Transcripts For CSPAN2 Former 20240706

This conversation with the Bipartisan Policy Center lasts about 45 minutes. Good morning and thank you for joining us for this live discussion on the state of Mental Health in the u. S. According to the most recent data from the nih or more thn 57 million americans are living with a Mental Illness. Thats just over one and five. Despite its prevalence the can remain out of sight. For too many, stigma, and despite medical advances far too often it is left untreated. This week we saw senator John Fetterman return to work on capitol hill after being hospitalized for depression. His candid remarks about the experience restates praise from his colleagues and the public. Reminded us of the toll Mental Illness can take and the stigma that continues to be attached to it. This is not a political issue. It is not defined by your point of view of where you live. At the Bipartisan Policy Center this is one of the many issues we focus on. We publish detailed reports with policy recommendations on a shortage of Mental Health care professionals, how telehealth can help, and treatment, and the nationwide 988 suicide and crisis line. And when working on a new report on ways to improve Mental Health services, particularly in rural america. To talk about these issues and more today we are very pleased to welcome doctor jerome adams who served as u. S. Surgeon general, and is now executive director of Health Equity initiative at purdue university. Throughout his career he has been a a public voice of mentl health, substance abuse, Suicide Prevention, and access to care. He will be joined by Rhitu Chatterjee who focuses on Mental Health issues for npr. This discussion is just ahead, but first we will have a special message from representative david trone of maryland who serves as a cochair of the bipartisan addiction and Mental Health task force. Hi, everyone. Im congressman david trone for marylands sixth district. Thank you to Bipartisan Policy Center for hosting this event and normalizing conversations around Mental Health. Americas Mental Health crisis only continues to grow. One in five u. S. Adults live with Mental Illness and suicide as the leading cause of death in america, over 50,000. In o congress my number one priority is to get folks fighting Mental Illness or Substance Use disorder, resources and the support they need. Thats why i i found it bipartin Mental Health and Substance Use disorder task force to bring attention to a National Crisis and move the ball forward on finding solutions. You know more than anyone that the onlye way to make Real Progress in this fight is work together. We must be bipartisan. Mental health doesnt care if youre a democrat or republican, liberal or conservative. It touches every family and every community. We need to ensure that we have all the resources needed to respond to folks in crisis and equip those on the front lines to save lives. Im proud to say i have worked with over 130 members every day to take action on this issue. Last year we introduce over 100 bills to combat addiction and Mental Health, all bipartisan, all. 26 became law. We we passed the largest investment in addiction and Mental Health ever, and the annual government funding bill. We are restoring hope in the Mental Wellbeing act as a package of 30 Mental Health and addiction bills, eight of which i lead, all bipartisan. Further, last to relaunch the National Suicide prevention lifeline, or 988, so that folks in crisis can get connected to trained counselors for free, confidential, 24 7 support. We also provide Mental Health care before it gets to that. So wewe passed the bipartisan Safer Communities act, investing 11 billion in student Mental Health programs, including Early Intervention programs, schoolbased Mental Health and Wraparound Services and a proven to school safety. Yet even as we take these major steps, many people still face the stigma surrounding Mental Health. This poses a significant barrier to assessing proper care. I commendto my colleague senator John Fetterman. Senator fetterman, great, great leadership putting himself first and being an inspiration to so many americans. Our message to america must be its okay not to be okay. Mental illness isnt a failure of character. Its a disease. It cant and should be treated just like cancer. Together, federals date levels must continue work across it e aisle, build a nationwide coalition and invest in communitybased services. Thank you for joining me in this mission. We have to win. Takess care. Thank you, congressman trone ssfor those remarks which actuay set up afo conversation with doctor jerome adams really well. I do want to point out we will be taking your questions today if you want to submit questions, you can use the live chat on youtube or you can do it on twitter using the hashtag bpc live. Dr. Adams, thank you so much for being here. I want to start with your personal perspective, like when and how did you start to see and understand Mental Health as a Public Health issue . Well, thats a quick question to start on i want to say thank you to you and thank you to the bpc for having us here for this incredibly important and timely conversation. And as an educator and former Surgeon General i dont want to assume anything so want to just start offff by defining Mental Health. Its important people understand the Mental Health includes our emotional, psychological and social wellbeing, and it is a spectrum. Spectrum. Far too often, when we talk about Mental Health, what people think about or what we are really talking about his Mental Illness. That is just one spectrum. There are many people who have Mental Health issues and or who are paying attention to their Mental Health without having a diagnosed Mental Illness. It is important to understand that until fitness is just as important as physical fitness. We can build up our Mental Health strength just as we can build up our physical health strength. To the question you asked, my story is like many others. It has been very personal. I have experienced Mental Health through my family, through my role as a physician, and also through my role as a Public Policy maker. From a familial point of view, many of your viewers may remember that while i was Surgeon General of the United States, i spoke very publicly of the fact that my brother was in a prison cell about 25 miles away from the district of columbia due to crimes he committed to support his addiction. I speak about his story with his permission. But it is important to understand that substance misuse is part of that spectrum of Mental Health issues and it is something i have seen up close and personal with many members of my family. I also have close family members who dealt with depression and anxiety. You heard congressman trone talk about stigma. I think that has really limited the willingness to talk about these issues, to even acknowledge that these are issues, and to receive treatment for those issues. That is the personal side of things. As a physician, i am in the hospital today working. I have seen far too many patients come in with physical Health Issues that really are manifestations of unrecognized and untreated Mental Health issues. Rhitu can you give us an example . Dr. Adams i can give you an example. I work in a level one trauma center. Far too often, we see domestic islets cases, suicide attempts, drug overdoses, gangrelated shootings that can be traced back to unrecognized and untreated anxiety, unrecognized and untreated depression, bipolar disorder. Issues that, if we had recognized them earlier or prevented them earlier, and prevention is possible in many cases, we would not have had these horrific manifestations of these issues. Finally, i solve these issues as a Public Policy maker as both an Indiana State Health commissioner, where in scott county, indiana, we have the largest hiv outbreak in relation to injected drugs in the United States. A Public Policy issue, many people remember me as the person who legalized Syringe Service programs both in indiana and many other rural and conservative states. But that was necessary because we did not recognize and treat and intervene early enough with the substance misuse issues, that were in many cases untreated upstream Mental Health issues. In many different ways, i have been involved. I think that reflects the reality for many across america. Rhitu you brought up the issue of stigma. So did congressman trone. It is so important. The pandemic did do away with a lot of the stigma just because, as you say, many, many more people were experiencing some sort of psychological distress during the pandemic. We hear about Mental Health a lot more the media now. Do you think we have really done away with it or is there more work still to be done . Dr. Adams that is a great question. You bring up an important point. The pandemic was certainly a once in a century crisis. A crisis often brings with it opportunity. The pandemic brought with it the opportunity to openly deal with many of the Mental Health issues that people across america are facing, in which and which were exacerbated by the isolation of the pandemic, the Financial Difficulties brought on by the pandemic, by a lot of the exposure to substances of misuse that increased during the pandemic, including alcohol. We saw that skyrocket, alcohol misuse skyrocketed. I spend a lot of time now with college students. I was at Indiana University last week talking to students. I was at ball state yesterday talking to students. I think we also have to give credit to the young people out there. What i mean by that is that they are in a very different place than what you and i were when we went to college. They talk very openly about their Mental Health issues and mental fitness, as i mentioned, strengthening Mental Health, strengthening resilience, understanding how to recognize when you are having an issue, also understanding what you need to do as an individual to help yourself get through tough times. Kudos to them. I think that much, if anything, has changed the way we view Mental Health. But to answer your question, we have not even come close to doing away with stigma, particularly in certain communities. We know that certain communities are at higher risk for Mental Health issues. I will name a couple. Military and veterans are at a higher risk for suicidality. Higher risk for Mental Health issues. Lgbtq community is at higher risk for Mental Health issues because of the stress and stigma they are subjected to. People of color and marginalized communities, higher risk for Mental Health issues. A lot of this comes back to stigma, stigma that society places on these individuals, stigma from the cultures that these individuals exist in. We need to aggressively work to lower stigmas. One of the reasons i talk openly about my familys situation is because people hearing that the u. S. Surgeon general is not immune to having to deal with Mental Health issues and Mental Health crises amongst family members, i think it really gives people permission to talk about these things. One of the most heartening things for me when i was Surgeon General was after a speech, when people would come up and say, that is happening to my family to. That is something i have dealt with and never talked about it before. As congressman trone said, we have to realize that it is ok to not be ok. We need to be more like our younger people and openly talk about these issues. We cannot assume that because we have made progress that we have reached the finish line. We have a lot further to go in terms of addressing stigma. Rhitu so, related to this and what you said about young people having far less stigma, being much more open to talking about Mental Health, much more aware of their own Mental Health, we also know from the data that young people, adolescents, young adults have the highest rate of Mental Health symptoms among them. You have more people, as it should be, seeking help. But that help is often hard to access. 988 made huge strides in making it ok for people to seek help. There has been historic levels of investments into 988, not just supporting the line, but also in Many Community Services Related to it. We know more people are reaching out in less than a year. I often hear that for these kinds of counselors who are providing this free and valuable service, it comes with connecting people to ongoing care in their community. That is still such a big challenge. Wait times are high. It is hard even in well resourced, urban areas with a high concentration of Mental Health providers. Things in rural areas are far, far worse, we dont have providers for miles and miles and miles. What are your thoughts on how we improve access to care. Access to care at many levels. You talk about just being in the er and treating patients who had been who, if theyve been treated earlier, things would not have escalated. We need to think of the whole continuum of care. I guess that is the term people use. Dr. Adams yes, yes. You bring up several critically important points. Again, i dont want to assume. For our listeners and viewers, i want you to know that 988 is the National Suicide and crisis line launched in july of last year. Prior to 988, there was not one number that people could call if they needed help or if they were in crisis. Far too often, people were first were forced to call 911. I do not to that pejoratively. 911 does great work. It is not a Mental Health Crisis Response line. In most cases, if you called 911, you ended up in one of two places. The emergency room or the jail cell. We know that neither of those places is an ideal place for people who are helping who are having an Mental Health crisis to be. 988 was a historic move forward. It was something that was initially approved by the Trump Administration and was ultimately funded and brought across the finish line i the biden administration. The bpc does bipartisan work. This is something that had bipartisan support. But as part of the bpc trying to promote 98 eight, we emphasize that we need three things in order to make this optimally effective for the public. We needed better interagency elaboration we know that often the right hand does not know what the left hand is doing. People worked in silos in the Mental Health world. We need better interagency collaboration at a state, local, and federal level. We need to increase to Behavioral Health workforce, as you mentioned, rhitu. What we dont want is someone to call 988 in crisis and knock it with a need. They will lose trust and faith in the system and it wont help anyone. We also need financing. I say this very directly because i know we have policymakers listening into our conversation today. We need to finance Mental Health in the same ways that we finance physical health in our medical systems and health care systems. I want to do a little bit of a deeper dive on the workforce issue that you brought up because that is huge. But we again have many opportunities. We saw a 7000 increase in Telehealth Services during the pandemic. Most of that increase happened into Behavioral Health areas. We can leverage new technologies to understand our behavioral workforce. Studies show most of the increase in telehealth increased in urban and affluent areas paired we have the potential to increase access, but there is also the potential to increase disparities and we need an equity focus to these technologies that not everyone has access to. We also need to look at alternative providers. If purdue university, where i worked, we were training Mental Health nurse practitioners. We need to better utilize social workers and psychologists. Not everyone can see or needs to see an empty an md psychiatrist. I think policymakers can help Fund Research on models that allow us to appropriately stratify and triage patients, so we can understand, ok, you really need to see a psychiatrist right now versus your issues are best dealt with by a social worker or Even Community Health Worker who can really get to know you and some of the social drivers that you are dealing with. A lot in that question that u. S. 988 is an important start. We have opportunities and wind in our sales because of the pandemic and because of some of the efforts congress has been leaning into. But a lot more work to do to increase the behavioral work health force Behavior Health workforce, and make sure we are publicly appropriately funding Mental Health, allowing people to get the care they need when they need it and where they need it. Rhitu just a quick little note on the Community Health worker. There were very successful trials done in india with Community Health workers. They have been trained to provide a brief psychotherapy to people in the communities. It has been found to be very successful. Now, i think theyre doing trials in the u. S. As well using that model. Also, your support people. Last year, i did a story dr. Adams a support specialist. That was a wonderful story and it is best practice, having people with lived experience, whether it is substance misuse or people who attempted to take their lives before by suicide, or people who have another Mental Health diagnosis. That pierced support is a best practice. That example in india that you talk about is a concept that we refer to as screening brief intervention and referral to treatment. You can train anyone from a teacher to a Police Officer or firefighter, all the way up to a primary care physician, to intervene in this manner. You have to help them understand how to recognize the problems with screening, a brief intervention. There are things we can do right in that moment to help people deal with the acute crisis, then referral to treatment getting them to appropriate longterm care. Im glad you brought that up. There are things we all can do if properly resourced, educated, and empowered to help individuals. We will never be able to produce enough psychiatrists so that everyone can see and md specialized in Mental Health when they need it. But we have got to lean on the full array of talent out there and increase our workforce by increasing the number of people we see as potential interveners. Rhitu can you also talk a little bit about prevention, would you brought up earlier . There have been recent recommendations made to Health Care Providers to screen early, like screen kids as early as 8 years old for anxiety, for example. Screen teens for depression and suicide. What is the role of prevention and what are the battery of tools out there with early prevention . Right now, we know that the gap between starting to show symptoms and actually connecting to care is huge, like years, sometimes over a decade. Dr. Adams now you are speaking to my heart. I am a physician. I work in a level one trauma center. I absolutely want to be there as a safety net for folks when they are in crisis. But there will always be more people who need care than i or the system can take care of, as long as we are in this Crisis Response mindset. What we really need to do is figure out how we can get upstream and prevent some of these problems before they become crises. You say, what can we do . There are a number of things we can do. We can do a better job of integrating Mental Health services into primary care practices. Just as we screening for Blood Pressure and diabetes, we should be screening you at every visit for Mental Health issues, so that we can intervene before it becomes a crisis. You can even get upstream of the doctors office. We know that in school settings, when we train and empower School Teachers to recognize issues, they can ward off negative problems, including sometimes school shootings, suicides, bullying. We know that even better is being able to have Mental Health practitioners, social workers, available to schools. With telehealth, we can make that more available if we find it, to schools without having to have a physical person on site. A teacher recognizes and then can set up a telehealth visit for that student and or their family. Even upstream from that, there are these things called adverse childhood experiences, or pieces. These are negative events that occurred to someone when they were young. It could include losing a caregiver, as over 250,000 people have had happen to them during covid. It can include abuse at home. It can include getting seeing somebody get shot, as too many urban people have had happened to them. Screening people for cases so we can intervene. You can actually intervene when someone has a high ace score and prevent Mental Health issues. That is what a true Mental Health public approach to Mental Health is. We are focused on it, but we are never going to solve the problem by looking solely through that. Getting as far upstream as we can to prevent problems before they occur or before they worsen, thats what i think we need to do a better job of. I hope policymakers will look at that. One more thing i want to mention, because we have been talking a lot about guns. We know that simply creating communities that people want to live in, called greening up communities, cleaning up graffiti, putting in parks and green spaces, that lowers violence in the community. It raises peoples morale and makes them want to protect their community. You end up getting Big Community buyin and less violence. There is a lot that could help lower Mental Health issues and negative manifestations on the backend. Rhitu you brought that up and there have been some wonderful studies in philadelphia that i have covered that also look at how greening lowers depression in the community. Turning empty lots into parks and green areas has a huge impact at the Community Level of depression. Dr. Adams people can see a mural that represents their community and makes them feel pride in it, as opposed to broken glass and other things. Again, incredibly important. You are lifting those things up. We need our policymakers to listen and to fund those efforts. Evidence shows they actually do work. Rhitu clearly, you brought up schools. The one good thing that came out of the pandemic is, i think, schools have recognized just how pivotal a role they play on the prevention side, early identification side. That is already starting to happen. I have a threeyearold. We just went to tour his prek here in d. C. And a parent was there with us after the teacher was giving the tour. They were like, what are you doing for social and Emotional Learning . They are doing that with at the daycare that my sono. Goes to. Thats already happening and thats a good change that i should bring up. But again, i am director of Health Equity at purdue university, Health Equity something im passionate about and asthth you mentioned the placement where you and i send our kids they are doing these things and that is important starts but we need to make sure the funding and resources are there so everyone t has access o the services. Because one of the challenges, both my parents are retired School Teachers. They can tell you as far back, they are both approaching 80 years old. Theyve been dealing with these Health Issues for as long as there have been children. It hasnt been recognized, it hasnt been acknowledged that in many cases we rely on our teachers through social workers, to be Police Officers, to be counselors, to be sometimes the fact of physicians. We need to properly resource and fund schools and not just put it all on the teacher to do it, particularly and marginalized and poorly resourced communities, or else again we will continue to see these disparities grow even as we see places that are more resourced take on a more enlightened and inclusive approach. One thing ive seen in my reporting is like schools that are getting, the districts that are getting decently allotted funding to help mental mental care and prevention schools are often the bigger districts with some resources to even apply for the grants and get them. Schools again, reaching people or they are, kids with it are, another place where people are with adults is their workplace. This is a question that came in from a viewer is, what about employers roles in managing Mental Health and wellbeing in the workplace . Thank you, viewer, for that question. When i was Surgeon General i put out a first of its kind report called Community Health and economic prosperity. The premise of the report was that we spend twice as much as the oecd average on health care, about 12,000 per capita in u. S. But yet we get consistently poor outside the top 20 rankings on health. Part of the reason is because were not investing Mental Health. You cant bewe n physically heay if youre not mentally healthy. You are not going to be compliant with your diabetes care, not compliant with hypertension medication if youve got crippling depression or anxiety. Ive worked with the National Business group on health, with the Darden School of business, with the Kelley School of business, with many others to make the case to businesses that you need to invest in communities that are supportive of peoples Mental Health. From beginning to end. This includesh making sure the plans you are covering are leaning into parity. Parity means that insurers need to cover Mental Health issues to the same degree that they cover physical Health Issues, and there are laws in place but their many loopholes in the law in many gaps. Regardless of the law i want businesses to understand it matters to your bottom line if your workforce is mentally unwell or unfit. Are more likely to miss work, more likely to have workplace incidents and, unfortunately, weve seen some of those play out in a tragic manner recently in the news. And you are not going to have a good pool in your community from which to pull from at a time when theres a workforce crisis in this country. I completely agree. We need to bring employers and businesses to the table as a talk aboutis these tough issues because, lets face it, there are three guerrillas in a room, medicare, medicaid and template provided. We need all three there looking at how can we rebuild a system that isnt functioning well right now and how can we appropriately fund Mental Health to the samey degree we would fd someone who has a broken ankle or a back issue. I want to stay with the parity issue. Because it comes up so often and its such a big issue. This week ich had a story abouta highly suicidal teenager. It tookk her family to years the most evidencebased effective treatment, which is dialectical behavioral therapy. She was in treatment. You know, treatment takes time. About two minds just as she is starting to make improvements, starting to feel better but she still suicidal, having suicidal thoughts, but insurance cutss hr off if they are like no, ite to move you to a lower level of care despite the fact there is plentyca of evidence switching between Different Levels of care was very harmful for her. And against the treating psychiatrists advice, the insurance cutter off. This is justra far too common. As several experts have told me, consider a cancer patient, consider a patient whos had a heart attack. If theyre starting to get better but if they still have symptoms, you would be hardpressed to find an insurance with as easily tell the patient or tell the doctors were not going to cover care anymore, they have to go home and start taking aspirin. Exactly. Right . Thats one aspect of parity really dont again like there are parity laws the state Insurance Companies have to cover Mental Health and physical health just theha same, but its not happening like Insurance Companies are routinely violating these, the federal law and many state laws. The other aspect of parity is just providers are not paid well. They are paid, paid much less compared to physical health providers, a physician gets paid much more to prescribe an antidepressant or an antianxiety medication than say a psychiatrist. You end up, many Healthcare Providers a of private network which ends up being much more expensive for individuals. And we know from surveys the people self ration care. As another jew asks, what can be done to enforce parity to better Access Services and appropriate reimbursement from commercial interest . Great question. You talk a lot about the issue. Its also important to know that not all insurers have to follow parity laws. Theres exemptions for Many Medicare plans, for medicaid feeforservice, for some state and local Government Employee health plans, and for individual and Group Health Plans created and purchased before 2010. Wonder the Things Congress can do is make sure everyone is included in the parity laws. We also as an mention have to continue to highlight the fact there is a cost, a cost not just individuals but to communities and a cost to businesses when we dont cover these Mental Health services before they become crises. We also have to educate the public, and went to educate them that there are steps you can take if your plan is denying services. You can file an appeal. So speak to your Mental Health professional or provider. If its an emergency you have a right to request anve expedited appeal. You can confirm with your Insurance Company that your services will be covered during that appeal. You can have your provider request, written notification of the reason for denial within 30 days. If you go to nami, uinta National Alliance on Mental Illness, nami. Org, theres more information on parity and the things you can do with an individual. I want to empower your but i was what people understand we cant putrs this on individuals alone. We need our leadersvi to make se everyone understands the importance of parity. We need accountability for businesses that dont comply with parity laws. You hit on a point which we talk about, not when were talking about parity, and thats the workplace. Many off these companies are not fulfilling their parity obligations because they have thousands of people on the waiting list and they dont have enough providers or enough resources to provide care so they solicit okay, you have been stabilized, im going to move my resources to someone on the list who actually has a more acute need. They t end up stabilizing somewt and putting on a bandaid and taking them out. Not because they do want to do the right thing but because they dont have the resources to do with everyone that needs the services. A big part of this are the things we talked about earlier that a dont want to repeat but that it would help increase the availabilityas of Mental Health services so that its easier for insurers to say okay, im not crisis someone in acute care by allowing you to stay in your bed for an extra week, even though thats the best practice. Congressman trone talked about senator fetterman who return to work and has been open about his diagnosis, his treatment. Senator fetterman was just on our airwaves on npr yesterday talking about this. You mentioned early on you own beliefs spoke about your brother struggles with addiction. A question from a viewer is how important is it for public figures sharing their personal expense expenses with Mental Illness to help reduce stigma . It is incredibly important. You mentioned i shared my story. I tweeted out accolades senator wentrman when he first into treatment and openly spoke about it, because it normalizes this in the same way that someone who sprains their ankle or have some other medical issue, is to do. I also done a lot of work with the pro football hall of fame. We are leveraging athletes to tell their stories so that we can normalize this because in many cases a kevin love talking about his Mental Health issues, or a hall of fame pro football player, and there are many who ive worked with talking about Mental Health. Its going to normalize in a way that even a Surgeon General of the United States cant normalize talking about Mental Health. We need more people talking openly about this. Again no athlete would have a problem saying yeah, i tweaked my knee, i need acl surgery. But many people will hide the fact that theyre anxious or depressed and needing or getting treatment for it. When they talk about it, then our kids will be more comfortable talking about it, our workplaces will be more accepting of it andng we will be in in a better place. One more important point is we need more research in public expectation about come Public Education about what expectations for recovery should be. So again im a physician. I canan tell you what recovery from your acl tear is going to look like. How long its going to take, what physical therapy youre going to need, how much work youre going to need to miss, what kind of work you need to do. We need research but we also need public and workplace education about what recovery from an acute depressive episode looks like. Fromom a bipolar flareup looks like, from what Substance Use Disorder Treatment and recovery looks like. So the both individuals and workplaces and communities understand that yes, we can return people to function, and these are supports theyre going to need inhe order to appropriately function in the workplace but we shouldnt exclude them from the workplace anymore than weeks would someone with a broken leg from the workplace. We just make accommodations and we understand its going to be a pathway forward that it would be beneficial for them and for the workforce if we all work together. The support is really key. Like again bring up like a lame energy, and knee injuries or any other part of your leg and its accepted that you going to do physical therapy for ayo while. And youre not going to get back to sort of preinjury fitness level and function right away. You may need to rant to get into your workplace or you may need a special equipment, a special chair, special desk. But we understand and we accept that for physical health. We dont for Mental Health to the extent that we could or should. Yeah. Now i know we talked about prevention before but there is another question so im going to throw, im going to mention it into case you want to add anythg else. The question is how about taking a proactive approach to preventative Mental Health care . And i briefly mentioned this earlier when i talked about mental fitness. I think we need to do much more research into resilience and how we build resilience. And we need to help people understand that are exercises and activities you can engage in to strengthen your Mental Health and not just look at it as a crisis for deficit when people go to the spectrum of Mental Illness. I go to the gym. I work out my biceps. I dont work out my biceps because im injured. I dont Pay Attention to them because an injured. I Pay Attention to them to strengthen them so that they wont become injured. We can do the same things for our Mental Health. We can understand our triggers. We can understand come thee dont get hurt mentallyfo just s we knowal what things to avoid o get hurt physically. We can strengthen ourselves with meditation or for some people its sports or displaying music. These types types of things increase dopamine in a positive way in your brain and can strengthen your Mental Health, and it can also decrease peoples reliant on or tendency to become addicted to dangerous substances. Its a good time for me to highlight that when i was u. S. Surgeon general id really focus on a lot of the Mental Health issues that ourta country was facing and the negative, so vaping, i put out an advisory on vaping, the first Surgeon General advisor in ten years, warning about the increase in use of vaping. Many youth are vaping to treat anxiety and depression and is becoming a vicious cycle. Put out a call to action on Suicide Prevention against speaking to this viewer question. We know there are evidencebased ways interNational Alliance has put out these ways in concert with me when i was Surgeon General on ways we can identify people at risk for suicide and intervene early on. Its important we focus on prevention, and again not just on downstreamve crisis care, because we wont have enough resources to deal with everyone if weev wait for them to fall of the cliff. We n need to prevent people from falling off the cliff in the first place. I think thats a wonderful place for us to in this discussion. Thank you so much, dr. Adams, for this very lively and engaging and informative discussion, and i want to thank the Bipartisan Policy Center for organizing this, for hosting this and for inviting me to moderate. And thank you to everybody watching. And i want to thank you and i also want to tell people, you nami. Org. You can go to the bipartisan policy committee. The written several reports especially if you are a policymaker on many of these issues, world health, 988, other issues important to the conversation today. There are resources out there and if we all come together, then we actually can create a better world, a more inclusive world where Mental Health is seen as critical to overall health. So thank you, rhitu. Thank you so much, dr. Adams. Use Senate Returns later today at 3 p. M. Eastern. Senate will vot on the confirmation of former montana solicitor general anthony john stumpf to be a ninth Circuit Court of appeals judge. Later in week lawmakers was consider nominations for use this accords in new jersey and new york. Live coverage of the senate on cspan and you can watch all