BID Needham Speaker Series: The Need for Behavioral Health Services
all right good morning everyone i’m samantha trotman-berman for those that don’t know me already and um as i said at the beginning if you missed it we are going to be recording this and uh what we’ll do i think is keep questions to the end and you can either do a hand up through zoom if you’re technically savvy or throw your hand up and there’s also a chat feature as well so thank you so much for joining us this morning for the first in what we’re calling a two-part series uh addressing the issues of behavioral health during these uncertain times i recently heard an author and a speaker mike vini say if you had mental health issues before covet now they’re worse and if you didn’t have any before covid you have them now and i think that that has been in my experience uh quite true we’re going to hear today from a very special speaker regarding the need for behavioral health services and why it’s necessary to work together to address those needs and then if you could please mark your calendars for november 9th it’s going to be an evening meeting 5 p.m to 6 p.m and in that meeting we’ll discuss behavioral health care now and in the future and we’ll have some staff from bilh and also bi d needham taking a look at what’s available now and what we hope to be able to offer in the future at a local state and national level i actually prefer to think of this conversation as much more of a starting point for something really big and special the need for behavioral health services is just too great and bid needham is perfectly positioned to rethink behavioral health care in our community just as it is rethinking physical health care in our community so i will i’m going to speak for a minute but just before that unfortunately john fogarty sends his regrets and is not able to be here today with us the president of b.i.d needham uh he usually does a very brief hospital update and samantha sherman vp of philanthropy has offered to take his place so over to you sam thank you sam yes i’m happy to fill in for john um he sends his regrets and wishes he could be part of the conversation today um but he’ll he’ll be there on november 9th for part two um the hospital is full our inpatient units our icu our emergency department we are at capacity um i’m happy to sort of let you know that volume has come back at the hospital i know after our covet days we were a little worried whether people would return to the hospital and actually right now we’re seeing volume at probably 130 to 140 percent in some service lines over where it was pre-covered so the hospital is incredibly busy inpatient outpatient emergency room today is particularly important because while this past year has really been marked by the pandemic and covid behavioral health has been really a constant for us and sort of escalating in terms of need so pre-copa days that sam had said behavioral health was the largest unmet health need identified by our community and we were rethinking starting to rethink how we address those needs in the community um with the with the onset of covid and more recently with the closure of norwood hospital we’re seeing now in our emergency department four times as many behavioral health patients as we had previously and so really there’s been a huge shift at bid needham in terms of the type of patients we’re seeing and the increased need for care at the hospital so this is an incredibly important conversation to have not only just for the patients that we’re seeing walk through our door but like many of you we’re also um you know looking at a workforce our staff members who have been handed challenges day after day throughout 2020 and risen to the challenge and we’re talking about resilience training and stress management and dealing with um their own personal anxieties or personal professional challenges brought on by covid and so we’re really thinking about how do we keep our staff as healthy as possible in terms of physical and emotional um wellness so that we can care for the community so this is incredibly important and i thank you sam for putting together the um this two-part series and nick thank you again for joining us i think this could be a yearly thing we have you come in september and um and talk to us about what’s happening uh that you’re seeing from your seat and i think it’s important that we take this and that um we have some even it’s even if it’s small things actionable things that we can do in our own lives um to deal with this but certainly were we looking at it from an organizational standpoint thanks very much sam for that update i really appreciate it um so i’m going to say a few words normally i just introduced the speaker at this point but as everybody i think on the call knows this is a very personal topic for me and so i’m typically moderating the speaker series as the chair of the board of advisors the new chair of the board of advisors uh but i’d like to briefly share with you how why i’m so passionate about the need for behavioral health services in our state and in our community and really it’s quite simple i need them my family needs them stepping back i am extraordinarily fortunate i have four physically healthy and spirited children spirited by the way i’ve learned is a pc term for very difficult kids that one day will make really cool adults but joking aside i am fortunate in many ways i’m married to a great man i have a wonderfully supportive family i live in a beautiful home in dover i’m well educated and between my husband and me we’ve had good enough careers that were financially well off and all four of my children have anxiety two of them have severe anxiety and depression one of my kids tried to take her own life three times before the age of six another was recently asked to leave for boarding school due to suicidal ideation two of my kids suffer from nssi which is non-suicidal self-injury which has really only emerged in the last 30 years as a very addictive unhealthy coping mechanism less extreme but still very impactful to our lives and perhaps more relatable we deal with school refusal learning differences social pragmatic issues pure ocd and phobias i have some excellent local providers some covered by insurance and some not and we’ve also chosen to seek out-of-state residential treatment for two of my children not covered by insurance and we’re struggling in telling my story i hope to highlight the behavioral mental health issues do not discriminate and remember i am fortunate i have resources support and connections i know what happens to those people that don’t have those advantages and it’s unacceptable dr cabino may use the world health organization statistic that one in five people in the world are affected by mental health issues but he and i both think that under represents the problem in my case the statistic is six out of six so i’m happy to answer questions along with the speaker at the end of our session today but now i’d like to offer dr nicholas covino to put this all into context i first met nick when we were rehearsing our behavioral health panel discussion for the 2019 bid needham annual meeting after hearing my personal speaking piece along the lines of what i just shared he paused thanked me for sharing my story and invited me to reach out to him if he could be of any assistance and by the way i have at least three times since so first and foremost he’s a really good human being during his career in clinical practice as a psychologist he has devoted his energy to helping patients he was formerly the director of psychology and of training at the bid medical center and since 2002 he has been the president of the william james college in newton and he is transforming the way that future mental health providers are taught to address increasingly diverse and complex issues in our communities so it’s my great pleasure to introduce you to dr nicholas covino oh thank you uh greatly uh samantha i i uh i feel the same way uh this morning that i felt when you spoke the last time and i heard this uh story and i know your story and not only am i moved by uh but by your honesty but uh as somebody who’s worked in mental health uh the several of you on the panel on the screen uh no people just don’t become advocates for mental health from their personal experience we don’t share the things about ourselves that feel in some way unfinished or challenging or embarrassing i started a couple of years ago to share my brother’s story so my brother had a beautiful young boy named nicholas also [Music] and another day we can talk about drug drug use but he died of a drug overdose and it was a nightmare for him my brother and my uh sister-in-law to get the care that this boy needed we just don’t have it we just don’t have it despite our best efforts and intentions uh it’s almost impossible to get care for uh for young people seventy percent of of moms and dads in massachusetts that want to get mental health care for their kids cannot find care uh and if you’re a person of color uh 90 of the time you’re going to find somebody who looks like samantha more than me but you’re going to find a caucasian person to do it so we’re woefully in a spot of inadequacy about this but what makes the change happen is people having the courage like you do to say let me share my story and tell you about me without uh fear of being criticized but because it needs to be changed and uh you’re a remarkable woman you’re a remarkable woman uh and your mother would say that and your mother would say that too um so let me let me uh again i’ve got a screen to share can i do that let me try um let me see let me see if i can do it so [Music] all right can we can everybody else just nod your head if you can see me all right i’m going to hide you i am for today’s program also changing my name to samantha so that uh so i’ll blend in with the other samantha’s in leadership uh at the moment um i’ll also say uh i’m trained as a psychoanalyst uh and we probably won’t talk too much about psychoanalysis uh in this presentation there’ll be a lot more behaviorism and cognitive behavioral work shared with you than than psychoanalysis but let me try to make a couple points and then maybe we can have a discussion uh here are three points first of all as as samantha said mental health problems are are prevalent and they’re consequential uh always mental health problems are prevalent and they’re consequential uh secondly if you think that mental health is worse uh during this time of covid you’re right uh it’s significantly worse uh so and and thirdly what i wanted to do instead of giving you an ain’t it awful talk and i’ve given those and it always makes me depressed when i leave uh so i was trying to make myself uh in a position to have a better day uh third point you can do something about mental health your own mental health your family’s mental health uh but it takes intentionality and effort you cannot wish to make it so it really takes effort and let me tell you a little bit about these things um so let me i’m gonna move guys around because you are crowding my slides um so as samantha said in a normal time i would say to you one in five people so about 20 percent of adults same with kids uh have a mental health problem a diagnosable mental health problem so depression anxiety substance use disorder something like that um but half of us are going to have it in our lifetime so cross-sectionally looking at today you might see one in five in a lifetime you see uh five out of ten of us will have uh some kind of significant episode of uh anxiety and depression uh second point youth mental health is worsening and it’s and it’s getting to a very serious place about suicidality uh with young people i’ll tell you about in a second but if you think that teenagers especially are experiencing increased episodes of depression anxiety uh more imp more depression and anxiety than substance use disorders these days um you’re right and again most of them don’t get treated even the diagnosed cases do not get treated about 60 percent of kids will not get the treatment that they are looking for and in massachusetts a couple of years ago the blue cross blue shield foundation did a study and found that 50 of the adults that were actively seeking treatment for themselves 50 could not find a provider because there just wasn’t anybody around to see them right so we have a woefully inadequate mental health or behavioral health care system woefully inadequate and i will tell you massachusetts is one of the top three in the country right 50 percent of the counties in the country have nobody like me fifty percent of the counties in the country have no mental health professional of any kind no social worker no licensed mental health counselor no psychologist no psychiatrist they don’t have anybody to deliver mental health care and we’ve been overlooking this for years overlooking this for years we’ve got access to mental health care unless something happens in the next month the affordable care act provides payment for mental health services so it’s not like we can’t afford to pay uh people but we really just don’t have enough providers to do the to do the work when mental health care does not get treated it’s impactful right so uh more than anything uh i don’t know if i can’t did i cover that slide yet no did i yeah so just to pause for a second uh dr insult said some years ago when he was at the international institute of mental health the economic costs of untreated mental illness are going to be larger than cancer diabetes and all respiratory ailments put together right so it’s not like well uh it’s really important to treat heart disease and so we build a big system for that or if i ask you does anybody know that joslin diabetes center or the dana far farber cancer institute right the jimmy fund uh everybody would raise their hand yes we know the jimmy fund one out of 330 children get cancer but 2 out of 10 get mental illness and we don’t have a jimmy fund for mental health all right consequences of that are that we’ve got an enormous problem with mental illness and substance abuse among the homeless population right so people are not homeless because they choose to be homeless people are homeless because they are disabled in some way significantly by mental illness or substance use disorder that’s untreated 30 percent of the homeless population are veterans right our veterans uh 25 of the homeless population are under 18. if you look at our prison systems people rightly say these are de facto mental health centers prisons because somewhere in the order of a third of imprisoned people have a diagnosable mental illness this means wrong place wrong time bad judgments bad choices not really wickedly bad people that you need to lock away to keep us safe right but these are people with problems that we’ve brought treatment to and 70 percent of the children the young people under 18 70 of those people in prison under 18 have a diagnosable mental illness right another day they’d be in a hospital another day they’d be in a treatment facility another day someone would be counseling them in school and with schools fifty percent of the kids that drop out of schools also have an untreated depression problem or anxiety and this costs about a trillion dollars or better to this country it’s really hard to estimate what the costs are of all of this but it’s probably more than a trillion dollars people say uh to treat what is the biggest cause of disability uh in the world but the biggest cause of disability in the country which are mental health and behavioral health disorders so this issue on normal times is a really really really impactful serious issue and again people overlook it because they feel like it’s not going to come to my house uh or to my kids but it does right so if four out of of 20 kids in a classroom right that’s one out of five so four to twenty children in the classroom 4 out of 20 kids in a classroom every classroom in the united states has a diagnosable mental illness what kind of learning goes on in that space it’s not the 420 it’s the other 16 that can’t learn because there’s a four and 20 blackbirds there in the space right and the teacher has to manage that group of folks right and we know that 50 of young teachers leave the field in five years right because putting people into that situation is untenable for an idealistic young person who has to manage a group right in that space uh so we’ve got some serious problems not the least of which is suicide which among young people is the third leading cause of death for 10 to 14 year olds third leading cause of death suicide imagine that second leading cause of death 15 to 24 and i’ll tell you that now a recent study finds that young people say 8 to 24 so all young people uh most young people uh 25 of them have thought about suicide in the last month 25 right these are your kids these are not samantha’s kids just these are not my kid or my nephew just right these are our kids this is everybody that we are living with has a significant issue moving forward and to the point i made earlier if you think it’s worse now it is right so the cdc did a study in uh summer time in june and they found that it’s not 18 or 20 percent of americans that report struggles with mental health or substance abuse disorder but in this time of covet 40 they’re reporting that 40 are reporting that and so think about those kinds of surveys and studies right they’re like polling studies that people do seeing are you going to vote for trump or biden a certain number of people will tell you the truth and a lot of people will lie right and they’ll or they’ll not respond right so imagine asking folks do you have these symptoms anxiety trauma ptsd substance use right imagine doing that at the stop and shop or uh wait how many people are gonna tell you the truth right a lot of them won’t tell you the truth right but 40 then probably is a as samantha mentioned are grossly under of what it is that we’re experiencing in this country at this point in time 40 that’s a lot of folks right when you look at the symptoms of let’s just say depression right people feel sad and and pessimistic they’re fatigued they have weight changes they’ve got body aches they’ve got suicidal thoughts they’ve got sleep deprivation they feel helpless so i’m going to come to that in a second right i think i’ve said to my staff and our folks when people say i’m just over i’m i’m feeling tired all of the time i hear this from people i’m just i’m tired of zoom i’m tired i’m feeling tired i don’t think you’re feeling tired i think you’ve got a sub clinical depression i don’t think this is fatigue if it was fatigue and you slept a couple hours on the weekend you’d feel better but i ain’t feeling better you know i’m i’m i’m fatigued like that every night right and i’ve had two very lengthy cycle analyses uh my emotional pretty accessible to me um but at night i am blue sad disconnected looking for pleasures in my spaces uh where i don’t have them anymore uh i could sleep for 12 hours if you let me sleep for 12 hours on a on a given day fortunately that didn’t happen this morning um but it could be uh that it it is the clue i think that the 40 50 of this country uh has an untreated sub clinical depressive syndrome this is not just i’m i’ve got zoom fatigued uh there and there are some reasons for that let me share some of that with you so here’s where please don’t report me to the boston psychoanalytic institute i don’t think there’s anything in what i’m about to say that has anything to do with psychoanalysis there might be but i’ll there might be i’ll make it up a little bit just to make sure that i don’t get kicked out uh there are several theories on depression that we really do have some psychoanalytic theories i’m not going to talk with you about those at the moment i’ve got to talk with you about really one important one uh there’s a biological theory of depression right people think there’s an imbalance in neurotransmitters and medication helps that i’m not going to talk about that either but that’s a that’s an area you know i’m going to talk about really one but i’ll tell you two i’ll tell you two others on the way into that one um there’s a long history of depression being triggered by separation and loss so somebody needs to mute themselves that isn’t muted uh so take a look down see if your if your microphone is muted uh and if it isn’t can you do that and if you’re the controller could you make sure that happens because i’m hearing people breathe um we we we are a human species that wants to be attached to each other uh we like that uh babies require that uh we learn about our emotions ourselves our how to regulate our feelings how to negotiate with other people by attachments that we have with people we feel better when we’re in the company of people that we love we feel sad when they go away remember when your kids went off to college remember even the first day of school how anxious you were how sad you were when that little being went off to kindergarten or or preschool and you were suddenly alone in that space remember when someone you loved died remember when you got divorced remember when you broke up with some right human beings are built for attachment human beings regulate their emotions in relationship to each other and when we don’t have that kind of of of rich connection with human beings we feel depleted right you see this in elderly people especially uh theorists talk about that as conservation withdrawal when people have lost so many they don’t attach to new people they stay disconnected because the pain of that loss is so significant we we as a species don’t want to continue to endure it right so on the downside separation and loss creates grief creates sadness depletes us as human beings attachments fill us up right look only to your own personal experience about holidays birthdays celebrations the last time you met this person or that person the last great social event you’re at right it boils us up those events boys that’s up those relationships poised us up what’s happening with covid we have to be six feet apart we can’t have thanksgiving when’s the last time you kissed anybody that you weren’t immediately attached to right or hugged anybody that you’re immediately attached to right we’re in a space and it and it’s not we’ve been in that space for a week or two anybody can endure something like that for a week or two we’ve been in this space for almost nine months where we are disconnected depleted and where we’re looking ahead and we can’t see attachments happening again in fact we’re looking ahead and samantha tells us the hospitals are full again right the news is telling us we’ve got worse spikes of this uh uh coronavirus uh than we had at the beginning right serious interpersonal distance and disconnection serious everybody not just ten percent not just 20 second thing that creates depression there’s a theoretical point of view that says when you have pleasant events and experiences in your life that don’t necessarily involve relationships so think about the last time you took a hike in the woods think about the last time you sat in a hot tub think about the last time you went to a wine tasting by yourself uh pleasant events right even if it’s you know uh buying a new pair of sneakers or running shoes or uh pleasant events make us filled with uh relief and pleasure and satisfaction when they’re not there enough we feel depleted right we feel depleted uh it’s almost like a hydraulic model right when you get a bunch of pleasant events and experiences happening in your life uh you feel happy so even just think about the last time you saw a great movie went to a nice play uh you leave that experience of this of the theater or the symphony feeling uplifted you can feel your mood buoyed up right when was the last time we had pleasant events in this uh uh cove en environment right can’t go to the restaurants can’t go to the can’t gather in places can’t see this can’t do that can’t buy this can’t go here uh and and that’s a real thing i want to say that’s not a 20 thing that’s a 100 thing right we are all feeling that degree of lost pleasant events third thing that i want to spend a little bit more time with because it’s it’s not that complicated but it’s impactful third theory about depression is learned helplessness right so you see the elephant what do they do with elephants people may know they chain them as baby elephants to a pig right uh and they cannot move when they’re baby elephants then they get to be these huge behemoths uh they chain them to the same little peg and they sit there now they could rip the pig out and half the ground out around them uh but they have learned at a very early age that any agency on their part when they’re chained to that peg is useless they have no agency they have no ability they’ve learned to be helpless learned helplessness reaction is a quitting response that follows a belief that whatever you do doesn’t matter okay so let me just tell you about this a bit seligman uh who looks a little bit like art garfunkel uh at least when he was doing these experiments in the 60s and 70s doesn’t look like that now because i i know him um but he was he did a famous experiment with with his partner and found that if you took a dog and you put him on a shock box in a box half of the grid was was a grid that gave a shock half of the grid was safe it was not a space where you’d get a shock you’d sound an alarm of some sort it took about a trial or two where you’d uh sound the alarm and give the shock before the dog got the idea that they could jump the fence and be safe and then they did and then they got so good at that in just a few trials that they found whenever they shown the the the alarm they wouldn’t even start the shock the jog would just jump and go to the other side right everybody know that experiment kind of right then what did they do they kept the job the dog from escaping by putting the wall up right and so then they’d sound the alarm or ring the bell and the dog would go nuts trying to escape trying to escape bouncing off the walls bouncing off the walls trying to escape feeling agentic feeling their agency feeling their power and then just discovering that there was nothing they could do to get out of that side of the box and they had to take the shock eventually after a few only trials like that they’d sound the alarm the dog wouldn’t even try to fight they’d just lay down like the dog in the right and and whimper and take the shock even when the wall got put down and they could see that they could escape they did not the bell would ring the light would go on and they’d say i’m gonna get shocked they’d think i’m just going to lay here and think this bad thing’s going to happen to me and there’s nothing i can do about it everybody get that model right not a hard model to understand what that happens is a dog starts to make sense of that experience and say this bad event is going to happen i have nothing that i could do to make it better it’s always going to be like this right and all i can do is sit with the consequences of this and sullivan called that learned helplessness so a bad event happens to that person they think it’s permanent they think it’s far-reaching and they think that it’s it’s because of them i’m no longer a gentic i’m no longer able to to make a change uh in my life think about the things we’ve experienced as human beings that are like that stock box and we are like that dog right how agentic how powerful how capable how helpful do we feel about this pandemic right it feels absolutely like it’s beyond our control it’s unending i mean this is the longest i except for the vietnam war which uh was unending or seemingly unending to me and my uh in my youth uh but narrow in its in its impact if you made it be right i could still go to school i could still have friends i could still grow up around that but my little boy going through this is in a covert spot can’t play basketball can’t see his friends can’t date can’t go to uh to the movies and he feels as a young person this is likely to last forever right older folks among us know it won’t right but it’s how you put this picture together that matters right think about what’s happening with our elections it’s not just the strong feeling that you have about it it’s the idea now that’s coming that no matter what you so some of us felt like we’ve waited three years and 47 day whatever it is to vote right we’re really looking to vote and now we’re told maybe it’s not going to count maybe we’re not going to count it right maybe i won’t leave if you vote me you know it’s not to get overly political but these are the messages that we’re hearing as human beings right think about the issues of race in this country think about how black and brown people feel as they’re looking at george floyd and then it turns into this episode and that episode of another episode they cry out for change around the police but it doesn’t come there’s another uh nightly story about some kid walking away some person walking away getting shot in the back right so the messages that people are getting some people will get are that nothing they do [Music] is is anything they can have control over right so we are as a group as a unit as all of us hearing these messages of learned helplessness right so two pieces of hope i will tell you first of all how you relate to that learned helplessness experiment it is dependent on on on how you understand that experiment and the psychologists call that attribution theory so it’s not whether you want to lose it’s how you place the blame they say right so the little boxes i’ll encourage you to learn more about it because this there’s material lots of material out there about attribution theory cognitive behavioral theory uh to help you understand that when people look at bad events as temporary isolated and beyond their control they feel more optimistic i tell my son i know this feels awful pete but it will pass you will get back to mountain biking you will get back to basketball it may not be in january but you will have it this will pass uh and it’s not your fault right it’s happening because of a virus but it’s not gonna and it is far-reaching it’s happening to the whole world as we go along with it but it’s time limited the time is just a lot longer than we expected that it would be that point of view when you can make yourself reason to that point of view allows you to keep hold of your sense of hope and agency when you think it’s permanent far-reaching and due to your own effort you’re going to get pessimistic about it so everybody see that this is this is an experiment that’s happening to all of us from a number of different places but the the way we think about the experiment is gonna influence how we feel about it right i will tell you that this was not an easy thing for the dogs to learn the dogs eventually learned that the shock box could be managed by their jumping over the little wall again but they had to be dragged multiple times by the experimenter from the shock side to the non-shock side to learn that right this is really important change in learned helplessness experience requires you to drag yourself to the other side of the box it doesn’t happen automatically it doesn’t happen effortlessly it doesn’t even happen easily right every single dog that learned how to escape the shock box had to be dragged from one side to the other it varied how many times based on the dog and his or her history right but change requires effort in order to regain your sense of agency does everybody get that that’s really important right so when you think about managing emotions this is a dog show this morning that’s not really me and my dog but i needed to do some psychoanalytic something in here to keep my license uh all right so there are ways you can learn to manage this i’ll give you a couple and then we can talk a little bit more there are three so looking backwards uh thinking about the uh the relationship issue you really need to make a plan to be with somebody that you love right so samantha brings your mother to this morning’s meeting uh that’s a good thing for samantha and it’s arguably a good thing for samantha’s mother to be present and connected but you have to be intentional about it you have to put the time into it you have to think to do it most of us are not most of us are going through the week and the weekend and the week and the weekend and the week and the weekend and we’re not thinking about have i seen phil recently have i called mary recently how do i get together with somebody maybe just for a drink in the outdoors with a mask and but it’s really important that those relationships come back and you need to be intentional about it you need to make a plan you need to do an analysis about who have you not seen what you can do how you can connect that’s one change you can make the other is if you if you look at your weekend and you don’t have a plan to do something enjoyable you’re going to leave at the other end of it depleted find a way to think about so in my family we’re thinking what are we going to cook uh and eat uh we’re looking at thanks you know new food special something to look forward to to give us a sense of pleasure i looked at my thanksgiving and i have a sister who missed the italian cooking gene uh and she can’t cook my sister dede uh and she’ll tell you that she’ll tell you that too so her family because i did get the italian cooking gene i don’t know how that happened but her family comes to my house for the holidays and other times during the year because they have to get fed a couple of times a year well right so i do that uh for them but i said you know uh i’m old you’re old uh my kid’s going to school you’re you’re young your young uh grown-up now woman is teaching school right we really should not congregate at thanksgiving but what i’d like to do is cook the turkey and cook the stuff and i’ll put it in a box and i’ll bring it to your house thursday morning and the things that you can cook like she stuffs celery like my mother used to do with cream cheese a very nice tradition in my family i said you do the stuffed celery didi and i’ll cook the stuffing and the vegetables and the turkey like i usually do but i’m going to bring them over because i don’t want to miss that i don’t want to say let’s just not do that right so enjoyable activities intentionality got to plan it kind of negotiated third thing and i’ll remind you that there’s a ton of of popular as well as uh more more serious research out there about cognitive therapy right you want to think about the thoughts that come to your mind so a bad thing happens how are you evaluating it how are you appraising it what’s the logic that you’re looking is it accurate is it the only explanation if we’ve learned nothing in the last several years and especially in the last year it’s to check the facts right because what we see is that what gets presented as truth not only influences your thinking it influences your feeling and it influences your behavior if you think and feel that something is true doesn’t matter whether it’s true or not you’re gonna behave in a certain way based on that data human beings are like that right human beings are like that the good news is human beings can edit that we can relearn that we can change it we don’t have to be brainwashed by that we can reevaluate that but again like the dogs you got to do the work at it this is not an easy process you can’t wish for it to happen you can’t think well i’m a healthy person i’m going to be fine i’ll remind you again 40 percent probably an underestimate of americans now are experiencing depression and anxiety because we’re in a learned helplessness experience on on multiple levels and we’re appraising it negatively and and we’re not doing the intentional work of seeking relationships finding pleasures and changing the way that we think all right but this is the puppy show this morning uh but there are nice sources of pleasure we can find there are ways we can think there are things that we can do um and as a community we not only have to since we’re a community uh we not only have to do that for ourselves we have to help each other with that because there are folks that are not sitting with this kind of information we need to share that information with them this is you know not not to sound like psychology today or some simplistic uh article you’d read in the u.s news and world report this stuff does have a scientific basis right we’re we’re sick because of good reasons right uh the science is there that shows us how these experiments can create low mood but the science also tells us how we can get better right and we need to be able to do that so uh so find a puppy right pat the puppy let the right put the puppy on your lap right spend some time get a nice cup of coffee right little things big things complex things all right so i think we’ve got time we can talk a little bit together i’ll stop my sharing i think that was useful thank you very much nick that was really i i actually was uh taking pictures and i texted a couple of the slides to my husband so there may be some immediate uh positive out of that you know what i loved about the i loved about the cbt part as well uh is the way you described it which was helpful but also it wasn’t don’t identify the emotions because i think that some of the unhealthy coping that i see around is denying that all this is going on so right it’s sort of back to what you were talking about with i’m just tired and all i really need is a night’s sleep well you probably do need a night sleep and is that something underlying that there’s something more than that and i think that as a society i think we uh we sometimes celebrate ways of hiding these things or pushing them away or using you know coping you know have a glass of wine don’t think about it those kinds of things and in the short term that might help but over the long term it’s only going to make things worse so i really appreciated the way that you got underneath that night’s in your house right if you uh don’t do the investigation if you don’t look eventually your house falls down right so really important to do the analysis and to seek an intervention right but god built us to be able to do that right god didn’t just build us to be reactive to our environment we’ve got capacity and we need to use it absolutely uh thank you so much i really uh really appreciated that and as i said i was taking notes so um i would like to open it up to questions i think uh sam sherman myself and dr covina would all be happy to answer any questions that anybody has or any comments so uh i’m trying to work this but i see shauna has her hand up so not that i’m rewarding the fact that she didn’t use the technology but i will let her get in on a question i was trying to find it i forgot how to raise my hand with the technology uh nick first and foremost thank you that was fabulous and um i am you know from a personal experience i’ve had a sister who’s been on lithium since 1975 diagnosed as a manic depressant um so um i would love to know because i uh operate a pub in your neighborhood real close to your college um i would love to know what would be your wish uh or call to action from the community how can we help and support your efforts i am so proud that you’re in our neighborhood and your college has grown so crazy to me in the last three years and i hear some wonderful things but i would love to know what i can do to support your effort and what would be your call to action so uh so we’re growing sane not crazy uh donna but but we uh so we’re looking for happy hour to come back to the pub with chicken wings and be right one thing that you could do not just for my students but for the faculty chicken wings and beer that would be great nick but i would say though that when sam and you said it in the beginning why is there not a jimmy fund and we always kid about it and bid about the sam and the sams i mean i i i immediately thought why don’t we have a samantha or a sam’s fund an initiative to do something like that because i’ve grown up in the last 45 years of of dealing with the fact that this is something that people just push aside and nobody wants to do anything about it and i think that we really need a call to action and i think sam trotman is probably about that person that could get that going i i quite agree so there are multiple things we can do right together the most important thing is we can understand that this is an issue like heart disease uh no different no stigma no inhibition no shame uh though i gotta tell you when i i told my brother’s story i didn’t even tell my own story right but i told my story in a group of a thousand people because i wanted people to understand that even a person who ran mental health who’s taught i don’t know how many people i’ve taught that are psychiatrists and social workers and and psycho probably in the hundreds now in my career i could never find treatment for my nephew and i felt terribly guilty when he killed himself terribly guilty when he killed himself that’s my brother’s story right i’m not i the the level of shame in that uh not so high right easier to tell a story about someone else than yourself tell your own story right what samantha does is she normalizes this for people and said look i’m a normal mom not only my normal mom she’s a super normal mom right she’s an accomplished businesswoman she’s done bright and bold things right so share your story and listen to the stories that people share that’s really important we have to normalize this right second thing is we’ve got to look for ways to teach about it so i gave you some stuff there’s there’s you know there i don’t even need to give you a reading list you can google something about any of these things i talked about this morning i will i’m happy to share the slides with people if samantha that uh helps you i’m happy to deposit those slides with you go find out something to read read a book about this read a book about this right and understand what seligman’s experiments were about understand the importance of attachment and relationship understand the importance of pleasant events and teach about that that you don’t need a phd to be able to do that so share information share your own information right and then look for ways to get active you know we you’re right we’re doing a lot of stuff because and now we’re in a space so when i came here 18 years ago we were a little tiny one department uh place that should have been a department in someone’s university right uh and we were broke we were called broke uh we grew because the work we do is necessary we grew because as we started to look for the need and we created programming people game we built it like the field of dreams here uh and people came we’re now a 35 million dollar business we were a two million dollar failing business uh but we you know look for ways to be supportive come to the things we offer for educational events if you’re able to send money to help support the building up of a diverse workforce we’re doing what no place in the country is doing with black mental health and asian mental health and military mental health and those kids need help getting through school so if there’s ways that you think that you could advance that please do that too but we’re all citizens of this experience right of of of health care and again when you think uh it’s not just a service to somebody else this is coming to your house right it may not be there yet but it will come to your house and you want to have providers able to treat it help it you want to have wisdom and knowledge and and folks to collaborate with so i think the biggest thing we could do is own this issue we all need to own this issue this is not someone else’s family this is our stuff right this is our neighborhood this is our it’s our mom it’s our dad it’s our spouse it’s our kid it’s our neighbor all of this is real thank you for that i did notice i want to reward janna for using the zoom hand raise so janna please thank you samantha i tried working at it um so nick thank you so much um so i work at a school as well at um a graduate school and if i think about and i have kids so i i think about the the long term yes we need more professionals in the field but it’s a long-term solution and i think about the way our kids like to communicate and get information and support it’s a very different mode than what we have um so i brought in a group to talk to my university about like talk space and the texting stuff and there are some serious um shaking heads they’re like wait the person doesn’t respond immediately like no no it’s a text and then there’s a pause and then the person texts back at a certain time like it’s just a very different model do you have any sense of the efficacy of those models are they helpful if i think about the way to scale up quickly that gives me a little hope and i just don’t know how effective they are so i’m i’m part of this akum group which is the association of independent college presidents so i sit with your college president if it’s larry and other folks uh in that space uh and they ask because i’m in the meeting of all these squares what are we gonna do about mental health their model is let’s put five more people in the counseling center and i say that’s five hundred thousand dollars it may be seven uh and they’ll see 20 extra kids right so that’s not the way to do it what’s the way to do it take your faculty gather them together and and say if people have a problem with isolation don’t talk with them like i was trained to teach uh as the wise person at the head of the class form groups give them tasks where they have to collaborate make connections for them take five minutes and ask how people are doing before you move forward with your class ask folks to exchange text uh email or telephone numbers with each other so there’s connectivity in the space offer yourself for that 25 of folks that are suicidal in your classroom even and say if you get in trouble i’m your guy i’m here you know i may not be a trained mental health professional but i want you to know that if you get jammed up in some way here’s my cell phone i’m ready for this right so i’m of the opinion that the same work we do about social emotional learning in k to 12 and try to help k to 12 people create responsive learning environments that are uh culturally fair based or supportive and inclusive uh and emotionally supportive for kids uh we we need to do that in college and we don’t and uh so we’re beginning i have a meeting after this meeting with the akm folks to say i need a grant i need them to help me find a grant so that we can begin to do this kind of information sharing and i don’t need the cynical faculty that thinks that the thing that they’re speaking about is the most important thing to get a young person in front of and the only thing that they should hear i need the folks that think i got kids here with me that look like my kids that i’m raising and or i’ve raised and and my job is to help them because five more people in the counseling service isn’t going to work and in your space uh paul barrera who was your medical director is an old friend not an old we’re both we got to learn how to do that differently me and paul but uh but he was a jesuit with me when i when when we were very young right so he and i trained together for eight years uh he’ll tell you if you know him that he was my angel he was my orienter but he’s a local expert in that space and has really taken this seriously he’s a psychiatrist that was the medical director at harvard but he’s done some good work thinking about how do we do this in a different way so we need we need to basically deputize right it’s like you know bad stuff is happening what do you do hire another sheriff while you can’t hire another sheriff you deputize the whole town and you say look everybody make a piece of this and if everybody took a piece of this on things would change things would improve but it’s not going to improve if we don’t do it it needs intention and probably funding so if you know a big huge funder that wants to fund it but we’re looking to do that at income and and bring that forward okay but that’s a that’s a message that the k-12 faculty have gotten but not so much in 25 again i’m telling 25 percent of kids in college have thought about suicide recently that’s some serious stuff that’s some serious stuff yeah i couldn’t agree more nick and um i i have um at least one neighbor on the phone and they they know that we’ve had some tragedy in our neighborhood and you know i’ve thought about things like as simple as what we used to call the neighborhood watch which was watching house out for robbers and i’d love a way of saying it’s not the neighborhood watch about robbers it’s neighborhood watches are you doing okay are you struggling uh at any level and is there any way that we can help as a neighborhood uh because i think we’ve sort of stopped doing that as well for some reason um so uh yeah i love the idea of of deputizing the whole neighborhood i like that and i don’t mean to dumb this down but part of why i wanted to present it the way that i did was to say first of all there is a science to this right these experiments have controlled replicable randomized designs behind them so there’s a science behind this but catherine will tell you the same thing as as i will tell you right you don’t need a phd or an md or an msw or an mph to do this work this is not rocket science right this is accessible human information uh that we could share with each other and we can implement in places where we work and we live and we congregate uh so we can read about this it does not take a long time to get up to speed on what this is about and if you would like to put something together uh that gives us some readings in that space i don’t have them handy but uh we’ll put the samantha’s together and maybe i’ll give you one of my graduate students and we can build a resource page at the hospital for you uh if that could work um but i want to say again you know if your name is virginia uh or alejandro uh you you can do this you do not have to go to graduate school to learn how to do this but if you’re interested in graduate school i happen to know one uh and so we’ll be happy to take you uh if you want to study it seriously all right so good thank you so much i did want to uh just recognize that we do have the director of psychiatry at b.i.d needham on the on the uh line danny mendoza so i didn’t want it so he actually is qualified thank you for joining us so thank you i’m not sure my wife i’m not sure my wife would agree with that but uh that it’s nice to meet you she would agree with that nick thank you so much for that very nice outline uh but but this is in fact a major crisis and and thanks for inviting me to join this forum um i i got called in by john fogerty um probably a couple of years ago to potentially look at starting a consultation liaison service at needham i’ve started services at plymouth and at milton and at that time greg mcsweeney told me that there’s probably one or two patients a week and mostly in a geriatric age because of the nursing homes and i did tell him if you build it they will come so along the way we got caught in this merger with the leahey so i’m involved at the system level as we try to build collaborative care programs in the 85 and growing number of primary care practices across the system but right now with the mice of norwood the population at the needham has changed dramatically and um i think we’re trying to implement as best as we can and and i’m i’m putting things on a table for this group your population has changed dramatically you still have your elderly patient who comes in with a copd exacerbation and devonia who is suddenly using words you’ve never heard or used before that’s a delirium very common we can help with that but you’re also going to see patients with delirium tremens from alcohol withdrawal people with opioid use disorders that we never saw before and um you know i’m also a psycho oncologist at the dana-farber you’re going to see people who not only are dealing with the impact of cancer and cancers cancer treatment but also the impact of being isolated from their families because of the pandemic so there are multiple things that we can do and one of the things i was thinking about is uh we had started a program called preventure in uh for the school system in plymouth and preventure is a an evidence-based practice um that was started by patricia conrod in montreal and it’s been utilized in the uk in australia and new zealand and at this eighth grade seventh and eighth grade level it’s the only evidence-based program that’s endorsed by sam’s that has both a primary and secondary preventive model attached to it so we are into year three and we identify kids that have four risk factors from a personality standpoint and those kids if their parents agree would be enrolled in a cognitive behavioral therapy approach and this has had a profound impact the challenge here is how do we how do how do how do we spread the word how do we scale this uh because i think that’s where we can have the most impact on this population so we we i i’ve not met you and i’m sorry for that though i uh uh i we we can fix that if your wife agrees we can fix that we’ll find a way in it but uh but i i know your school superintendent needham he’s been part of a group of leaders that i’ve worked with for the last uh number of years we’ve got a piece of william james that is teachers21 that’s consulting and and uh and work with school superintendents principals and teachers there’s money there’s funding for things like that uh in the community there’s certainly funding for primary care work or for integrative mental health workers you know very well and you know i’ve got 800 students here uh that need to be in training spaces and so we’ve got opportunities to do something serious if we’re looking and for many years with jeff levine at the beth israel i did your kind of work with consultation liaison work so we’ve got even with me but we’ve got other folks that are smarter than i am that can come and think with you about how we can collaborate i’d be eager to do uh work like that uh and get uh moving uh i can promise your faculty and folks to help you think uh and then maybe we get to uh hersa or samsa both to do training money and also intervention money for uh projects like that and especially projects like that for kids um so uh you know so you’re the sams know how to find me uh and we definitely definitely put you in touch and this is nick so i’m sorry sir i appreciate that nick but i also wanted to reach out to the board members uh uh when i asked patricia conrod what made it so difficult to get this off the ground because we were the first hospital system in the country to start it what she said was it was a pushback from the parents yeah and and and uh stigma stigma right yes the stigma so so um i’m glad that you know the superintendent gary is fantastic and we he decided to put no matter what then we we hit the few landmines along the way um but it’s moving into the third year but wouldn’t it be great if we had a system-wide approach to this from at least a bi standpoint can tell you that bill greenberg had met patricia conroy then was very impressed with her and um so so that’s one thing the other thing is that nick i’m not do you remember john levine yeah so which john levine there was a young woman john levine was a psychologist at the bi for 20 years then went to medical school and is now a psychiatrist he was my student and he’ll tell you the story about when he told me he was going to medical school i took him for a walk and i told him don’t even think about doing that but then he went ahead and did um so i know him i know him very very well he’s a terrific guy and the reason i want to bring that john levine up is john is the medical director of mbhp and the story the back story is that 30 years ago and nick would probably confirm this um the state decided brilliantly that they would carve out behavioral health and have outside agencies manage behavioral health to cut down the cost so we have a cottage industry built over 30 years where there’s a stratification of care depending on your insurance so we’ve gone the opposite way there this is not mental health parity so if you have commercial insurance not a problem easy to get evaluated in the emergency department or in the floors because you can make your own determination i can make the determination that you need more care but if it’s a patient with mass health or is uninsured even if i feel the patient needs to be admitted to the psychiatric unit the emergency service provider would have to come in and see if my opinion matters and this would typically be just a master’s level clinician so what the reason i’m saying is is john levine as direct is interested in a pilot that i’m trying to put together to run the evaluation of all the bi community hospitals as one uh there’s going to be a significant pushback because as you can imagine the emergency service providers will say no because they’re going to lose a lot of money but yes i’m so danny i think i think this is like a really really beautiful big topic and i warned nick that if i asked him to speak today this was just the beginning because this is what you know as chair of advisors now this is what i want people to be thinking about and so i would love to i’m just sensitive to people’s time because we’re running over time but i would love to reconvene this maybe even a smaller passionate group and i think there’s there’s a lot to be done here and i have as a user of some of those services that you just talked about and also as a parent that has witnessed intervention at the school system level where friends of mine have said how dare you suggest that my child has mental health issues you know and the pushback from the parents i’ve seen in person as well i think there’s a lot a lot that we can work on together so i’m excited about that thank you i did being sensitive to everybody’s timing i did want to let people go if they need to although i think that nick are you okay to stick around for a few more minutes for more questions about in about five so i can give us five because i know we have at least one more question i do want to before we lose people just remind everybody of the stronger together virtual gala this year for bi d needham uh it’s on november 7th from 6 to 6 30 pm it’s a great way to get to know the hospital if you don’t know it already if you do it’s a good way to learn and perhaps donate some funding to frontline staff and and our heart heroes fund uh which benefits our frontline workers and uh it’s a great way for other people to uh share and be you don’t even have to get dressed up to and leave the house to see it so if you need more information on that just email samantha either of the samantha’s um and then i know kip you were patiently waiting with a question um there please yeah no sam i just want to thank you you know i am your neighbor and uh lost my son two years ago uh so you know nick i think that this sharing our story is so critical um and there is such stigma and and i feel so passionate um about what you’ve said so thank you and and i think there’s so much room as we do share our stories to transmute the lower energy to higher frequency of you know from hopelessness to hope and joy and appreciation um but it does take a village and i think that my own experience sometimes is that people what to say so they don’t say anything and i just invite all of you if there’s pain in people around you and in their life that you don’t shy away from them and you move towards them and we lean in um and i’m just very appreciative of this dialogue and and it’s actually what the hollister institute’s all about right it’s real conversation so that in business even now we need to lean in the emotions because we’re forced into this emotional management space and there are a lot of leaders that are uncomfortable with it and so we must model it we must model this behavior and be it ourselves so that we can be a shared humanity that’s all i had to say and thank you sam for inviting me yeah so that’s not that’s not and all right so people as they hear of your loss and i’m sorry get touched by that very powerfully and so it’ll it’ll be on people’s minds i mean we yeah uh i i watch my brother come play with basketball with my son and i my heart breaks thinking about miss nicholas and not being there uh and you’re quite right nobody knows what to say because what do you say i mean i do it again the worst nightmare right there are inaugural losses they’re incalculable losses that live with you for all your life and the best you do is you find a place for that right personally and then uh as you can share with others and tell others and make them feel more in a space and if there’s a story that has prevention or intervention or something people could learn and do and you’re not afraid to tell that because of your grief that’s enormously heroic uh kip and it’s what it’s what we can do as a community and my hope i expect there are people who love you that connect back and find some way to just be uh but it’s really it’s really very it’s the hardest i could not imagine it uh when i see my brother i get this one little midlife crisis that i had yeah i can’t imagine um but thank you for bringing yes yes um guys i i gotta go because i’ve got something at ten o’clock i gotta even prepare you just just blame the two sams just say it was the sam’s fault that i played okay some people will let me get away with that this meeting will not let me get away with that i’m gonna so i’m going to blame i’m going to blame danny is what i’m going to do and send him to his wife bella’s wife on him right all right and so uh so thank you all for your attention and your engagement uh i’m happy to come back you guys are not that far i’m now starting to get my orthopedic gear uh in needham and uh you guys are and uh and on time and accessible on and though i miss going to 330 brookline avenue because i did it for 20 years i i’m happy to find needham it’s a much easier place all right thank you folks very much and thank you nick so much does um anybody else want by the way kip if you’re still on that was beautiful i think she dropped off um and um thank you so much this was a wonderful way to start the day and or continue the day and does anybody have any other comments before we before we close thank you so much for being here obviously very important topic i thought it was a great discussion and to be continued have a wonderful day thank you thank you sam
Behavioral health was a pressing issue prior to COVID-19, and the pandemic has multiplied the need for these services. Listen as Dr. Nicholas Covino, President, William James College, will discuss the need in Massachusetts, including the impact of the pandemic, and how we can work as a community to close the gap between need and provision of care.
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