← Advancing Health
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- [00:00]
A
Welcome to Advancing Health. People facing psychiatric or substance use disorders have enough to deal with without the added burden of shame or stigma attached to their challenge. Today we hear about the power of a large health care organization that's decided to push back against stigma and the difference it's making.
- [00:23]
B
My name is Rebecca Chickey and I'm the Vice President of Behavioral Health and Trustee Services for the American Hospital Association. It's my honor today to be joined by three exceptional behavioral health leaders from Common Spirit, Dr. Sapra, who is the system Vice President for Behavioral Health, Kathy Krebs Dean, who is Director of Behavioral Health Expansion and Development, and Robin Conyers, Vice President of chi's Behavioral Health. Thank you so much for joining us here today to talk about your incredible stigma reduction campaign as it relates to the stigma surrounding psychiatric and substance use disorders, the treatments for those and the individuals who suffer from those conditions. So, Dr. Sapra, I'm going to ask you to kick us off for those people for whom common spirit is a term they've never heard. Doubtful if they're in the healthcare field, but sometimes we get non healthcare listeners to our podcast. Tell us about Common Spirit's footprint. Just give the listeners a sense of when I say Common Spirit, what that means.
- [01:32]
C
Yeah, so Common Spirit is one of the largest health systems in the country. It was formed in 2019 with the alignment of Catholic Health Initiatives, or CHI and Dignity Health. Together these institutions bring over 150 years of combined experience with focus on providing compassionate health care, especially to vulnerable populations. We have a broad national reach. Approximately one in four Americans live within the Common Spirit service areas and we operate over 160 hospitals in 24 states. Our national footprint and the dedication to our core priorities like compassionate care, high quality health services and social justice position us uniquely to confront behavioral health disparities.
- [02:19]
B
I really appreciate the fact that you continue to talk about the mission and vision and how because of that, Common Spirit has dedicated a number of resources related to behavioral health. I'm going to turn to Kathy though, because today the focus of our podcast is really the journey that Common Spirit has been on to reduce the stigma surrounding behavioral health. Kathy, I'm going to put you on the spot, ask you to share. Why did Common Spirit make such a strategic investment in an anti stigma campaign?
- [02:52]
D
This is a system wide effort to address and reduce the stigma that's associated with substance use disorder and it's intended to improve patient care and outcomes. It has three main components. First and foremost, there's a data driven foundation. We surveyed over 500 providers to get a sense of knowledge, attitudes and beliefs. And the results that we obtained confirmed there's a high recognition of substance use disorder as a medical condition and strong support for medication assisted treatment and also help to inform some of the targeted interventions that we're doing, including our anti stigma education campaign. So that campaign has been phenomenally well embraced by our associates and providers. It's in voluntary training and we also have a train the trainer component so that there's an opportunity to help us scale this further. There's aspects that include impactful storytelling. So we created a video series to share the powerful impact of stigma and its reduction from the perspective of both patients and then also from providers. And we're also dovetailing with some of the work that we're doing around the clinical care. So there's an intersection with some of our community commitments such as increasing access to care through our emergency department, addiction care for people that are impacted by opioid use disorder. Then last but not least, we have this focus on language and culture that's woven in and this is made possible through our partnership with the American Hospital association and the People Matter Words Matter campaign. And that's all about promoting consistent use of nonjudgmental language across our facilities and then upholding this culture of understanding and support.
- [04:42]
B
There is such a broad swath and different types of stigma, as Dr. Sopra mentioned earlier. I think that makes so much sense to focus on one core piece and make an impact on reducing the stigma around addiction, because I do believe in many cases, and perhaps your survey showed this. Be interesting to know if it did, that often there's more stigma around addiction or substance use disorders than let's say, major depression or anxiety. If that is the case, then you picked a tough nut to crack, as they say, and just really are so grateful that you're going down that journey. I'd also like to thank you for mentioning People Matter. Words Matter. That was an initiative that the American Hospital association started back in 2021. It's a series of posters, the first one surrounded on people first language and the importance of that. We worked with member organizations around the country to create these posters to help educate around what words or phrases are stigmatizing and perpetuate that and then offering solutions and alternatives for our own workforce to know so that they can choose their words and use their words more carefully to reduce the stigma.
- [06:06]
C
Yeah, I think it really goes back to the values that I was describing. Right. And I feel like how we landed up here is understanding the value of large organization inability to affect stigma. And to understand that, we probably just need to understand stigma a little bit more. Stigma comes in multiple layers or contexts. For example, this cultural stigma that we all know, which is societal or community beliefs, values and traditions that view mental health as shameful, taboo or sign of weakness, then there is institutional stigma or a structural stigma that affects policies and laws and regulations which may lead to lower funding of mental health, whether it's research or services or within the organization helping grow these services. There's of course the interpersonal stigma that we feel towards family, friends or co workers, even interprofessional stigma. Right. Where for folks who have had history of mental illness who are working together with us, I think the employers or organizations have a lot of responsibility in busting the stigma. Common Spirit really looked at it as institutional priority and again as a responsibility of what a large organization, especially in healthcare, which is providing behavioral health, which includes substance use, as you said earlier and took that initiative. And I'll ask Kathy to chime in here and just give us the history of when this program started about three years ago.
- [07:38]
D
Well, I would say that this work has been deeply aligned with our mission, our focus on compassion and our tagline, hello human kindness. There's no greater kindness than fostering a culture of non judgment. So it definitely supports a culture that is supportive not only of our patients, our providers, but also our wider communities that we serve. And then there's been this catalyst from our philanthropic partners, this investment in helping to create and sustain this work over the last three years. And they helped us to create, for instance, some wonderful content, the video series on the impacts of anti stigma and the reduction of that, the training program that we're utilizing. So all this has helped to create this momentum and this interest across our system. And then finally, without a doubt, it's been incredible to see the passion of our associates and our providers. This has been sort of a bit of a grassroots movement in that it's been widely embraced by people. And I think it's because of the fact that many people have been personally impacted by substance use disorder. They realize just how widespread it is and how it impacts so many lives. And there's a lot of enthusiasm about being part of this transformative work. And that manifests in ways like some participating in training, some teaching the training, and then utilizing our videos as reflection in meetings and that sort of thing. So it's been incredibly impactful and I think we've been seeing a lot of interest in continuing the work.
- [09:20]
B
Thank you for making that idea come alive across the footprint of common spirit, because that's where the real work is in your organizations, in your hospitals, day in, day out, and to see it spread across the country. Robin, let's turn to you now. Kathy described the overall anti stigma campaign across the footprint of common spirit. But it's my understanding that it was really your grassroots efforts in your own organization that really was where this initiative was given birth, as they say. So can you help the listeners Understand how the HA's people matter? Words matter, substance use disorder posters have been used, what that looks like physically. Would they see posters? Would it be on screenshots, really help paint a picture for the listeners how you rolled this out at your own organization?
- [10:18]
E
Sure. So being members of the AHA and having the listservs and the communication come out, we heard about the People Matter, Words Matter initiative and I was just so intrigued by the impact that it could have within our organization and really even beyond. In behavioral health, we're always looking for ways to educate and to break down stigma and. And these posters, the series of posters that have come out and have continued to be refined over the years are just such a simplistic way to educate and to bring it into a layperson's terms, if you will, of being able to have conversations. As I was reading these posters, obviously being overseeing behavioral services in the Omaha, Nebraska area and southwest Iowa, this was an easy way to work within our organization to say, hey, we're a large footprint of behavioral health, but yet we know behavioral health patients see primary care, they see ob gyn, they see orthopedics, they have oncology and a variety of areas. And is there a way that we can speak these words or this platform of the emphasis that people matter, words matter. Again, such simplicity that the AHA came up with, how can we work outside behavioral health with our partners to educate? And so I met, actually met with our vice presidents of patient care, so our chief nurses within the organization, to see if they had an interest in owning that for their campuses or within our primary health clinics. I met with our marketing teams and what we ended up doing with our marketing teams was we partnered with AHA to of the all the series of posters to put the AHA logo, if you will, along with our CHI Health logo on the bottom of the posters. So that show in partnership of this work that's together. And then we also paired the variety of the posters with the months. So there's an eating disorder month, there's mental health awareness month, there's posters specific to Suicide awareness. So there's pertinent key posters that align very nicely with, if you will, areas of the month of focus across the country. And so as we put those posters together, we tied them, if you will, with a focus of the month, a topic of the month that paired well. And then we, we also design the ability for posters, table tents in the dining areas. The other unique thing that we did within our marketing department is recognizing that perhaps a poster of focusing on eating disorders may not be top of mind, that patients or families are coming in for treatment in regards to orthopedics, but they're seeing their orthopedic provider, if you will, in their clinic, yet recognizing they could put those posters up in those clinics so that individuals could see them while they're waiting for their provider to come in. But it allowed the nimbleness too, for those clinic leaders to pick the posters that are pertinent to their areas. So we're not putting something up that really has no applicability to the patients they're serving. But there are other broader topics of recognizing, caring for the caregivers, suicidality, substance use disorders that could have applicability across the board. So we started at Grassroots, really in the Omaha area, piloted it, met with our executive leaders within Common Spirit Health and the Behavioral Health Service line, talked about how this could have a broad implication within all of Common Spirit Health, if you will. And so then what we did was we worked with our national teams, took those posters, and we have them now digitally readily available for any leader within Common Spirit Health can go in, pick whatever subject they want, whatever poster they want, and they can also then choose their markets or their name of their hospital or their clinic, and they can put that at the bottom of their poster as well. So it shows a nice collaboration amongst the AHA initiative and, and tying it into with the department, if you will, or market that we're in. So because as Dr. Sapper talked earlier about our broad brush and where we're at within, across the country to this day, by launching that, beyond just the Omaha, Nebraska council plus Iowa market, we have over 2,000 materials that have been downloaded within Common Spirit Health. So we have a broad brush across the country that really has a vested interest in adapting these materials as well. So it has grown way beyond just the Nebraska, Iowa markets.
- [14:26]
B
So, Robin, now that the initiative has been in place for a year or more, what impact have you seen? Has there been a change in culture, a change in tone? Have you seen people actually using the different words that are suggested on the
- [14:42]
E
Posters, the visibility alone. If you're in an elevator reading the information that's there while you're waiting for, you know, to go up and down the floors, or you're waiting for your provider to come in your clinic setting. I actually was just in my primary care clinic last week and as I was setting for the provider to walk in, I look to the right and there's poster on the door. But I have had nurses across our organization. Actually not in behavioral health, but when we posted these out on the Internet and again and they're available, I have had nurses email and just say thank you. You know, I don't work in behavioral health, but I do care for behavioral health patients in critical care or in the NICU or, excuse me, in ob, in the emergency department. And this was such an easy tool for me. I had no idea that I was being disrespectful in some ways of not being conscious of the words I was choosing. For example of saying that, well, the patient's an addict, that person's an addict. Well, actually we're encouraging to say this person has a substance use disorder. One had said, and when I give report when a patient's going to critical care to detox or they're going up to behavioral health because they have suicide ideation and maybe have a substance use component to the treatment, I have found myself saying, now they're you have substance use disorders. I don't refer to them. This is an addict that now has to be detox. So just that shift in nomenclature in words matters. I mean, it gives me goosebumps to think to hear that.
- [16:06]
B
So as we bring this podcast to a close, I'd love to have each of you think about what call to action you would suggest for the listeners. What should they do? What first step or second step should they take to perhaps go on their own anti stigma or stigma reduction journey at their own hospital or health system?
- [16:29]
C
There are ways to address this issue of stigma and large employers, especially in healthcare space, have that responsibility to do that. And there are ways that they can create a culture, the language, the culture of well being and treating each other kindly and with awareness of these illnesses in a way that we can bring that whole culture of compassionate care and also when we're dealing with each other as healthcare workers, that we are being kind and compassionate. And there are initiatives that can be very effective in this space. So I think the call to action is to see that this works and it is a responsibility of our large organizations to take this on One of
- [17:26]
D
the first steps would be recognize stigma associated with substance use disorder as something that can impede a person's progress in seeking the care that they need. It's a condition that impacts millions of people every year. And when we are more supportive and recognize substance use disorder as a medical condition versus something like a moral failing, we know that people are more apt to get the care that they need.
- [17:56]
E
When I think about caring for individuals that have substance use disorder or mental health challenges, I think that nobody woke up one morning and said, okay, Lord, hand it down to me. I want the substance use disorder. I want to be called an addict. I want to have those suicidal thoughts. I want people to be afraid of me. I want people to judge me because it's all my fault that I've lost my job or I'm homeless or because of choices that I've made. Nobody woke up and said, hand me that. I want, I want to be stigmatized in that way or to be thought of in a different light. And yet it's our job to be able to recognize that mental illness, substance use disorders has no demographics, it has no impact on age, it has no impact on career. We see it all across the board. And so the ability to just be kind to one another and to have a curiosity in how we care for people as whole, not just as patients, but people as whole. So to be curious in the way of how you can self educate so that when your friends, your family members, your colleagues are reaching out to you in times of struggle or in times of sadness or feeling hopeless, the ability to just, in a very simple way, to be curious in how to educate yourself so that you can show it better for them. And the People Matter, Words Matter campaign is, again, as I mentioned, it's a very simplistic, non confrontational way to, if not this, do that.
- [19:23]
B
Well, thank you very much. Thank you for partnering in this effort. Thank you for, as they say, taking the ball and running with it. Really appreciate the inspiration that you've shared for our listeners today to take a look at People Matter. Words Matter as one way of beginning to reduce the stigma, in this case around substance use disorders. But whatever they might want to go on their journey, you're changing culture one word at a time and that is difficult work. So, applause and thank you for being here with us today.
- [19:58]
A
Thanks for listening to Advancing Health. Please subscribe and rate us 5 stars on Apple Podcasts, Spotify or wherever you get your podcasts.