Dr. Marc Harrison: I'm Dr. Marc Harrison, CEO of Intermountain Healthcare. Today I'm with Morissa Henn, a community health program director. Thanks for joining us, Morissa. First, could you introduce yourself and maybe tell us a little bit about what you do at Intermountain?

Morissa Henn: Sure. I'm really proud to be part of the Community Health team and I moved to Utah just over a year ago because of the incredible work that Mikelle Moore and her team have been advancing around some of the most cutting-edge issues of our era. And for me, that's really been around population mental health and specifically suicide prevention. I think we have such a high level of need here in Utah and we can go through some of that in more depth in this conversation, but mostly I think Intermountain is positioned to be the leading provider of behavioral health care, not just to our patients and members, but actually changing the way that these issues play out and the way that needs are met in our community. So I'm just so thrilled, even at a time when I'm so humbled by the extraordinary levels of unmet need.

Dr. Marc Harrison: Great. Where did we recruit you from, Morissa?

Morissa Henn: Yeah, so I sort of serendipitously came to Utah as part of a Doctor of Public Health consulting project at the Harvard School of Public Health. The Harvard School of Public Health has had a longstanding relationship with Intermountain. And so my husband and I love to ski and little did we know that we were about to fall in love with a lot of things about Utah, but especially this health system and the caregivers who have chosen to make their careers here. So, it was really... we immediately fell for the system and I was so fortunate to be able to come back first as a doctoral intern at Primary Children's and then in the Administrative Fellows Program. So, started off there in June and as an administrative fellow and transitioned into this role guiding our zero suicide work in October of last year.

Dr. Marc Harrison: Well we're thrilled to have you here and we're glad you're enjoying Utah. Can you maybe put a little finer point on the behavioral health challenges that we face in our state and in our region as well?

Morissa Henn: Absolutely. This is something that's really been top of mind. The Utah Hospital Association in partnership with the Gardner Policy Institute just released a startling report in which Utah is placed 51st, so dead last in the country when it comes to adult behavioral health. And that's really a measure of both the prevalence of mental health need and then how much those needs are being met. So it turns out that about 50% of adults and youth are not having their behavioral health needs met currently. And it's for a variety of reasons. Some of it is that we have a lot of rural areas that don't have a lot of professionals who can provide those services, but some of it's because we've had this high suicide rate where we're one of the highest suicide rates in the country. The whole Mountain West in fact has a very high suicide rate. And so, while those statistics are really concerning, I think what gives me hope is that we're finally beginning to understand what it takes to turn the dial.

Dr. Marc Harrison: So we've scrambled a lot of resources and are not just reacting. I think we're trying to plan in a thoughtful fashion for what our response to this huge problem, this terrible problem looks like. Can you tell our listeners a little bit about if we do our job well and we're going to, what should this look like over the next year or two years?

Morissa Henn: I think if we do our job well, all people in the areas we serve should be able to access quality, affordable behavioral health services regardless of where they enter the system. Whether that's coming into our EDs in a state of crisis, whether that's people who are our patients in primary care who we identify as having a need. We know of somewhere between one and four, one in five patients has some sort of mental health need. Whether those are just the members of our community who are struggling, who may not have a diagnosable mental illness, but are high risk for suicide because they're going through a divorce, or a job loss, or another major life stressor. And so, I think it's really about bringing all those components together, the quality of care we deliver, which is quite good, but we need to have it spread further.

So it's about also bringing together our best technology. Looking at opportunities to use telehealth Connect Care to reach people who are in hard to reach geographies in particular. And it's about really taking the skills and science of public health to say, what's going to make a difference? With suicide prevention, it turns out Utah's a particular outlier and really the Mountain West as a whole when it comes to firearm suicide. And that's why our zero suicide efforts have focused so intentionally around working with gun owners and gun advocates to ensure that no person in suicidal crisis ever has access to a firearm. It's a position that may sound controversial, but has the full buy in of our gun owners because it's a temporary approach during a time of high risk. And, their community has really helped us understand how to message that, how to respect gun rights as part of the fabric of our region, while at the same time keeping people safe.

Dr. Marc Harrison: So let's unpack that for a second, Morissa. So, if I were to play to stereotypes… So here you're this PhD from the East Coast, from Harvard, who's interested in suicide and you've identified that guns are our big problem. And here you've moved to a frontier state that's really red, right? And have a lot of people who love their guns and believe very strongly in their right to bear arms, that what I hear you saying is that we're finding common ground that's humanistic, which by the way, that's really exciting, if it's true. Can you actually sort of delve into that a little bit more for us?

Morissa Henn: Yeah. I had dinner two nights ago with the head of the Utah Shooting Sports Council and we were reflecting on this collaboration over the last two to three years, of which I am just a part. I mean there are so many people, legislators, veterans, public health officials who have been such an important part of this coalition. But I asked him what he thought the crucial ingredient was and he said, there's no question. It's about trust. It's about people coming together to say, as someone from Boston, I had never held a gun. I grew up in New Hampshire, so I definitely had a lot of neighbors and friends who were gun owners.

Dr. Marc Harrison: That's the ‘live free or die’ state.

Morissa Henn: That's the ‘live free or die’ state and really has similar politics and value of rights as Utah. But that said, it was something new to me and so if we're going to talk about this, you have to be able to do more than just parse data. And so I accepted an invitation to go shooting with some of these gun owners who were part of this coalition...

Dr. Marc Harrison: It's pretty fun, isn't it?

Morissa Henn: It was super fun. I think it was... that was what they, I think they were both really struck by the level of surprise I had that this was not the object of violence that I had sort of been maybe thought to believe in my graduate studies, but in fact a really important symbol of freedom, a really important symbol of family protection, and personal heritage. And so, it turns out that regardless though of our politics, there's just so much room for us to advance based on that common belief that we want our loved ones to be safe. I mean, that is a core value. That is one of the reasons people own firearms. It's one of the reasons some people choose not to own firearms, but fundamentally, if we can agree that we all want our loved ones to be safe and part of that is keeping them safe when they're going through tough times, when they're struggling with mental illness. Then we can talk about smart strategies that have nothing to do with whether this is a pro-gun/anti-gun issue. It's about preserving human life.

Dr. Marc Harrison: So, talk to me a little bit about... why you believe that Intermountain is making these investments in time and energy into this sort of work you're doing. And to be honest, so few other systems are actually doing any meaningful work around this.

Morissa Henn: Yeah. Well this, going back to why I made this journey, it was certainly for more than the quality of snow and mountain biking, but the fact that, that was part of it, but the way in which caregivers and leaders here are living the mission of this place is simply unmatched. I was told in fact by executives at other prominent health systems, “If we're being honest with you, you really shouldn't stay here. You should go to Intermountain because that is where the connection to the community, the value of affordable care, the value of access and ensuring that people have their needs met front and center is prioritized in a way that I am yet to encounter a health system where that value is as dear.” As a result, as someone who feels very passionately about the social justice underpinnings and the community drive of this work, I don't ever feel like I'm being stymied in the types of values I hold dear and instead am able to live those every single day, bring the data, bring the teams together without feeling like in any way it's going against the grain.

Dr. Marc Harrison: So that's interesting that you talk about social justice and I don't know if you've had a chance to read the editorial in The Wall Street Journal by the former Dean of the University of Pennsylvania Medical School who makes the argument that healthcare professionals shouldn't be interested in social justice. I personally have a hard time understanding that. What do you think about that kind of statement?

Morissa Henn: For me, if we are going to live and work in the healing field, we have to be looking much deeper than just diagnoses and dollars. We have to be looking at the humans before us and what it is that led to the conditions that we see and what will lead to their flourishing after we have our time with them. And so I think social justice is more than just a feel good mentality. It's actually the only way in which we're going to get the results we deserve.

So even this morning, I was on a call at seven o'clock this morning around a difficult case surrounding a suicidal behavior. And many of us paused and said, "You know, we can look at the screening devices, we can look at the evidence base and the medications, but are we connecting with patients in the human, deep, dignified way that they deserve and that ultimately will get us the outcomes that we need?" And I think until we do that, until we actually look inwardly at what makes a meaningful life and what makes a meaningful life for the people we serve, we're simply not going to get the results that we need.

Dr. Marc Harrison: So before we wrap up, Morissa, I'd really hope that you're getting all the resources you need from us to drive this work forward. And I know you'll speak up, and you should, if you're not. I wonder if you might tell our listeners maybe a de-identified story about an adolescent with access to guns, what she or he might feel, do, and what the outcome might be with and without the kind of education that you're really pushing across our region.

Morissa Henn: Mm-hmm (affirmative). Yeah, one story that comes to mind, and this has been repeated in so many different ways, is a story of a young person who was going through a lot as adolescents do in our complex world — pressures, changing relationships, shifts in identity. And this young person had been struggling but doing so silently. I think much as we talk about overcoming stigma, there's just a lot that all of us hold inside. And so, what is so important about this story is that this young person had an uncle who was a mental health provider in one of our rural areas. And that uncle had the good sense to say to the young person's parents, you know, "Your son may be doing okay today, but tomorrow he might not. So make sure your guns are locked in a safe. Make sure the ammo is separate."

And that step led to that young man, in fact, in the middle of the night, waking up, going down to the basement, and upon finding the guns securely locked in a safe, went back to bed. And that's the type of story, that's the type of miracle that we need to experience. Yeah, I mean it's as simple as that. Oftentimes these people who are experiencing near... these crises are no different from any of us. It's about ensuring they can safely weather that time, get the help that they need, and sometimes just turn out the light and go back to bed for a brighter day tomorrow.

Dr. Marc Harrison: One final thing and I've heard this a couple of times and... there are people who think that why are we working so hard at this because, you know, we may head somebody off at the pass this time, but they'll manage to kill themselves the next time. Is that in fact borne out by data, or not?

Morissa Henn: I'm so glad you raised that because I think this is one of the myths that we most need to correct. So, there have been 170 studies done about this very question of whether or not people who survive one attempt are going to go on to make attempts again. And some people do, some people make attempts, but it turns out after doing these meta reviews, 93% of people who survive even a very serious suicide attempt will never go on to die by suicide. Which means, if we can save a life in the short term, that one dark night, that one relationship break-up, we can usually save a life for the long-term. And so I think that's the vision. That's why this work is worth it because it's not about necessarily solving every problem. It's about keeping people safe through the vicissitudes of life so that they can get support and they can go on to flourish.

Dr. Marc Harrison: So Morissa, thank you for being on the podcast. Thank you for being an Intermountain caregiver. Thank you for your commitment to the community and for building relationships. Do you have any advice for me, or any asks for me before we wrap up?

Morissa Henn: I would just ask, please continue inspiring us with your work, with your vision, and the way in which mission is so front and center for all of our leaders, but especially across ELT. It keeps all of us feeling that fire within us, that what we believe and hold dear actually is a crucial driver of our everyday efforts.

Dr. Marc Harrison: Well, thanks. We feel a lot of urgency. This is a very special moment in time that Intermountain has done an enormous amount of hard work over decades and I think we're in the right place at the right time with the right model and the right resources to really make a big difference, not just for the people who we're privileged to serve in our communities, but we'd like to be a model for others and we'd like to share everything we learned. There's no secret sauce. You know, we want to share what we learned so that we can make things better in other places too.

Morissa Henn: Yeah, I couldn't agree more.

Dr. Marc Harrison: Thanks, Morissa.

Morissa Henn: Thank you.