Episode 10 – Problems in Behavioral Health with Eric Isaacsen

Episode Summary

In this episode we spoke with Eric Isaacsen about his experiences in the behavioral health field, some of the problems in that area, and what you can do if you’re having issues you need help with.

To learn more about Eric, Google, "Muscle Cars With Eric."

Show Transcript

David Enevoldsen: All right. Hello, everybody, and welcome to the Emotional Embuffination podcast. I'm your host, David Enevoldsen and here on Emotional Embuffination, we are training to become emotionally buff enough to overcome any conflict in life. And just as importantly, it's about discovering new levels of success and happiness. This podcast is just one of a bunch of resources I have available. If you want to learn more check out the Emotional Embuffination website, which is embuffination.com. All right today, I get the pleasure of getting to interview Mr. Eric Isaacsen. And Eric is kind of a fascinating guy. He's, in my mind, a man of many hats and one of those hats, what I think is most relevant to the Emotional Embuffination stuff is he has been working for quite some time in the behavioral health field, dealing with all sorts of stuff there. So, Eric, first off, thank you for agreeing to come on and do the interview today. Just to start off, can you maybe tell me a little bit about your background? First off, when did you start working in the mental health field and what were you doing when you first started?

Eric Isaacsen: I started actually, I went back to school in 2005. The economy in Michigan was kind of going downhill and I was in car sales, so I wasn't generating a lot of revenue that, so I went back to school and I realized that I could study and get good grades. So, I went to nursing school and I graduated with my RN in 2009 and I got my first job in 2009 at a behavioral health facility in Michigan. It was a lockdown unit. We had, I guess what's the term criminally insane people that were there, they were there as a result of their crimes and they were deemed to be criminally insane. So, it was a lockdown unit. We had security guards and whatnot, and it was an eye-opening experience. But it was a very, very good experience for me, primarily because it gave me a chance to see people with the same diagnosis, but with totally different symptoms. And then from there I went to the federal government with the VA, and that was

David Enevoldsen: When you say that, you mean like there were different people that had the same diagnosis but were different symptoms between the two different people?

Eric Isaacsen: Yeah. Let me let me clarify that real quick here, if I can. For example, schizophrenia, you have negative symptoms and you have positive symptoms. The negative symptoms of schizophrenia would be like not taking care of yourself, not brushing your teeth, not wearing clean clothes. I mean, being very, very dirty and nasty. And the positive symptoms would be your auditory visual hallucinations, tactile hallucinations, olfactory, like smelling hallucinations and whatnot. And so you could have two people with the same diagnosis, schizophrenia, but they could each present with totally different symptoms. So, I found that to be fascinating, because when I went to nursing school, basically the medical model of nursing was if you have a heart attack, you do this, you have diabetes, you do this, you have kidney disease, you do this. But in behavioral health, I found there's no such thing as the X marks the spot. It's very diverse, it's very eclectic in nature, and there's a lot of different medications that do different things with different people. So, I found that to be very, very fascinating. And so that's what I kind like went after it.

David Enevoldsen: Is that what kind of took you into behavioral health as opposed to something else, because it's my understanding, correct me if this is wrong when you're a nurse or you have nurse training, in essence, you have a lot of different options in front of you. You could go work in an E.R., you could go work in the behavioral health field or a bunch of other places. Is that statement correct? I guess as a

Eric Isaacsen: It is very, very correct, yeah. And

David Enevoldsen: Is that what took you into this behavioral health direction as opposed to something else?

Eric Isaacsen: Yeah, our our behavioral health rotation was actually at the same facility that I got my first job at, and I was blown away, man. I was like, holy crap. And we're talking about these people are dangerous people. We would often times have 12 patients to a unit, but would have 12 staff members there because many of those patients were on what's called a 1 to 1 for either patient or staff safety. And I just found it to be absolutely fascinating. And so when I had a chance to work there after I graduated and after I got my my license, I jumped at the chance. And it was really cool. And I've been doing that

David Enevoldsen: This was back in 2005.

Eric Isaacsen: 2009. I started school in 2005, 2009, Yeah, 2009. And I moved around different facilities and I was kind of tired of Michigan. So in 2010 I took a travel nurse job to Arizona, which landed me here in Arizona. And I've been here ever since, and I've worked at a variety of different facilities because of my status as either a travel nurse or a registry nurse. Registry is like workforce. I work for a company, but they assign me to different facilities to do a variety of different jobs. Whether those jobs were outpatient, where I had a a team of nurses to work with and a team of doctors to work with. And I had a patient load three, four, 500 patients that I would have to see on a on a regular basis. And then inpatient units where people are there for one or two weeks, for several months or for many, many years. As a case with the Arizona State Hospital, I was stationed there as well. So, it's actually been a really interesting career choice for me and I learned an awful lot about it and I learned a lot of humility and I have a lot of good experiences with that.

Eric Isaacsen: A lot of my patients, I could relate to them. You know, like I mentioned to you, I was in car sales and prior to becoming a nurse, I was in sales for 23 years. And in order to be successful in sales, you have to be able to relate to people. Sure, I'm not a high pressure kind of a guy, I just relate to people and it was really cool. I could actually get my patients to laugh and joke around with me and want to be with me in the medical field. You can't really do that so much because you don't have enough time to spend with them. You're going from call button to call button to call button the call button, and they're in so much pain physically and in a lot of anguish that it didn't really work. So behavioral health, I thought, was a pretty good avenue for me to use my my personality and my my personal listening skills and and whatnot.

David Enevoldsen: So you started your training in 2005. You actually started in the field in about 2009.

Eric Isaacsen: Yes.

David Enevoldsen: Are you still working in the behavioral health field as a nurse?

Eric Isaacsen: No, I'm not. I actually ended up leaving a company. My most recent position was a staff nurse at a behavioral health crisis unit, which is the behavioral emergency room. And it was a very, very, very stressful experience. As a matter of fact, the last three years of my behavioral health nursing career were extremely stressful for a variety of different reasons. But the most having to do with the the increasing of the acuity. Acuity is like how difficult the particular patient's condition is and the acuity is going through the roof. And this this happened actually since the open border crisis happened a couple of years ago. And now we're having patients coming in, or I was, I'm no longer doing that now, which is nice. But coming in, strung out on a variety of different drugs, particularly fentanyl, was just they're coming in almost in a comatose type of a state. And they didn't really need to be in a behavioral health facility. But the behavioral health facility I was at was open door policy. So, they would let anybody in for any reason, whether it was behavioral health or drug-induced or alcohol-induced or whatever. So, the acuity was really, really, really tough. Really tough.

David Enevoldsen: Okay. So. So, you're not working in that field now?

Eric Isaacsen: No. Nope.

David Enevoldsen: And then how recently was your last I guess

Eric Isaacsen: It was the Tuesday before Thanksgiving.

David Enevoldsen: Of this last year.

Eric Isaacsen: Of this last year. Yes, sir.

David Enevoldsen: So, in essence, between 2005 and the end of 2022, been doing something within this behavioral health universe, either getting training or working.

Eric Isaacsen: Well, more like 2008. I was an LPN in 2008. An RN in 2009. So basically, since since officially since 2009 to 2022. So, it was still quite a while. Oh, it is. Yeah. Oh yeah. No doubt.

David Enevoldsen: And so that whole time you're working in behavioral health, the in all of that time, did you ever want to shift out of it and kind of go to some other like just a more general medical nursing?

Eric Isaacsen: I did. But the problem was, once you're into the behavior health rabbit hole, unless you retain your skills elsewhere, and because I was working so many hours in the behavioral health rabbit hole, I didn't have the opportunity to pick up a part time job elsewhere because in behavioral health, the patients actually suck the energy out of you because you are their only person in the world. Sometimes they can talk to you, so they unload on, you know, they're not doing it purposefully. God bless 'em they're not. They're doing it because you're the only person that actually cares about them. And I did care about them. When my patient was with me, they knew I cared. But at the end of the day, you have to put up so many emotional, mental, and spiritual barriers that you are exhausted. So, I was in behavioral health for four or five, six years, maybe seven years before I started getting at burnout. And I looked to laterally move and I was advised by many people, recruiters primarily, that I would have to start at the bottom by being a bedside nurse, bedside nurse in a in a medical facility. And like, nah I'm too old I'm too old for that. So, I just rode it out and I was hoping ride it out longer than what I did, but I just couldn't any longer.

David Enevoldsen: And I feel like I can relate to that. As you're aware I've done family law in my background, so there was a lot of divorces and custody fights, and obviously it's not the same, but I feel like I had that at least that same kind of experience a lot, where it's like they just have to talk to you and there's nobody else talking to them. Sometimes they don't have friends and the world is against them, and so they've just got to unload.

Eric Isaacsen: Yeah.

David Enevoldsen: When I first started as an attorney, I remember I was really struggling because I hadn't yet figured out how to set up those kind of boundaries of all types, as you said, spiritual and procedural boundaries. You know, initially I had people just had my phone number. And so I have a memory of sitting in a movie on a weekend and my phone was like blowing up from this one client. And I remember we got to the end of the movie and I couldn't even, I had no idea what the movie was about because I just felt so much anxiety about this person calling me. And so over time, I learned to establish those boundaries. I imagine it's very, very similar in terms of what you were dealing with like you have to have walls or you lose yourself.

Eric Isaacsen: You do. You do. And one of the things I knew right off the bat was and this is something I learned in nursing school from one of my instructors was never give a patient your personal number.

David Enevoldsen: Yeah, well. I didn't learn that lesson right away.

Eric Isaacsen: No, that's okay. Well, you know, that's okay. We all live and learn. But I learned from their mistakes, and I'm not. I never took any phone calls from patients. But, you know, the the last part of it was, was, it was actually pretty stressful from a staffing standpoint.

David Enevoldsen: Sure.

Eric Isaacsen: Which is why I got out.

David Enevoldsen: Well, can we, let me circle back to that in just a second.

Eric Isaacsen: Sure.

David Enevoldsen: So we've kind of talked a bit about your background. Can you, I know you've worked in several different roles and positions, but can you give people just a sense of what the average day in the life of a nurse in the behavioral health field would be doing or the kinds of things that you do?

Eric Isaacsen: Well, most of it actually has to do with, believe it or not, medication administration. So, you know, behavioral health medications are different than your diabetes meds and so on and so forth. And just like all of the medications, you want to make sure that the patient is taking them as prescribed all the time. But part of that, though, is to do an assessment of the patient based upon you first seeing them. For example, in an outpatient facility, I would have patients scheduled for say, 8:00 in the morning. And I would greet the patient up front and then escort them back to my office in my lab where I have my own private office and lab where I would conduct my assessments at. And, you know, I'd ask them questions, you know, how are you doing? What's going on? How's Mom, How's Dad, How's grandma, how's grandpa? You know, the typical questions you would ask somebody. I'm not saying this in a flippant manner to be flippant. I'm just saying this for brevity.

David Enevoldsen: Sure.

Eric Isaacsen: And but I would also look at them like, are they engaging in good eye contact with me? Do they stink? Are their clothes dirty? Is there is their presentation any different than what it was the previous week? And you pick up on that stuff, like right off the bat. And I did especially and I feel I was blessed with this because I spent so many years in sales that I would pick up on people's presentation right off the bat. I would know in like a matter of 30 seconds what kind of encounter this is going to be.

Eric Isaacsen: And same thing with behavioral health. I would know right off the bat if this patient was experiencing some mania or depression or if they're super angry or super sad about something. And then I would ask more questions about how they were doing and what's going on and are they really taking the meds like they're supposed to are they eating okay? Are they sleeping okay? And all this stuff, you know, of course, you would document it and whatnot, and I'd make sure the patient either they would come in for an injection, they would come in for a lab, or they would come in for a weekly set of meds or biweekly meds or monthly meds, depending upon the cycle their appointment schedule was. And that was based upon the input that I provided to the behavioral health provider, as well as behavioral health providers own engagement with the patient themselves. So between the patient myself and the behavioral health provider, whether it was a psychiatrist, a PA, or nurse practitioner, would determine the frequency of that patient, would make visits to the clinic. Sometimes they only came in once every six months just to touch base with us to make sure they're okay. Sometimes we had to have them come in like once every couple of days to get them started on their medications to make sure they took their medications as prescribed. That was an outpatient facility. Inpatient is very similar to the same thing. You have a patient that's inside and they're there for a variety of reasons, for a variety of length of time.

Eric Isaacsen: And upon assumption of the shift, you would also assess the patient. You would go on the onto the unit and ask them questions, see how they're doing. Most of the time, my experience has been on the unit that they really did not want to talk to you too much. They would answer basic questions, but primarily they wanted to be left alone, isolated because they're dealing with a crisis themselves. And so my goal was just to be as as evenhanded and provide a level playing field and a nice, easy comfort, what's called a milieu. That's the area in which they are are living in and working in and try to decrease as much stimulation as I could. Make sure they took their meds. But overall, it's basically it's about communicating with people at the level that they can understand. So, I would have to kind of I don't want to use the term dummy down, but I would have to kind of slow down my rhetoric. You know, when I when I engage with you in a conversation, you and I use different types of vocabulary because we're both professionals, right? Whereas when I'm dealing with some of my patients, they're off the street. So, I have to, you know, use the old 'sup and how you doin' man and what's hanging how's, how's the kid, you know, talk like more in a in a slang vernacular.

David Enevoldsen: Yeah.

Eric Isaacsen: But the idea was primarily to communicate.

David Enevoldsen: That's funny. When I was in my first semester of law school, I had a class with a professor who, in the way law school usually works, you're, it's all Socratic method. So typically you read a bunch of cases and then you come in and then the professor grills you about everything. So, you stand up and the professor walks in. You don't know who's going to get called on when, right? So, they might say, "Eric, stand up and tell me the facts of Jones v. Smith and what was the holding in that case and what happens if we change the facts to this? And would the whole thing be different?" So, they sit there and they just grill you, right? And so, it's supposed to be training to keep you on your feet and thinking on your toes and that sort of thing. But at any rate, I had this one professor my first semester who would, in class, she would ask you a bunch of questions and she'd say, "That's great. That was in legalese. Now tell it to me in English." Or she'd say, "That's great that was in English...

Eric Isaacsen: Yeah.

David Enevoldsen: now tell it to me in legalese." And she had this theme that you, as an attorney are a translator between the court where they're speaking this legalese stuff and the client who has no idea what any of these legalese stuff means. And that really stuck with me. And it sounds very much like what you're describing there. You're you're kind of the translator between the mental health professionals and the client. The patient, you know?

Eric Isaacsen: Yeah, exactly. Exactly. Yeah, it is. It is. It is exactly right. I mean, because medical terminology is so weird. It's like I'm sure it's like legalese. It's just so. Yeah, you have to. Yeah, I had to. Yeah. Translate and speak in a common tongue if you will.

David Enevoldsen: Yeah. That makes, that resonates with me. So, one of the things that I guess struck me there is you were talking about the in whether an outpatient or inpatient or kind of whatever it is you're dealing with. One of the common things it sounds like you're doing is making assessments of patients and kind of where they are with what symptomology they're exhibiting, that kind of thing. Am I correct in understanding you're essentially then as a nurse in the behavioral health field, that you are sort of the front line and you're like, What are you doing with that information? Are you passing it off to like a psychiatrist or some other medical professional or

Eric Isaacsen: Well, yeah, that's that's a very valid question. I'm glad you asked that. That's exactly what happens. When I'm assessing a patient, of course, what we have to do is we have to document everything that they say to us. And I let the patient know. I say, "Listen, I want you to want to tell you that I am writing down everything you tell me. Now you can read what I'm writing down. I don't have a problem with that." After the charts closed, though, we can't let them have access to it unless they put it in writing that they want it. But I'll say "You come on over here. Look over my shoulder, and this is what I'm typing in because I'm typing in what you're telling me." And they're they agree to that because they're telling me, right?

David Enevoldsen: Sure.

Eric Isaacsen: Which is cool. And then I take that information. It goes into the electronic record, of course, so anybody within the facility can review it. But if there's a situation in which I'm concerned about that patient's presentation, then I will either text, email, call or stop by the provider's office, depending upon the unit that I'm assigned to. And speak with them directly about that patient's present condition.

Eric Isaacsen: And then I leave that up to the provider to determine what course of action they want to take. They may want to give that patient a injection immediately because they're having an increase in psychotic behavior. So, I would have I would administer that medication once the order was placed and just monitor that patient, another 45 minutes to an hour afterwards to make sure that they were okay. The psychiatrist may say, you know what, "This patient has to go inpatient right away. We need to make arrangements with the clinical team and bring them inpatient." Or if the patient's already impatient and they're starting to flip out, whatever, the behavioral health provider may again order another set of medication to be administered to the patient right away and maybe have to put the patient on a 1 to 1, which means one staff member to one patient, because the patient's presenting with either DTO danger to others or DTS danger to self or self-harm or other harm depending on how you want to look at it. And so, we have to monitor that. But yeah, it's all a matter of communicating that information to the to the, to the providers.

David Enevoldsen: So if somebody's never had any sort of diagnosis and they're just walking in off the street, are you kind of the front line on that too?

Eric Isaacsen: Absolutely.

David Enevoldsen: So in essence, then, if I'm hearing you correctly, somebody comes in where they're already in the system and been diagnosed or whatever, or they're just coming in fresh off the street and they've never seen a mental health professional before, you're really the front line and probably spending the most time with the patients. Is that a fair statement?

Eric Isaacsen: Yes, to a certain degree, yes. Yes. The only time it wouldn't be that accurate, although it's for the most part accurate, is when they present to a like a behavioral health clinic where I would perhaps be the first person to speak with, but I'm not the first person that they would actually engage with. They would go through an intake coordinator who would do the initial assessment and then schedule the appointment with the behavioral health provider, who would then schedule an appointment with myself, the nurse.

David Enevoldsen: Okay. Well, and that to me, that's sort of interesting because it's almost this almost makes you as a nurse in the behavioral health field seem like you have a far more valuable insight in terms of kind of making assessments and figuring out what's going on, even though you're not the one actually, it sounds like pulling the trigger on diagnosing someone you in effect pragmatically you are. Like you're the one gathering the information, figuring out what's going on and kind of identifying problems and symptoms and good things and whatever it is that happens to be the case for any given patient. So, it's fascinating to me because my own personal experience many years ago before I kind of got myself oriented on an emotional level, I went I started having a lot of problems. And I talk about this in all the Emotional Embuffination stuff all the time. And I went and saw various mental health professionals and I talked to a psychiatrist at one point. Literally

Eric Isaacsen: I bet that was fun, wasn't it?

David Enevoldsen: Well, it was not more than 15 minutes. And I basically described a handful of symptoms and I saw this lady checking stuff off on a clipboard. And then 15 minutes later, I was diagnosed with anxiety, depression, and borderline personality disorder. And then I was off and they were giving me mind-altering medications based on that 15 minute dialogue. And I remember and this is frankly, it's still kind of a point of, I don't want to say irritation, but maybe

Eric Isaacsen: How about point of contention?

David Enevoldsen: Point of contention with with sort of the psychiatric field in general is that I have concerns about that dynamic and that I know my experience is not the only time that's ever happened. I don't remember having a dialogue with any sort of behavioral health nurse in that particular.

Eric Isaacsen: Probably not.

David Enevoldsen: I mean, I probably should have, and it seems to me like spending a little more time getting into what's going on in somebody's world is really important before you start giving them medications that are going to alter their brain and physiology and all this other stuff.

Eric Isaacsen: You know, David, it is actually really important to do that. I just have to say that and I think I alluded to this in a previous comment that I made regarding staffing. You know, the whole world is all about mental health these days. And Mental Health Awareness Month, and Mental Health Awareness Day and all this other other I'm not sure what term to use, but niceties, if you will.

David Enevoldsen: Sure.

Eric Isaacsen: But reality is there's not enough staff to treat the people.

David Enevoldsen: That's probably a good segway into this issue. So, you've worked

Eric Isaacsen: That's why you were given 15 minutes dude. That's it. Because she had other patients she had to see. Some of our nurse practitioners and psychiatrists see a patient every 15 minutes. In a ten-hour day. With a half hour lunch.

David Enevoldsen: Let's talk about the problems in the nursing universe here, the mental health universe.

Eric Isaacsen: Okay.

David Enevoldsen: So obviously, this is a big issue. And tell me a little bit about that problem in terms of staffing. Would you say that that's one of the biggest problems or the biggest problem within the mental health profession, especially in the nursing universe?

Eric Isaacsen: Yeah, it is. It's it's been like that for quite some time. And, you know, when I actually when I was going to school years ago, God it's a lifetime ago, brother, but I was going to school years ago and there was this huge nursing shortage. And now it's even worse. It's even more critical. And the the mental health patient population has grown exponentially. It's just outrageous. There would be I was at a clinic, a major clinic within the last three years of my of my career. And it was actually a disaster from a number of reasons. But one of the primary reasons was staffing. We would have a clinical team, for example, that would have 600 patients in a one team. This particular facility had 2200 patients in the whole facility.

David Enevoldsen: Geez.

Eric Isaacsen: And they had six teams plus an ACT team. And so you take that number of patients divided up among those people, but then you would have a clinical team that would have like 600 patients. They would only have three case managers. Well, how is the case manager and a clinical coordinator going to handle 600 patients? Is it 200 patients per case manager? That's impossible to do because each each patient needs to be seen, excuse me, once a month. Well, now you can't you just don't have enough time to do all that. So, a lot of the patients get they get slipped through the cracks. And those are the patients that end up on the streets because they're not taking their meds properly. And it's really, the staffing is just critical. And what I find to be the most amazing part about that, whether it's nursing staff or support staff, in the case of outpatient clinics, it's case managers, and case managers, of course, are also used inpatient, but in my reference here is outpatient clinics have case managers who are assigned certain number of patients to take care of, make sure they take their meds, make sure they're doing okay. And then the inpatient facilities have behavioral health technicians. And a behavioral technician's job is not so much managing the case of the patient, but to make sure that the patients and the staff stay safe and provide for a safe environment.

David Enevoldsen: Sure.

Eric Isaacsen: And what happens is there are not enough staff to go around. Whether it's an inpatient facility or an outpatient facility, and primarily it's because they don't get paid anything. The kind of work that I ended up having to do far exceeded the money that I was being compensated for. My value was way higher than what I was being paid to do. And that's a very frustrating thing to experience. But then you have these behavioral health technicians who are going into a facility and putting their life on the line every single day because you do not know the nature of the patients coming through that back door, the police entrance. Or in the case of a inpatient facility you don't know the nature of the of the patient that's in that facility right there. And they you have to walk around with your head in a swivel. And unfortunately, if you don't have enough staff you're really in danger and they don't pay the staff 13, 14, 15 bucks an hour to provide safety for everybody. Well, that's incredulous. That's unconscionable. That is downright ripping off the people. So now you have a problem that's that's exacerbating itself because the lack of income provides the people who are actually down and dirty getting the dirt done, if you will, working the trenches, the front line people are not being adequately taken care of, so they're moving on to other things. Just saying, "See ya, I do not need to put up with this stuff. I do not need to not be able to sleep at night anymore because you're not taking care of me." And the issue is not that the behavioral health facility is not making any money. They're getting paid grand doses of dollars by the by the organization such as here in Arizona to be Mercy Maricopa or AHCCCS. AHCCCS is a state, of course, Medicaid and Mercy Maricopa manages the Medicare aspects of behavioral health payments. These facilities are being paid big money to properly take care of and treat these patients, but they're not paying the workers who are on the front lines. Adequate enough sums to keep them.

David Enevoldsen: And do you feel like this problem is universal, like it's in all the different

Eric Isaacsen: It is. Yeah, it is. I mean, you know, you may have a few places that that pay their employees more money, but it's still really not worth the time that you're putting in there from a safety standpoint. It's just not worth it. So, you have people, behavioral health technicians that are getting burnt out, left and right. And

David Enevoldsen: So, in essence, then you got a high stress situation. I'm going to recap and make sure I'm understanding.

Eric Isaacsen: Sure. Yeah.

David Enevoldsen: High stress situation. Massive volume because we've kind of had this increase in diagnoses and awareness, and let me circle back to questions about that in a few minutes. But you've got greater population of people coming in for help one way or another. You've got unsafe conditions and then you don't have enough staff essentially to deal with things in a safe way. And those that are there are kind of being underpaid such that you're going to have high turnover because there's high incentive to get out of that field because you're not getting paid enough for what you're risking and putting up with. In essence. Is that accurate?

Eric Isaacsen: Yep, 100%.

David Enevoldsen: What do you think the remedy is there then? Just allocate more money to front line workers or?

Eric Isaacsen: Sure.

David Enevoldsen: Okay.

Eric Isaacsen: That's it. Pay 'em. Pay us. Pay us what we're worth.

David Enevoldsen: Yeah.

Eric Isaacsen: We're the people that have taken it, we are the, in military terms, we are the tip of the spear. We are the tip of the spear. And pay us for what we're worth. Now, we're not military, so we're not going to be getting that kind of minimum wage pay. We're in the behavioral health industry and we're in health care, so we should start seeing more money. But they sure don't want to pay us.

David Enevoldsen: From an end consumer kind of patient sort of perspective, recognizing that this is a problem out there, do you have suggestions for somebody that has some sort of mental health problem, behavioral health problem, and they're thinking, I need help in light of that problem? Do you have suggestions about that? What they should do.

Eric Isaacsen: Well, let me let me ask you a clarifying question. Your question indicates that they're already aware that they have a behavioral health problem. Is that correct? Or are they just have a behavioral health issue?

David Enevoldsen: Well, I'm saying maybe you've got, well either way, somebody that maybe already has been in the system in some fashion or I guess in my head with the question, I was more thinking I'm I'm like, I was back in 2015 and I'm a mess and I know I'm a mess, but I don't really know what to do or where to go or who to talk to. And then I listen to this podcast and I hear Eric saying, "The system's messed up and there's not enough staff and there's a lot of problems and people are getting shortchanged. And David mentioned that he only spent 15 minutes with a psychiatrist and then all of a sudden he had medications." Like I mean, it sounds like that that puts me in a position of almost being afraid to reach out for help. So maybe that's appropriate or not. I mean, do you have a suggestion as to someone in that kind of situation?

Eric Isaacsen: Well, there's there's two sides of that same coin. On the one side of the coin is, and unfortunately, that side of the coin is really kind of tainted as well, but being aware of what's going on in your life. Like, are you a young person going through a relationship change where you broke up with your boyfriend or your girlfriend and all of a sudden the end of the world is coming down on you and you're emotionally immature and not able to deal with stuff effectively? So then what do you do? Do you reach out to drugs or do you do you come to a crisis unit or do you talk to your PCP? Well, chances are they're not going to talk to the PCP. They're not going to talk to the patient or their parents.

David Enevoldsen: Yeah.

Eric Isaacsen: And so they end up making choices that aren't suitable. They're impulsive choices. Now, that's one side of it. If, however, this person is a little older, a little bit more mature, let's say they've gone through some things in life and maybe they they have a job and they might have a roommate or they have their own apartment or they live in a trailer or whatever the case may be. They're kind of like self-sustaining. And they have these behavioral health issues, whether the issues are feeling really seriously depressed or anxious or angry or suicidal or homicidal or whatever the case may be, then they have a couple of remedies that they can go after. The first remedy, of course, would be if they are in tune enough with that particular set of symptoms to realize what's going on, then they can call their PCP. The PCP would then make a referral to a behavioral health specialist, or they can reach out.

David Enevoldsen: To make sure everybody knows, what is a PCP?

Eric Isaacsen: Primary care physician, your medical doctor, the guy you go to for your physicals and your shots and stuff like that.

David Enevoldsen: Thinking in terms of the translator thing again.

Eric Isaacsen: Yeah. Sorry. Yeah. Yeah. I thought most everybody knew what PCP meant. PCP's also a drug that. Angel dust baby.

David Enevoldsen: Maybe they do. Maybe I'm underestimating.

Eric Isaacsen: But anyhow, you know they're facied with a couple of choices again and it's just it's really not an easy question to answer. Because, you know, you have all the you know, especially on Mental Health Awareness Month, I think that just ended or something like that which was I think it's crock of shit. But anyhow well it's all these platitudes and oh, we're going to do this. We're going to do that. No, you're not, because you don't have enough staff.

David Enevoldsen: Yeah.

Eric Isaacsen: So the people call the suicide hotline, and if they call the suicide hotline, but they're not suicidal, then they can maybe get some help. But if they call the suicide hotline and they say, "Man, I'm feel so sad. Yeah, I feel like I'm going to kill myself." Boom. Game changer. Now, that particular suicide hotline, because those calls are recorded, they are under a law to protect the patient at all costs. So then that suicide hotline person has to reach out to either the police department, depending on the jurisdiction, or they'll reach out to a a crisis unit, a mobile crisis unit which would be dispatched to that patient's home.

Eric Isaacsen: And based upon the engagement with a crisis unit and the patient at the patient's home, we determine what direction that particular case goes in. On the other side of the coin, if a patient has been diagnosed and been in the system for a while, they kind of know the ropes, they kind of know what's going on. But often times they are not following their medication regimen as prescribed. And they self-medicate with meth, with pot, with fentanyl, with heroin, with coke, with all that stuff, because they're dealing with the demons inside of their brain and they're not taking their meds, I guess, like they do. And oftentimes like with medical medications, you know, the patient is, let's say, for example, they're depressed and they're they're prescribed Prozac or Wellbutrin or any of the number antidepressants. There's a variety of classes, let's say, that they're prescribed a antidepressant. When they start taking that medication in three, two, four or five, six months later, they feel great. They quit taking their med. Well, now they spiral out of control.

David Enevoldsen: Right.

Eric Isaacsen: And they come into the clinic or in the or an inpatient facility and say, why'd you stop taking your meds? Because I was feeling good.

David Enevoldsen: Right.

Eric Isaacsen: Well, the reason you're feeling good is because you're taking a med.

David Enevoldsen: Right.

Eric Isaacsen: And it's hard for a lot of people to understand. Even with medical people, you know, you have people who have hypertension and now the prescribed hypertension meds. Well, the hypertension goes away. So like, hey, I'm healed, I'm cured. I don't have to take hypertension meds anymore. And then next thing you know, they have a hypertensive crisis, end up in the E.R. and put on some nitroglycerin drip or something like that to bring their blood pressure way down. I mean, it's a lack of awareness, which is ignorance, which is a shame. But there's so much going on out there. I mean, we have sensory sensory overload right now. Did you know that the average attention span and I know this from my YouTube channel is 3 to 5 seconds long before they're off to something else? Did you know that? 3 to 5. It's true. Crap, man. I tell you what, I'm going to. I'm going to ask you to do this, okay? Next time you watch a TV show or movie, doesn't matter what it is, count how many times the scene cuts. Count how many seconds it is between the scene cuts. It's 3 to 5 seconds.

David Enevoldsen: Yeah.

Eric Isaacsen: Like, dang. And that's science. It's scientifically based. So, I mean.

David Enevoldsen: I actually heard there was some data indicating that it was changing, like the attention span actually reduced over time.

Eric Isaacsen: Yeah, it has. I remember back in the day when I was watching TV and I was my I was my parents' remote control. My dad would be like, change the channel to this son. I'd be the remote and get up and change the channel on the manual TV. And there would be a TV show, be 30 minutes long. There would be 15 minutes of TV, 2 minutes commercials and 50 minutes more of TV. But the entire 15 minutes, we're actually watching that TV show. Okay. Now, that's the scenes wouldn't change every 3 to 5 seconds. They would change probably every 8 to 10 seconds just to to change it up a little bit, you know? But anymore, it's crazy. It's getting worse, too. It's because there's so much going on. Well, so much going on.

David Enevoldsen: Let me circle back to something you mentioned a few minutes ago. So you were talking about kind of the exponential growth in terms of awareness of behavioral health and mental health problems and all of that. Can, do you have a sense of why that is? I mean, do you think it's because we're just socially more aware of it now? Do you think that it's become a crutch? Do you think it's like being diagnosed in such a way, like we're throwing it into situations where maybe it doesn't need to be or we're dealing with the things like you described earlier in terms of the teenager that's dealing with some acute situational factors and that that translates into like his or her depression or anxiety or something like that. Like, what's your sense of it? Or some combination of all those things?

Eric Isaacsen: Well, it would be a combination of all that stuff. I mean, there's no real set answer nor set category. I don't want to use a silo approach where it's going to be this or it's going to be this. There's this big mesh of things like.

David Enevoldsen: And I'm a huge advocate for the idea that everything is more complex than anyone really gives it credit for so I feel like I find myself saying that all the time, so.

Eric Isaacsen: It sure is. It's like it's like one of my favorite I can't eat meals anymore or eat side dishes anymore is garlic mashed potatoes. You have your mashed potato, you have your milk, you have your butter, you have your garlic, you have your salt, you have your pepper. So you have six ingredients going into one dish.

David Enevoldsen: Yeah.

Eric Isaacsen: So the same thing, it's an it's an analogy to the behavioral health. You have sensory overload. You have single parent families, you have no parent families, You have what is it disenfranchized people. You have dysfunctional families. I don't think there's such thing as a functional family anymore because there's so much dysfunction going on in the world. So I think I think truly dysfunction is functional in a weird sort of mishmash kind of a way, if that makes any sense at all.

David Enevoldsen: Yeah, I think so.

Eric Isaacsen: And so and then you have job insecurity. You have the the whole socioeconomic, political atmosphere out there in the entire world, not just in our country, which is a total mess right now. But I think it's getting squared away here soon. But you have all the stuff going on there. And so now the the the the person is faced with what's the first thing somebody does when they get up in the morning? They look at their social feed.

David Enevoldsen: Yup.

Eric Isaacsen: I don't do that. No, but that's that's different because I'm educated and I don't mean I'm educated in a smart way. It means I'm educated because that doesn't work for me. I need I need to slow my roll down here. But you have all these these inputs going in after them, and they just don't know where to turn. What do you do? Who do you talk to? Who do you trust?

David Enevoldsen: So I have a sense that just having done all this Emotional Embuffination stuff, I just want to see if you agree with the statement. Again, acknowledging there's a lot of complexity out there, and I certainly think that there are situations where there are legit mental health problems. You know, somebody's got a psychiatric issue, especially

Eric Isaacsen: I was going to answer the question about the crutch.

David Enevoldsen: Oh, okay, Go ahead. Go ahead.

Eric Isaacsen: Yeah. Yeah. Sorry. Yeah, I totally digressed on that. Sometimes, yeah. Sometimes it's easier to be uncomfortable. It's easier to be, oh you wouldn't understand my circumstances. I've got depression.

David Enevoldsen: That's where I was going.

Eric Isaacsen: Or I've got bipolar or I'm Eeyore, you know the character Eeyore, right?

David Enevoldsen: Oh, yes.

Eric Isaacsen: Even if it's sunny out, it's going to rain tomorrow. I mean, and you have a lot of people in the world, not just in our country, but in the world, probably more so in our country that want to have the crutch that somebody else will take care of them or somebody else will feel sorry for them, or whatever the case may be. And it's so much more difficult to change than it is to hang on to your misery. And people really it's sad, but it's true. But people really want to hang on to their misery because it's all they know and they're afraid to step out in and maybe get rained on or they're afraid to step out and stub their toe. I mean, fear sets in because they were diagnosed with this and all of a sudden, well, that's my life and lot. And as long as I have SSDI, Social Security, Disability Insurance, I'm good to go, I'm okay. And they're providing me a place to live and they're paying for my medications and they're paying for my food and. It's a crutch.

David Enevoldsen: And that's exactly where my head goes to.

Eric Isaacsen: Yeah.

Eric Isaacsen: Sometimes. Sometimes it is.

David Enevoldsen: My perspective

Eric Isaacsen: Not always.

David Enevoldsen: And I agree. I agree. And I feel like there's a balancing act between these two extremes, because on the one hand, I think a lot of people get really pulled into the labels. And I my concern is from a social perspective, I think we've gone too far into kind of acceptance and acknowledgment and awareness almost of of the labels, because those labels in situations, especially when things might be wrong, but it's all because of habits or situational factors, if you get that label and all of a sudden there's a lot of incentive to remain stuck and being a victim.

Eric Isaacsen: Well, let me let me let me address that here for a second. You mentioned something that I thought you're going to go down down this pathway with it. It's someone else's fault.

David Enevoldsen: Yeah, exactly.

Eric Isaacsen: It's not your own fault. I wasn't born like this. Well, maybe you were. Or maybe you had a situation in which you didn't know how to cope, but you didn't want to cope because you were so happy being taken care of by other people.

David Enevoldsen: Exactly.

Eric Isaacsen: So you're making these decisions. You're not choosing to do the right stuff and you're happy with it. You just, you know, you're just happy with it.

David Enevoldsen: And I think and I don't mean this as something that's accusatory because I don't think most people are really conscious of it when they're in that situation, and especially when you get that label. Like when I when I had my experience with a psychiatrist. I had spent pretty much well, I had spent my entire adult life kind of cycling in and out of extremely depressive states. I had suicidal ideations, like on a regular basis for decades.

Eric Isaacsen: Wow.

David Enevoldsen: And it was just like that was normalcy to me. I remember when I was in high school just having this perpetual dilemma of like, I desperately wanted to kill myself, but I was terrified of God would be angry and I'd go to hell. And so, I mean, there was a there's a lot of strong self-preservation mechanisms that kind of inhibit you from killing yourself. But that was normal to me for a long, long time. And then when I saw a psychiatrist, I was diagnosed with depression and amongst the other things I described and anxiety. And I remember getting that label and thinking, oh, okay, I've got a problem here. And then some other stuff happened. I kind of started my little emotional awareness journey, and then suddenly I realized that I don't think and this is my current belief, what I was diagnosed with had anything to do with how I was born or some kind of weird defect in my my cognitive physiology or anything like that. I am firmly convinced now that it was an affect of mindset, habits, behavior patterns and I was engaging in things I was doing essentially the way I was constructing my life, but I had no idea. I was absolutely oblivious to the fact that there was a better way and that I was contributing to this problem in the first place. And so, it's I feel like it's a delicate balance because on the one hand, there are people out there that legitimately have some issues. I used to work in a group home with developmentally disabled patients, and I remember we had one of the regulars that I worked with was this guy who had schizophrenia, and he would come in and tell me how his teeth were telling him to do this and that, and there was a person in his teeth talking to him all the time. I don't think that's a product of just I've got the wrong mindset. Like there was something really cognitively, or physiologically wrong or abnormal. However, on the other hand, when we have and it feels like the things that we hear the most about in the public sphere are depression and anxiety. And I cannot count the number of times I've seen things on social media that go along the lines of, "You don't understand what it's like to have depression." And I do because I was there. But I don't, I wonder if people are just kind of grafting onto that label too quickly oftentimes and then saying,

Eric Isaacsen: Well, you know. I think so. I really do. I really I really think that's the case. I you know, the last three years of my life is the last three years of my career were really rife with a lot of stress, a lot of anxiety. And I ended up having a case of of being depressed. Now, I guess you could label it as depression, because I was I was prescribed a antidepressant. I was prescribed Wellbutrin, which I titrated myself off of that six weeks ago, right after my last job.

David Enevoldsen: Interesting.

Eric Isaacsen: And yeah, I was on it because I was in an acute, depressed state. I knew it was situational. I knew that my anxiety I was even prescribed anti-anxiety medication, Ativan, because of the serious acute anxiety and stress that that particular situation caused. But I knew that it was cause and effect. I knew it was situational and I knew it wasn't chronic. I knew myself well enough that if I were able to somehow exercise my rights to get out of that situation, then I would no longer need those medications. And I don't. I was able to titrate myself off the medication. I am a registered nurse, so I've been doing this for a long time.

David Enevoldsen: Sure.

Eric Isaacsen: I know how to titrate, but I feel.

David Enevoldsen: In case somebody's not aware, what does titrate mean?

Eric Isaacsen: Titrate means to slowly decrease up or decrease down the particular dose, and you need to do this under doctor's supervision.

David Enevoldsen: So wean yourself off of the medications.

Eric Isaacsen: With a doctor's approval.

David Enevoldsen: Right.

Eric Isaacsen: I told my doctor, I did tell my doctor, Listen, I'm no longer feeling these symptoms. I'm going to wean myself off of Wellbutrin. He's like no sweat. When you go back on it just give me a call, we'll hook you up. Now, he knows that I've been a behavioral health nurse for longer than he's been a provider. He knows that I know my stuff well, you know, he knows I know all my stuff, but also, but I have to throw that out there to the listeners.

David Enevoldsen: Right.

Eric Isaacsen: Get your provider's approval first. And I did. And I tell you what, man, I feel wonderful. Now I'm not sleeping like I used to sleep, but I'll tell you why. Because I'm freaking excited about my future. I'm no longer in behavioral health. I'm no longer stuck in that rabbit hole, my friend.

David Enevoldsen: Let me circle back to that in one second. I want to hit up what you're doing now.

Eric Isaacsen: Of course,

Eric Isaacsen: Maybe just to kind of wrap up.

Eric Isaacsen: Yeah.

David Enevoldsen: This is probably a good kind of bring it all together moment here. So I guess.

Eric Isaacsen: The dovetail, right?

David Enevoldsen: Yeah. Let's let me recap really quick. So

Eric Isaacsen: Okay.

David Enevoldsen: You worked in behavioral health for a very long time.

Eric Isaacsen: I did.

David Enevoldsen: All in the kind of nursing area, which is really the front lines. That's where we're really seeing the action happening, which to me makes you a more valuable resource than a lot of psychiatrists, especially when I put it in light of people who are just kind of cycling in and out for 15.

Eric Isaacsen: Yeah, thanks. I think so too, actually.

David Enevoldsen: So that gives you a huge insight into what's going on. Huge staffing shortages. Clearly, allocation of money is a problem on sort of a global level, at least in this country. I don't know if we're talking global like literal, global or just more in a universal sense. Staffing shortages are a problem. If someone actually needs to get help, though, you know, say they're they're just a mess right now and they don't know what's going on. Where, do you think they should go talk to a primary care physician like what's the best avenue? Make sure I'm clear on that.

Eric Isaacsen: Yeah, that would be probably the first choice. A lot of people don't know about this other option, and it's a shame that they don't know about it. But most people who have commercial health insurance have what's called an EAP program, which is an employee assistance program. It's EAP and it's a free program for behavioral health purposes. And there's a there's a phone number that your insurance provider will give to you when you enroll. And that phone number is available to you, as well as any family member, whether or not they're covered by your insurance. So which is really cool. So it's a huge thing. It's a huge benefit. And I've used EAP before. I was a firm believer in every three months just call EAP and say, Hey, I just need to get my crap off my chest. And the last time I did it was right towards the end of my career as a nurse and I was really despondent. I was very angry, I was very hurt. I felt dejected, rejected, inspected and and unprotected, if you will. And they listened to me for about 45 minutes. We set up another couple of sessions. I call them up they listen to me again. Call them up, listen to me again. And it was all free and it wasn't, it was part of the insurance package that people have that they're not aware of. So that would be my first thing because I was actually able to talk to them on the phone.

David Enevoldsen: And is the EAP is that like an Arizona specific thing? Is that a

Eric Isaacsen: I don't know if it's Arizona specifically. I know it's available, I mean, I've used it only since I've been out here. So, I don't know the answer to that question. I think it's pretty much universal because my insurance company and my wife's insurance company were both United Health Care and I wasn't part of her plan because I had my own plan and I use my own EAP benefits. But since I left that company and now I have Medicare Advantage, I'm still able to use my wife's EAP if I want to, but I can also use my own. Its quote unquote, EAP through what I'm currently covered under. That'd be my best bet. But people don't know about that. So, the second choice would be contact your primary care doctor. But a lot of people don't have a primary care doctor, right? So, they're uninsured or underinsured. So, then they would have to kind of go to a crisis facility and just and just hope for the best.

David Enevoldsen: Okay. And

Eric Isaacsen: Always be honest, always be honest.

David Enevoldsen: Somewhere in this list we should also have making sure you're up to date on all the Emotional Embuffination materials, correct?

Eric Isaacsen: Absolutely. No doubt about it. Download all your books. Give all your books light up. Get all that stuff. Yeah. Don't forget to get the journal too.

David Enevoldsen: Okay.

Eric Isaacsen: Yeah.

David Enevoldsen: So, you're not nursing anymore. Tell me a little bit about what you're doing right now that's preventing you from sleeping and keeping you up.

Eric Isaacsen: Oh, my God. It's so exciting, man. I'll tell you. Well, when I was as a nurse, I opened up a YouTube channel just because I thought it was something interesting to do.

David Enevoldsen: And this goes back to my comment about you wearing many hats.

Eric Isaacsen: Yeah, well, I do wear many hats, that's for sure. But I was I opened up a YouTube channel and it was regarding cars, and I've been videoing cars and I would consider myself a professional automotive videographer because I do a great job with videoing cars and I get to go to really cool events such as Barrett-Jackson Auctions, Mecum Auctions, SEMA, which is the Special Manufacturers Association largest trade show in the world in Las Vegas. I do local and regional shows. I've traveled as far away as Michigan and far down as Florida to to cover shows and to get a look at collectors cars. I have this one client who has a collection of over 200 cars that he owns personally, and several of his cars are worth in excess of three or $4 million each. And the guy's just an average guy. He just made a whole butt load of money. So, I did that. And since I've been, and while I was working the last, oh, gosh, I was working midnight shifts three, 12 hours a week, sometimes four 12 hours a week. And when you work midnight, basically, you're screwed the day before and the day after because you're trying to correct your circadian rhythm. So, in essence, I was unable to really manage my channel effectively for the last three years. But we did one video per week religiously, and it was growing. It was growing slowly, but it was growing. And then since I've been doing this full time, I took the first month off of work from until just after Christmas. And basically, I actually worked a lot in December on this channel. But we're going in a new direction now, and I'm actually thrilled to death. Matter of fact, I spent probably an hour and a half on the phone today with my video editor redoing my channel. If you go to my channel, you're going to see a totally new channel. New channel.

David Enevoldsen: What is the channel?

Eric Isaacsen: What's the channel? Muscle Cars with Eric.

David Enevoldsen: Muscle Cars with Eric.

Eric Isaacsen: Yeah. Yeah. And it's all about muscle cars. And I have some of the coolest some of I have a muscle car there owned by Don Petty, which is Richard Petty's cousin. And it's it's a 1969 Plymouth Road Runner convertible. And gold, it's only one of three left in the whole world. And I had a chance to ride in it. And he and Don, actually, we were taking off one day from the from the video shoot. He's like, hang on. I'm like, okay. And he started smoking the tires like, dude, that's the way to go. It was so cool. David It was neat. So that's why I'm excited about. I'm excited about taking the experiences I had as a registered nurse and kind of doing a Segway into more passion, more dedication, a lot more humility than I had when I when I first became a nurse. I was an arrogant sales guy. I was I was a nice guy, but I was pretty arrogant. And now I'm actually I would consider myself pretty humble because being beat up, but also being involved in reaching out to people who have behavioral health diagnosis, they need you to be real with them. And I learned an awful lot about that. So I'm very thankful for that experience. It was really difficult at times, especially the last three years sucked and the last six months was horrible. But now I'm on to bigger and better things and I get to hang out with cool cats like yourself.

David Enevoldsen: Well, I appreciate that.

Eric Isaacsen: Yeah, you're welcome.

David Enevoldsen: So, if they want to find out if anybody wants to find out more about that, they just go to YouTube and and look up your channel there.

Eric Isaacsen: Nah, just just Google Muscle Cars with Eric boom, pops right up.

David Enevoldsen: All right. Just Google it.

Eric Isaacsen: Muscle Cars with Eric brother.

David Enevoldsen: Muscle Cars with Eric. Check it out. All right. Last question. I'm going to hit you up with here.

Eric Isaacsen: Sure.

David Enevoldsen: I'm asking everybody this so for, your life insight. So if you could offer one piece of advice to people about just developing emotional health or strength or how to be as optimized and happy as you can be, what would that piece of advice be?

Eric Isaacsen: Be honest with yourself. Be honest with who you are. Be real with you. The real deal. Be real. If you feel like crap, recognize it. If you feel like you're on fire, recognize it. If you know at the end of the day that you did not do your best. Then start over tomorrow and do your best. And just be real. Just totally be real. I mean, you know me. You've known me for a number of years now, and you know what you hear, what you see is what you get. I'm like this in public. I'm like this with my patients. It doesn't matter. Just be real. Be real, David.

David Enevoldsen: All right. I like it.

Eric Isaacsen: All right.

David Enevoldsen: I think that's good advice.

Eric Isaacsen: Thanks.

David Enevoldsen: Well, Eric, thank you very much for your time today. I appreciate you being on the show. I appreciate you doing the interview and all your insights with respect to quite a career in the behavioral health field. And I guess we can wrap it up there. So, any words of parting wisdom? Parting words of wisdom?

Eric Isaacsen: Drive it like you stole it, brother.

David Enevoldsen: Okay. All right. That's kind of your show, your channel motto, right?

Eric Isaacsen: It is. Yeah. Drive it like you stole it. Yep.

David Enevoldsen: Well, thank you, sir. I appreciate it.

Eric Isaacsen: Welcome. My pleasure.

David Enevoldsen: So, that brings us to the end of today's show. I hope you found all of this useful and interesting and that you can take away something, some little nugget that's going to help make your life just a little bit better. Remember, keep becoming more emotionally embuffed. This is a process. It's not just something you do one time. You don't just read a book or take a course or something and then you're good forever. You keep working on it all the time. At the end of the day, we want you to be emotionally strong enough to go from saying, "The struggle is real," to saying, "What struggle?" Thanks for listening. I hope you have a great week and I'll see you on the next show.