Transcript

Intro

Dr Matthew Chow: Employers have a tremendously important role because when you count up the hours in a day apart from our families and friends and our hobbies, we spend the most time actually at work.

And so how employers deal with mental health, how they talk about mental health, how they infuse it into their culture is so incredibly important for achieving excellent health outcomes.

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Diane: Today, I’m joined by Dr. Matthew Chow, a child and youth psychiatrist who is now the chief Mental Health officer for TELUS Health. During the COVID pandemic, Dr. Chow was the President of Doctors BC, the association that supports British Columbia’s more than 16,000 physicians, residents and medical students.

We discuss the experience of leading through a worldwide pandemic.

The profound impact the pandemic had on young people and the difficulty finding perspective in a society overwhelmed by negative news.

We also talk about medical advancements that inspire hope for the future.

Our conversation about burnout in health care and the guilt associated with shifting from being a clinician to a health care leader or technology innovator was particularly moving for me and I hope it will be for you too.

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Diane: Hi, Matt, I want to start by talking about the impact of the pandemic on young people.

We’re in what I’ve been calling the peri-pandemic world with globalization, travel, the way we move and mix and work across international boundaries.

This means we will have another pandemic.

We’re now seeing the very real impact on young people.

So as a child and youth psychiatrist, what concerns you most regarding child and youth mental health?

Matthew: I’m worried about the loss of hope.

You know, hope is such an important, important part of being a human being.

It’s such an important motivator.

It’s so important for our mental health.

And what I saw during the pandemic and now in this, in this phase, you know, as we recover from the ravages of that time is, you know, I see young people being far less hopeful than they were pre-pandemic.

These are young people that saw the entire world shut down.

These are young people that lost out on really critical developmental opportunities and you know, life events, you know, marriages were canceled or deferred, uh graduation ceremonies were canceled or deferred.

People started new journeys into high school or or postsecondary where they never actually set foot in a classroom.

Friendships were deferred. So just so much was deferred.

And then now as they, as we come into this peri-pandemic period, as you called it, we are facing a contest between global powers.

We are seeing, you know, economic uncertainty, rising inflation. Back here at home in Vancouver, British Columbia, a majority of young people are saying that they never expect to be able to own a home in their lifetime.

And so hope as much as labor shortages are happening.

Hope shortage.

You know, I really see and worry about a shortage of hope.

Diane: I hope through this conversation, we will find some reasons to hope because I, I can certainly understand why you’re concerned about that as I am. But I am a glass-half-full kind of girl. (laughs) I always, I always see that there’s a path ahead.

Matthew: Well, as am I so I like to describe myself as a long-term optimist and a short or a immediate-term pragmatist.

So I think at the end of the day, as you know, Martin Luther King Jr. said eloquently, right, the moral arc of the universe does bend towards justice.

Things are actually getting better over time.

But I also am realistic about short-term turbulence that we human beings have to go through.

And the last couple of years have indeed been very turbulent and I expect some continued turbulence as you know, as as these developments evolve.

But in the long run, you know, things are, things are getting better.

Despite the conflicts, despite labor shortages, despite the strife, despite the worries about housing affordability. Actually over the world today is better than the world 50 years ago or 100 years ago, demonstrably, objectively.

Diane: But if you’re exposed through social media, the news, all of the information that you get has that negative bend to it that, you know, we’re losing our forest, global warming, war, pandemic.

It’s scary for a young person because they’re not necessarily able to put it in the context of how far we’ve come.

Matthew: Yeah. I mean, you know, I think about an example, even in my own, in my own family. My dad had an event where basically, you know, a blood vessel blew up in his, in his eye.

Had that happened, let’s say 20, 25 years ago, he’d be blinded by that episode. Today, they were able to inject him with, you know, an advanced treatment that basically resolved that condition and he has, you know, 100% vision, you know, in, in his eye from that.

And so that innovation has happened, you know, in a very short period of time. People having heart attacks, that used to be a death sentence in upwards of 90% of people would die from heart attacks.

Now, it’s the other way around.

We actually expect many people, you know, if not most people to survive.

And again, in a very, very short time span that that’s, that’s happened.

So there’s, there’s actually a great deal of reason to be optimistic.

Diane: It’s something I think about a lot because we’re at a time where trust is very low, trust in institutions, trust in physicians.

Matthew: Oh for sure.

Diane:  And it’s, it’s a time of incredible innovation, but such low trust and imagining young people growing up in that environment and being infused with that fear of science rather than what it is for me, which is excitement.

It’s always changing.

Matthew:  Absolutely. Like science is always advancing and, and changing.

And I think part of the difficulty right now is just the pace of the change. Up until this point, things changed at a pace that humans could adapt to.

But now we’re hitting a point where things are accelerating to the degree that it’s just, it’s really hard to wrap your head around.

We have accelerations in terms of, you know, for example, Moore’s Law, you know, the ability of processing power, computer processing power to increase exponentially.

And actually just to dwell on that point for a moment, we humans are actually really bad at understanding what exponential actually looks like.

We got a taste of it during the pandemic when the term R value came into the common lexicon.

Well, I tell you before the pandemic, I don’t think most people knew what R value was.

To be honest, like honestly, you know, this was a very esoteric term and so they, it’s not something we normally encounter in nature.

So it’s hard for humans to, to wrap their head around, but it’s one of the reasons why I’m so optimistic is because, you know, a computer next year or 10 years from now is not going to be twice as fast or five times as fast.

It could be like 100 or 1000 times better than it was today.

And, and so we need to be thinking of that.

Diane: You know, a lot of people are uncomfortable talking about good things that came out of the pandemic because so many people had horrifying experiences.

Matthew: Absolutely. There was, there was so much tragic loss. There was so much suffering.

Diane: But we learned, we did learn a lot.

And you know, I learned this actually from treating people with PTSD who would say to me once they started to recover, “I never would have asked for that horrible thing to happen. But in some ways, I’m glad it did because this is how it positively changed my life.”

And that was a mind blowing experience for me.

And I’m sure like you, I’ve just learned so much from my patients. That out of horrible things, good things can come.

Matthew: Well, you know, we, we humans have a superpower. And that superpower is the ability to find meaning in almost anything.

And I think right now more than anything, we humans need to exercise that superpower because we’re at a really unique juncture in history.

You know, we are emerging from, you know, one of the greatest crises that any of us alive right now has ever experienced in our lifetimes.

We are seeing things like Moore’s Law in, in real time.

We’re seeing the development of AI, we’re seeing a change in the way people work.

We’re seeing globalization. Just so much change. And we need to exercise our superpower and find the meaning in that.

Because without that meaning, I think that’s where we get lost.

That’s where people start to lose hope is if we have not derived meaning from everything that is happening all around us,.

Diane: Matt, I’ve shared my personal experience with burnout and really what it stemmed from was almost entirely related to trying to create change. Trying to help my patients to live their best life.

And I felt like I was in a constant battle within a system that just didn’t meet me where I was and wasn’t able to help me to provide my patients with what they needed.

I know people who are in professions where other people’s needs come first, tend to be the most vulnerable to burnout.

And certainly people responsible for providing mental health care are particularly hard hit.

And just when we have this massive need for physicians, psychologists, counsellors, social workers, we’ve got a big problem with people just saying “I’m out. I’m leaving.” Who’s responsible for addressing these issues, Matt?

Matthew: Well,I think all of us collectively are. I really, in a systemic issue like this, try to resist blaming any particular party, any particular government, any particular ideology because it’s much more complex than that.

We as a society actually need to take a step back to understand and appreciate why so many people are burned out right now. And the burnout is isn’t just in health care.

You know, I see people working in airlines that are burned out.

I see people working in manufacturing that are burned out.

I see first responders that are burned out.

And so as a society, we really need to take a step back and understand why is it that people are burned out. If I zoom back in on health care, I would propose that the reason why people are burned out is because they are working in a system where they’re rolling a boulder up a hill and the boulder keeps rolling back down on them.

And in some cases is actually squishing people now.

And so nobody can thrive in an environment like that.

And so, you know, in, in my particular case and certainly in your case, and your career trajectory is something I really admire is that the two of us have I think, seen that that is what the system is doing to people like us.

And I’ve experienced burnout as well is that, and, and we’ve realized that the only way to deal with that is to escape the system and to actually take a look outside the system and, and change the system from the quote unquote outside.

Diane: There’s a little guilt that goes with that.

First of all, I want to say, thank you for saying that you’ve experienced burnout because it should not be something I remember when I first started talking about it.

People are like, “oh, that’s so brave that you talk” like, it should not be brave. It should be something that we talk about 100%.

Mathew: Exactly. 100%. If I sprain my wrist, I shouldn’t have to be told that I’m brave if I tell people. Yeah, that’s why I’m like, favouring that wrist right now because it’s, it’s sprained.

You know, if I break my, my leg and I’m walking around in crutches, I shouldn’t have to justify to people while I’m walking around crutches.

But yeah, burnout. It’s still, even in my role, I experience that, you know, when I tell people, I’ve, I’ve experienced burnout, I’ve experienced, you know, mental health challenges.

I’ve had therapy.

You know, people would say, wow, that’s so vulnerable of you.

That’s so brave.

And I’m like, well, actually, I’d like to live in a world where you don’t even need to approach me and say that like, thank you very much for the, for that feedback.

But let’s work together towards a world where we just say that.

Diane: I could not agree more.

One of the challenges for me facing burnout in an area of medicine where people are just desperate for a psychiatrist was the guilt that I felt about not being able to see patients.

I just could not see the, the number of patients I was seeing for so long of it myself.

Matthew: Even myself, you know, there’s sometimes, you know, when I wake up and think to myself, like, what’s the wait list look like?

You know, for my colleagues and someone will tell me, well, it’s two years now for someone in your specialty.

And I think to myself, oh my gosh, you know, by taking myself out of circulation and helping with that wait list.

You know, have I, have I done harm to humanity?

And then because I’m, I am so lucky to have just like an amazing partner and family.

They remind me that and actually one, actually the most poignant time is actually when a colleague reminded me because I, I confided this to them.

A colleague actually said to me, well, you know what Matt, we’re, we’re gonna keep doing what we’re doing.

We’re gonna keep seeing patients.

Really. What we need you to be doing is getting out there and representing to the world, what’s happening for us here in the front line and do something about it and change it.

Because if you just get into the trench with us, what’s gonna happen is you’re gonna get buried along with us, but you need to get out of there, right?

And actually change things for the benefit of, of everyone.

And that is, that is your purpose, that is, that is your purpose.

And that was actually the most kindest and most reassuring thing that, that anyone could ever ever say to a guilt-ridden person like myself who is, you know, trained to just like, head down, be on call all the time, work weekends.

See as many people as you can try to get that wait list down, you know, realizing that I was pushing a boulder up a hill.

Diane: That’s, it’s such a good analogy. That’s how I felt exactly.

And I think it’s one of the greatest challenges in psychiatry in mental health care is the fact that people don’t necessarily understand it as well as they would if you had a broken bone or arthritis or a headache.

It’s confusing to people and a little bit scary. Making that translation or understanding for a broader audience is one of the most powerful things you can do knowledge translation as I like to call it. People are open to that they’re hungry for it and you’re uniquely placed to be able to educate as well as advance well.

Matthew: And humbly, I might add that I’m merely following in the footsteps of pioneers like yourself, Diane, you know, who have been doing that knowledge transition for your entire career. Who have brought very complicated concepts down to earth, you know, for our colleagues and for the public.

And that is probably one of the most important things that any, any doctor can do.

You know, a colleague reminded me recently that the word doctor means to teach or to be a teacher.

And so knowledge translation is about teaching and that is a supremely important thing to do.

And like I said, I’ve learned from some of the best.

So, so I’m really just trying to channel that.

Diane: That’s very kind. I do know that TELUS is really focused on employers. I’m wondering what your thoughts are about the role of employers when it comes to mental and physical health and well being for their employees.

Matthew: Yeah. So employers have a tremendously important role because when you count up the hours in a day apart from our families and friends and our hobbies, we spend the most time actually at work.

And so how employers deal with mental health, how they talk about mental health, how they infuse it into their culture is so incredibly important for achieving excellent health outcomes.

And so, you know, employers can get involved in a number of different ways. They can get involved in terms of like inculcating a culture where talking about mental health is a safe thing to do, you know, psychological safety. They can inculcate a culture where taking care of one another and asking about one another’s well being and health is a part of what we do rather than an extra.

Employers can, can do very pragmatic things such as funding programs to make sure that employees have access to mental health services.

And also employers, I think contributing to the national dialogue around mental health and elevating the importance of mental health so that we’re treating it just as importantly as you know, COVID-19. Just as importantly as cancer care, just as importantly as wait list for surgery.

Diane: When we know your body and your mind are really inextricably linked.

If you have a mental illness, it increases your risk for physical illness.

And the reverse is also true.

I’ve recently learned of this drive within Canada to put employees on the ledger the budget, the spreadsheet as an asset view them as a really what they are a financial value to the organization.

And that’s a critical part of recognizing you got to take care of your employees for them to be able to take care of the business.

Matthew: Absolutely. Yeah, people are resourced to be cherished and cultivated and to help grow. And in return what those employees can do for you.

What your team members can do for you is incalculable.

But if the first step is absolutely to treat people like an asset as a resource to cherish and to hold and to grow as opposed to, you know, an expense or a cost.

You know, and on that point, you know, the language that we use to describe people, you know, to describe our goals is so important.

We’ve, we’ve learned certainly in the age of, you know, like misinformation and disinformation that language, you know, language matters and being inclusive matters.

Diane: What are some of the hurdles that employers face when they’re trying to advance the care that they’re providing for their team members?

Matthew: I mean, one of the perceived, you know, I’m choosing my words very carefully, is one of the perceived barriers is, is cost.

You know, I, I always hear and I, and this is not just employers, I hear this from provincial governments, federal governments, other stakeholders that well, how on earth would we ever afford to help people have the best possible mental health?

And my response to that is you cannot afford not to. If you look at, you know, just even zooming in again on health care, the amount of burnout that’s happening, the amount of turnover, the amount of people that are actually quitting the professions leaving health care behind.

We simply cannot afford to ignore people’s mental health.

We must invest in mental health across all industries during this time.

You know, when we have global labor shortages, global staff shortages, we absolutely must invest in that.

So again, you know, I describe that as a perceived barrier, this barrier of cost but really what we invest in mental health pays incalculable dividends on the other end.

Other barriers? Stigma. You know, I hate to say it in the year 2023 you know, in this era, but there is still stigma about mental health issues.

There’s still a lot of stigma about substance use, especially it’s still the last frontier.

It’s still the thing that people are reluctant to talk about and why wouldn’t they? Whether it’s in the media, whether it’s at family dinner table, whether it’s at school, there is still a stigma around people who are using substances.

And sometimes I would say not necessarily even intentionally, we still use outdated language to describe people and the issues that they are facing and that they’re living with that stereotype people that stigmatize people that uh call people out rather than calling people in, you know, other people like they, they push people away.

We still, we still have some work to do on that.

So stigma. Which I I’m happy to say is getting better over time, but it’s still there.

Diane: I would agree.

The challenge around stigma is powerful.

It’s still there.

I, I just don’t think we understand how powerful it is.

It is changing.

Young people are becoming more open, but it’s still there and it’s still very difficult for people to endure.

Now, Matt, if you were able to ask one thing of health care leaders, the government, industry, people who can create change to improve mental health care, what would it be?

Matthew: So it’s funny because it’s actually it’s not a doing thing.

It’s more of a stopping thing.

And so what I would say is the most important thing that governments, actually any stakeholder in this space could really do, is to stop thinking that doing what we’ve done in the past is what’s going to take us into the future.

Diane: Bam! That’s it.

Keep doing the same thing over and over again and expect a different result. It ain’t gonna happen.

Matthew: Yeah, we, we are not going to dig ourselves out of the global crisis by doubling down on what we’ve already been doing before that hasn’t been successful.

If anyone has any question about that, just look into the eyes of a burned out nurse, a burned out mental health worker. of people that have dedicated their entire careers to helping other people that are now walking away from health care. Look them in the eyes and say to them, “Well, I think that if we just double up nursing school admissions or medical school admissions or just write another $1 billion or 10 or $100 billion check that everything’s gonna get better.”

Look that person in the eyes and tell them that and see what their response is and you’ll have your answer about what we need to do differently.

Diane: Well, I’m looking into the eyes of a previously burned out child and youth psychiatrist and I started this conversation by talking about your many roles as a psychiatrist, as the president of Doctors BC, as the Chief Mental Health Officer of TELUS Health.

And I wonder if you could tell me because I’m sure there have been many accolades and achievements.

What are you most proud of professionally?

Matthew: The thing I’m most proud of is that I truly believe that the world that my 10 year old daughter is growing up into, is going to be better than the world that I grew up in.

Diane: Well, that’s a wonderful thing to think about and I know that you’re doing all you can to help to advance my specialty in yours.

And I’m very, very grateful for your time today, Matt.

Matthew: And back at you,

Diane: Thank you.

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Outro

Diane: Matt’s experience as a practicing child and youth psychiatrist.

Then a patient advocate, then champion for changing mental health care delivery through technology is incredibly similar to mine. His insight into how moving into leadership and advocacy could make such an impact, really resonated with me.

It’s just so hard to turn away from what you’ve spent so much of your life training for and doing.

It’s never an easy decision to leave practice, but taking that path can open new pathways and I hope create even more opportunities to impact more people.

Mental health care providers commonly grapple with guilt and pressure when they’re unable to meet the demands of their patients.

It’s critical that we collectively address burnout and strive to improve our system.

I wholeheartedly share Doctor Chow’s concerns regarding the loss of hope experienced by so many young people and these concerns deserve serious attention.

We need to emphasize prevention, early intervention and normalization of self care by having open discussions about stigma around mental health. By joining forces, policy makers, organizations, corporations, institutions, individuals, we can prioritize the well being of both patients and health care providers.

Until next time. 

Thank you for listening. 

The Wicked Mind podcast is a series of unique conversations with individuals that share experiences and perspectives on mental health care. Together we will uncover ideas that inspire action.

Please make sure you subscribe, share and comment.

And if you have a topic or guest suggestion, please reach out to me at DrDianeMcIntosh.com.