Addressing the Teen Mental Health Crisis
The Skyland Trail 2022 Dorothy C. Fuqua Lecture was held on May 17, 2022, at the Atlanta History Center. The keynote address and panel discussion provided important information about what is driving the teen mental health crisis and key strategies to address it.
Keynote Presentation: Debra Houry, MD, MPH, Acting Principal Deputy Director, Centers for Disease Control and Prevention (CDC); Director, National Center for Injury Prevention and Control, CDC
Panelists:
- Fred Assaf, M.Ed, Head of School, Pace Academy
- W. Edward Craighead, PhD, ABPP, Dept. of Psychiatry & Behavioral Sciences, Emory University
- Emily Anne Vall, PhD, Executive Director, Resilient Georgia
- Ray Kotwicki, MD, MPH, DFAPA, Charles B. West Chief Medical Officer, Skyland Trail (moderator)
Watch Video: Addressing the Teen Mental Health Crisis
Read Transcript: Addressing the Teen Mental Health Crisis
Introduction: Beth Finnerty, President & CEO, Skyland Trail:
Good evening, everybody. I’m Beth Finnerty. I’m President and CEO of Skyland Trail, and I want welcome all of you to the 11th annual Dorothy C Fuqua Lecture. I want thank all of you for being here tonight for this very important and timely conversation around teen mental health. I want take a moment to recognize some very special friends who have helped to make this evening possible, Duvall and Rex Fuqua and Edwina and Tom Johnson.
This annual lecture series was established in 2010 by these two wonderful couples in honor of Dottie Fuqua’s 90th birthday with the purpose of engaging and educating the Atlanta community about issues in mental health. Dottie was a long-time trustee and great friend of Skyland Trail, and an enthusiastic mental health supporter, and I know many you in this room knew here. We are honored to have this event named for her, and are grateful to the Johnsons and the Fuqua’s for their ongoing support of this lecture. Now, for those of you who are not familiar with our programs, Skyland Trail is a non-profit mental health treatment program for adults and adolescents. While our adult program opened over 30 years ago in 1989 – that’s hard to believe – the adolescent treatment program at the J. Rex Fuqua Campus opened in the fall of 2019, just six months before the pandemic became our new normal.
While that timing certainly posed a challenge, today, we are so proud and thankful to be positioned to meet the needs of young people at this very critical time. Now, as you know, May is Mental Health Month. May has been observed as a Mental Health Month since 1949, with the intention of raising awareness about the importance of mental health, and to end the stigma that so often surrounds it, this recognition feels especially important, this May, as recent news has been filled with staggering statistics around the growing teen mental health crisis. Treatment centers across the country are full, and Skyland Trail is no exception. Mental health challenges in children, adolescents and young adults are real, and they are widespread, but most importantly, they are treatable and often preventable. Tonight, you’re going to hear from experts on the front lines and hopefully leave with new ideas about how we can better support the young people in our communities. So now on with the show, I’m going to introduce our keynote speaker for this evening. Dr. Debra Houry is Acting Principal, Deputy Director of the Centers for Disease Control and Prevention, and Director of CDC’s National Center for Injury Prevention and Control. Dr. Houry earned her MD and MPH degrees from Tulane University, and completed her residency training in emergency medicine at Denver Health Medical Center.
Before joining the CDC, she served as Vice Chair and Associate Professor in the Department of Emergency Medicine at the Emory University School of Medicine, and Associate Professor in the Department of Behavioral Science and Health Education and in Environmental Health at the Rollins School of Public Health. In her career, Dr. Houry has authored more than 100 peer-reviewed journal publications and book chapters on injury prevention and violence, and has been the recipient of several national awards. We are honored to have you with us here tonight. Please join me in welcoming Dr. Debra Houry.
Keynote Presentation: Dr. Debra Houry
Well, good evening and thank you for the opportunity to speak with you all today. The other part I would say, of my background is I’m also a mom to an adolescent, and so I think during this pandemic really witnessing first-hand, I’d say a lot of the stressors that our children have gone through. And this COVID-19 has certainly challenged us, I’d say in many unique ways, just taking a toll on our mental health and well-being, and it has impacted communities across the country. Young people have been especially impacted by the ways in which their everyday lives have been altered. The disruptions were widespread, school buildings closed, opportunities for connection, we’re limited and communities were really challenged with losses and disturbances to normal routines. So across the lifespan, mental health is an important part of overall health and well-being, and we know that youth mental health is strengthened by supportive relationships and environments, and can also on the flip side, be put at risk by stress and negative experiences.
Pre-pandemic, adolescent mental health is moving in the wrong direction to begin with. And then we expected that this disruption and isolation caused by the pandemic would only further a road mental health, and that’s what we have seen in our data, particularly with our early studies in 2020 and 2021. We’ve seen that studies that looked at youth mental health have found associations between loneliness and depression, after social isolation, and we’ve also seen increases in the proportion of mental health-related emergency department visits from mental health and suicide attempts.
So we just released this data in the past few months, and I think that’s really important because it really dives a bit more when we look at some of our diversity issues, particularly among LGBTQ populations. So this was our Adolescent Behaviors and Experiences Survey, and it was really to look at the magnitude of challenges during the pandemic. We found that one in three high school students experienced poor mental health during the pandemic, and nearly half of students felt persistently sad or hopeless.
Female students and those who identified as LGBTQ are more experiencing disproportionate levels of poor mental health and suicide-related behaviors, and more than a third of students felt they were treated badly or unfairly at school because of their race or ethnicity. Asian, black and multi-racial students reported the highest levels of experience racism, and these numbers are just concerning when you look at all of the different statistics up here, and I’d say just really even greater concern is the disproportionate level of distress among certain populations of youth. So certainly before and during the pandemic suicide among youth in the US is a serious public health problem that requires urgent attention and it’s the second leading cause of death among youth ages 10 to 24. And when I think about years per life loss and just all the promise lost, to die by suicide in this age group, to be one of the leading causes of death, that’s just really a shame in our country and something that we can do something about, it’s preventable.
At CDC, we monitor indicators of youth suicide risk factors, and we saw the ED visits, particularly for adolescent girls, went up about 50% for a few months in 2021 compared to the same time period in 2019. And people know us as disease detectives, but we also do outbreak investigations for other issues like suicide and Stark County, Ohio called us in 2018 for an uptick of youth suicide, and what we found were nearly one in four of these youth were at elevated risk of suicide, one in four. When we look closer at it, we found that factors that were associated with these risk factors included; adverse childhood experiences, misuse of opioids, losing a loved one to suicide and posting on social media about suicide. We went in, gave many recommendations including how to report safely about suicide so is not to glamorize it and to really link to health and help-seeking instead, regularly assessing the well-being of students and really training community members to identify those at risk. When we look at what do online risk factors happen, ’cause we’ve heard a lot about social media, and it’s really a protective factor and a risk factor, it can be a protective factor particularly during something like the pandemic to where people could connect.
But it can certainly also be a risk factor if you’re exposed to cyber bullying, and in this study, we looked specifically at… There was a school-based online monitoring program to see who was most at risk of suicide, and those that had multiple online risk factors, which included violence, looking at drug-related content, hate speech, profanity, depression were at greatest risk. So the more types of these behaviors you’re engaging with online, this would trigger the BART alert and it was found to be associated with suicidal ideation. And when we talk about suicide… This was from our 2018 Vital Signs report at CDC. I always think it’s important to highlight, it’s not solely due to mental health, that’s an important component, but it’s all the precipitating factors that can lead up to a suicide death that we also need to focus on. More than half the people who died by suicide did not have a known mental health condition. Two of our other outbreak investigations that we did in schools, since I’ve been at CDC included one in Palo Alto, and we found that about half the students did have a mental health issue, but about half had a precipitating event such as family arguments, recent break up and school problems.
And then Fairfax County where I grew up, we also found factors like parents pressure for success, parental denial of children’s mental health issues because they didn’t want to acknowledge it, and social media issues also were precipitating factors. So going along with that, you can see on this slide, there are many factors that impact mental health, and for me, that’s important. There’s not a single factor, so there’s not a single intervention, we have to look at it across the spectrum at the individual family, community, environmental and societal levels. And we know, again, that youth mental health is strengthened by supportive relationships and environments and can be really at risk from negative experiences, including social determinants of health, so starting as early as we can, concerning things like adverse childhood experiences, we know from decades of research that if you’re exposed to something such as witnessing violence in the home, experiencing abuse or neglect, growing up in a household with substance use or mental health challenges, this can put you at risk for long-term health issues including suicidality, high blood pressure, and likelihood to become a victim or a perpetrator of violence.
We can prevent them, we can also lessen them, and what’s really important to realize about ACEs is they structure brains and have biologic effects. So our youth who are exposed to them, it can result in problematic ways in adolescence, including difficulty in making friends and maintaining relationships, reduced ability to learn and respond, which then leads to problems in school, decreased stress tolerance and increased risk of violence. And they can have echoing effects across generations. We’ve seen that if you have programs in schools that can prevent or lessen ACEs, those kids actually have decreased ACEs long term. So by focusing on today’s generation, we’re impacting future generations as well. And what we’ve seen in the pandemic too, with increases of domestic violence reports of that in the home, increased substance use, this is going to have a ripple effect on our youth because of the exposures they’ve had with ACEs.
So just focusing on what we can do about it, because I always think it’s important to say what can we do about this? So the Surgeon General released a report in December, really focusing on how we can address this youth mental health crisis in our nation. And it had a series of recommendations across 11 sectors, and I think that’s what’s so important, it’s not a single sector it’s 11 sectors that can work together on this. And there were a series of recommendations for young people and their family educators and schools, technology companies, including things like recognizing that mental health is an essential part of overall health, empowering youth and families to recognize, manage and learn from difficult emotions, ensure children have access to high quality, affordable and culturally competent mental health care, and really supporting the mental health of children and youth and educational community and child care settings.
So I’ll go through a couple of examples for some of these sectors. So specifically, we can really all play a role in promoting positive mental health from an individual to societal level. I spoke about this last week when we had a vital signs on firearms and some of the racial ethnic differences, when you look at what we can do at the community level, policies that support economic stability, such as an earned income tax credit, child care subsidies and affordable housing can reduce violence, stress and suicide, and we certainly see this when you look at racial and ethnic disparities in communities that this is further widened by these disparities. Schools have such an important role to play, and including things like teaching conflict resolution and coping skills. The good behavior game helps to teach and enhance positive emotional skills for individuals and groups and school environments. It is protective not only against substance use, but also teenage delinquency and substance attempts or suicide attempts, and we’ve seen that this has several years post the intervention that these effects last.
And then connecting youth to caring adults and activities such as Big Brothers Big Sisters. So this is a mentoring program which I’m sure many of you are familiar with, between a youth and a trusted teen or adult, but the program has been evaluated and has shown a decrease in skipping class, fighting and substance use, because again, it promotes those positive experiences. So there’s been a lot recently in the news about school policies and practices around LGBT youth, and it’s really important to realize that these policies, when positive, have a positive effect on the psychosocial health of you who identify as LGB and their heterosexual peers. We have found that when there’s positive policies, this is shown to improve mental health outcomes, including lower depressive symptoms, lower suicidal thoughts and lower suicidal attempts. More importantly, when we make schools safe and more supportive for LGBT students, we make them safer and more supportive for all students.
And we look at how do you increase that school connectedness, it’s a really powerful protective factor for students health and well-being. Schools can do several things to increase school connectedness, including training school staff and classroom management, so that students feel valued and heard, but also so that they know that structure and bad behavior isn’t tolerated, connecting students to youth development programs such as mentoring and service learning opportunities, and again, implementing policies and practices that are designed to support LGBTQ youth, and anti-harassment policies, and really professional development for all school staff on inclusivity and really helping to identify safe spaces and safe people in schools. Unfortunately, we saw that connectedness declined during the pandemic and has not rebounded yet to where we would hope that it would, and so we found that about half of students or less than half, felt connected during the pandemic, which again, decreases resilience and is concerning for a lot of these health outcomes.
So there are other tools that were developed. The National Academy of Sciences in partnership with the CDC, developed these mental and emotional well-being tools for children and youth, and it was to really teach you how to deal with some of the challenges associated with the pandemic like changes in routines, breaks and continuity of learning and of healthcare and missed significant life events, like for kids, a birthday party, and really low security and safety. There were videos and infographics that used to help focus on several topics, such how to change your thoughts, how to take a deep breath, and really how to do fun activities. My poor child gets exposed to these all the time, and so we did some of the scavenger hunts, we did some of the deep breathing, and we talked about how do you develop coping skills and really dealing with disappointments. But I say that because I think it’s important that we look at these tools and we use them with our kids and we have these discussions. I would also say the pandemic allowed us a lot more family time to also talk about coping and other risk factors and to talk through many of these things.
Two campaigns I just want highlight that CDC has championed and lead are the “Be the one to” campaign, which spreads the word about actions we can all take to prevent suicide. And this highlights five steps we can do to really safeguard people. It’s ask. So ask if you’re thinking about suicide. There is a myth that asking about suicide makes you more likely to try suicide, it doesn’t, and in fact, it means that you care. Be there, so if they do disclose something to you, be there, and then be supportive and keep them safe. Help them connect to services, and then follow up, ask them how they’re doing. Those are five simple steps that can really make a difference. The other campaign we launched during the pandemic, and it was called, “How Right Now“, and it was designed to promote and strengthen the emotional well-being and resiliency of populations affected by Covid 19, and this campaign is grounded in health communication and behavior change research. And during a formative research process, we found several lessons including, people want help, but they want it to be easily available and to have it come from a trusted source. And self-care resonates, but what self-care is is different to different audiences, and that help needs to be culturally sensitive and not overly prescriptive, and these are all I think, important lessons we look to how we support our youth.
What was really important about this campaign was it had a positive effect on community engagement and resilience, especially for those who were struggling most, and we found the highest shifts among people who are experiencing violence, people experiencing emotional distress and economic distress and communities of color. And then I just want to highlight a few resources that we have on our CDC website and includes what works in schools, which helps schools establish safe and supportive school environments with the specific focus on increasing school connectedness; the health education curriculum analysis tools, which has a module on how to manage interpersonal conflict in healthy ways, to show acceptance of differences in others, and to practice habits that promote mental and emotional health; and then finally, several technical packages which are sets of strategies for things like adverse childhood experiences, suicide and child abuse, which can help communities leverage good and evidence-based policies and programs to prevent these harms from happening in the first place.
And so we know that young people need to… We know what to do to help young people and to help them move forward, knowledge and skills to handle stressors and to build resilience, access to services, and really enhancing connectedness. Through this, we can minimize the effects of trauma experienced and promote positive experiences. I would love to stay for the panel, but as curve balls have it, somebody in my family has been impacted by the pandemic, which has impacted my ability to care for my child, so I will be leaving after this and not joining the panel. But thank you all for the work you’re doing to protect youth mental health.
Panel Discussion
(Beth Finnerty introduces panelists.)
- Fred Assaf, M.Ed, Head of School, Pace Academy
- W. Edward Craighead, PhD, ABPP, Dept. of Psychiatry & Behavioral Sciences, Emory University
- Emily Anne Vall, PhD, Executive Director, Resilient Georgia
- Ray Kotwicki, MD, MPH, DFAPA, Charles B. West Chief Medical Officer, Skyland Trail (moderator)
Ray Kotwicki:
Thank you Beth, and good evening, everybody. On behalf of the clinical team at Skyland Trail and most importantly, our patients, I welcome you to this essential conversation tonight. Just to reiterate what Beth said, please think of your most important topic in questions and write it on the index card so that we can spend the last 15 minutes or so of our time together tonight talking about things that you’re most interested in better understanding. One truth that we’ve learned in psychiatry in psychotherapy, but certainly was refined during the pandemic, is that crises don’t change us, they reveal us. This sentiment was reaffirmed during the COVID-19 pandemic, in which two often insidious and quiescent mental illnesses in our communities were magnified and sometimes exposed. Even before the pandemic mental health challenges were the leading cause of disability and poor life outcomes in young people with up to one in five children aged 3 to 17 years old, having a bona fide mental, emotional, developmental or behavioral disorder. Perhaps most concerning, there was a 44% increase in serious suicidal ideation in the American youth between the years 2009 and 2019, with a 57% increase in completed suicides in youth in that age group.
These data coupled with all of our own experiences of anxiety and depression and social isolation and loneliness and loss and fear of having all the other problems associated with viral infection, led our Surgeon General, Dr. Vivek Murthy to issue a Surgeon General’s advisory last fall, to call attention and action to the nation’s youth mental health crisis. Tonight we will explore some of the factors and hopefully a few potential solutions to this public health crisis that people like author Remnick in The New York Times this past weekend, are terming “the second pandemic.” So my job is to ask somewhat controversial, but not entirely controversial questions to this group in line as we try to answer some things related to the youth mental health crisis.
So first of all, I want to start off with the question to all of you, which is something that a lot of our parents in the Skyland Trail adolescent program, and I see a line of our adolescent staff over there, thank you for coming, ask us, and it’s a great beginning point for a discussion like this. Are youth just simply small adults when it comes to mental illnesses and behavioral disorders, or is there something different about being under the age of let’s say, 25, that leads to a different experience when somebody who’s 15 or 16 develops a mental illness. Emily Anne, which you start us off?
Emily Anne Vall:
Well, I can start maybe because I’m not a clinician, I’ll start and then I’ll pass it over that way so they can talk more about the science. But I think I always try to put myself in whatever population I’m trying to serve shoes. And when we start talking about teen mental health and youth mental health, I think about what I was doing during those years and what that would look like during the pandemic, and I really can’t imagine where I would be right now. I don’t think I would be sitting here if had to go through the pandemic stuck at home. So all of that to say, I think absolutely, adolescents are young adults, they’re more adult than some of us in a lot of ways. I think if anybody has been in the classroom, if they’ve been in the doctor’s office with teens, they’re much more forward than a lot of us are. They tell it like it is. They do a lot of things that I personally can’t do being a mid-40-year-old woman. So I would say… Absolutely. The other thing I will add that I think you can both speak too much better is the brain is still forming. So you add the hormones, and I taught seventh grade, so I feel like I’m a little bit of an expert on that, but you had the hormones you had brain development and all of those other factors, including the pandemic, and it’s just the perfect storm for a lot of different issues to come up.
Ray Kotwicki:
Ed, what do you think?
Ed Craighead:
I think when I first got involved in this field, the idea was that basically youth were little adults, and what emerged over the last 45 years or so has been a full recognition that it’s a life span perspective and that we need to study developmental psychopathology in a developmental way, and what we’ve learned by doing that is that youth really are different. The other thing that was true or something that Emily Anne just touched on, and that is, when I was in graduate school, I learned that by age 18, my brain was as fully developed as it was ever going to be. It was scary to my mother, but in fact, we know now that that was completely incorrect, and you touched on the age 25, it’s more or less around that now that we think the brain is fully developed and finished, it’s growing and pruning, etcetera. But the people who are 6, 7 and 8, and we’ll get into this later, who have say an anxiety problem, are quite different in terms of where the brain is in the connectivity from 17 or 18, which is also quite different from adults. So I think the answer is unequivocal at this point that child and adolescent development and even young adult is not just a downward direction of adults, but rather that these are different times in life, the treatments are different, some of them are the same, but most of them are developmentally appropriate and been developed for people at different age ranges.
Ray Kotwicki:
Thank you. Fred are mental illnesses in students, the same or different from adults and the parents?
Fred Assaf:
Thanks. I think, Ray, you have a unique perspective that I’m the impostor on the stage, I have no degree in this or don’t know the science like Ed does, and Anne, but it’s very obvious to me and to anyone who works with children that they’re much different than adults, and we like them better.
[laughter]
They’re forgiving they’re resilient, their understanding, but the thing that parents don’t get, and this is sort of the adult child thing is, whenever you’re in this type of crisis, the adults first reaction is, “Why don’t they just do this, this will go away, just… You don’t understand, you don’t care about this in a while.” But the child cannot put that out of their head. That’s the number one thing that you have to do is respect how they feel. And in order to generate any empathy and to try to get to solving those issues. So I think they are very different and that is a little bit of the problem in treating them is we don’t like to see them as how different they are.
Ray Kotwicki:
A question for Fred and Emily Anne. So there’s been a lot of news coverage that’s focused on the pandemic as being the impetus or a key driver for the emergence of mental illnesses in youth and adolescence. And to my point and my kind of lead off that crisis really don’t seem to change us, me, it reveals who we are, what coping strategies we have, what we lack in terms of resilience. From your perspective, to what degree is the pandemic responsible for what we’re seeing in the youth mental health crisis, and to what degree was this just an underlying state that we’re now paying attention to differently?
Emily Anne Vall:
Well, I think the pandemic just held a magnifying glass to all the issues that were really there. How many people were stressed out a little bit over the last two years, anyone?
[laughter]
It’s exaggerated everything. So for context, Resilient Georgia, for those of you that aren’t familiar with what we do, we work with regional partners across 120 different counties across the state, and so we’re constantly gaining information from them, giving information, and it’s very transactional and friendly, and so we hear a lot about what’s going on in the different areas of the state. And a lot of the common themes that have come forth from the pandemic is those inequities that were there before are heightened and so much worse since the pandemic hit. So areas without access to mental health, it’s even worse now. It was an issue before, but now you add that you can’t actually go into a provider’s office and you can only use telehealth, and you’ve got a child that needs services and they’re in an apartment with eight other people with one bedroom and they have dodgy Wi-Fi because there’s… Or they have to go to… One specific example, a child had to go drive half an hour to Chick-fil-A to do their homework, to pick up their Wi-Fi, and they’re trying to see providers that way too.
We’ve heard from some of our LMFTs that we work with, that they were seeing patients that were at the bus stop, they were just purposely scheduling their telehealth appointments from the bus stop because that was the one place where they could have privacy, which is like the most un-private place, you can think of. So when we look at a lot of the public health heat maps that Dr. Houry touched on, everything is just worse. We always knew Southwest Georgia had the highest level of chronic diseases, the biggest issues with access, the biggest issues with workforce, and now it’s just exemplified from the pandemic.
Ray Kotwicki:
Fred how has the pandemic changed your community in the school?
Fred Assaf:
So I don’t have as broader view as you do… 85% of our students come from a radius of six miles. Right, so we’re much more sort of… My data set is right here. And I think it’s changed us dramatically, and we also had the resources to stay in school. So we’ve been in school every day as lots of the independent schools were through the pandemic, which of course was an advantage. But I think for me, I want go back to what I think is the most important concept. So if you think of any school or university or Skyland Trail or any non-for-profit. The root of everyone’s mission is this idea of community, and even corporations, for-profit corporations, they want talk about how people can feel a connectivity to their corporation and for schools that’s very real, and for children. And what the pandemic did was really remove that idea of community, and it changed us in a way that we recognized how important it was to have that community, and we did not realize what we were missing. So we plowed through with education, we could do calculus, that was so easy, like, Well, alright, go get on your Zoom and do your calculus or do all those kinds of things, or…
But we missed the idea of engagement of parents, engagement of community, all the things that really build resilience in children and a sense of who they are, and I think… And that’s my data set, it was really missing. So I would say that’s the thing I’ve learned. I also learned something interesting, teachers were not immune from this, in fact, they were some of the hardest hit, and because they were managing, all of this got put on their doorstep, and the people we didn’t think about equipping were the teachers and they… Who do the children trust? Their teachers, they trust their teachers. And so they had an enormous burden, and I don’t think we were ready for that either. So it was a multi-faceted impact from the pandemic and that one that we’re out of by any means, but certainly something that I feel like we’ve made progress against it.
Ray Kotwicki:
I really love your analysis of the importance of community, and I was a community Psychiatrist fellow at Emory with Dr. McDonald years and years ago, which traditionally means that you work in safety net hospitals with people who don’t have insurance and don’t have resources. But for us at Skyland Trail, it really honors the idea of peers helping one another recover from a mental illness and demonstrating that being connected in a meaningful way is equally as important as any other aspect of what you do in mental health treatment. So to that end Ed, Dr. Houry mentioned that social media is sort of a double-edged sword, in the one sense, it can help develop a community and allows for some sort of social connection when physical interaction is impossible. And on the flip side, there seems to be a relationship between overuse of social media and bad outcomes. Where do you fall in thinking of recommending to parents and the patients you see at CAMP and others, how to have a healthy relationship with social media?
Ed Craighead:
I think that I’ve had this question over the last couple of weeks, two or three times, and it really is a mixed thing in several ways. I think there’s been a lot talked about the difficulties that have been created by overuse and even used late at night in the kind of light that affects the sleep and how that causes people to be tired, etcetera. And I don’t want to go through so much as the sort of constructive aspects of this that can be used. And one of the things that sort of allowed some sense of community in fact was, for example, in public schools, our grandson whose grandmother teaches down here. But at home, I did in fact be able to connect in some way, and that led then, when they went back to school to a quicker reconnection, in my opinion. Not that there wasn’t harm done during that time, I think that certainly was true.
I think the other thing, kind of tying this with the community that we’ve found, and as an administrator with mental health workers is that they were not immune from this either. And so, we have essentially 30 people in one floor of the building, and one of the things that we found out early on is how much they really missed each other, how much they missed the meetings where they could talk about the difficulties with patients and their own children that they were having to take care of in the background while they were doing Zoom. So, that’s not exactly a direct answer to the question, because I think that’s a really arguable point. I think it’s not arguable that there can be detrimental effects from overuse and that there are materials that are available that have to be monitored, and of course, as Dr. Houry noted in many cases that monitoring is not available.
I’ll just say one more thing about this, and then Fred can answer. I think the most interesting study of all of this with the pandemic and the consequences, there have been several studies that are now being published, they are coming out all the time about the negative consequences. But the best study, I think the most revealing study came out of the United Kingdom, in which what they found, of course, was a very negative effect of the pandemic, but the overwhelming negative impact came for those children where the parents were of a class where they had to work and leave the children at home under the care of an older sibling or of someone else. And those children turned out to have much higher than the 20% or so increase that we’ve seen in anxiety. We can talk more about that later, probably, but I think that that was a very revealing study that’s relevant to what Dr. Houry was talking about. And it’s a different group of people than maybe what Fred was mentioning.
Ray Kotwicki: Thanks, Ed. Please…
Fred Assaf:
Yeah. I’ll probably be a little more controversial on this. I think it’s bad, and most of the problems that you see in a school link back to some social media problem. If I take my 11th graders in an English class and say, “Should we give fourth graders iPhones?” They look at you like you have two heads. [chuckle] Like, “Mr. Assaf, do you know what you can get on a phone? That’s ridiculous, you should not give that to a fourth grader.” Yet the parents… Again, there’s a theme. They sort of go back and they’re like, “Oh, well, this is going to make my kid cool. It’ll be great for their 10th birthday. I just want them to be… You know, feel like they’re special. And it’s just an iTouch, not an iPhone,” or whatever. [chuckle] And what happens though is, of course, this is very detrimental to a child, okay? I don’t… You don’t have to read a lot of stories to know that or studies.
The other piece is, and I think this is really important. Our upper school principal says this all the time, and so I wanna footnote him. Conflict can’t remain at school because of social media. So when a child has a problem, they go home and then somebody posts about that or sends a Snap and other people comment, so that whole conflict continues all night. And the parents are unaware, they’re like, “Did you do your homework? Can you take out the trash?” And the kids are getting all this conflict constantly going, and that’s the part that no one talks about. And that’s really, really destructive, because we need… If you’ve ever gone for a walk, you walk your dog, you go for a workout, whatever it is you do to have some time to clear your head. If you can’t get away from things, and particularly for young people, they need… That’s why they love sports, right? They love sports, not because their coaches yell at them, because they get to play for two hours and their mother doesn’t ask them if they did their homework.
[chuckle] And they get to be with their friends and you know, run around. These are the things that kids want. So, anyway, I was preaching and I’m sorry. [laughter]
Ray Kotwicki:
No, I think it’s a really great point. We sort of refer to that in our treatment program as “psychological steam burn.” That you get burned over and over again because you can’t stop looking, in sort of a “FOMO / I’ve got to check my social media account” way. So, great point. And speaking of adverse events that happen in school and other times in children’s lives, Emily Anne, I know Resilient Georgia does a lot of partnership and collaboration and work in helping thinking about cultivating resilience and what that looks like and what it means for everybody, but especially youth who are at risk for developing a mental illness. What are some of the interventions and some of the things that you’ve found in your work and in Resilient George’s history to be effective in helping cultivate that resilience?
Emily Anne Vall:
Well, one resource that we’ve created, and I’m very proud of it, and a few different people in this room have helped with it, that we’ve created is called on our website, it’s the resiliency training toolkit and there’s… Or Roadmap, sorry. We have used the Missouri model, which tiers all of these different trainings into different levels, and we kind of ripped off the CDC when we created this web page. It’s an interactive web page, and when you hover over it, there’s 12 different sectors. So for example, you could hover over the fire station if you’re a first responder, click on that, and then it pops up with four different levels of trauma-informed and prevention-based trainings that are available to you, most for low or no cost. So any different sector can use that resource of ours, we share it with the masses, we’ve partnered with the Georgia State Public Health Policy Center to do a survey every other year.
So we survey all of the different groups across the state and nationally that have education and training opportunities that we can include on that web page, and we update it every other year. So that’s available to everyone, and we’re very proud of that, especially what we’re seeing a lot of is secondary trauma, so we’re talking about being in the school, being in a provider’s office, we’re seeing a lot of the adults being very stressed, like, God, I’m sure most of you can agree with. So, we also offer trainings that kinda help with that resiliency building and secondary trauma and stress. The other very exciting project that I am very proud of is called Handle with Care, and what that is, is different communities across Georgia have already implemented and many are starting to build efforts now. And it’s a program between first responders and a school district.
So, when a child goes through a traumatic event, the first responder, it can be in the form of an app or just a phone call, and for example, Savanna, they used an app. They built this app. So say I’m a policeman, I go to somebody’s house. Fred has been through something very tragic, I just send an alert that says Handle With Care to the school district, it says the student’s name, Handle With Care, they’ve been through something serious, and all the teachers and all of the school administrators are aware of that incident.
Fred Assaf:
That’s brilliant.
Emily Anne Vall:
And it’s very sustainable, it’s low cost once it’s created, and it helps all the educators care and give resources to the children, as well as the first responders in the community. So, we’re working really hard to push that out state-wide and I just love that one, especially because I was a teacher for a few years.
Ray Kotwicki:
Yes, congratulations.
Emily Anne Vall:
Thank you.
Ray Kotwicki:
One of the things that we’ve learned at Skyland Trail since opening the adolescent program is the degree to which populations are impacted by trauma, and the importance of thinking about resilience. Over the last two years, about 30% of our adolescent patients have had either moderate or severe sexual, verbal, emotional and/or physical trauma in their history. We’re looking now at that implication biologically, and we know that people who especially have had sexual traumas seemed to have uncontrolled inflammation in their system that really looks like… It leads to a poorer prognosis in general, but it can help inform some of the special attention that people who’ve had that horrific experience really need and deserve. So, one of the other things that we have learned from looking at our data is the overlap in our adolescent patients with depression and anxiety.
And virtually everybody who comes to Skyland Trail with depression has predominant anxiety or another diagnosis of some sort of anxiety disorder. So Ed, I’d love for you to educate us and the audience on sort of the developmental way in which youth develop anxiety and depression. How are they connected and can you have both of those different diagnoses or do they have a shared common kind of overlap in a Venn diagram of psychology?
Ed Craighead:
Well, that’s certainly an important point and Beth mentioned in the introduction that we run an outpatient clinic and we have the same experience. But the research data across the world, not just in the US, and is similar in Georgia as it is in most of the rest of the US, there are slight differences in some areas, but one thing we know is that these disorders are not any respecter of socioeconomic status. While it’s true that being in a poor socioeconomic status you have a higher rate, it’s not true that the other end of the distribution is immune from having these disorders. And so, if we look at the relationship, basically, what you’ll hear almost any person who’s in this kind of discussion talking about is that it’s somewhere around 20 and maybe now about a 20% or 30% increase during the pandemic, so somewhat, well north of 20% who have anxiety and/or depression.
And the way they seem to work developmentally, we talked about this at the very beginning, is that the most likely indicator of this for parents who are here is in the five to seven-year-old child who may experience separation anxiety. And when you move then into the children who are, say, 9 to 12-ish, middle school kind of children, the problem tends to become… That’s expressed more is the social anxiety. And we haven’t yet very many people, less than 1% in this age range who’ve experienced a depression. But as you move to 12 for females and slightly older for males, but beginning around 12, you start to see the appearance of depression, and it really comes full force around 14 or 15. And I mention these together because there’s about a 50% overlap. In other words, about half the people who have a depression, if you do a thorough interview or if as a parent you ask them questions in more detail, you’ll discover that they also have an anxiety disorder.
Or conversely, if you have a child who’s been growing up with separation or social anxiety, or what might happen, say around 12 or 13 is the beginning of generalized anxiety disorder, obsessive-compulsive disorder. I know it has the label of its own now separate from anxiety disorders, but historically they’ve been related and post-traumatic stress, of course, which has been talked about. But at 14 to 15, what happens with depression I is there this rapid acceleration from 1% or 2% up to about 17% by the time people reach the end of high school. As I said earlier, half of those people will have depression without anxiety, half of them will have anxiety. If I could just add a couple more comments, the…
Ray Kotwicki:
Please…
Ed Craighead:
There’s also these people who experience this as youth and who make up most of our population in an outpatient clinic as versus in-patient, they’re particularly in the mood disorders or depression. There’s a huge overlap with substance use. So that either they’re trying to control their mood or they may have that vulnerability. Sometimes they start using substances to deal with the mood, but it activates the genetic predisposition to a substance abuse and it sort of develops a life of its own then, and you have something else to treat, which we’ve discovered and led to the development of the addiction lines of Georgia, which grew out of someone who came here to treat children and youth, but who gradually has made it much bigger than it was.
There are other disorders also that overlap, but you asked about anxiety and depression. I think the other side of it is equally true, so you have the chunk in the middle who have both disorders, you have some people who have anxiety alone, and you have some people who have depression alone. And the treatments for those people may be different than the treatments… We’ll probably talk about treatments later, so I won’t go into that now, but that sort of developmentally how it happens, and that is about 2 to 1, or two and a half to one female versus male that have these anxiety and depression problems. And that ratio contingents over the life span with the overwhelming majority of people who have a depression. Obviously things happen and people get depressed later, but it used to be said it doesn’t happen early, but in fact, we know that it was ignored a lot at that point, and that it is those people who have it early who develop the problems later. It doesn’t keep you from having the problem.
Ray Kotwicki:
Right. And the earlier someone can get treatment the better.
Ed Craighead:
Right. The easier the more… You know, it just saves the life experiences. So, when we work on prevention of depression, for example, we try to identify people who are at risk with some symptoms. And if we can prevent that depression from occurring, that allows them to develop academically, it allows them to be more resilient in social situations. And another thing Dr. Houry mentioned was the interpersonal relationships, and that’s something that will not happen with the people who are experiencing the disorder and where it’s ignored. But when in fact, people can have it prevented or treated, they then can go ahead and develop relatively normal interpersonal relationships.
Ray Kotwicki:
Great points. I think the fabulous Skyland Trail staff are gonna start circulating through the room, so if you have a question, please pass it over to the aisle, so I can get some of your questions answered.
While that’s happening, Fred, I actually heard something very interesting today about what you were doing at school, which is that you actually asked the students what they thought, which is a novel idea. You did a survey about mental health, and I’m really interested to hear what the kids are saying. What did you learn?
Fred Assaf:
So, I was… I was intimidated to be involved in this group, and my connection to Ray and Skyland Trail didn’t have a glorious beginning. It started when we had a couple of suicides at Pace years ago, and Dorian’s out here, and like anybody who’s in any situation, you go look for help. And I’m forever grateful to the people who came to my… I went to the CDC and spent a day there and tried to understand and see how you can help, and I learned a lot. And one of the things I learned that Dr. Houry talked about was, you’ve got to ask… You got to ask people, we’ve done a lot of training with our teachers, these aren’t dangerous questions to talk to people about mental health and ask what’s going on and all of that. So I’ve learned a lot personally, and so one thing in preparation for this, I was worried after I said yes to Beth, because Beth is very convincing, she made me feel good and all that. So I said, “Sure, I’ll do it.” Okay, and I thought, “What did I get myself into?” So I thought, I’m going to go to my high school assembly, which is 500 high school students and tell them that I’ve done this. And I worked with my counselors and said, “I want to get some feedback that I thought might be useful for the audience.” Now, I wanted to tell you, honestly, I thought there’d be a dozen people here, so… You appreciate you all being here. But I thought, “What will the kids have to say?”
And so my counselors at school helped me craft some questions, just four questions, and the kids… And I made them take out their phones, I know that sounds ironic. But I wanted the answers. I know now you’re like, “Somebody’s video taping this now.” Okay, but I wanted the answers, then I wanted them to sort… Give me what was on their mind about this. So the first question was, what would be the one thing you would… Now this is not scientific. If you… Now, these are scientists over here. What’s the one thing you wish you could tell… And this was about mental health, what’s the one thing you wish you could tell your parents. I wish I could tell you to take out your phones and answer these questions. What’s the one thing you wish you could tell your parents about mental health, and I went through the hundreds of responses and categorize what I thought were the most consistent themes. The good things, there were lots of kids who said, I’m open with my parents, we talk all the time, that’s good. Times aren’t the same as when you were a kid.
[laughter]
You put a lot of stress on me about school performance, you may get worse, there’s too much pressure. Think about your word choice, please.
[chuckle]
When you aren’t, and this is perhaps the most powerful one in this category, when you aren’t feeling good mentally, it’s hard to communicate with people, the people you care, who care about you the most, it’s super difficult to have that conversation with your parents. I wish I knew how to say that better. That will make you think. As an adult, has an adult helped you through a tough time? And of course there… Or how as an adult helped you through a tough time? And I think these… We could probably guess the unconditional support, creating safe space, really listening and not… The child who said, really listening, really? Just listening. I thought that was… I’m that parent who’s not always just listening. Okay, and that my teachers and counselors always notice when I’m not myself, and I thought that goes back to the teachers really are connected. It’s good.
How does your school support mental wellness? This is more specific to us, they feel like they don’t have a stigma to talk about it, which I think is important, they said that every time we have an assembly, if we were to have an assembly, we always have a follow-up form that we send to kids, so they can give feedback. They like that. But some of the kids said, “We talk about it a lot, but I’m not sure how to get help.” That’s something that we can do better. And then the last question I asked him is, “When are you most stressed or when happiest?” This was a sort of two-part question. All the time, they’re most stressed about school grades, parent expectations, exams, tests. When are the happiest? Not on Instagram, they don’t say that. They’re happiest when they’re playing sports, hanging out with their friends, and in the summer.
[laughter]
I think we could all agree with that. So anyway, I thought that might be just something helpful and thoughtful that I could maybe give to you as a way to say, I think the kids are thinking about this and it’s amazing what they will give you when you ask… If you ask, and I’ve learned that through my relationship with you all, is the ability to really just… Don’t worry about it. Ask.
Ray Kotwicki:
Yeah. Great survey. Thank you. You by the way, have great questions, you’re a very, very smart audience. There are many of them, and we’re not going to get to all of them, but I’ve tried to kind of find some patterns and some themes, and I want to start with my favorite topic de jure, so I’m so glad that 12 of you asked about this. But let’s talk about drugs in psychiatry. So what are your opinions of the roles of psychedelic drugs like psilocybin, ketamine and S-Ketamine, the influence of things like marijuana and recreational places where you can use recreational marijuana. How do those things fit in with your idea of what mental health is, and how do you think they impact mental illnesses? Ed?
Ed Craighead:
Well, obviously, we have an issue with substances and substance use and substance abuse, and that really both is partially a function of the other mental health issues, it’s a social issue. And I think that’s the use side of it, which is the first part of the question. And undoubtedly, that’s a major thing, it’s not an area in which I personally have a lot of great expertise because we deal with anxiety and mood disorders, bipolar disorders, so I won’t attempt to go there. There are… The second part of the questions about treatments, and I think those treatments are relatively new. There is a… I guess, Bill, correct me if I’m wrong here, but I think there’s a lot more data for TMS in terms of actual research that it’s an effective treatment for some disorders. I don’t know that it’s particularly related to the substance question, but as a treatment, particularly for depression, it’s really… There’s a lot of recent data and clinical support for that, I know that you’re using that some, and we use it in our department and other places in town use it. Ketamine is newer. It’s not newer as a substance, but is newer in terms of the treatment of psychiatric disorders, it seems to be more rapid when it works, the question has to do with sustainability and how you can combine it, I think with maybe other treatments that have more endurance, perhaps although I say perhaps because that’s an unclear question.
Ray Kotwicki:
And just a quick sort of definition, TMS, transcranial magnetic stimulation, it’s a neural modulation, which really means that we try to change the way somebody’s brain functions from the outside rather than using things like medication. Skyland Trail offers TMS, and the results are pretty astounding.
Ed Craighead:
I might just add real quickly that when I was talking, I was speaking primarily about adults, and there’s very little research that’s been done with these treatments with younger people, although it’s very rapidly moving that way, and there are funded studies under way at various places to evaluate its effectiveness relative to other treatment.
Ray Kotwicki:
Thank you for that. Emily Anne, do you want to weigh in?
Emily Anne Vall:
The only thing I’ll say is, as we continue to talk about the stigma associated with mental health and recovery and all of those things, I think it’s important to think about the recovery and advocacy community and really lifting up that they are resilient, right? I don’t have a lot of… I certainly don’t have your education or professional work with drugs or medicine or anything, but I do have a lot of personal experience with lots of addiction in my family, and when I look at those that are in recovery, they’re really the epitome of resilience, and I think that should be applauded a lot more than it is, and we are working hard to reduce the stigma in that way and start having those conversations.
Ray Kotwicki:
Here, here. Yeah.
Ed Craighead:
And I would add to that that we often think of recovery if somebody makes one mistake and it’s disastrous, as opposed to if we were treating somebody for cancer and the drug stopped working, we would just bring them in and bring a new drug on board. And so we have to start to think of that continuum of recovery is something that people can get better and there’s going to be high points and low points, and it’s our job to work harder to find that recovery, so.
Ray Kotwicki:
Fred, let me reframe my question just a little bit for you which is, at Pace, what is the connection that you see between substance experimentation or all the way up to what we used to call addiction, now we call misuse and mental health problems? Do you think that there is sort of an association or a correlation that you see?
Fred Assaf:
Yeah, I don’t have a lot of data on it to say, but I guess my… anecdotally, I would say that you don’t end up with 25-year-old addicts who weren’t using in high school. It does not mean everyone who’s using in high school becomes a 25-year-old addict, and I think what we see is that the longer, the more vigilant parents can be the longer people put off use, the more responsible their use, the less likely they are to become. And that’s… We work closely with Hazeldon, Betty Ford and FCD to… When we have lots of peer coaching that we do, we have a lot of high school kids who take a pledge to not use and then work with middle school kids on that. But we worry a lot about that connection, sort of what I guess you would call… You’re referencing self-medication… Kids who are not well and are using to try to deal with mental health issues, and then it becomes an addiction, so. I don’t know as much as I should probably.
Ed Craighead:
I could just add one quick comment.
Ray Kotwicki:
Please
Ed Craighead:
Ray, I’ve been really shocked. We treat about 1,500 adolescents and children every year, and we’ve been doing that now 17 years. And one thing about Atlanta that I found different from other places was how many people… Now, of course, the time is different from when I was at other places, but how many people have come in and their children have been using and they had no idea, and they were at schools like Pace and at Westminster, and they were at public schools, and they were all strata of social life, and the amazing thing was that this had been going on for a while, it was going on with people leaving for lunch break and then participating with three or four friends because they had some stuff available. So that was really striking to me, and I wanted to share that with you because I think, as parents, many of you are, and so long ago, you were one of those people, maybe some of you are a lot younger who are doing that, and… So I think we can’t take it for granted, even when we have really good children like our own or others, that something like that doesn’t happen, because there is an experimentation and sometimes that then will lead to more difficulty. But it was the surprise of the parents that I wanted to mention.
Ray Kotwicki:
The second most common theme in the questions from the audience is, again, I think a really interesting topic that I’d love for all of you to comment on. Fred, I want to start with you first, because you were specifically mentioned.
Fred Assaf:
Uh oh. [laughter]
Ray Kotwicki:
Which is really the balance between holding youth to high standards, and not everybody being a winner because they show up (i.e the application process to get in Pace) versus getting a participation trophy when you do your best and you don’t win and you stink at soccer, but you still get a trophy, which is the better approach from a mental health perspective in working with adolescents and children?
Fred Assaf:
Wow.
[laughter]
I think it’s a really hard question. One thing in my career working, we have a lot of high-performing students, but we have a whole range of students at our school, and what I would… Everyone who’s applying a 5-year-old to Pace believes that their 5-year-old is going to someday sit on this stage and be a very famous doctor.
But expectations are high, and I think that is a bit of a challenge of understanding the horsepower and the capacity that different children have in an environment is a really important one, and we try our best to try, say, at a school like ours, to take children who we think fit the profile and can succeed. Does that always work? It does not. And I always like to say, statistically, half of the children will graduate in the bottom half of the class, and it’s not something we can change. And so as you sort of think through that, reality is sort of a way of sort of grabbing a hold over time of who am I and what are my gifts? I think when I would go back to what is… I’m not sure the nature of the question in terms of participation trophy… I guess I see it a different way. I think every child brings different gifts, and a school’s job or a parents job is to try to find those gifts and help them really celebrate those and oftentimes… And I think what you hear in sort of my unscientific survey is when it’s just, “Do better at school,” that can be really challenging for a child for whom B is the best they’re going to get.
If you keep saying, “Get As! I’m paying all this tuition,” that’s not helpful. And if B is the best they’re getting, and maybe there are other things about them. And I think that’s where we have to broaden how we think about what success is. It’s a tapestry. It’s not just a pinnacle. That’s what it looks like, it has lots of different colors and shapes and the pieces that go together, but you can’t just think of education as an achievement. It’s a process, and when you think of it just as a product, you’ve missed the point. And I don’t know how else to say that, and I think you do get a lot of folks for whom they think education is a product. It’s not.
Ray Kotwicki:
Do you know what they called the person who graduates last in their medical school class?
[laughter]
Fred Assaf:
I heard it’s a doctor.
Ray Kotwicki:
Doctor.
[laughter]
Ray Kotwicki:
Emily Anne, shark tank or participation trophy?
Emily Anne Vall:
Well, I will add with this question, sometimes the participation trophy is very needed, we work a lot with youth voices, and we try to really lift up their voices and hear where they’re coming from, and in a lot of cases with the youth that we work with, just to get to the field, they have to overcome extreme, extreme hurdles. If you are living in an apartment with 12 people, if you have nine ACEs, you’re dealing with all of these things and you still make it to your soccer game on time, then you deserve a participation trophy, and that should sit highly on your shelf. And some of the things that we do that we’ve worked with partners to do, we have some youth podcasts and use mentorship programs, and there’s no winner in the mentorship program, everybody gets a participation certificate. And that’s really important to a lot of the students that we work with. And so with that, I’m also one of the most obnoxiously competitive people in the whole world that I know.
[laughter]
Fred Assaf:
I think we probably would agree on, it’s you have to meet them where they are. And so for certain kids, it is that. You have to meet kids where they are, and they need that. And so that’s where we have to really trust our teachers and the people who are on that frontline who know, “This kid needs this.” I sign a lot of award certificates, and sometimes they’re totally invented awards. And you say, “Why is there this award for… ” And I think you’re right, it’s the teacher says, “You know, this kid needed something,” and that’s an important point. I think it is.
Ray Kotwicki:
How about you, Ed?
Ed Craighead:
Well, I want to say something different because I agree with what’s been said. And that one thing that we’ve observed over the years of treating so many youth is that, as everyone here knows, there’s a wide range of intelligence among… It may be narrower, but even within your school, there’s a range. And so I think that we have this notion that this negative feedback and perfectionism is a function of just the people who are the smartest. And the message I want to leave is, that that’s an issue for the people who are not the smartest as much as it is an issue for the smartest. And so it’s a matter of working successfully at the level that you can perform. I remember sitting in this building a few years ago when there was a lecture given by an author whose name escaped me, who talked about the importance of the individual getting feedback about performance rather than the outcome and making the effort. And that stuck with me until this time. And it’s something we work on with children.
And just to tie it to the earlier discussion, the very early study of suicide in teens, that… This again was done in England about 40 years ago, 35 years ago maybe. One of the things they found was that the biggest predictor in their sample was that people had done poorly in school and had gotten feedback, and Dr. Houry alluded to that. At the same time, the other variable that’s really critical is relationships. And so I think that the people… Some people excel in school, some excel in relationships, and some don’t excel in any of those. And those are the people that we work with a lot.
Ray Kotwicki:
These are such great questions, and I’m sorry we’re not going to have time to get through all of them. I want to ask one more thematic question, which relates to a lot of the treatment implication questions from the audience. And I love this, we do this in our psychotherapy sessions with some of our patients, which is the “Magic wand” question. So given your areas of expertise and what you know about the youth mental health crisis in the country today, what if you had a magic wand and you could wave it and anything would be different, what do you think would be the most impactful change in whatever institution, whatever community, whatever family that you think would lead to improve mental health? Where would we get the biggest bang for our buck? Emily Anne?
Emily Anne Vall:
Well, I think with my magic wand, it’s kind of a chicken and the egg. I think as we look statewide – access and workforce – we’re constantly using those two terms. And what comes first, lack of access, lack of workforce? And if we could magically build systems that create workforce, which then creates access so everybody can actually have available services. We’ve worked very closely with the governor’s Behavioral Health Commission, because my board chair, many of you probably know her, Brenda Fitzgerald, she’s part of the commission, and we’ve been supporting her with that. And we’ve heard testimony from all kinds of different providers, rural and urban, and some of the crises that we’re hearing from hospitals and clinicians are, “There’s nowhere to place teens, young adults, adults.” We’ve heard horror stories with some people. One rural hospital had a young adult, I think 23 or 24, stay there for 260 days while waiting to be placed, which is just horrifying. If you’re not in a bad state when you arrived at the hospital, after being in the ER for that long, you’re going to leave in a very bad state, even just after a few days. So I think I would wave and create access and workforce for everyone. That is definitely a magic wand.
Ray Kotwicki:
Dr. Craighead, your wand?
Ed Craighead:
You were asking about biggest pay-off, and what you do is the expansion of early identification and prevention programs, because you can reach so many more people who would have had the disorder, and we’ve had considerable experience with this in countries in Europe. And the people who come up to us after five, 10 years later and say, “I was headed in the wrong direction, and that really made a huge difference.” So I think if we had a way of identification. But the problem is you can’t just identify the people at risk, you then have to do something. And I think we have enough good prevention programs that are identified for those that are at risk for anxiety, depression. We don’t know as much about in terms of prevention with, say, psychosis or schizophrenia. There is a new prevention program with bipolar disorders, which is very exciting, it has not been available. So I just think if we could build programs around early identification, helping parents where they learn, they participate, that’s a critical part of it. And I believe that we would get further in terms of the overall picture of mental health.
Having said that, I want to be clear that there are people who are going to have to be treated, and we have good evidence-based treatments. And that lends itself to just what was said about the availability. You can go around the city. We have a really hard time finding private practice people even who are taking patients now. So I think that’s important and that will be there. But if we could do more in prevention, early identification and prevention.
Ray Kotwicki:
What would you do, Fred?
Fred Assaf:
Okay, ’cause I think that… I’ve been a little bold even about saying what I think is important. I do think the access is important. I think our biggest challenge, say at the school level, and again, I just run one school, I don’t have this broader view, it’s people. And it’s expertise around the triage. Somebody walks in, it’s more serious than the counselor can deal with it. “I need help, where do I get it?” That’s just not available. That’s the part where it’s like, “Well, you go to the ER and wait,” or how do you… That’s real and needed. I think we have a one-day-a-week consulting psychologist in our school. I think every school should have that. Because I think, I look around at public and private schools, we all have police officers and school nurses. There are lots of things we require, why don’t we have psychologists who are there? I think that’s needed more, frankly than…
[applause]
But we need psychological support at schools, not just Pace Academy, at all schools, because it’s just really important. And having experts who you can call is the most critical problem that I see.
Ray Kotwicki:
Well, Skyland Trail is humbled and delighted to be a resource in the Atlanta area. And I thank all of you, you’re truly life savers. And I know that you’ve impacted the great outcome of lots and lots of people, and we hope that we can partner with you to continue doing that. To anybody who’s in the audience who’s a clinician, thank you for your work. It’s a privilege to be on your team. And with that, please join me in thanking the panel.
Closing Remarks: Beth Finnerty
Well, I get to close this very special evening out. I want to thank Ed, Emily Anne, Fred and Ray for joining us in this discussion. Let’s give them another round of applause. Great job, guys.
[applause]
I know, I, for one, and I hope all of you are leaving here with a better understanding of some of the issues surrounding our young adult population, our teenage population, and some of the things we can do to be a part of that solution. So thank you, guys.
I also want to thank Dr. Houry again for her enlightening and inspiring talk. We appreciate all the CDC is doing on this important topic.
It’s been great to see so many old friends, board members, staff members, and some new friends as well. So thank you guys for all taking your evening to be with us tonight. This is the first time we’ve been back in person for two years, so this is great. We look forward to doing it again next year. Thank you everybody.