Mental Health And The JED Foundation

Jumo and the JED Foundation are teaming up to create more mental health resources for teens and young adults. We spoke with JED Foundation's executive director, John MacPhee, and psychiatrist, Dr. Victor Schwartz about what they are doing to expand the conversation, and about the resources available to help young people with mental health issues.

March 20, 2019

Rebecca: Hi there, and welcome to In My Words®, Jumo’s podcast series that brings the experiences of real patients directly to you. At Jumo, we provide resources for children and families to understand, manage, and own their health.

So for today's In My Words episode, I have the pleasure of sitting down with John MacPhee and Dr. Victor Schwartz, a.k.a. Dr. Vic, from the JED Foundation. And so I'd like to start off I just thanking you guys for coming here and talking with us and do a little recap of how we all know each other.

So about a year ago now, Jumo was introduced to the JED Foundation through one of our colleagues who worked with you guys in a previous life. And so what seemed like two very like-minded organizations, almost immediately turned into something a little bit more during our last Halloween meeting (seems like we kind of have a theme here).

But we knew that we both wanted to provide some super engaging stories and age-appropriate resources for teens and for young adults around mental health and that together we could do a really good job of doing just that. And so fast forward to today - we're ready to redefine and talk about how we present and engage around a topic that affects everyone in one way or another, and especially teens and young adults.

So what's amazing is that you guys already have a breadth of information out there, and we're excited to collaborate with you guys and kind of bring our own way into bringing this content to life. And this podcast is one of them. Without getting too far ahead of ourselves, I'd like to give you guys an opportunity to introduce yourselves to our listeners and tell us a little bit about your roles at the JED Foundation.

 

John: Sure. So thank you, Becca, and thanks for inviting us, and we're looking forward to this conversation. My name's John MacPhee. I'm the Executive Director of the JED Foundation. I've been with JED for 7 years. I have a background in both business and public health.

 

Dr. Vic: And I'm Victor Schwartz. I'm also known as Dr. Vic, as you said. Good morning; it's nice to be here. I'm a psychiatrist, i’ve have been working in higher ed (college and university) and young adult mental health now for about 30 years. I have worked at a variety of colleges in their counseling services and in the Dean of Students role. And have been at JED really overseeing our program content now for about 6 and a half years.

 

Becca: Great. Alright, let's talk a little bit more about JED. I think what most people may not realize when they first see the name is that JED is actually named after a young man.

 

John: Yes, that's right. So the JED Foundation, which is a charity (a 501C3 non-profit), is focused on protecting emotional health and preventing suicide for teens and young adults. And the organization was created in the year 2000, shortly after the death of a young man named Jed, Jed Satow, by suicide. He was 20 years old and at the time his parents - they were aware that he was struggling, but they did not know that he was a threat to himself. And as it turns out, there were some warning signs and there were opportunities for the people around him, in particular at his college, to connect the dots and notice that this was a young man at risk. But at the time there were no systems and recommendations or framework, if you will, for how a school can promote mental health and take steps to identify a young person at risk. And so the JED Foundation was created by the Satow family for that purpose: to educate people around teen and young adult mental health, what is it, what does it look like, how do you notice if someone is struggling and what do you do about it. And then, specifically, to help schools build what we call a ‘mental health safety net’ which is an approach, a comprehensive approach, on campus to support wellbeing and to identify and help those who might be at risk.


Becca: So I know that you guys have a mental health resource center and a number of different resources that are segmented by age group. So, tell me a little bit more about the different offerings that JED has to support mental health.

 

John: Yes, so we have several offerings. There are a number of online resources and campaigns that the JED Foundation produces. So we have a mental health resource center at JEDFoundation.org. We also have an online resource center specific for college students, which is called ULifeline.org, and ULifeline includes an anonymous mental health screener, so that somebody can check the symptoms they're experiencing and get recommendations for what they can do next. We also have a campaign called ‘Seize the Awkward,’ which is with Ad Council and AFSP...


Becca: Quick sidebar, for those that don't know, AFSP is the American Foundation for Suicide Prevention.


John: ..and that's about how to notice if a friend is struggling and how to act - how to seize upon that awkward moment when you're worried about a friend, but you are not sure what to say. And ‘Seize the Awkward’ provides a lot of information and conversation starters for young people and you can find that at SeizeTheAwkward.org, as well.

We have another mental health resource center called Half of Us, which we co-own with MTV, which is directed towards teens and is about mental health. And a social media campaign called ‘Love is Louder’. So a lot of resources around mental health promotion and education for the community. There is another resource which is specific for high school students and supporting the transition from high school to adulthood called 'Set to Go', and Set to Go has an enormous amount of resources for young people in high school, their families and high school administrators.

 

Becca: Amazing, so a lot of resources.


John: A lot.


Becca: And so you mentioned the word ‘transitions’ and transitioning into adulthood, so let's talk about that a little bit more, because that's kind of a buzzword in the health care industry in the health care world right now. So it refers to transitioning from one stage of life to the next. And why is that such a difficult time for young people?

 

Dr. Vic: Well, transitions are tough for everybody. Life changes really face us with new challenges, new situations - when people move, when they change jobs, when they get married, when they have a child. All of those things present us with challenges, but growing up is tough, and for people who are moving, let's say from high school to college, for many it's the first time that they might be living on their own and responsible for their own self care or their own health care. They're making decisions about what to eat and when to go to sleep, and while for many of us these things sort of develop naturally and happen fairly easily, they still require some preparation and they're not always as intuitive while we're going through those changes as they seem once they become simple and obvious to us.

 

Becca: And so what kind of things can someone find, what kind of resources can someone find on SetToGo.org that will be there for them and be tools to allow them to take on life's challenges during this time?

 

John: Yes, so on 'Set to Go,' or settogo.org, the idea is: what are the skills and the knowledge that a high school student needs to be what we call ‘emotionally prepared’ for life after high school? And so that includes such things as basic living skills - do you know how to manage money yet? Can you do your own laundry? Do you know how to feed yourself nutritiously? And these are the kinds of skills that can be developed before independent living happens.


The next domain is social emotional skills - so how are you thinking about and regulating your own emotions, dealing with other people, handling conflict, setting goals and making decisions in the context of those goals that you have for yourself. The next area is mental health literacy, so we want to make sure that before young people leave high school they really understand what mental health is, they understand mental illnesses and substance abuse, they know how to get help. And then there's the domain around college - is college right for a young person? Is it right now? If it is right, what's the right fit school. And we really encourage through 'Set to Go' the consideration of what's the right fit and not just the consideration of, you know, let's try to get into the most academically prestigious school possible without regard to what's the right fit for that for that young person.

 

Becca: Yeah, because it seems like that is kind of a pressure nowadays for kids, like that is the option that is what you need to do. End of discussion.


Dr. Vic: Well, unfortunately that does seem to be often the case, that we are caught up in branding. Some of that is, unfortunately, driven by the sense that there is more opportunity for people who've gone to elite schools. It turns out that for the same young person who has, you know, who's at a certain level of academic skill, for most of them it's not as important where they go to school as really what they get out of the experience and how engaged they are in that experience. So, we've gotten very caught up in branding rather than necessarily in the quality of the experience, which turns out to be way more important.


John: We've done surveys with high school seniors in first year college students, and they say that the preparation they experienced was really focused on academics and very little around the emotional side. And also, a large number - I think it was about half - said that their parents played a major if not final decision making role on where they went to school as opposed to the student themselves.

 

Becca: Interesting. And I mean, I'm sure you guys would agree, but from my experience, the preparation for college was just that: academic. There was no learn how to do your laundry, learn how to cook for yourself, learn how to enroll in a health care plan because it's just not a part of our high school curriculum, seemingly, but seems like you guys are kind of hoping to change that.


Dr. Vic: Well, and we're not trying to suggest that it's unimportant to be academically prepared for college and university, but that while you're doing that, it's just as important to learn how to work with other people and learn how to listen to other people, and deal with maybe not always getting an A+ or an even and A- in every single project or exam or activity that you've done so that you know these basic life skills and the social skills, and I think there's plenty of data out there supporting the notion that people do better along the way and along the path of their life if they have a good grasp of the social and emotional and life skills than whether they can, you know, recite verbatim some lecture they heard about John Stuart Mill (not to disparage John Stuart Mill in any way).

 

Becca: And so, John, you had said that some of these resources also focus on mental health literacy, so I'd like to go down that road now and talk a little bit about common mental illness, in general, and in this age group and what that means, and also how it relates to suicide. So we know that from our previous episodes that we've done on In My Words on mental health that 1 in 5 people has a mental illness and that half of these mental illnesses begin or present by the age of 14. So we know that suicide is now the second leading cause of death among youth; we also know that there's really a serious problem going on.

 

Dr. Vic: Well there are a couple of things that need to be put in perspective in relation to all of this. One of the reasons that suicide is the second leading cause of death in young people is that they tend to be medically a very healthy population. So in fact, the rates of suicide in 15- to 35-year-olds is lower than it is in middle aged, particularly middle aged men, and senior citizens who both as a group have actually higher rates of suicide. But as a cause of death which the CDC sort of evaluates this, as a cause of death it is more common because, again, the other causes of death occur at much lower rates in this population. That said, the rates have been going up in the last 10 years and that's incredibly worrisome and disturbing. We've seen also increases in the rates of other mental health complaints like anxiety and depression particularly anxiety in the last 10 years. But rates of depression have been increasing as well and those seem to be happening in parallel with each other. But it's also important to recognize that one of the problems and one of the things that feeds our for lack of a better term ‘stigmatized’ view of mental illness is that when we often think about this our image of mental illness is of the most persistent serious and chronic problems.


You know, the images we see on the media, our experiences of seeing, obviously you know, psychiatrically ill people who are homeless on the street, are reflective of the extreme end of mental illness and we forget that mental illnesses occur just like physical illnesses. There are mild, transient symptoms that are, you know, sort of reflecting, maybe, just a bad decision or a momentary life stressor/life challenges. And then there are these middle range things, just like there are medical illnesses that are sort of brief and manageable and go away after a period of time. So it's important to recognize when we don't emphasize enough that mental illnesses occur along a very broad spectrum, which is why they're so common. So when we say 1 in 5 people has a diagnosable mental health condition, that sounds terrifying because of our image of what mental illness is, but when we think about people having an anxiety disorder which might completely resolve in six weeks, doesn't quite sound so frightening anymore and actually reflects a much clearer view of what's going on.

 

Becca: Yeah, that's a really good way to put it. I don't think that a lot of people consider it that way at all, as a spectrum


Dr. Vic: Unfortunately not, and I think that leads to, you know, the the Boogeyman of mental illness, which is unfortunate because that becomes a kind of vicious cycle of people being afraid to go for care or to acknowledge that they have a problem because their image of the problem is: “Oh if I've got this, it's never going to go away. It's going to be, you know, really a sort of overwhelming problem” and that's simply not the case or not accurate.


Becca: So do you think that the increased rates are due to something environmental or something that has changed, or just an increased rate of diagnoses or awareness?


John: Well, we are seeing increased rates, as Dr. Vic said, in anxiety, in depression, in suicidal ideation, in suicidal behavior. It's likely that part of it is more comfort around reporting and speaking up, but it's also likely that that part of it is quite real. There are a lot of things happening and a lot of new things have been happening over the last 10 or 15 years. Information is shared faster and more readily, such that young people have more knowledge and information about what's happening in the world than previous generations. Social media, screen time, all the time spent on digital isn't just about the time spent on digital, it's about the opportunity cost and the reduction in time of spending face-to-face time with other people. And that may actually have more consequences for our emotional wellbeing as it reduces connectedness and time with others. We're seeing young people spend less time outside, you know, less time exercising; they're more sleep deprived than in previous generations. So, there are a lot of factors contributing to this.


Becca: It's interesting because, you know, for me the Internet came out about halfway through my childhood so I can remember when my dad came home with a computer and we had to plug it into the wall and I would just tear up Microsoft Paint for hours.


John: And you had to turn off the phone to get the computer hooked up.


Becca: Yeah, you had to completely isolate your whole family from receiving any outside calls just to use the internet. But now kids are kind of born with an iPhone in their hand and they don't even know what it's like to not have that constant connectivity. And so it must be also difficult for adults now especially adults who have never had the internet until they were adults to relate to how that is for young people now to constantly be exposed to this.

 

Dr. Vic: So things have shifted for everybody. I mean, we're in the midst of a massive social experiment, and we really don't know what impact this is having and will have. But, you know, where we're sitting here in New York; if you walk around on the street or ride the subway it's incredible to see how many people are sitting looking at this little screen in their hand rather than paying attention to their surroundings and seeing what's going on. I mean, there is an irony that we're sitting here and that this is going to be heard over a social media platform, of course, but kids are more and more relating through a medium of a phone. And not even speaking to each other but, you know, using using all kinds of shorthand and taking pictures.

And there is a value in being able to be connected easily to people across the world, and there are great things about this opportunity, but there very likely is some cost, as John said, in losing time actually interacting face to face. There are things that you learn about empathy and, you know, dealing with the politics of social interaction that might only be, or most successfully, done in a face-to-face interaction - listening to people and hearing their tone of voice or seeing the way they look and the way they're responding. It isn't the same doing something even over a phone, where you're having a conversation, but certainly through written word or pictures, you're not getting the same kind of context or the same kind of experience.

 

Becca: Yeah. So is there a thought or a recommendation from the medical community around screen time, specifically, or the age in which kids start interacting with these screens?

 

John: Yeah we are starting to see recommendations come forward. I don't know that there are universally adopted recommendations, but the idea of delaying the introduction, containing screen time to a certain amount of time seems wise. You know, so that there's space and time for face-to-face play and interaction with others which we know promotes mental health, but also helps develop life skills and social emotional skills as, Dr. Vic just said.

 

Becca: While maybe the delay is good, there is kind of a reality that we have to face that this is a part of our lives and teens, especially, are going to be using these social platforms all the time.


John: Yes.

Becca: They're doing it. It's happening. And so, I was reading an article on the JEDFoundation.org that was recently posted that said, “look for warning signs online, take action offline.” So it seems like these social media platforms - Snap Chat, Instagram, Facebook can be a place where people can identify potential risky behaviors or risky actions that may indicate a mental health issue.

 

Dr. Vic: Right, and bigger social media platforms are actually trying to do that and do have pathways to report things. And, you know, we actually work with some of them, and there are actual people - security teams - who are monitoring these reports and concerning content to some degree and have responded in some cases to emergencies. But, you know, of course in the end while there are sort of virtual medicine platforms that are developing and, you know, for people who have no other alternative, they're certainly adding value. As you say, the face-to-face intervention and interaction is going to be preferable. You have a much better opportunity to really understand what's going on when you're interacting with a person in real space and in real time.

 

Becca: So is that what someone should do if they see a friend post a potentially worrisome post on Instagram? Should they take it offline and try to talk to that person?

 

Dr. Vic: Yeah, if the opportunity is there to do that, they should. If they are, you know, halfway across the world, obviously they need to use the best resource they have. But the best resources are face-to-face interaction.

 

Becca: What are some of those other options, other resources?


John: We actually did a project with Instagram and Facebook on this very topic: about how to notice and help a friend if they're expressing distress on social media. And so one action you can take is to become knowledgeable about the reporting mechanism through the social media platform so that you can notify the social media platform that you're worried about this post. And they have protocols, as Dr. Vic said, that can be helpful. Then, trying to get in direct contact with that person, with the people you know, who are around them. Depending on what was expressed, potentially contacting local authorities, 911, so that people can be dispatched to check on the wellbeing of that individual.

You know, one thing to add when we talk about suicide being the second leading cause of death among young people today is that the leading cause of death is accidents, and those accidents are driven by alcohol and by drugs and drug overdose. And so, we like to think of that altogether as a set, you know, because some kind of wellbeing or emotional health issue, mental health issue is threading across the suicidal behavior and the risky behavior involving alcohol and drugs.

 

Becca: So let's talk a little bit more, going back to the basics, around mental illness. You mentioned anxiety disorders earlier, Dr. Vic, and substance abuse and how that kind of weaves in with mental illness, mental issues. So let's talk a little bit more about the most common issues that are affecting everyone - young people, any age.


Dr. Vic: Well anxiety at this point is actually the most common complaint and the most common disorder. It presents in a bunch of different ways from generalized anxiety, social anxiety, to panic disorder. Over the years there have been differences about whether obsessive compulsive disorder is or isn't a an offshoot of anxiety disorders, but it's certainly, often for many people, includes significant elements of anxiety. And depression, too, is fairly common and occurs across a spectrum, from typical sadness for brief periods of time in the face of a challenge or a loss to more persistent and more functionally impairing symptoms. Which in young people can present as sadness and, in some cases, particularly with young men, can present as irritability. So, for young men for whom it's often socially not acceptable to appear down or sad, the way they're depressed, and to some extent the way they're anxious, is by being irritable. Boredom, actually, with young people is often sometimes a reflection, also, of depression. So somebody who's constantly sort of in bed saying they're bored, they're not interested in going to school, in life activities and doing things that would typically be fun for them, can often be a reflection of depression.

So with younger people they're often lacking the language and the, sort of, self-aware language to say “I'm sad,” or “I'm depressed,” or “I'm down,” or “I'm anxious.” So it gets expressed in other ways. So people around them - their friends, their family, teachers, clinicians - really have to be sensitive to what they’re seeing in the whole picture. That said, we know that young people most often tell their friends when they're in distress, which isn't so surprising. And also that the people around someone in distress most of the time recognize that something is wrong. And at the end of the day it's not so crucial for anyone in that immediate ecosystem to be able to say this is anxiety or depression or even maybe even a burgeoning psychotic illness, which often does, again, present at this time, although is a much rarer entity. What we believe is important is for people to recognize that something is wrong and typically there are indications from the person's behavior, from their speech, from the way they're functioning, that something is not the way it should be, and this might be an indication to have that conversation or to get them help.

 

Becca: So a lot of those symptoms or those presentations that you mentioned are things that people go through throughout life: irritability, sadness, boredom, laziness. So how can people recognize once it is a problem? What are the signs to really look at for? Is there a time period or specific things people should look out for?

 

Dr. Vic: Right. So think about... you know, when I do these conversations with groups, I'll ask people if you've had a stomach ache in the last month or six months or a year, and whether or not when you had that stomach ache you called your doctor. Then think about why you might have or might not have chosen to call your doctor or even go to an emergency room. We intuitively, actually, make these kinds of decisions all the time, because it's actually something that happens all the time. So if we use the stomachache analogy, if you know why you had it - you had that extra slice of pizza that you shouldn't have had - and it's not that bad, and it's going away, and it's not persisting, there aren't other associated symptoms, it's not interfering with your functioning, Probably you chose not to call your doctor. But you didn't go through that checklist, you just kind of intuitively knew that, oh, this is a thing I understand what's happening, it's not interfering, I'm still sleeping and it's not causing me any real functional impairment. I would say the same thing about anxiety, or depression, or the boredom, or the irritability: if it's coming and going, you understand why it's there, it's not causing functional impairment, it's not getting worse over time, there aren't associated problems with it. So with a stomachache if you had, you know, if you were throwing up and had fever or your stomach felt rigid, then you would probably say this is a serious problem. With the irritability, or sadness, or anxiety, if you can’t sit in class, or you can't sleep, and you're not taking care of yourself, and it's getting worse and it's persisting, that would be a suggestion that it is a more serious problem. And if it's associated with thoughts of self harm, more violent fantasies, or things like that, then that would be the sort of analogy to - this is when you need to get to the emergency room.

 

John: Take the question from the perspective of you’re the friend, you're the peer, and you're worried about someone else. Really, the bottom line there is, if you have a gut feeling that something's wrong with someone else, you should trust that feeling and taken action. And that's what we talk about in our Seize the Awkward campaign, which is - you think something's wrong, say, “hey, you know, I'm concerned about you. I've noticed you've been missing school, or you know, not been coming out as much lately. Are you okay?” And that's really the action that should be taken. And there's no harm in taking that action, just that sort of concerned expression of care for someone else.

 

Becca: Why do people find it so hard to take that action? I mean it's kind of a loaded question... It's awkward! I mean, it's really awkward!


Dr. Vic: You just answered your own question!


Becca: Yeah, I’ll just answer that one. [laughter] Is this something that you feel is changing or improving among young people? Are they finding it easier to have these conversations, or is it still a really big issue?

 

John: Barriers to having these conversations still exist, but the barriers are changing. So you hear the word stigma a lot, and stigma is really speaking to the shame, and the prejudice, and the secrecy around mental health and not wanting to talk about it. That kind of classic stigma is going down and is at lower levels among teens and young adults than among older adults, and we have research that shows that. But, there are still a number of barriers that hold them back from seeking help or trying to help a friend. And those barriers are in the space of uncertainty - uncertainty about what to do, uncertainty about who and how to get help, fear, disbelief that the help might work, and that it's awkward, which we've talked about.

And then, also, this space about what does it mean to be a good friend, and is it a betrayal to go and get help from an outside source, and when and how do you do that. So the barriers are, in that space, more so among teens and young adults. And that's really what our campaign with AFSP and Ad Council is about: to say yes, we recognize it's awkward, but take advantage of that awkwardness. Lean into it. Ask your friend if they are okay, and that will start a process through which they'll get the help they need.

 

Becca: So let's talk about one of those uncertainties right now - one of the biggest ones: how to get help. So if someone has that gut feeling and they're going to go with it, they're going to trust it, their friend needs help, what can they do? What's the first step that they could take?

 

Dr. Vic: Well, the first step is just to have the conversation, and the conversation, again, doesn't have to be fancy. It really can be as simple as expressing concern. But the one thing that's important is: you know, it's very easy to say, “how are you doing?” And that will usually be responded to even if the person isn't doing okay with, “yeah, I’m fine.” You know, let's move on. It's valuable and helpful to explain why you're concerned, specifically. So, you know “you've been missing school a lot. I see you haven't been getting out of bed. You look like you haven't been sleeping. You know, you seem exhausted all the time,” is much harder to just dismiss with an, “I'm Okay,” than a vague, simple, “what's up,” or “what's going on with you?”

And, you know, from there it's as John said, and that's why I like the stomachache analogy of trust your gut a little bit. And, you know, if the person's telling you, “well, I'm worried because, you know, I'm having a hard time with my chemistry class,” and it fits a kind of simple, direct life problem, then the conversation might be about, “have you seen your adviser? Have you spoken with a teacher?” But if you still are concerned, then the next step could be discussing with the person, “Does your family know about this? Are you getting any help; is it something you're taking care of?” And if not, trying to work out some kind of sensible plan that would address the problem; going from the simplest level of “can we get a family [member], or a teacher, or a trusted adult involved?” And if it feels more urgent than that, thinking about “can we get you to the school counselor, or the counseling service, or in the most extreme, do we need to call 911 together now?”

 

John: And as that friend, if you're on a school, you can go and tell the counseling department yourself. You can make that report anonymously, if you want, but then that helps activate the care system around the person so more people can get involved and help. There's another piece of this that I think we need to recognize, and it's the frame we put on what does it mean when a young person's in distress or struggling. Because one of the issues is emerging mental illness, as you talked about earlier, half of the symptoms may appear by the age of 14. But young people will have sources of distress that may not be in the context of an emerging mental illness. It may be a struggle with gender identification, or perhaps they are being bullied or cyberbullied, or have been assaulted in some way, or their parents are divorcing, or they lost a beloved family member. And so it's important, I think, that we have a broader lens on this and at the JED Foundation, we work to have rather broad language around, “Are you in distress; are you struggling?” Because whatever the source of that distress is, it's in scope, and whatever the source of that distress is, we want that young person to connect with people who can help them.

 

Becca: I want to talk about what you just said John because I feel like there are a lot of misconceptions. We know there's stigma, we now hope that it's reducing in the age group of teens and young adults, but what are some of the major misconceptions around mental health, mental illness?


Dr. Vic: Well, I think the one that I addressed before, which is that mental illness implies a serious chronic persistent problem which will, you know, inevitably require a long term professional care is certainly one of the other things that that makes people hesitate to even raise the possibility. Because they, again, have this idea that if at some point they're diagnosed with an anxiety disorder, that's it. They've got it for life. So it raises the stakes in bringing this up and, you know, backing up to my analogy, the recognition that this is not often a yes or no question, that most of these areas [are] in the gray zone, just like with things like blood pressure. There's not some magical number that, you know, at some systolic blood pressure you now have an illness. But if you're reading is 3 points below that, then you're perfectly fine. These things occur along the continuum, and the thing that I want to emphasize, and I think as a response to your question, is that it doesn't really matter for either the person asking for help or the person reaching out to their friend to help whether there is a diagnosable condition.

And there are a lot of, you know, the various kinds of gatekeeper training programs and information out there [that] seems focused on, well, do you have a diagnosis, do you reach a certain threshold on a screening tool or on some survey that says, “Oh, now you have a problem.” If you're in distress, if you're struggling, there is a problem. It may be requiring different kinds of interventions. So one of the ways we make decisions about whether or not somebody needs medication for anxiety or depression is, again, the severity, and persistence, and functional impairment. But we want people not to be hesitating to either reach out for help or reach out to help their friend. Worrying about whether or not this reaches a certain threshold on a rating scale like the, you know, PHQ-9, which is a scale for depression - it just doesn't matter. Right? So, that yes or no question is both a misconception and a problematic misconception, because it might stop people from reaching out for help when help could actually be helpful.

 

Becca: And it seems like there are potentially a lot of misconceptions around suicide, as well?


John: Yes. Misconceptions around mental illness, around reaching out for help, I think, some of the classic ones, which are abating among young people but are still present are that it's somehow a weakness or failing to be struggling with a mental illness. And as a result, you know, that contributes to the shame and people's hesitancy about coming forward, when in fact, it's a sign of courage and bravery to speak up and to seek help, and that's the the change in attitude and behaviors that we need to seek. As it relates to suicide, you know, I think one of the things we need to keep in mind is that the person who's dying by suicide most often is in extraordinary pain, and is ill, and needs help - you know, is not making a choice meant to hurt others, but as somebody that really needed help.

 

Becca: And some of these topics and these issues come up a lot in the media and in popular culture right now; you know, different television shows, '13 Reasons Why', 'A Million Little Things' (I don’t know if anyone’s been watching that new show that's on), but, Dr. Vic, I know that you've worked with HBO, 'Dear Evan Hansen'... so when you're working with these big media companies who are experts in entertainment how do you kind of balance with them the entertainment level versus the right messaging and the language that we should use to be talking about mental health and reducing stigma?


Dr. Vic: Right, so it is a challenge, and I think we need to actually separate the way we're talking about mental health and mental illness versus the way the media might present suicide, because actually there are different challenges. So one of the wonderful things about Dear Evan Hansen Is that Evan Hansen, the protagonist, clearly is struggling with mental health problems. And at the same time, what's so wonderful is that the audience is able to identify with him. He's, you know, really sort of drawn and conveyed as a real person with all kinds of other life things going on, and some of those are related to his mental health challenges and some of them aren't. Some of them seem to be purely socially driven or driven from family circumstances. So portraying somebody with mental health problems as a sort of multifaceted person and a person with whom the audience can identify is a powerful and positive thing.

So there's a different challenge when we're talking about media portrayals of suicide. Actually, there is a kind of built-in irony or dissonance here because, you know, journalists or in the TV show, or a movie, or a play, actually typically the goal of the presentation is to tell a story with which the consumer will identify. And in fact, that's precisely what you don't want to do in relation to reporting on somebody who's died by suicide. So if you look at the media reporting suggestions around suicide, you want to leave as much detail out of the story both about the person who's died and the suicide itself. And the goal of this is actually to limit the identification of others with the person who's died because, you know, a story that's going to be consumed or a TV show that's going to be consumed by thousands or millions of people within that population - there will be inevitably people who are struggling with their own suicidal thoughts and impulses.

And if the idea is that someone has gathered attention or love in some way by virtue of having killed him or herself, then that could conceivably make suicide more appealing to the person who's struggling with their own impulses. And we call that “suicide contagion” when that actually occurs. So we know that telling stories about suicide that are you know romanticizing the person who's died or making them seem the, you know, the image of the long struggling artist who's taken his or her own life - I guess, you know, Van Gogh would be one of the classic examples of that kind of story - seemed to raise risk for people who are consuming that media as opposed to when there are stories about suicide that focus on people struggling with thoughts or impulses, getting help, and the help being helpful. We actually know a lower risk of suicide in the populations who consume those stories.

So it's a challenge to tell stories about suicide in compelling ways that are not raising risk. It's been done and it's been done successfully, but unfortunately much of the recent media has been not always completely responsible and responsive to these guidelines when they've presented their, you know, either TV shows or movies. Or journalists, at times, are not always either as knowledgeable or as careful about the way they report as others.

 

Becca: So we know that it's difficult to share an experience about suicide without, kind of, leading to these risks and portraying it, or romanticizing it rather. But we do know that sharing stories can be beneficial in reducing isolation and in creating a community around a shared experience. So let's talk about that a little bit so I know at JED you guys are trying to do just that and we at Jumo are doing just that, as well. So how can sharing stories about your own lived experience, especially with any sadness or mental health symptom benefit you and benefit others?


John: Yes, so sharing stories is a very powerful way to connect with other people. It lets the audience know that they're not alone themselves, that these types of experiences are shared and they belong to a community where other people are experiencing the same kinds of things. And so at the JED Foundation, we work actually to train storytellers - we've done trainings with 'The Moth,' which is a storytelling nonprofit - and we put on community events and create video podcasts and podcasts of people sharing their stories of struggle, of recognition of that struggle, of help seeking, help giving; and then getting help, and how that help, while not always, quick and easy, has resulted in people living good and thriving lives. And so those are, you know, just critically important things for us to share. So we're big believers in it at JED, and it's a big part of our programming.

 

Becca: Well it's great that you guys are doing that, and it's so great to hear that there are organizations that are dedicated to providing this kind of such needed information to young people and to everyone that everyone should have in order to lead a healthy life. So, thank you guys so much. It was really interesting talking with you today.


John: Thank you.

 

Dr. Vic: Thank you.


Becca: If you’re interested in learning more about the JED Foundation, you can visit JEDFoundation.org. That’s J-E-D-Foundation.org.

This podcast and the information provided is not to replace clinical therapy and treatment. If you are in a crisis and need immediate help, call 911 or go to the nearest emergency room
You can also text “START” to 741-741 or Call 1-800-273-TALK (8255), available 24 hours a day, 7 days a week, confidential, free of charge
You can also  go to your local healthcare provider or school’s counseling center (during normal business hours) or call campus security or the emergency number provided.
 

Becca: Thanks for listening! Interested in hearing something special or want us to help share your story? Reach out to us. We'd love to hear from you! See you next time.

The health information contained in this podcast is provided for educational purposes only and is not intended to replace discussions with a health care provider. In My Words is produced in New York City and distributed worldwide.

In My Words - a Jumo production.