(soft instrumental music) - [Announcer] Funding for PBS Utah Town Hall: Your Mental Health is made possible by viewers like you.

Thank you.

(upbeat instrumental music) - Thank you for joining us for this special presentation, PBS Utah Town Hall: Your Mental Health.

I'm your host, Raeann Christensen.

It's no surprise the COVID-19 pandemic has added stress to many of our lives.

Worries about our physical health are certainly spilling over to our mental wellbeing, leading many to feel overwhelmed.

It's a situation.

Some experts are even describing as a pandemic within the pandemic.

Tonight, I'm joined by a diverse panel of mental health professionals and community leaders.

We'll discuss these new concerns, the problems predating the pandemic, what we can all do to stay well, and even answer some of your questions.

On our panel tonight, we have Melissa Huntington.

She's the Executive Director of Four Corners Community Behavioral Health.

Dr. Mark Rapaport is CEO of the Huntsman Mental health Institute at the University of Utah.

Tekulve Jackson-Vann is a therapist with The Black Clinicians.

And Andres Brown is the Assistant Clinical Director with Encircle Therapy.

And Javier Alegre is Executive Director with Latino Behavioral Health Services.

Thank you so much for joining us for this important conversation.

I do want to start with some statistics about mental health here in Utah.

Earlier this year, between April and May, the Kaiser Family Foundation found 30.1% of Utah adults experienced symptoms of anxiety or depression.

That's similar to the nationwide rate of 30.7% during the same period.

Now let's compare those numbers to 2019, before COVID-19, when only 11% of adults reported feeling anxious or depressed.

Now, on paper that seems like a big increase.

Dr. Rapaport, from what you've seen, is there more to these numbers, or is the situation really this bad?

- The situation's actually a lot worse.

It's much, much worse.

If you look at the CDC data, four in 10 Americans are suffering from anxiety and depression right now.

If we look at the number of people that are dying of overdoses and who are abusing alcohol and drugs, the numbers again are staggering, compared to what they've been in the past.

And if you think about what's going on right now with so many individuals, with isolation, with the helplessness that people feel, we really are in the midst of a second pandemic.

- Okay.

And that same analysis by the Kaiser Family Foundation found nearly a third of adults who needed counseling or therapy didn't receive it.

We also know Utah has a shortage of mental health professionals.

How has the pandemic impacted the shortage?

Do you wanna go ahead and address that?

- Well, all it's done is exacerbate the shortage, but I think the other thing that's done, which is really positive, is it's brought to light, one, that mental health problems are truly important, and, two, that we in Utah need to change what we're doing in terms of enhancing our mental health workforce.

And there are a number of initiatives that have been launched recently to increase our workforce over the next couple of decades.

- Tekulve, you've been seeing patients throughout the pandemic.

In your opinion, did the pandemic prevent people from accessing mental healthcare, or is the stress of the pandemic simply pushing more people towards depression and anxiety?

- I think the pandemic actually opened up people's understanding that they needed mental health care.

And then when we made that shift towards telehealth, I think it actually made it more accessible to people.

From what I experienced as a mental health provider, I actually saw more patients reach out to set appointments, more people willing to acknowledge that they were struggling with their mental health and to seek treatment for that.

- So telehealth is helping?

- [Tekulve] Telehealth is helping.

- Okay.

Doreen Maxfield from South Jordan actually emailed us a question about this.

She asks, "Because of all the mental health concerns, including COVID-19, what are the most common diagnoses being seen and treated by therapists?

And does this include all age groups?"

Dr. Rapaport, can you address that?

- Sure.

We're seeing a lot of anxiety disorders, a lot of depression, but a host of individuals are suffering from grief and complicated grief and post-traumatic stress disorders.

And then, as we talked about earlier, the amount of individuals using alcohol and substances has just skyrocketed.

- Melissa, in rural areas, what have your clinicians been seeing?

- The same.

We've been seeing a lot of isolation and a lot of anxiety around the unknown.

This pandemic is something that none of us anticipated and none of us were ready for.

And so I think people didn't know how to respond, and they didn't know how to reach out for services during the pandemic, similarly to what they would have done before.

So a lot of anxiety, a lot of depression, and a lot of grief and loss.

- Javier, have the clinicians you work with seen more people needing support from their mental wellbeing since the pandemic began?

- Most definitely.

I think the need is across the board.

And I think, like Dr. Rapaport said, it's been exacerbated by the pandemic.

And we have also seen many, many other individuals reach out for support, which has not only brought to the forefront, but highlighted, the lack of providers, the lack of services available, and, for those BIPOC communities, like the Latinx community, the lack of culturally relevant services for those that need it.

- Okay, and we just got this question in from Phillip Brown from Logan.

He says, "It still feels strange to take any time off of work for mental health concerns, as if sick leave were only for physical illness.

How can we shift workplace culture to be more supportive of our efforts to care for your own mental and emotional wellness?"

Andres, you want to address that?

- Most definitely.

Yeah, I think that each time that we recognize our need to take care of ourselves, that that actually is making systemic change, that each of us have an opportunity to advocate for what we need.

'Cause I think a lot of the times why we don't take the time off is because of our own guilt, right?

We're in this society that tells us that our worth is tied to our productivity.

And so I think, by being able to interact with that and show compassion for ourselves, that of course we're gonna need extra breaks.

We're living in a global pandemic.

The social uprising.

So it totally makes sense as human beings that we would need just a little bit more time.

- Dr. Rapaport, calling in for a mental health day versus a sick day, you're in support of that?

- No.

And I'll tell you why.

Because of the same thing.

The mind and the body are connected.

That's why God made the neck.

You know?

We're talking about changes that occur in brain circuitry.

We're talking about physiological changes that are occurring in the body.

There is no difference between calling in for a sick day and a mental health day.

What you're doing is taking care of the most complex organ system in the body.

- [Raeann] Tekulve, how do you feel about that?

- I agree.

My mental health is as important as my physical health.

I was talking to Dr. Rapaport earlier.

I've actually taken more mental health days this year, because I recognize that, if I'm not well mentally, I am of no use to my patients or to my family and ultimately to myself.

And so I think it's helpful to have those days.

And I've been encouraged in my job to take mental health days so that I can stay healthy.

- That's great.

This gets us to the next point I want to talk about: the difference between mental health and mental illness.

The World Health Organization defines mental health as a state of wellbeing in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to her or his community.

So it seems like, when we discuss mental health, much of the focus has often been on mental illness because of those situations when people are already in crisis or they need immediate help.

Andres, what can people do to enrich their own mental health before the problems get out of control?

- Yeah, I think that's a great question.

I think the short answer would be to attune ourselves to ourselves, to recognize our own nervous systems, our own bodies, to become really familiar with our wellbeing to recognize when our wellbeing starts shifting.

I think sometimes we wait until it's to crisis level before we start saying, "Oh, maybe I need something."

And so maybe, yeah, becoming familiar with our own cues and our own signs I think could be a really helpful thing to start.

- [Raeann] Taking those mental health days when you need them.

- Totally.

- Melissa, as a therapist, what would you want people to pay attention to if they do feel their mental wellbeing slipping, and at what point should people reach out for help?

- I think at all points.

I think, just like has been discussed, people should not wait until they get to the point where they're in a mental health crisis.

And I think there's kind of a misconception that, if I'm not ill enough or if I'm not at a certain state, then I shouldn't reach out or utilize the benefits that are my right.

And I think mental health is everywhere from early intervention to prevention, clear to chronic illness and everything in between, and I think people should reach out at any point that they're feeling different than they felt before and it's distressing, or they're feeling debilitated in some way.

- Do you think that everyone could benefit from counseling, no matter what level they're on?

- Absolutely.

Absolutely.

Our own counselors, we encourage them to seek out counseling and receive that support, so I think it's useful for everyone, and it's useful for every need.

- If I may make a comment.

- Absolutely.

- To add to your answer is that there are also alternative ways to seek support and help.

Counseling therapy, which is a clinical approach to mental wellness.

I would also encourage people to find community-based supportive services that include certified peer support services or support groups or community organized activities, where they can not only get out of their home or get out of their environment a little bit to do something different.

And also, find a support that they need with someone that has the same lived experience and they can learn from one another and support one...

Create community.

- This is a really good question, Dr. Rapaport.

When someone develops a mental illness, explain to us what is actually happening in their brain.

We always hear that it's a chemical imbalance, or are there other factors that are in that as well?

- Sure.

What we know is that most mental disorders are disruptions of brain circuitry.

So what happens, for example, when we have anxiety disorders frequently, the front parts of your brain are not communicating to the amygdala the way they should, and it's not inhibiting the fight or flight responses of the amygdala.

We know that, in certain forms of mood disorders, we're seeing imbalances in different regions of the brain of neurotransmitters like glutamate and like dopamine.

We also know that there are actual dissociations in terms of the electrical connectivity between different portions of the brain with different types of mental illnesses.

So these really are physical illnesses of brain function.

We're fortunate we can use therapies, medications, many alternative approaches to try and rectify them.

- So antidepressants can help, even if you don't have a chemical imbalance?

- Well, you do have an imbalance of circuitry, and you have an imbalance of those neurotransmitters.

And yes, antidepressants help a lot for certain individuals, as do focused psychotherapies and other treatments.

- Javier, what signs should we all watch for in our family and friends?

- Yeah, that's a great question.

I think most of us get really... First, there are so many stereotypes and stigmas connected to mental health and mental wellness.

We don't want to talk about it.

We don't want to mention it.

However, I think we're looking for those big signs, like you were saying, I think we're looking people... Or we wait until we get to the crisis point, which sometimes require an acute intervention.

However, the most regular sign is our daily lives.

If we're in tune with who we are and our own personalities, when we start to get irritated, when we get impatient, when we lose sight of where we were going or what we were doing, those are simple things that we can begin to recognize, wait a minute, that's normally the way I would react.

So pay attention to your own body, to your own responses to the world around you.

If we really do pay attention, we'll start to see certain discrepancies in the... Whoa, where did that come from?

And those are early enough that you can... give yourself permission to seek support and ask questions from someone that can help you or say, "Oh, no, that's normal," or they can say, "Maybe you can seek additional support."

- Mental health also became a big talking point during the most recent Olympic Games in Tokyo, when gymnast Simone Biles withdrew from some of her events, citing her own mental health concerns.

During an Olympic news conference, Biles told reporters, "To bring the topic of mental health, I think it should be talked about a lot more, especially with athletes, because we're always told to push through it.

But at the end of day, we're not entertainment, we're humans, and there's things going on behind the scenes that we're also trying to juggle as well."

Biles joins a growing list of professional athletes to open up about their mental health, including Japanese tennis player Naomi Osaka, and NBA players DeMar DeRozen and Kevin Love.

Tekulve, how important is it to have people who are in the public spotlight openly talk about their mental health struggles?

- I think it's vitally important, because we have to shift the cultural narrative where mental health isn't something that we're ashamed of or that we only speak of behind closed doors.

When we see that people that we admire, people who we see as strong still struggle with mental health issues, and it doesn't make them any less strong, then some of us common people can go, "Well, if they struggle, it's okay if I struggle," and then we can have a conversation about that.

- Andres, how did you feel about Simone Biles opening up to the world?

- Yeah.

I think when you talk about like common people, I think there's something really beautiful about our shared humanity.

And so I feel like, when we see representation of people really advocating for themselves, we're able to advocate for ourselves as well.

- Okay.

Dr. Rapaport?

How did you feel about Simone Biles and all the athletes coming forward?

- I was really grateful, because, you know, all of us suffer from mental disorders.

And if we can begin to break down that prejudice, if we can begin to break down that stigma, then what we can do is enhance the access of people to care, and we can keep people from hurting themselves.

- Normalize it.

- Yeah.

- Okay.

This isn't just a problem with adults; it's also a problem with young people as well.

A report from the Kem C. Gardner Policy Institute shows 60% of Utah youth with depression did not receive mental health treatment.

Stigma is reported as the primary barrier to treatment.

Now, you were just talking about that stigma.

How do we go about even breaking the stigma?

- Well, there are a variety of things we have to do.

One is all of us need to be open about the fact that it's normal to have diseases of the brain.

Other things that we're doing is, in all candor, we're about to launch a multi-year campaign where we're going to bring together groups from around the country to work on this.

And we envision it'll take 10 to 20 years to do.

But the Huntsman mental Health Institute is committed to doing this.

And so we're really going to make this a national priority.

- Andres, when talking to young people, what language should be used to minimize that negative perception?

- Yeah, I think that there's a tricky balance between taking some academic speak and more clinical terms and bringing it into something that people can kind of recognize.

And so I often talk about with young humans kind of paying attention to heart rate and that there's a certain resting heart rate.

And then, when it increases, that that's maybe a sign that something's going, that danger, right?

So maybe maybe less about language and more about bringing it into kind of tangibles that young humans can really focus on and know and recognize in themselves.

- Javier, stereotypes and stigma are especially prevalent with Latinx youth.

What outreach efforts are happening to help them?

- We are constantly looking for new opportunities and approaches to speak.

So, at Latino Behavioral Health, we started a program which is implemented in middle schools and high schools, where we bring peer support, as we were discussing earlier, which is individuals with lived experience that have struggle either through high school with their mental health or their emotional disconnection to their own... Adolescence, it's a difficult time to begin with, right?

So the approaches that we are utilizing is coming down with conversations that are not necessarily academic or scientific but more tangible.

So I really love what you just said, because it's exactly what we have been doing, and it's working.

In addition to that, there are other efforts across the state, like the Live On campaign and other spaces where integration of culturally relevant messages are being incorporated.

- We posted about the mental health of young people on the PBS Utah Facebook page, and here's why some of you had to say.

Duane Quistberg comments, "Having mental health issues is looked down upon.

If someone tells you they are sick with pneumonia, you feel bad for them and ask if you can do something for them.

If a person has a nervous breakdown they are just weak and need to get over it."

Roger Marcotte had a different take, saying, "I have lived in nine different states.

Utah by far has the best services when it comes to mental health issues.

They helped my son."

Much different perspectives there.

Melissa, do you want to address how we can break that barrier?

- Yeah, I think open communication.

And honestly, my perspective is it starts in the home.

I think we really have to make it okay for adults to talk to their children about these tough issues that may be uncomfortable for them to talk about, like depression and suicide.

And I think we really need to educate parents on warning signs and what's the difference between troubling adolescence, normal grumpiness in adolescents, and, and what is potentially a really life-threatening mental health disorder that needs to be addressed.

- Dr. Rapaport, what role should schools and educators play in identifying mental illness and helping kids find resources?

She touched a little bit about parents.

- Well, one of the things I've...

I'm new to Utah, but one of the things I've been really glad about is how open the schools are to mental health needs of children here.

The implementation of SafeUT throughout K-12 and the public universities.

It's a real accomplishment.

And we're partnering now with a variety of school districts to enhance the counseling programs going on there, and we've really gotten a good response to that.

So I think there's a huge role for schools.

One of my colleagues has developed an entire program that has kept kids who are at risk from actually getting depressed.

- That's great.

- Yeah.

- Tekulve, you have a lot of experience working with families and children.

How should parents talk to their kids about mental health, and is there an age when those conversations should start?

- Well, I was fortunate.

About 38 years ago this week, my uncle completed suicide, and so the conversations about mental health were very present in our home, and it wasn't talked about any differently than our physical health.

So we had a language to talk about a tummy ache.

We knew how to explain to our parents the symptoms of a common cold.

And so we grew up learning how to also talk to them about when we're feeling sad or feeling the blues.

And so I think that we should start very early having that conversation with our kids.

They know how to tell us that they're not feeling well physically, and we need to also empower them with that same language to talk about when they're not feeling well mentally.

And when we do that, then they grow up to, one, not feel stigmatized by it, but also to feel like they can come to us and say, "This is what's going on with me," and then to ask for help.

- Mental health issues are an issue with many young people.

They are even more pronounced among young people in the LGBTQIA+ community.

A national survey from the Trevor Project found 72% of LGBTQIA+ youth experienced anxiety, and 62% reported experiencing depression.

Andres, you primarily work with this community through Encircle therapy.

In a conservative state like Utah, are these young people impacted even more than they are with their peers across the country?

- Yeah, I would say most definitely.

I think when we grow up in an environment where we're told that we're wrong, bad, shameful, abhorrent, sinful, that there are pieces of ourselves that we need to hide or repress, those messages kind of land in us, and so of course, we're gonna feel anxious, of course we're going to have heightened awareness and hypervigilance.

I often will talk with some of my young humans about even the way we sit is monitored as a potential outing of this piece of ourself that we're told doesn't belong.

So I would say definitely in this environment there's increased risk.

- We've talked a little bit about the family role.

What role would you say Utah's family culture plays in the dynamic facing young LGBTQIA people?

- Yeah, yeah, I think a huge role, right?

What we see is that parent support is huge, in combating a lot of the problematic... experiences that people have.

And so I think if we can integrate LGBTQIA+ identities and conversations and open sexuality and gender expression into our family environments, then a lot of, I think, the risk factors would be decreased here.

So I think the family plays a huge role in it.

- Speaking to that, what resources are available to LGBTQIA+ youth who actually don't have support at home?

- Yeah, yeah, I think that the pandemic has certainly made it even more difficult, 'cause I think one of the most important thing is community and belonging.

That's what we're told we don't have.

If we come out, we'd lose our sense of community, our sense of identity, our sense of family.

And so, yeah, I think resources are really important.

I know that Encircle does really good outreach and resources.

We have kind of a home model where a lot of youth who don't feel like they belong at home are able to come in, eat cookies, do art night, games, form community, we have friendship circles.

But I think also a lot of the pride centers in the different locations have also really good resources, and so, regardless of where we are, I'm always amazed by all of the pride centers out there and the resources that they have.

- One last question for you.

What challenges do LGBTQIA+ adults face, even long after coming out and living openly, and how can their peers be supportive?

- Yeah.

I think that the trauma of growing up in the closet doesn't go away suddenly when we are more vibrant with our identities.

And so I think often what we see is that a lot of these developed strategies to hide parts of ourselves continue in other areas where maybe we wouldn't expect it.

And so I think one important thing for peers to recognize is that we're constantly healing, and to be our authentic self is actually an incredibly brave, courageous act, and it's something that we have to remind ourselves to do on an ongoing basis.

And so if there's any way that we can make the world more kind, more accepting, more opening, if we can reduce some of the stigma, then that will help us across the lifespan live more vibrant lives.

- That survey from the Trevor Project also found an alarming 42% of LGBTQIA+ youth had considered suicide in the past year, and that number went up even more among youth of different races, especially native and indigenous young people.

Tekulve, what pressures are facing the LGBTQIA+ youth of other races that aren't as big of a problem for their white counterparts?

- I think in a lot of our cultures, non-white cultures, there is this thread of homophobia that is very closely related to the fact that most of our cultures have a very strong spiritual element to it.

And so, when you are raised in an environment where you're taught to want to please God or whoever, and then you're told that this part of you makes you not like him, makes you foreign to him or whatever, and then there's not... there's not a language there to talk about those type of things.

And then I think, as parents, we're already concerned about the safety of our children, just as brown kids.

And then when you add another layer to it, it adds another layer of danger to their lives.

And so I think there's this tendency to want to keep our kids safe by not wanting to open them up to more microscopes, more hatred, more whatever.

And so I think, for those kids, it's not just I need to balance being brown in white spaces, also need to balance being queer in straight places.

And some of their white counterparts I don't think have to juggle that as much.

- A lots of think about.

Javier, do you want to weigh in on that?

- I do a little bit.

I was thinking about exactly what you were saying, and I think just the only thing I could add is that there are so many other intersections that we have to face, right?

We're not just... We face a lot of discrimination, racism, you name it.

In addition to that you add other layers, like being queer or being in poverty or living in a part of town that is recognized as not a good part.

So it just adds up and I don't think is often recognized.

- Andres, you had something to say?

- Yeah, yeah, yeah.

I think language is such an important piece to identity, and so if we have labels that fit for us, then that's a really important piece of the identity development process.

But so much of our labels and our language used is white western European English, and so that's an added layer of complexity in trying to figure out, how do I describe myself to myself in words and language that fit, and then how do I communicate that to people who may not understand the nuances of adding an X to something to be more inclusive?

And so I think that's also an added layer.

Identity development feels really hard 'cause we don't have language to describe it.

- Okay.

Utah is in the middle of an unprecedented outreach effort to help people from different ethnic backgrounds who are struggling with their mental health.

In Utah the rate of major depression among the Latinx community is twice that of the statewide average, and Latinx people are three times more likely to die by suicide than their white counterparts.

That's a staggering statistic.

But Javier, can you tell us about the Live On campaign and how it could make a difference in the Latinx community?

- Oftentimes, as my panelists... counterparts here have mentioned, the language, the efforts, the approaches, even the clinical approaches are very Euro-centric or white-centric, which doesn't leave a lot of space for non-traditional, in that sense, approaches to wellness.

I think that the Latinx communities have expand... Latino Behavioral Health Services, it's busy.

We have increased need and increased gaps across the board.

But I believe that the Live On campaign is one of the few spaces that has opened up a little bit of a crack in the door, and it has the invited us to be a part.

So we, as an agency and as a Latinx community, have been able to collaborate with... We have been able to tailor some of the messaging.

Some of the actual advertising campaigns have been developed by the community, for the community, which is a new approach to this type of things, which I think brings the part of creating community and connectedness.

That brings a little bit more of a relatability to the message that's being delivered, which is unprecedented, particularly for Utah.

I'm not very familiar with the country, but in Utah it's probably one of the first times that the community, especially the Latinx community, has been included or offered a seat at the table.

- That's great news.

Latinx people often have to deal with language barriers when seeking mental health care, but there are also cultural barriers.

Javier, can you explain some of those and how they impact people?

- Absolutely.

And this is something that, when I saw this question, I'm like, "Wow, where do I go with this?"

So to summarize it, I think oftentimes we see agencies, providers, or large institutions say, "Oh, we have someone who speaks Spanish, so we got it covered.

Check."

Right?

And the reality is that the outcomes of services in agencies where culture is not considered an important part of the deliverables is very low.

So culture indicates all of those nuances you were referring to that each culture have, like the Latinx community.

We don't necessarily just speak a language.

We have historical trauma.

We have traditions.

We have... rituals that we are familiar with that are not necessarily considered or are considered untraditional, untested, or even not evidence-based or good enough to be a part of a treatment plan or program.

- Representation is a big problem in mental healthcare.

While black people make up 13% of the U.S. population, only 4% of psychologists in the country are black.

Tekulve, how does that translate to the care that people of color may receive?

- I think it brings to light one of the issues that we have in mental healthcare.

Psychology is this own field within behavioral health, much like psychiatry is this own field in medical health.

And so most of us understand that a lot of the mental health services are not provided by psychologists.

Some of them are great therapists, but most of them are trained to do something much different than your everyday mental health services.

Most of the mental health services are provided by marriage and family therapists, clinical social workers, community mental health workers.

And when you look in those fields, I think we are much more represented than that.

But I think there is kind of a lack of knowledge from the general population about, who do I look to for mental health services?

And that is not to say that you can't seek mental health services from a psychologist, but there are those of us in other fields where our training is more hands-on or direct towards the mental health treatment, where psychologists provide a great service for us in terms of testing and things like that, so that we know what we're dealing with.

And so I think, when you look at that, there are many more of us than the 4%.

Even still, it's a very small percent.

I think in my cohort in graduate school, maybe there were four black people.

I've been practicing for 15 years.

I don't know that I've had more than maybe two other colleagues who were black who were also therapists.

And I can see the look of relief on my patients' face when they walk into my office, and it's like... (sigh of relief) "He looks like me, so now I don't have to play cultural ambassador and explain generations of trauma."

Or, "Yes, I want to talk about my mental health, but if you really want me to get it, you gotta talk about Jesus too."

And so, for some people, we're taught, we don't go there in mental health treatment, but you get yourself a black therapist, we're gonna talk about therapy, and we're gonna talk about Jesus, and we're gonna make it all connect, you know?

And so I think now that there are more people, there are associations of black social workers, associations of black psychologists and therapists.

And so, as we're more visible, more people are feeling comfortable seeking services from someone who looks like them.

- In addition to the COVID-19 pandemic, this past year we've seen a social reckoning of sorts when it comes to police violence against people of color.

Tekulve, how do you think that narrative and seeing images of police violence on social media and in the news has affected people of color?

(laughing) - Let me adjust myself.

(laughing) Here's the thing.

This isn't new for us.

These are not new images.

These are not new stories.

What happened was the pandemic slowed everyone else down.

And so, whereas most other people had the privilege of not having to look at what was going on, now you're stuck in your homes in front of the TV, and now you had to see.

We've been dealing with this since Reconstruction, so this isn't new for us.

And now that you all are seeing it and go... (gasps) "This is horrible!"

We've been saying this is horrible.

This was horrible.

Rodney King.

This was horrible in the '60s.

This was horrible in the '50s.

My great grandmother was lynched by the KKK.

This is not new for us.

But since you guys are seeing it too, can we have a conversation about it?

Can we now talk about how we haven't felt safe for years?

That we have an exit plan when we get in the car.

We make sure that our license and our registration and everything is within reach so that, if we get pulled over, we don't have to make any certain moves.

Now you understand why we have this generational trauma and anxiety, because we send our sons out to the store, and we're just hoping that they come home, you know?

And for a lot of people, they haven't had to think about that.

And all of a sudden, now it's... people trying to walk into their own homes and they get shot?

People are asleep in their own beds and they get shot?

You mean people don't survive routine traffic stops?

That's a thing?

Yeah, that's a thing that we've been dealing with, and we've been saying that we've been dealing with it.

But by and large, I think we've been gaslighted by the rest of the world with slogans like "blue lives matter" and these types of things, and we're not saying blue lives don't matter, but some blue lives are also black.

And when they're not in uniform, they're praying they get home too.

And so we can finally have this conversation now that people are ready to see what we've been seeing for generations.

- Thank you so much for opening up about that.

I know that's a conversation that we're all having now, so I appreciate that.

Utah is a large state geographically.

And while the majority of the population lives along the Wasatch Front, some of the most vulnerable people live in rural areas.

The shortage of mental health care workers is even more significant in the rural parts of the state.

In these areas, the state has local mental health authorities, or LMHAs, overseeing state-funded mental health services.

So Melissa, we're coming to you.

What is the process like for receiving treatment at an LMHA in Utah?

- I think it's like receiving treatment anywhere else.

The differences is, at a local mental health authority, we sort of specialize in everything, and so we have to be prepared for whoever comes through the door.

We're community mental health.

We're the safety net for our communities, and so we are trained in an extensive amount of modalities, and we just have to be prepared for whoever comes in that needs treatment.

- What challenges do you think are unique to people in rural Utah?

- Lack of resources.

I think that stigma is a huge challenge in rural areas.

I think the geographic expanse.

Public transportation has always been one of my soap box items, because people can't get from here to there to treatment, and it's just a really big barrier.

- So, speaking of the stigmas, is there more of a stigma against getting help in rural areas than there are in urban?

- I don't know if there's more, but there's different challenges to being in a rural area, such as, if you live in the Wasatch Front, you live in Salt Lake County or work in Salt Lake County, you can go to Provo or another area of the Wasatch Front to receive treatment, and the chances of you running into someone that you know or work with or go to church with is not as high as if you work in a small rural area and you live there and you're receiving treatment, you're likely to have some conflicts with people that may be your provider and also people that will see you coming in for treatment.

- Javier, what are some ways providers in rural Utah can make sure they are providing adequate services to minority populations in their communities?

- I think I will take this back to the conversation about language specific versus cultural services.

I think the integration of cultural services...

I also want to mention integration versus assimilation.

We can talk about colonization, et cetera, et cetera, but that's for another day.

(laughing) But I think what's important to remind ourselves is...

I do want to mention that the Division of Substance Abuse and Mental Health just conducted a statewide needs assessment, I'm sure you participated in it, that kinda look to identify what those barriers or challenges were.

So, I would say that, out of that rapport, which I think I shared the link with you guys, if you don't mind posting it for people to read their report.

Some of the challenges were...

Some of the things that could be done better are taking a more proactive approach to cultural integration, meaning is your space welcoming to minority groups?

Is your website welcoming to minority groups?

When I walk into this space, do I feel I'm represented in that space?

Those types of things.

However, on the other side of that coin is the lack of providers, the shortage of providers, and that I welcome.

And I was actually talking to Melissa about this, is that there are non-traditional approaches to mental health and wellness, like the peer model, right?

If you can't have a team of licensed professionals to serve your community, there are other spaces where communities, especially small communities, can feel more comfortable in a more community-based gathering space that is not necessarily a mental health service provider, which some people take a problem with that.

- Okay, so, just two weeks ago, the country recognized National Suicide Prevention Week.

Here are some tragic statistics specific to Utah.

In Utah suicide is the leading cause of death for people between 10 and 24 years old, the second leading cause of death for Utahns 25 to 44, and the eighth leading cause of death overall.

In fact, only five states have higher rates of suicide than Utah.

Dr. Rapaport, what does the existing research tell us about this trend?

Is there a quantifiable reason why Utah and its surrounding states have higher rates of suicide than the national average?

- There may be many factors involved in there, some of which we've already talked about.

We've talked about some of the challenges that exist in a very conservative culture and a culture that, until recently, really has had difficulty accepting sadness, depression, or folks of other origins in it.

So there are cultural factors that are involved in this.

But there also may be a variety of other interesting factors, including altitude.

There's also data suggesting that there's increased depression and potentially increased suicide in areas with higher altitude.

And some very interesting work being done by Perry Renshaw in that area right now.

- [Raeann] That's interesting.

The environmental factors.

- Oh yeah.

And there's growing evidence in certain other areas about pollution and the role that pollution may play in all of this.

So there are a variety of different factors that may be involved.

And there may also well be genetic factors.

A recent study out of our group showed that there were over 100 different types of genes that, in different combinations, might predispose people to an increased risk of suicide.

- That wildfire smoke this summer I'm sure has not been been helpful, when we say environmental factors.

We posted about Utah's high suicide rates on the PBS Utah Facebook page, and here's what some of you had to say.

Melissa Leatherwood says, in part, "The good news is that we've seen a slight decline in suicide in Utah in recent years so something we are doing is working.

We did not see an increase during last year.

That is good news.

Even one suicide is too many.

We have to keep doing what we are doing, and that's talking about it.

Making sure everyone has someone to talk to and a safe space to go."

Tekulve, from a clinical perspective, why is it important for people to be willing to talk about suicide?

- 'Cause not talking about it doesn't make it go away.

I think as we...

I am a very language-based therapist, so that's why I've been beating to the language horse.

As we give language to it, and as we talk about, it becomes less scary.

And if we can understand it, then we won't fear it.

And if we can talk about why people may choose that route and the factors that might lead up to it, I think then we increase our understanding of it.

We can understand maybe how we can prevent it.

I think we have to have conversations like Robin Williams, like on the outside, everything looked great, but on the inside, obviously everything was not great.

And so, having those conversations and also talking about that sometimes, it's not that people gave up, it's not that people were weak.

It's just there wasn't another option that they could identify in that moment.

So I think we also have to change how we talk about people who do complete suicide so that it's not they did something wrong.

I think there's been a movement in our field in recent years to not use the term "committed suicide".

And so, not giving it that type of connotation as well.

So I think we've just got to open up.

It is what it is.

It is here.

By ignoring it, we're not gonna make it disappear, so let's just have the conversation.

- Melissa, what should people do when they are experiencing thoughts of suicide?

- Well, the good news is suicide is a 100% preventable.

And I think there's a misconception that a lot of times suicide is a one-time impulsive act or something.

But the reality is that there's a lot of small things that build up over time, and there's a lot of indicators that someone might be struggling.

And so I think one thing would be identifying changes in your loved one.

I think one of the things that people who are experiencing suicidal thoughts can do is reach out to others and utilize the crisis lines that are in place and utilize the crisis teams that are in place to serve you.

We have a lot of MCOT teams now around the state of Utah, where they can actually come to your home and help you through that mental health crisis if need be.

I think there's another thing that we often don't talk about with suicide, though, is there's an unspoken population of people who die by suicide, and those are people who don't reach out and those who don't feel comfortable reaching out and have complicated circumstances around their suicidal ideation, like chronic pain.

And we have to be discussing it, yes, in our homes.

I think we need to be talking to our families during periods of time when they're not struggling and say, "When you do struggle, what are some things that you can do?

If you don't feel comfortable reaching out, what else can you do?

There's a lot of research that's been done that indicates that the feelings are temporary and just moments, usually, for people, where they feel like they can move towards the completion of suicide.

And so if you can intervene during those, if you can interrupt those thoughts, it has a big impact with saving someone's life and helping someone to move past those.

So things like, what can you do?

Go outside and pet my dog and remember that my dog needs me, and I can't leave them right now.

Just moving past that temporary feeling of this is hopeless and helpless and there's no point, there's no hope.

- I do want to get to some of the solutions.

Here in Utah we have several hotlines and outreach programs.

Dr. Rapaport, can you talk about some of those?

- Sure.

We're fortunate in Utah, actually, that we have the best integrated crisis service in the country.

We really do.

I mentioned the app SafeUT earlier.

SafeUT is an app for anyone who's feeling overwhelmed, anyone who's suicidal.

And we have it in K-12 and all of the universities.

We also have a crisis line.

And by the way, with SafeUT, we average one save life a day here in Utah.

- Wow.

- One saved life a day.

And we have also prevented school bombings and shootings through the app.

And so young people are using it, where now you have the National Guard has it.

We are rolling it out to frontline workers during COVID.

Our crisis line gets over 11,000 calls a month.

And professionals answering each of those calls and helping those people and coordinates with our MCOT teams throughout the state, as well as our warm line, where anyone can call and get help.

So we actually have a tremendous resource here, and I would encourage anyone to take advantage of it.

- And we do have that suicide prevention number, 988, that's expected to be up and running July of 2022.

So I think that will be super, super helpful.

- [Dr. Rapaport] It will be.

- Javier, I was coming to you.

(laughing) Your organization is really pushing for systemic changes to remove barriers.

With all the good that is happening here in Utah, what still needs to happen so even more people can get the help that they need?

- I'm gonna take a cue from here.

Let me adjust myself.

(laughing) But I want to first piggyback on your comment, is that there are so many resources for individuals to reach our, like the ones that Dr. Rapaport just mentioned.

However, there has been a lack of services that are culturally relevant for minorities, especially BIPOC communities.

And we saw an increase on that need at the beginning of the pandemic, and we were fortunate enough to receive some funding from the Division of Substance Abuse and Mental Health.

And Latino Behavioral Health, actually, we have created a crisis line that is run by Latinos, for Latinos, by the community, for the community, with certified peer support specialists and some clinicians.

So there are resources our there.

And then I would love to collaborate and see how we can expand that type of services across the state and in all of those other spaces.

To answer your question, I feel like there's an opportunity for tremendous growth and tremendous work here.

I mentioned early the Division of Substance Abuse and Mental health and the Department of Health are colliding, so to speak, are merging.

And with that comes opportunity.

The division completed this needs assessment that brought so many things to light.

And then the Division of Mental Health is actually working on the implementation of some of those recommendations that came out of that needs assessment, which is fantastic.

We've never seen this before.

We're very happy, very excited.

Shout out to Doug Thomas, Kim Mayors, Brian Kelsey, Eric Tejada, all the whole team.

Fantastic to work with.

But also, at an even higher leadership level, where the Department directors, I think there's an opportunity for changes in policies, changes in procedures, changes in the procurement systems and the way that contracts and purchasing are associated with minority organizations, such as Latino Behavioral Health.

We are small organizations, and we can't compete with the larger institutions, So maybe there are more opportunities to change the way a request for proposals is written.

It's standardized standards, so class tenders for providers to make sure that they are actually providing relevant services to minorities and BIPOC communities across the state.

So there are many other opportunities, but the good news is we are at the table, and we have an opportunity to talk about it, which is unprecedented.

- Okay, Dr. Rapaport, we're almost out of time, but I want to give you final thoughts, about 30 seconds, wrapping up the show.

- Well, thank you for doing the show, and I'm really want to thank the panelists here today.

I've learned a lot listening to you, and I think the audience has too.

I think the future in Utah is bright.

We have an opportunity to lead the nation.

We have an opportunity to work together to change what's going on in mental health throughout not only our state but the country.

- Okay.

Thank you so much for being here and sharing all of your expertise and insight.

Such an important topic.

For all of you at home we've compiled a list of resources on our website.

Just go to PBSUtah.org/yourmentalhealth.

You'll also be able to find a digital version of this town hall.

We hope that you will share that link with anyone you know who may be struggling and need help.

Thanks again for watching, and have a great night.

(upbeat orchestral music)