Hospitals In Focus

Mental Health During the Pandemic with Karen Johnson


Every year, FAH joins mental health organizations and other proponents across the U.S. and around the world to raise awareness of suicide prevention during September, National Suicide Prevention Month. As society continues to struggle with COVID-19, there has been much discussion of the adverse psychological impacts of social distancing isolation and being away from loved ones. In this episode, Chip is joined by Karen Johnson of Universal Health Services and they discuss a wide range of topics from the ways COVID has affected the psyche of children and how to reemerge back into society after lockdown to what Universal Health Services is doing to help prevent suicides and the importance of celebrities sharing their struggles with mental health.

Announcer:                      Welcome to Hospitals In Focus from the Federation of American Hospitals. Here’s your host, Chip Kahn.

Chip Kahn:                        Each September, the Federation of American Hospitals recognizes Suicide Awareness Month and takes time to appreciate just how important mental health is when it comes to the overall healthcare of Americans. As the old saying goes, ” [00:00:30] You never know what someone is going through. Be kind, always.” However, what we do know is that of the estimated 43.7 million Americans who experience a mental health issue each year, only one in five will get the treatment or help they need.

Since the beginning of COVID-19, there has been much discussion of the adverse psychological impacts of social distancing, isolation, and being away from loved ones. This [00:01:00] has only been exacerbated as many struggle to re-enter society amid another COVID-19 surge caused by the Delta variant. As people returned to the office and kids head back to the classroom full-time, the stress of the pandemic is once again building.

So it is particularly topical that joining us today is Karen Johnson, Senior Vice President and Chief Clinical Officer for the Behavioral Health Division of Universal [00:01:30] Health Services. Thank you so much for being here today, Karen.

Karen Johnson:               I’m really glad to be here, Chip. Thank you.

Chip Kahn:                        To get started, could you tell us a bit about UHS and its role in behavioral health care and how you came to UHS and what your background is in mental health?

Karen Johnson:               Absolutely. Universal Health Services has been in business for well over 40 years and we’re one of the largest and most respected health care companies. And what’s unique particularly [00:02:00] about us as sort of a half and half division of physical health or acute medical hospitals and behavioral health hospitals. Meaning that we have 27 acute care hospitals around the country and well over 300 psychiatric hospital operations and other behavioral health organizations here in the states and also over in the UK.

We as a company have always had the mission of patients first [00:02:30] and our focus on both physical and mental illness has been key to our overall strategy. Particularly when we think about the awareness of issues related to mental health, having a conversation and then hopefully changing the conversation is critical. And focusing on taking care of our people is first.

I came to UHS in 1999. I have, quite frankly, have not done anything [00:03:00] else in my professional career other than work in behavioral health. I am a social worker and a music therapist by training. I’m also a former hospital CEO. And when I joined UHS in 1999, I became responsible for the oversight of clinical services in our behavioral health division at that time. And currently I am the Chief Clinical Officer for the Behavioral Health Division. And [00:03:30] I also chair the Quality Committee for the Federation and participate with the National Association for Behavioral Health in areas of quality as well. I have my bachelor’s degree in music therapy and my master’s degree in social work.

Chip Kahn:                        Karen, you alluded to this, but how can we chip away at the stigma surrounding mental health for so many? And how does conversations like ours help overcome some of these obstacles that have traditionally stood in the way of [00:04:00] Americans seeking care for their mental health issues?

Karen Johnson:               The first step, Chip, is having the conversation. And so I’m delighted to be having this with you. And the more that we talk about issues related to mental health, the better that the outcomes can be for Americans. So I think starting with this particular conversation opens the door for even bigger ones. And when COVID first hit back in May, we [00:04:30] conducted a survey, UHS conducted a survey of Americans to understand the impact of COVID in their lives.

And back then, more than 68% of the individuals surveyed indicated that it was an extreme stressor for them. And the majority of the survey participants also stated that they had felt concerns in increased symptoms related to depression and anxiety. And [00:05:00] the isolation that was required of us last year increased this level of anxiety. And I would say that if we were to do the survey again, those numbers would be even higher now.

Chip Kahn:                        So it’s clearly important during these times of crisis like COVID-19 for people to stay connected. What can we do to help maintain personal relationships at times like these?

Karen Johnson:               You’re absolutely right, Chip. The issue of connectedness is the way that we [00:05:30] stave off concerns around mental health and how we talk about these issues is key. The notion of social distancing and the language choice I think could have been better handled, a better word perhaps should have been physical distancing. Because the social distancing does create a barrier to those who need the support and need the help. And 20 years ago had this pandemic hit, we wouldn’t have had the benefit [00:06:00] of all of this virtual technology, including the technology that you and I are using today.

And that the key is to be intentional about that and to support those who are suffering and perhaps you’ve not seen or have felt isolated from is an opportunity for those who care about them to reach out. And to recognize that all of us have an opportunity to improve our level of social connectedness [00:06:30] as opposed to social distancing.

Chip Kahn:                        As the pandemic continues and one of the groups that’s maybe worst hit in some ways is children. How can we help them from feeling isolated and prevent or treat other mental health issues that may arise for the young ones in this very peculiar environment that we’re all stuck in?

Karen Johnson:               Well, as you know, school is our children’s workplace. And if we [00:07:00] make it difficult for them to be in school and it has been difficult and who knows what things are going to look like going into this school year and what the children are going to experience. Talking about it is important. It very well could be a long time before normal sets in. So talking about fears is important. I think managing screen time and managing news consumption is an important [00:07:30] component of this because it’s very difficult to turn things off as children that they’re focused on what they might be afraid of.

I would look for and monitor for unusual behaviors and encourage honest conversations about those fears. It’s scary. It’s scary for the children. It’s equally, if not more so scary for the parents. So reaching out and chatting and [00:08:00] focusing on the importance of talking about and asking, “How are you?” Waiting for the answer and gently continuing the conversation even if you don’t get a response the first or the second time.

Chip Kahn:                        Karen, as I mentioned, we’re getting together today because September is Suicide Awareness Month. What are some of the programs that UHS has implemented to prevent suicides?

Karen Johnson:               I think that UHS has partnered [00:08:30] with the National Action Alliance for Suicide Prevention back in 2013. And this is the agency or the organization by which we have continued our efforts on suicide reduction. Zero Suicide is a transformational framework that has been used in other healthcare systems. And we have taken this work to a different level with focusing [00:09:00] on care that’s provided in the inpatient psychiatric setting. And Zero Suicide, those are two tough words to put together, Chip. There they’re aspirational, but the Zero Suicide framework provides some practical guidance for healthcare systems, as well as other community agencies to focus their efforts on transforming the systems from a leadership perspective all the way to collecting [00:09:30] data and understanding the data.

And also including experience, the lived experience of suicide survivors, suicide attempt survivors I should say and others that have been impacted by suicide. The Action Alliance itself, there’s 250-plus agencies that are connected together through this extraordinary opportunity to have, again, changing the conversation around these topics. Patient [00:10:00] safety, as you know, zero harm is everybody’s aspirational goal. There’s not an acceptable limit nor is there an acceptable number of suicides.

But together as a community, we can do more. I’m proud to say that as a healthcare system in this alliance, we partner with the CDC. We partner with the Veterans Administration. We partner with the Department of Defense, the entertainment [00:10:30] industry, construction, the railroad systems, the NFL and others. And together, as I said, we can do better.

Chip Kahn:                        In recent weeks, Simone Biles came out with her own story on mental health during the Olympics opening up about how it was affecting her physical performance. How do celebrities and athletes impact this conversation around mental health?

Karen Johnson:               To hear celebrities and [00:11:00] elite athletes like Simone Biles and Naomi Osaka, and Michael Phelps to name just a few. There’s so many others who’ve come forward to have them take a stand and speak to their challenges and in some cases, their demons is really, really courageous. And I think about the courage that it takes to say, “I can’t perform at the expected [00:11:30] level that others have known me to perform at.” You don’t hear about a need to be courageous to talk about a medical illness in the same way. And so first I have to commend these folks for speaking out and speaking up, more importantly.

I think that they drive a conversation that allows people to see that even athletes at this level, even other celebrities can struggle [00:12:00] with what I might be or what somebody I love struggles with. And it allows it to be a more normalized conversation and that the message is critical in that they’ve all said, “It’s okay for me not to be okay.” And if that’s the words that other people can hear that allowed them to speak up and obtain critical health care, [00:12:30] then I applaud their statements and am confident that it’s going to lead to more and more care being provided. And at the very least, a lot more outreach by those who love them.

Chip Kahn:                        In terms of identifying potential suicide, Congress recently passed a new phone number for suicide prevention making it easier for those who are having a crisis to get in contact for help. How [00:13:00] has this reform impacted mental health?

Karen Johnson:               This is one of the most exciting developments in the arena of mental health care and suicide prevention than I’ve seen in my career. The use of 988 is going to be America’s first three-digit mental health crisis line. And it is so awesome to have this be dedicated to addressing those individuals in a mental health [00:13:30] crisis. I think it means, quite frankly, it means a greater focus on access and a greater parity and greater equity when it comes to those individuals suffering from mental health.

I believe it’s going to provide more equitable access to life-saving care, creating a better and broader safety net across the country. And right now even though we’re waiting until July of 2022 [00:14:00] for it to be fully implemented, if you call 988 today, you will be connected to the National Suicide Prevention Hotline, which is an extraordinary step in the right direction for someone who needs this assistance.

I think also it will create mobile crisis teams and managed through crisis centers across the country. Currently 911, Chip, as you may know, is the first response [00:14:30] to obtain care and who responds but the police. And the police are extraordinary partners in the initial identification of and in response to the crisis. This change will allow trained crisis response teams and crisis response individuals to be the first line of response as opposed to the police being the first line. And it changes [00:15:00] the way that folks will be able to get to care as opposed to the first response being potentially perceived as some sort of criminal behavior, which is often what the police are called in to respond to.

So I think that this is just an incredible opportunity for us as a nation to identify that there are specific and special needs that are and trained individuals who can respond and [00:15:30] should be responding to folks in a suicidal crisis or in another mental health crisis. And this is the work of our partners in the National Action Alliance who are working diligently to be ready for that first go live date in 2022. But I would say again that if anybody were to be calling the 988 number, now the 988 number is routed to the national [00:16:00] hotline for suicide prevention.

Chip Kahn:                        Clearly through our conversation this afternoon, this issue of getting connected and staying connected has been a theme. We just were talking about in a sense of the worst case when someone is having feelings of suicide. What’s your view of the advances in telehealth and other kinds of therapy hopefully to avoid ever having to use the 988 number?

Karen Johnson:               I think that there are [00:16:30] significant opportunities with all the technology that is available to us today. And that there are other ways through digital applications and telehealth to create that connectedness before a crisis and that’s an important first step. And I think that if anything helpful that has come out of COVID, it’s the ingenuity and the innovation of our technical partners, as well as the federal [00:17:00] government and immediately being able to stand up telehealth operations to support those who may need care and they hadn’t identified it yet.

Or as in our case last year where we were able to develop and utilize telehealth to continue the care that people were already receiving when states were shutdown for other procedures or other health care operations. And so [00:17:30] to me, telehealth has been also another life-saving opportunity. And I am excited to see its broader adoption because this is now become a significantly more comfortable way to communicate and to stay connected than it ever has been.

Chip Kahn:                        Karen, Thank you so much for your time and most especially for your service. How can people connect with you and learn more about the Alliance?

Karen Johnson:               [00:18:00] Wow, thank you, Chip. I so appreciated the opportunity to have this really important conversation with you today as well. To reach the Action Alliance, their website is www.theactionalliance.org. And to reach me, my email address is [email protected]

Chip Kahn:                        Great, really appreciate everything.

Karen Johnson:               My [00:18:30] pleasure.

Announcer:                      Thanks for listening to Hospitals In Focus from the Federation of American Hospitals. Learn more at fah.org. Follow the Federation on social media @FAHhospitals and follow Chip @chipkahn. Please rate, review and subscribe to Hospitals In Focus. Join us next time for more in-depth conversations with health care leaders.


As Senior Vice President and Chief Clinical Officer for the Behavioral Health Division of Universal Health Services, Karen Johnson is responsible for the management and oversight of clinical operations and regulatory practices for the company’s approximately 200 behavioral health facilities across the United States and Puerto Rico. She interfaces with accrediting organizations and leads the clinical staff in the development and implementation of best practices to ensure that quality and safety, including outcomes measurement, are primary initiatives in each organization.

Ms. Johnson represents the company on the Health Systems Corporate Liaison group with The Joint Commission and the Quality Committee of the National Association of Behavioral Healthcare (NABH). She serves on the Executive Committee of the Action Alliance for Suicide Prevention leading the implementation of Zero Suicide in UHS facilities while also serving on the Transforming Health Systems component of the Alliance. Ms. Johnson is a frequent speaker on behavioral health topics on various industry platforms.

Ms. Johnson has held corporate-level leadership positions in Clinical Services since 1999. Prior to that, she served as hospital administrator in freestanding psychiatric facilities in Chicago.

Ms. Johnson holds a Bachelor’s degree in Music Therapy from the University of Wisconsin and a Master’s of Social Work from Loyola University of Chicago.

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