EP150: Breaking Mental Health Stigmas in Healthcare with Dr. Anita Everett

Breaking the Stigma: Mental Health and Burnout with Dr. Anita Everett

In this episode of The Girl Doc Survival Guide, Christine engages in a profound conversation with Dr. Anita Everett, a psychiatrist and mental health advocate. They discuss the importance of reducing stigma, improving mental health support systems for healthcare providers, and separating burnout from mental illness. Dr. Everett shares her personal experiences and insights on thriving in a demanding career, the value of community and support, and highlights initiatives like the 988 emergency service. The episode emphasizes the significance of self-care and balanced living for healthcare professionals.

00:00 Introduction to Dr. Anita Everett

00:38 Thriving in a Public Service Career

01:34 Balancing Career and Personal Life

02:49 Addressing Physician Burnout and Mental Health

04:01 The Stigma of Mental Health in Medicine

05:28 Identity and the Physician's Role

06:14 The Evolution of Physician Burnout Awareness

12:35 Influence and Impact in Medicine

14:16 SAMHSA and Mental Health Services

21:13 Advice for High-Pressure Careers

22:08 Final Thoughts and Gratitude

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. Today, I'm thrilled to be joined by Dr. Anita Everett, a leading voice in mental health advocacy and a driving force behind systemic improvements. With her extensive experience in psychiatry, healthcare leadership, and policy reform, Dr. Everett is here to share her insights on creating better mental health support systems for healthcare providers, including reducing stigma, improving access to care and building sustainable change. Her work is paving the way for a healthier future for our profession. Thank you for being here, Anita.

Anita Everett: Oh, thank you. Thank you for having me. 

Christine Ko: How have you been able to thrive in your career?

Anita Everett: A lot of it for me, I love working in public service and in government. Most of my work has been in government related kinds of things. That drives me. And I really, I feel like I'm privileged because I'm in a situation where I'm managing programs, and we design programs that are really making things better for [00:01:00] people with the most serious mental illnesses. That's been a sustaining thing in my career. That gives me a sense of purpose, which is enduring across my career. I'm at a point right now where I have a sense of mastery. All of us as physicians have different periods where we feel we've mastered certain things: different interventions or procedures or different things that we do along the way. I'm at that period; not full on mastery, there's always things to learn, which I love about what I'm doing. I also have a fair amount of autonomy with how I do things. So that purpose, autonomy, and a sense of mastery; that drives me. 

And really, it's also been really helpful to have a wonderful spouse, who has a career that's been a little bit more flexible than mine. He's also a physician but primarily does research, and that means sometimes when the kids were sick, or other things would come up, his schedule was generally a little bit more flexible than mine, which has been invaluable in my career. So I'm extremely grateful to my husband for that.

And the other thing I'll say that we struggled with a little bit in my household at the beginning was having household [00:02:00] help. My husband was a proud person who didn't like the idea of having a housekeeper, but I value the housekeeper. When she comes and the house is all clean, and it looks good, and the beds are made, and all that stuff. It feels like a successful therapy session. It's really valuable having someone else help. 

Christine Ko: I love the things you said. To thrive in any career, whether you're male or female, we do need to ultimately develop a sense of mastery. I love it that you start off with you're doing what you love to do, what you really feel passionate about. If we have a passion for what we're doing, and we are able to have autonomy, and develop mastery, and have help from your spouse or partner, but also from someone you've hired.

Anita Everett: It was one of the ways for us in our household to reduce the stress. 

Christine Ko: When you became president of the American Psychiatric Association, you would go to different state branches and talk about burnout and physician mental health. It is hard for physicians to talk about mental [00:03:00] health problems. Even if it's not a full on disorder, but even burnout, just feeling a loss of pleasure or loss of meaning, because physicians don't even really talk about their physical illnesses. I was diagnosed with breast cancer in late 2022. I know other physicians with either a breast cancer diagnosis or other diagnosis of cancer or even a chronic illness, they do not want anyone to know. And that's a physical illness. 

Doctors are just human, and it's not like doctors are really any special group compared to, the general population, in terms of our humanness. The percent of doctors that get breast cancer, the percent of doctors that get clinical depression, or you know, an anxiety disorder should actually be the same, pretty much, or actually higher, than the general population.

Anita Everett: So by prevalence, that's right. You should know somebody who has those kinds of things. 

Christine Ko: Yeah. But we don't talk about it. So it just seems like all doctors are pretty much 100 percent [00:04:00] healthy.

Anita Everett: The stigma associated with mental illness results in thinking about being lesser than, or, not strong enough to power through, like so many of us do. We have to power through for others. For physicians, we're trained to be servant leaders, with a high emphasis on the servant component. Women also have a need to serve others. Sometimes that does mean putting others first to the exclusion of yourself.

Christine Ko: Oftentimes physicians end up thinking of themselves last. It's just so inbred, a cultural thing in the way that I was brought up, particularly maybe because I'm Korean, I'm Asian American. Definitely in Korean culture, women traditionally are second to men, and mothers are, in a way, second to their children and should sacrifice everything for their children, that's a good mom. And physicians, we're taught the patient comes first. So I realized [00:05:00] recently that it's sort of a triple whammy, actually, for me to be a woman, a mother and a physician. I've learned to give myself grace, in the sense of, I was always conditioned, actually, to do that, to put myself last.

Anita Everett: That does happen, and the physician element of that is particularly important. We're really conditioned to put patients first, and of course we want to do that. But we also don't want to do that to the exclusion of other parts of our lives. One of the ways that comes out for me is thinking about what your identities are as a person, especially when you're a woman. Being a physician, we assume that as an identity is the primary identity. I am a psychiatrist. I am a dermatologist. I am a physician, rather than, I work as a physician, which sort of gives you a little bit of a capacity to contain that into the hours that you work. You are a physician when you're working. But other times, in your other parts in your life, you're also a mother, and you also [00:06:00] have other identities that we tend to subordinate to the physician identities. Just so much goes into our careers, that we're forced to do that, but it's hard sometimes to let go of that as you get past the training period.

Now several years ago, during an era when physician burnout was first becoming able to be talked about in a more sort of public way. Now  it's a lot easier to talk about that. But at the time, when I went around to different district branches, and I began to talk about it, there was very like a hush over the audience. Physicians would come up to me afterward and say, I've experienced that, but I didn't want to say anything or ask a question. I think it's better now and more physicians are able to talk about it. It's still not where it needs to be. 

Christine Ko: Yes. 

Anita Everett: Burnout has become somewhat less stigmatized. One of the things that we tried to sort out from the very beginning of talking about burnout is it may or may not be related to a mental illness that a person has. Some of the features of burnout look like features of depression, let's just say, but they're not. [00:07:00] Burnout is largely caused by settings that we practice in and the work conditions that we work in. 

Christine Ko: You just said that one of the things you were interested in as a psychiatrist was separating burnout from a true mental health disorder, or illness. Burnout is different, even though there can have some degree of overlapping symptoms. Burnout being emotional depersonalization, lack of feeling of achievement. I'm forgetting the third thing.

Anita Everett: That's right. Those kinds of things. Just a sense of just numbness basically, too. Loss of a sense of the goodness of what you're doing. So sometimes it can feel a little bit like, you know, the psychiatric symptom we call anhedonia, or loss of pleasure in things.

During one period in that beginning of looking at physician burnout, across the membership of the American Psychiatric Association. One of the things that really stood out was the segment of our profession that was the most burned out were females, in particular minority females, which was a standout for me. It wasn't universal across all the [00:08:00] physicians, it was much more so the younger, early career female psychiatrist in this case, because it was a survey of psychiatrist members.

Christine Ko: Why do you think that is?

Anita Everett: Finishing training, building early parts of their career, trying to figure out what they want to pursue with their careers. It's also a period when major life decisions often are made about marriage, children,setting up your financial situation. And in these days, managing debt is no small thing for medical graduates. So when we really thought about it, it's not surprising. 

Christine Ko: Yeah, it's not surprising. I went through that. I didn't know it was called burnout at the time. When my kids were babies, and even now it's easier now that they're older, but still, like, my daughter just finished her last application to college late last night. Two minutes before midnight. We were both so tired. We couldn't even really celebrate. 

There's like these, sort of, roller coaster up and down in your life. There's a lot more work and energy that needs to be put into your job [00:09:00] versus your kids versus a spouse or versus a family member, a parent, or whatever. And it's not always like things are so clean: Oh, right now work needs a lot of attention, but nothing else does!, you it it might be, work needs a lot of attention, and so does my elderly parent and or a grandparent or a kid or a friend that's close, or whatever. So things can definitely pile up. Did you, after seeing the data, did you have ideas on how to make that better? 

Anita Everett: Calling attention to it was an important factor. We always think of risk and protective factors in a number of different ways. Being in that period in your life is a risk factor. For young, particularly female physicians, that's a high risk time.

Christine Ko: One of the reasons I do this podcast is, for whoever's listening, hopefully they don't feel as alone. When I was in the midst of it, if people were talking about this, I didn't know. I just internalized it as, this is just me. When I felt like I was [00:10:00] drowning, I just felt like, I'm the only one drowning. I didn't know that probably many other people feel that way. Not like misery loves company kind of thing, but more that it's normal to some degree to feel that way. It's not like a shortcoming of mine. It doesn't mean that I feel this stuff because I'm not good enough. 

Anita Everett: And that's a real challenge. You're certainly not alone. When I first became involved with some of the professional organizations that have been a lifeline for me, I learned that there was a community, other psychiatrists, that were up against some of the same sorts of struggles, related to my work life. They became my home group, so to speak, and it was very useful. 

Christine Ko: It sounds like one important thing is to try to find a community, or at least find one other person who you can talk to and share things with. 

Anita Everett: In my era of medicine and medical school, 30 or so years ago when I was in medical school, it was just becoming more acceptable, more known for women to be part of the [00:11:00] classes and things like that. I can't tell you how many times that, particularly as an intern or even a young attending, patients would ask, how old are you?, challenging me, as though I weren't old enough or have the gravitas, so to speak, to be the physician who was responsible for their care. You have to overcome your own sort of misgivings or, maybe some would call it imposter syndrome or whatever, about being a physician.

Christine Ko: You brought up imposter syndrome. I've definitely had that. I didn't know it was called that in the past. And when I've spoken to my colleagues, and even people who are senior to me, sometimes we'll talk about still having this, where we just feel like we're not exactly the right person to do something. We feel like we don't belong or something like that. You mentioned that women tend to feel that more than men. I think it goes to implicit bias too, right? Which I have as well. Everyone does. When I used to watch TV, or read books, predominantly, the doctors were [00:12:00] male, and they tended to be portrayed as someone older with gray hair, maybe wearing glasses, just like a very well measured, professional, older, male individual. This is something that I've realized as an adult, the impact of seeing that kind of thing over and over again, in an ad or in a TV show or in a movie; actually, in terms of creating stereotypes of what a doctor looks like, what a nurse looks like, what a firefighter looks like, what a dancer looks like.

Anita Everett: It's better now. It's still not where it needs to be. But it's better now than it was in the past. That is a comfort to me as I've grown wiser in my career. We have made progress. It's still may not be where we'd want it to be, but we have made considerable progress over the years.

Christine Ko: I think now more than half of medical students are female, so that's one thing. I was reading a transcript from a talk you gave for the American [00:13:00] Psychiatric Association. You said at one point that we are all influencers, but not in that social media sense. 

Can you talk about that?

Anita Everett: Sure. We as physicians have the privilege, the opportunity, to influence the lives of others; the patients who come to seek our advice on particular issues. We do have a chance to be influential in the lives of other individuals. Burnout is feeling like what you're doing is not making a difference. It's not hard to lose the perspective on our opportunity to be influential in the health and well being of the patients that we serve, for the particular thing they've come to see us about, but also for other things as well.

I do think we have a chance to be influencers. We may not have millions of followers on YouTube or whatever, but we have our people that we've seen. Hundreds and hundreds, thousands, of patients that we've seen over our career in one way or another. 

Christine Ko: I liked it that you said that because it resonated with me in the sense that a lot of times I feel like I have no power at all in my job. I'm just one little doctor in the [00:14:00] relatively small field of dermatology. But I do have power over my interactions with the patients that I see, with my colleagues, with the trainees. I do have a certain sphere of influence. It's easy to forget that and get overwhelmed by a million things to be upset about in the health care system. 

Anita Everett: I do spend half a day a week seeing a few patients still. And twice last Thursday when I was seeing folks, they asked me for a different time than what I can be there. It's only Thursday afternoons. Could you come in the morning? Could we make an appointment the morning the next time? And I said, I'm only here in the afternoons but if you'd like to see a different doctor, we can get you to see a different doctor. And there was like, no, no way. We want to stick with you. So that's a little bit that comes up every once in a while. It's gratifying. That's an indirect way of learning that they value the time that you spent with them. 

Christine Ko: With all your experience with your various roles in academia, as well as community clinics, you've been heavily involved with SAMHSA. SAMHSA stands for Substance Abuse and Mental Health Services [00:15:00] Administration. Can you talk about that?

Anita Everett: So SAMHSA is an agency that's in the HHS, the Health and Human Services Department within the federal government. We're a relatively small agency, but we have a number of different programs. We have a pretty good sized program that supports school based mental health services, so school systems that are interested in developing school based mental health services, we have grant fundings for that. The two most major programs that we're working on right now are  the availability of 988. Our big wish with 988 is that it become parallel to 911.

Just as you might call 911 for almost any kind of emergency nationally now, call 988. We've seen that over the last two years grow tremendously. That's important to us because that is a front door, so to speak, to get individuals in need Immediate access and that goes for anybody. For your daughter, for instance, when she gets to college, that goes for college .

We have funds that support the development of crisis [00:16:00] response services when the call doesn't work. We are also supporting alternatives to traditional emergency departments. Alternatives are crisis receiving centers, they're called, where individuals can be properly diagnosed and treated, but in a setting where the providers are more attuned to, trained in, and comfortable with treatment of acute mental illnesses. These three elements are really, a body of work that we're extremely proud of. 

Can you walk me through? I've never called 911 myself or 988, but I know from TV, what happens when you call 911? Someone answers, what's your emergency? What happens when you call 988? 

That's right. 911 is a triage. Their job is to triage you to someone else. Fire, police, paramedics or first aid. They have generally one of three choices. 988 is different in that it provides a service itself. So when you call 988, you're talking with a trained counselor. They generally are supervised by licensed providers, but the call taker may or may not be a licensed provider themselves. There are 200 call centers [00:17:00] across the United States. Right now, they go by the nearest area code of the caller. Over time, they'll go by geolocation so they would respond to the nearest cell tower. That's important because most of the time, the call and the counseling can help to resolve the situation and make a bridge plan with the person. When that doesn't happen, these call centers are connected to crisis response services. Generally it's a pair of individuals. Our preferred model is a mental health professional together with a peer who go on site to where the person is and can help to resolve the situation. We much prefer that to law enforcement. Too often in too many communities, there's a law enforcement response. We much prefer trained individuals to respond.

Christine Ko: So calling 988. For a physician or even a non physician who is trying to thrive in their high stress career and maybe feeling a little burnout, maybe, with some symptoms that overlap with mental health symptoms, that wouldn't really be the time to [00:18:00] call 988, right?

Anita Everett: Probably not. It's more oriented toward urgent situations. So if you're the physician and you've been working with that for a while, and you're feeling at the end of your rope, or you're just feeling like you're not sure you can go on, or you have a colleague that you're pretty concerned about, and you want to know some steps or some recommendations for how you could work with that. A lot of the callers are family members or friends of someone who's in distress, and they need some help with how to get the person help. 

Christine Ko: That makes sense because oftentimes if you're really struggling you don't have the wherewithal to make a call like that, but a friend or a family member could and then figure out next steps. What would you recommend for a physician who definitely feels like they have burnout?

Anita Everett: It depends on the setting that a person practices in. For physicians that are in hospital based systems, even if they're primarily outpatient, but they're in a hospital based system, a lot of institutions do [00:19:00] offer approaches to looking at at professional staff burnout. Generally, healthcare systems have incentives to want to take care of their physician workforce. That would be one place to look. Another place to look would be your local professional organization. Many of the national organizations also have local affiliates, whether they have a program on burnout or just a chance to get together periodically with kindred spirits in a similar practice setting. Those kinds of organizations can be really helpful for individuals.

Reducing hours sometimes is another thing. Taking a break. In the academic paradigm, there still are such things as sabbaticals. Taking a break sometimes can be helpful. Sometimes a different practice setting can be helpful. There are lots of different things that can be helpful, but a lot of those have to do with your identity. We're conditioned to over identify with being a physician, as though that is our being, and moving to the sidelines some of the other parts of us -hobbies: fishing or knitting [00:20:00] or, whatever hobbies a person has had or whatever parts of their lives they've neglected or put aside- getting back in touch with those can be really helpful, even if it means cutting back on the practice hours  or moving in some cases. You need to do that for the good of yourself, but also for the good of your community. 

Christine Ko: It seems silly to say it out loud, but I do really need to take care of myself. When I do, I am better able to take care of other people. 

Anita Everett: Yeah, and that's reminding ourselves that, like you said earlier, we're people. And so the same kinds of things that help human beings, all the things you can read about, what brings meaning to your life, those are really important things. One of the things that the current American Psychiatric Association president is working on, which I am looking forward to, is lifestyle medicine or lifestyle psychiatry. They're working on developing a curriculum that a physician could take, and it has six components. These are components that would have application to all people, including the patients that we work with that are going [00:21:00] through various struggles. The six categories are maintaining physical activity, well balanced nutrition, avoiding toxic substances, social connectedness, restorative sleep or good sleep, and stress management. So I'm really hoping that might create a resource. It wouldn't be restricted only to American Psychiatric Association members; other physicians might benefit from thinking about those domains.

SAMHSA actually has a document that's called the Eight Dimensions of Wellness that is a little bit broader, has a couple other categories in it, but it reminds us that it's a multi category thing. There's not usually just one magic thing that can help. We might call it magic thing, if only I exercise more, if only I got my skills up to run a marathon, or whatever. It's not usually just one thing. It's a combination of things. 

Christine Ko: If you could give one key piece of advice to someone navigating the demands of a high pressure job, whether in healthcare or otherwise, what would that be?

Anita Everett: One piece of advice. You don't have to do everything all at once. I don't think I thought [00:22:00] enough in the beginning about, something like, in 5 years, on down the road, will this really matter? I remember when the kids were young, I would be scurrying around trying to get child care figured out. And I'd be thinking, Oh, if only we find this 1 thing, we'll be set. And generally that was true, and then something would change. The caregiver would get a different job, or they go to a different school, or something like that. It works out in the end, but it takes a while, and things happen in different segments of time.

Christine Ko: I agree, but I didn't realize it at the time. Like you said, I was scurrying around, rushing around. Oh, if this gets done, it'll be better. If this gets done, it'll be better. Maybe if I had just been a little calmer, like, it will work out.

Do you have any final thoughts?

Anita Everett: I appreciate your doing this. One of the things that can be healing for physicians is having a sense of community, a sense of similarity to others. This community that you're creating through the podcast is just really valuable. So I want to thank you for the time that you take out of your career to do [00:23:00] this for the benefit of others. It's one other way of being an influencer, not over patients, but over other individuals, peers, that can be really valuable. I bet you don't hear too much about how helpful it is to people, but I'm confident in saying it's been very helpful for a lot of your listeners. 

Christine Ko: Thank you for saying that. Thank you for your time and all that you're doing. I think the 988 sounds amazing. Better community resources sounds amazing. And just increased awareness to physicians and health care providers that many of us may well struggle with either burnout or a diagnosable mental illness. It shouldn't be something that is so stigmatized, and hopefully increasingly it won't be. Thank you for all you're doing. 

Anita Everett: Thank you for the work you do. This is really amazing.