Worldwide, it looks like we're in the middle of a mental health crisis.

So my big question for you is what can be done about this?

I'm Insoo Hyun, a bioethicist and philosopher and Director of Life Sciences at the Museum of Science.

My guest is Dr.

Rebecca Brendel, president of the American Psychiatric Association and associate professor at Harvard Medical School.

Today we chat about the worldwide mental health crisis and some of the myths and facts around psychiatry.

So, Becca, thank you for joining us today.

You have so many different titles.

I want to just focus on your latest one, which is you are the current president of the American Psychiatric Association, the APA.

And it's in that context that I want to chat with you.

I have so many questions.

What do you think are some of the misconceptions people have about psychiatry?

What are like some of the myths around that?

Well, we could almost start that question with what aren't the myths about psychiatrists?

I sometimes think that the New Yorker wouldn't be able to fill their cartoons spaces if we didn't have psychiatrist jokes and humor.

But in all seriousness, you know, the the real misconception is that psychiatrists have tools or medications that cause mind control or alter people's personalities or who they are.

And in reality, psychiatrists are like other doctors who really want to help people be well.

And that means different things to different people when we're talking about managing symptoms that affect the very nature of how we experience ourselves in the world, our thoughts, our behaviors and our thinking.

Yeah, I think maybe some of the fear or anxiety around psychiatry may have to do with some of the history of psychiatry.

I think some people have seen movies like One Flew Over the Cuckoo's Nest, right?

Where, getting back to this idea of mind control, a kind of, somehow, psychiatrist changing who you are, you know, in some deep sense.

Is there actual history where some of these concerns are really legitimate, like, you know, decades ago was that actually how psychiatrists practiced, like with actual procedures on the brain that would maybe change your personality?

Yeah, you know, like so many things in society, as we learn and we've come forward, and you're really the expert in this, in thinking about the ethics of our science, is around how we we can now have more humane treatments.

We now understand mental illness as something that happens at the neurochemical and biological level of the brain, even though we still have big questions about exactly how that happens.

And there was a susceptibility of anything that has to do with people's thoughts to have political misuse, to think about behaviors that society shunned and in some ways to politically misuse psychiatry as an instrument of of power.

So there's no question that psychiatry has a dark history in a number of domains that we really need to learn from all the way to reinforcing erroneous beliefs about slavery, to pathologizing, making a diagnosis of, homosexuality.

Psychiatry really has to contend with that dark past in order to understand its future without question.

As you and I know, there are some pretty big differences internationally, culturally, about people's attitudes about homosexuality.

So from the American Association's point of view, I mean, what sort of went into that, the rehabilitation of kind of the psychiatry approach to homosexuality?

It used to be very stigmatized, used to be kind of pathologized.

What sort of led to a reframing of homosexuality as not a disease, but a legitimate way of life?

I'm curious about, you know, sort of these changes, like were they cultural?

Was that based on research?

What went into this evolution or this progress in psychiatry?

Well, there's no question that the the era of brain research has helped us think more clearly about psychiatric diagnosis.

But really, you know, in terms of removing the diagnosis of homosexuality from DSM, it came from within and pressure from without.

So I think society was progressing.

But a psychiatrist by the name of John Fryer — we now have a Fryer lecture at our meetings and we just had the 50th anniversary of his coming in with a mask, anonymous, and really challenging his colleagues in psychiatry to say that you're stigmatizing people and you have no scientific basis for this.

And so really it's been a model for holding ourselves accountable to the kinds of judgments and diagnoses that we make and really looking to make sure that they're based in our best research and our best knowledge.

You know, I've heard some people say, you know what, there's no such thing as mental illness, they█re just differences.

And, you know, these are just like drug companies that want to make money by pathologizing certain differences, you know, across the human population.

And how do we know when something is a mental illness or a disorder?

And something is just kind of a variation of just neurodiversity or human life?

Like, how would you make that distinction?

Well, you've put your finger on what makes psychiatry such an amazing profession and has captivated mine and my colleagues interest for such a long time.

Because really what we have to think about is when do we have functional impairment?

When are — we all know people who are wildly creative and march to the beat of their own drummer and take things in new directions, and that's amazing.

So we certainly wouldn't want to stifle that.

On the other hand, when those, when that wild creativity and not needing very much sleep is getting in the way of safety and leading people to think in ways that are not reality based or leading to damaging relationships or the ability to function, that's when we really have to start thinking maybe there's something more going on.

And where do we find that balance between individuality and being healthy?

So what I find when I feel burnt out is I really need to spend some time with friends and reconnect.

So even coming to a place like this and sitting down and chatting with somebody over coffee, you know, even the word companionship, companion, means to split bread or share bread, break bread with a friend, with somebody.

So this idea of just sitting down, taking some time, sharing a cup of coffee, breaking bread, I think are all pretty effective ways that people can combat the feeling of feeling burnt out.

So I think people feel safer talking about burnout.

Like I would feel safer telling my friends I'm really feeling burnt out this week, you know, I can't help you with this or that.

And I think that's actually a nice opportunity to open up the conversation around mental health in a safe way.

So rather than saying I'm in a crisis, I need help, you can just more safely say, I'm burnt out, folks.

We really need to think about the words we use and the effects they have on us and on others.

And in reality, our mental wellness is something we should always be thinking about.

And burnout really puts it in a frame that we can do something about.

Being burnt out might mean I'm doing too much or it might mean I have too much pressure on me and I need to ask others to jump in.

And we see also how important the structures are that we've set up in society.

So, it was so great to work at home in the beginning, you could throw in a load of laundry, you could walk the dog, you could get things done.

But it also meant that we didn't have a separation with the commute.

And so we were finding ourselves doing one more email that turned out to be eight or nine or 10:00 at night.

So all those things are just really important to our wellbeing.

A lot of people think about mental health as simply like a pathological state, like it's really severe.

You don't have the mental health issue until you need medication or until you have like schizophrenia or something dramatic.

But I think mental health could also be like the everyday things, right?

Everyday things of self-care.

I really like that, that pivot of talking about mental health as like normal aspects of everyday health.

You know, you take care of your body, you try to eat a good diet and you should also do other things to take care of your mental wellbeing.

I mean, mental health for me is just health.

You know, do you think that that's something that we can, again, try to elevate in messaging?

Really thinking about mental health as part of our overall wellness, as that when we check in with ourselves and think about how we're feeling, we also take a minute to say, “What's on my mind?” and “Am I sleeping well?

Am I blue?

Are there things that are really causing a lot of anxiety that I can do something about?” And we know that the same things that are good for physical health are good for mental health.

Exercise, eating well, sleeping well, all those things matter so much.

And the really simple basics of of life, there's nothing special about them for mental health.

It's just about our overall well-being.

Everybody feels sad at some point, everybody feels down, pretty blue.

And then it gets, for some people, it gets really debilitating.

So how do you know when someone has got depression and needs medication and anti-depressants and somebody is just having a rotten week, a rotten year or just are under a lot of stress?

You know, it's got to be a continuum, right?

And how do you make some of these important distinctions?

Well, it's definitely a continuum and some of the ways that we do that is by really measuring and using measurement based diagnosis, care and treatment.

So if something bad happens, right, it's actually normal.

It's expected that we're going to have a reaction to it.

If we think all the way back to when we were hunters and gatherers, having those kinds of reactions, well, that kept us away from danger and kept us alive.

Similarly, when we have a loss, right, we know that we are social beings and we're relationship driven.

And so losses do affect us.

So really seeing how those symptoms and those feelings play out over the period of days and weeks and months, how persistent are they?

How much are they changing the way we live our lives or leading us away from the things in which we find meaning and value?

It's really that line to keep an eye on.

And psychiatric treatment, one of the biggest myths is that it changes who you are.

It changes the way you think.

And those of us who really pay attention to our thinking and our moods and our feelings may notice changes, but it's much more subtle, generally, than something so marked.

So it's not really a change in personality, but really recalibration and bringing us back into a balance, into our whole selves.

So when somebody takes an antidepressant, how does that actually work?

Like what goes on when they take that?

Right.

So there are a lot of different antidepressants with different mechanisms of action.

But really what antidepressants do is work on neurotransmitters, so the chemicals in our brain, to rebalance the relative levels.

So that's all pretty nonspecific.

But the main thing, the most — some of the most commonly prescribed medications in the US are antidepressants, people may have heard of them, serotonin specific medications.

And what they do is they raise the level of a neurotransmitter, serotonin, in the brain.

And we know that serotonin has been strongly associated with depression.

We've seen this, for example, in looking at people's cerebrospinal fluid to measure levels within the brain and also looking at other specific findings.

So that's one of the main ways.

There are other neurotransmitters that we know are involved in depression, certainly, norepinephrine, certainly dopamine, but the real underlying mechanism generally starts with treatment in the serotonin spectrum and then might move on if people aren't responding.

Yeah, that can be some people who have like a lifelong struggle with depression, they might grow up to kind of think, well, they're kind of like the Eeyore of the human race, you know, sort of like this kind of part of who they are.

And then they take antidepressants.

And it really, it really does change their experience.

And someone might wonder, well, who is the real me?

Who's the authentic self?

Was it the one that's always been an Eeyore or is it now Tigger, or something that's not Eeyore?

And I'm really fascinated by that.

Kind of like, how do you identify who the authentic person is?

Is it the person on medication or not on it?

That's such a big question, right, in terms of thinking about treatment in the mental health range.

But I would also say back to you, there's a tendency to think, oh, these medications are changing my brain.

There are also situations in which people seek psychotherapies and long term psychotherapies.

And coming out of that, what we see is an ability to see the world differently or engage in the world differently.

And rather than seeing that as mind control, people often say, well, this is insight or this is psychological growth.

And so really just step away from the judgments that this is changing me in a bad way to the real possibility of treatment across mental health disciplines, that we can actually change the ways in which we interact in the world to make our lives more positive.

And so that goes across a continuum to getting some help, being stuck in a particular situation or around a particular life event, a breakup, a loss, a death, something happening at work or in or in a relationship or family changes all the way to, “Wow.

These symptoms have actually stopped me from living my life and I need to get help for that.” And I think being open-minded to the notion that we can change our brains and we can change the ways that we interact with ourselves and with the world is what makes the mental health professions broadly so interesting to be part of and so useful to people as we go through the life span.

So tell me if you agree with this, with this observation, it looks like at this point in time we have more treatments than we've ever had.

We have more awareness than we've ever had.

It could always be better, but it's pretty good, right?

More, more education.

And yet it looks like mental health is getting like, worse and worse for people around the world.

It's kind of a strange paradox and it's like we're as well-equipped as we have ever been.

And the problem is really bad worldwide.

It looks like we're in the middle of a mental health crisis.

So my big question for you is what can be done about this?

Well, there's no question that the need for mental health treatment is higher than we've ever known it to be.

Part of that is coming out of this global pandemic when all the kinds of things we've built up to keep ourselves healthy and functioning as bio-psycho-social creatures, people who have complex science behind us, who live in embedded relationships and social structures, there's a reason why some of these, why institutions like schools and community organizations and and faith-based organizations and religion have held people together for so long, because they help keep us healthy and they help keep us connected to other people.

So we've lost critical senses of connection.

And when that happened, we really struggled.

So that's certainly one one part of it.

Another part of it is that we've really never invested in a mental health or a public mental health infrastructure that for the past at least 50 years we've known is necessary and we really haven't trained an adequate workforce to address people's needs.

One silver lining, though, of where we are is that we're talking about mental illness.

You and I are here talking about it today.

You had this wonderful exhibit at the museum.

Our lawmakers are aware, the media is putting out good information.

And so that's really the first step in being able to build up the resources that we need.

So back to, let me turn the tables a little bit and ask you as a person, I mean, what are you anxious about?

What keeps you up at night?

What are the things that you sometimes have to struggle with?

Well, another way of asking that question is what am I not anxious about?

So in scientific terms, I often like to say that environment and genetics matter.

But either way, I'm a highly methylated person, so I get anxious about a lot of things.

I worry about my kids, I worry about work, I worry about my parents.

I'm in that generation now where one really doesn't know where the phone call is going to come and really worry about where we're going in psychiatry and in medicine and as a society and taking care of each other and becoming well again as whole people after a really, really difficult period of years that things broke down tremendously.

So tell me a little bit more about your training.

What really stands out in your mind about your training background?

Historically, one of the things that you do when you become a psychiatrist is have the experience of being in treatment yourself, in talk therapy and really understanding how much therapy and professional help can be helpful, even when we think we're doing pretty well in life.

And so that's something that I work on talking about openly with people who come to me for help if they ask, and something [I am] very open about in my life.

It wasn't easy for me to enter into psychotherapy.

And that's something I did because it was all but required when I was training in psychiatry.

So that hesitance or worrying that somebody might find something even more wrong with you than you already knew about yourself can be really frightening.

Reaching out to talk about that can really help us get better.

So we just said that it looks like there's greater awareness around mental health.

People are much more willing to talk about it, but it seems like access has not really been there to support that level of interest.

Is there a shortage of mental health professionals in the country?

How bad is that shortage?

What can we do about that?

We have a serious shortage of mental health professionals in the country for sure.

We are energized by government recognition of that.

So Congress recently, in year-end appropriations in 2022, added 200 medical training slots.

100 of those are going to psychiatry and and psychiatric subspecialties a year.

So that will help, but that will take a long time to build up.

And we know that innovation like telemedicine that became much more commonplace and as well as some changes in the laws that allowed people to access telehealth more easily also improved access.

And we've also had a rollout nationally now of 988, which is a mental health crisis line with a plan to really embed crisis response with community-based treatment in every community across the country.

But we're not there yet.

And if we keep thinking about models where one psychiatrist or mental health professional sees one patient at a time in a clinic then we're never going to meet that need.

And so the ways that we really need to go, going forward, are thinking about innovative models that bring mental health into every place that we live and we spend our time, as well as into primary care and pediatrics practices in particular.

There seems to be a big spike in homelessness all across the country.

What's the connection between that and mental illness?

There is a link between mental illness and homelessness, especially people with serious mental illness.

When we don't have the resources to support people and to have community-based treatment, it's very, very hard and it can lead to homelessness.

So there is a disproportionate amount of mental illness and also substance use amongst people who are homeless.

How we address that problem is not simple.

And what the research and experience is showing us is that we really have to use all members of a mental health team and also social outreach and support in order to help people with mental illness become healthy and live lives that are that are stable and safe.

You know, there seems to be a great need for students in public schools, students in school, to get good mental health care.

And my experience has been that there's usually like one person available for hundreds of students, and that's just not going to happen.

What do you think would be a more reasonable path forward for, maybe, at that point of contact because kids spend so much time at school?

Is that a promising site for some mental health support?

Well, there's a lot of evidence that intervening at the school-based level is really helpful for kids.

The American Psychiatric Association Foundation has a program called Notice Talk Act, which really trains trainers within school systems to recognize what some of the signs are of kids who are struggling, school-age youth who may need some additional intervention, and then bring them to the attention of those within the school system who can help and can help make connections to care.

Really thinking about also school based programs that are skills-based, that can teach skills of how to manage distress, how to manage anxiety, can be extremely helpful.

And we continue to study these interventions and to learn about them.

But that's one place because kids spend so much time in school, that really being able to intervene is high yield.

So sometimes parents may realize that their child needs some sort of mental health support and that can be kind of a scary time.

They can kind of like be overwhelmed and not know what to do next.

So if you're a parent in that kind of situation, what should you do and what should you kind of expect?

How do you navigate, you know, next steps?

Well, as a parent, it's most important to think about what resources are available and also to know your kid, right?

So to know the people who they might trust or what they might be open to doing, so resources in school can be helpful as well as really starting with a pediatrician and making sure that there's no health reason for a child to be all of a sudden having a change in the way that they're feeling or acting, but really asking for help wherever it comes.

Reaching out to trusted adults in faith-based communities can be incredibly helpful and can be a place where people may feel safe and be able to talk about what's going on within a community that has felt supportive and nurturing.

For others, that doesn't resonate.

So there's no one answer except to say that we really, altogether, going forward, will benefit by finding the places that we can not only promote wellness, but seek help when we know that something's not right.

So life's changed a lot since you and I were youngsters.

You know, we didn't have social media back in the day.

We had other pressures, other things going on.

But these days, you know, the younger folks are really dealing quite a bit with a vastly different world.

There's social media all over the place, not just for kids, but for adults.

Now, what are your thoughts about social media and mental health?

Do you think it's overall a good thing or a bad thing for mental health?

I know that a lot of parents feel very strongly about social media and exposing their kids to it.

Curious to know what you think.

Well, there's so many different ways to think about social media in our lives and the lives of our young people.

I'd say the first thing that people found was early on in the pandemic, when all of a sudden our social embeddedness and relations and our institutions abruptly shut down, most Americans found social media something that was really helpful to stay connected.

That being said, like with almost anything in life, too much of a good thing, right, can cause problems.

And so there are a couple in particular aspects of social media that can be particularly challenging for young people.

One is that really having an understanding that people can portray themselves any way they wish to on social media that may be true or not be true, that it always hurt when we were growing up and part of becoming an adult was dealing with negative interactions and difficult situations.

But those can be spread at the press of a button to so many people.

So experiencing life is so public and so exposing.

We've seen that a lot of young people in particular and adults too, really struggle with that.

And then really driving home the message that the kinds of social growth in relationships happen, like we're sitting here today, with the back and forth, and that on social media, nobody's really checking the information in real time.

There's no way to be sure it's true and to really not substitute social interactions in person with feedback, with this one way, a very, very contrived way of presenting information.

Yeah, I mean, so much of human communication is body language and reading one another and playing off of that, and you don't have that in social media.

The other thing I find fascinating about social media is when I was growing up, it was very rare to ever see like footage of myself, you know, video footage, very rare.

But now people grew up with that and have so many parts of their life documented, put out there on display.

Could be harmful, you would think, because we always make mistakes when we█re young and even now, and just to have it out there on the Internet, it could be to be harmful, I think, in that way as well.

Right, and what is the fundamental trust that happens in social relationships?

It used to be when we were growing up that people might describe it, but nobody could see it live.

And now we don't even know who's taping us and what we're doing.

So it's just a huge amount of pressure.

With my own kids, I tell them that growing up is about learning, so we want to try to make our best choices, but the, you know, the sign of who we are and who we're going to become has to do with how we deal with the inevitable times that we wish we might have acted differently and to just embrace them and learn from them.

But it's really tough and it█s really painful in the moment.

You know, as you know, for the past several years, there's been so much attention paid on like school shootings by teenagers against their peers.

And I can imagine some parents might really feel sort of frightened about both the safety of their own kids, but also, you know, the well-being of their own kid who they think might possibly lash out.

I heard you say on some occasions it's really important to separate out gun violence from mental health because a lot of times people will respond, politicians will respond, “So, you know what, the problem is not guns, it█s just mental health.

These kids don't have good mental health, or those who commit acts of violence using guns don't have good mental health.

It█s a mental health issue.” Can you unpack that a little bit?

You know, why is it, you know, problematic to make that conflation?

Well, mental illness is actually quite common and acts of mass violence, especially school shootings, are relatively infrequent events, even though a single event is too common, right, we shouldn't have any of it.

The evidence really points to the fact that individuals with mental illness are more likely to be the victims of violent crime than to commit those crimes themselves.

But that doesn't mean that we don't have factors that add up to a climate that seems more violent and is more violent in terms of the number of shootings.

The number one risk factor, though, for an act of firearm violence is the presence of presence of a firearm.

That's true in public spaces.

That's true in our homes.

And the best and most convincing argument that has become apparent to me is how similar we are to our neighbors up north in Canada.

But we have more firearms than people in this country, and Canada has a much, much lower rate of firearm possession.

And very similar rates of mental illness.

So when we compare the two countries, while there are incidences of mass violence in Canada, they're much less frequent than here.

And it just really highlights a take-home point that it's the presence of a firearm that's the biggest risk factor.

What do you wish that our legislators and our political leaders would know about mental health?

It seems like that's a population of individuals that tends to sort of not really quite understand the realities of mental health.

What would you want them to know if you could shake them and say, “Look, get it straight.

Here are the facts”?

Well, the overwhelming likelihood is that every day each of us interacts with multiple people who have or at some point in their life will have some episode of a mental illness.

We know, for example, depression is quite common, anxiety is quite common.

Having a response to a traumatic event is quite common over the course of of a lifetime.

If we add that all up, mental illness is just like physical illness, it's coming from our brains and it's something that's really treatable.

And so everything we do that stigmatizes mental illness makes it harder for all of us to live our healthiest lives.

You know, I grew up in a Korean-American community, and it seems like there's higher rates of stigma around mental health for some ethnic, cultural groups.

What do you think we should try to do about that?

I mean, people in the Korean-American community don't want to acknowledge that their children are having mental health issues.

They don't want to acknowledge that their loved ones are struggling.

It's very kind of frowned upon still.

Yeah, I wonder, you know, what do we do about that?

Well, I really want to ask you what psychiatrists should know about how to engage culture and how to most effectively reach out into different communities.

A part, you know, part of what we can do, right, is really developing a diverse workforce so that we know that people of ethno-racial, minoritized backgrounds are more likely to feel comfortable with health care providers who are of a similar background.

Yeah, so one is is really educating and diversifying our workforce.

And then the other is to think about culturally-informed ways of having conversations without having to put a diagnosis on it that can be very stigmatizing, right?

So to say, if we look around, we see every day, kids are struggling, people are struggling, right?

There is uncertainty in the economy.

Many Americans feel that they're going to have more stress in 2023 than 2022 based on polls and surveys that we've done.

So really normalizing the conversation that we should expect that we're going to have certain stresses, that we can manage them and develop tools for that.

And then if those simple things aren't working, that there is help, rather than stigmatizing with names and diagnoses, really having a conversation rather than a naming or a shaming.

Yeah, all of that's ringing very true for me because I think I can only speak to the Korean-American experience.

But in the Korean-American experience, my take is that there's a tremendous amount of family pride.

So to admit any kind of shortcoming is socially already sort of — there's a lot of social force against any kind of claim of either struggling in school academically, financially, any kind of struggle, is sort of not viewed as something you ever want to get out of the family and have other people know about.

There's a very strong connection to the church, typically.

And I don't think that, you know, a lot of older Korean-Americans feel comfortable, like seeking help for their loved one or for themselves, where that involves going outside to kind of the white community and asking for help, because that's almost like saying we're not fitting in, we're not flourishing.

And so it's kind of like this, like prideful, not wanting to admit that something's wrong.

So I think the idea of having a more diverse workforce where there's actually a Korean-American therapist you could talk to who understands that culture or even like enabling and empowering church leaders in the community to point people in the right direction so that it kind of like gives them permission to sort of do that, could probably go a long way.

But I think that there's statistically a very low percentage of mental health professionals from Asian communities, African-American and Latino [communities].

Is that correct?

I mean, it's a pretty low percentage.

Well, I would say that our workforce is becoming more diverse, but we are definitely looking at places in our workforce where we don't have enough psychiatrists to respond, both to support each other in our work within ethno-racial communities, as well as to take care of the patients who we serve.

And so that's really something that APA has been looking at and how can we measure and do it effectively, and really working within medicine more broadly to make sure that we have that.

You know, to your point about about working with faith leaders, that's something also that the APA Foundation has been working to advance.

How can we, knowing that in many communities that individuals are going to go to their pastor or their faith leader long before they would ever call a psychiatrist or a mental health professional, how do we provide resources and connections to transfer the trust from whoever it is who's trusted within the community to somebody who — out to a professional who can be helpful within the medical system or the mental health system?

So that's really been something that we've heard so much that we've been convening faith leaders from across the country to work on.

So there is greater awareness, especially amongst the younger generation, with celebrities coming out and talking about their struggles and Olympians who've been doing that, right?

Well, what about the older generations?

You know, the old-timers, the folks who kind of grew up during that period of time where you got to just kind of tough it out?

They could probably be a little bit hard to reach if they need mental health care, they may not seek, they might not even know that they have an issue that that is treatable.

How would you reach out to populations like that?

Well, it's so important to be reaching out to older adults because we know that older adults are at an increased risk of of suicide and of mental illness, especially mood disorders and changes in their thinking.

So one of the ways that we can make mental health accessible and increase awareness for all people is to do universal screening.

So we know that with two very basic questions, we can do some pretty good screening for depression in particular, and that also enters some of the common symptoms into every medical visit.

And just into our awareness about- What are those questions?

Yeah, so the questions really are, “Are you feeling down over the past two weeks?

Have you been feeling down, depressed or hopeless?” And really reading that from not at all to nearly every day or every day.

And the other one is about losing interest in the things that we used to enjoy.

And really screening in for those two questions can lead us to ask some additional questions about appetite, sleep, energy level feeling slowed down or or changes in our energy and other interests.

And that really does a pretty good screening as a first start.

We can also, with people who perhaps say, you know, “Doc, I'm okay.

I've gotten through however many years of my life and I'll figure this one out too,” to really track those symptoms over time, to be able to continue the conversation and sometimes finding what's most distressing.

Often sleep, “If I can just get a good night's sleep, everything would be okay.” Finding what matters to an individual as a way of starting a conversation or initiating.

Those two screening questions sound like they could be questions that family members can ask just to check in with Dad or Mom.

Would you recommend that?

Would you recommend that?

Like, you know, I guess the question is, what do you do with it once you get a response?

But those are the kind of questions I think, that kind of might naturally come up in a family conversation.

Do you think family members should be asking these kinds of things?

Well, family members can certainly ask questions as a way of starting the conversation.

And the most important thing is just to start talking.

Once we start talking, then we can develop awareness.

We can reach out for more help if things seem serious.

And just keeping tabs on each other, even within families like, you know, “Gee, mom, I notice that you haven't been going to your book group or you haven't been going out much or things seem to be pretty tiring or you've lost weight or aren't eating,” anything we can do to be aware of each other and connected and notice is a potential opening to a conversation about making our lives as healthy, happy and productive as possible.

So you do a lot of travel and you're very observant.

What have you seen as you've kind of gone around the country in your role?

What I've seen around the country and around the world is that people are more alike than they are different.

And one of the things that's really affected all of us is the ways in which the traditions, the togetherness, the relationships that we've spent millennia building up to sustain us as social beings were stripped away overnight.

And so how we think about coming back together to support our well-being, to advance our lives, and to flourish all of that, we have to give a lot of attention to.

There's very little difference, really, from place to place.

Some places have it easier.

It's certainly easier to build things up when we have more resources, but we're all struggling with the same challenges.

So you talked about the evolution of a lot of psychiatry, how you view issues, where is it going next?

Like where, where do you think that trajectory is leading the profession?

You know, coming back to where psychiatry goes with all of this, we often think within the medical community, a psychiatrist is the go-to person.

But it turns out that only about a single digit, probably in the realm of about 6% of the mental health workforce are psychiatrists.

And so we already know that effective mental health treatment involves working in teams and interdisciplinary teams.

And I think where psychiatry really needs to go is to figure out how to find synergy in the interdisciplinary backgrounds, training and experience of different members of teams and really expand the medical expertise as far and wide as possible, generating knowledge using research, measurement-based care to understand what's working, but in particular what is low-value care, what's actually not working, and how are we not helping people with the time that we spend knowing that we have seriously limited resources.

So what drew you to psychiatry?

Well, I remember sitting in a lecture hall during my preclinical years in medical school and being completely fascinated by this idea that something could be going on in your brain, regardless of your background, where you grew up, where you lived, that could actually cause you to have similar kinds of thoughts.

It was so intriguing to me.

Like you, I studied philosophy early on as an undergraduate, right?

And so when I went to medical school, it was this place where these big questions about how we define ourselves and our identities really just coalesced for me.

I think that that really had me hooked.

And then thinking about all the potential for ethical thought about around these issues and then how we translate that into our policies and our laws.

And I was sold.

What do you think are the key characteristics of a great psychiatrist?

So there was once this study that was done that all the great teachers of psychiatrists tell, which is that when you ask patients how much their psychiatrists talk in a session, and you ask a psychiatrist how much they, the psychiatrist relative to the patient, talks in a session, the psychiatrist will tell you, all they do is listen and the patient will tell you that all the psychiatrist does is talk.

So I think really being a listener, being present and understanding the patient's experience through their own eyes makes a great psychiatrist first and foremost, because in order to come up with a treatment about something that's so personal and so core to our identity as humans, it has to be about the person who's going through that experience.

And finally, what do you hope to accomplish as the president of the APA?

What I really hope to do this year as president of the APA has been to work around a plan for the future and coming up with a roadmap for how psychiatry as a profession can advance and how we can be part of the solution going forward, not just today, but a decade and 20 years from now in leading to, mentally and physically, but in particular mentally, a healthier nation and world.

Well, thank you so much for joining us.

It is a big responsibility and I'm sure a big honor to be president of the APA.

I really enjoyed your insights today.

Thank you.

Thank you so much.

This was a great conversation.

And thanks for all the amazing work you're doing on mental health.