Supporting Our Kids

Speaker 1: Welcome back to Until It's Fixed, season two. I'm your host, Stacy Dove. Callie is off this

Speaker 2: Week

Speaker 1: Until it's fixed. Takes an inside look at pressing topics in the healthcare industry, new approaches to care and how to make the health system work better for all of us.

Speaker 1: Today we are going to be focusing on adolescent mental health, which I [00:00:30] know is on the minds of many people, including myself as our kids go back to school and, you know, during a very unique time when many didn't socialize as much as they normally would with friends and you know, kids their age and were in and out of the classrooms for much of the past year plus. So this topic is near and dear to my heart. As I have four teenagers, myself and all have got a diagnosis of some [00:01:00] kind, whether it be adhd, depression, anxiety, and I have had a lot of personal experience navigating the healthcare system, a very complex system that is not easy to do. Our discussion today on depression and other mental health challenges can touch on topics that can be difficult and even triggering for some. So just a heads up that we will be discussing some of these more sensitive topics today to ground us a little bit.

Speaker 1: I'd like to provide some statistics on adolescent [00:01:30] mental health. According to the National Alliance of Mental Illness, 50% of all lifetime cases of mental health conditions begin by the age of 14. And according to the C D C, from 2019 to 2020, mental health related emergency department visits increased by 24% for five to 11 year olds, and 31% for 12 to 17 year olds. And as we all know, parents and caregivers [00:02:00] are facing their own additional stress and burnout and fatigue, which makes it very challenging to navigate a complex healthcare system to get the support and care both they and their children need. So how is the health system addressing this growing need? Today we have three incredible child and adolescent psychiatrists who will share their insights and provide some guidance for those of us who are struggling. Our guests are going to introduce themselves in a minute, but [00:02:30] first I'd like to just share with you their names. The first is Dr. Stra Ben. The second is Dr. Mona Potter, and the third is Dr. Jonathan Stevens. We had a really fascinating conversation that I think you are going to also find valuable. So let's spend some time, if you wouldn't mind just introducing yourselves [00:03:00] and just give us a little brief description what your role is today. And then I would love to hear what is it about adolescent mental health in particular that drives you? Why is this your passion? Dr. Stevens, we'll start with you.

Speaker 3: Sure. Dr. John Stevens, vice President of Growth and Innovation at the Menninger Clinic in Houston, Texas. I'm also the medical director for admissions and outpatient services. My academic rank is associate professor [00:03:30] of psychiatry through the Baylor College of Medicine. I've been here in Houston at Menninger in the Baylor College of Medicine for six years. It was an opportunity of a lifetime to restart Menninger's outpatient service, which after, uh, Menninger moved from Topeka, Kansas to Houston, just moved the inpatient portion and MENNINGER'S has over 96 year history and mental health and the opportunity to kind of expand the services beyond the walls of Menninger into the community has [00:04:00] been, uh, looked like the job of a lifetime and it really was. So, um, a trained child and adolescent psychiatrist. I actually trained with Dr. Potter in our fellowship, so I know her well and it's, it's been a wonderful journey. There have been challenges. Some aspects of the field have advanced in terms of personalized medicine, which is my particular interest in precision psychiatry.

Speaker 1: Wonderful. Dr. Potter?

Speaker 4: Hi, I'm Dr. Mona Potter. So I'm a child and adolescent psychiatrist. [00:04:30] I currently am, um, chief medical officer and co-founder of a new company that we're gonna be launching this fall to support kids and teens and families struggling with anxiety and O C D. But before that, actually up until July of this year, um, I was actually, um, the medical director of the child and adolescent outpatient services at McLean Hospital. My journey really started almost two decades ago, um, with Dr. Stevens actually in the Harvard Medical Mass General McLean [00:05:00] Hospital system where I trained. I worked as a clinician and then ultimately went into some leadership positions. And so kind of over the course of my career, I've worked with kids and families with a range of struggles including anxiety, depression, eating disorders, substance use disorders across multiple levels of care, outpatient kind of intensive outpatient, residential inpatient.

Speaker 4: So I've seen just how painful mental illness can be, not only for the child, but also just for the entire family and the entire system. [00:05:30] I love, love, love that I get to work with children and adolescents. There's so much opportunity to help build and grow and nurture them. And so while they might have struggles, there's also simultaneously a lot of hope from the interventions that we can bring to their lives to really help them grow into these resilient, strong, wonderful human beings. And so it really does feel like such a privilege to get to do what I get to do every day.

Speaker 1: Yes, thank you Dr. Ben.

Speaker 4: [00:06:00] Thank you Stacy, uh, you for Ben Halim. I am also a psychiatrist. So my specialty is in child and adolescent psychiatry as well as addiction psychiatry. So my story is I kind of always wanted to be a pediatrician actually. I knew I wanted to be a doctor, I knew I wanted to work with children. And then through my experience, uh, throughout medical school, I really gravitated towards the importance of uh, youth mental health, emotional health, psychological health and [00:06:30] working with families. And so that's really what took me to an unexpected turn towards psychiatry and child psychiatry in particular. And then after my first year of child psychiatry fellowship, I had this sort of epiphany that there was so much substance use really starting early on in life that I think most people were not recognizing and didn't necessarily have the tools to address both for the youth and within a family system.

Speaker 4: So I did a, a little bit of a detour [00:07:00] and went off and did an addiction psychiatry fellowship. And I have to say that I think it served me so well when I returned to work with children and families. So working within the addiction sort of psychiatry space, I learned a lot about meeting people where they are and being able to meet them on their terms wherever they were in the sort of journey of the stages of change. And that takes a lot of, I think humility and patience and really, um, [00:07:30] alignment with the other human being that it's not about me or my agenda, it's really about how I can best serve them at that moment in time. My current role is as senior national Medical Director at Optum Behavioral Health, I've been here for almost four years and, um, like Dr. Potter, I feel very privileged to be doing what I do every day. Now I sort of think about bigger problems on a national perspective and think about how can we serve individuals in the community [00:08:00] in ways that can have large impact to really reach as many people as possible, make it easy for them, and really make treatment work for them on their terms and their family's terms. So a lot of creativity, sort of thinking about solutions, designing things with a human-centered perspective.

Speaker 1: Thank you. It's so fun to hear your passion cuz I mean it's, it's obvious that you are in the right profession, all three of you. My first question for you is [00:08:30] if you could do a compare and contrast to perhaps 2019 and where we're at today, some of the more positives that have been a result of the pandemic and some of the more, you know, challenging kind of current state as well. Dr. Potter, do you wanna start?

Speaker 4: Sure. I appreciate that you're asking for both the positives and some of the challenges because it really does feel like, I mean it's almost equal footing in some ways. Um, I think that what we were seeing even before the pandemic was [00:09:00] an increase in the number of kids and families seeking help for mental health issues. And we were also seeing that when they were coming in there was a lot more severity, they needed more help. But the thing that I think has been kind of most positive about the pandemic is that I think we've leapt forward in our acceptance of new and different ways to think about meeting the needs of the individuals and families who need help. Before the pandemic, we were already interested in how we can use technology to [00:09:30] enhance the care that we gave, um, whether it was through telehealth or even introducing virtual reality into exposure treatment for anxiety disorders.

Speaker 4: And what we were finding was we had a lot of red tape. So we were just very slow moving in any kind of new adoption or innovation, it forced a relaxation of some of the kind of red tape and it allowed us to try new and different things. And what's come out of it is we have learned a ton. We've learned about some things that work really well and we've learned [00:10:00] about other places where things don't work well at all and we need to keep innovating and getting creative during the pandemic. What was really interesting was that there was no one size fits all. So even if we look at telehealth, we had some kids and families who embraced it and loved it and did incredibly well with it. And in fact I think would prefer to continue with that form of treatment. And then we've had others who were doing fine in treatment and then when it went virtual, it completely derailed them and [00:10:30] they struggled a whole lot more. And so again, I think there's no overarching statement of this is how it is. I think we've realized that kind of that precision medicine, personalized care, the ability to really think about individuals is more and more important.

Speaker 1: Right. And I think your comment, Dr. Benli, if you talk a little bit more, I mean just to add to what Dr. Potter just said, meeting someone where they are, that really gets to the heart of customization, personalization because [00:11:00] there is not a, you know, we love data, right? But ultimately people are individuals and humans.

Speaker 4: Yes. When we think about behavioral healthcare, we really think about how we meet people where they are and what does exactly does that mean. So that means sort of physical, right? Where are they physically? And like Dr. Potter said, telehealth and other sort of digital or virtual solutions have really helped us meet people wherever they may be in their house, in their car, at [00:11:30] a safe space. You know, talking to us through their phone or their computer. The other part is to think where are they on their journey, the continuum of their health. And part of that is thinking about their symptoms. Like Dr. Potter said, are we meeting someone when their symptoms are really high, where the symptoms have not received any treatment before? Their needs are very high and very complex. We know that those individuals tend to access care in very traditional ways, like [00:12:00] going to the emergency room, going to a hospital.

Speaker 4: We've actually seen, you know, an exponential surge in youth going to ERs across the country for mental health concerns, especially young adolescent females. And then we see a lot of people going into hospitals. What we're trying to do is we're trying to think about that continuum of the journey and be creative in ways that we can connect to people sooner and help them understand that this is a dynamic process. So if we [00:12:30] meet you at one of the highest sort of levels of need, of course you will get the supports and the recovery plan in place such that we can mitigate a relapse. But we also wanna think about not just solving that imminent crisis, we really wanna think about sort of health and how it encompasses our mental and emotional and psychological health. And that means that we don't want people to just get out of the hospital and go home and and sort of figure it out on their own.

Speaker 4: We wanna help [00:13:00] them understand how to not only survive, but to really thrive, especially young people with the whole world in their whole future in front of them. Are they in the very early stages of something that might be unfolding? And if so, how can we meet them where they are to provide them with health literacy, the tools, the resources so that perhaps we can help mitigate the unfolding of more symptoms and impairment later on. And then the people in the middle who are really kind of just trying to find their way on their own [00:13:30] and are struggling enough to connect with care, but again, maybe they're not thriving, maybe they're just getting through without a crisis. So we're really thinking on a larger perspective, not only how can our solutions meet individuals wherever they are on this continuum, but how can we also share that information so that they understand more about what this journey could look like and how they can utilize more of these solutions and tools to meet their needs in a way that works best for them.

Speaker 4: I think information [00:14:00] is very powerful and in child psychiatry in particular, there's a lot of fear because there's a lot of unknowns. I just don't know what's happening with my child. And oftentimes I think we are very paternal and maternal in, in child and adolescent psychiatry. So we come in just ready to really, really help. And I think it's important for us to pause and say we want to partner with caregivers and parents and the ecosystem around families and youth so that they really have the [00:14:30] tools to advocate for themselves to see the warning signs before there is a crisis and then be able to connect with those solutions and resources that are non-traditional but still very, very effective. So you mentioned data, Stacy. So it's important that when we do offer these non-traditional kind of, uh, new solutions, that they're always clinically sound, that we know that they're effective and that we're also very intentional about who would best fit this type of solution to get them closer to a really [00:15:00] successful outcome.

Speaker 1: Right. So I know we have a lot of parents and caregivers listening to our podcast and I'm guessing a lot of us have experience in the mental health field with our own children. And some are probably new to the journey, some have been at it for a while like myself. And so can you tell us a little bit about what are some of those things that we should look for as a parent?

Speaker 4: This is probably the most frequently asked question, and my [00:15:30] answer is, trust your gut. You know your child and if you are wondering if you should check into something or ask for help or wonder about something with somebody else, do it. Mental health is on a continuum. You're not gonna cross a line and all of a sudden after this line is when all of a sudden you need intervention be before you cross that line. Known intervention needed. It's a continuum. And, and again, every child is different and every circumstance [00:16:00] is different. And so again, if you notice yourself wondering, then ask, I still remember this from my MGH H McClain days, the motto of my training was Never worry alone. Because you realize that you are asking yourself multiple times a day, is that okay or do I need to worry about that? Do I need to do something about that?

Speaker 4: And so h just quoing your own kind of network of sounding boards. And then if that doesn't quite sit with you, then ask a professional, ask your pediatrician, [00:16:30] ask somebody at school. But generally speaking, we also look at functioning. If you notice a change in functioning, okay, your child is all of a sudden not being able to get to school, um, as easily or maybe choosing not to go to friend's houses or play, but instead kind of retreating inside. I mean those are also kind of flags that say maybe I might wanna ask for some help if we wanna get a little bit more concrete.

Speaker 1: I love that. The first thing that you said Dr. Potter, was trust [00:17:00] your gut because um, I can tell you from my own experience, you'll see like little signs or there's like little voices that will come out and go, you know, something's not right here. Yeah. For one of my kids, I talked to the pediatrician a few times and it was almost like, no, you know, your daughter's just, you know, she's just a spitfire, that's what you want when she's older. And I, I just, I kept on going back to her and advocating and going, you know, something's not right until she was 10 years old and then it showed up in the classroom [00:17:30] getting in trouble in school and it was almost like that was the trigger where the pediatrician was willing to listen and go, oh, I think we do have something here. So I guess my advice would be to parents and caregivers, if you feel like, oh, there is something here and you're not getting the help you need, just don't give up. Just keep on, you know, if, if your gut is saying there's something here, something's not right, then I would say just keep going.

Speaker 4: Stacy, I have to say that I really appreciate that you said that cuz [00:18:00] sometimes in the medical model there is kind of a, even kind of physicians or people who clinicians might look for an a threshold and again, it's kind of based on an old system of learning, right? Dr. Nelim was saying that we're really trying to think about this more along a continuum and we're in the kind of continuum of care, are you? And sometimes it's just like simple, smaller interventions that are going to help prevent things from escalating to a place where it's obvious [00:18:30] that the child needs more support. And so even kind of thinking about those little things that you can tweak even in daily interactions that might help them go in a different direction. And so I, I really appreciate that you said right, if something's not sitting with you ask more than a couple of people, right.

Speaker 4: Just really ensure that you have the conversation that helps feel right for you. Mm-hmm. as well. Mm-hmm. , yes, I, I appreciate what both of you said and I wanted to just add that I think, you know, Dr. Potter mentioned not hesitating to reach out. I think it's important that we kind of sit [00:19:00] in that moment and say what really stops caregivers or individuals from reaching out is, is stigma, right? Is that sort of self-doubt of, well my gut is telling me this but I don't really have much proof or I don't know a logical explanation as to where this worry is coming from, but as a caregiver I can feel it in my gut. So I appreciate that it takes a lot to get past that first barrier of stigma to even speak to, you know, a pediatrician or to speak to someone outside of maybe [00:19:30] that internal circle of trust.

Speaker 4: And then on top of it, it takes a lot more courage to continue to advocate until you are heard. You know, it's a lot for a parent or a caregiver to have to carry in order to finally get to a place where they're being heard. And to Dr. Potter's point, I think a lot of people think that there's this threshold that now suddenly there is a diagnosis, there is a condition, so let's go down the regular medical route of medications and an algorithm of treatment. [00:20:00] I think we are so lucky in child and adolescent psychiatry that we really come again with that human lens. Really it's all about quality of life and it's about function. So even if there is no diagnosis, even if someone is, does not meet all of the check boxes of a category, that doesn't mean that that's not an individual that needs some sort of support and a caregiver that also needs a partner to sort of take those next steps with.

Speaker 4: We're not rushing to medications and we're not rushing to diagnoses. [00:20:30] We're really just trying to work with young people who are evolving and really support them in whatever way they need at that moment. It's almost like we really do well now thinking about heart health, right? and we start thinking about heart health from when kids are very young start, we talk about kind of healthy um, diet and physical activity and all of that was kind of the campaign to prevent heart disease and stroke and all of that as you get older. Similarly, I think we have to think about mental health, [00:21:00] um, from an early age of kind of what interventions can you do And many of them overlap, which is great because you get a big bang for your buck.

Speaker 1: I was actually gonna ask that question. Um, Dr. Stevens, you might have a point of view on this. So I remember as a kid doing jump rope for heart in gym class, right? And learning about the physical health. So why aren't we there in schools? You know, why aren't we educating our kids on mental health the way that we do? What sexual health, physical health, [00:21:30] do you have any insight on that?

Speaker 3: Well I think it really goes back to what are psychiatric vital signs. I mean any of us seeking out mental health, regular medical care, going to our primary care physician, we know that you're gonna be sitting either with a nurse or the physician and you're gonna check your blood pressure, your heart rate, your weight, your you know, and go from there. Maybe your blood sugar. What do we do for mental health? We're researching that now and I could give you some of our early [00:22:00] results from our menninger researchers, but I think that that's really where we are. Mental health, it's an important starting point. I think sleep is one of those vital signs. I think quality of relationships is one of those vital signs. I think level of hopelessness and desperation is one of those vital signs and we're in different really levels of understanding how to incorporate this, this data that we have into clinical care when it comes to sleep.

Speaker 3: We know that poor sleep is an independent risk [00:22:30] factor for suicide in both youth and adults who are depressed. So asking someone about their sleep or better yet seeing their Fitbit or their, their iPhones data, which my patients will bring into me and show is a way of, of really getting some objective data. Some of the other ones quality of relationships that's a little bit harder. That's still a bit little bit on the research side, uh, hopelessness as well. Substance use is something we need to talk about. And then you talk about school Stacy, a lot of times that's where that begins [00:23:00] in terms of peer pressure and exposure to substances and, and really can affect greatly in terms of negative impact on executive functioning memory and overall academics. So I think that from my perspective, we need to get back to basics before we get into these global mental health initiatives. What are the important psychiatric vital signs that we need to be measuring?

Speaker 1: Right? And you know, this is for any of the three of you for um, the stigma, [00:23:30] your comment about the stigma. Tell me how you think that has changed since you first entered the profession and perhaps even how it's changed in the last year, year and a half.

Speaker 4: I think I have seen us move leaps and bounds with regards to destigmatized anti-stigma campaigns, being able to really talk freely that psychological emotional health is part of overall health in overall wellness. Where I see some [00:24:00] maybe differences is that I think there are certain generations who are embracing this much more than perhaps other generations. So we have people talking about uh, mental wellness and emotional wellness in very different ways. There are those who are advocating it as their right and as a priority in academic space, in employee space. And a lot of people are leading with um, you know, kind of attracting people because [00:24:30] of the way that they really invest in an individual's overall psychological and emotional health. I think we have a big divide though, where there are still a lot of people who have a stigma have um, either misinformation or preconceived notions, fears or anxieties about it or potentially have generational trauma of their own and have heard stories of other people going through the quote unquote system and potentially not having good outcomes.

Speaker 4: Over the past [00:25:00] year, I think we've seen a shift many more people really connected with treatment for the first time, specifically outpatient therapy. So we had a lot of people who were new to treatment, uh, during the pandemic we also saw that individuals who were already connected to care were increasing the frequency of contacting their therapist and having those sessions and getting the care and support that they needed. What I'm really curious about is coming through now the pandemic to where we are now, [00:25:30] is that I think that we've developed almost a self-stigma where we have all sort of, I don't know where we got it from, but we've convinced ourselves that we should be fine by now, right? That that the hump, we kind of went over the big hump as a community together through sort of this communal trauma and that now the expectation is to go to work, to go to school, to just kind of follow the guidelines and move forward.

Speaker 4: And so I think that there's probably a group [00:26:00] of us who are sort of saying, well if everyone else is fine by now or everyone else's child is fine by now, what am I doing wrong? What's sort of wrong with my family system or my situation? And that makes me hesitate to reach out even more. We've sort of created this concept of there's this new normal. I would really encourage us to kind of throw that term out because I feel like it's trying to put us all into a lane that really doesn't exist. That it is not too late for [00:26:30] us to speak up if we are struggling. That we don't have to hold ourselves accountable to this um, sort of standard that I think we've sort of imposed on one another and that we wanna recognize that not everyone is at the same right now and we want to make sure we're not inadvertently applying any stigma towards ourselves to be able to advocate for our own wellbeing at this point.

Speaker 1: I think that the amount of weight and blame that parents put on themselves for their children's mental health [00:27:00] is a really big barrier. And what I've seen from different people I know of friends and just kind of, you know, myself is the more that you put pressure on yourself and the more that you're wanting to fix your children, the more that will backfire because all of a sudden you're stressed out, you're wanting to control control. And I think it goes back to um, what you were saying yra about, you know, everyone's on their own journey, you've gotta meet them where they're at. And I think that just [00:27:30] having some sort of faith in the fact that okay, this is their journey and I am here to guide and provide resources, but I'm not an expert in this and I've never done this before. Now with that said, I think there are probably some of our listeners who can relate where, you know, you might have a child who doesn't want help and who clearly needs help and you can see them, you know, kind of going down a downward spiral. And so I would love to get your thoughts Dr. Potter on [00:28:00] how do you somehow, you know, because it's hard, it's hard work, you know, the child has to do the work and it's not fun work to work through trauma. And so how do you get them to, or can you to kind of open up?

Speaker 4: I think it's a great question and I would say that that is one of the first questions we ask when parents reach out to us. We ask kind of what is your child's motivation and willingness for treatment because that matters. And when we meet the child [00:28:30] we say to them, look, if you're not in this, if you're not ready for this, it's gonna be harder for us to help you. So we spend a lot of time actually gauging level of interest, willingness, motivation on the child's part and then working together to figure out how we move them. So for example, with anxiety, there's a whole new treatment protocol out there that's really geared towards just the family, just the parents to start and saying that if your child is not ready or if you're not ready to bring your child to a clinician [00:29:00] or a doctor quite yet, we'll engage you as parents and we'll we'll give you some of these tips and tricks and skills to kind of add that coaching in to your interactions with your child to help kind of shift the environment.

Speaker 4: Because again, these kids, they're growing brains, they're sponges, they're, they're taking in, there are multiple ways to learn. Some of it is directly one-on-one sitting with a therapist potentially, but other ways are just kind of what they're soaking in from their environment. And so if the child is not ready to to change, [00:29:30] then you might kind of think about environmental changes that might at least help shift the child and kind of get them ready to come in. The other thing we talk about is, as URA was mentioning it, we're trying to move away from this idea that it has to be a doctor-patient relationship to get somebody better. That there are lots of different ways that we can get creative and kind of think about how to support somebody really thinking about, okay, if they're not ready to go in to talk to a clinician, are there any other trusted adults that we might engage, um, in [00:30:00] this process to partner with us to help us?

Speaker 4: Especially with adolescents, they're supposed to be doing that whole separating individuating kind of from parents so that they can go and move out and become independent adults. And so reli being so, so reliant on parents is almost not developmentally appropriate. And that being said, they still need influence from adults and, and people who can kind of help guide them as their, their frontal lobe kind of that decision making part of their brain continues to grow. And so we're really big in child psychiatry about community and systems [00:30:30] of care and not making it all about the parents being responsible for every piece of it, but instead saying how can we build a network and who from our network is gonna be most helpful at this current stage of where we are to help us move to that next step.

Speaker 1: Right? And I think as a parent or a caregiver, the sooner that you can recognize and accept that you can't do it, you're not trained for it, the better you know Absolutely the better. Absolutely. You know, not only for yourself but also for your child. So Dr. [00:31:00] Stevens, can you talk to us a little bit about some of the treatments that are out there today and and some of the resources, if I'm a parent and you know, if this is a newer um, journey for me, where do I go? You know, how do I navigate the system because I know it's very, very complex.

Speaker 3: It is and it's overburdened as well. So even getting the right care could be a wait and if you're desperate or a stressed parent or anxious hearing that the next appointment [00:31:30] is several days, weeks, or months out, which is oftentimes the case, uh, does not help your anxiety and there's so many mental health deserts across this country in places you might not expect them. So just recognizing that, so addressing the issue sooner rather than later has already been said is crucial. But something that, you know, just to really elaborate on some of the points have been made. I think patients coming to the system really think of psychiatry in this kind of binary, like it's either inpatient or outpatient. [00:32:00] You're either in this plain vanilla once a week therapy, senior psychiatrist once a month for 10 20 minutes max or you're in a locked inpatient facility.

Speaker 3: So we can do better as clinicians informing parents informing children of the different levels of care because yes, we wanna start them off at the least intensive level of care possible if you get them early. Because just like for us, I'd rather go to my primary care once a year and stay in good physical [00:32:30] fitness rather than I have my first experience with a general medical facility being an intensive care unit with lots of tubes and people running all around and it's loud and you don't have any privacy. So I think we have to help explain that to the system. Cause a lot of people really and we train them and say it's either inpatient call 9 1 1 or go to emergency room or have this, you know, wait on a wait list to see someone if you don't know when or where. So those are the biggest challenges recognizing that there could be group therapy, there could be parental therapy [00:33:00] like Dr.

Speaker 3: Potter talked about. There could be intensive outpatient options and all sorts of unique new intermediate levels of care that might really fit the need. You mentioned schools and having embedded care in primary care physician offices in schools. There's so many innovative techniques on the horizon but it really hasn't been brought together and really the public education of this. So that's, I spend a lot of time talking about if this doesn't work then we might do this with parents and you know, a plan A, [00:33:30] a plan B and a plan C that's understandable not to scare them but to educate parents that this condition might get better and in worst case, we don't need this kind of frequency or or these medicines or therapy, but if it gets worse we'll do this next.

Speaker 1: There's a school system in the state of Minnesota who has um, an actual curriculum around dialectical behavioral therapy and it just, when I heard about that I thought why is that not offered everywhere? And actually I think that it would be awesome if all adults [00:34:00] were also required. It sure would help us in the workplace . So, um, does anyone wanna speak to that?

Speaker 4: So dialectical behavioral therapy or D B T is kind of under the umbrella of cognitive behavioral therapy or C B T and it was developed by Marshall Lenahan and originally to kind of support and help um, individuals with borderline personality disorders. So individuals who have really intense emotions and when those emotions get big, they do [00:34:30] destructive things, right? They self injure, they do risky things, they get into big fights or arguments with people they care about and end up getting more hurt and all because their emotions get so big and they respond to emotions in ways that are ineffective. And so at the core of D B T is mindfulness, just being aware and present in the current moment without judgment and interpersonal effectiveness. So really thinking deliberately about how you're interacting [00:35:00] with other people. Distress tolerance meaning when those emotions get really big in the moment, figuring out how to just get them down before you act.

Speaker 4: And then emotion regulation, being more proactive about how you take care of your emotions so that you're less vulnerable for them to get really big and start interfering. And what we've found over time is that while it was created for this, you know, group of people, it's actually just kind of common sense skills that all of us can use [00:35:30] and all of us can benefit from. And what I love about it is at the heart of it is kind of the dialectic that two opposites can be true at the same time. And so you can accept who you are, what the current situation is and all of that is with it and simultaneously go for change. It gives you kind of core skills to kind of manage with the day-to-day, but also this kind of acceptance of life is what it is. And I still have some ability [00:36:00] to make a, an impact on how I live my life and how I experience life.

Speaker 4: And um, so Stacy actually what's been really cool is here in Massachusetts we've also had a lot of schools who have been very interested in implementing similar both C B T and D B T curriculum in the schools. And so we've, it's been really, um, wonderful to see you were asking what's changed kind of with stigma. One big thing I noticed that when I started as a child psychiatrist, um, kind of consulting to schools, [00:36:30] they would consult on specific individual kids saying, gosh, this kid is so out of control that we don't know what to do to help this child. But they were not interested in anything that was global because they saw their responsibility as academic institutions we're here to teach these kids academic knowledge so that they can uh, you know, progress through the grades and graduate. And what's changed now is they're coming to us and saying, if we don't address the mental health of these kids, they are not able to learn, they're not able to progress, they're not able to be [00:37:00] the, their, you know, their best selves.

Speaker 4: And that has been a really significant shift in the conversation that schools have been having. And in that context, what they're realizing is that if they don't give these kids the skills early on, they're playing catch up when the kids get older. And so we have been seeing quite a bit of that here in Massachusetts as well with schools kind of giving this curriculum and giving this new lang, it's a language, right? It's a mindfulness of current emotion. Recognize what emotion are you experiencing and what's the urge that it's bringing into you? Like that actu [00:37:30] what's it causing you to want to do and then how are you gonna respond to that urge? You know, we've seen just incredible, I mean I'll say that I'm a huge proponent just clinically seeing how much the intervention just changes lives. Just takes kids who were completely overwhelmed by their emotions and struggling and unable to function, being able to get back into life and to their friends and their sports and their academics and and really reclaim themselves essentially.

Speaker 4: It's, it's really striking and just beautiful [00:38:00] to see it isn't. I'd like to add to that. So not only in the moment but I think, you know, something that really gravitated me towards child and adolescent psychiatry is that those changes that Dr. Potter just outlined, we see them, right? We see the results in the moment in while they're still young, but what we also see is how they impact the longer term future of that individual. So when we think about developing youth and the places and people that they come in contact with and this evolution [00:38:30] of thinking about what if we were to just remove the word therapy and we were just say that this is part of a sort of learning experience as a developing young person. So just like we learn about math and we learn about physics, we learn about sort of this awareness, this language and connecting our thoughts, emotions, and our behaviors literally just like math, input output, physics, input, output.

Speaker 4: And so I think that when we [00:39:00] really try to offer these solutions and offer these changes and advocate for them, it's because we know that we're doing it in real time. While a young person is sort of building their path, building their road in life, that's very different than meeting someone later in their twenties or their thirties and forties and saying, well let's go back and see why your path looks the way it is. So we all know how to terrible it is to have to drive through a city where they're still working on a highway four [00:39:30] years later, right? And so that's kind of what it is when we're trying to work with adults to help them improve their quality of life. There is to some extent a lot of undoing that has to happen and relearning that is taking place. Whereas when we really advocate for youth to have access to supports and resources and families, we're being very intentional about laying down the right bricks, the right path as much as we can at an earlier stage knowing that the impact [00:40:00] of that will go far beyond their younger years and hopefully, you know, really set them up for a successful and healthy life.

Speaker 1: So I have a question for each of you. What advice would you have for any caregiver or parent in terms of their child's mental health and their own

Speaker 3: Just a predisposition to act and not wait? And so many parents might say they think this is normal development, this is normal adolescent blues or withdrawal or [00:40:30] especially if there's a family history and you know, that issues like the this run in the family to really have that predisposition to act instead of watchful waiting and to ask and to be curious as been said with a child's coach or talk to their friends, talk to 'em about their social media use, try to understand the full child or adolescent to make sure you're not missing something because there's nothing worse than talking to someone where there's been an event and the parent is looking for [00:41:00] support of why didn't I notice this sooner? And that is just so devastating to have to have that kind of conversation.

Speaker 1: Right? That's good advice. I

Speaker 4: Completely agree with Dr. Stevens and I would say that um, parents be very aware of your own mental health and really take care of yourselves in whatever way it makes sense for you. My version of self-care is like a very fun conversation like this about child psychiatry, right? Figure out what gives you that dopamine surge, what gives, what that makes you feel [00:41:30] joyful and happy and and fulfilled or whatever is give yourself those moments. And also though, be aware of whatever tough emotions are coming up, the sadness, the anxiety, the worry, and figure out what you need in order to manage those emotions. We know that as parents, our emotions and are the way we manage them matter with the kids that we are modeling behavior and also we are impacting our kids' mental health. And so it really is important. I think as a mother sometimes I would feel guilty [00:42:00] if I take care of myself then I'm being selfish.

Speaker 4: But I've really switched my tune after being a child psychiatrist and realizing, no, actually by taking care of myself, I am actually doing right by my kids because I'm not only modeling for them what is good behavior, but I'm also more able to support them in what they need when I have what I need as well. Right. And Dr. Potter, I would bounce right off of that because I think that that is really the primary first step that has to happen for what I'd like to offer [00:42:30] is maybe another next step, which is to create a safe space that's stigma, shame, judgment, free to talk early and talk often. Now I know we're all kind of rolling our eyes because as teenagers are, are not always the easiest to talk to, right? And again, my work in addiction, psychiatry and really understanding the complexities of where an individual might be with their readiness, their awareness, and their motivation for change.

Speaker 4: So I think if we take care [00:43:00] of ourselves first, what that does is it helps us ensure that we don't bring ourselves and our challenges and our potential biases and preconceived notions into that room, into that safe space with a young person. So when we are there for them for a dialogue, we do it on their terms and we are there really to listen. If we were to tap into the mind of a young person, imagine all the noise that they're trying to filter through. [00:43:30] So when we come to be with them, we really wanna bring a sense of calmness and openness and give them the space because oftentimes even as adults, the first time we become aware of a thought is when we put it into words out loud. But a young person isn't gonna be able to do that unless they know that someone is there to actually listen to what they have to say.

Speaker 4: Oh wow mom, oh wow, dad, you, so you, when you asked me that you really care like about what I think, you know, how was your day at school? How's everything going? Fine, fine, fine. No, [00:44:00] I'm really curious like how was it like did anything need happen? Anything challenging happen? Anything tick you off today? Really lean in and show in that moment that you're present and you're interested in what they have to say and they will share on their terms however much and however often they're ready to. I think that we can always sort of lead with just keeping that window for that dialogue so that they know I can go back to mom, I can go to dad or grandma and let them know that I was having [00:44:30] a rough patch because I already know that they really care about what I have to say. And that in itself is leading with empathy and is very therapeutic in and of itself.

Speaker 1: Thank you. I think this is the perfect place to end and um, I know that you all three of you are very, very helpful, um, to all of our listeners and myself selfishly. So Dr. Mona Potter, Dr. Stra, Ben and Dr. John Stevens. Thank you so much for your time today.

Speaker 1: [00:45:00] I really hope that all of our listeners found this podcast to be very helpful. And if anything you took away that, you know, we are the ones as parents, caregivers, mentors who have to advocate for the children. The majority of parents and caregivers are not equipped or trained in mental health. I know I am not and we can't do it alone. So I would encourage you to partner with a professional and even get a mental [00:45:30] health screening for your child so you know exactly where they're at. You know, the other thing that we talked about today is that there's really no one size fits all solution. And successful care will look very different for different people. And that's why at Optum we're focused on providing a range of resources from self-help tools and apps to a network of providers that can provide effective evidence-based care to adolescents.

Speaker 1: We also recognize the unique needs of caregivers and [00:46:00] we talked about that during the episode too, which is why we're developing more ways to support them, whether it's connecting them with resources to help with their own mental health or helping them navigate the health system. That can include anything from finding a qualified provider for their child to identifying local community resources to understanding resources within the educational system that may be available for their child. Another theme that we heard was to be sure to start the conversations early on and seek help. [00:46:30] It's so much easier to make small adjustments early on than to unpack trauma and unhealthy behaviors years later. One of the most important ways that we as adults, especially caregivers, parents and mentors can help children and adolescents is to take care of our own mental and emotional wellbeing. So that is a theme that we also heard and it's much like the analogy of when you're in the plane, the oxygen mask come down, make sure that you put your own mask on before [00:47:00] your child's.

Speaker 1: So with that said, I really appreciate you listening and we have additional resources that will be in the show notes. So if your child or teen is taking steps to manage stress and anxiety that don't seem to be helping, we have mental health screening information, crisis hotlines and text lines, and of course the National Suicide Prevention Hotline. Today we talked about meeting people where they are. In our next episode we talk [00:47:30] to experts who are focused on access to local care. Thank you so much for listening and be sure to tune in next time. I'm Stacy Dub and this is Until it's Fixed, a health innovation podcast from Optum.