Mental Health Conversations: Insights from East Bay Experts

Addressing the Mental Health Crisis: A Conversation with Experts**

Introduction

In the latest episode of our "Capstone Conversation Podcast," we delve into the pressing mental health issue in the Greater East Bay. This episode, hosted by Jared Asch, brings together two leading figures in the field: Dr. Karen Tribble, Director of Alameda County Behavioral Health, and Jesse Tamplen, Vice President of Behavioral Health at John Muir. They share insights on the current mental health crisis, factors contributing to it, and how communities can play a role in finding solutions.

Understanding the Mental Health Crisis

The discussion begins with Jared Asch addressing the commonly heard notion of a "mental health crisis," particularly in the wake of COVID-19. Dr. Tribble provides context, explaining that the term encompasses a wide range of conditions, from anxiety and depression to more complex disorders like schizophrenia. She emphasizes that the crisis stems from resources being overwhelmed by an ever-increasing demand.

Jesse Tamplen expands on this, noting the role of societal stigma and economic challenges that compound the issue. He highlights a critical problem: the underfunding of mental health services, which hampers the recruitment and retention of necessary professionals to meet the need.

Listen to the full podcast episode www.capstonegov.com/podcast

Impact on Youth and Education

The conversation shifts focus to the impact of isolation during the pandemic, particularly on adolescents. California's prolonged school closures have had significant effects on children and teens. Dr. Tribble and Jesse stress the importance of external support systems like schools and community programs in ensuring children's mental well-being.

Dr. Tribble notes a decrease in children’s social service reports during COVID-19, highlighting the crucial role of educators in identifying children in distress. Jesse explains how social connections and activities, such as sports participation, are vital to young people's development and mental health.

Community and Industry Actions

Our experts discuss actionable steps the community can take to support those in need. Dr. Tribble advises taking every cry for help seriously and encourages parents and teachers to engage in open, non-judgmental dialogues. She stresses the importance of accessible resources, including telehealth and community support groups.

Jesse complements this by emphasizing a “no wrong door” approach, where any engagement point in society should be able to guide individuals toward help without stigma. They both urge the community to foster environments where individuals feel safe to seek help.

Moving Forward: Building a Supportive System

The podcast concludes with solutions for addressing workforce shortages and the need for systemic changes. Jesse discusses the necessity of supporting behavioral health workers and integrating them into a comprehensive healthcare framework. Dr. Tribble and Jesse call for legislative support to enhance mental health infrastructure and advocate for proactive community involvement.

Conclusion

This episode highlights the multifaceted nature of the mental health crisis and the collective effort needed to combat it. The insights provided by our experts underline the importance of an inclusive, stigma-free approach to mental health and the vital role of community and legislative support.

For further information and weekly updates, subscribe to stay informed about the latest episodes.

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THE FULL TRANSCRIPT

Welcome to the Capstone conversation where you learn about what's happening in the Greater East Bay. I am your host, Jared Asch.

Today we are going to talk about mental health. We keep hearing about the mental health crisis that's going on, with schools, with adults in the post covid world. I. What does that mean? How can we help people here in the Greater East Bay? Today I am joined by two experts, Dr.

Karen Tribble, who is the director of the Alameda County Behavioral Health, and, Jesse Tamlin, who is with John Muir. Dr. Trimble, will you start by telling us a little bit more about yourself and your role at the county?

Absolutely. And thank you. I appreciate the compliment of expert status, but we, I will do my best.

As you mentioned, I oversee the behavioral health department in Alameda County, which includes, system and services and partners. We provide county services, obviously, but really rely on our contract organizations, institutions. To help provide support to those particular need, and those are more vulnerable.

And in terms of who I am, I have an eclectic background, in behavioral health, behavioral medicine and, social work psychology, so that I am hopefully able to provide some insights globally. So that is, who I am. And in terms of the crisis, I think that's probably a broader question.

Jesse, you wanna, can you tell us a little bit more about your background and what John Muir's role is?

Yeah, good morning. It's a pleasure to be on this meeting with Dr. Triple. I've known her for years. My name's Jesse Tamlin. I'm the Vice President of Behavioral Health at John Muir.

I have system responsibilities for behavioral health, throughout John Muir. We focus on our emergency rooms, our medical hospitals, and then John Muir also has a 71. Bed Acute psychiatric hospital for children, adolescents, adults, addiction medicine, and general psych. We also have our partial hospital, intensive outpatient program and some innovative programs for behavioral health integration in primary care.

My background is a gerontologist, originally as a licensed clinical social worker. And then in gerontology we, I really found out there was something called therapeutic nihilism. Meaning that the older you got, the more society did it see you, especially when it was related to substance abuse and mental health.

I spent a lot of time, working in substance abuse and mental health before I came to a John Muir. And my goal in leadership is just like we want provide evidence-based, medicine and practice. We wanna have evidence-based management and evidence-based healthcare delivery. That's where one of my passions is to address any health inequity.

If it's in mental health. If it's in cancer, we wanna bring the same improvement science to support, our patients and elevate their healthcare.

That's that's a lot to take in, but I like the approach and how you're really looking at the whole person and how you could take a scientific reasoning behind it. Let's talk about the mental health crisis. We hear this is a news media headline a lot lately, especially post covid. What is going on?

Why is it being labeled as a crisis and how who's impacted by this? I know those are some broad questions, but I'd love to get your thoughts on Dr. Trimble if you want to go first and then Jesse.

I. Absolutely. And I will add one slight nuance. For us in the field, we use the terms interchangeably, but, the way that I think will be helpful to conceptualize it is when you think of mental health diagnoses and depression, anxiety, even schizophrenia, really complex, conditions, people have substance use is just as prominent.

And so when you hear a speak of, behavioral health that's inclusive and the integration with our healthcare partners and hospitals and clinics. It's a huge, monolith that speaks to a lot of different services. Now, to answer your question, why is it a crisis? I think it's helpful. I first to start in a very simplest terms, the resources are exceeding the need.

There is a huge number of individuals cross sectors used to, and unfortunately there's a lot of stigma obviously with mental health and substance use, period. And so I think, at both federal, national level, even worldwide, I would say there was a degree of comfort because people began to unfortunately attribute that to them or people who experienced that, or family members of those individuals and what we've seen over the last several years, so many factors that's probably for another, time.

But we're seeing growing need beyond. Those quote individuals who have historically been, suffering from long-term chronic conditions. The pandemic just ripped a bandaid. If I can be graphic off the wound of behavioral health because we saw many folks who, and as you mentioned, I really appreciate, VP Tamla description of holistic, approach.

I. Truly believe that bio psychosocial, even spiritual component of being a human being was rocked regardless of how you fell on a political level. People were isolated, really couldn't get their social needs met. People's health issues were way beyond their control. There was even a degree of an existential crisis.

Who am I if I'm not connected? I can't work, I'm not able to take care of my family. Is this real, is this political? There was just so much. And, after that. What people had hoped for was everything would go back quote, to normal. And we were not seeing that. We're seeing more people who ordinarily would've thought it was, again, people who are having more chronic disease and con issue whatever they, how they described it, having more anxiety, feeling more uncomfortable, feeling more scared, insecure.

It doesn't help that there's so much, I'll say complexity. Across the nation politically, people's livelihood, is impacted. People's ability to, just live and be, is feeling threatened. It is just enormous. And so the crisis is because truly the need is really outpacing the ability for many of us to catch up, and it's becoming more acute.

People who are presenting for, supporting care are much more complex, much more difficult to treat, much more, intense than they have been. It is really across the age spectrum, which is again, who we serve. From prenatal to older, adult and beyond, and families, we're just seeing things are more difficult.

And then the only thing I'll other say is it doesn't then help when there's a workforce crisis. You'll probably hear those come coupled together. We don't have as many people going into the field as we need to help support the need. It's just a really complex set of, variables. I won't say a perfect storm 'cause it's incredibly imperfect, but it is really hard right now for many people and not just people who impoverished any walks of life, any, political persuasion.

So that's how I would describe it.

Jesse

Dovetail on Dr. Tribble. The stigma for mental health has been around for a very long time. When we look at what is the impact of that stigma on individuals, we know that when you're diagnosed with a serious mental illness in the United States, you're dying 25 years younger than the average population.

If you have substance abuse on board, it's even higher, and they're not dying from their mental health condition. They're dying from untreated physical health, obesity, cardiovascular disease, diabetes. And so when Dr. Trimble articulately talked about, what is that stigma, that is where that stigma has had people be unseen or their diagnosis equal their identity.

I. I think through Covid with that understanding of whole Person care and I love that aspect of also adding spirituality, into it. In that bio-psychosocial spiritual model, people had that reckoning that we do need to take care of the whole person regardless of the economics of healthcare.

And where we see the economics of healthcare really drive the workforce shortage is when you look at behavioral health. Payments, from the federal government or the states, especially when you compare them to inpatient, they're the most underfunded care in the United States by 33%. So that means treating somebody in an inpatient hospital.

A hospital has to, that basically subsidize that 33% of unfunded care. Now at John Muir, we're a nonprofit and we're here to support our community. We have child, adolescent, adult, older adult and addiction medicine. And we partner with Dr. Trill and help, support all, Alameda County, residents as well too.

But many people throughout California don't have access to the, that inpatient lifesaving care within 30 to 45 minutes. Many times they're going seven to eight hours. My hospital at John Muir is a destination program for LA County and San Diego County because of how few child and adolescent, specialized inpatient treatment there.

There are, and we know that as Dr. Triple was saying, the earlier that we provide treatment, the more that people recover and people recover with effective evidence-based treatment. We know this. We were working to remove that stigma to get people the right treatment. And where we really look at that crisis because mental health depression is the biggest disease burden in the World Health Organization costs us more money than any other, disease, in the world.

But where we have that crisis is we don't have the trained professionals. To be able to meet the demand. We don't have the workforce capacity to be able to do it, and part of it has to go back to the economics. 'cause if mental health is underfunded, it's very hard to recruit a workforce to say you, you want to come into a field that's gonna be underfunded and you're gonna provide services, but it may not cover the cost of care.

That's not a very effective business model. But because so much of this is about health equity. Elevating our children, our adolescents, and our community. People have a passion not only to go into healthcare, but they have to have more of a radical passion to go into mental health with all of the challenging, economics, and also the stigma, associated with it.

I really agree with, Dr. Tribble, we're at a crisis because we don't have the providers to treat. Our patients or our clients. Now, what I can say is over the last 30 years, we've made gains in what we, what type of treatment we need to provide. So in the seventies, we may not knew, but knew what treatment to provide.

We have the treatment now we just need the providers to be able to, support those patients in our communities and provide whole person care.

Interesting. We talked a lot about. Adolescents, teens in here with the mental health crisis, is it worse in California than in other states that, weren't as isolated during Covid?

Did it get worse here because so many students, so many people were, we were out of school longer as an example, or.

And that's a great question. I would, we are in California and I, so I'll start off by saying again, regardless of what your political lean was, we are in, we were incredibly sequestered as compared to other parts of the nation.

We typically do have more per capita quote, organizations and county government and facilities that can help. Support in general. And we were one of the first counties states and everything else who, who actually lifted up telehealth and by phone and context. And many of us still wore our super suits and went out there even with Covid, when things shut down, we stayed in our offices or our clinics and we did the work.

In that way, California I think fared better. What? However, what's more complex, because you had so many, we're speaking of youth who were regularly used to having school-based services, having contact with their social workers, with their counselors, their clinicians, to move to a place where you abruptly don't have that was really complicated.

What was interesting, we also found in the pandemic we had a decrease in social service reports, so that meant that. Families or the community really relied on teachers to help say, Hey the student's not doing as well, or, Hey, have you dropped in with your counselor? Family's already approved and supporting services.

I would say that maybe was an abrupt shift, which can be incredibly. Complicated if you're used to have, being able to access as imperfect as they might be, services, to go from that to zero to figure out how to then reach my provider, because it took us a minute to do that. That I think was really complicated.

It's almost if you didn't have it, you didn't know that it was out there. That we did see just a significant drop in kids' desire to, acknowledge that I'm doing well. They really, it was really difficult for them. It really was that isolation. I it is a yes and with some context to I think how California did.

But we did thankfully, I think county by county or in the Bay Area even really recovered and had to recalibrate. That just speaks to what I was saying earlier about really focusing more downstream. We have a lot of preventative opportunities, but what we did find is that, again, as Jesse mentioned, the evidence-based, the things that really worked in communities, we actually had to ratchet that up, times a kabillion, if I can use that fake mathematic term.

That was actually unusual and a little bit more complicated as I think from the fact is that I just mentioned,

I. And I have three daughters, 10 and under, and the oldest one was in kindergarten and didn't get to finish that year when Covid first started. And I noticed the difference in her and the middle one versus the younger one that didn't have the same impact of all the covid stuff.

They're shy. They're timid in a way. It's Hey, we're at the ice cream store. No. Don't tell me what you want for your ice cream. If you want the ice cream, you gotta ask the person behind the counter. And it just like little things like that. I wouldn't say they're even in that. The social impact, mental health crisis.

The social impact,

that's what you're speaking. Absolutely. We take for granted what kids learned by being around each other. Even if they didn't like each other. They learned how to assert and speak and use their voice. Absolutely. And I think was a curse. Somewhat or a blessing. Social media kept them connected, but then social media also kept them isolated.

Parent, we weren't able to see exactly what those impacts were. A lot of folks, little kids got a little fluffier, and we all did. The covid pounds or whatever else you felt. And that was hard on them. So I don't mean to jump in, but yes. And yes. What you're describing is real.

It is very real.

Jesse, before I dive into the whole social media aspect that she, that we went into there, do you want to add anything else so far?

Yeah. I think one of the areas that I wanna just give a call out is all of the healthcare workers pivoted incredibly in this unprecedented area. When everybody else started shutting down, healthcare workers had to ramp up.

And I think it's also important to know healthcare's, workers, wellbeing. And many times we're still, healthcare workers are still recovering from covid because they were like a salmon going upstream. Why everybody else was shutting down. Healthcare workers had to pivot through telehealth. Maybe we created some more access in other communities than not.

We, our healthcare workforce was already strapped and frazzled, and then they even pivoted. Greatly and really went against the culture because everybody else was shutting down. But healthcare workers needed to lean in and do innovative innovative interventions to meet patients where they're at, clients where they're at in the community.

Also, I think people got a huge appreciation for what our teachers do and how important teachers are to the developmental health of our. If they have a mental health diagnosis, if they don't have a mental health diagnosis. So I think, we're still looking at what is that research, you said for, states that closed down schools and states who didn't close down schools.

We know that kids need to engage, they need to, as you mentioned about your daughter, don't ask me to order ice cream. Go directly. Be direct, stand up for yourself, say what you want. Those are areas that we're looking to overcome and help people move forward. But what Dr. Triple said, and I think it's critical about the ecosystem that we do to take care of our kids.

Our schools play essential roles in normal help. But also identifying those signals where there may not be, normal health, if it's mental health or physical health. Or if kids need food or, there may be challenging home situations. Our teachers are on the frontline and they're signal signaling expert systems, or getting people into the systems like Dr.

Trill and I run to be able to support those kids and when we need to expect that when those were removed and Dr. Trimble and other and myself and other people in the field in healthcare, try to do everything we could to, make sure that those kids got that care. But you don't see all those kids when they're in school interacting with each other, with their teachers, and those are how we have positive pro-social determinants of health.

Many people talk about social determinants of health as a negative, but there's the opposite side. They're also protective. And I think that is something that, we missed and we need to take that acknowledgement of how do we help those kids? Especially you noticed it in your daughters.

There's probably different critical areas that help. Like my son was in fourth grade. And he wasn't in high school and he wasn't in kindergarten. And for me, I thought he was actually the perfect developmental age to go through Covid because he had the autonomy to use a computer. He could talk to his friends.

He had some, he's developed those behaviors and for not only do I see clinically, with the patients we treat at John Muir, very early and those graduating high school. People have lost huge experiences in their lives, especially if those who were into sports, especially those who were into community, because some of their biggest positive social determinants of health, their protective resiliency factors were taken away.

And they're still trying to figure out what happened. Because they played on the football team, they played on the baseball team, they played on the wrestling team, they played on volleyball, and that got taken away from them overnight. And still navigating the, those areas.

The one positive thing that, I think Dr. Tripple talked about too, about the pandemic is people are much more open to talk about mental health, talk about Whole Person care, and connecting people to their community and making sure that they have the resources and the support and the treatment they need to succeed.

And just this conversation, would we be having it if we didn't have the COVID-19 pandemic? It has become visible and people are leaning in and we're looking at what can we do to continuously improve, to support our, children and, adolescents and of course anybody diagnosed with a mental health or substance abuse condition.

Let's build on that. What. How can the community help, how can the school system help? What should people be aware of to help identify it, to help get people resources?

Sure. I'll jump in and I think it, it'll build a little bit on what, the diamonds that Jesse mentioned.

I think probably more so than ever, because as, he described kids having a de developmental or a social break in their. Development, the experiences, the highs, the lows, the joys, even relationships, boyfriend, girlfriend, take notes. All that good stuff has changed and changed for them without the resources and the time they needed to really digest it.

Like we all got to have. , I say that to. Say when Now, more than any time, I think when parents or schools or teachers here, when a child reaches out or says something that maybe 20 years ago was just a colorful expression, oh, I hate this, or, school sucks. I don't ever wanna be here anymore.

I would encourage people to take it much more seriously than we ever have had to. Not to pathologize a child at all, but to lean into praising and encouraging them, to describing those feelings. And then in any way, even if it's text or comment or lunch or a burger or hot Cheetos, just have a conversation about what that means.

And, you know what we found, I mentioned it earlier. Even though Covid came and really then highlighted and people are now talking about wellness and mental health and all those good terms that we've been fighting for and are pleased that people are feeling comfortable with that. There's still a degree of stigma, and so having connections, and that's at least a real, another good thing that's was born outta Covid.

It could be with the local, religious facility or that, they have teen groups. It could be, folks that or clubs. It could be if a child I appreciate Jesse mentioned mentioning computers. I've got one of those who is a few of those who really love computers and coding and stuff. Is there a coding club?

Is there somewhere where they can have. Access to other people and be able to share and talk through some things and quite frankly, just giving a call to anyone. You know what was fascinating is, in the middle of all of this, the world didn't stop. Not only did our teams have to come and go to work and many of us, I'm proud, I'm barely now a year and a half, two years into virtual work.

I was one of those folks who were still here, yoing down the hallway because we didn't see many of our, county colleagues. But at the end of the day, nine, eight. Eight was something that the it really emanated at the federal government, but as opposed to 9 1 1, when you start to really see some complex issues, calling 9 8 8 is a easy, recognizable number to just, even if it's not emergent crisis.

We're now equipped as a system to figure out what resources are in your local community? There's so many toolkits out there. There's so many, literally you can just Google get onto your county or your, John Muir and healthcare websites to look out and research. So that's a long-winded way for me to say that when you hear it, when you see it more than ever because it has taken a person that much longer, probably because not getting those.

Milestones to practice reaching out to people, you should really take it seriously, and support them in it. And to answer your question, there is no one size fits all because as I said, for one child or youth or family, it could be support group or some folks, it could be counseling, it could be therapy, it could be medications, it could be actually.

Talking to your primary care physician because stigma, it's like throwing a pond, a rock into a pond. We had a ripple in a wave and then it is creeping back again. But it may be that you get your behavioral health needs met through a primary facility. So many of us, including our county and Jesse, that's why we have relationships because it's really, it should be, and that's some of the things that we're working on.

No wrong door. There actually is no wrong way to ask for help. And there's some really good strategies, that work. And even though you didn't ask this, if I can backtrack a couple seconds 'cause another diamond that Jesse said was, just the intersection with the workforce. As you can imagine, as he was saying, the actual people who are.

I, I, again I love all things sci-fi, so my mind pictures, shields, and magical swords and things coming out like the Super Friends, although I'm dating myself or the Justice League, I should say, to help fight this crisis. What was interesting and what we found was if you look at our, healthcare partners, non-behavioral healthcare partners, there were, I'm being euphemistic, but.

Roses, doves, butterflies. Yay. People were giving them lays. This is fantastic. You did a great job. And now that the pandemic is over, what you will see is that kind of as that ripple returning is that people are now more frustrated. There's so much need. Where are our providers? Why is there not enough people?

We're seeing the homeless crisis get worse, and you're seeing that exacerbated with people who have. Both behavioral health and homelessness needs. And it has unfortunately become that, gone back a little bit to it being a blight or how can you fix people who are suffering. And I just hope, because that's a difficult place to be in, if you're a provider of mental health, behavioral health, you don't get any roses.

But it's one of the hardest job to do to actually work with a person who you can't. Visually see something to extract surgically. It is something over time people have to be ready and engaged and there'll be multiple quote failures before a person really is on the road to recovery. And so really helping and supporting those that are providing the work.

Giving them their due because it really is a incredibly complicated, state we're at. People are, again, much more in need and I just hope that for those that are, leaders or legislator powers that be, can help reframe the conversation as to I. We're not going to solve, fill in the blank X crisis. Be by fixing those who have mental ill it's actually different.

We need more resources. We wanna celebrate putting on our shoulders. Super friends come together again, unite that those workers that are struggling with the pay. Who have a noble calling really also need to be supported because they are really making a difference and have, so it's a, and that I think added a little bit to, at least for us, retaining people in the field.

They really are just tired and had hoped, I think, like soldiers coming from a war to be celebrated for the effort, just affirmation. And we're not seeing as much as that as we would like, to see. So if there's a way to. Solve that quote, or at least lean into it. I think it would also make a huge difference.

I appreciate what Dr. Triple said. And I think, when we talk about workforce and some of the challenges in delivering care, we could have a whole nother podcast, on that because there are unique challenges and there are clear things that we could do.

To improve that workforce. What I really, resonated with me is the what can we do to support our children and adolescents, or our brothers and our sisters, our grandparents? Is that no wrong door approach, right? You see something, you say something, but in that no wrong door approach, you have to remove your judgment.

We, when you see something and you say something, you need to do it free of judgment because if somebody is coming up and they're, they have their worries, anxieties, and fear, and they took the stigma from the media or heard something, this is a diagnosis of depression. This is a diagnosis of schizophrenia, the diagnosis of bipolar, diagnosis of alcoholism, that diagnosis carries so much social weight in our society that people may be afraid.

To acknowledge that or move forward, and then that keeps them into that, their behaviors, all right? That may not be supporting help. When we have those conversations, especially initially, if it's a teacher, if it's a neighbor, if it's the mailman, if it's your or barber or your hairdresser, having those conversations.

See something, say something, and engage people non-judgmentally. So there's no wrong door approach. And no wrong door approach isn't related just to healthcare. It's related to society, right? Because as you mentioned, Jared, you are coaching your daughter how to order ice cream, right? No wrong door approach at the ice cream parlor.

We we are all in this together. And I think what Dr. Trimble was talking about, it's just not the behavioral health providers. In it, it is us. It is us as society coming together so that we're supporting our children and adolescents so they can be full citizens. And if they have a diagnosis, physical or psychiatric or behavioral health, we're giving 'em the right treatment so that they can get over it and go back to living a life.

And we're not letting that diagnosis define who they are, and we're not letting society put on those, worries, anxieties and fear that you'll no longer be a brother. You'll no longer be a sister if you have that, diagnosis. I really like what Dr. Triple said about the legislators and and government.

No wrong. We want a no wrong door approach, and we need to make sure our behavioral health workforce is supported and we have the reimbursement so that we can bring more outstanding people into the workforce so that we can make sure we can provide early intervention and treatment. One of the things that we saw.

In the United States and a new study just got put out last year. It you, I used to say it when a child had a diagnosis of mental health, it used to take five to six years to get the initial treatment. Now it's up to eight to nine years. And that goes back to some of the workforce shortages, but also goes to the stigma of mental health because, people may be afraid to get their child into treatment to see a professional.

Many times we rely on our school system. The more that we can get workforce and we want workforce with people with lived experience, oftentimes peers, but we also need workforces of psychologists, of social workers, of physicians, psychiatrists of nurses, of recreational, therapists, everybody in the workforce, and especially those who have those professional degrees to provide evidence-based treatment.

That's part of a team where we have lived experience because we know when we provide evidence-based treatment in an evidence-based healthcare delivery, people get better. And the sooner that we can provide that treatment to individuals, the sooner people we can eliminate a needless suffering. And that's what we want to have people do.

Eliminate suffering, choose to build a life. Full of living joy. As Dr. Trill said, sometimes the experience joy, you gotta experience, some lows, especially when you're in adolescents going through, those relationships. But that's what we want people to be able to embrace and we have the science to provide that we now need the workforce and the economic engines to deliver, that treatment, to people, with a diagnosis of mental health.

Substance abuse. In a nutshell, what we could do, no wrong door, see something, say something, and do it non-judgmental. Because when it's non-judgmental, that person's more likely to seek treatment and to get into treatment. , When people are judging what that person's going through, it's like a boomerang.

The person who made the judgment may feel really good because they threw that boomerang back, but then it comes back to hit everybody. We want to stop that boomerang effect. Stigma and discrimination with a mental health and substances.

We can continue on, but I promised our guests that I would let them get back to their important days here.

I may do something that I haven't done before and invite the same two to come back and continue this conversation. 'cause we haven't dove into some of these innovative programs that both of them are working with. We haven't dove into the role social media is playing in mental health and those are all key topics.

What. If people are looking for help in this, I know you gave some ideas, but is it 9, 8, 8? What do you want somebody to leave with? Where do they get help today?

Good question. I think for me, I, there, there have been so many kernels, so I hope whomever sees this. Anything that resonated, I hope it was written down to think of, I would say.

I would say first as, Jesse mentioned, see, say, see something, say something. But I wanna back up a second. Recognize that the signs may be much more subtle than you imagine. And again, the stigma is showing us, unfortunately, that people are way over there. They're not like us, they're not me, they're not that, but they really are.

Are you drinking more coffee these days? Are you. Sorry, when the coffee drinkers, are you doing more? This are right? Are you sleeping more? Are you eating in a different way? Are you even exercising way more than you did? Your muscle mass is really off the chart. Those may be signs that there's something going on for you and say it out loud.

It's not a bad thing that you as a human, a whole person, are going through something because collectively we all are just. Facts. And so the ability to articulate that without judgment as, Jesse mentioned or without stigma is critical. Recognize it. Are you out there like me? I'll plant trees.

You see my backyard. My kids are like, did you just plant another tree or did you get another goldfish for the pond? Yes, whatever that is. It can be something as benign as that or more serious, but if you learn to say something and give permission to people around you, first step. Then you identify what's comfortable for you, not only in terms of, resources access.

Yes, 9, 8, 8 Church, hospital, your primary care physician, your nurse, your job, if you're employed, EAP is a fantastic confidential resource that you can call. You. Just look up those numbers, telehealth. If you don't have resources, there are resources for those who have under insurance or are uninsured. I would literally at, in the age of technology.

I, I don't wanna, I won't market a particular, platform, but you can look it up on your phone. You can go to your local website, so there's so much out there. Or you can just talk to someone that you trust, teacher, pastor, rabbi, folks in your community. It's just a way to access the service. So I'll stop there,

To follow up, Dr.

Rill on those excellent, recommendations starting with people that you trust. In your network. They're part of your community. They're part of people who you talk with daily. And if they're able to see something, say something, engage you, ju non-judgmentally, that connection can have a huge protective factor, then if you need to reach out to somebody, that nine a eight, that warm hand. That warm line that California has, and it's across the country, that anybody can call 24 hours a day, seven days a week to talk to somebody. And on that 9, 8, 8, those individuals are trained. They will get you to a local provider in your network if you need, more care.

Also, if it's a very acute situation, always go to your local emu emergency room, if it's life or death, or you're concerned if it's life or death. That's what our local emergency rooms are here for. If it's physical, psychiatric, behavioral health or substance abuse, 24 hours a day, seven days a a week.

I know Motel six says we, they keep the lights on, but those emergency rooms keep the lights on even during covid, right? So we're we're here and we're here to support people. To get hit their recovery, but we're also here to support people in some of the most challenging and frightening times of their life as healthcare providers, and we want to be there with them to help them get that care.

I think the key thing is once they're in care, the profe, I. W our systems of care can support them and our pro as a primary care is able to refer 'em to specialists if they need it. Telehealth in person. But the first thing that we can do is help to decrease the stigma of mental health treatment.

Treat people not as their diagnosis, as people use people first language. And by that not saying this person. It is bi. This person's bipolar, this person's cancer. This person has a diagnosis of bipolar. This person has a diagnosis of cancer, so it starts locally. Before we can change it globally.

And those are some very simple things that start overcoming that stigma of mental health so that people do not feel judged. And when somebody sees something, they say something and it's gonna have those con connections with your trusted friends. And those are some of the best protective factors, and social determinants of health that we can build somebody up if it's a child, if it's an adolescent, an adult, if it's a, an older adult.

Those are the things that we know that have much more impact than people are aware of, and they don't cost a lot of money, but people have to change how they see one another with an open mindset, a humble mindset, and remove the judgment when they engage with people.

Such an important message and such an important topic and more to come on this, Dr.

Tribble from Alameda County Behavioral Health and Jesse, Tamlin from John Muir. Thank you both for being here. I really appreciate it.

Thank you. Thank you for the opportunity.

Thank you so much. It's always a pleasure to learn from Dr. Triple and all the great work that she's leading.

Likewise, the feelings are mutual.

Wonderful to be a partner.

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