Mikelle Moore: Hello, I'm Mikelle Moore. I am senior vice president and chief community health officer for Intermountain Healthcare, and I am delighted to be here with two members of Intermountain's Military Caregiver Resource Group for this podcast episode that we are doing in honor of Veterans Day. Mike and Jim, thank you so much for joining me today.

Mike Busdicker: It's our pleasure to be here, and I know it's my pleasure to be here to talk about something that I'm passionate about.

Jim Lamadrid: Absolutely. Likewise, thank you so much for the invitation.

Mikelle Moore: Jim, tell us a little bit about yourself as a caregiver and as a veteran.

Jim Lamadrid: I've been now with Intermountain for about 15 months. I work in the Care Transformation Information Systems Cybersecurity Department. A little background on my military history, I served eight years in the Air Force. My wife was also active duty. We were stationed up at Hill Air Force Base just up the road here. And then we served during September 11th in Ramstein Air Base in Germany where I was a reservist finishing up college, and then was called back senior year to serve once the attacks happened in The World Trade Center and at the Pentagon.

Took about a 15-year break in service, and now I'm serving in the US Navy Reserves, information warfare officer down in Draper, Utah. Missed the military. Missed the camaraderie and this pretty core that was part of that. So that's what took me back in. That's me in a nutshell in terms of my military experience.


Mikelle Moore: Mike, tell us about yourself.

Mike Busdicker: Certainly. So Mike Busdicker. I'm the system director of Clinical Engineering for Intermountain Healthcare. I joined the organization in 2011, so I've been here about eight years now at Intermountain. I actually got my start in clinical engineering or biomed with the Air Force. I joined the Air Force in 1982 and graduated from the Department of Defense or the Air Force BioMed school in 1983.

I served seven years of active duty. That included time in Texas, in Athens, Greece, Aviano, Italy. I did a short period of time at Lindsey Air Station in Germany, as well as Davis-Monthan Air Force base in Tucson, Arizona. After my seven years of active duty, I had a short break of about four years and then enlisted in the Air National Guard in Wisconsin, and I spent 19 years in the Air National Guard. So I retired from the Air Force in 2012, so 26 years. That included in an operational combat deployment to Iraq with Air Force Special Operations Command in 2007. I spent the last 10 years of my Air Force career as a First Sergeant and as a Senior Enlisted Advisor for the entire state of Wisconsin.

Mikelle Moore: I'm so glad that you're both here as caregivers at Intermountain, and you both spoken about a brotherhood or a comradery. And you are a part of Intermountain's Military Caregiver Resource Group. Is that an effort to bring together that comradery? Tell me about how that group came to be and how it's evolved.

Mike Busdicker: So the caregiver group came to be probably just about a little over a year ago, and that was a by means of Don Woodruff, who is the co-chair of the Military Caregiver Resource Group. I'm the other co-chair of that group and have been the co-chair just for a short period of time, but Don asked the question around Veterans Day, and he said, "What does Intermountain do for our veterans during this timeframe to honor our veterans and to put them in the spotlight?" And Dr. Harrison at that point called him back and said, "You know what? We need to do something, and you're going to start it off and lead the way." And I think through Dr. Harrison's support, as well as senior ... our executive leadership team, including you Mikelle, the group has made tremendous strides over the past year. And we've been included in a lot of different things with all of the CRGs (Caregiver Resource Groups), and I look forward to the programs and activities that we're going to participate in going forward.

Mikelle Moore: Good. I think I'm so glad that Don asked that question and that he got that answer. That's exactly the kind of energy we need to create. I hope it's apparent to our listeners , how well prepared you are to speak today about the topic of mental health and suicide prevention for our military service members and veterans and in particular those that work here as caregivers at Intermountain.

I want to thank you for your service to our country and for serving as caregivers in Intermountain and thinking about the intersection of these issues. We all need to honor the service of our military members and veterans and express appreciation to you for the role you have in preserving our freedom and think about how as a community we can all support one another in your role as veterans, particularly when we think about topics like mental health and wellbeing. And in our work at Intermountain, my role here is to think about how we can partner more effectively in our community, engaging all of our resources at Intermountain, but also thinking about other resources around the community to address some of the most complex issues that are affecting health and suicide and the implications of suicide, the rising numbers, is a topic that's on the front page of the paper or in our social media feeds nearly every day.

And I think it's so appropriate for us to pause and talk about how this looks for veterans. We have 294 caregivers at Intermountain Healthcare who have self-identified as veterans.. And in Utah where we're based, there's over 4,000 Active Duty Military and more than 12,000 reserve forces in Utah. So overall, about 140,000 veterans in Utah. That's a pretty sizable part of our population, 6.5% of this civilian adult population. I'd like for us to understand what it's like to be a veteran. When you transitioned from that act of service to veteran status, or for you, during your break in service Jim, tell me about that experience. What does that loss of comradery feel like?

Jim Lamadrid: Personally, after my wife and I ended up leaving Germany, getting federal jobs in the DC area. So we were still supporting the Department of Defense in a certain way, but one day you're in uniform, and the next day you're not uniform. But I think the transition was challenging, again, because usually in the military, you're told when you have to show up to work, when you have medical appointments, dental appointments, when you're going to deploy, and you do lose that connection. So I think that transition was challenging for a little while. It takes you time to, to adjust mentally to that, but then you just find other things to bury yourself in when it comes to like if you want to do continue education or other friends in that particular work what you do at that point, but there was a transition there from that.

Mikelle Moore: Interesting. Tell me about your experience.

Mike Busdicker: When I was deployed over in Iraq, we were a close knit group on our compound that we had with the Special Operations Command and we did everything together. We were in the gym together. We were in the dining facility together. We were working 14 hours a day, and you just had that comradery with everybody that you worked with and when you transition out of that and come back. So when I came back from my deployment, that wasn't there. And I had to come back and reacquaint myself with not only the people that were in my neighborhood, but my family as well.

Mikelle Moore: Mm-hmm (affirmative). Right.

Mike Busdicker: And I was used to doing things a certain way and taking care of certain things. And now I had to reach back and depend on them and look at that. And it's those people that understand, as well as the support I had from my employer when I was deployed, and how they reached out to my family on a continual routine basis. It's things like that that help make that transition a little bit easier.

Mikelle Moore: Yeah, I can see that. And I think about all the different people that I talk to about this issue of mental health and wellbeing and suicide. And there's something that you both described that I think is similar to things I hear from completely different life experiences people have had. And that's something of going through a crisis or an experience and then having to re-enter another part of life. Your service wasn't necessarily a time of crisis. It was a great honor. It was something that you were doing willingly. And yet, that re-entry, that adjustment to something else seems to be a little bit of something in common. That might be true of someone who's going through a crisis or a traumatic event or treatment for a substance use issue or something along those lines. Are there corollaries like that do you think?

Mike Busdicker: I think there is some commonality between them on that, and I think it's with the military when we transition, and as Jim said, we had such a regiment before. And now we don't have that regiment, and we're kind of ... I don't want to say that we're lost, but we're really looking for something to help keep us grounded.

Jim Lamadrid: It kind of reminds me of the transition from high school to college.

Mikelle Moore: Okay. Yeah.

Jim Lamadrid: Remember that when you're in high school?

Mikelle Moore: Yes, yes.

Jim Lamadrid: You got to be at home room, and you got to your classes. And when college happens, it's like really? I don't have to ... no one's taking attendance on me?

Mikelle Moore: No one knows if I'm here or if I did my homework.

Jim Lamadrid: Exactly. So that's kind of, in a way, there's an analogy there.

Mikelle Moore: Sure.

Jim Lamadrid: When it comes to transitioning piece, kind of a sad story. In the May of this year, I found out one of my buddies, he was a tech sergeant who retired.We were both active duty here at Hill Air Force Base back 94 to 98. And last time I actually saw him was at the commissary, which is the grocery store at Ramstein Air Base in Germany back in 2000. We happen to see each other, hugged and say, "Hey. How you doing?" This past May, I heard some from other friends on Facebook that he was about to retire, did 21 years in the Air Force, and he took his own life. And you think this guy has nothing but a great future to look after, a retirement paycheck. He gets to find a second job, or if the misses works, he can stay home and watch Netflix, whatever he wants to do, but there was something so traumatic for him.

Mikelle Moore: A time of transition.

Jim Lamadrid: Exactly.

Mikelle Moore: Right.

Jim Lamadrid: And I saw some of the other testimonies from some of his troops, people that he supervised in the military. They kind of made him like Robin Williams when there was down times, and everyone was kind of sad, long 16-hour days. And security forces in the Air Force work a long time. They're basically the security guards. They guard the planes and the facilities and go on convoys outside of the base perimeter and everything. And he was always be the one to be smiling and joking. That's the way I remember him back in the 90s, and to hear that a guy like that who had a great sense of humor that really cared about his troops, right, that dad gave it his all to make sure that they were progressing well in their careers, that he thought that he couldn't ask for help.

Jim Lamadrid: That's why this whole topic is really important to me, just knowing somebody personally that did 21 years for our country. And the transition, again, from leaving the military world, maybe he was scared of making that transition like how can I support my spouse and my children now.

Mikelle Moore: But there's certainly transitions and adjustments for him and his family at that point.

Jim Lamadrid: Absolutely.

Mikelle Moore: I think we all have a connection to something personally, unfortunately. And it's really hard, and I thank you for sharing that story. And it's unfortunately one of many, and we're often hearing about these topics together, suicide and military service or veterans. And when you look at the data and the statistics around this, the suicide rate for the US veteran population, we always talk about these things in rates, right? It was 27, nearly 28 per hundred thousand in 2017, which increased even over the prior year in 2016. For veterans here in Utah, the suicide rate was highest for that young person. I think of them young, anyway. 18 to 34 at a rate of 62 per 100,000. Really high rate compared to our overall rate of about 25.

Mikelle Moore: In Utah, it sounds like the population is similar in terms of veteran, as well as non-veteran, that the most common source of taking one's own life is using a firearm. About 63% of our veterans who die by suicide use a firearm. And as we think about these really sobering statistics, what role do you see as we think about it at Intermountain, trying to address and prevent suicide across all populations, what unique opportunity or role does the Intermountain Military Caregiver Resource Group have to think about this topic? And help us understand it and hopefully prevent.

Mike Busdicker: A couple of things on that. And one of them is that the members of the military that have served, no matter where they served, what their job was, it's hard to understand, or you may not understand what they've seen, what they've been through, what they've experienced. And a number of them, including myself, the majority of the time, don't want to talk about that. And it's probably not good for us to do that. But I would say as a starting point for our Military Caregiver Resource Group for Intermountain Healthcare and others as well, is education, education, education. We need to include military service members, veterans, families, other caregivers and people in the work environment. Everybody needs to understand some of the factors in the thought process for these individuals.

We don't need to be experts, but we at least need to have a basic understanding. And I know firearms is one of the leading methods of death by suicide for our veterans. And I believe that that's really based in the availability of those-

Mikelle Moore: Familiarity.

Mike Busdicker: Yeah. And familiarity of those firearms. And I think if family members and others understand this, they can help through locking those firearms up, taking those firearms and transferring them to a family member while the veteran or the military service member is getting the help that they need. So I think there's numerous organizations, treatment programs, therapy, assisted programs, and other things that can be invested in and developed to help in the treatment and suicide prevention for our veterans.

Mikelle Moore: What would you add, Jim?

Jim Lamadrid: Just doing some research on this discussion. I know Intermountain, I know there's a doctor of public health, Morissa Henn. She briefly just went to Congress I think the beginning of the month ...

Mikelle Moore: She did.

Jim Lamadrid: ... to address this particular issue when it comes to firearms in the state of Utah and collaborating with gun owners on suicide prevention. And that's a big piece. Like Mike was saying, take away the tool that ends their lives. I had drill weekend here in Draper. We had a captain from headquarters talk about this: If anybody has suicide ideations. He was talking about that the Navy has a very simple thing called One Small ACT, and ACT stands for Ask, Care, and Treat. So ask would be, "Are you thinking about suicide?" So just basically come right out if you have somebody that's showing indications-

Mikelle Moore: Right. Ask very directly.

Jim Lamadrid: Exactly. So they hopefully respond to you and then answer you. And then you work that way. And then you care, listen without judgment to understand where they're coming from. What type of stressors are they experiencing in their life? Are they going through divorce probably? Are they having financial difficulties? Did a parent just die? Figure that out, and be that person to listen and be a shoulder to cry on. And then you treat. In the military, you have chaplains available there. Therapists you can have also here in the private population as well. We have that with Intermountain. You have therapists. You have the same type of resources that we have. Or you just go to your church and see what you have. So that, again, the one small ACT…

Mikelle Moore: It doesn't have to be provided by the company necessarily to be of value.

Jim Lamadrid: That's true.

Mikelle Moore: It sounds so similar to many of the things that we're involved in from a community outreach perspective right now around suicide prevention. Hopefully you've heard about our commitment that we made about a year ago to zero suicide to say we need to first of all declare that suicide is 100% preventable and that no suicide amount of suicide is acceptable. Zero suicide is all we can accept as a society and as a healthcare organization.

And then we've tried to really build up some of the community resilience and education in our schools and other things by just supporting programs similar to ACT, it sounds like. We support QPR: Question, Persuade, and Refer training. We support HOPE squads, which are hold on, persuade and empower. Some of the same concepts just thinking about different communities and how what's going to resonate, create that spirit of camaraderie, in different settings because we know if we can encourage our communities to talk about the risks, openly talk about what people are struggling with and then create a safety plan or empower people and connect to them to resources, it's going to make a really big difference.

Mikelle Moore: And you mentioned, Jim, Dr. Morissa Henn. She's led a lot of this work, particularly around the link between firearms and suicide prevention. And yes, testified recently at a congressional hearing to that research. And we're really proud of it. I think it has a lot of potential to do good here in Utah, where half of all households have a firearm. We do have a lot of retired military and veterans who have a lot of comfort. We also have a lot of community sporting activities that relate to the use of guns. I grew up with a dad who's a hunter. But now it really is transitioning to talking about it differently. It's not about whether we have guns or don't have guns or hunt or don't hunt. It's thinking about that importance of locking up a gun and having that conversation when someone might be in a point of crisis or transition to keep the firearm locked up or relocate it for a period of time to prevent injury. So when we think about all of the things we are doing already, and yet we're just at the beginning of this. We've just recently announced that we're going to be a part of a community wide effort to fund public awareness campaigns around suicide prevention and measure the impact of those so that we can try to influence outcomes. I'd love for you to challenge us to think about how should Intermountain's efforts evolve or be inclusive of veterans as a specific group that we have an opportunity to impact health? What can we be doing?

Mike Busdicker: So I think it's just making sure that we are getting the word out there on the support programs and treatment that's available for our veterans, specifically for the veterans that may be through the VA healthcare system and being involved with our military units and organizations throughout the state as well. We need to encourage our caregivers and others in the community to be involved in helping our veterans live the healthiest lives possible, and that includes continuing on with that. And maybe we need to take a look at how can we help provide transition assistance for our veterans that are retiring from or leaving military service. And the other thing that we need to remember in that process is that most or the majority of them have families.

Mike Busdicker: And they're bringing those families with them in that transition process so-

Mikelle Moore: And the family is going through its own transition, right?

Mike Busdicker: Right. Yes.

Jim Lamadrid: Yeah. And to add to that as well, I remember in 1998 when I separated active duty here at Hill, the military has a program called TAPs, transition assistance program. I think it still exist. That might be something that Intermountain can probably volunteer to provide, so we can go there-

Mikelle Moore: Right. Align with it.

Jim Lamadrid: Exactly.

Mikelle Moore: Great idea.

Jim Lamadrid: ... and maybe provide some guidance, start some discussions about that as well. And one thing about the suicide piece, also, one thing in the military where if you didn't show up to work, or if you're sick, you have to go to sick call you. There's a stigma to that as well. And I think the thing with this is you don't want to be that girl or that guy to raise your hand and tap out and say, "I'm not going to work today." There's the show with suicide. Seeking help is a good thing, right? I mean, you're there to serve the nation, to be there for your family as well, but if you're not mentally healthy for that, there's resources available for you in the military.

Mikelle Moore: Have you noticed that that emphasis within the military to step out when you need a mental health day, has that effort helped de-stigmatize, or do we still have a lot of ground to cover?

Jim Lamadrid: I think because of the warrior spirit in the military, you do get frowned upon. I remember one time I had like a 101 degree temperature, and I worked the South Gate at Hill Air Force Base, where you stand out in the cold and the rain doesn't matter. And I felt guilty I was going to call in sick. So I just basically showed up to formation, got my M16, and went out to the gate. And looking back, I think I was pretty reckless, right? If I had to respond, I wasn't mentally there. But I think it's kind of like, "I have to show up. I can't let my buddies down."

Jim Lamadrid: And it wasn't like in a war zone. I wasn't Iraq. It was here at Hill up in Davis County, but I felt like I had to show up that day and just perform. So to let people know that it's okay to ask for help, that's probably one thing that's difficult.

Mikelle Moore: We need to proactively reinforce that in this work environment and in all environments. Right?

Mike Busdicker: Right. And that's one of the things that I had been thinking about as well. And as I looked at it, I said, Intermountain Healthcare, they really do a great job and continue to do a great job of being proactive instead of reactive in overall health of the people in the communities that we serve. And personally, I would love to see Intermountain Healthcare move in the same direction when it comes to our military service members, our veterans and their families.

Mikelle Moore: So I have kind of two questions that I'll ask as one. When you think about then what that support might look like, is it primarily addressing mental health needs specifically? We are a healthcare organization. We address mental health issues as a part of overall health. Is that thinking about our role in helping veterans feel comfortable accessing those services and making them truly accessible because they're not necessarily that way today, or is it also thinking about how we act as a responsible employer to help make transitions for veterans into the private workforce more comfortable, more healthy?

Mike Busdicker: So personally, I think it's both. I think there's things that we can be doing. I know when I came back from deployment, there was a health assessment process that I had to go through at 30, 60 and 90 days where I had to go in and actually sit down and talk with someone and say, "How are you doing? You've been back for 30 days now. How is your health? How is your mental state? Just how are you doing interacting with your family?" So again, that was at 30, 60 and 90 days, and I think something similar could be set up in the Military Transition Program to where, as a military person retires or separates from service, and they join an employer, we sat down with them, say "How are you doing?" We already have an onboarding process, but what about that process? As well as, I have members of my staff. I have one that's deployed right now and one that's leaving for a year in November to Iraq. And it would be great for the organization as well as myself to stay in touch with that family. “How are you doing while they're deployed?” And then when they come back, being involved in that transition process when they get back as well.

Jim Lamadrid: That's true. I also agree with the new build of the Layton Hospital right there at south of a Hill Air Force Base, that's a way that Intermountain's already providing that services because I know when I was there in the 90s they really drew down a lot of the medical services on the base just because of the cost.

Mikelle Moore: Right, right.

Jim Lamadrid: So that's also Intermountain stepping in that way and providing the care and services there. But also, I think with the targeting veterans right now with the Military Caregiver Research Group providing a table over at the Veterans Fair down in Sandy next month, that's a way that Intermountain's already leading the way to recruit out there for veterans to come and work in our ranks here with Intermountain. So I think those were the steps-

Mikelle Moore: Yeah, please join us.

Jim Lamadrid: Exactly ... to show that we have veterans already here, so they can look at us, and we can kind of share similar discussions and experiences and see what their skills are that they can bring over to Intermountain. So that's a way forward that I think Mike and Don and the rest of the folks here have been make happen already.

Mikelle Moore: I'm so glad that you all are a part of that effort, and I really appreciate you sharing your insights today. I'm struck always when we have conversations like this about how much by focusing on the needs of a specific community, some of the things we're talking about would be good for any community, right?

Jim Lamadrid: Yes, mm-hmm (affirmative).

Mikelle Moore: Think about we should be talking with all of our caregivers about, "How are you doing at 30 days, at 60 days, and 90 days?" and feel more comfortable to talk about aspects of health and mental health and wellbeing. And we often are maybe too careful about being personal, and I really appreciate you all being so personal today. It's made for a really nice conversation. Thank you.

Mike Busdicker: Thank you.

Mikelle Moore: Thank you to our listeners. If you have questions or comments about today's episode, please share them with us on Twitter. Our handle is @Intermountain. We would love to hear from you. This has been an Intermountain Healthcare Podcast episode with Intermountain's Military Caregiver Resource group. It's been a pleasure having you.