Mental Health

Speaker 1: 00:01 The fear of getting sick, financial pressures due to job loss or decreased hours, social isolation resulting from stay at home orders, distress from all the disruption and uncertainty brought by the coven. 19 crisis impacts each of us. Joining me to discuss ways to cope is dr Luke Bergman, director of San Diego County behavioral health services. Welcome to midday. Thanks so much for having me. First I want to ask you about the $25 million behavioral impact fund. The board of supervisors approved this morning. What will that fund be used for? Speaker 2: 00:33 It comes from money that was sort of locked up in litigation. So it's, it's one time funding. The idea will be that it will help to fund primarily capital projects for providers of behavioral health services. So mental health and substance use disorder treatment services. I think members of the board of supervisors today we're unanimous. I think in noting that it's an important moment, um, to be making these kinds of funds available to, um, in particular community based programs that um, of course are, you know, facing their own challenges, uh, that you know, their own sort of bottom line. And, and cashflow challenges and, and that those services will be, we anticipate especially critical in light of what's going on right now with covered 19, uh, given that we, we know from, from study of other population level natural disasters that while you know, while a natural disaster or in this case a pandemic has a certain kind of epidemic or pandemic arc, what's going on with the economy, we'll have a certain sort of trend line arc. A lagging arc will be that describing increases in, uh, mental health distress that will result in uh, almost certainly increased rates of depression, uh, increased, uh, heightened anxiety. We anticipate seeing higher incidence of, of suicidality, um, higher incidence of, of drug overdose Speaker 1: 02:03 regarding the mental health impacts of the pandemic. A trauma is a powerful word associated with combat veterans or shooting victims for example. But you've said we are all experiencing that right now. What's the nature of the trauma that we're going through now? Speaker 2: 02:17 The trauma that we are experiencing now results from a combination of things. The fact of being disconnected from people socially to the extent that we have to be under current public health, uh, orders and guidance is itself extremely disruptive to our sense of normal. And so there is something about that that is, that is traumatizing in and of itself that coupled with the uncertainty and fear and fear that folks have about what this, um, what this virus is, what the associated disease covered 19 is what it can do, how it can be dangerous. There's so much uncertainty about that particularly, uh, I think in light of, of the fact that folks who are asymptomatic or presymptomatic, I think there's, there's broadening understanding for, um, for the, you know, significant amount of, uh, community, uh, disease transmission that is happening between folks without symptoms. So there's increased uncertainty, fear associated with that. Speaker 2: 03:17 And then of course, we, you know, we always, um, see you wearing whenever there are significant economic downturns, we see significant increases in mental health distress resulting in increased suicidality, increased substance use, and those kinds of things. And so fear about what's going on economically is also traumatizing for, for folks. And for some people, of course, they are already experiencing the impacts of what's happened with the, you know, this sort of categorical shutdown on the economy. So many people are without employment that they never would have anticipated even two months ago. A change. That's, that abrupt is traumatic. Speaker 1: 03:55 Yeah. So the suddenness that's hit all of us here in what you're saying is it's really on two fronts. You're, you're afraid of getting sick or someone you love is getting sick and caring for that person or yourself. And then of course, the financial aspect. How should people work through addressing this trauma? Speaker 2: 04:10 So what's really important is that people are very observant of their own experience. Though it's been abrupt for lots of folks. The circumstances surrounding what they're going through right now are kind of mundane. You know, if you're in your home, certainly spent a lot of time in your home before. So it's, it's, you know, the way in which creeping anxiety and, and sort of steadily accruing, uh, depression can impact folks is maybe not something that people would recognize immediately. And it's really important that folks therefore keen observers of what they're experiencing and that they acknowledge that this is really difficult, that it's that, you know, normal under these certain circumstances will be an experience of heightened anxiety, will be an experience of some depression. And it's incredibly important that folks observe that, that they acknowledge it. And then that they talk about it. And this is a point I want to elaborate on a little bit. Speaker 2: 05:10 I think that you know that when, when you hear somebody from behavioral health say, you know, talk about it, there might be a, you know, sort of shrug of shoulders or um, or, or scoffing even. Cause of course that's what behavioral health is going to recommend. Um, the neuroscience though supporting how talking interrupts States of anxiety and stress by moving our response from the amygdala into the frontal cortex is really strong. This really works. Um, and so just as a, as a very, you know, a practical piece of advice, we recommend that this combination of observe what it is that you're going through. Think about it in the context of an acknowledgement that you're going through trauma and then talk about it. And if you don't feel like you have somebody to talk to, it's really important that you then reach out to some of the resources that the County is supporting and that have been longstanding, uh, and excellent within the, the County of San Diego. Primary among them is the access and crisis line that we are encouraging people to call. That number is (888) 724-7240. It's a service that is open 24, seven. You will talk with a licensed counselor immediately. Um, they can help you with your immediate concern. Uh, I'll, I'll add in 150 different languages and they'll also, uh, help get you connected to ongoing care if that's something, um, that you are interested in and that's something that, uh, that you end up feeling would be appropriate for you. Speaker 1: 06:44 Now in the press conference on Sunday, you said, we will see higher rates of depression, substance abuse, suicide attempts, drug overdoses. We started to see that yet, Speaker 2: 06:53 you know, interestingly, part of what we're seeing right now is a diminishment actually in presentations with behavioral health crises at our hospitals, including the San Diego County psych hospital. And this is a dynamic that we are in the midst of exploring my suspicion. I think, you know, a lot of folks in the field suspect that that what that reflects is fewer people getting access to care in the midst of this kind of heightened sense of crisis. And that that is part of what is, is contributing to this lagging indicator. So people are holding back from care now that is only gonna exacerbate their behavioral health conditions and it's only going to heighten need for care that they will have, uh, in the upcoming months. Speaker 1: 07:40 So the Corona virus epidemic and the economic fallout, the resulting impacts us unequally, which people are most susceptible to severe mental health impacts during this pen? Devic Speaker 2: 07:50 well, it, it certainly, um, is important to note that it is impacting all of us. So that's the first thing I would say is that everyone is experiencing some sort of distress as a result of this. That is the, that's the normal right now. It will disproportionately impact folks who have um, behavioral health conditions already. Folks who are already going through depression, mood disorder, people with um, with other psychiatric illnesses or people with substance use disorder. Those conditions will be exacerbated by it, by the current moment. So they will suffer disproportionately. And then it's also really important to note that that covert 19, while it is a, uh, you know, a collective experience and in lots of ways, uh, it also is, is impacting our community in terms of behavioral health unequally people who are more impoverished, uh, people who have a harder time navigating the current public health orders and also navigating the job system in the, in the context of all of these constraints are more vulnerable in lots of ways, you know, to the virus itself and then following on the more vulnerable to a downstream behavioral health consequences. Speaker 1: 09:09 Few quick questions to end here. What advice do you have for parents and talking to their kids about the impact on them. Speaker 2: 09:14 Be direct with your children. That's what's really important. Don't be roundabout your, your, your kids want to know what's going on. Talk to them in a straight forward way. Encourage them just as you should be observant of your own feelings. Encourage them also to be observant of their own feelings. Speaker 1: 09:30 And if someone we know mentioned suicide or you feel suicidal yourself, what should we do? Speaker 2: 09:36 It's really important if somebody you know, or in contact with is expressing any suicidal ideation or suicidality to talk directly with them about it. If you hear them say something that raises alarms for you, tell them that you, that the alarms have been raised, that you um, hear what they're saying, um, and that you are concerned about them and that you want to talk with them about that directly. Speaker 1: 10:00 And you also have a warning for those who use illegal drugs. Speaker 2: 10:04 You know, part of what's happening right now is that the whole street market is, uh, for uh, substances of use and abuse, uh, is very disrupted. And so we are hearing that there's a lot of dangerous product on the street right now. We would really encourage people that if ever there was a good time, uh, to engage in care, now is the time to engage in care. You can get that through the access and crisis line that I mentioned earlier. You can get medication assisted treatment if you've got an opioid use disorder. Also, if you're struggling with alcohol use disorder, now is the best time to seek care Speaker 1: 10:41 and that access and crisis phone number again, Speaker 2: 10:43 it is (888) 724-7240 (888) 724-7240. Speaker 1: 10:50 I've been speaking with dr Luke Bergman, director of San Diego County behavioral health services. Thanks very much. Speaker 2: 10:56 Thanks so much for having me. Marcus Speaker 3: 11:00 [inaudible].