Returning to Work Post Mental Health/Suicide Leave

What are some key practices in preparing the clinic for a team member returning from a mental health leave? Dr. Phil Richmond joins us to help a veterinary practice manager wondering how they can prepare a safe space within their clinic. Together, Stephanie Goss and Dr. Phil Richmond tackle many action steps and offer valuable resources to get the right work policy in place for any team. Let's get into this episode…

Content Warning: Mentions of suicide may be triggering to some listeners.

LINKS AND RESOURCES

JAVMA Article Suicide among veterinarians in the United States from 1979 through 2015: https://avmajournals.avma.org/view/journals/javma/254/1/javma.254.1.104.xml

EEOC Resources: https://www.eeoc.gov/laws/guidance/enforcement-guidance-ada-and-psychiatric-disabilities

AVMA EAP Resources: https://www.avma.org/news/exploring-employee-assistance-programs-veterinary-practices-are-they-bother-or-benefit

Return to Work Checklist (US Friendly) – Page 37: https://workplacesuicideprevention.com/wp-content/uploads/2022/06/20220630-FINAL-FINAL-HR-EmploymentLaw-WhitePaper.pdf

Not One More Vet: https://www.nomv.org/

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Episode Transcript

Stephanie Goss: Hey everyone! The Uncharted Veterinary Conference is just around the corner. And I have to take a quick second to say thank you to our amazing industry partners, because without them, the Uncharted Veterinary Conference wouldn't be possible. So from the bottom of our Uncharted hearts, I just want to say thank you to this year's partners, Nationwide, Nutramax, Hill's Pet Nutrition, CareCredit and InTouch Practice Communications. This group is absolutely amazing. So thank you. Thank you. Thank you from the whole crew. 

Stephanie Goss: Hey everybody. I am Stephanie Goss, and this is another episode of the uncharted podcast. This week on the podcast, I get to have one of my closest friends, Dr. Phil Richmond with me to handle a pretty serious question. And, I want to say right up front, we're going to be discussing, suicide. 

 So we've got some heavy subject matter today. So if this is something that is triggering to you. You may want to skip through this week's episode or read the transcripts. And, I think my favorite part about this episode was that Phil and I really got to talk about something that we're both super passionate about, which is breaking the silence around topics that generally feel uncomfortable or taboo to talk about and, really addressing some of the stigma and shame that comes with mental health. Talking about mental health in veterinary medicine that comes, from talking about suicide and the risk factors in our line of work and really any high stress line of work. 

And so I think that was my favorite part, but we really talked about a whole bunch. This is one of my favorite episodes, so let's get into it.

 And we're back. It's me, Stephanie Goss, and today I am joined by a very special, very, special co host and guest. My dear friend Dr. Phil Richmond is back by popular demand. I feel like everybody is like, Oh my God, I love when you and Phil podcast together. I feel like Andy better watch out.

Cause you know, you might be in the running to take over his sidekick gig with me. Phil, how's it going?

Dr. Phil Richmond: It's going well, it's going well. And I still think this holds true that I am the Wish app, Andy Roark or Temu. Maybe, is that new? They had a hell of a superbowl uh presence.

Stephanie Goss: The Temu Andy Roark.

Dr. Phil Richmond: But yeah, the Wish app Andy Roark. But yeah, so we've got, it sounds like we've got, we've. We've got something in the, mailbag that you mentioned that–

Stephanie Goss: Yeah, first of all, I want to start by giving a footnote up front that we did get a mailbag, a letter that has to do with mental health to do with talking about suicide in the team. And we're going to talk about some hard topics today.

And so if this is something that is triggering for you, this may be an episode that you want to skim through the transcript or skip all together. So I wanted to say that, that upfront. And when I got your, you're not wrong, Phil, when I got this mailbag email, I, the first person I thought of was So, I wanted to introduce you because although I think Andy and I are more than capable of having conversation about this, I think that your unique life experiences and the work that you do within veterinary medicine, give you a unique perspective that I wanted to, bring into this.

So, First of all, knowing that we're going to talk about some hard topics today. Second of all, knowing that we're going to drop some resources into the show notes. So if you don't normally check out the show notes for this one, we're going to have some HR resources, some scientific data study info as well.

So make sure to check out the show notes for this episode, but we did get a mailbag. So we got a mailbag letter from a practice manager. Who manages a hospital that has team members in the hospital overnight and they sent an email because they have they had their own personal first, which is and I'm going to use their words here.

They had a team member who attempted suicide due to personal struggles at home. And so they had some multifaceted questions that they wanted help with and they are struggling with. You know, they have done, oh, I think a wonderful job of supporting, supporting this, team member. They said, you know, we have given them a paid time off. We are supporting them with access to mental health resources and care. Which I think is wonderful. And usually sometimes the first step where we as managers panic, right, is knowing what do I do when something like this happens? But their questions are, okay, this has already happened.

They've gone out on leave. They're being supported and there is a return to work plan and a timeline for when they're at this point planning to come back to work. And they had a lot of questions about what happens when this team member comes back? How do I support them in the practice from a mental health perspective and standpoint?

What practices do, what steps do we as a practice take to support this team member and also protect the hospital, but protect them within the hospital? Because this is a credentialed team member who has access to the controlled drug cabinet and just drugs in genera and the unique circumstances are that, that while this team member is often buddied with someone else, there are absolutely times where this team member is working as the solo paraprofessional staff in the ER or ICU or overnights.

And so they said, you know, I have concerns about what the risk factors might be here and I want to support them and I want to know how do I do this? And they're struggling because they feel like the clinic has always been a very safe place for them. And they're They want it to be a safe place for this team member, and they're concerned about, are we doing them harm by letting them continue to have access to medications and it, and from the manager's perspective, feeling like they may be increasing the risk if they don't do some things.

And so I just thought, a great set of questions and the way that they asked them was wonderful. And I thought of you, Phil, and I thought this would be a good one for us to talk through together.

Dr. Phil Richmond: Yeah, absolutely. And just so, you know, I think one of the things that comes through when we hear what this person's concern was is that there's, you know, there's a couple of things. And one is that there's a genuine desire to support, you know, this person you know, and I think that certainly is, something across the board that we see, you know, in, in veterinary hospitals. You know, we're oftentimes, you know, when it's a relatively small group, we all, I mean, we all know each other very well.

And it's just, we want what's best and some of these things also remembering that we are veterinary professionals, but what we aren't as we're not mental health professionals. So we don't have to fix. We don't have to have. The answers for everything. You know, as far as, you know, healing this person or anything like that, but we can do the things that are evidence based that, you know, moving forward are going to be best to, you know, to help protect that person reintegrating. So we'll start. So this person is now on FMLA.

Stephanie Goss: They're on leave. Yep. They're on leave. Yep.

Dr. Phil Richmond: Likely FMLA. Yeah. Yeah.

Stephanie Goss: And then they're going to come back to the practice. And so let's start, let's start with headspace. I don't have a whole lot here. I just have a couple of things. I think when you and I talked about this, we both got really excited about digging into the action steps.

And I think from a headspace perspective recognizing that this is emotional. Like this is an emotional topic. It's emotionally charged for all the reasons you just mentioned. You have a team that cares about each other. We work in a compassion you know, a compassion focused environment.

And when you care about someone, no matter what happens and how And so I think owning that as a leader is really important and taking the time to process your own emotions and recognizing that it might not just be this team member that needs sup support from a mental health or emotional perspective right now that when something like this happens within a team environment, it's really important, yes.

To focus on this person and how we can support them and take a step back as the leader and let yourself be supported and support the rest of your team as well 'cause it is gonna be emotional.

Dr. Phil Richmond: I think what we can do, you know, and what I'd also say, you know, we said this is going to be emotional. And I think a couple of the emotions too, that we have to just be aware of as leaders is one is fear. You know, cause then there's, you know, there's a fear of, you know, and bias. And we talked about this a little bit.

And so what are guiding, you know, when, I have a fear, around having the person have access to the, you know, that they potentially have access to the, you know, to the box is right. Is asking, is it warranted? And I'm not saying it's not. However, there are some things that we want to know about.

And so what I, a couple of things that I want to say is, you know, when we talk about someone who's in a position that, you know, has has tried to take their own life Is that it's, always suicide is always multifactorial, meaning that there's not one single you know, event that's going to cause it.

There are oftentimes there are a number of other things. And one of the things we know is one of the bigger risk factors is, just undiagnosed mental illness is that, you know, and so if this person is out for three months, And that they're being treated, that's, you know, we, all, you know, we use the, you know, the broken leg analogy too.

And so is that, you know, if I'm going and getting treated for this is that I'm coming back and I'm hopefully, you know, not going to be in the same position that, you know, that I was before. So just knowing, you know, keeping that in mind is that now I am, under, I have a medical condition that is being treated and that I am, I'm in a mode of recovery.

And then, you know, and the other thing too, is just what is, you know, it's just looking at, you know, where does, we heard the birds.

Stephanie Goss: Yeah.

Dr. Phil Richmond: So the other thing is the yeah, yeah.

Stephanie Goss: It's part of what makes podcasting with you fun, Phil. There's just a menagerie always.

Dr. Phil Richmond: Indeed. Indeed. But so that, you know, that's just one of, one of the things that I think we want to keep in mind is that, you know, this person is a way and that they are being, you know, being treated.

And you know, and that's the, you know, that's really important. And so what is that going to look like, you know, when they come back. And so the question then as a leader, I think is on an individual basis, like what is our return to work policy? Do we have a return to work policy for mental illness?

Because a lot of us kind of do and probably do to some degree for, you know, like a back injury, you know, or, you know, whatever it is, you know, car, you know, whatever it is, we probably have some type of return to work. Do we have something in place? For a return to work after mental illness. Yeah.

Stephanie Goss: And I would say that's something that we don't talk about. And so I think part of this from a headspace perspective is recognizing that you know, we are, all human and I think that's important to, to recognize In this scenario with this team member, the manager is a human being, the team member is a human being, and we have to create space to, to be human and have that experience and recognizing that we don't know what someone else is, going through.

Right? And we don't know what we don't know. And so you're, you know, we're going to talk and get into the return to work policy when we dig into that, to the action steps. And that's a great example of where. A lot of times we don't know what we don't know and this manager said this is a first for them.

Like they've never experienced this. And so, it's interesting because you and I both picked up on the same thing when we read this email, which was so there was some language that we both picked up on. We talked about the, team member attempted suicide and both you and I from being in the recovery space are particularly sensitive and recognize that language is powerful and language matters.

And that's an example for me. A lot of times when I talk to other managers, we're human and we don't know what we don't know. And so we're using language that has been modeled for others or you know, put out there and it's interesting because I was looking and just refreshing myself on the the EEOC standards when it comes to return to work.

And even their language from the federal government I thought was really interesting because it, read something about making failed suicide attempts. And I was just like, really? We're using that kind of language that has a negative connotation when we say failed or when we say attempted.

You know, you and I were talking about when we use the word attempted it, we associate it often as humans with negative things like attempted suicide, murder or an attempted crime and it has a negative connotation associated with it. And so, you know, I think recognizing that we're human, we're not going to get this right and even professionals you know, because it is hard and it will probably get harder before it gets easier. And so I think recognizing that it's okay to know, it's okay to not know what you don't know and recognize that this is not going to be easy and don't stop asking the questions.

Don't stop talking about it. Don't stop looking at it. You know, because it is hard and it will probably get harder before it gets easier. Easier, but you're asking the right questions, it's though, from a headspace perspective, I thought that was really important. And I know you had some thoughts on the language as well.

Dr. Phil Richmond: Yeah. So the language the other thing that I wanted to touch on was, you know, the, fear. So is, you know, and there's been a lot of, a lot more research in, veterinarians and veterinary professionals around access to means. And so what, you know, one of the things that we do know is that there are tendencies of different genders, different professions, you know, of what, the method or choice of trying to take our own life might be.

And what's interesting is, so, so Dr. Tracy Wade from Auburn, and actually Andy just. Just you know, it was a coauthor on a paper with her from her lab at Auburn. But in 2019, I think it was September JAVMA 2019 you know, had published a paper. And what was interesting is when we look at the talks screen, the toxicology reports of the decedents is that in, in veterinary technicians there, there were no technicians. Now I'm not saying that doesn't happen, but there weren't technicians listed that kind of bar, you know, barbiturates were, you know, in, in their system. However and this is something, you know, of course, close to both of our hearts is, you know, being people in long term recovery from alcohol and substance use disorder is that half of the technicians you know, we're positive for opioids.

And so whether that, you know, and we don't know, all we know is that was present. We don't know if that was, if it was an accidental overdose.

Stephanie Goss: The fatal means are, right.

Dr. Phil Richmond: Or, you know, or potentially it was associated, you know, with, you know, with that. Because we do know that, you know, one of the, one of the higher, risks as well is you know, is alcohol and substance use disorder.

You know, as a risk factor for suicide. So again, one of the things on my soapbox of one of the things that I hope we do talk about more, but just saying is that and I think this is going to get into a little bit of our discussion on the return to work policy, but that may or may not. I mean, we want to, we always want to be cognizant of access to means but it may not be that may not be the, you know, the biggest risk potentially for, you know, for that person.

And that's where, you know, trying to be, you know, and again, we'll, discuss this as, you know, possibly being, you know, having the opportunity, not getting into the specifics of it, but consulting with that person's mental health professional about, you know, best practices. What would we be best, you know, for, this this particular person.

Stephanie Goss: The support plan.

Dr. Phil Richmond:Yeah. The support plan coming back. Yeah.

Stephanie Goss: And I, so I think, just recognize, so from a Headspace perspective, recognizing that it's going to be emotional. No one has answers. No one has all the answers. Right. And this is going to be something that we fumble our way through. first time that I handled the situation in my own management career.

I felt like I had no clue what I was doing and fumbled through the whole thing. And I don't even know that it's gotten any easier because it's always emotional because they're human beings and we care about each other. And so, you know, recognizing that it's going to be hard. Keep asking the questions recognizing that the language matters.

And one of the things that we can do as managers is work on educating ourselves about the power of language here, and then in turn, potentially educating the team. Hopefully this sparks some desire to bring mental health to the forefront in terms of both taking care of our team and also talking about it with the team.

And I think the last piece that ties to that though, from a headspace perspective, for me, that's really important as a manager is remembering that we have to be respectful of team members’ privacy, and we have to ask the team to do the same. And that's really hard. You know, when you mentioned, especially when you're working in a hospital environment that is maybe a smaller team or a particularly close knit team, everybody has a tendency to be all up in each other's lives.

And we have a tendency to know the details sometimes way too many details. And that goes for who's dating who all the way to the details of what happened potentially when someone You know, attempted to end their life. So I think that it is important to talk to the team about the fact that this is going to be hard.

And we need to respect this person's privacy and let them know. Be the guide and let them create boundaries and we need to be able to respect that and that's really, I think, sometimes as a manager, the hardest thing because we care about them and we see the team caring about them and when you care about somebody, the first thing you want to do is ask questions.

You know, and I think that's, I think that's a really important piece though, to recognize that you have to spend some time working through that from a headspace perspective and planning, how are you going to help support this person's privacy and how are you going to get the team to support their privacy as well?

Dr. Phil Richmond: Yeah. and I think that's the, you know, you really hit on it is if our guiding principle, you know, is empathy and respect, you know, in this transit is, that's our North Star is generally speaking. We're probably going to be okay. Like, you know, it's just no, or, but is, are we respecting the, are we respecting the privacy of the you know, the individual and then just going in with that with a, you know, a curious, but not judgmental You know, headspace, like you mentioned, just, you know, when they come in is like, is it, you know, is there the ability to have contact?

Like what, and, you know, discussing parameters like with, you know, what are the boundaries that. You know, each person that person is okay with because some, people may be okay, you know, with having the team want, you know, know what's going on and it's just, and it's just clarity around what the comfortable boundaries are. You know, and then, you know, and then just continuing, you know, in that transit, you know, when they're coming back is just letting them know, like you are, you know, You're a valuable part of the team.

Like, you know, we want you back and that you're what, you know, our, what we want is your wellbeing is the number one priority. So like any decision that we make is made, you know, anything that we do is going to be collaborative and that it's with that intention, you know, in mind. and so I think that's one of those things we can't ever do everything a hundred percent right, but in this case, I think, you know, again, if we're staying within the legal boundaries of, you know, certain things, but if that's our guiding, you know, guiding light you know, we're going to be, we're going to be okay. But we, I think we can, would it be okay now? You think kind of listing what some, what that might look like for a return to work policy?

Stephanie Goss: Yeah. Yeah. So let's do this because I think you and I both are like itching to get into some specifics about how to, how do we think through this? Because the questions here really had to do with what do I do when this person comes back? And so I think we've got some tools that we want to kind of talk through.

So let's do this. Let's take a quick break and then we'll come back and we'll dive into the Headspace as we go. Does that sound like a plan?

Dr. Phil Richmond: Indeed. The birds seem to agree as well.

Stephanie Goss: We'll be right back. 

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And we're back. So let's get back into this. Let's talk about the action steps, because I know you and I are both excited to get into this. So let's talk about what happens when we're prepping for and then working through someone's return to work after. Really like we're gonna, I think we're going to take the suicide piece out of this, I think is the healthiest way to do it because it really has to do with mental health.

Dr. Phil Richmond: Right. 100%.

Stephanie Goss: But really, I mean, because yes, there are circumstances and there are special scenarios that have to do with the mental health piece of it. But I think one of the healthiest things that we can do as managers is start to take the emotional, knee jerk reaction that has to do with it being associated with mental health and start to think about it the same way we would any other, you know, use the broken leg analogy.

Like, what would we do for an employee who has to go out on a leave? Does it really matter what the reason is? And, so I think that's part of the healthy piece of it from a manager perspective is, yes, let's be sensitive to the fact that there are additional things that we can do and should do when it comes to supporting mental health in our team.

And I think it makes the stigma effect less, for me, anyways, when I started associating it with the idea of what would I do for anybody else, you know, in, in any other situation.

Dr. Phil Richmond: And so, you know, I think that, and this is definitely twofold. So one is, okay, we're in the crisis, but thank goodness is the vast majority of veterinary hospitals, right in this moment, don't– aren't, having to create a return to work policy for, you know, for an individual. However, what do we have, you know, what have we done as an organization, you know, around education?

What have we done as leaders to decrease stigma, you know, in, in the workplace? Like what policies do we have in place? What are, what's the awareness around the resources we have? And then as leaders, are we, you know, do we, Look ourselves or have somebody come in to say, do we potentially need other resources?

Like, do we have everything we need? And so I think that first might be the plate, the place to start is because this facilitates, like if we have a good organizational mental health policy, you know, overarching policy. It's going to make this reintegration much better 'cause the team's gonna understand they're gonna be open, there's gonna be some education around this.

There's, more open con, you know, open conversation that's appropriate, you know, type thing around, around this. And then just, you know, and, certainly more understanding and more support for the person, you know, when they come back.

Stephanie Goss: And I agree with you a hundred percent. And I would hazard a guess that a lot of our listeners are going. Great. But I don't have any of that. That was me as a manager, right? Like when this first happened, there's the panic of, what do you do in the moment? Because like you said, how we're in the crisis.

How do we deal with it? Because we literally actively have someone who's trying to come back to work and how do we do it? And it feels very unrealistic to me. Now I've got to go do all of this education and learn all of these things. That felt really overwhelming. And so I think recognizing that, you know, It's important to talk about your point, it's so, so valid of the best way to have to deal with this is to be prepared for it, right?

And have some preparation and recognizing that for, I would argue most of us, when we get in situations like this, we're not actually prepared and we're flying by the seat of our pants.

Dr. Phil Richmond: Yeah, well, so what I want to say too is so not insinuating when this crisis happens. Oh now we've got to go do all of this stuff all at once. Like that's not, is, saying for the majority of listeners that, you know, here it is now the place to start is doing a mental health audit. And Marty agrees, is that, you know, it's just saying like, you know, the, most, probably most straightforward place to, to start is.

Do we have a, do we have an EAP and what's, you know, what's the level, you know, what's the level of awareness around that? And that's a, that's, you know, an initial, a good initial place, you know, to start. 

Stephanie Goss: So EAP employee assistance program for anyone who didn't recognize that alphabet soup. But yeah, I think that's a great place to start. Because that was also my starting place, it was like, let's look at what we have, what resources do we have for the team already?

Do they have access to mental health services through our employment through our insurance? If we offer insurance. Do they have access to an employee assistance program that offers mental health services? What are, if the answer to either or both of those is, no or none, what are the community resources in our individual community when it comes to mental health support?

Because there are often especially for clinics that are employing younger team members. There are often community resources for young adults teenagers through young adulthood that are accessible for you know, sliding scale, low cost, no cost. So I think those are three easy things that as a manager we can do, look at what do we offer, if we offer insurance, if we offer an employee assistant program, what are the resources and then what are the community resources?

And then to your point, Phil, it does no good if the team isn't aware of the access that they have through those resources.

Dr. Phil Richmond: Right, right, you know, to get on that part of the newest iteration of the Merck study or if it was separate, but I think the number was around like 32 percent of veterinary hospitals had an EAP and I just, I'm genuinely curious about that because all I have, and let me say this, they may have answered this and I, and all I have is this number, but that number is just has to be higher than that.

So I'm just curious if it's an aware, well, so let me say this is that oftentimes, even managers that the clinic itself, the hospital itself has access to an EAP and they don't know, like we ended up our group pretty sizable. I mean, we had a 3, you know, 3 practice group here, outside of Tampa.

And I ended up, you know, asking, it was, I don't know, maybe six, seven years ago, I asked you know, our practice manager, I'm like, do we have any EAP? She said, no. And what we ended up looking into was that we had it as a benefit associated with our payroll company and so, you know, it was like, there we have it.

It's like, you know, we have access to, you know, to this program. And so where I'm going with this, with the 32 percent is if we just look at, you know, not, I'm not going down this rattle hole, but if we look at the number of corporate, you know, corporate veterinary practices, I am almost certain that every, single one of those has an EAP.

And so if we just look at that means that then every other like private. You know, privately owned veterinary practice doesn't have an EAP. It's, you know, so the number, thank goodness is, it's probably an awareness gap versus, you know, actual, I'm hoping. 

Stephanie Goss: And there's three places that you should look if you don't know for your practice. like Phil said, one is your payroll company because they often, that's often lumped in with your package that you get through them. The second is through your medical insurance. insurance companies now have outsourced that piece and bundled it together with an EAP.

And the third is actually through your liability insurance for the practice and, or for your veterinarians. There are now I'm seeing more and more where they have put some EAP resources together with your liability insurance. So

Dr. Phil Richmond: just to put a shout to the state AVMAs doing the work. 

Stephanie Goss: Oh yeah. Yeah.

Dr. Phil Richmond: Is that probably, I think when we looked, it's probably about a quarter of state VMAs have a member assistance program. So they, that's also, you know, also available and like, depending on what program they have, there's access through, through that.

Plus a number of others, or, I mean, if we get into it, there is almost always a way. To get access free access or at least initial access to a mental health professional somehow in veterinary medicine went through it if it's through You know vin for I mean, we'll put all the resources up there, but like it vins you know vets for vets and veterinary support foundation NOMV. You know, there's the veterinary hope foundation.

There's, I mean, there's so many organizations you know, and then the FVMA right now, like we're putting, I'm really excited. We're putting together one with where we're going to have a veterinarian who's a therapist and then a veterinary social worker. So we're actually going to have those in addition to our you know, access to our EAP.

So, but just meaning that it's probably. Available and out there somewhere. And so again, like Stephanie was saying, it's just before, you know, we get into an issue, it's just knowing where, you know, where the resources are for that. 

Stephanie Goss: I love it. I, okay, so there's one, one last piece from an HR perspective that I have to drop in here before we get into the, how do we create a return to, to work plan? Cause I'm super interested. You've had a lot of experience working with and looking at stuff from countries outside of the states who are far more advanced when it comes to supporting mental health at work.

And so I'm super excited to dig into that. The thing that I think there's two pieces from an HR perspective that are really important. As a manager, you need to prepare yourself. And so you need to know what you need legally, and there are legal concerns here. And so I'll drop some resource information in the blog for the EEOC, because sometimes I slur that all together I'll drop it in the show notes because it's really important to know what your legal requirements are as an employer.

And the second piece of it is really important. We already talked about checking our biases. The number one thing. That's important, I think, as a manager is to consider what you actually know. And so it's really important. We tend to look at situations, especially when they involve an employee that we care about, we tend to look at it emotionally.

And it's really important for you to look at the situation objectively, and actively work against any bias or stigma that may come with the notion or idea about mental health, disease, mental health disorders, and conditions. The number one thing that I think for me that I had to work to overcome is recognizing that no two people are the same, and no two conditions are the same.

And so, you know, when you go through an experience with a team member and you think, okay, I've been through this and I know what this is like. It's really easy to put your, to project your experience and feelings and bias onto another person. And we don't do it intentionally, but I think it's really important to recognize that everybody's different and every situation is different and just because you had a team member who handled coming back from you know, a time off, a leave of absence for mental health in the past doesn't mean that the same person rules structure experience will apply to the next person.

And so thinking about that is, I think, really, important. And the way that I have learned to do that as a manager is to rely on the medical documentation that I'm being provided. It really helps with fighting your own bias and stigma. you have the ability to get information that tells you how to act as an employer.

What the rules are, what the restrictions are, what the supporting requirements are going to be. And if you lean into that I think it really helps it has certainly helped me look at the situation objectively. And so I think from that perspective, the other preparation piece that everybody needs to do is that if you do not have a solid background, job description for every single position in your hospital, and you do not have risk factors of that job and including potential access to lethal medications for those who have that access.

Now is the time to do that, because the way as a manager, part of the way that you work with mental health professionals who are supporting your team member in a situation like this, is to provide them a detailed job description with the risk factors so that they can help accurately assess the risk for this employee returning to, to work.

And far too often, I find that our job descriptions don't actually explain to people outside veterinary medicine What we do in veterinary medicine. And that goes for physical physical problems at work. I can't tell you how many times I've, you know, have seen someone say, well, this employee came back and there's no restrictions, but I know that they can't do this.

Well, what does the job description say? If the job description doesn't say that you have to be able to lift a 75 pound dog, on your own. How is the doctor that's trying to support this team member going to know that is potentially a risk factor for them, unless that employee tells them, and that's you putting the burden on the employees.

So from an employer perspective, this is where you have to do a little bit of homework and using the time for the leave of absence to dig into what are those requirements legally? What are you bound to do as an employer legally? Like now is the time to do that. Sorry. I had to insert that.

Dr. Phil Richmond: No, I mean, it's a hundred percent valid. And so, you know, I just, I was sitting in you and you, when you mentioned, you know, you want to do this now, like put these job descriptions together of everything and you know, and instantly it's like, Oh my God, like the anxiety of, Oh my God, I have to do that today.

Like, I'm listening to this and I'm driving into work and I'm a manager. It's like, Oh my God, I have to do this right now. And also know that. You don't have to reinvent the wheel. And so, you know, the thing that I would say too, is that in your manager groups, and I mean, certainly in, you know, pitch to the Uncharted group but you know, in different areas, there'll be a template, you know, where they're going to have…

Stephanie Goss: Your payroll company might have a template for you to start with.

Dr. Phil Richmond: And so, you know, people are, genuinely, you know, very open to sharing those resources. However, having the, you know, is that you do need to have that checklist and interestingly enough. So, you know, coming out this summer, we'll have some guidelines too for psychosocial risks.

You know, in veterinary workplaces and, you know, and factors for that, but you know, kind of OSHA for our brains, if you will. You know, it's things that we know that, you know, can increase our risk for psychological harm, you know, in the workplace as well.

Stephanie Goss: Let's talk a little bit about that because we've been talking about this return to work plan. And for someone who hasn't experienced that or hasn't seen it, I remember the first time that I was exposed to it, I was like, Oh, okay, this makes perfect sense. You have a team member who has had some sort of, whether it's illness or injury or they, mental or physical, and they've been out of work, it makes total sense to me now that there are questions that we should ask and some planning that should be done regardless of the circumstances to help support that person when they come back to work.

So let's start there because you've had a lot of experience. The resources almost all of the ones that I used came from outside the States. Cause there's not, I'm going to be honest there's not a lot, To go off of, the EEOC has done a great job of putting together some resources and there certainly are, resources that others have adapted, but there are other countries that are already doing what you referenced, Phil, which is basically OSHA for the mental health side for employees.

So let's start there.

Dr. Phil Richmond: Yeah and so what I would say too, is so the other thing we want to say is that like, let's split this into two, you know, two areas. So when we know, like, if we know that the person is going to be going away, you know, for, leave is that we've got that, pre, you know, pre leave talk as the manager.

And I think that's where knowing that they're supported a hundred percent, knowing that they're respectful. And then also set it, you know, setting those. Those boundaries of what, you know, what are the parameters? Like, how can we, what are we comfortable, you know, you mentioned like people, I mean, people are human and like, they want to know is like, can the manager reach out?

You know, can I reach out on, on, you know, occasion? To extend support. Like, can I, you know, is it okay if you know, if team members send personal, do you want to hear from the team? Like, is that, can we filter it through me? Do you want nothing? Like, is it okay if you know coworkers let you know that everything's gonna be okay?

You know what? Whatever that is like, but setting those things too, before. You know, if we know beforehand or, you know, when it's safe, like, can we, have that and then have that for as the, you know, again, empathy and respect as our guiding, guiding principle. And then on the return to work, you know, what are the boxes that we want to check off?

And you said, first thing, you know, you said was, what are the job duties? Like, what are the, things that if, we're going to do this, that we need, and then also the documentation, I mean, you know, having something you mentioned, you know, getting something from, you know, from the doctor or professional, like, what, you know, what does that look like?

Stephanie Goss: And I think that's, I think that was at the heart of it here for me the question that we got in the mailbag was really around wanting to make the clinic a safe space for this employee when they return and their immediate fear was that this, their job puts them and this is, I would say, this is where we have to check our bias, but this manager is like, okay, here's a team member who has maybe drugs were involved, but maybe they weren't.

And I have found that our automatic gut response as human beings is to go to, even if drugs weren't involved, there's drugs and they have access to it, right? Because we know that is a risk factor. The question here is, that a risk factor for this specific employee? And if so, in what ways?

And to your point at the very beginning of the episode, I think the really important thing is that we have to recognize we are not mental health professionals. And even if we are, even if you have a manager who happens to be a, you know, social worker or a you know, a therapist, you're not that employee's mental health professional.

And so, we need to step back and think about what are the risk factors valid that this manager is concerned about access to drugs and that concern should be no more than any other concern on that list. And so the best thing we can do to support this employee is to recognize, okay, they have access to controlled, they have access to drugs. What kind of drugs? They have access to the control drug box and everybody's mind goes to euthanasia solution.

And as you mentioned, Phil. We know from the studies that are out there that might not be the big concern for technicians. They have access to opiates. Okay, that's a valid concern because we know what the data shows there with technicians. And

Dr. Phil Richmond: And anybody, like, not, and also just want to say, like, not singling out technicians just as, yeah.

Stephanie Goss: Right. Yeah, but in this case, we're talking about a technician, right? So, so, but yes, no, like looking at it from that perspective and looking at, are there access to other potential lethal drugs? How many clinics keep insulin in the fridge? You know, and so looking at what are the actual risk factors for this team member, those ones and the physical ones, are they being asked to work 12 hour shifts?

You know, what are their breaks like? How does, when are they getting food? When they are, you know, calories are important. All of those things are part of it and it's not your job to figure out what to do with that information. And so part of the return to work policy is we do this together with the employee, right?

This is not us putting, projecting or putting our boundaries and barriers to try and keep ourselves safe as a practice and cover our own ass on someone else, which is how a lot of us are taught. to do it. Here's this form. You go deal with it. Right. That's not the way that I would want to approach it here.

We want to sit down and work with the employee and talk about those things.

Dr. Phil Richmond: Yeah. And one that, one of the things you just mentioned, and again, if we look at risk factors, you know, we look at these, risk factors in the workplace, that, that increase our, Likelihood for burnout, for mental illness psycho, psychological harm is one of the things that's interesting, you know, is that it's, we're looking at that this person is alone, but then we're saying, okay, they're alone with the drug, but it's like, this person is also potentially, you know, alone, like the doctor is, I think is, going to bed, but where is the, it's like, Is there, does this person then, like, what if I have a thought, like, what if I have, where, I, am now isolated and so isolated work 

Stephanie Goss: Right. 

Dr. Phil Richmond: is actually a risk factor for us. So what are, so not so much, you know, not even the drug, but then like, is the, is there something in place? Like how have we, you know, have we taken into account does this person, how, you know, is there a support network at, you know, three o'clock in the morning, like, you know, is there something, and this isn't just for this person, but any isolated work, you know, is that if I am by myself, like at work, if I'm isolated, like that is.

That is a risk factor. And like, what are the things that we're doing to potentially, you know, to potentially mitigate that. So that's, one of those other things that again, it's looking at the nature of work, looking at the work design for this particular, You know, particular places that, well, this particular person, but also for this, environment itself is that the risk factors aren't, you know, are for everybody, but, you know, we're, concerned about this person, but this is where I was going a little bit where it is, we want to do things that are specific, you know, to help this, individual, are there things just in the workplace in general that we can elevate that are going to, that are, going to both help that person and then help all the employees.

Stephanie Goss: And, I think making sure that you're doing this with the employee and there's questions. Phil and I are gonna drop some lists of questions. Because we could sit here and talk about this for three hours and I'm not sure, I'm not sure everybody would, keep listening.

And I want to make sure that there are some good resources here, because this is something that both you and I are particularly passionate about, Phil. But I think the, one of the number one questions that I think is really important for us to talk about before we go is, asking, are we okay, as your employer, are we okay to speak to your health professionals about your recovery and your work capacity?

If they contact us is one, and if the employee gives permission for you to reach out to the health professionals. That's where it gets a little dicey, right? And so the way that I like to ask the team member is, Hey, if you're, if your support team reaches out to us, I'm going to give you this information.

I, do I have your permission to talk to them? Because part of it is where that's part of working together, right? I don't. Okay. I’m not a mental health professional. And I want to take care of you here in the practice. And so can we create a team? Can we work together to help create a supportive environment? Getting that permission is so, so important.

Dr. Phil Richmond: Yeah. And, just, you know, looking at other, you know, we mentioned other countries, is other countries. This is part of the return to work program is that there is consultation, you know, with the workplace, with that person's, provider, you know, mental health provider to make sure that we are able to do the, you know, the appropriate accommodations or, you know, or, you know, as far as just like the pace of reintegration, like, is this, you know, here again, duties, this is the level, these are, you know, the potential stressors is this, you know, is this appropriate and like asking, you know, asking the mental health professional and the mental health professional then just guides you based on, you know, on that. And I just, that to me is, it's like, I understand it from, I guess, from a legal point of view, but it's challenging that we can't, that isn't more normalized, like, you know, like in Canada or, you know, in some, other countries where that's part of the return to work policy, like to make the best plan for the employee. 

Stephanie Goss: Well, I think the way we normalize that is to start to ask those, to start to ask those questions the way that we can, right? So there's that doctors are bound by, HIPAA, laws here and there, there is confidentiality. And You can absolutely, as a patient, give permission for that kind of thing.

And most people don't know that. And so making sure that you're as a manager, that you're asking that question of your team and encouraging that person that employee that you want to help support them. And so the best way to do that is for them to help facilitate that conversation with their with their health providers, I think is really important.

And I think, wrapping it up, I feel like we didn't. It's interesting cause I feel like we didn't talk so much about the access to drugs which was at the heart of this this ask. And I do think that we did in the sense that as managers, as practice owners, often the first place that our mind goes is to the drug box, whether it's someone who has, you know, in this case, attempted suicide, whether it is a team member who use disorder and has gone to treatment and is coming back to the practice, coming back to work our minds automatically go to the drug box.

And I'm not saying that they shouldn't, because that is a weakness. risk factor. It's always a risk factor. There are lethal, you know, it's access to lethal means. And I think we have to think about that. And I know that you and I are both really passionate about this from the stigma perspective. It's time that we start stepping back as employers and recognizing that the drugs are not the only risk factor, nor are they, I would say often the biggest risk factor for a lot of people.

Cause as you mentioned at the very beginning, it's multifactorial. And when you combine working isolated, when you combine the physical stresses of working nights. There's tons of published research on how much of a negative impact that has on our physical and mental wellbeing. When you can bind being, being, alone working overnights. Yes, the access to the drug box, but there are all of these other risk factors for team members that are as significant and could be more significant than access to the drug box.

And so I think it's, you and I agree, right, that it's time to start asking better questions. And I think that's, for me, the best thing we can do with this podcast is just recognizing that there is stigma. There's a lot of stigma. And the only way we start to overcome that is by having the conversation. 

Dr. Phil Richmond: Absolutely. 

Stephanie Goss: I feel like I could sit here, friend. I know we could sit here and talk for hours and hours. Thank you so much for doing this. Thanks for being here.

Dr. Phil Richmond: Thank you, my friend. 

Stephanie Goss: I feel like there's a lot more soap boxing that you could do. Maybe we need a second, we need a second part of this episode.

Dr. Phil Richmond: Yeah. But I think that too, I just, you know, before we wrap up is that there, you know, other, countries, when we talk about the, you know, workplace suicide risk, is that those are the main things that are looked at, you know, is, you know, social support, you know, in the workplace, job design you know, organizational justice, like, you know, are, things fair as the, as their job overload you know, is there poor change management?

You know, am I allowed to, you know, can I do my job in the way that I think is best, you know, best for me? Am I micromanaged? Those, all of those things. Are hugely impactful, you know, when we talk about and so that's what so I think is that is a box to, you know, for us to make sure that we're, you know, we've done everything we can to, you know, limit access.

And what I would say is that's that goes for, You know, for everybody, not just that person. And that would be something too, is not to single, you know, not to then single that person out, but just look at you know, the po the policy, yeah, the policy in general. but that these other factors in the workplace, you know, are, critical to, our mental health and, you know, workplace suicide prevention.

Stephanie Goss: Thank you, friend, for being here. This was this was good. I hope I hope that this conversation was helpful. We're going to drop some resources into the blog. The show notes, including a list of questions to ask when you're trying to create a return to work policy and some information from the EEOC and JAVMA on what we've talked about today.

So if you're not in the habit of checking that out, today is an episode that I would definitely suggest. I'm not doing just that. And you can find it at at the blog over at unchartedvet.com. So thank you so much, Dr. Phil Richmond for being back with me and talking this through. And I look forward to talking with you on the podcast again soon.

Dr. Phil Richmond: You too. Thank you, Stephanie Goss.

Stephanie Goss: Take care, friends.