Becoming a Mental Health Physical Therapist with Jeremy Fletcher, PT, DPT

Welcome to the Pain Science Education Podcast, where we discuss ways to treat and reverse persistent pain. I'm your host, Dr. Joe Tata, a licensed physical therapist and founder of the Integrated Pain Science Institute, where we train practitioners on whole-person pain care. This podcast also serves as a public health campaign to support those living with chronic pain. This podcast is for informational purposes only and is not intended to be a substitute for professional medical advice. Welcome to this week's episode of the Pain Science Education Podcast. On today's episode, we discussed how to become a mental health physical therapist and how physical therapy professionals can bring value-based care to mental and behavioral health care teams. My guest today is Dr. Jeremy Fletcher. Dr. Fletcher has over two decades of experience in clinical practice, education, as well as administration. His work bridging physical therapy and mental health grew out of his experience in the military, teaching in the Doctorate Physical Therapy Program, working at the VA, as well as his role as the chief operating officer of a $4 million funded SAMHSA Certified Community Behavioral Health Clinic. On today's episode, we discuss how conditions like anxiety, depression, and PTSD can affect physical therapy outcomes, the role of the physical therapist in mental and behavioral health, common misconceptions about physical therapists working in mental health, opportunities for physical therapy professionals in mental health, and suggestions and training for physical therapists looking to work in mental health care. Thank you for joining me for this week's episode and your curiosity in learning about mental health physical therapy. If you enjoyed this week's episode, please make sure to share it with a friend or a colleague. If you have questions about the mental health physical therapy certification program, you can learn more at the Integrative Pain Science Institute or you can send us an email to [email protected] that [email protected]. The next cohort opens up just right around the corner on Saturday, January 4th, 2025. Okay, without further ado, let's begin about becoming a mental health physical therapist with Dr. Jeremy Fletcher. Dr. Jeremy Fletcher, welcome to the podcast. Good to have you here. Glad to be here, Joe. I was excited to talk to you. I love talking to you and learning, really learning from you about your professional journey and your personal journey to becoming a mental health physical therapist. A lot of people in our community are familiar with you, but I think it's good that we give people a overview again. A lot of people know that you teach that trauma-informed care here at the Integrative Pain Science Institute, but you're now also leading a certification in a mental health physical therapy, but just give people a good idea of where you've been and how you've arrived, really, to this point in your profession where you're leading this important training. Yeah, it's a great place to start. I think my journey really began to come to this particular point. Through personal and lived experiences, and those personal, lived experiences are, you know, really, I say this a lot, but mental illness got interested in me, so I got interested in it, and I feel like that was really the impetus, if you will, for how I came to be involved in this work. And for me, that meant several people in my life that supported me through a lot of difficult life experiences, but then also those life experiences shaped a lot of the abilities that I have today, which are to be resilient, to continue to move forward, to make meaning and purpose out of pain, and also have really come to better understand, I think the subtleties and the differences between pain and suffering. And so I really feel like that's what has influenced my path. Now, I've had a lot of different career experiences that have shaped an influence in that. I began my physical therapy career in really in the military, so I was an active duty physical therapist, primarily dealing with sports medicine-related issues, but did become very interested in understanding, really look, the psychosocial dimensions of recovery for our soldiers, who were essentially coming off of three years of repeated deployments, and the amount of stress that was being applied to their lives, and really, how resilient they were, even in light of going to war for three years over a five-year period of time. And to me, that was really impressive. Their ability to withstand that amount of distress over a period of time was amazing. So I think I got very interested in that. And then, through my deployment experience myself, along with other childhood-related issues, also found some way to relate to some of the experiences that people had and found through that relationship and through those connections that I actually grew because of the relationships. And connections that were formed there and, you know, often became encouraging. And even today, now that I work within the veteran affairs setting, I get to build these amazing relationships, with these amazingly resilient human beings that have gone through just stuff that you couldn't fathom, you couldn't imagine, but they did it, and they're still thriving today. And that's, I think that's what gives me inspiration to continue to do what I'm doing today. Somewhere in your professional career and journey, there's another non-profit that you worked with that helped shape a little bit of your approach today in working both with physical therapists, and obviously with people who have either commorbid mental health or mental health conditions. Yeah, so myself in a clinical team, a psychologist and occupational therapist in a physician assisting, got together, along with a founder who had this idea that we can impact substance abuse and mental health issues for veterans along the Gulf Coast. And through funding through the Robert with Johnson Foundation, we were able to start a non-profit organization called Veterans Recovery Resources. And, you know, over a three-year period of time that led into seeing that we could make a tremendous impact in that area. And then on top of that, we were really able to learn a lot of lessons about how to solve complex and what the public health sphere calls wicked problems. And, you know, what you learn about a wicked problem is they don't really have a solution. It's just you always enter into this scenario where you're constantly learning and evolving, you're thinking about how to shift levers. And, you know, that was semi-very fascinating, but it also saved lives at the same time. I mean, we literally have stories and stories of the people's lives that we were able to save there. So that work continues in an inpatient residential treatment facility now in Mobile, Alabama. So yeah, it's always great to kind of look back and say, yeah, that was some pretty amazing work that led to lives being saved. Yeah, I'm familiar with your work as obviously we're good friends and colleagues. And I, you know, watch you go through that entire journey, but give us an idea of what it's like to work in mobile as a health slash mental health professional and the types of communities that you're serving and interacting with. Yeah, so I would say what it's like for me as a physical therapist who's involved in mental health is people don't know that I'm in mental health, you know, at all really when they see me most of the time, they come to me as a physical therapist. And that's often their expectations. And that's because of the context of the community that we're in, you know, has historically been pretty underserved when it comes to mental health. And you know, that means that some people get access, that means a lot of people don't get access to mental health care services. So there is a large group of people within the southern part of the state that don't really get the services that they need. Lots of barriers exist to that situation, but you know, for me, I've found it to be very beneficial personally as well as fulfilling professionally because there is this expectation that like a physical therapist is going to be able to help me move better. And I mean, I sort of meet people right there, you know, right where their expectations are, and then I'm able to bridge that into all of these other difficulties that they're having, you know, to open their minds around, well, okay, well, I can see now how a physical therapist can actually improve the ability to move through addressing some of the other life distressors that I have. And so I think those are, you know, that's kind of how it's shaping up for me now within the context I'm in. Why should a physical therapist be concerned about things like depression or anxiety or maybe not necessarily acute PTSD? I think we're good at recognizing acute PTSD, but somebody who has a history of trauma that may still inform the way their care or recovery is going. How does it impact physical therapy and physical therapy outcomes? Yeah. Yeah, so as a physical therapist, we're looking to help people move better, right? And I feel like I say this almost every day in the clinic. I say, listen, as a physical therapist, my job is helped you get back to doing the things that you love to do. And so if you think about what are the things that people love to do, right, I think about these buckets of places, you know, here's a bucket of where I live, here's a bucket of where I work, here's a bucket of where I play, and here's a bucket of where I pray, right? And we have these activities that we're doing. We're participating in some type of societal and social role. And they're occurring in these four buckets, right? Yeah, you may be having pain, and you may be living with pain, and that may be something that you deal with, right? But then I think about, okay, how can I move this person closer to a life that is living well? And that means that we have to figure out how to reduce suffering in their life. And so we know that depression and anxiety and PTSD and addictions and substances. A lot of times these are a result of disconnection, right? They're a result of disconnection with so many things. It might be a disconnection from ourselves. It might be a disconnection from others. It might be a disconnection from a higher power or meaning or purpose. And at the end of the day, though, our role becomes restoring connection, right? So restoring connection, and then once you do that, people are going to move better. And a part of that process to restore connection is movement, right? Like I have to be able to walk to go be with my family members. I have to be able to go out and meet people socially in order to engage in life's activities. So many people are dying and they love going to church on Sundays. If I'm isolated and I'm depressed, and I'm not feeling like getting up that morning, I'm not going to go do those things that do give me meaning in purpose in life. And so I think that is really how I see these mental illnesses, mental conditions, plan a significant role in how people move in everyday life. When you initially said movement, I'm sure many people's minds go to, well, someone has a deficit in their range of motion or sometimes a definite strength or maybe their balance and coordination. All those things are, of course, important. And we evaluate and assess and treat those things as physical therapists. But when you say movement, you're really talking about important life domains that people are kind of negotiating and traveling in and out of life that we don't necessarily, or I would say the majority of PT's don't necessarily necessarily approach it like that, although the awareness of approaching movement from that broader aspect I think is growing rapidly in our profession. Yeah, I hope so. I mean, I hope that it is because that's our real value proposition to the community that we serve is like, are we able to improve your quality of life by reducing human suffering? And the way we're going to be able to do that is by connecting people in community with one another. You know, that's how people with pain are going to be able to suffer less, right, is in relationship with other people. And when you really analyze the barriers that keep people from doing that, pain is definitely one of them. Yeah, in balance and coordination and motion or all these impairments, there are all these things that we must address. But the distal outcome we're hoping for is participating in whatever societal role they have with the gifts and the talents and the things that they enjoy and the value that they bring to the community. I mean, it's a more holistic perspective for sure. But I think it's one that if we were able to adopt, we would have a greater value proposition to, you know, to the communities that we serve. Yeah, it's definitely a more expansive view on assessing and treating someone. And obviously, much in the benefits of what we do versus the very reductionistic range of motion, strength, I don't know, gate speed, something like that. All important things, of course. We all need those. But I appreciate the the broad lens that you take to it. So there has to be a starting point for a physical therapist right here where some some of PT's work in either direct access settings, some are working in primary care teams, some may be in a small rural town where they're the only provider, you know, within, I don't know, 60 mile range. How does someone start, let's say, you know, in this area of mental health physical therapy in their practice? Yeah, so I think number one, you have to start by listening. And you have to start by listening to the needs of the people that you're serving because their needs are going to be different based on the context in which they're finding themselves, right? Like a mobile Alabama is probably going to look different than New York City, right? It's the environment's different. The context is different. So I think it begins with listening. And then of course, any change process begins with like some conscious reasoning, right? So like to be able to say, you know, these, I understand these things, these are things that you may be struggling with. And you know, I'm curious to know whether or not these things may be contributing to what's going on here. And would you be okay with me, you know, providing you with a few questions that you could answer to better help me understand how that might be influencing you and what's going on with you. And so we have screening tools for that, right? Like we have plenty of valid and reliable screening tools that can help us better understand how those might be influencing someone's particular ability to move forward in life. And then, you know, and then I think from there, once that's done, now you've elevated the conversation to something a little different. It's a little new and it might even be a little scary, both first and the therapist and for the, you know, and for that person because their expectation may not be that like, oh, I'm going to see a physical therapist. And that's going to be new. And so there's a there's a little bit of discomfort associated with that, but it's not, it actually deepens the relationship that you have with that person and your ability to influence their outcome is tremendously better. What do you recommend to physical therapists as far as screening for and addressing or let's just say screening screening for trauma because so many of our patients, you know, when I say there were a trauma, there's a lot of different things like along with that. Some people are thinking of early life adverse childhood experiences, but things like just falling and fracturing a hip is traumatic for people, right? Yeah, yeah, it literally could be. So what do you recommend as far as screening for PTSD and physical therapy practice? Yeah, so there's definitely valid and reliable tools that we can depend on, right? I think there's also, we need to not underestimate the ability for us to be able to listen to someone's story as a starting point. I think of trauma, like you mentioned, there's an event that occurs and there's an experience that that person has, and then there is some effect, right? And I think those are the three ease of trauma that if we were just listening for those things, right? And we just listen for those things. I could think Q is in to wonder and be more curious about what is it that may be happening here, and then maybe that's the role of the valid and reliable tool is to be yeah, here, you know, gosh, it sounds like your body may still be experiencing some of these, you know, manifestations of this experience when these are occurring, would you be open to me given you a screening tool? You know, I'm kind of wondering if this might look like a post-traumatic stress reaction or potentially even be something other than that, and we won't know until we do this tool. So would you be okay with that? And I've done that a few, you know, plenty of times in my practice, now that I'm in the VA, they standardize that stuff. So it's a pretty regular thing that occurs, and people are more apt to talk about it too, because it's a little bit more, like I know this is all connected. The body keeps the score and PT has a good place in trauma-informed care, right? It absolutely does, absolutely. So both you and I speak at state conferences and national conferences around the topic of mental health physical therapy and psychological informed care, and all the different facets that PT's are exploring now. What are some of the major misconceptions, like when you're when you're when those people at the end of those lectures, like come up to the microphone, right? And, you know, Dr. Fletcher, you know, you hear all these different types of questions, and some of them are excellent questions, and some of them are really just things that people are confused about. They haven't received good information in this area. The may or may not have got the depth or breadth that they deserved in in DPT school. What are the major misconceptions that you come across in when talking to, you know, physical therapists about this topic? Yeah, so I, you know, I think one is I try to hear and listen to the question for what's really at the heart of the matter. And I think the time that I spent in academia really helps me to put some context around that, right? So I spent six years an assistant professor very, you know, went through in a accreditation process with our university, learned what the captive requirements are, and I was kind of like the the multi-purpose player on our team, like I taught in all these different courses. And, you know, what that taught me was what the preparation is like for a physical therapist. And how difficult and challenging it is to embed new and innovative topics like this here into a curriculum. And, you know, and then to understand how, how change does occur throughout our profession over time. And how we still have to figure out how to meet societal demands, right? And obviously right now, mental health demand has gone up astronomically over the last five to 10 years, especially. Some would argue there was a tsunami that was just waiting to happen at some point. And now it's here. And so, you know, I think our professions write for that. And so these questions come out like, hey, I'm in the clinic every day and I'm dealing with these problems. And I'm here and people say these things. And I don't have the skills or the tools or the knowledge necessary to be able to deal with this and manage this. And so I hear those questions. And, you know, I think those are all valid and they're reliable questions. I mean, they're great questions to be able to ask because it drives us a little bit more forward, right? So, you know, what are those skills that you need? And what are those tools that you need? And then I would ask them, well, how would you address this issue if you were a manual physical therapist? You know, what would you do? Because that's something we already know. We're affiliate, you know, we know well, we, but they would go get another, they would get training. You know, they would go get training to deal with those issues. They would try to understand better the path of physiology. They would look at the biomechanics. They would, they would dive in just like any other area of our practice does now. And it's largely driven out of curiosity, right? Like we want to be curious. We want to know how we might be able to help this person in front of us that's suffering. And I think that's the heart of the matter, really. Joe is, people want to know how to care, better care for that person that's in front of them. But people are bringing them new issues that they hadn't been dealt with in a long time because of these, the prevalence and incidence of these conditions are going up. That also puts that therapist in a really difficult position because then issues for themselves come up, right? And in particular around this is, this is I feel like we're, you know, some of the burnout that a lot of people are experiencing now is they're dealing with so many people that have so many new issues and they don't feel like the skills or tools to be able to deal with that. Right. So they keep doing, let's say traditional, you know, what some of my term is traditional physical therapy. When they're leaving out or not addressing fully the psychosocial factors and because of that, they keep doing this repeating the same kind of clinical behaviors over and over which leads to professional burnout essentially. I mean, I think to some degree, we've all probably experienced a little bit of that. Sure. I have. That's for sure. I mean, too. And, you know, but I do think that's what's driving a lot of it is is we have to be able to adapt to the needs of the people that are coming to see us for help. Yeah. You know, and I think that's a good problem to have. It is, but really, you know, it's kind of this watershed moment like what really changed for me when I finally decided and I recognized I actually don't have the skills to help this person. Yes. There's something missing from my skillset. Yeah. Right. Rather than just trying to go deeper with what you have, what you already know and learn, but what what reaching outside like one of my missing here and is there way for me to attain that and then obviously use it in practice. I think there's something to be very there's something very freeing about that as well. Right. To be able to understand your limitations, be able to understand where where where you are able to care for someone where you are not able to care for something. And, and then if you find yourself in a situation where you have limited resources and capacity, then you kind of say, hey, well, I got to figure this out. You know, if I really want to have make a difference in someone else's life and help someone move to a better quality of life, then maybe I need to learn more. Yeah, I hope that's where most physical therapists are. I hope they're not in a situation where they're they're they're living the same day over and over and over and over. Usually doesn't lead to much growth. Yeah. But what is interesting is that exercise is a really powerful modifier of people's mental health and mental well-being. Yep. And physical therapists are figuring out, okay, how do I now take this skill intervention method that I have that fits greatly into my practice. And now how do I start to have this conversation? Not just about resolving physical impairments, but also about addressing psychological or physiological social factors that will improve that person's health. Yeah. And they're fascinating. I mean, that we get to prescribe exercise, essentially, to help someone's ability to to function mentally and social. Yeah. Right. I think that's such a major advancement in our profession and the way we think about our role that we get to play. And you know, because that is what it's it's so clear. That's what the data is telling us is what science is telling us exercise physical activity. They're enabling, right. They enable us to do those things to really care about and well to do. And, you know, to be able to to know, you know, physiologically, what happens in the brain when you exercise and then be able to communicate to that someone who doesn't have access to mental health care. And I say, hey, listen, or how many times do I sit there in the clinic and hear people say, I really don't want to take medication. I really don't want to take medication. And in my response is, well, there are other things that actually change the chemistry in your brain. And one of those is something that's readily available to you that you can participate in every day. And that's exercise. And that's just moving your body. And that's been shown to have some pretty great effects. And they're like, Oh, interesting. And so to have a physical therapist sit in front of you and say, Hey, I have the ability to help you with your mood. That's that's pretty cool stuff. But we do have that ability. And of all the lifestyle factors exercise and physical activity is the most powerful one probably has the most research in supporting changing people's mood and improving their mental well-being. Yeah. Yeah. And man, he even gets to sometimes do it in groups. One of the lifestyle factors would you go to after physical activity that help people with their mental well-being? Yeah. Right now, I feel like I have a lot of conversations about nutrition being one of those. And there's just some really, really simple things that do make profound differences in people's lives. I think the next thing comes to mind is sleep. And and also equally. So some very simple things that that do make profound differences in people's lives. And all of those are within our scope of practice. All of those are things people are looking to do, which is take or at least that's what I hear in the clinic every day. I want to take less medication. I don't want to be taking as much medication. I feel like I'm taking 11, 12 medications and I don't know what what is doing. I hear a lot of that in the clinic every day. So yeah, physical activity, exercise, nutrition, sleep. And then, you know, I think there's also in my particular community, the role that spirituality plays is also a behavior that people exhibit that does promote more life for them. Tell me more about that. I can so often in this, you know, biopsychosocial approach that is preached so often. Sometimes people will tag on spirituality, even yeah, cognitive behavioral techniques or methods, therapies, et cetera, or weaving in spirituality because they're realizing it's really important. How do you approach that? I mean, I know this is going to be different, obviously, for different individuals and populations. But how do you approach spirituality with your patients as a physical therapist? Because you're one of the few physical therapists that really has said, you have to address this in some way if this is important to your patient. Yeah, so it starts with endurance for me and enduring suffering, you know, I mean, practically speaking. You know, also, I know the people that I'm caring for really well, right? I know what motivates them. I know what they really aim for in life. And I think that's important as a as a first step. But often where that conversation leads in clinic is, and it's one of my favorite conversations to have with people is when I ask them, how you've been suffering for 25 years, you know, with these particular issues, and ailments, and, you know, what is it that's enabled you to endure? And, you know, I get different responses, but nine times out of ten, it's some type of relationship with an existential being, whether that's God, whether that's nature. It's some type of relational thing with something existential that's bigger than themselves and a connection that's something that's greater than themselves. Some people may call that meaning in purpose. Some people may call that God. Some people may call that different things. You know, but those folks that have that, I've literally had people respond to me, one, preaching and teaching to me in the clinic. I've also had people speaking in tongues. And then after they finish, I'll sit there and I'll say, "Do you have any pain right now?" And they'll say, "No." That's pretty fascinating. And as you alluded to, there's great literature out there. You know, there's Duke does some fascinating work in this area. And I think, you know, it's an area that I'm continuing to explore professionally, but also, you know, educating and training students to do that in their clinical practice as well. So I do think it's a pretty cool place for our profession to expand. Do you think it's equally as important for mental health physical therapists to be versed in that area as it is to be versed in, let's say, cognitive, behavioral, emotional, or, you know, somatic techniques that they might use? Yeah, so if, you know, because I know my friend, Joe Courier, who's a psychologist that studies and does a lot of work in the areas of embedding these psychological or really spiritual concepts into psychological practice, maybe listening to this. So I want to make sure that I say yes, but I really, but I really do feel as if it is equally as important, because out of, when we really look at things like moral injury, for example, and this is, you know, one of my colleagues, great interest, that deep question of why are we suffering? It's really hard to answer that question for someone cognitively without going to some type of meaning, purpose, connection, some type of extensualism that allows them to conceptualize themselves as moving through a period of suffering for a particular purpose. You know, and I think that's a really common question that people ask themselves as they're suffering for a long period of time, and they want an answer to that. They need an answer to that in order to continue to endure the way they're enduring now. So yeah, I think it's pretty, pretty critical. Where do you see growth happening for physical therapists in this area? Obviously we have, you know, as you mentioned before, a crisis of mental health in the United States and other countries. We don't have enough providers in really all the health professions that we look at all the health professions, all of us, you know, we need more PT's, we need more OT's, we need more mental health providers. Where do you see physical therapists starting to fill this gap? Man, right, there's so many places, right? There's so many places where that could occur. There's so many opportunities across each segment of physical therapy, regardless of your area of specialization, whether you find yourself to be a manual therapist, or you find yourself to be, you know, a neuro therapist, or however it is that we like to describe ourselves, I think there's some element of understanding mental distress and the role that it plays to improve that. So that's kind of at the individual level, right? At the individual condition level, I feel like there's always an opportunity for us to better understand the role that someone's cognitions, their emotions are playing and their ability to move forward, right? I think that right there is really interesting because if you ask, I think the majority of PT's, they would say, "Well, this fits best with people with chronic pain." But you're really saying, like obviously, no matter what practice setting you're working in, patients have thoughts and emotions and behaviors, whether you're working in pediatrics, or you're working in vestibular care, or you're working with older adults, mental health runs side by side with physical health in all areas of our profession, essentially. Yeah, it's an essential body structure and functions. It drives literally every movement that we do is tied to a cognition or emotion. It provides us the motivation to get up and go. I don't know how we could exclude it. In the same way that we can't exclude the heart either. Just because I work in a clinical setting where I see a lot more people who have mental health conditions and the prevalence of those conditions is higher, doesn't mean that I don't need to also assess for swelling and edema in their lower extremities. That doesn't keep me from saying, "I wonder how the heart and the lungs are functioning. Mental health should be the same. It should be the same." Those mental processes or psychological processes are part of a system's based evaluation and treatment of the whole person, essentially. It should be, I think that's how we're trying to move our profession forward. I think that's the goal everyone has in vision. In mind, I also feel as if there are barriers and there are things that are getting our way. That is great too. We need those barriers. We need those things because that's how change occurs through resistance. That's how we're going to grow through some resistance. What about if we take it broader? When we're talking about things like mental health, you think about just helping the person in front of you. Treating a patient and improving their outcomes. What types of stakeholders would be interested in the services of a mental health physical therapist? Stakeholders. I think stakeholders that would benefit from that particular skill set are organizations, companies, also clinical practices that find themselves in areas where significant shortages of mental health care providers. There's an opportunity for us as a physical therapist with a particular skill set to be able to improve the health outcomes in a population. That could look at thousands of different ways. That could look at large self-insured organizations. That could look like a rural clinical practice in an outpatient rural clinical practice where there is a significant significant shortage of mental health care providers. That could look like an academic institution where they're looking to build a relationship with community-based organizations for the purposes of scholarship and promotion of research. I think there's opportunities in many different places throughout that. It then becomes a matter of like, what are the challenges of the people that we're serving and how do we serve them better and how do we serve them well? If you really enter into the mindset, that particular mindset regardless of where you are, you're going to see it. You can't be blind to it. It's everywhere. You go. Challenge then becomes, how important is it to me to help serve people in a new way? Am I willing to do that? When I look at the landscape of the United States of America, I feel like we've left our kids behind in this area in some way. The mental health challenges, conditions, illness, oftentimes start when children are young or in adolescence. I'm going to if you can just talk about where you see our role in that area and just maybe about the mental health of children adolescents in general in our country. Yeah, I think it's significant. As you alluded to earlier, Joe, we know so much more about the role of adverse childhood experiences to influence health outcomes. If we have that knowledge, we have that understanding, we have to begin to shift our thinking and say, okay, if we're really looking to improve the health of populations of people, then what might that look like as a physical therapist, as a company or an organization that promotes movement? That means we have to be able to get involved in that to a greater degree. I think we also must be able to look at the opportunities in places where we already are as well. Give an example. I'm a father, I have three children, one of which is a 12 year old boy that loves playing baseball. I look at this opportunity that he has where he's in a relationship with a coach and his coach is stellar. His coach loves like nobody's, like nobody else, and they're successful because he's got a great role model who has a positive attitude, who is pretty aware. Why is he aware? Because honestly, that coach grew up in a really difficult situation himself and is inspired to do better and lead better. Sports is such a prevalent, it's a $15 billion industry in the United States, $15 billion. What an opportunity for physical therapist, or really anyone, but physical therapist to be able to look and say, okay, how do we fit in to this segment of the population that is trying to make a difference in the trajectory of people's health outcomes? There's injury prevention, there's all these performance things, but gosh, what about social emotional issues that can be addressed? A simple programmatic changes in how someone is going through a baseball development process, or someone's becoming a better soccer player, or I mean, sports is an amazing avenue to be able to explore. Likewise, arts and sciences is the same. I think you have to be able to look for these places and where people are living, where they're working, where they're playing, and where they're praying, and be able to say, how do I add value here and do that in the age and group range that I'm most attracted to and most interested in? And when that occurs, again, you're going to see the opportunities there. If you're willing to take that, wins an approach. Yeah. Sports physical therapy is an interesting concept. Well, I just think about what's happened over the past year or different athletes coming out about their own mental health challenges and how they're really balancing the physical with the mental and I think of sports PT and sports rehab and sports physical therapy. It's just a wonderful compliment for that, as you mentioned, like teams or working in the high school. Yeah, I think we were both athletes. I was a baseball player. A lot of the social and emotional intelligence that I developed was in the context of a team environment. So much so that whenever I left the military to go to the academic world, I felt pretty isolated. It felt like strength. It felt really strange and unusual because I loved being in a team environment. And, you know, so I think that's where we learned, that's where we grow. That's where we develop in the context of those things. And, you know, yeah, why not why not be able to, I mean, there's gosh, you look at all the money that's in IEL today, you look at what they're doing to attract those athletes, right? They're attracting them to their universities because they have sports psychologists because they have mental health care providers because they've got the best training staff. Don't get me wrong. What they care more, they care about their mind as well. You know, and they're in the military, they do a pretty, I think they do an excellent job, especially in the special operations as well as in now, even within the US Army and the Department of Defense. That's the one I'm most familiar with, but they do fantastic jobs, I mean, incorporating mental health clinicians into a team setting. Right. And PT's kind of serve that role as an optimal mind body practitioner at certain levels of, as you mentioned, play, community, direct patient care. Absolutely. Yeah. Yeah, Jeremy, Jeremy's great talking to you today and people are going to want to reach out to you and learn more about, you know, your work and the things you're doing. And just I think connect with you about, you know, kind of a trajectory you've been through and how you have arrived, where you are today. How can people learn more about you and reach out to you? Yeah. So I probably the best way is LinkedIn. That's, you know, I get a lot of messages there. And yeah, I'm also on the, I do work with different academic institutions as well. But LinkedIn is probably the best place to connect. Great. So if you have any questions for Jeremy, you can of course reach out to him on his LinkedIn profile at Jeremy Fletcher. You can also email us here at the Integrated Pain Science Institute and we can connect you with Jeremy and all the various ways that we have to do that. I want to thank Jeremy for joining us today on the Pain Science Education Podcast where you can learn more about becoming a mental physical therapist. If you're interested in learning more, reach out to us over at the Integrated Pain Science Institute for additional education and training opportunities. Dr. Jotata, please make sure to share this episode with your colleagues who are interested in mental health and physical therapy. And be sure to share with them. Thanks so much for joining us and we'll see you next week. Thank you for listening to the Pain Science Education Podcast. To subscribe to the podcast and learn more, visit IntegratedPainScienceInstitute.com. That's IntegratedPainScienceInstitute.com. Sign up to receive weekly updates and learn about our continuing education courses. If you enjoyed this episode, leave us a review on your favorite podcast platform and share this episode with your friends. Please join us next week as we share more science-back solutions for treating and reversing chronic and persistent pain.