(upbeat music) - Hello and welcome to Prairie Pulse.

Coming up a little bit later in the show, we'll visit Ukrainian Catholic churches in Western North Dakota.

But first, my guest joining me now is Dr. Jon Ulven, Sanford Health Psychologist.

Dr. Ulven, thanks for joining us today.

- Thank you for having me.

- Well, as we get started, tell the folks a little bit about yourself and your background.

- Sure, I grew up not too far from here about 25 miles south of here in the Christine-Walcott area.

I grew up on a farm.

I went to Concordia College, and from there I went to the University of Kansas and that's where I got my doctoral degree in psychology.

And then I've been from there, came to, at the time, MeritCare that became Sanford Health.

And I've been at that place for 18 years, soon to be 19 years, where I'm a licensed psychologist and I'm the department chair of our adult psychology group here in the Fargo-Morehead area.

- Well, with that said, you're here today because May is Mental Health Awareness Month, and we'd like to get you to talk a little bit more about that.

Why is this subject so important and why does May sort of shine a light on this to raise awareness?

- Yeah, I think, I actually think the timing on this is really good.

I think what we've had, especially in this area, we've had a really tough winter blanketed with snow since the end of October until just a couple weeks ago.

And I think people who have a seasonal component, people who have been isolated, what we know is that mental health can be really hard to manage under those circumstances.

And, so when it comes to springtime, what ends up happening is that people can still, they can be very depressed during those winter months.

And especially when we think about people who are at risk of suicide, what ends up happening is as springtime comes, they still feel really depressed.

But then on top of that they're starting to get some of that energy back.

And that energy, they can take some of that energy sometimes and use that for a suicide attempt.

And so, I think that highlighting that for this community is it's really good for this time of year for that reason.

But I would also add that we've been working at Sanford for the last couple years on, and myself in particular, on some grant-based work to provide resources for healthcare workers who have been impacted by COVID.

And through that programming, we know some research that has demonstrated that the second wave of a pandemic is a mental health one.

And so, and we're experiencing that now.

We have increased demand for our services.

We're seeing patients with more complexity and more distress.

And, I think that this is, in some ways, this is a perfect time for us to just pause as a community and think, okay, what are we doing to raise awareness?

- With that said, just briefly here, tell us about your practice.

You know, who do you see and what do you try to help people with?

- Sure, so as a licensed psychologist, I work as part of a multidisciplinary team in our clinic.

We're located in, my team's in the located in the Moorhead clinic there.

So we have social work, nursing, psychiatry, we have master's level therapists and psychologists.

And like I said, I'm the department chair of that group.

But I do a lot of clinical work.

And in my clinical work, I'm working with patients who have depression, different types of anxiety disorders.

I do a lot of trauma-based care, so people with PTSD.

And then in addition to that, I'm also doing, I also do some training and I also, throughout my career, I've worked a lot with healthcare professionals.

So I see physicians and clinicians, nursing staff who are showing signs of burnout.

And I also work with some physicians who have some comorbid, other conditions like substance use, and work as part of their treatment team.

- Well, and you talk about mental health issues and we've heard reports especially in teens that the rise during the pandemic.

Is data back that up or?

- It does.

So the American Psychological Association puts out a, it's called a Stress in America survey.

And they do this survey every year.

And that where they gather data from thousands of people from different age cohorts.

And this idea of the second wave of the pandemic being a behavioral health one, it seems to bear out in that survey.

It looks like our teens are as the rest of us are becoming more and more stressed.

They, and I don't treat teens and children, I primarily serve adults, but I'm certainly aware of that trajectory.

And I've got a couple of teenagers myself - And maybe you should define what mental health issues are and what range are they.

Do they fall in a little bit?

- Yeah, a good question.

So, I think what, especially when we're talking about, if we're talking about teens or people in general, I think it's the, what the question is, are we stressed or do we have a diagnosable condition?

And the diagnosable condition, I mean, in a sense, what we're looking for is we're looking for the presence of symptoms, but in addition, individuals with a diagnosable condition are gonna have problems functioning in their daily lives.

And so, that's what often what I'm evaluating patients for when I'm working with them in the clinic and in the hospital.

And, but there are also a lot of us who are, we're just stressed and so maybe where our functioning is okay, but we're still just not ourselves.

And so there is a bit of a continuum around that.

- Can you tell me the most common mental health issues with teens versus adults?

I mean, is it different?

- I think what I would say, I'll put a couple of what I find to be really provocative information that I just learned about the other day that, so the Surgeon General came out with a report that was looking at the impact of loneliness on, again, the people through the lifespan.

And this data has really surprised me, just a couple pieces to it.

One, when we look at our teens or, and young adults, so ages 15 to 24, if you compare their level of social interaction for two decades ago to now, our teens and young adults have 70% less social contact.

And we, and along with this this report found that people who are lonely, it is people who are lonely, it is the health equivalent of smoking 15 cigarettes a day.

That's it, you can calculate the same type of health impacts.

People who are lonely, they are 30% higher likelihood of having a heart attack, 30% likely higher likelihood of having a stroke.

And if they have that through their lifetime, they have a 50% chance, a greater chance of developing dementia.

And I think a lot of times people don't equate how people are doing socially with their health.

But this report certainly emphasizes that point.

- So again, what are the common mental health issues that adults deal with that may be different than the teens?

- Sure, so yeah, thanks for taking me back to that.

So, what I think about then as I think about this decreased social contact that we're seeing teens are especially experiencing.

If we go back to that Stress in America survey, what we find is that our teens are, they have more anxiety.

And there are lots of different types of anxiety disorders, but that they're experiencing more anxiety, also experiencing a good deal of depression too, which is similar to adults.

But I think when it happens at such an important time in our teens' lives, when they're developing their identities, they're developing their social skills, it can have longer implications.

- So, you talked about the stigma of dealing with and acknowledging mental health issues.

You know, there is sort of that stigma.

Is it still the case or is progress been made in dealing with that?

- I think that one of the silver linings of the pandemic, I think that it was so stressful for us, and locally, nationally that people are much more likely to acknowledge that they have a mental health concern.

They're much more likely to acknowledge that at work.

They're much more likely to acknowledge it with their family and their friends.

And I think going back to that Stress in America survey, the willingness of teens to acknowledge that they're having a mental health concern and their willingness to seek help has dramatically increased over the last several years that they've been doing that survey.

And on the one hand, we can take a look at that and say, that's a bad thing because they're more distressed.

On the other hand, we can take a look at it and think we really have to figure out ways to step up and get these folks care sooner.

And in that way, I think that in the long run it could serve us better.

- Is there a shortage of mental health services in the state especially when you get outside the higher-populated cities?

- Absolutely.

If you draw a map of North Dakota, what you would find is, so around the county of where Minot is located, the county of Bismarck, county of Grand Forks, and then here in Cass County in Fargo, you would find that those areas show that they have enough behavioral health workers, but outside of that, every other county in this state is underrepresented for behavioral health workers.

And I think another statistic that I've found just for the state of North Dakota is that teens who have depression, it's a very low percentage of those folks who actually get to care.

And so again, meaning that we've got a lot of our teens who are experiencing mental health concerns and they're not getting the help.

- Yeah, what about, I understand there's a new virtual healthcare visit for behavioral health at Sanford, and how is this improving so clients can get sort of quicker care for their behavioral health and from professionals?

- Yeah, I think this is really another silver lining piece from the pandemic.

We had to abruptly switch gears as behavioral health clinicians and start to offer care virtually.

And so we've been doing that essentially since the pandemic set in.

And with Sanford, I think what we're trying to do is we're really trying to build on that platform.

If you go to our SanfordHealth.org website, what you'll find when you come onto that page is you'll find there's a link that you can click on and you, from that link, you can schedule with a behavioral health professional.

And so we are starting to build at Sanford this virtual team.

And right now we have a couple of master's level therapists and we have a psychiatrist who are part of this team and just, and doing only virtual care.

And then within our clinics, within the Fargo-Morehead area and the surrounding area, all of our behavioral health staff are doing some virtual care.

- What are some of the harder mental health issues to treat?

I mean, you, you talk about schizophrenia or bipolar, can they be difficult?

- Sure, sure.

I think those are fall in this category of persistent and severe mental health disorders.

And yes, they can be hard to manage.

I think that when we are able to really function as well as a team to help to try to address some of the psychosocial issues, the therapy-related issues, and the psychiatric issues together, I think what we find is that as time's gone on over the last, if we just look back, over decades, our ability to manage those conditions, it's much improved.

When we look at different, it depends on the, you mentioned personality disorders.

One that is a common one is borderline personality disorder.

We do a lot of care for that disorder in our clinic.

And interestingly, I think that borderline personality disorder is, it's one of the disorders that we have evidence-supported strategies to treat.

We have a group-based treatment within our clinic and there are a lot of different community providers who also have programming and treatment for that condition.

And, but as you were saying, I think like other health conditions that can be really difficult to manage, we've certainly have those within mental health as well.

- Yeah, can you comment at all about the advent over the years of effective medications and, you know, some of those have really helped people?

- Sure, I think one of the things I feel very lucky and blessed to have the team of people that we do at Sanford.

I have a great group of psychiatry providers.

And with that, what we see and what I work, I often, what my job is with patients is, part of my job is to make sure that they're taking their medication regularly, when they're taking it, looking for side effects, working with our psychiatry teammates to try to figure out, is this helping or not?

And I think that we've seen a lot of progress in this way of having medications with fewer side effects and better treatment effects and have watched, just even in my, so I've been at Sanford for 18 years to just watch how we've been able to manage different conditions more effectively during that time.

It's really, it's an interesting time to be in mental health.

- Yeah, can you comment any about the importance of getting the right medication and then staying on the medication?

I do know that some people take their medication, feel better, and think they don't need it anymore.

- Sure, well, again, to clarify that, I don't prescribe.

But I'm often working with my colleagues who are prescribing these medications, and I think one of the things that's really, that's interesting about your typical antidepressant types of medication, what we find is that people will, sometimes they don't even pick up the prescriptions that they've been prescribed.

And in our community, that's mostly prescribed by primary care actually, but they might not pick it up and then they don't take it long enough.

So with many of these medications, you get some of the side effects first.

And if the patients don't understand that, they're gonna get side effects before they get the treatment effects, they think, oh I feel I don't feel good on this so they stop.

But they actually, there's a small window of time that if they were to stay on that, a lot of those symptoms would settle down and then they would start to experience the treatment effects.

- Let's get back to teen mental health for a moment.

What are some of the key pieces of advice you give to parents to recognizing and then to deal with a teen that might be struggling with it?

- Yeah, as I was saying earlier, I've got a teen and a pre-teen at home myself.

And, I think it's one of the struggles that we have about going back to that idea of 70% less social interaction amongst our teens and young adults.

We have to find various ways to communicate with them.

So if that's, it might be the best way that you communicate with your son or or daughter is to text them.

It might be just trying to encourage that they have good connections with other folks.

But often things that we look for as we look for changes in behavior.

They're just not themselves, often withdrawing.

And what's interesting about withdrawing is it's really hard to know what is going on, and it's hard to know when they need help.

But looking for those changes in behavior and then finding ways to talk with them about how they're doing, how they're caring for themselves.

And then, often it can be trying to figure out are there resources through a counselor at school, are there resources that they can access through their pediatrician or other, that those can often the, like, the gateway through primary care can be a really important one for behavioral health.

- Yeah, so well, it, so help is out there.

So, but we're out of time.

So if people do want more information, where can they go?

- Yeah, I think our SanfordHealth.org website is a good place to go.

I think that people, most people have a primary care provider.

And our primary care, that's where we do the majority of behavioral healthcare in this country.

So, your behavioral health or your primary care provider has the skills to help you and they're ready.

- Okay, well, Dr. Ulven, thanks for joining us today.

- Yeah, yeah, thank you.

- Stay tuned for more.

(upbeat music) Though small in number within the United States, traditional Ukrainian Catholic churches still exist.

One small parish has churches in Belfield and Fairfield, North Dakota.

Their Easter celebrations are a visual wonder to behold.

And members of the congregation are passionate about their faith.

♪ Let us pray to the Lord ♪ ♪ Lord have mercy ♪ ♪ That we be delivered from all affliction wrath and need ♪ ♪ Let us pray to the Lord.

♪ ♪ Lord have mercy ♪ - [Father Marty] When He rises from the dead, He's there again amongst us.

What greater joy can we have than Lord Jesus is really alive?

♪ Remembering our most holy most pure ♪ ♪ Most blessed and glorious Lady the Mother of God ♪ ♪ And ever-virgin Mary ♪ ♪ With all the Saints ♪ ♪ Let us commend ourselves and one another ♪ ♪ And our whole life to Christ our God.

♪ - [Father Marty] This is an unusual community.

We don't have too many places in the US where you have five generations of Ukrainians per capita.

This is the second densest population of Ukrainians in the country.

The Ukrainian Catholic Church officially as we know it started in 988 during the reign of Volodymyr.

He had decided that his country should be religious.

And so he sent delegates to the nations around him, and the ones that came back from the Hagia Sophia in Constantinople, they said when the liturgy started there, we didn't know if we were in heaven or on earth.

And so he said, okay, we'll be Christian.

The Ukrainian Catholic Church and the Roman Catholic Church are complementary.

We don't have anything that contradicts our theology or their theology, but we emphasize different things.

We have the beauty of the church, the icons, everything is chanted.

We also emphasize the mystery of God in our churches.

♪ For those who have lost their loved ones ♪ - The deacon is a servant.

First and foremost, the deacon is the servant of the people.

The deacon is the transition point between the altar and the people which is why I'm out on the solea leading the prayers.

And part of the function of that is so that everyone else can be at prayer.

The deacon is always directing with the orarion, the stole that's in my hand so that everyone can just get lost in prayer.

- I'm kind of an emcee.

I tell the people, what's going to happen.

I tell 'em to be attentive to what's gonna be taking place.

And the priest follows and does his part all the way through.

When we chant, we sing to God.

Every song is sung.

As you learn in church, you understand wherever we're at.

♪ The hills and run down the dales ♪ ♪ To the place You have chosen for them ♪ - Cantoring is assisting the priest with the music and the tones of the liturgy.

We sing the tropars and conducts and we answer the petitions, the Ektenias.

We're assisting the priest with the liturgy.

♪ Which You formally bless from resting from Your word ♪ - [Christian] It's a spiritual environment.

As we experience Easter, we're all gonna experience the joy with the words and the different melodies.

We'll experience with the lights turning on when we sing, O Joyful Light.

And everything, if a person really tries to hone in and tune into the words and the tradition, it all has a meaning and it's all helping the prayer.

- Easter, which we actually oftentimes will refer to it as Paska, we have lots of services during Holy Week.

Couple of services a day, each one different, each one rich in the meaning of what's going on in the day.

We begin on Saturday before Palm Sunday where we celebrate the resurrection of Lazarus, and then we end on Easter Sunday with the Resurrection.

The Ukrainian traditions are very much alive.

The Pysanky egg tradition goes way back.

Here you have an egg with a shell.

So it represents the tomb.

The shell, the white, and the yolk, it represents the Trinity.

A lot of the ways that they decorate the Pysanky have these symbols of new life on them.

- It takes anywhere probably from six to 10 hours to do one Pysanky.

Every egg is extremely special.

You cannot make two eggs identical.

- [Deacon Tony] Among the various traditions that we have in the Byzantine tradition are the blessing of the baskets and the foods that are associated there.

Wonderful things that God created that we put aside for those 40 days of Lent so that we can reflect on all of that sacrifice that our Lord went through for us.

And now we're going to feast with great joy.

- [Man] And then our procession around the church symbolically followed the myrrh-burying women's footsteps who defied danger, death, and despair to seek Jesus' body.

- We have not varied much in our church.

We have not made a lot of changes in our church.

Changes were made, but we've coming back to where it was.

- [Father Marty] Each church probably has about 100 parishioners.

Not only have they maintained this for a lot of time because of the great faith of the people that are here, but I really see energy really happening to grow the parish.

We have young families and so I really see a lot of life blossoming as well as we have strong elders here that have maintained the faith that are pillars to the community.

- The Ukrainian Catholic religion is really important to my family, especially the tradition part of it.

The Pysanky eggs, they're bright, colorful, they're really fun to make.

It's fun when we get to go home and go and eat all of this food in this basket.

That's part of our tradition.

- [Lilly] Our family believes in taking the Eucharist on the tongue.

We've always been interested in the Byzantine Catholic Church.

So when we saw how the Ukrainian Catholic receives it in the mouth, that was kind of the push we needed to try our first Mass and our liturgy.

And after we went the first time, we really liked it.

And so we kept coming back.

It's really homey.

We're all kind of so closely-knit together.

We all know each other.

And during the Easter celebrations, it's really joyful ♪ Christ is Risen from the dead ♪ ♪ Trampling death by death ♪ ♪ And to those in the tombs giving life!

♪ - [Christian] I really experience a connection to my heritage.

There's been hundreds of people here for generations.

So as I'm in the church, I do feel my ancestors, which is encouraging.

And it's really present to think how many people have contributed spiritually and physically within the church.

- Christ has Risen.

- [Congregation] Indeed He has Risen!

- [Deacon Leonard] We have a lot of young people that's left because of jobs.

But when they come back, they always come back to this church.

I feel that we are gonna grow.

Our churches never die.

God won't let it die.

And that's up to us to keep going.

(Priest chanting in Ukrainian) - This is a place where heaven comes and touches earth.

So when we come through these doors, when we come into this place, we get to touch heaven in a way.

And it's a very special and a unique way.

- [Father Marty] Christ has Risen.

- [Congregation] Indeed He has Risen.

- [Father Marty] Kristos Voskres!

- Well, that's all we have on Prairie Pulse this week.

And as always, thanks for watching (upbeat music) - [Announcer] Funded by the North Dakota Council on the Arts and by the members of Prairie Public.