay

• Central message: It is “OK to not be OK.” Removing cultural, legal, and organizational barriers empowers health workers to seek help without fear of retribution or career harm.
• Quote (Tiffany Little, 10:55):
  "Being okay with being not okay. You know, it's okay for us not to come out of a situation at work and feel not okay about it. We have to be able to have those avenues."

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Memorable Quotes & Timestamps

• Corey Feist (01:20): “We envision a world where citizens seeking mental health care is viewed as a sign of strength for our healthcare workers.”
• Corey Feist (04:27): “These mostly appear in the form of overly invasive and really inappropriate questions that clinicians are asked about whether they've ever been diagnosed or treated for mental illness, whether they've gone to therapy.”
• Tiffany Little (09:22): “We really need to find avenues that we could help support our healthcare team members, not only address their own well being so that they can carry that forward, but also not place calluses where we should have compassion because we were facing a compassion crisis, right?”
• Tiffany Little (10:55): “It's okay for us not to come out of a situation at work and feel not okay about it. We have to be able to have those avenues.”
• Tiffany Little (13:40): “It's a necessity, it's not a nicety... If you aren't healthy and, well, you aren't engaging in all those things that we need to engage in because we are stronger together..."

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Key Timestamps for Reference

• 01:16 – Lorna Breen Foundation mission and vision (Corey Feist)
• 02:15 – Description of the 'All In: Caring for Caregivers' coalition (Corey Feist)
• 04:18 – Deep dive on credentialing/licensing barriers and real-world impact (Corey Feist)
• 06:03 – Suicide drivers among healthcare workers and AHA’s suicide prevention guide (Corey Feist)
• 07:17 – Launch and operation of state-level caregiver initiatives (Corey Feist)
• 08:48 – Centra Health’s motives and starting point (Tiffany Little)
• 11:53 – Leadership support and measurable retention impact at Centra (Tiffany Little)
• 13:40 – The necessity of wellbeing and broader workplace impacts (Tiffany Little)

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Takeaways

• Stigma and legal/professional risk around mental health remain significant barriers for healthcare workers; changing policy and culture is key.
• Collaborative, cross-disciplinary efforts (like All In: Caring for Caregivers) are moving the needle, but ongoing education, leadership support, and transparency are crucial.
• Well-being is foundational—improving staff mental health improves retention, reduces costs, and enhances patient care.
• The core message resonates: Healthcare organizations must create safe spaces where “it’s OK not to be OK,” and staff are supported without fear.

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For further information and organizational resources, visit the Dr. Lorna Breen Heroes’ Foundation website.

Transcript

[Podcast Host]

Welcome to Advancing Health. Traditionally, healthcare providers have been very hesitant to seek help for the burnout and mental health challenges that many of them face. That is changing for the better as we hear in this podcast about efforts to destigmatize seeking mental health services for care providers. About being okay with not being okay.

[Rebecca Chicky]

Welcome to Advancing Health. I'm Rebecca Chicky, the Senior Director of Behavioral Health at the American Hospital association and it is my honor today to be joined by Corey Feist, the CEO and co founder of the Dr. Lorna Breen Heroes foundation and Tiffany Little, RN and director of Cultural Integration for Centra Health. Today we are going to talk about the ways that hospitals, health systems and and even states and regions can get involved to reduce the stigma and improve access to mental health care services for all our healthcare workers. Corey, I'm going to direct my first series of questions to you. Quite honestly tell our listeners what is the mission and vision of the Dr. Lorna Breen foundation and why was it founded?

[Corey Feist]

Thanks for having us today Rebecca. We are so grateful for the support of the American Hospital association in our work. The Lorna Breen foundation was created in the summer of 2020 following the death of my sister in law, Dr. Lorna Breen, who was an emergency medicine physician in New York City and a leader at New York Presbyterian Hospital. Our mission is to support the well being and job satisfaction of all health workers in the United States. We envision a world where citizens seeking mental health care is viewed as a sign of strength for our healthcare workers.

[Rebecca Chicky]

That's an incredibly powerful mission and a beautiful vision of the future. I know that the Dr. Lorna Breen foundation is not doing this alone. In fact, I believe there is an organization and AHA as part of it called all in Caring for Caregivers. Can you describe the relationship between the Dr. Lorna Breen foundation and All In?

[Corey Feist]

Absolutely. And as you noted, the AHA has been a really important partner of ours. With my background as a healthcare leader, I noticed that there are a few silos at healthcare and so one of our primary goals at the Lorna Breen foundation was to bring together health care organizations in an interdisciplinary way to wrap our arms around the mental health and well being of our workforce. So in the spring of 2021 we created a coalition called all in well Being first for Health Care whose focus was really to break down those barriers to mental health access and to accelerate solutions to this growing burnout and mental health challenge that the healthcare workforce had. As part of the work of the All In Coalition, we created all in Caring for Caregivers, which is a technical assistance program which has three main phases. First, to remove barriers to mental health access, the first. The second is to educate healthcare leaders on what they can do in their sphere of influence and control about addressing well being from a systems perspective as well as an individual perspective. And then it culminates in a year long learning collaborative. We do this work focused on getting at the root cause of many of these issues. We do it in an interdisciplinary way and we try to bring together states or large metro areas of hospital systems and their teams to do this work in a very transparent way so that their workforce can see the work is being done and so they can learn from each other about evolving best practices. And that's how we met Tiffany.

[Rebecca Chicky]

That's wonderful. Tiffany, I can't wait to get to you for a couple. I have a couple more questions for Corey first. Corey, some of the listeners may not understand when you say removing the barriers to access for mental health care. They may think they're working in hospitals and health systems, so of course they have access to mental health care. Can you go a little deeper on that and describe some of those barriers that you're trying to remove and mitigate?

[Corey Feist]

And it's a great point, Rebecca, because when my sister in law took her life In April of 2020, I had been in healthcare for many dozens of years, actually many decades I should say. And I was a leader at the University of Virginia Health system, yet I wasn't a clinician. And so I was completely unaware of the stigma as well as the professional barriers and really potentially penalties that healthcare professionals in the United States have. These mostly appear in the form of overly invasive and really inappropriate questions that clinicians are asked about whether they've ever been diagnosed or treated for mental illness, whether they've gone to therapy. And these are the same questions that my sister in law was terrified that she would have to respond to following a singular mental health episode. And so what we have been able to do at the Lorna Breen foundation through our all in Coalition and Caring for Caregivers is to get tools to the front lines, whether it's a licensing board that's asking these questions or hospitals who ask these questions most commonly and credentialing applications and have them change those questions and then importantly communicate the changes to the workforce. As I sit here with you Today, there are 1.5 million health workers in the United States that are benefiting from the changes that we've made which we hold out in the all in well, being first for Healthcare Champions Challenge for Licensing and Credentialing badge that we give out to hospitals as well as the licensing boards for doing that important work.

[Rebecca Chicky]

Thank you. I mean, I don't think many of the listeners may have realized that those questions were have you ever, as you noted, have you ever been treated?

[Corey Feist]

And if I could just add one thing, because the American Hospital Association a couple years ago published their first ever suicide prevention guide, at least the first ever that I'm aware of. And in that suicide prevention guide, you identified three key drivers of suicide among health workers. And the first one that you all identified is is this concern around the loss of license and credentials associated with the stigma for mental health care. So we know that for Lorna, this wasn't just an isolated incident and it's something that we hear from health workers all over the United States that they are fearful for these repercussions. And so we need to do something about it and address it, which is what we've done across the country. We've made great strides.

[Rebecca Chicky]

Thanks for mentioning that. There's a variety of drivers for this concern and this stigma. So thank you. I want to turn now towards another thing that you mentioned earlier, Corey, and that is working with states, working with large health systems in order to advance this in their own organizations and across a particular geography or a regional area. And I'm going to call out specifically the Caring for Virginia Caregivers work. Can you describe that a little bit and then we'll bring Tiffany into the conversation.

[Corey Feist]

Absolutely. Two seconds of background. When the President of the United States signed into law the Dr. Lorna Breen Healthcare Provider Protection act, it created two spheres of programs. And one of those sphere of programs was learning materials for healthcare leaders to address the root cause of burnout as well as mental health challenges. That was called the Impact Wellbeing Guide, which was led by the CDC and our all in coalition provided guidance on it. What we heard from the large health system across the country that was implementing the guide is they like to do this work together at a learning collaborative and they need some help. And so caring for Virginia's caregivers, caring for North Carolina's caregivers, caring for New Jersey's caregivers, and now caring for Wisconsin's caregivers are all efforts for us to take organizations through the phases of work from the Impact well Being Guide. And that begins with by addressing these mental health barriers. It then moves ToWards education of 10 person teams across health systems to address the issues at the root cause and Become educated about the solutions and then finally culminates in a learning collaborative focused on an operational initiative that drives burnout. And that's what we've done with Tiffany and the team in Virginia, now North Carolina, New Jersey and recently expanded into Wisconsin.

[Rebecca Chicky]

That's fantastic, Tiffany. I bet the question on many listeners minds is why did CINTRA decide to join the work of all in of caring for Virginia caregivers?

[Tiffany Little]

At the time, we had some really innovative leaders that understood that well being wasn't just a nicety, but rather a necessity for us to drive health care forward not only to our communities, but also to our healthcare workers. So 2019, we really started pulling together the evidence base for this work. And what we saw is that healthcare workers were far more likely to suffer from depression, to have thoughts of suicidal ideation, to have biopsychosocial disturbances, and of course use substances to help them cope with their roles. But we had never provided health care workers with the avenues, tools and support that they needed to be able to speak up and say, hey, we need help for coping with the very large burden of taking care of our communities and healthcare in the United States. Those were all published before 2019. Of course, you know what happened after 2019. We went into a global pandemic. We really need to find avenues that we could help support our healthcare team members, not only address their own well being so that they can carry that forward, but also not place calluses where we should have compassion because we were facing a compassion crisis, right? And when we tell people, you know, you have to be strong, you have to be confident, and yes, we are all of those things, but we also have to deal with messy, beautiful situations of life and humanity. And that can take a toll on us. It can leave echoes and it can leave scars. But we are well practiced in taking care of code situations. I mean, if you think about a code situation, we are practiced, rehearsed, we simulate it, we educate to it, we certify to it. Every single year we have avenues and tools to help us be better at coding situations and situations of that nature. What do we have in place for taking care of ourselves? Nothing. We don't teach that in school, we don't simulate that, we don't go over it, we don't get certified to it. Now we are starting to see some certifications for healthcare organizations come through. But that was about the time that we found the Lorna Breen foundation. And what perfect timing that we really needed to find a place for getting those tools for helping support us in that work and removing the stigma. And I have to say that's been one of the most important parts of engaging in our healthcare workforce's wellbeing is destigmatizing, healthcare destigmatizing, being okay with being not okay. You know, it's okay for us not to come out of a situation at work and feel not okay about it. We have to be able to have those avenues. And when we stigmatize it and put licensing questions like have you ever seen anyone for mental health resources or in the nursing realm, which is where I live, where our CNOs actually have to report this to the board of nursing, you know, when we have those stigmatizing questions, we are putting that barrier in place and saying it's not okay for you to get help, you know, because then we're going to question your entire life, your livelihood and how you perform.

[Rebecca Chicky]

Can you give the listeners a little bit more about. You described the journey well, but who led this journey? Was it your C suite leadership? Where did that backing come from?

[Tiffany Little]

We have wonderful champions here in our C suite. At the time that I was actually hired into this role, my original role was patient education and nurse wellness. So it was really leading the work with nurses and how we were engaging. We published research, our CNIO was actually one that, that led this effort to make sure that our nurses were healthy and well. Because, you know, the national data is that we are hemorrhaging new nurses at a rate of 1 and 3 in their first year. We'll leave the profession altogether. So what can we do to support that work of us being healthy and well and really figure out what those drivers are? So as we engaged in this journey, we started seeing really positive things like retention, engagement and, you know, better quality of work and, you know, better quality, better patient experience scores and better engagement scores. And we saw our nurses that were travelers even wanting to stay in Virginia, enrolled Virginia at that, you know, not going to these major cities because they said, you know, this is the first place I've been where I feel healthy, where I feel like I can actually get the help that I need.

[Rebecca Chicky]

So I will tie that back to your title, Director of Cultural Integration. It sounds like the impacts that you've been seeing, as you just described, are really that you have created a culture that not only better supports the mental well being of the nursing and other clinical staff, and I'm assuming administrative staff as well, but at the same time, you are having a positive, and let's talk about the positive financial return on investment, because what it takes to recruit a new nurse and train them or any new clinician or healthcare worker is a significant cost and it's a lost opportunity cost of retaining those who often leave. So it's having multitudes of impact, if I hear you correctly.

[Tiffany Little]

Yes, absolutely. Not only with engagement, but also our patient experience. You know, if you think about it on Maslow's hierarchy of needs, you know, if you are struggling with just physical safety, you're not going to find enrichment. That's not going to be part of your day. Your day is going to be, I need food, shelter and water, and I need to not be hit. So actually, we contributed to the Suicide Prevention Workbook. We actually have the piece on how do we respond to workplace? Because that is one of our drivers for burnout in healthcare communities. But even in addition to that, SHRM put out a study. It's part of their civility work and their scorecards. Incivility in the workplace is costing $2 billion a day in the United States. $2 billion a day. You know, we can't possibly engage with innovations, creativity, open communication, safety, even, you know, this all ties back to wellness. So when I started off by saying that it's a necessity, it's not a nicety, a lot of people hear wellbeing and they're like, oh, that's nice. You know, it's really nice that our nurses get it or our physicians, you know, they get an opportunity to talk about what's going on in their lives. But it's so much more foundational than that. If you aren't healthy and, well, you aren't engaging in all those things that we need to engage in because we are stronger together if we're working towards things like recreating healthcare and making it accessible to everyone. So it's not just how it plays out for our community members and how they are treated, it's also how we treat each other and how we are healthy enough to even engage in that work.

[Rebecca Chicky]

So many positive impacts of this work. Thanks to both of you for being willing to share your time and expertise with me, with the listeners for this podcast. And I encourage everyone to go to the Dr. Lorna Breen foundation website and get involved, get engaged and change the culture of your organization and remove those barriers and stigma for the healthcare workforce who may need mental health treatment.

[Podcast Host]

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