Audience Questions from the Community Conversation about Mental Health

Below are audience questions from the Community Conversation about Mental Health with Dr. Jim Yong Kim on October 10, 2024. A recording of the event is available here.

CARING FOR OTHERS

1. How do we care for people who have mental health issues other than extreme depression and suicidal thoughts? For example, anger issues, abusive behavior, other types of mental imbalance, or emotional immaturity. How do you get these people help? What is behind these issues?

   1. Behind these issues could be anything from years of learned behavior to a number of very real psychiatric diagnoses. Help in these situations comes in a combination of loving and caring accountability, and ideally the primary mode of care comes from a licensed therapist using cognitive behavioral therapy to break down some of these issues and allow for growth over time. At the end of the day, this question lists some of these character traits and actions that can be quite harmful to the people around us. For those individuals experiencing these things from loved ones, it's a great idea to pursue counseling for themselves as well as the ones we are caring for, as these things can certainly leave a mark over time. (Ben Pohl)

      
      

2. How do we help seniors, some of whom are still isolated in fear from the pandemic, connect with our community?

   1. Love this question – I think it really comes down to willingness to do the work. A direct connection can be harder to build when someone is isolated, but we’ve got opportunities at each of the assisted living and nursing facilities in our community. We should be taking advantage of the community-facing events that these facilities have and trying to visit when we can. (Ben Pohl)

      
      

3. How do you distinguish between high performance and burnout/crisis for high-performing individuals?

   1. Once the preponderance of negative symptoms associated with burnout appears, you know it’s more than just being a high performer – you've begun to stress your own system too far. Common symptoms are numbness/loss of empathy, increasing self-doubt, constant negativity, lack of joy, increased avoidance or procrastination (as a change from one’s baseline), reduced productivity, and others. Don’t forget the physical symptoms of stress as well – decreased sleep, daily fatigue, headaches, frequent illness due to reduced immune function, etc. (Ben Pohl)

      
      

4. How can nurses connect with and care for patients well, while considering their own mental health?

   1. Don’t be afraid of connection with your patients, it’s what makes a great nurse. That said, take time to debrief difficult cases or high-stress situations with staff, colleagues, a manager, or even family. Don’t be afraid to consider a counselor, and it would be ideal if you could find someone who has experience with healthcare workers. (Ben Pohl)

      
      

5. How do you gently correct someone who is believing things that aren’t true, having direct impacts on their mental health?

   1. This is a tough one – I’ll provide my personal opinion, and I’ll be honest in saying that I think you’ll encounter differences of opinions here. I would yield entirely to a trained counselor. That said, problems with perspective can be very difficult to shift. Questions to ask yourself are, “Am I the RIGHT person to correct this misconception? What is my goal in trying to change this person’s mind? What outcome am I looking for? Would attempting to break down this misconception/misperception result in the loss of a relationship?” These situations are difficult to navigate, and there’s seldom a black-and-white answer that provides us with the correct path. It’s important to weigh risks and benefits prior to the action, and take the path that supports one’s own mental health first while disrupting as little of the other person’s mental health as possible. If someone has a misconception that has helped form some core belief, there has to be very strong connection and strength of relationship in place prior to attempting to engage, and a great deal of tact and patience will be required. (Ben Pohl)

CHILDREN/PARENTING/SCHOOLS

1. We talked about the negative impact of smart devices on mental health and connection – in light of that, how can we help the children around us overcome their addiction to devices?

   1. Be brave – remember that children and teens are very likely to respond negatively towards these changes. We need to know this ahead of time, and shift our expectations so we are ready to weather the storm. Most importantly – provide real connection opportunities as an alternative. Consider joining them in this shift. For teens who already have smart devices, limit their use to a certain part of the house, and make it a family rule for all to follow, even us adults, so that we can walk with them on this journey. For our young children who are addicted to tablets and phones, get them outside, find a board game, engage in physical play – in short, teach them how to be a kid. (Ben Pohl)

      
      

2. What advice would you give for having age-appropriate conversations with children about mental health, forming positive habits, and specifically suicide?

   1. Don’t be afraid to be direct. For our older children, tweens, and teens, we often assume that our children can’t handle or aren’t ready for conversations about serious topics, and that most often just is not the case. When in doubt, seek professional guidance. In regards to suicide, remember the number scale for teens who don’t want to open up. For small children, bring play and crafts into the discussion, and again, bring in professional assistance when necessary. (Ben Pohl)

      
      

3. What questions can parents/caregivers ask children to check in on their mental health?

   1. Start with open-ended questions: How are you? How was school? Etc. Let these set the stage – they'll inform you on how open the child is willing to be. From there, you can be specific – Are you struggling with feeling down or depressed? Do you feel anxious or overwhelmed? Do you feel safe at home? Safe at school? Have you ever thought about hurting yourself? How do you feel about your friends/girlfriend/boyfriend? Do you feel they want what’s best for you? Do you feel like you use your phone too much? Etc. Don’t be afraid to be specific. (Ben Pohl)

      
      

4. What warning signs or symptoms should we watch for in children?

   1. Changes from baseline, changes/shifts in personality or character, lashing out, being obviously down or anxious, unwillingness to communicate. (Ben Pohl)

      
      

5. Are there any examples of schools where the kids themselves are initiating giving up social media or smartphones?

   1. Nothing comes to mind for me, but I haven’t done any significant searching. (Ben Pohl)

      
      

6. Does information about seeking mental health care stay on a child’s record in any way? If it does, can we somehow prevent it from negatively impacting their future?

   1. Medical records are legally protected information and in no way are involved in background checks. Court-ordered legal action may persist in some form in the public record, but I am not sure if this is the case and would have to consult with local authorities. (Ben Pohl)

      
      

7. Is medication overprescribed to children and young adults to solve mental health issues?

   1. This is a tough one. Generally speaking, in my opinion, I think the answer is yes, mental health meds are overprescribed in the United States. The US is the world leader in mental health prescriptions across all ages, and prescribes dramatically more to our children and teens than developed nations around the world – and this dynamic hasn’t led to dramatically different outcomes for us when compared to the rest of the world. That said, there may be multiple dynamics at play – if one lives in an area with a shortage of licensed counselors but with plenty of primary care providers/health clinics, it’s very possible that the only services available might end up in a prescription rather than counseling. Hopefully, continued development of virtual counseling services and improved resources for all can continue to improve this dynamic. (Ben Pohl)

THERAPY/TREATMENT

1. What advice would you give to someone who is nervous or hesitant about seeking therapy for the first time?

   1. Manage expectations. View mental health counseling/therapy as the pursuit of mental fitness. For many of us, going to the gym is intimidating, challenging, and unpleasant. It’s hard work. It takes time. Therapy is a similar process, but for our emotional and cognitive state. We are seeking a coach who can help us to become stronger, more resilient, and more knowledgeable. This is a process that isn’t always going to FEEL great in the moment. We are playing the long game! (Ben Pohl)

      
      

2. What advice would you give if someone opens up and needs medical treatment, but cannot get in to see a provider for weeks or months?

   1. Be sure to maintain a strong connection and check in daily while waiting. Lean into their “bubble” of support and the people that love them. Utilize virtual resources while waiting. If in crisis or it’s an emergency, present to the ER, ideally one at a facility with psychiatry, but anywhere will do. (Ben Pohl)

RESOURCES

1. Can we offer psychological first aid or similar programs in Muscatine? For schools, parents, workplaces? What other trainings would you recommend?

   1. Yes. Mental Health First Aid (similar but broader than Psychological First Aid) is offered in Iowa through the Department of Health and Human Services. Here is the link to request a training: https://hhs.iowa.gov/mental-health/provider-resources/grants/mental-health-first-aid

   2. Other possible community programs in Iowa are the ‘Make it OK’ campaign through the Iowa Healthiest State initiative. More information can be found here: https://www.iowahealthieststate.com/make-it-ok

   3. The Gray Matters Collective is establishing chapters in high schools and universities. This can also help drive conversations about mental health and decrease stigmas. (Rima Afifi)

      
      

2. Is there a list of local mental health providers? A list of resources for those who cannot afford to pay for professional therapy?

   1. This is not local, but the Substance Abuse and Mental Health Services Administration (SAMHSA) is a national resource that can be utilized. SAMHSA provides a national helpline that is a free 24/7 confidential treatment referral and information service, as well as a disaster distress helpline and a suicide and crisis lifeline. They also have a database called FindTreatment.gov that allows people to input their address to find support near them. (Rima Afifi)

      
      

3. How can we help those who need it while not always having enough resources? Many families have limited resources, and those children are often more at risk.

   1. Lean into local resources: schools, First Five Program, primary care, and psychiatry clinics locally all take Medicaid. (Ben Pohl)

      
      

4. Other resources mentioned:

   1. The Anxious Generation by Jonathan Haidt

   2. Bowling Alone: The Collapse and Revival of American Community by Robert Putnam

      
      

5. Other national resources:

   1. The Surgeon General’s report, “Protecting Youth Mental Health,” is a good report and has a list of resources on page 15. Take some time to explore this report and the resources: https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf

   2. The National Institute of Mental Health’s “Digital Shareables on Child and Adolescent Mental Health” provides great digital tools and other resources: https://www.nimh.nih.gov/get-involved/digital-shareables/shareable-resources-on-child-and-adolescent-mental-health

   3. “How Right Now” is a communications campaign by the Center for Disease Prevention and Control (CDC) and CDC Foundation that provides resources for coping with negative emotions and stress, talking to loved ones, and finding inspiration. It also links to numbers to get help right now:

      1. https://www.cdc.gov/howrightnow/index.html

      2. https://www.cdc.gov/howrightnow/get-help/index.html (Rima Afifi)

         
         

6. Other Iowa resources:

   1. The National Alliance of Mental Health Iowa or NAMI Iowa, provides mental health services for Iowa residents: https://namiiowa.org/ 

   2. The Iowa Department of Health and Human Services provides Your Life Iowa, which has a free helpline that provides information, support, and referrals to people in need of mental health support. The helpline is available for people to call, text or live chat online 24 hours/7 days a week/365 days a year. Your Life Iowa also has a facility locator on their website where people can search for treatment to address their mental health needs, including substance use needs: https://yourlifeiowa.org/ (Rima Afifi)

POLICY/PROVIDER SHORTAGES

1. What can we do in our community around policy and other upstream interventions?

   1. Upstream interventions focus on creating living, working, and playing environments that promote mental health. This often means focusing on the drivers of mental distress. Upstream interventions therefore can mean improving housing options in communities, increasing employment and minimum wage, ensuring the availability of safe green spaces, providing access and availability and affordability of nutritious foods to all, and ensuring our public schools are well funded to be able to effectively serve the educational needs of our children, providing health care to all. Taking an active role in decision-making regarding policies in your community and the State and actively advocating for these broad upstream interventions is critical. (Rima Afifi)

      
      

2. How is the shortage of mental health professionals being addressed by the College of Public Health?

   1. One of the programs that the College of Public Health is rolling out is an evidence-based program called Problem Management Plus which trains community members how to provide mental health support to people in their community. Currently, it is focused on refugee and immigrant communities, with a plan to expand. (Rima Afifi)

   
   

SELF

1. What is the balance in mental health between distracting/coping vs. healing/growing?

   1. In my opinion, we find this balance by selecting the path that leads to the greatest resilience and balance in our cognitive and emotional disposition. (Ben Pohl)

      
      

2. How can I continue to prioritize my mental health during busy or challenging times in my life?

   1. Schedule time daily for those activities that “refill our bucket.” Whether prayer, meditation, dedicated time with family, reading, or others. Carve time out of each day for tasks that fill you up rather than the typical things that fill our schedule. Don’t overlook the importance of all aspects of your health, physical, mental/emotional, and spiritual. Neglecting one will typically result in detriment to the others. (Ben Pohl)

      
      

3. What truths or habits do you ground yourself in, as a foundation for your own mental health? What are some strategies you personally use to be mentally healthy and maintain connections with people?

   1. For me, there are several strategies that I use. Being connected to others in my community is critical for my well-being, so I make sure that I am spending time not only with close friends and family, but in solidarity with community groups. Giving back to my community helps center me and brings me peace. Also, I have found that getting out in nature greatly helps to reduce stress. There is something magical about walking in a park – it helps me work out whatever is in my head without my even knowing it. Finally, I find it critical to get enough sleep, eat well, and get exercise (whether that is yoga, lifting weights, or walking). (Rima Afifi)

TRENDS/INFORMATIONAL

1. We talked a lot about smartphones – do you see any similar impacts from TV and streaming?

   1. Streaming “shorts” like YouTube, TikTok, Instagram, etc. taps into the dopamine economy of smartphones and tablets as well. These media are designed to be addictive and keep us glued to our devices. However, TV, movies, and long form screen use and media do not seem to engage the shorter feedback loops involved in these other processes. Maybe most importantly, TV/streaming/cable/etc. is actually an activity that can be done socially. Sitting down as a family or friend group to watch a movie together is entirely different than engaging in most handheld media. (Ben Pohl)

      
      

2. How do substance abuse and self-medication relate to mental health?

   1. Massively. For a simple answer, they are often another symptom or red flag. (Ben Pohl)

      
      

3. How are intellectual disabilities and mental health-related, if at all?

   1. Individuals with disabilities often have a higher risk of encountering mental health concerns. (Ben Pohl)

      
      

4. With all the different horrific events happening globally, what is the best advice for looking to the future with positivity instead of fear?

   1. Hang on to hope. Hope is powerful, and every action, however small, matters. (Rima Afifi)

      
      

5.  Veterans also struggle with mental health – 22 veterans die by suicide daily. Any thoughts about mental health relating to veterans or the military?

   1. It’s absolutely an area that we as a country, state, and local community need to work to support better. An inexcusable failure of our time. All the same tactics and advice that support general mental health need to be leveraged with particular attention towards this population, and ideally, we would build networks/resources through government action and legislation to better support our veterans at the time of leaving the service through the entirety of their lives. (Ben Pohl)

      
      

6. Ben, as a coach, do you have any comments on the trend of travel sports, compared to more city-led leagues with all-inclusive play in the past? Do you see any connections with children/teen mental health?

   1. The shifting dynamic away from physical play, fitness, sports, and time outside and towards handheld devices and gaming absolutely have played a role in the deteriorating mental health of our young people – for many, accessibility is everything. Unfortunately with the shift towards travel sports, fitness and physical play have become less accessible than ever. Even if there weren’t massive financial barriers, families where both families work or have multiple children have a much harder time committing to a travel program rather than a robust local sports program. As an aside, these programs don’t create better athletes overall, and can be particularly damaging in small to middle-sized communities, including Muscatine. Specialization at your ages further compromises an already shrinking pool of athletes, and a commitment to ultra-competitive travel dynamics starting in early elementary school means you will miss many potential athletes who aren’t as physically developed in early childhood – many of the best athletes found their way to sports after ages 10-12. Unfortunately in the modern age, these kids have left sports and committed fully to tech and gaming in a way that didn’t exist 20 years ago. This is a complex issue that I am passionate about and could keep rambling on for quite some time, but I’ll leave it at that for now. (Ben Pohl)