How to Design and Implement a Mental Health Collaborative with Adrienne Heinz, PhD
"We have to go beyond education, we need mental health action!" -Adrienne Heinz, PhD
SERIES: Role of the Mental Health Care Leaders
What's more terrifying and costly than cancer? Untreated mental health issues. Mental health is a huge part of recovery after a disaster. This week, Jennifer interviews Dr. Adrienne Heinz for an in-depth discussion about mental health. Dr. Heinz talks about the mindsets most people have about mental health, why it is important to address trauma as a community and as helpers, and how to overcome crisis fatigue. She also shares helpful apps and exercises to help you slow down, de-stress, and fight off anxiety. Join the conversation, recover from the inside, and reimagine a new tomorrow!
- 05:17: The Struggle with Collective Trauma
- 11:55: The Digital Aspect of Mental Health Intervention
- 19:19: The Stages of Grief
- 25:13: The Present and Future of Apps
- 29:33: The Value of Mental Health
- 35:26: Overcome Crisis Fatigue
- 38:38: Stimulate Your Vagus Nerve
- 41:25: Breathing Exercise
Get the Sonoma Rises App
Get the COVID Coach App
08:07: "We have to go beyond education, we need mental health action!" -Adrienne Heinz, Ph.D.
20:18: "If you don't provide channels to address the pain and acknowledge and validate folks experiences, then you pay for it another way." -Adrienne Heinz, Ph.D.
31:38: "Because we are the helpers, we're very ill-equipped but not in tune with our own needs because we're so outward-facing. The burnout level is absolutely unreal." -Adrienne Heinz, Ph.D.
33:56: "There is a price that's paid and you have to make sure that you are replenishing that account." -Jennifer Thompson
34:28: "You can be a more powerful leader when you demonstrate vulnerability and show where you're hurting and where your heart is." -Adrienne Heinz, Ph.D.
35:42: "The urge to help is a marathon, not a sprint." -Adrienne Heinz, Ph.D.
37:10: "There are a lot of ways to scale and address the need, it's a matter of not having to start from scratch, having reserves ready to go so that you can start implementing." -Adrienne Heinz, Ph.D.
In addition to her private practice, Dr. Heinz is a research scientist at the National Center for Posttraumatic Stress Disorder at the Palo Alto VA Health Care System and Stanford University School of Medicine. Within this organization, she conducts research trials to improve treatments for PTSD, disaster, and addiction, develops mobile mental health apps, and facilitates the implementation of mobile health technology into VA care nationwide. Dr. Heinz also works as a consultant advising on mental health strategy in the workplace. She currently serves as Vice President of the Redwood Psychological Association and is striving to increase awareness of the intersection of climate change and mental health in California.
Jennifer Gray Thompson: Welcome to another episode of How To Disaster, a podcast to help you recover, rebuild and reimagine. One of the most important things that community can address post disaster is around mental health. The trauma that comes with undergoing a major disaster is really something so profound. There are people who specialize in this in particular. One of the biggest questions that we get from the public, private nonprofit sector is, what can we do to help our community recover their insides and reimagine a new tomorrow? We know that the stages of grief and disaster are much like the stages after a death because you can't actually go back to the day before. So we've invited an expert in this area, Dr. Adrienne Heinz on with us today. Dr. Heinz designed and did the implementation with Debbie Mason, and in our area post 2017, designed a wildfire mental health collaborative. And the genius of it was they were able to intersect technology with modern understanding in science around trauma and mental health care. And at the same time, make sure that every person in our 500,000 person County was eligible for some kind of very well designed and very accessible treatment around traumatic mental health care related to a disaster. I'm very pleased to have Adrian with us today, and welcome.
I'm so pleased to welcome Dr. Heinz to the podcast today. I just want you to introduce yourself and talk a little bit about your specialty, and how it relates to our subject here, which is How To Disaster.
Dr. Adrienne Heinz: Well, thanks so much, Jennifer, for having me. This is certainly a cause that is near and dear to my heart. I am a clinical and research psychologist, and I am based at the VA National Center for PTSD and Stanford University. I specialize in the treatment of trauma, and specifically with creating digital interventions such as mobile apps to help reach people in places where they normally might not access help or services. And in terms of why this is so exciting for me is, I was kind of a resident of Healdsburg. We were in San Francisco. We had been on the fourth floor, walking up to kids, no elevator. And we just thought, what a lifestyle change we need. So we really overhauled our thinking about what our values were. And we moved to Sonoma, where it's just this lovely community where you know your neighbors, and you say hello to people on the street and to become part of that and so welcomed into it. And then to have these collective fire events happen, really shaped my trajectory. So I then became involved in the intersection of climate change and mental health.
Jennifer Gray Thompson: So one of the first things that happens when we enter into a community that they want to talk about is the collective trauma, the mental health challenges after a wildfire. And one of the things I wanted to talk to you about was, we've talked about wildfires for decades. But these fires that we're experiencing are mega fires, they're not your traditional calm, mild or wildfire. And that really, I think, plays into the resulting trauma. It feels like a fire monster behind you. So you experienced that in 2017, and you sort of saw your new community while we all came together, and it was an incredible human experience. We were also left traumatized, and then you worked with the northern Sonoma County Health Care Foundation, whose [inaudible] at the time was a Debbie Mason. We've also had on the podcast, I love Debbie, and she design, really use technology to design an app and at the same time, train hundreds and hundreds of people in trauma informed care. So I'm hoping you can talk about that moment when you all of a sudden saw the impact of this mega fire event where 6,000 homes were burned in one night and go from there in the development.
Dr. Adrienne Heinz: You're so spot on that. This feels qualitatively so different from other types of disasters. I grew up in North Carolina. We have hurricanes, you get more of a heads up. They are kind of a discrete event, they come and they go. This one felt imminently threatening, not just that terrible night, but for weeks. And that triggers the reminders, the air quality, the displacement, all of that was so evident and acute for weeks thereafter. It just wasn't like the threat was not gone. So our nervous system stayed on high alert for quite a bit.
Jennifer Gray Thompson: 24 days.
Dr. Adrienne Heinz: Yeah.
Jennifer Gray Thompson: It felt like 24 years.
Dr. Adrienne Heinz: Yeah. Debbie, she is just this incredible visionary. She had done a lot of hurricane relief work in Florida and recognized these disasters. They destroy homes, they destroy places of work, and worship, so forth. But really, there's a ripple effect upwards of a decade on the mental health effects that come with disaster. And getting ahead of that, and recognizing we need an ecosystem of mental health support and services to foster resilience. I think we're just starting to learn that it's more than just physically recovering. There's an emotional and spiritual piece to it as well.
Jennifer Gray Thompson: Well, in working with Debbie there, you designed a system in which I was so impressed by it. Even at the time, I remember thinking, well, I'm a helper so I'm not going to jump in line for any help at all, which is not the right way to go, by the way. But I knew that if I wanted help, that there was an avenue for me to get it simply by virtue of having lived here and experienced. You weren't saying we're going to mean test you, you didn't like cut out a swath and only decide to entreat that side of our mental health. But instead, you guys looked at the whole community. And there was yoga classes, there were people who could do group therapy and there was also the app for every student. So can you talk about like, but how do you sit in front of a community and really serve the people in front of you like that's a talent that is a lot of people actually don't have and don't even know that they don't have it.
"We have to go beyond education, we need mental health action!" -Adrienne Heinz, Ph.D.
Dr. Adrienne Heinz: Exactly. That's why we kind of targeted the whole community, or really anybody that felt impacted by the wildfires, because we have a long way to go. And we're getting there by educating folks about the mental health effects that you might expect, one week out, one month out, one year out. And now we're four years out and getting more different types of reactions when we smell smoke versus the 2017. And just recognizing that we have to not only go beyond education, need mental health action. And so we have to make it incredibly easy for completely overwhelmed folks who have a lot of competing priorities and not a lot of time to access services and to educate them about, well, here's some signs that you might benefit from taking some time for self care with this mobile app called Sonoma Rises, or creating a community that looks at the mind, body connection with trauma informed yoga. We're even going to see your health care professional who's trained in trauma informed psychotherapy practices to get you back on track.
Jennifer Gray Thompson: And inserted like it was like having an emergency room for mental health care on a community wide level. So can you talk about the difference between how you would design, how something is designed for more immediate emergency mental health especially in those first 12 to 24 months?
Dr. Adrienne Heinz: Well, so FEMA, which most people are familiar with, comes in and offers psychological first aid. And then there's local programs who've done a beautiful job of meeting people where they're literally going to their home to offer these acute services. They're not therapy, they're kind of more problem solving connecting folks to different resources and services. So it's not really processing what happened in the acute stages. And so what we were trying to address is what happened six months later when your adrenaline is just kind of faded and you're getting in fights with your spouse, you're not sleeping, you might be drinking more to cope, you're more irritable around your kids, you can't focus at work. What do when that stuff starts to sneak up, and how do we not only educate people about the signs of trauma, but give them something they can access and offer different approaches. One size does not fit all if we wanted to offer step levels of care.
Jennifer Gray Thompson: And that was a creative approach actually, but it was scientifically based, and it was really designed for here. But other communities can take lessons from that. We've certainly done the CDC calls. What I'm hoping is a mental health care toolkit, essentially, that we can offer to communities or an app. You and I talked about this that can be supported for the long term as we are pivoting to an organization that will serve 11 states, mostly rural areas. One of our main concerns is, how do you make sure that everybody gets equal access to the care that they need and may not even know that they need until six months later when everybody else has faded. The drama is in the background and you're really starting to understand the reality of how difficult that recovery is going to be, and that your mental health actually has to be part of that equation. Anyway, I love the notion of tech. We do this podcast because my dream is there'll be somebody like in some corner of a totally rural state, and they will have just gone through a disaster and they'll be like, oh, man, I don't know how to do that. But I can take this one piece at a time as one podcast based upon the subject. And I'll take on what I can, and then I might come back four months later and look at another one. So we have no expectations that this is going to blow up or go viral. But we're really just hoping to use technology to help the community that we may never even meet or know. So can you talk about, really it's a passion in a very smart one about how to use technology in a way that can actually democratize care, especially post disaster.
Dr. Adrienne Heinz: Beautiful question, and it's one that excites me a great deal. I think democratises is just a great word to sum up what can be achieved at scale with digital mental health interventions. So they knock down all the traditional barriers, geography for someone who lives in a rural location, competing time priorities. If you're a caregiver or a parent and you just can't get to appointments, if you have trouble accessing it because of cost, these are more affordable solutions for individuals. I get excited for them especially as we're kind of entering in the later chapters of COVID in the United States. We've seen the transformation and how acceptable these digital health solutions have become, and how desirable they are when we know we're all stuck at home. And did -- to connect with, that can be an opportunity for just kind of reaching folks where they are 24/7 from their couch and making it easier to say yes to accepting help.
Jennifer Gray Thompson: I like it because it meets people where they're at, which is really hard, which is like it's the most basic tenant for us doing disaster work is we don't figure out what we can do to you, we figure out what we can do for you. And we do that by asking, what do you need? How can we help? I know that it is the number one question that I get asked though is, how do we provide mental health care, especially because the communities that we serve, especially in these first six months, I am glad that there's less of a stigma attached to it. I mean, can you comment on that? Do you feel like there's a wave of greater acceptance coming especially because of COVID? And how did you take the system that you created and adapted into something that could serve COVID? During COVID.
Dr. Adrienne Heinz: That's a fun origin story. And by the way, we have taken a lot of these learnings and descriptions of our failures and our small wins. We have published, this in an upcoming article in psychological services, which is a journal of the American Psychological Association. I'm happy to share that link with you because you've no need to reinvent the wheel have all of our given--
Jennifer Gray Thompson: That's the whole thing. You can absolutely tell the mistakes, we are not, this isn't like experts in disaster with Jennifer Gray Johnson. There's a reason why the grammar isn't even really correct because we have to be human forward all the time, which is we welcome your mistakes.
Dr. Adrienne Heinz: Yes, yeah. So the humanity of it. So really, how this got cooked up was after the 2017 fires, and Debbie Mason called me and said: "Adrienne, we've got to do something. I know that you have a full time job and two kids. You're barely hanging on, you just got evacuated. Let's just imagine what we could do for the community. If we want to see it, return to a place where it can be find well being and thrive." And so with that in mind, I reached out to colleagues at the National Center for PTSD where I am at Stanford and said: "Hey, I've got a big need, who wants to help?" And there were a team of incredible psychologists who said: "I'm going to roll up my sleeves." We're going to build a global Mental Health app that's free, available in English and Spanish. And it's based in evidence, science based practices for how you work with someone in crisis and through disaster. And through that, we have developed summaries, and then we've since researched it with adolescents who lost their home and suffered damage to their school and found some really great signals that it was acceptable. And they've even recommended to a friend, which is a big deal with teens. We specialize in mobile mental health apps.
So when COVID hit, the same team said: "You know what? We can apply a lot of this thinking and framing to addressing COVID on a national and even global level." And so we developed COVID Coach, which provides tools to help people manage stress, education about what to expect, and how to parent during times of crisis, or to at least survive it and access to resources like food banks and medical care, getting people what they need. And then a self assessment where folks can assess depression, anxiety, PTSD, well being and just track their progress over time and see if there's a signal for meeting a higher level of care.
Jennifer Gray Thompson: Can you talk about COVID Coach and what you've done there? Let our listeners know where they might be able to find it, especially because a lot of our listeners are going to be people who are, they have like comorbidities of a wildfire disaster. And COVID at the same time, the COVID app might be able to help them actually through both of those dual traumas.
Dr. Adrienne Heinz: Exactly, yeah. So COVID Coach was kind of an idea that stems when folks are in crisis. They don't have a lot of bandwidth to seek out help and additional services, they kind of need something at their fingertips that they can access readily. So it is available in the Apple Store or on Google Play in both English and Spanish. It's designed to help people manage stress with tools that are based in science or getting through a crisis. Also whether disaster, it has access to resources like food banks or guidelines from the CDC where there's consistent information. So helping people meet their needs with a resource section. And then there's, of course, the assessments where folks can assess themselves for PTSD, depression, anxiety and well being, and determine that, hey, I'm noticing that I'm not really, this is kind of languishing over time, and maybe I would benefit from a higher level of care. And then finally, just a lot of education on what to expect in times of crisis, and how to be gentle with ourselves so that we can navigate a sea of massive uncertainty, the intersection of a global pandemic and a natural disaster.
Jennifer Gray Thompson: And it's really worth, what most counties don't know or states don't know is you have to actually request the funding from FEMA for these programs. So please, if you're in another state, go through your public sector, call your state senator or your Congress person at the federal level is actually asked to access these funds because a lot of communities will look. There'll be like, we already lost so much money on this disaster that we actually can't afford to provide this mental health care. But there are avenues that you have federal funding will come in and actually help for at least a couple of years to do this kind of work. I just have to note that if it gets called the hope grant? Is that correct, I think that's correct. Anyway, do ask for what you need. So what's the risk of not attending to mental health in a disaster community? Like what's the risk of just absorbing trauma and trying to just move on with your life?
"If you don't provide channels to address the pain and acknowledge and validate folks experiences, then you pay for it another way." -Adrienne Heinz, Ph.D.
Dr. Adrienne Heinz: So yeah, what's the economic case potentially for attending to wellbeing. Well, what we know from the World Health Organization is that depression is the global leading cause of disability. Anxiety is number six or eight. So that means it's beating out diabetes, cancer, chronic pain, and that the cost to our society for untreated mental health conditions is tremendous. Not only for the economic consequences. People not showing up to work are able to participate in the workforce, but also our well being as a nation. So when you don't address trauma in a community, it tends to manifest in other ways. You see more community violence, intimate partner violence, you see kids who are not thriving academically, you see more physical health conditions. And of course, substance use disorders. It has to go somewhere. So if you don't provide channels to address the pain, acknowledge and validate folks' experiences, then you pay for it another way.
Jennifer Gray Thompson: I think you actually end up nursing it in a way that you didn't intend to, which is why you see so many people who are incarcerated, have a long history of trauma. So we often think of people who are incarcerated as people who have inflicted trauma on others, which is often true, but there is a cycle of trauma, and it's traumatized for the hurt people, hurt others. When a community goes through a collective trauma, it is terrible, but it's also an opportunity. So can you talk about the dynamics of community trauma? And have you been able to track the stages of it, like the stages of grief?
Dr. Adrienne Heinz: Yeah, no, I think so. You were speaking about this notion of adverse childhood experiences, which are things like, during a natural disaster, having a parent who has severe mental illness or not, or having food and security, all of those events accumulate to affect the trajectory of our lifespan and how we function as adults. So we're seeing that by investing in systems that care for people holistically, not just their physical health that you get better outcomes. You look at models, I mean, just naturalistically, like after 9/11, or after Hurricane Katrina where some people received care and services and others didn't. You can see that there's more resilience among folks who felt like they had access to support and social support. That really matters for having a resilient response. You need protective buffers, resilience doesn't lie in just the individual, but also in systems. So in our schools, in our places of worship, in our governments and even culturally at a national global level.
Jennifer Gray Thompson: We use the words resilience a lot, sustainability and equity too. But I always like to talk about, how do you do resilience? How do you do equity? How do you do sustainability? I think you're bringing up an important point, you can actually sustain, you can recover and rebuild. You can do all of those things. But unless you attend to the entire ecosystem of, we call it the ecosystem of care. What we do is we bring people from our community that have had these experiences and set up systems like you, and we introduce them to newly disaster affected communities. I just listened to your interview with Pat Kerrigan, one of the things that you were talking about was, how it can feel when somebody who's been through the same trauma is sitting in front of you, and the amount of relief that can bring. Can you talk about that dynamic?
Dr. Adrienne Heinz: Exactly. That collective understanding and processing of a shared experience, we're neurologically and biologically wired for connection. That's how we survived, came out of caves and off the savannas. Yeah, that's exactly how we heal. So communities do that through art, music, storytelling. And unfortunately, with COVID, so much of that collective healing has been halted because we can't gather. There's opportunities digitally, and we're improving those user experiences. But yeah, having a narrative that everyone shares about adversity and do during it, and then I don't even have to say prevailing. Just saying that, hey, we went through a really hard thing, and we got through it.
Jennifer Gray Thompson: I think there was also--
Dr. Adrienne Heinz: It really matters. Yeah.
Jennifer Gray Thompson: I'm sorry about that, I may interrupt you. I found that my life completely changed because of the fire. I didn't lose my home. But I will say that I like doing this work because I'm always trying to tap back into that time during the fires. And it was also terrible. But people were so amazing. People were admirable, and some weren't. And they're on my list, don't get me wrong. I'm not a [inaudible] about it. But it is that A Paradise Built In Hell thing that Rebecca Solnit wrote about in her book. That in times of great struggle and how we can actually turn towards each other, and COVID was weird because it sort of prohibited all of our previous coping skills. How did you build that into that version of it using technology of your app, knowing that we could also couldn't hug or congregate.
Dr. Adrienne Heinz: It was really tough to build that function in. How do you create a shared experience with a user that's solo on their app? And I think a new part of apps and digital communities will involve a feature that allows folks to safely communicate about their shared experience and to use platforms for, if I'm displaced in a hotel room while my community is burning, can I connect with others? You see that on Facebook pages, but I think there's more healing spaces where we can start to have conversations for folks who can't gather. I think COVID has taught us a lot about the ways we can connect when we are displaced in a disaster, for example. Some learning opportunities there.
Jennifer Gray Thompson: I want to talk to you about virtual reality. And if you are looking at that area or not, because Facebook owns Oculus. I got one for my birthday this year because I wanted to go places, and I couldn't go anywhere because COVID. And I have found though it to be an incredibly healing, oddly satisfying, soothing experience to go into my virtual reality headsets. I don't socialize on it. But for many people though, that might be what we do because you can play games. I do an exercise workout called Supernatural. It lands me in places that are beautiful all over the world with music. And what I'm amazed by is how it helps the trauma. We really had triple traumas last year. We had the wildfire season, we had a very strange, political, national, all that nonsense. And then at the same time of COVID, politics, wildfire, so what do you think about, are you interested in that space? You venturing into there? Are you already there? The space of VR.
Dr. Adrienne Heinz: I think it's really interesting. There are some startups that have pursued it, like Lindex, for example, create like social anxiety exposures within virtual reality. There's other use cases when people are hospitalized and in pain, or they're about to have surgical procedures, they use VR to, and other mindfulness techniques to calm their nervous system response and to prepare for a medical procedure. So I think it's exciting. I'm not personally in that space, but I would also like to go places. Oh, sorry. I think there's just more of a trend for virtual communities. For example, there's startups that bring groups together with licensed facilitators. For example, I have led one through a company called Paste. It was for individuals going through a divorce during COVID. And the racial reckoning, the political fallout, and the wildfires, and just having communities that are, so that folks are appropriate for groups and together, but I think the virtual pieces are really interesting. I know that we can up level these user experiences and iterate upon them with time. So we'll see where it goes.
Jennifer Gray Thompson: Well, I would love for love to talk to you more about that because I know that it's not like you want to re-experience a disaster through VR, because that would probably be very upsetting, or I would want to be able to thank you. But the idea that can actually apply that the guy who created the workout game, it's like a workout game that I use called a VR headsets, their empathy machines. Because you can also like travel while black, or you can be in a car, you can actually dig, sit at the table with [inaudible], his mother, and listen to her. And it's weird for such a thing that is not reality, the way that sets you right down though into somebody else's reality. So we can table that for another day, but I'm excited about that area. Talk to us about what you learned since 2017 that surprised you the most around community trauma. And then we want to get into some advice for other communities that have nothing in place, whatsoever for their mental health needs. But what's been the biggest surprise that you've learned in the last three and a half years?
Dr. Adrienne Heinz: There's been many. I think for me it is the mental health professional who's clearly biased, and thinking that mental health is important to nurture, kind of how do you reach people to help them understand the value and importance of mental health. And to not only understand it, but to act upon it. It's often de-prioritized because there's other things on the hierarchy of needs, and all that to say. I thought we would have a lot more engagement with our ecosystem than we did. And I don't think it's because of the lack of need, but of people having mindsets like, oh, well, someone else probably had a harder time with it. And so they should use that resource, not me. Or I'm functioning, I haven't lost my job, or I'm not getting a divorce. I'm limping along, but I'm hanging in there. I don't think I can help. I think if you create these, you have to figure out how people will come. And that's been a big learning of mine.
Jennifer Gray Thompson: And that's where the apps will come in. I mean, I downloaded it, I really looked at it, I did a couple of self assessments. But like a lot of people who were in the helping space, I did not seek any help until my blood pressure was high. I gained weight, and then I had to go see a trauma therapist, and then I had to learn how to breathe. And Susan-Farren of First Responders Resiliency, she had to give me a talking about how toxic it is for people who are in a helping position to actually not access the help that they need in order to sustain the help that is offered. So what do you do, if I can ask, for your own self as a leader in this field though, to help yourself during these cumulative and multiple traumas we've had since 2017?
"Because we are the helpers, we're very ill-equipped but not in tune with our own needs because we're so outward-facing. The burnout level is absolutely unreal." -Adrienne Heinz, Ph.D.
Dr. Adrienne Heinz: Well, I wish I could say I was this paragon of self care, but I have not. I feel like because we are the helpers we're very, not ill equipped, but not in tune necessarily with their own needs. Because we're so outward facing for our clients, for our community, for the folks that we work with, our colleagues, and the burnout level is absolutely unreal. I mean, imagine being a psychotherapist, for example, in this unrelenting year where you are, for the first time maybe going through everything that your patients are going through, but you're still sitting there holding space for all that emotion, and having to compartmentalize your emotion. And not to say that you're acting like a robot or not showing your humanity, but your job is to show up for someone else, not yourself. And so that's a huge challenge. This year just been like, I've really grappled with that. I think I'm going to treat spending time in nature. Like, well, these redwoods, I've seen war and peace, and disease, and famine, and innovation and longevity. Something about the nature connection has been very grounding for me this year.
"There is a price that's paid and you have to make sure that you are replenishing that account." -Jennifer Thompson
Jennifer Gray Thompson: You do live in a beautiful place because you have a river, and you have redwoods, the opportunities to do that. That's certainly been hiking has been a huge solace for me. But also, my husband has a lot of opinions when I don't take care of myself. I imagine that yours is the same. Is he ever like, okay, stop. They noticed that it can be hard to listen to them. I just think it's important to have the contrary, to have the conversation a lot with helpers and leaders about how it's hard for us to be vulnerable in the way we're leaving so much space for other people to meet them exactly where they're at. And what I'm learning is when I come off a trip into fire affected zones for 10 days. I come back, I actually need like four days where I'm not doing any work because I have to offload it. You can't go to these communities and just stand there and just cry all over, they're looking for you for like some way through. But you also want to be honest that there is a price that's paid, and you have to make sure that you are replenishing that account. I hope you're doing that for yourself.
"You can be a more powerful leader when you demonstrate vulnerability and show where you're hurting and where your heart is." -Adrienne Heinz, Ph.D.
Dr. Adrienne Heinz: Well, thank you. I'm so glad that you're raising awareness of helpers needing help. Because usually, you're right. Their partners or their kids who are being like, hey, oh, you're super irritable, or you don't talk at dinner anymore. You're not participating. Your body's here, but your head is not. I think recognizing that you don't need to be this stoic figure. And in fact, you can be a more powerful leader when you demonstrate vulnerability and show where you're hurting and where your heart is. You don't need to spill your guts, but to show part of your humanity is really powerful.
Jennifer Gray Thompson: Yeah. And then just share your mechanisms with other people to say, take those days off, or listen to your spouse or your partner if they're telling you that, and granted, you're only going to listen like a third of the time, let's be honest. But that third of the time can be what actually gets to the space and time that you need. I wanted to, the podcast is called How To Disaster. I wanted to see if you could kind of say that if you were speaking to somebody who is a mental healthcare professional or a public sector person, and your community has just undergone a disaster, what are your first steps? What should you expect over the next year?
"The urge to help is a marathon, not a sprint." -Adrienne Heinz, Ph.D.
Dr. Adrienne Heinz: Yeah, that's an important question, a tall order. I think we're starting because of people like you and your organization, Jennifer. We're getting a better understanding where we're seeing more models for how to do this. We're not just reinventing the wheel, there are examples of things that land and resonate very well, and things that don't have as much uptake. So I think recognizing the urge to help is going to be feeling very urgent. But it's more of a marathon, not a sprint. I remember in 2017, what can I do? Who can I donate clothes to? And then now that we're three fires later, some of us are really enduring some crisis fatigue where there's been such an accumulation of trauma burden that we're not sure how to respond. And it's just exhausting.
"There are a lot of ways to scale and address the need, it's a matter of not having to start from scratch, having reserves ready to go so that you can start implementing." -Adrienne Heinz, Ph.D.
So thinking about developing consultation groups to support you emotionally as you do the work in a place where you can be vulnerable and open up about your needs, struggles and stuck points. And then FEMA does a great job of getting in there and offering folks the resources. And then Project HOPE comes and does some of the acute care. But thinking about how you scaffold around those responses to create the ecosystem of care? Is that virtual digital support groups where people don't have to come to a physical location to access. It's mobile apps that are self guided and self help. A mind, body experience that involves forest bathing, or yoga, or mindfulness meditation groups. Or offering individual therapy. There are a lot of ways to scale and address the need. It's a matter of not having to start from scratch and having to fundraise after in the wake of a disaster to do that. Having reserves ready to go so that you can start implementing.
Jennifer Gray Thompson: It's very good advice. So we're about to do a whole big mapping of the American West of all, it's going to take about a year to do that. We'll provide resources so that if you're in Montana, but you want to know what we did in this area, you'll be able to like go and and link to a news story. And then maybe to your homepage to give people some avenue towards moving away from reinventing the wheel, because that was very painful for here, for us. Even though a lot of people showed up to help, they kind of rush in and then rush out just as quickly, and doing long term care, and understanding that you do have to provide some sort of care for your community in years, two, three and four, and it goes on. I really just appreciate that beyond. One thing, I actually just remembered, I would like you to talk about is a lot of people, what helps me was when I learned about the role of the vagus nerve, can you talk about that with fight or flight, or when you're in that heightened awareness, and what that does to your body? And then a couple of techniques that people can use in order to relax the vagus nerve, because for some reason, that science behind that helped me a lot.
Dr. Adrienne Heinz: Yes. Well, I'm so glad you want to nerd out on neurobiology. It's so powerful to even have just a basic understanding of it because it offers us control, and mechanisms for turning the volume up or turning it down. We're not just a victim to our environment and our circumstances necessarily. So when you're talking about the sympathetic nervous system, this is fight or flight. I'm on the Savanna, I'm gonna get eaten by a lion, I have to run. There's fight, flight, freeze. Some even say that there's the fourth response, which is appease, and those can do missions have like a cascade of cognitive effects where it's kind of all gasp, just go, go, go. But our front, our prefrontal cortex, it's like this conductor for an orchestra of all these cognitive functions, decision making, judgment, inhibition, planning, creative thinking out of the box. All that turns off when we're activated. Our ability to really slow down and evaluate our options, it's really limited. So when we want to activate our parasympathetic nervous system and calm down, slow down our breathing, our heart rate, lower our galvanic skin response, then there's a few techniques that we can use. I'm an evangelist of frozen peas. I think you've heard me talk about this before, but it elicits the mammalian dive response, which is we're mammals, we're not penguins. But when we dive into cold water, our nervous system slows down our breathing and our blood flow. So you can emulate this through taking a cold shower. But if you want to cook peas, frozen peas are your friend.
Jennifer Gray Thompson: Okay. But really, that's always because people are gonna ask, where do you put the peas?
Dr. Adrienne Heinz: You gotta get a Yeti. And then you take it in the field with--
Jennifer Gray Thompson: You know what I mean? Do you put them on your head? Do you put it on your neck? Do you put them under your armpit? Where are they? I know this sounds silly, but we try to be as direct as possible. What's the best place to put frozen peas on yourself if you are having anxiety? Or you feel like you need to, you want to switch out into your parasympathetic state? Where do you put it?
Dr. Adrienne Heinz: Thank you for clarifying. It is on your face. Anything on your face, on your head. That is where you want it.
Jennifer Gray Thompson: Okay. And then can you talk about the role of breathing? Because I didn't even realize that I don't think I took a deep breath for two years.
Dr. Adrienne Heinz: So when our sympathetic nervous systems are revved up and the dials like crank to 10, our breathing becomes very shallow. And like our posture is a little hunched, or jaw clenched. Our body just holds the stress and the tension. And our breath is awesome because it's free, and it's always available to us. It's incredibly powerful in having like an instant effect. The Navy Seals use a technique called box breathing, and also first responders use it quite a bit because it helps them regulate down their nervous system so they can make these really important life saving decisions. I can explain it to the hour later.
Jennifer Gray Thompson: Let's just do it, we're here. Do you want a box breathe?
Dr. Adrienne Heinz: Yeah, yeah. I've adapted it for my family, with my kids. We did it over Thanksgiving because that's just stressful. Anyway, I don't particularly know how to cook Turkey. But if you take your hands, you make a turkey. And you start right here at the base of your hand, and the idea is you breathe in, breathe out. And then hold it for four seconds and exhale. So just follow me.
Jennifer Gray Thompson: Okay.
Dr. Adrienne Heinz: Breathe in, and the tip of your fingertip, hold it for four seconds. Exhale, that here. Inhale, the top of your ring finger. Hold it for four seconds. Exhale, one of your fingers. Inhale, to the top of your middle finger. 1, 2, 3, 4, exhale, inhale to the top of your pointer finger. Exhale down the turkey neck to the top of the thumb, hold it for four seconds and exhale to the bottom of your wrist.
Jennifer Gray Thompson: I love that. I'll probably sound weird for those of you who are on iTunes. It's like a little bit of heavy breathing there, but it's really practical things though. I know about box breathing, and Susan Ferren tried to me, but I didn't know about the turkey. So now, it's a good way to measure, and I really liked that. And it's also easy to teach to your kids because it's very practical. I love that. Yeah.
Dr. Adrienne Heinz: Yeah, that was an invention at our house for Thanksgiving where we box married the turkey, and then we have turkey breathing. I like it a lot.
Jennifer Gray Thompson: So Adrienne, Dr. Heinz rather, my hope is this can be an ongoing conversation. I really admire your work, and I really liked that you're bringing in technology because a big part of our future in this work. About a third of what we will do is about trying to really amplify it, invite and encourage the tech sector to look into exactly what you're doing, to support the work that you're doing in this technology in a way that builds actual resiliency that increases equity and disaster because regional equities is just an entirely huge problem. But on top of that, we leave a lot of people out of our recoveries , people of color and people who are not well resourced. I do believe that we can sort of level the field a little bit using technology, including increasing access to mental health care. I mean, how we're all getting through is using our mechanisms. We're all entirely human, and nobody has it all together. Anything you can do to build self compassion and empathy for others, and I think you are making your mark in the world and in the world I care about hugely, and I admire you, and thank you.
Dr. Adrienne Heinz: Thank you so much for having me on, and for raising awareness about the mental health consequences of disaster, and also the opportunity for technology to wrap around and scaffold what FEMA is doing. Because I know that we can use this as an experience to learn, grow and decrease the divide. There doesn't have to be such a gap in access.
Jennifer Gray Thompson: There really doesn't, and I was really pleased to see that FEMA released a statement of equity, a request for inputs. If you haven't seen that, they did it on the 22nd of April. I can send it to you. I'm very interested in having a lot of voices who have been there and experienced it. And to figure out how to partner with FEMA, how to support them. I always tell them, we're not here to supplant you, like we're here to supplement you because disasters are tough. It actually takes a lot of collaboration for it to get to the other side. I feel very lucky that in my county, you are at the helm of this really important project. And I think because you did provide that with Debbie Mason, it did change, did improve our ability to overcome subsequent magnifiers, and pandemic, and racial reckoning. There's just a lot of work to do, but you have to start someplace. And I'm proud to say that in Sonoma County, you started someplace and that we are going to get to the other side. It's going to be a long, but this is how we're going to do it, which is together.
Dr. Adrienne Heinz: Well, I thank you for all the efforts that you're putting forth to help people recognize that we have to care about each other just as much as we do for ourselves and our family. And by thinking about the collective recovery, we'll be able to endure what comes at us in a way that we can't do alone.
Jennifer Gray Thompson: Absolutely. Once again, Dr. Adrienne Heinz on the podcast, How To Disaster. Thank you.