When it becomes obvious that things are not going well, Holder believes it is crucial to slow down and take stock.

“I think slowing down is often a good start because oftentimes we are so quick to want to fix what’s happening that maybe we don’t really know, ‘what is the problem I really want to solve?’” she said.

This can mean taking time to write down or record a voice note to work through the thoughts and feelings, take a walk, or do an activity that keeps the mind engaged but also gives space to work through the emotion, like knitting or coloring.

Identifying the problem is the next step to practicing good mental health. Holder says that once someone has given themselves enough time to reflect on their inner self, it is then time to ask, “What is my major issue here?”

She notes that sometimes there are many things piling up in life that can contribute to feelings of depression, anxiety, or even suicide, but being able to narrow it down to one change that could make all the difference could do just that.

“A good question to ask yourself is, “If I made one change, what change might impact everything?” You can ask yourself, “what do I need most,” said Holder. “I like that question a lot because that helps kind of narrow through all the things and get down to the heart of what’s really going on.”

Once the problem or problems are identified, Holder said it is important to reach out to another for support. 

“If you have a mentor, maybe there is a counselor or therapist you’re working with, maybe you have a coach, maybe you have a really good friend that is good at listening to you. Reach out to someone and share that thing and then be willing to take their advice,” she said.

The fourth step in staying on top of mental health challenges ties right into the third – being willing and open to the advice you receive.

“Once you’ve reached out for help, follow the good advice that you get, the guidance that you get to move forward through whatever those challenges or struggles are,” said Holder.

Sometimes this advice can be to seek professional help from a counselor or therapist, which then means reaching out a second time. 

These acts of self-reflection and awareness are not easy and often require a great deal of fortitude to accomplish. Knowing this, Holder says that congratulating oneself throughout this process is just as vital as any other step.

“Congratulate yourself on every step. Congratulate yourself for taking the time to slow down. You’re worth the slowing down. Congratulate yourself. Say, ‘Thank you. I thank myself for taking this time to slow down.’ Congratulate yourself for identifying what’s going on. It’s a big deal to have self awareness and know what’s happening.

“Congratulate yourself for reaching out for help. That can be hard for a lot of us. So, you need to celebrate and support yourself in saying, ‘Ah I asked for help. Good job, good for me.’ Then definitely celebrate whatever small steps you make toward making your life more of what you’d like it to be,” she said.

In her new role, Holder is only just beginning her important work of ensuring the nation’s future physicians are not only taught about but also possess the foundations upon which mental health and wellness are constructed and maintained.

Physicians are among the groups of people who experience a higher rate of suicide than many others. She says that many factors go into making this true, including the culture of healthcare and medicine, the challenges of meeting high demands with taxed resources and personnel, and maintaining a work/life balance. 

These have the potential to lead to chronic workplace stress more commonly known as burnout. This type of chronic stress have catastrophic consequences and lead to worsening of depression and other mental health conditions.

For her, promoting good, positive changes within healthcare organizations and within academic medicine organizations to make it a healthier environment is one factor that is essential for the reduction of chronic workplace stress and burnout. Holder says some actions can include reducing the stigma surrounding mental illness, creating improved avenues for treatment and simply talking about suicide more often.

“Start at the level of understanding the organization and the system and how do we support our faculty physicians, how do we support our resident learners, how do we support our students?” she said.

Last year, Holder started with opt-in mental health and wellness checks for students and this year moved to opt-out. She says keeping an appointment is much easier than reaching out for one and the students are already responding well to “being able to have an opportunity to check in with someone around their mental health and wellness and get resources personally designed for them.”

Some of the projects Holder is most excited about are some of the policy and curricular changes that are being put in place to ensure that the students get all the information that they need but also creates a culture in which they feel like we are protecting their mental health and wellness.

Holder and Dean Rory Merritt host Wellness and Learning Environment rounds – a way to check in with the medical students regarding their wellness and the learning environment during their third year clinical rotations.

She says this has been a positive way to get feedback directly from students and support their needs as they navigate the new experience of working in the hospital system.

All exams are held on Fridays to allow students to have a weekend free of any classwork. In addition to vacation and excused absences, first- and second-year students are allowed one free day off (known fondly as the “Golden Ticket”) to do anything they need – no questions asked.

“[It’s] so they can practice saying, ‘Hey I need to take a day, no questions asked to do something that’s personal to me,’” she explained.’” We’ve extended some of that into their third year where they can have some of their excused absences, at least one per block, that's just, again no questions asked, towards their wellness. Whatever they need to do to care for themselves.

“This is progress. We are making progress.”