#12 – Equity in Mental Health feat. Dr. Rinad Beidas, Northwestern University
All right. Hello. My name is Ethan. I’m Ben. I’m Kabir. And today we have a very special guest, Dr. Bettis. Do you want to go ahead and introduce yourself? Yeah. Hi everyone. My name is Renad Rhymes with Glad Badis. Um, professor and chair of medical social sciences at Northwestern Fineberg School of Medicine. Yeah. So, it’s we’re so thankful that we could have you. your work has been so impressive from from the things you’ve done with implementation science and really all the areas you’ve covered and all these social issues you’re trying to solve. So I want to kind of before we dive into what we’re going to talk about today which is some of the problems with equity and quality of mental health care and you know how we can solve them I kind of want to dive into your personal story. So, as I alluded to, you’ve worked in many areas, mental health, cancer, firearm safety, and your specialty is behavioral economics and implementation science. So, how do how do those two disciplines lead to what you focus on? Is it kind of more rooted in your passion or is it more rooted in what what behavioral science and or behavioral economics and implementation science correlate well with? Yeah, that’s such a great question. And so I think about it with regard to like the mission and the passion that drives me and then the tools that I use to achieve the kind of mission of the work that our team hopes to do. Um so when I was young um uh I remember listening to stories from my father who’s an infectious disease physician. um and he was at the front lines of the HIV epidemic um in New York City um uh in the early days and he worked in a safety net hospital and he told me a lot of stories about patients who had a hard time accessing highquality care in time for their needs and I really felt outraged by that. I think I was like 10 years old and I was like this is this just doesn’t make sense to me. Health care is a human right. we should all have access to the best quality healthcare and we all deserve to have the best health that we can. Um, and so my mission has really always been about wanting to ensure that. Um, and being really uh committed to this idea that we all uh deserve to have good health and then I use the tools of implementation science and behavioral economics to achieve that mission. Um, and so let me tell you what both those areas are cuz um, I am so excited that you all are interested in those two topics cuz um, they’re kind of esoteric and not everybody has heard about them. So I’m going to boil it down into like a a way um, that um, might be easier to understand. So implementation science is all about closing gaps between what we know we should be doing and what we’re actually doing in healthcare. Um, so set another way, we really help people and places do the thing, whatever that thing might be. Um, whether it’s evidence-based secure firearm storage programs or highquality cancer care. And we have a whole process where we can like go into a setting and ask questions and become and kind of act like detectives or consultants to understand what might make it hard or easy to do that thing and then we deploy solutions or strategies to help. I did that work for about a decade when I began to wonder if we were just kind of always throwing the kitchen sink at um in terms of the strategies and solutions. And I was really drawn to behavioral economics because it’s all about making the right thing the easy thing to do. Um and there’s a lot of really elegant examples um from outside of the work that I do. But I’ll give you an example that you all may have experienced. Have you ever been watching Netflix and um gone to the next show because the default is um that it keeps going unless you stop it. Mhm. Yeah. Of course. Yeah. Okay. That’s leveraging a cognitive bias that we have as humans, which is how we think and um uh uh called the default bias, right? Where we don’t really change defaults generally unless we feel very strongly about them. So I became really interested in this idea of like how can we make it easier for clinicians who are doing the best they can. Every no one goes into being a mental health provider or a doctor or a nurse other than wanting to help other people like that’s why you do that work. Um and so how do we make their jobs easier? Um and make it you know easier for them to deliver best practices. So hopefully that answers your question. Yeah. And I I think it’s kind of interesting because in in my brief experience with economics and things like that, taking classes, I I feel like economists have kind of an idealized vision of things and but in practice they’re not um as applicable or don’t work out in the way like behavioral economics. I mean like there there are so many um there are so many flaws in the way we think about economics, right? you know, like the classic example of like if if you were going to a concert and it was raining, but you spent $10, you might leave, but if you spent $500, you might stay. That’s, you know, right. So, I think it’s I think it’s kind of clever. I don’t know. I don’t know. Um, and I’ll ask you like if you had this vision from like a young age that these things go so well together because um economists kind of, you know, think about things in theory, but their implementation doesn’t always go the way they plan. So, it’s kind of a nice mesh of things to to make things actually happen and make things actually work. I definitely did not come out of the womb knowing that I wanted to do implementation science and behavioral economics. Like everything else in my life, it was kind of the result of being in the right place at the right time. So, I I was mission driven. I knew I wanted to do something that was going to have impact. I started going down this implementation science path and then I used to be a professor at the University of Pennsylvania. um and they have an incredible program led by Kevin Vulp um called the center for health incentives and behavioral economics and I started going to their seminars and talking to you know faculty and realizing that there was such an opportunity at the intersection um and so that’s how it happened it was uh a little bit of luck and relationships and being in the right place at the right time. So in terms of like the business side of medicine and like some inequalities, what I um think about a lot is like insurance. I think like the business side to medicine is, you know, some people underestimate how much of a thing that is. And my question for you is like how much does um insurance play a role in this and like in terms of having um accessible care to people who maybe are low income versus high income and how much of a problem is that right now? Yeah, I mean I’m guessing we could spend the whole time talking about that and I don’t want to go into all the details around how health care is paid for um because first of all I’m not an economist um and second of all um it would take the whole time and I know we have a whole set of questions um but I think of kind of pay payment or insurance as an outer setting factor. So when we think about how to implement highquality care, there’s multi-level factors that are going to drive whether or not we are able to implement effectively. Does the person want it? Does the clinician provide it? Does the leadership of that clinic think it should be provided? And um amplifying that is the payer going to pay for it. So I think of it as kind of an outer setting if you think of a classic social ecological model and it absolutely drives um uh potentially quality of care and access um and particularly in mental health care. Um there are a lot of challenges because um many mental health providers don’t take insurance. Um and so uh if you are seeking mental health care and there are limited providers who take insurance or Medicaid or Medicare um then it’s going to be really hard to find a provider who can see you without a really long wait list. Um and I think we’ve all seen um particularly co 19 amplified how much as a as a world we need mental health prevention and intervention. You know, for a long time there’s been this stigma and this separation between mental health and physical health, but the truth of the matter is we can’t be wholehealthy people if um we’re not well both in our our mind and our body. Yeah. I mean, just to like speak to the Ethan brought up like the insurance thing. We kind of live in an area where there is an abundance of mental health care, I would say, in terms of therapists and and centers, some that we’ve worked with and they do amazing work, but you know, there’s a lot here and and not so much in other places that maybe even need it more. But just to give an example, um I go to therapy and I think insurance probably cover much less than 50% of it. I don’t know the exact number but it’s it’s exp therapy is expensive and and insurance obviously I mean the problem is that there’s such a problem that if all these insurance companies were covering everybody fully who needed therapy I mean the the premiums would be so high and these insurance companies couldn’t cover it because the problem is so big right now and the amount of people who need care is astronomical and I think you said things amplified by co I think mental health problems were really amplified by co so it’s kind of it’s kind of um gone down the the qual I think the quality of care in a way and the equity and um the equality has gone down over the last couple of years. Well, I’m I’m really glad to hear that you able to identify a therapist and that’s really important. I wish for a world where everybody who um would like to work with a therapist has that opportunity. I also really um envision a world in which we are baking or embedding these kinds of that this kind of thinking into where kids are naturally, right? Like um lots of all schools have social seal programs and are um you know providing support to kids, but not every school particularly those in underresourced environments have access to like a school psychologist or a guidance counselor or you know an MA level therapist that can provide support to kids. Um, and so one of the things I have thought a lot about, and I don’t have an answer for you, so don’t ask the question, but maybe you all are the next generation that’s going to solve this is like, and this is no longer a good example because of what’s happening in our broader context, but what is the fluoride in water for um mental health? How do we think about um uh supporting mental health from a very early age? And I think it even goes back to parenting. Like when I became a parent, I’m a child psychologist. You might think that I would know exactly how to be a parent. I don’t. It turns out I didn’t. And I’m sure if my kids ever watch that, they will agree. Um, and so thinking about like how do we support parents in their mental health when you know that a big change happens in their family like bringing a baby home. Um, so I just I wish for a world in which we do a better job embedding um mental health support into all of the systems that surround people. I I feel like mental health Um, sorry. No, you’re good. Um, you know, I would I the conversations you’ve been having about um insurance and and CO 19 really got me thinking about like some of these barriers that exist like preventing people from accessing quality care. And I was wondering kind of like do you have you noticed any like cultural barriers there as well? like um I know we’ve talked about like insurance, but like as far as like people in different communities trying to seek help, like what are some of the things that prevent um you know certain cultures or or certain groups of people from um accessing the resources that like people in a community like the the Northshore might um be more inclined to access. Yeah. I try not to speak in like broad generalizations. Um, just because I think it’s important to think specifically about each community and to know that community well. Um, but I would say broadly there tends to be stigma um around seeking mental health care. I see a generational difference. I see that younger people are more openly talking about seeking therapy and benefiting from therapy. So I’m hopeful that there will be some kind of culture change around that as we uh as the next generation of folks kind of talk more openly. Um but I think for a lot of time um and even in my generation um there’s stigma. People don’t want other people to know that they’re seeking out they’re seeking um therapy. And then of course the payment issues, the access issues. Um one thing that has made it easier I think for people to have access to um mental health treatment is the revolution that happened during co with tea health. Um so for example I don’t I don’t see clients anymore. I am trained as a psychologist. Um but when we switched I I was seeing clients during co 19 and I primarily see adolescents who have very busy schedules and you know are doing things after school and have school. Not having to like travel to my office and just logging in made it a lot easier for some of my clients to see me and not have it take up 2 hours or 3 hours of their day versus the 45 minutes to an hour that we were in session together. So I think there’s a number of factors that are shifting um and I have thought for some time that like now is the time for us to really leverage the momentum around um you know what happened in co 19 and around people’s mental health to make the case that like now is a time as a society where we have to prioritize and invest in mental health mental health research treatment services access all those things Mhm. And like adding on to like the cultural part, I feel like mental health and therapy is kind of often viewed as like an extra thing. Like you know, first you should take care of your body and make sure you’re fit and then you know the other mental stuff that should um you know follow that. But I think something that people need to understand is like um everyone can benefit from therapy and having someone to talk to. And I feel like um when we start to view it as not like a bonus or extra thing, more of like just like you know going to the gym, you know, talking to someone for even 30 minutes a day can be just as helpful. So yeah, I think that’s a good point for the cultural. So So um we were talking about kind of cultural barriers from the perspective of the clients themselves in different um communities. Do you view that there’s also a barrier in that many therapists are not trained on culturally specific issues that could be causing mental health issues? I remember this year I did a school project about mental health in the Camb in the Cambodian-American community. And one of the main things that they talked about was that as people came from um as people came and immigrated a um from Cambodia, the cultural differences in America were were so immense and and it was almost like a shock that carried over generations in that community, especially after they had just experienced the genocide. And it kind of talked about how how um how inadequate the care they were getting was and the investment that was being put into their care was because the people who were taking care of them and the people in the government who were supposed to be allocating the care were not were not trained on their specific cultural issues and how they kind of understand their kind of new life in America. Um like what are what are your thoughts on that? What are your thoughts on the barrier from the therapist perspective and not the client’s perspective? Yeah, I mean part of our training as psychologists is to be culturally competent, to have cultural humility and to take the interventions that we are deploying and to implement them with it the light of like context for the individual that we’re seeing, right? It’s impossible for any one therapist to fully understand all of the context and cultural backgrounds of every single um patient that they see or every client that they see. But it is my job to um learn from my client about the factors that are um important to them. And if I’m working with a particular population and I don’t share lived experiences with that population um then the expectation would be that I would um really work to understand and learn about what the specific needs are of the folks that I’m um working with. One thing that is a problem in the field of psychological science is that many of the interventions that we have um developed and tested have not been uh tested in uh all communities or with diverse populations. Um and so uh you know a critique of the field which is a very fair critique um is that our our interventions are not tested with our communities with with all communities or communities we’re working with in mind. And so there’s been a real movement to move beyond like creating treatments in the academic setting and then trying to push them out into the community to collaborating with community partners to understand what communities need and then with those partners developing and testing those interventions in the context with the populations in which they were intended to serve. So I’ve seen a real shift over the course of my career. I’ve been doing this about 20 years now. Um where there’s a greater understanding that um we really need to be um co-creating with communities. Um so in the example you gave, I would love to see um community partners and academic partners uh developing or adapting and um evaluating how the interventions work um with with that population given their contextual factors. And like adding on to like you know trying to have people specialize in their own communities. My thought is or my question for you is basically the like if it is a lowincome community are some mental health providers a little hesitant to open up maybe like practices there just because of it might not be um the best you know profit for them. Is there like some challenge with that? Um there are definitely different drivers um that influence how therapists decide and what setting therapists decide to work in. Um, I was very fortunate when I lived in Philadelphia, um, to work in the public behavioral health system in partnership with the public behavioral health system. And I worked with hundreds of incredibly talented and skilled therapists who worked in the community mental health clinics that were paid for um, through the public system or through Medicaid. Um, we did do a study kind of looking at turnover in that system, meaning when therapists elected to leave the system. And we did see that um when therapists turned over, there were a variety of reasons. Turnover tends to be pretty high in the public system, anywhere from 20 to 40% every year, which when you think about like as a supervisor or manager of a clinic, that means you’re like replacing your workforce every couple of years. Um and that’s really hard um uh to kind of do o over time. Um but some of them did go into kind of private practice settings. um some of them went to other uh clinics within the public system. Um so I I can’t directly speak to kind of how people make decisions about what context they want to work in. Um but I can tell you that I have worked with um many incredibly skilled folks who are working in the public behavioral health system and are um very missiondriven and wanting to make sure that all populations have access to highquality mental health care. Yeah, that’s that’s Go ahead. Yeah, sorry. Yeah. So, um, thinking about, you know, a clinician’s perspective when approaching an underserved community, um, you know, that kind of inspired me to think about like kind of the policies or laws that currently exist that kind of discourage people from either accessing or giving care to, uh, specific communities. Do you think that there are any like current policies or laws that um would need to change or or should be changed in order to you know encourage people to access care or to deliver care like just broadly you know that’s an interesting question. Um I have been tracking in the news um some evidence that given what’s happening right now around undocumented people and immigration that some people have not um been comfortable going to healthcare appointments for example. So certainly what’s happening in the broader context in the world impacts access to care. Um but I don’t have any specific examples from the work that I’ve done that I could uh pull pull in here. So, I wanted to ask just finally before we go into I guess the more positive um segment of this episode, the solutions, just something we talk about each episode is social media because we all view it as a huge huge driving factor behind the mental health issues we see. I was doing some research yesterday and the number or the p the percentage of kids or um people aged 18 to 29 that have severe mental health issues is almost double the the percentage for higher age groups. And obviously, I mean, one of the the main obviously there are a ton of factors like um that are that are uh that are like that are not systemic, but I think one of the new things that this age group is experiencing is social media. And I think it’s I think it’s caused a lot of mental health problems for me. Obviously Ethan and Kabir, we’ve all talked about how it’s caused problems for us. Just from your perspective and what the people you’ve dealt with and the solutions you’re trying to implement, how has that kind of caused a problem and maybe on another on another end, how could it be how could it be used to fix the problem? Yeah, you know, this is still kind of from my perspective an open question in psychological science because Ben, as you pointed out, so much has changed in our world um over the past generation and um there’s a lot going on. Uh so I I don’t know that we’ve been able to directly like see causal links between social media in you know broad population studies. If you look at the literature, my and again, this is not my area, so I’m speaking a little bit out of my um my area here, you’ll find studies that show either either way, right, that it is linked with or associated with that it isn’t. Um and I think uh last year the National Institute of Mental Health released um uh requests for proposals that were focused on this exact topic. Um, and so my hope is that in the coming years we’ll have a much better psychological science understanding of how social media affects well-being. Um, uh, I can speak as a mom, uh, for a moment because I am one. Um, I certainly worry about my kids using social media. I don’t know how you define social media. Like to me, social media is like Instagram, Facebook, Snapchat. Is YouTube social media or is that just like a So, it’s an interesting generational thing to me. I don’t think of it that way, but it’s something I worry a lot about when I see my kids like scrolling through these YouTube shorts and like I see their brain like I can see their eyes kind of glazing over as they’re doing that. Um, I think that the more that we can be together in community having conversations like this and feeling um fulfilling, meaningful connections, the better off we will be as a society. and understanding different viewpoints and connecting. Um there is some really interesting evidence that social media can also be protective um for uh certain subsets of populations um because people can find um people like them online in a way that you might not be able to find in your neighborhood. Um and we do have some f the entire point of you know what what we’re trying to do you know Yeah. trying to you know be able to connect people who are struggling right. Yes. And um and we do have some faculty actually in our department who do work on getting um young people access to treatment at the point of social media when it see and when there might be an indication that someone is struggling. And so I can see it as a an a delivery mechanism. The fact of the matter is that genie’s out of the bottle. Like do you all think social media is going away anytime soon? No, definitely not. Probably not. And so I think then the question becomes how do we learn how to live with it in a way where it doesn’t take over our lives? Um how do we engage with it healthfully? Um and how do we leverage it as a tool to get people help if they need it when they’re using it? Yeah. Um I spent I spent some time um researching uh social media algorithms through this class that I did. And really what we learned is that the entire goal of a social media algorithm and the machine learning models they use is try and figure out what next video they can show you that will elicit the maximum engagement. Right? So that’s what are you going to like? What are you going to comment on? What are you going to share? what’s going to keep you watching and watching and watching so they can sell ads and increase profit. And really what we found is that the most extreme content that’s pushed out pushed out elicits the the um the highest reaction rate. So people want to comment on um extreme posts and things that are um on on both sides of the spectrum. Yeah. that that um that kind of make that kind of make normaly and and and common sense in the middle seem seem almost out outside of the mainstream and that can really mess with people’s minds and and cause them to feel ostracized from the group around them that they perceive as normal. So I think that social media algorithms as they’re constructed right now, they’re great at making social media companies a ton of profit as you as we can obviously see. And I mean, they they do a great job of that, but they’re not good at actually bringing people together. They’re they’re more good at playing to people’s emotions and fear and and and kind of and kind of appealing to people’s um people’s worst side to to keep them on the app. And I think that hopefully people will recognize that in the future and and hopefully kind of create solutions for that. So maybe they’re more talking to people in their community on these social and networking sites instead of Yeah. Instead of just scrolling and scrolling. Yeah. I mean, there’s no doubt they’re designed to keep you engaged. Um and um I feel a lot of hope looking at the three of you that you all will lead social media for good campaigns andor companies. I mean, I think that um certainly there is a lot of room for improvement. Um and uh you know, uh we may start to see policies that restrict usage in ways that could you know protect younger people. I I feel that um personally I feel that uh you know my my kids are not permitted to use social media with the exception of YouTube. Um and I I half the time try to take that away too. though. So, I think something, you know, an interesting phenomenon I’ve kind of seen on social media, maybe not as common anymore, but like a few years ago, I I I often went on social media, there’s a lot of like self- diagnosis. I mean, you see a lot of people like claiming that they have like certain conditions or something like that. And I think that kind of spills over into, you know, like uh like talking to their friends about like, oh, I’m I’m so OCD. I have this type of certain conditions like what do you think? What are your thoughts on like the like this kind of epidemic of self diagnosis that exists on the internet like and how that maybe has been used as kind of like a substitute like kids talking to each other and like kind of confirming each other’s biases about things they have instead of seeking like actual care. Like do you have any any any thoughts about that? you know, Kabir, this really isn’t my area and I don’t know if you know this about scientists, but we really try to stay in this space where we have the most um knowledge. But what I’ll say in response to your question is um I think there’s probably every time there’s a topic, there’s two sides to every coin, right? Um in some ways, I think having a space where people can come together and find one another and talk openly about struggles and reduce stigma could be positive, right? Um uh for example, as I mentioned, um we have some faculty um who are working um with influencers who are young cancer survivors and they’ve developed a whole kind of community partnership model um where um it’s uh you know an opportunity for the scientists to share the latest information and for the influencers to help the scientists understand how people want to receive information and and that sort of thing. Um but certainly uh it can have delletterious effects as as you’ve described as well. And so I’m a person who wants to understand every situation, wants to understand what makes it good, what makes it bad, what makes it easy, what makes it hard, and then find a way to bring people together in a solutionoriented manner to move forward. Um so I I can’t say it’s inherently good or inherently bad. It is. Um and it’s a phenomenon that’s happening. I’d love to understand it better and um uh leverage it for good. Uh a question I have is you know in terms of solutions for mental health care and you know your work with implementation science. I kind of am wondering like when teens I feel like some people I know when they think mental health care a lot of times they think medication and I feel like a lot of times you know people are like oh I can’t focus like where can I go get some aderall and like things like that gets thrown around a lot and I guess my question for you is like do you think there might be more we need more of that less of that do you think it might become a problem in the future in terms of like implementing like effective healthcare. Yeah. So, um I’m digging back into the vault in my mind of the studies that I’ve seen. I’m pretty sure that um medication, psychotropic medication prescribing has gone up over time. Um I’m a psychologist by training, so I’ve always been a big proponent of psychological therapy. Um and I think that um we need, you know, a stepped care approach. like we need prevention baked into all of our environments into our schools. Um we need to have targeted programming um uh for kids around how to navigate um the world and relationships etc. Um but then we also need to make sure people have access to psychosocial psychological therapy. Um and then some people will need medication and I I think that uh and then there’s digital mental health tools as well. So there’s like a whole ecosystem and it does often feel like it feels easiest to reach for um medication as a solution. Um but I hope that everybody um knows and is aware that there is a wide range of options. Um and um uh for for each particular problem presenting problem there might be different evidence-based recommendations. So I my area of expertise clinically is pediatric anxiety. Um and uh we know that cognitive behavioral therapy is a really effective treatment for um anxious young people and that some anxious young people also need um an SSRI which is a type of psychotropic medication in addition to cognitive behavioral therapy. And that’s really a negotiation and discussion between that young person, their therapist and also um uh the guardian who’s involved in uh care. So, um, you know, I think it’s really important, especially now as there’s more digital mental health solutions, that people understand there’s different options and what the pros and cons and evidence are for each of those options. Yeah. Um, I have kind of one final question before we kind of wrap up and look at the future and what we can do as as teenagers. So, you mentioned uh cognitive based therapy, right? And cognitive behavioral therapy. Yeah. Exactly. And how um important and impactful it is. So do you see kind of and this kind of goes in just to to the to a broader catery of category of like creative solutions that we can implement faster to help people who are struggling and don’t have access to care? Are there um online approaches or any other creative solutions that um can be used with cognitive behavioral therapy? I wrote down that um we had a guest on the show uh Jason Mor Morazzki who’s a mental health speaker who said that um in a lot of underprivileged communities in fact he’s people like talking believe it or not to their barbers a lot about mental health yeah the barberh shop model y how can we use kind of these new technologies and and how can we create um creative solutions to implement these new technologies that could help people I think it comes down to empowering communities and figuring out what each community needs cuz like you shared a particular model that might work well in one community um and there may be different models that would be um helpful there and I think one of the things I’ve thought a lot about is wanting communities to have access to their data this is me in my science mind right like you want to know what are the need every community is different right what are the needs is it anxiety is it suicide prevention what resources are available and then we have a whole lot of evidence-based programs and approaches that can be implemented and we know how to implement them. Um, but it has to start with empowering the community, knowing what the problem is, selecting solutions that are going to address those problems, and continuing to collect data so we know that what we’re doing helps and make sense. Yeah. I I don’t like asking like what’s more important questions cuz you know we like we we would obviously ideally have um both problems solved but do you think that kind of erasing the stigma and creating awareness about mental health how prevalent it is how important it is to seek care is more important or has to happen first before public or private investment comes in to implement new solutions to help with the problems that exist? I think they can happen in parallel. I think they have to and I I like I don’t I don’t think we can be like we’re just going to wait until we can erase you know because people need to see that they can benefit from those solutions and feel better and that it helps their friends and family members and that will also shift um perspective and and and I think there’s enough need and demand right now that even if there’s still stigma people if if there were solutions people would access them. And uh just one final question. Um I know you mentioned you worked in in Philadelphia through what was it you said you worked with uh in uh Philadelphia with the public uh behavioral health system. Yeah. Yes. So do you view it do you view obviously there’s a lot of public help to or maybe maybe a lack of public health but most of the help is public help to help underprivileged areas with mental health. Do you think there’s a lack of private investment and do you think private investment is more sustainable over the future to implement solutions for mental health in these communities? I think in all communities we need a mix of diversified funding sources to support um public health and mental health and well-being. So, I think now is a good time to kind of ask about your research, what you’re doing. What is some good news that you can share? What is some progress that’s going on? What are some statistics that are encouraging? We see a lot of statistics. I’d say 90% of the statistics I see about mental health now are like negative. What is some positivity that’s Yeah. So, um, we do work in a lot of different areas, but I’m going to focus this conversation on suicide prevention. Um and so uh we have a program of research focused on implementing closing a no- do gap, helping pediatricians do a brief secure firearm storage program because um we know that one in three homes in the United States has a firearm. We know that suicide is increasing in the United States for young people um and that um about half of suicide attempts are with a firearm. And one of the big problems with uh suicide attempts by firearm is that it’s highly lethal. Um and we also know that um uh there is room for improvement in how people store their firearms to reduce access or unauthorized access to those firearms at a time when someone might be feeling um suicidal. Um, and so over the past decade, we’ve been working to figure out how to implement this brief secure firearm storage program that we we did a lot of adapting with and working with end users, including firearm owners in pediatric primary care. So, we just finished this really big trial. It was in Michigan and Colorado. Um, and it was with 30 pediatric primary care practices and over almost 50,000 wellchild visits. So, that’s what’s so cool about implementation science. the studies are at real scale. Um, and what we were able to show is that um, we tested two different implementation approaches. In one of them, we just created a little bit of a tweak to, you know, when you go see your pediatrician, they have the documentation template that they’re putting notes in while they’re seeing you. We added to it um uh a little tweak um or your primary care doctor if you’re not seeing a pediatrician um where it was a reminder to have a brief conversation about the importance of secure firearm storage and to offer a free lock for the gun in the home. Um and uh so half of the clinics, 15 of the clinics just got that change to the EHR template, electronic health record. The other half of the clinics got that change to the template I just described. And um uh the health system that the clinics were part of provided support to the clinicians and the clinics to figure out how best to solve any problems that came up like where do you store hundreds of firearm locks that you’re going to give to families over the course of a year. And what we found is that really this doesn’t happen at baseline. Um, if you do surveys with clinicians, they’ll report that maybe 2% of the time they’re having the conversation and giving a lock because it requires the lock to be there. We were able to get it up to almost 50% in the study arm where um the clinics got the change to the electronic health record template as well as support to the clinic. So, what does that mean? Thousands of um wellchild visits. So like you know when kids go for their annual visits included that brief conversation with parents and the offer of a cable lock. Parents took the cable lock. We have some data that’s not yet published showing that um receiving the program um uh by parent report changed their storage behavior and we were able to do this in a way that was acceptable to many many people um and including clinicians and patients of these health systems. Um, and so to me, um, I am, uh, really committed to suicide prevention. We lost a family member, um, to suicide by firearm. That’s really what got me in this area. Um, I want to do work that has impact and I think that study is a really good example of impact. Um, and actually potentially saving lives. I think that’s, you know, really encouraging to hear. And you know, just a final question, like what is one thing uh you kind of just want to leave our audience with? You know, we we have a lot of, you know, Northbrook mom listeners and also just other high schoolers. What’s something that um just an everyday listener, maybe someone who doesn’t have a lot of background in the space can do to kind of um get this mental health thing moving along how it should be. Can I get say two things? Yeah, of course. Yes. Okay. Um, one is a simple check in with your people, see how they’re doing, and um, get them connected if you’re worried. Um, take, you know, there let’s get rid of the stigma. Let’s try to make mental health for everyone. Um, and so, uh, that’s a pretty simple thing that everyone can do. But the other thing is about this current moment. Um, science, psychological science is unfortunately under threat right now. Um and uh uh get involved, learn about science. Science is how we continuously improve as a society. Um given um current threats, funding to do to learn more about how to implement and develop treatments is at risk. Um particularly for early career scientists um who might just be starting their career. Um, and so, uh, you know, find your local friendly scientist, learn from them, volunteer or get a job in their labs, and see why this kind of applied social and behavioral science can change lives and, um, contribute to society so that we can all live happy, healthy lives. Um, and I’m really proud that I lead a department, um, where that’s our focus. Um, and really committed to making sure that, um, all of our people can continue to thrive and do that work. That’s great. That’s great. Um, all right. So, I think that kind of wraps up our episode today. Uh, Ben, do we have any upcoming things that we want to just quickly shout out? Yeah. So, we’re going to have, um, a bunch of, uh, new episodes with new guests featured. We’re going to have therapists on the podcast and many people who run organizations throughout our community to try and highlight their work and break the stigma and raise awareness because um, as Dr. VA said it’s it’s a very important time right now and it’s a time that we can really either make or break mental health in the future and we’re going to do everything we can to break the stigma. We said it in our New York Times episode. I guess there’s some social tax, right? Especially I would say in the men’s mental health space for, you know, doing a podcast about mental health, but that’s okay because I mean we get messages about, you know, people we help and and that makes it all worth it. So, we’re going to do everything we can and we’re going to be having some good episodes coming out and we had a great episode today and you know, I want to thank Dr. Beta so much for taking the time to make an episode with us. Thank you. Yes, y’all are amazing. Keep up the good work. I’m I’m so inspired by what you’re doing. Thank you. Just to end on like kind of a personal note. um with all this talk about like mental health, what’s something that you do to kind of keep your mental health balanced or or just stay grounded in general like outside of your research like maybe we can listeners can apply that too. Um for me, nature really brings me peace and centers me when I’m feeling overwhelmed by what’s going on in the world. So I have created a little sanctuary for myself in my front yard with a bird feeder. Um, when you get older, you’ll get really into birds. I promise you, it’s going to happen. It’s like a psychological phenomenon. Um, but I have a little hummingbird feeder, and whenever I see the hummingbirds there um or I take a walk um outside and look at big trees or the lake, I’m reminded of how big this world is and how many good people there are in it. Um, and how um we are stronger in community and in nature. Perfect. All right. Well, I think that’s all for today. My name’s Ethan. I’m Ben. I’m Kabir. And just remember, your mind matters.
Curious to learn more about Dr. Beidas:
Recently published paper: https://www.pnas.org/doi/10.1073/pnas.2517704122
Department website: https://www.mss.northwestern.edu/
Magazine article: https://magazine.nm.org/2023/09/18/turning-research-into-action/
In this episode, Ethan, Ben, and Kabir sit down with Dr. Rinad Beidas of Northwestern’s Feinberg School of Medicine to discuss behavioral economics, implementation science, and their dual impact on equity in mental health. Dr. Beidas’s clinical research serves as a platform for their conversations about systemic inequalities in access to care, financial and cultural barriers, and the solutions being developed to address those challenges. #mentalhealth #equity #northwesternuniversity #therapy