Episode 7: Brush your brain: Rethinking mental health with Cara McNulty of CVS Health

Justin Steinman:
Definitively Speaking is a Definitive Healthcare Podcast series recorded and produced in Framingham, Massachusetts. To learn more about healthcare commercial intelligence, please visit us at definitivehc.com.

Justin Steinman:
Hello, and welcome to the latest episode of Definitively Speaking, the podcast where we have data-driven conversations on the current state of healthcare. I'm Justin Steinman, chief marketing officer at Definitive Healthcare, and your host for this podcast. I'm joined today by Brittany Morin-Mezzadri from our Definitive Healthcare team, and our special guest, Cara McNulty. Cara is president of behavioral health and resources for living for CVS Health, which, as I'm sure all of our listeners know, is one of the largest healthcare companies in the country. What you may not know, however, is the leading role that CVS is taking addressing our country's mental health challenges, and that's what we're going to explore today with Cara. Cara, welcome to Definitively Speaking. We're happy to have you here.

Cara McNulty:
Thank you so much for having me. I love to be here and talk about mental health and wellbeing.

Justin Steinman:
Yeah. I love how you talk about mental health and wellbeing. I think that's something that we'll talk about a little as we get in this. And Brittany, great as always to have you with me today.

Brittany Morin-Mezzadri:
Thank you so much. I'm excited to be here with you and to meet you, Cara.

Cara McNulty:
I'm excited to meet you too.

Justin Steinman:
All right. So Cara, get us started here. Can you share a little bit about your background, how you got to CVS Health, and what your role is there?

Cara McNulty:
Sure, absolutely. I am a population health scientist by background, so I study large populations. I look at what barriers get in the way of people being their best and how health plays a role. I have done this all over the United States, and one of the things I have learned over doing this for years is that almost always at the core of what is tripping people up in improving their own health or their own health wellbeing and outcomes, there is a mental health component. And it might not be the core issue, it might come as a result of an issue; maybe you get a cancer diagnosis and then experience anxiety, or maybe you have untreated depression and then experience homelessness, but at the core there is always a connection to someone's mental health wellbeing.

Cara McNulty:
And I started seeing it over and over and realizing that we as a country weren't addressing this and we were letting the conversations just go by the wayside. We would talk about our physical health, we'll talk about our financial health, but rarely do we openly talk about our mental health and wellbeing. So I started to volunteer. I got on different committees addressing youth mental health, and adolescent mental health, and then elderly mental health. I have been a consultant to plan sponsor. And when CVS purchased Aetna, I thought this is Nirvana. This is where mental health magic can take place. And lo and behold, here I sit today, given the unbelievable opportunity to not fix a broken mental health system but reinvent a mental healthcare system that gets up front and engages and is interactive. So we don't have to hide from our mental health wellbeing, we can embrace it.

Justin Steinman:
I really like how you talk about that. It's fascinating to me because I really think you are addressing one of the largest challenges facing our country today. And I don't, of course, want to set your own data back at you to kick off a podcast, but here I go.

Justin Steinman:
So according to a recent study conducted by Aetna and Morning Consult, 44% of Americans experienced a negative impact on the state of their mental health in October, 2021, which was a 10-point increase from what respondents said in April, 2020 when that number was 34%. So even before COVID, [inaudible 00:04:17] COVID, leave it at that, one out of every three Americans was having a negative mental health, and now we're frankly almost up to 50% of the country here.

Cara McNulty:
Yup.

Justin Steinman:
What can we do? Where do we start?

Cara McNulty:
It's a great question, because it's easy to have these conversations and end up feeling hopeless. And what I want listeners to hear is the hopefulness that is surrounding us. And yes, pandemic has affected everyone. There's no one who can say, "I haven't experienced something." And it's affected everyone's mental health wellbeing, no doubt. Maybe it is the micro losses that have happened. Micro losses are those repeated losses that build up, so on their own aren't a big deal. Maybe you didn't get to take a family trip, then maybe your kids didn't go to school in person. Maybe you didn't get that internship. Maybe you lost your job. All of those, sure, have impact, but they are contained, but you add those up over and over and what we have is, you are in your kitchen, you spill a glass of water and all of a sudden you find yourself in tears. That impact is huge.

Cara McNulty:
So what can we do? We need to be talking about mental health wellbeing in a way that's really different than we're talking about it right now. And we're working very hard to do that. And that means talking about our mental health wellbeing in a really positive light. A really different voice, a really different conversation. We at CVS Health are talking about mental health and wellbeing like we talk about your physical health. We see ourselves as a head first health company, meaning we are always thinking about your mental health and your physical health together. You don't separate those. Because I bet none of us woke up today and said, "Oh, today I'm just going to focus on my mental health." No, we got up, and we are like, "Oh my gosh, I got to get my kids on the bus. I got to pay that bill. I just don't feel so great." Life happens and so we're working to change that dialogue.

Cara McNulty:
It also means that we're treating mental health and your wellbeing differently. Most of us probably got up today and brushed our teeth. You do that probably every day. Some of us have kids who often that can be a little spotty but... And we know that we're trying to eat better for the health of our physical body. We're trying to get outdoors because we know it's good for us to move and get fresh air. Well, we need to be talking about our mental health wellbeing in that same vein. It is a daily practice. And often when I say that people are like, "Oh no, here we go. She's just going to start talking about meditation and zen moments." No, I am talking about what are we doing that feeds our brain and connects to our body that builds up our resiliency and builds up our wellbeing, because even, even when we do that, we might have an issue with clinical depression but we're going to be better off. And so we're helping communities, and members, and patients think about their mental health as a daily practice and investing in their wellbeing.

Brittany Morin-Mezzadri:
I really liked how you equated the mental health to the physical health. And I think that when we talk about our resiliency in our physical health and the practices that we do every day to ensure physical health and wellbeing, we can attribute the activities to, I guess, clinical activities. So, brushing your teeth for dental health, eating right for digestive health. There's clinical-

Cara McNulty:
Correlation.

Brittany Morin-Mezzadri:
... correlation. Thank you. How do we do that with mental health when we can't see the biologics of it, or when we're talking about zen and meditation or all of the occurrences that lead up to perhaps a mental health episode? Like you can't medically diagnose spilled milk.

Justin Steinman:
I think what you're basically saying, Brittany, is I can't brush my brain.

Brittany Morin-Mezzadri:
Yeah.

Justin Steinman:
So Cara, this is great. What are some of these activities that we recommend for people for resiliency and how do you think about this, right?

Cara McNulty:
Right. Totally.

Brittany Morin-Mezzadri:
How do you brush a brain?

Cara McNulty:
How do you brush a brain? Well, you give it nutrients, you give it the right tools, and you give it rest. I'll just share an example of myself. My husband and I are fortunate to have two teenage daughters. And when our youngest daughter, who is now 16 and driving, which is a whole another piece of talk about wellbeing-

Brittany Morin-Mezzadri:
Right there with you. Right there with you.

Cara McNulty:
Yep. Yep. And it's good, it's good. When she was a baby she got diagnosed with RSV, which is a infection in the lungs. And that infection can be deadly. I'm a population health scientist. I have access to great healthcare. I invest in my health wellbeing. When we got that diagnosis, I thought, "Well, I just have to make sure she's breathing. How am I going to make sure she's breathing? I'm just going to hold her. I'm just going to hold Isabelle and I'm not going to put her down because then I'll know she's breathing." Totally makes sense.

Cara McNulty:
I went from, I'm going to hold her, I'm not going to put her down, to, I don't need to shower. That's not necessary because if I shower I have to put her down. Now mind you I have a partner. My husband is there, capable, willing. I'm like, "No, no, I got it." So I'm going to hold her. I don't need to shower. I don't really need to eat because that seems like a waste of time, to, I don't need to go anywhere except just right here in my kitchen. I'm just going to sit right here on the floor with her. I went from functioning to all the way downhill; not sleeping, not eating, not taking care of my personal wellbeing. I'm in this field and didn't know what to do. And this didn't just happen overnight. I was already sleep deprived. I had a baby who was two. So I had a two-year-old and a newborn, and there were signs but I didn't pay attention. My husband didn't know to pay attention.

Cara McNulty:
And so I share that because there are small investments to get out of that spiral. One, I needed professional help, and two, I needed to start investing in my own daily practice of mental wellbeing. So for me, that practice, and to this day, includes... I'm not good when I don't get good sleep. And you know what? It's not realistic to think that every night you're going to have a great night sleep, but I remove the barriers and the things that get in my way of achieving that good night sleep, like Netflix. I love Netflix, but Netflix, for me, watching in bed right before I go to sleep is not good because it gets my brain going.

Cara McNulty:
I also know that I need to make sure I eat. You talk about kids when they get hangry, I am not good as a hungry person. And so pandemic, I am working at home, I'm working all these long hours, I realize, one, I'm not moving, I'm not getting outside. I'm not sleeping very much. And oh, by the way, meetings are back to back. I'm not even taking breaks to eat lunch. Well, I could see my spiral. I could see I'm going to be back in holding the baby, rocking back and forth. "I'm good. I'm good. She's breathing."

Cara McNulty:
So I'm going to get back to what I know. I got to get outside every day. I got to move more, and that means, making time to do it, conscious effort. And to this day I pack my lunch. I work at home. I pack my lunch the night before as if I'm leaving the house, so I have lunch every day. It's those things. All of those things add up. Yes, I love meditation, yes, I love the practice of gratitude, but it is self-care. Think about this as the things you would do to take care of your loved one or best friend when they are sick.

Justin Steinman:
I think that's really interesting, and the word I want to pick up, one you talked about is being conscious of it. If I roll my ankle playing basketball and I'm on crutches, I'm going to be conscious about it as I hobble up the stairs to my office, or as I'm sitting on the couch with my foot throbbing, and I'm going to take care of it because I can't do it. But if there's something, you know, I'm sick mentally, or I'm having mental challenges, or I'm stressed out, it's real easy just to kind of dismiss it because there's no physical throbbing pain on my ankle and it's not black and blue. You're like, "I'll deal with it tomorrow. I'm fine."

Justin Steinman:
And so I think we all need to be a little bit more conscious. I can tell you for myself, I try... I'm a go, go, go, go guy. I have to stop myself and be like, "You need to pause and catch your breath," because when I become the go, go, go guy I start snapping at everybody and then I'm like Mr. Nasty and nobody likes me. And I want to be liked, right?

Cara McNulty:
Totally. It's that self-awareness, but it's also helping others around us to say, "Hey. I noticed you don't seem to be taking care of your hygiene as you have," or, "You seem really tired," or, "I'm seeing you a little more crabby than you have been." And most people when I say that they are like, "Oh my gosh. That is recipe for my partner and I to have an argument." This is about leaning in with kindness and leading in... And these things, these small acts, all improve... We make better decisions when we're feeding and caring for ourselves and when we're taking care of that mental health. You know, Justin, you have a brain that goes and so you, I bet, find ways to slow that brain down.

Justin Steinman:
Sometimes. I try every day, I'm not always successful.

Cara McNulty:
Yup. But who are the trusted people around us that help us? I mean, one of the things that my family will say is, "Mom, have you not worked out?" So let's say it's two days or three days, because I'm a movement person, not everybody is. I'm like, "Oh that's code for, hey, you're a little sharp. You're a little sharp. You've lost your patience." So part of what we can do is start to focus on the small actions. And people often say, "Really? Is eating lunch... Is getting outside... Is moving more..." Yes, it's going to help. I'm not saying run a marathon, I'm saying step outside, take some deep breaths, maybe walk up and down the block, maybe just sit on your steps, but it's that slowing down to just be present that we know is what we as a society need, and it changes our brain chemistry but it also changes how we see things.

Justin Steinman:
Words are really important and I've picked up... You talk about mental health wellbeing, and that's your phrase, and you said it multiple times even in this podcast. I came in today and I was just talking about mental health. I'm going to walk out of here and start talking about mental health wellbeing, and I think that third word in the phrase makes all the difference. Right?

Cara McNulty:
I think it does, because often in healthcare you hear people talk about behavioral health. That's an insurance term. Most of us... I can speak for myself, having had anxiety and still as a woman who deals with anxiety and has to work to not let myself get worn down, get back to that kitchen floor, I don't want to hear that I have a behavioral health issue because that makes it sound like if I just did something better... Well, you know what, when things break down, most of us, that's not what we want to hear. I want to be treated in a positive on what can I do? How do I advance my mental health wellbeing? And words do matter, especially when we think about why people don't get care and why they wait until things are so bad.

Brittany Morin-Mezzadri:
So let me ask you this, when we're talking about wellbeing, we're talking about physical health. Physically there's a homeostasis of normal, there's a definition of healthy. When we're talking about mental health wellbeing, how do we differentiate between, I guess, clinical mental health, like what is a clinical effect of our mental health, what is affecting it there, versus what is a cultural impact on our health? Are we snappy because there's something wrong or something not healthy with us, or we're snappy because there's something not healthy with our environment? Does that question make sense? How do we separate the clinical from the cultural?

Cara McNulty:
Sure. It's a great question. I would think of mental health wellbeing on a continuum, and on the low end of the continuum is how we build our resiliency, what we've been talking about. Almost like building up our superhuman power shield. How do we build our resiliency? How do we manage stress? Because stress is good. Too much stress isn't good but having appropriate stress is good. It gives us the go get it attitude, or the I should hang back. So on that lower end of the spectrum; resiliency, stress management, maybe even situational anxiety, you get nervous when you present. You are a person who doesn't like to walk into a room without knowing exactly the people you're going to talk to. There are things like that that are lower level acuity. Those are issues that we wouldn't diagnose as a clinical mental health issue or illness.

Cara McNulty:
When you move upstream; things like addiction, things like depression or anxiety that isn't a situational anxiety, or an illness; bipolar, schizophrenia, those are things that... Maybe, maybe there's a prevention effort if it's a substance use disorder, or maybe anxiety, but the mental health illness; bipolar, schizophrenia, that's a different diagnoses. We're not going to prevent that but we can reduce the impact. We can help manage. We can help look at how to help people thrive.

Cara McNulty:
And that gets to your question. Sometimes for people it's a chemical illness. It's going to happen but how do we help to mitigate it and get that person treatment and ongoing care. Take that mental health illness, there are things in the environment that exacerbate that illness. If people don't get their medications, or people don't take their medications, if people don't have access to the appropriate level of care. And so that means they get to the right care at the right time and they feel comfortable with that provider. It means if people can't afford it. So there are genetic and there are environmental factors.

Cara McNulty:
The other important thing to know is all of us will experience mental health disruption. It doesn't mean everybody has a mental illness. And if you just pay attention to how mental illness is portrayed in our media, we need a whole rebranding. It just is so bad. We need to... There are so many people who are successful, highly functioning, engaging, loving, supporting individuals within community that have a mental health illness.

Justin Steinman:
It's almost like we've kind of shined a light into this like corner of the room that we never ever talked about, and now we're all kind of waking up when we realize the extent of the situation we're in. Some of the stats are alarming, as I'm sure you know. According to a recent Kaiser Family Foundation survey, two out of every five adults report symptoms of anxiety or depression every year. That's 40% of our US population. And then less than half of Americans with mental health conditions receive treatment. And this freaked me out the most when I was doing my research, the average delay from the onset of mental health symptoms to treatment is 11 years. I wouldn't live with a twisted ankle for 11 years.

Cara McNulty:
Right, and you probably wouldn't live with a twisted ankle and then decide to run a marathon either.

Justin Steinman:
Right.

Cara McNulty:
We as a society have kept that light off that corner, and instead of empowering people, we continue or have, it's getting so much better, tried to just ignore that corner. But the reality is we're all in that corner. Everyone. All of us will experience and have... The pandemic has just brought it out in droves. And it's normal. It's normal. It's normal to have times when you feel like you're languishing or you're just burnt out. It's normal to have times where you're anxious or you don't feel good. Maybe you just are down. It is normal.

Cara McNulty:
What isn't normal is when we let someone suffer for 11 years before they get care. What isn't right is when we look at the number of people who don't get care.. And I would tell you that we believe that number is way under reported. You get to diverse populations, we haven't opened up the conversation in a way to make it okay to say, "You know what? I'm not okay but that doesn't mean I'm not a good person, that I can't handle what I got going on, or that I'm not willing to seek help." We got to change that conversation.

Justin Steinman:
Yeah. I'm so glad that you brought up that conversation because that's critically important. A theme of this podcast is really we [inaudible 00:22:49] has been health equity, unfortunately turned into more health inequity is a lot of what Brittany and I have talked about with our guests. According to The Journal of the American Medical Association, in 2018, 69.4% of black and 67.1% of Hispanic adults with any mental illness reported receiving zero treatment in the previous year. That is two thirds of those populations who say they have a mental illness got zero treatment.

Cara McNulty:
Right.

Justin Steinman:
What can we do?

Cara McNulty:
Oh, there are so many things that we can do and we are doing.

Justin Steinman:
Talk to me. What are we doing? You're in a great spot. Like working at CVS Health there's like one in every street corner. You of all people can really do something about this challenge. What are you doing?

Cara McNulty:
First of all, no one wants to be talked at. No one. So one of the things we have done is a lot of listening, and listening in community, and listening in communities where we see that black and brown populations aren't getting care. And we're listening to see what are those barriers, so understanding, and how we talk about mental health wellbeing and how the language we use matters. So we're doing a lot of listening and a lot of investing in community. I'll talk a little bit about that.

Cara McNulty:
But we're also really helping to take the noise out. Let's not expect people to know what they don't know. Most people don't know what it feels like to have anxiety. They might think, "I'm having a heart attack," or, "I drank too much caffeine," or, "This is just how I'm supposed to feel." Most people don't know that when they don't have desire to get out of bed, or they are eating a lot more than they have, or not showering, or feel detached that maybe depression might be present. Let's not expect people to know what they don't know.

Cara McNulty:
An example of what we're doing is we listened in community to say, what would be helpful? How can we remove those barriers? What are they and how can we remove them? And we started a pilot almost two years ago that puts mental health services right in your community. So we're using our CVS MinuteClinics and HealthHUBs. So MinuteClinic and a HealthHUB. And a HealthHUB, just think of a CVS location that primary focus is on health and wellbeing, now there's a pharmacy, there's a MinuteClinic to get preventive care and primary care. There is healthy options of products and durable medical equipment. And we put in mental health services.

Cara McNulty:
But it's not enough just to put in mental health services, we put in licensed clinical social workers, whose first thing they do is they help you assess what's going on. So you don't have to know what you don't know. It's like pressing the easy button. Instead of trying to figure out, "Okay, what am I experiencing?" You can talk to this licensed social worker and they are going to help you with an assessment. Then they're going to look at that assessment and say, "Okay, let's look at what you have going on and what we can do with you to improve it."

Cara McNulty:
And so maybe it's an issue, because it often is, that has a social determinant factor. Maybe you can't find daycare, or daycare where you feel really comfortable in your price range and you are experiencing a ton of anxiety because you're worried about your kids all the time. So that licensed clinical social worker is not only going to help address the anxiety, they are going to also help with, okay, let's look at the resources available in this community where you work, where you shop, where you play, where you practice your spirituality, and find the resources available and we're going to help develop a care plan.

Cara McNulty:
But let's say that individual needs something more than that licensed clinical social worker can help with, because you might develop a care plan and you might choose to see that social worker three times or five times, all depending on your situation, but let's say you need something higher level. That clinical social worker is going to help you know what you don't know. So maybe you need to see a psychiatrist or a psychologist. That provider is going to help get you to that care, that provider, make that appointment, and get you the treatment you need. So you're not walking a journey blindfolded and alone.

Cara McNulty:
The other thing that we do is we help people understand their benefits. Most people are like, "Wait, what do I have covered? I have insurance but what does that cover?" And maybe if you have insurance through an employer you might have a benefit that covers lower level issues; that lower acuity level stress, anxiety, maybe marital issues, but maybe you have coverage that covers those higher clinical needs. We help you navigate that. And then if you don't have insurance, what are the resources available in your community. So this is an example.

Cara McNulty:
I will tell you what's so exciting is this democratizes access to mental health care and takes the stigma out of people having to know what they don't know. So when we look at the success of these efforts right now, we're seeing clinical outcomes that you dream of, you absolutely dream of. We're seeing anxiety reduce, depression symptoms reduce. People getting to the right level of care at the right time. People leveraging their benefits. People getting in earlier for care. And also people not feeling so alone, like how do I really do this? It's empowering. It's really empowering. And right now we can see people ages 18 all the way on up, and I'll tell you we see people ages 18 to 80s.

Justin Steinman:
Interesting. You said this is a pilot program, right? How many places... How many people have you guys seen in total? Are we talking a 1,000, 10,000, 50,000 people?

Cara McNulty:
So we're just in the process of publishing all of our outcomes. I'm going to say, no, it's only been two years, so it's not 50,000, but it's substantial. It's substantial. We are in approximately 30 locations right now. We're expanding. We are in four states but expanding to seven states and we'll continue to roll out and refine. That's the other piece is it's an agile system.

Cara McNulty:
We've also learned that letting people know about the services available is really important. We've done marketing. We have signage in our stores, because people might run in to get... You know, I need to pick up band aids, or I need to pick up a script, and see, oh gosh, there's support here for my mental health wellbeing. And even how we talk about it in the stores, around the stores, our language is really removing those barriers.

Cara McNulty:
The other thing we've seen is people talk about it. We have really set this up that we can meet emergent needs because many people wait weeks and months. People can get in, you can get same day. But often people don't want same day, they want to plan or they are like, "I want to think about it." And so we see people getting in within five days on average. We also see this as a lower cost of care model. It's also that navigation model, and it's right where you live, work, and play. So it really opens up the conversation.

Cara McNulty:
The other question I get asked all the time, and in the beginning I thought this is so funny but it's such a reality check, many people say to me, "Well, gosh, I don't know that I... It's not that I wouldn't want to get care in a CVS but are people going to know?" We don't have a neon sign that says, "Therapies happening in this room." What we have is you're in the same waiting area where you might have come to get your COVID-19 shot, your vaccination, any type of travel vaccination, a flu shot. You might have been there because you thought you had a sinus infection, or you're a new diagnosed diabetic and you're working on understanding your A1C and all your levels. We don't call out, "Therapies happening in this room." It removes the barrier. It normalizes the conversation.

Cara McNulty:
And then also you'll see in the stores, like there's signage in the aisles. If somebody's in the sleep aisle or in an aisle looking at sleep products, we're going to have signage about your mental health wellbeing because you might not know, oh, hey, the reason I'm not sleeping or having trouble sleeping is because something else is going on. So again, it's that helping people not have to sleuth out what they are feeling and letting us help you.

Justin Steinman:
Blown away.

Brittany Morin-Mezzadri:
I love that. Amazing that goes back to the question of how do you brush a brain. How do you connect those everyday activities back to something that folks will look at as clinical. One of the questions that I have is about getting people into the care process. If you think about some of the barriers or ideas about what it is to seek mental health, folks may not even want to seek mental health. So how do you get to those folks who have opinions or have preconceived notions about what mental health care is and shun therapy? They don't think it's important or valuable to them. How do you get them in?

Cara McNulty:
Right. It's really an important conversation. We also need to remove the myths about who goes to therapy or who seeks care and talk about it in a way that normalizes it. That is happening because of need, because there are so many people who have high needs. But it's also happening because you see adolescent, young adults saying, "I got to talk about this because I need help and I don't want to suffer." And thank goodness they are because they are helping to pave the path. And it's our responsibility to also be asking and bringing up this conversation.

Cara McNulty:
Let's not separate our mental health from our physical health. When you're in seeing a primary care provider, we are helping primary care physicians always think about, let's make sure we're asking people about their mental wellbeing, whether that's a brief assessment, or we're talking to them, do they feel safe at home? Are they drinking more? Are they self-medicating? So again, it's weaving the mental health wellbeing conversation into the broadest healthcare conversation possible.

Cara McNulty:
It's also really normalizing that it's okay to not be okay, and we're not all going to be okay every day. And as I talked about earlier, it's probably one of the hardest things we do, but being okay to ask people, "Hey, I'm concerned. Are you okay?" Or even further, if you have maybe a suspicion that somebody might do self-harm, it's hard to do it the first time but after you do it you're like, "I can do this." Asking somebody, "Hey, are you thinking of harming yourself? Are you thinking of hurting yourself? Has that crossed your mind?" Because I want to tell people, one in four young adults throughout the pandemic has thought about self-harm.

Justin Steinman:
I want to talk about the young adult and the youth population because that stat that you just threw out there is alarming. I got a couple here to kind of supplement that. I've got, 2.5 million youths in the United States have severe depression. That's terrifyingly high number. 15% of people under 18 experienced a major depressive episode in the past year, and over 60% of people under the age of 18 with major depression do not receive any mental health treatment. I know you said that the CVS clinics you're only treating 18 plus, how do we attack this problem with our children, everybody under 18?

Cara McNulty:
Absolutely. We have a robust strategy, and it's not just our strategy. Many of my peers are also working because it takes all of us, so in the future we'll be working to move the needle on offering adolescent and young adult services below 18. We don't have that today. We do have other offerings and resources available for parents, for adolescents and young adults free on our CVS Health website that offer tips, resources, and places to seek help. We do really specific interventions around adolescents and young adults through the Aetna population we serve, and that is investing in early diagnosis of depression and anxiety. We work with primary care providers to make sure they are assessing and then partnering with them to make sure that we can coordinate care.

Cara McNulty:
We do specific work around GLBT youth and transgender youth. They are a highly vulnerable population. And I just want to say to anyone who is suffering and is a young adult who happens to be LGBTQ, trans, that you're not alone. You're not alone. There is support, there's care, there is hope, because we as CVS Health are investing, whether it's through community, through the offerings we have in CVS, but we also do those offerings virtually, and we're investing in communities at large. You've seen probably quite a few pieces around the investment we're making in communities to reduce disparity, and those disparities are about democratizing access to care. The worst thing that I have and what keeps me up at night is when someone says to me, "I just wish I would have asked for help." Normalizing asking each other for help and doing this work is just imperative because we can change this conversation. We can change these stats. We can change these outcomes.

Justin Steinman:
Some of the stats... I'm so glad you brought up the LGBTQ because when I was preparing, again, I feel like it has got all sorts of scary statistics but this one really freaked me out, which was, there's roughly 9.5% of teens aged 13 to 17 of the US identify as LGBTQ. Even before the pandemic, these kids were four times more likely than heterosexual youth to attempt suicide. And according to the Trevor Project, those LGBTQs are now more than five times more likely to attempt to self-harm. Point blank, that's not acceptable. We have to do something.

Cara McNulty:
It's not acceptable. Last year we made a bold goal for the Aetna members that we serve. We believe suicide in almost all cases is preventable, and we made a bold goal to reduce suicide attempts 20% by 2025.

Justin Steinman:
That's a great call.

Cara McNulty:
I will tell you that we're doing amazing work and we're reducing the number of attempts and driving health outcomes far more than we ever thought we would. We're going to surpass that 20%. But where we're not making progress, that's the adult population. Where we aren't making progress or haven't is that youth population. And so we are partnering with institutes like Didi Hirsch and other key healthcare providers that support our highest vulnerable populations like transgender, LGBTQ. WeHealth is another digital therapeutic we are working with that helps teens engage virtually, offers them support in a timely manner in a way they want to engage. So we're not looking at how do you just come at this from a traditional, it has to be an in-person visit. And not even just a virtual visit, this is text, chat. This is a whole different modality of teaching these young adults and adolescents that they're not alone.

Brittany Morin-Mezzadri:
How do we address and reach those LGBT specifically right now in today's climate where politics and policy is preventing them from accessing care, preventing their parents from helping them access care? How do we reach them with mental health healthcare?

Cara McNulty:
This is such an important question, and whether it's those states or any state, we need to continue to evolve this discussion and continue to offer the support and resources for parents, for caregivers, for young adults, for adolescents. The more we have conversation, the more we educate, the more those in need get the care. We have to have these discussions. We have to normalize this.

Cara McNulty:
I have a passion for LGBTQ transgender youth because those are quiet voices that are often overlooked and unheard and I want those young adults to know, like we see you, we hear you. You aren't alone. You aren't alone. And you don't have to just... If I can just get through tomorrow, if I can just get through next week, we don't have to do that. And whether that's through support of CVS, or through your primary care provider, or through suicide hotline, or through some of the great organizations that we invest in: Trevor Project, We Therapeutics, Didi Hirsch, you are not alone.

Justin Steinman:
Wow.

Brittany Morin-Mezzadri:
Thank you.

Justin Steinman:
Cara, I could talk to you for another hour or another day-

Brittany Morin-Mezzadri:
Yes.

Justin Steinman:
... about this topic and just keep going. We have such a tremendous challenge in front of us as a country, as a culture. I think we've made tremendous progress, but we're running a marathon here. We might be past the mile one marker, barely. You're at the forefront here. You're leading the marathon. We're all running behind you. Whether it's Definitive Healthcare, our listeners, or people who aren't even listening to this podcast, how can we all get behind you and help out here? What can everybody as an individual do here?

Cara McNulty:
Well, that's pretty simple. One, we can think about our own health wellbeing and the importance of brushing our brain, I'm going to use that. How do we take care of our own mental health? Two, we can help to educate via conversation that mental wellbeing impacts us all. Whether we're parents, or the individual, or grandparents, or aunts and uncles, or kids, it impacts us all and it's normal. It's normal and you don't have to do this alone. So advance that conversation.

Cara McNulty:
And then specifically in healthcare, we're going to push really hard to be bold to change how we deliver mental health wellbeing and mental health illness services. So we meet people where they are at on their journey, when they need it and before they need it. We're going to make it easy for them to engage. And we're going to continue to evolve the discussion so that voices that aren't heard or that have been silenced, we are listening to, and we are learning from and with, because we're all running this marathon together and so we need all of us to advance these efforts. And I would ask everyone to think about reaching out to somebody they care about. Asking people how they really are, not the, "Hey, how are you?" I mean, for the reals, "How are you?" And being courageous, because this mental health wellbeing initiative takes courage, and our populations, and communities, and loved ones, they are worth it.

Justin Steinman:
That's just some really good solid sage advice. Cara, thank you so much for spending this time with us today. I tremendously enjoyed our conversation and I learned quite a lot.

Brittany Morin-Mezzadri:
Absolutely. Same here. Thank you so much.

Cara McNulty:
Thank you. I loved being here.

Justin Steinman:
And thank you to all of our listeners for joining us today for this special episode of Definitively Speaking, a Definitive Healthcare Podcast. Please join me next time for a special bonus episode where Todd, Brittany, and I will dive deeper into the mental health challenges facing our country. And then please join me in two weeks for a conversation with Erin Brenner, chief product officer at Pear Therapeutics, where we'll discuss the emerging market for digital therapeutics.

Justin Steinman:
If you like what you've heard today, please remember to rate, review, and subscribe to the show on Apple Podcasts, Google Podcasts, Spotify, or wherever you get your podcasts. To learn more about how healthcare commercial intelligence can support your business, please follow us on twitter @definitivehc, or visit us at definitivehc.com. Until next time, take care, brush your brain, and please, stay healthy.