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The mental health crisis has been looming in our country for decades, well before the pandemic hit. Covid-19 further exacerbated and accelerated the situation—for women especially, who have felt the burden in unimaginable ways at work and at home.
This global crisis, coupled with the bravery of public figures like Simone Biles and Naomi Osaka who are speaking openly and walking away, have led to a tipping point. It’s a movement that has given us the permission to prioritize our psychological wellbeing over others’ definition of success or pressure to live up to external demands.
Our guest Dr. Amy Gagliardi, associate medical director of McLean Hospital, will explore the current state of women’s mental health, and its impacts on family and the workplace, including the “Great Resignation.” Learn actionable strategies for self-care and emotional well-being (short-and-long term) for yourself, your family, and your teams.
Photo credit: iStock.com/ThitareeSarmkasat
Amy Gagliardi
DR. AMY GAGLIARDI is the clinical director for the Center of Excellence in Women’s Mental Health, and associate medical director of McLean Pavilion. In this role, she directs the evaluation and treatment of patients with complex psychiatric and neuropsychiatric disorders. She is also an assistant professor of psychiatry at Harvard Medical School, and has been immersed in clinical care of patients with major psychiatric illnesses for more than ten years. Her clinical responsibilities include the coordination of multidisciplinary psychiatric evaluations, diagnostic clarifications, medication evaluation and management, and leadership of treatment conferences. As the clinical director of the Center of Excellence for Women’s Mental Health at McLean Hospital, she has extensive experience in the diagnosis and treatment of trauma-related disorders, including advanced training in dialectical behavior therapy. She is the program director of the McLean Women’s Mental Health clinical psychiatry fellowship and is devoted to the teaching and supervision of medical students and psychiatric residents. Dr. Gagliardi has served as a consultant to multiple psychiatric practitioners throughout the Boston area.
Celeste Headlee
Celeste Headlee is a communication and human nature expert, and an award-winning journalist. She is a professional speaker, and also the author of Do Nothing: How to Break Away from Overworking, Overdoing, and Underliving, Heard Mentality and We Need to Talk. In her twenty-year career in public radio, she has been the executive producer of On Second Thought at Georgia Public Radio, and anchored programs including Tell Me More, Talk of the Nation, All Things Considered, and Weekend Edition. She also served as cohost of the national morning news show The Takeaway from PRI and WNYC, and anchored presidential coverage in 2012 for PBS World Channel. Headlee’s TEDx talk sharing ten ways to have a better conversation has over twenty million total views to date. @CelesteHeadlee
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Episode Transcript
Celeste Headlee:
How significant has been the impact of the pandemic and all the associated stressors on people’s mental health? Some of the research that I’ve seen has been pretty alarming.
Amy Gagliardi:
I think it’s been hugely impactful. I mean, there’s really been a mental health surge in terms of demand for resources. And we know across the country, really globally, but across the country, there’s been already increased rates of anxiety and depression, substance use disorders, eating disorders. I mean, all of the usual things that are highly prevalent already are becoming increasingly prevalent. And people are seeking resources.
Celeste Headlee:
One of the things that I found interesting was that things like sleeplessness on the rise. When you talk about self care, very often you talk about taking care of your body, getting good sleep, engaging in activities that you enjoy. And yet, all of those things are on the decline rather than increasing. And so that must make it even more difficult for people to find a state of wellbeing.
Amy Gagliardi:
Well, I think all of that’s true, and what we know about chronic stress is it has a huge impact on all of our usual activities. So when people are under chronic stress, stress hormones increase, cortisol levels rise, it changes the way we metabolize sugars, it changes the ways we eat. It changes the ways our body responds to stress, our thinking and learning. Sleep is usually something that’s first to go and last to come back, with really significant stress. Exercise.
Amy Gagliardi:
But I think one of the unique aspects of this pandemic is also just the profound social isolation and the disconnect. Even for people who are living at home with families, or have kids in the house who are doing school from home, they have people around, but they’re missing out on the kinds of connections people find at work, the kinds of connections people find with more extended family. The loneliness factor is really big.
Celeste Headlee:
What do we know about the impact and whether it’s disproportionate in how it has hit women as opposed to men? I mean, obviously there must be a difference when it comes to childcare, but we’ve also seen what’s been known as a she-cession, that women have experienced more job insecurity, for example. What are we seeing in terms of how women have been affected?
Amy Gagliardi:
Well, it’s a great question. I mean, pre-pandemic, women were already disproportionately impacted in terms of mental health. I mean, mental health problems are very, very common. One out of three people in the world will experience a significant problem with mental health at some point in their lifetime, but women are very disproportionately impacted. So women experience depression and anxiety at almost twice the rate of men. The risk for eating disorders in a woman is 10 times that it is in a man, and women experience PTSD at rates like three times what men experience.
Amy Gagliardi:
So across the board, women tend to be impacted by mental illness at very high rates, and early. A lot of the mental illness onset for women is in teens, early twenties and thirties, so really impacting women early in their lifetime. And then of course throughout lifetime, especially around reproductive events, like the peripartum period, onset of puberty, peripartum, and then menopause. Throughout the lifespan, women are really impacted.
Celeste Headlee:
I understand that there’s also a difference between how willing women are to seek counseling as opposed to men, in general. Is it true that women are more likely to seek help?
Amy Gagliardi:
That is true. Women are more likely to talk about it. They’re more likely to seek help and they’re more likely to act on getting help, so that is true. But even in studies where they’ve teased out that factor and looked prospectively at women across a lifetime, and men across a lifetime, it looks like women are experiencing mental health problems at a higher rate than men.
Celeste Headlee:
So that brings into light the recent headlines with, say, Simone Biles or Naomi Osaka, going public with their struggles with where they are mentally, and being willing to take a step back. Does that align with what you know about women and their approach to mental health?
Amy Gagliardi:
I think it’s true, but I think it’s also new. I mean, it’s been evolving over time, but it’s a big deal, and I think could have really good ramifications for somebody like Simone Biles to be so open and honest about her experience. And there’s all different kinds of ways she could have managed that moment in the Olympics, and for her to come forward and talk about it openly really takes a huge amount of both grace and guts. And she’s one of many who are opening up these conversations.
Amy Gagliardi:
Naomi Osaka, Michael Phelps has done a lot to talk about it, and even Kerri Strug, who spoke about her experience back in 96′ and how different it was, when she didn’t have the power to make those kinds of decisions in that moment and how it impacted her. So I think they’re all opening up a really important conversation about mental health and self care.
Celeste Headlee:
Just as a reminder for those who may not remember, Kerri Strug was a member of what’s known as the Magnificent Seven. That was the women’s gymnastics team that represented the U.S. back in the nineties. What difference does that make for you? How does this becoming a public conversation impact your ability to help patients?
Amy Gagliardi:
I think it has a huge impact on stigma. I mean, we tend to stigmatize things that we don’t understand and that we’re afraid of. And as the neurobiology has been better understood, as more evidence-based treatments have come to the forefront, I mean more and more people are willing to talk about these kinds of things. But to have young women, in particular, sort of set that as a role model, I think is incredibly important. Not just this can be talked about, but this is necessary for my success. To manage this effectively is something I need to do to be really effective in the world.
Celeste Headlee:
So how does this change the kind of conversations you might have with someone, especially a young woman, as you say, who comes to your office and says, my job is stressing me out. Does that open up a conversation for you about whether a job is a good fit for someone’s wellbeing?
Amy Gagliardi:
Yeah, I mean, I think by the time people come to my office, they know that they’re under some kind of chronic stress that’s really impacting their ability to be in the world in the way they want to be. I mean, there’s all kinds of ways in which chronic stress at work can impact one’s performance, one’s mood, one’s ability to sort of promote themselves along their professional trajectory. So I think most people who are dealing with chronic stress have some ability to realize it’s there. They often don’t know what to do about it. They often don’t know who to talk to about it and they’re often in a professional setting where there’s not a lot of resources made available.
Celeste Headlee:
I mean, it’s interesting what you say, that they don’t know who to talk about it, because in my obviously clearly anecdotal experience, when someone’s having problems at work that are stressing them out or they’re anxious about work, I don’t think they do go talk to a therapist about it. They’re more likely to talk to a therapist about problems they’re having with their family members or problems that they might be having with their own self-esteem or those kinds of issues, but with mental health issues at work, what do you think? Do you think we are likely to see that as something that can be addressed through therapy?
Amy Gagliardi:
Well, work is where we spend half our life. So a lot of people who come into therapy for anxiety or depression or PTSD or an eating problem will absolutely be talking about work because it’s where a lot of the stress originates for people, and it’s where they’re spending a lot of their day. So I think those kinds of things do make their way into therapy.
Amy Gagliardi:
What I was talking about more was that in the workplace, we don’t have often the kinds of cultures where these things can get talked about and managed preventatively. So if you don’t have a workplace that’s built to talk about mental health, that values mental health, that is modeling taking good self-care from the C-suite all the way down, people aren’t going to go to their supervisor because it’s not safe or comfortable to do so.
Amy Gagliardi:
So it’s hard to know when someone is struggling at work. Usually that shows up late, in absenteeism or low productivity. Sometimes you can see people struggle with more emotionality or they just don’t look like themselves. They’re more irritable, they’re more tearful. But people can have a lot going on emotionally at work, be struggling with a lot of problems with mood and anxiety, and have it be relatively invisible until it’s not.
Celeste Headlee:
So I’m sure you’re aware of what’s known now as the great resignation, all these people, especially women, who are choosing to quit, because either they have found the job does not fit what they want or need, or they have made demands such as that they want to remain working remotely, et cetera, sometimes it’s salary. For whatever reason, there’s a huge number of people who have chosen to leave their jobs. I wonder if you can give some guidance from a mental health perspective, at least, on how someone decides when it is time to go.
Amy Gagliardi:
Yeah. I mean, I think it’s important to note that millions of people have lost their jobs, so it’s not always an option or a choice. And so a lot of the people who left work did it because they lost their work or because they just had incredible caregiving responsibilities at home that were inconsistent with being able to maintain any kind of professional life. So for those kinds of people who were really forced out of the workforce, we know that there’s a really detrimental impact on mental health over time. I mean, unemployment and poverty is a standalone risk factor for depression. For people who lost their jobs, I think we know that it’s going to have a long-term impact on their mental health and probably the next generation.
Amy Gagliardi:
For people who have some choice, I think it’s been really interesting, because people have had some time and space to think a little bit about how they want to construct their lives, where they want to spend their time, what they think about in terms of what they value. How much money do I want to make, do I need to make? How important it is for me to spend time with my kids or to be home. How do I want to spend my days? And for people who have some choice and ability to reflect on this, they’ve made all kinds of different decisions. And I think remote work is opening up a lot of possibilities.
Celeste Headlee:
What kind of advice can you give someone who’s weighing these things right now, where perhaps their job is making them feel anxious and they’re trying to decide if they can work through those issues or not? What guidance would you give somebody who’s in that space?
Amy Gagliardi:
It’s a good question. I think I would, like with most decisions, you want to really think about your values and your priorities. I mean, stress will come and go at work, in any kind of setting and in life. So you want to think about what’s transient and what’s not transient. What is something that can be worked around or problem solved? Sometimes people are in an environment where just opening up some communication with a supervisor and manager, advocating more for what one needs, asking for some things, can sometimes make a big difference when you’ve assessed it and really understood what it is that you need to make a difference.
Amy Gagliardi:
So one thing I would say is start with assessing for yourself what you think is the source of the stress and if there are ways in which you can solve it at the job you have, but I think on a bigger level, one needs to think about how they’re spending their days and how it lines up with a thing that they really value in life. And there are people making bigger decisions about where to live, how to live, and what kind of work to do.
Celeste Headlee:
So in that same sort of line, what advice might you give to leadership? Things to think about, especially in terms of offering mental health resources to their employees and creating the kind of workspace where it’s okay to talk about these things, where people might feel comfortable talking about it?
Amy Gagliardi:
Well, I think the first piece of advice is to pay attention to the data about mental health and work, because worldwide, the number one cause of disability globally is depression and it has a huge impact on business. In this country, we lose something like $200 billion of cost per year due to mental health issues. That’s probably an underestimate.
Celeste Headlee:
Wow.
Amy Gagliardi:
Due to reduced productivity, missed deadlines, absenteeism, poorly negotiated deals and it really impacts people’s presence. I mean, there’s something like 30 to 40 days on average for somebody who’s depressed is absent from work and then you add another 30 days of missed work due to low productivity. And again, that’s probably an underestimate. These mental health challenges are big, big business, and those same people who are depressed and having low productivity or missing days are also going to have many more medical complications over time. We know that chronic stress causes changes in inflammation and puts people at much higher risk for medical illness, like two to three to four times the risk of having a major medical problem, compared to people who aren’t depressed.
Amy Gagliardi:
So all of that costs employers, so the first thing is just be aware of the data that’s out there. And there’s a lot of data out there. I mean, this has been well studied across the board. The other thing I would say is you can’t expect an employee to respond to an inquiry or an intervention or a suggestion if it’s not part of the greater sort of fabric of the culture of the business.
Amy Gagliardi:
In other words, we consult to a lot of businesses, large corporations come and say, “we have people missing because of depression or anxiety and we want them to take this resource” People are just not going to come out and accept resources like that if they don’t have a sense that it’s entirely safe to do so. You really have to create a culture from the top down where you’re talking about mental health, you’re talking about stress and burnout. You’re normalizing the fact that these things happen and you’re modeling it. I mean, the most effective companies I’ve seen are the ones who in the C-suite are modeling, talking about their own self-care. It’s still pretty rare to see that, but it has a big impact on employees being willing to treat things proactively, and that’s what you want them to do. You want them to catch things before they get bad.
Amy Gagliardi:
You know, I work at a psychiatric hospital, but I have a weekly meeting where we rate our burnout. So on a scale of one to 10, 10 being I’m all the way burnt out, I can’t do this job for another minute. And we give a number. You go around the room, everybody gives their number. And whoever has a high number, you stop and you attend to them and you help them think for a few minutes about how to decrease their load. It’s just like part of taking temperature, and it’s done every week, and it’s really easy and quick to do and I think it works. It’s preventative. So not that that’s going to happen in every workplace, but if we’re not talking about this stuff and we’re not normalizing it, nobody’s going to come forward in these environments.
Celeste Headlee:
So as not a therapist, how can I evaluate the people around me to make sure that they are doing okay? How do I recognize in my loved one or my colleague or my friend that they are burning out, that they are stressed?
Amy Gagliardi:
I think one of the challenges is it can be fairly invisible, especially in the beginning. I mean, think about in your own life how many times you’ve gone to work having had a terrible night’s sleep or multiple nights of terrible sleep, worrying about something in your own life or one of your kids, struggling with low mood. We all can put on a professional face, and we want people to, we want our staffs and our employees to be able to do that. So it can be relatively hard to see and sometimes employers are really shocked that their high-performer or somebody who looks like they’ve got everything in hand is really struggling with an addiction problem or a major eating disorder, or something like that.
Amy Gagliardi:
I think mostly you’re looking for changes in behavior and this is the kind of thing that is best seen at a very local level, the people right around the person and maybe the direct supervisor. It’s not going to be that visible to people many layers out. But changes in emotionality. Is somebody more irritable? Is somebody more tearful? Is somebody more withdrawn? Changes in work. The person who always meets their deadline, who’s always at a meeting early, are they running late? Are they missing deadlines? Is the quality of their work below average? And then I think absenteeism comes late. By the time you’re really not going to work, usually things have gotten pretty significant.
Celeste Headlee:
How are we to evaluate ourselves objectively? I mean, there’s tons of times when I tell myself I’m doing fine, when I’m sort of in denial about the changes that are happening in my life, and I’ll tell myself, wow, I’m just having a stint of bad sleep or I’m just kind of a little crabby. How can I make sure that I am giving myself a good honest once-over?
Amy Gagliardi:
It’s such a great question, because I think we’re so good at rationalizing every little blip and saying, oh, and also just pushing through. We’re busy, and we have people depending on us, so we don’t always take the time to really stop and reflect. I think one good rule of thumb is if it persists. It’s one thing to have a few bad nights of sleep. It’s another thing to have a couple of weeks of bad sleep. It’s another thing to really have your sleep off for two months or three months, so taking stock over time.
Amy Gagliardi:
And also just irritability. It’s hard to see in the moment and the day, but irritability can be a big marker for depression and anxiety. And do you have the resilience? Do you enjoy things? Do you have the energy? So I can be irritable at work, but I go home and something really fun happens and I really enjoy it, so that’s reassuring. That shows some sort of transience in the nature of it or flexibility. But when I’m stressed at work and stressed at home and there’s not a lot of variability in it, I think that’s another sign that one’s mood or anxiety can be off.
Celeste Headlee:
Okay, so let’s say that I have done what you just said. That I’ve gone from, “oh, I’m fine,” and I’ve somehow broken through this fear that admitting I’m struggling means all kinds of horrible things, right? Is there anything I can do at that point which is sort of a micro treatment? Short of taking a complete break, what can I do in the short term?
Amy Gagliardi:
There’s tons of micro treatments, so that’s a really good place to start. I mean, first of all, this sounds boring, so when you go down the list of what these things are, people think, oh, yawn, I know this stuff. But I think it actually makes a difference to pay attention to what the research tells us.
Amy Gagliardi:
For example, there was just a great JAMA article, the Journal of the American Medical Association, on exercise and depression. There’ve been thousands of studies on exercise and depression, but this one really looked proactively and tried to tease out cause and effect. And it’s very clear that short bursts of exercise, we’re talking about 15 minutes of running or something, cardio, a day, has a big impact on treating depression. So not just preventing it, but actually treating it.
Amy Gagliardi:
And for a long time, we knew that people who exercise tended to have more resilient moods and lower anxiety, but we didn’t know if that was just because they had better moods so they exercised more, or what was the cause and the effect? I think this really helps us tease out that it matters to move, and it doesn’t have to be long and it doesn’t have to be rigorous. I mean, even walking had an impact on mood. So movement matters, and a lot of us have pretty sedentary lives or sedentary work days. I have an incredibly sedentary work day, so just building that in small ways that are doable makes a big difference.
Amy Gagliardi:
We talked about sleep. I mean, sleep is tricky because sleep really goes offline with stress. Cortisol, adrenaline, it keeps us up. Even low, low levels of stress hormones make it hard to sleep. So then people worry about sleep at three o’clock in the morning. I should be sleeping. What I would say is you can’t control sleep, but you can sort of set yourself up for success in the sense that having a regular bedtime, waking up around the same time every day actually makes a big difference to when you fall asleep, because we have an internal clock that sets 16 hours after we get up. So that wake up time actually starts off the clock, and it’s going to impact our ability to fall asleep. Reducing alcohol at night. There are just certain kinds of basic sleep hygiene, and again, they sound boring. We’ve all read them, but you want to maximize your ability to sleep. Sleep has a huge impact on mood and cognition.
Amy Gagliardi:
And then the other thing is staying connected to people. And I think we let that go as we get busy. We don’t make time to see people and to connect with people, especially if we’re doing a lot of work remotely now. There’s just not that sort of casual chit chatting moments before and after a meeting. And that’s been shown to have a big impact on mental health, that just routine sort of connection, seeing the person who you like to see, having somebody be happy to see you, it sounds so simple, but we’re hugely social animals. Even people who are more introverted really need to see people, so that’s something that one can do.
Amy Gagliardi:
And then there’s tons of interesting research on gratitude and mindfulness and all kinds of other things that people can incorporate into their lives, but it takes some intention. It takes some intention to change these habits. And if I had to pick one, I’d probably add in a little bit of exercise.
Celeste Headlee:
So at what point, so let’s say that I’ve done this micro treatment. I’ve been taking walks, I’ve been trying not to guzzle down wine right before I go to sleep, all of those things. When do I know that it’s time that I can’t do this on my own and I need to seek professional help?
Amy Gagliardi:
I think that you would start just as you say, but I would give it something like a few weeks, three to four weeks, to really see benefit. I wouldn’t let it go six months. I would try to call it on the earlier side, when you’re really not able to do the things you want to be able to do. You know when you’re not working up to your capacity. Other people around you may not have realized that yet, but you kind of know when you’re slipping there. You know, when being with your kids feels like more of a chore than a joy, or managing the things around the house just feels overwhelming.
Amy Gagliardi:
So people start to feel like they’re sort of moving through cement. It gets hard to do things. Things are more easily overwhelming. Depression and anxiety really impacts us cognitively. We tend to think about mental health as emotions, but actually it has a big impact on how we think and learn. So if those things all feel like they’re moving in the wrong direction and they’re not correcting with a good amount of intervention at home, then you seek out some consultation.
Amy Gagliardi:
The place to start is just to get a consultation. And sometimes I tell people, get two, get one opinion and get another, because like with anything in healthcare, and maybe more so in psychiatry, there’s a huge variability in people’s training and background, so you really want to get good advice. You want to go to somebody who is well-regarded. If it doesn’t make sense to you, it doesn’t fit you, or something about it doesn’t feel quite right, then get a second opinion about it. Because there are really good evidence-based treatments for depression, anxiety, trauma, eating disorders, substance use disorders. I mean, this is really, in the whole span of psychiatry, now is a time where there’s more evidence-based treatments available and that’s what you should access.
Celeste Headlee:
But how would you advise people to get past the sort of tough it out culture that we have right now, this rise and grind culture of just bare your teeth, grit your teeth, and get through it and be tough? And you are the person of steel. How do we get past this idea that quitting, saying this is too much for me, is tantamount to not being successful or not being good at what you do?
Amy Gagliardi:
It’s true. I mean, we demonize quitting in our culture and we overvalue grit. I mean, I think of all those books, and I read books how to raise your kids with grit, so that’s true. And not to put too much on the Olympics and the messaging, but I think it’s important that people at a very high level of performance are stopping to take care of themselves. And I think that is very, very important messaging.
Amy Gagliardi:
It’s just good science. Our bodies don’t function well if our brains are not on. And if you learn a little bit about the neurobiology of these things, it becomes very obvious that the people who are very successful in life don’t have a lot of these problems or are managing to them in some way. And the more you talk to people about it, the more you realize other people are out there and other people have sought help as well.
Amy Gagliardi:
But I consider it to be just good maintenance. And once you start to get some treatment, you’ll be a believer, because you realize, oh, I’ve been doing this the hard way. It’s almost like an airplane is making its way through terrible turbulence. You can do it, but if you go up 10,000 feet or down 10,000 feet and hit smooth air, you realize, oh, this is much easier. So once people start to get a little bit of help, they usually become very committed to it.
Celeste Headlee:
Does that change at all, either for the worse or the better, in terms of the pressure put on women, that if they admit that their kids are stressing them out or they cannot deal at this moment, for whatever reason, that makes them a bad mom?
Amy Gagliardi:
I think that that is going to start to change, but yeah, it’s a big problem. When we talk about parenting, that is supposed to be an enormously sort of only gratifying experience. The truth is, I think parenting has probably gotten less gratifying over the years because we do so much for our children and we’re so focused on their care. We probably over function in a lot of ways for our kids and we provide at a very, very high level, physically and emotionally.
Amy Gagliardi:
And there’s some thought that we’re raising kids who are less able to be independent and autonomous and well-equipped for the world. There’s enormous pressure put on investing in parenting and I think it’s a complex problem, but self-care is really essential. You can’t be a good parent unless you’re functioning as well as possible.
Celeste Headlee:
And also possibly modeling to your kids that they too should put their own needs high on the priority list.
Amy Gagliardi:
Absolutely. The best way to talk to kids about mental health is start early and often, that it’s just part of how you think about being a human in the world. Whenever I talk to people about this, some people will say, “Well, I never talked to my kids about mental health and now they’re 35.” And I say, “Well, start now.” I mean, it’s not too late to have any of these conversations. Early on, you can really normalize it and get kids talking about even just identifying and observing their feelings. Are you angry? Are you sad?
Amy Gagliardi:
And noticing patterns. I will sometimes reference it myself. I went to bed grumpy and I woke up and I feel so much better. I think I needed sleep. Or, I realized I hadn’t eaten dinner. Or, these are the ways I was feeling. So I think just generating that vocabulary and that language early on, where you’re helping kids think about their minds and think about their emotions, is really critical. You’d be surprised how many people I see in middle age or even older who really have a very hard time with the fundamentals of identifying their emotion. They do not know what they feel. They grew up in families where there just wasn’t any language or attention to it and that’s something that we as parents can instill at any age.
Celeste Headlee:
So I was mentioning to one of my neighbors that I was speaking to you today, and she said, “I know what she’s going to say. She’s going to tell me to take care of myself. She’s going to tell me to get sleep.” She’s like, “But I just, I wake up every single day feeling overloaded already. Every day is this constant effort to just get my head above water. And I don’t think I ever do it.” And I have the sense that there’s a lot of people who are feeling this way, that they’re just in chaos.
Amy Gagliardi:
Absolutely. And, you know, I feel that way. I mean, there are times when I feel that way myself. And when we talk about sleep and self-care and all the things that a person can do, I think we have to be careful not to lay the responsibility of taking care of mental health at the feet of the individual, because really, this is a societal problem. I mean, we have a very difficult healthcare system. It’s very difficult to access care. It’s difficult to afford it. It’s difficult to navigate it. We have a culture that prioritizes self-sacrifice and overwork, we know that, relative to other cultures.
Amy Gagliardi:
If you look at how we treat people in our prison systems with mental health problems, or in our education system, we’re not taking good care of ourselves. When people are living with chronic stress, it may not all be about something they need to do to correct it. There may be larger societal factors at play that would make a difference. There’s only so much we can do, and we want to take control of the things we have control over, but the fact that we don’t have easy access to resources for mental health, and that we live in a culture that so prioritizes overwork. I think it’s starting to change, but very, very slowly.
Celeste Headlee:
Any last bits of advice for people? Anything we’ve missed? What should I have asked you?
Amy Gagliardi:
I would say is that, it isn’t easy, but we want to always be thinking about ourselves and the individual and our colleagues. I do think it’s important when we think about mental health to think about it from a societal perspective, because as long as we have the kinds of problems we have in terms of poverty and limited access to healthcare, it impacts all of us. So while these positive messages I think are incredibly important, reducing stigma is incredibly important, and focusing on the ways in which we have better delivery and better evidenced-based methods, we really need to work as a society to support mental health, to think about our own mental health, and to be good communicators about mental health.
Amy Gagliardi:
We have to become advocates because it impacts every single one of us. Not a single family in this country is not impacted. If we’re not talking about it, if we’re not advocating, if we’re not clamoring around this issue, then we’re hurting ourselves. So I think there’s the immediate kinds of things we need to do about self-care, but there’s also responsibility we have to ourselves and our families and others as a group.
Celeste Headlee:
Amy, thank you so much.
Amy Gagliardi:
You’re welcome.
Celeste Headlee:
How significant has been the impact of the pandemic and all the associated stressors on people’s mental health? Some of the research that I’ve seen has been pretty alarming.
Amy Gagliardi:
I think it’s been hugely impactful. I mean, there’s really been a mental health surge in terms of demand for resources. And we know across the country, really globally, but across the country, there’s been already increased rates of anxiety and depression, substance use disorders, eating disorders. I mean, all of the usual things that are highly prevalent already are becoming increasingly prevalent. And people are seeking resources.
Celeste Headlee:
One of the things that I found interesting was that things like sleeplessness on the rise. When you talk about self care, very often you talk about taking care of your body, getting good sleep, engaging in activities that you enjoy. And yet, all of those things are on the decline rather than increasing. And so that must make it even more difficult for people to find a state of wellbeing.
Amy Gagliardi:
Well, I think all of that’s true, and what we know about chronic stress is it has a huge impact on all of our usual activities. So when people are under chronic stress, stress hormones increase, cortisol levels rise, it changes the way we metabolize sugars, it changes the ways we eat. It changes the ways our body responds to stress, our thinking and learning. Sleep is usually something that’s first to go and last to come back, with really significant stress. Exercise.
Amy Gagliardi:
But I think one of the unique aspects of this pandemic is also just the profound social isolation and the disconnect. Even for people who are living at home with families, or have kids in the house who are doing school from home, they have people around, but they’re missing out on the kinds of connections people find at work, the kinds of connections people find with more extended family. The loneliness factor is really big.
Celeste Headlee:
What do we know about the impact and whether it’s disproportionate in how it has hit women as opposed to men? I mean, obviously there must be a difference when it comes to childcare, but we’ve also seen what’s been known as a she-cession, that women have experienced more job insecurity, for example. What are we seeing in terms of how women have been affected?
Amy Gagliardi:
Well, it’s a great question. I mean, pre-pandemic, women were already disproportionately impacted in terms of mental health. I mean, mental health problems are very, very common. One out of three people in the world will experience a significant problem with mental health at some point in their lifetime, but women are very disproportionately impacted. So women experience depression and anxiety at almost twice the rate of men. The risk for eating disorders in a woman is 10 times that it is in a man, and women experience PTSD at rates like three times what men experience.
Amy Gagliardi:
So across the board, women tend to be impacted by mental illness at very high rates, and early. A lot of the mental illness onset for women is in teens, early twenties and thirties, so really impacting women early in their lifetime. And then of course throughout lifetime, especially around reproductive events, like the peripartum period, onset of puberty, peripartum, and then menopause. Throughout the lifespan, women are really impacted.
Celeste Headlee:
I understand that there’s also a difference between how willing women are to seek counseling as opposed to men, in general. Is it true that women are more likely to seek help?
Amy Gagliardi:
That is true. Women are more likely to talk about it. They’re more likely to seek help and they’re more likely to act on getting help, so that is true. But even in studies where they’ve teased out that factor and looked prospectively at women across a lifetime, and men across a lifetime, it looks like women are experiencing mental health problems at a higher rate than men.
Celeste Headlee:
So that brings into light the recent headlines with, say, Simone Biles or Naomi Osaka, going public with their struggles with where they are mentally, and being willing to take a step back. Does that align with what you know about women and their approach to mental health?
Amy Gagliardi:
I think it’s true, but I think it’s also new. I mean, it’s been evolving over time, but it’s a big deal, and I think could have really good ramifications for somebody like Simone Biles to be so open and honest about her experience. And there’s all different kinds of ways she could have managed that moment in the Olympics, and for her to come forward and talk about it openly really takes a huge amount of both grace and guts. And she’s one of many who are opening up these conversations.
Amy Gagliardi:
Naomi Osaka, Michael Phelps has done a lot to talk about it, and even Kerri Strug, who spoke about her experience back in 96′ and how different it was, when she didn’t have the power to make those kinds of decisions in that moment and how it impacted her. So I think they’re all opening up a really important conversation about mental health and self care.
Celeste Headlee:
Just as a reminder for those who may not remember, Kerri Strug was a member of what’s known as the Magnificent Seven. That was the women’s gymnastics team that represented the U.S. back in the nineties. What difference does that make for you? How does this becoming a public conversation impact your ability to help patients?
Amy Gagliardi:
I think it has a huge impact on stigma. I mean, we tend to stigmatize things that we don’t understand and that we’re afraid of. And as the neurobiology has been better understood, as more evidence-based treatments have come to the forefront, I mean more and more people are willing to talk about these kinds of things. But to have young women, in particular, sort of set that as a role model, I think is incredibly important. Not just this can be talked about, but this is necessary for my success. To manage this effectively is something I need to do to be really effective in the world.
Celeste Headlee:
So how does this change the kind of conversations you might have with someone, especially a young woman, as you say, who comes to your office and says, my job is stressing me out. Does that open up a conversation for you about whether a job is a good fit for someone’s wellbeing?
Amy Gagliardi:
Yeah, I mean, I think by the time people come to my office, they know that they’re under some kind of chronic stress that’s really impacting their ability to be in the world in the way they want to be. I mean, there’s all kinds of ways in which chronic stress at work can impact one’s performance, one’s mood, one’s ability to sort of promote themselves along their professional trajectory. So I think most people who are dealing with chronic stress have some ability to realize it’s there. They often don’t know what to do about it. They often don’t know who to talk to about it and they’re often in a professional setting where there’s not a lot of resources made available.
Celeste Headlee:
I mean, it’s interesting what you say, that they don’t know who to talk about it, because in my obviously clearly anecdotal experience, when someone’s having problems at work that are stressing them out or they’re anxious about work, I don’t think they do go talk to a therapist about it. They’re more likely to talk to a therapist about problems they’re having with their family members or problems that they might be having with their own self-esteem or those kinds of issues, but with mental health issues at work, what do you think? Do you think we are likely to see that as something that can be addressed through therapy?
Amy Gagliardi:
Well, work is where we spend half our life. So a lot of people who come into therapy for anxiety or depression or PTSD or an eating problem will absolutely be talking about work because it’s where a lot of the stress originates for people, and it’s where they’re spending a lot of their day. So I think those kinds of things do make their way into therapy.
Amy Gagliardi:
What I was talking about more was that in the workplace, we don’t have often the kinds of cultures where these things can get talked about and managed preventatively. So if you don’t have a workplace that’s built to talk about mental health, that values mental health, that is modeling taking good self-care from the C-suite all the way down, people aren’t going to go to their supervisor because it’s not safe or comfortable to do so.
Amy Gagliardi:
So it’s hard to know when someone is struggling at work. Usually that shows up late, in absenteeism or low productivity. Sometimes you can see people struggle with more emotionality or they just don’t look like themselves. They’re more irritable, they’re more tearful. But people can have a lot going on emotionally at work, be struggling with a lot of problems with mood and anxiety, and have it be relatively invisible until it’s not.
Celeste Headlee:
So I’m sure you’re aware of what’s known now as the great resignation, all these people, especially women, who are choosing to quit, because either they have found the job does not fit what they want or need, or they have made demands such as that they want to remain working remotely, et cetera, sometimes it’s salary. For whatever reason, there’s a huge number of people who have chosen to leave their jobs. I wonder if you can give some guidance from a mental health perspective, at least, on how someone decides when it is time to go.
Amy Gagliardi:
Yeah. I mean, I think it’s important to note that millions of people have lost their jobs, so it’s not always an option or a choice. And so a lot of the people who left work did it because they lost their work or because they just had incredible caregiving responsibilities at home that were inconsistent with being able to maintain any kind of professional life. So for those kinds of people who were really forced out of the workforce, we know that there’s a really detrimental impact on mental health over time. I mean, unemployment and poverty is a standalone risk factor for depression. For people who lost their jobs, I think we know that it’s going to have a long-term impact on their mental health and probably the next generation.
Amy Gagliardi:
For people who have some choice, I think it’s been really interesting, because people have had some time and space to think a little bit about how they want to construct their lives, where they want to spend their time, what they think about in terms of what they value. How much money do I want to make, do I need to make? How important it is for me to spend time with my kids or to be home. How do I want to spend my days? And for people who have some choice and ability to reflect on this, they’ve made all kinds of different decisions. And I think remote work is opening up a lot of possibilities.
Celeste Headlee:
What kind of advice can you give someone who’s weighing these things right now, where perhaps their job is making them feel anxious and they’re trying to decide if they can work through those issues or not? What guidance would you give somebody who’s in that space?
Amy Gagliardi:
It’s a good question. I think I would, like with most decisions, you want to really think about your values and your priorities. I mean, stress will come and go at work, in any kind of setting and in life. So you want to think about what’s transient and what’s not transient. What is something that can be worked around or problem solved? Sometimes people are in an environment where just opening up some communication with a supervisor and manager, advocating more for what one needs, asking for some things, can sometimes make a big difference when you’ve assessed it and really understood what it is that you need to make a difference.
Amy Gagliardi:
So one thing I would say is start with assessing for yourself what you think is the source of the stress and if there are ways in which you can solve it at the job you have, but I think on a bigger level, one needs to think about how they’re spending their days and how it lines up with a thing that they really value in life. And there are people making bigger decisions about where to live, how to live, and what kind of work to do.
Celeste Headlee:
So in that same sort of line, what advice might you give to leadership? Things to think about, especially in terms of offering mental health resources to their employees and creating the kind of workspace where it’s okay to talk about these things, where people might feel comfortable talking about it?
Amy Gagliardi:
Well, I think the first piece of advice is to pay attention to the data about mental health and work, because worldwide, the number one cause of disability globally is depression and it has a huge impact on business. In this country, we lose something like $200 billion of cost per year due to mental health issues. That’s probably an underestimate.
Celeste Headlee:
Wow.
Amy Gagliardi:
Due to reduced productivity, missed deadlines, absenteeism, poorly negotiated deals and it really impacts people’s presence. I mean, there’s something like 30 to 40 days on average for somebody who’s depressed is absent from work and then you add another 30 days of missed work due to low productivity. And again, that’s probably an underestimate. These mental health challenges are big, big business, and those same people who are depressed and having low productivity or missing days are also going to have many more medical complications over time. We know that chronic stress causes changes in inflammation and puts people at much higher risk for medical illness, like two to three to four times the risk of having a major medical problem, compared to people who aren’t depressed.
Amy Gagliardi:
So all of that costs employers, so the first thing is just be aware of the data that’s out there. And there’s a lot of data out there. I mean, this has been well studied across the board. The other thing I would say is you can’t expect an employee to respond to an inquiry or an intervention or a suggestion if it’s not part of the greater sort of fabric of the culture of the business.
Amy Gagliardi:
In other words, we consult to a lot of businesses, large corporations come and say, “we have people missing because of depression or anxiety and we want them to take this resource” People are just not going to come out and accept resources like that if they don’t have a sense that it’s entirely safe to do so. You really have to create a culture from the top down where you’re talking about mental health, you’re talking about stress and burnout. You’re normalizing the fact that these things happen and you’re modeling it. I mean, the most effective companies I’ve seen are the ones who in the C-suite are modeling, talking about their own self-care. It’s still pretty rare to see that, but it has a big impact on employees being willing to treat things proactively, and that’s what you want them to do. You want them to catch things before they get bad.
Amy Gagliardi:
You know, I work at a psychiatric hospital, but I have a weekly meeting where we rate our burnout. So on a scale of one to 10, 10 being I’m all the way burnt out, I can’t do this job for another minute. And we give a number. You go around the room, everybody gives their number. And whoever has a high number, you stop and you attend to them and you help them think for a few minutes about how to decrease their load. It’s just like part of taking temperature, and it’s done every week, and it’s really easy and quick to do and I think it works. It’s preventative. So not that that’s going to happen in every workplace, but if we’re not talking about this stuff and we’re not normalizing it, nobody’s going to come forward in these environments.
Celeste Headlee:
So as not a therapist, how can I evaluate the people around me to make sure that they are doing okay? How do I recognize in my loved one or my colleague or my friend that they are burning out, that they are stressed?
Amy Gagliardi:
I think one of the challenges is it can be fairly invisible, especially in the beginning. I mean, think about in your own life how many times you’ve gone to work having had a terrible night’s sleep or multiple nights of terrible sleep, worrying about something in your own life or one of your kids, struggling with low mood. We all can put on a professional face, and we want people to, we want our staffs and our employees to be able to do that. So it can be relatively hard to see and sometimes employers are really shocked that their high-performer or somebody who looks like they’ve got everything in hand is really struggling with an addiction problem or a major eating disorder, or something like that.
Amy Gagliardi:
I think mostly you’re looking for changes in behavior and this is the kind of thing that is best seen at a very local level, the people right around the person and maybe the direct supervisor. It’s not going to be that visible to people many layers out. But changes in emotionality. Is somebody more irritable? Is somebody more tearful? Is somebody more withdrawn? Changes in work. The person who always meets their deadline, who’s always at a meeting early, are they running late? Are they missing deadlines? Is the quality of their work below average? And then I think absenteeism comes late. By the time you’re really not going to work, usually things have gotten pretty significant.
Celeste Headlee:
How are we to evaluate ourselves objectively? I mean, there’s tons of times when I tell myself I’m doing fine, when I’m sort of in denial about the changes that are happening in my life, and I’ll tell myself, wow, I’m just having a stint of bad sleep or I’m just kind of a little crabby. How can I make sure that I am giving myself a good honest once-over?
Amy Gagliardi:
It’s such a great question, because I think we’re so good at rationalizing every little blip and saying, oh, and also just pushing through. We’re busy, and we have people depending on us, so we don’t always take the time to really stop and reflect. I think one good rule of thumb is if it persists. It’s one thing to have a few bad nights of sleep. It’s another thing to have a couple of weeks of bad sleep. It’s another thing to really have your sleep off for two months or three months, so taking stock over time.
Amy Gagliardi:
And also just irritability. It’s hard to see in the moment and the day, but irritability can be a big marker for depression and anxiety. And do you have the resilience? Do you enjoy things? Do you have the energy? So I can be irritable at work, but I go home and something really fun happens and I really enjoy it, so that’s reassuring. That shows some sort of transience in the nature of it or flexibility. But when I’m stressed at work and stressed at home and there’s not a lot of variability in it, I think that’s another sign that one’s mood or anxiety can be off.
Celeste Headlee:
Okay, so let’s say that I have done what you just said. That I’ve gone from, “oh, I’m fine,” and I’ve somehow broken through this fear that admitting I’m struggling means all kinds of horrible things, right? Is there anything I can do at that point which is sort of a micro treatment? Short of taking a complete break, what can I do in the short term?
Amy Gagliardi:
There’s tons of micro treatments, so that’s a really good place to start. I mean, first of all, this sounds boring, so when you go down the list of what these things are, people think, oh, yawn, I know this stuff. But I think it actually makes a difference to pay attention to what the research tells us.
Amy Gagliardi:
For example, there was just a great JAMA article, the Journal of the American Medical Association, on exercise and depression. There’ve been thousands of studies on exercise and depression, but this one really looked proactively and tried to tease out cause and effect. And it’s very clear that short bursts of exercise, we’re talking about 15 minutes of running or something, cardio, a day, has a big impact on treating depression. So not just preventing it, but actually treating it.
Amy Gagliardi:
And for a long time, we knew that people who exercise tended to have more resilient moods and lower anxiety, but we didn’t know if that was just because they had better moods so they exercised more, or what was the cause and the effect? I think this really helps us tease out that it matters to move, and it doesn’t have to be long and it doesn’t have to be rigorous. I mean, even walking had an impact on mood. So movement matters, and a lot of us have pretty sedentary lives or sedentary work days. I have an incredibly sedentary work day, so just building that in small ways that are doable makes a big difference.
Amy Gagliardi:
We talked about sleep. I mean, sleep is tricky because sleep really goes offline with stress. Cortisol, adrenaline, it keeps us up. Even low, low levels of stress hormones make it hard to sleep. So then people worry about sleep at three o’clock in the morning. I should be sleeping. What I would say is you can’t control sleep, but you can sort of set yourself up for success in the sense that having a regular bedtime, waking up around the same time every day actually makes a big difference to when you fall asleep, because we have an internal clock that sets 16 hours after we get up. So that wake up time actually starts off the clock, and it’s going to impact our ability to fall asleep. Reducing alcohol at night. There are just certain kinds of basic sleep hygiene, and again, they sound boring. We’ve all read them, but you want to maximize your ability to sleep. Sleep has a huge impact on mood and cognition.
Amy Gagliardi:
And then the other thing is staying connected to people. And I think we let that go as we get busy. We don’t make time to see people and to connect with people, especially if we’re doing a lot of work remotely now. There’s just not that sort of casual chit chatting moments before and after a meeting. And that’s been shown to have a big impact on mental health, that just routine sort of connection, seeing the person who you like to see, having somebody be happy to see you, it sounds so simple, but we’re hugely social animals. Even people who are more introverted really need to see people, so that’s something that one can do.
Amy Gagliardi:
And then there’s tons of interesting research on gratitude and mindfulness and all kinds of other things that people can incorporate into their lives, but it takes some intention. It takes some intention to change these habits. And if I had to pick one, I’d probably add in a little bit of exercise.
Celeste Headlee:
So at what point, so let’s say that I’ve done this micro treatment. I’ve been taking walks, I’ve been trying not to guzzle down wine right before I go to sleep, all of those things. When do I know that it’s time that I can’t do this on my own and I need to seek professional help?
Amy Gagliardi:
I think that you would start just as you say, but I would give it something like a few weeks, three to four weeks, to really see benefit. I wouldn’t let it go six months. I would try to call it on the earlier side, when you’re really not able to do the things you want to be able to do. You know when you’re not working up to your capacity. Other people around you may not have realized that yet, but you kind of know when you’re slipping there. You know, when being with your kids feels like more of a chore than a joy, or managing the things around the house just feels overwhelming.
Amy Gagliardi:
So people start to feel like they’re sort of moving through cement. It gets hard to do things. Things are more easily overwhelming. Depression and anxiety really impacts us cognitively. We tend to think about mental health as emotions, but actually it has a big impact on how we think and learn. So if those things all feel like they’re moving in the wrong direction and they’re not correcting with a good amount of intervention at home, then you seek out some consultation.
Amy Gagliardi:
The place to start is just to get a consultation. And sometimes I tell people, get two, get one opinion and get another, because like with anything in healthcare, and maybe more so in psychiatry, there’s a huge variability in people’s training and background, so you really want to get good advice. You want to go to somebody who is well-regarded. If it doesn’t make sense to you, it doesn’t fit you, or something about it doesn’t feel quite right, then get a second opinion about it. Because there are really good evidence-based treatments for depression, anxiety, trauma, eating disorders, substance use disorders. I mean, this is really, in the whole span of psychiatry, now is a time where there’s more evidence-based treatments available and that’s what you should access.
Celeste Headlee:
But how would you advise people to get past the sort of tough it out culture that we have right now, this rise and grind culture of just bare your teeth, grit your teeth, and get through it and be tough? And you are the person of steel. How do we get past this idea that quitting, saying this is too much for me, is tantamount to not being successful or not being good at what you do?
Amy Gagliardi:
It’s true. I mean, we demonize quitting in our culture and we overvalue grit. I mean, I think of all those books, and I read books how to raise your kids with grit, so that’s true. And not to put too much on the Olympics and the messaging, but I think it’s important that people at a very high level of performance are stopping to take care of themselves. And I think that is very, very important messaging.
Amy Gagliardi:
It’s just good science. Our bodies don’t function well if our brains are not on. And if you learn a little bit about the neurobiology of these things, it becomes very obvious that the people who are very successful in life don’t have a lot of these problems or are managing to them in some way. And the more you talk to people about it, the more you realize other people are out there and other people have sought help as well.
Amy Gagliardi:
But I consider it to be just good maintenance. And once you start to get some treatment, you’ll be a believer, because you realize, oh, I’ve been doing this the hard way. It’s almost like an airplane is making its way through terrible turbulence. You can do it, but if you go up 10,000 feet or down 10,000 feet and hit smooth air, you realize, oh, this is much easier. So once people start to get a little bit of help, they usually become very committed to it.
Celeste Headlee:
Does that change at all, either for the worse or the better, in terms of the pressure put on women, that if they admit that their kids are stressing them out or they cannot deal at this moment, for whatever reason, that makes them a bad mom?
Amy Gagliardi:
I think that that is going to start to change, but yeah, it’s a big problem. When we talk about parenting, that is supposed to be an enormously sort of only gratifying experience. The truth is, I think parenting has probably gotten less gratifying over the years because we do so much for our children and we’re so focused on their care. We probably over function in a lot of ways for our kids and we provide at a very, very high level, physically and emotionally.
Amy Gagliardi:
And there’s some thought that we’re raising kids who are less able to be independent and autonomous and well-equipped for the world. There’s enormous pressure put on investing in parenting and I think it’s a complex problem, but self-care is really essential. You can’t be a good parent unless you’re functioning as well as possible.
Celeste Headlee:
And also possibly modeling to your kids that they too should put their own needs high on the priority list.
Amy Gagliardi:
Absolutely. The best way to talk to kids about mental health is start early and often, that it’s just part of how you think about being a human in the world. Whenever I talk to people about this, some people will say, “Well, I never talked to my kids about mental health and now they’re 35.” And I say, “Well, start now.” I mean, it’s not too late to have any of these conversations. Early on, you can really normalize it and get kids talking about even just identifying and observing their feelings. Are you angry? Are you sad?
Amy Gagliardi:
And noticing patterns. I will sometimes reference it myself. I went to bed grumpy and I woke up and I feel so much better. I think I needed sleep. Or, I realized I hadn’t eaten dinner. Or, these are the ways I was feeling. So I think just generating that vocabulary and that language early on, where you’re helping kids think about their minds and think about their emotions, is really critical. You’d be surprised how many people I see in middle age or even older who really have a very hard time with the fundamentals of identifying their emotion. They do not know what they feel. They grew up in families where there just wasn’t any language or attention to it and that’s something that we as parents can instill at any age.
Celeste Headlee:
So I was mentioning to one of my neighbors that I was speaking to you today, and she said, “I know what she’s going to say. She’s going to tell me to take care of myself. She’s going to tell me to get sleep.” She’s like, “But I just, I wake up every single day feeling overloaded already. Every day is this constant effort to just get my head above water. And I don’t think I ever do it.” And I have the sense that there’s a lot of people who are feeling this way, that they’re just in chaos.
Amy Gagliardi:
Absolutely. And, you know, I feel that way. I mean, there are times when I feel that way myself. And when we talk about sleep and self-care and all the things that a person can do, I think we have to be careful not to lay the responsibility of taking care of mental health at the feet of the individual, because really, this is a societal problem. I mean, we have a very difficult healthcare system. It’s very difficult to access care. It’s difficult to afford it. It’s difficult to navigate it. We have a culture that prioritizes self-sacrifice and overwork, we know that, relative to other cultures.
Amy Gagliardi:
If you look at how we treat people in our prison systems with mental health problems, or in our education system, we’re not taking good care of ourselves. When people are living with chronic stress, it may not all be about something they need to do to correct it. There may be larger societal factors at play that would make a difference. There’s only so much we can do, and we want to take control of the things we have control over, but the fact that we don’t have easy access to resources for mental health, and that we live in a culture that so prioritizes overwork. I think it’s starting to change, but very, very slowly.
Celeste Headlee:
Any last bits of advice for people? Anything we’ve missed? What should I have asked you?
Amy Gagliardi:
I would say is that, it isn’t easy, but we want to always be thinking about ourselves and the individual and our colleagues. I do think it’s important when we think about mental health to think about it from a societal perspective, because as long as we have the kinds of problems we have in terms of poverty and limited access to healthcare, it impacts all of us. So while these positive messages I think are incredibly important, reducing stigma is incredibly important, and focusing on the ways in which we have better delivery and better evidenced-based methods, we really need to work as a society to support mental health, to think about our own mental health, and to be good communicators about mental health.
Amy Gagliardi:
We have to become advocates because it impacts every single one of us. Not a single family in this country is not impacted. If we’re not talking about it, if we’re not advocating, if we’re not clamoring around this issue, then we’re hurting ourselves. So I think there’s the immediate kinds of things we need to do about self-care, but there’s also responsibility we have to ourselves and our families and others as a group.
Celeste Headlee:
Amy, thank you so much.
Amy Gagliardi:
You’re welcome.