Why It’s More Critical Than Ever to Support Mental Health and How Insurers Can Help
Editor’s Note: Recently, Fred Schott, The Council for Disability Awareness’ research consultant, hosted a second podcast on Long Covid – this time focusing on its mental health dimension. (You can read the highlights from the first podcast here.)
Fred’s guest was Dr. Les Kertay, a clinical psychologist, senior vice president of behavioral health at Axiom Medical, and adjunct professor at University of Tennessee at Chattanooga.
What follows is an annotated and highlighted transcript drawn from the original podcast.
~ You can listen to the full podcast here. ~
A Mass Deterioration Event
[1:30] Fred opened the discussion with a review of two thought-provoking pieces on Long Covid that recently appeared online in The Atlantic (Long Covid Be a ‘Mass Deterioration Event’ by Dr. Benjamin Mazer) and The Washington Post (Long Covid Is Showing Up in the Employment Data, analysis by Justin Fox, a Bloomberg Opinion columnist).
Schott: “Taking these two pieces together — and let me say I’m impressed by the carefulness of their respective authors’ analyses — we get a picture of a “mass deterioration event” that degrades quality of life for a large number of people, and one where the majority of those affected by it are still working.”
We’re Not Well Put Together To Manage Ambiguity
[3:22] Dr. Kertay weighed in on the psychological challenges of “working with and through a persistent, long-lasting, not very well understood condition, like Long COVID.”
Kertay: “The phrase you just used — ‘not very well understood’ — has an awful lot to do with the mental health impact of the pandemic . . .
“People have often heard me say that human beings hate ambiguity above all else. We strive for, and frankly are neurologically wired, to develop certainty; to make assessments of what’s going on around us and to respond in a manner designed to keep us safe. We don’t like uncertainty and we’re not well put together to manage ambiguity.
“And the last few years have been nothing if not ambiguous. And what we tend to do when things are ambiguous is we get anxious and we stay anxious until we get to an answer. And that answer might be right — or it might be wrong. It doesn’t matter as long as it’s an answer and we can settle on it. Then then the anxiety subsides.”
Little Evidence Of A Big Uptick In Long-Term Disability Claims
[7:03] Dr. Kertay observed the following regarding Long Covid’s impact on the incidence of work disability:
Kertay: “I think all of us who have been involved in the disability space, [including] disability insurance or disability evaluations, sort of predicted a wave of new applications for disability. We saw short-term disability bubbles when people got sick. That incidence went up, but we’re not seeing it long term.
“It looks like there is an uptick in applications for Social Security Disability, but even that bubble is smaller than we thought—and the article [entitled “Long Covid Could Be a ‘Mass Deterioration Event’” referenced earlier in the podcast] makes that point.”
In Order To Feel Reassured, You Have To Feel Like You’ve Been Heard
[9:20] The conversation turned to a recent Ezra Klein Show podcast (What We Do — and, Frustratingly, Don’t — Know About Long Covid) which featured an interview with Dr. Lekshmi Santhosh, a founder and medical director of University of California at San Francisco’s Long Covid clinic. Fred picked up on a statement made by Dr. Santhosh about the importance of providing patients with a sense of hope and asked Dr. Kertay how to go about giving people hope.
Kertay: “I go back to a maxim that when we’re troubled and we don’t really have a good explanation, but we know we’re having symptoms, people respond to reassurance. But they respond to a very specific kind of reassurance. And that is: In order to feel reassured, you have to feel like you’ve been heard. That means taking people seriously; doing a good, thorough physical examination; having a conversation about any emotional symptoms that people are having.
“When you pay enough attention for somebody to really feel heard, and then you say: “Hey, listen, we have things we can do that will help you” or even “We have things that we think will help — we’re not certain, but we’re gonna do everything that we can” — that kind of reassurance actually gives people hope. The important part is you can’t just tell somebody: ‘Oh, it’s gonna be fine.'”
Ask ‘How Are You Doing?’ In A Way That Indicates You’re Actually Interested In The Answer
[14:27] The conversation shifted to the art and skill of listening to people.
Kertay: “I tell people the most powerful intervention you can have from a mental health perspective is to ask somebody: “How are you doing?” in a way that indicates that you’re actually interested in the answer, and not just asking and expecting ‘fine.’
“When you ask that question with a tone that indicates: ”I’m checking on you. How are you doing today?” that’s a very powerful intervention. It really is helpful to other people, and frankly, it’s helpful to ourselves, too, because we make a human connection.
“I think that Mental Health First Aid is incredibly powerful for that exact reason. It helps you not be so afraid if somebody doesn’t say ‘Fine’ but says: ‘Hey Fred, you know, honestly, I’m really not doing that well today.’ It helps you not be so afraid of that answer.”
Call To Action: Be Rigorous, But Be Human
[20:20] Fred asked Dr. Kertay: What kind of call to action would you issue, based on what’s been discussed so far?
Kertay: “My call to action is twofold. On the one hand, I think we have to apply scientific rigor and understand what we don’t understand, and work really hard to be very precise about about diagnoses in mental health and in physical health. Let’s figure out what’s going on.”
Dr. Kertay briefly reviewed some observations he shared at an April 2022 webinar on Long Covid organized by the American College of Occupational and Environmental Medicine (ACOEM) about the proper interpretation of recent studies reporting very large increases in mental-health symptoms – noting that symptoms are not the same as diagnosable mental-health conditions. (Go here to watch a recording of the ACOEM webinar; Dr. Kertay’s segment begins at 28:21. You can also check out webinar handouts here.)
Kertay: “At the same time, the other half of [my call to action] is: Let’s not let our lack of knowledge make us cynical, and let’s understand that people are suffering and we need to pay attention to that, and make those kind of human connections.
“So that’s my call to action: It’s simultaneously to be rigorous scientifically, and to be human and really elicit deep listening to one another about what’s going on. Because, frankly, all of us have been affected by this pandemic.”
What We Can Learn From Ted Lasso
[23:40] Dr. Kertay’s call to “be human and really elicit deep listening to one another about what’s going on” prompted Fred to ask him if he’s a Ted Lasso fan. It turns out he hasn’t seen any episodes yet. Fred urged him to binge-watch the first two seasons to get an appreciation for why a speaker at the Society for Human Resources Management’s recent annual conference called that show “a masterclass in mental health leadership.”
There Are Other Things Going On Besides Just Covid
[25:02] Fred asked Dr. Kertay the all-purpose wrap-up question: Is there anything we haven’t talked about that we should be addressing? Referring back to the recent New York Times podcast on what we do and don’t know about Long Covid, Dr. Kertay noted:
Kertay: “Part of what’s happening is people are coming into the health care system who weren’t in it before, or who stayed out of it for a long time. And some of these things that are going on, they’re troubling, but they’re not actually the direct result of infection with the SARS-CoV-2 virus . . .
“And back to my call to action: to be rigorous—but listen—because there are other things going on besides just Covid. And these are things we’ve needed to talk about for a long time.”
~ You can listen to the full podcast here. ~
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