Episode 28, Part 1: Mental Health Care with the Flatwater Foundation and Mark Garza

Intro: [00:00:00] We are a resource for learners, including every member of the Live Strong Cancer Institute’s, on track educational pipeline from middle school to residency. We are a growing collection of interviews, talks and experiences that uncover the myths and the uncertainties of cancer and careers and cancer in order to empower and inspire generations of thinkers and leaders.

This is cancer. An education and empowerment podcast by the Live Strong Cancer Institutes.

Eugenio: Welcome back to Cancer Uncovered. I’m Eugenio Sobrevilla with the Livestrong Cancer Institute at Dell Medical School here at the University of Texas at Austin. I am a student volunteer on the behalf of Dell Med and I’ll be co-hosting this podcast alongside [00:01:00] Kristen, and we’ll be interviewing Mark Garza, who is the founder and executive director of the Flatwater Foundation, a nonprofit that provides mental health services to families impacted by.

As of now, the foundation has provided over 3000 people with over 56,000 hours of therapy provided at no cost for families. The foundation helps expand its services and its range with the help of its growing team and recognition. And in this first episode, we’ll be discussing the history of the Flatwater Foundation and how it became Mark Garza’s goal to reach families impacted by cancer. We hope you enjoy, thank you.

Eugenio: Hello, my name’s Eugenio Sobrevilla, I’m currently a student here at the University of Texas of Austin. I’m a communications major and I’ll be another voice on this, uh, podcast.

Kristen: Yay, welcome. Glad to have you. Mark, can we have you introduce yourself?

Mark: Absolutely. My name is Mark Garza and I’m the founder and executive director of Flatwater Foundation here in Austin, Texas.

[00:02:00] And what we do is we cover a hundred percent of the cost of, of mental health therapy for families, touched by cancer, touched by a diagnosis.

Kristen: Fantastic. Thank you so much for making time to do this today, mark, why and how did Flatwater Foundation begin?

Mark: So, Flatwater Foundation is an organization that I actually started here in Austin in 2010 after seeing the need firsthand, like after experiencing the difficulty of navigating not just a cancer diagnosis and what it does to the mind, uh, but also how difficult it is to navigate mental.

Especially for most of us who have never even considered it. Yeah. Uh, you find out too late in a time of need trying to navigate, that’s very difficult. So we created the organization to help others get through that easier so they didn’t have to go through what I went through. Which we can get more into as well.

Yeah. But, uh, but yeah, it’s, it’s a problem and I’m a very much a see a problem, find a solution kind [00:03:00] of. .

Kristen: So can you go ahead and tell us more about why Flatwater started?

Mark: Where did that come from? Yeah, yeah. So, you know, in 2009 it was when my dad came to, I’m the youngest of four Austin, Texas, born and raised.

Mm-hmm. like. Been here for a long time. In my early thirties. I’m, I’m brought this news of my dad having, uh, his PSA levels over 120,000.

Eugenio: Hey, y’all, Eugene here. So, when Marker first did PSA levels, he’s talking about a blood test taking the Czech, the levels of prostate specific antigens, also known as psa.

The Mayo Clinic defines PSAs as proteins produced by cancers and non-cancerous tissues in the prostate. PSA tests are done to check the risk for prostate cancer, which are one of the leading cancers in the United States. High levels of PSA in your blood indicate an issue with your prostate. I could potentially indicate cancer

Mark: was something insane.

We didn’t even know what that was. Yeah, and that sort of introduced the first part of like finding out news like your dad’s [00:04:00] been given a terminal diagnosis of cancer. , but not really understanding how to hear it and how to understand what’s going on. Yeah. And that, you know, that affected so many people.

And then really, you know, for a long time when somebody’s diagnosed with cancer for a long time, people understand what’s going on and how’s your dad? How’s your dad? How was your, you know, how’s he doing? And he’s got that medical care and he’s got the doctors and they’re doing what they can, but really we’ve got a mom.

Who has been with my dad for 47 years. I’ve got brothers and sisters who all handle this differently. Yeah. And so it was just really evident what this tight-knit community, which in our case was our family. It’s not always a family, but can be absolutely shattered through news like this. And then with.

There’s just a big gap in care. There’s a lot of stuff happening on the medical side, but What about the wife? What about the children? What about the spouses? Oh, [00:05:00] siblings, yeah. Is a big one. Yeah, and so I just saw it and I was just experiencing it in so many different ways and thought, like I said, this is a problem and nobody’s doing anything about it.

I kind of want to come up with a way to streamline how people that are given this news, Navigate the care, but more importantly, it’s too expensive. . Yeah. Yeah. And through my story, I got there and I didn’t even find out how expensive mental health support was until I was in the chair after figuring out finally who I wanted to see.

Eugenio: Eugene here someone researching the average cost of therapy in the United States. The cost of therapy generally ranges from $65 an hour to $250 or more. And in some parts, the country, a person can expect to pay upwards of 100, $200 per. .

Mark: And then I had to take a pause and realize, I don’t know if I can do this.

Yeah. And so this special therapist called me on a Saturday a week later and was like, Hey, I wanna talk to you. There was something special. Don’t worry [00:06:00] about the money. Like what can we do? We need to get you in here. And this is, you know, this is a while back. But yeah. And that was it. That was my aha moment.

Like it changed my life, that first session. changed my perspective. I wanted to be a beacon. I wanted to, to help other people understand what I was experiencing. Yeah. And that money barrier didn’t need to be there. If I could figure out a way to remove that mm-hmm. or, or at least kind of get it out of the way for those that, that were experiencing that roadblock.

Yeah. Um, I knew I’d find a way, and that was 12 years ago, . It’s amazing.

Kristen: Yeah. I’m fascinated by this. . You didn’t work in healthcare. No. Right. No connection to mental healthcare services whatsoever. Absolutely. So what is it? I just think it’s really special when someone says, I see this problem. I’m navigating this for the first time.

Yeah. But I’m gonna do something about it. I don’t know how to put that into the form of a question except to say just, Where does that come from for you? It,

Mark: it, it comes [00:07:00] from a lifetime of really being, being driven to solve problems Yeah. And being a problem solver and think, and so for me, I was fortunate enough, like I said, I’m one of four and we solve their own problems.

Yeah. In a good way. Mm-hmm. like our parents took very good care of us. But we, all of us, have this very strong skill of solving a problem, figuring it out cuz it’s, it’s life is gonna be full of these problems and so, I think really it wasn’t about what are the reasons I shouldn’t do this, which were, I have no, no business working in mental health.

I have no knowledge, I have no training as a social worker. I’m not sure. And really all of the reasons why it needed to happen. And we could figure out the, figure out the other ones. Yeah. And so for me it really comes from that notion of like, what is the problem? What is the solution? And if you can identify those, you can bridge from one to the other and you’re gonna fail and be okay with failing or doing the wrong thing.

And I have gotten very comfortable with that, knowing that we just don’t repeat those failures. We [00:08:00] learn from ’em. And so I think that’s it. You know, I, HIPAA was a big one. I . I did not live in a world of hipaa. I was not a doctor means Sure. Um, things like, uh, filling out the paperwork. I didn’t hire a lawyer.

I actually had to start a company. You had to start a nonprofit. In the end, when I decided I wanted to take this in-house and wow, be the bank, if you will, to pay all these, we had to start a company and I had to learn. Yeah. And so just this heavy desire to learn, learn, learn. And. education and knowledge was basically the key to unlock the problems.

Mm-hmm. and knock ’em out one by one. And I couldn’t solve all of ’em. And 12 years later, the biggest one of all, we finally hired at the organization, you know, 12 years in a an absolute, she’s a professor at UT in the school of social work. Nice. We brought in Becky Morales, who’s an expert in the field and a couple decades here in Austin, and she’s been helping us.

Forever, since the beginning, actually for about 10 years. So to me she represents eventually when you get there, like [00:09:00] financially for example, you bring in the the right person to do it, but just don’t be afraid to figure it out. Yeah. I’ve said it for over 10 years. I’ve said this was a very much a case of jump out of the plane and build a parachute on the way down.

And it’s such a cliche, but that is why stuff doesn’t get done because we tell ourselves I’m not the person for it, or I don’t really know how. and you know, as a, as a father, like, I can’t let my kids think like that. So, yeah. Yeah. You have to, you have to understand how not to think like that.

Kristen: Can you tell us really, basically, mm-hmm.

for those that don’t know, , what does Flatwater Foundation do? Sure.

Mark: So let’s start with a name, Flatwater Foundation. Start with a name. My dad’s cancer was the impetus, sort of the, the power behind me of discovering all this, his terminal diagnosis. And he was a huge believer in the healing power of water.

Mm-hmm. . And so I’m going, you know, I do this PR stunt that we can talk about, but this PR stunt to make people realize how important mental health is, right? Yeah. [00:10:00] And especially around a diagnosis and. . It was so interesting because it’s on water. My dad, who was sick, was a big believer in the healing power of water, and so I really quickly understood that what we represented was these waves and all this trouble.

This turbulence waves is really the best way to think about it. They come with the diagnosis that disrupt so many people, and if we could bring these people back to flat water mm-hmm. this imagery of this calm. , uh, this place of balance and serenity, which in my head just lives so strong. That image does Yeah.

And brings me such happiness going up to a big body of calm water. And so that was what we planned to do. And so from navigating what is an L C S W? lpc, what are they, what do they do? Who do I need to see from helping navigate that? And then also finding somebody that’s willing to see you. That’s, we call that the navigation of this problem, but then on top of that is the money and the finances and helping [00:11:00] pay for it.

Mm-hmm. . So we are going to, the solution that I said was that was the problem. We’re going to set this up so we can let people find the people in. and because I was not a mental health professional and a social worker, I went and partnered with where they are. You go where the problem is. Right. You don’t try to find a new place to send people.

We went there to Texas Oncology and the, uh, the Lyfts Trying Navigation center. Yeah. When it was still, um, still operational here in Austin. That was our core. And so we went to Live Strong and said, okay, well if anybody needs help, can y’all help them? And they were like, . It’s too expensive. I heard it everywhere.

Yeah. So I said, okay, well, we’ll build a system where you can find the people that really need it and you know, can’t pay for it. I’ll go find therapists. And with those therapists we’ll agree to a flat rate. That’s a reduced rate so we can see more people, and I’ll figure out raising money. I’m a marketer by trade.

I’m, I’m an events guy, so it was like, [00:12:00] Problem is money. Yeah. The solution is going to be money. Mm-hmm. people not having it and getting it. That’s a simple one. I just, this is really gonna be a fundraising organization. And like I said, we’re gonna be a bank and we’re gonna pay for this. Yeah. Let’s start there.

And then working with all these expert navigators and social workers in the field, we could find that people that needed help figure out a system to connect them with us, build a hipaa. Border around all of that. Yep. Like bring the HIPAA aspect in and solve for that and then use technology. So putting all those pieces together very quickly.

It started with a spreadsheet of all the providers that we had that were willing to do this cuz this was novel and new. Got those in the hands of the people that were working with the families and said, send us the bill. Wow. It was that simple. It was really. It’s as simple as you see the problem. People don’t have money.

Yeah. Let’s raise it. Yeah. Build a system so people can send us money, but let’s build a firewall, if you will, around who they are. The thing that

Kristen: keeps popping up for me is like, so are you [00:13:00] cold calling psychologists and psychiatrists and saying, Hey, we will be, will you do this for like a, a flat fee of,

Mark: no, we will be, we’ll be here soon because we’re in hyper mode to get more and more and more people.

But for a decade what we’ve done is I went to Live Strong’s Navigation Center. Yeah. We had all started. A conversation. Hey, do you have therapists that come in here and say, oh my gosh, you know, I’m so passionate about the cancer community and I’m a therapist. Yeah. I would love to see people. And they said, yeah, all the time.

And I said, great. Okay. What do you do? And they were like, have you ever sent anybody? And they said, no, it’s too expensive. Yeah. And that just kept coming up. And so the navigation center was building the opportunity to see somebody, you know, four or five, six times they’re in. Within Lift Strong, but we were all about like, cancer’s not a two, three month rental journey, right?

Yep. So I was handed a stack of business cards and so Vin, initially it was cold calling. Okay. Um, warm calling. Warm calling. A warm [00:14:00] handoff handoff of these cards of. . And so we started there and that was the first network, but then Word got out and friends of friends or people did it. And so it was nationally kind of an evolution of friends.

Of friends, right? Yeah. Yeah. This network was growing organically, internally. and then we had to start taking referrals and references. And in the Covid pre covid world, in the old world, it was all about geography. So there were times that we would see a spike or a need or a population, a demographic geographically that we weren’t.

Really close to. And so we might go and ask or cold calls some people in that area. But now that we’re ready to grow, we’re building systems around enhancing the website as a portal and a link that we can start building forms and forms for interest. Because yeah, it’s just been Mark call Mark, or Mark calls you, let’s build the database, put you in there, help you if you, if you’re a fit and you wanna be a part of this network and agree to our, you know, $85 rate today, and [00:15:00] it’ll go.

In next year, and we try to stay paying a good rate because this needs to be sustainable. Hey

Eugenio: there Eugene again. While looking up the increase of interest of therapy throughout and after the pandemic therapy for the treatment of things like anxiety and depression, increase across the board with more than eight, 10 psychologists reporting that they have seen an increase in demand since the start of the pandemic.

Psychologists are even reporting that they’re working at or beyond capacity with more than four intent, being unable to meet the demand for. and 46% saying that they feel burnt out. This just puts in perspective the true interests of mental health services, but also the struggle to access these services due to the sheer demand, but also the lack of

Mark: providers.

We don’t need to be, yeah, taking advantage of these providers and it’s just sort of becomes. Referrals, internal referrals. Mm-hmm. , every time we meet with all of our, once a year, we meet with everybody in our network and say, we need more. We need more. They’re the best advocates because they say this is some of the their favorite work that they do, but it’s time to [00:16:00] grow and the demand has risen and the number of PR of therapists has actually decreased through the pandemic.

People start practicing, so more people go into, Same old story pandemic, supply down, demand up. So now we’re gonna start cold calling, we’re gonna start building this. And now that we’ve hired a full-time program director, we are so excited to raise that rate that we’re gonna pay because we wanna incentivize these people to do their best work and we wanna be around forever.

As long as until cancer, we can get rid of this cancer deal. Right. Right. So, yeah. So. Again, that’s one of those failure points. Like, does this work? No. Does this work somewhat and getting creative? Becky Morales comes in and helps us understand how we can more effectively increase the size of our network and also the amount of sessions, uh, available with each of those providers.

Kristen: So we were talking about that a little bit before you walked in here, mark, is what does care look like for someone who’s. Seeking services. Right. Do they get, like we were talking about here [00:17:00] at ut, there’s actually a service for employees and staff where you get six sessions a year. Right. So like how does that work?

No,

Mark: that’s So that to me, that’s, to me that was part of the problem. Yeah. Yeah. Um, and I think it’s actually amazing. I think it’s fantastic and I’m very careful not to speak negatively about it, because that’s not a problem. that they’re people are providing this care. I think it’s the norm. Yeah. And the norm is six or seven.

It’s based on decades and decades old research plus cost. Yeah. Right. So if you look at cost and you look at research done by insurance companies has said that, okay, efficacy shows that after so many times somebody that has a generic problem talks to a therapist, after X number of sessions we see improvement and we can’t pay for this forever cuz we’re the insurance company.

Right. Totally understood. And it’s valuable to understand that with cancer, we can’t apply. , you know, mental health norms to all different sorts of things. And I think we’ve done that as a business, in business for [00:18:00] a long time, especially the business of, of insurance, which again, is a great thing that gives people access to the care that they need.

However, it’s very limiting. Mm-hmm. , and they’re in the business of saying, okay, we’re done. Yeah. . So we wanted to be a solution that, so Flatwater Foundation actually pretends, like the whole insurance side of things just does not exist. Okay. We don’t, people say, can we get, can we, can you pay my covid? We actually don’t.

We don’t want to and we can’t Because you’re in contractual agreements with your insurance companies. Yeah. That you’re paying for your part and they’re paying for the other. Yeah. We are not disrupting that. We are very careful to not interrupt that process. Cause it’s very. and we don’t want that to be a problem.

Right. We want to say, okay, instead of that, let us come in and be the payer. Mm-hmm. for you. We don’t take names and emails. Currently we are working very hard. on finding great talent and Edu and lawyers and knowledge in the HIPAA space to help us be able to start using technology to token and encrypt and, and be able to take names.

But for over 10 years, we’ve not taken names in emails because we want to [00:19:00] grow and help thousands and we’ve helped, you know, 3000 people and we’ve done 56,000 hours of therapy. Amazing. We didn’t think that having their names and email addresses and data to be able to interact with them. i e, having protected health information, who they are was as important as making sure that we save lives.

Yeah. Mm-hmm. , we’ve come to this juncture right now, which is huge, that we are gonna be able to do both, which is actually where we need to be. I wish we were there a long time ago, but now that we’ve worked hard to raise the funds and we have resources and we’re always looking for, for more resources to help us do that, we can program into our.

Protections and then we can actually start to survey and talk to them and, and email ’em and get better. Yeah. And have feedback loops and all of the things. Make sure that, that we are helping them. It, it, it’s, it’s paramount.

Kristen: Yeah. There’s so many places I wanna go.

Mark: I know. And I go, I go all over this. I’m super passionate about this.

I love it. I’ll go, I’ll go into, into so many, so many different, [00:20:00] I live this and have lived this for 12 years and it, it’s something that like is still, it’s actually a bigger problem when we are recording this podcast at the end of 2022 is not 2010 when the Flatwater Foundation started. And I think that’s a very important thing to think about.

Yep. . I was solving problems over a decade ago. We’re solving new problems today, and that’s the future of the organization is putting ego aside and knowing that we don’t always do things right for the best way and constantly searching for a better way, and it can be less. Yeah, like, you know, doing less can actually be a better sure way of doing things.

So just running it like a business and, and making sure that we are singularly focused on a mission and accomplishing that mission.

Eugenio: Uh, I’m curious to know, since you’ve been doing this for quite a while. You said new challenges came up. Mm-hmm. , could you expand a little bit more about what

Mark: those are? Yeah, very.

I can simplify it. If you think about in 2010, when I started this, there wasn’t a conversation at the table about [00:21:00] therapy mental health. It wasn’t something that people were talking about at Thanksgiving. It wasn’t something that people were celebrities were posting. Constantly. Right. It is something we did early on by using the world’s greatest athlete who was Trey Hardy and, you know, world champion of Decathlon.

The year we started, that was how we went to market with, and he’s still our global ambassador today. Amazing. Ut, UT graduate and, and decathlon Decathlete. but like using that space cuz people listen to these athletes was something that we wanted to do. Cuz it’s all about mental toughness, mental health, mental fitness for success.

And then here we are. That problem goes away when the whole world is hit with not just Simone Biles and the Olympics. And then the pandemic comes along and then our children. . So now it’s not as much of, of a problem to tell people that it’s important. It’s a problem that we don’t have enough space. Yeah.

To put people and therapists and supplies down, et cetera, et cetera. So [00:22:00] that’s a huge shift. I’m a te storyteller and I can, you know, talk to people or we can create a why and express it and get people to get care that we had great success with. And we did peer-to-peer fundraising. I’m an events person, et c.

those are no longer the problems. We have a 1.2 million paddle boarding event that we started your house. Awesome. Now we need to look at our new problems. How do we raise money without doing events? We’re not a production company. We’ve never had more than two people on staff in 12, first 12 years of doing this.

We now have three, but we don’t need to do build and build and build and create more events. We need to get better. major gifts and giving campaigns and stuff like that. So those aren’t necessarily problems. I think they’re approaches, but like the problems that you’re solving change. Mm-hmm. . And so now it’s like, okay, let’s bring in an expert.

This mental health expertise is going to help us get where we need to be at this point, for sure. I gotta move out of that spot. Mm-hmm. , I’m just a [00:23:00] business guy, you know, who worked in global ad agencies and I need to be sure that my strengths are. and let’s bring in somebody to run the program. And then as a business, let’s bring in an ed, which is the plan going into 2023.

I’ve been the executive director. Mm-hmm. and run this from the beginning. . Now I’m looking to go to a volunteer spot on the board of directors so that we can bring in a, a, a seasoned licensed development person that is all about major gifts and bringing in money, knows a bunch of people in the, in the community, but also that knows how to run a business and has a very strong acumen for, for nonprofit.

I wasn’t creating the organization to give myself a job. You know, we have. , move this thing forward as long as we can with, with the right, with the right tools. Yeah. And so I’m, that’s the most thing I’m most excited about is all this learning and then just putting, so as the problems change, finding the right tool.

It’s like fixing a car, like, you know, just gotta get the right tool for the right issue. But none of that works if [00:24:00] you’re not constantly looking for issues and, you know, with a staff of three, it’s overwhelming. Well, you, well it’s, it’s, it’s great cuz. don’t have to look far. .

Eugenio: That’s true. That’s, that’s very, so much so over 7 million

Mark: raise.

Yeah, over seven and a half million and over, over seven and half million worth of care. When we say worth of care, there’s a value that goes with each session, even though we pay less, so it’s not a one-to-one. Um, but we have spent millions and millions, like it’s over seven and a half million worth of therapy has been covered at No.

to these families in Austin. Incredible. And that was the problem. And it’s not the money that we’re paying, it’s, to me it’s 56,000 hours of care. And guess they’re correlated. And it’s one in one in one. But the money was the problem, like I said. So that’s just, those are just the keys that we’re using to unlock the door.

Yeah. But the number of hours I want, you know, I want to double it. I want to, yeah. If my goal is 25, $30 million,

Eugenio: And that was [00:25:00] part one of our episode. Thank you, Mark Garza for your time and expertise. If you have any questions about today’s episode or ideas for our future episode, please give us an email at livestrongcancerinstitutes@dellmed.utexas.edu

You can also follow our guest, Mark Garza on Twitter on his foundation website at Flatwater Helps. And also on Facebook: Flatwater Foundation. If you have more questions about the Livestrong Cancer Institute, please visit dellmed.utexas.edu This is Eugenio Sobrevilla Reporting for Cancer Uncovered. Thank you for listening and learning with us.