How has the pandemic affected the mental and overall population

Rollis Fontenot III:

All right, if you're just outside again go and let us know where you're signing in from what city what state or country, we're glad to have you. Thanks for spending your time with us, we're going to spend the next hour with what I believe is a great round table, it's very very relevant for today's environment that we're in. And in fact, if you're here to learn about how the pandemic has affected mental health and population health to the whole community as well as those who are sometimes underserved or are in very vulnerable situations, you're definitely in the right place we want to welcome you here we're looking forward to hear your feedback, your comments, your questions as we interact with our guests and I want to welcome both our guests, we have at the very top of my screen as kena pace she is the CEO of the Harris center, and then just below we have Wayne young who is the CEO of the Harris center. So I want to welcome both of you to the show.

Glad to be here. Thanks for the opportunity to join you.

Thank you so much for having us.

Thank you very much. And you know just looking at your profile, I know that. A couple of years ago you moved moved down from the Dallas, Fort Worth area to the Houston area, and we just, it's a belated welcome but Welcome to the Houston area.

Thank you.

And it's been great. The community is really, really welcomed us and and Ben Affleck engaging and open to coming in and thinking a little differently about some of the services we deliver. Awesome.

Thank you so much. I grew up here so it was a coming back. I came back, three years ago.

I did see that and one of your videos I was watching one of your videos that you had left and then you came and you came back that's awesome though those who are just coming in, let us know where you're where you're coming from, where are you signing in from today and we'll be reading off your comments here. In fact, I'm going to pull up my comments to make sure that I can see yours, as they come across. And then we also have flippy riddles in the background she's going to help us with the reading of the comments of course I have my production crew, which was composed of Joanne, and Jonathan so Welcome all to the show. Let's get right into our conversation. One of the main questions I did want to ask both of you and perhaps we can start off with yukina since you're at the top and then we'll go to little Wayne right after that, from your perspective how has the pandemic affected mental health, which of course, affects population health in the community that from, from your perspective.

Now we've definitely seen an increase in needs for support and services and reassurance and we started a mental health COVID support hotline. That's a statewide hotline and we've received a little over 12,000 calls so far. So it really highlights the need for individuals, reaching out and those calls are specifically COVID related, whether it's vaccine related or you know where to get information. And so we're very lucky that we were able to get snapped up and get that hotline up and, and the beginning of the pandemic, and then seeing how we're able to then coordinate to the next level of services.

 Awesome. How about your perspective. Yeah, I think there's. It's really interesting dynamic, I think, first of all, it has brought mental health to the forefront of a lot of conversations that maybe it hasn't been in the past. This kind of shared experience that we all have and I don't think there's anybody that can escape the impact right and and some of those impacts are very dramatic and scary and, you know, need a lot of intervention, but some of them are just general aches that we all feel you know that we we see when our kids are struggling we see them, you know, the challenges of getting them back into school and being successful and the social developmental stuff that begins to happen. And then they did their, the American Psychiatric Association did a tremendous study, and it was very interesting because they they went at it through the lens of kind of the diverse diversity of our communities, and began to recognize that kind of a pre post study of depression and anxiety about on general about seven or 8% of the population was experiencing depression and anxiety. Back in 2019, and then they look kind of mid 2020, and that number had gone up to around 30 as high as 34%. And they noted some of the differences in different populations. So, for example, our friends in the African American community were the highest they experienced the higher percentage of depression and anxiety than any other race or ethnicity, ethnic group and so it was with the need to be intentional about how we address that and be attended attended to that

I think is critical, but it does show that I think everybody is experiencing this and and feeling that pain. Absolutely. I'm just going to open up this right here my one here, one quick little sound interruptions I miss adjust. There we go. Good. I just want to make sure all. We also have a couple folks who have just come in. So Philippa you can read off a couple of folks who just come in their name and their where they're from.

You can unmute yourself. There we go.

Yes, hi hi Rollis I'm trying to see.

Okay, well we'll come back to you it's on the screen right now I see we've got Rosina she's coming in from Indiana, says Dr. Alaska we have Sinead trous from Alabama. Welcome. Welcome. So I want to give you kind of a follow up question, she said the hotline I'm curious kina, has there been any analysis as to the types of concerns that people are calling in with what are some common concerns that people are are being faced with right now that you're seeing quite a lot.

We do we do track that and do do weekly report the most common in early on, there was more loneliness and anxiety and wanting that warm, you know, you know, person to talk to and feeling a little just anxious about the pandemic overall. And then it's then kind of to Wayne's point it went to a little more when are the schools are they going to be open or what do I do about childcare Am I going to have a job or might have a loved one, you know, that was unemployed and managing all of that and multiple stressors, and then. Recently, more of the calls have been vaccine related, where they get a vaccine when to get a vaccine Should I get a vaccine and wanting to talk that through with someone.

Oh, interesting. Okay. And, you know, along with the lines of what you were saying earlier to Wayne you talked about how the black American, African American population has been more adversely affected from a mental health standpoint. What are some of the things that you've maybe observed that could perhaps be the reasons, what are the stressors that could be causing this being It is so lopsided to other demographics.

Well, I think some of it could come into play in terms of some of the other social determinants of health pieces you know if if if any group, no matter what their race or ethnicity if there's instability in terms of their housing. A lot of people are facing food instability right now. The more of those stressors you have pile up, the more you are going to experience mental health challenges right and so if if certain groups tend to be more represented in terms of those negative impacts of social determinants of health, so it only begins to make sense that those those stressors pile up, they begin to experience that and I'm kind of excited we are right, we begun the process. We do some promotion of that crisis line out in our, in our community we as kina mentioned it's for the entire state of Texas, so anybody can call from anywhere in Texas and gain that support, but here closer to home in Houston. We are fortunate that one of our partners actually does a COVID registry. And so we know the zip codes and they actually do an anxiety scale and they understand kind of quantify people who are experiencing greater anxiety so we've been able to kind of cross reference those zip codes that are primarily neighborhoods of color. And with those that are being more impacted and now we're able to begin targeting. Some of our outreach and promotion of that crisis line in those communities, to try and counterbalance that disproportionate impact and and make sure that if they are being disproportionately impacted. They also are receiving disproportionate education and information about resources that are out there to them and I'm excited about using data and using some of the the registry information that's out there in that intentional way so that we have more direct outreach.

Wow, you know, I want to thank, I want to thank you both for for this and just your whole organization for doing this kind of study because it's one thing for one person to say hey you know this is why I'm stressing or. This is why I think we're stressing, but you're using actual data to come up with, with this with these conclusions, you're looking at zip codes versus where the calls are coming in from and how it matches up that I had this I want to give you this for that this is well deserved. Thank you very much. That's great work. Just as a follow up I'm curious what what got you into healthcare I want those in the comments if you are in healthcare, I want to thank you. But what inspired you to get into healthcare I want to start off with you and they will ask you know what what inspires you get into healthcare and then also mental health.

Yeah, so, and most of my career. While I've worked in a variety of kinds of systems and settings, it's all been around, they have real health, mental health care substance use disorder services and, and it. There was always kind of a keen interest in it, I will also share them. I'm a person with lived experience I'm in long term recovery myself. And so that obviously drove some of that although I often say i don't i don't know that that makes me any better or worse at my job, it gives me a little bit of insight, maybe. But then I still have to work hard and try and do a good job to meet the needs of our community here, but it is certainly a passion and predominantly most of my work has been in nonprofit and safety net systems, kind of that public mental health workforce section, realizing that there's an entire population of people that if we're not here to serve them they're probably not going to be able to receive services in another location either they, they don't have the resources they don't have the insurance and and so knowing that we are kind of a system that is there as a backstop between and there's not much app for us right if you, if we're not there to catch you then it's a long fall from us and so knowing that we play that vital role in our community and we are that certainly system of significant need is a lot of what motivates me and what kind of drives me to continue in this field.

Oh that's inspiring Oh my gosh. Now, I just learned something new about you that you you're actually a long term recovery. I think, you know, is better or worse the job I don't know about that but the insight is that resonated with me. You You definitely have more insight. I think that you can come from a more more empathetic to I would think it must must help in that regard as well. Would you agree with that.

I certainly i well i think and there's a lot of research that shows people in recovery. The biggest advantage is the ability to develop rapport, right, like if I, if someone else is struggling and I say look, I'm in recovery too or. I've had similar struggles and the truth is we all have right i mean it's one in four people in their lifetime are going to have a mental health issue it's, it's pretty common at this point. And so, now once you develop that rapport, you've got to have some ability to actually support and help people and that sort of thing but it certainly opens the door and creates some comfort with people right away.

Absolutely. Keen I love to get your perspective what brought you into healthcare.

Well, about 18 years ago, I was helping a loved one who's uninsured at the time, navigate the public system to receive services and I was with him every every step of the way going and realized it was very complex and there was a lot to it, and I kept showing up at those those appointments and they hired me, they hired me as a case manager, um it was one of those where I was more of advocating and helping and then was also a case manager at home, and felt like hey this is, this has a good feel to it I could make a difference and came on as a case manager 18 years ago and then in community behavioral health ever since.

All of that too, you know, in fact, when I talk with a lot of nurses because I interview a lot of nurses throughout the year and. And when I asked them about what got them into health care, a lot, a lot of stories start off with, I helped my grandmother I hope my, my relative or my friend and, you know, they just got in. I guess inspired to want to enter into the health, health field so. Sounds like you have a similar experience.

I can't imagine doing anything different.

That's awesome. Well it's it's inspiring it just lifts my spirits to hear both your story so thank you for sharing that. There are quite a few comments that have come in Philippi, do you have access to those comments.

Rollis It doesn't look like I can view the comments I'm looking at you in LinkedIn. I'm on your LinkedIn and you follow us. If you follow our profile on LinkedIn you'll be able to see all the, all the comments on them off. Let me go ahead and do that here, I've got. Wow, quite a few here we have Glen chambers coming in from Houston. We have Brian Hudson, this is in my world the slow mental drip has had a very profound impact. It's like the frog in the warm than boiling water syndrome, we have seen a huge demand for behavioral health nurses. And so we also have Dr. Alaska she says the stress experienced by the disparities population those that fall into the low socio economic status, no access to health care only one life challenge. Prior to COVID is really off the charts. Now in the pandemic they have a lot to deal with. So if you wanted to comment on either one of those comments there, any thoughts on that kena yeah i think i think anytime you layer challenges on top of right i mean it's it's it's one thing to be going through the pandemic but I've been fairly fortunate I've been able to, you know, haven't had to worry about my employment, you know, you add a stressor of do I get to keep my job or not or, you know, we've we've had food on the table and that hasn't been a concern for my family but but I can only imagine the compounding factor that would have if I were faced in that situation and so anything that tends to put people into any disadvantaged groups, especially if it's disproportionately So, and I think we've also seen that COVID has impacted. Many of our communities of color and greater ways to write they've, they've had, you know, more challenging outcomes they've often had less access to care physical health care. And so all of those things just become additional stressors and it's, you know, it isn't that someone taught me a long time ago, mental health issues are not about the presence of symptoms, it's about the degree right like we all have days where we're down and we all have our periods we're anxious, but the intensity of those symptoms the degree we experienced that is at some point become problematic and begin to interfere with with our daily lives and in our enjoyment in life and so anytime you start compounding those different variables on there, I think it's inevitable that you began to see the fracturing that people are experiencing and. And frankly, I'm worried if you look at traditional disasters, more, more environmental disasters. What you began to see is that mental health issues and challenges, become much more significant after the physical safety issues resolved, so you know the first few weeks after disaster is not the time where people are really looking for maltreatment right it's it's six months later when they're suddenly they're not sleeping anymore and, and they're waking up and they're having nightmares and they're reliving stuff and and so I'm worried about what this mental health, kind of wave. We might experienced after we begin to kind of get our feet back under us and the vaccines kick in, we get some immunity in our communities. I'm worried that we're just beginning to see the rise of this tide and there's going to be kind of much more to come and all of our communities as we begin to recover from this process. Wow, which is why we need organizations like you. I mean, so thank you for what you're doing.

Okay, did you have anything you want to add to that, yes Rollis I'd like to respond to the comment about nursing shortage and, and the need for nurses your that comment is absolutely spot on, you got it correct workforce shortage and recruitment and talent acquisition around our nursing positions has been a priority, and a shameless plug for us also that we do have some, some physicians on our website. Harris center.org if you'd like we have some amazing new, new programs, innovative programs with very rewarding work for our nursing team and all of our medical positions but I do think that that is, is something that's a priority for us keeping up with keeping up with the trends in healthcare and staffing appropriately.

Well when it comes to talent acquisition is right down my proverbial alley so I love talking about that stuff. I'm glad you did mention that that you have that we look forward to, to partnering with you guys very soon on something so I'm excited about that is looking at some of the other comments we have Philippi, do you have access now, I'll see a few more.

I'm sorry Rollis I'm on my phone at work and difficulties here so no problem we appreciate you take it out your time to do that, to be with us today Philippa, I'm gonna I'm gonna do the best I can to go ahead read the comments so you don't have that pressure anymore but thank you for doing that. Okay, I'm looking at I'm able to see pretty clearly today which surprises me my comments are working great today. So you guys are bringing good vibes with you today. Thank you very much, kena and Wayne. A few more things I've seen is that it says that a mental health issues during this pandemic is not discriminating it affects everyone in the world, in some way or the other. That's an interesting thought too because you know this is one of the, like you mentioned natural disasters. Usually that's usually in a certain area that happens but now we got it is everywhere. This is affecting folks everywhere, which is seems to be quite unique. Glenn says Glen chambers she's a psychological safety goes a long way. Thanks for creating solutions versus stigma. Oh, that's a good one. Solutions versus stigma, talk about this, let's talk about stigma. What have you had, if you've experienced some who avoid using your services because of the stigma, and if so, what can we do to help to turn that around.

Yeah, I think, I think there's always that part of the challenge and overcoming stigma, there's, and it's it's broad across our society. You even seen in healthcare settings right I've worked in. I've worked for hospital systems and it's not uncommon where you see a primary care provider it's usually not malicious. It comes from a place where they have a little bit of angst about not knowing what to do right and so the person shows up and, you know, they, they have some symptoms and they well that's probably just your anxiety right and they kind of shuffle them around and and don't really get to what the core of the problem might be and I don't think it's ill intended. And then there's the stigma. And a lot of that stigma is external like the people who do come to us. They're like, Hey, I got a mental health issue I need your help this you know I need the medical I need whatever. But, but society seems to apply that stigma and have some judgment about it but it's interesting though that's why I think there's the potential that there's a Silverlight one more maybe a few silver linings, this is that because this is shared right and there's nothing, no one did anything to cause this right no one created this for us that shared experience might reduce or break down some of that statement right so if I'm, I think we're all anxious for what does this mean for our kids. What does this mean for our spouses what if, what if my spouse loses their job. And that creates that anxiety and that shared experience makes it really hard to differentiate right and it's it's hard for me to say well that must be about something you did or something that's different about you. When we're all experiencing some of that kind of shared experience and process and so I'm hopeful that the stigma will reduce I think conversations like this, though, go a long way. It's it's one of the reasons why I got a new employee orientation every time I introduced myself as being a person in recovery very similar to how I did. When we first started talking about it. And part of that is I talked to another leader one time, who was in recovery and identified. And I asked him about that decision to disclose and identify as a person in recovery, and he said if I can't do it in my position, then how in the world could I ever expect anybody else to be comfortable talking about their mental health issues and that's part of my feeling right now I get to be the CEO and it's a huge privilege to lead, one of the largest payroll organizations in the country. And so, with that comes a responsibility to try and break down some of those stigma barriers and so if I were uncomfortable with it. I certainly don't know how I could ever encourage anyone else to be open about it so so we share freely and hopefully these small conversations and planting seeds and expanding these national conversations will ultimately lead to a continual reduction in that stigma, because the consequences of our individuals not getting treatment are significant right there's some very bad things, and very bad trajectories begin to occur when they don't get treatment early and the supports that they need.

I literally experienced joy when I saw you say that if I'm not willing to do it. You know, if I feel uncomfortable doing it, how can I expect others so this this makes me want to do this right here too. That was awesome. Thank you very much for that. So, if kena from your perspective, maybe you can kind of go a little bit further into the scope because you mentioned how you're one of the largest in the country, maybe talk about the scope of your organization so that folks and other because those folks watch us from all over the United States, they may not be familiar with your organization. You could talk about that, and all that. And maybe Wayne expanded a little bit more on it, he does a phenomenal. Overview agency and, yeah, I'll let him I'll let him do that and then if there's any, any a little bit slow.

No, you go ahead cookina. Go ahead and then we're gonna let Wayne's he's on he's on back. Yep.

Okay. Okay. Yeah, he mentioned where though, one of the largest community mental health centers obviously in in Texas, we are one of one of 39 in the state, and we do provide IDD services. Early Childhood intervention services crisis services we provide all the, the mental health services and the Harris County Jail. We have some presidential programs that maybe we'll get into in a little bit. And we provide outpatient mental health services for adult and children. I think last year it was 88,000 is a right wing. Okay, and provide full continuum of care and overview of all of our services that I think a lot of people are probably pretty familiar with the outpatient mental health services but we have some really unique innovative law enforcement partnerships that are a cert response team and the mobile crisis team our core, which is officers with tablets out the deputies and then our clinicians on the other end and as we mentioned also the. The 24 seven crisis hotline. So those are our main, main services in addition to I'm sure there's plenty of them that I've left out when can help me out here.

I go for a wing. Instead of going more specific I'll go more general right so we are. So the Harris center, our formal name is the hair Center for Mental Health and IDD. And if you're not familiar IDD stands for intellectual and developmental disability so what historically that the term that we previously used was mental retardation that term is considered insensitive and not not the most respectful of language and so intellectual developmental disabilities is the verbiage and the words of choice and that now. And wait so we are a unit of government we are the local mental health authority for Harris County. A lot of people as you mentioned may not be familiar with Houston and Harris County so we're, we're a large area where large urban center Harris County has about 4.74 point 8 million people. If Harris County was a state we would be the 26th most populous state so we have a large public mental health system. We provide kind of those safety net behavioral health services so if you're, I think, 80% of the people we serve are at or below the federal poverty level. And so that if you go to 200% of the federal poverty level. Almost everyone we serve I think 98% of our, our clients that we serve are at or below 200% federal poverty level so the vast majority of people we serve are poor, have serious mental health issues, usually diagnoses like bipolar schizophrenia, those kind of things. And it is a broad array of services we have about 2400 team members. Our annual operating budget, this, this year I think we were budgeted for about $286 million. And so we're we're very large scale for most compared to most community health centers and most bayero specifically focused systems most were tiny for a health care system. You know when you think about the big systems that are out there and in the country but for a behavioral health provider we're pretty large pretty significant I do cover a broad array as kina mentioned of services across all kinds of different continuums all different segments of our community. And do do a lot of collaborative work is big as we are. It's a big community, and we don't have all the answers and so we try and partner as much as we can with other agencies and organizations. Absolute safety net services out there, love that so and I think I want to say your your pop your employee down somewhere between two and 3000 people right yeah we're like, we're just short of 2500 employees and and the vast majority of those are direct care delivers, so everything from physicians to nurse practitioners to masters level counselors social level social workers, care coordinators, we have in especially in like our ACI program we have speech therapist and physical therapist, it's really a very diverse broad group of disciplines that make up our team here providing services.

And I'm going to read a couple of comments but before I do, I want you to think about. Give me some scenarios so people watching can really understand give me some real life scenarios of stuff that happens, that they're calling on you guys and you're able to help them either whether it's from a family centered standpoint, children that sort of thing, all the way up to those who are in the jails because I think it's really incredible what you guys are doing. I'm just gonna read a couple of these comments here as I see them here there's quite, quite a bit of interaction going on in the comments, they're like having these this is, you guys are spurring a lot of really good conversation so thank you for what you're doing. So, the yeah so Dr Rosina agrees the way and she said the after effects of the pandemic will live with us for years to come. And Shan Shan Shan Atreus, I think, pronounce it. She's I'm finishing up my mha her masters of healthcare administration. I wanted to know if anyone thinks it's crazy for me to get my doctorate in psychology. Ah, I wasn't expecting that. Okay. Okay, before I move on. Do you have any comments on that. She's, she's about to graduate mha thinking about dn her, her doctorate in psychology.

So that's brilliant. Yeah, sounds well qualified I would say and probably wouldn't use the word crazy in any context, respectful language.

No, that's okay it's just words matter right and so just be intentional about it but here's what I would say is it really depends on what you want to do. If you want to be a direct care, you want to work, close one on one with people then certainly that that would be important. If it were more of a administrative path and it might not be as critical so I think it really depends on where your passion lies. What do you want to do with that education once you're done with it and kind of what role you see yourself in in the behavioral health system, but I'm excited that more formal business education I think is also welcome in the mental health system I share your background I did go and get an MBA in healthcare administration because I thought that was important from an administrative perspective but I'm excited to see you bring your, your talents and skills to the field in whatever capacity you do. I love it. Okay, this is great and I had another one, another question that came in and as there's so many here I'm trying to make sure I don't miss it. Okay. Brian Hudson he's a Avon healthcare he says how will deferred procedures caused by the pandemic affect overall population health and future demands on our health systems that either one of you want to take that one. So, probably there's a lot of impact I'm going to try and stay focused on the mental health side of this. And that is the uncertainty that comes as we've had to delay procedures right and and and if that is, you know I think most life threatening procedures have been taken care of. But most people don't go and have procedures done for for nothing right there's some, some driver, and it's usually health, maybe there's some that are vanity driven but most of its health related and so as we put off those procedures as our providers also try and think about catching up right at some point when things begin to normalize, hopefully, a little bit, you know all that pent up demand is going to come in and I think it's going to strain our healthcare workforce I think you think about the professionals that it requires to do those procedures, and obviously I'm straying out the Milhouse out a little bit but but the the burnout, the wear and tear on our professionals, you know we've had this kind of huge trauma effect on our health care system and our health care workers, and we're all going to come out of this thing like, Okay, that's good. We're done with that now let's get back to normal, and they're all going to be exhausted right I think about my own team, and everybody else is going to be thinking we're getting back to normal and they're gonna be like, when do we get a break right and so I think how we how we contemplate transitioning back in the smoothing of that, the easing of that and the intentionality around the psychological impact this has had on our healthcare workforce, how we buffer that how we give them some space, and how we create some support for them because I think they felt a lot of support early on. But I think right now it's wearing I think it's hard for them and. And even with some of the, the, improving trends that we've seen, we still have quite a few scary ones that are happening but I don't think that alleviates and removes all that pent up stress and challenges that we've experienced.

Yeah, definitely. do you have anything to add to that keynote before I move on.

I wholeheartedly agree with that i think it's very important for us as in leadership positions also acknowledging the stress and employees and burnout and offering opportunities for conversations around that and employee benefits acknowledgement and just having the conversations and keeping them going. And so, that's not procedure related but again for us for the, for the behavioral health workforce that we do have that is continued to work during the pandemic it's very amazing amazing work that they've done, and just. And third, whether it's additional shifts or covering for each other it's, it's been beyond, you should do that. Do the clap for.

Oh yes, absolutely. This is for all of our yeah well the health care workers and our staff. Yes, standing ovations that's for all of them. Yeah. In fact, Dr. Alaska, just now she was just saying that she says it's wonderful all the services you provide, and Glenn she had a question is Harris centers part of the Harris County Hospital. This is a good question that you can help to clarify for us.

Oh in it, we get that a lot. And frankly, a lot of people. Sometimes, even though they know we're separate because we are they all, they will might still refer to us as ourselves sometimes because of the similarity of names but now we are a separate entity from from ourselves. There are a tremendous organization that does a lot of good in our community, that I mentioned I worked for a healthcare system before it was in a different community, but it was it was the hospital district for another community here in Texas and that the critical work the access that they provide for low income individuals for people who are in desperate need of services and care is tremendous. And so, those folks are heroes and they have continued to be through this and they've had some significant demands on their system. And so nothing but kudos for me to them but we are separate origin, we are, we were actually created in statute. And the one, the. There's probably several but they have an advantage that they're actually a taxing entity, they have taxing authority and so they leverage property taxes in Harris County, that further their mission whereas we don't have that authority and so we typically most of our funding comes from state general revenue dollars and some local support dollars as well as a few federal dollars here there but our organizational structure is different, although we are accountable to the county through the Commissioner's court, who appoints our board. And so those members of court appoint all of our all all the nine members of our Board of Governors for trustees. And so there's a close connection and accountability to relate to the local entity here, but a little different structure than hersfeld that I love that nuance you add, I did not realize that this is so true about the, the taxing situation that's a big difference. Okay, this is this brings up another question and this is just overall I think this is everywhere, but it seems like, whether you're looking at insurance policies are you looking at priorities in a, in a community and that sort of thing, more emphasis, a lot of times a budget is put on the acute physical health care and less on the mental. First of all, why do you think that is and then what what what change Are you seeing that starting to shift and change where there is more emphasis on mental health. When we're talking about community support dollars coming in. Yeah,

I'll take a shot at that and then Kenan might follow up and add some to it I will say that, as you noted nationally spending on behavioral health is far lower than, then spending on physical health, part of that need driven part of that is stigma. Part of that is the way that the system came about, you know, early on and in mental health care most people with serious mental health conditions were treated in state hospitals, and in institutional settings and in the 60s, they set out to remove those people from institutions and put them back in the community and provide community based services and, and, and some of that was about trying to reintegrate people and some of that was about a way to save money. And so unfortunately when they made that transition the investment of resources into the community health system never really followed. And so we ended up with all these folks beginning to transition out of, out of state institutional settings into community settings, and the dollars weren't there and so we are literally still trying to catch up from 5060, years ago, I will say and, and there's lots of rankings about per capita spending and. And there are significant differences across states in models of funding and in levels of funding. The one thing I will say about here in Texas historically, if you look back long term we haven't always been that robust and spending for mental health. However, I will give kudos to our legislature the last five or six sessions, they have intentionally every session, tried to look at what they might be able to do to invest in mental health for our community. And if you listen to the governor state of the state address that just happened a few weeks ago as the session went in. He noted, well first of all he talked about our COVID crisis line which I thought was kind of cool. but he also noted that he was really looking forward to partnering with the legislature to continue that investment so even in these challenging economic times that we're in the state has some pretty significant shortfalls in terms of budget expectations, their messaging is that they still want to continue that investment and so i i don't you know I want to give kudos and credit where it's due and, and they have pretty consistently almost every session for the last five or six sessions which, if you're not in Texas they meet our legislature meets every two years. So that means for the last 10 to 12 years, they have really been intentional about trying to build it up and of course when you get behind you. No one has the money to make it up in one session right you have to build it over time and they started off with crisis services have slowly been building capacity. There was a window for a years ago where most of the centers have waitlist. Today, most of the community centers don't have waitlist. It may not mean we can provide all the services to everybody but at least you can get in and get some basic care, and some of the basic service levels and so we're not in the situation we used to be in. But there are still gaps and i don't i don't know any community in any state where they would say you know what we got all we need to take care of these problems right we we got this taken care of that that's not my experience in any community and and some have more challenges than others, that's for sure.

Right. Right. Exactly. Okay, so before I move on. Do you want to add something key No,

I agree. I think that there's been an intentional effort for mental health to be to be a priority, and it, it is a bipartisan issue and there seems to be a lot of a lot of interest in preserving those dollars and generating an easy access to care for people that need services so they've, they've invested and. And we're very appreciative.

And, you know, this, this brings up another question. Where do you think the biggest gap is like, you know, because we only have so many dollars to do so many things and it won't have so much, so many resources. Where do you think the gaps still exist that you would like to close, maybe in the next year or two or next several years.

Yeah, so I think is I think about the population that we serve, which again is predominately lower income, have a lot of other health issues I think the issue of integrating behavioral health and physical health together is critical. And I think there's a gap in that there's a gap in practice, there's a gap in knowledge, there's a gap and, in some ways, probably even in the evidence around how to do that best although there's lots of people working including us working diligently to try and make strides in that area, but you know kind of reconnecting the head with the body so to speak medically, so that we began to treat people as whole people. And that, in that our primary care providers are comfortable, treating some low acuity better off conditions and that and that they can take on some challenging cases because frankly they'll know that the payroll system is there, and that we've got their back and we'll support them if that person begins to struggle and need some additional support. I also think we've got to figure out something around the substance use disorder piece, the opiate epidemic the the overdose deaths, the dramatic rise in that. There's a lot of discussion about it and some resources have been applied to it. But I think we've got to figure that out there's a pretty significant gap there. When you think about the mental health system being a little bit fragmented and a little bit underfunded. I think the substance use disorder, and the IDD fields are even more so they do great work I'm not being critical the providers, they, they do tremendous work with, with their resources and try really hard and provide excellent care, but there's a lot of gaps there that we as a country are going to have to figure out how we how we meet that challenge.

You mentioned that about the collaboration between dr z, she says. Collaboration is key in care and treatment, especially in a worldwide pandemic. She said Wayne it's already happening with our nurses respiratory therapist docs etc. That's good. It's good to hear. Okay, so I wanted to kind of lighten things up just a little bit here. I want to ask you though I'm gonna start off with yukina what three words if you had three hash tags to describe yourself. What would you say those three would be for you.

I'm gonna go with problem solver, by nature i'm gonna i'm a problem solver. I'm grateful. I'm extremely grateful for the work that we do and that we get to transform lives every day, and passionate.

Awesome. Okay, I like those problem solver grateful and passionate. Okay, those are good, okay. but what's what problem do you do you, you get the most joy and the most satisfaction in helping to solve like is there one in particular that that really drives you yeah I

I don't have one in particular, but all of them have the same end goal of helping someone achieve, you know, whether it's recovery or connecting them to that next appointment or getting care or, you know, being available and being able to listen and talk somebody through it, love it. Absolutely love it I will spend all afternoon if somebody were to reach out and say, Hey Nick Could you help me get this I take it on and and make it my job.

That's amazing. I love that. Okay Wait How about you.

So first before I say man I'd like to add a hashtag for kina, I would add Rockstar is awesome at the privilege of working with her every day is is is part of what makes my job as fun as it is and so she is tremendous. As for me and I you know I was born in the south and so talking about myself for more than like 10 seconds makes me really uncomfortable, but I would say probably. Hashtag collaborative. Probably innovative and accountable accountability is important to me. I think that's particularly because we're in a safety net system and and the people we serve, don't always have other options and so we have to be accountable to make sure that we deliver the best possible services to our community when they need it and hold ourselves to high standards and so that part's important to me and, frankly, working with somebody like Keno like I said makes that pretty easy, all that stuff is pretty easy to come out with you have a tremendous partner like her in this deal.

I love it so collaborative innovative and accountable. I've seen that collaboration I've seen that firsthand, you're very collaborative way it's, it's, it is very refreshing I'm sure your team appreciates that about you as well. Those are the comments I want you to tell me the same three about you what are your three hashtags you would use to describe yourself I'm curious. And, since you said she was a rock star I'll go ahead and give you that so we'll give Kenya this one here and one for waiting.

Yep. Yeah, and of course Wayne Yeah absolutely. So, give us your three rollers, my three. I'm one of you know it's interesting collaborative is is one of my top three as well. We should we share that. I think appreciative. Which kind of goes to your gratefulness kaina. That's one of mine as well. And then, being informative informing others, kind of, kind of like what we're doing now it's it's kind of fulfills that part of my hashtag if you will inform or helping others in that way so I guess those will be my three. So I was just envisioning this is maybe this is a, this is Wayne when he's going through the, the halls, pre COVID. Yeah.

He does he does and he rounds at every location and those town halls with the staff he's extremely engaged and absolutely amazing. And is is an innovator.

Yep, that's the kind of leaders we need right now is like you said collaborative it's not like my way of the highway it's like let's let's kind of put our heads together and see what's the best solution and that that's that's that seems like the kind of leader that Wayne is would you agree kena.

Absolutely. and I know that he's extremely uncomfortable with.

Keep going. about him to make him.

Bang through the wall over here.

Okay, so we're gonna move on here. I want to ask you this question what are the top two or three things that you feel that organizations or communities can do. Or consider should consider to allow more people to have access to proper mental health treatment and services. Well,

I'll say a couple I don't want to get political on this but i think you know we have a lot of states mine included that hasn't expanded Medicaid, and so obviously you know a basic safety level of health coverage is is would do wonders for access and availability of care. There's lots of reasons why states haven't and it's not necessary for me to judge or opine on those but but that's one step that could dramatically impact that. I think the room a piece because I do still think there's there's often services available but people are hesitant to reach out to them. And, and then add that to making putting ourselves out there I hear a lot Tina's point earlier, people who say I don't know where to go, I don't know how to start I don't know what the next step is I don't know who to reach out to. I get a lot of calls personally I think kina does too. We're just people we know will reach out and say hey I've got this cousin I've got this friend. This is what's happening. They don't know where to go and so we've got to do a better job as the behavioral health system and figuring out how to get out in front of people, making it easy to access us letting people know how they connect with us. And then if we're not the right door, how do we get them through that door anyway, how do we get them to where they need to be without this well we don't do that, we don't do that, you know, I think we've got to figure out how to make ourselves more accessible so expanding access, reducing stigma and then making ourselves more accessible I think are all critical things and in almost every community.

Love that you know what we're so what we're gonna do Joanne I'll ask you, can you make sure you go the website and get that number let's put it on this on this chat line here and let's put it in the description. So if anyone needs some help they can they can call that number, especially if you're in Texas you say anywhere in Texas right. Yeah, that's right. Okay, so, and then if anyone has resources in other states that you know of if you look it up on the website put that in the chat as well so we can give some numbers out for folks who possibly could, would need some help. So thank you for sharing that. Kenny Do you want to add something there are any gaps that you'd like to see closed, a little better than what they are now.

Well, it's not so much a gap, but I think along those same lines, the importance of being able to pivot in your, your service model and use technology, we've seen huge success with telehealth and, or even just just kind of asking making sure if we're meeting the mark with with person served and we've learned that we needed to try some new things and be a little more innovative in our approach and add a chat function to reach a younger demographic that might not want to do a phone call or come in in person, we've gotten a great response to the chat function. And and being able to, to not just stick with the same surface model as, as we mentioned, and and getting feedback customer you know customer service feedback and inviting people to come in and our Behavioral Health Advisory Committee tell us how we're doing and make adjustments as needed.

Hello that, let's talk about what's what are some things that your organization has done to help folks who are able to give a couple of examples, homeless. Those who are in the jail system. Any of those who are low income, what are some of the services that you've been able to provide some success stories you want to share along those lines.

You want to go for Kamath.

That was how you could, I was thinking earlier that I forgot to mention the jail diversion program and 16 months 16, I was hoping we would have time to cover that.

Yeah, we got a couple of programs. Both relatively new one we just started back a few months ago with, in partnership with the city of Houston and Harris County. We acquired and opened a respite rehab and reentry center. And it's a it's 108 beds and it's really focused for individuals that are at that intersection of criminal justice homelessness and serious mental health issues. And so we've we've got places where people leaving jail who are homeless can have a little reentry stop and spend a few days there rather than their first night out of jail, being on the streets where, you know, there's some risk and potential that they might make a bad decision that might not, you know, go the direction we want them to run out of jail. It also has a landing spot or rehabilitation beds for people coming out of inpatient psychiatric hospitals who are homeless, who need a place to go, our jail diversion program moved over there recently it's our jail diversion program is a pre charged diversion program. So the whole idea is if if the police are about to arrest somebody for a low level nonviolent charge I think about like trespassing for a homeless person right or a homeless person who maybe, maybe urinates on a, on a, on a trash can behind a business right and somebody calls the police and, and they don't probably they're not really criminal masterminds right they're not doing anything that really hurts anybody, but they can't do that behavior either right they can't just stay and keep, you know, violating society norms and so, but rather than take them to jail law enforcement will bring those folks to us, and we engage them in treatment and care and case management kena runs all these programs, by the way, so she's letting me talk about them but she does all the hard work behind the scenes make them all actually happen and so we did some early outcomes in two years, literally over 3000 people didn't go to jail who would have if we didn't have my goodness, and then it and then after they were diverted not only do they not go to jail that time, but then there's there's strong statistical evidence that we reduced future, but new bookings into jail. By doing that diversion the first time and so able to help them kind of break that cycle get out of that, that, that revolving door of the criminal justice system, enter into mental health treatment and, and now we're working on kind of building out the housing part of that continuum, permanent supportive housing in partnership with the housing services and the Homeless Coalition in our area. So it requires a lot of work and energy, you know kena did mentioned we deliver the behavioral services in the jail. On any given day there's about 3000 people in the Harris County Jail who need psychiatric medications and we are the Bay Area health provider for those individuals, but a lot of our work is trying to get upstream. Let's not wait till they're in Jail, How do we keep them from being in jail and. And to that end kena created a program where we do juvenile justice diversion Where are we targeting youth who are beginning to enter, or who have recently are at risk of entering into the juvenile detention center, and we try and figure out how we can change that trajectory in a much earlier age, because we know by the time if they if they continue down a path where they have a lot of heavy involvement in the juvenile justice system that's likely to continue into the adult system, and with, in many cases, much more serious consequences on the adult side and so a lot of our energy and work is spent trying to create some diversion opportunities and and avoid them continuing down that path and and reduce that footprint of the criminal justice system in their lives.

Wow that's powerful I mean, because a lot of times we don't think about this but these kind of services, literally can reduce crime in the area, it can reduce. You know those folks who, like you said, if they didn't go to jail that one time that may have saved them from having to go over and over and because of the whole problem with him, repeating going back into jail over and over again so thank you for what you do for that. Now there is a question here. Let's see Dr Alaska she says uh how do you, how, how much homeless people also seem to have cell phones, do you serve as them interesting Do you have Do you experience calls from those who are homeless, calling from their cell phone I never actually thought about that before.

Yeah, we and there's, um, we added some charging stations and things that are at our respite rehab and reentry making sure people, you know, communication is important and making sure that they have a way to connect but yeah we do I do see a lot of cell phones that we've also got a program, when COVID happened we transitioned a lot of our services to virtual what we realized is that a lot of our clients didn't have access to broadband at home right they're only access was was their phone, and but many of them have kind of pay as you go plans right they don't have unlimited minutes they actually have to pay per minute still for their utilization and so some of them wouldn't participate in telehealth because it was costly for them. You didn't think about it because I have an unlimited plan and I, you know, if I want to do video chat I do video chat if I want to stream a video I stream a video but but when you're paying for that. That's a different conversation and so we actually got some grants and are actually putting in the hands. Some devices with a plan. Now they only really can connect us so it's not like we're giving them true internet access. But on that plan they can connect and do telehealth services with us and so we've had to try and figure out how to be creative to help support people who, who may not have all the resources in the world, but still need care need access to us. And frankly, if they don't, they're either going to not get care, or they're going to come into for care and then they're at risk. We're at risk and so how do we want to, you know, trying to invest in that resource for them to mitigate their risk of infection and and downstream consequences. We had to get creative in this process. That's awesome. So, the doctor says wonderful is joyful, based on your answer. Okay, so I have another question for you guys this is more of an introspective question here. If you had the ability Would you rather have to speak, one foreign language fluently that you don't already speak now, an extra foreign language fluently. Or would you rather be able to read six foreign languages, but not be able to speak them so the first choice is you'd be able to speak one foreign language fluently, but not be able to read it, or read six, the ability to read six foreign languages, but not be able to speak them. kena Which one would you go with first now number one for me. Okay.

I think it would it would be very difficult if I weren't able to then communicate. If I had the information but weren't able to communicate them in the other language I could read it but I couldn't have conversations that would be hard.

Okay, okay. Yeah, that makes sense. How about you.

Yeah, living in Texas, at what I wouldn't give to go back to high school, and take Spanish more seriously right so it's a. There's a lot of people who speak in our community we are certainly a melting pot, there's lots of languages that we deliver services and last year I think in like 36 languages to our clients. Wow, but Spanish is huge and and and especially where we sit and and proximity to Mexico I really wish I could speak Spanish, it would be a tremendous asset for me to be able to communicate in the language of their choice. If I had that ability.

Those are the comments I want you to answer the same thing if whether you're watching this live or in the replay I want to know what you think and I will definitely read your comments Okay one more for you. If you had the ability, would you choose to see your own future. Five years from now. And not everybody else's or the ability to see everyone else's future one year from now, but you couldn't see yours. When everyone else. Okay, okay okay candies everyone else Okay everyone, why did you Why did you pick everyone else.

It's a little bit mixed. That was first as you were talking about I was first thinking about my daughter, think about that but then from a larger perspective, I'd like just to see where everyone else is if everyone's Okay, where we are with the pandemic people are healthy. I just, I would love to see that.

 And because you're a problem solver, you're probably going to figure out how you can fix some of the mistakes everybody else's and just, I don't I don't see mine I'll be okay but I want to help everyone else first.

Oh, I love that about you. Okay. What would you say what would you pick.

I don't think I want to see in the future, I think I like, I like this surprise I like the unknown I like I feel like it might ruin and if I knew what was coming in so I would probably pick to not know the future if I could.

Oh wow, okay so okay but what if you just have two choices.

I was trying to the clinic, the counselor in Kenya came out and said, If I had if I had to pick one, I would probably pick the others only so that I could see what was happening with my family. You know I have kids and those kind of things and soon to be a grandchild on the way and so I would love to, to be able to explain what that what that looks like and see what's going on with them.

Congratulations Thank exciting.

I didn't have anything to do with it but it's exciting. I'm getting credit for it but I'm excited.

Yeah, that's great. So, let's see, she says. She'd rather speak one foreign language fluently. I'm a, I'm more of a social person. I would much prefer to be able to use the language in conversation and speech more so than just being able to read, read an article or read a street sign or whatever I have to read, I rather just, I can use my phone for that if I need to. I can just use the translate for you. I'd rather be able to speak it so I think I'm with both of you guys on this, this hour has flown by I cannot believe how quickly this hour has gone by. We have like a minute or so just for you to tell us anything you want to tell us that we missed that you definitely want to make sure you got out there, kina you want to do that first and then Wayne if you want to add anything, just in closing, this has been so fun. Amazingly fun and great to get to know you. And just, just to the every all the listeners come join us come to our, our website. Come check us out, we'd love, we'd love to meet you, we'd love to tour you at our locations and it's been an absolute pleasure spending this hour with you. Awesome.

Thank you. Likewise, 100%, okay Wayne.

The only thing I would add is just a Thanks to you, I appreciate you, creating this conversation bringing this issue up to your point there is sometimes stigma associated it's not always a popular subject. And so I appreciate your, your willingness to broach the subject to hold the space open for us to have a conversation and talk about it. And just your overall willingness around this topic so thank you for creating that.

Wow, thank you this so this is this last one this last applause has to be more of a rockstar cow has it has to be a bigger one. So this is the one I want to give for both of you for your entire team. Everything you're all you're doing at the Harris center and IDD appreciate everything so thank you for being on today and I want to thank everyone who watched today thank you for all your wonderful comments, if I missed them, I apologize. Oh by the way, Leah she says communicator adaptable and respectful I just saw that those are her three hashtags are pretty good.

Yeah. Very good. So stay on for just a moment but this right now we're just going to wave bye to our audience Bye everyone. Thank you for watching. Have a great day. And then I'll just leave it kind of running for just a little bit so that we don't, because there's a little bit of a delay. If I stop it immediately it'll it'll stop everybody from seeing the end of the presentation, and also those who are whose are watching live, let us know or replay. Let us know what resonated with you today. What is it that you heard that really you really enjoy and appreciate it and and inspired you so we'd love to hear that as well. And I certainly want to thank our two guests today. So, Jonathan let me know when it's okay to stop the stream, and thanks for lippia for giving us your best shot on the comments we'll, we'll make that a little smoother for you next time Thank you, Joanne Jonathan as well.

Can't take it.

Yeah, perfect, just hit the stream. Okay. And then, if you don't mind just a quick word What was your this is your first time being on a show like this a live show right this like this right well no it's not not Wayne's for action so he's, he's worldwide.

Like last week it was from May of last year, Jim was interviewing you. But if you don't mind. Kim, this is your first time. So what was the experience like for you.

It was wonderful. I'm very introverted and averse to any social type so I was, I didn't know what to expect and you made it so easy and so fun and just like a, just like a nother meeting that was great. I really enjoyed it.

I thought I thought there's no way we're gonna fill an hour, this is gonna be Oh, and it went. It went just like that you didn't.

I couldn't believe it I couldn't believe in it popped up was like oh that went, that went so you're wonderful, wonderful facilitation and made me very comfortable.

Thank you. Well, I'll tell you the audience absolutely loves you guys I can tell it was so much interaction on this one it was amazing so you know you guys are doing great work and it was very engaging so I'd like to have you guys back one day. If you don't absolutely love them.

And then we're gonna be doing some videos to hear, hear and the next the next week I think we're having a common conversations with your team to see when we can arrange the other interviews, so looking forward to that as well. I have a great rest of the day.

Thank you Thank you.

Bye.

Bye. Bye.