[Applause]
hi well I have to say mental health the
20/20 challenge and solutions Within
Reach
I am really honored to be here on this
very professional-looking stage to shed
light on this very very important issue
and to hopefully share with you some
important insights so I’m a parent and
for any parents out there you know we
think a lot about our kids help them we
want them to be healthy so soon after
they’re born
we’re gonna take them outside we lather
them up with sunscreen when they learn
to bike ride we make sure they’re
wearing their helmet when they go
outside and we brush their teeth even
when they don’t want us to and that’s
because we really take it very seriously
do you think about their physical health
but I recently saw a TED talk that made
this point that as parents we kind of
have a routine about taking care of our
kids physical health well we don’t
really have a parallel routine for their
mental health
we don’t have sort of basic things for
upkeep we don’t really necessarily know
what are the warning signs we need to
think about in case there might be a
problem
and you know that’s kind of a strange
thing I mean we do take them to the
doctor and I am a doctor
I’m a pediatrician and when you go to
the doctor you know they check certain
things but actually in the medical field
there’s a similar strong focus on
medical issues and I’m not so much on
mental health issues so I was very
fortunate I had great training I went to
Harvard Medical School I was with
professors who were you know national
experts on complex diseases and I
learned a lot from them when I decided
to become a pediatrician I trained at
Children’s Hospital Philadelphia it’s
also a great place and it’s a wonderful
place where they really do care about
the kids they know the cutting-edge
treatments and they also care a lot
about teaching so you know I kind of had
learned a lot I should have been pretty
ready and I learned about things you
know when I left there I knew a lot
about treating disease and
how to assess kids I learned that when I
went out into practice it was gonna be
important to screen them for all kinds
of problems including their vision make
sure they didn’t need glasses I got
really good at using my stethoscope
checking kids hearts listening to their
lungs making sure that they were
breathing okay
you know asthma is a common problem and
affects about 9% of kids so it’s good
that I learned a lot about that so I was
really well trained but I was not well
prepared because when I went out into
practice and saw patients out there in
the community I was directing my focus
on their physical health their
development of the kids but many many
families and patients were concerned
about emotional issues or behavioral
concerns and I know what to do mental
health was the elephant in the room and
I’ll share with you that this is not an
unusual problem many many pediatric
trained people and all kinds of primary
care providers aren’t really learning
this and they’re training and there’s a
story I still remember during clearly
and regret it quite a bit I was assigned
a lot of patients when I started in
practice and many of them had the
diagnosis of ADHD I remember this one
boy Kevin great kid doing well in school
lots of friends play the sport really
doing great and Hammond’s and the other
kids who had that diagnosis they were
also doing well I thought you know I
kind of have this public perception like
you know I’m not really sure this is a
real disease and I think maybe the
medications are overused so I took them
all off of medication well about six
weeks later Kevin came in I can still
picture his face he hung his head he was
demoralized he told me I don’t know
what’s wrong I can’t seem to get my work
done
my thoughts are ping-ponging around my
head I sit down to do my homework and I
can’t get it done he’s got in trouble
twice in his classroom which had never
happened before and he looked at me and
he said do you think I could restart my
medicine and that was a really powerful
moment for me I had gone into medicine
to help kids and here I was with my lack
of knowledge I had hurt this young boy I
was crushed by
elephant I realized I had a lot I needed
to learn and I did learn I learned that
one in five youth are affected by mental
health conditions it’s twice as common
as asthma and although I could really do
well with any kid who came in with
asthma I was lost for mental health it’s
so common in fact that I suspect
everyone here in this room know someone
who’s affected could be someone in your
family a friend maybe even you now
people realize that of course everything
like a lot of things happen on a
spectrum or a continuum so on one end
you know we all have ups and downs we
have days we can’t focus we might feel
blue sometimes but if those symptoms are
persistent and they’re severe and
they’re starting to interfere with how
someone functions like how they get
their work done or how they’re
interacting with the people around them
their family their friends then it’s
time that they’re moved into that yellow
zone or red zone and they need some help
now these conditions happen across the
population and you might be surprised to
know that 50% of people with a mental
health condition in adulthood those
symptoms started by the time they were
14 years old and most of them by the
time they were 24 so really people who
work with kids need to be aware of these
conditions and understand how to address
them so what am I talking about these
are the common mental health conditions
that happen in kids and teenagers
anxiety related disorders depression
related disorders an attention deficit
hyperactivity disorder now much more
rare 1% or less is bipolar disease or
schizophrenia it happens but it’s not
common these are the most common
conditions so the 20/20 problem is this
20% of kids have a significant
empowering mental health problem and yet
only 20% of them are getting the help
they need there are multiple reasons for
these this problem these bear
there’s oneness stigma people are
ashamed they feel uncomfortable about it
they don’t want to talk about it they
don’t want to tell anyone I will say
that the young generation is doing a lot
to talk about things that before people
felt uncomfortable talking about and
discussing and I really applaud this
generation because you guys are changing
the world there’s also a stigma though
even about the treatment some people
don’t understand what is really
psychotherapy what does that gonna
involve they picture themselves lying on
a couch and that’s not typically what
happens anymore and there’s also stigma
about medications people have a lot of
fears and they don’t realize that the
medicines have been studied and they’re
safe and they’re effective now another
warmus problem is that there’s a huge
shortage of the specialists who were
trained in their training to handle
these mental health problems and kids
people like child and adolescent
psychiatrist and child psychologists
there are fewer and fewer out there and
unfortunately the problems not getting
better it’s getting worse so that means
that other people that work with kids
like pediatricians or owners
practitioners or pas or family doctors
we all need to be able to step up and
take care of these kids but it even
today 20 years after I finished my
training the issue persists people are
not getting adequately trained in these
problems it’s recognized the people in
the training programs know that they’re
missing this and yet it’s not
significantly changed yet now what are
the ripple effects of this untreated
mental health problems well the kid
themselves feels awful and that affects
all the people around them it can lead
them to not do well in school and then
it has kind of problems for their whole
life potential increased risk of
substance use the homeless the
incarcerated those have high rates of
mental health problems and suicide
90% of suicides occur because someone
has a mental health problem and
unfortunately suicides on the rise in
young people and then their suffering
when someone has a mental health
condition that’s been treated there’s a
lot of negativity
and they experience it they’re siblings
experiences it affects the whole family
the community it can’t affect all of
society and I urge you to kind of take
another look if you are someone who
maybe works or interacts with kids
because sometimes people perceive oh
that’s a bad kid
maybe they seem really lazy or they’re
always antagonizing everybody or they’re
irritable all the time well sometimes
that bad kid is actually a kid who’s
just suffering from a bad disease and
then you’ve helped so what is the help
well there’s three basic components of
the therapy one is the social and
support networks and this is kind of
like the power love like the teeth
brushing what we should all be doing
with all the kids you know understanding
how important sleep is for me how
important exercise is making sure kids
have a time to take a break and relax
making sure they have time to do
something but they feel good about but
they can achieve it whether it’s school
or not school let them know that it’s
important to have a social life
and also sometimes to take time and do
something nice for other people these
are all things we know improves our
overall well-being and of course love
the kid and support them but even if
you’re providing all that these are
diseases and make them happen anyway
so then you need extra professional help
like psychologic therapy now with little
kids it’s important for parents to get
extra help to be able to handle these
challenging behaviors you know it’s
funny if you think about it most people
who delivered their children went to
childbirth classes but then we have a
baby and with most of us to go to
parenting classes and I think if there’s
any parents in the room you probably
would agree that it’s the hardest job in
the world and yet we don’t consider
really going to classes now for the
person themselves who’s suffering
there’s all kinds of psychological
therapy and if you’re not aware of
what’s out there you might not know so
typically it’s time limited typically
three to four months it’s very much
focused on building skills learning
coping techniques how to handle
different situations and it’s
evidence-based
it’s been studied and it’s effective so
two good examples are cognitive
behavioral therapy and interpersonal
therapy so if you’re looking you want to
look for something that’s evidence-based
and then there’s biologic therapies now
these are diseases of the mind
so medications can make a difference and
they have been studied extensively in
kids and they are safe and they are
effective so what we know is that if
someone is in that yellow zone or all
the way over to the red zone you really
want to give them everything we’ve
helped them get better and they can get
better and if they’re somewhere in the
middle then maybe we’ll be parts of some
of these things so treatment really
works and that’s what’s really profound
to remember that most people depending
on the condition seventy to ninety
percent will get better it’s more
effective than a lot of the treatments
we have for medical conditions like
heart disease are as in our diabetes I
wanted to share with you just a little
bit about the reach Institute because
this is how I developed ability and
skill to be able to handle the mental
health care problems that came up in my
office and the reach Institute was
started by a child psychiatrist who
recognized these problems but there was
a shortage of good providers who were
trained that the people on the front
line were knowing how to deal with this
and so he worked with a lot of academic
experts looked at that evidence and the
research and tried to put together good
training programs to help people like
pediatricians like being and other
pediatric providers and schools and
therapists who they would know what do
they need to share with the kids and so
I’ll share with you an experience I had
in my office now that I know what to do
it’s so rewarding because I can make
such a big difference for these kids so
I had a teenage girl Mina and she came
to me because in her office in school
she needed a note that she had missed so
much time and so she came in she either
nope she missed ten days of school in
November and I’ve known it for a long
time she sailed through middle school
but in high school her mom shared with
me she started having all these episodes
of problems throwing up stomachaches
she’d miss all this school they took her
to a specialist couldn’t find anything
wrong with her and they found out that
you know they didn’t know what to do so
they came and brought her to me for a
note and it turns out that all this
started she had this really hard test in
school she was freaking out she had a
big panic attack and she vomited and
that was so traumatic for her that she
began to have panic attacks about having
panic attacks which actually is really
common
now anxiety is very treatable and so she
got treatment and she’s doing so much
better she hasn’t missed a day of school
and she’s really failing along and Mina
has some techniques that I’ll share and
just briefly go over with you cuz I
think I’m running over time one of her
techniques is distraction so she uses
her mind to change the channel and this
is kind of a some kind of behavioral
therapy where she takes when she starts
to feel that she’s stressed she makes
herself think about something different
just to give her relief so that feeling
can pass so what she likes to do is look
around the room and spell everything
that she sees and because she’s a bright
kid sometimes she has to spell it
backwards to keep her brain engaged or
she’ll choose a color and notice that
everything around her that is that color
and it just helps the feeling pass
another thing she does is the fist
squeeze we all know that when you
exercise it releases endorphins helps us
feel better and so it also eats up
adrenaline which contributes to the
intensity of those hard feelings and so
if you squeeze your fist as tight as you
can for 10 seconds in a moment where
you’re really having a hard time it can
help you gain back your control and
breathing probably all of you know
breathing can be helpful in a tough
situations but you might not know why
and it’s because it pulls on the nerve
that tug that tugs it pulls on the
nerves that basically causes your body
to become more physically comfort
comfortable it’s called the relaxation
response so sometimes even despite
really good support even in the case
where maybe you think that it is
everything why would they have a mental
health problem what do they have to
worry about it’s a disease it can happen
to anyone
and so someone’s slipping down the
continuum into the yellow zone or the
red zone they need help and so I hope
that you’ll kind of reach out to people
and let them know like there are safe
and effective care out there and make
your of it and it works if we saw a kid
with a fever and a rash we’d say you’d
better go to the doctor where somebody
who broke their arm and we say you
get some medical help but we also need
to be doing that for mental health
problems so I’d like everybody to just
quickly snap a photo of this slide
because in case you know anybody now or
maybe not now but maybe someday you’re
gonna come across someone who maybe
could benefit from some of this
information and it’s certainly not a
substitute for a professional help but
it might give someone some resource or
some additional information to get them
so I’ve learned it’s not enough for me
to say to my patients when they come in
I’m just gonna check what you’re seeing
and then you know we’ll you’ll be on
your way I really need to think about
how they’re seeing are they looking out
and being afraid are they overwhelmed by
everything they see are they having
trouble focusing are they looking out
but everything’s kind of dark and
hopeless I need to pay attention to that
so the distorted view of the mind cannot be overlooked thank you
hi well I have to say mental health the
20/20 challenge and solutions Within
Reach
I am really honored to be here on this
very professional-looking stage to shed
light on this very very important issue
and to hopefully share with you some
important insights so I’m a parent and
for any parents out there you know we
think a lot about our kids help them we
want them to be healthy so soon after
they’re born
we’re gonna take them outside we lather
them up with sunscreen when they learn
to bike ride we make sure they’re
wearing their helmet when they go
outside and we brush their teeth even
when they don’t want us to and that’s
because we really take it very seriously
do you think about their physical health
but I recently saw a TED talk that made
this point that as parents we kind of
have a routine about taking care of our
kids physical health well we don’t
really have a parallel routine for their
mental health
we don’t have sort of basic things for
upkeep we don’t really necessarily know
what are the warning signs we need to
think about in case there might be a
problem
and you know that’s kind of a strange
thing I mean we do take them to the
doctor and I am a doctor
I’m a pediatrician and when you go to
the doctor you know they check certain
things but actually in the medical field
there’s a similar strong focus on
medical issues and I’m not so much on
mental health issues so I was very
fortunate I had great training I went to
Harvard Medical School I was with
professors who were you know national
experts on complex diseases and I
learned a lot from them when I decided
to become a pediatrician I trained at
Children’s Hospital Philadelphia it’s
also a great place and it’s a wonderful
place where they really do care about
the kids they know the cutting-edge
treatments and they also care a lot
about teaching so you know I kind of had
learned a lot I should have been pretty
ready and I learned about things you
know when I left there I knew a lot
about treating disease and
how to assess kids I learned that when I
went out into practice it was gonna be
important to screen them for all kinds
of problems including their vision make
sure they didn’t need glasses I got
really good at using my stethoscope
checking kids hearts listening to their
lungs making sure that they were
breathing okay
you know asthma is a common problem and
affects about 9% of kids so it’s good
that I learned a lot about that so I was
really well trained but I was not well
prepared because when I went out into
practice and saw patients out there in
the community I was directing my focus
on their physical health their
development of the kids but many many
families and patients were concerned
about emotional issues or behavioral
concerns and I know what to do mental
health was the elephant in the room and
I’ll share with you that this is not an
unusual problem many many pediatric
trained people and all kinds of primary
care providers aren’t really learning
this and they’re training and there’s a
story I still remember during clearly
and regret it quite a bit I was assigned
a lot of patients when I started in
practice and many of them had the
diagnosis of ADHD I remember this one
boy Kevin great kid doing well in school
lots of friends play the sport really
doing great and Hammond’s and the other
kids who had that diagnosis they were
also doing well I thought you know I
kind of have this public perception like
you know I’m not really sure this is a
real disease and I think maybe the
medications are overused so I took them
all off of medication well about six
weeks later Kevin came in I can still
picture his face he hung his head he was
demoralized he told me I don’t know
what’s wrong I can’t seem to get my work
done
my thoughts are ping-ponging around my
head I sit down to do my homework and I
can’t get it done he’s got in trouble
twice in his classroom which had never
happened before and he looked at me and
he said do you think I could restart my
medicine and that was a really powerful
moment for me I had gone into medicine
to help kids and here I was with my lack
of knowledge I had hurt this young boy I
was crushed by
elephant I realized I had a lot I needed
to learn and I did learn I learned that
one in five youth are affected by mental
health conditions it’s twice as common
as asthma and although I could really do
well with any kid who came in with
asthma I was lost for mental health it’s
so common in fact that I suspect
everyone here in this room know someone
who’s affected could be someone in your
family a friend maybe even you now
people realize that of course everything
like a lot of things happen on a
spectrum or a continuum so on one end
you know we all have ups and downs we
have days we can’t focus we might feel
blue sometimes but if those symptoms are
persistent and they’re severe and
they’re starting to interfere with how
someone functions like how they get
their work done or how they’re
interacting with the people around them
their family their friends then it’s
time that they’re moved into that yellow
zone or red zone and they need some help
now these conditions happen across the
population and you might be surprised to
know that 50% of people with a mental
health condition in adulthood those
symptoms started by the time they were
14 years old and most of them by the
time they were 24 so really people who
work with kids need to be aware of these
conditions and understand how to address
them so what am I talking about these
are the common mental health conditions
that happen in kids and teenagers
anxiety related disorders depression
related disorders an attention deficit
hyperactivity disorder now much more
rare 1% or less is bipolar disease or
schizophrenia it happens but it’s not
common these are the most common
conditions so the 20/20 problem is this
20% of kids have a significant
empowering mental health problem and yet
only 20% of them are getting the help
they need there are multiple reasons for
these this problem these bear
there’s oneness stigma people are
ashamed they feel uncomfortable about it
they don’t want to talk about it they
don’t want to tell anyone I will say
that the young generation is doing a lot
to talk about things that before people
felt uncomfortable talking about and
discussing and I really applaud this
generation because you guys are changing
the world there’s also a stigma though
even about the treatment some people
don’t understand what is really
psychotherapy what does that gonna
involve they picture themselves lying on
a couch and that’s not typically what
happens anymore and there’s also stigma
about medications people have a lot of
fears and they don’t realize that the
medicines have been studied and they’re
safe and they’re effective now another
warmus problem is that there’s a huge
shortage of the specialists who were
trained in their training to handle
these mental health problems and kids
people like child and adolescent
psychiatrist and child psychologists
there are fewer and fewer out there and
unfortunately the problems not getting
better it’s getting worse so that means
that other people that work with kids
like pediatricians or owners
practitioners or pas or family doctors
we all need to be able to step up and
take care of these kids but it even
today 20 years after I finished my
training the issue persists people are
not getting adequately trained in these
problems it’s recognized the people in
the training programs know that they’re
missing this and yet it’s not
significantly changed yet now what are
the ripple effects of this untreated
mental health problems well the kid
themselves feels awful and that affects
all the people around them it can lead
them to not do well in school and then
it has kind of problems for their whole
life potential increased risk of
substance use the homeless the
incarcerated those have high rates of
mental health problems and suicide
90% of suicides occur because someone
has a mental health problem and
unfortunately suicides on the rise in
young people and then their suffering
when someone has a mental health
condition that’s been treated there’s a
lot of negativity
and they experience it they’re siblings
experiences it affects the whole family
the community it can’t affect all of
society and I urge you to kind of take
another look if you are someone who
maybe works or interacts with kids
because sometimes people perceive oh
that’s a bad kid
maybe they seem really lazy or they’re
always antagonizing everybody or they’re
irritable all the time well sometimes
that bad kid is actually a kid who’s
just suffering from a bad disease and
then you’ve helped so what is the help
well there’s three basic components of
the therapy one is the social and
support networks and this is kind of
like the power love like the teeth
brushing what we should all be doing
with all the kids you know understanding
how important sleep is for me how
important exercise is making sure kids
have a time to take a break and relax
making sure they have time to do
something but they feel good about but
they can achieve it whether it’s school
or not school let them know that it’s
important to have a social life
and also sometimes to take time and do
something nice for other people these
are all things we know improves our
overall well-being and of course love
the kid and support them but even if
you’re providing all that these are
diseases and make them happen anyway
so then you need extra professional help
like psychologic therapy now with little
kids it’s important for parents to get
extra help to be able to handle these
challenging behaviors you know it’s
funny if you think about it most people
who delivered their children went to
childbirth classes but then we have a
baby and with most of us to go to
parenting classes and I think if there’s
any parents in the room you probably
would agree that it’s the hardest job in
the world and yet we don’t consider
really going to classes now for the
person themselves who’s suffering
there’s all kinds of psychological
therapy and if you’re not aware of
what’s out there you might not know so
typically it’s time limited typically
three to four months it’s very much
focused on building skills learning
coping techniques how to handle
different situations and it’s
evidence-based
it’s been studied and it’s effective so
two good examples are cognitive
behavioral therapy and interpersonal
therapy so if you’re looking you want to
look for something that’s evidence-based
and then there’s biologic therapies now
these are diseases of the mind
so medications can make a difference and
they have been studied extensively in
kids and they are safe and they are
effective so what we know is that if
someone is in that yellow zone or all
the way over to the red zone you really
want to give them everything we’ve
helped them get better and they can get
better and if they’re somewhere in the
middle then maybe we’ll be parts of some
of these things so treatment really
works and that’s what’s really profound
to remember that most people depending
on the condition seventy to ninety
percent will get better it’s more
effective than a lot of the treatments
we have for medical conditions like
heart disease are as in our diabetes I
wanted to share with you just a little
bit about the reach Institute because
this is how I developed ability and
skill to be able to handle the mental
health care problems that came up in my
office and the reach Institute was
started by a child psychiatrist who
recognized these problems but there was
a shortage of good providers who were
trained that the people on the front
line were knowing how to deal with this
and so he worked with a lot of academic
experts looked at that evidence and the
research and tried to put together good
training programs to help people like
pediatricians like being and other
pediatric providers and schools and
therapists who they would know what do
they need to share with the kids and so
I’ll share with you an experience I had
in my office now that I know what to do
it’s so rewarding because I can make
such a big difference for these kids so
I had a teenage girl Mina and she came
to me because in her office in school
she needed a note that she had missed so
much time and so she came in she either
nope she missed ten days of school in
November and I’ve known it for a long
time she sailed through middle school
but in high school her mom shared with
me she started having all these episodes
of problems throwing up stomachaches
she’d miss all this school they took her
to a specialist couldn’t find anything
wrong with her and they found out that
you know they didn’t know what to do so
they came and brought her to me for a
note and it turns out that all this
started she had this really hard test in
school she was freaking out she had a
big panic attack and she vomited and
that was so traumatic for her that she
began to have panic attacks about having
panic attacks which actually is really
common
now anxiety is very treatable and so she
got treatment and she’s doing so much
better she hasn’t missed a day of school
and she’s really failing along and Mina
has some techniques that I’ll share and
just briefly go over with you cuz I
think I’m running over time one of her
techniques is distraction so she uses
her mind to change the channel and this
is kind of a some kind of behavioral
therapy where she takes when she starts
to feel that she’s stressed she makes
herself think about something different
just to give her relief so that feeling
can pass so what she likes to do is look
around the room and spell everything
that she sees and because she’s a bright
kid sometimes she has to spell it
backwards to keep her brain engaged or
she’ll choose a color and notice that
everything around her that is that color
and it just helps the feeling pass
another thing she does is the fist
squeeze we all know that when you
exercise it releases endorphins helps us
feel better and so it also eats up
adrenaline which contributes to the
intensity of those hard feelings and so
if you squeeze your fist as tight as you
can for 10 seconds in a moment where
you’re really having a hard time it can
help you gain back your control and
breathing probably all of you know
breathing can be helpful in a tough
situations but you might not know why
and it’s because it pulls on the nerve
that tug that tugs it pulls on the
nerves that basically causes your body
to become more physically comfort
comfortable it’s called the relaxation
response so sometimes even despite
really good support even in the case
where maybe you think that it is
everything why would they have a mental
health problem what do they have to
worry about it’s a disease it can happen
to anyone
and so someone’s slipping down the
continuum into the yellow zone or the
red zone they need help and so I hope
that you’ll kind of reach out to people
and let them know like there are safe
and effective care out there and make
your of it and it works if we saw a kid
with a fever and a rash we’d say you’d
better go to the doctor where somebody
who broke their arm and we say you
get some medical help but we also need
to be doing that for mental health
problems so I’d like everybody to just
quickly snap a photo of this slide
because in case you know anybody now or
maybe not now but maybe someday you’re
gonna come across someone who maybe
could benefit from some of this
information and it’s certainly not a
substitute for a professional help but
it might give someone some resource or
some additional information to get them
so I’ve learned it’s not enough for me
to say to my patients when they come in
I’m just gonna check what you’re seeing
and then you know we’ll you’ll be on
your way I really need to think about
how they’re seeing are they looking out
and being afraid are they overwhelmed by
everything they see are they having
trouble focusing are they looking out
but everything’s kind of dark and
hopeless I need to pay attention to that
so the distorted view of the mind cannot be overlooked thank you
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