(bright music) - [Announcer] Funding for the Hinckley Report is made possible in part by the Cleona Peterson Eccles Endowment Fund.

- [Reporter] Tonight on the Hinckley Report.

As the country emerges from COVID-19, experts warn of a mental health crisis that could take the shape of a second pandemic wave.

Lawmakers respond by implementing programs, laws, and policies to address this critical issue.

And our experts examine the strength of the existing resources and what still needs to be done.

(upbeat music) - Good evening and welcome to the Hinckley Report.

I'm Jason Perry, Director of the Hinckley Institute of Politics.

Joining me tonight to discuss the relationship between mental health and the COVID-19 pandemic, we have Dr. Mark Rapaport, CEO of the Huntsman Mental Health Institute, Representative Steve Eliason, member of the Utah House of Representatives, and David Huntsman representing the Huntsman foundation.

Thank you so much for being with us this evening on an absolutely critical issue.

So glad for the three of you in particular because you represent really the three pillars of the spot response, not just from the state, but for the country, in terms of the response to how we take care and handle mental health issues in our state, in our country, representing the philanthropic side, the legislative policy side, and also the treatment side.

So I'm just so happy to get your expertise tonight and talk about where we're going as a state.

I wanna start with you, Dr. Rapaport, many are talking about there being a pandemic within the pandemic.

We have the second wave as we emerged from the COVID-19 issues that we have been having, and it's a mental health crisis we're seeing.

Talk about why that's the terminology that we're using and some sense of just how devastating this has been.

- Yeah.

Well, thank you very much for asking the question.

It really has been a true pandemic within the pandemic.

Over 40%, four in 10 individuals report that they're having symptoms of anxiety and depression.

We know now that there's been a massive increase in the number of individuals that are using alcohol and drugs, and there's been an increase in suicidal thoughts across the board.

If we look at children, if we look at adults, if we look at people of color, the impact of this pandemic in terms of mental health has been phenomenal, absolutely phenomenal.

And it affects different parts of our population in different ways.

So for many years, hospital personnel and physicians have sort of thought they a little bit immune to mental health problems, but what's become apparent with this pandemic is just how prevalent problems with depression, substance abuse, PTSD, and anxiety are for first responders and people involved in caring for people with COVID-19.

If we look at people in general the social isolation that we've seen, the lack of sense of agency, the lack of feeling a sense of control over one's life.

Being able to go out normally to the market or to a concert or to a restaurant has really adversely affected individuals.

And if we look at our children, developmentally different groups of children are going to have different series of challenges they face.

The young children although they've had a wonderful experience with parents haven't been able to socialize and gain the social skills that one would expect.

Our children who are in middle school and high school not only are lacking the interaction with their teachers that are so important for ensuring that they stay up to speed in education, but really critical social interactions that are necessary for people to individuate and appropriately learn social skills, have been sort of lost for a while.

So this pandemic within the pandemic is really one that's going to have long life consequences.

The only good news about it is that I think for once the importance of mental health is really coming to the forefront for everyone.

And people are realizing that all of us are vulnerable to anxiety, depression, PTSD, and substance use disorders.

- I wanna get to a couple of these key groups, but David what he's mentioning now is these things coming to the forefront because you are at the forefront of the response in this.

Talk about not just the investment that the family has made into this issue, but a little bit about what's happened in the business community itself, because everyone's talking about this now.

- Well, first of all, lemme say, and I can say this 'cause Mark's not here in the studio with us Dr. Rapaport.

How fortunate and lucky we are to have someone to have his name and reputation and expertise here in our community.

Throughout 2020, we conducted an exhaustive search looking for the most capable, the best, the most gifted leader when it came to mental health, and I just wanna say that Dr. Rapaport is, he's the best of the best.

And so Dr. Rapaport, we're grateful for you to be a part of our team, a member of our community here, and for all the good work that you're gonna do here.

And I think that COVID gives us an opportunity to talk about mental health, to talk about it openly, to have discussions that maybe wouldn't take place otherwise, and I think that's really important.

You know from my perspective, too many people suffer from the shame or the embarrassment or the pain of stigma and is because we don't talk about it enough.

And I think that COVID, and the effects that it's having, gives us an opportunity to have discussions exactly like we're having today, and I think that's a really good thing.

- In the business community itself are you seeing more and more of these business leaders like you and members of your family and others, you see them making investments in this, is this an understanding that we're finally getting in the corporate culture to an effort to reduce the stigma and to get right down to the core issue?

- Yeah, I think that we're recognizing that this is real, and this is serious, and something needs to be done about this.

And so I think there are conversations happening today not only in the business world, but with state lawmakers with religious leaders, with individuals, foundations.

I think everyone's recognizing that, you know, we have to come together on this, we have to talk about it, and we have to collectively join together to really addresses as a serious issue.

- Your Representative this is a critical shift we're seeing now too.

For too long, we didn't talk about this particular issue, and people suffered in silence because of that.

One of the things that both David and Dr Rapaport mentioned was the impact ranges, it's not just the youth.

Let's talk about that.

We have the youth, for example, men, women, minorities throughout our community, communities of color impacted significantly also.

Talk about the differences there in terms of the response that we were able to help with and their impact as well, 'cause this is not just the young people.

- Yeah, absolutely.

So, you know, there's a quote from the movie Apollo 13, "Houston, we have a problem."

And a lot of people are talking about, you know what the mental health health effects from the pandemic will be.

The reality is we had a problem before anybody had heard the words COVID-19.

In Utah suicide is the leading cause of death for young people, ages 10 to 24.

And we're, you know, ranked in the top 10 in terms of states with the highest rate of suicide year in a year out, even though it's slightly getting better.

It's interesting when you delve into the numbers we see that this adversely impacts men in terms of suicide deaths, much more than women.

Females will attempt suicide at about three times the rate of men, but men will die at about three times the rate of women.

And that was true coming into the pandemic, and we've seen that data actually stay consistent through the pandemic.

I think the important thing to understand is that every demographic to some degree, is at risk for a mental health issue.

And it's important for everybody to understand what are the signs of a potential mental illness or somebody who's contemplating suicide.

And when we become aware of those signs, how do we reach out with care and concern?

What are the right words to say?

And maybe what are some of the wrong things to say?

I think that's the most important message we can get out because suicide doesn't discriminate.

It takes the old, it takes the young, male, female, and we just all need to learn more so we can see those signs and everybody needs to play a role.

- Dr. Rapaport, will you address that for a moment, because it's just such great counsel.

You are our mental health expert not just in the state, but across the country as David mentioned.

For the families that are watching, tell us how we can get engaged, the things we should be looking for, how we help our loved ones.

- Certainly.

But before even dealing with that I wanna address something else.

And that's the fact that we're talking about brain diseases here.

This isn't a matter of a weakness, this is not a matter of a fault, it's not a matter that somebody has done something wrong.

What we're talking about are changes in brain circuits.

And the fact that we can remediate those changes we can fix them with psychotherapy.

We can fix them with medications.

We can fix them with somatic treatments.

And it's very, very important for people to realize that this is not, as David said, this is not something to be ashamed about.

This is not something that is your fault just like heart disease or cancer isn't anyone's fault.

You know, what we're talking about here are dysfunction of brain circuits.

So how would it manifest itself?

It sort of depends a little bit in terms of age but some of the things you see is all of a sudden people begin to act differently.

And in different age groups, one can act, it'll manifest itself a little differently, as I said.

But if somebody is more withdrawn, people are having problems with sleep, if people are suddenly feeling as if the world is closing in on them and they can't see a way out, or a future.

If people are finding themselves to be more irritable, or you're noticing that your loved one all of a sudden is more irritable and more anxious.

These are some of the cardinal signs you see with individuals who are developing a mental illness and who are at increased risk for suicide.

But particularly if someone manifest these types of things where they're more agitated or more irritable on a regular basis, or not being able to see a way out and not able to think about the future, these are the types of things that are warning signs.

And the best thing you can do is just ask, Hey what's going on?

How are you feeling?

How can I help you?

Those are some of the first questions to ask.

- Well, it's been interesting Representative Eliason 'cause if you go to some parts of the state 'cause I know you showed them to me, that we have billboards and it's, how do you address some of these key issues?

And the word is ask.

All right, talk about that.

- Yes.

So several years ago, the legislature funded funds to promote suicide prevention messaging.

And we created the Live on Utah Campaign, liveonutah.org.

And I've taken some pictures of these billboards, and actually I just received a response of one I'd put on a social media post.

And a father said, "I saw the billboard, I asked."

And it says, "How do you know if your child may be thinking about suicide?"

And it says, "Ask."

And he says, I asked my daughter and she says, "Dad quit doing what those billboards are telling you to do."

He said, but then we went on to have a nice conversation and luckily my daughter was doing well.

But Dr. Rapaport is exactly right, we just need to ask.

And, you know one way people can do that is say, you know, some people that have experienced what you've gone through or experienced a loss of a job or relationship breakup, you know, have considered suicide, have those thoughts ever crossed your mind?

And, you know, the good news is we don't have to be a psychiatrist like, you know, Dr. Rapaport to be able to, you know, delve in and start doing psychotherapy though that could, you know, have a role in the future.

We just listened to them.

And that's actually from a clinical perspective one of the best things we can do is just let them know that we're there and willing to, you know, connect them to resources if we deem that that's appropriate.

- Right.

- But, you know, I think what's really important to realize that we here in Utah benefit from having the best integrated crisis system that I know of in the country.

And Representative Eliason has a lot to do with that.

But we've put together a system here that if you ask and you have a loved one who's in distress we've got the SafeUT app.

We have access to the crisis lines, the ward lines, and for mobile assessment teams, both for adults and children.

We have a comprehensive system here like none other in the country and people need to be aware of it and take advantage of it.

- I wanna talk about some of these tools.

Go ahead, David.

- I like what Dr. Rapaport said when he talks about this just being brain health.

You know, sometimes when you look at mental health as being a second class, you know issue relative to our physical health.

And sometimes it gets treated differently by insurance or by the way we think or feel or talk about it.

When in reality it's a health issue and mental health and our physical health they're, I'm not a health expert but they're inseparably connected.

And we need to look at this as a health issue no different from any other health issue, and I like that emphasis.

- Lemme just say one thing here.

We've tried to change the dialogue for decades.

My whole life you'd say, "Oh, that person committed suicide."

Now we try to use the term they died by suicide, just like any other brain disease.

What if I said that somebody who had a stroke, well they committed a stroke or they committed a heart attack, that doesn't make sense.

But as we, you know, change this narrative that it is a brain disease, it can be treated, that was the cause of death.

Instead of, you know, a crime.

- A very interesting and much needed reframing of that.

Can we get to a couple of these resources 'cause David I wanna start with you, the resources that are available but particularly for the substantial investment in mental health that your family has made.

Talk about the Huntsman Mental Health Institute, what you're hoping to accomplish from that because this is going to, not just help this issue in our state, but across the country.

- Well, we hope so.

And our family Jason is extremely united together when it comes to making mental health a priority.

You know that and cancer, that's 1A and 1B, but those two will always be our preeminent focus.

And I think the reason is, is that, you know, mental health is our generational health challenge and it's also our generational health opportunity.

And our family is no different from any other large extended family.

Where we see, you know, too many people suffer in silence 'cause they're hesitant to speak out for whatever reason.

Too many people don't understand the effects that mental health has on the quality of their life.

You know, too many people get up and they just aren't able to feel joy or happiness.

You know, too many people don't know where to go or don't have access to resources to help them, and that's not okay.

You know, that's not good enough.

We have to do better.

And so our family, you know, wanted to step forward to begin to try to address some of these big complicated issues.

And these issues aren't gonna be addressed in the next year or two, these are longer term issues but you know, our commitment is a generational commitment and our gift, you know, $150 million as substantial as that is, I hope that's just an initial down payment because, you know, this is a big and a serious challenge, and we're really committed to wanting to make a difference for those people that are suffering.

- Dr. Rapaport, talk about this because it's such a state resource as well.

Some of the research that's being done by you and many of your colleagues right there to advance the cause here in Utah.

- Yeah, we're very fortunate in the state of Utah to have a really strong resources when it comes to research.

We have one of the best groups in the country and it's a multidisciplinary group that's not just in department of psychiatry here but actually spans the entire University of Utah and the Utah population database studying suicide and studying the biology of suicide.

Hilary Kunz in our group has recently published a paper where she's identified approximately a 100 different low signs that may be associated with increasing the risk of suicide in individuals.

We have individuals that are using the data from SafeUT and the crisis lines to begin to look at predisposing factors and the social determinants that might be influencing suicide for example.

We also have some of the best brain imaging individuals in the country doing work and not only in suicide but in developing evidence-based treatments that are based on being able to change brain circuitry, and demonstrating that we can refine our treatments so that we can actually demonstrate changes in brain circuitry associated with psychotherapy, associated with repetitive transcranial magnetic stimulation and a variety of other approaches.

But one of the critical things and one of the things that excited me about the Huntsman Mental Health Institute and the Huntsman family commitment to this is they understood as did the leadership in the University of Utah, that we needed to go beyond standard treatments and standard approaches.

And the intended the Huntsman Mental Health Institute is really serve as a nexus for researchers throughout the state of Utah and beyond to address these major priority areas, be it suicide or be it child mental health or rural mental health.

Our goal is to get the best minds, people who are experts in public policy, people that are experts in business, people that are experts in implementation science working closely with people that are experts in translational biology and developing new medicines, and new psychotherapies, and basic scientists looking at the interaction between the genes and life experience all working together, to look at why do we have such a huge prevalence of mental illness that really take shape between the ages of 10 and 24?

What's exciting is that that's what the Huntsman Mental Health Institute is about.

And that's what we're beginning to do here.

- The... Oh yeah, go ahead.

- We just outlined some of the great things that we have going on here at this state, but, you know we have a unique opportunity to do great things here.

And we want the Dr. Rapaport's of the world to wanna come here and be a part of, you know, what we're doing here.

We wanna become a magnet to attract the best and the brightest minds to come here.

And we think we have an opportunity to do that to become a center of excellence, to become, you know, we aspire to become a national standard.

What we're doing it right here in Utah, our goal isn't to move our suicide rates from 48 to 45th, you know.

We wanna become a global standard that everyone else looks at how we're doing and says, "We wanna follow their example."

And I think that, you know, we've taken some steps.

We have a lot of work yet to do, but we're confident that we have that type of an opportunity before us here, and we're really excited about it.

- So true, and I love the research side of this because it informs so much, but there's also certain things we can do even right now in our own homes.

I wanna get to that because Representative Eliason you're actually sponsored most of the legislation that we're gonna talk about here in your role as a State Representative.

Can we talk about some of those things?

Run us through a few of them, family should know about, things that should be on our refrigerator, on our refrigerator magnet or something like that.

Let's talk about some of these SafeUT, the CrisisLine, go through a couple of these items.

- Yeah, certainly.

So SafeUT is a free app that any student in Utah can download.

It's not only for K through 12 it's for higher education also and for parents that have children in school.

So that actually opens it up to most of the Utah population.

They can download that, and what they can do is they can chat through the secure texting a licensed clinical social worker, 24/7 365 days a year, anonymously and confidentially.

And it's had huge utilization.

And again, there's no cost and it can be completely anonymous.

So that's, I would advocate for any parent to sit down with their child ask them what they know about the resource help them download it and tell them if, you know, if you ever need someone to talk to and you're not comfortable maybe talking to mom or dad or teacher whoever you can use this resource.

The Utah CrisisLine 1-800-273-TALK is a critical resource that is answered at the Hudson Mental Health Institute.

There again, licensed clinical social workers that are there 24/7 365, taking those calls and they can connect the people with additional resources if they're not able to work with them through some of those immediate challenges right then.

Such as a mobile crisis outreach team, which is like a mental health ambulance, no sirens, no uniforms and... - So how does this work?

So as they can't come to your home, no one knows who's coming completely confidential and private.

How does that work?

- Yeah.

So I'll give you an example.

I had a neighbor who was experiencing a crisis situation.

We sat down together and called the CrisisLine.

The professional on the other end asked a series of questions.

We had a discussion, and then the crisis worker said "You know, I think you could benefit from a mobile crisis outreach team."

We can have them at your home in about 30 minutes.

We stayed with this individual until the mobile crisis team came, that's a licensed clinical social worker and a peer mentor, who's had a lived experience.

They'd been there, they know what this person is going through to a degree.

And when that team came, we left, and my neighbor had a fantastic experience.

And that person was able to be stabilized, got some strategies to deal with the immediate things they were facing and then some ideas about longer-term treatment.

And so no flashing lights, no bill, it's a free service.

And we now have mobile crisis teams basically statewide due to a recent legislation.

So this is the question sometimes I hear, particularly in the community you have a family member who is clearly having a mental health crisis of some sort.

And where do you turn, you give us a couple of resources but Dr. Rapaport in our last minute that we have here, just give us a sense of what we can do there because, where do you turn?

If you don't know, we have the app, we have the mobile crisis line, but give us from your expert opinion just where do we turn right away when we need that help immediately?

- Well, I think that the first thing you do is within the family itself.

It's really, really important for people to know that they're loved, that they're important, they're not a burden, and that although they may feel as if they're trapped, that they're not trapped.

There's hope, there's a future, there's a greater world available to them.

And then using the resources that Representative Eliason just talked about or just reaching out to many of the tremendous providers we have in the Utah community make perfect sense.

Also, it's important to realize that other types of peer support resources do exist.

There are groups that NAMI has, their groups that the American Federation for Suicide Prevention have, there many resources that are available.

- It's such a great point, and I think that's put the right frame on this.

And certainly the approach from the Huntsman Mental Health Institute.

Thank you so much for this conversation this evening.

It's critical that we have it.

It's critical we talk about it in our homes as well.

So thank you.

- Thank you, Jason.

- And thank you for watching the Hinckley Report.

This show is also available as a podcast on pbsutah.org/hinckleyreport or wherever you get your podcasts.

Thank you for being with us tonight, we'll see you next week.

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