Mental Health with Marni Stahlman

technology has not really been something that I've seen embraced inside the field And then we were forced into the innovation, and I think that's what COVID did, it forced innovation in fields that were not ready maybe to embrace them. I think it's been revolutionary Our teens and adolescents, our children are really in a crisis for lots of reasons. And telehealth and telepsychiatry has possibly opened up a way for them to reach out and get assistance in a way that they may not have been able to. And quite frankly, could be life saving.

Welcome to a virtual view where we talk about tele-health healthcare and everything in between.

Thanks for tuning into this collaborative episode of the virtual view and the telehealth unmuted podcast today. I am joined by telehealth unmuted, host Kara, and we're excited to have Marnie Stallman with us today who works with the Florida mental health association. He's gonna just tell us a little bit more about herself as well as some of her work within the virtual care space. So Marni for our audience who may not be familiar with you, why don't you tell us a little bit about yourself?

Thanks for having me today. I'm excited to be with both of you and also with the listeners to share a little bit about who I am, what we do here at the mental health association and explore some important topics related to mental. My background is as a clinical psychologist, I've been in the field now for probably close to 40 years. Primarily working within the marriage and family children in adolescent sector and had sometime in clinical private practice, I've been a. The CEO and president of a psychiatric hospital here in central Florida at one time for children and adolescents. And I'm really excited now to be the president and CEO of the mental health association of central Florida. For those of the listeners not familiar with M H a CF. we are the oldest nonprofit here in central Florida. We just celebrated our 76th anniversary. We were founded back in the 1940s with the primary mission and goal to be an advocate for individuals with acute mental illnesses, along with their families. For those of the listeners that are familiar with NAMI, the national association for the mentally ill, that was really formed in the late Nineties, mid nineties really to be an advocacy group, but back in the 1940s, if you were an individual diagnosed with even a. Chronic mental illness, more than likely you were institutionalized. There was not a lot of treatment back in that time. Medications weren't very sophisticated talk therapies were still considered cutting edge. And the whole field of psychology and psychiatry was relatively very young. And so unfortunately, quite a number of people who by today's standards would be considered an individual, maybe dealing with a depress. Episode or an acute anxiety disorder or something like that would find themselves in a commitment situation and the mental health association, not just in central Florida, but across the country. Cuz there are other mental health associations that spring up as a result of that really worked to free the. So to speak. And so the, in the symbol for the mental health associations is a bell which was actually created as a symbol in real life from the chains and shackles that people were institutionalized and bounded, and they were melted down symbolically to form that bell. Today. The national mental health association is mental health America, which I'm sure many listeners are familiar with. They're quite an advocate working across the country and internationally on really important issues related to advocacy. And de-stigmatizing the work that needs to be taken around mental. Over the years, the mental health association here in central Florida has evolved as you can imagine. And so we are not just an advocacy organization, but we also provide direct mental health counseling on an outpatient basis, primarily to individuals without health insurance. Florida has the infamy of being just one of 12 states in the United States that did not do Medicaid expansion. And as a result of that really important services related to mental health and behavioral care for the uninsured have not been able to be delivered. And so our outlook clinic is one of the few in the state of Florida that is providing at no charge outpatient mental health services for individuals over the age of 18 that do not have health insurance. And we're supported by grants and philanthropies and hospital partners here locally to do that work. So we spend a lot of time in our state legislature advocating for some of the changes in laws that we feel are necessary here, as well as bonding together with our brethren across the country, on state national issues, and then working on the delivery of direct care. That's a mouth.

Wow. Really appreciate. Comprehensive, description that you've given. It really helps. Us as interviewers, but also our audience. I'm curious to know, everyone has a series of experiences maybe that inspire them to pursue a certain career. So I'm curious to know for you, when did you decide that mental health was a passion of your.

I was very fortunate or unfortunate depending on how you look at it, that my mom is a psychotherapist. And so I literally grew up her practice initially was in our home. She had a home office and she was one of the first individuals here in the state of Florida back in the late seventies, before there was even licensure to work in marriage and family. And just watching it, getting dragged along to psychotherapy conferences. Isn't every high schooler's best idea of fun with their parent, but I got to meet some really amazing trendsetters people that are now in textbooks that I got to see in the late seventies, early eighties, before most of them passed in marriage and family therapy. And it was just a kind of natural progression and, in other families, if your dad's a doctor or a lawyer or bus driver or whatever you might wanna aspire to say, I wanna be like my parent. And so in that instance, but I also saw the impact that was being made from family therapy. And at the time in the early, late seventies, early eighties, family therapy was very new. As a modality and a treatment option systemic theory or systems theory as it's called, was really a radical approach back then, back in those days, even seeing somebody with an addiction disorder was a dual diagnosis was considered really far out. Now, of course the field embraces that and says but yes, of course, somebody with an addiction must always most certainly be grappling with at least anxiety or depression and is using the substance use and abuse option as a way to medicate. For other things that are going on. But back in those days, as my daughter likes to say in the old days where we had to have a remote for our television, instead of, getting up and changing the channel that's the way that the state of the field was.

Amazing. Just to see what the progression of the field of mental health has really. Evolved over the past several decades and also just how special it is for you to be able to see, even your own mother who has been a part of this process and help to shape some of that desire. As you said, depending on how you look at it, that's a pro and a con, but it is cool to hear how Those experiences you had with a close family member who was doing that work really helped to shape the passion and where you are

Yeah, it really was something. And other family members have followed suit in one way or another. And my daughter's been very clear that she may be interested, but we'll see, she's only 14.

Yeah. So who knows, you know, it may be generations that continue to to work in this work. Since you're working specifically within the context of. Florida. What does the prevalence of mental health conditions look like within your.

Yeah. That could be a long conversation as I alluded to. Florida has really grappled for a very long time on a number of healthcare related issues as it attends to the needs of the uninsured and underinsured. We have the infamy of dropping in the last two years from 48th to 49th in the country for the amount of money that we spend per resident here in our state on mental health and the funding that goes with it. Very unfortunate that in Florida, the funding that comes through for most of the programs that are supported by local governments through the state. There's no recurring dollars. So every year we have to go back and ask and it's difficult and it really makes it an obstacle. As you try to educate your legislators and local advocates and government. Why is it important to put funding behind mental health? So the state of Florida has been in a bad state for quite a while. The mental health association is part of something called the Florida mental health advocacy coalition. Those are other organizations across the state and we band together to really take up the cause. One of which is a drum beat that we've been drumming now since 2013 and the affordable care act, which is the expansion of Medicaid. Because by doing that, it really will help to encompass and bring into the fold for Medicaid benefits a portion of our population that is just. Completely left out by disparity because of socioeconomic issues that are sometimes not in their control. And we need to see that. And we certainly know that and have seen that in communities of disparities, of color of poverty, they are com most often the most afflicted with issues of substance abuse and use and disorders and mental health conditions that go untreated. Most recently, I was in a conference with some colleagues here in Florida and we were discussing, and someone quoted a statistic that I found just to be incomprehensible, which was that in a community of color, an African American male. It could take as long as 11 years from the point of diagnosis to treatment. because of access to care issues that we have here. We just don't have enough. And obviously with the COVID pandemic and coming out of the recovery, we've seen. International and national focus on the fact that mental health is part of your physical health and that this previous stigma about this separation of the two really is being closed. As we see more celebrities, people of note, Michael Phelps, Simone Biles selena Gomez, influencers who have come forward, but until we see members of our business communities that are here, local running organizations that are recognized, it will still seem far away that celebrity has disclosed that they have our grappling with a mental health condition, but we need to see and have it be demonstrated that there. People walking right among us in our workplace, in our communities, in our churches and synagogues in our community organizations are really grappling with everyday issues and it doesn't necessarily have to be something that is chronic, but it can certainly be acute. And it's okay to talk about that. I long for the day that we can openly talk about being on medication for mental health disorders, the same way we say I take high blood pressure. Nobody thinks twice about the fact that you might eat too much salt on a daily basis or drink too much Coke and therefore have to modulate your blood pressure. But if you were to say, I take Wellbutrin or Zoloft, then people start to say, oh well, you know, and I don't know how that goes back to your original question about this data, Florida, but we're trying every day here to raise the awareness and the level of funding that comes in so that more and more people can get their treatment and get on a road to recovery.

Yeah, absolutely. I think you bring up a lot of really interesting points here and I think you're absolutely right. That part of the destigmatization that needs to happen is To have people that are public facing, maybe high profile individuals that are respected in the community to be vulnerable and to share if applicable their mental health struggles because they think that when people at the quote unquote top are able to do that, it permits everyone else in the community to, follow suit and. Also share. So I think that's really interesting and I also think it could be applied to really anything, even in the working world, having people in leadership or having people, that you aspire to be like or inspired by to have them, set that example.

Over the last several years, there's been a huge focus on something called D E and I equity and inclusion. How are workplaces, community organizations, communities really embracing. The people that are different, the people that look different sound different, come from different backgrounds. And how do we integrate them so that there's this wholeness and equity and inclusion. But interestingly enough, we have seen some of that work and again, Florida may not be at the cutting edge of de and I certainly we've. Some issues that they've had here in the last several months recently, but we see it across the board for the most part, but do we see it with people with disabilities? Do we see it with people that come forward and say that they have a mental health disorder? Not very often. We did have something really interesting happen here. Just this week. We have an Amazon fulfillment center that's pretty central to the central Florida region. And we got a call from Amazon saying, Hey, we're reaching out because we just want you to know that if individuals with mental health conditions or diagnoses that are looking for work, we're hiring. and that was really a monumental shift, right? We've seen individual organizations like Google and Amazon reach out to the autistic or autism community to the deaf community, to the blind community, but never reaching out to specifically say we're hiring people with mental health conditions who are just as capable and able bodied. as long as they're on, the medications that have been prescribed or they're involved in a therapeutic relationship or they're staying stable within a peer recovery option, which is certainly a movement that's grown they're very functional. They can do the work. They're smart, they're energetic, they're artistic. They're happy. They're talented. They're all the things. You know everybody else's. And so that was an interesting conversation, but it is also of note that when we talk about diversity inclusion and equity across lots of different categories, how often do we get to say, or have that conversation around mental health and individuals with.

Yeah. I love that. And as somebody growing up. A sister with down syndrome. It's really interesting to see that same theme in employing people. Special needs and down syndrome specifically. A lot of nonprofits have, really popped up in the last couple of years that make that their central focus having professional development, job training, and opportunities to make in income. So I really love that. And I think it's super, super important. Like you said, not only to make it acceptable if you have depression, but to say like, you're not any less of a person for that. And, we would love to have you working within our organization. I think that provides a level of empowerment and acceptance that people so desperately need.

I would. Yeah, and I would say if we had more of that, we would have a less present prevalence of suicide attempts and completion. Because it really, when someone is getting to that point of an attempt or unfortunately, a completion it's because they've reached that point of despair. It's because they've reached that point of not feeling included of not feeling like there's a resource or an alternative that will help them feel differently. And that's really unfortunate and can be changed.

Yeah, it can be. Absolutely. I think. What you described as a really effective way to do that and also making it, normalized in general, to be able to talk about this. And because so many people are on medication, we just don't vocalize it. So you feel so alone.

Yeah. And I liken it back to before Betty Ford came forward in the 1970s with breast cancer, women didn't talk about breast cancer, it was taboo. And if, even the prevalence of getting mammograms and having a breast care check and doing it on an annual basis Was really something that was unheard of. And it took somebody like Betty Ford in the presence, as the first lady of the United States to come forward and talk openly about her breast care and her journey on cancer. Today, both my mom, my sister and my sister-in-law are double vasectomies. They're thank God. Okay. And two of them of the three have had reconstructive surgery. My sister said a boob is what you call your husband when you're mad at him. So think of the normalization before, in 1972, we couldn't talk about a woman's breast care and what breasts cancer was about. and now we joke about it and what's a boob and we have the Susan Coleman foundation and we have the pink brigades and it's just out to save women's lives. And if we could somehow come up with that same kind of mentality about openly and freely talking without the stigma about mental health, think of the lives that could be saved.

Yeah, absolutely. I think that's a fantastic example, too. Which also indicates that we absolutely can do the same when it comes to mental health, but it will take the collaboration and buy. Of the community in order for it to happen. I do wanna make sure we ask about the social determinants of health, which you did touch on in your earlier response about, mental health conditions facing Florida and the populations you serve. Are there specific social determinants of health that you see. Very commonly in the region that you serve. Are there ones that are a specific focus right now in your practice? Any, anything that comes to mind would be, I think, relevant.

So social determinants of health are really characterized as conditions that people are born into grow into live, work age, but all of these factors can strongly influence the health outcomes of any person. And what we've really experienced here, not just in central Florida, but when I talked to colleagues across the country, the COVID 19 pandemic really ripped the bandaid off of where we saw some really strong disparities. And where these most common social determinants of health really were deeply entrenched into the health and social and economic inequities that exist here in the United States. The most prevalent one, I think that most people are aware of, especially coming out of the pandemic, that was the most visible was food. And what we saw where people were lining up to try to get food or have food. And had never, previously been donors to food Harvard's banks, we still see feeding America to this day. We're still having food giveaways here. Access to healthcare, I think is another really critical one, particularly in communities of color where you're not gonna see an emergency department or doctor's offices or dentist's office, really dental care is a really big one. And then housing. Orlando is now considered one of the top five, most expensive places to live in the United States. It's nearly impossible to get housing here. You have to have an income of over 50 or $60,000 to afford a one or two bedroom apartment. And we have a gig economy here in most of central Florida and also a low wage tourism based economy in hospitality. So those are not individuals that are typically making more than 15 or $16 an. In recent years, we've seen exposes in the front pages of our paper, where we've had hospitality, tourism, theme, park workers going to work every day and they live in their car.

Wow.

So when we talk about really the social determinate of health and how they affect everyone's mental health being I think that you can't exclude any of the social factors. When we talk about health and wellbeing, the most recent one that I came into contact had to do with climate disparity or climate discrimination, that there are regions in different states and areas of the United States where people are more subjected based on poverty and race to climate conditions that are adverse to their health conditions than people with. And stature. So that's a very new one. I think that has been added to the social determinants of health is climate. And how we build buildings where we situate them. I think is really important here in central Florida and in a lot of communities across the south. We have a street in our downtown that's called division. The reason for that was the division street that divided the African American community from the white communities. And those streets are still here. They're still named. And we see that's typically where highways go through. That's where large sports stadiums are built because the lands are cheap. And so there's just a lot to say there, but we certainly have seen it particularly after COVID where there was a loss of income, job loss. And now with the economy and a state of inflation and some families not being able to get back to where they were. We're seeing a lot more in our clinics.

That was a great overview of some of the things that individuals in your particular community face. And, one of the things that we talk about in this podcast is, despite some of these social determinants of health and other equity barriers that these individuals may face, what are some ways that your organization has utilized digital health solutions like te. To help bridge the gap that some of these patients may face when it comes to seeking out mental health.

You know, It was really remarkable. And I don't think we're alone here in the responses that we've seen. And you've seen the rise of telehealth medicine, not just in psychiatry and mental health, but across the field. It was something that was fairly untapped pre COVID in Florida. We really were a little bit behind the times legislatively about how telehealth could be utilized and reimbursed for. So people were a little bit more hesitant. And then of course, when we went into lock. There really wasn't much of an alternative for individual communities that had not been able to access in the category of mental health. We saw an enormous jump. And what now becomes a new social determinant barrier is access to broadband. So it used to be access to transportation would be a big denominator for somebody following through on treat. Because we don't have a rapid transit system here in central Florida. We don't have a light rail that's effective and utilized. And we have a transportation network on our roads that is just. mess. So when we would talk to individuals and do community round tables, we would see our access to medical care was inhibited by the lack of transportation options. Telehealth now puts you on an information highway and not a regular highway. And so we saw a huge jump in the number of individual. In our outlook clinic that were coming to the clinic and keeping their appointments. One of the things that practices look at is of their patients. What is the confirmation rate? How often do patients cancel their appointment? How compliant are they and compliance and mental health treatment is really important, right? To be consistent. We're at about an 89, 9% compliance with our telehealth patients, which is really remarkable and that's caused celebration, but also now opened up questions about how to deliver broadband into communities that again, have been left out. Most everybody has a, a cell phone, but do they have a data? That will allow them to sit on a 30 minute or 40 minute appointment. And how do we bring that? The Biden administration has really tried to open that up with funding for through the American rescue plan for individuals to get a supplement for their broadband and also even digital equipment. But we have to get that word out.

I'm curious to know, what do you think has been the impact of digital health solutions for patients with mental health conditions? How has, I guess telehealth telemedicine impacted your line of.

So I'm gonna, I'm gonna make a statement and I'll preface it and then come back. I think it's been revolutionary no less than revolutionary that said, I will tell you, I myself was not an early adopter. So as has already been noted, I've been doing this since the seventies where you had to get up to change the channel on your televis. So technology has not really been something that I've seen embraced inside the field, but as the evolution of that has come around and I was always trained old school that for a therapeutic relationship to be successful, it requires a bond between the therapist and the client, the patient, and. I was always suspect how's that gonna happen in a digital virtual space? So many cues come in a therapeutic relationship for, how someone is acting, reacting, how they're sitting, how they've mapped themselves in the room. There's lots of verbal and physical cues to take. and I was really not an early adopter. I have to tell you. And then when we were forced into the innovation, and I think that's part of what COVID did, unquestionably was wreak havoc on our emotional and physical senses of safety and security, but it also forced innovation in fields that were not ready maybe to embrace them. Or we're just starting to, and I think psychiatry and mental health or behavioral healthcare treatment was one of. And the need for the innovation. I think forced us to embrace something that probably would've taken many more years to evolve into the way that it has today. Now, two years later, I go back to the word that I think it's been revolutionary. I think what it's opened up is the opportunity for people to access mental health services in a way that may, they may previously have not been afford. Or location wise it's taken away barriers and boundaries of geography and provided that you're with a good telehealth provider that you've done your homework with. I think that the therapeutic relationship is just as informative and just as impactful as if it were to be a face to face. And I think it's opened up the opportunity to remove the barrier of exclusion. I also think that it's taken away a little bit of the hesitancy that people had about going face to see a therapist. While you're still having an intimate interaction. There is something to be said for, it's still flat and in this virtual space you can cut your camera if you want to. If you've got some social inhibitions and phobias about anxieties being seen before you can be coaxed out to have that. That's removed some of those intimacy barriers that may have prohibited people in the past from seeking out care and then the affordability of it, as I said Florida's been a little bit behind the times about how to legislatively allow for. Medicaid and Medicare to pick up billing for telehealth and private health insurance companies, to be able to have their providers, bill for telehealth services. Other states have certainly been more progressive and have set the standard and led the way on that regard. But it's also opened up a level of affordability, I think again that may have been prohibitive for people looking for a one on one. That's not to say that I've given up on one on. I'm still old school in that regard, but I certainly can't dismiss the efficacy of what telehealth has been able to do.

I did see a study about an increase in teenagers getting mental healthcare. Previously they might have been too intimidated to go for an in person visit or maybe ashamed or whatever. It might have been back to the stigmatization, but something about, being able to, jump on a video call is more approachable and easier for them to do.

Yeah, especially with adolescents provided that they have the sign off, obviously parent or guardian, but there's some startling, sad statistics that are floating now, post COVID, one I just was talking about today with a colleague, an American teenager takes their life with a gun every seven hours on average. Gun violence, and now is the number one cause of death of children and adolescents in the United States. And that's not homicide gun violence. That's a mixture of self inflicted or self intended gun violence. Not to mention the statistics, 50% of teenagers by the time that they're in 12th grade are gonna have tried an illicit drug. Our teens and adolescents, our children are really in a crisis for lots of reasons. And telehealth and telepsychiatry has possibly opened up a way for them to reach out and get assistance in a way that they may not have been able to. And quite frankly, could be life saving.

Yeah. So I think, one of the things that sticks out with what you're saying there is it's important to be able to have options. So whatever modality that is the most comfortable for that patient to want to seek out, help. Being able to have those different options available. Cuz you know we're seeing with a lot of telehealth programs that, one of the biggest drivers is patient choice. And so being able to provide patient choice and I think especially when it comes to mental health treatment when. Perhaps as you mentioned individuals may be intimidated to have an in person appointment. And so they wanna have some of that separation, or you may have someone on the flip side that, being in a virtual encounter feels less personal and they want to be in person, but really having the opportunity to have options for both is going to improve, the outcomes that individuals can have. Whatever modality is gonna work for them. They can pursue that.

Yeah. And I wanna point out too, something that we may not have highlighted enough or at all, really in this conversation is within the treatment modalities and options there. I wanna make sure that. make a deposit and recognize the peer recovery space movement, and how important that is in attributing and contributing to the recovery of individuals who are in an acute crisis or dealing with a chronic mental illness because peer to peer. And this is something developing here in Florida, where we're getting certifications for peer to peer specialists, having somebody that's had a lived experience. That's similar to your. And having a place to repo those experiences and share them and collide with them and see people that are like you in your experiences or have been similar in your journey is a very effective method now. And, just as I mentioned earlier on, in the, in. Seventies and eighties when people were, poo-pooing kind of the oh dual diagnosis, there's no such thing. Peer recovery really is at that same kind of juncture right now over the last couple of years where it's emerging out of, its own cocoon into the butterfly that it should and needs to be. And is in a very effective modality when talking about. Of who to access for care and where to go. And so for the listeners, there's a lot of peer recovery options that are out across the country, Florida is this in this area's been leading surprisingly but that's because the peers have stepped forward. The people that have been chronically dealing with this for their lifetimes, or have family members that have been chronically dealing with this as their lifetime. And that's where we see, Organizations like NAMI mental health, America other peer led groups really important to include them.

The peer recovery space. Is really important when it comes to mental health, being able to have individuals who understand what you're going through have lived through it themselves. And, know, I've seen a lot of emerging resources specific to that, especially when it comes to substance use and addiction. Because no, One person facing that mental health condition looks exactly the same, but being able to have someone who understands what you're going through can be a huge benefit.

So what's interesting is we talk about, the cocoon on wrapping on the peer recovery space movement would make it appear as if this is something that's relatively new, but it's interesting, Cameron that you pointed out in the addiction space, AA has been around for a very long time. And when you look at the model of how AA operates or Alanon It's a peer to peer space. So it's not that peer to peer recovery and the space movement itself has just been an epiphany. And so everybody's Hey, we should have peers talk to each other. AA is 87 years old. It was founded in 1926 it's been here a long time It's just that we've evolved now to see it beyond the addiction space, into the chronic behavioral health and mental. Space as well that people with chronic mental health conditions like schizophrenia or bipolar disorder or Schizoaffective, people that are, as I said, chronically, mentally ill with a diagnosis that needs to be treated and monitored so that they stay out of crisis. Having those peer relationships is really, I.

And it's interesting to see the little full circle moment, right? When we think of, peer relationships are one thing and then also, big picture thinking about how community and how. Social acceptance and conversations drive change and, help people, especially in the realm of mental health. You have such a, extensive background and career journey and you've led. Organizations and, you are also, on the clinical side too treating people and have been, I'm curious to know, like what advice would you give to, a young professional who is interested in pursuing a career, in mental health and potentially, doing it digitally as well. What have you learned? Do you have any big insight or takeaway that you would want to IM.

We need people coming into the field desperately. We have lots of people being recruited by business schools and by trade schools and different things like that. But part of the difficulty is that as a career path, it's not maybe the most. Financially rewarding path to take, whereas it is emotionally a really rewarding path to take, and we need a lot more people coming into the field, particularly people that are representative of the communities that we just spent some time talking about because effective treatment needs to be delivered by people that look like the people that they're treat. And that's been one of the concerns and issues that we've seen in some of our communities of disparities is that they don't have the same lived experiences, the therapists, or the professionals they'll try to have the empathy and understanding, but they can't know it. And it's something that I really think is missing in the field and has been for a very long time. What would I say to inspire somebody to come into the field? It can save a life. You can save a life. I once had a reporter say to me, you with the amount of volume that you have at your clinics, how do you manage it every day? And I said I don't look at the people that come to our clinics as 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. I look at 'em as one plus one till I get to 10. And that's how you have to space the day, every day. You just have to go for the. and make the difference in the one and then move to the next day. Cuz if you don't do it that way, it can be overwhelming and you can just feel despair, but you can do a difference with one. And I think that's when we talk about, and we speak to young people that are going into the medical or helping professions, why they're going to med school or different kinds of opportunities within the healthcare field. That's what's motivating. but we seem to not be able to do it very effectively with getting more and more people to go into the mental health, behavioral space. And I think that's also where tele telehealth has helped because it's allowed for some of the disparity in workforce to be made up, especially in more rural areas. You don't have to worry that you don't have a psychiatrist in a rural area. You can dial. And find someone that might be a couple hundred miles away, but they're close. I wish I had that magic answer about how to entice more people to choose it as a field, as a calling, as a vocation. That's how I view it. I don't say that when I speak to my family, I'm not getting up to go to my job. I'm getting up to go to my, do my work.

Love that. And I think, especially true in helping professions, like you said, be focusing on treating the one and really. Taking care of yourself in the process so that you avoid that burnout and avoid that fatigue and overwhelm. I think that can also be applied, in any career. And I think, it's something that. They've luckily started talking about a lot more, having those boundaries and setting those boundaries and, just really being honest with yourself in order to, be productive, but also not at the expense of your own mental health. And I, but I still think we have ways to go. When we look at career and work life culture,

Yeah. And in my training when I was coming up and I'm sure it's still this way now, if you're gonna be in a direct clinical field. Where you're doing direct patient care. You need to be in therapy yourself. There's no way that transference isn't gonna happen. There's no way that projection is not gonna happen. You're a human being you're going to absorb what's happening. And as you pointed out you're no good to anybody. If your own mental health is precarious, right? So you wanna safeguard that you wanna do things that are self-care related and nurturing so that you can be the help. In return, but it's I have this analogy. I tell people all the time, when we get on a plane and we fly after the doors close and the flight attendants are standing up and the gate is being pushed back and the pilot's getting to the runway. What happens next? The steward is flight attendant stands up and they start going through the safety pre. They point out where the exits are in case you have to jump out of the plane on a tube or a raft, and then they say, what in the event of an emergency and air pressure in the cabin being reduced, air masks will automatically drop from your seat above. What's the next thing they tell you to do after they drop put the mask on. Before you put it on the person next to you. And the reason for that is if you're not breathing, then you're not gonna be much help to the person next to you. And that's the same kind of thing. When I talk to and in supervision with other clinical team members and staffers that I've worked with and therapists in the field that I was taught very early on in my own clinical training, put your mask on first, cuz you're of no use to somebody if you're not breathing. And that really means self. And making and taking care of yourself because it can be very hard. And there are times that you have to step back and there are times that you have to impose limits and say, this is not something that's healthy for me to be involved in that this is a toxic relationship with the client or the patient may see the boundaries of what you may be able to help, as caregivers, as helpers, as clinicians. We like to think we can help everybody. That's not. It isn't, we're not a one size fits all. We have to know what our limits are. We have to know what our capacity is. We have to know where our strengths and opportunities lie. And also be honest about that.

Yeah, absolutely. Especially when we're. In an era of, caregivers really experiencing a lot of burnout because there's so much need out there, there's gotta be a balance of, making sure that you take care of yourself. Despite some of the other things that are going on marni want to thank you so much for just taking your time to come and lend your E. On this collaborative episode with the virtual view and telehealth unmuted. Marni we really appreciate it. We hope to talk to you again sometime soon on the podcast but really wanna just thank you for your time today.

It's my pleasure to be here. Thanks for having me.

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