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    Mental Health & Burnout in Frontline Healthcare Workers

    Jan 11 2022

    Burnout has been an issue for healthcare workers far before the COVID-19 pandemic. So, how are our frontline healthcare workers, who often didn't have good mental health to begin with, coping amidst all of this trauma? Today, psychiatrist Dr. Jessi Gold joins us to talk about healthcare workers' mental health and steps health systems and mental health professionals can take to support them better.

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    Darcy Gruttadaro (00:04): Hello, and welcome to Mentally Healthy Nation, a podcast from the American Psychiatric Association Foundation. I'm today's host Darcy Gruttadaro, Director of the APA Foundation Center for Workplace Mental Health. On today's episode, we will be talking about burnout, stress, mental health, and wellbeing in our nation's frontline healthcare workforce. This is a topic of great concern in diverse workplaces across our nation and in many parts of the world. However, we all recognize that frontline healthcare workers have been hit hard by these issues in providing care throughout the pandemic. Today, I am extremely fortunate to be joined by Dr. Jessi Gold, a psychiatrist, an assistant professor, and the director of wellness engagement and outreach in the department of psychiatry at Washington University School of Medicine in St. Louis. Dr. Gold is a nationally recognized expert on the topic of healthcare worker mental health and burnout. She has written a and spoken extensively on this topic. One of major interest and concern before and during the current COVID 19 pandemic. Welcome Dr. Gold. It is a pleasure to have you with us.

    Jessi Gold (01:17): Thank you so much for having me.

    Darcy Gruttadaro (01:19): Okay. Let's jump right in and ask you to help ground our conversation by giving us a sense of the magnitude of concern around healthcare worker burnout, stress, and mental health concerns.

    Jessi Gold (01:31): It's a really good question, and I'm glad you all are interested in it. I think that what we need to know first of all, is that healthcare workers didn't have good mental health to begin with. It's not like this problem all of a sudden dramatically appeared when COVID started. We've seen it on TV more when COVID started, which makes sense because healthcare workers are speaking more which is great. But it wasn't a problem just in COVID. So before COVID, we had high rates of depression, high rates of burnout up to 50% in healthcare workers, high rates of suicide in our profession and high rates of prescription drug use. So we start with that and then COVID comes and COVID's been a really long, really hard, particularly different stressor for healthcare workers where we've been exposed to different things than we've ever seen before.

    Jessi Gold (02:23): A lot more death than we've ever seen before. Rationing resources in ways we would never have thought we would. Exposed to maybe getting infected ourselves and maybe then transmitting that to friends and family, all these different risks. And so as a result have had really compounded mental health stressors. Then that has led to significant rates of anxiety, depression, and trauma. And some of the data that we have is kind of new and right out of New York, which is hard to necessarily apply to everybody because New York at the height of the pandemic is a specific case. But the data there in one study showed that 57% of the healthcare workers had acute stress, which is a measure of PTSD. It's just they can't call it that because it's right too close to the trauma. And then 48% of them had depression and 33% had anxiety. And those are really big numbers. And on top of that, 75% of them were saying they weren't sleeping. And 65% of them said they were lonely.

    Jessi Gold (03:31): And I think the loneliness thing is also something really important in this kind of conceptualization of emotions in medicine, which is if we go to work every day and we're around people every day, how are we possibly lonely? And I think we're lonely because we don't actually talk about what we're actually experiencing and we're not actually talking about, what's hard about our jobs. And so it feels really isolating to be the person who's struggling, if you think you're the only one struggling. So really COVID has been a tremendous stressor on healthcare workers, will continue to be a stressor on healthcare workers. Is definitely not something where the pandemic will magically end and our mental health is all of a sudden going to be great. And I think that's an important thing for people to realize that these symptoms could come out in years or at least months, and it can last for a really long time too.

    Darcy Gruttadaro (04:31): So I guess one question given those incredible statistics you just shared is, as you've looked at these issues, how are hospitals and health systems really effectively addressing these high rates of burnout and stress?

    Jessi Gold (04:44): It's been a hard thing for hospitals and healthcare systems. I think it's interesting because I kind of see that my patient panel across the board. So I see administrators and I see healthcare workers. So I hear about the stressors on both sides mentally. And I think that's a unique perspective in that I think a lot of people can understand where healthcare workers are coming from, but maybe don't understand how hard this has been for administrators, but when things have really changed that quickly and you're left with budgeting for a pandemic and trying to stop the bleed, so to say. It's hard to then go, how do I also help this mental health crisis that's coming because people are not right in front of me, actively dying of a mental health problem. So it's hard to ration that thinking and the money. And it's been a really hard thing for administrators.

    Jessi Gold (05:39): I think for a long time, they also known it's been a problem and administrators have tended to put more lip service on it. And we would have these kind of jokes that people would give us yoga classes and pizza parties, or make people go to lectures about burnout and mental health when you would rather be sleeping and actually dealing with your burnout and mental health. And that was kind of the long standing joke in medicine, that it was a checkbox that they had to do that the ACGME and some of these other organizations said, "You need to talk about burnout. You need to tell trainees, you need to be dealing with this." And the way they did it was these sort of like checkbox answers with lectures or little quick self care tips. But I think over time now they don't have that as what they should be doing because they know it needs to be a bigger solution.

    Jessi Gold (06:31): It's hard to do that in a crisis. I think a lot of people tried as best they could to put sort of like bandaid fixes in during a crisis. So like setting up hotlines, increasing access to resources, like mental health resources, trying to set up funds to help people actually pay for it, trying to make sure that people are just really aware of that. And I think all of that really happened over the crisis that was COVID. But the long term, actual management of that and how to sustain that, I think is the big question. And I don't know that we have good answers to that.

    Jessi Gold (07:06): I also think that a lot of healthcare systems do good things, then we don't hear about it, or it's hard to find. And that's been one of the things I find most frustrating about working in this field or are being interested in this field is that people tend to do really great innovations or are working on them, but they don't study them. So then they don't end up in journals or there's no place for them to really go. And so you don't know what programs are working or you don't know what the evidence-based method of trying to help people in these fields are. So you're just kind of going from scratch and throwing darts at different things. And that feels ineffective, I think.

    Darcy Gruttadaro (07:43): Yes. And we often think about leaders as setting the culture of the organization they're working within. So I would think administrators play such a key role and it's unfortunate if they aren't creating the right kind of feedback loops so that physicians and nurses and others in healthcare systems have the chance to really communicate what's important. And then what's most important is that leaders act on it, because there's nothing worse than sharing what you're looking for and then having no action.

    Jessi Gold (08:13): Absolutely. I think one of the hardest things is transparency. I think there's often things that leaders are doing, but no one has any idea that they're doing it. So what it feels like as a healthcare worker is I am actively working and doing clinical work and I'm being hurt by it and nobody cares. And that's not often what actually is happening because sometimes there are these things happening they're just slow moving because culture change takes time. Big changes in hospital systems take time. Implementing new treatment plans take time. But unless you say, "Oh, by the way, we're actually working on this. This is something we care about. We're putting money into this. We're just trying to figure it out," and like tell people the steps along the way and have those transparent communications, it feels very disconnected. You don't even notice that there's a problem or you don't even see it. And you're sort of just ignoring it.

    Jessi Gold (09:06): And as a healthcare worker, that can be really hard in terms of really feeling supported by your organization. And you're right, communication is critical, I mean, we started in our organization at Wash U really working with HR because the way that HR sends out their emails and the way that even just saying like, "Hey, we have these resources," can feel hurtful to people if they don't feel also, like the emails were empathetic and supportive and aware of all they've given to the cause and in their work during this year. And so trying really hard to work on what wording people use, I think is really important because they want to feel noticed.

    Jessi Gold (09:47): And if you're telling them what childcare resources exist, that also includes mental health related things. And it's important to acknowledge the struggles and strain of the year for people and not just say, "Here's the stuff we have, like deal with it, find it, figure it out yourself. I'm sure you have time for that." So really focusing on the fact that these little things can really make a big difference, because they really do make people just feel like somebody notices and somebody cares.

    Darcy Gruttadaro (10:15): Yeah. And I'm so glad you mentioned mental health because as we think about healthcare workers in mental health, I guess one question is, are healthcare workers likely to seek care when they need it? And if not, why not? And what can be done to help them feel psychologically safer seeking help when they need it?

    Jessi Gold (10:35): So the answer that question is mostly not. I have a clinic where my majority population is healthcare workers, faculty, staff, their spouses, and their college age kids. And one of the things that we notice and a lot of people that work in, what I do notice is that people come in late, as in they're a little bit sicker than we'd like, and psychiatry takes time, unfortunately. I wish that I could give you a medicine and tomorrow you'd feel better, but it doesn't work like that. So the longer you wait and then the longer it takes for you to come in, the longer you're going to be sick and the harder it's going to be for me to treat it, if you're really, really sick at the time. So we often see people much further along down the mental health spectrum than kind of middle or preventative stages because they're not noticing it.

    Jessi Gold (11:25): And a lot of that has to do with stigma. I think that's a really big thing in our culture. There's some studies that suggest that that's a thing that people really do notice in the medical culture, in their peers, in their supervisors, in their fears of people reading their applications, in their fears of licensure. And that really actually does translate to people being afraid to get care. That's even true during the pandemic, there was a study from the Kaiser Family Foundation, sort of looking at people, getting care and what the mental health outcomes have looked like. And about 20% of people said that they thought they needed services but didn't get them. And 17% of them said that was because they were afraid or embarrassed about seeking care.

    Jessi Gold (12:13): Of course, there are still other barriers that are more systemic. Like people are too busy, they can't afford them. They can't get time off work. And those are things that we need to be thinking about and need to be focusing on too, because how do you get a healthcare worker to take weekly appointments when they can't get off of work for something like that? That's very critical. And it's something we do need to be thinking about. But the stigma thing is something that as a healthcare population, we need to be working together to fix and change the way we talk about mental health with each other and change the way that we feel about mental health as a system for us, and why it's important for us to take care of our mental health as it is to take care of our physical health.

    Jessi Gold (12:56): And even though there are these things that have long been passed down as things to be afraid of, like licensing, for example, they have improved over time. The Americans with Disabilities Act says that you can't ask about things that are outside of, are you actively right now having something mental health wise that makes it so you can't do your job. And so they're not supposed to ask about historical mental health treatment or are you just in therapy or getting meds right now. That doesn't mean that they don't, there are still states that do but that number has really decreased over time. Unfortunately, it's a state by state advocacy thing because we don't have universal licensure. And we don't have a one board that mandates what every licensure board should be doing, but it has changed over time and people are aware of this and advocating for it and trying to change it. I think the next step is credentialing and hospitals because this comes up there too.

    Jessi Gold (13:54): And I do you think that it's fair and valid to say, I understand why healthcare workers are scared of that because if you work your whole life for something and you put money and time and energy, and it's your purpose in a lot of ways, and then you go get help when you need it. And then that could be affected. It's scary, but there should be nothing in the time, especially of crisis that goes through your mind, that makes you think you can't get care, especially that somebody's going to take your job away from you or make you have restrictions on your job that you didn't expect. You should be free to get help. Asking for help is strength. Asking for help is good leadership. Asking for help should be commended. It shouldn't be penalized. And those are things we need to be working on to make it safer for people to feel like they can get help when they need it.

    Darcy Gruttadaro (14:47): Yes. Oh my goodness. So much there what a rich description of what's really going on the front lines. And the thing is I think sharing personal stories, having that personal connection goes such a long way toward helping to eradicate stigma and the leadership piece. Having leaders willing to say, "We're going to change our policies so you can take time off every week to get the help you need." And yes, it is so much a sign of strength. So I guess my question is, is there a need for specialized mental health care? Is there something unique about the care delivery to those in the healthcare system that's different from others? How does that look?

    Jessi Gold (15:31): Yeah, I mean, it's a really good question. I think that it's not necessarily that it's different but there are some things that people would like people to understand if they're taking care of healthcare workers. So the people that I see would like people to be aware of what the training process looks like and what healthcare looks like. So they're not having to explain the whole thing to them. They would like people to understand that they don't actually have control over their schedule or their schedule changes a lot or they might not sleep a lot. And that's part of their job and they're not doing bad self care because they can't change that. I think there's an awareness that comes with taking care of healthcare workers that has to be like, this is what the profession looks like. And some of that they don't have control over and you have to be helpful to them about the things that they do have control over.

    Jessi Gold (16:18): And that's what is important in the people who do take care of healthcare workers is some awareness of that because I think it's exhausting to have to also explain training or feel judged for something that is totally outside of your control or feel like somehow you should be doing something that you know you can't do. And that kind of thing is definitely hard. And then I think hours and time of when things are offered is particularly important for healthcare workers. So for me, we did a kind of survey thing in our healthcare system to try to understand when healthcare workers want to get appointments and it's early morning, lunchtime after work and weekends. That's hard for people who work in mental health because they want normal hours too. Therapists in general sometimes tend to be a little more flexible with their hours and there are some therapists that work nights and weekends.

    Jessi Gold (17:09): And so then you wonder, so should those therapists be the ones that you're attracting to work in these environments with the healthcare workers, because their schedules are so out of control. Psychiatrists, it's more complicated. I like to work eight to five. So it's a little harder. I take my lunch at a different time so that I can be free on the lunch break. And that's like sort of how I've dealt with the adjustment but hours is a big thing. I think people don't always want to get care in the system that they work in. I would love that to be the case because it's easier. We're there. We can help them et cetera. But there's a lot of stigma around, like if I see you at work, what does that mean? And discomfort around, like even saying hi to me, because does that mean they know me from work or does that mean they know me from treatment?

    Jessi Gold (17:58): And I always think it's kind of interesting because people have no problem going to get their OBGYN care at the same hospital that they work in. And that's quite a sensitive area as well. But mental health has this whole other degree of sort of like airing your laundry in a way that people don't really like to do that. And so sometimes people don't want to come to their healthcare system. And so you also need to think about how do I give options to people both inside and outside so that they can have access to every. And I think that also is, do you cover cost inside and outside? Do you have a lot of names and access and quick access both inside and outside? And people then can choose where they want to go.

    Jessi Gold (19:09): And one of the things I think that we don't think about, which I'd love people to think more about is how to actually help make sure that healthcare workers get to appointments and like actually follow through because anybody who's ever tried to make a therapy appointment knows that it's very challenging. It's a lot of work. You have to call a lot of places, put lot of phone calls. Often there are wait lists, you're playing phone tag. Then on top of that, if you're sad, you don't have the motivation to do it anyway. If you're anxious, you are too anxious to be on the phone. So there's all these barriers to trying to make an appointment and actually follow through with an appointment without even thinking about what the work day looks like for a healthcare worker to play phone tag. So I would love for us to think about like, what does it look like to have people like social workers, case managers, something who are really helping healthcare workers follow through on appointments and get to where they need to go.

    Jessi Gold (20:06): I think that it's hard for people to think about the fact that they need help with these things, because it feels like giving control to someone else, or it feels like asking for help in a way that maybe you don't need the helping because you actually do understand the system and could navigate it if you had the time, but it takes that burden away. And I think it's really important to not feel like, oh, this huge hill to climb to even just make an appointment, then am I actually going to go to that appointment? And what if I don't like that person when I go to the appointment? I have to go do that whole thing again? So then I think people sit with people they don't like for a long time too because it's just so tedious to get an appointment in the first place. And so having someone who helps people navigate the mental health system or navigate what resources would be good for them, I think would also be really helpful.

    Darcy Gruttadaro (20:54): Wow. I'm just sitting here reflecting on what you're describing. And we work a lot, at the Center for Workplace Mental Health, with corporations and the sort of top three things that often get described as barriers or stigma first and foremost, which you described of course, fear of judgment by colleagues and those they work with, which is probably why people want to go outside of their own system, along with their own personal information, not being shared. And there may be issues related to the workplace they're actually in. And then the third is really challenges around navigating care. It's very hard to secure mental health care. And so I'm just struck by the fact that what you described is just exactly what we hear in so many industries absent this excessively high rate of burnout and stress. And I guess it's causing me to wonder a bit about this whole discussion around great resignation and how that might be hitting the healthcare field and what is being done to address that?

    Jessi Gold (22:00): Really good question. I think it has a lot to do with what we're experiencing burnout and mental health wise. I think that the healthcare system was struggling again before COVID just like healthcare workers were struggling before COVID and I like to liken COVID is sort of this way to bring out the fault line. So anything that you're really had problems with, you see a lot of the problems over COVID. So healthcare in general, you saw a lot of the things that are wrong with the healthcare system over COVID because it was strained to the point that you saw them. Mental health is going to get to that point and is getting to that point. And so people will see that too. And I think the great resignation thing is sort of this evaluation of am I valued in my workplace? Do I actually find meaning and purpose still in my job? Is this job what I thought it was going to be?

    Jessi Gold (22:56): So you get a lot of burnout from the difference between what you think work is going to be and what work actually is. And we get meaning and purpose from patient care, from people getting better, from feeling like we have some control over our day and then actually getting to help people. And we're not doing that if we do paperwork all day and we're not doing that, if we feel like we don't have support to do our jobs or feel kind of like left out and can't help people the way that we want to. Like in COVID, there's so many patients not enough people to take care of them. You don't have the resources, you feel like you're hurting people in ways that you wouldn't have had to hurt them. And that's really hard for people. And so you sit there and you evaluate this and you say like, "How does this work for me?" And do I want to be doing this?"

    Jessi Gold (23:47): And I think a lot of people don't do that actively in the moment. I think a lot of people in healthcare maybe compared to some other industries, haven't had the evaluation period time yet. So some other industries have had like, okay, we're transitioning back to the workplace and do I actually want that workplace? Because I actually really liked flexible work and if they're not letting me do that, I'm going to get a new job. But we haven't had time to breathe yet and go, can I make that choice? And it's a really, really big choice to choose to leave healthcare. You put in years of your life, you sacrifice money and time and friends and family and so much. And so to really choose to do that is no small... Like it's not just changing jobs. It's changing your soul, honestly. The thing you define yourself by.

    Jessi Gold (24:40): And so how do you do that? You have to be pretty certain that's what you want to do, takes a lot of reflection and a lot of time for that reflection. And I don't know that everybody has really had time to do that. And I don't know that everybody wants to do that while they're actively helping people and trying to get the pandemic under control. But when we get time to pause and do that, I think we'll see more healthcare workers go, do I feel valued in this job? Do I feel valued at this workplace? Maybe they'll just change workplaces or is this not what I actually signed up for? I'm a psychiatrist. I didn't actually know that you could pull me into the ICU to do a job. I thought I trained in psychiatry. What is this? That is a thing I never knew was a thing. I went to psychiatry training. I thought I was done with the ICU. It turns out in emergencies, they can tell us to do whatever we want.

    Jessi Gold (25:32): Those kind of things I think are differences in our job that we might not have realized and stressors that we might not have realized that COVID really emphasized. And when we have time to think about it, will definitely contribute to extend decision making and maybe leaving. I think nurses have been leaving actively before and are leaving now too. And they have a little bit more union support than doctors do so often they do get to make those decisions a little bit earlier than we do, which I think probably doctors would say they are a little envious of, but then it makes the workplace even harder for doctors because there's new nurses and travel nurses and nurses that are really stressed out and burnt out. And so that whole environment is even harder to begin with. So I do think that we'll see a lot of it.

    Darcy Gruttadaro (26:22): Yeah. And as you're describing these day to day experiences for many, I'm sitting here thinking, wow, for parents that had children at home and schools closed or classrooms are closing because there was a COVID positive student. I can't even imagine as a parent playing the school role and all this stress around the workplace. And caregivers of elderly family members and that's just hard to imagine.

    Jessi Gold (26:49): Yeah. People forget that healthcare workers are actually dealing with the exact same stressors that everyone else has over the pandemic plus working in the front lines of the pandemic. So if it's been hard for you over the pandemic to figure how to deal with your kids, so has it for them. If you have been taking care of a person at home who's maybe unhealthy and you're afraid of getting them sick. Imagine what it's like when you also go to work every day where you're exposed to COVID every day. And so I think there are these compounding stressors where the whole mental health landscape in the US is really struggling because of all of these additional stressors even without working in healthcare.

    Jessi Gold (27:28): So if you think about that, it makes sense why that would also contribute to our added stress. And I think things like childcare, things like leave and ways to actually take time off in our job, support around that. Having actually enough people that we don't feel like we're burdening our coworkers by taking time off and asking for time off and not burdening our patients or not supporting our patients too, I think has always been a problem in healthcare. I mean, I was chief resident and I remember sort of like when we were scheduling people who were out on maternity leave, it was like, "There's so many people out on maternity leave." And then I heard myself say that and I was like, "They can have babies if they want to have babies!" But it's just we don't have a system that's well designed to support that, because then everyone else is picking up the call shifts and the time and the Slack and they feel very stressed by it.

    Jessi Gold (28:19): And so even as someone just doing the scheduling, you kind of hear yourself say like, "I can't believe they had a baby." But I'm a female. And I very much support everything that is, gender equity and all the places and you should be able to do whatever you want to do. And I can hear myself saying things like that but we don't take time off when we're sick for the same reason, because we go, "I might be sick, but how do I take time off if there's only one ICU doctor in this whole hospital system in this tiny town. Who's going to do this?" And so trying to understand how to actually deal with those stressors is something healthcare's never done well.

    Jessi Gold (28:57): And some of that comes from the actual infrastructure of healthcare and supporting people with policies and understanding that policies have mental health outcomes. And you can't just do that in a bubble. And anytime you're making those decisions, you should have someone who understands mental health in the room but also how do we have more redundancy in our workplaces? How do we have people who are less irreplaceable? It's great that we are the best at what we do, but it's also nice to feel like sometimes we're not the only person who can do it.

    Darcy Gruttadaro (29:30): Yeah. Gosh, that's so amazing to think about those issues and the pressure that alone puts on people who work in the healthcare field. So, okay. I'm going to give you a magic wand and I'm going to give you three things that you could do with a magic wand when it comes to healthcare workers and burnout, stress and mental health. So go to it.

    Jessi Gold (29:56): The first thing is that people talk openly about failures and vulnerability in healthcare, so that the culture is just more open and honest about emotions in general. I think that that would have tremendous effects and also on patient care, to be honest in the way that we would actually take care of each other and take care of patients and being able to even just say like, "This is hard. I didn't sleep well. Turns out being a doctor in COVID is not easy. I actually didn't do well on my test yesterday." Having these conversations openly and not just pretending everything is amazing all the time, I think would really change the culture for good and would lead to eventually making the stigma be much less forgetting care. But that first step is really just like, how do we be more open and vulnerable and honest with each other? So that would be my first thing is making it so people feel like they can talk about whatever and healthcare and feel supported.

    Jessi Gold (31:02): The second thing is that people understand what healthcare workers are going through. And that is sort of like in all places. I think that it feels sometimes like we're screaming into avoid and that the population hears it, but they don't care. Or the population's mad at healthcare workers, which has been the trend over time more recently. And that just adds to people being particularly hurt. And so I don't think hero worship is necessary. I don't think anybody in healthcare likes that word. I don't think that they want that but I think that it would be nice if we went back to actually valuing how much work and care goes into the job and how much people actually do care about you when they're in the profession.

    Jessi Gold (31:50): And I worry some that the way that people have been treated over the pandemic has really taken that away from it. And that is a reason that people feel good about their day. I feel like people understand that I'm sacrificing X, Y, or Z to help them. And they say, thank you. And I think that's really important and it's much different than when they yell at me. They tell me I'm lying. They tell me science is fake. So I think having an environment where if I could wave a magic wand where people valued health care workers again, or at least cared about the work that they put in would be something I would say.

    Jessi Gold (32:30): And then the third thing would be probably something about time. If I could make time more available with a magic wand, that would be nice. I don't know what that would look like, but I think time is this really big problem which is we have a lot of responsibilities in healthcare. And if you're in academics, it's not just patients. It's also like, are you publishing, are you mentoring? Are you doing all these things that you're not getting paid for? And that doesn't really work in a pandemic. And it also doesn't work in a pandemic if you have all those other stressors you were talking about like caring for loved ones and teaching at home or anything like that. And then it certainly doesn't work if you're trying to do weekly therapy or get help when you need it.

    Jessi Gold (33:21): And so I think having some like magical availability of time when you need it, where you could be like I need to go to treatment. Now I'm going to not cause any disruption to my day or anyone else's day. And I'm just going to pause time and take this hour and go back later. That would be really nice because I think that barrier is one that I'm not really sure how to solve and isn't going to be solved for a long time. And I think that it's really hard for people to ask for weekly appointments off. And I think it sort of in the same way that stigma exists. If you ask for a weekly appointment, what are you going for? There are very few things that you need weekly appointments for. It's sort of like, "By the way, I'm going to therapy." And there's nothing wrong with that but it feels like, "Why does the employer need to know that?" And so I think some way to have control over time would be nice. I just don't know what that looks like, like a remote control or something.

    Darcy Gruttadaro (34:26): Well, it's fascinating to me because PWC did a survey. They put out over the summer that asked employees across industries, what is it that you'd really like to have? Because so many employers are giving people little perks and the number one thing people wanted was time. So that is spot on with what is being seen as important across industries. But I can only imagine in the healthcare field how critically important that is. So, oh my goodness. What a rich, practical, wise conversation this has been. I really want to thank you, Dr. Gold. We really appreciate that you are a guest in taking time out and contributing your wisdom on Mentally Healthy Nation. So thank you so much for joining us.

    Jessi Gold (35:13): Thank you for having me.

    Darcy Gruttadaro (35:15): Thanks to our listeners for joining us. If you'd like to learn more about the work of the APA Foundation, please visit us on, apafdn.org, where you'll find free high impact resources on how we are working to create a mentally healthy nation. You can also visit the APA Foundation Center for Workplace Mental Health at, workplacementalhealth.org. If you enjoyed today's podcast, please share it with a friend. I'm Darcy Gruttadaro. Hoping that you all stay well.

    Speaker 3 (35:47): The views and opinions expressed in this podcast are those of the individual speakers only and do not necessarily represent the views of the American Psychiatric Association Foundation. The content of this podcast is provided for general information purposes only, and does not offer medical or any other type of professional advice. If you are having a medical emergency, please contact your local emergency response number.