A Conversation with BJ Miller and Sonya Dolan — About Their New Venture: Mettle Health

by Henry Fersko-Weiss

BJ Miller has been at the forefront of conversations on end of life care since his extremely well received TED talk in 2015, entitled: “What Really Matters at the End of Life?” That talk led to a great many other speaking engagements over the past five years. In addition, BJ continued practicing as a Palliative Care physician at the University of California Medical Center and taught at the University of California San Francisco (UCSF) School of Medicine. Earlier this year his book with Shoshana Berger, A Beginner’s Guide to the End: Practical Advice for Living and Facing Death, was published by Simon and Schuster. Now he and Sonya Dolan, a long-time associate, have started a new venture, Mettle Health, which is a non-medical approach to serious illness and dying. On a recent afternoon I was able to talk with BJ and Sonya about Mettle Health and their vision for its future.

 

Henry: First of all, what does Mettle Health do?

BJ: Mettle Health is an extra layer of support for a person and or their caregivers facing a serious illness. Our main focus is on the physical, emotional, social, and spiritual needs of all the people involved.

Henry: That sounds like palliative care, which I know has been your main area of practice as a physician. So, what is different about Mettle Health?

BJ: Mettle Health focuses on the psychological and spiritual pieces of palliative care that are too easily left out of the medical model. Medical palliative care has come a long way, but the other aspects of it that I just referenced need to get a bigger slice of the pie, which is what Mettle Health is about. We don’t serve as a client’s medical team, we don’t prescribe medicine, nor do we speak directly to your medical team. But we can help people understand what they are being told by their physician, encourage them to advocate for themselves, and offer a place where they can talk through their decisions and feel reassured.

Sonya: The idea for Mettle Health came out of the early days of the COVID-19 pandemic and all of the unexpected grief. We wanted to do something to help. On top of that we were seeing that palliative care is not always accessible. For example, I had a family friend with leukemia who couldn’t get palliative care. We’re offering a way for people to get the crucial support of palliative care without needing a referral.

Henry: Where did the name Mettle Health come from?

Sonya: We were trying out various names that related to helping people find the inner strength to cope with a serious illness and the word “mettle” came up, as in “testing one’s mettle.” We just immediately liked it and its implication of being courageous and tenacious. These are qualities that people need in these circumstances and that we can help them find within themselves.

Henry: Tell me some more about the kinds of services you offer.

BJ: Our services consist of hour-long consultations to answer questions, help people think more clearly about the road ahead, or to deal with the emotions of facing a serious or terminal illness. People come to us for anywhere from one to three sessions, sometimes more. While working with people around end of life issues is an important part of what we do, we also work with people facing a serious illness that isn’t terminal.

Henry: How is it going so far?

BJ: We really just started in early July. But, the feedback has been great so far. I’m doing most of the sessions right now. People have been coming to us through word of mouth. But we are also getting referrals locally from oncologists, hospice and palliative care physicians. Lately our reach has expanded to the Midwest and even the East Coast. The need is huge, the technology makes it possible to work with people anywhere, and we have something very critical to offer. It’s a matter of right-sizing it.

Sonya: One of the things that is holding back our growth is that we aren’t able to get reimbursement. We hope that as the client volume increases we’ll be able to offer a sliding scale. We want to make our services accessible to anyone. Eventually we want to work with employers, so they can make our services available as a benefit to their employees. We also hope to work directly with insurers. Every week brings a new milestone. We’re absolutely moving forward.

BJ: We are still building our team of physicians, nurses, social workers and chaplains, all of whom will be palliative care trained. In the process of vetting other palliative care doctors, we find that they can’t wait to get beyond the 15-minute visit and updating electronic records.

Henry: What do you see as the future of your services:

BJ: A year to a year and a half from now we hope we’re at a place where we can attract funding and expand our offerings to include education and training. We want to have a bigger impact and offer the public more ways in. We also want to find ways to work beyond one-on-one sessions—to work at a different scale.

Sonya: We’re still working on the website, which is part of my role in the organization. People can find us at www.mettlehealth.com. I’m really the behind the scenes person from a client perspective. But I’m also working on moving along the relationships we’re building.

Henry: I think INELDA and the network of doulas we have trained could be a valuable resource for Mettle Health.

BJ: I agree. It makes great sense in our efforts to help people find the support they need to suggest that they might benefit from working with a doula. We could then point people to INELDA and the doulas you have trained.

Henry: And of course, referrals will go in the other direction as well. A doula might suggest to a client that they look into the services of Mettle Health, especially if they need to better understand the medical decisions they face or want more support with complicated emotional or psychological issues from leaders in the field.

BJ: Yes, and collaborating in some way might help with another goal we have, which is to see care move further upstream in the course of a person’s illness. One of the things that palliative care has struggled with is being called in late, when there is less time left. Our aspiration is to work much earlier in an illness when we can have a bigger impact on the quality of life.

Henry: Our organization shares that goal. One of the benefits of the doula approach is that we can start working with people well before they would be eligible for hospice.

BJ and Sonya, I want to thank you for talking with me today. We at INELDA wish you well with Mettle Health. My hope is that we can find creative ways to work together in the future as your company grows and evolves.