Welcome to ACL in Action, brought to you by the Association of California Nurse Leaders. I'm your host, Charlene Platon. Our guest today is Jeremy Fishback, founder and chief executive officer of Happy, a peer-based mental health service whose mission is to create a more supportive culture by expanding access to mental health care and teaching and inspiring people to better emotionally support each other. Thank you so much for joining us, Jeremy.

Thank you for having me, Charlene.

Yes, and I'm so excited about this topic and your work. I think that what we're going to talk about is something that's really near and dear to my heart. And I just want to first start with learning more about Happy and what inspired you to start Happy and what is its mission. I just want to learn more.

Yeah, so um thank you for the intro and for all the amazing work you do. Um Happy's calling card is frictionless mental health. We obsess over removing obstacles that prevent nurses and other frontline workers from getting the support we need. We don't prioritize removing these obstacles. We literally obsess over it. And uh the the we are reaping the fruits of that obsession. Um, you know, I'm happy to give you a little bit of the origin story because I think it will frame it. Does that does that sound good?

Um Yeah, absolutely.

Yeah, so um happy started in a very ordinary place um a few years ago. Um I I have a background in in psychology, neuroscience, law, but um, not sure any of that really relates to this. Um I'm sure some of it does, but really happy began with uh a mundane personal event. I went through a divorce a few years ago, knew I needed support, knew there were two places to get it, namely my primary support system, family, friends, et cetera, where we get 99% of our mental health support in life, and then secondary support, like therapy. And happy's born out of the failure of both of these systems in rapid succession. And my primary support system failed first. Um, that looked like nine out of 10 calls going right to voicemail. And if I actually reached somebody, they had no idea what to say to me beyond something like, you know, I told you not to marry that woman. And that was um almost as depressing as the divorce itself, just realizing that I don't really have a primary support system or an effective inner circle. And I did what a lot of people do, Charlene. I sucked it up. Um, and then I started noticing that um I was doing a lot of unhealthy things. Um, I had occasionally smoked in my life. I started chain smoking and I never really drank. I started having, you know, a drink a day. And then I started having dark thoughts, not suicidal thoughts necessarily, but perhaps cousins of them, like who cares if I die of lung cancer? And I really hadn't been in that dark of a place in a while. And I decided enough is enough. I will try therapy, which you know I had tried in the past. And that failed for the reason that we call friction. Namely, it takes 15 to 20 steps to get support. You know what these steps are, Charlene. And all nurses, whether they've been in therapy or not, will appreciate that to get support, you need to be struggling. You need to be aware of that, which most people are not, because we don't bleed when we're anxious and depressed. Most people aren't even aware they're struggling. You have to know, you typically have to reach a breaking point, like this is enough. I can't deal with life anymore. You have to research available resources, connect your struggle to a particular resource, typically download an app, go through registrations, make an appointment, wait sometimes weeks for an appointment. I waited, you know, two months before I was actually seeing a therapist. And she gave me emotional support mostly for, you know, 50 minutes, interrupted me to tell me my time was up. And at that point, I just said, enough is enough. Um, there has to be a better way to do mental health than the way we're doing it. And I and I'll leave with just the series of questions that I asked myself as we started to build this company, because they really form the philosophical foundation of happy and also I think can frame our whole conversation about mental health. So the first question was: is there a single person on the planet who thinks that the way we're doing mental health, is there a dream version of mental health? Literally one person who says, I love registration requirements, I love downloading apps, I love getting support weeks after I actually need it. And I thought, probably not. Um, and then second was, well, what would be the dream version of mental health? And for me, it was very simple. It was, I want my friends and family to check in on me. And when I acknowledge that that will never happen, the last couple of questions were first just, well, what would be the next best option? And for me, that was simple. Um, I want somebody like my friends and family to check in on me. And the last question I asked her was, what do you want them to say to you? And it kind of broke my heart, Charlene, because I thought nobody's ever going to say this to you. Uh, but what I wanted to hear was something like, hey, Jeremy, just a call coming into my phone that I had to do absolutely nothing to initiate, saying, I'm here for you. Um, you're not alone. I'm in your corner. I've got as much time as you want, today, tomorrow, whatever's going on in your life, I want to hear it. And I'm not that person who's here when you need me. We never reach out to those people or rarely. Um, I am here if you need me, but if I don't hear from you, you're gonna hear from me. And while I can't promise life won't be a struggle going forward, because it will, whether you're a nurse, lawyer, uh Happy serves a lot of soldiers and airmen in the Department of Defense, life is tough, but getting support doesn't have to be tough. And I wanted to hear somebody tell me that going forward, all that struggle is going to be on my shoulders, as in the the person providing support. Um, all you have to do is answer my call. And with that, Charlene, we kind of had the blueprint for this proactive, peer-based mental health resource that I'm happy to elaborate on. But that was the um the thinking that led up to it.

Yes, thank you for sharing your story, Jeremy. I just want to acknowledge that it's not a an easy journey whenever there are struggles for our mental health. And that can look like so many different things. And I think that what you highlighted with your story is actually reflective of a lot of barriers that people encounter when they try to find support for mental health or well-being support of any kind. And what you said really resonated where you really have to be at a breaking point for many people to be motivated enough to go through all those hurdles, right? Like 10, 20, 30 hurdles before you actually get the support. And then when you actually reach that point, it might not even be helpful, as you had demonstrated, as I have also personally experienced and I've known from many different people. And it sounds like Happy's model really differs from what we know about traditional mental health services because of this proactive type of approach and what you described as removing the friction to these um health resources or mental health resources. And so, can you can you talk a little bit more about how Happy's model is different in that way or how Happy actually does have this more proactive model? I'm super curious. And it's really, really interesting to hear about just because traditionally we just know the opposite, right? Where the one who is the person who is experiencing these challenges has to be the one proactive.

Yeah, no, of course. And and and look, you know a lot of the research that's coming out as we speak, identifying extremely high rates of um nurse depression, anxiety. I mean, the study I recently saw, two-thirds of nurses um are have experienced depression very recently. Um, the vast majority, uh, you know, over 90% do not think that their mental health is being either prioritized or effectively addressed through their existing employee assistance programs. And and nurse retention continues to be a huge issue. So I'll start with the with the with the, I guess, humble observation that existing solutions do not seem to be working. Um and yet we keep proliferating just more and more of the same solutions that aren't working. Um, let me give you an example to illustrate how happy is is very different, you know, and for better and worse. I'll say for worse, because when you do something very differently, it takes a little while for people to get comfortable with it. But um, if um you take a hospital, okay, so we're rolled out now with one of the largest hospitals in the country, and let's just say it's a thousand nurses. Um until now, um, if I'm a human resources director, maybe a CNO, like the way if I care about mental health that I'm going to act on that and really try to help my nurses in many cases is here's a digital app that offers, you know, either self-guided, you know, meditations or uh reflections, or if you really take enough steps, you may eventually get to a therapist. But a lot of these apps are designed to make it difficult to do that. Um, and really the idea is you you as a nurse should be able to just deal with this on your own through a lot of these steps. And I would just make this app available to my nurses. I might promote it and say, hey, you know, for those of you who are interested in mental health, you can do meditation here, you can answer some questions, et cetera. And we know from the data that, you know, two, three, maybe four percent of employees will eventually use that app. And and despite the fact that 50 or 60% or more are struggling. And so you might ask, Charlene, um, why is that so? And we would say, uh, friction. It's very simple. Um, literally go to a whiteboard and write down every step somebody has to take to get therapeutic support, and you're gonna, uh, it will no longer be a mystery why almost nobody is using it. So Happy has a completely different model. So when we go into an organization like uh one of the largest hospitals in the country or the Air Force or the Army, we get a list of every single person in the organization. Um, so part of Happy, part of Happy's model is we call it universal eligibility, which means that we assume everybody needs a service. Um, and then we build a team of our providers. Uh, we call them support givers. These are individuals who are non-cl are providing non-clinical support, but have in many cases um extensive backgrounds in healthcare and caregiving as nurses, as social workers, case managers, crisis line managers, people who have backgrounds in healthcare. Um, so we build a team, and then that team, Charlene, proactively reaches out to, checks in on, and provides unlimited ongoing support to every single member of the organization every single month. So we, in the case of this hospital, are proactively checking in on every single nurse every month. And um if nurses do not want to receive the support, they can affirmatively opt out. Um, but they do not have to take any steps. So that means Charlene, if you are a nurse in this hospital, um, you would get a call from somebody a lot more emotionally supportive than me, saying, Hey, Charlene, um, it's Jeremy calling with happy. Uh, we know it's been a long couple years, want to see how you're doing. As you know, you know, we provide confidential support. It's unlimited. And um, how are you? You know, and because the people doing this are uh a lot better than I am, we see the highest adoption rates of any mental health service in the country. Um, a typical EAP may have two, three, five percent um happy and similar models, um, I'm sure, have um very high adoption rates compared to that, almost 35% um to 40%. Um, and a lot of other um outcomes we can discuss, but I'll just say um for you to get that call, Charlene, just to illustrate what we mean by fruit frictionless, you did not need to be struggling. That means we are actually doing preventive mental health. Okay. If you were struggling, Charlene, you did not need to know that. Okay. We're not depending on you to know that. You did not need to conduct research, you did not need to check your benefits, you did not need to register, you didn't need to download an app. Okay, you did not need to opt in, you didn't need to make an appointment, you did not need to wait for an appointment, you didn't need to worry about confidentiality. We don't record calls. Um, you didn't need to pay any money, you didn't need to worry about how much time am I staying on because you have unlimited time. And that's what we mean by frictionless.

Yeah, that's great. And it's so refreshing to hear about the different um challenges that Happy is targeting because that is such a disruptive, different model than what many people might be familiar with. And I I know that you mentioned with the support givers that Happy has, uh, they might not necessarily be clinical, but they it seems like they have a lot of the a lot of them do have a health-related background or healthcare related background. And one of my questions too, if someone is interested in in utilizing Happy, is there uh any specific type of, I guess, mental health challenges that Happy does um the best in supporting, or is it really like a wide range of things? You know, what's like the best kind of um I guess target if there is a niche, or is it just really broad?

It's pretty broad. The the only handoffs that we do are for suicide um or you know, homicide, uh that that mostly comes up when we work with um the Army and the Air Force. Um, but no, I mean, look, the service we're providing at the end of the day, if you want to look at just what happens once we begin a conversation, you can call it emotional support. Um, it's the essential ingredient of mental health for most people. Um, it's the common factor of almost every effective therapeutic practice, as in you can't really do psychotherapy or CBT without a lot of listening, acknowledging, validating struggles, encouragement, compassion. Um, and we just say, like, we just call it out, like that that is what our focus is. And it happens to be one of the most effective antidotes to isolation, anxiety, depression. So in our partnerships, um, we we partner with some of the largest health plans in the country, too. We are specifically sent individuals who have been already been diagnosed with, you know, anxiety or depression. But in the example we gave, or I'm calling you, we're also um a great resource for people who are doing fine. So, in a typical week, Charlene, just with respect to nurses, um we may reach a nurse who is having an amazing day, and um, and we are there to to keep them in a positive state of mental health and well-being. And we may reach a nurse who 24 hours before tried to commit suicide. Um, so it's really the full range.

Yes, that's great to hear about. And I wonder too, is there any sort of matching system? So if one if someone wanted to talk to the same support giver, is that a possibility as well? Because I know in therapy you might be matched with the same person, but yeah.

Um there's a a high degree of likelihood it will be the same person. Uh, we we support continuity of support. So typically the the support giver who initially reaches out to you um is going to be the same person supporting you throughout um the partnership. Um I'll answer, come back to another question you asked, Charlene, which is just, you know, these are non-clinical providers. Um, it's it's really non-clinical support. Well, let me just start with one detail I left out, which is when we um started this initiative, which was kind of um initially orbiting around the Princeton Psych department, we surveyed a lot of people and asked them a crazy question, which is what do you want with mental health? Including many, many nurses and doctors, a lot of um active duty military veterans. And mostly what we heard people say is, I want my friends and family to check in on me. Um and that probably isn't gonna happen in the absence of that. I want somebody like my friends and family checking in on me. So again, we um took that to be the blueprint for this two-part solution, you know, something that feels more peer-based and not a psychiatrist or psychologist and this proactive engagement model. So we we um have tried to give people what they want. And when I'm reaching out to you, you may not even know that that I have um a clinical background or a background in nursing, social work, et cetera. It's gonna feel like just a peer to you.

Yeah, that's great. And and I know that in in speaking of the peer support, I know that Happy has several peer support workshops. And can you explain a little bit more about those peer support workshops? And, you know, do participants need um training or qualifications themselves, or um what are what are the things that are taught in those workshops?

Yeah, so um I'll I'll I'll just highlight that the um the main service, frictionless mental health, is what I just described. It's it's these monthly check-ins and ongoing support that we provide um to every employee who doesn't opt out. In addition, we've been asked by some of our organizational partners to conduct um you can call them monthly happy hours, where you know, we're now partnered, for example, with the American College of Emergency Physicians. So this is actually for almost all medical personnel. And in these more group dynamics or group sessions, um, we have facilitators and we really allow members to connect with each other in a little bit of a more intentional way. So it's not gonna feel like um a cocktail party. It's gonna be um, yeah, we're really teaching people how to provide this support themselves and get comfortable opening up as well. I think people need to develop skills both in receiving support better and providing it. So, you know, this is not something that all of our partners choose to do, but I think the ones who do find it that at least some of their employees or members uh get a lot out of them.

That's great. Thank you for sharing about that. And and you know, I do want to go back to uh what you shared in the beginning too with Happy's origin story. And you spoke to the high amount of depression and anxiety and burnout among nurses, and and there's a lot of contributing factors to that, especially more recently. But what, in your view, do you feel has been um has have been those factors that contribute to this current mental health crisis that our nurses and healthcare workers are experiencing?

Yeah, I mean, just just from the thousands of nurses that we support. I mean, you you know this, Charlene. I mean, I would say um toward the top of the list is just this is a difficult profession. Um it can be thankless. Um, it can be thankless because you you oftentimes do not get a lot of gratitude from other colleagues, from doctors. Um I would say, even though um, I'm not sure how we could possibly fix this, I think a lot of nurses um are quite disappointed in the lack of gratitude they get from even patients. Um that's not you know the the case all across the board. But I think just the profession is hard, right? COVID adds, um, you know, it obviously exacerbates everything. Um, but but I would say um, you know, beyond just, you know, since COVID, I think most nurses we talk to feel that it's in the past, I think that a large part of the ongoing struggle is with um a nurse's perception that the hospitals that employ them um are either just giving lip service to mental health and well-being or are actually investing in solutions that simply aren't working. Um and that's our perception, too, is that a lot of the digital apps in particular that that have proliferated recently, they're not really focused as much on um improving nurse mental health and and retention. They're really Talent acquisition tools. You know, you need to be able to tell a nurse when you hire them, we offer this, we offer that. But when year in and year out, you know, these EAPs, whether they're traditional digital, fail to break, you know, 5% adoption rate, you know, it's hard to argue with a nurse who just, you know, is showing up at work long hours day in and day out, saying, you know, I'm giving 40, 50, 60 hours of support this week. I can't even get one myself, you know, and back to the origin story, a lot of these nurses, and this is not the fault of a hospital or any health system, are not getting support at home. You know, they're not getting support from their primary support system and they're not getting support at work. Um, they're failing to get uh access to therapy or, you know, through digital apps or an EAP. And they're just left with a wildly imbalanced ledger of support. And when we come in and and you know, do our uh, you know, just I guess just marketing and education, you know, that's a lot of our message is we're just trying to even the balances a little bit.

Right. And I wanted to ask too, with uh with the work that you all have done at Happy, do you have any notable outcomes that you'd like to share or any interesting types of results that you've seen from sharing Happy with a group that traditionally hasn't really sought health, you know, mental health services or resources or might be reluctant to seek those services?

Yeah, I mean, number one, the highest adoption rates of any mental health service in the country that that publishes its data. I'm not talking about uh, you know, a meditation app or anything like that, just you know, therapeutic level or clinical level, you know, support. Um, in a typical rollout, we see, you know, 35 to 50 percent adoption. So um 10 to 20 times a typical employee assistance program, which again is not surprising given that we make it easy, um, even frictionless for somebody to get this support. Um, just imagine a call coming into your phone or a text that you've had to do nothing to initiate. So that's number one. Number two, when we measure the impact of happy on isolation, anxiety, depression, we see almost the exact same outcomes that you would see from a traditional therapist. And that's because um a lot of what we're providing is very similar listening, acknowledgement, compassion, encouragement. And also we don't have any constraints on the amount of support we can provide. So if Charlene, you come, we we find you in a difficult state, you need five or 10 hours of support instead of what a therapist would do and say, okay, Charlene, we're gonna see you 50 minutes now, next week another 50 minutes, um, the week after that. You know, we can just give you all the support you need right now. And that tends to make problems go away more quickly. Imagine you're in the ER and you know, you show up with a broken leg. It would be preposterous. Um, you you would be um floored if they said to you, well, we're just gonna spend 50 minutes, Sherlene, you know, conducting an X-ray, but then, you know, next week we'll we'll spend 50 minutes looking at the x-ray. Then the week after that, we'll we'll decide what to do with it. No, I mean, we we need to like treat problems as quickly as possible. Um, and that's what Happy does. Um, the third thing, the third outcome, I would say, is um uh a significant impact on turnover. So with one of the largest hospitals in the country, um, in the first six months, this is a completely new resource that people are just finding out about. Uh, we saw around a 35% reduction in turnover that this hospital was unable to attribute to anything else because it began, that reduction began the exact uh week that we we launched with them. Um, and the last thing I'll say is, um, and I'm happy to share this, you know, in the podcast notes, um we get an unprecedented amount of workforce intelligence. Um, a lot of what's driving this um reduction in turnover, we think, is just that when employees feel much more emotionally supported, they're less likely to leave the job, right? It it it's it's really simple. But also, um, because we have such high adoption rates and because um we're a non-clinical service, we create for every every partner, whether it's the Air Force or a large hospital, a 24-7 real-time stream of the mental health and morale of the workforce. Um, there is no data set like this. Um, and then we typically meet with our health system partners weekly, um, whether it's a CNO or somebody else to review the data. We're able to, you know, identify problems very early on, um, discuss preventable stressors, really coach our, you know, our partners in, you know, looking at um the their the health system in a much more granular way, who needs support, um exactly in which department, et cetera. So we work really closely with our partners, not just providing support to employees, but supporting and helping to collaborate with um directors as well. So we can, you know, work um, yeah, to just collaboratively to build a more supportive culture.

Those are amazing results. And you you're right in that we don't have a lot of data points when it comes to the workforce utilization of a lot of these resources, right? Because even if we might offer apps or other things, it could be really hard to understand the utilization of those different resources and how helpful those are to the workforce. And in if uh for those who are listening who are healthcare leaders and they're interested in offering more services to support their nurses, um, beyond um offering these types of mental health services like Happy, do you have any other thoughts for what healthcare uh leaders or employers can do to better support nurses and um support their mental health and resilience?

Yeah, I mean, I'm glad you brought that up. I mean, obviously I'm focused day in and day in day out on partnerships, but really we we think about this from a much more um academic perspective too. We're writing, you know, a thousand-page textbook now on just how to do better at building a supportive culture. And a lot of that is what you're talking about, where we are helping to coach directors and leaders on um, I would say the main thing we think directors can do, CNOs, is um take the time to learn themselves and to really promote a culture of education within the health system about just emotional support one-on-one. Just let's go down to good, let's go back to the basics and remember how to listen to each other without interrupting, um, how to provide non-judgmental support, um, how to encourage people, how to really get dialed into the goals and objectives of everybody and the um, you know, all the staff so that you're you're able to encourage them. Um, and you know, this is very difficult to do. I mean, I think ultimately a hospital has a will have a very hard time providing all the support its nurses need and doctors and also, you know, run the hospital. Um, it's a very tricky thing to do, but I absolutely think there is a lot that um chief nursing officers and other directors can do at the margins to just make every interaction in a hospital between staff could be um, you know, you you could rank it on a scale of just how supportive is this interaction. And when we talk to our and observe our partners, we see um abundant room for improvement. And and you know, it takes the same amount of time to cut someone down as it does to lift them up. Um and we just, you know, that that that that's part of what we do too, is just provide and certainly encourage um our partners to um just dial up the supportiveness of every interaction.

Yes, and I'm sure that you've heard of this before, but there is a uh a strong tendency for, or at least there has been a strong tendency in the past for nurses to eat their young, or, you know, for um people in the healthcare culture to not always be as emotionally supportive. So uh I truly appreciate resources like Happy and what you're all doing because it's it's really an overhaul of what we've learned for so many years, how we've been trained and kind of helping us to reprogram how we support each other as healthcare workers. And I think that's really powerful.

Well, where does the eat your young come from? Well, what's your sense of that? I know we don't have much time left.

Yeah, yeah. It's a part of our culture of medicine. I think that because historically a lot of these uh topics that we're discussing, just like being vulnerable, seeking support, seeking emotional well-being, those aren't things that we're taught or trained or you know, about or that we learn in any part of our process when we become clinicians and healthcare workers. There is this unspoken expectation that you don't need help or that you don't ask for help. Otherwise, you could look weak or you could look, you know, you could look differently or negatively in in um, you know, in light of your other coworkers. And I think uh that in in terms of uh is just one piece of how our culture has been historically in the healthcare system. So for many years, I'm I mean, including in my own career, it was never a conversation. Uh I think most of the conversation more recently has been a result of the of the global pandemic that we've experienced. Um, I think it it drove those conversations to happen more frequently and more regularly. But before that, it really wasn't a conversation. So uh, and there's there's many different um pieces to that, but a lot of it does stem from our culture.

Yeah. Well, you know, when you look at the ridiculously high rates of nurse mental health issues and dissatisfaction with resources, I think, you know, I'm glad you you mentioned that, Charlene, because I think there's there's a lot of arguments for wanting to shift that culture. Although I'm sure it's had many benefits, we we fail to appreciate. I think, again, I I always come back to this simple line that just it takes the same amount of time to uh cut someone down and and lift them up. And like what what benefit really do we have by you know not being supportive? Like what are the what's the real ROI of that? Um, but it does it does take an intentionality and uh anyhow.

Yeah, absolutely. And and that's an interesting piece too, because you don't measure that ROI, right? For um behaving in that way. Um, but when you lift someone up, that's also there's a lot of room for improvement for measuring that ROI as well. So it's really exciting to see what you're doing, Jeremy. Uh, I know that we're coming to the end of our conversation today, but were there any final comments that you'd like to make for our listeners?

No, I mean, just um if anybody's listening, you know, I'll just say we do a lot of work with the military. Um, but um I think everybody listening deserves a whole lot of gratitude for their service. Um, and that that's mostly um my closing sentiment to just deep gratitude for um incredible work, incredibly hard work, oftentimes incredibly thankless work. And um, you know, we happy is out here, and I am out there um just humbly doing what we can to um even the balances a little bit, to make sure, you know, nurses are never going to get it's it's just a fact, as much support as they provide. They will never even get close. But I guess Happy's um thesis is that they deserve to get a little more than they're getting. And the only way that is going to happen is if we start pushing out resources, whether it's Happy or others, that make it very easy for nurses to get help and literally require them to do nothing. Um, they work hard enough as it is.

Yes, absolutely. Thank you so much for all that you do, Jeremy, and thank you for being with us today on the podcast.

Thank you very much, Charlene, for everything you do and to ACNL and Kim and the amazing people at the organization. And Jacob, let's just give a shout out to production.

Yes, absolutely. Thank you, Jacob, and thank you, Jeremy, for being with us.

Absolutely.

Our guest today was Jeremy Fishback, founder and chief executive officer of Happy. You can learn more about Happy at happythemovement.com. And we'd love to hear your feedback. Email us at social media at acn.org and connect with us on LinkedIn and Facebook at ACNL Nurse. And as always, if you like the show, please remember to rate, review, and share. ACNL in Action is presented by the Association of California Nurse Leaders with new episodes on the first Friday of every month. To learn more about the show or ACNL in general, visit us at acnl.org. Thank you for listening.