Mental Health IS Health

[00:00:00] [Jaunty Guitar Music]

[00:00:11] Mike: Welcome everyone to Avoiding the Addiction Affliction. A series brought to you by the Kenosha County Substance Abuse Coalition, I'm Mike McGowan. Our conversation today is again about our young people and specifically their mental health. As we continue to get data coming out of the pandemic, we continue to see that our youth are experiencing ongoing mental health challenges that literally we have never seen before.

I'm really happy that my guest today is Amy Herbst. Amy is the Vice President of Mental and Behavioral Health at Children's Hospital Wisconsin in Milwaukee, Wisconsin. Welcome, Amy.

[00:00:50] Amy: Thank you. Thanks for having me and covering this topic.

[00:00:53] Mike: Well, I greatly appreciate. Well, let's start, let's just start with the basics, right?

So what are you seeing? Cause everywhere [00:01:00] I'm seeing we're seeing young people with huge spikes in anxiety, depression. Are you guys seeing that also?

[00:01:06] Amy: Yeah, we are seeing that. And what I would tell you is I could answer this in, in three parts. So when we took a look at how our kids were doing prior to the pandemic, we were able to recognize that they were not doing well, right?

We were already in the midst of a mental health crisis as it related to our children and our adolescents. And then the pandemic came and it really exacerbated the problems. And we pay pretty close attention to the data and the numbers. And so when we were taking a look at what was happening during, and then I would say into 2021, we saw things like our call volumes to our mental behavior, health access center, triple from 2019 to [00:02:00] 2021.

Since 2020, we saw visits to our emergency department increase by 40% for reasons of mental and behavioral health issues. And the most concerning piece of data, if that wasn't already concerning enough, was that we saw a 60% increase in patients coming to the emergency department at Children's who had a suicide attempt.

[00:02:24] Mike: Yeah.

[00:02:25] Amy: When we looked at the timeframe from 2020 to 2021. So things absolutely got worse during the pandemic. And then the third part of how I would answer this is what are we seeing now? And I would say what we're seeing now is that kids are still struggling. They really suffered from the isolation they experienced, and also though some positive things.

So we can see early intervention has mattered to our kids, so getting to them as soon as we can. We can see that increasing access points for [00:03:00] mental health has made a difference. So there's a lot of different doors you can come through now at Children's and other organizations, and that's created some better access, not all of what we need.

And then we opened the Craig Yabuki Mental Health Walk-in clinic and made something available to families that never existed before. And while. We're not sure yet that we can make a causal relationship. It looks like there's at least a correlation between opening that and a drop in school-aged kids coming to our emergency department in a mental health crisis.

So we gave them another better option and it looks like it might have changed the numbers. So we've been paying close attention and, and our, our kids are still in a mental health crisis. We are not out of it.

[00:03:47] Mike: Well, I'll go back to the services you offer in the walk-in clinic in a minute, but let me, let me go back to your first point.

I think I know what you're gonna say, but you said even pre-pandemic, you were seeing spikes in [00:04:00] children's mental health. Do you have speculation for causes of that?

[00:04:06] Amy: Yeah, so you know, when we talk to the scientists and we look at the research and. Just as importantly, talk to the kids and families. We spend a lot of time talking to our kids and families and giving them a voice.

I would say there's some negative reasons and maybe a positive reason. So in terms of, you know, some of the negatives, kids are really often negatively impacted by some of the social media that they're involved in, right? So it looks like, you know, their friends are having more fun than them. It looks like their life is better.

It looks like, you know, things are so good in social media, which we all know isn't true, but for kids, they, they get a false impression of, of what's reality. I would say that our kids, and for a positive reason, We were maybe beginning to see some [00:05:00] improvement in reducing stigma. And so with that reduced stigma, we believe more families started accessing care.

So maybe things weren't necessarily, were [inaudible], but it felt that way to, to providers because they were inundated with kids seeking mental health treatment. So I think it's a combination of some, some not good reasons and, and maybe this positive issue of reducing stigma.

[00:05:27] Mike: Well, and certainly reliance on social media and devices didn't get better during the pandemic.

[00:05:34] Amy: No, it didn't. It didn't get better at all. I mean, that was some of the ways. Many kids interacted, if at all with anyone else. And so we heard from kids that would come for their mental health treatment and say, you know, my parents are not allowing me to interact with my friends, but I just saw a group of my friends altogether.

And I'm, I'm missing out and I'm depressed and I'm so [00:06:00] isolated. We, we definitely saw that. And also if that's your only interaction and it's not face to face and based in some more real time and realistic interactions with people, then really all you are seeing is sort of what people are willing to put on social media, which isn't the whole story, and kids can't always make sense of that.

[00:06:25] Mike: Well, let me, let me ask you too, cuz you, you, you said something about teens and adolescence and of course during adolescence you have, who am I? Right? That whole identity formation coming up and that couldn't have been easy during a time of isolation or if even through social media, if you're feeling isolated.

Amy, I've had girls at the schools I go to, especially girls say that they can have a great day. And then they check their social media right before bed and it not only ruins the day that they thought was great, but the next couple as well.

[00:06:58] Amy: Yeah, absolutely. And, and [00:07:00] kids are engaged in social media now, that's normal part of their day in a way that, that for previous generations wasn't the case.

And so I'm not sure parents always appreciate what that impact is on their kids. And for kids, it, some of them, it's all they know. And so they're, you know, they're saying, listen, The first part of my day was great, and like you said, then I went home. I had access to things I would never have access to if it was just in-person, in my community, in my school, in my home, and it makes me feel bad about myself.

It makes me feel, you know, that I am missing out on something. It makes me feel that I'm less than somebody else. It makes me have a lot of negative feelings about me as a developing person. And it's hard for kids to, to have the words to describe that. And so they end up with a lot of feelings of anger and depression and [00:08:00] sadness and it, it's not always a positive for kids.

[00:08:04] Mike: Well, I don't know about you, but I needed no extra help to feel bad about myself in middle school, right?

[00:08:10] Amy: Absolutely. Yes. Middle school, I can tell you as a parent, It was one of the most difficult times as a parent for all of my kids, for all different reasons. That is a tough time in a child's development physically and socially and even under the best circumstances.

I, I think it's a struggle for most kids and their parents.

[00:08:32] Mike: I'll get to your services after the next question, but you, you also mentioned the emergency room and suicidal ideation and attempts. Do you break that down female to male? We, historically, we've always heard more female.

[00:08:45] Amy: Yeah, we have looked at that by gender and by race.

And yeah, absolutely. We see more female patients coming in that have had a suicide attempt, and that was true prior to the [00:09:00] pandemic, during and after.

[00:09:02] Mike: And you know, at, at the same time, we're not, you know, for every minute you're spending on a device, you're not spending developing social, emotional coping skills either.

[00:09:13] Amy: Right, absolutely. Yeah. You know, our kids really missed out on years of that interaction with their peers and with their teachers and with their coaches or with their theater instructor, whatever they might have been involved in. And so they missed out on the opportunity not only to be with other adults, which matters, right.

How you engage with them and communicate and interact. But also with their peers as well, which matters just as much where you're might be having more fun and more natural conversations and interactions. And so we really saw that its toll on, on our kids in the moment. And still yet today we're seeing that.

[00:09:59] Mike: Well, [00:10:00] so tell us about Children's Institute for Child and Family Wellbeing.

[00:10:04] Amy: Yes. So we do have an Institute for Child and Family Wellbeing that was put together at Children's for us to focus on kids and families and how they are doing in terms of their wellbeing. And also it's not just about care delivery. It's also about influencing policy and practice, et cetera. And that has really been a nice piece of groundwork for us at Children's that lays a foundation for us focusing on keeping kids healthy and well. Keeping kids living and playing in their environments and doing well.

And out of that. We've been able to develop many different programs in the organization. And one that I do wanna mention, we opened up in the spring, is the Craig Yabuki Mental Health Walk-in Clinic and we opened [00:11:00] up the mental health Walk in clinic. Based on some of those foundational beliefs that we need to give a voice to kids and families. We need to create for them what they need from us to have health and wellness.

And what kids and families told us was when we are having an urgent mental health issue. We don't want just to go to the emergency department. We're not having an emergency medical issue. We're having an urgent mental health issue. And we might have a therapist that we're already working with and we might not, but we can't wait.

Whatever it is, we feel like it's urgent. And so thanks to a, a very significant gift and partnership. We were able to open the Craig Yabuki mental Health Walk-in clinic and that is named in memory of Jeff Yabuki's brother. Craig Yabuki died by suicide. And [00:12:00] this clinic is in his memory and I'm so proud of it because it does a few things.

It offers same day availability to mental health care for kids 5 to 18. And those kids are uh, determining, or their parents are, that they're having an urgent mental health issue. We don't screen them in or out. If you believe you're having an urgent mental health issue, that's all it takes. You don't need an appointment.

If you want now you can actually reserve a spot in line by going to the website and saying, "Hey, I think I'll be there around seven", which makes it even more convenient for families. Or you can just walk in anytime between 3 and 9:30, 7 days a week. And we have a team of mental health providers there that are available to kids and families for whatever it is, kids and families say they need.

We're not gonna decide if it's urgent or not. You will, and that's good enough for us, and, and [00:13:00] we will take care of you right in the moment.

[00:13:02] Mike: Wow. And those are perfect hours for families rather than during the day. That's the time right after school, right.

[00:13:10] Amy: Absolutely. Yeah. We actually created the hours. Based on two things.

One, looking at our data to see when were kids and families coming to the emergency department for urgent mental health issues. So what days of the week, what times of the day. And it was during that after school and before bedtime hours. Mostly during the weekdays, but sometimes on the weekend. And then we also talked to kids and families and said, this is what the data's telling us, but you tell us when you need something like that.

And they said, we need it after school. We need it before bedtime. And some of our appointments go much later than that. But not often. And it would be really nice if it was every day of the week. And so we [00:14:00] listened to the families and we paid attention to the data and that's how we settled on those dates and the time.

[00:14:07] Mike: And, and obviously we'll put the links to both the institute and the walk-in center on the podcast. What you said with or without their parents. Is there an age at which kids can walk in by themselves? Young people?

[00:14:20] Amy: Yeah, so you know, they can come in if they're 18, by themselves. Sometimes kids will come in maybe not with their guardian. But with another adult, that's not at all uncommon. Cuz most kids need some kind of way to get there. And thankfully most kids have a caring adult that is right there with them and wants to help them. And so we can obtain verbal consent from the guardian and then we'll follow up and get written consent when, when those moments happen.

And, but I would tell you that almost all of the time, it's a caring adult that is coming with the child. And we're really grateful [00:15:00] for that cuz kids, kids need that.

[00:15:02] Mike: Well, and as a caring adult or a parent, you know, sometimes. Well, sometimes we never want to hear about our kids struggling, right? We just, we are adverse to that or having any illnesses.

And sometimes we can't, as parents see what other people can see. I, I, I'm in so many schools where schools get concerned and then call home, and the parent blows the school off, and the schools feels powerless to deal with that. But what should parents know in order to support the children's mental health concerns?

Especially now I feel like we're in this period where we're still on this denial about what kids are having to deal with and the whole social media. We don't even know what we're doing with the social media stuff.

[00:15:44] Amy: Right. I love this question and I'll answer it. Based on being a parent, based on working in this mental health space, but also based on what kids are telling us they need from their parents.

And so two things. [00:16:00] Normalize mental health. Normalize talking about mental health. So mental health is health. That's, that's all there is to it. It doesn't need to be more complicated than that. Think about it that way. And when you can think about it that way, then I think it, it can open your mind and your thinking about how, how is your kid doing?

And what might you need to do for them, if you are worried about their mental health or if they're telling you, "Listen, I'm very depressed", or, you know, "I'm having a lot of anxiety" and let's say stomach aches "now that I'm back in school every day". So normalize it and talk about it maybe for your teenager, you're gonna talk about it when you're driving in the car somewhere because you're both facing forward and you don't have to look at each other...

[00:16:56] Mike: [chuckle]

[00:16:57] Amy: ...and that's comfortable for you and maybe for [00:17:00] your teenager. Maybe for, you know, a five year old. Because five year olds also struggle with mental health issues sometimes.

And we often see that show up in their behavior. Maybe with your five year old, you're going to be having conversations about mental health that are age appropriate while you're in your living room floor playing with a toy. So, but that is a way to normalize it and to think about it in a way that works for a five year old is different than a teenager.

And then the other thing I think parents can do, and we often forget about this, is model good behavior. So as a parent, talk about how you are feeling, share with your kids maybe if you are sensing or having some anxiety and maybe for the past 10 years you've been dealing with some anxiety and maybe you're seeing a therapist or maybe you should and haven't yet. Model that good behavior, because your kids are watching [00:18:00] you and they're listening to you.

And so it's an opportunity for you to say "Mental health is health, and I'm gonna talk to you that way, and I'm also gonna talk about myself that way". Kids have been very clear with us that they're more comfortable most of the time than the parents are. So let's follow their lead and learn something from them.

[00:18:21] Mike: You know, that's great. I love "Mental health is health" and I think parents also, we have to know what's going on with the kids. You know, I'm, since I'm in front of them every day, I've been struck in the last few weeks by two things. One is how many of them bring up all the negative stuff that they've seen on the ads in their social media.

They are sick of the, as they put it, the incredible hatred that they're seeing in the political ads. They're just, and they just will speak up and tell you. And the second, being in Milwaukee, the number of middle school and elementary school kids that [00:19:00] tell me that they are watching on Netflix, Dahmer.

[00:19:04] Amy: Hmm. Wow.

[00:19:06] Mike: I wonder how many parents are, you know, like, you have to know, right.

What your kids are getting involved in, that can affect them. I don't think kids can process that.

[00:19:16] Amy: No, I, they absolutely can't process that. And you're right, you need to know what your kids are doing, so there's nothing wrong with, you know, spending time with them in the, in their bedroom or in the living room or wherever it is that they are.

You don't have to necessarily be engaging all the time in a conversation, but you should be paying attention to what are, who are they spending their time with? What are they spending their time with? And if you are listening to this now and saying, "You know what, I'm not sure". Okay, well now is your opportunity to say, "I'm gonna pay more attention".

"I'm going to be more aware". And you can do it just by paying attention and being present and [00:20:00] watching, and then also by talking with them. I, I always loved having my kids and their friends in my car driving them places because you get to listen to what they're talking about [chuckle], and you can learn a whole lot from a conversation of a bunch of kids in your car that you might be taking to the movies.

So spend... time... with your kids and spend time with your kids' friends. In your space and in their space and, and you'll learn a lot.

[00:20:27] Mike: Well, and, and lastly, Amy, what would you, what would you say to young people? I mean, how do young people prepare for the inevitable challenges that we all face while growing up?

Like what, not that they're, they're all listening to this, but their parents are. So how do we prepare young people for the inevitable disappointments or anxiety or down periods in our life or periods of stress?

[00:20:50] Amy: Yeah, that's a beautiful question because it is reality, right? It's everybody's reality and, and maybe thats the beginning [00:21:00] of the answer, is struggles are not unique to you. We all have them. We all have them. And you've experienced some and you and you will experience some more. So think about what it is that works for you in terms of coping with those difficulties and the supports that work for you.

So for some kids, you know, a healthy coping mechanism might be, you know, meditating. Another kid is gonna need to, you know, maybe pick up a basketball and like, you know, play basketball for an hour. Another kid might need to write in their journal. Who are the people around you that you trust and that you can go to when you're struggling?

Is that a teacher? Is that a parent, an aunt? My kids, their aunt is very involved in their life. I know she is one of their caring adults and I'm grateful for that. [00:22:00] So, think. What it is you can do for yourself that's helpful and helps you have wellbeing and helps you with your mood.

And also think about who in your life can play that role with you as well. I'm sure you saw the statistic, but there was a statistic recently reported, and it said 44% of high school students reported being persistently sad or hopeless within the last year, and that was the highest number ever recorded.

44%, like that is awful and so concerning. This question I think is so important because let's not ignore that reality. Let's empower kids to think about what they can do for themselves, and then let's also be responsible to those kids and, and be their person. Whatever, whatever that means. And for whatever kids are involved in your life you know, be [00:23:00] their person and, and kids will often tell you, if you say " Who can you go to?" Most kids can name a person. I, I sometimes wonder if that person knows it's them.

[00:23:11] Mike: Oh, that's, that is really great. I, that is a great question, isn't it?

[00:23:17] Amy: Mm-hmm.

[00:23:19] Mike: Oh, I love that question. I'm gonna ask that next time I'm in front of a group of kids. If that person actually knows, I think that's great.

[00:23:26] Amy: Yeah.

Cause they might need to tell him, and I think that person would probably love to hear that.

[00:23:32] Mike: Yeah. I had a neighbor kid walk up to a another adult neighbor of mine and ask him if he could take some of the hateful signs out of his yard. The kid was 10. And, and, and when in talking with the neighbor who had those signs, he was unaware that his message might be read or seen by kids, and he was embarrassed by that. And I think, you know, we have to watch our [00:24:00] own P's and Q's too. Don't we?

[00:24:02] Amy: Absolutely. And good for that 10 year old, right.

[00:24:04] Mike: [chuckle] He's a, he's a pip. I'll tell you, he's something else.

[00:24:08] Amy: That's great.

[00:24:09] Mike: He comes and asks me for bags of candy at Halloween.

So he's a good kid.

[00:24:14] Amy: [laugh] Yeah. I, I, I'll be interested in finding out where he is in 10 years from now.

[00:24:19] Mike: [chuckle] Ya, right. He'll, advocating for something.

[00:24:22] Amy: Absolutely.

[00:24:23] Mike: I know you're, I know you're on away from your office, so I really appreciate you taking the time to spend with us today. It means a lot to us. And for those of you listening, again, we're gonna put the contact information for Children's and the Institute and the Walk-in Clinic on our website.

Please listen in next time when we talk about more issues around substance use and mental health. And until then, stay safe, connect with kids, and ask somebody if you're that adult in some kid's life.

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