Us 2

[Upbeat Guitar Music]

Mike: Welcome everybody. This is Avoiding the Addiction Affliction, brought to you by Westwords Consulting, the Kenosha County Substance Use Disorder Coalition, and by a grant from the state of Wisconsin's Dose of Reality. Real talks reminding you that opioids are powerful drugs and that one pill can kill. I'm Mike McGowan.

Mike: A landmark new study published earlier this year in the Journal of American Medical Association Internal Medicine examined the self-reported mental health of nearly 200,000 female parents across the nation between 2016 and 2023. I was stunned by this. Only about 26% of moms reported excellent mental health in 2023 compared to about 38%. So we're down 15% in 2016.

Mike: We're gonna discuss that topic and much more with our guest today Sheng Lee Yang. Sheng is the founder and Executive Director of Us 2 Behavioral Healthcare in Appleton, Wisconsin. Sheng is a licensed clinical social worker and perinatal mental health therapist, which we'll get into.

Mike: She's a former professor who taught social justice issues, mental health and advocacy to social work students. She's also a first generation Hmong refugee, and most importantly, a proud mom. Welcome Sheng.

Sheng: Thank you for having me. I am a proud mom, you know, especially as we are gearing up the next school year.

Sheng: Right.

Mike: I know.

Sheng: It's always such a good time to kind of see your kids grow up, but also [unintelligible] that they're growing up and those are the things that nobody ever tells you about as parents.

Mike: I did a freshman orientation last night in a school district with parents and kids.

Mike: One of the seniors was like, it goes so fast, and the mom said, not fast enough. (laughs) So that's good.

Sheng: Give her until the end of the school year.

Mike: I know, I know. Yeah. Well, Sheng, tell us about Us 2 behavioral healthcare.

Sheng: Yeah. So we opened doors in September 2019. So a couple of weeks or next week actually, we'll be hitting our sixth year anniversary.

Sheng: It was an idea that was kind of incubated between my partner and I. His background is in business finance. In 2017, maybe 16. I can't remember anymore. He and I were really exploring about, you know, we were kind of at the top of our careers and we talk about this American dream, right?

Sheng: And at that time we really felt like we were there. We were in roles that from an outsider perspective would be really successful. Right. But he and I kept having conversations about like, what is next? Do you just go to work every day, collect your paycheck and come home and is there more to life?

Sheng: But, we were also at a stage where we were really planning our family and what does this community look like for us as we age and we raise our children? So anyhow, long story short, we knew we wanted to stay in the Fox Cities area of Wisconsin and wanted it to be a good place for our children, but also, with our professional careers, recognizing some of the gaps. And that was culturally inclusive access to behavioral healthcare. And so he and I incubated this idea. 2019 we opened doors and here we are, right, almost six years old with 26 FTEs, I think now. In our what, like fifth facility. (laughs) Yeah.

Mike: That's huge. As I was reading about Us, I'm curious. Us 2, you named it purpose... Tell why the name?

Sheng: Yes, so it was intentional and it wasn't. Okay. So initially I wanted it to be Us Too, T O O because our populations are marginalized communities that are typically perceived as second class citizens. Right.

Sheng: So initially it was supposed to be Us Too. Grammar, correctly grammar way to spell it. But funny story, when I went to file, there was a trucking company with that name already. (laughs)

Mike: (laughs)

Sheng: So I thought, oh, of course. Right. My mentor at that time who was with Score was like, well you know, we have some options.

Sheng: You can call them up and ask 'em to change their name. I'm like, right, this trucking company is just gonna change their name 'cause I want the name. So I really thought long and hard about it that I thought, you know, if the intention behind it right. Is that our population served our second class citizen, that I'll just throw in the number two.

Mike: Wow.

Sheng: So that's how I came to be. (laughs)

Mike: I think it's great and I love that it was designed so right in your name, you're talking about the people who have difficulty accessing. We'll get into that in a minute.

Sheng: Yeah.

Mike: You know, in the introduction Sheng, I mentioned the study from the AMA. You're not surprised at those numbers based on what I've read.

Sheng: No, I'm not surprised by those numbers at all. In fact, I think that those numbers really reflect what I see. And I think, you know, in our practice we see every day, especially with mothers and parents. The pressures right, on moms and female parents have really intensified over the past several years.

Sheng: I mean, you think about balancing caregiving, right? Work and household responsibilities and we see parents or who are in what we would call our sandwich generation, right? Where we're caregivers to our children and our aging parents. So when you combine all of these stressors.

Sheng: I'm really not surprised that mom's mental health or female parents mental health has declined, despite this increased awareness of mental health and wellbeing.

Mike: You know you, you mentioned what they're concerned about, and I read that you said that you've noticed that what moms, young moms are concerned about has shifted from their kids to just make and do.

Sheng: Yes. It's not so much just the parenting piece, right? I mean, you know, having a child, definitely a baby or a child definitely changes roles and expectations. But a shift in basic needs you know, you and I know, and we all know, right? That childcare centers are closing, right?

Mike: Yep.

Sheng: There's a decrease in professionals or young people entering the education discipline and profession. We know that the cost of living in general is going up. We know that the housing rate options right, are just declining while interest rates increase. And so when you think about just the very basic needs to be alive for yourself, right? And yet alone, another child or another human being, of course that you know that mental health and wellbeing is going to decrease while the needs are going up. And systemically, we don't have enough to go around.

Mike: Yeah. And tack onto that, I think, right?

Mike: A little bit of stigma. I don't even know what to do with those people. And they're loud! I don't know how numerous they're, but they're loud! The people who say, well then you shouldn't have had children, or the other one would, well just stay at home and take care of your kids. (raises hands into air) Ugh, you know.

Sheng: Right. I'm willing to bet that most moms, 'cause we're talking about female parents here, would love to stay home with their kids. But again, economically, it's not affordable. Right. And so then as we talk about also going back to school.

Mike: Yes.

Sheng: We cannot deny the fact that there is school violence.

Sheng: And as a parent, as a mother and myself knowingly, that I am sending my children, my young children who are still in elementary and middle school to an environment that is not safe. And in America, here we have normalized and become complicit to school violence. So that is a compounded stressor for, of course, moms, I mean, I certainly can't speak for every mom, but I know the folks that enter my office and are in my community or the people I work with.

Sheng: There's a huge component and stress and anxiety about like. Holy crap! I am literally sending my children to an unsafe environment for the purposes of (finger quotes) "learning".

Mike: Mm-hmm. Yeah. And for the listeners, we should say that we're recording this the day after the Minnesota shooting in the church.

Sheng: Yes.

Mike: And yeah, which I think since August 1st, I read today Sheng that it is the fifth school shooting since August 1st. And this one is in a church. So if you're a young parent, you're like, well, if my kids aren't safe, praying in a church.

Sheng: Right.

Sheng: Absolutely. And then you think about the educators, right?

Sheng: Many educators are female parents, and so you have this compounded trauma organizational and systematic trauma. That we are expecting, essentially out of female parents.

Mike: Yeah.

Sheng: That they have no control over.

Mike: Well, and I think that's a big part, right? What can you control? And you just mentioned a whole bunch of things they can't control. The cost of housing, which is... I have kids in post-college age, right?

Mike: And I feel so bad for that generation. Unless you're getting help, how do you afford to buy a home at this point? Because the housing is out of control, right.

Sheng: The housing market and inventory is out of control.

Mike: Mm-hmm.

Sheng: The cost of it is outta control. And so when we take a step back and we say, well, why, why is it that people have worse mental health despite having more awareness? And less stigma because of that awareness? Well, because now we've shifted blame to the individual despite systematic issues and that creates then internalization and internal stigma now. So before when we talk about mental health, it was this external stigma of like, there's not a lot of awareness, so people can't talk about it.

Sheng: And now we're talking about it, but there's no resources because the issue is so systematic.

Mike: That's fascinating. And then when we shift it to the individual, then that adds to the stigma because if it's your fault, then I'm even less likely to talk about it if I think I'm gonna get the blame for my own mental health.

Sheng: Right. Because as you mentioned, because there's this perception that you have these children, they're your responsibilities. Absolutely! I don't want anybody else to raise my kids.

Mike: Right.

Sheng: Like, I don't trust people to raise my kids at this rate. But at the same time, people don't have resources to raise kids.

Sheng: And it's the very basic function of human beings. We know that what makes us different is animals from the animal kingdom and every other animal. Is that we are meant to be social creature. Like we are meant to be born in tribes, die in tribes, and have a village.

Sheng: But we have created a system that is so individualized that folks are now internalizing that they're the problem. Where really it's the world that we've created.

Mike: Hmm. So that's people in general, but add to that, your work focuses on, I know you treat everybody, but your work focuses on underserved populations.

Sheng: Mm-hmm.

Mike: Talk about the additional challenges they have.

Sheng: Yes. The additional challenges that I see a lot with our marginalized populations is one, the very first basic right, is that the continuous questioning of their existence here in the United States.

Sheng: That's just like the very basic of like, I can't, I don't even feel safe to walk outside because I'm an immigrant.

Sheng: I am, you know, a trans mom. I am black African American. I'm Hispanic, I'm Hmong. So let's just start there. When we think about, you know, some challenges, it's like constantly being question about their existence here in the United States. And then on top of that, you add access to resources like you and I have talked about.

Sheng: You add discrimination, you add transportation, closure of childcare centers. We cannot talk about marginalized communities without thinking about hours of operations within their places of work. Right. We assume everybody works eight to four, nine to five.

Sheng: Now mind you, school ends at three. (laughs)

Mike: Right.

Sheng: Right, right. And so the additional challenges of simply being born an immigrant or a different race or different gender or having affiliated different family dynamics and constantly being questioned about your existence is going to create some internalization and some questioning about like, yeah, why am I here?

Mike: I would assume that a lot of your patients don't exactly have Cadillac insurance coverage for mental health or addiction.

Sheng: No, no. Absolutely not. And it's interesting. A lot of folks don't know this, but for a long time, health insurance were not obligated to cover addiction. This actually only became law in here in the United States, and I think it was like 2012 or 2013.

Mike: Right.

Sheng: It's wild. And so when we think about addiction and moms, I mean, yeah, health insurance coverage really doesn't cover it. And then you think about health disparities in marginalized communities.

Sheng: You don't have a lot of folks who are culturally informed and even though they say they are, they're probably not really. 'Cause they've taken a two hour CEU credit on it. Right, right. (laughs) They checked over the box.

Mike: (laughs) Yep.

Sheng: Even though it requires more internal work than just attending a two hour workshop, you know, and transportation.

Sheng: And even from a provider perspective, the wait list goes for miles.

Mike: Yeah. You made me laugh a little bit. One of my... It's not a pet peeve, but it's a funny observation and I don't want to get off too much on this tangent. Is when you look in psychology today for a therapist or whatever, and underneath them I am skilled at, and the list is so long, (laughs) it's like, okay, you're 29 years old, you can't possibly be expert in all of this.

Mike: Right?

Sheng: Right, yeah.

Mike: But I think that's just to get patients and to get coverage.

Sheng: Yes. Yes. And I know you said you didn't wanna go on this tangent for a long time, but you know, I think, I'm glad we are talking about it because I think maybe many, I'm assuming here maybe a lot of your listeners and folks are from the mental health perspective or background as well as that.

Sheng: I don't know if anybody could ever say that they're culturally competent because cultures just change. People change if we know that generations change, right. And as generations change, cultures change. And so you really have to be willing to deep dive into that work.

Mike: Absolutely. Well, you also work a lot with young people.

Sheng: Mm-hmm.

Mike: And they face, I think I spend a lot of time with young people. I talk a lot, about a hundred thousand kids a year I end up talking to. There's a skill gap that is visible when you meet with young people as far as coping skills and taking care of themselves.

Sheng: Yeah. I would say absolutely right, and I think that makes a lot of sense that we feel though, as though young people are lacking a little bit in coping skills. Now, think about for a minute, this idea of like generational transmission and generational trauma. So we just talked about parents and female parents, right?

Sheng: And that they're traumatized because the system is traumatizing. And the parents, and again in our case, our conversation here, female parents are coping with drinking alcohol, using prescription pills. And they have kids. What do you think is being transmitted to the children?

Mike: Exactly.

Sheng: The coping skills, right. (laughs) And if the parents don't have answers, how are the kids supposed to have answers? And so it's not rocket science. And I don't wanna say it's intentional, but it's obvious because if we wouldn't expect a child to know French because they've never learned French, we can't expect young people and children to know coping skills if their parents in the systems are not teaching them coping skills or the coping skills are maladaptive in nature.

Mike: Before I ended up speaking last night, I looked at the group I'm talking to people and there was it was about, well obviously about half kids, half parents, and there's about 300 people there. The people with the phones in their lap, for the most part with the parents.

Sheng: Mm-hmm.

Mike: The kids were talking to one another. But the parents were not engaged. And that's not untypical where you're spending more time on a screen than face-to-face. Where, right, listening comes in, asking questions, problem solving, conflict resolution. And I assume those are all topics that you talk about with young people so that they develop that skill base.

Sheng: Yes, absolutely. We think about what are coping skills that maybe you were taught or given in early life and what are new ones that maybe you can try. Conflict resolution, anger management, all of those pieces.

Sheng: But from an neurobiology perspective, we have to take accountability for the dopamine flood that we have given to young people with electronics. And I'm not preaching like I'm a perfect parent. I mean, my kids have electronics and I know I'm fully accountable to that and responsible for that dopamine flood, but these are the things that we have to think about.

Sheng: Okay. Why are our kids so glued to electronics? Or why is that their coping skill? Because from a neurobiology perspective, again, it's that dopamine. And so when they're not constantly on their phone, when they don't have access to 15 of their friends on social media.

Sheng: They are going to demonstrate some withdrawal symptoms because that's essentially the root of addiction.

Mike: And then if you are that connected, it doesn't take much to be offended or to feel slighted or bullied or whatever you wanna call it. And those are permanent scars much more than arguing in the hallways 30 years ago.

Sheng: Yeah, absolutely. Right. And there's more access to this information being spread. If there's a bully in the school and they're taking pictures or videos of bullying a student or a child. And they're posting that on social media, I mean, that's going to get spread really quick across that school.

Sheng: But also we can't talk about children's mental health or young people's mental health without taking into consideration the impact of COVID-19 on them.

Mike: Yes.

Sheng: Because some of our, you know, 12th graders now, right? You think about six years ago they were in sixth grade. And because of COVID, their way of life was completely wiped from them.

Sheng: Right. You know, going to school, right? Interacting with their peers. Wear a mask. Don't wear a mask. One student's here today, the other student's not here the next day. Our expectations of them really changed. We plop them in front of a screen to our online schooling and normalized that for so long.

Sheng: And then on top of COVID, there's this compound rate of parents separating maybe mom or dad developed addiction. You can't see grandma or grandpa or your cousins during Christmas time. I mean, all of these things impact our little minds. And then when now we're just like, oh, go back into life, like nothing ever happened.

Sheng: Again, we talked about this as well, is school shootings. Do we really think that we're sending our kids to school knowing that there's an increase in school violence and that our kids are just supposed to be like, oh, okay. We can't. And my second grader yesterday was telling me on the way home from school meeting her teacher. Mom, i'm really scared about a bad guy coming into school. And because they have these drills and it's, her fear is valid. And as a mom. I have no solution. I feel powerless.

Mike: What do you do then? I think that's a situation a lot of parents are in and a lot of them blow it off.

Mike: Like, oh, you're okay. You'll be okay. Which is not a empathetic response and tends to make the kid bury it. So how would you respond if your second grade child says, I'm a little scared 'cause the bad guy would come in?

Sheng: Yeah. I tell her like, I know honey, it is scary and mommy is scared for you too.

Sheng: And I don't know. But what I do know is that your teacher and your principal and everybody who works in that school is gonna try their best to make sure that you're safe. Because that's all I know. (laughs) Right?.

Mike: Well, right. And that goes back to the training. So talk about your perinatal mental health training.

Sheng: Yeah. So, this training is a four hour [unintelligible] long training, but it really focuses on the populations of not just after childbirth, but also challenges with fertility all the way to about like 24 months postpartum. And it really explores and brings into light the challenges of motherhood, parenthood, between a biological perspective.

Sheng: So the changes in hormones, but also raising awareness about mental health conditions as a result of pregnancy, trying to get pregnant, and parenthood. And so, oftentimes people think about parent and mental health and parenting as a mom's issue. But I do wanna raise awareness, especially around fathers as well, and the criticalness around fatherhood engagement and father's mental health.

Sheng: And so the trainee looks at explores the men's mental health and mother's mental health as well and also right our LGBTQ population and our non-binary parenting as well and their experiences. But the goal of it is to raise awareness about, hey, as a clinician, as a human services provider, as a friend, as a colleague, these are things that may surface or manifest after somebody has a baby or brings a baby into the home. And know whether it is role changes or challenges with wellbeing. Again, hormonal changes and what do we do about it? What are some solutions. If I'm a therapist and I'm seeing this, what do I do?

Sheng: If I'm a human services provider, what do I do? Whether I'm a neighbor, if I'm a mom, right?

Mike: Well, how do people find that training and sign up for it?

Sheng: They can go onto our website. And we have an on demand, an asynchronous workshop that's available out there.

Sheng: It is CU approved. So folks can kind of either take it on the website and register there. Otherwise, periodically, a couple of times a year, we do offer the community offerings.

Mike: I think that's outstanding. And I found this part fascinating too. I was reading an article where you were interviewed and you were talking about culturally specific therapy being important and that it's difficulty sometimes getting funded.

Mike: Under the traditional Western approach for things like racism and can you talk about that for a second?

Sheng: Yeah. When we think about access to mental health, we know that typically folks require insurance for that. And if you are going to be utilizing your insurance for that, it has to be what is considered a billable diagnosis. And those diagnoses are based on then certain criterias and it's very medical in nature. But it also is very individually based. In fact, PTSD is the only mental health disorder that requires an external circumstance.

Sheng: Everything else is internal. So when I talk about that like with PTSD, you have to either been exposed or witness somebody in a traumatic event. Every other disorder is more internal. Something happened to you, you are the problem. So when we think about like racialized trauma, when we think about the lack of access to resources and the lack of power.

Sheng: To make changes in your own life with systematic issues, those things are not billable on your insurance because that's not a us problem, that's a you problem. Does that make sense? And so, because the, the DSM and the way that insurance works right now is that we will only pay for you problem, not us problem.

Sheng: It's not going to be billable such as racialized trauma.

Mike: Okay. We do have a lot of therapists listening to this, and I'm sure they're nodding their heads. How do you get around that? Do you have to code it differently so that you make sure that it's covered and then, you know, that's playing a little bit of a game?

Sheng: Yeah. As a therapist, it's always this balance between compliance versus justice, and that's the craft that nobody teaches you in school, right?

Mike: (laughs)

Sheng: I mean, we can have a whole nother conversation.

Mike: Yeah, we should. That's why I'm laughing. I'm like, oh, there's another podcast right there.

Sheng: Right. So when I code it, right. I look at symptoms. And do these symptoms meet certain criteria, whether it's generalized anxiety disorder or adjustment disorder or depression. But I know the root cause of it is because of these systematic issues that we know through data and research people have no control over.

Sheng: We know that through research and literature, only about 30 to 40% of someone's actual life choices is going to impact their quality of life and how long they live, so you flip that. 70% of someone's life is impacted through policies, through access to resources, through things that they have no control over.

Sheng: That's why I say, honey, eat that cake, forget the gym. You can't control it. (laughs) It's all through systems that you and I have no power over. (laughs)

Mike: Well, and think about what you said earlier about how fractured we are as a society right now, and how we're adding to those external things, you know, like you don't belong here or who you are is not relevant as a human being.

Sheng: Yep. Absolutely. Yep. Like I said, it's so fascinating in a bad way that we have created a society that has completely dismissed the very core functions of being human for the purposes of... i'm not really sure.

Mike: And yet when people find you and others and get help despite the obstacles, the success stories are incredible.

Sheng: Absolutely. I think one of the biggest challenges as being a clinician is that in my work, I see people in, for the most part individually, and we do work in my office and it's great, but internally I know I'm sending them back into an environment and a system that is not created and designed for them to thrive.

Sheng: And that's one of the biggest hurdles and challenges that I internalize oftentimes. But also I think one of the biggest positive things about my role as a clinician is something that I find deeply rewarding and keeps me doing what I'm doing, is that I also get to experience the joy.

Sheng: And the positive improvements and the basic human functions of being human with other people. And I don't think every discipline gets to experience that, right.

Mike: That's a great response. I love that. That is true. What changes would you make if you could, if you had the power?

Sheng: Oh, I don't know if this is gonna be appropriate for your show, Mike. (laughs)

Mike: (laughs)

Sheng: You know, honestly, if I had the power and I could make any change to the world, honestly, like I would bring peace, joy, and love to the world. And I say that as we wrap up here in summary and really remembers of my late father is, he always said, no matter what, always remember peace and love.

Sheng: Because no matter the hate and how much hate there is out there, peace and love will destroy all. And so I think if I had the power to change anything, I think I would bring peace and love to the world. And I think just between those two, everything else would follow. And those again, are very basic human functions that many of us have kind of put to the back burner.

Mike: Wow. Well, that's not only appropriate for the show I'd put that in a box with a ribbon around it. If we could do that.

Mike: Sheng, I'm so glad you could join us today. This has been awesome. This is so delightful to talk about.

Mike: For those of you listen, you know that there are links to Us 2 Behavioral Health on our website and Sheng's work is on there. Her socials, all of the articles that I referenced earlier. We hope that you are able to find love, hope, peace, courage, support wherever you are. As always, thanks for listening and be safe.