Mental Health Care in America

[announcer] Major funding for Mental Health Care in America is provided by the O'Brien Family.

Hi, my name is Patrick Kennedy.

I served in the United States Congress for 16 years and I was honored to be the prime sponsor of a bill called the Mental Health Parity and Addiction Equity Act.

This is a medical version of Civil Rights that says mental illness and addiction should no longer be left to the margins of healthcare but rather integrated throughout our healthcare system.

But I'm also a person in long-term recovery.

Which means for me that I have not had to drink or use drugs since February 22nd, 2011.

I have lived the story of someone who suffered from alcoholism and drug addiction, but has been able to be fortunate enough to get the support that I need to now be able to live a life of recovery and sobriety where I can break the family chain and cycle of addiction in my family, so that my five children do not necessarily have to succumb to these illnesses simply because they have a medical predisposition to them.

If we get in early, and if we know how to address these illnesses, we can avert the terrible tragedy that is taking too many of our fellow Americans' lives to suicide and overdose every year.

I invite you to this conversation with all of these great experts and people with lived experience, so we can learn more about how we should move forward both as individuals, as members of families who are also suffering.

And when one member of the family suffers, every member of the family suffers.

And finally, as a nation.

Where we as a nation are losing too many of our fellow citizens and we need to do more to save them and to build a stronger country in the future.

Thank you, Patrick.

Hello, my name is Amy Kennedy.

Today we invite you to join us for a discussion about our country's growing mental health and substance use disorder crisis.

A crisis that requires our concerted and immediate attention.

In generations past, our parents and grandparents too often regarded these subjects with skepticism.

However, in the wake of a pandemic that forced people across the planet into an unprecedented state of isolation, we can no longer ignore the necessity of mental healthcare.

It is our sincere hope that this program will empower you, the viewer, to act in your own community in whatever capacity you can to provide support for your community members in need, increase acceptance of these topics in conversation, and allow yourself the care you deserve.

Thank you for joining us.

It's important that this discussion include a wide range of perspectives.

Perhaps the most important and often the least heard are the voices of America's youth.

In the fight for equitable and culturally competent mental health services, youth are often overlooked.

Victims to circumstances neither they nor their parents can control.

A young person dealing with a mental health condition might face additional challenges if their family doesn't understand their illness or what they can do to help.

In other cases, parents may have limited capacity to help their children if they are coping with their own mental health conditions or other challenges.

Adults struggling with mental illness can find peer groups.

Youth facing mental health issues can be isolated from their peers or worse, find that they're peer groups are making things worse through bullying or other behaviors.

In the following segment, we'll hear directly from young people and their caring adults in their lives.

As you know we're here to talk about how mental health has impacted your lives.

And I'm so glad to have a variety of perspectives both in school, out of school.

Maybe you could start for us, Ralphie, and tell us a little bit about what it's been like to kind of get through your school day.

What's been the hardest part at school when you're dealing with mental health?

When I don't have my medicine, it's hard for me to concentrate.

I bet.

What does that look like kind of in the classroom?

So, let's say, is it a challenge for you during certain subjects?

Is there a time of day that you find it most difficult?

Yeah.

When is it hard?

Like, when I have to concentrate.

Did they ever reach out to you, Ralph, when Ralphie's having a hard time at school?

No, but there's been times when I was in a hurry to get ready in the morning and I've went ahead and forgot to give him his medication.

And I know that it's a struggle for him.

Like we went ahead and just last Thursday I walked in and I said, "My name is Ralph Cortez.

"I'm here to give the medication to my son.

I want to give it to the school nurse."

And around the corner, his paraprofessional or the assistant teacher, she heard my voice.

She goes, "Is that Ralph Cortez's dad?"

And I was like, "Yeah, it's me."

She goes, "Yeah, we kind of thought something might be-- He's having a challenging morning this morning."

So yeah, it's definitely something that affects him and it affects him being able to execute at school.

And you're at a new school, Ralphie?

Yes.

[Amy] How's that going?

Good.

Yeah.

Well, what are some of the differences that you've seen?

Did you switch schools this year in second grade?

Yeah.

Yeah.

What are some of the things that you notice that are different about your new school compared to your old one?

There was, third grade, fourth grade and first all in the same class.

[Amy] So, a little bit more separation based on your age?

Yeah.

[Amy] How do you like that?

I like it a lot.

[Amy] And have you made a lot of new friends in your new school?

Yes.

Yeah.

Oh, that's terrific.

You're also in a new school, is that right, Carlos?

[Carlos] Yeah.

How's your new school going?

Oh, it's all right.

It's an alternative school.

So, it's a lot smaller, slower paced and seems a lot easier to graduate compared to regular public school, so I'm doing good.

Ruth, could you tell us a little bit about your experience as a school nurse at a high school?

Absolutely.

So, I was a school nurse for three years on the southwest side of Chicago.

Some of the time or most of the time I should say a lot of the kids would come with headaches and stomachaches and we would, you know, as adults we're like, oh that's pretty benign.

But when a kid is sent to the office by their teacher because they can't focus on class because of a stomachache or a headache, and then as the nurse I would notice that this would be happening more and more.

Like, one student would come multiple days a week and then I would reach out to the parents.

I would see if maybe the social worker had interacted with the child and see if there's maybe a root cause of these constant headaches and stomachaches or, yeah.

That's a hard conversation to have.

Did you have any training as a school nurse on how to talk about mental health with parents when you kind of suspected that maybe it wasn't a chronic headache but something, an underlying cause for that.

Right, no, I didn't have training on how to go about that.

But as a nurse we do see the body as a whole, and the mind is very important to how the body functions.

And so, just treading very lightly with parents about like, "Oh, you know, tell me about "what's going on at home.

Is there anything stressful or--" And sometimes the parents just needed to vent, or, you know, would then share that they were having to have two part-time jobs.

They're working well over 40 hours a week.

They would rarely ever see their children.

So, that in and of itself is hard as a child.

If you leave home in the morning your parents are already gone.

You get yourself to school, you eat at school, and then you get sent home with a bagged meal for dinner.

And then you get home and your parent is still at work.

There were a lot of cases like that at the school.

You, Ralph, have your own kind of experience, parent experience here.

One, did you ever get that call from school?

How did you know that you needed to start to advocate on behalf of Ralphie?

A lot of times I was getting the call that he doesn't want to listen or he's talking back or he's getting up out of his seat.

Or, you know, he's just like kind of bouncing around, and he's being defiant.

And sometimes I'd have to go stop what I was doing and go to school to talk to him and kind of talk him down and reason with him or maybe even entice him with a reward if he goes ahead and changes his behavior.

And so that happened quite often and he would sometimes-- You get to the point where they would call me because he did something that was totally unacceptable, and I got to take him out of school.

I got to take him home for a day.

He's done.

He's can't stay here.

And so, that used to be-- That was pretty heartbreaking.

Carlos, in your experience have you had kind of adults in your life look at your behaviors at school as bad behaviors versus symptoms of mental health concerns and kind of put some kind of judgment on your behavior at school that you felt like was misdiagnosed.

Yeah, I experienced that a lot from adults in my life, but I had a very turbulent time in history.

the leading cause of death for youth is gun violence and stuff.

Just having to like, soon as you step out the house worry about what clothes you got on, who's outside, who's walking behind you, who's walking across the street, who's walking in front of you.

You know, just being aware of your surroundings and that kind of leads to this very heavy anxious mentality that kind of weighs on you as time goes on.

And then you just kind of start disassociating from school, and I guess teachers just take that as you don't care no more and they just give up on you because you gave up on school.

Yeah.

So well said.

I taught in a classroom for over a decade and I think my perception started to change but it took a long time, and it definitely wasn't something I learned in college about how to look at the behaviors that I saw in the classroom.

How to be able to drop those kinds of perceptions of what's lazy or bad and start to look a little closer at what's the underlying cause and what might else be going on there.

Ruth, how do we get that shift to happen with other faculty in the school building?

That's a great question.

And I don't know if I have any good answers.

But I think from my experience just the things that I would wish that could've happened were more visibility for the staff at the school.

That is the social worker, the counselor.

Like you mentioned, as a teacher, you weren't trained to like, recognize these things.

So, I think starting at the beginning of when teachers are educated teaching them how to recognize certain things in children.

In our school, our child study team, the school I taught in, our child's study team was down in the administrative offices.

So, how would a student find them?

[Ruth] Right.

You know, it's a lot about, we show how much we value things by where they are, how we want them used in the system that we design.

So, if we want kids to be able to access the guidance counselors, to access the social workers, then we need to put them in spaces that the kids can find easily, make time for that in the day.

And I think even more so if we think about that on a broader scale, if this is what we value, and this is where our youth are spending all of their time, then are we investing enough resources in the place where they're spending their time.

So, I'll turn it maybe back to Ralph.

And Ralphie, have you found in your new school that you have access to supports in a way that you have enjoyed or been able to use.

Can you tell me a little bit about that?

Yeah.

Like my friend Lucas, he's really nice and he helps me, like if I can't understand something.

And do you have a guidance counselor in your school, do you know?

He has his Special Ed teacher.

And her name is Ms.

Jail.

So, he goes every day?

Is it every day, Ralph, you go to class with her?

Not every day.

Not every day.

But she helps him.

He goes there for special attention and to take tests and things because he is on an educational-- [Amy] An improvement plan?

Yeah.

And so, they're kind of following that and he has special stipulations that they do.

When it comes to testing, he has a little bit more time to test.

And then the teacher also helps him and makes sure that he understands what he's reading and testing on.

How did you find that process of getting the IEP?

And was that something that you initiated or did the school bring that to you?

How did you know the path?

I did it through research.

Through getting on the Internet.

Through asking people that I knew that worked in the school system.

And another big help which I would probably say, I got the most help was from his child psychologist that we had him going to.

She kind of recognized it and thought that actually look into getting him checked out and possibly diagnosed because she thought he might have ADHD.

So, we went through that process and then it was once we found that out and I seen that he wasn't able to get the support at his Montessori school, then that's when I made the decision to put him into a public school because I knew that he would have a better chance to thrive, and he has.

He really has.

He's turned things around.

Where he was struggling.

He came to school and he was struggling.

In some places he was at a kindergarten level at the start of second grade.

Or he was first grade at highest.

But now, within half a year, he's caught up to his peers and it's through a lot of hard work that he does.

And he's not scared to go in and roll up his sleeves and put the work in.

And after he puts the work in, he's going to show you his papers, his grades and, yeah.

[Amy] Congratulations, Ralphie!

That's great.

I'm so proud with all the progress you're making.

Yeah.

Thank you.

You've all been so great at sharing your stories today.

Hi.

Thank you for being here today.

Could you tell us a little bit about yourself?

Hi, my name is Cindy Bellvieu.

I'm a licensed Clinical Social Worker.

I have the pleasure of working with Sidney.

Hi, I'm Sydney.

I'm from Chicago, or Libertyville more specifically, and I am a sophomore in high school.

But this is the first time you're meeting in person?

Yes.

How long have you worked together?

Two and a half years.

We started working together in, I believe it was September of 2020.

So, I know it seems like so long ago.

Sydney got connected with me.

We've been doing telehealth therapy for two and a half years now.

And yeah, this is-- How's it feel to meet in person?

It feels even more like I have a deeper connection with Cindy.

Especially after seeing her face a bit better and her body language I feel like that does play a part.

If that person's kind of being open then you could feel free to be more vulnerable.

I would imagine if you started during the pandemic, did you feel like the pandemic had an impact on your mental health?

And if so, could you just tell us a little bit about that?

Certainly.

There was a sense of fear kind of like, what is happening?

What is going on?

And I remember having so many questions.

And I was questioning what to believe because I felt like people were so divided among it, like this whole issue, and some people still are.

That I kept hearing different things and that uncertainty really, along with the isolation, really impacted my mental health.

How did you decide it was time or did somebody else, an adult in your life decide it was time to get some more support or-- I remember talking with my parents, kind of multiple conversations.

And I think they both decided that it would be best if I got therapy.

And I also thought it was a pretty good idea as well because I thought that talking to someone would be extremely beneficial.

What's making you show up today and want to tell us about your experience?

Well, I mean, first of all, yeah.

I mean, I'm not crazy because I go to therapy, you know.

I feel like that was sort of the stigma before.

But especially like after the pandemic, I think a lot of people focused on their mental health.

Because I feel like after people being by themselves for so long, they had so long inside of their own head that some people identified, maybe I need help.

This past year in high school, she's in a great place.

Able to join the swim team.

I don't want her to have to miss any practices, any meets, anything.

You know, being on the swim team is definitely as important as her weekly meeting with me.

And so, we were able arrange with the school during study hall.

So-- Wow, that's very flexible.

So, during your school day, you're able to step out during study hall and do this extra meeting with Cindy once a week?

Yes.

So yeah, I go and it's actually my lunch period.

Your lunch period?

You're still eating of course.

Yes.

I go to one of the social worker's offices or sometimes the LST is very, very flexible and they're like, "Hey, we have this open room that you can use."

And they seem very eager to help and not just me but all of their students which I think is very respectable that the school does that.

So, now that some of the telehealth's parameters are changing, what are the challenges that you'll face or that licensed clinical social workers will face or that other professionals will face as they try to continue to offer telehealth services or kind of work force issues that you're seeing?

We have state licenses.

And so, we are only allowed to practice when a client is in the state that we're licensed in.

And so, I'm looking forward to reciprocity among states so that we're able to practice if a client goes on vacation to another state.

Or someone goes to college.

Or somebody goes to college.

I have had other clients go to college and outside of Illinois, even in just neighboring Indiana, and I haven't been able to stay with them, and that would be a great thing.

Clearly a young person whose dealing with anxiety, that's a huge thing going away to college, and it would be nice to be able to keep that consistency.

And you've mentioned that this is something that really isn't just for the time of crisis but kind of an ongoing wellness practice.

That this is something that you would continue to do.

Are there certain techniques or things that you found particularly helpful, and how does that translate into how you deal with your peers?

I don't know.

I think the most important thing I've learned is certain frames of mind where you have an emotional frame of mind and a rational frame of mind.

And you have to learn to combine it in a way where you need to validate your feelings and emotions.

That you also kind of, in my mother's words, produce your suffering.

Is this true, right?

Yes.

Is this a huge deal or is the-- Is anxiety amplifying-- Yeah.

"Oh, I'm going to fail this test and it's the worst thing in the world."

Is that true?

Where's the evidence?

Yeah, anxiety is the worst liar that you could possibly ever meet.

Ah, my job is done.

Not done, but-- Sydney, how did your parents, I guess, know it was time that this is serious enough?

Because I think a lot of people probably know that teens-- It's in the news all the time.

Teens are struggling but we also have our own experience whenever we say, "Well, being a teenager is just hard."

I remember isolating myself and sort of feeling like what's the point on getting up today?

What's the point on doing anything?

And I remember some days, although rare, I didn't get up until like 3pm and sometimes later.

I remember not eating or not wanting to eat.

I remember having a lot of insecurities which is normal.

But I feel like I took those insecurities and worried about them all the time.

And I remember a few conversations with my parents.

And I think that they both decided that after hearing some of what I had to say, I think that they decided it was best if I could talk to someone and be able to share these problems to someone who knows how to handle them in the correct way.

And have that, not necessarily a disconnection but like, not have that emotional attachment that a parent has or that overprotectiveness.

I get it.

So, you mentioned insecurities.

A lot of people attribute that now to social media.

Sometimes I still compare myself to the other girls at school.

And I'm just like, "Wow she is gorgeous, and you know, "I wish I had the specific trait."

You know, there's always a little voice that's just like, "Well, look at the stuff you do have.

And, you know, you're fine."

And I didn't have that voice before, and I needed to be able to establish that.

It's like therapy was sort of the building-- gave me the building tools to sort of build that part of me almost, in a way.

Well done.

Well done to you also.

I'm so glad that you've been able to meet in person finally and find that support and know when to ask for it.

It sounds like you've been a terrific advocate for yourself as well.

And thank you, Cindy, for being here.

Thank you for the invitation.

Absolutely.

Thank you.

Hello, my name is Mary Garrison and I'm President and CEO of Heritage Behavioral Health Center in Decatur, Illinois.

It may be unsurprising when non-residents of Illinois hear mention of our state and think immediately of Chicago.

However, Illinois is home to a diverse population of city denizens, suburbanites and world dwellers.

And while the problems of big cities occupy so much of our nation's attention, the struggles of Americans isolated in rural areas often go unnoticed.

Our panelists will shed light on how our mental health and the substance use crisis is stretching an already taxed system.

So, I'd like to start off with a few questions, and Margaret, I'm going to start off with you if you don't mind.

Sure.

All right.

So, as a guardian of a child with a severe mental illness, you've gone to great lengths to try to get care for her.

Tell us about the difficulties you've encountered to get the care that she needs.

Well, at first, they were kind of helpful but then the more they regressed, and her condition got worse, it just seemed like people started shutting doors on us and not helping us.

And just medication, medication.

Change in medication, adding more medication.

Just, you know, putting her here, putting her there, not really stabilizing her to the point where it got violent, you know.

It was scary.

So, Margaret, do you think that the inability to get care for your daughter was due to you being new to the community?

That might have been part of it, but I think the other part was I did a lot of phone calls and stuff before they met us.

And before things started rolling to the other side, they didn't realize that we were Native American, and once they found that out it just like, turned.

And then it was right away, "You need to sign your child over to the county.

That's the only way you're going to get services."

And how were you able to access those services?

How did you get what you needed for that?

I had to sign her over to the county.

But it was laws and stuff that was illegal, but I kept asking them and they said, "No, we can do this."

And they didn't ask the tribe.

So, tribe has to also okay that their child can be placed into a facility.

And she was in different facilities.

It took a while for them to even find a facility because by that time she was able to go to a facility, she had done so much stuff.

So that was a long, long record.

Police records and all the different things that happened to her.

When she was in services, at times that she was, how did you feel about those services?

Were they meeting her needs in terms of your culture?

And really understanding who your-- The counselor was very sympathetic to all that stuff.

And in the meantime, all with this happening she was coming out as a transgender and that was taking a toll on us too because people were being cruel about it, you know.

Like, super cruel at school.

Super cruel in the program she was at.

It was hard.

It was like, I'm not against her doing that if that's what she wants, but people weren't really helping her or helping the problem by saying mean things to her all the time, you know.

And when you think about access to care, it's a problem across our nation in so many areas.

And what you're describing then in this rural area and specifically in Native American communities, it's difficult.

And I think this is exactly why we're talking today to unfortunately have to highlight that this is an issue, and that this does happen.

I guess lastly here, and I'll give you a little break, I want to ask how you as her guardian, how did you manage and have you been managing and functioning through this?

It's affected because I have four other children in my home, four total, all girls, and it affected all of us because they feel fearful when she gets into these states of violence, and it still comes up once in a while, you know.

And then they feel...

It's hard.

She was gone for a while.

They love her, and they want her to be their sister.

And they want her to be not back wherever she was or if she wants-- They're even calling her Willie when she wants to be William or Chase.

She chooses her name a lot.

During the process of this, my husband couldn't handle it and he left, so we got a divorce.

In the process of all this stuff that it was like, hard because they've already lost family members before and it was hard for them for him to walk away.

Thank you for your strength and you''re incredible advocate for your daughter and your entire family.

And thank you for sharing that.

So, David, I'm going to transition over to you.

You come from a farming community with many families with generations.

You've a close-knit community.

So, how does that small, tight-knit community affect the support and treatment of people that experience mental health conditions in how they seek that out and access care?

I'm fifth generation.

My son is sixth generation.

So, we've been there a long time, 1867.

So, a lot of these families have tracked through their lives together.

I said I had five or six fatherly figures and likewise with motherly figures in my life just because of the closeness of the community.

There was an incredible support system that we had.

As I was a youngster, I felt I was sheltered.

I thought I was in the best place in the world.

There was always an adventure.

There was a baby something all the time: a rabbit, a dog, a puppy, a calf, a pig, a baby bird.

I mean there was-- it was always excitement.

And I think it was for me, mental health has been a journey.

But then there's this tender side that I saw when I was 5 years of age when the whole community came and helped finish up a harvest.

And I think that's what I see is mental health is the good things that I had in life.

David, we have, I think, made great strides related to stigma surrounding mental health and substance use.

But with that, do you think there's an increased stigma that happens in rural communities because of that tight knit... That's a hard one to answer.

But yes and no.

I think there's more awareness, but I think the stigma is lifting.

I really do, and I think that's a great thing.

I went through an era in my life where you just swept it under the rug.

You didn't talk about it.

"Oh, you'll get over it.

"It's okay.

You're not melancholy," or whatever the word they wanted to use at the time.

But I think there are probably-- a lot of people probably could've gone through life a little happier if they just had the opportunity to share.

So, we just heard from Margaret about the story related to her daughter.

From your role as a hospital administrator, what can be done to get people the care they need when they need it?

So, putting on that administrator hat.

I wish I was the administrator.

Just a director, so I just run my specific units.

But I think that her story is very common amongst a lot of people who have mental illness or struggle if their children have mental illness.

Unfortunately, it's very difficult to get services unless you're actually in a crisis situation.

And then once you have the crisis situation, once you're stabilized, once you're medicated, you're kind of sent on your way and it's very difficult.

A lot of people fall between the cracks that way.

Martina, what are the challenges of providing suicide prevention and crisis intervention in large rural areas?

We realize that no one system, no one program, can address all the needs.

This is not one entity's, one system's problem.

And how do we create a continuum of support and especially in rural communities when there aren't as many community-based services.

So, the health department, maybe the behavioral health entity in that community, the school system, not necessarily, you know, a specific school, but like the entire district bringing people together to really problem-solve.

And so that is not a one size fits all.

That is a community specific.

And so really, we have taken it upon ourselves to be conveners across the state to start these conversations so that what happened to Margaret-- I'm sorry, to you Margaret and your family, doesn't happen consistently.

Absolutely, and at that unique community level and what needs to be created there.

Wonderful.

Thank you.

Angie, you have not been forgotten.

So, tell us about mental health and substance use disorders, how they have impacted delivery in the public health service sector in your region.

Yes.

Well, as I'm sure everyone can imagine, working in public health over the last few years has been somewhat challenging.

I will say that the Illinois Department of Public Health prepared us for a pandemic in that they required us to develop a public health emergency plan.

And then you exercised that plan on a very regular basis.

I think what we were not as prepared for was the increase that we would see in the demand for our crisis services.

The struggles that our adolescents were facing.

The tragic increase in drug overdoses and then of course the increase in suicides as well.

So, a lot of things that we have the resources in place to be able to work together but the demand was so great that we needed more partners on board.

So, we did just that exactly what Martina was saying and that we brought together our communities and said we're all going to need to do this work together.

And honestly, that was the easiest part in bringing everybody together because in rural communities, that's what we're used to doing.

We haven't always had the resources that some of the larger areas have had.

So, that's how we got things done.

We all come together.

We work together.

We do a lot of those things, but we cannot do it in silos.

So, our communities are wonderful to come together and address those issues.

That's wonderful.

And thank you all for being here and for your voices that you've brought here to help us move that needle, right?

And to keep this in the forefront.

So, with that, I appreciate all of you.

-Thank you.

-Thank you.

Hi, and thanks so much for joining us.

I'm Anna Davlantes.

I'd like to welcome you to our conversation on mental health equity.

When the CDC finds one in three teenage girls in the U.S. has seriously contemplated suicide, and over half reported feeling persistently sad or hopeless, when we learn that over half of adults with mental illness receive no treatment at all, some because they cannot afford it, some because they cannot afford the stigma attached to it, when Black Americans are 20 percent more likely to suffer severe mental health outcomes, but also receive lower access to care, we know we have a problem.

Here to address these issues and talk about some potential solutions, Dr. Catherine Ettman, Assistant Professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.

Also, with us, Denise Brown, Founder of the Caregiving Years Training Academy.

And David T. Jones, Chief Behavioral Health Officer for the State of Illinois.

Welcome panelists, and thank you for lending your voices.

Thanks for lending your perspective to this important conversation.

I just want to say to those in the room and those watching, we have reached an important moment in time because mental health is finally on peoples' radar.

It took the pandemic, sadly, to get us here, but who amongst us was not touched by some or impacted in some way through the pandemic either personally or through someone we know or love.

And I guess, I'd just like to start out with you, David, and explain kind of big picture for us.

Like, what your perspective is.

Do you think that there are more mental health issues in existence today post pandemic?

Are things more severe?

Or would you say that the awareness is a piece of this?

That there's just so much more awareness.

If we look at what happened for example here in Illinois, it's not only behavioral health but it's addiction as well.

So, we saw when we looked at data that compared 2019 to 2021, we saw an increase in overdose fatalities that range from 18 percent to 49 percent.

Eighteen percent in small urban areas, about 25 percent in suburban communities, 33 percent in rural communities and 49 percent in our largest urban metropolitan area, obviously Chicago, right?

We saw that occur predominantly on the south and west sides of Chicago, certainly having a disparity as it pertains to race.

And so, we've seen both an increased awareness and then coming out of the pandemic more people coming forward to talk about the symptoms that they're experiencing.

Catherine, let me ask you the same question, what do you think?

Our team studied mental health at the start of the pandemic.

In March of 2020, we conducted a nationally representative study going to U.S. adults asking them about their mental health, about the stressors that they were experiencing, and about different demographic characteristics such as assets.

And what we found is that levels of depression, anxiety and post-traumatic stress have remained elevated.

So, while they have varied over time, they were highest at the start of the pandemic and they have gotten slightly better.

They are still much higher than what they were before the pandemic started.

Denise, weigh in on this too.

What do you think?

You know, I think we had a crisis that led to more crises.

And I think one of the crises that we have alluded to is that we lost helpers during the pandemic.

We lost our childcare workers.

We lost our hospital nurses.

We lost our staff and home health.

We lost direct care workers.

We lost teachers.

So, families were scrambling to put plans in place only to have plans crumble the next day, constantly.

And it's still like that.

You're still trying to put the pieces together when the pieces just don't fit.

You know on that note, Catherine, let me ask you this, because the pandemic is something I think all of us can point to moments where there were challenges either personally or with someone we know or love when it comes to mental health.

But the pandemic alone was not one of the causes.

It was only one of the causes, I should say.

Let's talk about some of the others, and I know your research has led you to explore a lot of the foundational causes of mental health.

Mental health is sensitive to the world around us.

It has to do with multiple factors: personal characteristics, genetic factors, but also the family environment, employment, the neighborhood environment and things like state, local and even federal policies shape mental health.

And I should note that while no group was unharmed by the pandemic, we did see differences.

We found that there were inequalities that emerged during the pandemic.

People who had fewer resources, who had lower income, who had less to begin with, fewer savings, they saw job loss at higher rates.

They saw family members lose work at higher rates.

They experienced loss at higher rates.

And so, we found that people who had less going into the pandemic experienced more stressors and therefore their mental health was disproportionately worse during the pandemic.

So many powerful conversations here today.

So many people candidly sharing their personal stories.

Let me ask all the panelists just what resonated with you and to put your professional focus on it.

Denise, let's start with you.

You know, Margaret shared her story of trying to get help for her daughter.

And she shared system navigation, 11 systems, I was counting as she was sharing.

Typically, a family caregiver will navigate 17 systems and you're navigating multiple systems at the same time.

So, Margaret was managing the impact on her children, her daughter, but her marriage too.

One thing that I didn't know is if she was working because that was the one that I just wasn't sure if that was the 12th.

But you can imagine the stress of that, managing all those systems without a lot of help.

You are on alert during a caregiving situation and we heard that from Ralph too.

Where you are waiting for the next shoe to drop, but you're not sure what size it's going to be, what color it's going to be or how to catch it.

But you have to be there to catch it.

So, this constant stress of being on high alert.

It's this pressure we put on ourselves to be able to predict in order to prevent.

And yet it's impossible to do it.

So, we are feeling that we are failing our family.

We are failing a family member in need.

And it's this inability to meet the basic needs, which Catherine, you were just alluding to.

We go through these caregiving experiences without having our basic needs met.

We are deprived, and we are asking for help and yet the help isn't there for us.

It's just an experience of feeling despondent at times.

David, what about you?

Something that stood out to you that you want to comment on.

Sure.

I mean, I think all of the panelists, I mean, I think that the courage that it took to share stories, to inform us in terms of kind of what their experiences were, was quite remarkable.

We talk a lot about stigma and I think stigma certainly has a role.

But what I heard even more explicit was the extreme discrimination that she and her daughter experienced.

And how we know the history of institutional racism, what role that plays in terms of trauma.

And so, the fact that they were experiencing both primary and then repeated secondary trauma and how toxic that all is, the fact that they demonstrated the resilience to be where they are now is quite remarkable.

But I was really struck by that.

Truly.

I was too.

Catherine, what about you?

So, earlier today, Mrs. Kennedy asked Carlos, "What does your mom do to support your mental health?"

And Carlos said, "She provides a roof over my head.

"She provides food and she gives me love.

What more could I ask for?"

And what I appreciated about that answer is that Carlos understands that our health relies on these foundational factors.

And so, before we can get to treatment, we should work at prevention.

And we should work to have a society that makes people as healthy as possible.

And in order to do that, people need safe housing.

They need healthy food.

They need livable wages and meaningful work.

And they need to know that they can exist in the world with respect and dignity without discrimination.

And so, if we can address these factors, we will be addressing mental health.

All right, then let's talk about stigma.

It's come up and it is such an issue.

We talk about people who may not go seek treatment because they don't know how to navigate the system.

That's one issue, right?

But then there's also the, "What if I do seek treatment?

What happens then?"

Catherine, let me ask you about that because you've researched this.

And you have looked into this whole idea of cultural and social barriers around seeking treatment, about saying I need help.

Stigma can prevent people from getting treatment that can help.

And as long as stigma stands in the way, we are not serving our population as well as we can.

If people are afraid that they will lose their jobs, if coworkers find out that they are getting mental health treatment, then that is a barrier standing in the way to getting the very care that can help.

And it is promising to see that there are many notable public figures who are now becoming more public about their mental health situation and their circumstance.

And I think this is creating a pathway for more people to feel comfortable and secure in recognizing their own mental health needs and also seeking the resources that can help.

So, I am hopeful that the conversation is changing.

We're also seeing that the younger generation does seem to have less stigma.

That younger people do seem more comfortable in expressing their mental health needs and that is a good thing.

We want to address that, and we want to ensure that we have the resources in place to help those who articulate the need.

David.

And if I could build on that, I think the idea too, and this again fits with the idea of getting more upstream, is that we also know that there are programs out there that have proven effectiveness in terms of informing broad communities about mental illness.

For example, mental health first aid.

So, if we think about mental health first aid and the idea that it's really kind of training people to both recognize the signs and symptoms of someone going through kind of mental health distress, and that as a community member who's been trained, they are much more likely to go to support a person as opposed to backing off and having that person feel both isolated and more stigmatized.

And so, when we think about those type of programs and when we scale them up-- in fact that is both a way to-- it becomes a protective factor to some degree.

So, we are building resilience and then we are creating just kind of more broad community support.

And so, there is the opportunity to again utilize what we know is effective to really mitigate stigma and discrimination.

And I think one thing that also became clear during the pandemic is this sort of collective mental health can be important.

We're impacted by those around us.

And when someone's suffering, when someone's struggling, it hurts us.

Caregivers see this firsthand for so many reasons.

Address that a little bit about the challenges for caregivers and what kind of tools you need to do.

What things we have to be acknowledging in order to help them be effective.

So, when you're caring for a family member, they're the pressing need.

Which means you become the less pressing need.

And I think you heard that from Margaret.

She was really focused on taking care of her children, but she kind of fell to the back side because she thought, "I'm not the pressing need.

I have to really focus on the pressing need."

But the challenge is when do you become the pressing need, and then how do you take the time to really devote to your own mental well-being.

Because you feel like there's not enough time and the time you have goes toward making sure that others in the family are well.

It's difficult.

It feels like you're always juggling these priorities but you're the priority that doesn't get juggled.

You're just not in the game.

And oftentimes we hear that clich about when you're on an airplane and the oxygen masks drop, you put yours on first and then you help someone who's with you.

The truth is that's not applicable in a caregiving situation because enough oxygen masks don't drop for you.

So, you're always choosing who gets the oxygen mask.

Self-care during caregiving is very different.

We are exhausted during caregiving.

And it's important for us to acknowledge that self-care during caregiving could just be five minutes in the bathroom to myself and that's good enough.

It could be 10 minutes for a walk and that's good enough.

It's just whatever it is that makes you feel like, "Okay, I've reconnected.

"I've centered myself.

I can keep going."

And it's important to have someone who listens to you without judgment.

That's the other piece.

I think we're looking for that space where we can share what happened during our day without someone saying, "You know what you should do?

"You know what would help?

You know you have to take care of yourself."

Instead, it would be so nice just to connect to a listener who receives the story of your day and says, "Wow, wow, tell me more."

That would be awesome.

It's a good place to end.

Thank you to everyone in this room.

Thank you to our panelists for how hard you all are working to boost awareness and address this important issue.

It's been a great conversation, really.

I am more optimistic now than I ever have been with this kind of direction in leadership.

And the energy around mental health is palpable.

There is a strong commitment.

I think it has risen to the top of mind of most of America.

So, we're at a real inflection point where we can really make a difference and we're very fortunate in this state.

We have a great governor.

He's very progressive.

Makes strategic investments for youth.

And I think that dealing with trauma as I said earlier, embracing these kids who have had these really difficult life experiences and helping them get on the right path is what we need to do.

And mental health is at the center of that.

If there is one message we hope you've taken from this program it is this, mental health is essential health.

It is long past time that we stop afflicting the afflicted with stigma and judgment.

It is long past time that we neglect to acknowledge that those who struggle are our loved ones, our closest relatives and our dearest friends.

How long will we allow them to struggle alone for fear that we will meet their pleas with cynicism and contempt?

It is easy to feel powerful in the face of this fight.

Insurance companies, law makers even service providers can all feel more like insurmountable obstacles than people.

And none of us as individuals has the power to move them.

However, the change we need starts with you.

You don't have to join a picket line.

You don't have to call a congressman.

All you have to do is make a pledge to treat those who struggle with more compassion even if that person is you.

Thank you for watching.

You've already taken the first step toward joining us in this fight.

[announcer] For more information about this program, please visit mentalhealthcareinamerica.org.

Major funding for Mental Healthcare in America was provided by the O'Brien Family.