Avera hotline gives stressed clinicians a place to vent, access treatment

September 15, 2022


As health care delivery systems have waxed and waned in their commitment to mental health care over the decades, Avera Health and its predecessors have remained steadfast in efforts to increase access to — and reduce the stigma of — mental health care in rural areas.

Workers at an Avera Health hospital don protective gear as they gather in a unit during the ongoing pandemic. The system has set up a hotline to help its staffers and other health care workers across its footprint deal with stress.

The system was formed in 2000 when the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen and the Benedictine Sisters of Yankton Sacred Heart Monastery combined their sponsored health ministries.

Avera Health opened Avera Mental Behavioral Health in 2006 in Sioux Falls, South Dakota, putting its mental health inpatient and outpatient care on par with its medical services. Earlier this year, the center, now the Avera Behavioral Health Hospital, added a four-story wing with several new services including 24/7 mental health urgent care, residential addiction care services for youth and a day hospital program for youth.

As it has broadened access to mental health services, Avera Health also has pinpointed services where it has seen specific needs. In 2016, the Indian Health Service contracted with the system to provide tele-mental health to all 19 of its Great Plains service areas. In 2019, with extreme weather, trade turmoil and record-low commodity prices making life especially hard for those in the agricultural industry, Avera Health set up a stress hotline for farmers, their families and others living in rural areas.

When pandemic stress and burnout pressed down on Avera Health staff, the system added a stress hotline for its employees across five northern prairie states and quickly made the call line available to all health care facility workers in South Dakota.


Thomas Otten, assistant vice president of behavioral health at Avera Health, spoke with Catholic Health World about the caregiver hotline and Avera's efforts to increase access to mental health care. His comments have been edited for clarity and length.

When did Avera's health care worker stress hotline originally launch?
It was in stages. Around January of 2021 we launched to Avera and then in June of that same year, we launched to all health care workers in the state.

Why a dedicated hotline just for them?
If you think back to, at least in our region in that time frame, COVID was spiking again. These workers were doing this remarkable thing of caring for us and we needed to make sure that we were there for them.

One of our lofty goals is that we would always be the employer of choice, so whatever we can do to take care of our employees makes good sense.

Was it embraced from the start by Avera workers?
I'd say yes. Our volumes have not been huge. Probably the max volume would be about 10 calls in a week. Sometimes we get two or three calls in a week. You can say four calls a week on average is not big, but it is to those four people. It is to their family. That line mattered a great deal to the people who have been able to either find new hope from that line or get connected to resources and then find hope.

We have a farmer stress hotline that is doing very similar things and the farmer stress hotline likewise ebbs and flows.

Are the calls being answered by Avera providers?
They get answered around the clock, seven days a week by our assessment team as part of our behavioral health urgent care. We have either master's level counselors or sometimes we'll have a psychiatric nurse who will be answering those calls overnight.

Do the callers get counseling? Referrals?
Yes, to both. I would say probably most of the time, it's just venting with somebody. It might be just debriefing with somebody over the course of 10 minutes. It doesn't have to be a long call, just an opportunity to get stuff off your chest.

What the counselors are going to do on that call is largely listen, talk them through maybe a breathing technique, maybe some coping skills, maybe offer some suggestions or thoughts of ways to deal with what they called about.

A lot of times we might recommend that it would be fantastic for them to follow up with a provider and that could be counseling, which is probably most commonly what we would recommend. We can tell them about the free counseling available through employee assistance programs. Sometimes it might be that they really need to get in to see a psychiatrist or a family practice doctor to look at medications, because if they're struggling with depression, depression is an extremely treatable disease.

Do you think it's more difficult for health care workers, who are used to being the ones providing care, to seek help?
I do feel like it is harder for them. They feel like this is what I'm supposed to do, and I'm the one that's supposed to be a healer or a helper, not the one who receives the care.

Why did Avera open the hotline to health care workers across South Dakota?
We realized that this is a pandemic that has struck much, much more than just the Avera footprint or the Avera enterprise. We care a great deal about those who work for the Avera enterprise, but I would say we care a great deal about anybody in our community. So, it's just the right thing to do. I think it's just kind of who we are, that we should be the hands and feet of Christ to all, not just to those who happen to fit inside the Avera box.

How has Avera gotten the word out about the hotline?
We've done marketing in different magazines, like health care magazines and regional magazines, that people might read. We certainly did a lot of internal communication. We sent out an email a couple times a week to all employees and we have newsletters. We do brief daily lineups in each department where we have talked about it as well. We also marketed the health care workers stress hotline through social media.

Is the hotline part of a wider strategy at Avera to address the workplace stress and burnout that has plagued the health care sector?
We do have multiple different angles that we take and this was part of it. Another program we have is called LIGHT. It's an acronym for learn, improve, grow, heal, treat. It is really targeting physicians and advanced practice providers. It's basically an EAP-like service.

It's hard for physicians sometimes to reach out for help, to be the one that's needing healing. But if you work in this profession, the statistics will bear this out, it is a very high-stress profession and a high-burnout profession. Maybe doctors don't want to come for counseling, but life coaching might be a better fit. In some respects, there's overlap between those two. You partner with them wherever they're at and LIGHT is a way where they can reach out and get help.

Avera Behavioral Health Hospital in Sioux Falls opened a four-story wing earlier this year. Can you speak in general about Avera's commitment to providing mental and behavioral health care?
I think it's a very strong commitment from Avera, but quite honestly, it's an amazing commitment from our community to help us with the philanthropy of this project because it's a $32 million project. Our goal was to be able to raise $18 million in three years and we raised over $25 million in 16 months. We in fact had the $18 million raised in three months as we went out and talked to people. Our first 42 asks were 42 donors who said yes to a substantial gift.

This is a community that has gotten behind behavioral health. It touches everybody because a very significant number of people have problems with behavioral health. The sisters who founded us — the Benedictine Sisters of Yankton, South Dakota, and the Presentation Sisters of Aberdeen, South Dakota — made a commitment way back in 2006 to behavioral health when nobody else was because it's the right thing to do. In fact, the sisters will tell you without behavioral health, the mission of Avera is not complete. It's a really important component to what we do. It's healing those who are oftentimes marginalized.

Will the hotline for health care workers operate indefinitely?
We can determine that in time, but we have no intention in the foreseeable future of closing down the health care workers stress hotline. We don't have people 24 hours a day, seven days a week where this is their only job. This is a part of people's jobs. Our number that you can call into is 1-800-691-4336. When you call, you'll have an option: Am I calling for farm stress? Am I calling for health care worker stress? Or am I calling for behavioral health urgent care or other needs? Those same people are answering all three of those lines. We will continue to meet the behavioral health needs of our region in whatever way is necessary.

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