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Dr. Christopher Holstege: We just finished up some projects with a Master Naturalist, which has to do with poisonous plants and animals in Virginia. It just helps you to look at nature a little differently.

President Jim Ryan: In a way that would make us more nervous or in a way that would make us appreciative?

Holstege: It's appreciative and it's, it's actually if you really start to think about it, some of our drug development and such has come from these animals too. So it's pretty interesting if you start to look at what we have around us in nature.

Ryan: Hi, everyone, I am Jim Ryan, the president of the University of Virginia and I'd like to welcome all of you to another episode of Inside UVA. This podcast is a chance for me to speak with some of the amazing people at the University and to learn more about what they do and who they are. My hope is that listeners will ultimately have a better understanding of how UVA works and a deeper appreciation of the remarkably talented and dedicated people who make UVA the institution it is. Today I am lucky to be joined by Dr. Christopher Holstege, who is multi-talented and has four titles to prove it. He is the executive director of Student Health and Wellness. He is UVA's chief of the Division of Medical Toxicology, a professor of Emergency Medicine and Pediatrics and the director of the Blue Ridge Poison Center. In addition to those four demanding and important jobs, Dr. Holstege is also a prolific scholar with over 200 publications under his name, including 10 books that he has either edited or authored. His work has been rightfully recognized. Dr. Holstege was inducted into UVA Medical School's Academy of Distinguished Educators. He has received the Dean's Award for Clinical Excellence from the UVA School of Medicine. And he was twice named Attending Teacher of the Year. He is a native of Grand Rapids, an avid outdoorsman, and a dedicated father of six. And we are grateful to have a moment of his time today. Chris, thank you for being here.

Holstege: Yeah, thanks for inviting me.

Ryan: So, tell me about the path from Grand Rapids to Charlottesville.

Holstege: Yeah. So, chemistry major undergrad. And I think as you know, and talking with students, it's all about mentorship. Yeah, talking with faculty members on whether or not, at that time when I was graduating from college, to get an MD, get a PhD, get an MD/PhD, with a route of a straight MD, but then did a residency in emergency medicine, and then did a very new specialty known as medical toxicology. In fact, most people at that point were wondering "What in the world are you doing going into that? You're gonna take more calls and spend more time in the hospital," and really a fascinating time in the 1990s, to go into the field, especially with the plethora of drugs that were coming into society. And what we had with our mental health crisis, came to Virginia, and was recruited by Marcus Martin, then chair of Emergency Medicine to start the Division of Medical Toxicology. There were very few programs in the country and still remain very few.

Ryan: Why is that?

Holstege: Just aren't many of us in the specialty. They're usually aligned with poison centers. And like our Blue Ridge Poison Center, we cover 48 hospitals, and we really care for the critical access hospitals. We really manage those cases there, too. It's not just the University of Virginia, but also these other small hospitals with very limited resources.

Ryan: So outside of treating someone who's been poisoned, what else do you do in the field of toxicology?

Holstege: It's broad. So anything that is a potential toxin, or poison. So it's people who are suicidal and do drug overdoses, young toddlers who get into things that they shouldn't and get poisoned. Snake bites, environmental, occupational, there's a whole host of things that come in that we train our fellows in.

Ryan: So if you're living in Virginia, How worried should you be about getting bitten by snakes?

Holstege: You know not very much, very rare. I've been hiking and out in the wilderness quite a bit. So first time ever, Jim, I actually had an encounter with a snake this past summer, on a trail run that actually bit my dog in the face, but my dog did very well.

Ryan: What kind of snake?

Holstege: Copperhead.

Ryan: Oh, geez.

Holstege: Yeah, it's very rare. Again, but not a lot, seen a lot of snakes, but it does occur.

Ryan: And how do you do four jobs at once? I gather there are some connections, except for maybe student health and wellness. So, I can see a connection between toxicology, the poison center, and even emergency medicine. But where does the student health and wellness piece come in?

Holstege: Yeah, so 2013. If you remember, I was in the Faculty Senate for eight years and then chair of the Faculty Senate. Got to know the schools well, leadership very well. Got to know Pat Lampkin very well. During that time, the previous executive director had stepped down and she talked to me about stepping into the interim to take a look at it, evaluate it and see what we could do to potentially revamp Student Health and Wellness.

Ryan: And so how long have you been in the position, close to 10 years, or maybe 10?

Holstege: 10 years, it's not interim anymore. And I, actually it's been a wonderful ride, I never would have thought my career would have gone in this direction.

Ryan: Yeah, well, you have been a phenomenal director of the Student Health and Wellness Center. And I'm wondering if you can talk a little bit about the changes that you've seen in the last 10 years. How is student health different either in terms of the cases that you're seeing or the way that you're responding to them?

Holstege: A lot of complexities, and I think what we've really tried to do was do multidisciplinary teams. And those teams are engaged. If you think about student health and wellness, since the Office of Health Promotion, the Student Disability Access Center, the Counseling and Psychological Services and the Medical Services, they all interconnect. And for our students who come with health concerns, it's working in a multi-collaborative way with all those entities, including the health system and their expertise. If you think, for example, concussions, we've published on this, we have a number of students who get concussions, working with the Department of Neurology and the Education School where Kinesiology does work on this to do best practices, and assure that those students who have concussions get good medical care, if they have depression that follows that, follow up with a counselor, get accommodations that are necessary. And then our Office of Health Promotion works very closely with them to see what is going on in our student population, and how do we do prevention efforts.

Ryan: And so we have a new Student Health and Wellness Center, how much of a contribution has that been to your work and to the University community more broadly?

Holstege: It's been tremendous. It's given us a space that we need as we start looking at doing not just what we do in the care of students when they're coming with issues, but also as we start to look at wellness and well being. And how do we bring groups in, it gives us the space to do that. It's a destination place, we've learned from 1515. This was seen as a destination place too, where students would come and spend time together. But it also allows us to do prevention efforts, and to focus on other things than just studying all the time.

Ryan: And do you find that students themselves are more interested in this topic than they might have been 10 years ago, that is to say, students are interested in learning strategies for resilience and healthy lifestyles and the like, or is it about the same?

Holstege: No, I think it's much more so. I'd say this new generation is more in tune with that, as opposed to when I think when we were going through college. And it's, I think, a good change, and especially with the mental health crisis that's occurring right now, as we look at that, and how we're gonna mitigate that.

Ryan: Yeah. So you anticipated my next question, which is about student mental health, and you use the term crisis. So tell me a little bit about what you're seeing and what you've seen over the last 10 years or so and why you would describe it as a crisis.

Holstege: So when I first came in in 2013, there was a debate that was ongoing about "What do we do with the students who have mental health needs? And do we refer them in the community? Do we hold them close? And what do we predict the future would bring?" And we knew based on what we were seeing in the data, and also what I've seen in emergency medicine, where we could not get the care, mental health care that we need for our community, much less for our students, or have our students take that community time. And so what we've done is we've really looked to expand that. Now if you look at 2013, when I first came in CAPS had 8,158 visits an academic year in 2014. CAPS is the Counseling and Psychological Services. It has our counselors and psychiatric specialists. In this last academic year, CAPS alone had 18,074 visits.

Ryan: This is all for mental health.

Holstege: It is.

Ryan: So, 18,000 visits to CAPS alone.

Holstege: Correct. And then add to that, we started Timely Care, which is a telehealth service. We learned during the pandemic that telehealth worked very well. Some students prefer telehealth. Some prefer in person. And so we contracted with Timely Care. That was another 4,878 visits last year. And so we're looking at, you know, around 24,000 visits; we tripled the amount of visits from when I first started 10 years ago to now, in regards to mental health, and there's many reasons for that.

Ryan: Yeah. So can you describe them? I mean, how much of it is more awareness, less hesitation, less stigma, versus how much of it is just an increase in need? I'm sure it's a little bit of both.

Holstege: It's both and certainly there's less stigma. And so I think students, which is great, which is what we want, we know the visits have increased because there's less referrals to the community. They just don't exist. Even our good friends and colleagues in the health system that do psychiatric services are overwhelmed right now. So we're holding more close, which is good because we have specialists who know the University and what the stresses are. We just finished a study that's going to get published in the CDC Morbidity and Mortality Weekly Review. But we did a study of Pediatrics during the pandemic, and how many suicide attempts occurred during that time period, did it increase did it decrease: marked increase that occurred, in fact, in the 9- to 13-year-old age groups, and I bring that up, because this is a growing problem that we're still going to inherit in the future with the generation that we see coming too.

Ryan: So, what's the answer? How do we solve this problem?

Holstege: But I think, again, it's, this is going to be multidisciplinary too. And I think that's a team approach. It's the importance of what we're doing in Student Health and Wellness. But as a faculty member, what the faculty are doing in regards to mentorship, what we're doing from a community standpoint holistically, and how we look at the prevention efforts, right, we're looking at what other things can we do, it's not necessarily all about seeing a counselor or psychiatrist, great teams that are overseen by Nicole Ruzek, who does a wonderful job with those teams. But also, what can we do to mitigate this, and prevention efforts? Right, what strategies can we use? And somehow we've lost touch with this new generation. How do we do that? We're looking at exercise, we're looking at outdoor activities, or the arts, music, sports, there's a whole host of things that we can look at, for the students. How do we keep them from getting to the point where they're in crisis mode?

Ryan: Right. So, I've heard people say, and it makes sense to me, that this problem won't be solved simply by trying to hire more and more counselors, that you have to be thinking about the prevention side of it. Perhaps as much or if not more so than the treatment side. Would you agree with that?

Holstege: I do agree with it. I think from the prevention side, it's looking at what are the things that are causing it to get to that crisis mode? I think more research is to be done on that, especially with this new generation. But I agree prevention is gonna be a big component of this.

Ryan: So, you mentioned research, and I'm completely impressed that you find time, amidst everything else you do, to stay active and research. How do you balance the two?

Holstege: They're interconnected. Much of the research that I'm doing now pertains, especially in the student health realm, of the changes that we're doing administratively. So I, my team probably gets tired of me talking about that if we make a change, we change, for example, during the pandemic, we're going to change our counseling from in-person to telehealth, we're going to research that and see what kind of impact that had. And so it also then helps to inform the other universities, if we're going to be a top university in this arena, we want to be able to publish on that and be able to disseminate that to other universities that don't have the means that we have and what lessons do we have to learn. And we're engaging the students, the trainees from the School of Medicine, many of the doctoral students from other colleges in this too. So we have some really active teams that I think benefits the students. And then there's some research that I just like to do. We just finished up some projects with a Master Naturalist and some of the things in nature, Cleopatra Project, the Socrates Project, which has to do with poisonous plants and animals in Virginia. That was just a riot to do with the Master Naturalists of Virginia.

Ryan: Okay, so what did you learn? And what should we know about poisonous plants and animals in Virginia.

Holstege: Hey, it's all listed on the Blue Ridge Poison Center website, we linked it up, we actually have a large booklet and we've distributed the book out to school nurses and other providers. But you can get online and see that and many of the Master Naturalists are actually, many are retired faculty or in business who went into that expertise. But it was really a fun project. We had students and residents who worked with us on the project too, but explains, it just helps you to look at nature a little differently.

Ryan: In a way that would make us more nervous or in a way that would make us appreciative?

Holstege: It's appreciative and it's, it's actually if you really start to think about it, some of our drug development and such has come from these animals too. So it's pretty interesting if you start to look at what we have around us in nature.

Ryan: And I know you like to spend a lot of time outdoors. Is that where your interest in toxicology and poison came from? Or the other way around?

Holstege: No, I think it's probably the other way around. I would say for me, you know, the stresses in life. My favorite thing is to get outdoors. I'm always thinking about "What am I doing? Where am I doing my next trail run, what I'm gonna do with the hikes with my family. What about camping?" So for me, that's actually been where I decompress.

Ryan: And do all your kids like to camp or are they just good sports? Or do some of them go under protest? Have they learned to love it?

Holstege: They, so my six kids, they, I think all of them enjoy it. There is a time period, my daughter especially, would ask me the question when I say we're gonna go for a hike "How far?" before we would go. But no, they're all much into it. My good wife's family is from Bozeman, Montana. So we've had some great times going out west, but she certainly introduced me to in her family, the outdoors, a great deal too in a whole different way.

Ryan: And what have been some of your favorite camping trips?

Holstege: Lake Sherando, that's nearby. Forty-five minutes away. Absolutely fantastic. Best sights, great trails, it's got the lakes, have an island you can swim to, nice beach. It's probably one of my favorite places. My wife loves it, because there's no cell phone service. And no one can bother us while we're there. So it is, it's a fabulous place.

Ryan: I agree. I've gone running and biking up there. It's a spectacular place. And it's basically in our backyard.

Holstege: Yeah. And it's interesting my students in fourth year rotation with medical toxicology, where I taught this morning, the students I asked, "You know, where have you gone outdoors?" and many of them haven't, their fourth year, right? They haven't been to the Shenandoah National Park, they haven't been, they don't know what Lake Sherando is. I think that most students you would think would do is Humpback Rock. Many of them haven't done that either. And so it's one of the initiatives too, is to try and teach the students about the outdoors. We're often rated as one of the top universities for outdoor activities, and certainly some of our students engage others don't. It's a lot of fun. And I would really like to see more of our students get out a little bit more.

Ryan: Yeah, I agree. And it's close by, O'Hill is walking distance from main Grounds and has great hiking trails.

Holstege: Yeah, I agree and, you know, Ragged Mountain's very close. There's a whole host of things. And we're hoping to put up in the Student Health and Wellness building some maps of where you can go that are easy walking distance, and also where students can post where they have done their hikes with pictures and such just to start educating others that, "Hey, there's some great areas to go." I know the outdoor clubs do a great job, but not everyone is engaged with those.

Ryan: Yeah. So last question, Chris. I know that there are some parents who listen to this podcast, and they're probably wondering how they can best help their kids who are students at UVA, and what would you say in terms of health and wellness that how parents can help their kids?

Holstege: From a student perspective, there's so many great activities to do at the University of Virginia and to introduce them a bit. It's not just the outdoors, but I think about Old Cabell Hall with the music that goes on, the artwork that's around, the history, trying to get them engaged a bit more; find some downtime. That downtime, I think, is refreshing. I think they're better as students. I know in my life I'm better and I'm more efficient as administrator and as a clinician and a faculty member. It's important to have that downtime and find groups I can go out and do those activities with.

Ryan: Yeah, well. That's very sound advice. Well, Dr. Holstege, thank you for your time and thank you even more for everything you do for UVA and our community.

Holstege: Thank you for your support and all that the administration and the board has done for the Student Health and Wellness too.

Mary Garner McGehee: If you or someone you know is struggling with a mental health challenge, there are a lot of resources available. UVA students can get in touch with Counseling and Psychological Services, or CAPS, online at studenthealth.virginia.edu/caps. UVA staff and faculty also have access to free mental health resources including counseling through the Faculty and Employee Assistance Program better known as FEAP. We will also link some resources available in the Charlottesville community and nationwide.

Inside UVA is production of WTJU 91.1. FM and the Office of the President at the University of Virginia. Inside UVA is produced by Kalea Obermeyer, Aaryan Balu, Mary Garner McGehee and Matt Weber. We also want to thank Tab Enoch, Maria Jones, and McGregor McCance. Our music is Turning to You from Blue Dot Sessions. Listen and subscribe to Inside UVA on Apple Podcasts, Spotify or wherever you get your podcasts. We'll be back soon with another conversation about the life of the University.