July 12, 2023 • 33 mins
The MDRG team explores mental health and its increasingly important role to consumers. Sondra Brown speaks with Chris Hemphill, Sr. Director, Commercial Intelligence at Woebot, as they dig into the role of empathy in providing consumers with better mental health solutions and experiences.
Outside the Echo Chamber explores mental health as a critical issue that affects millions and challenges the traditional healthcare system.
And of course, we hear from our consumers. This month, we asked consumers, "Where do you go for support during tough times?"
For more on mental wellness in healthcare, download MDRG’s four-part series, The Business Case for Empathy.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Laura (00:03):
Welcome to what Consumers Want, the podcast that brings the
voice of the consumer to the health care conversation. Are
you interested in getting outside the health care echo chamber?
Using research and insights, we explore key health care opportunities
through the eyes of the end consumer. We examine trends
outside of health care that are driving consumer expectations, as
well as what consumers expect from brands now and in
(00:25):
the future. This podcast is brought to you by a
market research firm that unlocks the whole mind for deeper insights.
I'm your host, Laura McCabe. Let's find out what consumers want.
This month, we're going to explore mental health and its
increasingly important role to consumers. We have a great conversation
on deck for you with MDGs, Sandra Brown and our guests,
(00:47):
Chris Hemphill, senior director, commercial intelligence at Robert. You will
hear Chris and Sandra dig in to the role of
empathy in providing consumers with better mental health solutions and experiences.
And this week's Outside the Echo Chamber will explore mental
health as a critical issue that affects millions and challenges
the traditional health care system. We will, of course, hear
(01:10):
from our consumers this month. We ask consumers, Where do
you go for support during tough times? Here's what they
had to say.
Consumer #1 (01:17):
Usually I go first to my spouse or secondly to
my adult children, or thirdly, to a close friend or
colleague and work.
Consumer #2 (01:27):
I usually go to my partner or some friends like
to get together during tough times. When I really think
about it, the one person I always go to to
rely on for strengths and support and advice is my mom.
Consumer #3 (01:42):
During tough times, I usually turn to my sister because
no one knows me better. My family, my husband. My friends. Therapy.
Sondra (01:57):
Hello. I am here with Chris Hemphill, a data science
expert in digital mental health. I know that they are
an avid runner and an amazing podcast host. The current
podcast being meeting of the Minds. Welcome, Chris.
Chris (02:13):
Appreciate the intro. Thank you. Sandra.
Sondra (02:15):
It might be helpful for you to tell us a
bit about your role at Robot and about Robot itself
before we get into some of my questions.
Chris (02:25):
Okay. Okay. Well let's start with robot itself. Whoa Bot
is a chat app. It's a tool that is there
for people when they have mental health needs. So think
about the ability to have a conversation. And it was
with a bot or I think people say relational agent,
if they want to sound fancy, I say chat bot.
(02:45):
It's a model that is trained on cognitive behavioral therapy
along with other therapeutic methods. So the whole idea and
this this company has been around since before all this
chat GPT stuff, I have to bring it up. It's
been around since 2017, so it's been a focus on
having a conversational way to talk about these challenges that
(03:08):
you might be having from a mental health perspective for
for a very long time. Established by Dr. Ali D'Arcy,
who is a Stanford trained clinical psychologist. I think that
it's important to bring that up because the whole idea
behind these conversations is not to generate these just semi
random answers to the prompts that people are putting in
(03:30):
or the responses that people are putting in. But really
to go down very specific, clinically validated pathways to help
guide people through a CBT process. So my role within
that like this is a this is an app that
is like clearly being a chat bot is very, very
focused on having an open communication, a natural communication back
(03:54):
and forth between the agent. So my role in data
science is to understand the communication patterns that are happening
at an aggregate level and help health care decisions better,
make decisions about things like behavioral health integration and how
this might play a role within their overall ecosystem. I
(04:17):
don't know if that sounds weird. It does. That clearly
lay it out. Is that.
Sondra (04:23):
Crazy? And I think that with all of the conversation
that's going on about ChatGPT right now, that description might
have not been as intuitive even 6 or 9 months ago.
So think that it should be very clear as to
the role that robot is playing. One of the things
that I love about it that we've talked about is
(04:44):
the fact that it is 24 over seven, seven days
a week, 365 days a year. So it is an
always on solution for people when they need to access
mental health resources.
Chris (04:59):
Yeah, that's an extremely important point because when we talk
about the company's mission is a radically accessible care. But
when we talk about the access challenge, it's not just
limited to the fact that there is a major shortage
of workers who can look like we're talking about clinical
psychologist or licensed clinical social workers. Like there's there's a
(05:22):
shortage of people that can address mental health needs. But
even if we were to solve for that, one thing
that that's extremely important is that between 72 and 78%,
depending on what population you're looking at of the usage
within what happens outside of your 9 to 5 clinic
hours with a heavy concentration of like our longest conversations
(05:43):
around 2 a.m.. So we look at it as an adjunct,
something that that can work alongside and a lot of
significant number of our users are seeing therapist or are
seeing seeing psychiatrists and things like that. But this is
something that works alongside, especially in times that people have
needs that that just can't be addressed in person.
Sondra (06:05):
I love that. But one of the things that we
are doing here at DRG is really exploring the role
of empathy in providing consumers with better mental health solutions
and better experiences. I'd love your thoughts on the role
that empathy plays in this arena or not at all
(06:29):
from your perspective.
Chris (06:30):
You know, there's the role that empathy does play and
should play. I'd like to focus a lot on on
just I can't say we I'm going to say me
personally what I see as an ideal. I honestly just
had a conversation yesterday with Dr. Dr. Edwards, who is
a she's a practicing gastroenterologist, but also just wrote a
(06:53):
book called Navigating Your Health Care Journey. And the reason
I want to focus in on that is because she
was talking about the challenges and difficulties that people have,
like accessing services that they need, advocating for themselves if
they don't feel like their provider team caretaking team is
listening to them. These are the types of issues that
that she was talking about. And the major the reason
(07:16):
that she wrote that book, which is directed towards the consumers,
literally a guide, an instruction manual on how to navigate
within a complex health care system for patients like me
and consumers like me and things like that. But the
reason she wrote that book is because she said that
always on her mind is like no matter what role
she's been in. So like, she's been in leadership and
(07:38):
executive roles within payers and within health systems and providers,
associate medical director roles and things like that. But the
empathy part is what's kept her grounded and kept the
patient as the North Star. So it was just a
reminder that whatever position you're in because, you know, she's
a practicing gastroenterologist. To what better position than having your
(07:59):
hands directly involved in a patient's life? But when you
start getting removed from that through layers of management and
spreadsheets and things like that, it's important for everybody within
health care, whether you're in it or analytics or marketing
or what have you, to just find some way to
center back on the people who are ultimately going to
(08:20):
be impacted and often even put yourself in their shoes
so that you can basically inform the work that you're doing.
I don't know if that's too broad an answer, but
I just think that that empathy has a really powerful
role to play if we approach it right.
Sondra (08:36):
I agree that we are researchers here at and some
of the biggest complaints that we get about the health
care experience from a consumer perspective is my provider doesn't
listen to me. I don't feel seen and heard and
I want to be more involved in my health care.
(08:57):
So this idea that she brings up of how do
you advocate for yourself, aka, how do you become more
involved in your own care, the choices for care and
and outcomes. I'm curious, like if we had to bring
empathy down to a definition, how would you define empathy?
Chris (09:16):
There's a number of definitions I would I would use
and some of those definitions I would say, well, it
doesn't really exist because I don't think that you can
actually feel what another person is feeling. You can make
assumptions about what people are feeling and kind of operate
within the within those parameters, but that's getting too nitty gritty,
That's getting to like that. That's not respecting the need,
(09:39):
the like, the concept of empathy that we need. So
I like to boil empathy down into making the effort
to put yourself in someone else's shoes. So like we
can we can have a philosophical debate about like whether
we can truly feel what someone else is feeling, but
at least taking the effort to attempt to understand and knowing,
(10:00):
like if we go from the acknowledgement that like, hey,
just by looking at you, by seeing that you're smiling,
I can't necessarily assume that that you're happy. It could
be hiding many other things that like, there's all kinds
of reasons that somebody could smile that are not related
to happiness. So it's like perhaps it's understanding that you
don't understand and have to ask and have to go
(10:21):
layers deeper to really confirm what people are thinking and
how the things that they're going through. My impact, what
they're doing today and how they're treating you agreed.
Sondra (10:30):
So making the effort which underpinning that is her notion
of listening. Because if you're going to make the effort,
you're going to have to listen to someone else's experience
and try to understand that.
Chris (10:42):
Yeah. And that listen word is is so powerful and
so necessary. And even as much as we like, we
have phrases like two years in one mouth. But I
still think listening is underappreciated and undervalued.
Sondra (10:55):
Exactly. So how can we promote more empathy if we're
going to operate from your definition? For the purposes of
this discussion, how can we promote empathy and emotional intelligence
in health care professionals, particularly those who are working with
mental health patients or in the mental health space?
Chris (11:16):
Well, gosh, with health care professionals, they're going through such
a ridiculous and burdensome amount of work. In a lot
of cases. Again, we talk about the overall shortage and
lack of supply. Oftentimes, like when we're talking about workers
in behavioral health or clinicians in other fields, be they nurses,
(11:38):
doctors or technologists or what have you, there's often something
really deep at an organizational level that kind of cascades
downward into how patients might be treated. So if people
are let's take a residency program. Where you have these
people who are newly like newly delivering care on the
(12:00):
floor and working for nearly 100 hours a week while
being told that they're only supposed to report a 40
or certain a certain number of hours. It's a system
that grinds people to the bone and like think about
if we were to take people that were already this
taxed and then introduce some classes and exercise and things
like that, like that takes away from other other time
(12:23):
that people might have. And I just think that a
big issue with addressing empathy is figuring out how to
improve working, working conditions for our employees and make sure
that they are heard and like responding to a lot
of things that they need. There's just so much work
to do and so little support and emotional support and
(12:43):
policy to get it done.
Sondra (12:44):
And so taking away some of the busy work so
that they do have the time to really sit down
and listen. I've read an interesting article last week on
this idea of using AI and ChatGPT to perform some
of the administrative tasks that we expect of health professionals
(13:08):
so that they do have more time to really spend
with their patients. So not using these technology solutions to replace,
but to take away the things that cause the distractions.
Chris (13:22):
Yeah, I can understand where some of those tools might
be helpful and useful if you're because when I think
about a generative AI platform, let's go to a large
language model, like a chat GPT, for example. There's the
output that happens if someone who has no clue about
(13:42):
the underlying practice, just type it like you type in something.
If I am a complete layperson and I have no
idea what the context behind that is and I send
that to a patient or I send that to someone else,
then that's a major danger. I love your point on
not looking at this as a replacement to people who
are already working in that space, because the degree to
which it's even accurate, to the degree to which to
(14:04):
which it is helpful is semi random versus if you
have someone who is they have this experience, they understand
what the content that that's being produced and they kind
of like when you're working with those platforms, you're kind
of having a back and forth conversation with it. You
tell it to say one thing and it doesn't quite
hit the mark that you were looking for, and you
(14:26):
wouldn't know if it doesn't hit the mark. If you're
not a trained professional, you're going back and forth until
it's refined into something that's usable, which you might end
up editing. That takes away a significant amount of time
at like generating the a lot of the baseline and
things like that or like organizing your thoughts and things
like that. But still is a scenario where a professional,
(14:46):
a trained professional is at the helm and ultimately, ultimately
we just don't want to just blindly trust what comes
out of it.
Sondra (14:54):
Sure. One of the things that you mentioned when you
were describing who Cobot is to us at the beginning
of this conversation, we talked about this idea of access, Right?
We do have an access issue right now in in
mental health and with mental health providers. So let's kind
of talk a bit more about that. But if we
(15:15):
could start first to just a little more broadly, what
are some of the common misperceptions about mental health currently
in our country and how can some of these be addressed?
Big question.
Chris (15:29):
Yes, a very important question in my community and where
I grew up and how I grew up, one of
the biggest misperceptions is that it doesn't apply to me.
I think that a lot of people, the way mental
health is, is portrayed. There's a lot of focus on
really extreme examples or fictionalized examples of certain illnesses, and
(15:53):
that causes people to divorce from the reality of things
that that might be impacting themselves. I think that the
mass trauma of Covid 19 forced a conversation, forced people
to start looking inwardly at maybe recontextualizing issues that have
been stemming since childhood, things that that have been stemming
(16:14):
for a very long time. There is kind of a
mass re conceptualization where people are now realizing like, hey,
this does apply to me and this isn't just for
for those most extreme, extreme cases. And most importantly from this,
this mass realization is there's been some level of stigmatization
(16:35):
around certain illnesses. I still say that mental health is
heavily stigmatized, extremely difficult for many people to talk about,
but there's a little bit of a crack in the
door that's happening right now.
Sondra (16:47):
Do you have any thoughts on how we open that
door wider? How do we address some of the stigma
and these misperceptions?
Chris (16:55):
Sometimes there's a couple of fronts here which at one level,
addressing the stigma, I'll just call her out. Melissa Shackelford.
She's currently the managing director of marketing at Evernorth. And
I think that she's leading a really big conversation, at
least within a well, partially and heavily within the communications
(17:16):
context on understanding when you actually are using stigmatizing language.
For example, I am guilty. I earlier in this conversation,
just offhand, I use the word crazy to describe something
and I slapped myself. I was like, dang. But yeah,
literally guilty of that. Using stigmatizing language. In this conversation,
(17:37):
we weren't told that this was like a dirty word
to use when we were growing up, but there's just
there's a lot more education, like as we find out
that this impacts more and more people than, than we
initially than we initially thought, there's a call for us
to be more responsible in like we're talking about personal
1 to 1 communications here. But Melissa's Melissa has a
(17:58):
big focus on mass communications and broad media and mass
internal communications and things like that. So that's one front
in terms of training ourselves. And then there's another if
you're new to even the idea that there are mental
health challenges that you've been struggling with for years, then
you're going to have your own personal stigma. And because
(18:20):
we have our own personal stigmas, we need to be
able to access care in completely well access care or
access some sort of communication and completely stigma free environments.
And those are scenarios in which people might not be
ready to talk to someone face to face, or if
they were to talk to someone face to face, they
would not tell the truth about their issues, not be 100%
(18:42):
honest and transparent. There needs to be an openness to
stigma free environments as well.
Sondra (18:46):
I'm also starting to see a shift toward and I
think this is a stigma about mental health, that it's
chronic and lifelong versus this idea that we can have
sort of episodic mental health challenges throughout our life. It
might be tied to a trauma. I think I've shared
with you that I lost a son in 2021 and
(19:10):
I very much had a very challenging 2021 that needed
some therapeutic intervention. So this idea that, you know, there
are going to be events in our lives that we
need to address in some way with a mental health
professional or a company like Robot or in combination.
Chris (19:30):
Something major to address there. And again, want to be
fully transparent. I am new to the digital mental health space.
I think I started with Woba in May 2022, but
one thing that that has guided me to is a
lot like works with a background in data science. Like
that's a it's a very specific and narrow domain where,
(19:52):
you know, I'm performing operations with, with large data sets
and everything like that. But in order to make sure
that we're doing the right thing, that we're analyzing the
right things. There's a lot of communication with the psychologists
and clinicians on our team. There's a book by Dr.
David Burns called Feeling Great, and I recommend that one
for people who are like, It doesn't matter if you're
using robot or not. I just think that like being
(20:14):
equipped with kind of self-help understanding, like especially from people
who are involved very deep in the founding and spread
of cognitive behavioral therapy. This is a great book to
read because it talks about scenarios in which Dr. David
would have conversations with people who thought that their issues
were chronic, but he would get deep down to the
(20:38):
underlying thoughts that might have been manifesting themselves in all
kinds of other ways and kinds of anxieties and depressions
and things like that. So this doesn't apply to literally
every scenario. But I think that there needs to be
a much more nuanced understanding of what mental health care
challenges are and and, you know, how some of the
like some approaches that people might be able to take
(21:00):
and some things that people might be able to do
to help themselves as well.
Sondra (21:03):
Exactly. You know, we often assume that consumers want to
talk to a mental health professional when they want help.
You talked about being a companion to potentially talking to someone,
but there's also data that shows that 25% of only 25%
(21:24):
of consumers, it's a study of 8 million consumers conducted
by the mental health by mental Health America, that only 25%
of consumers wanted to talk to a professional. What they
wanted was information and do it yourself tools. And then
some people really just want to talk to a peer
or a family member as opposed to a trained mental
health professional. What would it look like if we took
(21:47):
that statistic to heart, that 25% statistic, and we designed
mental health solutions based on what consumers. Actually want instead
of what we think they want.
Chris (22:00):
You know, it goes back to that word we were
discussing a little bit earlier, listening. I think that part
of what that would look like is finding more opportunities
to identify where people are with their mental health and
like direct them to the resources that make the most
sense for them. Listening, of course. Like what? What might
(22:21):
need to happen first before listening is asking. So it's
being able to communicate and ask those questions. Like if
we're if we're talking about like in a clinician environment
of one major stat, I forget where exactly it comes from,
but it's discussed is that I think about 75% of
where we see mental health issues surface happens in the
(22:44):
primary care setting, not in the like. That makes sense
because a lot of times you might be seeing a
mental health professional as a result of a referral, but
if all that's happening in a primary care setting, but
there are not mechanisms in place to to guide people
to resources that would be effective for them, then then
(23:04):
mean we lead to to where we are right now.
So I think a lot of it a big part
of the focus and a big part of conversation that
that I've been seeing in the past year is this
concept of bringing behavioral health resources closer to the primary
care setting. You said in on this session that we
did a lot on. It was very heavily oriented on
(23:27):
what we call coordinated care or behavioral health integration. I
feel like that's a major a major component of what
a listing system would look like. And just further on
to that, it's you have the listening component, but then
what happens next perhaps like and identification of what's going
to work best for people where they are. Perhaps if
(23:47):
someone has never seen a therapist and has difficulty with
understanding therapeutic language and discomfort with talking directly to them,
that is where like a digital health solution can come
into play versus other people might have needs that are
more acute and be more ready or ready to talk
to someone in person. It's a matter of understanding which
people descend where you're.
Sondra (24:08):
Talking about this idea of doing a better job in
health care, of integrating mental health services with primary care.
What are some ways that we can integrate mental health
into more traditional health care, particularly as you talked about
at the primary care level?
Chris (24:27):
There's the primary care level and there are just many
other areas where this applies. And I think that one
important first step is to identify where the opportunity is
or where the need is for a specific health system.
For example, there's a study in the AMA that Intermountain Healthcare,
(24:48):
Intermountain Healthcare published about integrating behavioral health with a diabetes
management program, with the investment required with behavioral health integration.
Like clearly an organization would want to know that this
approach is going to be effective for patients. I think
that it's a matter of finding the appropriate literature, finding
(25:09):
the appropriate science where we're available and using that, like
using that as a little bit of a blueprint for
the types of approaches that you might take given the
realities of your own situation. With the Intermountain study, for example,
they basic hypothesis was that if if you have a
diabetes population that has unaddressed mental health care needs, then
(25:31):
they're going to be less likely to adhere to the
to their prescriptions and their physician's direction and the things
that they need to do to work along with their
providers to to better their care. It's a connection between
mental health and physical health that they were hypothesizing about.
So in the study, you had a situation where they
randomized people into groups, where they were, where there was
(25:52):
a behavioral health, behavioral health resources, very close to the
diabetes management and those that where they weren't I don't
remember the exact numbers here, but there was a statistically
significant bending of the cost curve by addressing that. So again,
that's Intermountain Healthcare, a major value based organization, incorporating that
in a way that was beneficial to patients and also
(26:17):
like benefit cost curves as well. So it's just one
of the one of the examples that you might want
to look for when examining the body of research and
identifying whether this approach might work for your health system.
Sondra (26:28):
So last question, Chris. If you were going to transform
the nation's approach to mental health care, where would you start?
Chris (26:40):
I ask a similar question on on meeting of the
minds around. If you had a magic wand, what's the
one thing that you would change but where you would start?
Like I have the advantage of having so many, so
many other people's answers kind of floating and floating in
my head. So now that it's getting it back. Where
would start is at the beginning of the conversation, I
talked about the fact that we often don't think that
(27:03):
these mental health care situations apply to us. I think
if I had a magic wand, it would be addressing
the needs of every individual out there. So this might
be I could give a more practical example, but but really,
where I want to where I want to go is
like a culture that understands our own personal needs and
(27:25):
understands the needs of other people and are able to
empathize with other people. Like I think that developing a
more understanding population and destigmatizing mental health care at the
individual level would have gigantic rippling effects across the like,
across the culture and across the, I guess, the health
economic scenario.
Sondra (27:44):
So that means acknowledging that only 25% of consumers actually
want to talk to a mental health professional. That other 75%
are looking for other avenues to support them from a
mental health perspective.
Chris (28:01):
Yeah, understanding when and what is right right for people
and acknowledging the barriers that would prevent somebody from wanting
to talk to someone even if they had access and
even if they could afford it. The additional barrier of
like wanting to engage in that conversation.
Sondra (28:17):
Which is what you all are doing about health.
Chris (28:20):
That's a major focus that that's a major reason why Dr.
Ali started the company. Well, thank.
Sondra (28:25):
You, Chris. This has been such a great conversation. I
have really appreciated your time. I'm looking forward to sharing
this out more broadly. Just as a reminder to those
who are listening, DRG has been conducting a series of
content pieces on empathy, so there's a link in the
show notes to this series. If you are interested in
(28:49):
this fourth piece of content in the series, which is
really tied to this idea of empathy and mental health.
Thank you all very much and I look forward to
our next conversation. Chris much.
Chris (28:59):
Appreciated. Thankful to be here and appreciate your research focus.
Laura (29:07):
Mental health is a vital component of our overall well-being,
but it is often stigmatized or misunderstood. According to the
World Health Organization. 1 in 4 people in the world
will be affected by a mental or neurological disorder at
some point in their lives. In the United States, nearly 20%
of adults experience mental illness each year, and more than 50%
(29:28):
of them do not receive any treatment. Why is this
a problem? Because untreated mental illness can have serious consequences.
It can impair physical health, reduce productivity, increase disability and
lower quality of life. It can also increase the risk
of chronic diseases, substance abuse, violence and suicide. Moreover, untreated
(29:50):
mental illness can impose a huge economic burden on the
health care system. In 2019, the US spent an estimated
$225 Million on Mental Health care, accounting for 5.5% of
total health care spend. However, much of this spend was
deemed inefficient. How can we improve the situation? One way
(30:10):
is to rethink how we deliver and pay for mental
health care. A recent article by Deloitte highlights some of
the challenges and opportunities for transforming mental health care in
the US through a human centered vision for a more
accessible and effective mental health ecosystem that involves five major shifts. First,
expanding the mental health workforce by attracting and retaining more
(30:33):
diverse and qualified professionals, especially in underserved areas. Second, transforming
the user navigation experience by simplifying and streamlining the process
of finding and accessing appropriate care and support. Third, catalyzing
the development of innovative models of care delivery that integrate
behavioral and physical health. Leverage technology and data and offer
(30:56):
more choice and flexibility for consumers. Fourth, increasing public and
private insurance coverage by enforcing parity laws, eliminating discriminatory policies,
and expanding telehealth reimbursement. Fifth, building long term relationships with
consumers by providing ongoing care coordination. Another opportunity for improving
(31:18):
mental health is to develop culturally competent mental health solutions
that respect and respond to the different values, beliefs, practices
and experiences of people from different backgrounds and identities. This
can help address the disparities and discrimination that people face
in accessing mental health care and improve their trust and engagement.
(31:39):
It's imperative to recognize that mental wellness is not equivalent
to clinical diagnosis. Mental wellness is a broader concept that
encompasses not only the absence of mental illness, but also
the presence of positive emotions, thoughts, behaviors and relationships. Mental
wellness can be influenced by many factors beyond clinical diagnosis
(31:59):
in promoting mental wellness, supporting self-care and fostering empathy, we
can assist in creating a culture of compassion and understanding
for people who experience mental health challenges or seek mental
health care. In conclusion, mental health is a critical issue
that affects millions of people and challenges the traditional health
care system. We need to rethink how we deliver and
(32:20):
pay for mental health care and create a more accessible,
equitable and effective mental health ecosystem that can meet the
needs and preferences of consumers and improve their well-being.
We'd like to give a big thank you to our
guests and, of course, the consumers who share their thoughts
with us today. If you are looking for more information
on this topic, you can subscribe to our four part
(32:41):
Empathy Whitepaper series. You can go to our show notes
for a link to that content.
All right, you guys, thanks so much for tuning in.
If you like what you heard, please share rate and
review on Apple, Spotify or your favorite podcasting platform. For
more content about simplifying health care, visit DRG. Inc.com. That's inc.com.
(33:04):
This show is produced by Shift Forward Health, The channel
for Change Makers. Subscribe to Shift Forward help on your
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Health one subscription. All the podcasts you need and it's
all for free. We'll see you next time on what
Consumers want.
Welcome to what Consumers Want, the podcast that brings the
voice of the consumer to the health care conversation. Are
you interested in getting outside the health care echo chamber?
Using research and insights, we explore key health care opportunities
through the eyes of the end consumer. We examine trends
outside of health care that are driving consumer expectations, as
well as what consumers expect from brands now and in
(00:25):
the future. This podcast is brought to you by a
market research firm that unlocks the whole mind for deeper insights.
I'm your host, Laura McCabe. Let's find out what consumers want.
This month, we're going to explore mental health and its
increasingly important role to consumers. We have a great conversation
on deck for you with MDGs, Sandra Brown and our guests,
(00:47):
Chris Hemphill, senior director, commercial intelligence at Robert. You will
hear Chris and Sandra dig in to the role of
empathy in providing consumers with better mental health solutions and experiences.
And this week's Outside the Echo Chamber will explore mental
health as a critical issue that affects millions and challenges
the traditional health care system. We will, of course, hear
(01:10):
from our consumers this month. We ask consumers, Where do
you go for support during tough times? Here's what they
had to say.
Consumer #1 (01:17):
Usually I go first to my spouse or secondly to
my adult children, or thirdly, to a close friend or
colleague and work.
Consumer #2 (01:27):
I usually go to my partner or some friends like
to get together during tough times. When I really think
about it, the one person I always go to to
rely on for strengths and support and advice is my mom.
Consumer #3 (01:42):
During tough times, I usually turn to my sister because
no one knows me better. My family, my husband. My friends. Therapy.
Sondra (01:57):
Hello. I am here with Chris Hemphill, a data science
expert in digital mental health. I know that they are
an avid runner and an amazing podcast host. The current
podcast being meeting of the Minds. Welcome, Chris.
Chris (02:13):
Appreciate the intro. Thank you. Sandra.
Sondra (02:15):
It might be helpful for you to tell us a
bit about your role at Robot and about Robot itself
before we get into some of my questions.
Chris (02:25):
Okay. Okay. Well let's start with robot itself. Whoa Bot
is a chat app. It's a tool that is there
for people when they have mental health needs. So think
about the ability to have a conversation. And it was
with a bot or I think people say relational agent,
if they want to sound fancy, I say chat bot.
(02:45):
It's a model that is trained on cognitive behavioral therapy
along with other therapeutic methods. So the whole idea and
this this company has been around since before all this
chat GPT stuff, I have to bring it up. It's
been around since 2017, so it's been a focus on
having a conversational way to talk about these challenges that
(03:08):
you might be having from a mental health perspective for
for a very long time. Established by Dr. Ali D'Arcy,
who is a Stanford trained clinical psychologist. I think that
it's important to bring that up because the whole idea
behind these conversations is not to generate these just semi
random answers to the prompts that people are putting in
(03:30):
or the responses that people are putting in. But really
to go down very specific, clinically validated pathways to help
guide people through a CBT process. So my role within
that like this is a this is an app that
is like clearly being a chat bot is very, very
focused on having an open communication, a natural communication back
(03:54):
and forth between the agent. So my role in data
science is to understand the communication patterns that are happening
at an aggregate level and help health care decisions better,
make decisions about things like behavioral health integration and how
this might play a role within their overall ecosystem. I
(04:17):
don't know if that sounds weird. It does. That clearly
lay it out. Is that.
Sondra (04:23):
Crazy? And I think that with all of the conversation
that's going on about ChatGPT right now, that description might
have not been as intuitive even 6 or 9 months ago.
So think that it should be very clear as to
the role that robot is playing. One of the things
that I love about it that we've talked about is
(04:44):
the fact that it is 24 over seven, seven days
a week, 365 days a year. So it is an
always on solution for people when they need to access
mental health resources.
Chris (04:59):
Yeah, that's an extremely important point because when we talk
about the company's mission is a radically accessible care. But
when we talk about the access challenge, it's not just
limited to the fact that there is a major shortage
of workers who can look like we're talking about clinical
psychologist or licensed clinical social workers. Like there's there's a
(05:22):
shortage of people that can address mental health needs. But
even if we were to solve for that, one thing
that that's extremely important is that between 72 and 78%,
depending on what population you're looking at of the usage
within what happens outside of your 9 to 5 clinic
hours with a heavy concentration of like our longest conversations
(05:43):
around 2 a.m.. So we look at it as an adjunct,
something that that can work alongside and a lot of
significant number of our users are seeing therapist or are
seeing seeing psychiatrists and things like that. But this is
something that works alongside, especially in times that people have
needs that that just can't be addressed in person.
Sondra (06:05):
I love that. But one of the things that we
are doing here at DRG is really exploring the role
of empathy in providing consumers with better mental health solutions
and better experiences. I'd love your thoughts on the role
that empathy plays in this arena or not at all
(06:29):
from your perspective.
Chris (06:30):
You know, there's the role that empathy does play and
should play. I'd like to focus a lot on on
just I can't say we I'm going to say me
personally what I see as an ideal. I honestly just
had a conversation yesterday with Dr. Dr. Edwards, who is
a she's a practicing gastroenterologist, but also just wrote a
(06:53):
book called Navigating Your Health Care Journey. And the reason
I want to focus in on that is because she
was talking about the challenges and difficulties that people have,
like accessing services that they need, advocating for themselves if
they don't feel like their provider team caretaking team is
listening to them. These are the types of issues that
that she was talking about. And the major the reason
(07:16):
that she wrote that book, which is directed towards the consumers,
literally a guide, an instruction manual on how to navigate
within a complex health care system for patients like me
and consumers like me and things like that. But the
reason she wrote that book is because she said that
always on her mind is like no matter what role
she's been in. So like, she's been in leadership and
(07:38):
executive roles within payers and within health systems and providers,
associate medical director roles and things like that. But the
empathy part is what's kept her grounded and kept the
patient as the North Star. So it was just a
reminder that whatever position you're in because, you know, she's
a practicing gastroenterologist. To what better position than having your
(07:59):
hands directly involved in a patient's life? But when you
start getting removed from that through layers of management and
spreadsheets and things like that, it's important for everybody within
health care, whether you're in it or analytics or marketing
or what have you, to just find some way to
center back on the people who are ultimately going to
(08:20):
be impacted and often even put yourself in their shoes
so that you can basically inform the work that you're doing.
I don't know if that's too broad an answer, but
I just think that that empathy has a really powerful
role to play if we approach it right.
Sondra (08:36):
I agree that we are researchers here at and some
of the biggest complaints that we get about the health
care experience from a consumer perspective is my provider doesn't
listen to me. I don't feel seen and heard and
I want to be more involved in my health care.
(08:57):
So this idea that she brings up of how do
you advocate for yourself, aka, how do you become more
involved in your own care, the choices for care and
and outcomes. I'm curious, like if we had to bring
empathy down to a definition, how would you define empathy?
Chris (09:16):
There's a number of definitions I would I would use
and some of those definitions I would say, well, it
doesn't really exist because I don't think that you can
actually feel what another person is feeling. You can make
assumptions about what people are feeling and kind of operate
within the within those parameters, but that's getting too nitty gritty,
That's getting to like that. That's not respecting the need,
(09:39):
the like, the concept of empathy that we need. So
I like to boil empathy down into making the effort
to put yourself in someone else's shoes. So like we
can we can have a philosophical debate about like whether
we can truly feel what someone else is feeling, but
at least taking the effort to attempt to understand and knowing,
(10:00):
like if we go from the acknowledgement that like, hey,
just by looking at you, by seeing that you're smiling,
I can't necessarily assume that that you're happy. It could
be hiding many other things that like, there's all kinds
of reasons that somebody could smile that are not related
to happiness. So it's like perhaps it's understanding that you
don't understand and have to ask and have to go
(10:21):
layers deeper to really confirm what people are thinking and
how the things that they're going through. My impact, what
they're doing today and how they're treating you agreed.
Sondra (10:30):
So making the effort which underpinning that is her notion
of listening. Because if you're going to make the effort,
you're going to have to listen to someone else's experience
and try to understand that.
Chris (10:42):
Yeah. And that listen word is is so powerful and
so necessary. And even as much as we like, we
have phrases like two years in one mouth. But I
still think listening is underappreciated and undervalued.
Sondra (10:55):
Exactly. So how can we promote more empathy if we're
going to operate from your definition? For the purposes of
this discussion, how can we promote empathy and emotional intelligence
in health care professionals, particularly those who are working with
mental health patients or in the mental health space?
Chris (11:16):
Well, gosh, with health care professionals, they're going through such
a ridiculous and burdensome amount of work. In a lot
of cases. Again, we talk about the overall shortage and
lack of supply. Oftentimes, like when we're talking about workers
in behavioral health or clinicians in other fields, be they nurses,
(11:38):
doctors or technologists or what have you, there's often something
really deep at an organizational level that kind of cascades
downward into how patients might be treated. So if people
are let's take a residency program. Where you have these
people who are newly like newly delivering care on the
(12:00):
floor and working for nearly 100 hours a week while
being told that they're only supposed to report a 40
or certain a certain number of hours. It's a system
that grinds people to the bone and like think about
if we were to take people that were already this
taxed and then introduce some classes and exercise and things
like that, like that takes away from other other time
(12:23):
that people might have. And I just think that a
big issue with addressing empathy is figuring out how to
improve working, working conditions for our employees and make sure
that they are heard and like responding to a lot
of things that they need. There's just so much work
to do and so little support and emotional support and
(12:43):
policy to get it done.
Sondra (12:44):
And so taking away some of the busy work so
that they do have the time to really sit down
and listen. I've read an interesting article last week on
this idea of using AI and ChatGPT to perform some
of the administrative tasks that we expect of health professionals
(13:08):
so that they do have more time to really spend
with their patients. So not using these technology solutions to replace,
but to take away the things that cause the distractions.
Chris (13:22):
Yeah, I can understand where some of those tools might
be helpful and useful if you're because when I think
about a generative AI platform, let's go to a large
language model, like a chat GPT, for example. There's the
output that happens if someone who has no clue about
(13:42):
the underlying practice, just type it like you type in something.
If I am a complete layperson and I have no
idea what the context behind that is and I send
that to a patient or I send that to someone else,
then that's a major danger. I love your point on
not looking at this as a replacement to people who
are already working in that space, because the degree to
which it's even accurate, to the degree to which to
(14:04):
which it is helpful is semi random versus if you
have someone who is they have this experience, they understand
what the content that that's being produced and they kind
of like when you're working with those platforms, you're kind
of having a back and forth conversation with it. You
tell it to say one thing and it doesn't quite
hit the mark that you were looking for, and you
(14:26):
wouldn't know if it doesn't hit the mark. If you're
not a trained professional, you're going back and forth until
it's refined into something that's usable, which you might end
up editing. That takes away a significant amount of time
at like generating the a lot of the baseline and
things like that or like organizing your thoughts and things
like that. But still is a scenario where a professional,
(14:46):
a trained professional is at the helm and ultimately, ultimately
we just don't want to just blindly trust what comes
out of it.
Sondra (14:54):
Sure. One of the things that you mentioned when you
were describing who Cobot is to us at the beginning
of this conversation, we talked about this idea of access, Right?
We do have an access issue right now in in
mental health and with mental health providers. So let's kind
of talk a bit more about that. But if we
(15:15):
could start first to just a little more broadly, what
are some of the common misperceptions about mental health currently
in our country and how can some of these be addressed?
Big question.
Chris (15:29):
Yes, a very important question in my community and where
I grew up and how I grew up, one of
the biggest misperceptions is that it doesn't apply to me.
I think that a lot of people, the way mental
health is, is portrayed. There's a lot of focus on
really extreme examples or fictionalized examples of certain illnesses, and
(15:53):
that causes people to divorce from the reality of things
that that might be impacting themselves. I think that the
mass trauma of Covid 19 forced a conversation, forced people
to start looking inwardly at maybe recontextualizing issues that have
been stemming since childhood, things that that have been stemming
(16:14):
for a very long time. There is kind of a
mass re conceptualization where people are now realizing like, hey,
this does apply to me and this isn't just for
for those most extreme, extreme cases. And most importantly from this,
this mass realization is there's been some level of stigmatization
(16:35):
around certain illnesses. I still say that mental health is
heavily stigmatized, extremely difficult for many people to talk about,
but there's a little bit of a crack in the
door that's happening right now.
Sondra (16:47):
Do you have any thoughts on how we open that
door wider? How do we address some of the stigma
and these misperceptions?
Chris (16:55):
Sometimes there's a couple of fronts here which at one level,
addressing the stigma, I'll just call her out. Melissa Shackelford.
She's currently the managing director of marketing at Evernorth. And
I think that she's leading a really big conversation, at
least within a well, partially and heavily within the communications
(17:16):
context on understanding when you actually are using stigmatizing language.
For example, I am guilty. I earlier in this conversation,
just offhand, I use the word crazy to describe something
and I slapped myself. I was like, dang. But yeah,
literally guilty of that. Using stigmatizing language. In this conversation,
(17:37):
we weren't told that this was like a dirty word
to use when we were growing up, but there's just
there's a lot more education, like as we find out
that this impacts more and more people than, than we
initially than we initially thought, there's a call for us
to be more responsible in like we're talking about personal
1 to 1 communications here. But Melissa's Melissa has a
(17:58):
big focus on mass communications and broad media and mass
internal communications and things like that. So that's one front
in terms of training ourselves. And then there's another if
you're new to even the idea that there are mental
health challenges that you've been struggling with for years, then
you're going to have your own personal stigma. And because
(18:20):
we have our own personal stigmas, we need to be
able to access care in completely well access care or
access some sort of communication and completely stigma free environments.
And those are scenarios in which people might not be
ready to talk to someone face to face, or if
they were to talk to someone face to face, they
would not tell the truth about their issues, not be 100%
(18:42):
honest and transparent. There needs to be an openness to
stigma free environments as well.
Sondra (18:46):
I'm also starting to see a shift toward and I
think this is a stigma about mental health, that it's
chronic and lifelong versus this idea that we can have
sort of episodic mental health challenges throughout our life. It
might be tied to a trauma. I think I've shared
with you that I lost a son in 2021 and
(19:10):
I very much had a very challenging 2021 that needed
some therapeutic intervention. So this idea that, you know, there
are going to be events in our lives that we
need to address in some way with a mental health
professional or a company like Robot or in combination.
Chris (19:30):
Something major to address there. And again, want to be
fully transparent. I am new to the digital mental health space.
I think I started with Woba in May 2022, but
one thing that that has guided me to is a
lot like works with a background in data science. Like
that's a it's a very specific and narrow domain where,
(19:52):
you know, I'm performing operations with, with large data sets
and everything like that. But in order to make sure
that we're doing the right thing, that we're analyzing the
right things. There's a lot of communication with the psychologists
and clinicians on our team. There's a book by Dr.
David Burns called Feeling Great, and I recommend that one
for people who are like, It doesn't matter if you're
using robot or not. I just think that like being
(20:14):
equipped with kind of self-help understanding, like especially from people
who are involved very deep in the founding and spread
of cognitive behavioral therapy. This is a great book to
read because it talks about scenarios in which Dr. David
would have conversations with people who thought that their issues
were chronic, but he would get deep down to the
(20:38):
underlying thoughts that might have been manifesting themselves in all
kinds of other ways and kinds of anxieties and depressions
and things like that. So this doesn't apply to literally
every scenario. But I think that there needs to be
a much more nuanced understanding of what mental health care
challenges are and and, you know, how some of the
like some approaches that people might be able to take
(21:00):
and some things that people might be able to do
to help themselves as well.
Sondra (21:03):
Exactly. You know, we often assume that consumers want to
talk to a mental health professional when they want help.
You talked about being a companion to potentially talking to someone,
but there's also data that shows that 25% of only 25%
(21:24):
of consumers, it's a study of 8 million consumers conducted
by the mental health by mental Health America, that only 25%
of consumers wanted to talk to a professional. What they
wanted was information and do it yourself tools. And then
some people really just want to talk to a peer
or a family member as opposed to a trained mental
health professional. What would it look like if we took
(21:47):
that statistic to heart, that 25% statistic, and we designed
mental health solutions based on what consumers. Actually want instead
of what we think they want.
Chris (22:00):
You know, it goes back to that word we were
discussing a little bit earlier, listening. I think that part
of what that would look like is finding more opportunities
to identify where people are with their mental health and
like direct them to the resources that make the most
sense for them. Listening, of course. Like what? What might
(22:21):
need to happen first before listening is asking. So it's
being able to communicate and ask those questions. Like if
we're if we're talking about like in a clinician environment
of one major stat, I forget where exactly it comes from,
but it's discussed is that I think about 75% of
where we see mental health issues surface happens in the
(22:44):
primary care setting, not in the like. That makes sense
because a lot of times you might be seeing a
mental health professional as a result of a referral, but
if all that's happening in a primary care setting, but
there are not mechanisms in place to to guide people
to resources that would be effective for them, then then
(23:04):
mean we lead to to where we are right now.
So I think a lot of it a big part
of the focus and a big part of conversation that
that I've been seeing in the past year is this
concept of bringing behavioral health resources closer to the primary
care setting. You said in on this session that we
did a lot on. It was very heavily oriented on
(23:27):
what we call coordinated care or behavioral health integration. I
feel like that's a major a major component of what
a listing system would look like. And just further on
to that, it's you have the listening component, but then
what happens next perhaps like and identification of what's going
to work best for people where they are. Perhaps if
(23:47):
someone has never seen a therapist and has difficulty with
understanding therapeutic language and discomfort with talking directly to them,
that is where like a digital health solution can come
into play versus other people might have needs that are
more acute and be more ready or ready to talk
to someone in person. It's a matter of understanding which
people descend where you're.
Sondra (24:08):
Talking about this idea of doing a better job in
health care, of integrating mental health services with primary care.
What are some ways that we can integrate mental health
into more traditional health care, particularly as you talked about
at the primary care level?
Chris (24:27):
There's the primary care level and there are just many
other areas where this applies. And I think that one
important first step is to identify where the opportunity is
or where the need is for a specific health system.
For example, there's a study in the AMA that Intermountain Healthcare,
(24:48):
Intermountain Healthcare published about integrating behavioral health with a diabetes
management program, with the investment required with behavioral health integration.
Like clearly an organization would want to know that this
approach is going to be effective for patients. I think
that it's a matter of finding the appropriate literature, finding
(25:09):
the appropriate science where we're available and using that, like
using that as a little bit of a blueprint for
the types of approaches that you might take given the
realities of your own situation. With the Intermountain study, for example,
they basic hypothesis was that if if you have a
diabetes population that has unaddressed mental health care needs, then
(25:31):
they're going to be less likely to adhere to the
to their prescriptions and their physician's direction and the things
that they need to do to work along with their
providers to to better their care. It's a connection between
mental health and physical health that they were hypothesizing about.
So in the study, you had a situation where they
randomized people into groups, where they were, where there was
(25:52):
a behavioral health, behavioral health resources, very close to the
diabetes management and those that where they weren't I don't
remember the exact numbers here, but there was a statistically
significant bending of the cost curve by addressing that. So again,
that's Intermountain Healthcare, a major value based organization, incorporating that
in a way that was beneficial to patients and also
(26:17):
like benefit cost curves as well. So it's just one
of the one of the examples that you might want
to look for when examining the body of research and
identifying whether this approach might work for your health system.
Sondra (26:28):
So last question, Chris. If you were going to transform
the nation's approach to mental health care, where would you start?
Chris (26:40):
I ask a similar question on on meeting of the
minds around. If you had a magic wand, what's the
one thing that you would change but where you would start?
Like I have the advantage of having so many, so
many other people's answers kind of floating and floating in
my head. So now that it's getting it back. Where
would start is at the beginning of the conversation, I
talked about the fact that we often don't think that
(27:03):
these mental health care situations apply to us. I think
if I had a magic wand, it would be addressing
the needs of every individual out there. So this might
be I could give a more practical example, but but really,
where I want to where I want to go is
like a culture that understands our own personal needs and
(27:25):
understands the needs of other people and are able to
empathize with other people. Like I think that developing a
more understanding population and destigmatizing mental health care at the
individual level would have gigantic rippling effects across the like,
across the culture and across the, I guess, the health
economic scenario.
Sondra (27:44):
So that means acknowledging that only 25% of consumers actually
want to talk to a mental health professional. That other 75%
are looking for other avenues to support them from a
mental health perspective.
Chris (28:01):
Yeah, understanding when and what is right right for people
and acknowledging the barriers that would prevent somebody from wanting
to talk to someone even if they had access and
even if they could afford it. The additional barrier of
like wanting to engage in that conversation.
Sondra (28:17):
Which is what you all are doing about health.
Chris (28:20):
That's a major focus that that's a major reason why Dr.
Ali started the company. Well, thank.
Sondra (28:25):
You, Chris. This has been such a great conversation. I
have really appreciated your time. I'm looking forward to sharing
this out more broadly. Just as a reminder to those
who are listening, DRG has been conducting a series of
content pieces on empathy, so there's a link in the
show notes to this series. If you are interested in
(28:49):
this fourth piece of content in the series, which is
really tied to this idea of empathy and mental health.
Thank you all very much and I look forward to
our next conversation. Chris much.
Chris (28:59):
Appreciated. Thankful to be here and appreciate your research focus.
Laura (29:07):
Mental health is a vital component of our overall well-being,
but it is often stigmatized or misunderstood. According to the
World Health Organization. 1 in 4 people in the world
will be affected by a mental or neurological disorder at
some point in their lives. In the United States, nearly 20%
of adults experience mental illness each year, and more than 50%
(29:28):
of them do not receive any treatment. Why is this
a problem? Because untreated mental illness can have serious consequences.
It can impair physical health, reduce productivity, increase disability and
lower quality of life. It can also increase the risk
of chronic diseases, substance abuse, violence and suicide. Moreover, untreated
(29:50):
mental illness can impose a huge economic burden on the
health care system. In 2019, the US spent an estimated
$225 Million on Mental Health care, accounting for 5.5% of
total health care spend. However, much of this spend was
deemed inefficient. How can we improve the situation? One way
(30:10):
is to rethink how we deliver and pay for mental
health care. A recent article by Deloitte highlights some of
the challenges and opportunities for transforming mental health care in
the US through a human centered vision for a more
accessible and effective mental health ecosystem that involves five major shifts. First,
expanding the mental health workforce by attracting and retaining more
(30:33):
diverse and qualified professionals, especially in underserved areas. Second, transforming
the user navigation experience by simplifying and streamlining the process
of finding and accessing appropriate care and support. Third, catalyzing
the development of innovative models of care delivery that integrate
behavioral and physical health. Leverage technology and data and offer
(30:56):
more choice and flexibility for consumers. Fourth, increasing public and
private insurance coverage by enforcing parity laws, eliminating discriminatory policies,
and expanding telehealth reimbursement. Fifth, building long term relationships with
consumers by providing ongoing care coordination. Another opportunity for improving
(31:18):
mental health is to develop culturally competent mental health solutions
that respect and respond to the different values, beliefs, practices
and experiences of people from different backgrounds and identities. This
can help address the disparities and discrimination that people face
in accessing mental health care and improve their trust and engagement.
(31:39):
It's imperative to recognize that mental wellness is not equivalent
to clinical diagnosis. Mental wellness is a broader concept that
encompasses not only the absence of mental illness, but also
the presence of positive emotions, thoughts, behaviors and relationships. Mental
wellness can be influenced by many factors beyond clinical diagnosis
(31:59):
in promoting mental wellness, supporting self-care and fostering empathy, we
can assist in creating a culture of compassion and understanding
for people who experience mental health challenges or seek mental
health care. In conclusion, mental health is a critical issue
that affects millions of people and challenges the traditional health
care system. We need to rethink how we deliver and
(32:20):
pay for mental health care and create a more accessible,
equitable and effective mental health ecosystem that can meet the
needs and preferences of consumers and improve their well-being.
We'd like to give a big thank you to our
guests and, of course, the consumers who share their thoughts
with us today. If you are looking for more information
on this topic, you can subscribe to our four part
(32:41):
Empathy Whitepaper series. You can go to our show notes
for a link to that content.
All right, you guys, thanks so much for tuning in.
If you like what you heard, please share rate and
review on Apple, Spotify or your favorite podcasting platform. For
more content about simplifying health care, visit DRG. Inc.com. That's inc.com.
(33:04):
This show is produced by Shift Forward Health, The channel
for Change Makers. Subscribe to Shift Forward help on your
favorite podcast app and you'll be subscribed to our entire
library of shows. See our full lineup at Shift Forward
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