(piano music) - Welcome and thank you for joining us, I'm Dr. Rhonda Herb.

Today, we watched Ken Burns Presents Hiding In Plain Sight: Youth Mental Illness with a live studio audience.

Our goal now is to facilitate an open conversation about the issues surrounding mental illness, especially in our children.

These issues are extraordinarily complex.

The risk factors are daunting.

The economics are bewildering and the politics often contentious.

Public Policy Research and Education can all help, but the most important step, and often the most difficult one, is to start talking about the issue.

To that end, Valley PBS has invited a panel of clinical professionals to discuss and to help us begin to destigmatize mental illness.

(broody music) Today's panel includes Dr. Matthew Tatum, Clinical Psychologist and CEO with Ascend Behavioral Health, Christina Valdez Roup, Executive Director of NAMI, Dr. Jason Christofferson, Clinical Director of Ascend Behavioral Health, Julia Garcia, Supervising Mental Health Clinician with Madera County Behavioral Health, Jason Williams, Executive Director of Brain Wise Solutions, Lesby Castro-Flores, Division Manager with the County of Fresno.

Ken Burns calls his series Hiding In Plain Sight, I like to know if you think that is an apt description, a good title, and why, why would he have chosen such a title?

- I think when you look at individuals who are struggling on a daily basis, many clients that I have come across, say they have a mask, like nobody knows, and it's this mask that they wear.

They take the mask off and they're great in pu- you know, certain situations.

And, but really the mask is there.

Nobody knows that they're actually hiding behind that mask, that mask of pain, that mask of isolation.

And so I think it's an appropriate title for this particular film.

- Thank you, okay.

In terms of a definition of mental health, obviously it's very broad, at one part in this show, they talk about mental health being everything, everything that happens every day, does that seem like a good definition for us to use for mental health?

- I think it is all encompassing, because it involves our thoughts and our feelings and our daily experiences and our relationships, mental health really is all encompassing, in my opinion.

- Okay.

Thank you.

I'd like to talk a little bit about historical comparisons.

I think a lot of us, perhaps who are older, tend to think, "Is this issue new?

Has it suddenly escalated?

What's going on?

We didn't talk about it to the same extent when we were youngsters."

Do you think perhaps we didn't diagnose the problem sufficiently in the past?

What's going on?

Perhaps you could start.

- I believe stigma plays a lot at that.

There's generational issues, as well.

I experienced mental health challenges as an adolescent and did not want, I had no awareness of it.

I didn't have words to use for it.

When I did realize things may be different with me, I didn't feel like I could speak up, because I felt scared and I didn't wanna create any shame for my family, because that's how we saw challenges with our mental health at that time.

And of course, I didn't have those words then.

I think what we're seeing today is movement.

We are seeing changes in stigma.

We still have a lot of work to do around that, but we are normalizing the conversation and acknowledging we have mental health challenges at times in our lives.

What we do when we experience those challenges really define our journey and we can find healthy places of recovery, stories are being told, support is extended, and there are resources available that we are becoming aware of.

We still need more.

We have a lot of work left to do.

- Great.

Thank you.

We'll talk about that.

You wanted to add.

- I will say that culture has a big role in accepting and acknowledging that we have a mental illness.

In the Hispanic community is something that parents and kids are not able to talk about it, because they define it as something else, like, "Nervousness is not depression.

She's nervous."

So in, the cultural background of the family suffer from mental illness.

I think we need to reach out to those communities where mental illness is not necessary, something that you can't talk about openly with the family, because most families will say, "Don't say that," and I'm gonna say the words, and we don't say this words in DBH "Crazy.

They're gonna say you're crazy."

So those are the things that probably will have a youth kind of rethink, "How do we express how they feel?"

So.

- And you wanted to add.

- And I think things are completely different today than they were 40 or 50 years ago, because we have access to other people's homes and other people's lives.

Whereas in the 50s, you knew your neighbors that lived on the either side of you, and maybe a few people in your neighborhood and whoever you went to church with.

Whereas now with social media, it's really a double-edged sword.

Now we can see everything that's going on in everyone's lives in the entire world potentially.

And so whatever we portray, whatever mask we wear on social media, everyone can see that.

So teenagers can compare themselves to teenagers that live in a completely different environment and were, have a completely different life than they're experiencing, and now they can see that.

Whereas before, you turn on the television and you probably saw something very similar to what you were experiencing, like I think of Leave It to Beaver.

- But there's an irony there, because obviously social media gives us the mean to stay connected, and there's even a scene of two girls texting each other seated side by side, texting each other.

And what are they talking about?

Not their relationship, but, "Isn't my phone wonderful?

My whole life is on my phone and I don't know how I would exist without my phone."

So, so how do we address the issue?

We have more means for people, for children to stay connected, and yet they're feeling increasingly disconnected.

What's that all about?

- Well, we have to go back.

We have to go back to, you know, infancy.

All we need is one healthy person in our life, really mentally, physically, emotionally, spiritually, to connect to.

And if we have that one person who helps us regulate the scary stuff, the good stuff, falling off my bike, I develop in my prefrontal cortex with those mirror neurons.

There's nine functions in here, nine functions, that help us in our daily lives.

Those nine functions need this, not this, this, and if I, and so what we're having today with technology is you have immature minds connecting with immature minds, and those immature minds are finding their own path, that doesn't necessarily make it the right path, but they're finding a path.

And there that comparison is very daunting at times to a number of young people.

But if parents are on their device and kids are on their device, there's nothing happening in-between.

And that really is what we need to talk about.

Social media, it's been there.

Technology.

Technology is happening so fast, our brains can't even wrap around the concept of what really technology is about, but that social media, this part here is more important than this part here.

This gives us a sense of belonging and this is searching for.

- Okay.

- Now, it's important to understand that we're not really yet fully understanding how the brain interacts in a social media context.

And there's some key neurological concepts, for example, especially young brains, they can't differentiate very well between reality and fantasy, and so, what you see on social media may be reality, but you're gonna have a much harder time checking that against what is actual reality, and that connection is not gonna ever really be the same as two people who are connecting in real time, in reality, face to face.

And there are parts of the brains that you're not even consciously accessing, that actually fire in tandem with the person that you're engaging with.

That's not gonna happen in a social media landscape, because those, you can't respond to the same stimuli, you can't respond to the person's facial expressions and their tone of voice and their body posture, and all of the other things that cause your brains to kind of sink up.

And so, while that's becoming more common for them to socialize in that context, I think that we're having a harder time helping them understand the difference between what that is versus what real connection is.

- That's such a prevalent problem.

I want to ask, what advice would you have for parents right now who are saying, "my kids are happiest when they're on their devices, how am I supposed to manage that fine line between allowing my children to grow up, but ensuring that they're getting the kind of personal connection that they should be getting at home?"

- I think most addicts are happiest when they're using or at least that's what they believe, and it's a very addicting thing to be on your phone.

- So what do parents do?

- I think that it's our job as parents, not necessarily to make our kids happy, that there's a responsibility that we have as parents to provide a well-rounded context for the development of our children, and if the goal of the parent is to keep their kid happy by keeping them on their phone, they're not necessarily providing them with the best opportunity for the brains to develop.

- Before social media, in all the devices that we have now, available for kids, the kid will go to the parent for information, and that connection was there, because they relied on the parent's information and knowledge, And if the parent didn't have it, they will give this to, the information to somebody else who will help them with that.

So that connection was still with somebody in real time.

But now, anything a kid wants to know, they will go to Google or they will go into their device and they will do their own research, which is not necessarily sometimes accurate information.

So we need to help 'em empower the parents and teach them the importance of connecting with the kids.

And in environmental health, we talk about at least 15 minutes of play every day, 15 minutes of connecting with your toddler or with your child a day.

So don't spend two hours with them on a Friday.

Yes, it's good.

You go, and they spend two hours, but at least 15 minutes every day will help with that connection.

So they don't have to rely on not necessarily accurate information in social media.

- So that's a, I think a thorough discussion of the challenges around media.

They also adressed in the show, however, the challenges that we're facing in terms of societal changes, divorce, increasing cases of abuse, natural disasters, and of course, the recent pandemic.

How do you think those factors are impacting what our children are facing today?

- We go back to, who's helping them regulate in the process.

You know, when your kid was riding a tricycle and they fell off the tricycle, you went up, you told them they were okay.

"You're doing okay," you know, "Rip it off.

You're okay."

Give 'em a little hug, get 'em back on the bike right away.

And then, "Okay, keep going," and your kid's looking, riding the bike, looking back at you, and like, "Am I okay?"

and you're like, "Yeah, you're doing good."

That interaction tells me my world's okay for a kid.

You can have a scary situation occur, "I still need somebody to help me regulate that.

I still need somebody to tell me that I'm okay, that I'm safe in any situation that came, that comes up."

Once we went into a close-down, a shut down, who was regulating the parents?

So, who's regulating whom?

That's the big question, is who's regulating whom?

- When you have parents that are working three jobs and they have three kids, they don't have the time to teach them how to ride a bike.

So then you have COVID, and it just, again, it shows that those parents, a lot of those parents still had to go to work, 'cause they were those... - Essential.

- Essential workers.

So again, those kids that were already struggling with things like poverty, still had, now that's greater divide and their parents still had to go to work, and now they're Zooming on their school by themselves, if they even have WiFi.

- Yeah, and I'm- - Go ahead.

- Excuse me.

I wanna add, it really highlighted the gap in shortage, in the workforce for mental health resources.

We were already short and inadequate and available resources readily available.

With the pandemic, we started seeing more and more conversation about people experiencing mental health challenges, who'd never experienced them really in the past, things were shifting.

They didn't understand how to cope.

They didn't know.

So they were making a reach or they were speaking up and saying, "I do need help.

My children need help.

I'm hearing things I've never heard my children say," and we encourage that.

We encourage anyone who's challenging or experiencing those challenges to speak up.

My concern all along in the work I've done is if we encourage someone to speak up and I'm pretty motivating to get them to do that, what happens when we don't have the resources when they make the reach, but it, the conversation as we heard, it's complex, but we need to keep it going.

- Let's take a minute and talk about identifying the problem.

So, you're all the professionals, I'm sure you deal a lot with parents who come to you and say, "I'm not sure if I should be concerned or not.

I feel like I'm seeing some changes in my child.

Is it just normal puberty?

What's going on here?

He's a little more withdrawn than usual, but I need to give him some space."

How do parents know when to intervene and what steps to take?

- I think that the minute they see that there is something different in their behavior.

Maybe it's nothing.

maybe it's something that is going to resolve on its own.

But what if is just the beginning of something more serious?

So I will say that they need to reach out the minute they feel that there is something different and get assessed, get evaluated, and follow the advice from the professionals.

'Cause we don't know what depression looks like in a child is different from an adult.

Anxiety in a child is different from an adult, and parents might not have the knowledge what that looks like.

So if they have any concern, I will say, reach out to mental health professionals, the resources in the community, and get them assessed.

- And I'll add to that, when making the reach, recognizing the behavior that's changed and identifying the behavior and really pulling that away from the child or the individual, because "I don't like to hear that anything's wrong with me or that I'm bad.

Those were my internal fears already."

But to hear someone acknowledge that "My behavior changed, my appearance changed and that it's different, and that there's help."

There's folks to talk to, to work through that," but also asking that individual, if they're aware of those changes, "Did you, do you feel different?"

because this is what I'm seeing and reminding youth that, that they're not in trouble, that there's nothing wrong with them, is so important, because when our mental health is challenged, we have changed perceptions often about ourselves, we feel shame and guilt and we're afraid to speak up, and to hear that reminder from the people we have safety with is so important.

And that's something that parents can give to their children or a trusted family member that's making that reach, or a trusted friend that's making that reach also.

- I like how you said that, because oftentimes kids are looked upon as, "Well, he's acting out," you know, "He's acting out, well, lemme give you a little thing."

When you play charades, what do you need to do?

You can't talk in charades, so what do you have to do?

You have to act out.

- Yeah.

- You have to act out.

So acting out is another language that kids are doing.

They may not have the verbal language to say "I'm in pain, I'm depressed.

I don't know what this is, but it doesn't feel good.

So I'm gonna act it out."

So having adults recognize that "This acting out isn't like I've seen before, you must be trying to tell me something."

- Yeah, exactly.

- And then asking the question.

- There's a number of, you know, things you can really watch out for.

Earlier we talked about dramatic shifts in behavior, if there's a big change in personality, if you have really big shifts, especially like in academics, if you have big changes in grades or big changes in performance, that are sort of not, don't seem to be connected to other things that are going on.

If there's anything that's been really troubling, you know, losses in the family or things like that, that you can connect it to, then just because you can connect it to something, doesn't necessarily mean that it will resolve on its own, so you may need to seek help in those instances.

Other changes that you'd really be looking for are dramatic shifts in their social structure and in their social relationships.

If they're pulling away from friends, if they're isolating more, if they're spending more time in their room, you know, yeah, teenagers are gonna spend more time in their room, but isolation is not a healthy thing, and is oftentimes a sign that there's something bigger going on.

And there's usually nothing very harmful about going yourself and meeting with a professional, and a professional will be able to ask questions, try to get more information and ascertain whether or not this is more of a developmental thing, or if it sounds like maybe there's need for further assessment of the actual child.

- I think that's a great point.

I think we have normalized checkups for physical health, right?

And if my child has a cough, I want them to get assessed or checked by their pediatrician.

And so in the same way, mental health wellness checks or assessments, as we oftentimes call them, should become a normal part of our daily life.

And as parents, we shouldn't be afraid of taking our child to get assessed, or have a mental health check-up with a clinician, just as much as we're not afraid to have their cough checked out by they pediatrician.

It will give us the education, the knowledge that we need, whether treatment is even needed or not.

- Let's take that a step further, because I remember one of the children saying, "When I heard in my head, when I'm depressed and discouraged, I feel it in my body, I feel physical ailments," which is that very important mind-body connection, which I'm sure is very hard for children to distinguish, probably hard for adults to distinguish.

How important is that?

And you mentioned it, approaching it as a medical issue, what would be a good structure, a good system that would help us do both for children?

- That's a really complex question, because, especially in young people, the primary symptoms are gonna start or are gonna early manifest as somatics or physical symptoms, and so, depression will often manifest itself as boredom, stomach aches, you know, just like poor mood, not feeling well and things like that.

And so, anxiety will typically manifest itself as tummy aches and all of those kinds of physical symptoms.

And the complexity of it is, not necessarily making it sort of like we need two systems, because the systems already work pretty well together.

Medical education has been improving a lot in the last decade in training early, you know, young, early career physicians, how to, you know, do brief screenings for mental health checkups.

Psychologists and counselors are also being trained in a lot of the early signs of medical things, it's very common and it's standard practice.

If you're doing an assessment on a young person, who's having a sudden onset of depression, to also refer them to their pediatrician, to have things like their thyroid checked, and other influences like, "is there been a shift in their diet?"

you know, all of these kinds of things.

And so I think as the training in both those professions continues to come together, then we're gonna be able to manage that much better, as opposed to trying to think about them as these sort of like discrete and disparate things.

- Okay, thank you.

So I think, I think it's time to move into discussing treatment.

I'm sure an awful lot of viewers really want to know, right here, in our Central Valley, in our communities, what resources are available, the range of resources, we talk of course about clinical opportunities, but also school and church.

I think almost, I'd like everybody here to address that question.

So maybe Ascend could start for us.

- Sure.

So Ascend offers a wide range of services in order to try to fill what I consider to be a gap between inpatient hospitalization and outpatient therapy, once a week meeting with a counselor, a therapist.

For a long time, at least in the private sector, so people that have commercial insurance, usually through an employer, there's been no levels of care available in Fresno for kids that are suffering with moderate to severe mental health conditions.

They kind of try to hold it together in outpatient therapy, and then they get into crisis, and then they end up in a inpatient unit for a short stabilization.

And oftentimes they haven't been able to receive the services that they need in a rehabilitative way, right?

And so focusing on treatment multiple times a week, or for multiple hours per day, sort of a program, in order to help them get back to a healthy level of functioning.

So Ascend offers those different levels of care.

So some of our kids that are kind of struggling at the more severe into the spectrum or with a six hours a day, five days a week, and then they kind of work themselves down, as they develop the coping skills and develop the internal and family support resources that they need to kind of go back to their individual therapists or, or their lives outside of treatment.

- Okay.

All right.

Let's hear from Madera and Fresno County.

- Well, for Madera, we're a small community, but we have outlined clinics.

And so for us, our children's unit in Madera, we do the zero to five, plus as well as the children's outpatient, we provide tremendous amount of support to the youth, as well as the families.

We have an education group for our families, called a Parent Orientation Group, to help them understand what treatment is going to look like for their child.

They have any questions about what that might mean, what, what if your, your child is, what if you would like medication for your child?

So we have that orientation group for parents.

We feel that it assists parents in understanding what their treatment might look like.

Also, if their child might go into crisis, what that would look like, the support they would need around that.

And so, having that parent orientation group is really helpful for parents to understand that pace.

- Okay.

- In Fresno County Children's Mental Health, we have contracts with a lot of our partners in the community and, and our vendors for zero to five, we have EPU, we have Fresno County Superintendent of Schools, seeing all the children in all the school districts in Fresno county.

And they see the kids in the school and they provide all the services for all levels of care.

So we have a lot of services available in the community.

We are also not only clinic-based, we go into the schools and also into the community to provide the services, from assessment to treatment and everything in-between.

- Okay.

Anything you wanna add?

- So at Brain Wise Solutions, we actually really focus on prevention.

So we want to get ahead of, hopefully, kids and families won't need all of these other services that are vitally important, by helping parents understand that relationships are the foundation of mental health, mental health versus mental health disorders.

So we really, we created a curriculum, called Food for Thought, because one of the main things is help popping parents model behavior for their kid.

"I think I need help, so I'm going to go to Adult Services, because I need some help, too.

And maybe Johnny, you should think about going in and getting an assessment too.

Maybe as a family, we need to go and get some of this stuff worked out," 'cause that's gonna be showing the kids that it's okay to ask for help and to get help and to change.

- Christina, I know you're not a provider, but how do you fit into the spectrum?

- That's a great question.

We actually compliment everything that the providers are doing.

NAMI's been around for a little over 40 years.

We were created by family members and peers, for family members and peers.

And often, a family will be in a situation helping their child get help, and they'll say, "Well, you have services, direct services for my children, but what about us, as the parents?"

And that's where we really can bring some value, providing education for them, providing safe support groups, letting them lean on another family, who's walking this journey, because we deliver everything to the community from a lived experience perspective.

So we walk this journey as peers who are finding healthy places of recovery, we've been involved in the mental health system of care, in some way, or we have a family member lens, we're navigating with our family member, whether they be young or adult, helping them navigate through the journey of living with mental health challenges, getting care at various levels, and often that lens is both, it's an individual, as we talk about parents needing to do work as well, family members often need to seek that work for themselves to get the care they need, so they can be in a healthy place of recovery, but really, modeling what that journey looks like.

And then from an advocacy perspective, we're advocating for systemic change in the mental health system of care, so that there are adequate resources available, the barriers are removed to getting the care that they actually need, and that we reduce stigma.

We have funding available to have programs in our communities that meet the needs, and eliminating those disparities that we're so very aware of, and lean on someone, because you do matter, and you deserve that.

- Thank you.

- Thank you.

I wanna thank everybody for watching today.

I hope that you are able to take away some wisdom and knowledge from our great panelists who came down, gave up a big portion of their day to share expertise, knowledge, training and experience with all of us.

I wanna thank our studio audience, you also came down and sat here, shared some very personal stories about issues that you were familiar with.

And everyone watching, we know that this is a universal problem, and we are so glad to have started the conversation.

Keep it going.

Thank you.

(broody music)