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Whole Person Workplaces

Whole Person Workplaces 

Hello All!

I gave a plenary talk recently at the excellent UCLA ISAP conference, and spoke about how many times I’ve avoided talking about my own behavioral health in the workplace. When I looked back at my career, often I had outright lied rather than disclose mental health or substance use disorder struggles of my own, or my family’s. And all my workplaces have been in health and social services!

In some ways it seems normal; most of us have been raised to separate work and our personal lives (this artificial separation has many patriarchal attributes), we all have different levels of comfort with self-disclosure, and of course, when disclosures concern our family members, we take their wishes around privacy into consideration. The more I reflected on my own lack of disclosures though, it became clear that my omissions were more about stigma than any of these things. This insight became clear when I noticed the difference between my comfort in disclosing what were considered ‘physical’ conditions, vs. those that were considered behavioral health.

I’d never disclosed the harrowing four months my husband underwent ECT for depression; although years later I didn’t hesitate to share at work when he’d been diagnosed with a treatable cancer. Neither decision had been about my husband’s preferences. He always said he didn’t mind me telling anyone either of these things. I’d been very open about my lower back going out twice in one year, sharing freely even with those who hadn’t asked; while in contrast I facilitated an entire staff meeting on post-partum depression, never disclosing taking anti-depressants for three years after my son was born. I called my daughter into school ‘sick’ when she was suffering from depression so badly she sat on the couch and cried in her pajamas.

And I know I’m not alone. Most of us don’t talk about behavioral health at work – even in health care work environments. Mind Share Partners did a wonderful report on mental health at work; what they found won’t surprise most of us: 60% of us experience mental health difficulties that affect us at work – and the same percentage, 60%, had never talked to anyone at work about mental health.

Our health and social care organizations can lead the way for other fields in inviting the emotional health of all our employees into the organization culture and conversation. We can ensure that we talk about mental health and substance use disorders as much as we talk about traditionally physical conditions.

I’ve committed to disclosing honestly about behavioral health in everyday conversation, especially at work. I’ve noticed when I do so, often others are quick to share as well and the conversations are richer for it. Recently I was at a wedding when someone I work with asked me what my husband does since he is retired. I took a deep breath and said he goes to AA meetings and socializes with his buddies in the fellowship. They shared about someone in their family in active addition. When I was in the early stages of discussing work with a new colleague, around obesity, I pushed myself to tell her I had a history of an eating disorder, and consider myself in recovery in that area. She then shared with me her history of obesity, and the stigma she has endured in health care services.

What we are silent about often strengthens the stigma around it; I’ve come to believe that it can be an act of social justice, just telling the truth about what we experience.
Wishing all of you well, and I’d love to hear from you!


I have been interviewed on a few podcasts recently, both about communication in healthcare. The first is on Healthcare Communications: Effective Techniques for Clinicians. You can check it out HERE.

The second is on Complex Care Today about the Power of Motivational Interviewing. Listen to it HERE.

“Bring your whole self to work. I don’t believe we have a professional self Monday through Friday and a real self the rest of the time. It is all professional and it is all personal.” – Sheryl Sandberg

Relational Screenings

Relational Screening

My son wet the bed every night until he was 10 years old. When his friend group started having sleepovers, we had ongoing conversations about who he was going to tell and who he was not.  He identified clues about his peers’ levels of trustworthiness. He felt he could tell a friend who had been nice to him when he was crying before. He decided he wouldn’t tell another friend who he had observed talking poorly about another peer. Once, he even ranked his peer group for me from most trustworthy to least trustworthy, based on some very minute and subtle behaviors.

We all engage in this process of assessing the trustworthiness of others. We make rapid, sometimes unconscious, decisions about who we can disclose to safely and what we are comfortable disclosing.  When asked if we are married, we might not share that we are newly divorced if the person asking us doesn’t make eye contact, interrupts us, or checks their phone during the conversation. We remember these cues about trustworthiness too. For example, we might tell our doctor that our 12 month old is off the bottle, even though he isn’t, because it’s the same doctor who told us at the last visit that we shouldn’t have our baby sleep with us in the bed, while looking down at his files.

Okay, that last one was me…and I’m not alone.  Research indicates the majority of us (61-81% in one study) withhold some important health information from our care team and that one of the primary reasons we do this is to avoid judgment. In some ways, this isn’t necessarily a problem. When it comes to our personal lives and health, we get to decide who we tell and what we tell. When we decide not to share, it is often because we have picked up on something that indicates we would be judged for doing so. In that sense, in the moment, we make a wise decision to protect ourselves.

Still, there are real consequences if our health systems, clinic environments, or interpersonal ways of interacting are barriers to patients feeling comfortable with sharing openly.  Over 85% of the information needed for accurate diagnosis and treatment recommendations come from self-disclosures.  We also know that the process of self-disclosure, when met with acceptance and empathy, can be healing all by itself.

We now routinely ask patients about things that are increasingly personal and even historically stigmatized- substance use, mental health symptoms, trauma in childhood, intimate partner violence and more. For this reason, its more important now than ever to understand how we can ensure our patients feel comfortable sharing with us when we ask these questions.

Relational Screening means developing a relationship with patients as people, before engaging them in a transactional exchange, such as closed-question, agenda-driven, screening.  We can use names, both ours and theirs, and ask about their day. We can purposely use humor, genuine compliments or other connecting strategies to engage with them as fellow humans before starting the screening process (saying something like, “I love your necklace!” Or “How is your daughter doing?”). We can focus on normalizing one’s circumstances (one medical assistant I work with always says, “I’ve got lots of stuffWe all have stuff”), acknowledging the difficulty of some questions (“I know, right? These questions are super personal.”), and most importantly, identifying their strengths (highlighting, “I’m so impressed with your openness. I can hear how much effort you put toward being a good mom” or “I can hear how much you care about your health.”). We can conclude with showing appreciation for what they have just said, even with a brief “thank you for sharing this with us”.

All these strategies are so simple and… not necessarily easy.  Our health and social systems are often not set up to be supportive of relational screening with time pressures, EHR check boxes, and often minimal resourcing for support staff.  Engaging with patients in conversational, empathic  screening is actually a radical act, in that it mitigates power differentials and prioritizes relationships.  For all of you out there that are engaging in relational screening yourselves (and/or supporting staff at your organization in relational screening practices), you are doing incredibly important work!

I’d love to hear your experiences, barriers and strategies in relational-screening practices.  You can reply to this email, or email me at: elizabeth@emorrisonconsulting.com.

For free resources on relational screening, such as workbooks, videos and conversation guides, you can go to www.rsourced.com and click on the Telehealth tab. There, you’ll find a guide book for medical assistants and others who screen patients, another one for the providers who have follow up conversations after there is a positive screen and much more.

Wishing you all well as 2020 winds to a close,