Patrick Cournoyer: Anxiety at work. I am sure the majority of you have been hearing discussions about this in your conversations, both at work and at home as so many organizations begin to transition to reopening offices. Dr. Georgia Gaveras is joining the conversation today to discuss anxiety, what it means for an individual, and how organizations can think about incorporating an approach to mental health in an effective way.
Georgia has over seventeen years of experience and has also founded an organization called Talkiatry, which is helping to shape the future of mental health services. Georgia, thank you so much for joining the conversation today.
Dr. Georgia: It’s good to be here. Thank you for having me.
Patrick Cournoyer: This season of the Be More podcast, we have been very focused on wellbeing in many different aspects. The conversations have ranged from talking about financial wellbeing, physical wellbeing, but the most prominent topic that we have been discussing, and also that we are seeing across the world, but very specifically in the United States as well, is this topic around mental wellbeing, mental health, and how conversations in the workplace around mental health and mental wellbeing have really become much more accepted, much more prominent.
That’s amazing in a lot of ways, but that’s also really challenging for so many organizations and for leaders and executive leaders, and also for employees because we’re in this new world of being able to speak a bit more comfortably, or a bit more honestly in a lot of ways about mental health. As you know that comes with a lot. First off, I’d like to understand a bit about your journey because you’ve had quite an interesting one, and you’ve built a company to help address some of this. In a couple of minutes, could you tell us a little bit about you and your background and what inspired you to be doing the work that you’re doing today?
Dr. Georgia: Sure. I’ll fast forward to medical school. I started medical school in 1999 and I thought I was going to be a surgeon. I actually was in medical school from ’99 to ’03. During my surgery rotation, which I was very excited about, I was in New Jersey, I was rotating at a hospital and 9/11 happened. My surgery rotation was atrocious because in my mind, I connect surgeries to 9/11. I’m from New York, I was born and raised in Manhattan, this is home. It was a terrible time. Surgery was off the table. It wasn’t necessarily that inspired me to be a psychiatrist, but just surgery was off the table at that point.
All of a sudden, I had to figure out what I was going to be when I grew up. I started doing my rotations and I got to my psychiatry rotation. I was like, “Wow, this is really cool. This is genuinely cool.” I ended up being a psychiatrist. I came back to New York, did my residency, I became a child psychiatrist, did a child psychiatry fellowship. Then my first job after fellowship was in a program working with kids who were dually diagnosed, both with mental illness and substance use disorders. It was a day program. The kids came in every day, they had their school there, they got their mental health treatment there, and it was amazing. You really become immersed in these people’s lives.
I saw those kids at the program more than their parents saw them. Really when you think about it, eight hours a day, every day. It was incredibly rewarding. I absolutely loved it. It also got me really interested in academia. I was affiliated with a hospital. I eventually became a Fellowship Director in Child and Adolescent Psychiatry. I was teaching a lot of residents. The thing about working in academia is you keep getting older, but fellows and residents stay about the same age, so you just see the gap getting bigger, but also eye-opening because you see the generational shift. I’m very firmly Gen X, then I had the millennials. Now we have Gen Z.
You see all the differences in how they look at mental health. Then I was working with teenagers, so you see this great span. For personal reasons, my career changed, a lot of different things happened. I still stayed academically affiliated with my clinical work. I had to switch to something that was not as intense because I didn’t have the time to spend with patients in that way, so I started working more in emergency rooms. What happens when you work in emergency rooms is that you see people at their worst. You see when all other things have failed for the most part, what happens?
Long story short, I’ve been working really hard in emergency rooms for a long time. My last job was running a pretty, fairly busy emergency room, one of the busiest actually in the country. It was just really, really hard for staff at that point. I went from working so hard with my patients to really seeing a problem with staff. They were really burned out. I stopped working in emergency rooms full time right in the middle of the pandemic, actually last spring. That was not because of the pandemic. I had already planned to open Talkiatry. It just happened that way. It was really interesting during the pandemic. I had two things.
I was still moonlighting in the emergency room because they desperately needed help, and I started this private practice. Really, we started this private practice to give psychiatrists the opportunity to be able to work with patients and help them, so they don’t end up in emergency rooms, but it was still also focused on the providers and how they need support in order to do their job as well. We created this to provide flexibility to docs. We actually did not anticipate this being a telemedicine thing, but who would have guessed we’d have a pandemic, so here we all are.
Now we’re really focusing on how to work with our docs in order to allow them flexibility and to decide are they working from home? Are they working from the office? Are they doing some hybrid? Some people have chosen to do tele, but do it from the office so that they can get out of their house a little bit, which I think we can all understand. That’s more than a few minutes, my journey from the best of my years.
Patrick Cournoyer: That’s perfect. We’re going to talk about Italy in just a bit because I think it’s amazing in many ways. Let’s start out with this conversation today that is going to be centered around anxiety and anxiety at work, anxiety about the next phase or the next chapter. This continued journey that so many organizations, every organization around the world is going on. Let’s start with, you’ve made a statement, which I really appreciate, and it resonated with me, which is anxiety is at its core is not knowing. Can you tell us a bit more about your thoughts on the core of anxiety and then we’ll jump off into some other areas?
Dr. Georgia: You don’t have to be a psychiatrist to really think about it. Think about what you’re anxious about. You’re anxious about things that you can’t predict. If you don’t know what the outcome is, and there’s a possibly detrimental outcome, then that’s what we worry about. Worrying is okay. Worry is the reason that we do certain things. Think about dark alleys. If you’re in a city that– everyone’s seen dark alleys. You don’t go down dark alleys at night for a reason. You’re worried something will happen to you. I went down this rabbit hole on the internet, really unrelated and the international dark sky society, which you’ve never heard about, it’s super interesting.
We’ll talk about it another time. The interesting thing is studies haven’t shown that actually lighting things prevent crime. It’s really interesting, they did an analysis out of Chicago, there was another one out of London, but why is it if something is well lit, do we feel more comfortable? That’s because we can see, we can predict, we can see if someone’s down the alley. We can see what might be behind a corner. Really, it’s not being prepared, the anticipation and anxiety is really the anticipation going to the worst-case scenario. It’s the reason we practice for things. It’s the reason we study for tests.
There’s a lot of things for which some level of anxiety is okay. It’s protective. Anxiety disorders happen when that circuitry goes a little haywire and you really can only go to that worst-case scenario. It’s always going to happen. In your head it’s like, oh, there’s a very good chance it’s going to happen even if it’s a very small chance. I flew yesterday, I was on an airplane. I don’t really know how airplanes work. I’m going to be frank. I know, but in the end, I just have to have faith that the people that are taking care of me know what they’re doing. The more you get on an airplane and the more predictable the whole routine becomes, then the more comfortable you become with it.
That’s just it. Not knowing, not understanding what is going to happen, that’s really, I think we’re anxious, that’s where it comes from. The more predictable things can be, the more well-lit the alley can be, that’s when we start to feel more comfortable and don’t have to anticipate the worst-case scenario.
Patrick Cournoyer: As we all are looking at the workplace and obviously, the past year and a half has been very unknown for everyone, let alone the workplace, but just life has been very unknown for the past year and a half. In the workplace, I think there has been an increased level of unknown because many organizations have just been figuring out how to remain resilient and stay in business in many ways. Also, figure out how to be agile as a business. So many organizations have had to completely change the way they plan, the way they interact with their employees, with their customers, and there’s just been so much change.
I think it probably is, as you said, would not be a surprise that change also drives a significant amount of anxiety for many people, but how do you see anxiety in the workplace having changed over the past eighteen months? Do you see that it’s gotten better since the start of the pandemic? It’s gotten worse? Have you seen a shift in it? What is your perspective on where we are today with anxiety, and this concept of anxiety in the workplace, as opposed to maybe where we were at the start of the pandemic?
Dr. Georgia: I think we can all agree that anxiety has evolved for all of us. Even when I worked in an ER, I never really worried about my safety. There were aggressive patients and all that other stuff, but even living in New York, I never really worried that much about my safety. I felt comfortable. Now, since a certain pandemic, we are washing our groceries. You know what I mean? Wiping down our cereal boxes. We didn’t know. This was something that only happened in the movies. We were living in completely, I hate the term unprecedented at times because it’s one of those things that make me itch at this point, but it’s true.
We really did. Really unprecedented. I think we just discovered things to be worried about that we never knew existed. Now, when it comes to the workplace when you’re in an office, you don’t really worry about your safety. You went to your office job, you had other worries in your life, financial, family, stuff that everyone has, but you never really worried that you couldn’t go to the water cooler or to the coffee machine. Now, it’s a completely different ball game. Now, people are worried about physically being in rooms with other human beings, which as human beings we’re very social creatures.
Zoom was fine in the beginning, but it’s good to be in rooms with your friends and with your family. Everyone appreciates that. To have that fear now, it’s trying to get over that fear now and try to get back to that normalcy it’s a big thing. That anxiety is something that no one’s ever experienced before. It’s not something that anyone thought wouldn’t be an issue. Certainly, there’s been an evolution of anxiety during this whole pandemic. I think that’s a really significant change where people don’t even feel comfortable being in their space.
Patrick Cournoyer: That’s a tough spot right now for organizations because there’s this, I would say the majority of organizations, people that are listening today, probably have some level of interest in going back into a social environment. As you said, we’re social people, creatures in general. Human interaction is quite important and many, many companies are quickly making the decision to have some sort of a return to office plan. Figuring out what the future looks like for their specific organization, whether it’s hybrid work, whether it’s definitely some flexible working is very popular right now with organizations.
Dr. Georgia: For sure.
Patrick Cournoyer: How would you suggest these organizations that are considering bringing employees back into the office, providing the opportunity to bring employees back and to be in workspaces in offices, how do you suggest for organizations to think about maybe some areas they might not be thinking about when it comes to employees returning to the office, that anxiety around fear of being in a workspace again, around people? What should organizations be thinking about?
Dr. Georgia: I think it goes back to what we were talking about earlier about transparency and about predictability. People have to know what to expect when they get there. I think flexibility, not just about people’s schedules and how they’re going to work, but also on the part of administrations and organizations to be flexible about what plan they come up with may not be the plan that they end up with. It’s not just about telling people that this is the new plan. Let’s say it’s a hybrid thing. You’ll work three days from home, two days from the office. Would also be able to flex that and say, “You know what we thought it was going to be this way, but we really now see that it should be a different way.”
I think we have to let go of any defensive feelings that they may have about maybe they didn’t make the right decision at first and be able to change. I think it’s also important not just to tell their employees let me know– because when you leave it open-ended like that, people are much less likely to come tell you, but to actively solicit feedback. To go through individual people ask them how they’re doing. They’ll be a lot more proactive in that way. You’re a lot more likely to get feedback. [unintelligible 00:15:42] from an employee if you actually go up to them and ask them, and leave it feeling like you’re going to listen to the answer and actually take that into account. I think that’s super important.
I think employees really want to– a lot of them are very grateful that they still have jobs, obviously, that is huge for people. I think that they’ve stuck with you this long, they want, they’re committed to it. I think that it’s important to work with them and really, it’s a big, big thing I think is to be flexible in that and understand that maybe you might’ve made a mistake in the beginning and be willing to make the change if you need to. I think that’s a really big thing and making it predictable for your employees so they know what to expect.
Patrick Cournoyer: You bring up a good point and transition there around managers. Over the past year, as we’ve been doing the podcast, we’ve been having conversations with so many different people, different experiences from all over the world. One of the common themes that I’ve been hearing is that the role of the manager in the workplace has significantly changed over the past year and a half, and in many ways has increased expectations around connecting, interacting, supporting their teams, their employees. Which is a great thing in many ways because this personal connection is, as we were talking about before, the human interaction was taken away from us in so many ways.
Then leaders and organizations were placed in this situation to create comfortable environments, connected environments in a virtual world with their teams. Some leaders and organizations were really skilled with that because they led distance teams, they had teams all over the world. For many, many managers and leaders in organizations, they had been very used to going in the office every day, working with their teams in-person, being able to see how somebody’s body language was a certain day, or their expressions on their face, all of that human connection and human interaction that was taken away.
Leaders all of a sudden were catapulted into this virtual world, and also the volume was turned up on wellbeing and the availability to discuss wellbeing, and how important it was for employees, leaders, everyone at an organization to talk about wellbeing. There are all of a sudden are a lot of leaders that are having discussions around wellbeing that are also then escalating to mental health, mental wellbeing, employees telling their managers, “I’m worried, I’m anxious, I’m concerned,” and a lot of managers feeling like, “Oh, gosh. I don’t feel equipped to have these conversations, I don’t feel confident to have these conversations.”
How would you suggest organizations help their leaders feel really confident around these types of conversations, these types of interactions with employees? As you’ve said in America particularly, we’re facing the worst mental health crisis in twenty years, maybe longer than twenty years, and that’s coming. We’re probably at the start of that, but it’s not going away. How do you suggest organizations really think about how do I empower my leaders to have these confident conversations with employees about anxiety, about worry, about fear? How do we tackle that?
Dr. Georgia: I think a lot of it has to do with just the comfort level in general, not just talking with mental health and being with your employees about mental health, but just the concept of mental health. Thankfully, even though we are definitely facing a huge crisis right now, I think that we are also destigmatizing discussing mental health in general, which I think is a generational thing too. Gen Z always gets a lot of flack for a lot of things, but they are so open to talk to you about mental health. When I was telling someone, when I was in high school you were more likely to say, “You’re going to go to your parole officer” not to your therapist. This wasn’t a thing. Now it’s like talking about therapy is great. They talk about mental health struggles all the time. I think that’s just, it’s a great thing that it’s just making mental health, health, that’s it? Why are we separating this out? We’ll take physical and mental health, my brain is part of my body that’s physical, right? I think just taking out the qualifier and just calling it health, I think it really helps people realize that this is not a luxury. This is not an add-on. This is definitely an essential part of functioning. Mental health and mental health struggles are one of the leading causes of disability in the world.
If you look at the World Health Organization, if you look at their definition of disability, they just in their little introduction, depression is one of the things that they use to describe what a disability is. It’s not uncommon at all. I think that just getting over what it is for yourself that’s making it difficult is the first step because that’s once you can get over that hurdle for yourself, if your employer told you God forbid somebody had cancer or somebody comes to you and said they’re pregnant or whatever, something physical, then you’re prepared to say, “This is the algorithm I do. These are the people that I can send them to get help.
This is the support I can provide. These are the changes I can make to their schedule.” If somebody told you they had to go to chemo every X number of days, you figure out a way to make that happen. I think really thinking about it more as just another aspect of health is a big first step for people. The other thing is figuring out where they can go and helping your employees get that help because mental health help is not just chatting with your friend. That’s a whole different thing. There are trained professionals. We have tons of different types of mental health professionals in the United States.
I think that it’s about encouraging people to get that professional help to be able to discuss these things. Your boss is going to– if you can go to them and tell them you’re having issues, that’s one thing but you’re not going to go into depth about what your problem is with your wife or whomever.
Patrick Cournoyer: Leads us a little bit to Talkiatry. Tell us a bit about what drove your passion to start this. Originally, you said it was about providing an opportunity for psychiatrists to be able to have a bit more easy access or easy experience, and then it progressed into some different aspects. Tell us a bit about Talkiatry.
Dr. Georgia: Sure. I co-founded Talkiatry with Robert Krayn who is my CEO and wonderful friend at this point. He’s terrific and because psychiatry is a very small world, he has his own story as to why he decided to switch from the world of finance to mental health. Ends up that his coworker’s wife was a former coworker of mine. She’s a psychiatrist. We connected through that. He was looking through how to figure out how to increase accessibility for people to speak to a psychiatrist. He saw that there was definitely a need for people to get access to psychiatrists. He decided to start something where people could get in-network coverage, in-network providers for their mental health needs.
In New York city finding a psychiatrist who takes insurance, even people with insurance were paying tons of money out of pocket, and let’s face it, it’s a luxury that a lot of people don’t have that cash. Quite frankly, you have insurance, why have insurance if you have to pay for something that you have insurance specifically for? We found that it’s a three-pronged approach. When you find in-network psychiatrists, you’re really helping patients because now all of a sudden, they have choices to go see a doctor. You’re also helping insurance companies really because insurance companies now have places where they can direct their members.
That’s great too. I think for psychiatrists, we’re now creating an environment, we created a workspace where they can just be doctors. I say I went to med school. The only thing I’m good at is being a doctor. I’m a good cook but I’m never going to make money off of it. I’m a good doctor. I can’t run a business for myself. I wouldn’t know where to start. I’m not a medical biller. I know the nuances of it, that’s a degree, somebody gets a degree in that. Then there’s the whole thing, scheduling, space, all the other things that go into running a business. Most doctors don’t have the ability to create this scale.
What a lot of people do is they work in academia and/or for a hospital or clinic or something like that. Then they have a side job during fiber practice, but a lot of docs just want to have a private practice where they see patients, develop relationships with patients and have that ongoing. At Talkiatry, what we did is we created a space where someone can handle your billing, someone handles your scheduling. We have a technology department that handles all our tech. All that is settled. We have lovely offices. We take care of your malpractice. You get paid time off. You get your own health insurance.
You have all that support and all you have to do is be a doctor. What you do all day is you see your patients, and that’s it. That’s all you have to do. We handle the business side of it. Now with the pandemic, like I said, we never expected to be a tele-psyche company. That’s not what we started this to do, but we’ve all had to pivot. Everyone worked remotely. Our first patient was April of 2020, so right smack in the middle of everything, when we started seeing patients and because patients were home, they had nothing else to do, and they all had Wi-Fi because they were watching the tele thing.
We knew they had access to a computer and that’s all they really needed to see us. A lot of people were just seeking mental health care that had never sought it before. We started seeing patients and it just exploded. I’m going to be totally honest. We had packed schedules. We’ve hired lots of more doctors. We actually do still have physical space. We’re opening a second office. Hopefully by the end of the summer construction continues. We’re really looking forward to allowing psychiatrists to make the decision, will they work from home? Will they be in the office, doing a hybrid? It’s really up to them and up to their patients because we’ve had patients now asking when can I come see you? It’s really funny.
To all my patients, I’m about two inches tall, when in reality I’m 5′ 9″. They’re like, “Oh my God, you’re so much taller than I thought,” or all these other things, and being in the room with your patients really is a special thing. Tele-psyche is great and it serves a purpose, but at least for me, they’re certain patients that you really need to be in the room with. We really want to allow that ability for providers if they choose to have a day in the office where they see the patients that they want to see in person, and then they tele-psych other days.
Patrick Cournoyer: I think it’s great because it is allowing more access to mental health work. You recently stated this statistic which was pretty shocking. Quite frankly, when I read it around, there’s an average of thirty psychiatrists for every 100,000 people in the United States. Those numbers are surprising in so many ways. The availability of psychiatrists to employees, just to people in general and how we can create that in an easier way, in a more streamlined way. Like you said, that really benefits, not only the doctors but it benefits the patients.
It benefits the workplace, it benefits so much because the more the ability that we have to provide mental health services for everyone, and particularly for employees in the workplace is just going to benefit all of us. You brought up the generations, and I’ve been reading a lot around the change. The future change that is about to happen in the workplace. Many of the older generations in the workplace will be retiring. Over the next three years, two, three, five years and Gen Z and millennials are going to make up the majority of the workforce in not that far of a distant future, a couple of years.
As you mentioned earlier, Gen Z particularly is– and I don’t like to use generalization of statements but it is in a lot of ways very open to discussing, very open to having their voice heard, their feedback, their thoughts. That’s great in so many ways but there is going to be this very significant need for mental health services, mental health awareness but also support and work. Organizations like yours are definitely, I think, helping prepare for the future.
Dr. Georgia: Yes. There’s an assurance of psychiatrists and then when you think about, let’s say child psychiatrists only about 7,000 in the country, maybe fewer actually. It’s unbelievable or geriatric psychiatrists, people are living a lot longer so it’s just staggering how few psychiatrists there are for the need that exists. There’s plenty of other mental health providers that provide other services. There’s counselors, there’s social workers, or psychologists and they are an amazing part of the mental health team for sure.
If I told you there were thirty oncologists for every 100,000 people in the United States you’d say “You’re out of your mind.” There’s definitely a shortage. The shortage is only going to become more pronounced as more people seek help. I’m hoping that we’re doing everything we can obviously to help bridge that gap.
Patrick Cournoyer: Well, Georgia, we’re coming to the end of the conversation. First off, thank you very much for your insights, your perspective, helping the audience understand a bit more about anxiety at work. A bit about what the future will probably look like when it comes to conversations around anxiety, mental health in the workplace. How leaders can take a look at themselves and grow their comfort level a bit around having these discussions. I really liked your statement around mental health. That’s quite a powerful statement because statements like that help us to reduce the stigma around mental health, and the stigma around talking about it.
This concept is about transparency. I also think taking that a step further around vulnerability and being able to discuss this can be quite positive. Also, for helping us to understand a little bit about your organization and how that’s really key and helping the future of mental health, particularly as we move into this next phase of rightfully stated crisis around mental health, particularly in the United States. It’s been a great conversation, Georgia. I appreciate you joining. Thank you so much.
Dr. Georgia: Thank you for having me.