How to Create a Mental Health System with Debbie Mason

Transcription:

Jennifer Gray Thompson: Hi, welcome to How To Disaster, a podcast to help communities recover, rebuild and reimagine. I'm so happy today to have Debbie Mason here with me. Debbie Mason is one of my most admired colleagues, and she has recently moved back to her home state of Florida. But prior to that, she spent about two years creating a Mental Health Care Collaborative. Debbie, welcome to How To Disaster.

Debbie Mason: Thank you, Jennifer. It's great to be here and share a little bit, and learn from others as well. So it's a journey we all need to do collectively. I'm glad to be a part of that.

Jennifer Gray Thompson: I like to tell people that you are one of the most impressive people that I saw, step up post disaster. Mental health is something that we struggle outside of a disaster. And then something as monumental as what happened in 2017 occurs in a community, and mental healthcare becomes one of our most important tools for how we're going to recover. Can you please tell us a little bit about your personal fire story, where you were working and the path that took you to create this collaborative.

Debbie Mason: I came to Sonoma County in 2016. I had been visiting Sonoma County and spending a lot of time out there since the late 80's, and said one day that I'm going to live out here. It's an amazing place, so I had the opportunity to move there. I came, luckily enough for an amazing position as CEO of the Healthcare Foundation, Northern Sonoma County. And in that first year, working with my board, we identified mental health as a critical need. So that was already a platform for us. As to my personal fire story, I'm a Floridian and we do hurricanes. Hurricanes are much easier than fires. Everybody said to me, why would you go out to Florida? You have hurricanes. Look, hurricanes coming about a week in advance. That's a really beautiful time period to figure out, am I going to leave the area? Or am I going to bunker in, watch what happens and figure it out. But with a fire, you don't get that notification. My own fire story of watching the fires rim around Healdsburg in 2017, which was where I was living was very, very frightening. And literally, I had no family there. I was lucky enough to have friends, but most of them were in the fire area too. I ended up camping out on my Board Chair's couch, who's a lovely individual with a packed house of her own family, dogs, cats, kids, people. I was grateful to have her and her family there, but it was very scary. I, from that point of that first fire, never unpacked my go bag and stayed ready. From that point on.

Jennifer Gray Thompson: Very smart. I was so excited to put my go bag in the closet about a week ago, fire season.

Debbie Mason: Exactly. Fire season's over, just move it in the closet, but leave it like it is.

Jennifer Gray Thompson: Right. So okay, you see what happens to our community, you are evacuated. But how did you even find out? Or how did you even decide to step into this space of creating this collaborative?

Debbie Mason: It sort of happened serendipitously. Before the fires, because our Board's through its strategic planning had identified mental health as a pillar, I was doing outreach to connect with professional mental health groups. So connecting with the local group of psychiatrists, psychologists, social workers. Identifying everybody who was in the mental health space and psychologist saying, what kind of partnerships could we create? And also, all areas have the shortage, but Sonoma County has a severe shortage of mental health professionals, particularly Spanish language serving professionals. So we had already identified, wow, there's a huge gap of mental health professionals to begin with. And then for folks that are primary Spanish language speakers, they can wait a really long time to see a mental health professional, if they can afford a mental health professional, and then free was a whole nother category. So we were already kind of parsing through all that.

Jennifer Gray Thompson: I would like to pause there and say, actually, that is really good advice for building resiliency into your community is that, say, you haven't had a disaster yet. So you'd like to be somewhat prepared, because we don't know what's going to happen. I think COVID has certainly taught us that, but just really building that network out in advance.

 

"Building a network ahead of time is a resiliency piece." -Debbie Mason

 

Debbie Mason: So we were really fortunate. We had already done some listening tours around the county, and we had already done some convening of folks that were somehow in the mental health space. So we literally had a starting place of people to convene to bring together for solution building. But if we had been starting from scratch, it would have taken us that much longer because people are displaced. So if you're trying to go through their association with they're not working in their office, they're not checking office emails. So the ability to already have personal cell phones and personal emails, like you said, building that list, building that network ahead of time is a resiliency piece.

Jennifer Gray Thompson: So how did you come to be the point person, though. Because you've only been here for about a minute before it happened a year, but you came to be the point person, and I don't think I sat on a panel for like years, not where I wasn't sitting next to you in the county. I mean, how does that come to be? And where did, can you talk about the funding too?

Debbie Mason: So a lot to unpack there. I was the steward of my Boards passion. My Board was passionate that this was a need, that it disproportionately affected families, and lower income families. And that had always been the voice of the Healthcare Foundation of Northern Sonoma County. We needed to step into that void. And for a long time, I felt like I was talking to myself, because everybody was so focused on immediate needs. I would say, yes, we have to meet immediate needs. And we have to be budgeting, and fundraising, and planning for this longer term wave that's going to come. So I just felt like I needed to be doggedly persistent about keeping that in front of people. Because at some point, they'd be ready to hear it. Even if they weren't one.

Jennifer Gray Thompson: I think it's one of the things that a lot of people struggle with is the idea that they do need to sort of something in reserve. Even though we all walked around saying, this is going to be a marathon, not a sprint. I think I've heard that 500 times. And in every other community that we've worked with post disaster, but actually understanding that you really are going to be at miles 7, 13, 16, 20. When you sort of get tired, and it's a marathon that nobody's really training for so it can be a hard message for people to hear that we need to reserve some cash, some energy and some of our efforts for year 2 through 10, essentially.

Debbie Mason: Right. I also think it's human nature to want to fix all the problems now. We have to remember that some of our brothers and sisters already walk in uncomfortable situations. And when a disaster happens, they slip back even further. So at some point, you have to say to yourself, am I bringing that person to what hole was before the disaster? Or am I trying to take them exponentially to another level? Those are really difficult conversations to have as human beings because we want everybody to be well and good.

Jennifer Gray Thompson: And sometimes, it's really hard to hear that you can't go back. I think that that's one of the messages that we try to share with newly disaster affected communities, you can't go back to your October 7, that moment is gone. And that's hard to let go of, but you can reimagine how you want your future to be.

Debbie Mason: Well, Jennifer, that's exactly an important part of the mental health response strategy. You have to come to that AhA moment on your own. Everybody I knew in the space of recovery had their own mental health advisor that we saw regularly. I mean, I remember being on a panel where everybody on the panel, all of us said, yeah, I see somebody. Yeah, I see a professional. Yeah, I need help. I'm completely fine to say I need help. It wasn't until my therapist said: "Hey, you can't go back. Remember what you had before will never exist again. come to grips with that." How do you come to grips with that? And then you can get to the third word of your slogan, which I love, which is, now let's reimagine what it can be, will be, should be going forward. But there's this period of mourning that has to happen with all of us at varying degrees depending on what our loss was, or what our stress level was to come to grips with. It's never going to be like it was, and you really gotta own that big step.

Jennifer Gray Thompson: Big step. Can you talk to us about how the Healthcare Foundation found the funding, or talk to us about how you started to build out all the components of the network? I really do love that you were specifically focused on the high need populations, high need low and low resource. But how did you even beat, I think that there was a federal grant, it is called the HOPE Grants.

Debbie Mason: We brought together all of the mental health experts from the local associations and said: "We will commit, as the Healthcare Foundation to finding the money, y'all are the experts, you tell us what does best practice looks like in disaster mental health response." So those practitioners, they're just amazing, amazing people took it upon themselves to reach out to national experts, to find out internationally what had been the mental health practices that had been measured and could be considered best practices. And then we just also had some really innovative thoughts of, what would fit locally on top of that, which is how we came to yoga and iRest, which people all over the country poo pooed us for, but it worked. We actually saw the data, it worked.

Jennifer Gray Thompson: Well, talk about what made the yoga different, because what you ended up doing was training hundreds, if not thousands of people in trauma informed care. And that includes yoga teachers.

 

"A fire survivor is anyone who felt affected- you didn't have to have anything burned in the fire." -Debbie Mason

 

Debbie Mason: So we took yoga teachers and said: "We know you're already doing classes, can you incorporate at least some of your classes, and we'll pay you to do these classes for fire survivors." And our definition of fire survivor, by the way was, anyone who felt affected, you didn't have to have anything burned in the fire. But if you felt affected, which frankly was every human being in the county, we wanted you to have those resources. So we trained the yoga instructors in trauma informed yoga, which is a particular practice of yoga that opens the body, creates calm, releases feelings. And then iRest meditation, which is a documented recovery strategy for folks recovering from trauma. So we had a legion of yoga instructors where we could have classes all over the county at different times, in different days, in different places that people could drop into.

Jennifer Gray Thompson: And it wasn't just an English too, for those who are not aware in Sonoma County, we have at least 27% of our population, about a little over 100,000, probably more though, Latinos, and they are the backbone of our community, and of our economy. They're incredibly important to us on a multitude of levels, on a multitude of levels. Like I said before, accessing care is very difficult. It's great, it's very expensive. And if you can afford it, then it actually has to be made available too. So I love, if I'm on the Board of La Luce, and they still have exercise classes for free in Spanish.

Debbie Mason: That was really important to us. At first, we started by trying to identify yoga instructors that already had practices of Spanish speaking clientele. And then what we realized was we were going to be more successful at reaching those with the highest need if we went to partners that were already in the community. So that's when we searched out La Luce and others that already serve clients and said: "How can we incorporate this for your clients for free? We'll pay for it, but let's make sure that your clients have access to this." And we also reached out to some of the organizations that serve our undocumented neighbors, because it was important that folks who are sometimes perceived as invisible didn't have to worry about fear and getting help.

Jennifer Gray Thompson: That's a big part. If you do have an undocumented population in your community, and most communities in America do that. Any kind of disaster from COVID, to a wildfire, to a hurricane, they have an extra added layer of fear going into the shelter's role that we know. They certainly can't access all of the services made available, they don't have access to unemployment insurance. So giving them access to mental health care whenever possible is incredibly important and deeply humane. So I really love that.

Debbie Mason: A good partner for reaching a high need low income and undocumented populations in any community across America would be the federally qualified health centers in those communities, because they're receiving federal dollars to serve anyone and everyone at a low income level. And they often are the medical center of service to undocumented folks. They're also a very good pathway into, and many of them offer mental health services too. Not all, but many. For folks listening that are in different communities trying to figure out how am I going to build these partnerships in advance? We've identified the local mental health professional chapters, but don't forget about the FQHCs because they can be really valuable partners.

Jennifer Gray Thompson: That's great advice. Thank you. Can you talk to us about your work with the school district, and how you provided services to children post disaster.

Debbie Mason: We approached the school system on a number of different levels. We approached it at the county level. And what I learned is, California School Districts are different from Florida School Districts. So they may be district in different, in other areas too. In Sonoma County, you have the Macro County Organization, which really serves as a consultant to the individual township unit school boards. So we did reach out to the macro and said: "Let us integrate into your training, and be a part of our steering committee." So we had a school board, County School Board representative, that actually was a part of helping us build the language of the app that we created, and helping us from an advisory perspective on the advertising campaign to reach people. But then we reached out to the individual districts and said: "Let us pay for yoga, let us teach. We're bringing in international experts to teach skills for psychological recovery for free. Let's make sure some of your school psychologist and school nurses get into these trainings to bring that training back into your school." And it took a little while because schools had their own thing coming down from the federal government. But after a little while, we started to see those folks coming into the countywide system we created, getting that free training and taking it back in.

Jennifer Gray Thompson: So was part of it, there was an emotional resistance to having outside, because they already had their own programs, or what was the resistance?

Debbie Mason: Schools do have their own training and their own training protocols. They are their own universes. They're very closed, often to wrap around the families and children. So sometimes, you kind of have to beat on the door to get her to offer something and you want them to be at the table with you. In their defense, lots of people approach them with lots of different ideas. And it probably gets pretty tiring to weed out which ones of these are really evidence based, and which ones of these aren't, and what do we have the bandwidth to do? And then they're all reeling too. They're all residents of the county dealing with their own individual issues and dealing with loss. So a lot of their students were moved and affected because of fires. A lot of their teachers were wrapped into their own losses. I don't ever look at these things and say, well, gosh, it was this one thing. It was just in a post disaster situation. There are many mitigating factors. And I always tell everybody, the key to my success and disaster recovery is consistency with the message, and doggedly persistent about continuing to bang on doors that I know could really benefit. And at some point, it'll be the right time for them to hear it.

Jennifer Gray Thompson: I think that that is an incredibly valuable lesson for anyone who has post disaster, everyone's traumatized in a community. I often talk about this in terms of the public sector, that everyone looks to the public sector and says, okay, fix what just happened. Be the recipient of all my trauma and grief, and also carry on doing everything you were doing before. And what I've seen is a public sector, some elected, they're made for it, and they can step into that space. Others though are more traumatized by it, and struggle with it. And then as far as staff is concerned, it's much the same, like a lot of them lost their homes, they were traumatized and they still had to work in the EOC for 12, 15, 16 hours a day. And then have all these town meetings, and there was a lot going on. But we forget sometimes that people who are in positions of service to the community are also traumatized themselves, and that will inform their readiness to take the next step or not, or how their ability to do their jobs. At the same time, trying to come to terms with their own grief.

Debbie Mason: Very true. That's such a true statement. I think about on my own, the people that I know that were locked in the EOC serving our community, and their houses burned down. And they literally were living out of their car, or a friend's house when they got to be out of the EOC. And they didn't even have time to take care of their own needs because they were so busy caring for the community. That's just a beautiful sense of service. Public servant is really a real title for people who work in government and do such a remarkable job for us.

Jennifer Gray Thompson: I totally agree. I feel very fortunate to have that experience working alongside the most wonderful human beings I've ever worked with, and have been in public service. So I agree, can you actually talk to us about the app that you all created? I think people would love to hear about that, who it was targeting, and what was the level of engagement?

Debbie Mason: So we were really fortunate. One of the partners we identified was the local chapter of the American Psychologists Association. Dr. Christine Neymar and Dr. Adriane Hines were the leads for that. Christine was the President, and Adriane was very engaged. Adriane who lives in Healdsburg and was affected by the fire actually worked for the Department of Defense for the Veterans Administration, on technology based healthcare resources. So Adriane dialed us very quickly, let's develop an app, and she gets all the credit for that, and really worked with the app developer on the content. She did the very same thing for COVID. She developed an app for COVID, as well. And for free, never got paid, never looking for money. But we made sure the app was bilingual. We also made sure that the app had a special section targeting youth, because we know youth would rather do it on their phones, they'd rather talk to you on the phone. Even if you're across the dinner table, they're still texting, you're like, I'm right here, talk to me live. 

So we thought the app would reach, first of all, people that might be far from resources and not have transportation. Because a lot of low income folks rely on their phone as they're tethered to the world. They might not have internet in the house, they might not have other things, but they've got a phone. So that gives them some freedom, some liberty and some information. But for kids and teens in particular, we knew that app could be a bridge. And indeed, we got some really great testimonials from folks that were able to use the app, and the app had several intervention strategies. One was what I call the casual visitor. And the casual visitor was an approach of, how are you feeling today? Are you mad? Are you sad? Are you having a fuzzy mental headache? Can you not sleep? And it was kind of what I call a symptom based approach. You could go in, and we'll give you some strategies to help you with that. Some folks learned that you could set up an account, and you could measure your own progress over time. Those folks saw tremendous gain, because they were able to say, I'm going to take these assessments every day, measure how I'm feeling and be able to track, Am I feeling any better in any of these areas? So we try to approach it on what would work, regardless of how you would enter the system.

Jennifer Gray Thompson: So Debbie, from what I understand, your app developer created one that works with COVID. And COVID has been a particularly strange puzzle and a strange disaster because it's global, but it also prevents us from doing the number one thing that will help us post disaster which is gathered together. Can you talk to us about how that app has made a difference, or if you're aware in this region?

Debbie Mason: Well, the COVID app is built on the same resiliency and response strategies that you would find in the fire app. It's just not customized to fire. But many of the things that folks are feeling in COVID, they also endure during and after the fire. And that is isolation, fear, stress. And then all of the factors, behaviorally that come with that. Lack of sleep, fuzziness, depression, all those kinds of pieces.

Jennifer Gray Thompson: Debbie, we are actually three years out from our disaster, and this podcast is meant to help people who are a little closer to the event, can you kind of go through some of your top three pieces of advice. I'm also going to ask you at the end of that, to really talk about some of the things that you would have done differently, or mistakes that were made. We think that's a really important element of getting through the disaster is being brutally honest.

 

"It's never too late to build a network of partners, even if you're not sure how you're going to partner with them." -Debbie Mason

 

Debbie Mason: Okay. So three pieces of advice, it's never too late to build a network of partners, even if you're not sure how you're going to partner with. Creating relationships, understanding what different organizations do, what constituencies they serve, and a little asset mapping, who's got what strengths, who's got what outreach, who has what resources. So when disaster does hit, you know who and how to share. That would be my number one piece of advice.

Jennifer Gray Thompson: Can be really hard to share. I used to, I had to once tell somebody who's almost in the same space as I was, was getting very protective. I was like, there's enough disaster to go around. That's the one thing that I'm sure that we have to be able to share. And what's one of the mistakes that you made, something you would have done differently?

 

"The cycle for a response to help with mental aid is a lot longer. It may take people longer to realize that they need help." -Debbie Mason

 

Debbie Mason: I would have anticipated that the cycle for response to help with mental aid is a lot longer than you think it's going to be. What I mean by that is, normally, the curve, if there is one, is somewhere between six and nine months. Someone who's been through something traumatic, if they haven't already sought help will say, okay, I thought I could tough my way through this. But clearly, I need help. In a fire situation where there's repetition, relating, literally of the trauma, there's a fire and you're okay. And then there's another fire, that whole fire season is now half the year. It may take people longer than that to realize that they need help. And the last fire for Sonoma County was two weeks after I left in 2019. I was traumatized in Florida because I was so worried about all my family and friends, even though I was so relieved to say, oh, I'm so glad that I'm not there living. And then one weekend, I said, but I am living it. I'm just now living it across the country, because I know what everybody's going through. And I'm not there to help with the recovery piece. 

So the other piece of advice I would offer people, you have to get over yourself because this is done about turf. If you're a funder, or you're a make it happen organization, you need to be able to sit at the table and say, let's all divide up the rules. And then let's work together collectively to identify funders. Whichever piece they fund, that's fine. But if we're all working together, we will quilt these wonderful disparate pieces into a beautiful quilt solution. I really ran into a lot of resistance in 2017, from some funders who were just going to do it. I'm like, yeah, you're going to do it, but you're only going to do these pieces. And these other pieces are equally important. If we approach it as a collective community together, it'll really be beautiful and will attract national funding that we might not get on our own.

 

"You have to get over yourself because this is not about turf. If we're all working together, we will quilt these wonderful disparate pieces into a beautiful quilt solution." -Debbie Mason

 

Jennifer Gray Thompson: I absolutely love that advice. I think that that's critically important. You also then need, not waste a lot of energy trying to protect your turf, or trying to keep other people off of it. I always use the term matrix. But actually, I think I might take your term quilt instead. Because I think that that's a much nicer image of it too. It's very accurate for how this actually has to go. There's really only one way to get through a disaster successfully, and that's together. I do think we were more successful in Sonoma County than on average. And that is very much due to a quilt that was made and a matrix of care. I like to call it actually an ecosystem of care as well, and that's part of why I wanted you to be definitely on this podcast. But I think that I just want people to know that it doesn't mean that we escaped all of the issues that do arise post disaster. So Debbie, one of the things that I've noticed now, doing this work constantly for three years, there is a dire need to actually help the helpers. I'm very happy that we interviewed first responders resiliency a couple of weeks ago, Susan, and created that for peer to peer health, mental health care for families of first responders and for first responders themselves. And now that we are three years out, some of my colleagues that I was so happy to work with, the first two years in particular, have not been able to sustain this kind of constant focus on disaster. Did you run into that when you were still here in Sonoma County with us?

 

"There's only one way to get through a disaster successfully and that's together!" -Jennifer Gray Thompson

 

Debbie Mason: Absolutely. Remember, mental health is the lagging indicator. So the first indicator is, how many people are still displaced by homes? How many people still need food, cars, all that daily living assistance? So by the time we had attention to raise serious dollars to fund the strategies and start implementing the strategies, we were six months after the first way, even though we were talking and opening doors during those first six months and planning the right strategies. So there is a fatigue factor. There is a dropout factor. And even amongst donors, even amongst professionals, it's like, why are you still talking about that? Surely, people are over it. It's like, no, some people are just getting to a point of realizing they need help. Folks, there's so little that we, as Americans, understand, unfortunately, about good mental health and positive mental health strategies, even without a disaster, so add the disaster part on it. And that knowledge base goes even smaller, even among mental health professionals. A lot of the mental health professionals we approached about training for skills for psychological recovery. I'm a psychologist, I don't need that. And we said: "Well, actually, yes, you do." The evidence shows that if you approach disaster mental health, in a traditional therapeutic clinical model, you may actually harm people versus help people. Their eyes would get this big and say, look, just look at the data, look at the studies. And then come for free for the skills for psychological recovery training, which is a recovery and resiliency based approach to trauma. It's not ongoing therapy. So even among mental health professionals, we had a long education curve. But you're absolutely right, it requires a long term staying power.

 

"It's the land of a thousand heroes. You don't need to be the actual hero. You're just a person like everybody else. Take care of yourself and allow yourself to be cared for." -Jennifer Gray Thompson

 

Jennifer Gray Thompson: It really does. I like to remind people that because there are a lot of the communities that we're working with right now, I almost call it a hero stage, and that's, the disaster has just happened, they've stepped into that space, some of them have sacrificed their entire lives to it. And now, they're between two and six months out, and it's almost an addiction, you know how people will step into this space of service, and you can actually pour your entire self out, and forget that if you're going to do a marathon, you actually have to, you have to take care of yourself, you have to try meditation or breathe. I know that I had to stop everything and learn how to breathe, meditate and make sure that I exercise and eat right. And even then, it could be a struggle because you're like, oh, there's much more important things that happen that you're going to do or take care of somebody else. But it's really important to always remember that it's the land of thousand heroes, you don't need to be the hero, you need to do things that are perhaps, but never to mistake yourself for being an actual hero, I guess, is what I want to say very articulately. That you're just a person like everybody else, and you have the same needs as everybody else, which means to take care of yourself and to allow yourself to be cared for.

 

"To have a clear mind, you have to take care of yourself. Otherwise, you're not effective and you're potentially hurting the mission instead of helping the mission." -Debbie Mason

 

Debbie Mason: That's so important. It's very easy to get wrapped up in, I should do more, I should do more. But you really have to have a clear mind. And in order to have a clear mind, you've got to take care of yourself. Otherwise, you're not effective, and you're actually potentially hurting the mission instead of helping the mission.

Jennifer Gray Thompson:: I totally agree. Debbie, is there any last words you'd like to leave us with today, or any resources that you want to recommend. We can always drop them into the slider or below in the chat part.

Debbie Mason: I do think sharing the COVID app would be very helpful for folks, because it does have a lot of the resiliency factors in there that Dr. Hines created in the initial fire app. Also, if the free yoga and IRS are still being offered, that would be a wonderful thing to be able to direct back to the Healthcare Foundation, Northern Sonoma County's website. Or however, they're linking into that free yoga opportunity as well.