Mental Health: What You Can Do | Greg Baugues, Twilio | BoS USA 2018

Greg Baugues, Developer Community Manager, Twilio

Greg Baugues has bipolar disorder and ADHD. He spoke at BoS USA 2013 in an extraordinary talk that has been instrumental in helping start a conversation for many about mental health in tech. Today, he leads the Developer Community team at Twilio. In this short talk, he updates the BoS Community his story, and shares some of the lessons he has learned that go beyond talk, with some thoughts and observations that will help you to support coworkers and others who we suspect might be struggling with their mental health.

Talking is the first step. How can you best support a co-worker who is strong enough to take it?

Video, Slides, and Transcript below


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Greg Baugues: Thank you. It is such an honor to be back here today. Actually it’s funny I almost didn’t make it here today. Last week I was at the office and I’m here with my wife Rachel and we live in New York and I work for a company called Twilio. They’re based in San Francisco but I work out of our New York office and we’re on the 12th floor over by Union Square and like a lot of office buildings in New York we have a fire escape. And I’ll often step out on the fire escape in the middle day if I just need to think a little bit. And I was working on this talk trying to figure out what I was gonna say. And you can see it’s twelve stories down and these two pictures were taken from the same spot. There’s the part of the fire escape that wraps around itself on the way down and then since we’re on top there’s some stairs that go up to the roof. So I went up to the roof and was up there for a couple of minutes just thinking about you know what I was going to say here today and then I come back down to make my next meeting, get about two thirds of the way down put all my foot on one of the steps and the step just gives way. And I just looked down and my foot’s just hanging in the air and my other foot is still on the step and there was a single rusty bolt that held that step in place and that was all that was keeping me from the twelve floors of air right below me.

And I had two epiphanies last Wednesday. The first was safe is a relative term… New York fire escapes are safer than a burning building but they’re not necessarily safe. The second epiphany I had that day as I just kept going back and looking at that stair that afternoon was I’m really glad I didn’t die. And it might seem like an obvious thing to say, but there’s been a lot of times in my life when I didn’t necessarily feel that way. And some of you were here in this room when I got to speak five years ago. I gave a talk about my struggles with depression. I’m a developer. I have bipolar and ADHD. The short version of this talk is that in college depression started really causing a lot of problems for me. I fell out of school sleeping like 12 16 hours a day. I just bounced around from job to job I typically worked there for like a year and then I’d either get fired or I quit right before I got fired. And then finally ten years ago this month in 2008, actually on October 17th 2008, two significant things happened to me.

The first is I set my first appointment with a psychiatrist. And I got put on meds for bipolar. Second thing has happened is I met my wife Rachel and between the meds and Rachel coming alongside me, meeting me where I was at, and helping me just overcome what I was going through, life just steadily got started getting better. And that went on for about five years till I stood right here in this spot and I gave this talk. And it’s really cool Mark to hear, and you know I’ve talked about this before, that talk had an effect on you, but this conference has had a transformational effect on our lives. We were so encouraged by the response here, so inspired by the stories we heard that I went back to the job I’d been working out for six years and six weeks later I put in my notice. And I didn’t have anything else lined up I just wanted to go find a job where I could do more speaking where I could spend more time serving the community or so inspired by the stories that people were sharing here and by the folks we met. And about three months later I took a job at Twilio, with a company that was started by another BoS speaker Jeff Lawson spoke here in 2010 and 2011 and when he spoke here Twilio had less than 100 employees. When I joined five years ago we had about 250. Today we have about 1,300 employees and two weeks ago something crazy happened in my life something I never expected to happen and I got to stand on the podium at the New York Stock Exchange and ring the opening bell with Jeff to celebrate Twilio’s 10th anniversary. And out of thirteen hundred people I got to be one of the ten people at Twilio who were chosen to go represent the company.

In the five years since the conference, the conference that started my path to this spot on the podium here, we’ve had some pretty cool personal experiences too. Rachel and I came back in 2014 when she was pregnant. We brought our daughter back the year after that when she was just about a year old she got to meet Peldi, which I’m telling you was the highlight of her life up until that point. She also got to meet Tania when she gave her a lightning talk and she got a sticker and a cape and about a year after that we moved to New York where we lived for last two years. It’s pretty easy to look at the story in the last five years and feel like life professionally and personally was all up and to the right. Which is why I feel like it’s important to tell you the story about what happened last year, when I decided to stop taking my meds for bipolar after nine years.

First I feel like I probably should address why I decided to start taking them in the first place because I was really resistant 10 years ago. It was actually two years between a psychiatrist telling me that I might have this thing and me deciding to take meds and it’s weird because at that time in my life 10 years ago I was like smoking half a pack of cigarettes a day, I was smoking weed every day, I was drinking two litres of Coke every day. But I was like “I don’t really want any chemicals messing with my brain”… I think what I had to come realize is that the decision to take meds is like any other decision in life. It’s a cost benefit analysis right. Like what are you getting, what are you giving up in return. And I’m really fortunate. These meds work really well for people who have type 2 bipolar like I have. A lot of people have a much harder time, much more complicated math, they make my quality of life so much better for a minimum amount of side effects. But after nine years I started to wonder and I was just like I wonder if I’m missing out on something I wonder if I’m in a different place. I wonder what life would be like off of them. Like do I really know what it’s costing me anymore. And so I tapered off my meds and I went off and a few things started happening.

The first thing that started happening was I got really into chess. Like I’ve played chess most of my life but I’ve never really studied it. And I started studying and I started going to the park Washington Square Park Union Square playing all the time. New York has some pretty famous historical chess clubs and I started going and spending time there. I started bringing Emma there with me. I say she’s still never beat me at chess which I’m quite proud of. I started learning how to play, I started reading books, I started logging my games and I started carrying around this little magnetic chessboard in my bag that I would use on the train so I’d go back and replay the games look for mistakes. I read biographies of chess players like Bobby Fischer and Garry Kasparov and I remember coming across this quote in Bobby Fischer’s biography that said “Chess doesn’t drive people mad, it keeps mad people sane” – which really resonated with me. Which like in retrospect should have been a warning sign. Another thing started happening was I started staying up late working on side projects again. Emma turns 4 next month, and New York City recently rolled out universal pre-K so the year that your kid turns 4 they’re eligible for a full free year of preschool and there’s 3000 preschools that have opened up in the city. And I found the way in which the city displayed that data to be appalling. So I went and I found a CSV with all that data and I was inspired by Dave Collins here with some of the lessons he’s taught about SEO to build an SEO-optimized Web site (that turned out to be quite shitty) to display this data for the 90,000 parents who were going to enroll their kids in preschool. And this thing was so unimportant but it felt so important to me, I felt like I had to do this, it felt like I had to build this thing. And I’m not here to say that intellectual hobbies are bad. I’m certainly not going to tell this crowd that side projects are bad. They’re like clearly not, right.

But my problem was that it didn’t feel like I was choosing to do these things. It didn’t feel like I was making a decision like this is the best move for my life right now. What it felt like was that my brain was just deciding to run in the direction of these things and there were consequences. One consequence is that when I’m staying up late every night I’m grumpy in the morning and I don’t wake up. And our daughter she wakes up around 6:45/7:00am and she wants to play. And there’s a long stretch there where I was just really grumpy every morning and sometimes that’s the only time I get with her. I had her record this greeting for me. This is my alarm now.

“Daddy wake up, wake up. I’m going to get up soon. Will you please get up so I can play with you?”

But over time my depression started kicking in again. And it got harder and harder to wake up again. But the place where I noticed it the worse was at work. And I don’t know that I was really playing chess and working on side projects because that’s what I wanted to do. I think I was doing it because work was so hard, because the work I needed to be doing I wasn’t doing. And I had recently taken over leading the developer community team, it was my first time as a manager. It’s my first time hiring anyone and I had to create a job description for the person we had to hire. And I remember telling my boss Ricky that I would have this thing done on Monday. And Monday came and went and I just wasn’t able to make any progress on it and Tuesday comes and it’s the same thing I write a sentence I delete a sentence. And then it got to the point where Wednesday rolls around and I’m starting to hide from them a little bit kind of hoping that we don’t talk to each other and over day over day it goes and I’d be like man I know I need to write that thing but maybe I’ll just like play one game of chess online real quick for like five minutes. All right. As long as I start working on it by noon I’ll be fine. Then noon comes and it’s noon 15, and then it’s maybe if I get up early tomorrow I can work on this I just get in the spiral. This spiral of like guilt and shame or because I couldn’t do this thing that seemed so easy I felt like hiding and I felt even more guilt. And I got to this place where after a week all I had to show for a week’s worth of work was like two lines in a Google Doc and I started to be afraid. I started to be like you know at some point someone at Twilio is gonna figure out I don’t actually do any work around here. And maybe it’d just be easier if I just quit before they figured that out. Then I started thinking you know I don’t think I’ll be able to get another job that pays what Twilio pays, certainly not in this condition. New York’s an expensive place to live so we’re gonna have to move. We couldn’t make it in New York. And we’d have to go back where I came from, back to Indiana. That’s how I end up looking up how much homes cost in Indianapolis at 2 o’clock on a Friday, when I’m still writing the job description.

Finally I got to a place where I had my one on one with Ricky one day. And Ricky’s like how are you doing… And I am so thankful that I was able to say that day “I’m not good, I’m really depressed right now”. And you know I had more work I had to do to get back to a place where I could treat the biological condition that was happening. But the day and the minute that I said that the minute I was able to say to someone at work I’m depressed right now that spiral stopped. I set up an appointment again to go see a psychiatrist. I went back on my meds here. You know I remember like ten years ago when I first started taking these things I was I would take them at work and I was like so afraid, I’d go take them in the bathroom because I didn’t want anyone to know what I take. This is my Lamictal, I take it twice a day. Rather I take two once a day… And I had to decide you know yes there are costs. Yes I would like to be the kind of person that can beat all the players at the park at chess right. Yes I would like to be the type of person that does side projects and starts something from nothing. But I also really like being employed. I like living in New York. I like being able to play with my daughter in the morning. And as I think back I feel like last year I went through the best case scenario of an employee who is struggling with a mental health crisis. And I think about what are the things that the managers in this room, the CEOs in the room, or just the people in this room who work with others, can do to help folks who are struggling. Just out of curiosity if you know a friend, a family member, a co-worker who’s struggled with a mental health crisis could you just raise your hand. Just about everyone.
So I think back. What is it that Ricky did? Like why did this go so well for me? The first thing that he did, and I think Twilio’s done well, is to cultivate vulnerability. I knew it was gonna be OK for me to walk up and say I’m depressed. And you know what, vulnerability causes a chain reaction. A couple of weeks after that conversation with Ricky I sent an email to the rest of the team just sharing with them where I was at. And this caused the rest the team to be able to open up to me and I had some conversations over the weeks after that and some other folks were able to get some help. And this isn’t something that just happens at Twilio. A few months ago there was this tweet of this woman Madeline Parker who emailed her whole company saying that she would take a couple of mental health days and her CEO wrote her back just to compliment her and to thank her for being so transparent. And she tweeted out his reply and that got 16,000 Retweets. There is a hunger right now to go work at places where people can be their whole selves when people can talk openly about these things.

The second thing that went really well for me is I had access to health care. I was able to get back on meds that worked for me right away and I was able to see a therapist. And that just doesn’t happen very easily for most folks. First thing I was able to do is I was able to take off in the middle of day. I put a block on my calendar every Wednesday three to four thirty said I’m going to therapy. And I don’t know that everybody knows that they can go see a therapist in the middle of the day. Which is tough because therapists and psychiatrists typically only work like 9:00 to 5:00. And so if you can’t go see them during the workday it’s really hard to see someone. And that’s assuming that you can find someone to see in the first place. Like most people can only go see someone who’s covered by their insurance. And how do you figure out who’s covered by your insurance. You go to your insurance Web site. I tried to do this this morning just to see what their lists would look like. And I hit the spot where you’re supposed to sign in. I don’t have my username and password – Rachael probably does. I don’t have it like I don’t know how to sign into this thing, why is this Web site so bad. And the answer is because the insurance companies aren’t incentivized to help you use your insurance. Like they don’t want you to go see someone, they don’t want to have to pay someone. And if you think about the conditions that are happening in someone’s life at the moment in which they make a decision like maybe I should see a therapist or a psychiatrist for the first time – that’s the point in their life when they’re least mentally capable navigating the health care system. Like think of someone who has anxiety or depression how are they supposed to make a decision about which therapists from basically the Yellow Pages are they going to go tell their deepest darkest secrets to? And there’s a few things here that have started to get better over the last couple years. Zocdoc does a pretty good job, Psychology Today has a pretty good directory listing where you can filter and you can actually set an appointment online. But if you’re not using one of these services in the way to appointments typically get set. Now if you’re supposed to pick up the phone and call and you’ll typically leave a voicemail… and you’re going to play a voicemail tag back and forth because these people are in sessions all day and so we’re talking about what can you do? It dawns on me that for a roomful of software minded entrepreneurs there might be an opportunity here for someone here to fix this problem?!. There’s a lot of a lot more demand for these services today. The stigma is getting better. We’re talking about this stuff so much more than we used to. And right now it seems like the way in which these appointments are set are stuck in the 1990s. In our case the Twilio we have what’s called an employee assistance program. There’s an 800 number, we can call it, we can have four free sessions with a counsellor over the phone and someone on the other end of that line will help us out.

Now I think it’s pretty easy to underestimate how many folks are struggling with this I think it’s pretty easy for us all to underestimate how many folks at our companies who work with us are struggling with this stuff. The World Health Organization estimates that one in four people will experience some sort of mental disorder and that two thirds of them with a known mental disorder will never seek help from a professional. I want to stand up here and just say that the only difference between me a year ago and being in a place where I was considering leaving Twilio so I didn’t get fired, and me two weeks ago where I’m on the podium as one of the 10 high performers in the company, is that I had access to mental healthcare; is that I worked at a place where there was a culture of vulnerability; and where there was very low friction to me getting the mental health I need.

And so as you all are trying to figure out how do you make your companies operate better like we talk about this idea of this 10X developer right but if there’s an employee in your company and right now the World Health Organization says that 16% of the people that you work with are gonna go through something and won’t get access to health. Two thirds of that one in four. Right. So if you were going to company one hundred fifty people there’s twenty five people in your organization who are gonna go through some sort of crisis and not be able to get help. If you’re able to give help to one of those people you will increase their productivity by 10X. You can do to them what Ricky and Twilio did to me. You can take someone who’s underperforming and have them be a high-performer.

But I think it’s a lot bigger than that right. Peldi talked a lot yesterday about fulfilment. There’s been a lot of talk over the last couple days about fulfilment. And as I look back I don’t know what’s going to happen to Twilio in the long run or what Ricky will do in the long run… and the Business of Software Conference, I don’t know where this will be in 20/30 years… But I know that Ricky will be able to look back on his life; and Mark, you will be able to look back on your life; and Rachel will look back on her life; and know that they played a part in saving mine.

Thank you all very much.

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