COVID-19's Adverse Impact on Mental Health Access for People of Color
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Video Transcript
00;00;02;27 [Bill Hoagland]: Good morning, everyone. Thank you for joining, joining us here at where this discussion of covert the impact on the mental health of poor people of color. Uh, first of all, the Bipartisan Policy Center, if you're unfamiliar with, it was established about 10 years ago by, uh, four former majority leaders of the United States Senate Senator Bob Dole displayed Senator Howard Baker on the Republican side, Senator George Metro and Tom Daschle on the democratic diet, all former majority leader. I am bill Hoagland. I have the pleasure
00;00;34;40 of working with our health team and health programs here at BPC a little bit over a year ago, we began work on the integration of behavioral health and clinical health services. Former Congressman Patrick Kennedy and former Senator, uh, John Sununu are pairing our task force on this work. And a major element of their investigation will be the inequities in the
00;01;01;08 distribution of mental health services to minority populations. Our goal is to release policy recommendations to address these inequities along with a focus on payment systems, workforce, and technology that would better integrate behavioral health services and benefit minority population. We look forward to the discussion here today to help guide our thinking and recommendations. Finally, we know from very recent CDC statistics that the symptoms of anxiety and depression in non Hispanic,
00;01;36;08 black adults Rose to over 40% in late may and June, um, unbelievable percentages. So the challenge before policy makers indeed, uh, the challenges that regardless of race is great today, we have an outstanding group of experts to discuss these issues. First, a quick little logistics. We will have a moderated panel that will last 40, 50 minutes followed by 15
00;02;08;54 minutes or so to address your questions. If you have questions, you can submit them through the live chat function on your YouTube or via Twitter at hashtag BPC live, following the panel and audience questions.
00;02;25;10 [Bill Hoagland]: We are honored to have the us surgeon general join us and to have him share his thoughts on this critical issue. So without further ado, let me introduce the moderator of our panel con in a motel. And she will introduce the panel. Kana is a senior expert at McKinsey and company specializing in behavioral health, public health and delivery system reform. With more than 20 years of experience, she previously served
00;02;56;16 as the senior advisor and chief of, to the surgeon general and the Obama administration. And she also served as the acting administrator of the substance abuse and mental health services administration SAMHSA, a critic, a clinical psychologist by training from the university of California at Los Angeles. We are very honored to have you and to moderate the panel. So without further ado Kana.
00;03;24;53 [Kana Enomoto]: Great, thank you so much, bill. I am honored to be invited to participate in this panel and really thrilled and appreciative to the Bipartisan Policy Center for having the vision and commitment to have a session on this topic, which we know is of increasing importance to so many Americans. Uh, you know, when you look at COVID-19 broadly, uh, you see that age adjusted mortality rates for populations of color are dramatically higher than for white Americans where you're seeing 3.8 X, uh,
00;04;00;04 mortality rates for black Americans, 3.2 X for American Indians in 2.5 X for our Latin X population, and 1.5 X for Asian Americans. And when you look at mortality happening at that level of intensity, then you know, it's going to have a significant impact on people's behavioral health. In addition, we know that populations disproportionately affected by unemployment and being frontline healthcare workers or essential workers
00;04;28;39 are also going to have more drain on their mental wellbeing.
00;04;34;48 [Kana Enomoto]: And we see that communities of color are disproportionately represented in those high contact professions and among those who are financially vulnerable to loss of job or loss of health insurance. So we know that COVID-19 like other disasters that we've experienced in this country will have a negative impact on mental health and substance use. We've seen early data coming out to that effect, and we anticipate that it's going to have a disproportionate impact on our black
00;05;07;25 indigenous and people of color population. So I'm thrilled to be here honoring a BiPAP mental health month or minority mental health month, uh, with my friends and colleagues who are on the sharing the panel with me today. So I will do an introduction of our panelists, uh, and give you a brief description of each of their backgrounds. And then we will be opening it up to questions. And hopefully this'll be a really robust conversation
00;05;35;24 with all of you who are viewing and will be sending us your questions being via Facebook, uh, YouTube and Twitter. So first we have a Dr. Anita Burgos, who is a senior policy analyst for the Bipartisan Policy Center health program before joining BPC, Anita worked on healthcare policy for us, Senator Tina Smith, and a research position at Columbia University. Anita has a PhD in neuroscience from Columbia where short research focused on how sensory information to just pain and touch
00;06;07;13 converges in the nervous system. And in addition, and Anita is a primary caregiver for family member with serious mental illness and has seen firsthand the impact that our fragmented mental health system has on individuals living with mental illness, as well as their family. Next, we have Dr. Patrice Harris, the immediate past president of the American medical association and a child psychiatrist by training as the 174th president of the AMA Dr. Harris was the first African American woman to
00;06;37;38 hold the position. And during her tenure, she spearheaded the AMA’s effort to end the opioid epidemic and to address access to care stigma and substance use disorders and other barriers to treatment.
00;06;49;54 [Kana Enomoto]: Having served on the AMA board of trustees since 2011 and its chair from 2016 and 2017, she's long been a mentor, a role model and an advocate, and we're thrilled to have her on our panel today. Next, we have Chris Myrick, chief of peer and allied mental health professions for the LA County department of mental health, where she oversees the training and support supervision of some 600 community health workers, mental health advocates, peer supporters, and medical caseworkers. Previously Charisse was president of the board of directors at the national
00;07;23;14 Alliance of mental illness. And it was the director of consumer affairs at the substance abuse and mental health services administration. We are thrilled to have Keris here as it bringing both a peer perspective and her expertise on digital behavioral health and the experience of those with serious mental illness. And finally, we have Dr. Brian Smedley, chief of psychologist in the public interest and acting chief diversity officer at
00;07;49;16 the APA American psychological association. He currently leads American psychological association efforts to apply the science and practice of psychology, to the fundamental problems of human welfare and social justice. Brian co founded the national collaborative for health equity, a project that connects research policy analysis and communications with on the ground activism to advance health equity. And he's held a number of leadership roles in DC with research and policy organizations focused on aiding and representing communities of color. And
00;08;20;19 I am sure he will add a, an important and unique voice to this conversation. So I'm going to start, uh, uh, op with an ask question about actually minority mental health or bypass, um, cares you and your family, new BEBE Mark Campbell, personally. And you were one of the early advocates of, for the recognition of this month. Can you tell us a little bit more
00;08;46;25 about Bebe her legacy and the history of this month? Um,
00;08;56;52 [Keris Jän Myrick]: Sure, Sure. Thank you, Kana. And thank you, um, Bipartisan Policy Center for inviting me to partake in speak with you today. So, um, Bebe Moore Campbell was just an outstanding advocate, mother, grandmother, but most know her as a writer. Um, she, um, had several awards for writing books about, um, African Americans and others, um, living with a mental health and mental illness and the struggles that, uh, many of us have had in a system that
00;09;30;31 isn't equitable. So, uh, her books are, um, when mommy gets angry and also a 72 hour hold in 2005, she spearheaded a campaign actually to have July recognized as mental, um, mental health awareness month minority mental health awareness month. Um, unfortunately she passed away in 2006. And so, um, in 2007 representative Albert Wynn from, um, Maryland introduced the
00;10;01;44 congressional resolution number one 34 to recognize July as Bebe Moore Campbell minority mental health awareness month. And so it's really important that we do not forget her legacy. She was an outstanding, outstanding woman. Um, when I was, um, you know, ill, I was on disability, I asked my parents to come out to California. Um, and they
00;10;27;23 actually, we all went to hear her read from her book 72 hour hold and myself, my mother, whose name is also Bebe. And my father we're literally just clutching each other pants crying because we finally had heard our story told by somebody who looked like us. My father recently told me he never will forget that day because it was when he first felt like he wasn't alone as an African American. So, um, though the term BI POC or BiPAP, um,
00;11;00;22 is a new term and one that capture so much about black indigenous and people of color, um, we don't want to forget the legacy of BEBE Moore Campbell and all the work that she did. Um, even, you know, uh, founding along with other people, NAMI urban LA, um, which serves the community are primarily black and Brown folks, but we don't want to forget her national legacy. She's a luminary for us. And I think it's important to always
00;11;28;43 remember our history and from months where all of this came
00;11;35;52 [Kana Enomoto]: For kicking us off in that way. And thank you to your you and your family for your leadership and helping us all get here today. Um, so next, uh, thinking back to how we, how is it that we are, where we are, how is it that women of low or women of color are 50% more likely to say they're maltreated in maternity care or that 40% of black Americans feel like they've been mistreated by a health professional? Brian, I wonder from your public health perspective, if you can help us
00;12;08;07 understand the dynamic issues that have contributed to racial and ethnic disparities in access to healthcare and behavioral healthcare.
00;12;18;12 [Dr. Brian Smedley]: Sure. Thank you so much kinda I too want to thank the Bipartisan Policy Center, this important discussion, and I appreciate being part of it. Um, we're all well aware that there are tremendous barriers for many populations in accessing needed health and mental health and behavioral health services. Uh, these inequities have cause we've collected the data and for no doubt longer than that. Uh, and there are many reasons why these disparities occur, um, from a public health standpoint, it's important to recognize that these services are needed more
00;12;50;07 than ever. We are seeing facing tremendous stress and distress related to the pandemic. Uh, as you pointed out, people of color are disproportionately working in essential jobs or frontline positions where contact with the public is often inevitable. Distancing is, is often problematic. So people have fears about it either requiring the virus or spreading to their families.
00;13;14;06 [Dr. Brian Smedley]: We also see deep economic anxiety. People are losing jobs and disproportionately for people of color. Um, often the choices between working, getting that paycheck and putting oneself in one's family at risk. Um, so clearly these are times that are calling for, uh, and, and the public is demanding access to needed services. So the challenges that we faced, uh, in terms of barriers and obstacles, be they cultural, linguistic economic geographic, uh, that we faced prior to the pandemic or
00;13;46;37 amplified even more add to that what the American psychological association president Dr. Sandy Schulman has called the racism pandemic, which of course existed well prior to this viral pandemic. Uh, but it has deeply complicated, uh, our ability to mitigate risk against the virus. Uh, and it is placing many populations at greater risk for further mental distress. So when we see things like the killing of George Floyd, uh, that videotape was
00;14;15;40 traumatizing and retraumatizing to many people of color and other people of Goodwill who saw the horrific actions, uh, in Minneapolis on that day. So we're seeing exposure to social media, uh, that can be deeply disturbing and retraumatizing. Um, people of color often have their own personal experiences, uh, dealing whether with police or with, uh, the resurgence of overt expressions of racism, xenophobia and hate speech we're seeing of
00;14;46;15 course arise in recent years in, uh, hate speech and other kinds of attacks. Again, all of these problems are compounding, uh, our ability to address the needs of populations in the face of the pandemic. Um, so there are many challenges that we're facing, and this is a perfect opportunity for us to understand as a nation, how do we position policies, uh, so that we can reduce those barriers to accessing needed services, for example, uh,
00;15;14;11 the recent federal ruling, uh, to allow for tele mental health, uh, is an important step forward that I know that we'll talk more about, uh, during this discussion, uh, we believe that telemental health has tremendous potential to reduce cultural and linguistic and geographic barriers, um, for people who need services.
00;15;33;31 [Dr. Brian Smedley]: So if you live in a community, for example, where you're looking for a psychologist or psychiatrist or other mental health professional, uh, and if you are looking for a professional who shares your culture, your language, uh, but if you don't have that available in your community, uh, under telemental health, you can actually seek services from providers and other communities in your state who might be able to best meet your needs. So these are important developments and examples of ways that we can help these populations to overcome the challenges that they're
00;16;03;34 facing. Uh, and then, um, as we continue in this discussion, I'd like to talk further about the tremendous toll of racism itself, uh, as a stressor, as a source of mental distress for many populations, uh, and importantly, the opportunity that we as a nation have to hold a mirror up and to recognize racism and other deep sources of social division, uh, which in fact, um, make our population less healthy. Uh, it makes our population less trusting, less cohesive. And as I said earlier, it complicates our
00;16;37;32 ability to manage the spread of the virus.
00;16;43;55 [Kana Enomoto]: Thank you so much, Brian, just super powerful words and, um, you know, and, and questions that you're raising or all of us during this hour that at Brian rains of all physicians about physicians are
00;17;23;12 black, whereas 39% of orderlies are black. So how do we reconcile these disparities, uh, professionally as we're trying very hard to meet the needs of diverse populations?
00;17;41;56 [Dr. Patrice Harris]: Well, thank you for that question. And let me also add my, thanks to the B PC for having a focus conversation about mental health. Uh, you know, although it may seem typical, uh, for those of us who are participating, perhaps for many who are participating to have a focus conversation about mental health, it's been a relatively recent phenomenon. And if you add into that, a focus on mental health and, uh, communities of
00;18;13;52 color, um, it really is a recent phenomenon for far too long as we talked about mental health and substance use disorders. Because I think when we are talking about this, we should make sure and, uh, be explicit, uh, that substance use disorders are a part of this conversation. Um, we did not have a forum to talk about these issues. I also, on a note of personal
00;18;43;48 privilege, I want to say that I had the honor of meeting BEBE Moore Campbell, and so appreciate as was noted her work in making sure that these conversations are elevated in communities of color. And so here we have in the midst of COVID-19, uh, laying bare, um, issues, uh, that are called preexisting conditions again, pre COVID. And those were
00;19;12;04 around a public health infrastructure that has been underfunded and under resourced a mental health infrastructure that has been underfunded and resource, and then the whole issue around health inequities. And they've been elegantly talked about, um, and, uh, the previous, uh, speakers notes. And so as we begin to talk about, um, equity, uh, one of the areas we need to focus on is diversity of the workforce. And, and certainly I have been
00;19;46;00 particularly attune to, uh, diversity or lack thereof in the physician workforce. I do want to make sure though that as we talk about diversity in the workforce, uh, that we don't talk about diversity as an endpoint, uh, diversity is really a valuable, uh, strategy and piece of the puzzle as we
00;20;09;31 move towards a journey of equity.
00;20;12;06 [Dr. Patrice Harris]: We certainly, as I said, in my inaugural address last year need to be on a journey where the faces of our physicians and I'll broaden that, uh, the faces of the mental health workforce, uh, look like the faces of, of patients and the community. And so we have a lot of work to do there. I've said to him to, to many, we have some acute things to do right now, but we will have a huge, uh, to do lists after we get through the acute phase of COVID-19. And one of those issues is addressing,
00;20;45;11 uh, the diversity of the workforce. Now let's be clear about that. There is no panacea and no magic wand, and by the way, that can't happen overnight. And so we have to have conversations about how we start and as a child psychiatrist, I have to tell you, it will be important to start very early, uh, so that our children have the skills, the foundational skills around socio emotional development and all the skills needed to succeed in school,
00;21;16;47 uh, early on, uh, because success in school, uh, certainly in and of itself is a determinant of health. Uh, but it certainly means that, um, our youth will go on to educational attainment. And I think all of us on this call want them to be a part of the workforce. I selfishly want them to be a part of the physician workforce again, but that will take time. So what can we do right now? And
00;21;43;22 now is the time I think for all institutions, um, and even individuals, everyone from individuals to institutions to look first inwardly, uh, to look are issues around implicit bias. We have to have the very difficult and uncomfortable conversations. As you heard about racism, um, how structural racism has impacted these health inequities again, around, uh, mental health. We will have to talk about childhood trauma, uh, because we
00;22;15;26 know, uh, that childhood trauma actually trauma at any time impacts overall health. But again, as we start back and think about our children, we have to address those issues because they have a longterm impact, but we have to make sure that we are looking at policies. We are looking at practices, we're looking at norms. We are looking at educational curriculums to make sure that we are not further exacerbating, um, discriminatory practices and
00;22;47;27 health in equities. And we have to make sure that we are ready right now. The current workforce is ready, um, to learn I'm willing to be educated, have difficult conversations so we can address the issues right now as we work for the long term, uh, to increase, uh, the diversity of the workforce.
00;23;11;43 [Kana Enomoto]: Amazing, thank you so much, Dr. Harris, she raised a lot of things, uh, that, that we're going to circle back to, uh, as, as we keep talking, particularly the workforce child trauma, SUD, um, and you know, you, um, you raised a point that we want the faces of the workforce to look like the faces of the community. And, and I think now in the most forward-leaning communities, we want the faces of the workforce to be the faces of the community. Right. We want those peers, we want those family
00;23;40;20 members engaged. Um, and, and we want to be, you know, our own. So we want, We want the doctors and the nurses and the PAs also to be from our, from our community. Um, and so we have a lot of challenges ahead of us. Um, so to think about, uh, you know, I know you have many roles when it comes to, uh, behavioral health and policy and so on, but I'm to tap into your experiences as, as a caregiver, you know, first hand, what have you
00;24;13;03 observed as the experience, uh, from a family of color, um, and, and how it has been to navigate the behavioral health system from that perspective.
00;24;28;29 [Anita Burgos]: Yeah, absolutely. Um, and thanks Kana for that question. It's really important. And thank you for my colleagues at BPC for putting together this event. I think it's a really important thing to be talking about. So, um, I think there are many barriers to, to accessing mental health care in communities of color. And so what I want to do today is share a personal story that highlights some of those major barriers, but also gives us some idea about the possible solutions. And so today I want to talk about my mother. So my mother is an immigrant from the
00;25;01;46 Dominican Republic, and she's been living with serious mental illness for over 35 years. I'm her primary caregiver up until recently, my mother was receiving her mental health care from a primary care provider. And essentially what this means is that he was writing her prescription for anti-psychotic, but wasn't managing her medication.
00;25;21;35 [Anita Burgos]: Anyway, wasn't managing her symptoms in any way. And every time that she got a referral to see a mental health provider, she didn't go, she didn't show up. So about, last, about this time last year, my mother stopped seeing her primary care provider because he became too far away for her to go to go visit and she didn't have anyone to go with her. And so she, as a result, stopped taking her medication. Her family didn't know about it. Her doctors didn't say anything, didn't follow up on
00;25;52;06 that. And she fell through the cracks and this resulted in a hospitalization last July of about two weeks, that thankfully led to her being more stabilized and connected to a social worker and as a result. And I also signed her up for Medicaid. So she was connected at a loan to a social worker, but to a care coordinator through a behavioral health home program in New York city. And with this care, what this care coordinator was able to do was connect her care with her psychiatrist, her social worker slash therapist, and a
00;26;24;31 nurse practitioner to really manage her behavioral and physical healthcare. And the difference is night and day. So my mother has this team now of Latinos, all Spanish speaking, who helped manage her care. And there's mutual level of respect of understanding. My mother is now an active participant in her care, which allows me as a caregiver to take a step back. Um, and so it's really wonderful to just see how empowered and how
00;26;53;53 much better this type of care is working for her. And I think a question we all have to ask ourselves is why did it take a two week hospitalization for my mother to have more integrated care?
00;27;06;21 [Anita Burgos]: There are other stories like this. Um, when you continue to silo mental and physical healthcare, this leads to additional burden on primary care providers. It leads to painful experiences for families and patients, and thirdly, it's expensive. So I think that one key solution, and this is supported by my personal story, but also tons of research is, is to integrate care, to integrate behavioral and primary care. And we can do this in a bi-directional manner. So currently my mother is receiving more for mental health, her physical health here in a mental
00;27;40;44 health care setting, but it can also work the other way around having more mental health services in primary care settings. And so that's why Bipartisan Policy Center has put together this task force that, um, that bill talked about at the very beginning. And we're really excited. We're really excited about this work.
00;28;08;51 [Kana Enomoto]: That's, I'm so glad I needed to hear that your mom is doing better and that she's landed that respects her and respects your family way. Um, so I think, uh, we are getting a little bit of background noise, um, and as we just, uh, to that were going to go to questions. Um, so our first question, I think just building off of now that I think the
00;28;38;52 momentum that we've had to, we've talked about the need for a more diverse, uh, behavioral health workforce to get better integration, uh, with, with primary care and also specialty care. I imagine, um, what are your top ideas are for this, for the speakers on the panel of, of key steps we could take, uh, to reach a more broader, better, younger, faster, uh, to get that workforce that we know that our folks deserve and need, um, who would like
00;29;11;55 to go first,.
00;29;14;14 [Dr. Patrice Harris]: I'll go, I'll start. And I'm sure each of us has 30 ideas, but let me just say, sometimes we let's, let's anchor. So, and I think maybe about five years ago, folks were talking about health in all policies and that met, I would say health everywhere. Um, so I think, uh, we should certainly broaden that and say mental health in all policies, right? And we need to center, uh, the care of mental and substance use disorders And equity. And I will say that equitable care let's even get more focused,
00;29;46;57 um, in all policies regarding, um, uh, mental health. And that means, again, not just integration of primary care and behavioral health care, but even all of the, the, um, issues around the other determinants of health, right? So housing. So we should be looking at housing policies, right? We should be looking at employment. We should be looking at transportation because we need to integrate every, uh, piece of infrastructure or our
00;30;20;41 system. And we need to make sure that, um, there's equity centered in those systems, as well as mental health, uh, centered in those systems. And, and I'll just say in the schools, right. Um, as we, uh, think about what we should do in schools and potentially, and again, you know what, here's the one thing I will say as all of us, there is no one size fits all solution. It will depend on the assets of a community. It will depend on the needs of
00;30;48;48 a community. And by the way, um, whatever solutions should come from the community, uh, we should not have experts go into the community, tell the community what they need. So as long as we just follow those principles, um, not have a one size fits all, but have that lens of health and all policies and health does include mental health. I long for the day when we don't talk about physical, physical health and mental health, right?
00;31;14;35 Because there's all sort of a, it should be integrated, but right now we do need to use those terms because that's how most people understand those. But, but I think it's about truly integrating and making sure that beyond the traditional, uh, folks that are involved, that traditional stakeholders, we bring in a broad selection of stakeholders. And I'll say one more thing we certainly need to do. And that is invert the burden right now. It, I believe in our systems, we expect the folks who are navigating
00;31;49;40 the systems, uh, to manage the navigation and they end up having all the burden. We should also center in all of our work, a core principle of inverting that burden, we, every system should do all that they can to make it easy for the community to navigate the system and get the help, uh, help
00;32;13;30 that they need.
00;32;17;32 [Anita Burgos]: Yeah, I can follow up on that. Nope. I just wanted to quickly define a little bit what integrated care is and why actually has the potential to really impact access and for communities of color. And so when we talk about integrated care services, kind of how I illustrated with my other story, but also what the research says is that integrated care is when you have behavioral health providers and primary carrier working together to manage physical and behavioral health care in a team based
00;32;47;40 patient center way. Um, and so there are kind of four components when it comes to integrated care. The first would be identifying folks who need additional services, whether it's physical or, um, on behavioral. The second is that care coordination piece. So this is usually facilitated by peer coordinator, making sure everyone on the team is on the same page. The third would be being able to share patient information across provider. So you have the most up to date information about your patients and the fourth is measurement based care. So in the same way that we measure blood
00;33;19;23 sugar, every time you go to the doctor, um, for seek you have diabetes, we should be doing the same thing with symptoms of mental health conditions. So that if you aren't doing better on medication or treatment regimen, you can get that chair adjusted as necessary. And so the research shows that, that, um, that communities of color often go to primary care to seek mental health due to stigma in the community. And, um, and due to the level of trust that people often have with, um, the Fairmont primary care provider.
00;33;49;46 And so there are very few studies, unfortunately looking at integrated care in communities of color, but those, but the evidence shows that, um, it has, it does actually improve integrated care. It doesn't prove access in Latino and black communities. And there are, there's also some evidence that can improve diabetes and depression measures in black communities. So I just wanted to kind of tee up a conversation with that kind of that definition as well.
00;34;19;42 [Keris Jän Myrick]: Sorry, sorry. Yeah,
00;34;23;58 [Kana Enomoto]: We have a question from, we have a question from Rosie Bingham, what are the opportunities and challenges for integrated health care, especially for BiPAP community. So thanks Karen. Go ahead.
00;34;36;31 [Keris Jän Myrick]: So I'll kind of wrap my answer up into that question too, if I can, but, um, I was going to comment that, you know, I really don't want to forget the importance of peer support of people with lived experience of mental health and substance use condition, both, uh, the person, themselves, family members and parents that have training to support people in their, um, mental health and substance use recovery along with, um, integrated care that sometimes, um, you know, so important for
00;35;06;42 people to navigate a pretty complex system. Think Dr. Harris was saying that, you know, we need to invert it because a lot of times the patient or the family, while they're in the midst of crisis or on their road to recovery, have to figure it all out and have to kind of understand. But where is, how do I get from point a to point B to point C, um, and integrating and people with lived experience who look like you. Like, for
00;35;33;53 example, I never really believed could get better from my
00;35;36;57 [Anita Burgos]: Diagnosis of a serious mental health condition. I saw other people getting better, but they didn't look like me. Oh, I met somebody who looked like me, who had a similar diagnosis who was doing very well. They had finished their master's degree. Um, but they were like on the, you know, giving keynote lectures and things like this. I was like, okay, wait a second. Maybe I can get better. Um, and it was having access to someone like that to help me see the whole map versus the little, um,
00;36;07;22 um, space that I within that really, really made a difference. Um, here's our, um, generally look like the communities in which they're providing the services. So we have this ready-made workforce of people who are linguistically and culturally aligned with the people that we're serving, uh, both across integrated care. They're less used in, um, um, quote unquote physical care healthcare. But, um, there are now more, um, more
00;36;37;43 movement and training her peers to be involved across the spectrum of care, to help people when, where, and how they would like in order to move forward in their recovery.
00;36;53;12 [Kana Enomoto]: That's great. Thank you. And tremendous opportunity, I think, to bring in more diversity in our workforce in that way. So, Brian,.
00;37;03;11 [Dr. Brian Smedley]: I just wanted to build on what Dr. Harris said, but I also very much appreciate, um, uh, the other panelists comments about integrated care treating the whole person, uh, is a notion that we've got to come around to, and, uh, interesting than other cultures have seen, uh, the whole person in treatment settings and understand the mental, physical, and spiritual needs of a patient. So I appreciate those comments, but something that Dr. Harris said earlier is really important too, as we were talking about the, the workforce and the pipeline of people coming into
00;37;36;17 middle and behavioral health professions, we absolutely need that workforce to look like the communities that we're serving, but this is how are these issues are intertwined because Dr. Harris also mentioned the social determinants of health, one of which is educational attainment. Part of our challenge in the United States is that structurally we have deep inequities in our K-12 public educational systems that are a real impediment to diversifying the workforce. Um, very few people know this,
00;38;08;32 but our schools are actually more segregated racially than they were in 1954. When the Supreme court handed down the Brown vs board of education decision to integrate our public schools, that order was made to do so in old do, uh, with all deliberate speed. And unfortunately there was no political will to do so. The challenge today is that we have kids of color,
00;38;33;12 largely majority
00;38;35;16 [Dr. Brian Smedley]: Kids of color schools that are chronically underfunded under resource teachers, not credentialed to teach in the subjects that they're teaching in, in many other challenges, including, uh, in many instances, communities that have a very suppressed local tax base, which leads to the under resourcing of these schools. Um, so we need to recognize that our, that these issues are deeply intertwined. The very systems that put people at risk in the first place, such as in an inequitable educational systems, or also the very problems that we've got
00;39;08;41 to tackle if we want to diversify or middle and behavioral health workforce. So that begins with recognizing the critical role of policy in addressing some of these inequities, such as deeply inequitable, separate and unequal schools, which will continue to drag down our efforts to diversify the health and mental health workforce.
00;39;35;40 [Kana Enomoto]: Thank you, Brian. It's a, it's an excellent point. I want to riff off of that to talk about schools and kids and what we can be doing in light of all of these issues to foster, uh, the wellbeing of, of young people of color.
00;39;54;44 [Dr. Patrice Harris]: So the traits clearly, um, I think we are all alarmed, uh, that over the last several years, we have seen an increase in the number of suicides and suicide attempts in African American youth. And so we really, again, need to have, uh, and all hands on deck. I know there are a lot of moments where people feel like we needed all hands on deck, and it's probably true that there are, as I said earlier, a lot of issues
00;40;24;48 on our to do list, but we really do need to make sure that we are looking at our services and supports, uh, for our children. Um, you heard me say earlier about understanding, uh, stresses, the adverse childhood experiences survey. We really need to make sure we, um, have services for children who have acute stress disorder and post traumatic stress disorder. I have been saying for about 20 years now, uh, that, um, PTSD was certainly
00;40;57;53 underdiagnosed.
00;40;59;16 [Dr. Patrice Harris]: Um, and our children, I'm seeing more anxiety, I'm seeing more, uh, depression and my practice. And so again, we need to marshal all of our resources to build an infrastructure again, with all, everybody on a team, a team base infrastructure though. Uh, but I think we do need to have a focus on trauma. What's evidence base, uh, care, uh, for our youth, um, who have experienced a trauma or anxiety disorders or, um, or mood disorders. So I think we certainly need be laser focus on our
00;41;34;10 children and to make sure, you know, we cannot speak in schools and a little bit tangential. Um, I think another issue that's being laid bare, um, in COVID is how we have, um, I would say these are my words. Some institutions have been the default institution to care for a lot of other
00;41;55;01 issues that might be, uh, beyond their initial mission, certainly. And certainly again, getting back to the resources. So I think we have to be laser focused on that particular, as we are seeing this increase in the number of suicides. So wherever we can, we need to get services available. Now I do support technology. Maybe there's a later question, but I'll say this now, just like everything else. There is no one panacea. I see children using tele-psychiatry, but, um, that's right. Patient right time. And so again, we wanna, we want to put that in there as part of the
00;42;30;38 delivery system, but then, um, here's a new determinant of health that's been laid bare and that's technology. So I would say yes, now technology is determinative health because either with a distance learning or a tele-health, if you don't have a data plan, can't afford a data plan. Um, you know, you don't have wifi, uh, then that again, further exacerbates the current inequity.
00;42;56;03 [Dr. Patrice Harris]: So a focus on children and youth, um, with a broad focus on services and structures. I want to say one more thing. We may not get to this. I'll say now, particularly as we are talking about the black community spirituality was mentioned earlier today, now the good news is that we have our churches and other faith communities, but in the black community has been traditionally churches, um, who, uh, for many years, um, uh, may not have, uh, recognize and been as aware as they needed to be
00;43;28;48 around mental health and perhaps characterizing, um, issues as moral failings or character flaws, or you just didn't pray hard enough. Now, the good news. And in fact, at last year's congressional black caucus, legislative weekend, I was on a panel of faith leaders, uh, talking about this issue in the black community and the room was packed, standing room only a huge, huge, uh, wasn't a ballroom, but a huge, uh, meeting room. So
00;43;57;18 the good news is we are having those communities and the black community with the churches involved in that we will need to do more of that, uh, to combat the stigma and make sure that people are getting the help that they need and aren't shamed and don't feel like, um, they are doing something wrong or not praying. Uh,
00;44;20;13 [Keris Jän Myrick]: Okay. Um, can I ducktail on Dr. Harris's comments around? Um, tele-health because that's an area where I have, uh, extreme concern about access because, um, it's, you know, being said that this creates access for people, but of course, people of color will have to have, um, uh, the broadband, the equipment, um, in order to, um, partake in telehealth. Um, there are of course, uh, programs like the lifeline program for people who are below a certain poverty level, but even in those FCC
00;44;53;07 programs, like the lifeline program, there are limits on your data plan. There are limits on your call plan. So, um, people will have to make hard decisions about, well, do I have enough minutes to be able to make that call or to be on that call with my provider? Um, do I have enough broadband? Does it go quick enough for me to be able to participate in a video telehealth, um, a meeting with my provider.
00;45;19;10 [Keris Jän Myrick]: And then the other thing I think people have, have sort of forgotten about on the tele-health side of the equation is do people know how to use the equipment that they have? Are they understanding how to use some of the newer equipment? They might've had a flip phone before and now they have a smartphone, but they need to understand how to use that smartphone. They also need to think about how are they participating, um, in the telehealth meeting, whether it be on the phone or, um, you know, uh, in a video chat. So, uh, you know, we have created a
00;45;52;53 specialty called tech peers and basically what the tech peer does is they help people learn about digital health, digital health literacy, and how do I participate using all of these new technologies? Some of them are not so new, but you're using them in different ways. And some of them are new. You might have to download an app in order to do that. Tele-health meeting suddenly your world opens up to all of these
00;46;19;50 10,000 mental health apps. How many of them are good? How many of them mind your privacy? How many of them are in language that is that you speak? So when we help people think about participating again, this is another great role for, for peers to be trained, to sit and work with another person so that they can be engaged in that, um, meeting with them, um, in that, um, tele-health appointment. Um, and so a lot of times the providers may not have the time to help somebody understand how to use the equipment.
00;46;52;08 However, the role of the peer, they can actually, you know, you can bill for that service as an engagement service, so that it becomes a part of, uh, uh, you know, Anita was talking to activating and helping that person be engaged and take part in the activity. Um, but we do have to work on ensuring those limits are reduced so that people of color do have access
00;47;15;52 equally, um, uh, to the telehealth that's now out there.
00;47;23;55 [Kana Enomoto]: That's great. Thanks. Thanks Keris. We have another question that, Uh, is dovetails on that, but it's, I think maybe it gets more to rural communities to Sabrina smellier as to how do we address the tele mental health gap with an access to the internet, especially geographical areas that do not have telecommunications services. So are there efforts that you all have seen that are helping people get access to care when they don't
00;47;52;37 have, uh, the digital tool to, um, connect, um, in that way?
00;48;00;00 [Anita Burgos]: Yeah. I want to quickly add something, um, kind of as Paris was getting into, I think it's important to have a degree of flexibility. So, you know, if you don't have the literacy to really understand how to use a smartphone in for medicine, or you don't have the broadband to, to access the internet, audio only isn't is another option as well. At least as we sort of, maybe as Dr. Harris mentioned, that's an acute solutions, maybe your short term solution is working a little bit more with audio only, and then longterm solution, getting people, getting that broadband and that digital, digital literacy
00;48;33;56 up and where it needs to be. And so I know that at least with my mother, she's been doing her appointments through the phone and they've been working, they've been working pretty well, but there is a preexisting relationship between her and her provider. So there's a lot there. A lot of people are talking about this right now. I'm thinking these things on the coordinate issues through there. There's a lot of, there's a lot to say.
00;48;56;46 [Dr. Patrice Harris]: I think that's important. because some rules and regulations were relaxed, uh, because prior to co you know, during COVID, because prior to COVID, um, it wasn't seen as a visit that could be, uh, coded and reimbursed for, um, if you use audio only. So again, we, you know, COVID is really, um, bringing to bear some, the need for change in some regulations, of course, we'll have fair-minded debates about what we should continue and discontinue afterwards and
00;49;30;19 privacy and all that. But, um, I think that's good news. I'm glad to hear that for, um, uh, Nate, his mom, I do want to say one more thing about access before, because I don't want to forget that Medicaid. Uh, so you know, has really gone a long way in, um, folks who previously did not have insurance. Um, Medicaid has been very helpful and those folks having the coverage so that they could, um, access care, mental health care and care
00;49;59;47 for substance use disorders. So that has been critical, um, particular, you heard that I chair the AMS opioid task force, and we know that so many people I've been able to access care, uh, for their substance use disorder because of, of, of the affordable care act in general, let's say, uh, and certainly, uh, the expansion of Medicaid
00;50;25;13 [Kana Enomoto]: And, um, Medication assisted treatment as well. There've been some flexibilities that have come about, uh, during the pandemic. And so Nathan Hoff of Geisinger Commonwealth asked the question, has the pandemic resulted in any positive findings or changes that may have surprised you and are worth exploring or continuing post COVID-19?
00;50;52;54 [Keris Jän Myrick]: So I'm going to go back on the telehealth thing, sorry. And then I can rip off the next thing. And I think that the thing that's surprising about the tele-health was like, um, how, how quickly some of the rules could be changed so that more people could participate, but it was only on one side of the equation. And that happened, um, you know, more recently that the limitations for the FCC lifeline program, um, were still in play. So again, how can people participate if they have limitations on
00;51;24;38 their calling minutes or how long they can be on broadband? Um, so finally, um, those limitations have been eliminated for the covert period, but they're, um, in the heroes act that hasn't been signed yet, it would have been nice, had both happened at the same time. Um, so I think that's one thing that's kind of surprising is how do we make sure when, um, policies are changing, um, on, on one side of the equation, if you will, on the system side or the provider side that they're actually, uh, supporting, um,
00;51;55;16 any kind of policies that need to be changed, changed, um, or addressed on the consumer side or the, or the client side. The other thing I think that was really surprising for me is how quickly, and again, I'll speak for LA and what I've seen across the nation is how quickly, um, the peer community and the advocacy community was able to, um, shift gears and push things out to, uh, a virtual environment. So things
00;52;24;04 that were happening in person then suddenly, you know, there were, you know, zoom meetings or Skype meetings or team meetings, whatever people had the access to use. So that folks still though they had to be, uh, you know, socially, physically distanced, they still could be socially connected. We know how important that is for people in their healthcare. We know how important that is for, um, communities of color to be connected to their family and their families, not just mom and dad, it's, it's extended big thing. Like how do we stay together and how quickly we were able to, um,
00;52;57;31 pivot to be able to provide those, um, uh, services and supports to people in the virtual world. Um, some of the peer respites were able to stay open and keep people safe, uh, with physical distancing mask and do that education, um, uh, both in the rest of it and in the community. So I think those were some of the surprising things for me. I think people were very worried about people with mental illness and serious mental illnesses being
00;53;23;01 vulnerable, and really
00;53;24;56 [Keris Jän Myrick]: Under a lot of pressure here that, uh, that they might get more, uh, their centrals might exacerbate, but in fact, many folks have really been able to move forward and be part of helping people stay better. And that was really exciting to see something very surprising.
00;53;45;45 [Anita Burgos]: I can add something quickly to that as well. Um, and so one thing that's really exciting now is that there's a lot of bipartisan energy in Congress around telehealth and trying to see what works what's working. What's not working in order to implement things longterm. I think that's really that's. And I'll say I'll put on another hat. I'm also a web PPC working on a project on opioids and sort of tracking the federal funding to the States and how they're doing. And so in S we send around a survey, this is to get
00;54;18;35 a sense of how things have changed due to COVID in terms of opioid treatment. And there's at least anecdotal evidence that, um, treatment engagement has increased and that no shows have decreased. So there might be some, some potential there where, um, treatment acts is actually improved as a result of expanding beads, these kind of flavors.
00;54;42;15 [Kana Enomoto]: That's, that's, um, hopeful news. So I we're seeing distressing news on the overdose side, uh, but I'm hoping is we see, uh, treatment access increase. We can see those numbers come back down. Um, a question from Omar, uh, even before COVID access to non-English services and materials has been historically low. How can we address this disparity now, but then many communities that cannot communicate in English?
00;55;17;29 [Dr. Patrice Harris]: So, so, uh, uh, you know, again, uh, the other issue that everyone is now talking about is, is, um, equity and health equity. And, uh, so I, I think it starts with leadership. Um, and I think you have to be intentional, right? Because I think before some folks were doing somethings, uh, those were not, it would be in fits and starts. And the burden was, was typically on the community to come up with how they could negotiate and navigate the system. And so I would say it starts with these
00;55;47;49 questions, uh, saying, and people saying, Hey, my needs are not getting met. I don't speak English, I speak X. And, um, it's difficult for me to navigate your system. Um, how can you have, what are you going to do? And I think, um, so opportunities for institutions should make sure there opportunities to get that feedback, uh, from the communities that they serve, what are the gaps, what they need, and then the institutions need to address those. And I believe, um, institutions need to make a commitment to
00;56;21;35 leadership metrics, um, funding, resources. I mean, I, again, statements are great. Um, but it's about metrics, uh, commitment, um, and resources that match, uh, that, those statements. Uh, and, and I think also a commitment to hearing from the community. What, what do you need, what's missing? Alright, we don't have, uh, services in your language. We don't
00;56;48;21 have documents in your language. All of that, uh, comes from a commitment to listening to the community.
00;56;57;54 [Anita Burgos]: Yeah. And, and this ties into the, the workforce issue as well, and not having as much diversity in the workforce. But I think also when I think about the workforce, it's not just medical. Um, and, and of course for your support is really important too, but also the front staff at the office, like the whole office, if we have cultural competency kind of resonating across the whole team, I can make a really huge difference. At least in my experience with my mother, there have been times when she's having a psychotic episode and the Epic in the primary care office and the front staff was Spanish speaking. And that made a huge
00;57;30;39 difference. There was a level of sympathy there. They were able to sort of talk with us and, and talk with her. And I think that when we think about cultural competency, we should also be a little bit, a little bit broader.
00;57;43;38 [Kana Enomoto]: So Stephanie DeLuca, if Senator Casey's office asks this question, building off of the comments on lived experience and peer support, how can policymakers better center the voices of patients, primary caregivers, and particularly for people in communities of color. So what are our suggestions to policy makers?
00;58;07;03 [Keris Jän Myrick]: Do we have an hour kana, or just, if you think that the momentum has started, um, you know, there are, uh, 48 States that certified peer specialists, including parent partners, um, they're 30, some odd that bill Medicaid for peer services, meaning unique services delivered by peers that are within their scope of practice. Um, they're only a few for substance use recovery coaches that you can build certain States that
00;58;40;08 have that. So I think there are policies that need to happen there, certainly, but as far as listening to and hearing that lived experience research does show that in behavioral health, um, you know, people with lived experience who partner, um, to, uh, an in stakeholder meetings, their, their input is not valued equally as it is for other disabilities. And I think that has something to do with people being concerned that our
00;59;07;31 illness is a quote unquote brain illness. So if you have a brain illness, how can you have the cognition and the ability to participate and give meaningful feedback? So we have to kind of, that's part of the stigma,
00;59;20;51 [Keris Jän Myrick]: If you will, related to our movement of talking about things, being a brain illness. So just like there's a customer base and you get customer feedback around a shirt that you bought, or you get customer feedback around a service that you receive. That actually is a right. And we have the obligation to listen to that information because it's, it will be the things that will really help us to, um, improve and reform our systems to meet the needs of people to help them for us. Um,
00;59;55;01 Anita story, I think was beautifully told, didn't tell mine, cause you can read about it if you want. But point being is that, you know, our stories lift up the gaps that can be fixed. Um, and so they have to be listened to and be a part of it's about cocreation it's about co-design we don't want to kill the system. We want to make the system better and we want to be a part of that. So, um, you know, I think some of the, uh, uh, policies are around, um, having 50%,
01;00;26;25 uh, or 51% lift experience, voice, um, when you're, you know, doing your funding or when, you know, you have your mental health commission meeting or things like that, your commissions that they need to be made up also people with lived experience and thank you to, you know, BPC for their work on integrated care and ensuring that the advisory board had people on it that have lived experience of various types. That's how it's done. Great
01;00;52;14 example.
01;00;55;11 [Anita Burgos]: Yeah. I'll use this as a time to shout out to Keris Kana and Dr. Harris for Participating in our advisers are for that behavioral health integration project.
01;01;06;38 [Kana Enomoto]: Thank you, Anita. Brian, I know that you have, um, similar countable for this really, really good data. Uh, and you know, the, the fact that we aren't measuring all of these things, what can be done about that and what are your thoughts there?
01;01;30;06 [Dr. Brian Smedley]: Yeah. We have a number of challenges with respect to understanding, um, from a very simple, uh, data standpoint, who is affected by the middle and behavioral health challenges that we see, uh, we need much better data. We need much better surveillance and we need, uh, for those data to be public publicly reported, same analogy with the spread of COVID. Um, if we are serious about stopping the spread of COVID, we've got to have much better data on case rates who is testing positive, who's
01;02;00;31 getting hospitalized, what treatments they're receiving. Um, when we understand that data, we'll be better able to target interventions at communities that particular particularly needed. Um, this is also related to our issues around infrastructure and, uh, Dr. Alluded to this earlier, Sadly, over a number of decades. Uh, we have defunded our public health systems or mental health systems, um, in a short shortsighted effort to balance budgets, but yet we've seen that those investments, in fact, save
01;02;31;55 lives, uh, and help improve the quality of life for so many. Um, we need to, if we're speaking to Congress, um, have the conversation about the resources that are needed to ensure that we have infrastructure that meets every community's needs. Right now, we have an inequitable distribution of health and mental health providers, uh, communities that often have the greatest needs, uh, in terms of the health challenges and mental health challenges, those resource challenges have the least, uh, access geographic
01;03;02;22 or financially to needed services. We've got to correct that challenge. I think, uh, the COBIT pandemic, uh, helps to illustrate why those investments are so critically important to ensure an equitable response to the pandemic and equitable opportunities for people to seek the treatments and services they need.
01;03;23;53 [Kana Enomoto]: Thank you so much, Brian, that was really well stated. I see are coming to nodding in their boxes as well. Um, and with that, I think we're going to wrap up because we have a very special guest, uh, who will be speaking after us. And I just wanted to finish off by saying that, you know, I had a chance to hear E Brown Kennedy speak recently. And he said, racial inequity is a problem of bad policy, not bad people. And that's why it's so wonderful that the Bipartisan Policy Center
01;03;54;05 is hosting this conversation, uh, because in order for us to overcome the challenges that you all have articulated so well here to date, it is gonna require policy and a vision that is clear about the equity groups and the value of investing in health and in particular mental health and substance use. So thank you to the panelists, uh, for, for your wonderful thoughts today and, uh, tossing back to you, Bill thank you.
01;04;24;29 [Bill Hoagland]: Thank you very much, Kana. Thank you, panelist. I'm sorry, Carrie and panelists. We don't have another hour to talk about what policies that we should be pursuing, but I can assure you the Bipartisan Policy Center, the work we're doing with this discussion and these issues are going to continue to delve into them over the next of the next few months, particularly. Um, it is now my very distinct honor and privilege to introduce the 20th surgeon general of the United States, vice Adam with Dr. Jerome Adams. Thank you, Dr. Adams for taking time out of
01;04;55;23 your very full schedule today to speak to us on this subject of mental health access, uh, for people of color, a surgeon general is a model, as I understand is, uh, better health through better partnerships. And in that regard, I personally have been impressed with his commitment of developing those partnerships
01;05;16;03 [Bill Hoagland]: With members of the business faith education communities, which I think as we discussed in the previous panel are critical, uh, to improving that access for services out there. Uh, Dr. Adams received his degree in both biochemistry and psychology, psychology from the university of Maryland, his MPH from the university of California at Berkeley and his medical degree from Indiana university. Uh, while I went to that other rival school, uh, Dr. Adams up the road in my home state
01;05;49;46 of Indiana Purdue, I am still very proud that Dr. Adams served as the former health commissioner of my home state at Indiana, where notably he led the state response to the largest HIV outbreak in the U S related to injection drug use. Finally, a doctor. I just want you to know that we take your admonishment of mass squaring seriously here at BPC. My wife has so
01;06;18;38 together over 650 mass for public, including ones for BPC staff with, if you can see it here at bipartisan matter of Republican with elephants and donkeys. So, uh, we are very serious about this, and I know you are too, so thank you, uh, uh, Dr. Adams for joining us and I'll turn it to you now.
01;06;39;56 [Vice Admiral Jerome M. Adams]: Thank you so much for that incredibly kind introduction. And thank you for starting things off where I started in most of my conversations today, and that's what the importance of wearing a face covering and all doing our part to help slow the spread of COVID-19. And I want to thank the panelists who just finished up. I fortunately got a chance to hop on after I finished up my previous meeting and hear most of that panel, and it was amazing. And, uh, my apologies,
01;07;06;47 [Vice Admiral Jerome M. Adams]: to you all that we had to cut them short that you all could hear from me Because I could have listened to them all day long, and I especially want to give a shout out to Kana Enomoto who worked in our office for a, about a year, and really helped me wrap my head around the, the issues related to mental health and into substance use disorder that we can tackle through the bully pulpit of the office of the surgeon general. So just want you all to know that a lot of the work you have seen come out of this office is
01;07;39;00 thanks to the work of Kana. I appreciate the opportunity to join you today, to discuss the impact of COVID-19 on the health of Americans, especially our most vulnerable, and to highlight the intersection between the pandemic and mental health. Let me start by thanking this group for its bipartisan commitment to promoting health security and opportunity for Americans today. I think we need to get your wife to really, uh, uh, uh, uh, get some other folks together and get those kinds of mask out there for everyone because,
01;08;10;03 uh, gosh, uh, we have once in a century pandemic, which would be difficult in its own, right, but there's no chapter in the pandemic book on impeachment, and there's no chapter in the pandemic book on a presidential election. And there's no chapter in the pandemic book on a social justice movement, the likes of which we haven't seen in over half a century back to the sixties. And so it's incredibly difficult to disentangle the politics
01;08;41;06 from the policy and the practice, neither truly unprecedented times. And, uh, as you've heard the speakers articulate, this pandemic has hit us hard as a country. It's especially hit people of color, those who are older, and those who have underlying medical conditions, as we know, uh, not only are the regions rooted in preexisting medical conditions, but they're also rooted in preexisting social conditions that can to reduce our resilience,
01;09;11;03 our opportunity, and our health.
01;09;13;48 [Vice Admiral Jerome M. Adams]: And it's important to set the stage, uh, particularly with a group like this, by acknowledging that as critical if healthcare is. And when most, when most people hear health, they think of doctors, they think of hospitals, they think of clinics. Yeah. They make a policy debates in Washington, DC, over a reimbursement. The fact that if we know that health actually begins at home, 80% of your health is determined outside the hospital, outside the clinic, by people other than doctors and
01;09;44;30 nurses and pharmacists and respiratory therapists. Health happens in communities that are designed to provide income and financial security education access to transit. safe places to be active and healthy, affordable food and housing community must also provide trauma informed public services. And it must have a focus on preventing adverse childhood experiences and further all of these things must be free of structural and
01;10;13;38 institutional barriers related to race and bias. The fact is COVID-19 have laid bare the significant gaps in both equality and equity that exists when it comes to these critical contributors to health. These social determinants contribute to the medical determinants, chronic conditions, such as that diabetes, cardiovascular disease retention, and chronic lung disease that are especially common in people of color. And that put them at risk for COVID-19 and they create vicious
01;10;45;38 downward cycles where the more medical conditions you have, the oftentimes more likely you are to find yourself with fewer and fewer social supports to be able to counteract those medical risk factors and conditions. The combination of preexisting social and medical conditions make individuals not only susceptible to infection with COVID-19, but also are associated with more complications and higher rates of death, American Indian, and
01;11;15;32 Alaskan natives and African Americans have been hospitalized at five times rates higher than whites. We know that hospitalization rates are four to four and a half times higher for Hispanics compared to whites.
01;11;28;27 [Vice Admiral Jerome M. Adams]: COVID-19 simply have laid bare the fact that not everyone in this great and prosperous nation of ours has an equal opportunity to achieve and to maintain their health. Uh, I often tell people I am a big believer in personal responsibility, but I think it's important for anyone who says that to also acknowledge that the choices people make are 100% dependent on the choices that they have in front of them. And not everyone has the same menu of choices. For instance, social
01;12;00;26 distancing and teleworking, we know are critical to preventing the spread of coronavirus. How do I know this? Because I helped write the task force guidelines that suggest social distancing and teleworking. You had only one in five African Americans and only one in six Hispanic Americans have a job that allows them to work from home. We know that people of color are more likely to live in densely packed urban areas, and oftentimes in multigenerational homes that makes it more likely that the virus can spread
01;12;30;51 in the first place. It also makes it impossible in many cases for people to actually isolate and quarantine. When we tell them to, we know that people of color are more likely to use public transportation. And these are just a few of the risk factors that create a greater risk for a spread of a highly contagious disease like COVID-19. And while it's critical to understand and address the physical harm from COVID-19, we must also acknowledge the threats to
01;12;59;03 mental health from this pandemic. For example, for far too many children out there, this pandemic and the disruption caused by it will in and of itself be a major adverse childhood experience that will put them at increased risk for negative outcomes far into the future. We're seeing increases in anxiety, depression, and acute stress, which we know all can precipitate or worse than substance use disorder. PTSD and suicide are also
01;13;31;27 increasing.
01;13;32;48 [Vice Admiral Jerome M. Adams]: In fact, suicide in America is now on par with opioid overdoses in America. We know that suicide deaths reflect the complex interaction of risk and the loss of protective factors at the individual community and society levels. And unfortunately, we're seeing increased risk and decreased protective factors due to COVID-19. Uh, I've often put it this way. Almost everything we tell you to do to protect yourself from COVID-19 is the exact opposite of what we tell you to do to
01;14;07;12 lift up and support your mental health and wellness. That's the situation that we're in and related to suicide. Again, that's why I'm honored to be a prevention ambassador and to work closely with Dr. Barbara van Dalan and the prevention task force to decrease veterans suicide just quickly want you to know the goal of the prevention task force, uh, was, was to lower suicide in veterans, but also to look at ways that we can then expand what
01;14;37;22 we've learned to people all across the country. And we recently announced our reach campaign to change the conversation about suicide and create an environment where people reach out to loved ones, friends and others who may be vulnerable and urge those who may be struggling to reach out to others. No one should be afraid to reach out, even in the midst of COVID-19, no one should be afraid to seek help, and it is incumbent upon all of us and all of you to help people understand the
01;15;06;14 resources that exist out there. Even in the midst of a pandemic for them to be able to access care and services and support the campaign website, www.wearewithinreach.net, provides information to help people recognize risk factors for suicide, including financial stress, chronic illness, or pain, isolation, and mental illness in themselves and in their loved ones. And again, everything that I just mentioned to you have a risk factor or
01;15;36;35 things that we have seen substantially increased during the pandemic and our response to it.
01;15;43;27 [Vice Admiral Jerome M. Adams]: The website also links to resources that can provide assistance and addressing hopelessness that can lead to suicide. But I also want you to know that in the midst of tragedy, because I'm not here, just appreciate doom and gloom. There are many opportunities wrapped up in our response to it. We now have the opportunity to invest in prevention and an early identification to get people to help that they need and deserve. We can address the fragmentation of systems that you heard the panel so
01;16;14;07 eloquently layout and apply what we know works to save lives. This pandemic has altered healthcare delivery and access to mental health services in many negative ways, but we've also seen the explosion of telehealth services. Uh, the panel talked about this, but I'm going to give you a shot, a shocking to me, number, the average number of telehealth visits nationwide pre pandemic was just over 10,000 per week. We now are seeing several million telehealth visits occur every single
01;16;46;59 week. Uh, we now need to make sure we are studying what works well, what doesn't work well and make sure everyone has an equitable access to these services, because we know that in many cases, telehealth services are unavailable. If you don't have broadband internet, which again, another social determinant of health, uh, speaking of opportunities, we've also seen the American consciousness increase in terms of awareness of the
01;17;15;27 emotional and mental health struggles. The weathering, the allostatic load often caused or worsened by structural racism. And we know now that these things impact the wellbeing of people of color in ways that go far beyond the traditional measurements of racism. There's also an increased awareness on the importance of focusing daily on caring for our own emotional wellbeing and supporting those that we love. People are realizing how
01;17;44;52 important that is as we're being more and more isolated by COVID-19.
01;17;50;16 [Vice Admiral Jerome M. Adams]: And we know that this isolation, uh, can, can cause fear, uncertainty and other emotions that arise from our current circumstances. But we know that simply picking up a phone and calling someone that making people aware of various hotlines that are available, that writing a note to a loved one, that technology and resources that are available can connect people in ways like never before. This is an incredibly difficult time in our nation's history. And I remained steadfast
01;18;21;50 and encouraging Americans to use healthy mechanisms, to cope and to band together, to practice the tried and true habits that will keep us safe and healthy in mind, body and spirit. I urge you to reach out to friends and family, especially those who may live alone. And I'm not joking here. People. I really want each of you to think about someone in your life, who you haven't talked to in awhile, and whether it's a phone call, a video chat or arranging a socially distant, get together, remind them that you
01;18;52;35 were there for them in order to limit the risk of contracting. COVID-19 again, a variety of options that are available to make mental health resources safe, accessible, and affordable, even include individual and group therapy, as well as medication assisted treatment for opioid use disorder. Again now available in increasing amounts by a telehealth. If you or anyone, you know, is struggling, please visit findtreatment.gov or call SAMHSA's national helpline at 1-800-662-4357
01;19;27;47 [Vice Admiral Jerome M. Adams]: I know I had a much larger discussion today regarding the complex interactions of mental health and minority communities. So I just want to clearly state my conviction. Now, if we come together to prevent and limit emotional suffering in an equitable manner, I know we'll save lives and we can use this pandemic to lay the foundation for a mentally healthier nation for all Americans going forward while COVID-19 should, and will remain a top priority. For many of us, we must not forget about other health issues that
01;20;02;11 not only exacerbate the virus, but will be exacerbated by the virus and we'll be present long after this pandemic returns. While this pandemic has been an unprecedented challenge. And we're still discovering what this novel virus is or does. Remember, this is just a six month old baby that we have here. It's important to note that we've learned something new every day about this virus. We now know who is most at risk and why, and it's allowed us to better
01;20;29;59 protect those individuals. The average age of diagnosis has gone down by a decade and a half. We know much more about how to treat those most severely affected. We know that we must address the underlying drivers of disparate outcomes, the social conditions that can limit or unleash a healthy future. We know what works to keep people in their community safe. And we've launched a messaging campaign called #COVID stops with me. Why? Because of it, yes. COVID stops with me. COVID stops with you. We all have
01;21;00;51 a role to play in preventing the spread of this virus. And some of you may have seen me talk about this just this morning on a CBS this morning with a, with Gayle King. Uh, yes, we need more testing. Yes. We need more contact tracing and isolation.
01;21;17;13 [Vice Admiral Jerome M. Adams]: Yes. We need to open schools, but guess what? All of these things are made substantially easier. If we have lower communities spread, all these things become difficult. If not impossible, if we have runaway community spread. So at the end of the day, it still comes back to each of us taking the measures that we know will lower community spread so that ultimately we can stamp out this virus. I asked that you visited my Twitter account at surgeon underscore general to watch my PSA, uh, for the
01;21;48;03 COVID stops with me campaign and share it with your organization, with your networks and with your loved ones. Because again, one of the most important things we can do to promote mental health is to do everything we can to stop the spread of COVID. I need your help in spreading the word that our nation, our nation's future is literally in your hands. That being said, I'm sure you've all heard. We've seen arrive in new cases across the nation in many places. And if we don't act fast, this will inevitably lead to a rise in human suffering. The good news again, is that
01;22;20;23 we know what works, and we have the power literally within our hands to help the people of this nation. While we're gathered here today to talk mental health, I just want to close by reminding you our best immediate defense or those tried and true public health practices that you all are tired of hearing me talk about, but that we need to continue to say over and over and over and over again, because if we've met, if we've reached a million people, guess what? We've only reached to one, 300th of the
01;22;47;58 United States. So we need to keep saying these things, please help me reinforce that people need to wash their hands frequently and thoroughly.
01;22;55;51 [Vice Admiral Jerome M. Adams]: I think that they need to stay home when they're sick, but they need to maintain a safe distance from others and avoid gatherings whenever possible. And they need to wear a face covering in public to protect others. At all times, if we do these things, we know that we can turn around this epidemic in short order. It was just a few months ago that Italy was still talking about people dying in hallways of hospitals because their healthcare system was overwhelmed. We can, within weeks to months, turn this around. If everyone does their part. And my
01;23;27;49 final request is that you incorporate health equity into all your efforts, overdose of they're improving. And some sets of some subsets of our population and worsening are plateauing and others. And that's why we must all work together to eliminate disparities and generate better health outcomes, health outcomes for all, and all areas of mental health. We're facing an unprecedented challenge, fighting a global pandemic while continuing to expand access to life changing and life saving treatment to individuals fighting substance misuse and mental health issues. This
01;23;59;53 tremendous fight is also our opportunity to reinvent a nation that have healthier, more resilient and more just, I remain optimistic that we will get through this. And we'll look back on this time, certainly with, with, uh, a heavy heart for the 140,000 people who've died from COVID-19. But then we'll also look at this at the time when we really took a different approach to dealing with mental health, to dealing with social determinants
01;24;27;36 of health, to really addressing those factories that we know, put people at a disadvantage, but when adequately addressed and equitably addressed can put people in a position to be their healthiest cells. So thank you for having me here today. I know we have the opportunity to reinvent, to reinvent a nation that is healthier, more resilient and more just, and I look forward to realizing this future together. Thank you.
01;24;52;51 [Bill Hoagland]: Thank you. Thank you, Dr. Adams, for those very wonderful, uplifting and optimistic re uh, remarks. I really appreciate it. I also want to, once again, thank Kana, Dr. Harris, Anita, Keris, and Brian, and the panelists for their very fulsome discussions and issues that they raised. Um, and while I'm at are, do want to raise a thank you to wellbeing trust for their support of the work that we're doing here at BPC in this area, in this a very special month, Bebe Moore Campbell, mental
01;25;24;04 health minority month. Uh, I can assure you that BPC will take seriously to issues that have been raised today. I'm sorry. We were not able to get to all the questions, but we're going to look at today. The social conditions, policies, practices, and norms as Dr. Harris had suggested while also focusing on the longer term workforce issues, confronting minority populations. Thank you all for participating today. Stay safe, wear your mask.
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The incidence of mental health and substance use problems has increased dramatically due to the COVID-19 crisis. The situation is even worse for Black, Indigenous, and people of color (BIPOC) populations, which have long experienced disparities in access to care.
July marks BIPOC Mental Health Awareness month (formerly known as Minority Mental Health Awareness Month), which highlights the disparate impacts of mental illness, substance use, and behavioral health care on communities of color. BIPOC are less likely to access the care they need compared to their white counterparts and are more likely to be uninsured or experience stigma related to mental illness. According to the Substance Abuse Mental Health Services Administration, nearly 67% of Latino and 69% of Black Americans did not receive treatment for mental illness in 2018 compared to 56.7% of the general population.
Join BPC on July 21 as we discuss how COVID-19 exacerbated the adverse impact of behavioral health care access for special populations, specifically BIPOC, and how integrating behavioral health services with primary care can benefit these groups.
Featured Participants:
Keynote remarks by:
Vice Admiral Jerome M. Adams, M.D., M.P.H
U.S. Surgeon General
Panel Discussion with:
Anita Burgos, Ph.D.
Senior Policy Analyst, BPC
Dr. Patrice A. Harris
Immediate Past President, American Medical Association
Keris Jän Myrick
Chief of Peer and Allied Health Professions, Los Angeles County Department of Mental Health
Brian D. Smedley, Ph.D.
Chief of Psychology in the Public Interest, American Psychological Association
Moderated by:
Kana Enomoto
Senior Expert, McKinsey & Company
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