All right, I think we're going to start, I mean we're a few minutes late, but there's always stragglers. Okay, so topic, best practice for evidence-based employee assistance programs. I'm David Francis, I'm a psychologist. Now I work for an occupational medicine firm, so I'm an ex-shrink, but I owned an EAP company for 32 years, so that's my association with EAPs. So here's what we're going to talk about. I'm going to spend a short amount of time just talking about the mental health climate in the world currently, and what's an evidence-based EAP, and what are the best practices, which is really the core of what I have to say. Okay, so the World Mental Health Survey was conducted initially in 2009 by people from Harvard School of Public Health, and also University of Michigan. It was a massive study, I think it was over 170,000 people in 28 countries, and big surveys. So they acquired a lot of data, and it was shocking, but on the other hand, if you're an occupational physician and it's not that shocking, you're used to it. But what it really said is mental health, mental illness problems constitute the number one leading cause of disability throughout the world. And a third of the respondents indicated that they had some kind of mental health issue. In the United States, it was even more, it was close to half. So I'm going to go over this quickly, because most of you probably already are familiar with this data. So the people that we work with, we call the working well. So they have a job, but they have stuff going on just like everybody else does. So anxiety is the most prevalent issue among the working well, and astronomical costs. Depression also, even more astronomical. And so there are direct costs, and the direct costs are primarily disability costs and medical and pharmaceutical costs. And of course, depression especially is comorbid with all kinds of other medical problems. Then there are the indirect costs of mental health at work. So the primary one is absenteeism, and again, it's estimated that mental health accounts for about 7% of absenteeism worldwide. So it's a tremendous number. And then there's presenteeism, which is you're showing up to work, but you're not all there. You're kind of zoned out, more liable to get into fights with people or to create conflicts or accidents, and it's a rotten situation in any way you look at it. So the global costs in terms of dollar amounts are just absolutely astronomical. So this is the estimate from the World Health Organization, $2.5 trillion are lost as a result of mental health problems. And the projections are that by 2030, it's going to be over $6,000. Good grief. How do they estimate that? I have no idea, but it's mind boggling. And on top of that, of course, when you're talking about mental health, stigma is a big issue. So I have some data up here from an American Psychiatric Association survey that was conducted in 2019. And what it indicated was that 20% of the respondents were completely comfortable talking about mental health. That means 80% were not. Moreover, a third were concerned that they might be fired or they might experience retaliation if somehow they owned up to mental health problems, which is bizarre. So that's the background. So that's the context. That's the mental health context out there in the world. Again, if you're an occupational physician, you're well aware of this, depression and anxiety and what to do about it. Corporations are always wondering what to do about it because they're so prevalent. So here we have employee assistance programs, which are really the only company benefit that is exclusively dedicated to mental health. And yet the average utilization for employee assistance programs is less than 10%. Usually it hovers around 5%. And different companies have different ways of measuring utilization percentage. So a lot of it has to do with marketing. So this also is astounding. To me, 93% of employees have an employee assistance program, and yet half of them don't know that they have one. Good grief. So this is kind of a discouraging background. So just to summarize, depression and anxiety are the most prevalent conditions. And stigma remains very high, and utilization of employee assistance programs remains low. So it seems to me, given that context, given that context, the primary goals for an employee assistance program to be most effective, it seems to me, would be, first of all, to do things to reduce stigma, right off the top, to get to people. And then secondly, provide access to the best kind of treatment, evidence-based treatment. Right? I mean, this seems to make sense. So how do you go about doing that? Well, the way... So I've been thinking about this a lot for years. And so I start by examining the very definition of mental disorder as explicated in the DSM-5. And here it is. It's a mouthful. A mental disorder is a syndrome characterized by a clinically significant disturbance in an individual's cognition, emotion, regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental function. That's a lot of words. That's a lot of words. What are they really saying? Well, it turns out there are a lot of redundant words. So you could actually squeeze this definition into something more manageable. So here it is. So take out the letters in blue. And so now we have a mental disorder is characterized by clinically significant disturbance in an individual's cognition, emotion, regulation, or behavior. So that's what it is. So it's no longer a syndrome and a disturbance. It's really focused on thoughts and feelings and behavior. Okay. Now it's starting to make sense. It's not all a jumble of words. You notice that definition makes no reference to the mind. Zero. However, the whole area is referred to as mental health. The definition doesn't involve the mind, but the field is mental health. So the mind is not definable though. I mean, that's part of the problem with the mind. It's a leftover term. So unfortunately, because the field is called mental health, people ask the wrong questions. Most people, if you ever get to discussing their mental health with them, most of them want to know why. That's the question most people ask about their mental health. So why do I have these issues? And the presumption is that if I discover exactly why, then I'm going to feel better. Unfortunately, this is not confirmed by the research. Research disputes the insight cure. And of course, we all know this. We highly educated, driven health professionals, we all know this. Because I'm guessing every person in this room has tremendous insight about your stuff, your personal stuff. And of course, we all have personal stuff. But in such a highly educated group, you have tremendous insight. But why do you still have those hangups? What a drag. So, the whole business about trying to learn why is not really evidence-based. So the real most important question to ask about your mental health is what? What are you doing? What habitual behaviors and thoughts are you doing that is harming you, that are harming you? So the origins of your, of whatever you got, are interesting. In fact, they're even fascinating to learn what exactly happened when you were three years old. And that accounts for how you are now at 45. Oh yeah, that's interesting. I like that. And of course, everybody likes to talk about themselves. You could go on about that for many years. In fact, many of us do. Learning the intricacies, the details of why. But so what? You still got stuff. So, the reality is that your history today lives on in your thoughts. I mean, that's it. History is history. Here you are today. You still think about that stuff. But that was then. This is now. So that's what you got to focus on, the now. So, the thing of it is, so much of stigma, I mean, stigma as the APA study reveals, stigma has to do with the present. I don't want anybody to suspect that I have a mental health issue. Nope. But it also has to do with the past. So, a lot of people will approach the whole topic of mental health like the picture. And, you know, the picture really means, yeah, I don't want to go there. It's too complicated. I don't want to do years of therapy because that's what it's going to take to learn the exact details of my mental health history. I don't want to dig up the past. Might be painful. I'm afraid to discover stuff like maybe I have a weak personality or maybe I have a character flaw or maybe, uh-oh, yeah, that could be, too. You know? So, I mean, these are all erroneous associations that people have attributed to mental health, all these things. Character flaws, weak personality, you know, demonic possession, good Lord. All right. But what would happen to mental health stigma if you abandon the term mental health? Could you do that? What if you called it cognitive health instead? Because, honestly, you can't. How do you define the mind? It's really what does the mind do? It thinks. So, what if you didn't call it mental health anymore? Labels affect stigma. You know, what would you rather have, a mental health problem or a cognitive health problem? Boy, does that make a difference. Makes a big, big difference. When I see this slide, I'm reminded of a series of trainings that I've done at major corporations about unlearning, self-defeating thinking habits. And they're usually fully booked. People sign up, because there's no stigma associated with that. You know? Unlearning, self-defeating. Who doesn't have a self-defeating thinking habit? You know? I mean, so, oh, yeah. I always forget my keys. What's that about? Hmm. You know? Anyway. So, labels count. When you're talking about a mental health problem, these are the kinds of words that are usually used to describe a mental health problem, a serious mental health problem. Yeah, I mean, yeah, these are all nasty, pejorative terms about mental health. And yet, when you're talking about a cognitive health problem, hmm, hmm, different. Problematic thinking habits. Yeah, OK, all right, I can own that. That doesn't mean I... Demons don't care about that. Ha-ha. Yeah, it's really what the cognitive therapists call automatic thoughts. So, that's the kind of thinking I'm talking about. It's in the background lurking, controlling you, talking to you. It's a very influential voice. It's you talking to you. High credibility. Even though it may be completely wrong. So, what kind of problematic thinking habits? Well, I like the picture. Yeah, the picture says a lot. But these kinds of thinking habits, to which we are all subject, tend to be self-defeating. They tend to be not rational. And what the cognitive behavioral therapists refer to as cognitive distortions. So, my suggestion for an EAP, or for the field in general, to de-stigmatize mental health, limit the term mental. Why is it there? It makes people crazy. Ha-ha-ha. Substitute instead cognitive health whenever possible. Why not? That's what it's all about. It's what you're thinking, right? They're pretty much equivalent. Cognitive is equal to mental. So, again, I'm repeating myself, but the only way to define what the mind does is what's going on inside. What are you thinking? So, evidence-based treatments identify problematic thinking habits. That's a lot of what they do. The most popular evidence-based treatments. So, the key concept is your present-day thoughts determine, or strongly influence at least, how you feel. The reality is everybody's got them. It's just a question of intensity and frequency. So, the people who are debilitated, boy, they are hung up. They do it a lot. The rest of us, it's just normal neurotic stuff that we all deal with. And then, of course, you know, think about meditation now as a cognitive technique. You know, meditation is so terrific because the whole idea is to focus your thoughts on a sound, or a symbol, or a bodily process, something that's neutral. So, you're not driving yourself a little bit nuts thinking about how deficient you are, or whatever. So, you know, meditation certainly counts. So, here's an example of the kind of typical thoughts that depressed people think. I'm a total failure. I'll never get it. I'm such an idiot. Why can't I get things right? Will I ever feel satisfied? This is very typical. Even among this population, smart, highly educated professionals. You know, because the thing is, the same drive, the same focus, the same intelligence that got you way at the top of your class in college, that got you into medical school, that got you into a great residency, that got you into Harvard School of Public Health, all that stuff is a reflection of your focus. And how detail-oriented you are, which is great. But it's not great if you take it and you focus it on yourself, because now you're so perceptive. You see all of your imperfections and all of the things that aren't exactly right. And this is why you so often read about highly accomplished people who commit suicide. You know, great Olympic athletes, you know, who go to Stanford, you know, have a Stanford degree and world's records, commit suicide. What is going on? Well, you don't know how imperfect they really are, but they do, and that's what they dwell on. That's what they focus on. Boy, I really stink. So this is cognitive distortion. All right, and this is typical anxiety thoughts. I love this cartoon. So this is Roz Chast from The New Yorker. So it's really, you know, there's so many uncertainties out in the world. I mean, what is anxiety about? Anxiety is about fight or flight. It's about uncertainty, it's about ambiguity. So there's so much going on here that you don't know about, so it's worries. Oh man, there's so many things to fuss about. And to ask questions about. Now, most anxiety-ridden people that I know, or with whom I've worked, generate a lot of what-if questions. And what-if questions are especially damaging because they predict disaster. What if this? Oh my God, what if that? Oh my God, what if, oh, you know. So, but the problem with an open-ended question, with a rhetorical question, is you can't challenge it. It just implies stuff. It's just sitting there, implying gloom and doom. Whereas, you know, a statement, like I'm gonna bomb, it's gonna be terrible, you can challenge that. Well, maybe you won't be. Well, I think I will, but maybe you won't. Yeah, I'm doomed for sure. What proof do you have? Well, I don't exactly have any. You know what I mean? So you can challenge a statement. You can't challenge an open-ended question. So that's why it's especially damaging. All right. What if you can't hear your thoughts in the moment? Because that's what most people say. That's what a lot of people say. So this is the exercise that I've always used in the past. Okay, but you had a rotten day yesterday, right? Yes, I did. And when was the worst part of your day? Well, it was when I went to work. Okay. And how did you feel? Oh, I felt defeated. Okay. And what were you thinking? I just don't remember. All right, but picture a video of you, right? Yesterday when you went into work and you felt terrible, picture a thought bubble over your head. Just like this. What were you probably thinking? Take a guess. Well, I'm not exactly sure. I don't care. Take a guess. What's reasonable? Well, what were you probably thinking? And this works. This is a good technique. So if you could fill in the thought bubble, what might you be thinking when you're depressed or anxious or anything else for that matter? And so I have a catalog of the most common cognitive distortions that you might be thinking. And you know, this is not medical jargon. This is regular people talk. You know, so it's not, it's real. So maybe you're overgeneralizing. You're taking a negative event and you're expanding it. You're saying, oh yeah, this is the beginning. Yeah, okay, it's gonna be awful forever. No, it's not overgeneralizing. Or mental filtering. You're only dwelling on the negative stuff. And discounting the positives. This is a variation on the theme. Discounting the positive, you insist that your accomplishments don't count. Jump, there are two kinds of jumping to conclusions. The most common one is worrying, which is also known as the fortune teller error. That's what a worry is. It's gonna be awful. That's what a worry is. Worry is a prediction of something bad. Fight or flight response. You know, big surprise. Oh, then the other type of jumping to conclusions is mind reading. I know she just hates me. Well, how do you know that? Well, I feel that way. Well, how do you know? Well, she looked at me funny. What do you mean? You know, mind reading. So, jumping to conclusions. So, these are cognitive distortions. Awfulizing or catastrophizing. That's just really jumping to conclusions in the extreme. That was a term, you know, I got most of these from David Burns' book, his seminal book, Feeling Good. So, he's one of the pioneers. He's really terrific. And these terms come from Albert Ellis. I mean, if you know anything about the history of psychology, he invented these terms. Awfulizing and catastrophizing. I once saw him live. I'm not gonna tell this story. It was shocking. All right, and like I said before, the what if questions are disturbing because they imply doom and gloom, but you can't challenge them. But they count. If you're dealing with somebody who has serious anxiety problems, sometimes in the past, I have asked people to just count the number of times a day they generate what ifs. And you'd be amazed. Actually, they're amazed. Usually, when you ask people to do this, I'll say, how many times a day do you worry? And they'll say, well, I worry all day. That's the usual response. And I say, well, okay, I believe that you think that, but I'd like you to start counting them. So it very rarely exceeds 40 a day. Go figure. All right, magnifying or minimizing an issue. Emotional reasoning. I feel like an idiot. Therefore, I must be an idiot. Okay, should statements. So guilt always involves shoulds. Shoulds or ought tos, moral imperatives that you're saying to yourself, oh, I'm a bad person. I should have done this, I should have done that. Guilt caused by thoughts, should thoughts, ought to thoughts, must thoughts, moral imperatives. Calling yourself names. Taking responsibility for stuff that you don't own responsibility for. And procrastinating. So these are the kinds of things that people will record if you get them to record stuff. So once you've identified your cognitive habits, the things that are keeping you stuck, what can you do about them? So you challenge them with evidence over time. And so the idea is to unlearn them. So first you have to be aware of them. Then you learn to hear them and classify them. And they will, usually people do two or three types of cognitive distortions over and over again. For most people with whom I've worked, it's mostly overgeneralizing and jumping to conclusions. David Burns refers to those as cognitive distortion number two and number five. Makes it real easy. Most people repeat those over and over again. And so this is like traditional cognitive therapy. And this is from David Burns' book. And so they start out, cognitive behavioral therapy has a lot of homework. And so you start out in the left column by saying, look, I just want you to record the low points of your day. And you can do it at night. When you go home at night, just review when were the worst times of your day. Okay, so you write it down here. And then you see what we have here is, you rate how intense the feeling was from zero to 100. So that's what the numbers are, okay? And then what were you thinking? Again, use the thought bubble technique if you don't remember. So here are some examples. And you rate those too. How much do you believe those thoughts? So, you know, 100% or 80%. So they're like, the first line is I was really frustrated and I'll never be able to organize this mess. I'll never be able to. Yeah, so that's, you know, pretty typical. Jumping to conclusions, right? That's what it is. So now, when you can record and categorize these things, you now have some control over them. You now have a handle that you didn't have before. And before it was just mental, whatever that is. But now it ain't mental. Yeah, it's cognitive. So there it is, you've identified it, you've labeled it, and now you're honing in on it, you know? And so the next step is, what's a rational counter thought? Like my initial thought when I got there in the thought bubble was, I'll never be able to organize this mess. And so you, you know, is this true? Well, that's how I feel. I know that's how you feel, but is it true that you will never be able to organize this mess? Well, I don't know. Well, have you ever had a mess this bad in the past? Yes, I have. And what happened? I ended up organizing it. Good, that's my point. So is it possible that the presumption I'll never be able to do it is incorrect? Yes, that's possible. Okay, all right. So that's the challenge. How much do you believe the challenge? If I do a little at a time, I'll be able to organize it. Well, I believe it a lot. Yeah, that makes sense. Yeah, I mean, I have past experience. I've been able to do it. So now you're filling the other parts, the other cells. And lo and behold, the disturbing emotions have diminished over time. Now imagine doing this kind of homework assignment religiously over a period of weeks. Wow, suddenly you're hearing the inner voice. You're challenging it. It's nonsense. You know, you're disputing it with evidence, rational counter thoughts. Now you feel better. This doesn't, this is not an instant cure with everybody. It really isn't. Sometimes people do this and they feel marginally better. But so what? It doesn't, from my perspective, it doesn't matter. The reason why I like cognitive health is it just removes the mystery. Forget about demonic possession. That, you know, this is it. Fellow humans, this is it. Is it feasible even to replace the term mental health? Because it is an obsolete term. To me, it's analogous to a horseless carriage. Once you didn't need the horses anymore, you didn't need it in the term. So we don't really need mental much anymore. Why is it still there, you know? Okay, it's by convention is the answer because it's widely used around the world. But is it feasible? Yeah, it's feasible. I mean, the army has already done it. United States Army has renamed the domain behavioral health. Which is pretty smart. But the problem with behavioral health is it implies that the person is violent or has some kind of overt behavioral issue that is problematic. And it really doesn't take into account the cognitive part. But still, it was a nice effort by the army. Way to go. So I like the term cognitive. Pertains to psychological processes involved in acquisition and understanding of knowledge, formation of beliefs and attitudes, and decision-making. Formation of beliefs and attitudes and decision-making and problem-solving. Yeah, all right, that's all good. By the way, if you search, if you do a Google search for cognitive, the only references to cognitive in, you know, NIMH, pertain to aging. It is interesting. You know, to dementia and aging. Which, of course, it's a, you know, that's a big part of it. But it's a big part of us. You know, all of us. Okay, so this is it. This is the essence of my presentation here. It's really healthy thinking is rational and reality-based. And unhealthy thinking is not rational. And self-defeating, that's really what defines mental disorders. That's it. So learning about your childhood is very interesting. But you have to unlearn the bad thinking that you're engaged in right now. So the focus for cognitive health is on measurable real-time variables. That's automatic thoughts. So psychological problems, regardless of where they come from, exist in the present. That's it. Now, I might, in this presentation, I may sound a little bit cold and data-oriented. You know, you still have to be compassionate and caring. So it does minimize, the cognitive focus does not minimize the pain or intractability of serious psychological problems. So we're not dismissing emotional pain or personal histories or talking about stuff. I mean, just talking about stuff is important. The need for empathy and rapport. And the appropriate use of medications. So I'm contending that the EAP focus on cognitive health reduces stigma, increases the likelihood of evidence-based treatment. Now, a key part of my message is that for corporate medical directors, you have some latitude. I mean, you're not gonna change the label mental health throughout the world, but you might do, but you might influence how mental health problems are discussed within your world, over which you do have control. You know, you could do what the army did, but call it cognitive health. So we're really talking about problem solving instead of insight seeking. That's really what an evidence-based EAP should be all about. But I don't wanna neglect that there are really four areas of problem solving. It's not just cognitive. I mean, you know, if you're gonna be a good therapist, you really gotta take into account all of these things. The context in which somebody lives, you know, the social determinants, the thoughts that people have relative to that, the emotions and the behaviors, and all of these four classes of variables are connected. So a focus on cognitive health doesn't rule out these things. You're still considering it. You're just, you know, you're removing the mystery. That's all. So here's how we've gotten so far. The best practices involve, by the way, I have a lot of these slides in the handouts that, you know, that you can all get. I think I took out the most meaningful ones, but maybe not. Anyway, best practices reduce stigma, make it as easy as possible to get evidence-based treatment. Now, this is another issue because a lot of times EAPs really don't have a good handle on how effective these providers are out there. And, you know, any EAP really should have a decent idea of who you're referring your employees to. So you need to develop a database of effective providers. Well, how do you do that? The best way I know is to interview some of these providers, ask them what they actually do. If you can do that. If you have a big, expansive network, it may be very hard to do that. So, okay, you can laugh at this one, but there are reviews on Yelp. I'm telling you, not a bad idea. Or you can develop your own Yelp among your employees. So tell them right up front that you would really appreciate their input. So you send them, you ask them to do an anonymous survey and, you know, to answer questions about those providers out there. So you'll develop a decent database. And then, of course, there are all kinds of online resources and smartphone apps. I list this one down here, MooJim, just because that's probably the most comprehensive website that I've seen. It's from Australia. You know, they do a lot of good stuff there. And cognitive therapy. Anyway, moojim.com.au. That's the Australian National University. So let's go down our list here. Now we get to mandatory employee orientations. So mandatory employee orientations. So you wanna have them live, if possible, if possible, and involving a real counselor, if possible, because the idea is to dispel stereotypes. There's a stereotype. Okay, so hopefully live orientations. Because, you know, that statistic that we saw earlier, half the people don't even know that they have an EAP. Holy cow. So, okay, company, you're paying all this money for an EAP, even though it's a low-cost benefit, still, you want people to use it. And mental health is an issue in the company, that's for sure, so okay. So in these orientation sessions, you describe the services of an employee assistance program. You make a big deal about confidentiality. That's the primary emphasis in employee orientation sessions and that the service, the best EAPs are available to family members as well, for obvious reasons. All right, so we go down our list. The next one is mandatory supervisory trainings. Mandatory, this doesn't always occur, it really needs to. If you wanna get the most benefit out of an EAP, the EAP is really uniquely situated to do good stuff in your company. So what is a supervisory training about? It's about improving the employee's job performance. So typically, you're gonna invoke a supervisory referral if this employee is behaving strangely or looks out of it. So you're not sure what's going on there. Or maybe the person smells of strange substances, say. And supervisors and managers are very uncomfortable talking about that stuff. So supervisory training, the whole purpose is to help supervisors recognize and address performance issues. Should emphasize, this is the hard part, constructive confrontation. That's tough conversations. That's looking the person in the eye and telling them they gotta go to the EAP. So here's how it's supposed to work. The manager, supervisor, or the HR person will observe the employee's behavior, obtain confirmation from other managers if possible, document those observations, and then feedback those observations to the employee. And then you refer the employee to the Employee Assistance Program. And in the best of these kinds of interviews, you would make the call right there in the person's presence if you're the supervisor, say. I mean, the other alternative is, I want you to call the EAP. Okay, I'll do it. You're gonna do it? Yeah. I don't believe you. What do you mean? I've never lied to you in the past. Yes, you have. Okay, anyway. So you could make the call directly. Now here's the hard part. This is what the training should be about, actual constructive confrontation. I like the picture. She's got it right, I like the look. And here's what you say. Here's what I've observed, employee, and now the employee has an excuse. So now you gotta listen to this employee. Respectful listening. I hear what you're saying, but you can't show up to work smelling of alcohol, okay? I know you believe it's your aftershave. I'm sorry, everybody smells it. So I'd like you to meet with the Employee Assistance Program. Well, I don't know if I wanna go talk to a counselor. Well, okay. I can't make you go. I really can't. But your performance has to improve. That's what it's about. It's not whether you go to eap or not. So it's whether you get better or not. And, you know, i'm very concerned about you. So in most cases, the employee will say, okay, i'll go. Good. And if the employee goes, They sign a release form, and this enables the eap counselor To get back to the supervisor and tell you if the person actually made an appointment. And did they keep the appointment? Did they make and keep subsequent appointments? And did they follow through on recommendations or not? Okay? So, i mean, that's what eap has allowed feedback to you. This is all part of the training. Now, i just want to outline briefly a very effective and easy way To train supervisors in how to do this. Because i'm talking about uncomfortable conversations, fellow humans, Which we all have difficulty with. Looking somebody in the eye and being totally straight. So, anyway, this is a format that i've used in the past that works very well. You divide the group up into threes, and you assign them roles. Boss, subordinate, and observer. And, you know, you go through three rounds. At the end of each round, you ask the observer, how did the boss do? So, you know, and there's a simple rating scale, something like this. And, you know, did the boss have good eye contact? Did she state the facts? Did she actively listen? Did she refer the person to the eap, and did she make the call? You know, so now they have to role play this stuff. And you'd be amazed. Is it contrived? Yes. Artificial? Yes. Does it work? Yes. I mean, this is worth it. This is a simple training format. So, we've worked our way down past stigma. We've gotten a really good network of providers. We got the mandatory orientations. Everybody supervises your trainings. And now, you've got to promote the thing. If half the people don't even know that it exists, you better have posters all over the place. So, here's an example. Ways to challenge negative thinking. I got this just off the internet for free. So, you want to have frequent visibility. So, the eap counselor should be able to show up at EHS events and HR events, and even all-hands events. You want maximum visibility. You want to get the most out of the eap. You want to help people. Brochures, sure. A lot of brochures. In the olden days, you know, before the internet, we'd mail these terrific brochures. And a spouse would get to see it. See, that's really important. You want family members to be involved, if possible. So, posters like this, and messages to employees, personal e-mail accounts, if you can do that, you know, in the hopes that maybe a spouse will see it, too. You know, and say, you know, might be a good idea. And here are a couple more posters that I got off the internet. You know, pretty typical stuff. All right. So, here's our final rundown. This is it. So, this is my best practices for an evidence-based eap. Reduce the stigma by focusing on cognitive health, minimizing the term mental health, and then you're really educating people regarding what this evidence-based treatment is. You know, that it's present tense, focus on problem solving in the present. Make it as easy as possible for people to get the right kind of help, good help. Mandatory orientations, mandatory supervisory trainings, and widespread eap promotion. So, that's it. That's my last slide. And I'm open to questions, if anybody has any questions. It's pretty straightforward. Okay. Christine, you have a question. Thank you. Yeah. So, I really loved your thought log. And as somebody who does, sometimes with occupational medicine, somebody returning to work after being out because of depression or anxiety or some type of a mental health issue, they can go back to work, like, you know, it has to be a gradual transition. At least that's what has been more successful in the past. Do you have any recommendations, like, for somebody who's doing occupational medicine and the psychiatrist or the psychologist cannot prescribe anything, but the psychiatrist is once every month or once every two months for whatever it is. What do you think about using the tool that you provided to help the person, at least where it's work-oriented? Okay, well, I'm horrible at my work. Well, what exactly is that? Or is that overstepping? Because, you know, we're not psychologists. We're not licensed social workers. We don't want to go beyond the realm of our expertise, but there's not many of you out there. So, sometimes it's really hard to be able to get. So, I just wanted to get your insights. Sure. It's a good question. Yeah, so, see, the question really intersects with the whole business of, I mean, it becomes political after a while, because, you know, the psychiatrists, you know, they're wedded to drugs, and, you know, that's what they do in their, you know, 15-minute visits. You know, and sometimes it makes a lot of sense. And also they may, intellectually and philosophically, may dispute this, may disagree. Many of them have been trained in a more traditional way, and so they may say this is just superficial nonsense. You're not getting at the real problem, which is, you know, the relationship with their parents. But to directly answer your question, yes. I don't think you have to be a shrink to be able to do some of this. The whole thrust of my presentation is to really think about yourself, cognitive health, and try to educate the people that you see about cognitive health. Yes, you've had a troubled childhood. Yes, but it exists today in your thoughts. Do you understand that? And they will understand that. Well, how do you mean it exists today in my thoughts? And you could do the Thought Bubble. That's what I would recommend. That's what I would recommend. And I think you should get David Burns' book, Feeling Good. And he's got these charts in there. And, you know, I think as an OCDOC, yes, do it. You may be the only one who has access to this person who can expose them to these evidence-based treatment ideas. So, yeah, go for it, Christine. Sounds good. Okay, other question. So I had a question. Yeah. So as far as employee assistance programs go, have you seen a rise in any mandatory or requests for mandatory participation of employees in EAP programs? I've been asked to consult on a couple situations where there's some organizations in health care that have made mandatory requests that employees go to the EAP as opposed to a private or personal counselor or therapist. And then, in addition, I've seen a trend where they make requests that they must continue working with the EAP as opposed to working with a private physician. And I'm just curious, have you seen trends like that or where this might be going or coming from? Okay, another good question. No, I don't see trends like that. And I think that that is ill-advised on the part of companies who make EAP mandatory because it's really about their job performance. So they can argue with you about, you know, you don't want to get into an argument about EAP or not, you know. Some of these beliefs, they're just not going to let go. I just want to tell you a brief story. So I had an operation a few months ago, and I was in a, and this was at MGH, and I was in a room where I was separated by a roommate, by, you know, a sheet or, you know. And on the other side of the, you know, so I had an operation, you know, so I was recovering. I was fine. On the other side of the sheet was a person with a very serious injury, you know, a large aortic aneurysm. Physician came in and said, you know, this is a serious operation. You're going to need a lot of blood. And the response was, well, I don't want any blood with anybody who's been vaccinated for COVID. I don't want any contaminated blood. You know, and his family went on and on. So my point is, you're never going to convince that guy. You know, and his whole family, you know, we're sitting there going, oh, my goodness. And, you know, you're listening to these people, and they're saying, why do you have to wear a mask here? Everybody, they require you to wear a mask here at MGH. Nobody wears a mask in New Hampshire. That's what they said. Okay. But you know what? It speeded my recovery. Got out of there quickly. Okay, another question. Great presentation. Thank you. A couple of questions, kind of the same coin, different sides. One is, is there any evidence on employee training on these cognitive distortions and trying to upskill the general population, employee population in managing their cognitive thoughts? And on the other side is, why isn't there more training on education in children at a younger age on these types of skills? I'm with you, man. Makes total sense to me. You know, in the United States, the center for this type of education is Center for Cognitive Therapy right here at University of Pennsylvania Medical School. Unfortunately, the United States pales in comparison to the work that's been done in Australia and New Zealand and even the U.K. regarding cognitive therapy, where cognitive therapy is actually a part of the National Health Service in the U.K. So it's politics. That's what it is, man, you know, honestly, because the whole mental health business... All right, so now I'm going to... Yeah, well, okay. So the whole mental health business is controlled by psychiatrists primarily, and so its medical model, you know, it's different. Yeah, so that's why, you know, the people who you see espousing cognitive behavioral therapy are going to be people like me, clinical psychologists, because, you know, they're open to new ideas. But to me, it's very hard to dispel, you know, what you've learned if you've spent many, many years in therapy learning a certain approach, and now suddenly these new guys are saying, wait, hold up, all that stuff, all that inside stuff is really not necessary, you know? I mean, so there's a tremendous resistance, so it's politics. About psychiatry, we know a lot of psychiatrists, like David Burns, who make cognitive behavior oriented, so it's the other groups that are not, that this medication is the only way you're going to get better. You know, there's a combination that works together. Yeah, so it's really political power, which is really getting in the way. But, you know, in Australia, they're doing some very good things, you know, on many levels. Also, if you're interested, check out, there's an organization called the International Positive Psychology Association, IPPA, I-P-P-A. And there, too, one of the leading voices is here, Martin Seligman, here in Philadelphia at University of Pennsylvania Medical School. And they, too, are doing things throughout the world. It's very interesting. If you go to one of their conventions or you read their stuff, all the research, all the smart research is being done not here, but in the Commonwealth countries around the world, interestingly. Yes, sir. Thank you. Thank you for a great presentation. And talking about the business of mental health and the mental health business, I'm curious on your thoughts about, for us that have global populations, if you support global EAP providers, is it better left to not lose the talent and cultural nuances to keep it more regional or even country-based focus? The second question is, there's a trend in training first aiders or mental health first aiders on other sites or down to the business unit. If you had a view on that and whether there's a definition problem there and there is some value in that or to move away from that trend. Thank you. So, if I understand you correctly, so the first part of the question was, does this approach take into account cultural nuances and differences? Yeah, sure. Why not? I mean, yeah. Sorry. Would you support one provider for companies that are navigating the global EAP problem and you would recommend more keeping it country, region-based? Well, I would. What do you think, Kaoru? Yeah. Hi, I'm Dr. Kaoru Ichikawa. I'm a board member of EAP Association International and global EAP, what you really want is global EAP company that has providers in each country. So that way they use each provider in each country to add more cultural flavor or legal connotation that is necessary. Otherwise, each country has different requirement of occupational health. So, the second question was about first responders. For the first responders population? Oh, like a peer support program? Yeah, yeah. There's high evidence for that. So, the EAP Association really encouraging that kind of program to create more peer support. But also, we are actually creating special training now for the peer support for first responders, by the way. Peer support for police and U.S. law enforcement, by the way. And Kaoru has an interesting perspective aside from being an EAP person from Japan. She also just came prior to this convention. She was at a meeting in Bangkok for, I guess, the Asian EAPs. So, she has a perspective that I don't have. Did I answer your question? Not really. Can you clarify this? Because we're doing the same thing in my company. Yeah. And mental health first aid is something that a lot of people in the company are very interested in because there's just some people that people go to and say, I need somebody to talk to. A lot of them sign up for it. But I think what, and I'm not answering your question, I'm just sharing, is that one of the things that we're kind of rebranding is because there's a lot of concern that, especially among both the people who are doing it, who are mental health first aiders, but also the EAPs that we have that say that, look, I'm not a psychologist. So, being a mental health first aider implies that, you know, okay, I'll put a Band-Aid on something that needs stitches psychologically. So, we're rebranding it to kind of collaborate, not only get the training of our people who are interested in doing that, but also collaborating with our EAP to develop a program where we give our mental health first aiders, who are now hopefully mental health ambassadors, kind of resources as to, okay, when this person is really in trouble, this is where you can go. So, that's what we're looking to do. I think it's really, a lot of people have similar questions as you do that we're just kind of figuring that out as we go along. But I like the fact that, in a global company, the cultural connotations, like mental health in the Caribbean, which is where my parents are from, is different from the mental health in England, where it's more acceptable in Asia. So, I think that it's really helpful to have that global perspective, because there is definitely a cultural connotation to it. See, I hear you loud and clear, and you do have to be careful, because, you know, it's politics, it's politics at every stage, and you don't want to get in trouble. And the politics comes into it, because a lot of times the EAP counselors have not been trained in this, and don't know about cognitive behavioral therapy or evidence-based treatments. The healthcare providers aren't exactly sure. The psychiatrists, you know, so you don't want to step on toes. For me, you know, if I had control over a whole, you know, big organization, I would want to mandate training, you know, at every level. Because I don't think you have to be board certified to say to somebody, what were you thinking? You know, what's a thought bubble? What were you thinking? Is that true, what you're saying about yourself? You're right to be very careful, and you know, you're walking on eggshells. But I mean, I would like to see things reduced to a conversational level. You know, so you were feeling, what were you thinking? Does it make sense? Really, so much of the mental health thing, I know you're hurting, and you're in a lot of pain. But the evidence shows that it's usually related to what people think. So I want to be able to help you to pinpoint what you might be thinking. So that's where I would go. And you know, that would be my master plan. But you would need buy-in at a very high level. You need buy-in from somebody who gets this. So obviously they've done it in the Army. So, you know, anyway, that would be it. All right, thanks guys. Thank you. Thank you.

David Francis

evidence-based employee assistance programs

mental health

cognitive health

reduce stigma

cognitive distortions

mandatory employee orientations

EAP services

accessibility