Steve Ragusea, a long-time psychologist friend, keeps reminding me that “clinician burnout” is a major public health hazard in today’s healthcare environment. The National Academy of Medicine’s report “Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being” fully supports his view, finding that between 35 and 54 percent of the nation’s nurses and physicians have substantial symptoms of burnout, with between 45 and 60 percent of medical students and residents reporting similar concerns. Their underlying conclusion: “The high rate of clinician and learner burnout is a strong signal to health care leaders that major improvements in the clinical work and learning environments have to become a national and organizational priority.” We would wonder, however -- what have these dedicated clinicians been doing proactively to take care of themselves? Health care providers represent the educated elite of society. Yet, could they learn from the experiences of colleagues such as Mike Sullivan (formerly of APA) and Dale Smith (Professor of Military Medicine & History at the Uniformed Services University)?

Volunteering for Meals on Wheels. I am writing this update on Martin Luther King, Jr. Day in 2020, which marks the 25th anniversary of its being the only federal holiday designated as a national day of service. “A day on, not a day off” aims to encourage Americans to volunteer on this holiday to improve their communities. I am most fortunate to be able to do this as my part-time unpaid job in retirement. I deliver Meals on Wheels four days a week at lunchtime and enjoy it. I’ve been doing this for 13 years, which was as long as I worked for APA’s Practice Directorate. It’s been just as fulfilling for me as my paid work there was.

The Meals on Wheels program offers volunteers many benefits, of which I would like to mention four. First, it provides the chance to give back to others. Marian Wright Edelman’s observation that “service is the rent we pay for being” has always been a personal aspiration. Meals on Wheels gives volunteers the opportunity to serve others who are in need. Delivering a meal is a small thing, really. But at the same time, it is a big thing because feeding the hungry is a noble calling. Doing it gives meaning and purpose to one’s life.

Second, the Meals on Wheels program makes it easy to volunteer. Volunteers don’t have to buy the food or cook the meals or package them. All we have to do is pick up our meals and deliver them. Third, the Meals on Wheels program makes a big difference in the lives of so many elderly, frail, and homebound seniors. Volunteers see this firsthand. Getting a hot meal every day saves many people from going hungry. It makes it possible for some homebound persons to remain in their own homes rather than be institutionalized. It gives many isolated elderly people daily contact with another human being.

Fourth, the Meals on Wheels program gives volunteers a chance to get to know their communities better, and to do other helpful things. For example, my wife Susan was delivering meals to an endearing lady named Louise who lived on a street with three abandoned houses.  The vacant buildings were an eyesore and a safety threat. Susan made persistent calls to the city government and got all three houses torn down. One of Louise’s neighbors then planted a vegetable garden there. On one of my routes, a very bright man named David had been down on his luck for years. He was estranged from his family. He was trying unsuccessfully to subsist on Social Security of $511 a month, far below the federal poverty level. I was able to help David increase his income by almost $3,000 a year. All I had to do was print out applications for benefits programs he was entitled to but not receiving. That extra income afforded him more dignity and less hardship.

Being in a position to do extra things like these is all due to local Meals on Wheels programs. Senior Resources is the non-profit organization in Columbia, South Carolina that operates my program. Each year their volunteers deliver almost 170,000 meals to over 1,000 clients, driving over 55,000 miles. These are remarkable numbers for a small city, yet funding shortfalls mean there is always a waiting list to receive meals. Nationally, the crisis is alarming with 5.5 million seniors being food insecure and often socially isolated and financially strained.  I recommend the Meals on Wheels program as a volunteer opportunity to anyone who can spare a couple of hours once a month, or once a week, or more. Truly, “It is better to light one candle than to curse the darkness” (the Christophers)” (Mike Sullivan).

A few months ago, I asked another friend and colleague at USU, Dale Smith, to coffee and he declined “because he was to be in prison that day” – a response which begged further inquiry. Dale told me he participated in a Christian Interdenominational ministry program called Kairos and went into a local prison twice a year for a long weekend to provide this ministry. I was intrigued and asked for more information: did they stay the whole time, what was the nature of the program? Dale told me of Kairos International and its local branch, Kairos of Maryland.  Kairos is an international program that started in Florida in the 1970’s; it is now in over 400 correctional institutions in 36 states and nine other countries. It has three components: Kairos Inside (a four-day intensive ministry in the prisons -- the volunteers go to a local motel each night). Kairos Outside for the spouses of those incarcerated; and Kairos Torch, a one on one mentoring program for young (under 25 of age) offenders to help them reintegrate into society.  It has 13 staff members and approximately 30,000 volunteers who contribute over three million hours of service each year.

The central theme of the ministry is “Listen, listen, love, love” and centers on the idea that most prisoners are isolated and feel abandoned. By listening to their concerns and affirming by their presence that the individuals are loved by God and their fellow man. The goal is to build a transforming community in the prison thru Kairos alumni joining a weekly, prisoner run, meeting called “Pray and Share.” The “Prayer and Share” sessions have outside volunteers as guests of the prisoners to continue the theme of “Listen, listen, love, love.” Does it matter?  Dale tells me that wardens in multiple prisons have affirmed that as the Kairos Christian community inside a prison grows and begins to gain influence, the incidence of violence decreases. In a study of 505 inmates released from Florida prisons, the recidivism rate was only 15.7% among those who had participated in one Kairos session, and just 10% among those who had participated in two or more Kairos sessions. The non-Kairos control group in the study had a recidivism rate of 23.4%. In Maryland, where the state is having great difficulty in recruiting and retaining correctional officers, the Kairos of Maryland program in 10 institutions for both men and women is building pro-social character and behaviors and changing the community.

I cannot help but wonder if those who find themselves feeling increasingly overwhelmed by the day-to-day pressures of their current employment environment would take the time to reflect upon what is really most important to them – perhaps by becoming engaged in meaningful volunteer activities such as those described above by dedicated colleagues – that the reported rate of clinician and learner burnout would be significantly lower. Randy Phelps, another former senior staff member in the APA Practice Directorate, is now the CEO of Give an Hour. By the end of last year their licensed mental health providers had topped 300,000 hours of free mental health services (valued at $30 million) for Veterans, military personnel, and their families. In 2015, they expanded their services to address the mental health needs of other populations including at risk teens, survivors of gun violence, and those affected by natural and man-made disasters. There are clearly many opportunities for those colleagues willing to reach out and address society’s pressing needs.

The National Academies of Sciences, Engineering, and Medicine (NASEM) released its workshop proceedings Multigenerational Approaches to Fostering Children’s Health and Well-Being: The Opioid Crisis as a Case Study at the end of last year. “The opioid crisis affecting countless families throughout the United States has caught the attention of groups spanning the sectors of health care, education, social services, criminal justice, and even business and labor.  According to the Centers for Disease Control and Prevention from 1999 to 2017, more than 700,000 people died from a drug overdose. On average, 130 people die every day from an opioid overdose in the United States. Within these average numbers, certain populations are being affected more than others. According to the National Institute for Children’s Health Quality: ‘The crisis is especially prevalent in rural and economically disadvantaged communities where poverty is associated with poor physical and mental well-being, health access is limited, opioid prescription rates are higher, and treatment programs are few.’ Children are one of the most vulnerable populations caught in this public health crisis, as a growing number are sent to live with other relatives or placed in foster care following the death of a parent or a parent’s inability to continue as a primary caretaker while in recovery.”  For those colleagues who take the time to reflect, they will find that there are numerous venues where they can contribute their needed skills.

Reflections from the Past: When I became President of APA in 1987, several major problems were facing us. One of the most important was that having assumed ownership of Psychology Today, we were fast approaching bankruptcy. In dire financial straits, we decided to sell the magazine. We went further to sell our buildings and begin the search for a new building site. We found an excellent location where our magnificent building now stands and acquired another building close by.

At that time, many of our officers and members believed the governance system of APA to be inefficient and outdated. For several decades, various Committees and Task Forces had proposed new models for reorganization, all of which had been met with failure. A new working group was formed and delivered yet another proposed model of governance for APA, a federation model. Most science-oriented members of the Association supported the proposal but practitioners were opposed. The plan failed when put to a vote by members. Disappointed by the outcome, many academics and psychological scientists left APA and established what is now APS, the Association for Psychological Science.

I proposed the first Opening Ceremony of our Convention. I would regularly hold meetings to try to establish more positive relationships with our counterparts such as Psychiatry and Nursing. I represented APA in various capacities including international meetings. I testified before Congress for increased funding for psychology and the social sciences and for increased attention to and support of efforts to combat the AIDs epidemic. I marched with psychologists and allies in one of the earliest demonstrations for LGBT rights. I proposed a Task Force on Women and Depression. Excerpts from the findings were printed on the first page of The New York Times as well as across many other newspapers. Task Force members appeared on major television shows. Media coverage was the most APA had ever received and a book covering the work of the Task Force was published. During that time, women and minorities were underrepresented in APA. Perhaps the actions for which I am most proud, were my overall efforts to recruit and maintain more women and minorities into the Association and the governance.

Being President of APA was both exhilarating and humbling. Members of APA appeared to support me, and it was a delight to work with the officers and staff of the Association. I made close friends and enjoyed meeting psychologists from other nations and other mental health organizations. It was a busy and exciting year and I will be eternally grateful for the opportunity to have served” (Bonnie Strickland). “Your dreams come true.”

Aloha,

Pat DeLeon, former APA President – Division 29 – February, 2020

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