♪♪ This show is made possible in part by California's Mental Health Services Oversight and Accountability Commission.

Ken Burns' film Hiding in Plain Sight takes us inside the youth mental health crisis facing our country.

This series reveals the struggles of more than 20 young Americans in heart-wrenching detail.

Joining us to discuss this crisis are mental health advocate Makalynn Powell, and psychiatrist and neuroscientist Dr. Tom Insel.

Makalynn, you said, "We don't talk about what's going on inside our head."

What were you hoping to communicate when you made that statement?

I think that, at that point, um, especially speaking about youth and mental health, a lot of times, we don't have the vocabulary, um, the proper words to convey what's actually going on, um, so, it's- it becomes very difficult to accurately describe, um, you know, the... the... the difficult things that we're experiencing in our own heads.

So, um, you know, for instance, I had to come up with, like, kind of code with my mother, um, to explain, "Hey, I'm going through a tough time right now."

You know, we would... we would talk about the war in my head, um, you know, because I didn't have the right words to say, "Oh, I'm experiencing a manic episode," or "a depressive episode," at that age, so- Hmm.

You- I...

I was also watching a panel discussion that you had participated on, and you had said that in the process of filming, a feeling that you had was vulnerable.

What made you take the step of participating in telling your story in... in such candor, uh, for such a broad audience?

Well, I think, initially, I didn't know that the audience would be this broad.

Um, so, that was a bit of a shock to me, but, uh, my personal experience, uh, in my mental health recovery, uh, the journey- I first met people who were very open and honest about what they were experiencing.

Um, and I credit that to me seeking help in the first place.

Um, you know, if I hadn't met those people who were open and honest about what they had experienced, and... and their feelings, and, um, just being blunt, honestly, then I don't think that I would have been comfortable with that.

Um, so, just experiencing that therapeutic value, um, made me want to continue it.

Hmm.

Dr. Insel, with the U.S. having some of the highest rates of mental illness in the world, what's causing our society to miss the mental health issues of our young people?

Well, to some extent, uh, the problems that we're seeing, especially with young people, are... are... are... are old problems.

This isn't just emerging, but I think it has become considerably worse with the pandemic.

And it's interesting, the film which- you know, originally, when they started, they weren't really sure what they were going to focus on.

There was- They knew they wanted to do something around mental health and mental illness, but they could have gone in lots of directions.

Um, I think what they decided maybe in 2018, 19, before the pandemic, was they really wanted to try to bring in what seemed to be already emerging as a youth mental health crisis.

And they really wanted to get the voices of people like Makalynn, who could sort of take us through this and give each of us a feel for what it is.

What they don't do in the film, and what I think we still are struggling with, is, like, what are the drivers?

What's this really all about?

How much of it is due to what we all went through in the pandemic?

And we know in many ways, though young people were less likely to get COVID and much less likely to die from COVID, they were far more likely to suffer the psychological consequences of the last two and a half years, the last three years.

And it's been, uh, without question, um, a... a real threat to mental health for people under the age of 30.

The numbers are stunning.

If you look, you know, about 8,000 people died of COVID under the age of 30, but about 120,000 died of suicide and... and drug overdoses in the very same time, in that same age group.

So, it's- You know, it's a very significant, um, set of issues right now.

And the drivers, uh, I think we're still trying to understand all of them.

A lot of people point to social media.

People point to, um, to what the effects of the pandemic have done, in terms of social isolation and people not having a... a healthy normal to depend on, and, uh, losing a lot of the milestones that you normally would have, uh, through adolescence and young adulthood.

But I think, you know, what everybody seems to agree is that, um, certainly, for young people growing up today, they don't have that sense of opportunity that their parents had.

They don't have the sense that they're going into a world where, um, it's going to be easier, um, the way their parents might have experienced the world, uh, 25 years ago.

You... you talk about the parents, uh, the caregivers and others.

Are we equipped to listen and to hear, when the cry or... or the need presents itself from our young people?

Well, that's a great question for Makalynn, I think.

I mean, I would love to know what your experience has been with, um- As you- You know, you were talking about starting to share your experience with others and whether you felt they were ready to listen and ready to really hear what you were living with.

Makalynn, um, [chuckles] let's bring you into this.

I think that, um, figuring out how to communicate with people around me has definitely, uh, been a learning curve.

Um, I talk about this a lot and to- Not to discredit my mother by any means, um, but I have a distinct remember- memory, excuse me.

Um, when I was younger and, uh, we had this little, you know, tiff and I said, uh, "You hurt my feelings."

And, um, her response was, you know, "We don't have feelings here."

Um, and I was, like, ten, at this point, at this time in my life.

And that kind of set the tone for as I got older and started to really experience, um, these kind of highs and lows with my mental health.

And I didn't feel comfortable.

Um, you know, I kind of shut off at that point.

I- You know, I put a wall up and, um, kind of just put every- pushed everything to the back of my head and didn't really- didn't express anything that was going on for a long time.

Um, and that is just simply because the way my mom was raised.

Um, you know, her parents- you know, "We don't talk about depression.

We don't talk about, um, things like that."

Uh, you know, a lot of times, it was viewed in my family as a sign of weakness.

Uh, I come from a very long line of very strong women, um, very strong independent women.

So, I felt like any time that I talked about something that I was going through, uh, it made me seem less than, or weaker, um, or incapable of handling life.

And that was one of my biggest fears growing up, um, feeling like I wasn't able to hack it.

Um, but things got bad enough, to the point where, um, my mom actually stepped up and educated herself and... and came to me about it.

And I think that kind of set the tone for me.

Um, you know, we still- I still have these issues with other... other members of my family, other older family members.

Um, you know, we don't- They know that there's something going on.

Obviously, we have this national documentary out now, so that- it's kind of hard to hide everything, but, um, we just don't talk about things.

Uh, and that's OK because I was able to find support in other areas, um, you know, and I still have to navigate the difficulties with certain friend groups.

Um, you know, I have very close friends who I'm very open with and I can say things, and they know that, um, it's not necessarily a cry for help.

It's just me expressing my feelings.

Um, but there are other gr- you know, friend groups where if I were to say something like, "Man, I'm having a bad day today," they may freak out and not know how to respond to that, um, and immediately want to, like, have me committed or something.

You know?

So, um, I think that the overall theme here is, like, a lack of education when it comes to communicating and accepting the fact that some people are just never going to- not... not necessarily never going to understand, but it's going to take some people a little longer to get to that point, um, and just being patient, I guess, with other people, when it comes to talking about my... my journey.

Hmm.

Yeah.

Does it surprise you at all that in this day and age, still, it- we, as a society, seem to struggle so much with being receptive to communicating or hearing about these issues from each other?

I think that- Honestly, with the last few years, nothing really surprises me anymore, when it comes to our society.

But, um, I think that I'm seeing more of a shift because of my age.

I'm seeing more of a shift to- towards understanding from the younger generations.

Um, it does not surprise me at all that the older generations are still struggling with understanding certain aspects of mental health.

So, um, I wouldn't necessarily use the word "surprise," um, but it is disheartening at sometimes- at times, um, you know, to think that we've come so far as a society and we've still got, um, ignorance at such a deep level that is, uh, causing harm in a lot of people's lives, due to lack of access to care and, you know, just a- the general lack of understanding that keeps people from seeking care.

So- OK, Doctor Insel, I...

I'm curious.

Uh, you're a... a... a noted expert in these areas, but you've also had personal experiences as well.

Tell us how you come to this fight.

Yeah, you know, I...

I think- I've said that there really are only two kinds of families in America- there are families who are struggling with mental illness and families who aren't struggling with mental illness yet.

But eventually, you know, we all get there.

We become what I call "involuntary experts."

And it's... it's a reality that, um, is really common.

And, uh, to Makalynn's point, you know, it is kind of odd that it's been so difficult to have it as part of the national conversation.

We do talk about things that are far less common, uh, but this has been shrouded a lot in a kind of sense of blame and shame.

Uh, and one of the things that's so refreshing is to see less of that in the younger- I would say, people under the age of 30 are certainly more open.

My own experience with this, as I- you know, I trained as a psychiatrist.

I worked in, uh, neuroscience in a department of psychiatry.

And, uh, my daughter developed anorexia, uh, when she was in her last year of high school, first year of college and I simply didn't see it, couldn't see it.

And it's partly, you know- to Makalynn's point- there's a sense that parents often don't want to deal with it.

You know, you tend to see your kids as perfect.

And, um, you want to- You don't want to think of them as... as... as suffering.

Uh, and it really took my daughter confronting me and saying, "I need help.

I can't do this by myself and you've got to help me find someone."

Uh, and she did very well, ultimately.

But, um, it was, uh, probably not that unusual that, you know, for me- somebody who was an expert, who knew quite a bit and, you know, treated many, many people with eating disorders- that I couldn't see it in my own family.

There's an expression we have in medicine that doctors say, you know, that the... "the cobbler's son goes without shoes."

Uh, and, um, that's not to say that the families of physicians have more medical problems than any other, but often it is the case that, um, psychiatrists, um, want to think the best of their own kids and it's a little hard to actually see that they may be struggling and, um, could really benefit from help that they don't get.

One of the things about children and young people, in general, is that they're trying to step into their own agency and power as individual- independent individuals.

But before they reach that stage, what additional challenges do young people face in trying to get those- just like you're talking about in your story- to get those closest to them to understand what they're experiencing, and when it is that they're really reaching out for help?

Do you want me to take that on, Scott?

[Scott] I do.

I do.

[Dr. Insel] Yeah.

Yeah.

I- You know, I think you have to understand, you know, adolescence is a storm.

It is a really hard time.

And it's- You know, nobody sails through this.

And often, it's the people who look like they're sailing through it who are... are really struggling the most inside, and they just can't share that.

But it's- You know, it is, fortunately, a storm that most people weather and survive, because we're fundamentally resilient.

You know, we do well.

And we're... we're wired to grow and to develop and to connect.

Where things often go off the track is when there's not an opportunity to connect.

There's not an opportunity.

I was struck by Makalynn's point about her mom saying, "We don't have feelings."

You know, that- You know, there's not an opportunity to actually- um, to... to be authentic around the things that you're going through, um, and to be able to recognize that it's OK to not be OK. You know, it's just something that, um, you learn as you get older, hopefully.

Um, but it's really hard for, um, a 15 year old to begin to understand that, um, things can work out, that- you know, that what seems like, um, the end of the world, um, is, um, is a momentary crisis.

And one of the things that we do when we help kids, um, is to give them some perspective.

Um, we also give them a language, to go back to Makalynn's initial point.

Really important to help young people understand that sometimes you have to name it to tame it, to be able to actually understand how to talk about this gives you some power over it.

Uh, and that- There's, you know, a lot that we can do to help people navigate that storm.

Makalynn, as you go out and you reach individuals, audiences, all the folks that you touch, who... who ends up coming to you for advice more, you know, as they get a chance to interact with you?

Is it the young people or is it the older people who are... are looking for advice on... on how to reach out, or how to be there?

What... what... what do you say to people?

I think- I found more that, uh, people that reach out are people who have friends who are struggling, um, or have some sort of secondhand experience with mental health, um, rather than, uh- I mean, I've certainly had people who have firsthand lived experience, but a lot of the times, it's people who- "Yeah, my friend is going through this," and, um, you know, "I didn't know how to deal with it," or, I- Just... just last, um, uh- You know, recently I had somebody come up to me and tell me that they lost a friend, um, I think a couple years ago, due to, uh- He ended his own life, due to mental illness.

And, um, you know, the... the person told me how validated they felt, in knowing that, um, you know, they did all that they could, I guess, um, to help, and that- knowing that everybody has their own personal struggle and, um, it kind of, you know, brings everything back full-circle and makes me realize that what I've done in this documentary is... is truly important.

But I haven't had a ton of people who have struggled firsthand, um, come up to me.

[Scott] Really?

[Makalynn] Um, the... the few that I have, um, have explained later on that they, uh, felt a bit discouraged because I seem like I have everything together at this point, um, almost like I'm recovered.

Uh, and I had to...

I had to sit back and laugh for a second and explain to them that this is one hundred- that this is... this is in no way a linear process whatsoever.

Um, you know, this journey is- You know, I may seem like I'm OK today, but last night I could have been curled up in a ball and, you know, having a complete meltdown.

Um, or, you know, it could have been, you know, a year since I've had, um, a major life crisis that resulted in a mental health crisis.

Um, but I also point out the fact that- you know, the... the mere fact that they think that I look OK and I...

I'm...

I'm better now, um, should give them hope that they can be there, too, one day.

You know?

Um, just emphasizing the point that this is a process, 100%.

Mmhmm.

Uh, you... you used the word hope.

What message do you hope that the people who watch this film take away from it and how it empowers them?

Um, I think- First and foremost, I think that anybody who, um, is younger, um, feels some sense of connection, um, like Dr. Insel had mentioned, um, knowing that they aren't alone in this, um, knowing that- Because I think that was a... a major, uh, struggle, for me, growing up, is that I was like, "There's no way anybody my age could feel this way, and that's why I don't want to talk about it.

I don't want to seem, um, like I'm-" I mean, "I don't want to other myself within my peer group."

Um, so, definitely, anybody who's going through it at the time, uh, I hope that they find some sense of understan- um, some sense of belonging, but my- I think- I also hope that anybody who is involved, anybody who is a member of somebody else's support system, they understand that this is a journey for them as well.

Um, you know, they are also experiencing this and, um, it's OK for them to not be OK as well.

You know, while you're supporting an individual who is going through this- their mental health journey, um, check in on yourself.

Make sure that you are educating yourself and taking the time to... to check in with that person and... and make sure that everybody around is good so you can, um, be the best support that you can.

Hmm.

Uh, I...

I...

I love hearing that- uh, your focus on also acknowledging that, uh, loved ones, support system, caregivers all are on this journey as well.

Dr. Insel, where is it that those who may have a loved one, uh, a young person who is afflicted or... or under stress right now, how do you suggest, or where do you suggest they go to make sure that they've got the stamina and strength to actually be there for that young person in their lives?

Oh, that's such a great question, Scott.

I mean, it is really- You know, this is a process and it is a journey, but it- uh, people often make the journey alone, which is tough.

Um, there is an organization called the National Alliance for Mental Illness, or NAMI, uh- which is across the country, it's all- and in... in virtually every community- and they've created a- what they call a Family-to-Family network, so that families can educate each other, support each other, be there for each other.

Uh, extremely helpful to have that, and... and this is a journey you... you don't want to do alone, um, because you're doing it for the first time, uh, and it's so helpful to have other people along with you, if only to tell you that, "Hey, it works out," that people do recover, there is hope.

And you're in the middle of this, you don't feel that at all.

So, highly recommend that people connect with the Family-to-Family program that NAMI runs.

Hmm.

I...

I...

I want to step back for a second.

The statistics say that a half of all mental illness starts by age 14, and 75% by the age of 24.

If this data is widely known, Dr. Insel, why are we still working today on spotlighting this issue?

Shouldn't... shouldn't we have already gotten to a point where we've, uh, sufficiently focused to... to know and act on this information?

Well, I think we are now, at least in California.

You know, we have this new Children and Youth Behavioral Health Initiative, uh, which is this massive new effort to begin to move upstream.

So, we're not waiting until there's a crisis, we're not waiting until it's more difficult to help somebody, but we're providing the services much earlier, not only services for people who are struggling, but giving young people in schools the tools they need to be able to become resilient.

Um, there's a- I like the term "future-proofing."

We can help kids to learn how to manage emotions, to facilitate social connection, to... to learn mindfulness as a way of getting control of their anxiety, and giving them the fundamental principles that they need, so they have a kind of mental health that matches what we do for physical health.

We... we think about physical fitness all the time, but mental fitness, probably, in the 21st Century, even more important.

Right?

And you need to have that to be competitive and to be successful.

We don't teach it and we haven't been teaching it, but we will begin that.

And that's a process that's underway with this new program in California, um, that I'm...

I'm actually quite hopeful that, um, with all the investment, all the focus, the awareness- and this film helps to bring that to the fore- that, um, the next generation will have that set of tools that will make it easier for them to navigate.

Incidentally, what's the name of that program?

It's called The Chil... Children and Youth Behavioral Health Initiative.

Uh, it's a $4.4 billion program, uh, in California over the next five years.

It's probably- From my, you know, back of the envelope calculation, it's probably 100 times bigger than any other precedent, any other program for, uh, youth behavioral health in any other state.

So, it's... it's a big deal.

It's a place where, um, California really wants to make a statement, and it... it's really- To be clear, it's really California saying, "What do we want for this generation?

How do we want our kids to be able to... to thrive, and what do they need?"

And it's clear that, uh, we haven't been meeting that need and we need to do something different.

That's... that's big news.

Makalynn, I...

I...

I want to get your perspective on this.

If you were sitting in the room with the people who were going to be designing this $4.4 billion program to really reach young people in California and address their mental health challenges, where would you say that the interventions need to start, and where they're going to be the most meaningful, if you had to take first steps?

Any thoughts?

That's a hard question.

Um, it's a very interesting question, though.

I think that I would probably suggest first steps being, um... Just- Well, let me... let me rephrase it in this way.

[Makalynn] OK. [Scott] In your own lived experience, when you think about your own journey, where would- If there was outside help that was available, when and where would it have been most meaningful for you?

I- So, I did fortunately receive outside help, um, my freshman year of high school.

Um, and it was from- It was within the school system.

So, it was an outside organization, but within the school system.

So, um, I think that helped, you know, being away from the home environment, um, which at that time was a major stressor for me.

Um, so, I think I would probably suggest in the school setting, uh, but definitely as early on as possible.

Um, especially today, we're seeing kids experience, um, you know, problematic behaviors and symptoms very, very early on.

Um, so, definitely as early on as possible, honestly.

[Dr. Insel] Yeah.

I like that, uh, you know, the... the California program actually defined school as the center of gravity for mental health care and says that's really where we need to focus.

We can't ask teachers and school administrators to do more.

They're already overburdened.

But we can bring in a new workforce and... and some new tools to help students, uh, even in elementary school.

In fact, the program starts much earlier.

It starts with what's called "dyadic care."

It's a term actually I didn't know, uh, before I saw this program, but it's an interesting idea.

It says that when parents bring- or- Well, when parents bring their baby in for a well-baby checkup at six months, nine months, 12 months and 18 months to get vaccines and to get checked up, um, it's a family visit, not a kid- not a baby visit.

And dyadic care means that the... the care is there for both parents, as well as for the... the infant, and because what we understand more and more is the risks of adverse childhood experiences, and how so many things that happen in the first five years of life lead to, um, adverse mental health consequences.

So, getting there early is really important.

Right.

And Dr. Insel, thank you.

Um, we're going to have to leave it there.

But, uh, that... that, uh, identification of that early childhood trauma, um, and those interventions, I'm sure, will be topics that will- are yet to be discussed, and we'll look forward to that.

Thank you both for your time.

And please keep up the great work.

[Dr. Insel] Thank you so much.

[Makalynn] Thank you.

[Scott] All right.

And that's our show.

Thanks to our guests and thanks to you for watching Studio Sacramento.

I'm Scott Syphax.

See you next time right here on KVIE.

♪♪ This show was made possible in part by California's Mental Health Services Oversight and Accountability Commission.

All episodes of Studio Sacramento, along with other KVIE programs, are available to watch online at kvie.org/video.