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Let’s reframe how we talk about mental well-being

May 10, 2023 |4 minute read time

Headshot of Cara Grey, President of Behavioral Health and Mental Well-being at CVS Health

Cara McNulty
President, Behavioral Health and Mental Well-being at CVS Health

It’s OK not to be OK

Are Americans underestimating their mental health struggles? A new study from CVS Health and Harris Poll found that nearly three in four Americans describe their mental health as “excellent” or “good,” and only one in 10 say their mental health has gotten worse in the last year. Yet nearly 60% of physicians report declining mental health among their patients. Why aren’t more people willing to talk about their feelings of anxiety, sadness or the “blues”? In honor of Mental Health Awareness Month, we present a special episode from LinkedIn’s The Anxious Achiever podcast featuring Cara McNulty, President, Behavioral Health and Mental Well-being at CVS Health. “Mental well-being is part of our physical well-being, which is a part of our total well-being,” says Cara. “Instead of trying to pretend that our head is not attached to our bodies, let's reframe how we talk about mental well-being.”

Fighting mental health stigma

In the interview with host Morra Aarons-Mele, Cara traces her career path as a population scientist along with her personal and professional experience with mental health. Cara and Morra open up about their mental health challenges as mothers and talk about the persistent myths around mental illness in our culture and health care system. “Mental illness just means a chronic condition that you're dealing with like schizophrenia, like bipolar,” explains Cara. “That doesn't mean you're broken. … We don't tell people who have colon cancer that they're broken.”

Instead of trying to pretend that our head is not attached to our bodies, let's reframe how we talk about mental well-being.

Cara McNulty

President, Behavioral Health and Mental Well-being at CVS Health

A change in attitude toward mental health

For most people, the mental health system in the United States is complicated, unfamiliar and hard to navigate, and while mental health and physical health are equally as important, mental health has not historically received the same prioritization that physical health does. Changes in attitudes toward mental health and higher adoption of digital tools and virtual health services are ushering in a new era. Over a year ago, CVS Health made a commitment to reduce suicide attempts among its Aetna members by 20% by 2025 using a population health approach and nearly surpassed that goal in just the first year. “That meant 2,000 people didn't die by suicide," says Cara. "That's someone's mother, father, brother, sister, son, daughter, aunt, uncle, grandparent. That's somebody's person.”

Learn more


Are you okay? Really? In a recent survey from CVS Health and the Harris Poll, 72% of Americans say their mental health is “excellent” or “good.” That seems like great news, but could it really mean that people are just underestimating their own mental health issues?

Only 14% of Americans say their mental health has gotten worse in the last year, yet 56% of doctors see declining mental health in their patients. Why the 42-point gap?

Maybe one reason is we’re not comfortable talking about mental health. So, today, in recognition of Mental Health Awareness Month, we’re airing a special episode of The Anxious Achiever podcast from LinkedIn. It features a healthy conversation between Cara McNulty, President of Behavioral Health and Mental Well-being at CVS Health, and Anxious Achiever host Morra Aarons-Mele. Morra has also written a great book by the same name.

This is a wide-ranging discussion about mental health that covers everything from suicide prevention to learning how to talk about our own mental health issues with friends, family and even at work. I hope you’ll enjoy it as much as I did.


ANNOUNCER (01:00):

LindkedIn Presents.


I'm Morra Aarons-Mele and this is The Anxious Achiever, the show that looks at the intersection of mental health and work and how we can all do both better. Sometimes you set out to have a conversation with someone as an interviewer and you think you kind of know what to expect. And then sometimes an interview turns into something else entirely. I wanted to interview today's guests because of her trendsetting work on mental health on behalf of America's fourth largest company, CVS Health. I wanted her to be our guide, as we thought about the healthcare ecosystem and why it's so broken in providing mental health to so many. A lot of companies and individuals are trying hard to right the wrongs, to step in for a system that is broken and improve the situation for the many people who are suffering.

Cara McNulty is president of behavioral health and EAP at CVS Health. She is a population scientist. But Cara and I ended up diving into our personal mental health stories, which happened when we were pregnant. Maternal mental health is crucial, but it's still really hard to talk about and I thank Cara for her story and invite you to listen. Here's our conversation.

So Cara, you're a population scientist. Tell us what that is and why you chose to become one.


CARA McNULTY (02:48):

You know, Morra, it's interesting, I always thought that I was going to go to medical school and be a pediatrician. And I was doing all my work to go to medical school and my father was diagnosed with a very rare, rare form of cancer, of leukemia. And at the time, he was one of four in the United States that had this rare form of leukemia.



Oh my God.


CARA McNULTY 03:17):

And long story short, he had an unbelievable oncologist at the University of Minnesota and so was in the hospital for long extended periods. And I ended up shadowing his oncologist. And at the end of this two-week period, his oncologist asked to speak with my dad and I, my dad in his hospital bed, me sitting on the edge of the bed. And, you know, I am doing all my work and to get into medical school and the oncologist says to me and my father, "Listen, I don't think you ought to go to medical school," and all I heard from there is, "Oh my gosh, I don't like this man. Why would he say this? Why would he say this in front of my father?"





CARA McNULTY (03:57):

And he said, "Here's the reason. You are asking these unbelievable questions about, 'Could this have been prevented? What about the future? How do you stop this from happening with other people? What is the outcome for more than just your family, but broader?'" And he, he said, "I really think you ought to study population medicine." I barely could hear what he was saying because I was, I think, seething inside.





CARA McNULTY (04:27):

And I said, "I don't even know what that is." And he said, "Well, population medicine is looking at, instead of an individual, once they've been sick or diagnosed or they're coming to, you're looking at large number of people and community and looking at what's tripping them up or getting in their way of being healthy. And you're making inferences and taking actions around policies, clinical systems, environmental changes, to impact a population, not just an individual." He then took out a piece of paper, scratch down suggestions on where he thought I should consider getting a master's degree and getting a doctoral degree. My father died a week later and I did exactly what his oncologist suggested. And it is probably the best thing that's ever happened to me in my life. So when I think about the sadness of my father dying, I am filled with gratitude for what came of that.



It sounds like you were hurt by his, the way he said it, "Don't become a doctor." D- did you feel like he was saying, "Y- you don't deserve to be a doctor"? Like did you feel negative about it? But then obviously, you listened to him and you took his advice. Like I'm just curious how you heard that.


CARA McNULTY (05:52):

W- what I heard is, "I don't know that you're going to be good enough."





CARA McNULTY (05:59):

And, and that's what I was telling myself. What I realized, you know, in unpacking all of that and listening is this oncologist was truly empowering me and believing in me and even said to me, "You know, you have the opportunity to focus on children and adolescents, who are always going to need our help. And so you can be in population health science and population medicine and focused on children." What I realized is this oncologist truly was helping me find my path. But what I heard at first, Morra, was totally, "Oh, he doesn't think I'm good enough." It wasn't until I really started thinking about him encouraging me to get a doctoral degree and the reason so I would be heard in a room that I understood. And, and I saved that piece of paper, that piece of paper sits on my desk and it's ripped, it's worn and it's a gift. It's such a gift.



And often people say to me, "Gosh, it seems like your work and your personal life all meld together." And they do, not in a way that you can't find balance, it's my passion. I, I, I, I wanna help people who I'll never even meet, remove barriers, so that they can be the best they can be. And those barriers often are things that we set up erroneously in our healthcare system or, you know, myths about, for example, what mental illnesses or, you know, that because you're having a mental health struggle, it means you're broken. You know, those are things that we, we have the opportunity to change and I wanna use my skills and voice to do that.



Hmm. I wanna talk to about your job and your work, but I wanna talk to you about your own story of mental illness and your postpartum. W- what was your diagnosis actually?


CARA McNULTY (08:12):

Postpartum anxiety.



Postpartum anxiety, that's not ... P- p- postpartum depression is a pretty familiar word to people. I don't think postpartum anxiety is.


CARA McNULTY (08:21):

(laughs) I, I, I had never heard of it when I was given that diagnosis.



I wanna talk about that. I wanna start by saying that I, myself, I have three children with my first son, I had another unusual form of maternal mental illness, which is I had ...


CARA McNULTY (08:37):




... antenatal depression and psychosis and that happened when I was three months pregnant. So I had all the, the horrible, horrible sy mptoms when I was pregnant and it was terrifying.


CARA McNULTY (08:53):




And, you know, I was forever changed. I'd love to hear your story and also how it intersected with your professional identity.


CARA McNULTY (09:05):

Mm-hmm. Sure, I, I, I will tell you, Morra, I just hearing you talk about your own experience and, you know, we say the word psychosis ...





CARA McNULTY (09:18):

... and I will tell you it stops me in my tracks. Because when we get pregnant, often, you know, we've talked about this as the happiest time of our lives.


(laughs) Yeah.


CARA McNULTY (09:31):

And there's so much joy and excitement. And to hear you talk about, you know, your experience and going on Prozac at three months, having gone through postpartum anxiety, there's not a time that I hear another woman talk about their own experience where I'm not, I don't have a moment of pause and a big gulp, you know, for like, how it's more common than we know and it's so important to share voices. So thank you for, for sharing that. Because I know it's hard. I know-



And it's hard. You know, i- it is a truth certainly in, in our society in the US, you know, being a mother is a real milestone culturally and societally for many women and, and I felt like such a failure. (laughs)


CARA McNULTY (10:21):

I- it's so true. I mean I, it is, I didn't find pregnancy comfortable. And, you know, so my story is pregnant at 33, and, you know, pregnancy, I was physically sick through both of my pregnancies.





CARA McNULTY (10:42):

And so it wasn't an easy, you know, I was nauseated the whole time and had the first baby all good. The gift I am given is easy delivery. (laughs)





CARA McNULTY (10:55):

The days, the long, you know, g- gestation not so great, but easy delivery, no problems. Now, if I go back, I had my first anxiety attack on the day that we were burying my father.





CARA McNULTY (11:13):

But I didn't put two and two together. I, at the time, it was an open casket ...





CARA McNULTY (11:20):

... memorial before the service began and we, as a family, needed to be there two hours early and I couldn't get myself in the door. And it took my mom probably 45 minutes. We ended up coming in the side door ...





CARA McNULTY (11:34)

... but I had my first anxiety episode. But I didn't ever think of that as anxiety. I thought of that is the reaction to a death.





CARA McNULTY (11:44):

Fast forward many years later, nothing in between. And I have my first baby fine. You know, I'm an anxious mother, I, you know, now looking back know I was having more anxiety than I really realized or stopped to pay attention to.





CARA McNULTY (12:04):

Mind you, I'm in this field, I'm in health and, you know, uh, easy to look at others, not yourself.



Of course.


CARA McNULTY (12:15)

Then we have our second baby and our daughters are 23 months apart, so they're close in age. So I have, you know, a history of this anxiousness that I have not addressed. Adeline is our oldest and at the time, you know, not two. Isabel is born and it's busy. And the one thing I know about myself is I'm not great when I don't have good sleep. And I have all the support around me, I have a very supportive husband, who is very capable. My family is here. I have all the ingredients. And when Isabel is five months old, I mean it's busy with these two, it's very busy and Isabel gets diagnosed with RSV.





CARA McNULTY (13:09):

And RSV absolutely can be very serious and it can be very mild. Isabel's case was probably in the middle, but not life-threatening. But what my brain heard was, "Oh, she could die. She could die." And we ended up in the hospital for a day and, you know, they were doing all the treatments, wanted to put her on a nebulizer, sent us home. And I got it in my head because this seems very rational to me, I'm sure I was very low on sleep, that, you know, "The important thing is she has to just keep breathing."





CARA McNULTY (13:52):

"So I am just going to hold her. I'm going to hold her. And because if I hold her, I'll know she's breathing." And more I went from, "I'm going to hold her," to, "I don't need to change out of my pajamas."





CARA McNULTY (14:08):

"I don't need to sleep," to, "I don't need to shower because then you'd have to put her down and why eat?"



(laughs) Oh.


CARA McNULTY (14:18):

"I mean that seems like an unnecessary step." To, and this was a fast spiral, you know, three days and now I'm sitting on the kitchen floor holding this baby who's doing fine, by the way, who's doing just fine, bawling.



Oh my God.


CARA McNULTY (14:33):

My two-year-old is next to me, patting my back saying, "Mama crying, mama crying."





CARA McNULTY (14:40):

And my husband saying, "Honey, this isn't how this is supposed to be."





CARA McNULTY (13:45):

"We, we can get help," and I'm educated, I'm financially stable.





CARA McNULTY (14:50):

I have a partner, who is in it with me. I have a mother, who is there in a heartbeat, a sister. I mean I have all the makings, all the makings and I can't get myself off the kitchen floor, which that's okay, but I had all the support. Now, the beautiful story is I had all the support and got in to care right away ...





CARA McNULTY (15:17):

... and was seen by an unbelievable expert, who said, "Oh, you're suffering from postpartum anxiety." And I said, "I have no idea what that is. W- what is that?"





CARA McNULTY (15:31):

You know, and then started doing this deep dive on it, but what takes me back to you sharing your story is I had all the support and tools and resources and access and it was so hard, I could have gotten myself up off that kitchen floor and most people don't have that. And, and then we don't talk about it.



And y- you're "s- supposed to be fine."


CARA McNULTY (15:58):

Well, and that's it. You know, the other thing that we got I often do to women and families is ... Listen, I, I am a person that usually looks like they have their act together. I stay really calm, especially in energetic situations or if there's, you know, an emergency, I am calm. I, you know, I'm not the best multitasker, but I can fake it. And I look like I have it together, but the reality is looks are really deceiving. Looks are super deceiving. And just because we look like we have it together doesn't mean on the inside we're saying, "Gosh, I should have it together more," or, "I'm, I'm not a great parent because I couldn't do X, Y and Z or they're ponytails didn't look great," or, "I couldn't get them into this school," or, you know, that internal conversation, we don't see externally.



No, no, we get good at faking it. I'm curious how your experience going back to work was after, after having Isabel and going through postpartum anxiety?


CARA McNULTY (17:06):

You know, i- it's such a good question. It was really hard.





CARA McNULTY (17:11):

It was really hard. I have always been someone who wanted to be a mother. In fact, I think I wanted, I knew I wanted to be a mother before I knew I wanted to do anything else. I also knew I wanted to work. And so I felt that struggle of, "Wow, I, I need to work for my own, I need my own brain food, I need my own like identity, but am I, am I screwing up my kids." Now it wasn't like I could just stay home. Financially, I needed to work and I wanted to work. Going back, I had anxiety, it just sparked my anxiety, I went on medication right after the diagnosis of postpartum anxiety. And I will tell you that I have gone off anxiety medication twice since then and, you know, did it with my provider, you know, weaning down and always end up going back on ...





CARA McNULTY (18:16):

... because it just helps me to equalize who I am. And it's why I continue to do therapy because that combination of medication and therapy really works for me. But as I went back, it was very hard. I felt very anxious. I felt, you know, my own self talk of, "Gosh, I don't want a- anyone to know. Do they know? Can they tell? Can they tell I take, you know, anxiety medication and f- fluoxetine? Can they tell that I ... Can they tell my mouth gets dry because that, that medication ..."





CARA McNULTY (18:52):

"... make my mouth dry? Do they know? Do they know? Can they see it?" You know, I felt, I felt all of that.



I just wanna talk about how normal this stuff is and I wanted to give you a statistic that I'm sure you know and ask you to reflect on how, how it affects how you talk about mental health in your job, which is that 80% of us will experience mental ill health in our lifetimes, right? We m- may not be diagnosed with a mental illness because it's on a spectrum ...


CARA McNULTY (19:21):




... right?


CARA McNULTY (19:22):




But almost all of us has a story. And how do you translate that in your work in an attempt to get people talking?


CARA McNULTY (19:32):

Hmm, gosh, it is such a great question because I believe it's even higher than 80%.



Yeah, probably.


CARA McNULTY (19:44):

I think if you just even take the snapshot of the pandemic, who didn't feel some kind of mental unrest, maybe you had more fear or anxiousness or the blues or stress ...





CARA McNULTY (20:02):

... or sadness that maybe lingered. And so one of the things that I'm passionate about is really changing the conversation, the nomenclature and the myths about mental health ...





CARA McNULTY (20:24):

... mental illness. So you'll hear me use the term mental wellbeing.





CARA McNULTY (20:30):

And I use that term, because in healthcare, we often call it behavioral health.





CARA McNULTY (20:37):

Well, that's an insurance term.



(laughs) Yeah.


CARA McNULTY (20:41):

That's a healthcare term.



Oh, interesting.


CARA McNULTY (20:44):

And as a woman who's been sitting on the floor in pajamas for many days crying ...





CARA McNULTY (20:49):

I didn't want to be told it was my behavior. And people will say, "Well, that's not what it's meant."





CARA McNULTY (20:58):

But words matter.





CARA McNULTY (21:00):

Words matter. And, you know, our mental wellbeing is a part of our physical wellbeing, which is a part of our total wellbeing. And instead of trying to pretend that our head is not attached to our bodies, let's reframe how we talk about mental wellbeing.





CARA McNULTY (20:25):

And, you know, we make it really clear, it's good and important to talk about how we take care of our physical health. I mean, every day, there's an article, there's podcasts, there's a story, there's a conversation about, "You know, are you getting enough sleep because it's good for your physical health? Are you eating well? It's good for your physical health."





CARA McNULTY (21:41):

"You know, are you in healthy relationships? It's good for your physical health."



Well, and I know what Jeff Bezos eats. I know that he has a meditation coach. I know that his biceps are huge because this is his exercise routine. (laughs)


CARA McNULTY (21:56):

Right, right. Exactly, exactly. And, you know, we need to normalize that our mental health, our brains need that care and feeding and support because they're a part of our total health wellbeing. And this brain, this mental muscle often is not addressed, not associated with our physical health. I think about, you know, the exciting news of being pregnant and having a baby. There is a mental health capacity or, or connection there always. And it might be your excited, it might be your nervous, it might be there's fear, but there's always that connection. You have a new cancer diagnosis. I remember the day ...





CARA McNULTY (22:53):

... our father told us that he had prolymphocytic leukemia. I- I'll never forget it. And he said he's likely going to die, but he will do everything he can to live, to live basically while he's dying.





CARA McNULTY (23:07):

And if you don't think there's a mental health issue associated with that, I'm sure he went through anxiety and depression and stages of grief, but we didn't know that, as did we. You know, everything, everything we do in our health has a piece of mental health with it. And so, one, calling it behavioral health just helps to raise the stigma.





CARA McNULTY (23:33):

Talking about our mental wellbeing and that it's not one plus one equals two, you know, it is a continuum from stress and resiliency and anxiety and situational depression and depression to mental illness. And mental illness just means a chronic condition that you're dealing with like schizophrenia, like bipolar. That doesn't mean you're broken. It doesn't mean you are damaged. It doesn't mean you are anything other than, "That's an illness you have." We don't tell people who have colon cancer that they're broken. So naming and framing and normalizing is really, really important to ensure that we're helping people understand that you have to give care and feeding to our mental health and wellbeing and there's gonna be some disruptions.



How do you operationalize? I, I wanna dive in on the effects because I think we can't sugarcoat sometimes that when you are in a deep state of anxiety, when your father has cancer, you're showing up at work and work is harder and it might affect how you show up. And we have to deal with this.


CARA McNULTY (24:56):




How do we deal with this? How do we make this both accepted and okay, but also not devastating to a company that needs you to show up?


CARA McNULTY (25:07):

Right, right. You know, it's when we think about work and culture and companies that thrive, if you think about companies that really are doing well ...





CARA McNULTY (25:20):

... they have a culture that is purpose driven, so those employees know why they're there, they believe in that purpose. That purpose-driven culture is steeped in inclusivity. So people feel like they can bring their full self to work, their physical self, their emotional self, their historical self, their demographics, their sexuality ...





CARA McNULTY (25:50):

... and their mental wellbeing. And so it's so important when we think about a company success that there purpose driven with an embedded inclusiveness and those are the companies that consistently do well and are driving value. And so if you unpack that, it's really important in that lens of equality and inclusivity that we make it okay for people to bring their physical health.





CARA McNULTY (26:27):

You know, if you have a broken leg, we don't tell you, "Don't come to work."



Right, "Walk to work."


CARA McNULTY (26:30):

We tell you to come to work ...





CARA McNULTY (26:33):

... you know? And, "We're gonna help you." We have things with our mental health, and when we empower a culture that is accepting, and accepting doesn't mean that then you're making excuses for behavior ...





CARA McNULTY (26:51):

... or that you're letting things slide, accepting means that you're creating an environment where an employee can tell their employer, "Listen, I'm going through this and here's what I need," or that manager can help that employee get connected to services like Employee Assistance Program or behavioral healthcare coverage. It doesn't mean that it's an excuse. It means it's empowering. I can remember, a long time ago, I had a new employee, a young male, who said, "I wanna tell you something because I feel like HR will tell you and I wanna be the one to tell you that," and it just goes to show how most of time employees are so worried about somebody finding this out.





CARA McNULTY (27:38):

He said, "I'm, you know, you hired me for this job, I know I'm gonna do a great job and I'm bipolar."





CARA McNULTY (27:43):

"And I'm afraid to tell you this because I'm afraid that you'll then maybe think of me different or not give me the workload that you should or that you'll think I can't be able to handle more." And he said, "I, I just ask that you let me be the one who manages my health and do let me own my bipolar. You don't own it or try to make decisions for me." It's the most empowering thing, conversation about mental health I've ever had with an employee. It has forever changed how I operate. And I can remember I, I even think to this day, "Wow, that young man had such courage." And I'll tell you, he is unbelievably successful.





CARA McNULTY (28:38):

He, he (laughs) he knew himself better than I know myself and it was empowering. It didn't mean that he didn't have difficulties.





CARA McNULTY (28:45):

It didn't mean that he didn't have situations, but everybody does, everybody does. So it's really important that, if we want people to bring their best self to work, we have to understand how we can help them do that and that means life happens.





CARA McNULTY (29:04):

You know, we have loved ones get sick. We get sick. We have challenges. We have times that we struggle, but it doesn't mean we don't get to the other side.



"Let me own my bipolar," I love that.


CARA McNULTY (29:21):




Thank you for illustrating that because I think people often wonder about how these conversations can unfold in, in a positive way and, and I think that's helpful. I know that, that youth mental illness is a huge focus for you and your work. I want to talk to parents out there who might be managing their kid's mental health, as so many of us are, I am myself. How do you recommend, if at all, they bring that to their manager and their team in that same empowered way that your colleague did with his bipolar?


CARA McNULTY (29:58):

It's so important that we, as leaders, as managers, as supervisors, as colleagues, we share our experiences ...





CARA McNULTY (30:16):

... because when we do, we allow others to then feel comfortable to do the same. So when a boss of mine shared that she had a child going through mental health situation and it was, she found it really hard because she was trying to manage home and work and it felt like she wasn't doing a good job in either place.



Also, you feel like you can't talk about it, right? It's not like-


CARA McNULTY (30:51):




It's not like you can say, "Oh, my husband broke his leg and it's such a pain because now I have to do all the laundry and all the dishes." Like it's not like that.


CARA McNULTY (30:57):

Right, and when my boss shared this, I felt this unbelievable sense of relief like, "Oh gosh."





CARA McNULTY (31:11):

"She, she also is trying to do all the things. She's trying to be a leader at work and she's trying to be a mother and a wife. And oh, by the way, she's concerned about her son." It liberated me. It absolutely liberated me. And when I think about what we can do as parents, especially as parents, whether it's in the work setting or it's in community or it's with one another, is to share what we have going on. One, we're gonna get some unbelievable support from friends and family ...





CARA McNULTY (31:50):

... because anyone who has kids has experiences ... You know, there are, there are experiences that are happening with those kids that have a mental health impact.





CARA McNULTY (32:05):

I, I mean ...





CARA McNULTY (32:06):

... anyone who has teenagers, they're, you have a mental health impact.





CARA McNULTY (32:11):

We've gone, you know, we've gone through COVID. I, I, I can remember one of my daughters, I was kind of checking in on my kids because I had just done an interview and talking about the importance of checking in. I thought, "Oh gosh, I haven't checked in on my kids," and, you know, t- they're homeschooling and I checked in and Isabel is the one who said ... Well, besides that it's the year of ultimate disappointment ...





CARA McNULTY (32:34):

... because everything gets canceled.





CARA McNULTY (32:36):

"I think we're doing great," and I remember thinking, "Oh, Isabel's sarcasm is how she shows grief ..."





CARA McNULTY (32:47):

... and started to unpack that, and she said, "I don't even get excited about things anymore, mom, because they always get cancelled."



Oh my gosh.


CARA McNULTY (32:55):

And you know what? One of the things I had to work really hard on was how to support my kids in grieving and not telling them to buck up.





CARA McNULTY (33:06):

You know, because my first thought is, "Oh, buckle up. Somebody else has it worse."





CARA McNULTY (33:09):

You know, and no, you have to help them grieve. And so when my boss at work told me about her son, it unlocked for me, "Oh gosh, you know, what if that made me feel comfortable?" So I then, you know, now, always, not always, but talk about with my own team what I have going on and it just inspires people to bring their full self, that inclusive self. Now, not everybody has the same skills, and so my boss, she had the skills to say it and share it, but not everybody has the, you know, you might tell a manager and they might be like, "Oh," they might be really uncomfortable.





CARA McNULTY (34:03):

And that happens. Oh my gosh, it happens. And the best thing we can do, as the employee, is to think, "I'm not gonna take that personally," because we don't know what that manager or supervisor has going on, and the more we normalize these conversations, the easier this gets.



Ooh, that's hard.


CARA McNULTY (34:24):

Yeah, it's hard. It's hard, but it's worth it because you know what? When we don't, we let people suffer in silence.





CARA McNULTY (34:34):

And, you know, at CVS, we believe suicide is preventable. We do. And we made a bold statement over a year ago to reduce suicide attempts by the members we serve through Aetna, our medical insurance ...





CARA McNULTY (34:51):

... 20% by 2025.





CARA McNULTY (34:54):

And we took a population health approach and we almost achieved our goal in one year. That meant 2,000 people didn't die by suicide and that's someone's mother, father, brother, sister, son, daughter, aunt, uncle, grandparent. That's somebody's person. And so I, I just think if we don't continue to normalize the conversation, to connect our heads and our hearts, to share our stories, to share our interventions and solutions, we're gonna lose ground and nobody has to suffer alone.



Could you tell us, a, how you approach that from a population health lens and also how you, you almost did it?


CARA McNULTY (35:47):

Yeah. And, and listen, we're gonna achieve it.





CARA McNULTY (35:51):

So we just stepped back and looked at instead of just assessing people who have shown maybe a trigger that they are engaging in self-harming behavior, so, you know, that we would then give them an assessment, we assess everyone. So anyone we're servicing, we do a brief assessment. It's called the PHQ2. There's two questions. If they answer those questions in a way that would show possibly self-harming behavior, we give them a PHQ9, which is nine questions. So we stopped making assumptions and waited for people to show self-harming behavior or possibly leaning towards self-harming behavior. So that's one way we started an easy assessment of all people. So that's getting upfront. You know, that's like that prevention.



We then looked at anyone who had been hospitalized and looked at why they had been hospitalized. And most of the time, it's not gonna be coded as suicide or suicide attempt. It might be, but not, most the time, it's not. So we looked at anyone we thought had self-harming behaviors and we did outreach. And that outreach was really simple and we talked about support and normalizing mental health. And then anyone who we knew had attempted a self-harming suicidal behavior, we did a very simple, it's called carrying postcards and it doesn't talk about, you know, "Here's all the resources." It talks about why they matter.



Wow. Literal postcards?


CARA McNULTY (37:42):

Literally a postcard and this is something that's used across the world, this carrying contact and other countries have been doing this for decades. And it's very simple. And so we did behaviors like that. And then we started, you know, really training our providers to understand, "Hey, what are the signs? What can you do? How can we get upfront, so we're not waiting for people to be in crisis?" You know, in all of this, what we saw, we did this for adults, is this great reduction. We then have now continued that work with adults, but put a greater focus on adolescents and teens because their numbers continue to go up. And we're taking a different model with teens. We're using some of the same interventions, but teens and young adults need a different approach.



And so instead of waiting for that number to continue to go up, we're getting at it. We're holding ourselves accountable, because these young people, they are our future and they're worth it.



Oh. Thank you for taking us through that. That's really interesting, right? It (laughs) it really brings life to how you can support people by asking questions. A- and I know now that that anxiety screening is happening at primary care as well, right? For all of these ...


CARA McNULTY (39:16):




... all of these supports are being operationalized, which I hope will lead us to talk more about it.


CARA McNULTY (39:22):

Absolutely. It will as long as we continue these conversations, we continue to support each other that, you know, mental health disruption is just part of who we are and that we're not broken, we're not damaged. Having a mental ill episode or a mental illness isn't, doesn't mean we're less than. It means we're normal. It means for normal and we're successful and engaged and really awesome humans. That's what it means.



That's it for today's show. Our show is produced and edited by Mary Doo. Our assistant producer and sound engineer is Nick Krinco. Many thanks to the LinkedIn Presents family, to all of our guests for sharing their stories and to our advertisers who bring you the show. If you love The Anxious Achiever, tell your friends. Subscribe, leave a review, follow us. You can also tweet me @morraam or find me on LinkedIn where you can follow me, message me or subscribe to my newsletter for more from The Anxious Achiever world. Thanks for listening.