Psychology and neuroscience professor Mitch Prinstein discusses the impact of the pandemic and social distancing efforts on mental health.
Mitch Prinstein: I’m really, really concerned about folks from underrepresented racial and ethnic minority groups that already have had such disparities in receiving mental health treatment. Increased risk factors have been experiencing discrimination and heightened levels of infection but lower access to health care. And now, with the Black Lives Matter movement, hopefully finally reaching a tipping point and reaching this kind of national tragedy moment. There’s even more reason for thinking about stress in ways that, as a white person, I probably couldn’t begin to fully, fully appreciate.[musical interlude]
Matthew Andrews: Welcome back to “COVID Conversations”. This is a production of the University of North Carolina at Chapel Hill. My name is Matthew Andrews. I am a professor in the Department of History here at UNC.
Jonathan Weiler: And I’m Jonathan Weiler, and I’m a professor in Global Studies here at UNC.[musical interlude]
JW: How’s it going?
MA: Well, I’m doing all right, Jonathan, how are you?
JW: I’m doing okay. The world is in flames right now.
MA: Yeah, just for those of you, you know, who are listening, we’re recording this on Thursday, June 4th and the nation has obviously been dealing with the death, with the murder of George Floyd and the reaction to it.
JW: And today is his funeral. So-
MA: That’s right. That’s right. So we have that on our minds as we talk about COVID and mental health. I think a lot of these issues probably are going to intersect in our conversation. So I think this is the right conversation at the right time. Today we had the privilege of talking with Mitch Prinstein, who is a Distinguished Professor of Psychology and Neuroscience here at the University of North Carolina at Chapel Hill. He is a Board Certified Clinical Child and Adolescent psychologist. And we learned he’s an Assistant Dean in the Honors Program.
JW: So among the many things about our conversation with Mitch today that really struck me were just how profound a disruption of the kind we’ve been going through over the past few months, and who knows how much longer, can have on child development, on the development of the brain, on how people learn to socialize, that was a, I felt like a particularly sobering revelation.
MA: I think sobering is the word. There are a lot of sobering moments. You know, in the many conversations, Jonathan, we’ve been having about COVID, different points just keep being brought up. Yes, but have you thought about how it’s going to affect this and how it’s going to affect that and it just seems like every day there’s: Oh, yes, of course, that’s going to be profoundly changed and usually not for the better. And Mitch was talking about how the effects of this, how the mental health effects of this, you know what, we’re not going to really realize them — and he was talking about this in a negative way. These are negative effects — we are not really going to realize what these effects are years down the road and sobering, once again, I think that’s the word to describe that.
JW: Yeah. And of course, things like anxiety, depression, are all going to be more prevalent during a time like this. And underneath all of that, is this just profound uncertainty about, not only are the circumstances stressful, because we’re dealing with a deadly pandemic. And now we’re dealing with what feels like a social unraveling for political reasons. But just not knowing what the future will hold is, it’s challenging to try to manage that.
MA: Yeah, I will say this, though, Jonathan despite all of that, I thought Mitch left us with some pretty good advice about how to more effectively navigate this moment. It wasn’t advice I was expecting, but it’s advice I am grateful for.
JW: Yes, I agree. And he’s just — he’s a very calm, even keeled, comforting voice.
MA: Yes. So keep listening, our conversation with Mitch Prinstein in just a moment.[musical interlude]
MA: Mitch, thank you so much for joining us today.
MP: Sure. Yeah. Thanks for having me.
MA: Mitch, you sent us a little pre-reading — you sent us an article you’re co-authoring, in which you called for flattening the mental health curve. I think maybe we could start by, if you could explain to us and to the listeners, generally speaking, what you mean by that? What you have in mind when you talk about flattening the mental health curve?
MP: Sure. You know, clinical psychologists like me have been very concerned because mental health is generally not given quite as much attention as physical health and certainly with COVID, it makes perfect sense that we’re focusing on reducing infection and contagion of the coronavirus. But we do have to remember that this is a remarkably difficult stressor for everyone on the planet, including children. And there is a big increase in the amount of mental health distress, diagnosable conditions, and less resources available to help people and we probably will see that increase in prevalence really be something we have to address in the years that follow the end of the physical ailment pandemic.
JW: Mitch, one of the things that people have commented on, you know, from the beginning of this is –among the many mental health impacts, and I know we’ll get into a lot of those — is just the impact of social isolation, which so many people are experiencing. Before we talk about social isolation and COVID. Can you talk a little bit about just what we know about the deleterious effects of social isolation, on health more generally?
MP: Well, we’re learning a lot more than we knew even just a few years ago. I mean, social interactions, they’re not just for fun, you know, these for kids are, it’s just the context where kids really express emotion in a much more dramatic way than they ordinarily would. They learn all kinds of skills, they put into practice things they’re learning in the classroom. Many have said that the opportunity to engage socially is as important as practice with math and reading. But for adults, too, we know that there are huge impacts on our social lives, from our social lives, excuse me on the way in which we feel every day and the way in which we process information and cope with stress. So we’re now even learning that even just brief moments of social rejection or isolation, has a remarkable impact in our neural responses. So our brain changes and treats it as if we’re experiencing physical pain. And we know that there are ways in which social isolation changes the expression of our DNA. So three months or so after we experienced prolonged social isolation, we might see an increase in inflammatory diseases because of — inflammation changes in the expression of our genes.
MA: Mitch, this is so interesting. I did not know any of that and I’m wondering — are there specific groups then that you’re worried about at this moment? I mean, I know you’re a Board Certified Clinical Child and Adolescent Psychologist and so obviously your research focuses on children. Are children, are teenagers, are young adults — are any of these groups more vulnerable at this moment than others?
MP: Well, unfortunately, I am worried about a lot of different groups right now for very different reasons of — very worried about the elderly, given that people might be spending even less time interacting with the elderly for concerns about their heightened risk of death and serious presentation of COVID. Very worried about health care providers right now who are facing unspeakable decisions and tragedy right in front of them and being asked to engage in really difficult medical practice. So that’s not a group that tends to go for therapy very often, but I hope that will change. I’m concerned for kids and adolescents, not because they’re worrying about the economy, or they’re worrying about infection, as much as the change to their daily roles and routines is remarkably difficult. And I’m really, really concerned about folks from an underrepresented racial and ethnic minority groups that already have had such disparities in receiving mental health treatment, increased risk factors, have been experiencing discrimination and heightened levels of infection but lowered access to health care. And now, with the Black Lives Matter movement, hopefully finally reaching a tipping point and reaching this kind of national tragedy moment. There’s even more reason for thinking about stress in ways that as a white person, I probably couldn’t begin to fully, fully appreciate.
JW: Well and just I’m just thinking about, I mean, among the many compounding issues we’re dealing with is this, you know, killing of George Floyd takes place, which brings people out into the streets en masse. And that’s perilous enough, given some of the police responses in normal times but now there’s this whole other factor looming over all of that, which is the prospect that people are exposing themselves to a virus and breaking the protocols that, you know, we’ve heard are necessary to at least try to minimize that impact. So I don’t know if you could just maybe talk about just some of that.
MP: I mean, the level of stress that people are experiencing now is extraordinarily justified. And — but as you say, it’s so compounded today, because of COVID but also some of the political, you know, kind of rifts that are reemerging right now. Regardless of what side people may be on, I think we can all agree that things are more politicized than they are about social justice at this moment. And unfortunately, the hostility that’s been growing in our country for the last three years, maybe, for decades beyond that, has been exacerbated. You know, we’re experiencing stress in every domain right now. And for those of us that study stress, as psychologists, we can really categorize which stressors are going to be the worst and which are going to be a little bit easier to cope with. And what we’re dealing with right now checks every single box for everything we know to make this the worst possible kind of stressor. And we’re experiencing like five of them all at the same time.
MA: Mitch what are some of those boxes? I mean, if you could just speak a little more generally, about that, when you say checking the boxes, what sort of categories are we talking about here?
MP: Yeah, we really think about stressors that are time limited versus uncertain time, right, and clearly, we have no idea when any of this will end. We think about stressors that involve just local, proximal types of factors like you and one particular part of your body or one particular domain of your life. This is affecting everyone in all domains, right? So our health, our social connections, our economy, our feeling of safety. And I mean that for people coming from all backgrounds, but especially for African Americans right now. We think about ways in which we could turn to others for support. And this stressor has actually instrumentally taken away a lot of our support mechanisms by suggesting that we stay home. It’s an economic stressor, it’s a political stressor, it’s an ideological stressor, it’s everything, all at once. And usually we find that stressors in one domain can be — we can be resilient, if some of the other domains — we can find factors to help us but not today.
MA: Well, so as a professor of psychology and you’re, you know, you’re studying this as it’s unfolding, and you will be studying this moment for decades, I would imagine. How do you separate all of these things? I mean, because social isolation alone in a box is going to be problematic. But then when you add 35% unemployment, when you add videos of a police officer killing an African American, when you add the looting and the violence in the street, justified or unjustified, whatever, how do you separate all of that stuff as a researcher or is that an impossible task?
MP: Well, a lot of people really study stress by looking at the perceptions that people have of what was most stressful to them. So we might see individual variability and which aspect of this was more difficult. Some people experience privilege and are fortunate to be not furloughed or not laid off right now. Others don’t. Some experience privilege based on race and ethnicity. So that’s one thing. But the other piece, I think, is that we know that there are ways that individuals vary on how they respond to stress. How they biologically respond to stress, how they socially respond to stress. Some of us are on the phone all day, every day making those social connections, imperfect as they are, to try and compensate, and others don’t have that opportunity. So we have to measure individual differences and resilience factors as well. I know for us, for clinical psychologists, there’s a lot of talk right now about transforming the field and transforming the way we talk about mental health, hoping that a revolution, in ways that perhaps sort of long due within our own field decades ago, will allow us to understand this stressor and this moment, you know, differently and be able to help in ways we weren’t able to help even just three months ago.
JW: Mitch, among the things that you talked about in the paper, you and your many co-authors, were that these — and even you’ve touched on some of this already. But you mentioned that all of the sort of usual antidotes to stress, I’m just reading off, well you listed: enjoyable distractions, as you said, talked about social relationships, and you also talked about behavioral activation. So first of all, can you tell us what behavioral activation is, and then just maybe talk a little bit more about the role that those antidotes might normally play on the meaning of their absence right now?
MP: Sure, when we talk about behavioral activation, we’re usually talking about people who are susceptible or experiencing depression. And the idea of simply getting out and experiencing social interactions, engaging in physical exercise, and changing your scenery, can have remarkably powerful effects, not just because of the ways that it can help us literally engage in new behaviors, but because it’s usually also an opportunity to go out and challenge those things that you’re most concerned about, you feel most sad and pessimistic about, and collect data, if you will, on the world in a way that helps to disconfirm those worst case scenarios. Right now a lot of the worst case scenarios are unfortunately, not entirely inaccurate. And also people are limited in what they can do outside the home. So people can be quite susceptible to that, whether it’s missing out on changes in the lighting or social interaction or exercising, those all are known to have a very big effect on our sleep, and subsequently, and in addition to our mood and our behaviors.
MA: Well, I think what — I’m gonna [sic] ask a question that like Jonathan’s, demonstrates that we did read the essay that you sent us. Like our students, you know, we want to demonstrate with our questions [laughter] that we did the reading. Now, I was struck by a line in your piece where you talked about how the disruption to daily routines has been severe, which it obviously has. I mean our lives have been turned upside down. And let me say this — Chapel Hill seems to be just about the best possible place to be at a moment like this, you know, the disruption to our lives — are you talking to us from Chapel Hill-
MA: -Mitch, right now? Yeah. And so you know, it’s not New York City, right? We’re able to do many things in Chapel Hill. So this question, in some ways is coming from my position of sort of COVID privilege, I guess, is the way I would put it. But is the disruption do you think — maybe thinking a little more broadly here — to our daily routines, is that necessarily a bad thing? And again, we’ve been reluctant to look for the silver lining in this moment in all of our podcasts, but I’m watching as people are outside, kind of walking more, biking more. I see parents with their children much more than I saw when we are leading our you know, 40 hours a week, 60 hours a week, whatever, lives. All of that is a long winded way, I guess, of asking, is a disruption to our daily lives – can that be a good thing?
MP: Yeah, I think you’re exactly right. I mean, I think there’s a lot that’s really good here. I think there is a lot more interaction with families. We have to be concerned about kids who are stuck in families with really negative patterns, because they’re getting extra exposure to it. I think it’s good that we are able to spend more time at home and we can be more efficient. I think there are some people who are having a really tough time learning how to balance family and work life now that their kids are tapping on their shoulders, you know, inches away from them, rather than at school. I think there are ways that we’re going to change the way we think about work, the way we think about our home versus work commitments, the way we think about whether we need to leave the home and contribute to traffic and pollution and global warming by driving our cars and commuting. There’s so many silver linings and so many things that have to be thought through. The key for me about this change is that it usually doesn’t happen in a week. This kind of systemic, lifestyle overhaul takes generations for humanity usually to get through and make. And I think it’s great in some ways that we were forced into it, it accelerated social change that needed to happen. But I think it’s been so challenging because we all had to make that change practically overnight. And we haven’t figured out how to do it yet. So I, you know, that’s really a struggle and really an opportunity all bundled into one.
JW: Well, and I’m also just thinking Mitch, and Matt, you know, the — and again, I think COVID privileged, Matt is a good term because we’re all in comfortable places, we have the food we need, we’re in safe and loving homes. But also, I just wonder whether — so we’re basically coming up on three months of living like this, and what it will look like in another three or six or nine or 12 months. I mean, if we’re lucky, we’re getting a vaccine a year from now. And so, you mentioned earlier, Mitch, just the sort of, the looming fact of uncertainty. And so I guess I’m just interested to hear you talk about how things like this might unfold or how people might psychologically experience these things unfold when they just sort of keep going with no obvious end in sight.
MP: Yeah, I mean, it’s tough to crystal ball that but I think that there’s already been some really interesting observations that are, you know, worth thinking about. We’ve started to notice in this grand, worldwide, natural experiment that we’ve all been, you know, we haven’t necessarily expected to be enrolled in, that we’re seeing some phases. You know, we saw in those first few weeks, lots of Zoom happy hours and social gatherings and ways of trying to compensate and we’ve seen a drop off in you know, in some groups and in some ways. And I think that now people are starting to realize, wait a minute, I need to actively make those things happen again, because this is happening longer than I expected and I need to put in the effort in a different way. So I think we’re noticing that and I can anticipate that we’ll see ups and downs continuing. And we’re going to need to be effortful and mindful about the way that we do that. I’ll also say in my work with kids, and talking with superintendents, and lots of parents, that I think we’ve just discovered an interesting fact about kids, which is that 10 weeks is the limit for their patience and flexibility and willingness to kind of engage in this new way. Everyone is talking about their kids having hit a wall about a week and a half or two weeks ago, and suddenly, they just can’t, they just can’t take it anymore. And I don’t know if it’s the warm weather or the idea that school is ending or just their tolerance but we’ve reached the end of the rope. And I think we’re going to have to see some shifts and patterns in summer activities feeling very different then emerging back into school, potentially under Zoom classroom conditions all over again in the fall. But I think we can anticipate some phases there too.
MA: Well, it Mitch, this isn’t necessarily a question, just sort of a comment. If there’s been a saving grace in this moment here, down here in Chapel Hill, where we’ve lived, has been this amazing spring that we’ve had.
MA: The weather has been beaut — and maybe it’s always this beautiful, and we just never took the time to notice it. But I go outside every single day and I am regenerated, and I’m beginning to think what is this going to be like, in the fall, as the days are getting shorter? You know, it’s getting darker earlier. I mean, I would imagine that the toll is going to be more difficult in the fall than it would — had this whole thing unfolded last October, rather than this March. I mean, in some ways it happened at the perfect time with regards to the way the sun interacts with the earth and so on.
JW: And, Matt, I mean, just to add to that before Mitch responds — a concern at precisely that moment of a second surge coming-
JW: -which will force us to go back into a much more severe lockdown than we are currently in.
MP: And I mean, I agree and you know, our family is literally going out every day and stopping and smelling the flowers around our block and counting the buds that have opened since yesterday’s walk. I mean, who does that? [laughter] Who has ever had time to do that before now? So we are both getting that silver lining but we’re also feeling inspired and enjoying and appreciating because of the great weather here and you know, the fall is scary. I mean, not only will we have accumulated so much more time but we’re going to be in the middle of – you know, there’ll be apprehension about back to school and Halloween. What does trick or treat look like for the kids now and are we taking that away from them as well, in addition to summer camp, and end of year milestones? And the political you know, political aspects of this will be obviously, all the more ramped up as we get closer to an election day. And so I think, you know, you guys are smart to be thinking about what we could be doing now to prepare for that and the ways that we can start anticipating what will be harder and can we build up some stores of resilience and psychological wellbeing now to help us through what could be literally darker days, you know, to come.
JW: Mitch, you mentioned school reopening. I know these are challenging questions for policymakers and everybody else. But just from a psychological perspective, I’m interested in your thoughts about how to weigh the trade-off between safety, minimizing spread on the one hand, and the — all of the problems that would attend to kids not being able to go back to school on the other.
MA: Yeah I mean, is there a tipping point? I mean, theoretically, at some point, the costs of social distancing and social isolation and the stay at home orders, theoretically, at some point, those costs outweigh the benefits. I’m not — that’s probably a difficult thing to express. You know, a lot of people don’t want to hear that. But yeah, well, just to sort of compound what Jonathan asked there. What are your thoughts on that?
MP: It is, I mean, you’re absolutely right. Just like the economy tanking is at some point going to physically harm people and families and communities in a way that can’t be ignored forever. You know? It’s so tough, you know, I would say, — well, I have a couple of thoughts. The first is, you know, we know that individuals’ prefrontal cortex, the area of the brain that allows us to inhibit from impulsive behaviors, allows us to engage in the most thoughtful, careful behaviors — we know that’s not fully developed in people until the age of 25. We know that for some people, it doesn’t develop all that well after then either. So given that most of the people who are in educational settings are below the age of 25, when we’re talking about going to school, we’re talking about using the CDC and federal and state guidelines from a developmental perspective, because not everyone will follow them in the way that people over 25 will [laughter]. You know, they will be tempted to engage in impulsive behaviors and not follow the rules in ways that adults might be better capable to do. And I haven’t heard a single guideline take a developmental perspective and say, we have to be mindful that when it comes to children, they’re gonna [sic] have a hard time running to each other on the playground, or engaging in impulsive behavior with the presence of alcohol in their dorm rooms. So I think that that’s just a cold, hard fact of science that needs to be part of this equation. But more to your point, and sorry to ramble, but it’s a complicated question [laughter]. I do think that it is essential that we have kids, you know, through college age, having some opportunities to have educational value that comes from things you just can’t get on Zoom or Google Classroom. And if we have the testing to be able to put small groups of kids in very small rooms, five kids, you know, with a teacher and test them every week, we might be able to get there. But there are so many systems and issues that are making that hard to happen, I realize. But I would be, I could, I could argue either way about why we would need to really move in a direction of trying to get people back together for their educational, you know, value, but recognizing that this is a hard group to get asked to follow these really weird and strict rules we’re under now.[musical interlude]
MA: You’re listening to “COVID Conversations.” Today we’re speaking with Mitch Prinstein about mental health during the COVID pandemic. Now back to the show.[musical interlude]
MA: Yeah, you know we had the geographer Betsy Olsen on with us last week and we were asking her to find an analogy from the past. You know, can you compare this moment to a previous moment and she compared the effects of COVID on caregivers, which is her focus. She compared the effects of COVID on caregivers to a hurricane. She was comparing the amount of social isolation caused by this pandemic to the challenges and the social isolation caused by a natural disaster like that. And I’m wondering if you’ve seen anything — if people in your field — is there anything comparable to this in the field of mental health? It seems to me — and correct me if I’m wrong here — but it seems to me that the last time we were actually talking about our collective national mental health was in the immediate aftermath of September 11th. And so I’m wondering if that’s the best analogy or are there other analogies out there?
MP: Yeah, it’s an interesting coincidence, because we are drawing in the psychology literature on the natural disaster literature as well. And, you know, this is a funny past life for me because I got to graduate school back in 1992, in Miami, Florida, and I unpacked getting ready to start my doctoral training, you know, like many of us did, who are professors now, but it was a week before Hurricane Andrew hit Miami, category five. And before I knew it, I was surprisingly engaged in a three-year study to understand the effects of natural disasters. And I think that that literature can be helpful to us now, but in some ways, it is completely inapplicable [laughter], I’m finding, because when we went down to the most affected areas in Miami, people were helping each other, walking down their block and engaging with their neighbors and, you know, engaging in a variety of behaviors we now know it can be really resilient. So it gives us a hint in mental health. And at the same time, it’s really a horrible indicator we’re finding, because the things about natural disasters that make them unique, are also making them incomparable to what we’re going through now. I can say two things, though. One is we know that the effects last for years. When the news coverage stops, some of this suffering is just beginning when it comes to mental health. There are delayed responses because you’re changing kids’ trajectories. You’re affecting something today that might put them slightly, at a tiny angle off of their path, and you won’t see an effect for the next two weeks or even two months. But two years later, that subtle change to the path they were on, will put them at a destination far further away from where they would have been had they been on that undisrupted path, if you can imagine that idea. And the second thing is we see that there are community effects, the more that especially kids see their parents upset, and they don’t talk about coping strategies together, or they see society reacting, that has effects on kids that are sleeper effects.
MA: It’s changing their trajectory — to go back to your first point — changing their trajectory and putting kids on a different path. Can you be a little more concrete about what that might look like?
MP: Yeah, so you know, let’s think about kids, for a second, as an example. Right now, they’re missing out on three months of social interactions. So that’s three months of conflicts and opportunities and times where they could learn to share or socialize and they’re not going to look very different from their peers, the day we all are having these restrictions released. But that’s three months where they change their development. Now, some kids might have changed their development more dramatically than others. I feel bad for only kids right now, only children right now, for instance, because they’re losing out on that with any age mates. And you could imagine that while that might not look a whole lot different, you know, let’s say in January, when hopefully by then there’s a vaccine if that soon, and the world is starting to come back together. But you can imagine years later that that missing three months of interaction starts to be noticeable when they enter a new transition, like when they get into middle school or high school and they have social demands that that three months of practice would have been needed to help them succeed. And you don’t see that gap really manifest until they are having struggles with the next social transition. Yeah, so that’s what we see with disasters and other areas of mental health. And it’s always very frustrating to us in the psychology realm because we already don’t talk about this enough. But it’s very hard to get people to care about something years after it happened. And tell them hey, remember COVID back in 2020? We’re working on that. Everyone’ll be like, yeah, that’s old news, we’re not covering it anymore. And we all tear our hair out as mental health providers, and scientists trying to explain that that’s a missed opportunity for helping people.
JW: Mitch, I’m just thinking about American culture, which I know is a big, vague term, but our — the sort of just the sense of individualism we have. I mean, the whole time, you’re talking and I just feel like this entire pandemic is a master class in — actually, we’re intensely social creatures. We can’t really survive on our own. We need each other. You’re telling us that our brains and our DNA are being rewired by social isolation, and so I don’t know, I guess I’m just wondering whether there’s particular particularities of the American experience in this, from a psychological perspective, that you have thoughts about as compared to maybe how some other societies approach these sorts of issues, and think about interdependence in social life more generally.
MP: Some of my research studies how kids get along with each other, which means that I have to study popularity as an area. And when we think about popularity and status and being famous and standing out among all others, and we try to say the same concepts with our colleagues and China, they tell us, we don’t have that word. We don’t have the word popular in the way that you have the word popular. And it really suggests to me in a way that I’m not an expert in but in a way that resonates to you know, with your question, that we are individualistic to an extreme here in America. And putting aside the political factors that might make America very different in this situation than others, we also are, you know, proud of our individualism. And we have a hard time working together to flatten the curve in many ways, because we want that freedom and that individual, you know, ability to engage in the behaviors that we think are best before thinking about necessarily what’s best for our neighbors. We see it now as we are in phase two. And we see some people wearing masks or not, and there’s, I don’t know about your social media, but, you know, I see all kinds of debates about whether it’s fair to yell at people when they’re not wearing a mask and educate them on how they’re hurting others as well as themselves and, but that’s America. That’s our individualistic kind of framework in a way and I think that that is unique to our country, especially if we look at the ways that other countries were able to have success, but again, I’m talking outside my expertise. I’m not a cross cultural psychologist, so I need to be careful.
JW: No, understood but — and I just want to note the particular bubble — I’m being presumptuous in saying — that we’re all in. That it goes without saying that everybody we know is wearing a mask. The only question is whether you yell at other people who are not wearing masks [laughter].
MP: Right, right. Fair enough [laughter].
MA: Well to you know, maybe get a little bit more in your lane then, you just had said: This is what America is. I’m wondering, I’m guessing you had a critique of the way mental health issues are talked about, discussed, treated in the United States before COVID. Or maybe that’s presumptuous of me. Has this pandemic exposed a particular problem in the way that we as a nation deal with issues of mental health? You know, is it just more of the same problems exacerbated or has this demonstrated a different type of problem?
MP: I think all the skeletons in the closets of a lot of of fields right now are coming out to expose themselves. I think there are new issues for sure but I think that the mental health disparities in — for different races and ethnicities, even before the murder of — the murders that we’ve seen. I mean, those those were very, very prominent and in what no one’s done a good job with and everyone’s tried, but but not good enough, you know, because we haven’t really solved the problems. So I think race and ethnicity disparities in mental health and the ways that we think about providing services that meet people in a way that fits culture. That’s number one, without question, you know, I think something that’s very, very important. I think the funding issues in mental health are something that we’re talking about a lot in the field of clinical psychology, you know, we have no: everyone gets a mask, everyone gets funding, everyone gets away of helping them to engage in mental health treatment, the way that we now see it in physical health treatment. I mean, we are tracking our resources down to the gown and the mask. And if that was done for mental health decades ago, think how different this could be. There are kids that wait for years to get tested to see whether they’re experiencing intellectual disabilities or learning disabilities. Talk about altering trajectories — that changes their entire educational path. And we’ve, as a country, turned a blind eye to that, sorry to sermonize, but for decades, and now, we’re realizing: wait a minute, the federal government could have somehow dedicated more energy to making sure that everyone had an opportunity to get the services they needed. And I think that’s caused you both an outcry and a call for reform in a way that I think could be game changing. My own research is on suicide and I’ll just say that, you know, suddenly a lot of people are talking about suicide. It’s the second leading cause of death for youth between the ages of 10 to 24 years old, it remains a very high leading cause of death throughout the lifespan. And it is the only leading cause of death, compared to all of the other physical ailments and whatever, that has not seen a major decrease in the last 50 years. In fact, the rates have doubled. So, it is this has also been exposed as people start saying, oh, I wonder if we should be worried about suicide and many of us are saying, well, yeah, you know, yes, we’ve been saying that for a long time. And certainly now is another time we should be doing so. But, I think first and foremost, just to be clear, that concerns about race and ethnicity and health disparities are probably the issues that we in psychology are turning directly and fully towards right now more than any of those other factors.
MA: Well, and I’m embarrassed that I don’t know the answer to this, but in the billions and billions of dollars of relief packages that are coming out of Congress: has any of this money been earmarked for research in mental health or mental health services?
MP: Very little. You know, that’s exactly what we see with other things as well, but very little and a recent package, I believe, it was about three, four weeks ago now was put together by the house with a more substantial mental health component to really offer money for existing programs and establish new resources. But my understanding, and I’m not on top of this as closely as I’m sure others are, is that it died in the Senate. So they’re really that never did go through which is unfortunate because it was the one where mental health was going to have more of a focus.
JW: Mitch, again, I guess, trying to go back to some silver lining aspects of this. One thing you talked about in the paper was the need to go to telehealth to do remote work and for mental health practitioners. One potential benefit, and maybe this will be along a longer term benefit, is potentially increasing access to certain kinds of services. And so can you can you just talk a little bit about that and how you see that potentially sort of playing out in the time ahead?
MP: Yeah, that’s a major silver lining and I’m so glad that you raised it because I don’t know if everyone is aware how big this change is, but it’s not just the case that you don’t have to go to an office anymore to get mental health services. We are all now able to, meeting our ethics and licensure requirements within the psychology field, we can now do telehealth. But many, many states, not all of them, have opened the door to allowing telehealth across state lines. And this is huge, because people literally were not able to sometimes drive just a few miles across the border and get any services, which disproportionately affects rural America and also racial and ethnic minorities who might not have the time to get up and drive downtown and go to some fancy psychologist office, you know, so this is huge. Anyone can call any psychologist and again, in many states, not all of them, it doesn’t even have to be in your own state, and get services in the same way that we’re Zooming for everything else now. And the data are suggesting that the efficacy of the treatment over Zoom is not really much different than what you get from being in person. If anything, there are silver linings in that we get to see people in their homes and we get to see and engage in ways where you normally wouldn’t have because you can see what’s behind them and if there’s chaos and despair or not, and that can really help with your assessment and your treatment. So I hope that everyone out there knows that mental health treatment is now just a phone call away. And we have been fighting for that and wishing for that for decades. So that’s a huge silver lining that I hope opens the door for access in a great way.
JW: Just to quickly follow up, on that Mitch, just on that point about opening up the door to being able to access health services across state lines, is there are people already pushing to make sure that that is permanent, that that doesn’t go away when this crisis is over? And what does that look like?
MP: Yeah, there’s a lot of pushing for that very hard. The American Psychological Association is really working hard to try and convince folks that that would be a good idea, I believe. Of course, the big thing will come to insurance panels and whether they continue to reimburse because otherwise, it’s hard for that to continue. And that’s not completely determined by legislators. So there are some issues that really have to be worked out there. But there is a desire for that to continue. And I think that’s what’s best for people’s welfare.
MA: Mitch, you’ve been very generous with your time. So it’s probably time for us to wind down. I’m wondering if you could end by giving us all your expert advice on how we as adults, or we as adults with children, can be navigating this moment. And I, you know, I assume you’re going to say things like, go outside and smell the flowers and count the blooms, but I don’t think we can hear this advice enough. How would you direct us, you know, in the name of a robust individual mental health, what are the keys to that mental health?
MP: Well, you know, I could say all of those things, but, you’ve mentioned them and we’ve heard them elsewhere. So I’m going to say something else instead. Lower your expectations across the board for everything [laughter]. We’re not going to be great parents, at this moment. We’re not going to be great at our jobs at this moment. We’re not going to feel good about ourselves and we may engage in choices that hopefully are totally, totally safe, but may not be our best selves at this moment in all of our behaviors. And, you know, again, assuming that we’re doing that safely, and we’re not harming anyone, I think we got to cut ourselves some major slack. You know, because for people who are experiencing COVID privilege, as you say, and you know, for those who are experiencing privileges and other ways, it’s still a stressor. It’s a monumental stressor, and no one expected to deal with it. We had no preparation time, and no one had a toolbox of resources waiting to deal with this when it came around. So even though it’s been three months, that doesn’t mean it’s any less stressful and we’re not supposed to be getting used to this. So I think we have to forgive ourselves and I think we have to give ourselves credit as much as we can. I think we’re in this new stressor in just the last two weeks where we really need to think systemically and differently about race and ethnicity and how we’re battling institutional and systemic racism. And I think that’s bringing up a whole different batch of stressors for both African Americans and non-African Americans — soul searching, conscience kind of debating and wrestling, and I think that’s a stressor too. So it’s great work we have to do. But I think we have to acknowledge that that is new for a lot of people and that’s a stressor as well. So again, lower expectations in all other domains and give ourselves a little bit of a break. This is not going to be when we’re our most productive and we’re our best selves at all. Beyond that, you know, I think we just have to be grateful. You know, this is an opportunity presented to us to rethink our lives, our priorities and if there’s some capacity we have at any moment to say, you know, I’ve been given a huge message here that I need to rethink it all, then that would be a good way for us to emerge from this and say I was given a moment to really reevaluate. And I have different priorities perhaps, or I’m going to enhance things like stopping and smelling those flower bushes or, you know, spending time with family and maybe that’s more important in the long run. And if we all came out with a little bit of perspective, then maybe this would have been, you know, a way, a silver lining that we can all be grateful for, in some way, in some small way, given all the tragedy that we’re all experiencing.
JW: Mitch, thank you so much for your time. This was just super interesting and enlightening, and we really appreciated your sharing with us your expertise.
MP: Thank you so much for dedicated time to talking about mental health. I really appreciate you guys focusing on this topic and thanks for having me be a part of it.[musical interlude]
JW: This has been another episode of “COVID Conversations,” a production of the University of North Carolina at Chapel Hill. We want to thank Dean Terry Rhodes, the Dean of the College of Arts and Sciences at UNC Chapel Hill, and Senior Associate Dean Rudi Colloredo-Mansfeld. We also want to thank Geneva Collins and Kristen Chavez in the communications office in the College of Arts and Sciences, as well as Matthew Belskie and our producer extraordinaire, Klaus Mayr. And we encourage you to share and subscribe and like the podcast, which you can find at covidconversations.unc.edu and wherever else you may find your podcasts. And thank you for listening.
Transcript edited by Kelsey Eaker.