♪ ♪ This program is brought to you by the members of WCNY.

Thank you.

♪.

♪.

JOHN KATKO: Welcome, America, to "Balancing Act,' the show that aims to tame the political circus of two-party politics.

I'm John Katko.

This week, the mental health crisis in America, and what can be done about it?

We'll ask our center ring guest, Jessica Schleider, associate professor of Medical Social Sciences at Northwestern University.

On the trapeze, we're joined by Congressman Don Beyer and Tony Gonzales to discuss the crisis and the bipartisan approach toward solutions.

Plus, you'll hear my take, and Bloomberg's Laura Davison with what's happening next week in Washington.

But first, let's walk the tightrope.

♪ ♪ The mental health problem in America impacts all of us.

The Centers for Disease Control reports that more than one in five American adults lives with a mental health condition, making it a public health crisis.

We can discuss this today, but that wasn't always the case.

In America's early days, mental health was viewed as a moral or spiritual disgrace.

People with mental illness were often placed in poorhouses or jails, not hospitals or treatment facilities.

Care was minimal, and the shame could be overwhelming.

In the 1840s, activist Dorothea Dix traveled the country, documenting inhumane conditions faced by people with mental illness.

Her work led states to build the first generation of public psychiatric hospitals, a major, if indeed imperfect, step toward more humane care.

By the mid-20th century, however, those large institutions were overcrowded and underfunded.

By the 1950s, a third or more of all psychiatric patients in America lived in state institutions, many receiving inadequate treatment.

In 1963, President John F. Kennedy signed the Community Health Act, calling mental health one of America's most urgent health needs.

The law pushed care away from massive institutions and toward community-based treatment.

Sadly, much of the funding needed never materialized.

Then came one of the most influential voices in reducing the stigma associated with mental illness: First Lady Betty Ford.

In 1978, she bravely acknowledged her struggle with alcoholism and prescription drug addiction.

Her candor reframed addiction as a medical condition and not a moral failure.

The founding of the Betty Ford Center in 1982 went on to help millions and changed how the country talked about recovery.

By the late 1990s, science caught up with that message.

A 1999 U.S.

Surgeon General's report emphasized that mental illnesses are biologically based, common, and, most importantly, treatable.

Still, the crisis remains.

According to the Department of Housing and Urban Development, mental illness can contribute to homelessness, domestic turbulence, violence, and substance abuse.

The Department of Veterans Affairs reports nearly 30% of post-9/11 veterans experience PTSD, depression, or both.

Perhaps the clearest indicator of America's mental health crisis is found, sadly, in the numbers.

According to the National Alliance on Mental Illness, or NAMI, as of 2023, suicide is the 11th leading cause of death overall, and a leading cause of death among young people ages 10 to 14, and again, among those in the age group of 15 to 24.

But there is hope.

Proven therapies, early intervention, the 988 suicide and crisis hotline, and new and Better support systems are helping millions recover and thrive.

And that's what we'll explore in the center ring.

♪ ♪ KATKO: In the center ring is Jessica Schleider, an associate professor of Medical Social Sciences at Northwestern University.

Welcome, and let's get to it.

Can you tell me what factors are contributing to mental health issues that you are concentrating on?

SCHLEIDER: The factors that my research lab, the Lab for Scalable Mental Health, is most focused on are the pervasive lack of access to mental health resources and support.

Only about 20% of youth and about half of adults with mental health needs are able to access Affordable and timely care.

KATKO: So can you just reiterate why that is?

Why is it so hard to get access to mental health care?

SCHLEIDER: It's wild that that's still persistent, right?

But there are so many different reasons.

One is lack of affordability.

You know, there are parity laws in insurance, but even so, many providers are unable to take insurance because it isn't cost-efficient for them to do so.

Another is just there aren't enough providers in the United States, particularly not enough providers trained in child and adolescent mental health.

So there simply aren't enough.

And even if we magically doubled the number of providers overnight, there still wouldn't be enough, particularly in rural counties.

And a third is a lot of logistical and personal barriers get in the way when families want to seek out care.

They're not sure if it's really necessary, or if they are sure, then there's stigma potentially in their communities, so there are all sorts of things.

Also, young people often don't feel able to disclose the mental health problems they're experiencing, which really constrains their ability to get help.

KATKO: So let's talk about the younger segment of our society, because the suicide rates are alarmingly high, and mental health issues seem to be going up.

So what are the contributing factors, and what are you working on to address that?

SCHLEIDER: So we're working on a variety of things.

Our lab actually focuses on developing, testing, and deploying interventions and treatments that can circumvent a lot of the barriers to traditional face-to-face in-office care.

We study brief interventions, specifically those that make the most of every moment, so the single-session or a one-at-a-time approach.

And those that can be deployed digitally-self-guided programs that can circumvent barriers like having a difficult commute or a difficult time traveling to care every single week.

So, you know, if we can deploy these brief barrier-free interventions at exact points of need, when people first reach out for help, whether that's online or in schools or in primary care clinics, then we're really hoping that those interventions can catch people Precisely when their risk is highest for outcomes like suicide, self-harm, and related difficulties, and maybe circumvent those difficulties into a more helpful path for them.

So we really focus on these just-in-time interventions that can catch people at just the right moments and make a difference for them.

KATKO: Okay, so now let's talk a little bit about some of the contributing factors to this mental health epidemic among kids.

What are some of the contributing factors you cite?

SCHLEIDER: Absolutely.

So I think there are several that are all over the media these days.

One, of course, is the possible role of social media and generative AI chatbots in Exacerbating mental health difficulties.

There's a lot of mixed Literature as to whether this is really a primary cause, but there are certainly risks to these platforms that, when young people are in severe distress, this is often the first place they go.

So making sure that these platforms are safe and built for supporting youth mental health is absolutely essential and simply not done today.

Another factor is increases in academic stress and pressure.

Of course, when we talk to adolescents, they cite peer relationships, which again, can be magnified by social media complexities and bullying and cyberbullying and these kinds of factors.

But really, the causes are both technology-based and offline, coming together to make this Sort of perfect storm of distress for young people and difficulty coping.

KATKO: So let's take the adult segment of the population, and, when suicide is the 11th leading cause of death amongst all Americans, that is alarming to me.

What are the factors that adults face, and are they different than what the children face?

SCHLEIDER: Yeah, so I think in many ways, they are similar.

So things like income inequality in the country, things like struggling to make ends meet as a family, as an adult, as an individual.

These are things that, of course, impact adults directly, but they also impact entire families.

And many adults are parents, they're caregivers.

So when adult mental health is Threatened by societal factors, contextual factors, and just how difficult it is to make it in Today's world, especially with how divided it is, that trickles down to young people.

So caregiver distress is youth distress, and it feeds off each other.

So in so many ways, it's intertwined.

KATKO: It sounds like anxiety is part of that component, but what about the component in a larger scale that anxiety and depression play with respect to mental health?

SCHLEIDER: Oh, anxiety and depression are the most common types of mental health distress out there.

And those are, of course, tremendous contributors and risk factors for somebody experiencing, you know, thoughts of suicide or self-harm.

You know, one in five young People will experience a major depressive episode.

And that number has only Increased in the past couple of decades due to all these cultural factors and complexities.

So those are extremely important issues, and that's primarily what our lab focuses on-trying to prevent and reduce symptoms of depression and anxiety in youth.

KATKO: So how important is it to recognize these conditions at an early stage of a person's illness or, more importantly, at an early stage of a child's life, and to recognize these conditions and get the treatment?

SCHLEIDER: You know, this is why I'm so focused and dedicated to promoting and protecting youth mental health in particular, because the population health Impact-the impact across the lifespan for their future families-cannot be understated.

Half of lifetime mental health disorders onset by age 14, 75 percent by age 18.

If we can help folks, catch them at the right moment and divert their pathways to a healthier one, one where they can cope more effectively with what life throws at them, even in such a challenging-to-navigate world, that can pay dividends across their entire lifetimes.

So early intervention, early detection, and support precisely when those needs arise is exactly what we focus on in our lab.

And I think exactly where the field should be focusing on as well.

KATKO: So what about trying to scale this?

You're talking about getting intervention at an early age, But then you mentioned earlier that there's not enough Caregivers out there, and there certainly doesn't seem like there's enough money, even close to it out there.

Based on my time in Congress, it's clear to me that mental health still isn't a priority- it should be.

So how do you scale this?

What do you do?

SCHLEIDER: Well, our lab is called the Lab for Scalable Mental Health for a reason.

This is precisely what we care so much about.

We are aiming to scale out mental health support by focusing on interventions and treatments that can circumvent barriers to care.

So interventions that don't rely on somebody showing up once a week in a clinic and that don't rely on expensive providers.

We've studied single-session interventions.

Those can exert a meaningful Impact for somebody, even if they're not going to solve everything in a single encounter.

KATKO: Jessica Schleider, I just want to thank you for your work in this field.

It's so critically important, and I want to thank you going forward.

And we're going to talk to our next guests on the trapeze.

♪ ♪ On the trapeze this week are Virginia's Congressman Don Beyer and Texas's Congressman Tony Gonzales.

Welcome, gentlemen.

Don, I'll start with you.

Tell us about the mental health caucus in Congress and why you Became a part of it as a co-chair.

BEYER: Well, John, you know, 11 years ago, you and I started the bipartisan suicide prevention task force.

And so, with your help, we've been working on that for many years-a lot of big successes.

The biggest one was the 988 number.

In the meantime, Grace, a wonderful older woman from California, created this bipartisan mental health caucus, and she retired last year, and she turned it over to Tony and me.

And a couple more people.

But Tony Gonzales and I are going to lead as Republicans and Democrats to try to do everything we can for the mental health of American people.

KATKO: Yeah, Grace is not to be denied.

She got a hold of me early on in Congress, and that's how I got in as well.

So, Tony, tell me about why You're involved with it.

Why you're motivated to be a Part of it.

GONZALES: Yeah, I know, thanks for having me on, John.

And, you know, there's no doubt that there is a mental health crisis across this country, whether you live in a big city or a small town.

Doesn't matter if you're from Virginia or from Texas, New York, Florida, California-there's a mental health crisis.

And in Congress, so many times, Things are partisan.

This is a nonpartisan issue that should bring us together.

There's not a person that hasn't been impacted by this in some form or fashion.

And I think it's important for us to have these tough conversations and ultimately deliver, like Don mentioned, Deliver year after year, finding real funding, ways to save real people.

It isn't just always throwing rocks at the problem.

It's coming together and finding solutions.

And I'm grateful that Don is a partner on this, and I'm excited to be part of the mental health caucus as well.

KATKO: You know, Don, Tony mentioned the bipartisan nature of the caucus, and that's certainly true.

But, you know, you don't hear about a lot of those things in Congress.

So why don't you tell the viewers, what are some of the primary goals of the caucus?

What are you attempting to accomplish?

BEYER: Well, let me just pick One or two.

We have the Barriers to Suicide bill that, John, you and I Started years ago, and right now, Brian Fitzpatrick, a Republican from Philadelphia, is co-leading with me.

Tony is a great co-sponsor.

And that's to help state and local governments put up the bridge nets and the like around bridges and other high-risk places where people commit suicide.

The most famous example is when they put nets up on the Golden Gate Bridge.

Suicides there basically Stopped, and you're losing six, eight, ten people a year.

Often, there's interesting research that people would go up To a bridge intending to jump off and die.

There's a net, they don't go to the bridge half a mile down the River, up the river.

They just go home and think about something else.

So that's one of many really important priorities for us.

KATKO: So, Tony, what about the funding aspects?

Are you concerned about the level of funding that's dedicated to mental health and Prevention in counseling?

GONZALES: I always am.

Yeah, I'm an appropriator.

I sit on the Appropriations Committee, so a lot of times, I will look at it through the lens of dollars and cents.

You know, don't just say Something's a priority to you-give the actual funding to the programs that work.

You know, don't just write a blind check and then pat yourself on the back.

But the programs, like Don mentioned, a lot of times it isn't creating these large Amounts of money.

It's just being innovative.

It's finding simple solutions to A very complex problem.

I spent 20 years in the military, so a lot of my peers are veterans.

Veterans deal with a lot of the issues that they had faced in conflict.

They bring those home.

But whether you're a veteran or an everyday person, whether you're from a small town or a big city, we as the American people deserve to have some barriers in place that help people in their darkest hour- not wait until it's too late.

And the funding aspect of it is so key.

We got to get money to these programs that are working.

KATKO: We've noted how prevalent the mental health issue in general is.

And suicide is one of the top 11 killers of all Americans.

It is an epidemic and it doesn't seem to be the spending is where it should be.

What do you hope to achieve or goals with respect to spending levels and where do you think they should be?

>> Well, John, as you know well, there are Democrats and Republicans and then there are appropriators like Tony who actually get to spend the money.

One of things we want to do is spend money wisely.

So, another initiative that Congressman Gonzalez and I are working on is the peer-to-peer support networks.

Through COVID, we discovered this epidemic of depression and anxiety among young people, especially young women, high school and college kids.

And also there aren't enough psychiatrists or psychologists or mental health workers.

It is expensive.

The insurance often doesn't cover it so we're trying to set up peer support groups.

They are not experts at counseling, but as long as you can get the mental health first aid and alert them to fact that, they can be a first resource for their friends and relatives and classmates.

We can spread mental health good practices throughout the whole community, throughout the whole country, and for relatively little money because, none of these people are getting paid.

They are all doing it for free.

>> Tony, you're in appropriations, and is there any consideration given to trying to address this?

Seems like chronic short fall with practitioners in the mental health field.

Are there any ideas out there that might address that?

GONZALES: There is, and there is a few different ideas.

One is just increasing the number of clinicians that you have in the pool.

That's the big part of it.

How do you get more doctors in this space and you have to encourage them.

Not everything is about money, sometimes it is about showing up and saying thank you for saving a life.

Thank you for coming to work today.

Like Don mentioned, thank you for being a peer.

That's one aspect of it.

The other aspect of it is technology.

Our children, our grandchildren are growing up in a very different world than we all grew up in.

They have technology at their fingertips, the stress they are under is constant so we combat that with them having the ability.

What if you could hit an app and go directly to a clinician?

What if it is not disclosed.

What if it is a private setting but you're getting help from a professional.

How do we end funds this type of things that ultimately help to save lives.

The other part is too, not everybody is going to commit suicide.

But I guarantee you, people, everybody goes through financial issues, relationship issues, work issues so we've got to make is that we're taking care of everyone, not just those at the very end of the spectrum, if you will.

KATKO: You know, Don, I think you mentioned earlier about COVID, and there was a development within the COVID time period that I think has made a big difference.

And maybe you can talk a little bit about that, and that is, not having to go to the actual office to get treatment-getting treatment online via Zoom, for example.

Has that been a game changer, and should we encourage more of that?

BEYER: Yeah, very much so.

It's a huge game changer for so many different reasons.

A small part is the stigma.

A lot of people don't like showing up in a mental health clinic and feeling that they're weird somehow or strange.

The other deal is it gives a lot more freedom.

You don't have to take the bus or the cab or the Uber, and you can do it at different times.

It's also, by the way, been great for the clinicians.

I know a couple of friends that are psychiatrists, many more that are social workers.

You know, they can sit there in their office or their home and talk to many, many more people per day.

It's something that we really need to preserve-the whole telehealth.

By the way, it includes making sure that we recognize often they have to go across state lines.

I might live here in the Washington, Virginia, Maryland area.

You can live in Maryland, work in D.C., but your doctor's in Virginia.

That needs to be easy to happen.

KATKO: Yeah, that sounds like a logical address to do.

Tony, we have about a minute left, so if you could look into your crystal ball, what would you like to see happen going forward as a major accomplishment of the mental health caucus in Congress?

GONZALES: Yeah, the biggest thing, I think, is the stigma.

Don is spot on.

The stigma.

We got to get away from this idea that this is only happening to a certain amount of people.

This is happening to everybody.

Everybody is dealing with one issue or another.

It's how we treat it.

And we got to look for innovative ways.

You know, don't just throw pills at the problem, if you will.

Sometimes it's, you know, riding a horse or growing a garden or petting a dog or whatever it is-painting a picture.

So find the things that give people that will, which again, in that darkest moment, like Don mentioned, instead of jumping off that bridge, they take a step back and they go, you know what?

Tomorrow is another day.

Tomorrow, I get a reset and start it all over.

If we can do that, I think that will ultimately save lives.

KATKO: Don Beyer, Tony Gonzales, you're uniting in Congress on a great cause, and you're proof positive that bipartisanship can work in Congress when it's taken seriously.

We thank you both, and America thanks for what you're doing.

There's nothing more important than this right now in our country, so thank you very much.

BEYER: Thank you.

GONZALES: Thank you, Merry Christmas, Happy Hanukkah.

KATKO: Merry Christmas.

BEYER: Bipartisanship is the only thing that works.

KATKO:Now it's time for my take.

Nearly every family in America has been touched by mental health challenges involving a loved one, including my own family.

That's why I made mental health a priority when I went to Congress, serving as chair of the Mental Health Caucus and the Suicide Prevention Task Force.

While mental illness numbers and suicide rates in particular remain alarmingly high, there is also reason for hope, as awareness is growing and treatment options are expanding.

It starts with recognizing the warning signs and getting help.

If you or someone you know is in crisis, you can call or text 988 to reach a suicide and crisis lifeline.

Like 988, there are more mental health resources available today than ever before, but they still fall far short of what's needed, given the scale of the crisis.

Let's push our leaders at state and federal levels to invest far more in mental health research and treatment-on par with what this country has done for cancer and AIDS, to name a few.

And let's encourage and reward careers in the mental health field, which is wide open and where help is urgently needed.

And that's my take.

♪ ♪ KATKO: Now, let's look at what's happening next week in Washington.

We're joined by Bloomberg's Deputy Washington Bureau Chief, Laura Davison.

Laura, what's happening next week?

LAURA DAVISON: Well, this is generally one of the quietest weeks in Washington.

It will be Christmas week.

The president will be down at Mar-a-Lago.

Congress will be done for the rest of the year.

They left Washington this past week and will go home and resume activities come January.

But there's still a bunch of things that folks are watching and really could kind of set the tone as we head into 2026.

One is the issue of affordability and the economy and jobs.

We just saw some jobs data this week that shows that unemployment rates have ticked up.

President Trump has really struggled as he's tried to message on this issue.

You know, his aides and advisors clearly want him to talk about the economy, talk about the tax bill he passed earlier this year.

But there's lots of warning signs out there that people are not feeling confident about the economy.

Consumer sentiment has hit some recent all-time lows.

And this is as we're seeing lots of prices tick up, particularly on the energy front.

That is something that Trump said he wanted to really, you know, get prices down.

But we're seeing energy prices, particularly electricity, have risen 10% and have hit the highest increase in a decade.

So everything that's happening, this week, next week, and as we head into 2026, it's all sort of clouded in how folks in Washington are thinking about the midterm elections.

Republicans right now have a trifecta in Washington.

They want to maintain that, but particularly in the House, where there's a very, very slim margin for Republicans.

Democrats see an opening, especially as voters are discontented about their job situation, their wages, and their ability to afford everyday items.

KATKO: Now, Laura, the affordability issue is what put the president into the White House on his second term, White House on his second term, he vowed to fix it, and we still have these vexing numbers for him.

And it seems to me that going forward, that is going to be the preeminent issue in the next year's campaign season.

>> Yes, this is something that Democrats are very eager to run on, and Republicans are scratching their heads a little bit, trying to figure out how they want to frame this.

You know, Democrats had a lot of success with affordability in those off-year elections we saw earlier in November, you know, both with very moderate candidates, in Virginia and New Jersey running for governor, seizing this issue, as well as Mamdani on the New York City mayoral election, also messaging on affordability.

Democrats in Washington, in particular, are eager to talk about health care costs.

This is an issue that, you know, was really at the center of the shutdown we saw earlier this year.

For weeks now, members of Congress have been debating this.

There's been a bunch of different proposals.

None of those were able to pass.

When they come back, when members of Congress come back to Washington in January, there's talk that they may continue to try to talk about ways to get health care costs down.

But they're also facing a deadline at the end of the month, at the end of January, to fund the government.

So there's a lot that needs to happen, and a lot of these issues that are really plaguing people may not be able to be addressed either at the White House or in Congress.

KATKO: Yeah, it's interesting.

Turnabout is fair play, I guess, Laura, because now the Republicans own the affordability issue because they're in control.

So, thank you so much, Laura Davison from Bloomberg, and we'll talk to you next time.

That's all for this week, folks.

To send in your comments for the show, or to see Balancing Act extras and exclusives, follow us on social media or go to BalancingWithJohnKatko.com.

And remember, if you or someone you know is in crisis or feeling lonely this holiday season, please reach out to the resources on your screen.

Thank you for joining us, and remember, in the circus that is politics, there's always a balancing act.

I'm John Katko.

We'll see you next week, America.

♪ ♪ ♪