Nota Bene Podcast Ep. 166
Mental Health in Great Organizations with Dr. Thomas Franklin and Dr. Marina Nikhinson of the Mindwork Group
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Listen to the original podcast released July 26, 2023, here:
https://www.sheppardmullin.com/notabene-500
In this episode, Dr. Thomas Franklin and Dr. Marina Nikhinson of the Mindwork Group join host Scott Maberry to explore what the best companies in the world are doing to promote the mental health and well-being of their people.
Guests:
About Thomas Franklin, M.D.
A national leader in psychiatry and psychoanalysis, Dr. Thomas Franklin served as Medical Director of the Retreat at Sheppard Pratt, the premiere program of the prestigious Sheppard Pratt Hospital. He was appointed a member of the American College of Psychiatrists and the Group for the Advancement of Psychiatry.
Dr. Franklin is board-certified in psychiatry and addiction medicine and is a graduate of the Washington Psychoanalytic Institute and the Johns Hopkins Carey School of Business. In addition to serving as a faculty member of the University of Maryland School of Medicine faculty, he also serves as a discussion group leader for the American Psychoanalytic Association.
Dr. Franklin is a co-founder of Mindwork Group, where he is President and Chief Executive Officer of MindWork Group. He has extensive experience treating professionals, executives, business owners, political leaders, and their families. He has been extensively quoted in the areas of substance use disorders, personality disorders, and mental health policy.
Marina Nikhinson
Dr. Marina Nikhinson is a board-certified psychiatrist with advanced training in psychodynamic psychotherapy, mentalization-based therapy, dialectical behavior therapy, and the treatment of mood and personality disorders. She is a master-trainer in the general psychiatric management of borderline personality disorder. In her role as attending psychiatrist at the Retreat at Sheppard Pratt, Dr. Nikhinson became a recognized leader in the treatment of people with complex psychiatric, psychological, and substance use disorders.
She is a graduate of the Washington-Baltimore Center for Psychoanalysis. A faculty member at the University of Maryland School of Medicine, she is also a Fellow of the American Psychiatric Association.
Dr. Nikhinson is a co-founder of the MindWork Group, serving as its Executive Vice President and Chief Operating Officer. In her distinguished career, she has cared for an international cadre of patients, including business owners, political leaders, and executives of Fortune 100 companies.
About Scott Maberry
As an international trade partner in Governmental Practice, J. Scott Maberry counsels clients on global risk, international trade, and regulation. He is also a past co-chair of the Diversity and Inclusion Working Group for the Washington D.C. office, serves on the firm's pro bono committee, and is a founding member of the Sheppard Mullin Organizational Integrity Group.
Scott's practice includes representing clients before the U.S. government agencies and international U.S. Department of Treasury’s Office of Foreign Assets Control (OFAC), the Department of Commerce’s Bureau of Industry & Security (BIS), the Department of Commerce Import Administration, the Department of Homeland Security (DHS), the Department of State Directorate of Defense Trade Controls (DDTC), the U.S. Department of Justice (DOJ), the International Trade Commission (ITC), and the Committee on Foreign Investment in the U.S. (CFIUS). He also represents clients in federal court and grand jury proceedings, as well as those pursuing negotiations and dispute resolution under the World Trade Organization (WTO), North American Free Trade Agreement (NAFTA) and other multilateral and bilateral agreements.
A member of the World Economic Forum Expert Network, Scott also advises the WEF community in the areas of global risk, international trade, artificial intelligence and values.
Transcript:
Scott Maberry:
Welcome to episode 166 of the Nota Bene podcast. I'm your host, Scott Maberry. My guests today are the eminent psychiatrists, Dr. Thomas Franklin and Dr. Marina Nikhinson of the Mind Work Group. We're talking about what the best companies in the world are doing to promote the mental health and wellbeing of their people. Before I introduce our guests, I'd like to thank our listeners in over 100 countries worldwide. We're glad you're tuning in, and please keep the feedback coming. It definitely influences our programming. You can email me directly with your comments and suggestions. My email address is in the program description.
My guest, Dr. Thomas Franklin, is a national leader in psychiatry and psychoanalysis. He was the medical director of the retreat at Sheppard Pratt, the premier program of the prestigious Sheppard Pratt Hospital. He was appointed member of the American College of Psychiatrists in the group for the advancement of psychiatry.
Dr. Franklin is board certified in psychiatry and addiction medicine. He's a graduate of the Washington Psychoanalytic Institute and the Johns Hopkins Carey School of Business. He's on the faculty of the University of Maryland School of Medicine. He's been quoted widely in the areas of substance use disorders, personality disorders, and mental health policy. Dr. Franklin has extensive experience treating professionals, executives, business owners, political leaders, and their families. He's the co-founder, with Marina, of the MindWork Group. Tom serves as its president and chief executive. Tom, welcome to Nota Bene.
Thomas Franklin:
Thank you. I sound very fancy.
Scott Maberry:
Yeah, you do and you are. Dr. Marina Nikhinson is a board-certified psychiatrist with advanced training in psychodynamic psychotherapy, mentalization-based therapy, dialectical behavior therapy, and the treatment of mood and personality disorders. She's a master trainer in the general psychiatric management of borderline personality disorder. In her role as attending psychiatrist at the retreat at Sheppard Pratt, Dr. Nikhinson became a recognized leader in the treatment of people with complex psychiatric, psychological and substance use disorders.
She's a graduate of the Washington Baltimore Center for Psychoanalysis. She's a faculty member in the University of Maryland School of Medicine and a fellow of the American Psychiatric Association. Dr. Nikhinson is co-founder, with Tom, of the MindWork Group and serves as its executive vice president and chief operating officer. In her distinguished career, Marina has taken care of an international cadre of patients, including business owners, political leaders, and executives of Fortune 100 companies. So Marina and Tom are just the right people to help us think about mental health and wellbeing in great organizations worldwide. Marina, welcome to Nota Bene.
Marina Nikhinson:
Thank you very much.
Scott Maberry:
So often in big business we think about bottom lines, quarterly results, corporate successes, but those things can only be achieved by people. The very best organizations recognize that the health of their people has to come first, and mental health in organizations is only now really coming into focus, but it's always been an issue. According to the most recent Gallup's State of the Global Workforce report, rates of daily stress, worry, sadness, and anger have been trending steadily upwards for workers since at least 2009.
Of the worldwide workers polled for the report this year, 44% of employees said they experienced stress for a significant portion of the previous day. That number is at an all-time high, but in the 12 years of the study, that number has never been below 31%. The percent of employees experiencing worry, anger, and sadness at work are all likewise at near all-time highs.
The global pandemic exacerbated these issues for many of us. I know it affected my family and me. I know many families had it much, much worse. But one possible silver lining of the pandemic, at least for me, is that it's helped some organizations shine a light on mental health, and we're hoping to do more of that today, and Marina and Tom are here to help us. So let's talk first about the mind of the executive. From a psychological perspective, what type of people do you typically see rising to leadership positions in large organizations, and what mental health needs do they tend to have?
Marina Nikhinson:
I think you can look at the qualities that are notable in those folks as two sides of the same coin. You get somebody who is driven, who is ambitious, who is energetic, who is probably pretty charismatic, and those folks are able to not only organize themselves, but they can organize the people that they lead. That requires a lot of energy and a vision and the ability to create a reality, visualize a reality, and then bring it into the world. And those are wonderful qualities on their face.
But I think that oftentimes for a lot of people who are very successful, those qualities also hide some of the darker sides of them, feeling lonely, feeling excluded, feeling inadequate, feeling pressured to perform. And so there's this balance of go, go, go. And then backing up from that and feeling like that's the only way to hide from those darker parts of oneself and one's mind. And it's hard to talk about these things and not mention issues around substance abuse or difficulty managing personal lives because you end up in a situation where the professional world, the professional benefits are so powerful, they can themselves be like a drug, but ultimately they create so much gratification that people can often lose themselves in that place and forget to attend to their personal lives and freedoms and having balance.
Scott Maberry:
And that's a really profound thing when you mention the way an executive or leadership person might seem on the outside to be really successful and might feel really driven and successful, and also feel lonely or also feel excluded or also feel sad. And it can be very confusing when you're in that situation, too. So let's talk about the treatment needs for people like that. What types of psychological issues are you seeing for those types of people?
Thomas Franklin:
Well, the folks that end up in these jobs, this sort of ambition is not normal, too. The trappings of these positions, the money, the prestige, the power, in some cases, everybody thinks that this is so wonderful, and it is in some ways, but what one has to do to get those things is really huge. I mean, the CEOs that I've worked with can't really complain about their jobs.
Scott Maberry:
Right.
Thomas Franklin:
Right? But their jobs are incredibly difficult.
Scott Maberry:
It's really hard for all of us, even where we are because you, from the outside looking in, we're all one-percenters, right?
Thomas Franklin:
Certainly.
Scott Maberry:
So it feels weird to say, "But I'm unfulfilled," or "I'm unhappy, or "I'm lonely."
Marina Nikhinson:
But those folks are also the people who can create tremendous change in the world. So yes, they're one-percenters, but there's also a pressure to perform higher. There's a higher expectation, there's more wealth, there's more resources, there's more, more, more, more. And so you end up with the pressures that ultimately create an unsustainable lifestyle for a lot of people, unless they're really paying attention and scaling down and addressing what they need.
Thomas Franklin:
The expectations of these folks, especially in large organizations, is enormous. I mean, it's a 24/7, 365-day-a-year job. Oftentimes, these folks literally are scheduling themselves from 7:00 in the morning until 9:00 or 10:00 or later at night.
Marina Nikhinson:
If we're talking about the mental health component of it, I think it's important to say that many people who end up in that level of performance do tend to have some mood instability. Sometimes that escalates to bipolar disorder, sometimes it doesn't escalate to bipolar disorder. I think what we see a lot in folks like this in treatment is that they can perform a lot. They don't end up in an actual manic psychiatric state, but they are kind of under that level. But the problem is that their mood is not entirely stable, and they cycle into depressions and then they're in bed and they can't get out of bed. And then pressure mounts and then expectations are still there and they're struggling and they're trying to dig themselves out of a hole. So if someone performs, performs, performs and then for a week they can't get out of bed, what's happening to all that work that they're supposed to be doing?
Scott Maberry:
It's true.
Marina Nikhinson:
And that creates a lot of vulnerability for substance abuse, not just, let's say, stimulants to create a way to get back to that performance, but also, they're probably not sleeping very well. They're trying to manage their moods, they're trying to manage their agitation, their irritability. So those two situations really pair, unfortunately, quite well together-
Scott Maberry:
Yes.
Marina Nikhinson:
... where you have this need to manage internal states by external factors.
Thomas Franklin:
Right. And then you see addiction problems or alcohol abuse problems, relationship difficulties, family problems, the very qualities that we often select for in our leaders co-occur with a lot of psychological vulnerabilities.
Scott Maberry:
Say more about that. That's really interesting.
Thomas Franklin:
Well, I mean, it's not normal to want to work this hard.
Scott Maberry:
Right.
Thomas Franklin:
Right? Why are these people doing it? Generally it's because they need to. Why do they need to? There are a lot of reasons for that, things that speak to a lot of psychological vulnerabilities.
Marina Nikhinson:
I think it's important to also say something about distinguishing vulnerabilities from actual disorders. We all have vulnerabilities. We all have personalities, like it or not, and we all tend to oscillate in our abilities to perform and our abilities to think clearly. And when we're vulnerable or when we're sick or when we're sad or when we're in pain, for whatever reason, all of that fluctuates. So vulnerabilities don't necessarily equate to being psychiatrically ill or psychiatrically disabled, but if someone isn't attending to those vulnerabilities, doesn't know what they are, doesn't know what makes them not sleep, doesn't know what makes them fight in their relationship, doesn't know what makes them lose relationships.
Scott Maberry:
Why did I get so angry at that one thing?
Marina Nikhinson:
Right, exactly. That capacity to ask yourself those questions is actually a huge protective factor, which many people don't have.
Scott Maberry:
And people need to learn these things. I think learning about oneself is kind of what you guys are in the business of, teaching people how to deal with these things by understanding themselves.
Thomas Franklin:
Well, certainly we've dealt more with clinical populations in our careers, but I've done some executive coaching. I mean, I think it's not a coincidence that over the last 10 or 20 years there's been a whole new profession, defined, to try and help folks deal with the sort of interpersonal and psychological demands of these jobs. Is it quite therapy? But it's also something that's done with somebody outside of the organization and there's an expectation of confidentiality. I mean, I think that it's very interesting that this is becomes sort of de rigueur now, is a symptom of the fact that these jobs have unreasonable demands, and they attract people that are willing to live up to those unreasonable demands.
Scott Maberry:
I can see it so clearly when you say it that way. And it's so interesting because so often those are people who are bringing something good into the world and doing a really good job of it. But if they're not able to manage the emotional issues around that and their own vulnerabilities and understand them, they're going to pay a huge price for doing that.
Marina Nikhinson:
Absolutely. I think something to say about this that probably leads us into more of a conversation, too, is that one of the things that is very useful is putting in place relationships for high-level executives where they can have a professional intimacy and privacy in order to be able to process and think about things, that it can be a therapist, that can be very useful, but it doesn't have to be a therapist.
But I think a lot of people find themselves in situations where they don't have those types of trustworthy relationships without strings attached. They have vice presidents, they have boards, they have assistants. And that creates another problem, which we didn't touch on, but I think is an important one, of people forming inappropriate relationships at work because they need an outlet for someplace where someone understands what they're going through. And so boundaries start to get crossed and confusion gets created because they just don't have a space to set aside and say, "I had a really terrible day of work today. I had to fire somebody."
Scott Maberry:
Wow. And that's not something you can normally say in your workplace to someone who maybe is a subordinate or maybe is a superior or maybe is a competitor for the position that you're aiming for. Well, I think what you're saying is that we've created these super-efficient structures for business-
Marina Nikhinson:
For management.
Scott Maberry:
... for management, that also tend to isolate people. And so I guess what you're talking about is we could all use a therapist. We could all use some kind of relationship where we can go in and say, "Here's a really terrible thing that happened in my day-to-day," and not have that come back to haunt your work.
Thomas Franklin:
Well, and it also reminds me of the fact that we put on the individual the onus of taking care of their own mental health when really so many of our corporate or structures and processes really are what is causing a lot of the problems. I'm not at all surprised that a lot of Silicon Valley companies are running into massive sexual harassment scandals when they sort of encouraged everyone to live at work.
Scott Maberry:
Yes.
Thomas Franklin:
Right? Intimacy is a basic human need. And if you're asking your employees to spend their entire lives in the workplace, guess what's going to happen, right?
Scott Maberry:
Exactly.
Thomas Franklin:
They're going to get their intimacy needs met there.
Scott Maberry:
We are asking young people, especially right now in almost every profession, we're asking young people to commit an enormous amount of time and energy to work, and we're trying to attract them into the office and we're giving them free snacks and we're giving them a bed to lie down in some cases and all that stuff. And we're also telling them, "Hey, no intimate relationships at work," right?
Thomas Franklin:
Exactly. When, as it turns out, a third of people meet their life partner at work.
Scott Maberry:
Yeah. And where else are you going to meet them in a workplace like we're talking about? Well, there's another topic that I want to talk about because I think it can tend to create a lot of confusion because nobody quite understands what it means. What is burnout and what are really good organizations doing to help people with that issue?
Thomas Franklin:
Often, there's a lot of overlap between burnout and just depression, and other sorts of mental illness, and it's important to differentiate the two. Oftentimes, a burnout is a sign that there are other problems afoot. Those having been ruled out, I think burnout is most usefully thought about as an inability to get pleasure from work the way you used to. In psychiatry, we have a term called anhedonia. It's an inability to experience pleasure in things that you used to take pleasure in.
So if somebody is still enjoying their hobbies and their relationships, but things they used to enjoy about their job are just making them angry or irritable, I think that that's a good differentiator between maybe an episode of mental illness and somebody who is just burnt out. Somebody that has been at it for too long or in a way that's not sustainable or the moral hazard of their job is too much of a burden to bear over time in terms of maybe letting people go or having to be a problem solver of disasters or being in a job that doesn't really suit their personality style.
Marina Nikhinson:
One of the concerns about burnout, besides just the obvious, that it makes people less productive and more miserable at work, probably creates more problematic work environment for other people, is that, if unmanaged, somehow, if unaddressed, it really can progress to depression and can lead people to feel suicidal. One of the issues that I think often happens is people experience burnout in positions that they can't leave for financial reasons, for responsibility reasons.
I mean, in the medical field we see this a lot with physicians who are in high paying jobs with tons of debt and they can't get out. And I imagine that may be true for lawyers, and that may be true for a lot of people who've developed lifestyles that match their income and that they feel that they cannot step to the side in any way in order to regroup or find some sense of purpose again, some sense of joy again. They are much more likely to progress to feeling depressed and developing clinical depression and everything that comes along-
Thomas Franklin:
Substance abuse.
Marina Nikhinson:
Substance abuse.
Thomas Franklin:
And, too, we have so much of our egos invested in our jobs these days, which actually, in history, is a pretty recent phenomenon. Our profession and our professional identity is almost a religion for some people. And the idea that you worked your whole life for this brass ring and now that you have it, it sucks, or at least there are some things about it that are really painful and difficult, is a hard thing for people to wrap their minds around.
Scott Maberry:
It is, especially if you've borrowed a ton of money to get there and your lifestyle does not countenance taking some time off. One of the first things that comes to mind when you think, "Oh, I'm really burned out. I should just take some time away," which is a luxury that most people just don't have. They just can't afford it.
Thomas Franklin:
Well, and that brings me to burnout and organizations, right?
Scott Maberry:
Yes.
Thomas Franklin:
Some organizations are burnout machines. I mean, medicine is notorious for this. I mean, burnout is almost a lifestyle in medicine, and it is in a lot of organizations. I so often see organizations take the tack that preventing burnout is an individual responsibility and they think that they're doing good by providing people opportunities to individually take care of themselves, when they're not at all looking at the organization itself as a generator of burnout, and the org chart processes, like the culture and the team-
Scott Maberry:
The hierarchy.
Thomas Franklin:
Right. It's very easy to say, "We're here for you. We'll pay for you to get massages or see a coach," or what have you, "and we expect you to work 70 hours a week. Here are the massively unreasonable expectations. We have alcohol in the office." So it's kind of a cop out. They pretend to care about burnout, but only in so far as, "You should take care of that." When really it needs to be addressed from top to bottom as an organizational problem.
Scott Maberry:
Well, I want to think about that specifically with you. Our audience includes leaders in large organizations around the world. So what can they do to become more educated consumers of psychotherapy and mental health services for themselves and their employees, for the business world?
Marina Nikhinson:
Obviously, we're a little bit biased because we're therapists.
Scott Maberry:
Yes. You want people to get therapy. So do I.
Marina Nikhinson:
But I think being in therapy yourself creates a lot of advantages. It teaches you to think a certain way, which I think even very intelligent, high achieving people don't always think.
Scott Maberry:
It doesn't come naturally to most people.
Marina Nikhinson:
It does not. It may come naturally once you have a guide, but it's a way of thinking about yourself in the world that's very different than how we're taught to think anywhere else. To be able to stop and think, "Oh, I wonder why I felt that way. I wonder why I yelled at that person." Or "Gosh, this employee of mine is really tearing this other person a new one. I wonder what's going on for them," That openness to not knowing. I mean, I think a lot of what happens in executives, lawyers, doctors, anybody who is at a high achieving level with a lot of people working for them is expected to know. We're expected to know everything at all times. We're expected to have answers.
And in therapy you learn, or not just in therapy, but in the process of therapeutic thinking, you learn to tolerate not knowing. You learn to develop a humility around not knowing, that actually it's okay not to know what's in your mind. You can make guesses and you can make guesses about what's going on in other people's minds. That creates space to just pause and wonder with people, that it's not an expectation of, "I must have an answer. You must have an answer." It's more like, "Okay, well, let's think about how that situation played out."
Scott Maberry:
Well, you've put your finger on something that I think that really resonates for me, for sure, which is that it's very hard to say, "I don't know." And so you really have to learn that skill and somebody has to be there with you to guide you through that. If you're a person like me, it takes a lot of work to learn how to be humble and to have an inquiring mind about something.
Marina Nikhinson:
I think that that skill of curiosity is what we... We all have it when we're kids, and then it kind of gets beaten out of us a little bit.
Scott Maberry:
Especially in professional schools. We go there to learn how to give other people answers. In med school, in law school, in B School, you go there, you learn to solve other people's problems. So I think what you're saying, at least at the top level or the first thing we're talking about in how to help our organizations become more mentally healthy, one thing is, as leaders, learn some of these skills. Get some therapy or get somebody who can help guide you through this type of thinking.
Thomas Franklin:
Well, and who are the people that become leaders? There are people who do. There are people who know. There are these hard charging doers, knowers. And in lower levels, and even in middle management, this is what makes you successful. And then they become senior leaders. And what we need in our senior leaders is psychological sophistication, but unfortunately our system doesn't actually select for that.
Scott Maberry:
Right.
Marina Nikhinson:
There are two terms and psychotherapy that I think are useful ideas. There's psychological mindedness, which is the ability and the awareness that we don't know everything that's going on in our mind at all times, that there's an unconscious part of our minds, the part that we don't know so well, but it may very well influence our behavior, our choices, our ideas, our vision.
Thomas Franklin:
And other people. People on our team, people that work for us. We have multiple motivations, some of which are out of our awareness.
Scott Maberry:
Right.
Marina Nikhinson:
And then the other idea is the term called transference, which is where we develop relationships with peers, authority figures, people around us, that are based on templates that we develop as kids. And we are forever influenced by those first early templates, the patterns that get placed in our minds about how to relate to people come from before we can talk. And so to be aware that someone, let's say you have a subordinate who's underperforming, well, there might be something going on in your style of authority, in your style of managing, that's pushing a button for that person, that maybe it's recreating some sort of dysfunctional pattern from when they were younger.
And obviously you're not that person's therapist. But thinking about it that way, that there might be something going on out of everyone's awareness that's creating that underperforming for that person can create space for the executive to say, "Oh, there's more to think about here. It's not just about punishing this person for not getting the reports in."
Scott Maberry:
This idea of learning how to recognize that there are things driving me that are below my level of awareness. That's a really, really important piece of this, I think. And people need help learning how to do that, if they don't already. Because that goes back to something I said earlier. It doesn't quite come naturally, at least not to me. You have to learn that.
Marina Nikhinson:
Well, and there's a real barrier for a lot of people because it's very scary. It can be terrifying. I mean, we've both worked with so many people who are terrified of the idea that they're acting outside of their awareness. And so, learning about that in a setting that's hopefully safer, without the consequences, without the trappings of having to look all together, can be really useful. But it's a very scary proposition for a lot of people.
Scott Maberry:
Right, which is why you need somebody professional who can guide you through that and in a setting that is confidential.
Marina Nikhinson:
Right.
Scott Maberry:
Certainly.
Thomas Franklin:
Yep. And somebody outside of the organization.
Scott Maberry:
Yeah. Yeah. That's really critical. So that's about the executives. What about turning to employees who are seeking out mental health options, what types of programs and organizational help that organizations are giving? What works and what can be harmful?
Thomas Franklin:
Again, back to what a healthy organization looks like. I mean, just in a basic way, you need to create a healthy work culture where people have the time to develop lives outside of the office. I mean, not only is it the right thing to do, but it's going to be good for the organization because you're going to have less turnover, you're going to have more creativity. You're going to have a much higher productivity, overall. Make people take vacations.
Marina Nikhinson:
Create systems where you don't get punished before and after.
Scott Maberry:
That's another one, too. Make vacations easy for people to do. Do you like systems where they have sabbaticals for their people?
Thomas Franklin:
Certainly. And, interestingly, they're doing more and more studies on work culture and the four-day week and vacations and whatnot. And the closer they look at this, the more you find that you have a better retention, more productivity, more creativity, not just less absenteeism, but there's a concept called presenteeism where people are in the office but not really productive. This is another sign of burnout, back to burnout, is a lot of presenteeism.
Scott Maberry:
We talk about this a lot, too, in connection with COVID and the return to office. At first, the expectation was you were going to stay home and work from home and we're going to give you the resources you need to do that. People liked that at first, at least I did. And it felt kind of freeing for a while, and then it felt very depressing for a while because you're very isolated and there's the terror of the pandemic and all of that other stuff. But then, once the lockdown became lifted everywhere, we started asking our people to come back.
And in many organizations, including ours, there was an initial expectation we'd have people back five days a week, where you're coming back, let's go. And almost everybody said, "No way." Now we say, "You must be back three days a week." And most people are able to do that. But to me, what you're talking about is a different way of looking at all of this, because we're tending, I think, in a lot of organizations to look at it as, "We need to have you back in the office so that we can have things the way we're used to so we can collaborate together around a table and we can get things done."
And others are looking at it like, "You're asking me to come in, but I'm just fine working from home some days." And so that's kind of a battle about where I'm going to work, where I'm going to do my work. But I think what you are talking about is a little more sophisticated. It's a little more about how are we going to work and how are we going to think about our organization as an organization?
Marina Nikhinson:
Because I think that it is hard for most people to be isolated and to work from home all the time and to just be in their own little mental bubble, but to feel like there's just an authoritarian direction to do the same thing you're doing at home, but in the office, seems a little foolish, too. I think some of this gets back to the idea that, as an organization, or as a sub-organization within a big organization, it's really helpful for people to feel like there's a purpose, that there's a purpose to be together. That, if you are together, if you're actually showing up to the office to do something, that there's a purpose to that, that there's a sense of community around it.
Hopefully not a community that take shots in the office at 5:00 PM but an actual sort of development of a sense of being together. And that might be connected to people being able to pursue passion projects and have a little bit of time designated for themselves to do something that they're interested in, even if it doesn't make the most money for the company, but they're interested, then they're motivated, then they feel grateful that they're given space to pursue that.
Scott Maberry:
And that's a great idea because having that be the purpose of being together means that it's different from just doing the work that I need to do, which I feel like I could do anywhere.
Marina Nikhinson:
Right. I think the other piece that's really important in organizations is having the culture that you can ask for help, that you can say, "I don't know," or, "I don't have time for this week," or "You're emailing me, but I'm actually away. Can someone else cover this tomorrow and I'll get back to it next week? Let me know where things stand." I think we all that's logical and makes sense, but it doesn't actually happen.
Scott Maberry:
It doesn't. Most organizations are always on. Most people's phones are always right next to them. Most people's emails are always there demanding to be checked. And most people, at least most people in big organizations, feel like, "I've got to answer the email if it comes in."
Marina Nikhinson:
Right. And I think that executives and people in leadership positions can help create that culture by modeling that, that they can say, "I'm not going to answer my emails on Sunday between the hours of 7:00 AM and 8:00 PM. We're just going to have to deal with all of that on Monday morning," and showing that there can be a discipline around taking time off. I think if people see that in their leaders, they're going to feel like, "Okay, well, I'm not going to get punished for doing that."
Scott Maberry:
That's so true.
Thomas Franklin:
Well, by some measures, the French are the most productive workers in the world, and they're guaranteed six weeks of paid vacation, and it's illegal to contact them outside of work hours.
Scott Maberry:
Wow.
Thomas Franklin:
Right. And for that, you get a very hardworking, engaged employee for the 37 hours a week or whatever that they're contracted to work. I mean, there's something to that. And I think we're still trying to figure things out. I mean, how many days do we need to be in the office? If we're going to be in the office four or five days a week, maybe it makes more sense to have six or eight weeks of vacation. There needs to be some sort of healthy balance.
Scott Maberry:
Yeah, and we need to think about it as organizations because no one person's going to solve it and no one vacation is going to solve it.
Marina Nikhinson:
Well, and obviously there's also this really important piece of women in the workplace, men in the workplace who have kids, and childcare. And I think that that's a big piece, too, that companies that can create an environment where they're either providing the financial support around that or they literally provide childcare on their campuses, I think will get a much more devoted, thankful, and productive employee if that person knows where their kid is.
Scott Maberry:
I think the best organizations in the world are starting to think about that, like, "We're going to have aftercare for your kid when they get out of school, so you know where they're at, and you don't have to worry about setting that up." Because for many, many, many workers in our country, at least, that's the number one concern. It costs a huge amount of money, and it takes a huge amount of time, and somebody's got to take care of the kids.
Thomas Franklin:
I mean, in terms of finding good mental health treatment when somebody needs it, unfortunately that's harder now than it's ever been.
Scott Maberry:
How come?
Thomas Franklin:
There are more good treatments available for mental health concerns now than there have ever been but, unfortunately, our system of mental health care has been broken for a long time and is even more so these days. A generation ago, nearly 10% of the healthcare budget in this country was devoted to mental healthcare, and now it's 4%.
Scott Maberry:
Really?
Thomas Franklin:
So you have an immensely squeezed system where there are very few places that you can get comprehensive treatment of serious mental health concerns. They've squeezed so much money out of the system that most places are just barely getting by in terms of providing treatment. So if you need a bed in a residential treatment center or a hospital, sometimes they're very difficult to get. When you do get one, particularly in a hospital, the amount of quality care you get there and the time that you spend there is less than it ever has been. It's a very challenging environment these days to find decent care.
Scott Maberry:
So if I'm looking for good care for myself or for my people, what types of things do I look for? What do you look for in finding good care?
Marina Nikhinson:
Well, it depends on whether it's outpatient, residential, inpatient, but you want to look for how long do people stay? What is the focus of treatment? Are they looking at stabilization? Are they looking at making some meaningful inroads for this person, trying to assess what got them into difficult circumstances to begin with? Who is providing care? Is it psychiatrists, psychologists, or is it entry-level folks who are six months out of school? Who is supervising them? Who is providing the executive-level of care and supervision and wisdom? I mean, psychiatric treatment actually requires a fair amount of wisdom and a fair amount of pacing yourself. And if you're in a situation where the pressure is to get in and get out, that's a problem.
Scott Maberry:
Yeah.
Thomas Franklin:
Unfortunately, the psychiatric care of severely ill people now, in most places, focuses on crisis stabilization. So you go into a hospital and as soon as they get you through that crisis period, you're turned loose to outpatient care. And there's the whole middle of treatment where you are an outpatient but getting intensive care that actually helps somebody grow and develop and recover has been completely hollowed out.
Scott Maberry:
Interesting. So we really need spaces for that, and we really need to look for that if we've got a severe case.
Thomas Franklin:
Certainly. And, unfortunately, the way we provide healthcare in this country is through insurance companies, and they're profitable because they say no a lot. They make money by denying care. They don't make money by providing care or making sure people are healthier. They don't make more money if people recover at a higher level, right?
Scott Maberry:
Right.
Thomas Franklin:
And they make money by saying no. And they make money by making whatever care they provide as cheap as possible.
Scott Maberry:
Right.
Thomas Franklin:
Right? So, in the face of this, finding really high-quality care has become very difficult within that system, which is a reason so many high-level executives and professionals seek out private care, outside of that system.
Scott Maberry:
Outside the insurance system. And so, coming back to people who just need help and they don't need to be institutionalized, there seems to be the option of looking for someone who's on an insurance panel and getting paid for it and using your insurance. And then, if you're really wealthy enough to afford it, you can go outside of that system and pay somebody more. So what's the advice to somebody who's seeking out that treatment and where do we go to get it and what's the system look like for us now?
Thomas Franklin:
But in America, if you are not going to be in the insurance payment system, there are numbers of institutions that offer a very high quality of care outside of that. Unfortunately, there are also people who are just trying to make a fast buck, quick, in that area, too, particularly in the substance use disorder arena.
Scott Maberry:
So we have to be really sophisticated consumers of this, just as we are of any other service that we're seeking?
Thomas Franklin:
Certainly, yeah.
Marina Nikhinson:
One thing that I would add at an organizational level, and something that I think organizations can do and can do better with, is providing a third-party employee assistance support that creates a way for people to get into treatment and in a little bit more streamlined way, at least to get their foot in the door.
Scott Maberry:
And we're seeing that in a lot of organizations now. Good organizations are making employee assistance available to their people and making it very easy. They can go on their intranet, they can click a button, they can start getting into care.
Marina Nikhinson:
And I think, if it's at all possible, having a component of that be somebody who's more of a broker of looking for care, for people who need more intensive care, who actually has relationships with intensive outpatient programs or residential programs or hospitals, who can say, "Okay, this is what this person needs. Let me help the family get there." Because what we find, I mean, Tom just dealt with this two or three times in the last month, is families are just given the runaround. So they have a family member who's-
Scott Maberry:
Suffering.
Marina Nikhinson:
... very ill, suffering, sometimes missing-
Scott Maberry:
Oh, boy.
Marina Nikhinson:
... because they're just so unstable, and they just have no idea where to turn. And it would be so useful to have a resource like that with your employer, not necessarily in your HR, but somebody who the company contracts with, to be able to say, "Okay, let's walk through this." It's unfortunate that it takes families weeks, then sometimes months to get to somebody that isn't even treating their loved one. They're just trying to get them oriented to where they need to turn. It's heartbreaking sometimes.
Scott Maberry:
Well, that seems like a really good place to end it, because what we have is we have people who need help throughout our organizations and, as leaders of our organizations, we have our own needs. And so what we've talked about today, and I really thank you for this conversation, is learning how to take care of ourselves and then starting to think of ways we can better take care of our organizations so that our people have a lot better care for themselves.
Thomas Franklin:
Certainly. Thank you so much for having us today.
Marina Nikhinson:
Thank you very much.
Scott Maberry:
It's really been great. Thank you so much for being with us.
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