麻豆传媒

Topic: How has the pandemic affected the mental health of the public, mental health practitioners and telehealth, mental health of healthcare workers, and other psychology and behavioral science research about the pandemic.

Who: 

• - Professor and Chair, Department of Human Development and Family Studies Iowa State University
• - Associate Professor in the Department of Prevention and Community Health - George Washington University
• - Senior Director for Health Care Innovation - American Psychological Association
• - Assistant Professor in the Department of Psychiatry & Behavioral Sciences- Medical Director, Child Psychiatry Consultation Service - University of Miami Health System
• - Professor Psychiatry and Behavioral Sciences, Emory at University and former president of the American Psychology
• -  Professor of Psychological Science, Medicine, and Public Health - UC Irvine and Fellow of the Association for Psychological Sciences

When: June 11, 2020. 2PM - 3PM EDT

Where: 麻豆传媒 Live event space on Zoom - 

This live event will also be recorded and transcribed for use by media and communicators after it is concluded.

Transcript:

Thom: Welcome to this 麻豆传媒 wise live expert panel. I'm Thom Canalichio here with 麻豆传媒 wise. We have with us today six panellists to discuss various topics related to mental health and the current pandemic, as well as the recent protests involving the Black Lives Matter movement and how all of these things converge to impact people's mental health as well as psychological research. I want to introduce our panellists and then go over a few instructions and notes for our participants today. So first, to introduce our panellists – we have Dr. Carl Weems. He's Professor and Chair of the Department of Human Development and Family Studies at Iowa State University. We also have Dr. Roxane Cohen Silver. She's Professor of Psychological Science, Medicine and Public Health at UC Irvine. And she's also a fellow with the Association of Psychological Science, and her participation today has been made possible with the help of the Association for Psychological Science. We also have Dr. Vaile Wright. She's Senior Director for Healthcare Innovation at the American Psychological Association. Next, we have Dr. Olga Acosta Price. She's Associate Professor in the Department of Prevention and Community Health at George Washington University. We have Dr. Nadine Kaslow, Professor of Psychiatry and Behavioural Sciences at Emory University, and Dr. Kaslow is also a former President of the American Psychological Association and her participation today has been made possible by our contacts at the APA. And last but not least, we have Dr. Nicole Mavrides. She's Assistant Professor in the Department of Psychiatry and Behavioural Sciences, and she's also a Medical Director of Child Psychiatry and Consultation Service at the University of Miami Health System. Thank you very much to all of our panellists for joining. The combined the combined crisis of these three converging events – the pandemic, the economic consequences in these Black Lives Matter protests. This seems to be an amplifying effect. What do we learn from these other past crises that gives us insights into that?

Roxane C. Silver: I think that we're seeing a set of cascading traumas, a cascading set of collective traumas that may seem for many people almost too much to bear. First, we have the pandemic and then right at the same time as we crossed 100,000 deaths in the United States, we had about 40 million individuals unemployed and within a week or two; after that we had the George Floyd video that filled our feeds, both our social media and our traditional media feeds. And that combination of crises is really unprecedented. We have very little information to go on that in which we understand how people respond to this unfolding disaster. However, from a variety of prior crises, we do know that in general the public is quite resilient, and I would expect that many people will look back on this 2020 in the first six, seven months of 2020, and be able to see how resilient they were in coping with all of these combined crises.

Thom: Thank you Dr. Silver. I want to go next to Dr. Weems. Dr. Weems, you study especially traumatic events and adverse events in childhood. So, we've obviously had major disruptions to the school year and parents and students coping with that, as well as these other crises – the economy and the Black Lives Matter protests. How did these events potentially shape children's response to these events for years to come? And what kind of long-term impact can be seen or predicted based on previous examples? And let's make sure your audio is live. Go right ahead.

Carl Weems: Thanks. Again, thank you also for having me here. Well, it's a complex question. And we know from previous research that the experience, the pre-existing conditions that children bring to an event like this will influence it. To build on what Dr. Silver was saying, we expect some level of youth to be resilient. Sometimes that number is less than what we what we think it might be, particularly for those who have pre-existing conditions. For example, our research shows that those who have pre-existing trade anxiety are more likely to have a negative reaction to a traumatic event. But there's also some really interesting research that – [distraction] – some nice dancing coming through.

Thom: Thank you, Dr. Weems. We've removed that person. The meeting room should be locked. I apologize everybody but the settings that we've enabled from Zoom are just not working. And these disruptions are obviously a problem and I apologize for that. Please continue, Dr. Weems.

Carl Weems: No, no worries. So, one of the best builders of resilience I think is humour. So, being able to deal with disruption, with humour is a positive thing.

So, we know that also from previous research that those youth who take an active coping response are more likely to be resilient and do well and positive. But to answer your question more specifically, what is this going to potentially do for us, is I think up to some extent, it resets all of our baselines with a heightened level of stress. This is a world event. And so, youth and everyone is kind of – we're all now been exposed to this very kind of world traumatic event. And so, our baseline is changing, but hopefully we can adapt to that. And, the brain is a resilient organ and it can respond to many amazing things. But I think we have to be mindful of those things that we can do as individuals, as organizations, as communities and as a nation that can foster resilient action. So, there's, lots of work to be done in terms of developing things that we can do to respond to this. I don't think we can bury our head in the sand and hope that we're all just going to be better after these things, but that we need to take proactive action based on science to address, particularly the mental health issues because I do think we're going to see a spike in mental health problems, substance abuse and things like suicide.

Thom: Dr. Wright, I want to ask you how the pandemic, the economy and the Black Lives Matter protests all combine and create a sense or perception of trauma for people, even if they are not impacted directly with job loss or a death of a family member or something like that. How does this happen?

Vaile Wright: Again, thanks for having me here as well. I think it's not just the protests themselves but what they represent, right. What they represent is systematic racism as well as police violence against people of colour. And so, you have that pandemic combined with the economy, and you end up with – like as a nation, we're being confronted with on-going threats that don't seem to have an end and that we don't have a solution for. And that just becomes very taxing on people. Like Dr. Silver said, I think reaching a point where we're so overwhelmed that we're wondering if we really can handle this as a stressor. But as both the panellists have already mentioned, we are resilient. We've had experiences in our life that maybe we thought we weren't going to overcome like divorce or the loss of somebody, but we have. And so, if we can remember that, I think that does help address the trauma of the situation.

Thom: Thank you, Dr. Wright. You work on the APA stress in America survey, and I know that you may not have results of the current iteration of that survey yet, but it is something that's in process. And what can you tell us about the methods of that and any predictions for what you might see in terms of trends in response to current events?

Vaile Wright: Sure. So, we do our stress in America survey as an annual nationwide survey. This year we're doing it a little differently. We're doing it as a monthly sort of pulsing, check-in kind of survey. So, we do have results from our first wave, which was conducted about a month and a half ago. And what we found was that for the first time in over 10 years, we saw a significant increase in average stress levels. So, for the last 10 years, stress has really been declining to almost a plateau and now we have a significant increase. And while nobody seems to be immune, certain groups are disproportionately affected. Those are parents with children under the age of 18 and individuals from communities of colour were in the highest levels of stress compared to other groups.

Thom: Great, thank you so much. I want to go next to Dr. Olga Acosta Price. You specialize in mental health in the education setting, and as we discussed earlier with one of the other panellists about, you know, students having a disrupted school year and a summer break that's going to be far from normal, how are parents and students coping with the uncertainty in these disruptions and how is mental health in these kinds of cases being measured? And what are you seeing as an impact there?

Olga Acosta Price: Hi! So, thank you all for having me. Pleasure to be with you. So, as you said, and as it has been mentioned, the stressors are really impacting us all. But what's important is that it's impacting us differently, and how we are able to handle them varies quite a bit. And some other factors that help us understand how the stressors, how these conditions are impacting us, and that we can predict sort of that level of adversity is really determined by what you already had going on, sort of the pre exposures and risks that some families some children have already been contending with. So they were really already at a level of stress that may be was higher than the normative, how the current situation is actually maybe exacerbating our kind of ability to really function appropriately and then what resources, either material, emotional or social that we actually have available to help us buffer the impact. And so, as you can imagine, as some others I think have said that does impact some of us disproportionately, particularly if you are from lower socioeconomic status, if you are an individual of colour who's already historically been experiencing discrimination on a regular basis and structural racism. How folks, you know, I think generally have been coping is – first that we have, I think, very naturally folks first think about how to stabilize what's going on. So, stabilize your home environment. And so that means, do you have access to food? Do you have a stable home? How can you make sure that sort of through that crisis you've managed and then making sure that everyone's connected and that means to what degree do we have the resources, the tablets, the internet, the ways that families and students now have for this period of time in the spring, have had to rely on being connected with each other, which again some communities have disproportionately been disconnected from those kinds of resources that have meant that they have had a much harder time engaging in schooling and learning. But what learning and schooling is for many people is not just a place to gain more knowledge, but they very much are very protective environments. They have a lot of individuals within them that are protective for kids who are important for the social, emotional well-being of kids. So, making sure that we also support people's familiarity with even how to use technology, there's varying levels of understanding how to use technology so that we can stay connected, that we can do our healthcare visits, that we can meet with teachers. So, there's a lot of about – again, that meet is going to disproportionately show up differently in various communities, the non-English speaking families and communities where there's fewer resources available. So, I think the ability to cope is very much tied to many of those factors.

Thom: Thank you to Dr. Kaslow – what mental health disparities are being exacerbated by these current events and how would you describe which populations which demographics are at the most risk?

Nadine Kaslow: Thank you also for including me. So, I think that the truth is we don't have a lot of clear information about this. There is some evidence that there are certainly more symptoms of anxiety, more symptoms of depression, insomnia. But if you look at the data from multiple countries now, you see that that's true for many people. There are some people that are sort of about the same, and there's a sizable subgroup in each country that's looked at this now, that suggests that there are some people actually doing better during this time. There's a group of people who may appreciate the opportunity to be home more, or who find going out really stressful. And so being able to be home and not have all the social pressure is easier for them. Similarly, people with a history of mental health problems, there's no question that there are some people – this is making their anxiety worse, their depression, their psychotic illnesses or substance-use, their suicidality. But there are again some people with a history of mental health problems who are doing better, especially if they have access to the appropriate psychotherapy and medication, that they're actually doing fine or maybe even doing better. So, it's variable. And again, the intersectionality with class and with race is seen in this regard because people who have less resources; people are more in marginalized communities have unfortunately less access to much needed mental health services during this time.

Thom: Thank you, Dr. Kaslow. To Dr. Mavrides, how is the pandemic affecting people with mental health vulnerabilities or other conditions such as autism, and what can be done to support these patients better?

Nicole Mavrides: Thanks for again, including me, Thom. But, you know, I think especially with the vulnerabilities like autism and developmental delay, these kids are really used to the structure and the routines of school and therapy. And so, having everything so disrupted, there's been, I think a lot of families who have been struggling with increased aggression, increased agitation difficulties with sleep in these kids and then getting them off-cycle can really be very disruptive, not just to the individual but to the whole family. Some of the things that we're seeing in our clinics at University of Miami is that, these are the families who are asking for the most help because they've lost their in-home therapy or they're just not able to do get all the services that they're so used to. And so, we're really talking with parents about setting up a schedule, setting up structures so that these kids have at least some idea of what's going on. It's harder in the kids I think who have no limited verbal ability or limited cognitive understanding. But even those kids are used to structure with school, so they can respond to a schedule that the parents are setting up. But you know what, we've seen an increase in our autistic patients getting hospitalized because of aggression towards family or aggression towards themselves. And so that's been a struggle I think for a lot of these families.

Thom: Thank you so much. Dr. Mavrides. I want to go ahead and start taking some questions from our media participants. I do see a couple of questions in the chat. We'll come to you shortly. But first, a few questions that we've gotten from participants ahead of time. I want to call on first Deb Wood from Nurse Zone; and Deb, I'm going to make your audio live. And if you have a video, you can enable that. Please go ahead with your question. I think Dr. Kaslow might be the best person to answer this, so please go ahead.

Deb Wood: My readers are nurses and a lot of them are working on the front line. And I've heard there's some risk of PTSD on other long term like issues and I wonder how real that risk is and what nurses can do to avoid that?

Thom: One second, Dr. Kaslow. I'm trying to make your audio live and it's not working. Go ahead. I got it – co-hosts. Maybe I don't. Zoom is failing on me, people. I'm so sorry. Dr. Kaslow, please be patient. Okay, your audio is live, Dr. Kaslow, please go ahead.

Nadine Kaslow: Thank you very much. So, I've been spending a lot of time working on the front lines with our nursing staff at multiple hospitals now. And there is no question that the nurses who are working on the frontlines in the COVID ICUs is intensely stressful. It's been profoundly painful. They've witnessed so much death. They've been working really long hours. They've had to give everything to these patients because other people aren't allowed in the room and so there are the nurse and the nurse tech, and the environmental services person and the food services person and the family often because family isn't allowed to be there. And so, it's very stressful. And there's no question that there's increased risk for a variety of problems – for anxiety, for depression, for acute stress disorder now, Post Traumatic Stress Disorder down the road at least; as has already been mentioned by panellists, many of these nurses, nurses who work in the ICU tend to be a very resilient group of people. And many of them are going to come out of this without a “psychiatric diagnosis”. But they have witnessed tremendous collective trauma and just trauma in their experience. And I think the more that we can honour them, that we can validate their experience, give them as much support as possible, give them opportunities to take care of themselves, I know there is a lot of concern now with some of the same people who've been on the frontline being furloughed and that adds to an additional stress for them. And I think being really mindful that they really need a lot of extra support, attention, but they also need ways to take care of themselves and to be honoured and appreciated for what they have done.

Thom: Thank you, Dr. Kaslow. I want to go next to Jamiereno of Health Line. Jamie wants to ask about over-prescription, potentially of benzodiazepines. Jamie, you have a couple questions – if you could sum up those questions in brief, and we'll see which panellists are best to answer them.

Jamiereno: Sure. Thanks for having me, guys. I think I sent you way too many questions on that email. So, I'll try to dilute these down a bit. But the main thing I'm interested in, I'm writing a story and I'm actually a little bit of a news here – I might be writing a book on this.

I think we all agree that this pandemic, we also have a mental health pandemic, if you will, globally. And one of the results is a pretty dramatic spike in the prescribing of benzodiazepines, which I'm sure most of you know, all of you probably know, are the anti-anxiety medications so often – Ativan and Valium and such. Anyway, just so you guys know, I was at 麻豆传媒 Week 23 years and I'm also an author. I'm a three-time cancer survivor.

Thom: Thank you, Jamie. We are limited on time. So, if you could come to the questions – that would be great.

Jamiereno: Yes, thanks. Thanks for interrupting me, but I'll cut to the chase now. Bottom line is, there's been a dramatic increase in prescriptions, and I think this is a dangerous trend because we're learning more now about how dangerous these drugs can be. They certainly are helping some people but they also are very quickly catching up with opiates in terms of addiction and suicide. And I'd like to get your take on this, both the psychiatric and psychologist take on this on this trend.

Thom: Panellists, who would like to weigh in on that. Dr. Kaslow, is that something that you've got information about? Go right ahead.

Nadine Kaslow: So, there certainly has been some evidence of increases in the prescription of antidepressants, anti-anxiety drugs like benzodiazepines that you mentioned, and drugs to help people sleep. And again, as already been mentioned, this is a collective trauma, a certain amount of anxiety and depression is understandable. I don't think we want to call something a psychiatric problem when it is an understandable response to a stressful situation, and certainly medication alone would never be the answer for that right now. If somebody really requires medication in a monitored way, it can be very helpful, but certainly over prescribing or prescribing for things that aren't really psychiatric conditions, whether it’s normative stress responses, is not going to be helpful. But there's a subgroup of people that can benefit.

Thom: Dr. Wright, what are your thoughts about use of benzodiazepines.

Vaile Wright: Yeah, I absolutely agree with everything Dr. Kaslow said. I think what we saw at the beginning of this pandemic, when everybody needed to social distance and change the routines, was an immediate kind of panic that people were experiencing and weren't sure how to manage that panic. And they reached out to physicians or whoever they were working with, and those physicians mailed them drugs because they didn't know how to handle it either. And that's unfortunate because benzodiazepines are so addictive that while they can be maybe an immediate response to panic for those who really need it, when not monitored well. And if somebody continues to use it as their coping mechanism, then you really have a recipe for trouble. And so, I think where we are now is a better recognition of how our responses at the beginning of the pandemic are no longer effective. And I think this is just another example of that.

Thom: Dr. Mavrides, what are your thoughts?

Nicole Mavrides: I agree with both Dr. Wright and Dr. Kaslow. But I also feel like, being a child psychiatrist, we're a very under represented specialty and so, there's about maybe 10,000 child psychiatrists in the country. Many many of the drugs that are prescribed are not necessarily prescribed by child psychiatrists or psychiatrists in general. A lot of it is the family practitioners, the internists, nurse practitioners and other providers who are maybe dispensing these benzodiazepines as preventative or kind of first-line saying, “Oh, we don't really know what to do. We're going to give Ativan or Xanax or, you know, Klonopin,” whereas if they were to come to a psychiatrist or child psychiatrists, they probably would get different kinds of medication suggestions. So, I think that that is one of the bigger problems that they're being over dispensed, but it's not necessarily by people who have trained in psychiatry or child psychiatry. It's by, you know, general practitioners because that's who's prescribing the majority of the psychiatric drugs in our country right now.

Thom: Thank you, Dr. Mavrides. I want to go to another question from Bill Prasad at KHOU. Bill, would you like to ask your question?

Bill Prasad: Yeah, sure. Can you hear me?

Thom: Yes, please go ahead.

Bill Prasad: Okay, thank you for having this panel. I work closely with epidemiologists and physicians and all of them are anticipating a second wave. Can all of you look into your crystal ball and tell us what we might see if we see a more deadly second wave among the mental health of people who have pre-existing mental health disorders?

Thom: Panellists, who would like to address that – a second wave potentially complicating further these mental health concerns. Dr. Kaslow, would you like to weigh in on that? I'm trying to get your audio to activate.

[overlap]

Thom: Go ahead.

Nadine Kaslow: I see that Dr. Weems said she wanted to weigh in on that, so.

Thom: Right. That's absolutely correct. Dr. Weems, please go ahead.

Carl Weems: Thanks. I'm going to give a somewhat interesting response to that, which is that, you know, our expectation with a second wave is a second more difficult way of mental health problems. And linking to this idea of, you know, that we didn't – we weren't prepared public health wise as well as we should have been. And with a second wave, hopefully we will be a little bit more prepared. And so, our research out of Hurricane Katrina and the subsequent hurricane that happened three years later, Hurricane Gustav showed us this really interesting finding. When I was following a fairly large sample of children after, the youth after Hurricane Katrina, Gustav happened and we followed, we assessed them pre and post hurricane Gustav. And I expected their symptoms to go through the roof. And I found the opposite to be the case. Their symptoms actually decreased. And what we subsequently kind of learned was that the Gustav event was like a therapeutic exposure of that where the experience of Gustav for most – I'm not saying that it wasn't bad for some subsample of the group but for most people, it taught them that they could handle it, that they were able to deal with this event that what, and had been very horrible or similar event at least, was very horrible. And they were able to experience a similar thing with less trauma, so to speak. And we saw their symptoms go down and we actually learned that part of the reason for this was they began to think about the previous event in a slightly better light, and so it was a resilience actually building event. So my hope is this – if we have a second wave, we will have a better public health response and that that response will in turn teach large groups of people that they do have that self-efficacy, that they have some resilience and that they will know how to handle it.

Thom: Great. Thank you, Dr. Weems. Dr. Silver, would you like to weigh in on this as well?

Roxane C. Silver: Yes, I agree with what Dr. Weems just said. But I would also like to add that it's extremely important that we recognize that people's experiences, both in the first wave and the anticipated second wave, are not uniform. Many people will experience personal loss that they may not be able to grieve in the normal way. Individuals may also remain unemployed. And so, it's important that we don't think about this, about the public as a uniform group of people but recognize that there are individual exposures and there are consequences for people that may impact how they do respond, both to the first wave and anticipated second wave.

Thom: Thank you. Dr. Olga Acosta Price, with concerns in education and a second wave potentially further disrupting returning to school in the fall or a return to school and then another emergency abandonment of the school year could clearly be a major issue, what would you have to say about that in response to Bill's question?

Olga Acosta Price: Yes, yes. Thank you. I agree. I think that the education system in many cases, as many of us know, may take a fairly significant stance and in most cases across the country, in moving to distance learning and closing school buildings, and there's been a lot that's been learned I think about what was successful and what continues to be challenging about that. I think I mentioned a few pieces about that. This right now, as number of schools now are officially closed, certainly districts and state agencies and particularly local school districts have been furiously trying to make plans and contingency plans about what it will look like to return to school and also anticipating a second wave and how they can then, as you said, close and again remove 100% of the distance learning. So, I think part of what I wanted to mention is that may be what makes the second wave a little easier to digest is that we anticipate the probability that it can happen again. And so that does mentally prepare us. It allows us to – we've lived in many ways and when I think about students and families through a very disruptive, quick and difficult period – so in some ways, we kind of have a sense of what that worst-case scenario is. It's not as unknown. And so moving again to something where people have hybrid models of doing some face-to-face some loose concern, a whole bunch of different kinds of models being played with right now and thought through, but if they have to move 100% to distance learning again in anticipation of keeping everyone safer, folks and families of students know what some of that feels like, and now are more mentally prepared. Hopefully also have, that the schools are more materially prepared. They can recognize where there are segments that need additional quick attention to make sure that they are connected and supported. So, I think that's part of how we may see some of this play-out in our public education system.

Thom: Dr. Weems, you’d like to add further to this?

Carl Weems: Yeah, I’d like to just highlight or underscore the point that Dr. Silver made which is – it’s really, really important to realise that there are multiple trajectories of mental health problems. So when we answer these questions – the news media really needs to understand, we’re over generalising the people in general but there's folks who’s mental health problems will stay high and they’ll continue to stay high after a second wave, or there's folks who will decrease – they’ll show response to resilience and there's folks who will stay – they were buffered the whole time or they did well the entire tidal wave through – so really thinking about this, when you think about answers to these things are the multiple trajectories that people’s mental health and responses play out.

Thom: Dr. Kaslow, you’d like to add some thoughts to this as well – go ahead.

Nadine Kaslow: Yeah so part of the question had to do with people who had – adults who had existing health disorders and I really feel like we were not prepared to help that population very well at all and I think that we need to do much better preparation - in many ways it gets to the other question that has to deal with the pandemic response and how do we integrate mental health in a public health response for any future pandemic response. For the general population, for people at various kinds of risks, one group are those with serious and persisted mental illness and I think that we really need to do a much better job with helping people prepare, helping people, many people with serious and persistent mental illness have – social support networks, finding – and that was already mentioned about children who have mental health problems or developmental disabilities, making sure that there is a better support network, built in to play, making sure they move much more quickly to telehealth, for many people with serious and persistent mental illness they struggle economically, don’t have jobs or live in very crowded environments and so I think that many of the things that are public health wise recommended in terms of physical distancing and the like are extremely difficult for them and I think we really need to mobilise much more quickly and help them upfront build a kind of resilience that they need to manage through such a difficult situation.

Thom: Dr. Kaslow you mentioned tele health, that’s obviously been crucial in almost immediately upon instituting social distancing and major interventions across the US and around the world. Do you feel that telehealth will and should become the new normal for most doctor visits as a result?

Nadine Kaslow: So, I think that tele health should become the new normal. What I do think is we need to move to a more high route approach where we take it on a situation by situation basis, a person by person basis and figure out that for this person based on what's going on in their lives, maybe a tele health visit would be best, they have a bunch of kids at home and they can't leave them and get to the appointment, and for other people there's really a sense that this two dimensional space is not optimal for doing many kinds of really effective kind of work, but I certainly hope that our federal system, our insurance system will continue to support telehealth – we’ve seen it can be very effective, it can be very helpful but I don’t want it to be this very blanket kind of thing – let’s leave everything to telehealth. I think we need to really figure out who it works for, under what conditions and do a much more individualised approach.

Thom: Dr. Mavrides, what would you like to say about telehealth?

Nicole Mavrides: I absolutely agree with what Dr. Kaslow is saying and I think there shouldn’t be a blanket one size fits all for any one psychiatry, but specially with children – those who are from underserved populations or people who don’t have the internet capabilities or whatever – it’s been very difficult to get them into a Zoom or even a Facetime situation. Many of my private patients are absolutely loving telehealth because their parents can be working and they can be in school and they can pop in to a visit and then pop right back into what they were doing, but we’ve had a lot of issues with our community clinics and our patients who are in – under Medicaid and Medicare – getting them access. So, I do think that it’s not going to be a one size fits all situation but I certainly agree with Dr. Kaslow and hope that our insurance providers both private insurance and public insurance continue to at least give this as an option because for some people it really is wonderful but for others it’s been really, really difficult.

Thom: Right, Dr. Acosta Price would also like to weigh in on this.

Acosta Price: I absolutely agree with Dr. Kaslow and Dr. Mavrides and that there really should not be a blanket approach to this, but I think one of the benefits in school mental health at least that we’ve seen in working with children is that there are again, some conditions or some circumstances in which telehealth has actually helped engagement and has allowed people to have better regular access to care. In addition one of the challenges that has been really gradient – and again in communities where school mental health is part of what is offered to support children and families is that one of the greatest challenges has been engaging families, because much of those models have been school based models which we think really support access to care for children who otherwise wouldn’t get it, but it does add a challenge about engaging families and we know how critical it is to do that as part of that care. But telehealth has actually in many circumstances in the communities that we’ve been working with, we’ve seen that that has actually opened up many opportunity’s to connect with families, to engage with them before - because you can't actually access children in many cases, maybe some adolescents but not children, unless you are – it’s the family or the parent or caregiver that’s allowing that access. So, it’s actually then providing these opportunities for 1] to check in on the family’s wellbeing, the parents own health and mental health and resources they may need that we know absolutely impact their child’s wellbeing.

Thom: Another question for you Dr. Acosta Price, on the subject of teachers and their relationship with students, why is it so important for teachers to be so conscious of and even maybe focused on their relationship with students and parents and their families that they serve as compared to a focus maybe solely on or mostly on curriculum or content. That’s obviously been I think on the mind of a lot of families in dealing with the emergency shift to remote learning and with talk of a lot of schools potentially doing some combination of remote learning or maybe even exclusively remote learning, planning for and preparing for that relationship maintenance – I want to ask you – should that continue to be a main emphasis and why?

Acosta Price: Thanks. Absolutely – so I’d love to sort of divide this into two main points. One is that second only to families and caregivers – school adults and so that means educators and even staff in schools are – we know from the protective literature that adults in schools play an incredibly important role in helping young people buffer the stress and adversity that they may experience and that these relationships are incredibly protective against the kind of impact that we may otherwise see. And so, again we also – if you combine that with the fact that we know that adult well-being is highly predictive of child working, so if we do concurrently – it’s not to say that one is more important than the other, but to neglect adult well-being, the wellbeing of the educators, of the adult administrators and others in the building I think is to really jeopardise how well we can – and the kind of – again, thinking as a public health person, how well we can actually improve the school populations wellbeing and so efforts to support adults ability to engage in self-care, to support their own mental health and wellbeing is going to impact entire classrooms, entire school populations in a positive way to the degree that that's built in, but I think also because we want adults to also be modelling the kind of behaviour that we want young people to be adopting themselves and when they see people that they care about engaging in those practices, asking for help, taking breaks, attending to their well-being, that’s very powerful for young people to then adopt.

And then the last part is your social emotional learning and mental health and wellbeing has taken a high priority in efforts to think about return to school and it’s in a way that for those of us who have advocated for this as an important part for education have not seen an opportunity before and so I think the continued attention because we know that learning is such a social and emotional process, we want to make sure that we continue to support young people’s ability to actually engage in their learning and actually retain their learning – which we know they cannot do as its very highly compromised when they are stressed, when they are feeling challenged in a negative way, we feel that – so some – again continued attention to social emotional development and processes is critically important.

Thom: Thank you Dr. Acosta Price. I want to go to Dr. Wright and we’ve referenced a lot of different topics related to current events and I want to ask you a little bit about how people are responding to the pandemic and to the black Lives matter protest and what that can signal to us about the psychology and mental health of our public discourse and one of the things that’s been really major in the news – or a couple of things that's been really major in the news are the backlash to social distancing and protests about reopening the economy and then more recently we’ve seen these protests about Black Lives Matter and counter protests kind of raising a denial that it’s even a real issue. So I want to ask you about empathy and if you see that empathy is missing from our culture in a certain way or if there's some sort of deficit and what can be done to improve that and what you think that means about how people are responding to these parallel crisis that are going on.

Vale Wright: Yeah, I mean I think this notion of empathy deficit isn’t new. Its human to look at the world through our own perspective, but then it needs to be balanced with our ability to understand the distress of others and then be moved to help alleviate it and I think we are in a situation right now where it is all too easy to dehumanise other people and to fail to take their perspective into consideration as we’re confronted with the stressors that are occurring right now. So, I think some of the things that we need to be doing is thinking about what are the perspectives of others? How can I put myself in others shoes? How can I educate myself through novels or TV or movies about others experiences that are unlike my own and it’s not just empathy in and on itself that’s going to solve some of these problems around our public discourse, its balancing them with the other values that are important like fairness and liberty, but I do think that we are suffering from a lack of empathy in this country right now and that’s due to a number of factors.

Thom: Dr. Weems I’d like to ask you about these kind of converging crisis as well and in particular – is it your opinion that the Black Lives Matter protests have become so widespread because of circumstances as a result of the pandemic and the economic crisis?

Carl Weems: Yeah, I certainly wouldn’t attribute it solely to that, I think that the response is something that's built up over hundreds of years of injustice and so we’re seeing there's coming to ahead now, primarily probably because of fully being fed up with this, but I think to some extent that we did have a laser eye focus on things, so we were primed by this event – the Covid—19 event to shift the attention to something that we might all have some level of control over. So I think that the activism that we’re seeing is a response in part to time and ability and desire to be able to do something to change the world that we couldn’t do – as we’re not epidemiologists, we’re not working on a vaccine to stop the Covid-19 thing, but we can go out and protest. We can write to our congressmen or senators; we can do things to change this injustice which is pandemic in itself.

Thom: You referenced perceived control and I wonder if you can expand on that and how that or the lack of it in relation to these current events is a factor in people’s response and how they cope with trauma or how it impacts them.

Carl Weems: I think we have very good data to suggest that the more perceived control and the more self-efficacy that we feel in events, the better we do in those events. So perceived control and self-efficacy is a protective factor for mental health problems and a number of different health problems even. And so I think that we’ve very much felt with the Covid-19 that there was not much we could do besides social distance and we could feel some level of self-efficacy about doing that but that was isolating us and that was leading to great unemployment and so there was – the social isolation thing I'm not sure was building much self-efficacy but if we feel like we’ve seen something unjust and we feel like we can go out and demonstrate and change what’s going on, that’s helpful and so that it’s probably fostered to some extent our sense of self efficacy. We’re beginning to see hopeful signs and the legislature and city governments doing things, taking action to actually do differently and so I hope there's a silver lining to that, if it was in fact connected the facilitator, the intent outpouring that we’re seeing and that it helps maintain that intense outpouring.

Thom: Absolutely Dr. Weems, it feels when we look for that silver lining that we don’t want to downplay the severity of the crisis that people are going through, but it also is a little bit cathartic to see people really get motivated and active, so thank you for your thoughts on that. I want to go to Dr. Silver – how do you feel that conflicting information we’ve seen in media coverage of the pandemic as well as other topics that we’ve referred to that there are conflicting - that there's conflicting information being put out there either in media or by public officials or even not necessarily attributing nefarious motives but even just changing information, changing data can also create a certain level of confusion and harm the publics ability to pass out what's true and what's not or deal appropriately with these kinds of events. What do you think about that? Can you explain it a little bit for us and what do you think can be done to combat misinformation?

Roxane Silver: I've been thinking about this quite a bit because I think one of the challenges of this novel corona virus is that it is so new that the science, the information that we’ve learnt from the scientific community has been changing very rapidly. So at the very beginning the message was that individuals could only shed the virus when they were exhibiting symptoms, that was revised -information originally suggested that –or we were informed that there was no use or value in using face masks because in particular those needed to go to the healthcare providers, and because the science has shifted, people have found it very difficult to know what's the current messaging and I think that it is extremely important that the public use the information that is coming out of the public health system as opposed to public officials maybe who are maybe politically motivated to share messages that may conflict with the science. And as a scientist I strongly encourage people to use the public health information that is often very effectively communicated by the media. In the absence however of clear, consistent messaging, people often can seek out what they want to hear and if they are confused, they're much more likely to listen to a friend or something that they read on social media, because there isn’t a consistent message coming from our public officials.

Thom: Thank you Dr. Silver. Just a quick note for everyone, we are at the hour mark but due to a few hiccups and a few disruptions I really hope that we can squeeze in a few more questions for our panellists and we’ll go a few more minutes than the hour if you need to exit the meeting we totally understand, but we want to continue with a few more questions. Especially media, if any of you on the call have any questions, please do chat them to me and we will invite you to ask those questions. I want to ask Dr. Wright and any other panellist who want to also weigh in on this about an uptick in substance abuse. Alcohol or drug use during the pandemic. Whether its people who are dealing with addictions to those things or even just recreational use that can affect people’s mental health. What are your thoughts about that and is that a major concern? Have we seen data about this and what would you say about it?

Dr. Wright: Yeah, we have seen some data on it and mostly from what we know from the beverage companies, they're saying that they have been selling a lot more than in the past. So obviously people are buying – I haven’t seen necessarily any data on peoples consumption and how its effecting them but I think we can expect that yes, people are drinking more as a way to cope and respond to the situation, and while that’s very human, it’s not very effective generally and so I think people really need to be mindful of how they use alcohol or smoking or other sorts of substances to help them manage with their stress. Be mindful how often you're doing it, when you're doing it and why you're doing it and certainly if you're somebody with a pre-existing substance use issue, this event can be very triggering and we’re very concerned for relapse and encourage people to also seek out telehealth options around AA if that’s been a source of help for you, many AA groups have gone online as well, so again its really about finding effective ways of coping with the stress from the situation including reaching out and finding those social connections.

Thom: Thank you Dr. Wright. Dr. Acosta Price you’d like to weigh in on this and I've clicked the button to unmute your audio – go right ahead.

Acosta Price: Thank you, so no I totally agree with Dr. Wright I just wanted to kind of reiterate a point that I think was made earlier that its important again if we’re spending much more time at home – and children really observe and imitate a lot of what they see and so to the degree that caregivers are utilising maybe unhealthy coping strategies that may be unhealthy in the long term, they may be in some ways good temporary measures - getting through difficult periods – if that isn’t balanced with other coping strategies that young people can learn about, can witness, can see and then adopt for themselves – I think we – it hopefully provides more encouragement to those of us as adults to not just talk about using those coping strategies but actually do them. Make sure we get enough sleep, make sure that we find some time to exercise, that we stay connected to people emotionally, even if we can't be with them physically. That we talk out some of our problems, that we – all those kind of things that again may seem very basic and very natural but are very powerful in helping us adapt to challenges and distress and hopefully that will encourage adults to try to find some balance between some of those temporary measures and what we hope to be long term healthy strategies for coping.

Thom: Thank you. Dr. Kaslow I’d like to ask you if you can compare a little bit for us how the pandemic is affecting people that have dealt with mental illness versus those that haven’t. people who maybe have already dealt with anxiety and depression or are they being triggered by these circumstances or maybe do they already know some of the tools to deal with these things and they're more equipped to deal with it and then what can you say about people who’ve never dealt with anxiety and depression. Are they presenting with symptoms and are they may be experiencing these kinds of things for the first time and they're not sure how to handle it?

Dr. Kaslow: there's definitely people who are experiencing depression and anxiety for the first time. Who are seeking help, who are reporting symptoms for the first time, they're not even sure what it is, they just feel uncomfortable, they feel that kind of panic that was mentioned early on, the sort of sense of being out of control that people already talked about, things being so uncertain, unpredictable, the stress that they may have in their who life’s, that has to do with juggling work and children or unemployment or being on some frontline that’s really, really difficult. So there are definitely people who are presenting with symptoms of anxiety and depression and even getting a diagnosis for one of those kinds of problems for the first time and they really need help and you can see, mental health programs popping up everywhere where people are offering crisis calls, text lines for teens, for adults, the numbers have just skyrocketed for people texting, calling and reaching out for counselling.

In terms of people who already have a history of depression and anxiety, as I mentioned before I think that's going two ways. There's a group of people where this is really bringing up prior traumas or prior situations where they were really anxious and depressed and its reawakening that, making it worse, just like it was with the substance abuse for some people who are really vulnerable and they stress upon stress upon stress that sense of being overwhelmed. If you're vulnerable to anxiety and depression there are some people really getting worse, but again there are a group of people where maybe because everybody else is overwhelmed, they don’t feel so unusual, they don’t feel abnormal, they feel more connected to people because now they're not the only one having obsessive thoughts or ruminating or quite frankly washing their hands so much, and so we’re afraid to go out and try to figure out when it’s safe to go out, they’ve got a whole world having their same problems and they actually feel more bonded and more connected and are reporting less stress.

Thom: Thank you Dr. Kaslow, I saw a really relevant post on social media early on in the pandemic that I found really relatable about somebody who had dealt with severe mental illness and other kind of family trauma saying – I'm able to be calm during all of this because my life has already been a certain level of chaos and now everyone else is freaking out and I'm just as cool as anybody. They didn't quite put it that way, but that was the jist of it and it was going viral on reddit or something like that.

Dr. Mavrides as we’re trying to deal with this uncertainty, as we’re trying to deal with this low perceived control that Dr. Weems was talking about we are consuming probably too much news and too much social media and why is watching too much news and scrolling endlessly on reddit potentially creating that sense of trauma for people or at least increasing it even if they themselves are not being impacted directly by something and what would you suggest about taking breaks from those kinds of things.

Nicole Mavrides: Great question, I mean I think that the amount of news access, the amount of news availability right now that’s covering the pandemic, the Black Lives Matter, the various protests, it’s all consuming and so what happens is that you watch one thing or you watch two things and you kind of get sucked in and so even though it may not be happening in your town or the pandemic might not have reached the same levels in your state as it did in the North East or West, it feels like it’s happening so close at hand, because you're involved in this news media. So, the trauma that all these people are experiencing, you kind of feel it too because you feel like – if all these news services are reporting it, it has to be happening, it has to be impacting you. So, especially with kids, these chronic and persistent exposures to these kind of violence and hearing about death, it can lead to fear and it can actually increase aggression in kids that are watching these things so much. people don’t always understand what they're watching. They may get their news from only one news source, so they may not be hearing the different opinions that some of the other public news sources are putting out there. So, the trauma that comes can be really collective, it can be long-lasting. Some of the things we’re recommending to both adults and the kids is to not scroll aimlessly through reddit for hours on an end although it can definitely get there, but maybe to set times to check the news, to see whether or not – whether you do it three times a day, like maybe in the morning, lunchtime and evening after dinner, so you're at least getting caught up on what's going on but you're not getting alerts all day, every day. With parents and kids, its really limiting what you're doing and how much screen time they’re having. We know that kids especially over the summer now, there's not much else to do, but they don’t need to be on their screen and on the news media all day every day. So, just really putting some limits in place can be really helpful for kids, but adults have to place themselves and really put the limits on and not allow themselves to be bombarded by the negative stuff all day.

Thom: Thank you Dr. Mavrides and I’d like to thank Dr. Mavrides for joining today, I understand that she needs to go because she has clinic hours so –

Nicole Mavrides: My phone is blowing up right now.

Thom: I totally understand Dr. Mavrides, we don’t want you to keep your patients waiting. Thank you so much for joining us.

Nicole Mavrides: thank you so much for having me.

Thom: Thank you. Dr. Wright would like to also weigh in on bingeing too much news and social media, what would you like to say?

Dr. Wright: Yeah, I absolutely agree with all of that. I think one of the challenges with the uncertainty of this situation is it reminds us of all of the things that are outside of our control. So, one of the ways that we try to regain control is through reassurance seeking - and that’s really, I think what people are trying to do when they're compulsively looking at the news is, they're trying to find new information that’s going to make them feel better. The problem is there really isn’t any new information making us feel better right now. Instead we’re just reading the same things over and over and over again which is actually maintaining our anxiety, not reducing it. Keeping us in this state of hyper vigilance so I absolutely agree with all the recommendations. I think we need to be putting our devices down, we know from research that being constantly connected to our devices itself increases our stress and then you have a pandemic with a pandemic on top of it, then it magnifies it –so setting times aside where you just maybe read the news over lunch and then you let it go, turning off your notifications, modelling good behaviour for your kids, so if there's a no device time in your house, both you have to model that too, you have to put your device away and don’t just rely on willpower, put it in another room, keep it far away from you so you're not just mindlessly grabbing stuff and looking and scrolling and losing hours and hours again. It’s just not a very effective coping response.

Thom: thank you Dr. Wright. I know that Dr. Kaslow and Dr. Silver both need to part for other commitments but I do have a couple of other questions so I want to thank them both before they leave. Dr. Kaslow at Emory and former president of APA and Dr. Silver from UC Irvine and a fellow with the association of psychological science. Thank you both so much for joining. One more question for Dr. Weems – what can you tell us about modelling for suicide and are you seeing predictions potentially based on those models of an uptick in these events?

Carl Weems: Yeah, I’ll add one more thing which is – I know that my own mental health has improved as I've watched less news, not to blame the news outlets for my mental health problems or whatever but – early on what we tried to do was to – there was quite a few individuals talking about concerns about suicide rates, increasing because of the pandemic and so we looked at two previously known predictors of increased rates for suicide which is unemployment so people who are unemployed are at an increased risk for suicide and also social isolation and feelings of isolation is a risk factor so the – so we created a model based on what we were seeing in terms of the amount of unemployment and the number of folks who were under social isolation orders and kind of created a model and immediately the model was out of date for the world and the nation could – because the numbers of unemployment is constantly changing and the numbers of folks who were under isolation, but we tried to predict, we used the previous models and our models do obviously suggest that we should see an increase in suicide, unless we take action. I think there's all these resilience factors that we talked about and there are those things that we can do – my colleagues who are psychiatrists and public health folks are involved in those kinds of efforts where we’re trying to get the mental health services to folks to reach out to our friends and colleagues who might be impacted by social isolation or loss of employment and helping lift them up. I'm hopeful that my model does not come true.

Thom: Indeed, thank you Dr. Weems. I want to take time for one final question and then we’ll wrap up with a few notes. We have with us a student from Duke University and also an NASW intern who is working with one of our 麻豆传媒 members, training to be a future science writer and Jordan has a question for Dr. Wright. So, Jordan, I’d like to invite you to go ahead and ask your question.

Jordan Anderson: I'm Jordan and I'm a student like you said at Duke University. My question really ties back to addiction and so as we were talking about the addictive medications and those sorts of things, how do we access those people and those communities and sort of bring a community environment to those sorts of people that might not have the necessary resources that are available. It’s like a lot of the different people of these groups that we’ve been talking about.

Thom: Go ahead Dr. Wright.

Dr. Wright: Yes, thanks. I think it really piggy backs on what Dr. Weems was just saying is that it’s really incumbent on all of us to reach out to each other and to see how people are doing, and not just ask how they're doing but really listen and really see, where are the gaps that we can help fill in, whether its resources, whether it’s a connection or just being there for somebody. I think that we know that one of the biggest buffers to stress, whether it’s this level of stress or just the normal stress that we experience is social connection and so we need to be creative about how we use virtual connections and technologies to reach out to people and to see how they're doing and help shore them up and make sure that particularly those that we know are most vulnerable, don’t feel like they're alone. Even if we are in social isolation it’s not the same as loneliness. Loneliness is a perceived sense of not having that connection and we can be the community that wraps our arms around people and really helps them stay as mentally well as they possibly can.

Thom: Thank you for your response Dr. Wright and thank you for your question Jordan. I want to toss it to my colleague, CEO of 麻豆传媒 Jessica Johnson.

Jessica Johnson: Hi everyone, thank you so much for joining and participating today. I'm sorry for the interruptions and thank you for being so patient. We were having kind of a whack a mole session behind the scenes of trying to get people out and it was I guess a little bit stressful so I appreciate Dr. Weems your comment about – even in these moments how to use sense of humour, so thank you all and thank you to everyone who joined and I hope you guys had a great day. And Thom – you did a great job in handling that, thank you.

Thom: Thank you very much, I appreciate that. Thank you so much to all of our panellists, Dr. Kaslow, Dr. Mavrides, and Dr. Silver who have all had to go on to their busy days and we were lucky to have also with us Dr. Weems, Dr. Acosta Price and Dr. Wright – thank you so much for sticking with us for a little bit of extra time to answer those final questions. We really appreciate it. These are such unprecedented times and all of us are suffering or struggling in one way or another and you know, I debated about what to say about this but I will go ahead and say it – I've dealt with anxiety and depression all my life and these moments – because of this pandemic have exacerbated those things but they’ve also as some of the panellists said created a little bit of sense of solidarity with people who are maybe a little bit more sympathetic to some of those struggles and it’s very important I think for us to have visibility about these issues, that's a big reason why we wanted to do this panel and all of you have really contributed to that conversation in a really positive way and we really appreciate it. So, thank you.

To the media who are on the call and have stuck with us, thank you – we will get you the recording and the transcript of this as soon as possible and with that I will say thank you, good luck, stay safe, say healthy, have a great rest of the day.

Dr. Weems: You're welcome.