Hello and welcome. I'm Dr. Amy Cohen, a clinical psychologist and the director of SMI Advisor. I'm pleased that you're joining us for today's SMI Advisor webinar, Evidence-Based Strategies for Addressing Burnout and Enhancing Well-Being for Mental Health Providers. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patients. Today's webinar has been designated for one AMA PRA Category 1 credit for Physicians, one Continuing Education credit for Psychologists, and one Continuing Education credit for Social Workers. Credit for participating in today's webinar will be available until April 26, 2022. Slides from the presentation today are available in the handouts area, found in the lower portion of your control panel. Select the link to download the PDF. Please feel free to submit your questions throughout the presentation today by typing them into the questionnaire found in the lower portion of your control panel. We'll reserve 10 to 15 minutes at the end of the presentation for Q&A. And now I'd like to introduce you to the faculty for today's webinar, Dr. Michelle Salyers. Dr. Salyers is Professor of Psychology at Indiana University, Purdue University, Indianapolis. She directs the ACT Center of Indiana, a collaboration of academic and community partners, including researchers, administrators, clinicians, consumers, and family members, who all share an interest in recovery-oriented, evidence-based practices. The overarching goal of her work is to help adults with serious mental illness live meaningful lives in the community. Her research addresses both consumers of mental health services and the providers of those She's increasingly targeting the interaction of consumers and providers, looking for the best ways to support relationships that promote recovery and well-being. Her current work involves developing effective ways to reduce provider burnout and to increase shared decision-making in mental health care. Dr. Salyers, thank you so much for leading today's webinar, and I'll hand it over to you now. There we go. Thank you, Amy, and I am delighted to be here with you guys today. Excuse my mouse difficulties. I have a brand new computer, so I'm struggling a little bit to make that happen smoothly. But I'm really happy to be here today. I have no financial relationships or conflicts of interest to disclose, but I do like to say that this is a personally meaningful topic for me and that it's still an ongoing journey for how to manage my own level of burnout and well-being at work. So this is a topic near and dear to my heart. So our learning objectives for today, first, I want to provide some theoretical framework for how to understand the drivers of burnout and well-being at work, and that that way it will help us figure out different ways to prevent burnout, promote well-being at work, and ultimately have better patient outcomes. And we'll also talk about strategies to reduce demands and increase resources in your workplace. So I want to make this something that is practical that you can take home. And also touch on some strategies that might help enrich your workplace culture, because that's also important, as you'll see, to our well-being at work. So what is burnout? And I'm sure all of you have your own image of what that might look like. The World Health Organization has really been helpful in clarifying a definition for us. And this builds off of Christina Maslach's work. She was a, or is still, a pioneer in the burnout world, but they define it as a syndrome that results from chronic workplace stress that has not been successfully managed. And it involves the three areas of feeling just depleted. You don't have enough energy, you feel emotionally exhausted, overextended. That's often the first thing that comes to mind when people think about burnout. And the second dimension is really feeling disengaged from your work. She had called this depersonalization, or later cynicism, but it's this idea of feeling negative, cynical, and just kind of distancing yourself from your work. And then finally, feeling ineffective or not accomplishing as much at your work. Importantly, individuals may experience it, but the problem is really situated in the workplace. And we'll come back to that later in the webinar too, that I want it to be clear, this is not an individual problem, it's a broader problem than that, and something that we all need to address in our workplaces. So why is burnout a problem? Well, several meta-analysis have shown different effects at all different levels, including a review that really focused just on prospective studies, which has a little bit stronger evidence to show that it's not just an association, but maybe more of a consequence that happens after burnout. But we know from the literature that burnout can affect us as clinicians. So we have worse physical and mental health difficulties when we feel those three components of burnout. Burnout also has really negative connotations for our organization. So people who are burned out are less satisfied with their work, they're less committed to their organizations, and they're more likely to leave. And finally, for those we serve, so our patients, our clients, the consumers we work with, these reviews have shown that higher levels of burnout are associated with lower patient satisfaction, lower perceived quality of care, and actually more errors. A lot of those have been more with nursing and inpatient settings where they can actually measure some of those things. So what causes burnout? One of the most widely used models of understanding burnout comes from the job demands and resources model, which is up here. And we can see that job demands, these are the things that tend to add strain to us, and those lead to increased levels of burnout. And those could be thought of both as challenges, so having a workload that is a heavy workload or working with patients who have very difficult problems. The mental health world, we often have to have a lot of emotional labor in our jobs. We deal with a lot of difficult things, and that can add to the demands. There are also a lot of hindrances or hassles in our work. So having some conflicts, too, between what we expect our role to be and what we're asked to do can be a big demand, and also coworker conflicts. These are just some examples in the boxes that I've highlighted, but you can think of a variety of different demands that can lead to burnout. At the bottom, we have job resources. These are things that contribute to better engagement at work and less burnout. So here, when we have clarity in our roles, what is expected of us in our job descriptions, if we have autonomy, do we have choice? And we're going to come back to autonomy later, because that's such a big one. Do we have job development opportunities? Do we have feedback, supervision? All of those things might be resources for us. And burnout happens over time when our job demands really outweigh the resources and in a chronic kind of situation. Now we all come with our own personal resources and demands. So how do we manage our own emotions in this work that we do that can be very emotionally straining? Are we mindful of our own emotions? How do we tackle that? How do we manage our time? We're all very busy, have a lot of things going, and so managing our time effectively can be helpful. How do we think about our work is important too. Our physical well-being, so if we're exercising and getting good sleep, we're much better able to handle the job demands. And then also our social support and having a sense of purpose or meaning is really important. And all of this is embedded in an organizational context. Where you work really matters. And even at your team level or your department level, how are your coworkers? What's the culture like? Are you in a respectful, supportive environment? Do they want you to have some level of work-life balance? All of those things can affect our level of burnout and engagement. More than that, we have a lot of cultural factors that are coming into play. Technology, we have now, we can have a 24-hour workday. There's no clear boundaries anymore with our cell phones and always ways to be connected. And so we're always on, in a sense, and always connected to our work. And often having this technology that can be really helpful for us also leads to multitasking, despite a lot of evidence showing that it's not very productive. Our culture is also experiencing a lot of gig work now. So we know about Uber drivers and DoorDash and those kinds of things. But even in the mental health world, you might have contract employees or you might be on contracts. It gives you a lot of independence, but not as much commitment from our employers. And social justice. So now we're focusing much needed attention on issues of race and identity. And in our work with people with severe mental illness and substance use, those vulnerabilities of people from minoritized backgrounds really can multiply stigma and multiply the problems that our patients are facing. And of course, all of this is magnified by the pandemic. We have all experienced loss and major life disruptions through COVID. For many of us, work and home totally merged. And we're trying to do all that we did before, but we may not be feeling safe doing it. So what can we do about it? Well, for my work, I'm a clinical psychologist and I have worked with my colleagues, Gary Morse and Angie Rollins and Maria Monroe-DeVita. And we really first came at this from the idea of helping people build resilience. Like we do with our clients, trying to take a strengths approach and focus on recovery. We can apply similar frameworks for burnout. Like any other stress-related concern, we can help people become more aware of burnout, identify our own personal patterns of stress response at work, and help people learn or if we're dealing with clinicians, help remind them of the skills that they already have to address it. And many of them are the same approaches we might use in our mental health treatment. And we were also really interested not just to reduce burnout, but to enhance well-being. And so we have adapted the job demands resources model. And I showed you this earlier. And the part that we brought in was that individuals have their own resources and demands. And that wasn't part of the original model. But thinking that if we could help build up those personal resources, then people would be able to manage the demands better at work. And so our intervention is called BREATHE. I always talk about it's important for researchers to have a great acronym, even if the title is a little clunky. But our BREATHE intervention really focused on increasing those personal resources. And our first area that we really think about are the core contemplative practices. So bringing it back to focusing on our breath, being mindful, we do some imagery exercises as well. And so that contemplative practice can help us be centered. And they can also be practices that you can do like right before going in to see a new patient or going into a new meeting. Having that time to just slow down and breathe can help. We also focus on the cognitive practices, helping people reconnect with what's important, what brought them to this work. What do they value? Reminding people about the physical strategies, of course, getting good sleep. We do some yoga exercises in our intervention. And we talk a lot about time management approaches and different ways to structure and think about our work that could be more effective. And finally, we focus on building social support and relationships at work so that we can better integrate all of these practices too into our daily work life. But we found it's not enough. Our initial pilot was really promising. It showed reduced exhaustion and cynicism and more positive attitudes towards their patients. But our subsequent RCTs were really mixed. So my colleague, Angie Rollins, led one of these studies in the VA and we found improvements over time for those who were in the breathe condition, but they weren't statistically significant from controls who got more of a motivational interviewing type of training. And then we had a second study that was going partially at the same time, funded through PCORI, where we looked at implementing breathe compared to motivational interviewing training and looking at the impact on client outcomes. And we found no improvements in burnout over time in our measures using Maslach's measure of burnout. The qualitative findings though, participants talked about breathe being helpful. The things that they said were helpful were really giving themselves permission to care for ourselves. They talked a lot about how it felt supportive for the organization to bring this in because they were given productivity reductions to be able to go and spend time to focus on themselves. And it was really nice to be in a room and have small group activities and talk to each other and get support from each other. And even just hearing that other people in your same work environment are feeling the same level of pressure and stress and that that can be very helpful. So what do we do if building resilience is not enough? We really need to focus on organizational change and that's what we're trying to kind of move more into this area ourselves with our own research. But we know from the research, organizational factors are really the strongest predictors of burnout and reduced work engagement. So having excessive demand, so having a workload that you just can't keep up with, all the administrative hassles, paperwork, for a lot of you, maybe the electronic medical record, which is supposed to be helpful, but often brings its own level of stress, role conflict, I mentioned that one earlier. And then not having job resources, so not having autonomy over your schedule or having a micromanaging kind of environment, not having support of your coworkers or your supervisors, not being recognized for your work. In mental health, many people are not paid very well for their work and other forms of recognition may not be happening as well. And not having opportunities for development. So we know from the literature that those are strong predictors of burnout. And there have been some reviews looking at interventions in mental health. And so one of my doctoral students actually did a meta-analysis a few years ago and found that most of the studies really focus on individual interventions to either increase coping or stress management, and overall they have a pretty small effect on burnout. And then there have been a few meta-analyses for physicians, not specifically in the mental health field, but for physicians focusing on that role. And one of them ended up recommending that we should really combine individual and organizational interventions, and another one really focused more on emphasizing the organizational level. So there are a lot of reasons that we need to go just beyond the individual and start thinking about organizational change and what we can do about that. So what aspects of the organization actually need to change? Well, right now we don't have an evidence-based package for reducing burnout and increasing engagement, an intervention that really focuses just on organizational change. There are some related possibilities though, so specifically from the mental health field, the ARC intervention, availability, responsiveness, continuity, that was developed to support implementation of evidence-based practices, and they actually found that this intervention also reduced burnout in mental health workers. And this is an intervention that is kind of multi-leveled, but it involves work groups of stakeholders working together to identify strategies that they can implement to overcome the difficulties that they are seeing when they're trying to do a new evidence-based practice, and they're facilitated by outside people. So that's one intervention that has a lot of possibility. There is another intervention that's related called CREW, civility, respect, and engagement at work or in the workplace, and that's been done, I know, in the VA and several settings there, and that was really focused on that interpersonal civility and working together in teams, but it also has facilitated work groups, different stakeholders working together. And then the third one, which is my personal favorite because it also relates to our work in community mental health of trying to be recovery-oriented and strengths-focused, is appreciative inquiry. And this is an organizational change approach that tries to look at the idea that all organizations have some strengths, something positive that allows them to continue to survive. And if we can tap into what are those strengths and how do we build more of those, then that can be a very effective way to do that. And again, in that approach, that involves stakeholders from all different levels of the organization trying to understand better what do we do well and how do we do more of that. So these are all approaches that might have some value as an organizational change approach. We can also look to theory. So we've talked about job demands, resources model. It shows that there are many demands and many resources that could be important, but it doesn't really tell us which ones we need to focus on. And so looking to self-determination theory, I think that that could really help us focus. And so self-determination theory is really about human motivation and intrinsic motivation. And it's the idea that we are, as people, at our best or most engaged in what we're doing when we have a sense of autonomy, when we have a sense of belonging or connectedness, and when we have a sense of competence. So are we being appropriately challenged in what we're doing? And when we have all three of those, and all of us differ maybe in the level of autonomy or belongingness or competence that we want or need, but when those needs are met, that's when we are at our best. And so I think using self-determination theory could really help us focus on that. And so there's been some research looking at self-determination theory at work and showing that autonomy-supporting environments are very important. So when we have choices over how we work or when we work, if we have flexible work policies, and when we have input on decisions, all of those things can relate to less burnout and more engagement at work. And that input on decisions can reflect those multi-stakeholder groups that I talked about in those organizational interventions. That's when people are coming together and sharing ideas of how to overcome barriers at work or how to build on their successes. And so it does involve the input from a lot of people. Belonging. So we know from the literature that co-worker and supervisor support is really important. Feeling connected to the mission of the organization is really important, and feeling valued by the administration. And so all of those are aspects of belonging that we can think about. And the third area is competence. Are you feeling challenged the right amount? Are you working at the top of your license? And so a lot of times people are asked to do things that someone else could really be doing so that you could be working more for the role that you were hired to do. And so making sure that people are working at that right level of challenge. And do you have opportunities for professional development and growth? And that really falls in that competence area as well. So I'd like to have you think about, for ourselves, our teams, or our organization, what can we do to reduce demands? The demands that drain away from your sense of autonomy, your sense of belonging, and your competence. So you might think about what are some of those things for yourself, and then you can have these conversations with your teammates as well. But also, not just reducing demands, but increasing our resources so we can think about what things could we put in place that might help us have a greater sense of autonomy or control, have that sense of belonging and connectedness. And here, I do want to say, in COVID, that's been even more difficult because so many of us are on Zoom or on some kind of remote activity to make us connected. And so it's harder to have that. You can't have those informal conversations in the hallway anymore, chatting about something that happened over the weekend. So we have to work harder, I think, now. And then the last one is competence. What can we do to increase our resources that will help there? So as you think about some of these things, you might be bringing this back to your organization and having these conversations together. I did want to bring up an article that came out recently. Christine Senske in the American Medical Association identified organizational, evidence-based, and promising practices for improving clinician well-being. And the first one is really a sense of organizational commitment. So does your organization care about the well-being of their workers? And I'm sure that they do because they have to have the workers to continue the organization, right? But how is that expressed? Are they actually making a verbal commitment and following through? Have they identified a leadership group or a specific person who's going to be accountable for that well-being mission? So those are things at the organizational level that are really important to showing that commitment. The second thing they talk about as being really important is having some type of workforce assessment. What is the level of burnout? What are the stressors and strains of the people in your organization? And so really having a solid needs assessment, basically, of what is going on. I will say here, though, that people often talk about being asked about their burnout and their engagement so much that they're burned out on that. So you need to think about, if you're in a leadership role and want to do something like this, doing it in a way that doesn't add to the burden so that you can get the information but not continue to add to the extra demands on people. And the third domain is leadership. And this is really important at a number of different levels. So really thinking about accountability for well-being and this distributed leadership idea of having input from a variety of people so that sense of autonomy and feeling valued is your voice part of the organization if you can have any impact on the change or the direction of the organization. So sharing that is really helpful. And having some kind of balance between standardized workflow and a customized one. And so being more efficient but also allowing people the flexibility to do things that make sense for themselves as well. The fourth domain that they talk about are having policies in place that support well-being. And these policies really need to align well with the mission of the clinicians as well. And sometimes there is a mismatch between what is written in a policy and what we are here to do and why we became clinicians in the first place. And so organizations can really look at those policies and make sure that they are aligning with why we're doing this work. And the fifth domain they talk about is having an efficient work environment. So really looking at can we streamline our work more? Are there things that we can take away? A lot of times we add policies or add new things but we forget to look at, well, what can we stop doing? What can we take away? And so that domain is really important to think about. How do we do our work more efficiently? And the last one is really having support from our leaders, from each other, and trying to really focus on making a supportive workplace can be really helpful. Sometimes you need a cultural revolution, though. Sometimes in your organization you might not have the leadership in place that is driving these changes. And so what can you do about it? And I heard a great podcast. Adam Grant hosted Mae McDonald who does work looking at the connections of kind of social revolutions and then how could you do that within an organizational context? And she really talks about these kind of four bullet points that you could keep in mind that when you want to make a big change in your organization, you need to stand for something, not just against it, something. So not just that we're overworked and overwhelmed and we have too many service responsibilities and not enough time. What is it that you want? And being very direct and specific in your requests. She also recommends that when we make requests, we need to ground that request in a common identity. Tie it to the values that many of the people in your organization can relate to or get behind, even if they're not the ones directly affected. So trying to come together with other people in your organization and frame those requests in ways that other people will really support and understand. Finding allies and positions of power. So depending on where you are in the organization, are there leaders that might feel similarly to you or that might have a shared connection that could be an ally for you to help make this change in your organization? And then finally, they talk about building a coalition. So working with other colleagues, even just one other person can help you get started with this so that you don't feel like you're so alone. But she also recommends if feasible, you might connect with existing groups. Maybe there might be other groups in your community that are helping to do something similar. But having that coalition behind you could be helpful if you want to try to make a big change and you're not necessarily the boss, right? So there are still ways that we can try to make change in our organizations. And I wanted to put in a plug to stay tuned. SAMHSA is working on a resource guide that is focused specifically on organizational level strategies to help reduce burnout in the behavioral health workforce. And so that will be out later this year. And I know that they're really making some good progress on that. So before we go to more housekeeping things and the question and answer period, I wanted to pause and just have each of you think about what's one thing, one thing from today that you want to take back and try in your organization. And if you have a pen or you're at your computer, you might want to write that down and remind yourself that one thing that you might do to make a difference. And I have the references for you and those will be available on the slides. And there's a little bit more to do before we get to the Q&A, but I did want to put this up here. Please contact me if you have any questions, you want to get copies of the articles. I'm really here for you and I'm delighted to share any resources that you might need. So that's how you will get ahold of me. And I want to thank you for your time. And I think when I turn it over and I'll come back for the Q&A part. Wonderful. Thank you, Dr. Salyers for such a timely presentation. I know that it resonated with many of us today. Before we shift into Q&A, I want to take a moment to let our audience know that SMI Advisor is accessible from your mobile phone. Use the SMI Advisor app to access resources, education, upcoming events, complete mental health rating scales, and even submit questions directly to our team of SMI experts. You can download the app now at smiadvisor.org forward slash app. So let me just start by the easiest question, low-hanging fruit here. Can you tell us your email address again? Oh, yes. Should I go backwards? Sure, go back and just keep it up. I think that's fine. Yeah, I'll just keep it up there. So my last name is actually Salyers with the S, but for the email they chop the S right off at the end. So wait, we can't see your email. I don't think. Oh, it's not on the screen anymore. I'm on presenter Q&A. We'll get it up there for you folks. Can you just spell it out for us? Sure. M-P-S-A-L-Y-E-R at I-U-P-U-I dot E-D-U. I am sending it to all. All right. Great. Wonderful. So, you know, again, this talk was just, unfortunately, you know, for years now, we've known that we haven't had enough mental health providers, psychiatrists, psychologists, social workers, peer support specialists, etc. for the amount of need that we have in this country. And it's just been exacerbated during COVID where there are more people with need and we're all pretty burned out and really struggling. And so I really loved your idea of thinking of one thing that we could take home. And I wrote down about that podcast because I thought it was really good. You know, when you think about aligning your change that you want with the mission or value of the organization. You know, a lot of us, the mission or value of our organization is helping others, right? It's not about necessarily focusing on the workforce. And so why don't you talk for a minute about how you can word the value to leadership about how taking care of the workforce is actually taking care of our audience. Right. Well, one of the things that we talk about when we do the breathe intervention is that people often come to this work because they do wanna help other people and it feels at a personal level, maybe selfish or you feel guilty about taking time for yourself. But if we don't fill up our cups, you know, of our resources, we don't have enough to give to other people. And I, before COVID, I used to travel a lot and on the airplanes, they always would say, you have to put on your own mask in the event of an emergency, you put on your own oxygen mask before you help someone else. So reminding leadership that it is really critical that we are in a good place to be able to give to other people. I am actually in the middle of trying to do our own cultural revolution in my department. We've had a lot of faculty leave recently. So kind of like turnover or not having enough faculty to do all the work. And we're being asked to do more with less. And so at our next faculty meeting, I've asked the chair to let me have some time to do some small group conversations about this and to say, what do we need in order to fulfill our mission of teaching and research and to support our students the best? How do we do that? What can we take off our plates to really focus on that mission? And so far, at least he loved that idea. We'll see what happens. We're gonna meet next Friday and try to do these small group conversations. But I do think it has to be a cultural thing. It can't just be individuals making that change. There are a couple questions coming in around trainees, practicum students, residents, people who are new and therefore not prepared necessarily for the burden and the stress. Also who don't have a lot of autonomy, right? Somebody else is telling them what to do and really keeping a close eye on them. And the question is really twofold from these people. One, are we working with our graduate programs or medical schools to fold in more around burnout and self-care? And also as supervisors to new trainees, what can we do? Great questions. I think that it probably varies widely. I think with, for the first question that is, it varies widely what programs are doing to be more proactive. I think with COVID and the new public discourse about depression and anxiety and some of those issues around stress and seeing the healthcare burden that has come out of COVID, I think programs are going to be more proactive about that and in our own clinical training program, we're gonna have a workshop, for example, on self-care. That's a critical part of professional development and professionalism is how do you think about those things? And I have done workshops for graduate students and for them, I do talk about, there are times in your life when you're gonna be out of balance, like graduate school or medical school, residencies are a time of high stress. So you're not gonna have some kind of balance per se and you may not have much autonomy, but what are the other things you can do? What can you do to get enough supports in place to feel like you're competent enough that you're doing a good enough job? And I think that sort of ties into the second question about what can we do? And I think as supervisors, really addressing these topics with people and if they're not bringing it to you, being open to saying, how are things going? How are you managing this stress? You've got a lot on your plate and talking through it with them about how they might be able to manage those things. Let's talk for a minute, Michelle, because I was just attending a session yesterday with our EAP here at my office about what are some of the signs that we can see in our employees or our coworkers that should remind us to reach out? For example, yesterday they were saying, you're noticing a change in their attention to detail in the work or they're starting to show up two, three minutes late to every meeting or they're having more sick days than usual. So can you talk a little bit about some of the signs we should pay attention to in our colleagues and those that we supervise? Yeah, those are excellent examples that you've already given. We can think about when people are exhausted and overwhelmed, they're often more critical and short. They might be less responsive to requests. Some people may do more isolation. So you used to see them around a lot, but now they've got their door shut and they're not interacting with people so much. For each person, burnout or just chronic stress can affect us differently. But I think those are some of the key things that you might notice. I'm gonna switch gears for just a minute, but then I'm gonna go back to what we're talking about now. But let me switch for one minute to your research. Someone asked, what are the scales you used during your RCTs? What kind of scales did you use to measure burnout and those things? Yeah, so we usually use Maslach's burnout inventory, which has 22 items. There's another one, I think that has 15 items. I think in a research context, that's okay. But if you're wanting to do it from an organizational perspective, having shorter measures. So in the literature, some people have shown that just taking a couple of items from Maslach's scale could be helpful. And I know Tate Shanafelt and West, they have a specific item on burnout that's more like self-defined. That's one item, but four different or five different anchor points. And so feel free to email me and I can send you some of those documents or well, the Maslach scale you have to purchase, but I can send you references for those and some of the other items that we've used that are not proprietary. Yeah. One of the individuals wrote in and, this is not something that should surprise any of us. And they said, I find this information really useful, but unfortunately I had to leave my large multi-specialty hospital system because they didn't implement it. They talked about burnout, but they weren't actually listening to employees or physicians. And I noticed, for example, that one of the research studies that you did that was funded by PCORI, which of course we know insists that the work that you do includes consumers and includes the people who are. And so, I think this is often a stress at organizations where it can be very top-down. We hear that you're burned out. Here are the ideas that we're gonna implement. And it's like, that's just left of actually what we need. Thank you very much. So, can you talk a little bit about how you, I mean, and maybe we go back to these four ideas about building the coalition, getting a powerful ally, et cetera. How do we get communication two-directional, bi-directional with leadership and line staff? Right. I think the, if you're not a leader yourself and want to affect that change, I would look to that building a coalition idea. We did do a study where we did appreciative inquiry, an appreciative inquiry approach with an organization that involved interviewing different staff about when they were at their best in this organization. And we came up with some themes. And then we had work groups that had senior leaders and a couple of team leaders and a couple of case managers, receptionist, like different levels in these work groups. And they spent some time getting to know each other and coming up with some ideas for how we could do build on those. And that sense of building relationships so that the top level people understand more what other people are experiencing and the case managers understand some of the stressors at the top level as well. Sometimes there is a mismatch in those perceptions. And I think by building some of those more informal relationships and having opportunities to learn from each other can be very helpful. And if there are ways to encourage, like I think it's reverse mentoring, sometimes people call it, or walk a mile in my shoes kind of things or the undercover boss. But can leadership come and hang out with your team? Can they go and see what a day-to-day life is like for you or for your team members and trying to facilitate those experiences can be helpful. So a couple people have written in either in the positive or the negative ways that their organization has addressed this. So for example, someone suggested, it's really helpful if we have criteria about sort of the fences of our program, what we accept and what we don't accept. That's like really helpful because that can really sort of be clear what our mission is. Another person said, valuing education and self-improvement, giving us time to take CEs like this or other ones are really helpful. Another person wrote in and said, they're the head of a clinical program manager, they've developed a wellness committee. And we know that, for example, wellness committees, it's really important to have these out of our reporting lines. For example, I don't wanna be in a committee with my boss and saying I'm really burned out and I'm not being listened to and it's horrible because then I'm worried about my next performance evaluation. So I think, would you wanna talk a little bit about how to develop sort of this wellness culture that's also not where we can be open and it's a safe place, but not evaluated on it for our performance. Can you talk a little bit about that? Yeah, I wish I had the magic bullet for that because I think that is critical. When we've done workshops in the past, we've tried to have separate workshops for supervisors so that people could feel more free to talk about their level of stress. So I think having some separate groups like the valiant groups that I'm not sure who is doing them now where people can talk about cases together and maybe you do that some within your levels, like supervisors meeting together. But I think you also have to have some of that cross collaboration or cross conversations too. And it is hard to develop a safe space. I think a lot of that comes from developing relationships with people and understanding who they are. In the appreciative inquiry approach really does that well. So even small things, and this is something I do with all of my classes or meetings that I run. We start by sharing some personal thing maybe something you're looking forward to this weekend or your favorite thing to do, some little sharing like that. So you get to know people and then you start to feel more comfortable talking with them and in front of them. You can have more difficult or challenging conversations when you feel like this person is another person who has similar interests or similar concerns. And so I think that can be helpful as well. Can you talk a little bit about the importance of sleep? I think a couple of people have written in that they work for example, emergency mental health services, or they work on the weekend at their clinic and they sort of don't have that rhythm sleep. And can you talk a little bit about how important that is? Yeah, that is critical. And there have been a lot more studies on linking sleep with wellbeing. So. I feel like there were some studies talking about a link even between people who did not sleep well at night or were an obesity and heart disease and things like this. I mean, it can be both physical and emotionally damaging. Yeah, it really can. And as a psychologist, we know about these things, but it took on a new personal understanding when I had my first child and never slept through the night for almost four years, I think it was. And then you can just see how that affects your ability to respond to stressful situations and things. And so I don't have the fix for it. I know that there are a lot of even sleep apps and self-help kind of apps around getting a consistent schedule set up, making your environment so that it's cool. You wanna be at like 68 degrees, I think, when you sleep. Having a cool environment, but maybe a weighted blanket, that's also very helpful for people. So making sure you have the environment set up to support it. But yes, sleep is definitely critical. So someone wrote, it might seem obvious, but have there been studies on reduced work week or differential schedules having an effect on burnout? I mean, I think to some degree, I'm not sure if there's, I mean, you would think nursing would have done studies on this because they do a lot of different schedules. But I do think even the ability to have some control over your schedule can help with burnout. Yes. I don't know about the like four-day work weeks versus five. I'm not sure about the research on that. I'm happy to look into that. I know when they reduced the duty hours for residents, that had an impact on reducing burnout, some of those studies, I think. But I don't know about those things. I do know that having more autonomy and being able to have more flexibility is related to less burnout though. Well, Michelle, it has been a pure pleasure for me to talk with you this morning. Known you for many years and have followed your work and I'm a real fan. And so I appreciate the fact that you're stepping into an area that we're all desperate for some answers in and that is sort of our mental health wellbeing and burnout. So thank you again for joining us today. To our audience, if you have any follow-up questions about this or any topic related to evidence-based care for SMI, our clinical experts are now available for online consultations. Any mental health clinicians can submit a question and receive a response from one of our SMI experts. Consultations are free and confidential. SMI Advisor is just one of many SAMHSA initiatives that are designed to help clinicians implement evidence-based care. We'd encourage you to explore the resources available on the mental health, the addiction and the prevention TTCs, as well as the National Center of Excellence on Eating Disorders and the Suicide Prevention Resource Center. All of these initiatives cover a broad range of topics from school-based mental health through opioid epidemic and they are there as a resource for you. To claim credit for participating in today's webinar, you'll need to have met the requisite attendance threshold for your profession. Verification of attendance may take up to five minutes and you'll then be able to select next to advance and complete the program evaluation before claiming your credit. And lastly, I'd like to invite you to join us next week on March 3rd, 2022, as Dr. Leon Rabin presents Worth a Shot? Evidence-Based Approaches to Prescribing LAI Antipsychotic Medications. Again, this free webinar will be March 3rd, 2022 from 3 to 4 p.m. Eastern time. Michelle, our audience, thank you everybody for joining us today and until next time, take care.

burnout

well-being

mental health providers

evidence-based strategies

organizational interventions

supportive workplace culture

self-determination theory

job demands and resources model

clinical support system

Q&A session