Pretend to be a cat. Play some air guitar. Watch a pottery video.
In their new book, “How to Stop Freaking the %#$@ Out!” therapists Erin Pash and Kyle Keller provide lighthearted, practical suggestions for people experiencing stress or anxiety. It’s the same approach the pair likes to take at Ellie Family Services, the St. Paul-based mental health clinic they founded three years ago.
Writing the book was an attempt to make talking about mental health feel as natural as talking about physical health, Pash said. Staff members at her clinic, which provides a range of mental health services to clients of all ages, try to focus on normalizing the treatment of mental illness. One way to do that is through humor.
“When we decided to write this book,” Pash recalled, “Kyle and I sat down and said, ‘We give this kind of slightly off-the-wall advice in therapy all the time. When we’re a little bit ridiculous it normalizes things.’ Our suggestions for fighting stress and anxiety might sound a little bit ridiculous, but if they work, who are we to judge?’ ”
The book, which Pash and other Ellie staff members have been handing out to clients and colleagues at therapy sessions and professional meetings, takes an intentionally humorous tone. Reader response has been positive.
“So far a lot of people who’ve read the book are coming back with comments like, ‘It’s been pretty funny to act like a cat when I’m stressed out. Or to narrate an animal’s life for three minutes,’ ” Pash said. “The suggestions are helpful and funny — that’s the idea. Some people have said, ‘Before I can even do the skills in the book, I get distracted from my anxiety because I’m laughing so hard.’ ”
A different model
From the start, Pash and Keller set out to create a clinic that was a judgment-free zone, a place where staff and clients (or “customers,” as Pash likes to call them) can feel free to talk openly about what’s going on in their brains.
The two have backgrounds working in government and nonprofit mental health agencies. Both felt frustration with what they saw as the slow pace of bureaucracy. They felt tangled in the miles of red tape that goes along with that kind of work.
“We had all these jobs where we were like, ‘We love this work, but there are so many gaps that need filling,’ ” Pash said. The two, who’d led “parallel careers,” planned to one day open their own clinic and do things the way they’d always dreamed could be done.
“When we finally decided to go ahead, we said, ‘We are going to offer our staff lots of creativity, we’re going to pay them really awesome and we’re going to create a work culture that makes them want to do this hard work,” Pash recalled.
At first, Pash and Keller assumed that their new business would be a nonprofit.
“We actually put money down with a nonprofit attorney who helped us do all the incorporating,” Pash said. “Then we realized that if we’re going to be a nonprofit we’re going to have to recruit a board. We’re going to have to get approval before we do anything.” This would slow them down. “Our goal was to remove the red tape, to be more agile, and to be a nonprofit means you have to have a lot of red tape.”
So they decided to make Ellie Family Services a for-profit clinic.
“I want to be able to find a way to piecemeal things together to serve my clients without all the boards and governments and all of the extra stuff slowing me down,” Pash said. “I just want to be able to say, ‘We want to do this and we’re going to figure it out.’ ”
In the end, the decision felt like a natural fit. Pash and Keller decided that if they wanted to feel free to create a clinic that served clients in a new style, they’d need to cut ties with the nonprofit model they’d grown up in.
“It’s like passion and frustration had a brainchild and that made motivation,” Pash said with a laugh. “That’s where we started.”
Fill the gaps
One of the biggest frustrations from Pash’s years working in government and nonprofits was how hard it was to fill care gaps for clients. Often, she recalled, a need would arise, a situation where a new service might help clients get the mental health care they needed, but the governing structures were so bulky that the agency couldn’t respond. That felt frustrating.
Now that she’s at the head of her own clinic, Pash tries to specialize in developing therapy programs that fill gaps. The idea is to create new mental health care options that work for people, rather than making people try to squeeze themselves into existing services.
Pash likes to call this approach “embedded mental health.” An example? “We’re working with a local hospital to provide support for parents that have children in the NICU,” she said. “These parents need a lot of mental health support but they are not patients of the hospital — the baby is — so then end up feeling isolated, scared and alone.”
Ellie therapists decided to bring mental health services to NICU parents, to make it as easy as possible for them to get the supports they so desperately needed. “We are now coming into the hospital, providing trauma support to parents,” Pash said. “Nothing like this existed before.” After the babies are discharged, Ellie therapists “follow the parents from the hospital to their houses to continue to support mom and dad.”
Another mental health care gap can be accessibility, Pash said. Often people’s work schedules make it hard for them to see a therapist during regular business hours. When she founded Ellie Family Services, she focused on creating clinic hours and practices that erased those limitations.
“I believe in customer service,” Pash said. “We call people back within 24 hours. Everybody has to do it. We share our personal cell phone numbers with clients. They are free to text us if they are running five minutes late. Because of that, if a client needs to reschedule, they don’t need to call the main clinic number and wait on hold — they have an interpersonal relationship with the therapist. They can text or call us at any time and we will call them back.”
To better accommodate clients’ schedules, the clinic is open from 7 a.m. to 9 p.m. Monday-Friday and from 9-5 on weekends. And some staffers work extended hours. “We have a couple of clinicians who see clients at 9 p.m.,” Pash said.
When a clinic is open at convenient hours, therapy is democratized, Pash said.
“We see the people who fall between the gaps because they are working evenings and weekends and three different jobs. We want to help the middle class get adequate access to mental health care services.”
This approach is outside the norm, Pash allowed, and it’s taken some getting used to. “I don’t think I know of another clinic that runs like we do. There’s definitely some growing pains that we’ve had to get over, but I would say that it’s really different and really great.”
It’s not that mental health clinics that operate in a more traditional way don’t care about their clients, Pash added. “They do good, important work,” she said. “But I think some of the limitations they struggle with are about health care as a whole. We’ve corporatized health care and made the way we care for patients a little bit cold. That’s at least been my experience as a consumer of our health care system. I think we need to make it better and be more creative in how we provide care.”
Hard work can be fun
Whether Ellie Family Services’ approach to care is superior is still up for debate, but it seems to have struck a chord among their client base. The main clinic has expanded twice since it opened, and they have two satellite offices in Lakeville and Richfield with a third scheduled to open the summer in Washington County.
Ellie’s 37 employees all keep a caseload of clients.
“We put all of our money back into the business to keep adding programs and services,” she said. “Kyle and I only make money that we earn. I keep a caseload. Kyle keeps a caseload. Everybody who works here does that. Some people who are directors get a small salary, but mainly they have to see clients to get an income.”
If that’s not enough of a motivator, there are plenty of opportunities to keep busy. Ellie offers a wide range of services to a diverse range of clients. “We have in-office therapy, in-home therapy, anything from generalized anxiety disorder to ‘My parents are getting divorced,’ to a kid with emotional problems. We have family therapy. We have couples therapy. We serve anyone aged 0-100. We do lots of intergenerational family therapy here, trauma-focused therapy. The list goes on.”
This “everybody’s welcome” approach is intentional, Pasch said. The more people see that mental health care is for everyone, the more people will get the mental health care they need. Pash and her colleagues want to break down the shame that surrounds mental illness, to make it OK to talk about it — and to even laugh.
“I’d say the biggest thing we do here is use humor,” Pash said. “We use ourselves as everyday models of, ‘Hey, I’m a mess, you’re a mess, let’s be a mess together, get through it and find enjoyable ways of helping each other.’ ”
With that goal in mind, Pash and Keller recently developed a line of “stigma reducing” clothing.
“There’s a T-shirt that says, ‘My Amygdala Makes Me Anxious,’” Pash said, “because the amygdala is the part of the brain where anxiety originates. Or another one has a picture of a mason jar on it that says ‘Holding Space.’ The clothes are all about making mental health feel like a normal thing instead of this big, stigmatized, scary thing.”
That message seems to be getting through to their clients.
“A lot of people come to therapy here and after the first session they say, ‘I didn’t expect it to be that way at all,’ ” Pash said. “That’s because we make therapy fun — with the caveat that we also do hard work. There is no reason that hard work can’t be fun.”