Who Supports the Crisis Workers with Becky Stoll

welcome to Mental Health Evolution, a podcast about what's changing in mental health and why it matters. I'm your host, Rachel Harrison, inviting you into honest conversations with people from all perspectives in the field. Clinicians, tech founders, investors, insurance companies, and all the folks in between. Let's explore what's working, what's not, and what's next. Welcome. Welcome everyone to the Mental Health Evolution Podcast. We are excited to be here today with a guest, Becky Stoll. She is the Vice President for Crisis and Disaster Management at Centerstone. Becky oversees crisis and disaster response systems and has spent her career thinking deeply about how we design mental health systems for are experiencing the most acute moments of need and just as importantly for the people who show up every day to do that work. In this episode we're going to focus on something we don't talk about enough, which is how crisis mental health systems can be intentionally designed to support staff well being, retention and long term sustainability. We'll talk about staffing models, leadership, responsibility, operational design, and how technology can support rather than replace the humans doing some of the hardest work in mental health care. This in turn, from my perspective, also supports good quality care to the people that are receiving care from these mental health workers. So as always, before we dive into this conversation, I want to highlight a few articles that can kind of help frame today's discussion and give our listeners an idea of where we're jumping off from. These are going to be linked in the show notes so you can you all listening can go ahead and check them out and dig into them a little further if you so desire. The first article here is called Burnout, Moral Injury and the need for Systems Changed. And this is from the American Journal of Public Health. This article talks about how chronic stress and burnout in healthcare are often rooted in structural conditions and moral injury. Not so much resilient deficits of individual workers. And I think it's important to just talk about here. I think a lot people know, but in case you're not aware, staffing for healthcare in general is really a crisis right now. For most businesses, most organizations, hiring is difficult, retaining staff is difficult. These are difficult jobs and there is a lot of burnout. And so looking at how we design this and how we put this all together is really important. The second article I wanted to highlight is called the Effectiveness of Eye Movement Desensitization and Reprocessing, also known as EMD Therapy in Treating Post Traumatic Stress Disorder. Among ICU healthcare professionals in Cameroon. So this was a quasi experimental study from the African Journal of Clinical Psychology and this article presents research for six weeks of EMDR therapy for crisis hospital workers and how it decreases the PACL5 scores for PTSD in these workers to a non clinically significant range in 100% of the group that received EMDR. This article I thought was interesting because it's highlighting a potential solution for helping workers deal and address PTSD in the workplace. And then the last article is called Designing Sustainable Crisis and Mental Health Services. This is from BMC Health Service Research and it looks at how crisis systems can be designed for long term effectiveness including staffing, follow up care and staff system coordination. So with that as a jumping off point, I would like to welcome our guest, Becky. It's great to have you here.

Thank you so much, Rachel. Super happy to be here.

Awesome. Well, let's dig in. Crisis is clearly your expertise. So how would you define crisis work specifically in mental health? And what kind of roles and jobs are we talking about?

Yeah, I mean crisis services in the behavioral health space is an embedded part of the mental health system and it really ranges on a continuum. So when you talk about a crisis system within a healthcare, behavioral healthcare system, you know, you're talking about the capacity for people to reach out, usually via a call, a chat or a text. And then it really cascades from there in terms of what need is. You have mobile crisis teams who can go out, see individuals who cannot be handled telephonically or cannot be handled via a chat or a text, something like that. And then you have walk in centers where people can present. You have facility based crisis programs where people can stay sometimes up to three to five days, three to eight days. So it's kind of this, I call it niche, but it really should be looked at as part of a comprehensive system. So when you talk about what jobs are available, you know, it really can run the gamut from people who have lived experience and they might have a certification as a peer specialist, all the way up to folks who are providing medical care, nurse practitioners, registered nurses, physicians. And then you have the gamut in between people who have bachelor's and master's or a license who are providing the care that's, you know, within their wheelhouse in those different settings.

And how did you get into this work specifically? I'm always fascinated with that question. I'd love to hear a little bit about how you decided or ended up in crisis mental health systems work.

Well, you're going to laugh, Bartending. So, you know, I was an undergrad. I'd started out in pre law, that didn't last a semester and I really didn't know what I wanted to do. And I remember thinking, well, I liked an elective I took in high school, which was abnormal psychology. So I pivoted off of pre law into getting a bachelor's degree in psychology and I was bartending. And this was, you know, this was in the 80s, this was in the late 80s. And so it's good money, it's probably still good money today, maybe that I'll do that when I retire. And I had a regular who came in who was a licensed clinical social worker and ran a unit at a, at a psych hospital. And she, you know, she knew I was getting, we would talk, she always get my degree. And she asked me if I wanted to be a tech. Saturday and Sunday, noon to midnight. I was in my early 20s, I said I was single as a Pringle, ready to mingle. And I'm working, you know, bartending during the week, I'm in school during the day. And then I took this job on an inpatient psych unit and that was it. I mean that, that stepped me on the road and literally that was probably 1986 and you know, here we are in 2026. And that, that was really the genesis of it for me. I fell in love with it and I fell in love with crisis work also, you know, worked then with a lot of social workers who told me that I would have to go to graduate school if I was going to stay in mental health or I'd have to eat beans the rest of my life. And I didn't want to do that. So I was really put out that I had picked something that really probably required advanced education. But here we are.

But here we are. Yeah. And, and I just immediately think about the sustainability of that. Right. Because I started also in inpatient work. And so many stories that I hear about, myself included, that wasn't sustainable for me.

Right.

So when you say that, and we're looking at this time frame, I think that segues nicely into our conversation about how have you sustained staying in that work for so long?

Yeah, I mean for me it wasn't the self sustainment, this when I worked at the hospital. So I work, you know, I worked on the weekends, I got my degree and then I went to an adolescent male unit. This was prior to managed care. So an acute day might be 90 days. I mean you just kind of came in, the insurance companies paid And I ended up going into marketing. They felt like I would be a good match. So I was in our marketing department for a few years, had an assigned area to do kind of community liaisoning. And then I became that. They pulled me back in because the director of admissions left. That's where I really fell in love with crisis. I knew I was not going to be. And I'm in grad school at this point. I knew I did not want to be a therapist. My version of therapy would have been, Rachel, tell me what's going on. Okay, I heard that. Let me tell you what I think you should do about that. And when you came back, I would want to hear that you did that. And that's not therapy.

No.

So I knew I wouldn't be good at that. I was probably not a good fit for that. But I liked crisis. I could remain calm. I liked that kind of assess what's going on, figure out what needs to happen and get the person on the path to that. It was fast paced. Sometimes it was high drama, sometimes it was humorous. You know, like it just. It was a really good fit for me and I would have stayed there. So talking about sustainability, I suspect if that hospital had stayed open, I might still be there. I enjoyed that work. But managed care came into play and all of a sudden you had to call the insurance company and have a number of days authorized. And we were like, how dare you? You know, and it really, that. I don't know if you were around then that totally changed the entire structure financially of companies. And we started. We were admitting more people than we had ever admitted and we were bleeding money. So that hospital shut down and I was going to go work for an insurance company doing pre authorizations. I had a 10 month old baby at the time and I needed a job. And right before I was going to go do that, somebody at Centerstone who I knew through my work reached out and said, hey, do you want to come be the program? It was a demotion. Do you want to be a program manager over our crisis call center? And I jumped at it because I just did not want to work for an insurance company offing days all day. And the person who I worked for, I'll never forget. She said to me, I think you're going to get bored in this role. You'll need to look for other things here you can do. And that was October of 1999. And I've gotten to do amazing work in the crisis space, in the suicide prevention space, and in the disaster mental health space. So, you know, lucky me, I'm. I'm blessed.

Yeah, definitely. So what. What have you seen in terms of systems, in terms of supporting the staff that are doing this work? What. What are your observations? What kind of things work? What doesn't work? I'd love to hear some of your thoughts on that.

I think tradition, having been at this a while, I think traditionally, and I mean traditionally, up until not all that long ago, I think we asked people to be well, physically and mentally well, in spite of maybe the system not being the best system. And I really, you know, a shame on us as an industry for doing that. So it's a. These are crisis. Jobs are tough. These are very tough jobs. The hours can be tough, the people you get to work with. The stories can be horrifying. They can be challenging. They're sad. And it's the repetitiveness of it. I remember when I worked inpatient in the. In the admissions office. I mean, just suicidal. Suicidal. Suicidal. I mean, you almost felt like you could get numb to that. And unless it was some kind of dramatic story, it didn't really catch your attention, which is terrible. You know, like, I have to watch my dinner conversations sometimes when I'm not with people who work in mental health, because I can say something or tell a story, and you see their eyes bug out of their head. You're like, gosh, I didn't think a thing about that. So I think we did that traditionally. I do think we've turned, and I know we definitely at center stone, have tried to make the turn to say the very first thing we have to do is take care of your own house. We shouldn't even be talking about how to make sure staff are well until we make sure they're operating in a system that is the best it can be. So you do that first. I think you have to check that box office and say, am I running a system that's. Well, is it not causing trauma to the staff in unnecessary ways? Are we giving them the tools they need? Are we giving them the training and the supervision, all that stuff. And then to me, it's almost like a taffy pull. This isn't. I just wrote something yesterday. Somebody asked me about this, and I was writing about it. To me, it's a. It's a continuum. It starts with even how you advertise for these jobs. That's where it starts. You need to advertise and make sure people understand what these jobs entail. It's taking standardized interview templates when you interview people and giving them Some scenario based interviewing just to see and expose them a little bit to what this job could be like. So I think it's getting the right people in those positions and sometimes we have not done a good job of that and then people leave. So you've got to make sure you're doing all of that about vetting and hiring and making sure they understand. You have to be cognizant of doing things like making sure you're offering a shift differential. It's different to work midnight than it is to work 8 to 4. You should acknowledge that doing routine market analysis to make sure your pay is consistent with what they should be being paid for these jobs and then putting differentials on top of that. Then I think it's about onboarding. I think you have to be purposeful. People should get a schedule ahead of time for what their training and orientation period is going to look like and their opportunity for mentoring and shadowing. You have to train people initially. That really shouldn't end. You should continue to train and build people's skills and provide them the necessary supervision and guidance. And then you can have fun and have a shared Spotify playlist and have birthday parties and do things like that. The more you know the things that are on the fun side and then the last thing I'll say is I think it's really important. We've done a terrible job of this as an industry and I hope we're getting better is talk to people about career paths. So if you came to work for us, Rachel, what do you want to do in five years? And if you say, I want to be the best crisis worker, I love this work, I have no aspirations for management, then that's on me to make you the best worker bee that ever worker be'd. If you say, I really think I might like to be in management, we should foster that and expose you to. Because we also haven't done a good job of training managers. You know, if you're a good case manager, then you'll probably end up being a case management coordinator. Which doesn't mean you'll be a good manager, it just meant you were a good case manager. So we need to foster and teach people who want to do that. So I think career paths are something we really need to make sure we're, we're laying out there.

Wow, that was a lot of great information. And I love your focus on the system working first. Yes, I think so. Often in mental health we are known unfortunately for not having the great business systems or processes and things like that and how much that can affect a workflow. You know, if we're asking people to bend over backwards just to get through their intake process, that's going to have a huge impact before we. Before we go and do the birthday parties.

Right, exactly. And how dare us, how dare us to then have a system that's not set up well and then wonder why the staff aren't well and then just say, well, here's the EAP number. How dare we should not. That is a travesty that we. I hope, I feel like we're doing that and I think others are too. We have to change that.

Well, and I love your comment about. I mean, a lot of the pieces that you just shared about are specific to getting the right people in the right role and giving them good information about what this job is.

Yes.

Which I think sometimes is a little bit tough. Right. Because you can't always know fully until you're in it.

Sure.

And still, still giving that picture. Still trying to hire. We start to know the right fit for our organizations. Right. Who does? Well, here, for example, is something we look at as an organization. You probably do too.

Right.

But I love that idea. Then two of them. And where are you going? Because I think I have seen in myself and also in other mental health practices and organizations, just because somebody is good at one job, if you're a good therapist, that does not mean you're a good supervisor and it certainly does not mean you're a good manager. You can be and you might be able to learn that, but you also might not.

So I currently sit as the executive vice president of crisis services for the largest mental health company in the. I think we have a 10 or 11,000 employees over a multitude. I think it's nine states. I hope I got that right. I think it's. We just went through a merger and, you know, you've got to get that part right. I didn't. Nobody. I remember the first time I looked at a financial, like a profit and loss statement. I didn't know what parentheses meant. I didn't know that was bad. You know, the first time I had to manage a grant, I had never managed a grant. I think it was a million dollar grant. And I remember thinking, okay, so if we spend 800,000, we keep 200,000. And they were like, no, that is not how that works. You know, like you just. I mean, I know now, but I didn't know then.

Sure.

And we just got to do a better job of teaching people and everybody can't Be. Everybody wants to be a manager. It's more money and all that stuff. It's also sometimes not. Oh, it's cracked up to be. It's a lot of pressure and managing people is hard and. But we should do a better job of that.

Yeah, yeah, no, I agree. And the mental load, the number of people I think I've seen in my career take on a supervisory role of whatever kind because of the money or the prestige or whatever. Well intentioned. Everybody in the process was well intentioned. Right. But wow, without the right tools and the skills to back it up, that's really. That can really be harmful to the whole organization.

And the person.

And the person.

Yeah, I've seen it. Yeah. Sometimes it's just not a good fit. And that's okay.

Right. And I think too, I don't know if you've seen this as well, but giving people the freedom to, like you say, you mentioned, like exposure to those roles. So how do we allow people to try it out, see what it looks like, try their hand at a couple of things or shadowing someone so that they can have a better sense of whether that job is something they want to invest in. And the mental load too, and responsibility that comes with it.

Yeah, I think that's where shadowing become. I mean, it's almost like I've had two. I don't normally take on students, but I had people I knew whose kids needed that. So I've done that twice recently. Once for a master's program and once for a bachelor's. And that's exactly especially for the bachelor's degree. This was a bachelor's in healthcare administration and I had her hooked up with, you name it, just to go like, this is what finance looks like. This is hr, this is talent acquisition, you know, this is compliance, this is legal. All of the buckets. And it was really interesting because she then is going to intern with us again this summer. And she was like, oh, I liked these two. Which I thought was, you know, I don't like everything on the menu either. Sometimes back of the menu, you know, sometimes you got to turn the back of the menu over. You even know the rest of the stuff was on the back. So I do think that's, that's a good way. That's why these career paths can be important.

Yeah. What do you think about. I'm watching in the news. There are so many mergers, acquisitions. You mentioned one yourself. A lot of things are shifting actually, especially daily in the mental health world. In terms of the industry, what do you Think about all those changes. What are you seeing? What's the good, the bad, the ugly there?

I mean, what I see for us, and I've been very excited, I mean, this was a big merger in the industry. And so what, you're big. I mean, big is big is big. Who cares if you're big? It's what it can allow you and give you the resources to, to do. And that's the part I like about it. And I think with that expansive system comes responsibility. And that's what I hear from our leadership. It's not, well, look how big we are. It is, what can we do with that? That gives you a bigger voice in terms of policy, it gives you a bigger voice in terms of research. The science to practice gap. We know something works and by the time it gets down to clinicians, it can be, I don't know the current number, so I don't want to quote it, but it's definitely well over a decade. So having a voice I think is important. And then taking things that we have access to or can create or produce and sharing that with others that don't. You know, we have a, we have our own research institute and that's great. You know, we recently did a lit review on what it does to the brain to be in a mental health crisis. And that's a direct result of a frontline staff saying to me in a meeting I was in for a grant. We have, we were talking about the difficulties that people who've been in a mental health crisis have with completing tasks like calling this resource or going and getting that resource and this offhandedly. One of the staff said, I wonder what it does to your brain to be in a mental health crisis. And I went, whoa. So we, you know, I asked for a lit review and ta da, A lot of things happen to your brain. And it was a real duh moment for us. So we created a companion PowerPoint for that, you know, to really get that kind of information out to our staff in crisis services to say, look, you know, people are not firing on all cylinders. So if we come at them with all of this, call this, call that, get the food bank here, and they're not capable of that. So it really changed the way in which we've approached people in crisis and definitely post crisis. But then I've shared that document a bajillion Times and the PowerPoint and some of our follow up guidelines. Just because we have that, I feel a sense and I think our company feels we should share that. If our Staff get trained on it. Why shouldn't everybody else staff get trained on that and don't go create it? Here it is. I can give that to you. So we created some QR codes after I made the mistake of offering to send it to people a few times when I presented at conferences. And then I'd go back to my room and have to email it out like 87 times. Yeah, we finally did some QR codes for it. But I think that that's what I see, you know, mergers and things like that. What is the core reason to do it? And I think for us, that's what it is. And hopefully for others that are doing it.

Amazing. I love that. If you had one thing that you could leave our listeners with, maybe a mindset shift about these systems, what would that be?

I don't think enough people entering the field. I mean, I have a lot of thoughts, but this is the one that popped into my head, so I'm going to go with that.

Okay.

I don't think enough people entering into educational programs even understand that crisis services is. I think everybody thinks I'm going to be a therapist or I'll go get a nursing degree or I'll be a PA or I'll be a psychiatrist. I don't think these young folks or, you know, anybody entering into the education system understand that these are jobs. I've guest lectured a few times at universities and when I'll talk about this, they all, I mean, they kind of slouch in their seats at the beginning, but then you start talking about this and they'll say, those are jobs. That's a job. I can sit and talk to somebody in a crisis or I can chat and text with somebody or, oh, I can go work in a facility. So I don't. I think we're doing a huge disservice. We need to be out there more and more and more talking to people who are. Have an interest in this so that people understand the breadth of what this industry might be able to offer them.

Yeah, I like that. Well, we are out of time for today, but I loved this conversation. I can tell you are a wealth of knowledge. I like there were some deeper places that we certainly could have gone. But thank you for the overview and talking about the design and how we can support crisis systems because I do think it's so important for how we roll out mental health care in our communities to all of our listeners. The articles we mentioned today will be in the show notes if you'd like to dive deeper and Next week we will be back to explore more about the issues shaping the mental health care community currently. Becky, thank you so much for being here with us.

Thank you. Thank you for having me.

You bet. And thanks for listening everyone. Bye for now.