Ken Huey 0:00

Welcome to the Voice of Hope, where bold leaders and healers share how they're building hope, not just talking about it. I'm Dr. Ken Huey. Let's meet the changemakers transforming lives from the therapy room to the boardroom. Hello, welcome to The Voice of Hope. Today's guest is Dr. Shomava Shaha, founder and executive lead of Well-being and Equity in the World and executive lead of the Well-Being in the Nation Network, a physician and public health leader dedicated to advancing health equity, community transformation, and collective well-being across systems. Shoma, thanks so very much for being with us. Thank you.

Somava Saha 0:38

It's a pleasure to be with you, Ken. Thank you for having me.

Ken Huey 0:41

Yeah. I'm always fascinated to know what inspires people's journey. How did you get into medicine and public health and this focus on equity and well-being?

Somava Saha 0:50

I think my journey began in my childhood growing up in Quokata, seeing all around me. I was part of a family that on average translated made about $10 a month, which meant that we were housed, but not always stably. My neighborhood often lost electricity. And on those nights, my mother and our veranda would say, Look at all the world around you. Look how many people have so much less than we do. In fact, there were millions when I saw, and not just what was in front of me, but when I thought about Kolkata, millions and millions of some of the most hardworking, creative, resourceful people in the world. And so for me, the question became as she said, if you have gifts and talents, your job is to use those to make the world better for those who have less. For me, what I saw was this untold, almost infinite source of abundance in our world that was being trapped or untapped by poverty. And as I came to the US and ended up at Harvard, began to see, for example, people on the streets in the wealthiest country in the world, outside the wealthiest university in the world. And as I came to know the men and women in the streets of Harvard, the only way I knew how is to go get a cup of coffee or a meal together when someone would ask for change. And just to listen to people's stories and their journey, I came to see how poverty was in some ways the same and some ways deeply different in the US, that it was a poverty of isolation, of stigma, of mental health and addictions. I met veterans and families and others where the system, even in the wealthiest country in the world, outside the wealthiest university in the world, had left behind. And for me, the question of how do we change the underlying structures and systems that create this, what would it take to move it? What can we learn from that people have successfully done that? And how can we begin to understand how to unleash that well of abundance that of people who had so much to offer, including here, and yet whose gifts and talents were marginalized or unable to actually contribute to our world? It really begins with the idea that we all hold a piece of the puzzle. In a way, we're about to celebrate the Declaration of Independence, and we're a country that celebrates individualism. And I love all the unique ways all of us are different. But I think that view often doesn't include or doesn't fully account for, is that we aren't really built to exist alone. We are social creatures, that in fact we're built to be interdependent. So I often wonder if the founding mothers had been there with the founding fathers or other perspectives of people whose cultures are more communal. For example, indigenous communities had a say, would we have had a declaration of interdependence, not just a declaration of independence? And I spend a lot of time in our work on a Baha'i. We say that everyone holds a piece of the puzzle, that all people hold a piece of the puzzle that's needed for the healing of the world. And so collective well-being isn't just about all of us are okay, that's part of it, but it's really about the idea of how we create organizations, communities, societies where all of us are able to put the pieces of the puzzle that we might hold so that we can see the whole picture together. And that part of our common connection with each other is both knowing we don't have to be the hero or we don't have to have all the pieces, but to trust that if I can create the conditions, what you have to be able to be put forward and what I have, that together we are enough. And that that requires an obligation for us to be part of assuring one another's well-being together, because our well-being is bound up in each other's.

Ken Huey 4:52

Wow. You highlight nicely the individualism, kind of rampant individualism in America. And you've come to be here and you understand our culture, your culture, I'm sure now too, but you've seen what it's like in India. What is the American culture missing that they could learn from other people?

Somava Saha 5:12

I think the strength of American culture, of course, is the way in which it values a person, and the wholeness of that person and the uniqueness of the person. And that is, I think, quite special and important. In the absence of that, you don't value a particular human life. When that I think that neither extreme is actually great. But what's missing often in that view is that sense of how much more we can be when we're together. That it's when we walk together, when we're with others, even when we struggle together, we learn, we grow, we have more together. And that in the absence of that individualism, we tend to over-prescribe both credit as well as responsibility and workload to a person to solve, whether that's the workload of making it if you are experiencing structural inequities, or the workload of having to create change in the world and having to have the answers instead of what it looks like when many people can create those solutions and recreate the conditions for all of us to hold a part of it. And that means that there's more joy, more connection, more ideas, more abundance together.

Ken Huey 6:28

Yeah. There is a frenetic energy to the American experience. I've bought into it myself in many ways. And the idea that we're all part of a greater whole and add something is a beautiful sentiment. I appreciate really it's a grounding conversation. Thank you. All right. So systemic issues. What are the systemic issues that impact mental health and really healing on a community level, do you think?

Somava Saha 6:54

I think there's systemic issues at multiple levels. One is actually our culture itself, something we've already begun talking about. Because when we believe in that individualism or that we have to make it alone, then people can feel very isolated and lonely. That's what I found was the biggest difference between those experiencing homelessness in the streets of the US and the streets of India. But beyond that, there is just the fact that in some racial groups, for example, if you're born black or if you are indigenous, you may, depending on where you are, what tribe you are, just based on history and what's happened. It's this idea of a monopoly game where you didn't get to buy in early enough. So you can have equal rights now, but if all the property is already bought up and you're paying rent every time, like the gap gets to be bigger and bigger. And that's true, for example, where on average a black family might have eight dollars in discretionary wealth versus hundreds of thousands of dollars. Now, I want to be clear, all of that isn't distributed equally. If you're in the Appalachians, you can be far poorer than someone who is black or someone who is indigenous in Palm Springs because they made different kinds of investments. But I think the structural and systemic barriers, if we can stop worrying about them being associated with guilt or shame and instead say, actually, where are there people or groups or communities that are set up without what we call the vital conditions all of us need? Access to connection and belonging and that civic muscle, that sense of agency or purpose that we can actually affect change in our world, access to meaningful work and wealth, or that security that our children are going to be okay or live a better life, something that many across the Appalachians and Rex Belt and many other groups have lost, something that's becoming a more common thing, access to humane housing, all of those things, they compromise our mental health because you wake up knowing and worrying that you won't have what you need to provide. So farmers, especially small generational farmers, have some of the worst rates of mental health and addiction issues because of this feeling of losing a generational legacy that looks very different from a structural perspective from people who may be experiencing racial discrimination or weight discriminations. There's other things that cause structural racism andor other inequities. And then a new layer on top of that is a healthcare system that prioritizes particular kinds of knowledge and experience. When you add everything up, mental health comes from a combination of things, how we're set up structurally and in our families, what we have in terms of resilience and coping strategies, family unit, but also what we have access to societally to be able to create that sense of agency and hope in our lives. And then, of course, there's a genetics piece that is often the part that we have emphasized more recently. Right now, all of our mental health and addiction systems tend to focus on the more biomedical piece, which was missing for so long. But I think we may have overcorrected and instead of thinking about what does it look like to create the conditions of for continuum solution that addresses the structural and historic inequities, that addresses the care needs that people have with a wide range of people, including one another, that could help to provide that, and then creates the conditions where mental health and well-being are built into our society itself and then gives access to everyone, whether it's to treatment or medication or to other supportive therapies. I just think until we can solve those issues, we don't get there. I'll also say that we tend to believe that being wealthy protects us from these things, but that's actually not the truth. In fact, if you look at it, there's actually a J curve where if I could have an advertisement that says too much advantage is bad for your health, I would. Because it's true. Actually, like the more wealth we have, the more we isolate from one another, the less of a sense of purpose and meaning sometimes we have. So there's something about not too little and not too much, but actually being in a just right category that somehow is protective of our mental health and well-being, because we actually have to depend on one another. If you can eliminate the stigma, we can actually create the conditions for supporting what we need from one another. And then there is more likely to be enough for everyone to go around versus being isolated or too famous, in which case you have too much of a spotlight or too wealthy, in which case you don't meet the others, and then you can be isolated. And I keep mentioning isolation because it's the opposite of belonging is that sense of isolation. And I think we often don't think about how these other things can isolate you too. But what we know is that loneliness can increase your risk of disability and death by sixfold in that term. And that isn't just people who are poor, that's everybody. And so how we create a world in which we can all belong is ultimately something that isn't just about our collective well-being, it's also how we can be healthy and well together.

Ken Huey 12:28

All right. I agree with you, but let me try to push against this and give me information to help me understand correctly. So you're saying that isolation is bad and connection and relationships are really key for solid mental health and good communities. Why? I just want to be alone. I don't need people around me. How would you defend somebody trying to speak like that?

Somava Saha 12:48

Well, there are a wide range of individuals. So I would never ever speak to where an individual is. Some people are introverts and love solitude. But as a species, as a people, we are built to be social and we do need one another. It's why solitary confinement is one of the worst punishments that you can receive in prison. Think about that. And people describe it as being terrible in terms of their mental health and well-being. And I think that idea that we don't need one another, I cannot imagine my life. My life is so enriched by the diversity of people I get to have around me from all walks of life, their stories, their lived experiences, their insights. And so to me, it's both impoverishing and likely to set someone up for poor mental health outcomes if you don't have connection. Now, connection isn't enough. And every connection isn't healthy. So to be connected to someone who's abusive isn't necessarily good for you, or be connected to peers. But we don't think of connection as a mental health intervention. And yet in other societies they do. And reliably, when you build that in peer-to-peer systems, what we've seen is whether that was in the context of primary care where we began doing suboxone treatment as a group visit with a focus on the belonging and connection, not the prescription, that led to far better outcomes than individual treatment. And of course, we can do whatever we want, one person at a time. But actually, in general, that also means way more work, way more difficulty, even on the path of getting better, even if you remove all the structural barriers. Now, structural barriers divide us from one another. So for me, I love everything I've learned, for example, from how indigenous communities have approached healing, historic trauma, and the work of somatic archaeology, for example, pioneered by Dr. Ruby Gibson. If we're not connected, those solutions can't actually be connected. The way in which people think about belonging, not just to themselves and to one another, but belonging and being grounded in the earth. Some people find that in just wanting to be in nature. Others find that it's this a different way of being in relationship. And I think like there are so many gifts that we would gain. We would all be so much more enriched if we could remove the structural barriers that remove us from being connected to one another. And so I think of that belonging at both of those levels, individual and interpersonal, but also strong.

Ken Huey 15:37

I long said that joy is the product of a shared experience. I think I can have happiness, excitement, lots of different emotions, but joy really requires another human being to be involved in the experience with me. So you're speaking to that too. I appreciate that. How do we move from individual solutions to more collective approaches in mental health care?

Somava Saha 15:57

A lot of our work has been focused on that actually. So one is prioritizing relationships. So at Cambridge Health Alliance, at South Central Foundation, in the state of Delaware, places that have achieved double-digit improvements in mental health outcomes. It hasn't been by just adding treatments at the top of the pyramid. It's actually by creating the conditions, not only for removing mental health stigma, but for creating well-being of peer-to-peer support systems that where all of us are part of each other's mental health and well-being system. And then as people need it, then it triggers that the need for professional support, but keeps the base focused on what we might each need to be with one another. And that has shown if you look at Support Wall, which won the EU Innovation of the Year Award, where people are connecting with people. And then there's people might be writing art or story. They may be talking and being engaging in a group. They may be doing something by putting that in to say mental health and well-being is a normal thing that we need to practice, just as we might need to go for a walk by normalizing what is needed for one another's mental health and well-being and deprofessionalizing it to something that we all do with one another, we then can create a much more sustaining system. And then by saying having a system of care partners who might be those people that are in every community that are those natural connectors and problem solvers and valuing that, what that brings and creating a workforce there that is about that. To those men that bring in that expert therapy or psychiatry, what we were able to do at Cambridge Health Alliance is build a stepped care model that for our hundred thousand people who are in the safety net, often with significant mental health addictions issues, where up until they got to level three, like we could lower the wait list for someone to get into mental health care from several months down to a day or the same day. And not just with a walk-in appointment, but with something where people got coaching and support, treatment and care, and that there was enough for everyone, but we could really build the base of who could provide that and how that could be provided and planned for that for mental health and well-being to be a population health property of the system.

Ken Huey 18:22

You have spoken before about becoming a better ancestor. Please explain that.

Somava Saha 18:29

That is a big part of what we're we spend a lot of our time doings and thinking about now. And I personally spend a lot of my time thinking about that. I think that idea of being a better ancestor is about that capacity to reflect, whether it's at the level of one's own life with one's family, in the level of one's neighborhood or community, or the level of our nation, to be able to know that we can know and understand the past. And then when we understand history and can acknowledge it, it sets us free. But we don't have to be drowning in shame from it, but we have to be honest about it, it's just reality. To deny reality, it takes a lot of energy to do that. That's a lot of work that I don't know about you, but I have no interest in doing. But more importantly, we can't learn from it if we don't understand it or understand how things in the world are set up based on structures, systems, et cetera. And then when we can hold it and acknowledge it, the reason we don't have to be bound by it is because we don't have to repeat the past. We can be the ancestors that say we understand how we got here. What can we choose to do to be the ancestors for the next one, two, three, seven generations? Not just for me and my family, but for all of us. And to me, that is this powerful question. In a moment where there are so many shifts in the world where things are being dismantled or being built, it's a chance for all of us to say, who do we want to be in this generational moment to build a path forward that our ancestors will be proud of, that our ancestors can know that we were part of healing ourselves, whether, again, that's a mother or a father with their child or a grandmother, with their grandkids, if they're the ones holding, or whether it's a whole community. And in our work, it's often about being able to see the reality and own it, not from a place of politics, but from a place of honesty, of hearing each other's stories and seeing how systems are operating, even in each other's stories, but not stopping there at just a place of empathy, but rather to say, well, what would it take to interrupt these systems? What do we have together? What pieces of the puzzle do we have access to? What would it take to really change this? And by doing that in the state of Delaware, in the midst of the pandemic, they rewired systems so that peers could become workforce members, could become those interrupters. They shifted and connected systems across emergency room social services. They saw that the problem of mental health and addictions was being created at age 12, 13 with school discipline policies again at 18 to 21, as people aged out of child mental health, foster care, et cetera, and began a strategy that during the 2020, and during the midst of the pandemic, because they prioritized well-being and could practically move change forward, they were one of three states that reduced deaths of despair, while every other state on average increased it by an average of 23%. And I think that's when I say that this work, it wasn't easy. It required multiple agencies to come together, but in very practical ways to say what could each of us do to change this and what would a better system look like. When we're able to be honest about the system as it is, when we're able to have the collective process to bring our pieces of the puzzle together. And if we can collectively change what we need together, that's how we create the conditions for our well-being.

Ken Huey 22:19

To talk about connection and larger systems doing that in ways that then creates healing is just wonderful. And you're putting that out into the universe, really, I appreciate it. Dr. Shomava Shaha, thank you for spending time with us.

Somava Saha 22:33

It's my pleasure. Thank you for having me, Ken.

Ken Huey 22:36

Thanks for joining us on The Voice of Hope. If you were inspired, share the light. And remember, hope's not just a feeling, it's a force. We'll see you next time.